Patent Application
20050214345
The present invention relates generally to the field of treatment of eye disorders. More particularly, the present invention relates to implants for retinal disorders such as age-related macular degeneration.
Diseases of the retina, such as age-related macular degeneration (AMD) are the leading cause of severe visual impairment or blindness in elderly patients in the industrialized world. Although the exact pathogenesis of AMD is unknown, one important factor involves the death of retinal pigment epithelial (RPE) cells at the posterior of the eye, underneath the retina in the sub-retinal space. The RPE basement membrane (Bruch's membrane) is also damaged in AMD by mechanisms that include oxidative damage, and allows for new blood vessel growth. Death of the photoreceptor cells, and eventual blindness, follows death of the RPE cells.
One theory suggests that replacement of dying RPE cells in the sub-retinal space may rescue or restore function(s) to the photoreceptor cells. First attempts at RPE cell transplantation involved injecting a suspension of RPE cells into a patient's sub-retinal space. This approach was supplanted by transplant of intact sheets of RPE cells. Each of these techniques was plagued with problems arising from disorientation of the transplanted cells, inability of these cells to spontaneously form an organized monolayer, ineffectiveness to perform phenotypic functions of native RPE cells, and from continuing destruction of the Bruch's membrane in the AMD process. It has been suggested that transplanted RPE cells also perform poorly in the pathological sub-retinal space because such cells attach poorly to a damaged Bruch's membrane of eyes affected by AMD. Transplantation of cell suspensions, or even of patches or confluent sheets of such cells, may therefore be ineffective for AMD treatment.
Another possible approach is to grow RPE, iris pigment epithelium (IPE), and/or stem cells on a suitable support material and to transplant both the cells and the support material into the sub-retinal space. Several groups have studied different materials, such as anterior lens capsule and Descemet's membrane, for transplantation of RPE cells and IPE cells into the sub-retinal space. These attempts have been unsuccessful because of the handling properties of the support materials used by these experimenters. Although cells have been grown on lens capsule, it is difficult to implant lens capsule into the sub-retinal space, due to its tendency to curl on itself, especially in an aqueous environment like the eye. It is an even greater challenge to maintain lens capsule material flat when the material is implanted into the sub-retinal space. Furthermore, the growth properties and related characteristics of pigment epithelial cells are greatly influenced by the surface properties of a support material on which the cells might grow.
Accordingly, there is need in the art for new types of implants and methods for the treatment of retinal diseases such as AMD. It would be desirable to have an implantable support material that (i) is biocompatible, (ii) will serve as a growing surface for selected biological substances, (iii) has a controllable range of porosity, and/or (iv) will not spontaneously roll up, form creases or tear during surgery and once implanted into the subretinal space.
The present invention provides a retinal implant with an artificial biocompatible support material for RPE, IPE and/or stem cells that can take on the function of RPE. The surface topology of the support material of the retinal implant is characterized by being rough, which promotes cell adhesion, having surface pits to allow pigment cells to grow into, and having pores to allow for proper diffusion of nutrients, waste, oxygen, and carbon dioxide. In general, the support material could be any type of artificial biocompatible material having such characteristics. An example of such a material is for instance an unmodified dialysis membrane of about a 100 kD molecular weight cutoff (MWCO). The characteristics could also, for instance, be etched-into the support material for instance by using an 193 nm excimer laser. Examples of suitable materials are, for instance, but not limited to, cellulose, cellulose acetate or any derivative thereof, cellulose acetate ester dialysis membrane, silicon, polyester or any synthetic polymer provided that it has the physical characteristics as described herein. An additional characteristic for the support material is that it is relatively rigid and remains flat in an aqueous environment, but can be made flexible enough to conform to the inner retina or any other space that hosts the implant. The material is preferably non-soluble when present in a subretinal space and would therewith remain as a support of the cells.
