Shear targeted drug delivery to stenotic blood vessels

In this review we focus on shear targeted drug delivery as a novel strategy to selectively deliver drugs to sites of vascular obstruction. We review the physics of stenotic (abnormally narrowed) blood vessels, while focusing mainly on the hemodynamics and transport phenomena at these sites. We then discuss how the local abnormal levels of shear stress, which can mechanically activate platelets, can be leveraged for localized drug delivery. We describe the development of Shear Activated Nano-particle Aggregates (SA-NPAs) that are designed to release and localize their nanoparticle drug carriers at sites of vascular stenosis. We present results in a variety of in vivo models, demonstrating the superiority of SA-NPAs carrying a thrombolytic drug compared to conventional treatment with the free drug. We also describe, shear-stress sensitive lenticular liposomes, which also show selective release under stenotic flow conditions. We then discuss limitations of both technologies, challenges in this new field and potential future applications. Altogether, we believe that mechano-sensitive therapeutics may offer a potential new approach for treatment of cardiovascular diseases. (C) 2016 Elsevier Ltd. All rights reserved.