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Babu R, Sathy BN, Gopal K, Thennavan A, Unni AKK, Nair SV, Rao H, Nair P, Menon D. Design, safety and efficacy evaluation of gemcitabine-eluting nanoyarn-integrated heparinized self expanding metallic stents for long-term management of malignant biliary obstruction. Acta Biomater 2025; 194:169-184. [PMID: 39798640 DOI: 10.1016/j.actbio.2025.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 01/05/2025] [Accepted: 01/08/2025] [Indexed: 01/15/2025]
Abstract
Malignant biliary obstruction presents a significant therapeutic challenge and has serious consequences including cholangitis and death. Clinically, biliary stenting using self-expanding metallic- stent(SEMS) relieves this obstruction. However, stent occlusion occurs with time due to tumor/epithelial in-growth and bacterial colonization. To achieve sustained palliative benefit of stent-based approaches, both biliary sludge formation and in-growth need to be obviated. In this study, an innovative approach was adopted to inhibit sludge deposition and tissue in-growth by developing a heparinized drug-eluting SEMS. For this, heparinisation was performed on dopamine-functionalised-stents, which averted bile protein adsorption in vitro. Further, Gemcitabine loaded polycaprolactone electrospun-nanoyarns were integrated with heparinized-SEMS to achieve sustained drug release for nearly six months in vitro. Nanoyarn integration with heparinized-SEMS did not hamper its crimping, ease of deployment or functional behaviour. In vivo safety and efficacy were evaluated for five months after implantation in porcine bile duct through Endoscopic Retrograde Cholangiopancreatography. Minimal sludge deposition with no obstruction in bile flow, good stent patency and localized-sustained drug elution were observed for nanoyarn-integrated heparinized-SEMS. No alterations in the biochemical parameters, nor any inflammatory reactions were observed in vivo, all in comparison to control-SEMS. Overall, our research established an efficient multipronged strategy to tackle malignant biliary obstruction. STATEMENT OF SIGNIFICANCE: Bile duct occlusion due to cancer has several life-threatening consequences. This is clinically treated using metallic stents, with simultaneous intravenous use of anti-cancer drugs at high-doses. Nevertheless, tumor-growth along with bile-sludge accumulation happens after stenting, causing re-occlusion. Existing research uses stent modifications that fail to tackle both simultaneously, yielding short-term efficacy. To address this, heparinized-metallic stents were modified using chemo-drug eluting polymeric-nanoyarn integration. The key features of this device are: nanoyarn-integrated, uncovered stent design facilitating easy endoscopic implantation in bile duct; reduced bile-sludge deposition; prolonged, low-dose, localised drug release that can mitigate tumor-growth; and provide long-term stent patency without stent migration. This device proved to be safe, functional and efficacious for a period of five months in pig bile duct.
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Affiliation(s)
- Rosebin Babu
- Amrita School of Nanosciences & Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - Binulal Nelson Sathy
- Amrita School of Nanosciences & Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - Kavitha Gopal
- Amrita School of Nanosciences & Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - Arumugam Thennavan
- Central Animal Facility, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - A K K Unni
- Central Animal Facility, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - Shantikumar V Nair
- Amrita School of Nanosciences & Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - Harshavardhan Rao
- Department of Gastroenterology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - Priya Nair
- Department of Gastroenterology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India.
| | - Deepthy Menon
- Amrita School of Nanosciences & Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India.
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Zhang L, Ren L, Chen Y, Cao Y, Li S, Lu W, Jia Y, Li Y, Liu C, Li C, Dong Q. An Octopus-Inspired Stimulus-Responsive Structural Color Hydrogel for Uterus Cervical Canal Stent. Adv Healthc Mater 2024; 13:e2400439. [PMID: 38870451 DOI: 10.1002/adhm.202400439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 06/07/2024] [Indexed: 06/15/2024]
Abstract
Soft-bodied aquatic organisms have exhibited remarkable capabilities in navigating and moving within liquid environments serving as a profound inspiration for the development of bionic robots with intricate movements. Traditional rigid components are being replaced by stimulus-responsive soft materials such as hydrogels and shape memory polymers, leading to the creation of dynamically responsive soft robots. In this study, the development of a bionic robot inspired by the shape of an octopus and the adsorptive properties of its tentacles, specifically tailored for targeted stimulation and pH sensing in the cervix, are presented. This approach involves the design of a soft, water-based Janus adhesive hydrogel patch that adheres to specific parts of the cervix and responds to pH changes through external stimuli. The hydrogel patch incorporates inverse opal microstructures mimicking the legs of an octopus, to facilitate efficient and stable locomotion, unidirectional transport of biofluids, and pH-responsive behavior. This miniature bionic robot showcases controlled adhesion and precise unidirectional fluid transport highlighting its potential for targeted stimulus response and pH sensing in the uterine cervical tract. This breakthrough opens new avenues for medical applications within the expanding field of soft-bodied robotics.
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Affiliation(s)
- Lihao Zhang
- Center for Future Optoelectronic Functional Materials, School of Computer and Electronic Information/School of Artificial Intelligence, Nanjing Normal University, Nanjing, 210023, China
| | - Lehao Ren
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yufei Chen
- Center for Future Optoelectronic Functional Materials, School of Computer and Electronic Information/School of Artificial Intelligence, Nanjing Normal University, Nanjing, 210023, China
| | - Yue Cao
- Center for Future Optoelectronic Functional Materials, School of Computer and Electronic Information/School of Artificial Intelligence, Nanjing Normal University, Nanjing, 210023, China
| | - Sunlong Li
- Center for Future Optoelectronic Functional Materials, School of Computer and Electronic Information/School of Artificial Intelligence, Nanjing Normal University, Nanjing, 210023, China
| | - Weipeng Lu
- Center for Future Optoelectronic Functional Materials, School of Computer and Electronic Information/School of Artificial Intelligence, Nanjing Normal University, Nanjing, 210023, China
| | - Yaoyuan Jia
- Center for Future Optoelectronic Functional Materials, School of Computer and Electronic Information/School of Artificial Intelligence, Nanjing Normal University, Nanjing, 210023, China
| | - Yachun Li
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201601, China
| | - Cihui Liu
- Center for Future Optoelectronic Functional Materials, School of Computer and Electronic Information/School of Artificial Intelligence, Nanjing Normal University, Nanjing, 210023, China
| | - Chen Li
- School of Electronic Science and Engineering, Southeast University, Nanjing, 210096, China
| | - Qian Dong
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China
- Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China
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Ledenko M, Toskich B, Mehner C, Ceylan H, Patel T. Therapeutic biliary stents: applications and opportunities. Expert Rev Med Devices 2024; 21:399-409. [PMID: 38716580 DOI: 10.1080/17434440.2024.2341960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/08/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Biliary stents are used to optimize ductal patency and enable bile flow in the management of obstruction or injury related to biliary tract tumors, strictures, stones, or leaks. Although direct therapeutic applications of biliary stents are less well developed, stents can be used to deliver drugs, radioisotopes, and photodynamic therapy. AREAS COVERED This report provides an in-depth overview of the clinical indications, and therapeutic utility of biliary stents. Unique considerations for the design of biliary stents are described. The properties and functionalities of materials used for stents such as metal alloys, plastic polymers, or biodegradable materials are described, and opportunities for design of future stents are outlined. Current and potential applications of stents for therapeutic applications for biliary tract diseases are described. EXPERT OPINION Therapeutic biliary stents could be used to minimize inflammation, prevent stricture formation, reduce infections, or provide localized anti-cancer therapy for biliary tract cancers. Stents could be transformed into therapeutic platforms using advanced materials, 3D printing, nanotechnology, and artificial intelligence. Whilst clinical study and validation will be required for adoption, future advances in stent design and materials are expected to expand the use of therapeutic biliary stents for the treatment of biliary tract disorders.
