Patent Application
20230001052
The present invention relates to an acellular nerve graft, and methods for the production thereof. Also contemplated is the use of the acellular nerve graft in the treatment of long nerve gap injuries in a subject.
The nervous system is one of the most highly organised systems within the human body, integrating various bodily processes and reactions of the organism to its environment. It is subdivided into the central nervous system (CNS) and peripheral nervous system (PNS). The CNS is the larger system, including the brain and spinal cord. The PNS involves a vast network of nerves that are linked to the brain and the spinal cord receptors. The function of the PNS is to help process changes in the internal and external environment. Injuries to peripheral nerves are common and debilitating and may result in loss of motor function, sensory function, or both. In the United States over twenty million Americans suffer from peripheral nerve injury (Lundborg 2003) and over $150 billion is spent annually on treating these injuries (Taylor, Braza et al. 2008).
Previous studies have demonstrated that decellularised nerve extracellular matrix (ECM) can be used as a material to generate scaffolds for nerve regeneration, however producing an acellular scaffold for treatment of long peripheral nerve gap injuries has proved challenging. Furthermore, it is unclear if these scaffolds can be further enhanced by the addition of extra ECM components such as glycosaminoglycans (GAGs) to help stimulate the regeneration process.
Methods of preparing acellular peripheral nerve grafts are described in U.S. Ser. No. 14/274,156, U.S. Ser. No. 10/672,689, WOUS16042273, U.S. Ser. No. 14/776,765, U.S. Ser. No. 13/776,606, U.S. Ser. No. 13/525,753, U.S. Ser. No. 10/624,534, WOUS16031313, U.S. Ser. No. 10/615,623 and U.S. Ser. No. 10/478,198.
Buckley et al. (Sridharan, R., Reilly, R. B. and Buckley C. T. Decellularized grafts with axially aligned channels for peripheral nerve regeneration. Journal of the Mechanical Behaviour of Biomedical Materials 41: 124-135, 2015) describes short and narrow acellular peripheral nerve grafts formed by a method comprising a decellularization step comprising chemical and enzymatic washing of the section of nerve followed by a unidirectional freeze-drying step to impart porosity into the nerve tissue. The nerves employed in this study were small rat nerves, and the content of DNA in the decellularized nerves was about 257+/−36.9 ng/mg.
Describes decellularized nerves formed by treating nerve segments with the detergents Triton X-100 and deoxycholic acid, followed by treatment with DNAse and RNAse. After this, the nerves were unidirectionally freeze-dried to form longitudinal pores with an average pore size of about 40 micrometres.
It is an object of the invention to overcome at least one of the above-referenced problems.
The Applicant has discovered that the methods of the prior art can be improved by performing an initial freeze-thaw treatment step, then performing unidirectional freeze-drying of the nerve tissue to introduce longitudinal pores into the section of nerve, and performing a chemical and enzymatic decellularization step on the porous section of nerve. In particular, and without being bound by theory, the Applicant has found that performing unidirectional freeze-drying prior to chemical/enzymatic treatment allows for greater penetration of the chemical and enzymatic decellularization agents into the section of nerve due to the presence of pores in the freeze-dried nerve tissue, resulting in greater decellularization of the nerve tissue (e.g. less than 100 or 60 ng/mg (dry weight) of DNA with the method of one embodiment of the invention, compared with 257 ng/mg with the prior art method). Data presented also shows retention of high levels of the ECM components laminin, fibronectin and collagen (
In a first aspect, the invention provides a method of producing an acellular nerve graft comprising the steps of:
In any embodiment, the section of nerve is a section of peripheral nerve. The method of the invention has been found to be particularly suitable for longer sections of nerve, of the type used to repair long peripheral nerve gap injuries. In one embodiment, the section of nerve has a length of at least 40 mm, 50 mm, 60 mm, 70 mm, 80 mm, 90 mm, or 100 mm.
