Learning from the Cardiologists and Developing Eluting Stents Targeting the Mtor Pathway for Pulmonary Application; A Future Concept for Tracheal Stenosis.
Learning from the Cardiologists and Developing Eluting Stents Targeting the Mtor Pathway for Pulmonary Application; A Future Concept for Tracheal Stenosis.
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DOI：
10.4172/1747-0862.1000065
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发表时间：
2013-08-26
期刊：
影响因子：
--
通讯作者：
Freitag L
中科院分区：
文献类型：
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作者：
Zarogoulidis P;Darwiche K;Tsakiridis K;Teschler H;Yarmus L;Zarogoulidis K;Freitag L
气管狭窄无论是良性或恶性疾病是一种情况下，肺科医生和胸外科医生必须科普在他们的日常临床实践。在恶性肿瘤导致气管狭窄的情况下，可以使用激光、apc、冷冻探针、球囊扩张或一种以上设备和技术的组合进行微型介入干预。另一方面，在良性疾病的情况下，如气管软化，临床医生可以在诊断后立即进行支架放置。然而，在这两种情况下，均观察到支架在支架两端或一端诱导肉芽肿组织形成。因此，经常对患者进行评估是必要的，同时也要考虑到原发病的性质。先前已经发表了识别不同类型和程度的气管狭窄的评价方法。然而，我们仍然没有有效的辅助治疗来预防肉芽肿组织形成或延长已经治疗的肉芽肿病变。已经提出了许多诱导局部组织异常生长的机制，例如：局部压力、局部应力、炎症和血管内皮生长因子过表达。抑制mTOR途径的免疫调节剂能够局部抑制炎症级联反应。在当前的小型综述中，我们将尝试介绍药物洗脱支架抑制mTOR通路的现有知识，并提出这些支架作为局部抗增殖治疗的未来应用。
Tracheal stenosis due to either benign or malignant disease is a situation that the pulmonary physicians and thoracic surgeons have to cope in their everyday clinical practice. In the case where tracheal stenosis is caused due to malignancy mini-interventional interventions with laser, apc, cryoprobe, balloon dilation or with combination of more than one equipment and technique can be used. On the other hand, in the case of a benign disease such as; tracheomalacia the clinician can immediately upon diagnosis proceed to the stent placement. In both situations however; it has been observed that the stents induce formation of granuloma tissue in both or one end of the stent. Therefore a frequent evaluation of the patient is necessary, taking also into account the nature of the primary disease. Evaluation methodologies identifying different types and extent of the trachea stenosis have been previously published. However; we still do not have an effective adjuvant therapy to prevent granuloma tissue formation or prolong already treated granuloma lesions. There have been proposed many mechanisms which induce the abnormal growth of the local tissue, such as; local pressure, local stress, inflammation and vascular endothelial growth factor overexpression. Immunomodulatory agents inhibiting the mTOR pathway are capable of inhibiting the inflammatory cascade locally. In the current mini-review we will try to present the current knowledge of drug eluting stents inhibiting the mTOR pathway and propose a future application of these stents as a local anti-proliferative treatment.