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Affiliation(s)
- Matthew Ledenko
- Department of Transplantation, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Beau Toskich
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Christine Mehner
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Jacksonville, FL, USA
| | - Hakan Ceylan
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Jacksonville, FL, USA
| | - Tushar Patel
- Department of Transplantation, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Jacksonville, FL, USA
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Yang K, Sun W, Cui L, Zou Y, Wen C, Zeng R. Advances in functional coatings on biliary stents. Regen Biomater 2024; 11:rbae001. [PMID: 38343880 PMCID: PMC10858350 DOI: 10.1093/rb/rbae001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2025] Open
Abstract
Biliary stenting is an important interventional method for the prevention and treatment of biliary tract diseases. However, complications, such as postoperative biliary infection and restenosis, frequently occur due to the extensive scope of the biliary system and the complex composition of bile. The combination of coating technology and biliary stents is expected to bring new approaches to the solution of these problems. The cutting-edge advance on functional coatings on biliary stents is reviewed from seven perspectives: anticorrosion, -bacterial, -tumor, stone-dissolving, X-ray visibility, antistent migration and functional composite coatings. The development trend is also discussed. Overall, the performance of the numerous functional coatings for various purposes is generally up to expectations, but the balance between the medications' effectiveness and their safety needs to be further adjusted. Many contemporary investigations have advanced to the level of animal experiments, offering crucial fundamental assurance for broader human studies. The combination of biliary stents and functional coatings is an innovative idea with great potential for future development.
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Affiliation(s)
- Kaining Yang
- Department of Bioengineering, College of Chemical and Biological Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Wenxin Sun
- Department of Bioengineering, College of Chemical and Biological Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Lanyue Cui
- Corrosion Laboratory for Light Metals, College of Materials Science and Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Yuhong Zou
- Department of Bioengineering, College of Chemical and Biological Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Cuie Wen
- School of Engineering, RMIT University, Melbourne, VIC 3001, Australia
| | - Rongchang Zeng
- Corrosion Laboratory for Light Metals, College of Materials Science and Engineering, Shandong University of Science and Technology, Qingdao 266590, China
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Liakina V. Antibiotic resistance in patients with liver cirrhosis: Prevalence and current approach to tackle. World J Clin Cases 2023; 11:7530-7542. [PMID: 38078132 PMCID: PMC10698443 DOI: 10.12998/wjcc.v11.i31.7530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/02/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023] Open
Abstract
Regardless of etiology, complications with bacterial infection in patients with cirrhosis are reported in the range of 25%-46% according to the most recent data. Due to frequent episodes of bacterial infection and repetitive antibiotic treatment, most often with broad-spectrum gram negative coverage, patients with cirrhosis are at increased risk of encountering multidrug resistant bacteria, and this raises concern. In such patients, extended-spectrum beta-lactamase and AmpC-producing Enterobacterales, methicillin- or vancomycin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, carbapenem-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii, all of which are difficult to treat, are the most common. That is why novel approaches to the prophylaxis and treatment of bacterial infections to avoid antibiotic resistance have recently been developed. At the same time, our knowledge of resistance mechanisms is constantly updated. This review summarizes the current situation regarding the burden of antibiotic resistance, including the prevalence and mechanisms of intrinsic and acquired resistance in bacterial species that most frequently cause complications in patients with liver cirrhosis and recent developments on how to deal with multidrug resistant bacteria.
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Affiliation(s)
- Valentina Liakina
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
- Department of Chemistry and Bioengineering, Faculty of Fundamental Sciences, Vilnius Tech, Vilnius 10223, Lithuania
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Viola GM, Szvalb AD, Malek AE, Chaftari AM, Hachem R, Raad II. Prevention of device-related infections in patients with cancer: Current practice and future horizons. CA Cancer J Clin 2023; 73:147-163. [PMID: 36149820 PMCID: PMC9992006 DOI: 10.3322/caac.21756] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Over the past several years, multifaceted advances in the management of cancer have led to a significant improvement in survival rates. Throughout patients' oncological journeys, they will likely receive one or more implantable devices for the administration of fluids and medications as well as management of various comorbidities and complications related to cancer therapy. Infections associated with these devices are frequent and complex, often necessitating device removal, increasing health care costs, negatively affecting quality of life, and complicating oncological care, usually leading to delays in further life-saving cancer therapy. Herein, the authors comprehensively review multiple evidence-based recommendations along with best practices, expert opinions, and novel approaches for the prevention of diverse device-related infections. The authors present many general principles for the prevention of these infections followed by specific device-related recommendations in a systematic manner. The continuous involvement and meaningful cooperation between regulatory entities, industry, specialty medical societies, hospitals, and infection control-targeted interventions, along with primary care and consulting health care providers, are all vital for the sustained reduction in the incidence of these preventable infections.
