Mechanisms of Tissue Uptake and Retention in Zotarolimus-Coated Balloon Therapy

1Harvard-MIT Division of Health Sciences and Technology & Charles Stark Draper Laboratory, Cambridge, MA.
Circulation (Impact Factor: 14.95). 04/2013; DOI: 10.1161/CIRCULATIONAHA.113.002051
Source: PubMed

ABSTRACT BACKGROUND: Drug-coated balloons are increasingly utilized for peripheral vascular disease and yet, mechanisms of tissue uptake and retention remain poorly characterized. Most systems to date have used Paclitaxel, touting its propensity to associate with various excipients that can optimize its transfer and retention. We examined Zotarolimus pharmacokinetics. METHODS AND RESULTS: Animal studies, bench-top experiments and computational modeling were integrated to quantify arterial distribution after Zotarolimus-coated balloon (ZCB) use. Drug diffusivity and binding parameters for use in computational modeling were estimated from kinetics of Zotarolimus uptake into excised porcine femoral artery specimens immersed in radiolabeled drug solutions. Like Paclitaxel, Zotarolimus exhibited high partitioning into the arterial wall. Exposure of intimal tissue to drug revealed differential distribution patterns, with Zotarolimus concentration decreasing with transmural depth as opposed to multiple peaks displayed by Paclitaxel. Drug release kinetics was measured by inflating ZCBs in whole blood. In vivo drug uptake in swine arteries increased with inflation time but not with balloon size. Simulations coupling transmural diffusion and reversible binding to tissue proteins predicted arterial distribution that correlated with in vivo uptake. Diffusion governed drug distribution soon after balloon expansion but binding determined drug retention. CONCLUSIONS: Large bolus of Zotarolimus releases during balloon inflation, some of which pervades the tissue and a fraction of the remaining drug adheres to the tissue-lumen interface. As a result, duration of delivery modulates tissue uptake where diffusion and reversible binding to tissue proteins determine drug transport and retention, respectively.

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