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VIEWPOINT

Sirolimus and Paclitaxel on Polymer-Based Drug-Eluting Stents

Similar But Different

Deutsches Herzzentrum and 1. Medizinische Klinik, Klinikum rechts der Isar, University of Technology, Munich, Germany.

Manuscript received July 15, 2005; revised manuscript received September 17, 2005, accepted September 26, 2005.

^_* Reprint requests and correspondence: Dr. Rainer Wessely, Deutsches Herzzentrum, Lazarettstr. 36, 80636 Munich, Germany. (Email: rwessely{at}dhm.mhn.de).

Recent clinical studies that investigated the efficacy of the two U.S. Food and Drug Administration-approved drug-eluting stent (DES) platforms Cypher (Cordis, Johnson and Johnson, Miami Lakes, Florida) and Taxus (Boston Scientific, Boston, Massachusetts) suggest that there are differences between both DES concerning neointimal growth. Both DES elute compounds that inhibit the cell cycle, but at different stages: Cypher stents elute sirolimus, which induces G₁ cell cycle inhibition, and Taxus stents release paclitaxel, which predominantly leads to M-phase arrest. In an attempt to explain the differences observed in human studies, the properties of these stent-based compounds on critical molecular and cellular events associated with the pathophysiology of in-stent restenosis are discussed in detail with the conclusion that both sirolimus and paclitaxel are different in their pleiotropic anti-restenotic effects. This may be in part responsible for the differences observed in recent clinical studies.

Abbreviations and Acronyms   CKI = cyclin-dependent kinase inhibitor   DES = drug-eluting stent   mTOR = mammalian target of rapamycin   PTX = paclitaxel   SRL = sirolimus   TLR = target lesion revascularization   VSMC = vascular smooth muscle cell

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