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Affiliation(s)
- George M Viola
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ariel D Szvalb
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexandre E Malek
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ray Hachem
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Beus M, Pongrac IM, Capjak I, Ilić K, Vrček E, Ćurlin M, Milić M, Čermak AMM, Pavičić I. Particle surface functionalization affects mechanism of endocytosis and adverse effects of silver nanoparticles in mammalian kidney cells. J Appl Toxicol 2023; 43:416-430. [PMID: 36065485 DOI: 10.1002/jat.4392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 11/11/2022]
Abstract
Silver nanoparticles (AgNPs) show a plethora of possible applications due to their antimicrobial properties. Different coatings of AgNPs are used in order to increase stability, availability, and activity. However, the question about the toxicity after prolonged exposure still remains. Here, we show that different surface coatings affect in vitro toxicity and internalization of AgNPs in porcine kidney (PK15) cells. AgNPs coated with cetyltrimethylammonium bromide (CTAB), poly(vinylpyrrolidone) (PVP), sodium bis(2-ethylhexyl)-sulfosuccinate (AOT), poly-L-lysine (PLL), and bovine serum albumin (BSA) were toxic at the concentration of 10 mg Ag/L and higher. The toxicity increased in the following manner: PVP-AgNPs < CTAB-AgNPs < PLL-AgNPs < AOT-AgNPs < BSA-AgNPs. All types of AgNPs were internalized by the PK15 cells in a dose-dependent manner with greater internalization of AgNPs bearing positive surface charge. Transmission electron microscopy (TEM) experiments showed that AgNPs were located in the lysosomal compartments, while the co-treatment with known inhibitors of endocytosis pathways suggested macropinocytosis as the preferred internalization pathway. When inside the cell, all types of AgNPs induced the formation of reactive oxygen species while decreasing the concentration of the cell's endogenous antioxidant glutathione. The comet assay indicated possible genotoxicity of tested AgNPs starting at the concentration of 2 mg Ag/L or higher, depending on the surface functionalization. This study demonstrates the toxicity of AgNPs pointing to the importance of biosafety evaluation when developing novel AgNPs-containing materials.
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Affiliation(s)
- Maja Beus
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Igor M Pongrac
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivona Capjak
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Krunoslav Ilić
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Ena Vrček
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Marija Ćurlin
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
| | - Mirta Milić
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | | | - Ivan Pavičić
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
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Aboelwafa HR, Ramadan RA, Ibraheim SS, Yousef HN. Modulation Effects of Eugenol on Nephrotoxicity Triggered by Silver Nanoparticles in Adult Rats. BIOLOGY 2022; 11:biology11121719. [PMID: 36552229 PMCID: PMC9774980 DOI: 10.3390/biology11121719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
The use of silver nanoparticles (AgNPs) is expanding. This study evaluates the modulator effect of eugenol (Eug) on AgNP-induced nephrotoxicity in rats. Sixty male rats were separated into six groups: control, Eug, AgNPs low-dose, AgNPs high-dose, Eug + AgNPs low-dose, and Eug + AgNPs high-dose. After 30 days, kidney function, antioxidative and proinflammatory status, histopathological, histomorphometrical, and immunohistochemical assessments were performed. AgNPs markedly induced oxidative stress in renal tissues, characterized by increased levels of blood urea nitrogen, creatinine, uric acid, kidney injury molecule-1, the total oxidant capacity, malondialdehyde, tumor necrosis factor-alpha (TNF-α), and interleukin-6, as well as decreased levels of the total antioxidant capacity, superoxide dismutase, catalase, reduced glutathione, and glutathione peroxidase. Moreover, the normal renal architecture was destroyed, and the thickness of the renal capsules, cortex, and medulla, alongside the diameter and quantity of the normal Malpighian corpuscles and the proximal and distal convoluted tubules were decreased. Immunoreactivity for P53, caspase-3, and TNF-α reactive proteins were significantly increased; however, Bcl-2 immunoreactivity was decreased. Eug reversed most biochemical, histological, histomorphometrical, and immunohistochemical changes in AgNP-treated animals. This study demonstrated that nephrotoxicity in AgNP-treated rats was mitigated by an Eug supplementation. Eug's antioxidant, antiapoptotic, and anti-inflammatory capabilities were the key in modulating AgNPs nephrotoxicity.
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Xu X, Zhang Y, Zheng W, Wang Y, Yao W, Li K, Yan X, Chang H, Huang Y. Enteral extended biliary stents versus conventional plastic biliary stents for the treatment of extrahepatic malignant biliary obstruction: a single-center prospective randomized controlled study. Surg Endosc 2022; 36:8202-8213. [PMID: 35536485 DOI: 10.1007/s00464-022-09265-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 04/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The main limitation of plastic stents is the relatively short stent patency due to occlusion. We designed enteral extended biliary stents with lengths of 26 cm (EEBS-26 cm) and 30 cm (EEBS-30 cm) to prolong stent patency. This study aimed to compare patency among EEBS-26 cm, EEBS-30 cm, and conventional plastic biliary stent (CPBS). METHODS A single-center prospective randomized controlled study was conducted. Eligible patients were randomized into the EEBS-26 cm, EEBS-30 cm, and CPBS groups, respectively. All patients were followed up every 3 months until stent occlusion, patient death, or at 12-month follow-up. The primary outcome was stent patency. The secondary outcomes included stent occlusion rate, patient survival, mortality, the rate of technical success, and adverse events. RESULTS Totally 117 patients were randomized into the three groups. There were no significant differences among the three groups in technical success rate, hospital stay, mortality, patient survival, and adverse events (P = 1.000, 0.553, 0.965, 0.302, and 0.427, respectively). Median stent patency durations in the EEBS-26 cm, EEBS-30 cm, and CPBS groups were 156.0 (95% CI 81.6-230.4) days, 81.0 (95% CI 67.9-94.1) days, and 68.0 (95% CI 20.0-116.0) days, respectively (P = 0.002). The EEBS-26 cm group had longer stent patency compared with the CPBS (P = 0.007) and EEBS-30 cm (P < 0.001) groups. The EEBS-26 cm group had lower stent occlusion rates compared with the other groups at 6 months (48.1% vs. 90.5% vs. 82.8%, P = 0.001) and 9 months (75.0% vs. 100.0% vs. 92.9%, P = 0.022). CONCLUSION EEBS-26 cm has prolonged stent patency and is safe and effective for the alleviation of unresectable extrahepatic malignant biliary obstruction.
