Advances in nanotechnology for the management of coronary artery disease

Abstract

Nanotechnology holds tremendous potential to advance the current treatment of coronary artery disease. Nanotechnology may assist medical therapies by providing a safe and efficacious delivery platform for a variety of drugs aimed at modulating lipid disorders, decreasing inflammation and angiogenesis within atherosclerotic plaques, and preventing plaque thrombosis. Nanotechnology may improve coronary stent applications by promoting endothelial recovery on a stent surface utilizing bio-mimetic nanofibrous scaffolds, and also by preventing in-stent restenosis using nanoparticle-based delivery of drugs that are decoupled from stents. Additionally, nanotechnology may enhance tissue-engineered graft materials for application in coronary artery bypass grafting by facilitating cellular infiltration and remodeling of a graft matrix.

Figure 1. Current management of coronary artery disease and the overview of nanotechnology opportunities

For conservative management, nanotechnology can be utilized to create synthetic HDLs, deliver drugs that are otherwise difficult to be used clinically due to poor pharmacokinetic profiles or systemic toxicity, and reduce plaque inflammation by heat-induced ablation of macrophages using light-activated targeted nanoparticles. For invasive management with coronary revascularization with either PCI or CABG, nanotechnology can assist to deliver anti-proliferative drugs to prevent stent restenosis, facilitate re-endothelialization over stent struts with nanofibrous scaffolds, and create biosynthetic tissue-engineered grafts with improved cell attachment and viability.

Figure 2. Progression of atherosclerosis and therapeutic strategies

The main goal for the treatment of CAD is to control atherosclerosis, a multi-step process of chronic vascular inflammation and subsequent plaque formation. Current treatment strategies have been developed to modulate blood lipid levels, decrease inflammation or angiogenesis within atherosclerotic plaques, and prevent clot formation.

Figure 3. Anti-restenosis versus pro-healing strategies after PCI

In the anti-restenosis strategy, in-stent neointima formation can be prevented by nanoparticle-assisted delivery of anti-proliferative, anti-inflammatory drugs, or by heat-induced ablation of inflammatory cells with light-activatable nanoparticles. In the pro-healing strategy, re-endothelialization can be facilitated by using nanofibrous scaffolds that mimic extracellular matrix in vessels, or by using magnetic nanoparticles for enhanced delivery of cells to stent struts under magnetic field.