A Senolytic-Eluting Coronary Stent for the Prevention of In-Stent Restenosis

• Published in: ACS biomaterials science & engineering Vol. 8; no. 5; pp. 1921 - 1929
• Main Authors: Kim, Cheesue, Lee, Seul-Gee, Lim, Songhyun, Jung, Mungyo, Kwon, Sung Pil, Hong, Jihye, Kang, Mikyung, Sohn, Hee Su, Go, Seokhyeong, Moon, Sangjun, Lee, Seung-Jun, Kim, Jung-Sun, Kim, Byung-Soo
• Format: Journal Article
• Language: English
• Published: United States 09.05.2022
• Subjects: Animals; Constriction, Pathologic; Coronary Restenosis - prevention & control; Drug-Eluting Stents - adverse effects; Endothelial Cells; Everolimus - pharmacology; Hydrogen Peroxide - pharmacology; Rabbits; Senotherapeutics; Stents; senolytic therapy; cellular senescence; in-stent restenosis; angioplasty
• ISSN: 2373-9878; 2373-9878
• DOI: 10.1021/acsbiomaterials.1c01611

The vast majority of drug-eluting stents (DES) elute either sirolimus or one of its analogues. While limus drugs stymie vascular smooth muscle cell (VSMC) proliferation to prevent in-stent restenosis, their antiproliferative nature is indiscriminate and limits healing of the endothelium in stented vessels, increasing the risk of late-stent thrombosis. Oxidative stress, which is associated with vascular injury from stent implantation, can induce VSMCs to undergo senescence, and senescent VSMCs can produce pro-inflammatory cytokines capable of inducing proliferation of neighboring nonsenescent VSMCs. We explored the potential of senolytic therapy, which involves the selective elimination of senescent cells, in the form of a senolytic-eluting stent (SES) for interventional cardiology. Oxidative stress was modeled in vitro by exposing VSMCs to H O , and H O -mediated senescence was evaluated by cytochemical staining of senescence-associated β-galactosidase activity and qRT-PCR. Quiescent VSMCs were then treated with the conditioned medium (CM) of H O -treated VSMCs. Proliferative effects of CM were analyzed by staining for proliferating cell nuclear antigen. Senolytic effects of the first-generation senolytic ABT263 were observed in vitro, and the effects of ABT263 on endothelial cells were also investigated through an in vitro re-endothelialization assay. SESs were prepared by dip coating. Iliofemoral arteries of hypercholesteremic rabbits were implanted with SES, everolimus-eluting stents (EESs), or bare-metal stents (BMSs), and the area of stenosis was measured 4 weeks post-implantation using optical coherence tomography. We found that a portion of H O -treated VSMCs underwent senescence, and that CM of H O -treated senescent VSMCs triggered the proliferation of quiescent VSMCs. ABT263 reverted H O -mediated senescence and the proliferative capacity of senescent VSMC CM. Unlike everolimus, ABT263 did not affect endothelial cell migration and/or proliferation. SES, but not EES, significantly reduced stenosis area in vivo compared with bare-metal stents (BMSs). This study shows the potential of SES as an alternative to current forms of DES.