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Affiliation(s)
- Xiaofen Xu
- The Department of Gastroenterology, Peking University Third Hospital, Haidian District, 49 Huayuan North Road, Beijing, China
| | - Yaopeng Zhang
- The Department of Gastroenterology, Peking University Third Hospital, Haidian District, 49 Huayuan North Road, Beijing, China
| | - Wei Zheng
- The Department of Gastroenterology, Peking University Third Hospital, Haidian District, 49 Huayuan North Road, Beijing, China
| | - Yingchun Wang
- The Department of Gastroenterology, Peking University Third Hospital, Haidian District, 49 Huayuan North Road, Beijing, China
| | - Wei Yao
- The Department of Gastroenterology, Peking University Third Hospital, Haidian District, 49 Huayuan North Road, Beijing, China
| | - Ke Li
- The Department of Gastroenterology, Peking University Third Hospital, Haidian District, 49 Huayuan North Road, Beijing, China
| | - Xiue Yan
- The Department of Gastroenterology, Peking University Third Hospital, Haidian District, 49 Huayuan North Road, Beijing, China.
| | - Hong Chang
- The Department of Gastroenterology, Peking University Third Hospital, Haidian District, 49 Huayuan North Road, Beijing, China.
| | - Yonghui Huang
- The Department of Gastroenterology, Peking University Third Hospital, Haidian District, 49 Huayuan North Road, Beijing, China.
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Wu T, Yang Y, Su H, Gu Y, Ma Q, Zhang Y. Recent developments in antibacterial or antibiofilm compound coating for biliary stents. Colloids Surf B Biointerfaces 2022; 219:112837. [PMID: 36137334 DOI: 10.1016/j.colsurfb.2022.112837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/26/2022] [Accepted: 09/09/2022] [Indexed: 11/18/2022]
Abstract
Cholestasis of the indwelling biliary stents usually leads to stone recurrence after endoscopic retrograde cholangio pancreatoraphy (ERCP). Biliary stents, including metallic and none-degradable plastic stents are widely used in clinical settings due to their many excellent properties. However, conventional biliary stents still suffer from poor antibacterial activity and anti-bile-adhesion, which lead to injured, local fibroblasts proliferating. Currently, various coatings for biliary stents have been prepared to meet the clinical demands. In this review, we start by summarizing and discussing classifications of biliary stents and antibacterial/antibiofilm mechanism. Then, the latest advances about developing antibacterial and antibiofilm coatings for improving the properties of biliary stents are reviewed and discussed in detail. Lastly, we list several possible directions for future development of biliary stents coatings and biliary stent, such as anti-bile-adhesion coating, multifunctional coating, drug-eluting biodegradable biliary stents and 3D printed biliary stents.
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Affiliation(s)
- Tao Wu
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu province, Gansu Provincial Hospital, 730000 Lanzhou, PR China
| | - Yan Yang
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu province, Gansu Provincial Hospital, 730000 Lanzhou, PR China
| | - He Su
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu province, Gansu Provincial Hospital, 730000 Lanzhou, PR China
| | - Yuanhui Gu
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu province, Gansu Provincial Hospital, 730000 Lanzhou, PR China
| | - Quanming Ma
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu province, Gansu Provincial Hospital, 730000 Lanzhou, PR China
| | - Yan Zhang
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu province, Gansu Provincial Hospital, 730000 Lanzhou, PR China; The First School of Clinical Medicine, Lanzhou University, 730000 Lanzhou, PR China.
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Silver Nanofunctionalized Stent after Radiofrequency Ablation Suppresses Tissue Hyperplasia and Bacterial Growth. Pharmaceutics 2022; 14:pharmaceutics14020412. [PMID: 35214144 PMCID: PMC8876892 DOI: 10.3390/pharmaceutics14020412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 02/01/2023] Open
Abstract
Intraductal radiofrequency (RF) ablation combined with placement of a self-expandable metal stent (SEMS) for malignant biliary obstruction has risks such as stent- and heat-induced biliary sludge and restenosis. Here, we investigated the efficacy of a silver nanoparticles (AgNPs)-coated SEMS to inhibit tissue hyperplasia and bacterial growth caused by RF ablation with stent placement in the rabbit bile duct. The release behavior and antibacterial effects of AgNPs-coated SEMSs were evaluated. Then, SEMSs were successfully placed in all rabbits immediately after RF ablation. Ag ions were rapidly released at the beginning and then showed a gradual release behavior. The AgNPs-coated SEMS significantly inhibited bacterial activity compared to the uncoated SEMS (p < 0.05). Cholangiography and histological examination confirmed that the level of tissue hyperplasia was significantly lower in the AgNPs group than in the control group (all p < 0.05). Immunohistochemistry analyses revealed that TUNEL-, HSP 70-, and α-SMA-positive areas were significantly lower in the AgNPs group than in the control group (all p < 0.05). Intraductal RF ablation combined with nanofunctionalized stent placement represents a promising new approach for suppressing thermal damage as well as stent-induced tissue hyperplasia and bacterial growth.
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Synergistic effects of silver nanoparticles and cisplatin in combating inflammation and hyperplasia of airway stents. Bioact Mater 2021; 9:266-280. [PMID: 34820570 PMCID: PMC8586718 DOI: 10.1016/j.bioactmat.2021.07.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/04/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022] Open
Abstract
Anti-inflammatory and antihyperplasia activities are essential requirements for the successful use of airway stents. In this work, silver nanoparticles (AgNPs) and cisplatin (DDP) were combined in a synergistic modification strategy to improve the surface function of airway stents. Using polycaprolactone (PCL) as a drug carrier, a dual-functional PCL-AgNPs-DDP fiber film-coated airway stent was fabricated by electrospinning. The physicochemical and biological properties of the obtained fiber films were examined. The ATR-FTIR, XPS, SEM-EDS and TEM results suggested that AgNPs and DDP could be successfully immobilized onto the airway stent surface. The drug release and surface degradation results revealed that AgNPs and DDP can undergo sustained release from films for 30 d, and the weight loss was approximately 50% after 35 d. In addition, the dual-functional fiber film suppressed human embryonic lung fibroblast growth and exhibited excellent antibacterial activity against Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans. Furthermore, the effectiveness of the dual-functional fiber film-coated airway stent was evaluated by application to the trachea of New Zealand rabbits. The in vivo results indicated that PCL-AgNPs-DDP fiber film-coated airway stent can significantly inhibit granulation tissue formation and collagen deposition, reduced the expression of IL-8, TNF-α, IL-1α, PCNA, α-SMA and CD68, and ultimately achieved anti-inflammatory and antihyperplasia effects. Hence, this study provides a dual-functional surface-coated airway stent to address the clinical complications associated with respiratory tract inflammation and granulation tissue hyperplasia, thus inhibiting tracheal stenosis.
This study provides a dual-functional PCL-AgNPs-DDP nanofiber film-coated airway stent. The airway stent processes antibacterial activity and suppress CCC-HPF-1 growth. The stent inhibits tracheal stenosis by antiinflammatory and antihyperplasia treatment.
