Macrophage Polarization as a Novel Therapeutic Target for Endovascular Intervention in Peripheral Artery Disease

Richard P Tan; Isabelle Ryder; Nianji Yang; Yuen Ting Lam; Miguel Santos; Praveesuda L Michael; David A Robinson; Martin K Ng; Steven G Wise

doi:10.1016/j.jacbts.2021.04.008

Macrophage Polarization as a Novel Therapeutic Target for Endovascular Intervention in Peripheral Artery Disease

JACC Basic Transl Sci. 2021 Jul 23;6(8):693-704. doi: 10.1016/j.jacbts.2021.04.008. eCollection 2021 Aug.

Authors

Richard P Tan^{1

2}, Isabelle Ryder², Nianji Yang^{1

2}, Yuen Ting Lam^{1

2}, Miguel Santos^{1

2}, Praveesuda L Michael^{1

2}, David A Robinson³, Martin K Ng^{4

5}, Steven G Wise^{1

2

6}

Affiliations

¹ Chronic Diseases, School of Medical Sciences, Faculty of Health and Medicine, University of Sydney, Sydney, New South Wales, Australia.
² Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.
³ Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁴ Department of Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
⁵ Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁶ University of Sydney Nano Institute, University of Sydney, Sydney, New South Wales, Australia.

Abstract

Peripheral artery disease (PAD) has a significant impact on human health, affecting 200 million people globally. Advanced PAD severely diminishes quality of life, affecting mobility, and in its most severe form leads to limb amputation and death. Treatment of PAD is among the least effective of all endovascular procedures in terms of long-term efficacy. Chronic inflammation is a key driver of PAD; however, stents and coated balloons eluting antiproliferative drugs are most commonly used. As a result, neither stents nor coated balloons produce durable clinical outcomes in the superficial femoral artery, and both have recently been associated with significantly increased mortality. This review summarizes the most common clinical approaches and limitations to treating PAD and highlights the necessity to address the underlying causes of inflammation, identifying macrophages as a novel therapeutic target in the next generation of endovascular PAD intervention.

Keywords: BMS, bare-metal stent; CAD, coronary artery disease; DES, drug-eluting stent; FP, femoropopliteal; IL, interleukin; MI, myocardial infarction; PAD, peripheral artery disease; PTA, percutaneous transluminal angioplasty; SFA, superficial femoral artery; TGF, transforming growth factor; TNF, tumor necrosis factor; drug-eluting balloon; drug-eluting stent; endovascular intervention; macrophage polarization; paclitaxel; peripheral arterial disease; vascular healing; vascular inflammation.

Publication types

Review