Key Points
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Nanomedicine — the use of nanotechnology for medical purposes — is a fast-growing field that has had numerous applications in cancer and is now increasingly being considered for atherosclerosis, the major cause of cardiovascular disease.
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Several methods of targeting atherosclerotic plaques using nanoparticles have been explored, which can be classified into nonspecific targeting, specific targeting of the vasculature as well as specific targeting of plaque components either with synthetic nanoparticles or via interaction through a natural conduit.
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Nanoparticle-facilitated therapeutics can potentially be applied to target the liver and change lipid levels systemically, or they can consist of direct injections of high-density lipoprotein nanoparticles to enhance the transport of cholesterol in plaques to the liver for excretion. Nanotherapy can also be used to intervene in specific atherosclerotic plaque processes by depleting monocyte recruitment or decreasing plaque inflammation and neovascularization.
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Silencing of plaque inflammation after a clinical event — such as a myocardial infarction or stroke — using nanotherapy is a promising therapeutic paradigm as it may improve the effectiveness of subsequent (statin) therapy.
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Medical imaging is increasingly being applied to assess atherosclerosis and to evaluate the effects of therapeutic interventions. It allows the direct and non-invasive visualization of plaque build-up and plaque characteristics in animal models as well as in patients.
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Nanoparticle-enhanced diagnostics allow the molecular imaging of atherosclerotic plaques by several clinically available imaging modalities, including magnetic resonance imaging, computed tomography, positron emission tomography and ultrasound imaging. Multimodal nanoparticles have exhibited valuable roles in the evaluation and corroboration of targeting mechanisms.
Abstract
The use of nanotechnology for medical purposes — nanomedicine — has grown exponentially over the past few decades. This is exemplified by the US Food and Drug Administration's approval of several nanotherapies for various conditions, as well as the funding of nanomedical programmes worldwide. Although originally the domain of anticancer therapy, recent advances have illustrated the considerable potential of nanomedicine in the diagnosis and treatment of atherosclerosis. This Review elaborates on nanoparticle-targeting concepts in atherosclerotic disease, provides an overview of the use of nanomedicine in atherosclerosis, and discusses potential future applications and clinical benefits.
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Change history
31 October 2011
The following sentence was inadvertently duplicated on page 835: Subsequently, several other nanomedicinal therapeutics have been approved for clinical use, including an albumin-bound nanoparticle delivering paclitaxel for the treatment of breast cancer (Abraxane; Abraxis BioScience) and liposomal amphotericin B for the treatment of fungal infections (AmBisome; Astellas Pharma). This has been removed from this both the html and pdf versions.
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Acknowledgements
We gratefully acknowledge D. P. Cormode for discussions and recommendations. Support for this work was partially provided by the International Atherosclerosis Society (M.E.L). This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) and the US National Institutes of Health (NIH), as a Program of Excellence in Nanotechnology (PEN) Award (Contract no. HHSN268201000045C), as well as by the NIH grants R01 EB009638 (Z.A.F.) and R01 CA155432 (W.J.M.M.).
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Glossary
- Atherosclerosis
-
A chronic systemic inflammatory disease in which the arterial wall thickens as a result of the accumulation of fatty material within the vessel wall.
- Drug-eluting stents
-
Stents that are typically coated with antiproliferative or immunosuppressive drugs for local release to prevent restenosis within the stent.
- Apolipoprotein
-
The protein constituent of lipoproteins that provides cell specificity and is essential for their structural integrity.
- Vasa vasorum
-
A microvascular network that supplies larger blood vessels with nutrients.
- Stenosis
-
Luminal narrowing of a blood vessel.
- Atherothrombotic events
-
Clinical events such as myocardial infarction or stroke that are the result of atherosclerotic plaque disruption with superimposed thrombosis.
- Reverse cholesterol transport
-
Transport of cholesterol from peripheral cells to the liver for excretion.
- Mononuclear phagocyte system
-
A branch of the immune system that consists of phagocytic cells that can remove macromolecules from circulation.
- 18F-FDG
-
A radioactive glucose analogue that is taken up by metabolically active cells, and is frequently used for molecular imaging in combination with positron emission tomography.
- Restenosis
-
The reoccurence of stenosis after previous treatment.
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Lobatto, M., Fuster, V., Fayad, Z. et al. Perspectives and opportunities for nanomedicine in the management of atherosclerosis. Nat Rev Drug Discov 10, 835–852 (2011). https://doi.org/10.1038/nrd3578
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DOI: https://doi.org/10.1038/nrd3578
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