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An X, Liu L, Schaefer M, Yan B, Scholz C, Hillmer S, Wang K, Luo Y, Ji H, Gladkich J, Herr I. Alpha-Lipoic Acid Prevents Side Effects of Therapeutic Nanosilver without Compromising Cytotoxicity in Experimental Pancreatic Cancer. Cancers (Basel) 2021; 13:4770. [PMID: 34638256 PMCID: PMC8507678 DOI: 10.3390/cancers13194770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 01/14/2023] Open
Abstract
Silver nanoparticles (AgNPs) have attracted attention in cancer therapy and might support the treatment of pancreatic ductal adenocarcinoma (PDAC). Silver is in clinical use in wound dressings, catheters, stents and implants. However, the side effects of systemic AgNP treatment due to silver accumulation limit its therapeutic application. We evaluated whether the antioxidant and natural agent α-lipoic acid might prevent these side effects. We synthesized AgNPs using an Ionic-Pulser® Pro silver generator and determined the concentration by inductively coupled plasma-optical emission spectrometry. The effect of α-lipoic acid was examined in four PDAC and two nonmalignant cell lines by MTT, FACS analysis, TEM, xenotransplantation and immunohistochemistry. The viability of PDAC cells was nearly totally abolished by AgNP treatment, whereas nonmalignant cells largely resisted. α-Lipoic acid prevented AgNP-induced cytotoxicity in nonmalignant cells but not in PDAC cells, which might be due to the higher sensitivity of malignant cells to silver-induced cytotoxicity. α-Lipoic acid protected mitochondria from AgNP-induced damage and led to precipitation of AgNPs. AgNPs reduced the growth of tumor xenografts, and cotreatment with α-lipoic acid protected chick embryos from AgNP-induced liver damage. Together, α-lipoic acid strongly reduced AgNP-induced side effects without weakening the therapeutic efficacy.
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Affiliation(s)
- Xuefeng An
- Department of General, Visceral & Transplant Surgery, Molecular OncoSurgery, Section Surgical Research, University of Heidelberg, 69120 Heidelberg, Germany; (X.A.); (L.L.); (M.S.); (B.Y.); (K.W.); (Y.L.); (H.J.); (J.G.)
| | - Li Liu
- Department of General, Visceral & Transplant Surgery, Molecular OncoSurgery, Section Surgical Research, University of Heidelberg, 69120 Heidelberg, Germany; (X.A.); (L.L.); (M.S.); (B.Y.); (K.W.); (Y.L.); (H.J.); (J.G.)
| | - Michael Schaefer
- Department of General, Visceral & Transplant Surgery, Molecular OncoSurgery, Section Surgical Research, University of Heidelberg, 69120 Heidelberg, Germany; (X.A.); (L.L.); (M.S.); (B.Y.); (K.W.); (Y.L.); (H.J.); (J.G.)
| | - Bin Yan
- Department of General, Visceral & Transplant Surgery, Molecular OncoSurgery, Section Surgical Research, University of Heidelberg, 69120 Heidelberg, Germany; (X.A.); (L.L.); (M.S.); (B.Y.); (K.W.); (Y.L.); (H.J.); (J.G.)
| | - Christian Scholz
- Institute of Earth Sciences, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Stefan Hillmer
- Electron Microscopy Core Facility, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Kangtao Wang
- Department of General, Visceral & Transplant Surgery, Molecular OncoSurgery, Section Surgical Research, University of Heidelberg, 69120 Heidelberg, Germany; (X.A.); (L.L.); (M.S.); (B.Y.); (K.W.); (Y.L.); (H.J.); (J.G.)
| | - Yiqiao Luo
- Department of General, Visceral & Transplant Surgery, Molecular OncoSurgery, Section Surgical Research, University of Heidelberg, 69120 Heidelberg, Germany; (X.A.); (L.L.); (M.S.); (B.Y.); (K.W.); (Y.L.); (H.J.); (J.G.)
| | - Huihui Ji
- Department of General, Visceral & Transplant Surgery, Molecular OncoSurgery, Section Surgical Research, University of Heidelberg, 69120 Heidelberg, Germany; (X.A.); (L.L.); (M.S.); (B.Y.); (K.W.); (Y.L.); (H.J.); (J.G.)
| | - Jury Gladkich
- Department of General, Visceral & Transplant Surgery, Molecular OncoSurgery, Section Surgical Research, University of Heidelberg, 69120 Heidelberg, Germany; (X.A.); (L.L.); (M.S.); (B.Y.); (K.W.); (Y.L.); (H.J.); (J.G.)
| | - Ingrid Herr
- Department of General, Visceral & Transplant Surgery, Molecular OncoSurgery, Section Surgical Research, University of Heidelberg, 69120 Heidelberg, Germany; (X.A.); (L.L.); (M.S.); (B.Y.); (K.W.); (Y.L.); (H.J.); (J.G.)
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Yamabe A, Irisawa A, Kunogi Y, Kashima K, Nagashima K, Minaguchi T, Yamamiya A, Izawa N, Takimoto Y, Hoshi K, Nonaka L, Masuda M, Tominaga K, Goda K, Iijima M. Development of biliary stent applying the antibacterial activity of silver: A literature review. Biomed Mater Eng 2021; 32:63-71. [PMID: 33720871 DOI: 10.3233/bme-201163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endoscopic transpapillary stenting is commonly performed in patients with obstructive jaundice caused by a biliary stricture. Although the plastic stent (PS) is widely used for biliary drainage because of the low-cost and easy procedure, patency is short after placement in the bile duct because of the small diameter. Dysfunction of PS is primarily caused by biliary sludge that forms as a result of bacterial adhesion and subsequent biofilm formation on the inner surface of the stent. It is well known that silver ions have excellent antibacterial activity against a wide range of microorganisms. OBJECTIVE This review provides an overview and perspective of the significance of silver-coated biliary stents. METHODS We collected literature regarding silver-coated biliary stents, reviewed the current research/development status and discussed their possible usefulness. RESULTS To date, several in vivo/vitro studies evaluated the patency of silver-blended or silver-coated biliary stents. These studies suggested that the silver coating on a PS was likely to prolong the patency period. CONCLUSION The development of biliary stents using silver is expected to prolong stent patency and prevent frequent stent replacement.