The method of the invention generally comprises freeze-drying the section of nerve longitudinally, whereby longitudinal pores are introduced into the tissue. The pores are generally unidirectional and generally co-axial with a longitudinal axis of the section of nerve. Unidirectional freeze-drying of sections of nerve is described in Buckley et al. In one embodiment, the longitudinal freeze-drying comprises freeze-drying the (thawed) section of nerve in an upright position in the freeze-drying chamber.
In any embodiment, the thawed section of nerve is placed into a tube formed in an insulating block, and freeze-dried within the insulating block. In one embodiment, the tube is an upright tube and the section of nerve is freeze-dried in an upright orientation. In one embodiment, the insulating block comprises ertalyte polymer.
In any embodiment, the primary treatment step comprises freezing the section of peripheral nerve to −70° C. to −90° C., typically about 80° C. In one embodiment, the section of nerve is wrapped in filter paper during thawing.
In any embodiment, the freeze-drying conditions comprise a freezing stage at a freezing temperature, a primary drying stage at a first drying temperature that is less than 0° C. and higher than the freezing temperature, and a secondary drying stage at a second drying temperature that is higher than the first drying temperature. In any embodiment, the freezing temperature is less than −10° C. or −20° C., for example −20-40° C., preferably about −30° C. In any embodiment, the first drying temperature is about −5 to −20° C., for example about −10° C. In any embodiment, the freezing stage lasts for about 30-90 minutes (ideally about 60 minutes when the freezing temperature is about −30° C.). In any embodiment, the first drying stage lasts for about 12 to 36 hours (ideally about 24 hours when the first drying temperature is about −10° C.). In any embodiment, the second drying stage lasts for about 1 to 10 hours (ideally about 5 hours when the second drying temperature is about 20° C.).
Thus, in any embodiment, the freeze-drying conditions comprise a freezing stage at about −30° C. for about 1 hour, a primary drying stage at a temperature of about −10° C. for about 24 hours, and a secondary drying stage at a temperature of about 20° C. for about 5 hours.
In any embodiment, the method comprises a further step of contacting the acellular nerve graft with a solution of sulphated glycosaminoglycan (sGAG), for example chondroitin-6-sulphate, typically at elevated temperature (i.e. a temperature greater than room temperature, for example greater than 25° C., 30° C., 35° C. or 40° C., for example 25-45° C., 25-40° C., 30-40° C.
In another aspect, the invention provides an acellular nerve graft obtained by or obtainable by a method of the invention.
In another aspect, the invention provides an acellular nerve graft prepared from native nerve tissue and comprising reduced DNA content (e.g. compared with the prior art methods), typically of less than 100, 90, 80, 70, or 60 ng/mg.
In another aspect, the invention provides an acellular nerve graft prepared from native nerve tissue and comprising longitudinal pores having an average pore size of at least 30 or 40 μm.
In another aspect, the invention provides an acellular nerve graft prepared from native nerve tissue and comprising a native nerve structure with retention of nerve fascicles and connective tissue layers, endoneurium, perineuriem and epineurium.
In another aspect, the invention provides an acellular nerve graft prepared from native nerve tissue and comprising a sulphated glycosaminoglycan (sGAG) content of greater than 0.21 μg/mg.
In one embodiment, the acellular nerve graft is an acellular peripheral nerve graft.
In one embodiment, the acellular nerve graft has an average pore size of at least 30, 40, 50, 60, 70, 80, 90 or 100 μm when determined by the method of determining average pore size as described below. The pore size may be up to 150 μm. The pore size may be up to 200 μm.
In one embodiment, the acellular nerve graft has an average pore size of at least 40 μm.
In one embodiment, the acellular nerve graft has a DNA content (dry weight) of less than 100, 90, 80 70, 65, 60, or 57 ng/mg.
In one embodiment, the acellular nerve graft has a native nerve structure with retention of nerve fascicles and connective tissue layers, endoneurium, perineuriem and epineurium.
In one embodiment, the acellular nerve graft has a sulphated glycosaminoglycan (sGAG) content of greater than 0.10 μg/mg, 0.15 μg/mg, or 0.21 μg/mg.
