title: Fludarabine prevents smooth muscle proliferation in vitro and neointimal hyperplasia in vivo through specific inhibition of STAT-1 activation.
abstract: Drug-eluting stents are increasingly used to reduce in-stent restenosis and adverse cardiac events after percutaneous coronary interventions. However, the race for the ideal drug-eluting stent is still on, with special regard to the best stent-coating system and the most effective and less toxic drug. Fludarabine, a nucleoside analog, has both anti-inflammatory and antiproliferative cellular effects. The aim of the present study was to assess the cellular and molecular effects of fludarabine on vascular smooth muscle cell (VSMC) growth in vitro and in vivo and the feasibility and efficacy of a fludarabine-eluting stent. To study the biomolecular effects of fludarabine on VSMC proliferation in vitro, rat VSMCs were grown in the presence of 50 microM fludarabine or in the absence of the same. To evaluate the in vivo effect of this drug, male Wistar rats underwent balloon injury of the carotid artery, and fludarabine was locally delivered at the time of injury. Finally, fludarabine-eluting stents were in-laboratory manufactured and tested in a rabbit model of in-stent restenosis. Fludarabine markedly inhibited VSMC proliferation in cell culture. Furthermore, fludarabine reduced neointimal formation after balloon angioplasty in a dose-dependent manner, and fludarabine-eluting stents reduced neointimal hyperplasia by approximately 50%. These in vitro and in vivo cellular effects were specifically associated with the molecular switch-off of signal transducer and activator of transcription (STAT)-1 activation, without affecting other STAT proteins. Fludarabine abolishes VSMC proliferation in vitro and reduces neointimal formation after balloon injury in vivo through specific inhibition of STAT-1 activation. Fludarabine-eluting stents are feasible and effective in reducing in-stent restenosis in rabbits.
authors.affiliation: Laboratory of Molecular and Cellular Cardiology, Magna Graecia University, Catanzaro, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Torella
authors.forename: Antonio
authors.initials: A
authors.lastname: Curcio
authors.forename: Cosimo
authors.initials: C
authors.lastname: Gasparri
authors.forename: Valentina
authors.initials: V
authors.lastname: Galuppo
authors.forename: Daniela
authors.initials: D
authors.lastname: De Serio
authors.forename: Francesca C
authors.initials: FC
authors.lastname: Surace
authors.forename: Anna Lucia
authors.initials: AL
authors.lastname: Cavaliere
authors.forename: Angelo
authors.initials: A
authors.lastname: Leone
authors.forename: Carmela
authors.initials: C
authors.lastname: Coppola
authors.forename: Georgina M
authors.initials: GM
authors.lastname: Ellison
authors.forename: Ciro
authors.initials: C
authors.lastname: Indolfi
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects; D000818:Animals; D001011:Aorta / Q000187:drug effects / Q000378:metabolism; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D020212:Carotid Artery Injuries / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D016893:Carotid Stenosis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D049109:Cell Proliferation / Q000187:drug effects*; D002478:Cells, Cultured; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D005240:Feasibility Studies; D006965:Hyperplasia; D053614:Janus Kinase 2 / Q000378:metabolism; D008297:Male; D009131:Muscle, Smooth, Vascular / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D032389:Myocytes, Smooth Muscle / Q000187:drug effects / Q000378:metabolism; D010766:Phosphorylation; D011474:Prosthesis Design; D016372:RNA, Antisense / Q000235:genetics / Q000378:metabolism; D011817:Rabbits; D051381:Rats; D017208:Rats, Wistar; D050794:STAT1 Transcription Factor / Q000235:genetics / Q000378:metabolism*; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D014162:Transfection; D017539:Tunica Intima / Q000187:drug effects / Q000473:pathology; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D002317:Cardiovascular Agents; D016372:RNA, Antisense; D050794:STAT1 Transcription Factor; C494081:Stat1 protein, rat; C507927:Jak2 protein, rat; D053614:Janus Kinase 2; D014740:Vidarabine; C024352:fludarabine