A Novel Endovascular Approach to Remove Atherosclerotic Plaque Lesions In Situ

摘要 在美国，继发于动脉粥样硬化的心血管疾病是主要的死亡原因。 目前治疗严重动脉粥样硬化的经皮血管介入治疗需要球囊充气 或不使用刚性、非顺应性金属支架。然而，这种技术并不能去除 动脉粥样硬化斑块负荷并对动脉壁造成机械损伤，导致显著 再狭窄率。FDA批准的斑块去除技术确实存在，并在临床领域使用。 然而，为了清除斑块，这些疗法中的每一种都会导致某种形式的机械或热损伤 血管壁，最终刺激新的内膜增生的发展，并导致显著的 动脉再狭窄。因此，本研究的目标是开发一种新的血管内技术，以 减少动脉粥样硬化斑块负荷，而不会对动脉造成热或机械损伤 墙。我们的范式转换技术基于一种安全的原位消化动脉粥样硬化斑块的方法 通过使用双闭塞球囊导管、声学钢丝和高度定制的解决方案 为安全消化动脉粥样硬化斑块量身定做。鉴于大多数动脉粥样硬化斑块是由 胶原蛋白、纤维蛋白、脂类、蛋白多糖、炎症细胞、平滑肌细胞和钙，我们假设 含有针对这些斑块成分的试剂的消化液将溶解并 在临床相关的时间范围内原位消化斑块。避免使用弹性酶在我们的 溶液将斑块的消化限制在弹性板层上。与我们的多学科调查团队一起，我们 已经通过初步数据证明了我们方法的可行性和初步安全性。我们有 显示了对切除的人颈动脉粥样硬化斑块和斑块的有效消化 在完整的人股浅动脉内。我们评估了我们的方法在非动脉粥样硬化性疾病中的应用 在活体猪模型上，表明我们的治疗方法没有损伤动脉壁，仅限于内部 没有导致夹层或动脉瘤的形成，这表明我们的治疗是安全的。 最后，我们在动脉粥样硬化猪模型中评估了我们的方法，并在 减少斑块，不会导致血栓形成或动脉瘤样变性。鉴于……的可行性和前景 这些初步数据，我们相信这项新技术的进一步科学探索和开发 这是有根据的，并将导致一种治疗人类动脉粥样硬化的创新临床疗法。因此， 这项建议的总体目标是强有力地评估安全性、有效性、耐用性和 这种疗法在临床前动脉粥样硬化猪动物模型中的可重复性。成功 这些研究的完成将直接导致FDA申请进行人类第一阶段临床试验， 并因此与美国国立卫生研究院的使命高度一致，即“增进健康，延长寿命， 并通过应用新知识减少疾病和残疾。

SUMMARY Cardiovascular disease secondary to atherosclerosis is the leading cause of death in the United States. Current percutaneous vascular interventions that treat severe atherosclerosis require inflation of a balloon with or without deployment of a rigid, non-compliant metal stent. Yet, this technique fails to remove the atherosclerotic plaque burden and causes mechanical trauma to the arterial wall, resulting in significant restenosis rates. FDA-approved plaque debulking technologies do exist and are used in the clinical arena. However, to debulk the plaque, each of these therapies induces some form of mechanical or thermal injury to the vessel wall, which ultimately stimulates the development of neointimal hyperplasia and results in significant arterial restenosis. Therefore, the goal of this study is to develop a novel endovascular technology to reduce atherosclerotic plaque burden without inducing thermal or mechanical trauma to the arterial wall. Our paradigm-shifting technology is based on a safe method of digesting atherosclerotic plaque in situ through the use of a double occlusion balloon catheter, sonication wire, and a highly customized solution tailored to safely digest atherosclerotic plaque. Given that most atherosclerotic plaques are composed of collagen, fibrin, lipids, proteoglycans, inflammatory cells, smooth muscle cells, and calcium, we hypothesize that a digestion solution containing agents that target these plaque components will dissolve and digest the plaque in situ within a clinically relevant time frame. Avoidance of the use of elastases in our solution limits digestion of the plaque to the elastic lamina. With our multidisciplinary team of investigators, we have already demonstrated the feasibility and initial safety of our approach through preliminary data. We have demonstrated effective digestion of excised human carotid artery atherosclerotic plaques as well as the plaque inside intact human superficial femoral arteries. We have evaluated our approach in a non-atherosclerotic porcine model in vivo and showed that our therapy did not injure the arterial wall, was limited to the internal elastic lamina, and did not result in dissections or aneurysm formation, suggesting that our therapy is safe. Lastly, we evaluated our approach in an atherosclerotic porcine model and demonstrated initial efficacy at reducing plaque without inducing thrombosis or aneurysmal degeneration. Given the feasibility and promise of these preliminary data, we believe further scientific exploration and development of this novel technology is warranted and will lead to an innovative clinical therapy for the treatment of atherosclerosis in humans. Thus, the overall objective of this proposal is to robustly evaluate the safety, efficacy, durability, and repeatability of this therapy in a preclinical porcine animal model of atherosclerosis. Successful completion of these studies will directly lead to an FDA application for a first-in-human Phase 1 clinical trial, and is thus highly aligned with the mission of the National Institutes of Health to “enhance health, lengthen life, and reduce illness and disability” through the application of new knowledge.