In one embodiment, the invention provides an acellular peripheral nerve graft characterised by comprising:
In another aspect, the invention provides a method of treating a nerve gap injury (especially long nerve gap injury) in a subject, comprising a step of implanting an acellular nerve graft of the invention into the subject to bridge the gap in the nerve.
In one embodiment, the acellular nerve graft is an allograft.
In one embodiment, the nerve gap injury is a peripheral nerve gap injury.
In one embodiment, the nerve gap injury comprises a long nerve injury (e.g. a gap of greater than 30 mm), and wherein the acellular nerve graft has a length of greater than 30 mm.
Other aspects and preferred embodiments of the invention are defined and described in the other claims set out below.
All publications, patents, patent applications and other references mentioned herein are hereby incorporated by reference in their entireties for all purposes as if each individual publication, patent or patent application were specifically and individually indicated to be incorporated by reference and the content thereof recited in full.
Where used herein and unless specifically indicated otherwise, the following terms are intended to have the following meanings in addition to any broader (or narrower) meanings the terms might enjoy in the art:
Unless otherwise required by context, the use herein of the singular is to be read to include the plural and vice versa. The term “a” or “an” used in relation to an entity is to be read to refer to one or more of that entity. As such, the terms “a” (or “an”), “one or more,” and “at least one” are used interchangeably herein.
As used herein, the term “comprise,” or variations thereof such as “comprises” or “comprising,” are to be read to indicate the inclusion of any recited integer (e.g. a feature, element, characteristic, property, method/process step or limitation) or group of integers (e.g. features, element, characteristics, properties, method/process steps or limitations) but not the exclusion of any other integer or group of integers. Thus, as used herein the term “comprising” is inclusive or open-ended and does not exclude additional, unrecited integers or method/process steps.
As used herein, the term “disease” is used to define any abnormal condition that impairs physiological function and is associated with specific symptoms. The term is used broadly to encompass any disorder, illness, abnormality, pathology, sickness, condition or syndrome in which physiological function is impaired irrespective of the nature of the aetiology (or indeed whether the aetiological basis for the disease is established). It therefore encompasses conditions arising from infection, trauma, injury, surgery, radiological ablation, age, poisoning or nutritional deficiencies.
As used herein, the term “treatment” or “treating” refers to an intervention (e.g. the administration of an agent to a subject) which cures, ameliorates or lessens the symptoms of a disease or removes (or lessens the impact of) its cause(s) (for example, the reduction in accumulation of pathological levels of lysosomal enzymes). In this case, the term is used synonymously with the term “therapy”.
Additionally, the terms “treatment” or “treating” refers to an intervention (e.g. the administration of an agent to a subject) which prevents or delays the onset or progression of a disease or reduces (or eradicates) its incidence within a treated population. In this case, the term treatment is used synonymously with the term “prophylaxis”.
As used herein, an effective amount or a therapeutically effective amount of an agent defines an amount that can be administered to a subject without excessive toxicity, irritation, allergic response, or other problem or complication, commensurate with a reasonable benefit/risk ratio, but one that is sufficient to provide the desired effect, e.g. the treatment or prophylaxis manifested by a permanent or temporary improvement in the subject's condition. The amount will vary from subject to subject, depending on the age and general condition of the individual, mode of administration and other factors. Thus, while it is not possible to specify an exact effective amount, those skilled in the art will be able to determine an appropriate “effective” amount in any individual case using routine experimentation and background general knowledge. A therapeutic result in this context includes eradication or lessening of symptoms, reduced pain or discomfort, prolonged survival, improved mobility and other markers of clinical improvement. A therapeutic result need not be a complete cure. Improvement may be observed in biological/molecular markers, clinical or observational improvements. In a preferred embodiment, the methods of the invention are applicable to humans, large racing animals (horses, camels, dogs), and domestic companion animals (cats and dogs).
