Is it time for a retinoic acid eluting stent or a retinoic acid-coated balloon? Insights from experimental studies of systemic and local delivery of retinoids

Hellenic J Cardiol. 2023 Aug 9:S1109-9666(23)00140-9. doi: 10.1016/j.hjc.2023.08.003. Online ahead of print.


Restenosis and stent thrombosis, although they have been substantially declined during the last decades, still constitute the two major causes of stent failure. These complications are partially attributed to the currently used cytostatic drugs which can cause local inflammation, can delay or prevent re-endothelialization and essentially exert toxicity on the arterial cells. Retinoic acid (RA), a vitamin A (retinol) derivative, is a naturally occurring substance used for the treatment of cell proliferation disorders. The agent has pleiotropic effects on vascular smooth muscle cells and macrophages: it influences the proliferation, migration and transition of smooth muscle cells to other cell types and modulates macrophage activation, observations supported by accumulated evidence from in vitro and in vivo experiments. In addition, systemic and topical administration of RA can decrease the development of atherosclerotic plaques and reduce or inhibit restenosis after vascular injury (performed by embolectomy, balloon catheters, or ligation of arteries) in various experimental models. Recently, a RA-drug eluting stent (DES) has been tested in an animal model. In this review, we explore the effects of RA in atherosclerosis and the potential of the local delivery of RA through a RA-DES or RA-coated balloon for targeted therapeutic percutaneous vascular interventions. Despite promising published results, further experimental study is warranted to examine the safety and efficacy of RA-eluting devices in vascular artery disease.

PMID:37567563 | DOI:10.1016/j.hjc.2023.08.003


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