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Affiliation(s)
- Akane Yamabe
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Yasuhito Kunogi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Ken Kashima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Kazunori Nagashima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Takahito Minaguchi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Naoya Izawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Yoichi Takimoto
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Lisa Nonaka
- Department of Nutritional Science, Faculty of Human Life Science, Shokei University, Kumamoto, Japan
| | - Michiaki Masuda
- Department of Microbiology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
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A Novel Design of Tri-Layer Membrane with Controlled Delivery of Paclitaxel and Anti-Biofilm Effect for Biliary Stent Applications. NANOMATERIALS 2021; 11:nano11020486. [PMID: 33673016 PMCID: PMC7918081 DOI: 10.3390/nano11020486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
Here, we developed a novel biliary stent coating material that is composed of tri-layer membrane with dual function of sustained release of paclitaxel (PTX) anticancer drug and antibacterial effect. The advantages of using electrospinning technique were considered for the even distribution of PTX and controlled release profile from the nanofiber mat. Furthermore, film cast method was utilized to fabricate AgNPs-immobilized PU film to direct the release towards the tumor site and suppress the biofilm formation. The in vitro antibacterial test conducted against Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria species showed excellent antibacterial effect. The in vitro drug release study confirmed the sustained release of PTX from the tri-layer membrane and the release profile fitted first order with correlation coefficient of R2 = 0.98. Furthermore, the release mechanism was studied using Korsmeyer–Peppas model, revealing that the release mechanism follows Fickian diffusion. Based on the results, this novel tri-layer membrane shows curative potential in clinical development.
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Abstract
Malignant biliary obstruction (MBO), result of pancreatobiliary diseases is a challenging condition. Most patients with MBO are inoperable at the time of diagnosis, and the disease is poorly controlled using external-beam radiotherapy and chemotherapy. Biliary stent therapy emerged as a promising strategy for alleviating MBO and prolonging life. However, physicians find it difficult to determine the optimal type of biliary stent for the palliation of MBO. Here, we review the safety and efficacy of available biliary stents, used alone or in combination with brachytherapy, photodynamic therapy and advanced chemotherapeutics, in patients with pancreatobiliary malignancies and put forward countermeasures involving stent obstruction. Furthermore, 3D-printing stents and nanoparticle-loaded stents have broad application prospects for fabricating tailor-made biliary stents.
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Metallic Stent Mesh Coated with Silver Nanoparticles Suppresses Stent-Induced Tissue Hyperplasia and Biliary Sludge in the Rabbit Extrahepatic Bile Duct. Pharmaceutics 2020; 12:pharmaceutics12060563. [PMID: 32560473 PMCID: PMC7356520 DOI: 10.3390/pharmaceutics12060563] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 01/26/2023] Open
Abstract
Recent therapeutic strategies to suppress restenosis after biliary stent placement are insufficient. Here, we demonstrate the usefulness of a self-expandable metal stent (SEMS), a stent mesh coated with silver nanoparticles (AgNPs), for suppression of both stent-induced tissue hyperplasia and biliary sludge formation in the rabbit bile duct. The AgNP-coated SEMSs were prepared using a simple bio-inspired surface modification process. Then, the prepared SEMSs were successfully placed in 22 of 24 rabbits. Sludge formation in the AgNP-coated SEMS groups was significantly decreased compared to the control group on gross findings. Cholangiographic and histologic examinations demonstrated significantly decreased tissue hyperplasia in the AgNP-coated SEMS groups compared with the control group (p < 0.05 for all). There were no differences between the AgNP-coated SEMS groups (p > 0.05 for all). However, in the group coated with the greatest concentration of AgNPs (Group D), submucosal fibrosis was thicker than in the other AgNP-coated groups (p < 0.05 for all). The AgNP-coated metallic stent mesh significantly suppressed stent-induced tissue hyperplasia and biliary sludge formation in the rabbit bile duct. Taken together, the AgNP coating strategy developed in this study could be widely utilized in non-vascular medical devices for anti-bacterial and anti-inflammatory responses.
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Safety and efficacy of a metal stent covered with a silicone membrane containing integrated silver particles in preventing biofilm and sludge formation in endoscopic drainage of malignant biliary obstruction: a phase 2 pilot study. Gastrointest Endosc 2019; 90:663-672.e2. [PMID: 31220446 DOI: 10.1016/j.gie.2019.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/07/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Membrane-covered self-expandable metal stents (SEMSs) have been developed to prolong the patency of stents by reducing tissue hyperplasia or tumor ingrowth. However, their effectiveness is attenuated by stent clogging as a result of biofilm formation on the inner surface of the membrane. The aim of this pilot study was to evaluate the efficacy and safety of SEMSs covered with a silicone membrane containing integrated silver particles (Ag-P) in malignant distal biliary obstruction. METHODS Twenty-four patients who underwent SEMS placement because of malignant distal biliary obstruction were enrolled in this single-center pilot study. The main outcomes were technical success, clinical success, adverse events, stent patency, and survival. RESULTS The technical and clinical success rates were 100% and 91.7% (22 of 24), respectively. The rates of early and late adverse events were 22.7% and 36.4%, respectively. The primary reintervention rate was 27.3% (6 of 22). Only 1 case involving stent malfunction was associated with sludge impaction. Median stent patency was 179 days. During follow-up, there were no serious adverse events or mortality related to the stents or Ag-P. Serum and urine silver concentrations before and after stent placement and at 32 weeks after placement did not differ. All serum and urine silver concentrations were <3 μg/L (3 ppb) and 5 μg/L (5 ppb), respectively. CONCLUSIONS SEMSs covered with a silicone membrane containing integrated Ag-Ps may be effective and safe in malignant distal biliary obstruction. Stent dysfunction related to sludge impaction may be less frequent using this new stent. (Clinical Research Information Service identifier: KCT 0002310.).
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Bartel MJ, Higa JT, Tokar JL. The Status of SEMS Versus Plastic Stents for Benign Biliary Strictures. Curr Gastroenterol Rep 2019; 21:29. [PMID: 31098767 DOI: 10.1007/s11894-019-0696-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Benign biliary strictures can be treated with plastic stents and self-expandable metal stents (SEMS). This review article delineates the latest scientific evidence for their usage. RECENT FINDINGS Despite evolving literature on both type of stents as treatment modalities of benign biliary strictures, which encompass mainly anastomotic strictures and strictures related to chronic pancreatitis, no final conclusions can be drawn regarding the superiority of a particular stent. SEMS tend to have higher stricture resolution rates and fewer procedural requirements which are partly offset by higher stent migration and stricture recurrence rates compared with plastic stents. Additional studies focusing on new SEMS types with anti-migration features as well as cost-effectiveness calculations are necessary for clinical decision-making when treating patients with benign biliary strictures.