In the context of treatment and effective amounts as defined above, the term subject (which is to be read to include “individual”, “animal”, “patient” or “mammal” where context permits) defines any subject, particularly a mammalian subject, for whom treatment is indicated. Mammalian subjects include, but are not limited to, humans, domestic animals, farm animals, zoo animals, sport animals, pet animals such as dogs, cats, guinea pigs, rabbits, rats, mice, horses, camels, bison, cattle, cows; primates such as apes, monkeys, orangutans, and chimpanzees; canids such as dogs and wolves; felids such as cats, lions, and tigers; equids such as horses, donkeys, and zebras; food animals such as cows, pigs, and sheep; ungulates such as deer and giraffes; and rodents such as mice, rats, hamsters and guinea pigs. In preferred embodiments, the subject is a human. As used herein, the term “equine” refers to mammals of the family Equidae, which includes horses, donkeys, asses, kiang and zebra.
“Acelullar nerve graft” refers to a section of nerve that has been treated to decellularise the nerve while maintaining the nerves structural and mechanical integrity and many of its ECM components, and that can be used in the treatment of nerve gap injury by bridging the severed ends of the nerves and providing a scaffold for migration of cells and generation of newly formed nerve tissue. The acellular nerve graft of the invention is particularly suitable for treatment of long nerve gap injury, especially long peripheral nerve gap injury.
“Peripheral nerve” refers to nerves that are outside the brain and spinal cord, and that connect the central nervous system to the limbs and organs.
“Freezing and thawing” refers to a step in the process of the invention in which a section of native nerve is frozen and then thawed with a view to decellularization of the section of nerve by rupturing cell membranes resulting in bursting of cells and cell lysis. In any embodiment, the section of nerve is frozen to −50° C., −60° C. or −70° C. or lower, typically to −70° C. to −90° C., typically about −75° C.-85° C., typically about −80° C. and then thawed typically to room temperature, although it will be apparent to a person skilled in the art that other freezing and thawing temperatures may be employed to achieve decellularization.
“Freeze-drying” (also known as lyophilisation) is a process that comprises freezing the section of nerve, then lowering the pressure during drying phase and removing ice crystal formed in the nerve tissue by sublimation leaving pores in place of the ice crystals. The process typically involves a primary drying phase where the ice is forced to sublime, and a secondary drying phase in which unfrozen water molecules are removed. In one embodiment, the freeze-drying conditions comprise a freezing stage at about −30° C. for about 1 hour, a primary drying stage at a temperature of about −10° C. for about 24 hours, and a secondary drying stage at a temperature of about 20° C. for about 5 hours. The method of the invention employs unidirectional freeze-drying, where the freeze-drying is configured to generate axially aligned ice crystals in the nerve tissue, resulting in axially aligned pores. In the present invention, the freeze-drying is generally “longitudinal freeze drying”, which means that freeze-drying step is configured to generate longitudinal unidirectional pores in the section of nerve that are co-axial with longitudinal axis of the section of nerve. This may be achieved, for example, by arranging the section of nerve in the freeze-drying chamber in an upright position which promotes the growth of longitudinal ice crystals in the nerve tissue. In one embodiment, the section of nerve tissue is placed in a tube formed in an insulating block, and then placed on the cooling shelf of a freeze drier.
“Average pore size” as used herein is measured using the method described in Buckley et al. (Sridharan, R., Reilly, R. B. and Buckley C. T. Decellularized grafts with axially aligned channels for peripheral nerve regeneration. Journal of the Mechanical Behaviour of Biomedical Materials 41: 124-135, 2015).
“Sulphated glycosaminoglycan” or “sGAG” refers to long linear (unbranched) polysaccharides consisting of repeating disaccharide (double sugar) units. The repeating unit (except for keratan) consists of an amino sugar (N-acetylglucosamine or N-acetylgalactosamine) along with a uronic sugar (glucuronic acid or iduronic acid) or galactose. In one embodiment, the sGAG is a chondroitin sulphate, especially chondroitin-6-sulphate. In one embodiment, the invention provides an acellular nerve graft comprising exogenous sGAG and typically obtained by contacting the acellular nerve graft with a solution of sGAG, typically at elevated temperature. The term “elevated temperature” refers to a temperature that is greater than room temperature and lower than a temperature at which protein in the nerve tissue denatures, for example 25-40° C.
