Photodynamic Therapy to Prevent Arteriovenous Fistula Maturation Failure

项目摘要-光动力疗法预防动静脉瘘成熟 失败：未满足的临床需求 建立和维护动静脉（AV）穿刺部位对患者至关重要， 血液透析。最优选的AV入路是前臂瘘，目前用于 大多数血液透析患者。然而，AV瘘的常见问题是原发性的， 成熟失败，即在手术放置后，他们的瘘管不能进行透析 没有额外的经皮或外科手术干预，有些永远不会成为可行的。这 失败可导致长期使用中心静脉导管的发病率增加， 给医疗保健系统带来了巨大的经济损失。这是特别令人沮丧的，因为它是好的， 确定成熟的内瘘为血液透析患者提供最有效的方法 AV访问。虽然成熟失败的确切机制尚未完全理解，但它是 普遍认为，术后新生内膜增生和静脉重塑不足 发挥关键作用，预防这些过程中的任何一个都可以大大改善动静脉瘘 结果。 该项目将研究一种特殊形式的光动力疗法的潜力，以改善 瘘管成熟率。相关心血管模型的初步研究表明， 可以显著影响瘘管成熟失败中涉及的主要失败机制。 从商业化的角度来看，这种疗法也具有优势， 不相关疾病适应症的晚期开发，因此典型的药物开发风险 大幅减少。该项目将是一个商业实体之间的共同努力， 工作人员在血管光动力疗法方面有丰富的经验， AV通路临床前和临床研究的领导者。 该I期项目将重点在已建立的AV临床前模型中验证这种疗法 瘘管成熟失败。如果该项目成功，预计这项技术将 在短期内适合于初步临床可行性研究。

Project Summary - Photodynamic Therapy to Prevent Arterio-Venous Fistula Maturation Failure: An Unmet Clinical Need Establishing and maintaining arteriovenous (AV) access sites is critical for patients on hemodialysis. The most preferred AV access is the forearm fistula which is now used for the majority of hemodialysis patients. However, a common problem with AV fistulas is primary maturation failure, i.e. following surgical placement, their fistulas do not become viable for dialysis without additional percutaneous or surgical interventions and some never become viable. This failure can lead to increased morbidity from prolonged use of central venous catheters and results in a large financial cost to the health care system. This is particularly frustrating because it is well established that a mature fistula provides the hemodialysis patient with the most effective means of AV access. While the exact mechanisms of maturation failure are not fully understood, it is generally accepted that post-surgical neointimal hyperplasia and inadequate venous remodeling play key roles and preventing either of these processes should substantially improve AV fistula outcomes. This project will investigate the potential for a particular form of photodynamic therapy to improve fistula maturation rates. Preliminary studies in related cardiovascular models indicate this therapy could substantially impact the main failure mechanisms involved in fistula maturation failure. From a commercialization perspective, this therapy also has the advantage that is already under late stage development in an unrelated disease indication, thus the typical drug development risks are substantially reduced. The project will be a joint effort between a commercial entity whose staff has extensive experience in vascular photodynamic therapy and a research partner who is a leader in AV access preclinical and clinical research. This Phase I project will focus on validating this therapy in an established preclinical model of AV fistula maturation failure. If this project is successful, it is envisioned that this technology should be suitable for initial clinical feasibility studies within the near term.