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Affiliation(s)
- M J Bartel
- Section of Gastroenterology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA.
| | - J T Higa
- Section of Gastroenterology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | - J L Tokar
- Section of Gastroenterology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
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Vaishnavi C, Samanta J, Kochhar R. Characterization of biofilms in biliary stents and potential factors involved in occlusion. World J Gastroenterol 2018; 24:112-123. [PMID: 29358888 PMCID: PMC5757116 DOI: 10.3748/wjg.v24.i1.112] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/01/2017] [Accepted: 12/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To quantify the components in biofilms and analyze the predisposing factors involved in occlusion of biliary stents. METHODS In a prospective study conducted from April 2011 to March 2014 at a tertiary care hospital, all consecutive patients who required endoscopic biliary stent exchange/removal were included. Etiology of the biliary disease was diagnosed by imaging, cytology and on follow-up. Clinical details of patients with biliary stent retrieval were noted. All extracted stents were collected in sterile containers and immediately processed for quantification of biofilm proteins and polysaccharides. Molecular identification of commonly known and unknown bacteria was performed by polymerase chain reaction and density gradient gel electrophoresis methods. RESULTS Eighty one patients (41 males) with age range of 20-86 years were studied. The underlying causes for stent insertion were bile duct stones (n = 46; 56.8%) benign stricture (n = 29; 35.8%) and malignancy (n = 6; 7.4%) with cholangitis in 50 (61.7%) patients. The retrieved stent sizes were 7 Fr (n = 62; 76.5%) and 10 Fr (n = 19; 23.5%) with 65 days median insertion duration. Polybacterial consortia were detected in 90.1% of the stents. The most common bacteria identified by polymerase chain reaction alone and/or sequencing were Pseudomonas (n = 38), Citrobacter (n = 23), Klebsiella (n = 22), Staphylococcus (n = 20), Serratia (n = 16), Escherichia coli (n = 14), Streptococcus (n = 13), Enterococcus (n = 13), Aeromonas (n = 12), Proteus (n = 10) and Enterobacter (n = 9). Protein concentration according to gender (0.547 ± 0.242 mg/mL vs 0.458 ± 0.259 mg/mL; P = 0.115) as well as age > 60 years and < 60 years (0.468 ± 0.295 mg/mL vs 0.386 ± 0.238 mg/mL; P = 0.205) was non-significant. However, polysaccharide concentration was significant both according to gender (0.052 ± 0.021 mg/mL vs 0.049 ± 0.016 mg/mL; P < 0.0001) and age (0.051 ± 0.026 mg/mL vs 0.038 ± 0.016 mg/mL; P < 0.011). Protein concentration in the biofilm was significantly higher (0.555 ± 0.225 mg/mL vs 0.419 ± 0.276 mg/mL; P = 0.018) in patients with cholangitis, lower (0.356 ± 0.252 mg/mL vs 0.541 ± 0.238 mg/mL; P = 0.005) in the 10 Fr group than the 7 Fr group, and significantly higher (0.609 ± 0.240 mg/mL vs 0.476 ± 0.251 mg/mL; P = 0.060) in stents of ≥ 6 mo of indwelling time. However presence/absence of cholangitis, size of stent, indication of stent insertion and indwelling time did not affect the quantity of polysaccharide concentration. CONCLUSION Plastic stents retrieved from patients with biliary tract disease showed polymicrobial organisms with higher protein content among patients with cholangitis and those with smaller diameter stents. Longer indwelling duration had more biofilm formation.
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Affiliation(s)
- Chetana Vaishnavi
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Yao Q, Fan B, Xiong Y, Wang C, Wang H, Jin C, Sun Q. Stress sensitive electricity based on Ag/cellulose nanofiber aerogel for self-reporting. Carbohydr Polym 2017; 168:265-273. [DOI: 10.1016/j.carbpol.2017.03.089] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/25/2017] [Accepted: 03/27/2017] [Indexed: 11/24/2022]
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Kyaw K, Harada A, Ichimaru H, Kawagoe T, Yahiro K, Morimura S, Ono K, Tsutsuki H, Sawa T, Niidome T. Silver Nanoparticles as Potential Antibiofilm Agents against Human Pathogenic Bacteria. CHEM LETT 2017. [DOI: 10.1246/cl.161198] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kaung Kyaw
- Faculty of Advanced Science and Technology, Kumamoto University, Chuo-ku, Kumamoto 860-8555
- Department of Chemical Engineering, Yangon Technological University, Yangon 11-011, Myanmar
| | - Ayaka Harada
- Faculty of Advanced Science and Technology, Kumamoto University, Chuo-ku, Kumamoto 860-8555
| | - Hiroaki Ichimaru
- Faculty of Advanced Science and Technology, Kumamoto University, Chuo-ku, Kumamoto 860-8555
| | - Takayuki Kawagoe
- Faculty of Advanced Science and Technology, Kumamoto University, Chuo-ku, Kumamoto 860-8555
| | - Kinnosuke Yahiro
- Department of Molecular Infectiology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba 260-8670
| | - Shigeru Morimura
- Faculty of Advanced Science and Technology, Kumamoto University, Chuo-ku, Kumamoto 860-8555
| | - Katsuhiko Ono
- Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto 860-8556
| | - Hiroyasu Tsutsuki
- Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto 860-8556
| | - Tomohiro Sawa
- Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto 860-8556
| | - Takuro Niidome
- Faculty of Advanced Science and Technology, Kumamoto University, Chuo-ku, Kumamoto 860-8555
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Duarah R, Singh YP, Gupta P, Mandal BB, Karak N. High performance bio-based hyperbranched polyurethane/carbon dot-silver nanocomposite: a rapid self-expandable stent. Biofabrication 2016; 8:045013. [PMID: 27788125 DOI: 10.1088/1758-5090/8/4/045013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Development of a bio-based smart implantable material with multifaceted attributes of high performance, potent biocompatibility and inherent antibacterial property, particularly against drug resistant bacteria, is a challenging task in biomedical domain. Addressing these aspects at the bio-nano interface, we report the in situ fabrication of starch modified hyperbranched polyurethane (HPU) nanocomposites by incorporating different weight percentages of carbon dot-silver nanohybrid during polymerization process. This nanohybrid and its individual nanomaterials (Ag and CD) were prepared by facile hydrothermal approaches and characterized by various instrumental techniques. The structural insight of the nanohybrid, as well as its nanocomposites was evaluated by TEM, XRD, FTIR, EDX and thermal studies. The significant improvement in the performance in terms of tensile strength (1.7 fold), toughness (1.5 fold) and thermal stability (20 °C) of the pristine HPU was observed by the formation of nanocomposite with 5 wt.% of nanohybrid. They also showed notable shape recovery (99.6%) and nearly complete self-expansion (>99%) just within 20s at (37 ± 1) °C. Biological assessment established in vitro cytocompatibility of the HPU nanocomposites. The fabricated nanocomposites not only assisted the growth and proliferation of smooth muscle cells and endothelial cells that exhibited reduced platelet adhesion but also displayed in vitro hemocompatibility of mammalian RBCs. Significantly, the antibacterial potency of the nanocomposites against Escherichia coli MTCC 40 and Staphylococcus aureus MTCC 3160 bacterial strains vouched for their application to countercheck bacterial growth, often responsible for biofilm formation. Thus, the present work forwards the nanocomposites as potential tough infection-resistant rapid self-expandable stents for possible endoscopic surgeries.