“Allograft” as used herein in the context of the use of the acellular nerve graft of the invention means that the nerve graft is prepared with a section of native nerve tissue from one subject, and used in treatment of a different subject. This is distinct from “autograft”, where the donor of the native section of nerve and recipient of the prepared acellular graft are the same person. The use of an allograft provides many advantages over an autograft, including less hospital and operating theatre time for the patient, and a lowered risk of infection. The invention also relates to an acellular nerve graft of or obtaining by the invention, for use as an allograft or an autograft.
Decellularisation of nerve tissue with detergent and enzymatic decellularization agents is described in the literature, for example Sridharan et al described above. In the examples provided herein, the freeze dried section of nerve is decellularized with detergent and then with an enzyme. The detergent may be an ionic detergent. The detergent may be a bile acid, for example sodium deoxycholate. The detergent may be a nonionic detergent. The detergent may have a hydrophilic polyethylene oxide chain (e.g. on average it has 9.5 ethylene oxide units) and an aromatic hydrocarbon lipophilic or hydrophobic group. The detergent may be a Triton X-100. The nerves may be washed in a detergent solution, for example 1-10% w/v detergent. The nerve section may be washed in two detergents separately. The nerve section may be washed first in sodium deoxycholate and then in Triton X-100. The nerve may be washed at above room temperature, for example 30-40° C. The nerves may be incubated in buffer after the detergent wash(es). The nerves may be washed in one or more enzymatic agents, for example an agent that degrades nucleic acid such as a nuclease or benzonase. It will be appreciated that the choice of detergent and enzymatic agent may be varied provided that the agents are capable of decellularizing the section of nerve adequately. Likewise, the concentrations of the agents may be varied depending on the agent being employed, and the type of nerve being decellularized.
The invention will now be described with reference to specific Examples. These are merely exemplary and for illustrative purposes only: they are not intended to be limiting in any way to the scope of the monopoly claimed or to the invention described. These examples constitute the best mode currently contemplated for practicing the invention.
Development of an Acellular Porcine Peripheral Nerve Graft with Axially Aligned Pores
Peripheral nerves used for the fabrication of the decellularised allografts were harvested from porcine hind limbs (sciatic nerve branches). The excess fat and connective tissue from the nerves were trimmed away and washed in phosphate buffered saline solution (PBS) (Sigma Aldrich) to remove any excess blood from the tissue. The nerves were then cut into 5 cm segments and placed longitudinally in tubes lined with PBS soaked filter paper and kept at −80° C. for storage.
The decellularisation process starts once the nerves were taken out of −80 storage and allowed to thaw. This physical process disrupts the cell membrane, burst cells and starts cell lysis. The thawed nerves were then placed in a freeze-drying polymer block (made out of an insulating polymer such as Ertalyte) and freeze dried longitudinally to create unidirectional pores.
The freeze-drying conditions consists of:
−30° C. (freezing stage)—1 hour
−10° C. (primary drying stage)—24 hours
20° C. (secondary drying stage)—5 hours
The unidirectionally freeze dried nerves were then subjected to chemical and enzymatic decellularisation process. All chemical processes and washing steps were carried out at 42° C. under fast agitation (40 rpm). Enzymatic processes were carried out at 37° C. under slow agitation (10 rpm) for two cycles, with each cycle lasting approximately 3 hours. The freeze dried nerves were first subjected to a chemical wash whereby the nerves were incubated in 4% Sodium Deoxycholate solution (Sigma) (pH 7.8-8.2) in distilled water for 24 hours and were then further incubated in 3% Triton X-100 solution (Fisher Scientific) (pH 7.2-7.6) in distilled water for 12-24 hours. The nerves were then washed three times in PBS (half an hour each time) and incubate overnight in PBS.
The nerves were then subjected to an enzymatic process whereby the nerves are incubated in a nuclease solution (50 mM tris buffer (Sigma), 1 mM MgCl2 (Fisher Scientific). 6H20, 1 U·mL-1 Benzonase (VWR); pH 7.5-7.7) made up in distilled water. The nerves were then washed three times in PBS (half an hour each time) and incubated overnight in PBS at 42° C. The nerves were then stored in 10 mM phosphate (Sigma) and 50 mM sodium (Sigma) solution in distilled water at 4° C. for short term storage (1-2 weeks).