In one aspect the support material is about 1 micron to about 150 microns thick. In another embodiment the thickness is up to about 100 microns. The material has pores sized to allow diffusion of nutrients, waste, oxygen and carbon dioxide, and has surface pits about 0.05 microns to about 1 micron in diameter to allow cells to grow into it. These surface pits could meander up to about 5 microns from the surface into the support material, typically on the order of 2-3 microns, however they could also be completely through the thickness of the support material. For a retinal implant in the foveal region the implant could be a single sheet of material with an area of about, but not limited to, 9 mm2. However, the present invention is not limited to such an area and could be small or larger depending on the area/space that requires restoration or repair.
The cells are grown on the support material either in situ or in vivo and will typically and preferably arrange themselves on the surface in a monolayer. In another aspect, the cells could be arranged in a pattern on the surface of the support material. Such a pattern could be established by means of microcontact printing, means of soaking or means of coating of inhibitory molecules, adhesive molecules or inhibitory molecules and adhesive molecules. Examples of patterns are triangles, quadrilaterals, pentagons, hexagons, n-sided polygons with n at least equal to 7, circles and ovals.
In one example the method of implanting the retinal implant, i.e. the pigment cell-enriched support material, could be surgically transplanted into a selected region in the sub-retinal space by insertion through an aperture created in the selected region using a sharp instrument (e.g. a knife) after the selected region of the retina has been elevated through an injection of a physiologically appropriate solution such as a balanced salt solution. After the insertion the selection region could be flattened out through the use of a heavy fluid like perfluro-carbon and/or the use of air-fluid exchange.
The advantages of the present invention are that the support material of the present invention will allow for improved precision during surgical handing and will remain relatively flat against the choroid when the combination of support material and RPE, IPE, and/or stem cells are transplanted into the sub-retinal space. The support material of the present invention will serve simultaneously as a cell growth substrate and as a “patch” for damaged Bruch's membrane to prevent the growth of unwanted blood vessels into the retina. Another advantage is that the growth and support of cells could be accomplished without a surface modifier such as collagen or the like.
The present invention together with its objectives and advantages will be understood by reading the previous summary and following description in conjunction with the drawings, in which:
The present invention provides an implant to rescue or restore diseased photoreceptor cells, using transplantation of RPE, IPE, and/or stem cells adhered on an artificial biocompatible support material to the sub-retinal space of the eye. The artificial biocompatible support material serves both as a transplant/support material and as a basement membrane (Bruch's membrane) patch. Even though the following detailed description refers to a dialysis membrane as the artificial biocompatible support material, the present invention is not limited to the dialysis membrane as described supra in the summary and description of the figures. Furthermore, the cells or stem cells used for this invention could be of human or animal origin as well as possibly Xenobiotic organ, tissue and cell transplants.
Cell Culture
Human RPE cells for transplantation were maintained in D-MEM/F-12 solution, supplemented with 10 percent fetal bovine serum at T=37 degrees Celsius with 6.5 percent carbon dioxide. The cells were removed from 100 mm tissue culture dishes with 0.05 percent trypsin-EDTA and were cultured at a 1:10 ratio. A concentration of 106 cells/L was cultured onto sterilized dialysis membrane.
Animal IPE cells were harvested and isolated from New Zealand Red or hybrid rabbits, using an enzyme-assisted microdissection procedure modified from that which is described by Hu and McCormick, in Archives of Ophthalmology, Vol 115 (1997) pp. 89-94. The primary culture was maintained in F-12 nutrient mixture (HAM) with L-glutamine supplemented with 20 percent fetal bovine serum and 50 μg/mL gentamycin. The maintenance media was exchanged every three days.
Surgical Technique
A dialysis membrane was implanted into the sub-retinal space of New Zealand Red and hybrid rabbits, each weighing 2.5-3.5 kg. The rabbits were anesthetized with ketamine (40 mg/kg) and Xylazine (5 mg/kg), administered through intramuscular injection. One dose of Tropicamide (0.5 percent) eye drops and Phenylephrine (2.5 percent) eye drops were instilled into the conjunctival sac of the left eye. A standard three-port pars plana vitrectomy was performed, and a retinal bleb was inflated in the macular area by injection of approximately 0.5 mL of balanced salt solution (BSS) through a 41-gauge needle. A 1 mm retinotomy was created using a MVR blade, and the dialysis membrane was inserted into the sub-retinal space through the aperture. Perfluro-carbon heavy fluid was used to flatten the retina followed by a perfluro-carbon silicone oil exchange. The care of animals conformed to the ARVO Statement of the Use of Animals in Ophthalmic and Vision Research, and the Administrative Panel on Laboratory Animal Care at Stanford University approved the protocol (No. 6597) employed.
