Faculty Bibliography

BACKGROUND:Drug-coated balloon angioplasty (DCB) is an emerging alternative to percutaneous transluminal angioplasty (PTA) for below-the-knee (BTK) revascularization in patients with chronic limb-threatening ischemia (CLTI). DCBs deliver antiproliferative agents to reduce neointimal hyperplasia, but results are mixed. This review assessed the clinical outcomes of DCB vs. PTA in BTK interventions for CLTI. METHODS:This systematic review and meta-analysis was registered with PROSPERO (CRD420251073999). PubMed and CENTRAL were searched for randomized controlled trials and clinical trials comparing DCB and PTA in adult CLTI patients undergoing BTK intervention. Studies until June 2025 were included in the review. Outcomes included clinically driven target lesion revascularization (CD-TLR), major amputation, all-cause mortality, primary patency, and late lumen loss (LLL). Risk of bias was assessed using the Cochrane RoB 2 tool, with most studies judged to have low or some concerns but no critical sources of bias. Random-effects model was used to calculate pooled odds ratios (ORs) and standardized mean differences (SMDs). RESULTS:Ten studies were included in the review; seven were eligible for meta-analysis. DCB significantly reduced CD-TLR compared to PTA at 12 months (OR: 0.39; 95% CI: 0.04-0.73), but not at 5 years. No significant differences were observed in major amputations or all-cause mortality at 12 months or 5 years, though mortality trended lower with DCB in the long term (OR: 0.57; 95% CI: 0.13-1.01). No significant differences between DCB and PTA were found for 6-month primary patency or LLL. CONCLUSION/CONCLUSIONS:DCB reduces early revascularization compared to PTA, but shows no significant long-term benefit in amputation or mortality. DCB may be selectively useful in certain patients at high risk of restenosis. Further long-term, risk-stratified studies are needed to optimize DCB use in CLTI management.

In view of the importance of the IL-2 receptors in the expression of antiallograft immunity and the currently existing controversy regarding the effect of CsA on the induction of IL-2 receptors, we explored the effect of cyclosporine on the induction of interleukin-2 receptor alpha and beta in normal human T cells. The effect of CsA on the induction of IL-2 receptors was examined at the levels of mRNA expression (with the aid of the polymerase chain reaction), protein (by SDS-PAGE analysis of chemically crosslinked 125I-IL-2 membrane protein complexes and by FACS), and function (by Scatchard analysis of 125I-IL-2 binding to T cells). The T cells were signaled with sn-1,2-dioctanoylglycerol and ionomycin or with crosslinked anti-CD3 and anti-CD2 mAbs. Our experimental design revealed that (A) CsA inhibits the induction of IL-2 receptor alpha and beta in normal human T cells, (B) the inhibitory activity is realized by a direct effect on T cells, and (C) the inhibitory activity is detectable at the pretranslational level--CsA significantly reduced the induction of mRNA encoding IL-2 receptor alpha and IL-2 receptor beta. These observations together persuasively demonstrate the ability of CsA to interrupt the emergence of IL-2 receptors on the surface of normal human T cells.