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Affiliation(s)
- Rituparna Duarah
- Advanced Polymer and Nanomaterial Laboratory, Center for Polymer Science and Technology, Department of Chemical Sciences, Tezpur University, Napaam, Tezpur, 784028, Assam, India
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Lee TH, Jang BS, Jung MK, Pack CG, Choi JH, Park DH. Fabrication of a silver particle-integrated silicone polymer-covered metal stent against sludge and biofilm formation and stent-induced tissue inflammation. Sci Rep 2016; 6:35446. [PMID: 27739486 PMCID: PMC5064322 DOI: 10.1038/srep35446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/29/2016] [Indexed: 12/19/2022] Open
Abstract
To reduce tissue or tumor ingrowth, covered self-expandable metal stents (SEMSs) have been developed. The effectiveness of covered SEMSs may be attenuated by sludge or stone formation or by stent clogging due to the formation of biofilm on the covering membrane. In this study, we tested the hypothesis that a silicone membrane containing silver particles (Ag-P) would prevent sludge and biofilm formation on the covered SEMS. In vitro, the Ag-P-integrated silicone polymer-covered membrane exhibited sustained antibacterial activity, and there was no definite release of silver ions from the Ag-P-integrated silicone polymer membrane at any time point. Using a porcine stent model, in vivo analysis demonstrated that the Ag-P-integrated silicone polymer-covered SEMS reduced the thickness of the biofilm and the quantity of sludge formed, compared with a conventional silicone-covered SEMS. In vivo, the release of silver ions from an Ag-P-integrated silicone polymer-covered SEMS was not detected in porcine serum. The Ag-P-integrated silicone polymer-covered SEMS also resulted in significantly less stent-related bile duct and subepithelium tissue inflammation than a conventional silicone polymer-covered SEMS. Therefore, the Ag-P-integrated silicone polymer-covered SEMS reduced sludge and biofilm formation and stent-induced pathological changes in tissue. This novel SEMS may prolong the stent patency in clinical application.
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Affiliation(s)
- Tae Hoon Lee
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
| | - Bong Seok Jang
- R&D Institute of Intervention, M. I. Tech Co., Ltd., 174 Habuk 2gil, Jinwi-myeon, Pyeongtaek, Gyeonggi-do, 451-864, South Korea
| | - Min Kyo Jung
- Department of Convergence Medicine, University of Ulsan College of Medicine &Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea.,School of Life Sciences and Biotechnology, Korea University, Seoul, Korea
| | - Chan Gi Pack
- Department of Convergence Medicine, University of Ulsan College of Medicine &Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | - Jun-Ho Choi
- Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, South Korea
| | - Do Hyun Park
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul 05505, South Korea
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25
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Guo Z, Chen G, Zeng G, Huang Z, Chen A, Hu L, Wang J, Jiang L. Cysteine-induced hormesis effect of silver nanoparticles. Toxicol Res (Camb) 2016; 5:1268-1272. [PMID: 30090430 PMCID: PMC6061518 DOI: 10.1039/c6tx00222f] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 07/25/2016] [Indexed: 12/25/2022] Open
Abstract
The toxicity of silver nanoparticles (AgNPs) is widely exploited, but their hormesis effect has, so far, received little attention. This study reports the hormesis effect at low AgNPs concentrations of 0.34 mg L-1, with a 29.9% increase in bacterial viability compared with the control. Cysteine can induce a hormesis effect at a higher concentration. 12.5 mg L-1 cysteine induced a hormesis effect in the AgNP concentration range of 1.7-5.1 mg L-1. Results suggest that this cysteine-induced hormesis effect is concentration-dependent; the concentration that make sulfuration rate (ns/nAg) of 6.15 shows strong excitation to cells.
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Affiliation(s)
- Zhi Guo
- College of Environmental Science and Engineering , Hunan University , Changsha 410082 , P.R. China . ; ; ; Tel: +86 731 88822829
- Key Laboratory of Environmental Biology and Pollution Control (Hunan University) , Ministry of Education , Changsha 410082 , P.R. China
| | - Guiqiu Chen
- College of Environmental Science and Engineering , Hunan University , Changsha 410082 , P.R. China . ; ; ; Tel: +86 731 88822829
- Key Laboratory of Environmental Biology and Pollution Control (Hunan University) , Ministry of Education , Changsha 410082 , P.R. China
| | - Guangming Zeng
- College of Environmental Science and Engineering , Hunan University , Changsha 410082 , P.R. China . ; ; ; Tel: +86 731 88822829
- Key Laboratory of Environmental Biology and Pollution Control (Hunan University) , Ministry of Education , Changsha 410082 , P.R. China
| | - Zhenzhen Huang
- College of Environmental Science and Engineering , Hunan University , Changsha 410082 , P.R. China . ; ; ; Tel: +86 731 88822829
- Key Laboratory of Environmental Biology and Pollution Control (Hunan University) , Ministry of Education , Changsha 410082 , P.R. China
| | - Anwei Chen
- College of Resources and Environment , Hunan Agricultural University , Changsha 410128 , P.R. China
| | - Liang Hu
- College of Environmental Science and Engineering , Hunan University , Changsha 410082 , P.R. China . ; ; ; Tel: +86 731 88822829
- Key Laboratory of Environmental Biology and Pollution Control (Hunan University) , Ministry of Education , Changsha 410082 , P.R. China
| | - Jiajia Wang
- College of Environmental Science and Engineering , Hunan University , Changsha 410082 , P.R. China . ; ; ; Tel: +86 731 88822829
- Key Laboratory of Environmental Biology and Pollution Control (Hunan University) , Ministry of Education , Changsha 410082 , P.R. China
| | - Longbo Jiang
- College of Environmental Science and Engineering , Hunan University , Changsha 410082 , P.R. China . ; ; ; Tel: +86 731 88822829
- Key Laboratory of Environmental Biology and Pollution Control (Hunan University) , Ministry of Education , Changsha 410082 , P.R. China
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