Tumor progression involves a series of biologically important steps in which the crosstalk between cancer cells and the surrounding environment is an important issue. Angiogenesis is a key tumorigenic phenomenon for cancer progression. Tumor-related extracellular vesicles (EVs) modulate the tumor microenvironment (TME) through cell-to-cell communication. Tumor cells in a hypoxic TME release more EVs than cells in a normoxic environment due to uncontrollable tumor proliferation. Tumor-derived EVs in the TME influence endothelial cells (ECs), which then play multiple roles, contributing to tumor angiogenesis, loss of the endothelial vascular barrier by binding to ECs, and subsequent endothelial-to-mesenchymal transition. In contrast, they also indirectly induce tumor angiogenesis through the phenotype switching of various cells into cancer-associated fibroblasts, the activation of tumor-associated ECs and platelets, and remodeling of the extracellular matrix. Here, we review current knowledge regarding the involvement of EVs in tumor vascular-related cancer progression.
Nucleic acid drugs, such as siRNAs, antisense oligonucleotides, and miRNAs, exert their therapeutic effects by causing genetic changes in cells. However, there are various limitations in their delivery to target organs and cells, making their application to cancer treatment difficult. Extracellular vesicles (EVs) are lipid bilayer particles that are released from most cells, are stable in the blood, and have low immunogenicity. Methods using EVs to deliver nucleic acid drugs to target organs are rapidly being developed that take advantage of these properties. There are two main methods for loading nucleic acid drugs into EVs. One is to genetically engineer the parent cell and load the target gene into the EV, and the other is to isolate EVs and then load them with the nucleic acid drug. Target organ delivery methods include passive targeting using the enhanced permeation and retention effect of EVs and active targeting in which EVs are modified with antibodies, peptides, or aptamers to enhance their accumulation in tumors. In this review, we summarize the advantages of EVs as a drug delivery system for nucleic acid drugs, the methods of loading nucleic acid drugs into EVs, and the targeting of EVs to target organs.
Volume 4 -Issue 1 | DOI: exposed. After systemic heparinization, the supraceliac and infrarenal abdominal aorta and the superior mesenteric and left renal arteries were clamped and a vertical aortotomy was made at the level of the renal arteries by mobilizing the left renal vein in a caudad direction. A 3.5 × 1.5 cm defect of the intima, from which the aneurysm had arisen, was found in the posterior part of the abdominal aorta. A 6-French gauge Foley balloon catheters were inserted in the orifice of the renal arteries from within the opened aorta. Renal hypothermia was provided with cold saline solution. Back-bleeding from the celiac artery was stopped using 5-French gauge Fogarty balloon catheter which was inserted from within the opened aorta. Debridement of infected tissues including infected arterial wall and numerous irrigation of the aneurysmal sac were performed, thereafter, the defect was repaired by using bovine pericardial patch plasty with 3-0 polyproplylene running sutures. After the aortotomy was closed using bovine pericardial strips, we performed omental wrapping (Figure 3). Renal artery perfusion time was 45 minutes. Culture from abdominal aneurysmal tissue was negative. The patient was discharged from hospital 17 days after surgery without the need for antibiotic therapy (Sulbactam/Ampicillin). Thereafter, oral antibiotic treatment (Levofloxacin) was continued for 11 months. The patient is alive and well 5 years after his operation (Figure 4). DiscussionIAA is a complicated disease with difficult treatment and poor survival. In addition to systemic antibiotic therapy, removal of the infected aorta, debridement of the surrounding tissue, in situ aortic
Stent-graft infection is a rare but potentially life-threatening complication of endovascular aortic repair. There are currently no consensus guidelines for treating stent-graft infections, but surgical treatment is generally considered preferable due to the low overall survival rate of patients receiving conservative therapy; however, the revascularization method remains controversial. We report a case in which stent-graft infection after endovascular aneurysm repair was successfully treated by stent-graft removal and extra-anatomical bypass (EAB). EAB is an effective method of revascularization for stent-graft infection.
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