Highly Selective PPARα (Peroxisome Proliferator‐Activated Receptor α) Agonist Pemafibrate Inhibits Stent Inflammation and Restenosis Assessed by Multimodality Molecular‐Microstructural Imaging

Author:

Iwata Hiroshi12ORCID,Osborn Eric A.34ORCID,Ughi Giovanni J.5,Murakami Kentaro1,Goettsch Claudia1,Hutcheson Joshua D.1ORCID,Mauskapf Adam3,Mattson Peter C.1,Libby Peter6ORCID,Singh Sasha A.1,Matamalas Joan1ORCID,Aikawa Elena167ORCID,Tearney Guillermo J.58,Aikawa Masanori169ORCID,Jaffer Farouc A.35ORCID

Affiliation:

1. Center for Interdisciplinary Cardiovascular Sciences Cardiovascular Division Brigham and Women’s Hospital Harvard Medical School Boston MA

2. Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine Tokyo Japan

3. Cardiovascular Research CenterCardiology DivisionMassachusetts General HospitalHarvard Medical School Boston MA

4. Cardiology Division Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA

5. Wellman Center for Photomedicine Massachusetts General HospitalHarvard Medical School Boston MA

6. Center for Excellence in Vascular Biology Cardiovascular Division Brigham and Women’s Hospital Harvard Medical School Boston MA

7. Department of Human Pathology I.M. Sechenov First Moscow State Medical University of the Ministry of Health Moscow Russian Federation

8. Department of Pathology Massachusetts General HospitalHarvard Medical School Boston MA

9. Channing Division of Network Medicine Brigham and Women’s HospitalHarvard Medical School Boston MA

Abstract

BACKGROUND New pharmacological approaches are needed to prevent stent restenosis. This study tested the hypothesis that pemafibrate, a novel clinical selective PPARα (peroxisome proliferator‐activated receptor α) agonist, suppresses coronary stent‐induced arterial inflammation and neointimal hyperplasia. METHODS AND RESULTS Yorkshire pigs randomly received either oral pemafibrate (30 mg/day; n=6) or control vehicle (n=7) for 7 days, followed by coronary arterial implantation of 3.5 × 12 mm bare metal stents (2–4 per animal; 44 stents total). On day 7, intracoronary molecular‐structural near‐infrared fluorescence and optical coherence tomography imaging was performed to assess the arterial inflammatory response, demonstrating that pemafibrate reduced stent‐induced inflammatory protease activity (near‐infrared fluorescence target‐to‐background ratio: pemafibrate, median [25th‐75th percentile]: 2.8 [2.5–3.3] versus control, 4.1 [3.3–4.3], P =0.02). At day 28, animals underwent repeat near‐infrared fluorescence–optical coherence tomography imaging and were euthanized, and coronary stent tissue molecular and histological analyses. Day 28 optical coherence tomography imaging showed that pemafibrate significantly reduced stent neointima volume (pemafibrate, 43.1 [33.7–54.1] mm 3 versus control, 54.2 [41.2–81.1] mm 3 ; P =0.03). In addition, pemafibrate suppressed day 28 stent‐induced cellular inflammation and neointima expression of the inflammatory mediators TNF‐α (tumor necrosis factor‐α) and MMP‐9 (matrix metalloproteinase 9) and enhanced the smooth muscle differentiation markers calponin and smoothelin. In vitro assays indicated that the STAT3 (signal transducer and activator of transcription 3)–myocardin axes mediated the inhibitory effects of pemafibrate on smooth muscle cell proliferation. CONCLUSIONS Pemafibrate reduces preclinical coronary stent inflammation and neointimal hyperplasia following bare metal stent deployment. These results motivate further trials evaluating pemafibrate as a new strategy to prevent clinical stent restenosis.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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