Histology
Rabbit eyes were enucleated one, two, and four weeks after implantation. The eyes were fixed in 1.25 percent gluteraldehyde/l percent paraformaldehyde in cacodylate buffer (pH=7.4). After fixation, the eyes were cut open, fixed, post-fixed in osmium tetroxide, dehydrated with a graded series of EtOH, and embedded in epoxy resin. Sections of 1 micron thickness were stained with toluidine blue for improved contrast.
Dialysis Membrane Patterning
A pattern (or array) for RPE, IPE, and/or stem cell growth can be defined. The pattern could be established by means of microcontact printing, means of soaking or means of coating of inhibitory molecules, adhesive molecules or inhibitory molecules and adhesive molecules. Such techniques are common and known in the art, however the present invention is not limited to these techniques since other or newly developed patterning techniques could also be used. Examples of different possible patterns are triangles, quadrilaterals, pentagons, hexagons, n-sided polygons with n at least equal to 7, circles and ovals.
In a specific example, a cell growth inhibitor, such as polyvinyl acid (PVA), can be stamped onto the surface of the dialysis membrane using the technique of microcontact printing (soft lithography) to influence the surface growth properties of the cells. Thus, the cultured RPE, IPE, and/or stem cells may more closely resemble the morphology of RPE in vivo. Poly(dimethylsiloxane) (PDMS) stamps can be prepared as described by Whitesides G M, Ostuni E, Takayama S, Jiang X, and Ingber D E, Annu Rev Biomed Eng., Vol 3, (2001), pp. 335-373. Briefly, a chrome mask with the desired microscale pattern was fabricated at the Stanford Nanofabrication Facility. The mask was used to pattern a 7 μm layer of SPR-220 photoresist (Shipley, Marlborough, Mass.) on a silicon wafer. PDMS (Sylgard 184; Dow Corning Corporation, Midland, Mich.) in a 10:1 mixture of elastomer to curing agent was then poured onto the patterned silicon wafer and cured at 90° C. After one hour, the PDMS stamp was removed from the patterned silicon wafer to reveal the desired microscale pattern. PDMS stamps (1 cm2) were placed in a plasma cleaner/sterilizer (PDC-32G; Harrick Scientific Corporation, Ossining, N.Y.) for 1 minute at 100 W to obtain a hydrophilic surface. Stamps were sterilized by immersion in 70% ethanol for 1 minute and dried with nitrogen. To stamp a surface, the PDMS stamp can be placed carefully onto a thin layer of either 5% mucilage (Elmer's Products Incorporated, Columbus, Ohio) in distilled water or 2% polyvinyl alcohol (PVA) in distilled water. In both cases, the solution is supplemented with 0.1 mg/mL of fluorescein for imaging. Immediately after contact, the PDMS stamp is removed from the thin layer of solution and placed in contact with the surface to “wet transfer” the solution. A 40-g weight is placed on top of the stamp for 30 minutes after which the microprinted surface is ready for cell culture.
The present invention has now been described in accordance with several exemplary embodiments, which are intended to be illustrative in all aspects, rather than restrictive. Thus, the present invention is capable of many variations in detailed implementation, which may be derived from the description contained herein by a person of ordinary skill in the art. All such variations and other variations are considered to be within the scope and spirit of the present invention as defined by the following claims and their legal equivalents.
This application is cross-referenced to and claims priority and the benefit from U.S. Provisional Application 60/546,392 filed Feb. 20, 2004, which is hereby incorporated by reference.
| Number | Date | Country | |
|---|---|---|---|
| 60546392 | Feb 2004 | US |