Characterisation of Acellular Peripheral Nerve Grafts of the Invention
The acellular peripheral nerve sections were characterised by scanning electron microscopy (
Mechanical Evaluation of Native and Acellular Porcine Nerves
As indicated in Table 1 below, mechanical analysis revealed that the decellularisation process does not affect the mechanical properties of the nerves. The table reveals no significant changes in the UTS, strain or Young Modulus in when compared to their native nerve counterparts.
Unidirectional Freeze-Diving has Beneficial Effect on Enhancing VEGF Release Compared to Standard Freeze-Diving Protocol
Nerves were cut up into 1×1 cm segments, placed in 24 well plates and primed with 10% DMEM overnight. The media was then taken off and dorsal root ganglions (DRG's) were added on top on top. 1.5 mL of 10% media was added to each sample (enough to cover the samples but careful not wash away the DRG's) and transferred to the incubator. Media from each sample was taken every 2 days and stored in labelled test tubes in the −20 freezer. Samples were analysed using ELISA (enzyme linked immunosorbent assay).
Three experimental groups were evaluated
1. Unidirectionally freeze dried decelled nerves
2. Normal freeze dried decelled nerves
3. Decelled nerves
While lower than Decelled group, unidirectional freeze-drying has beneficial effect on enhancing VEGF release compared to standard freeze-drying protocol. This has implications on subsequent bioactivity.
Introduction of Chondroitin-6-Sulphate into Acellular Nerve Tissue
Unidirectional freeze dried acellular nerves are prepared as described above. The nerves are then incubated in a 50 μg/mL GAG solution made up to 50 mL in PBS overnight under slow agitation (10 rpm) at 37° C. Sulphated GAG content in acellular nerve tissue after the addition of chondroitin-6-sulphate is shown in
Sterilisation and Biocompatibility Assessment:
Decellularised nerve segments were sterilised using either peracetic acid, ethylene oxide or gamma irradiation. In vitro cell compatibility assays were performed with these sterilised decellularised nerve segments using fibroblasts and Schwann cells, with a collagen gel serving as a control [
Assessment of Biomechanical Tensile Properties:
Uniaxial tensile tests were performed using a Zwick tensile testing machine (Zwick Z005, Roell, Germany) [
In Vivo Rat Sciatic Nerve Defect Model:
Decellularised nerve segments were evaluated in vivo in a 15 mm sciatic nerve defect in adult Lewis rats, 294±19 g (Envigo, Blackthorn, United Kingdom), with inverted autografts serving as controls [
Functional Recovery Assessment:
Functional improvement in the operated limb was assessed every 2 weeks using a response to electrical stimulation (0.1 mA to 0.6 mA) [
Electrophysiology:
Compound nerve action potential (CNAP) and compound muscle action potential (CMAP) was determined (100,000 samples per second with a 10 kHZ lowpass filter and 25 mV gain) by stimulating the nerve using a concentric needle electrode (stimulus intensity of 1 mA) and recording with a second electrode in the distal end (CNAP) or midbelly of the gastrocnemius muscle (CMAP). Both CNAP and CMAP are expressed as a percentage of the non-operated contralateral limb recordings [
Wet Muscle Weight:
The tibialis anterior muscle was harvested after 8 weeks post-surgery, washed once in PBS solution, dabbed on blotting paper to remove excess liquid and weighed [
Histomorphometry and Immunofluorescence Staining:
Excised decellularised [
The foregoing description details presently preferred embodiments of the present invention. Numerous modifications and variations in practice thereof are expected to occur to those skilled in the art upon consideration of these descriptions. Those modifications and variations are intended to be encompassed within the claims appended hereto.
| Number | Date | Country | Kind |
|---|---|---|---|
| 19212601.9 | Nov 2019 | EP | regional |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/EP2020/083811 | 11/27/2020 | WO |
