Patent Application
20140081070
Embodiments of the present invention relate generally to the field of tissue repair and regeneration. More specifically embodiments of present disclosure relate to devices or constructs and methods to prepare various devices or constructs useful in directing cellular repair and controlling tissue regeneration to prevent or minimize postsurgical or post-traumatic adhesions, excessive scars and/or fibrotic reactions of injured tissues.
Adhesions form as a natural part of the body's healing process after surgery or trauma in a process similar to the way that a scar forms. The term “adhesion” is typically used when the scar extends from one tissue to another, linking the two. In response to injury and bleeding the body deposits fibrin onto injured tissues. The fibrin acts like a glue to seal the injury and is the initial glue that builds the fledgling adhesion, generally referred at this point to be “fibrinous.” In body cavities such as the peritoneal, pericardial and synovial cavities, a family of fibrinolytic enzymes may act to limit the extent of the fibrinous adhesion, and may even dissolve it. In many cases however, the production or activity of these enzymes are compromised because of injury, and the fibrinous adhesion persists. If this is allowed to happen, tissue repair cells such as macrophages, fibroblasts and blood vessel cells, penetrate into the fibrinous adhesion, and unguided by a proper matrix lay down collagen and other matrix substances to form a permanent fibrous adhesion.
While some adhesions do not cause problems, others can prevent tissues and organs from moving freely, sometimes causing organs to become twisted or pulled from their normal positions. The sequence of adhesion formation is believed to occur and has been reported as follows: tissue ischemia, inflammation, fibrin deposition, fibrin organization, collagen formation, and maturation with the formation of adhesions. Surgeons use several agents to reduce adhesion formation at each of these steps. Physical barriers, including both mechanical and viscous solutions, are widely used to prevent adhesion formation by limiting and guiding tissue apposition during the critical stages of mesothelial repair. However, at least 50% of patients still develop significant adhesions. Moreover, there is no satisfactory way to monitor non-invasively the formation of unwanted adhesions after application of these techniques to a patient. Thus, improvements and further developments are critically needed.
Purified collagen from animals or humans is widely used in various medical devices, in research, and in cosmetics. However, the materials prepared from soluble purified collagen lack the macrostructure and organization seen in tissues. For example, the collagen fibers in tendon are highly aligned for maximal tensile strength, but also have a kinked structure to allow some give to the tissue. In contrast, the collagen in the cornea is arranged as small parallel transparent fibers. The collagen in the skin is arranged in bundles, not parallel, which allows more expansion and flexibility than seen with tendon. Each structure has obvious advantages to the tissue it comprises. Each structure is unique.
Collagen prepared from both human and animal sources has been shown to be safe and of minimal immunogenicity when implanted into humans. Collagen has the advantages that it is biocompatible, can form structures with high tensile strength, that the tensile strength of the constructs can be increased by covalent cross-linking and that the construct is replaced by normal tissue by repair and regeneration.
Methods to deposit collagen molecules in defined structures including aligned, woven and transparent materials convertible into bandages, sutures and multilayered structures for diverse indications are described in U.S. patent application Ser. Nos. 11/951,324, 11/986,263, 12/106,214, and 12/539,563, all of which are incorporated by reference herein in their entirety. One advantage of these collagen materials is that they closely approximate the natural structures of tissues, are biocompatible and induce the guided growth of cells attaching to them. The collagen materials appear to be an excellent substrate for applying mesenchymal and other stem cells to precise tissue sites. While these advances have been made, there is significant need for continued advancement and development of devices, constructs, implants and methods that promote and/or enhance tissue repair and regeneration, particularly constructs that provide an anti-adhesion barrier.
Accordingly, some embodiments of the present disclosure provide medical devices, materials or constructs and methods that enhance and/or promote tissue repair and regeneration. In some aspects, embodiments of present disclosure relate to devices and methods to prepare various constructs from soluble collagen and other material, either alone or in combination, to direct cellular repair and control tissue regeneration to prevent postsurgical or post-traumatic adhesions, excessive scars and fibrotic reactions of injured tissues. Certain embodiments enable the constructs to be monitored in situ when implanted.
In one aspect, a method is provided comprising the steps of preparing a biopolymer based multilayer construct, covering and separating tissue using this construct and inducing repair and regeneration of a defect or injury. In some embodiments a material or construct is provided comprised of: a composition of at least one biocompatible polymer (also referred to as “biopolymer”) and one or more metal nanowires. A medical device is also described, comprising: at least one connected network of metal nanowires and at least one biocompatible polymer, and wherein the device exhibits electric conductivity in at least one direction across the device, and at least some of the network of metal nanowires are disposed in at least part of the biocompatible polymer. In some embodiments, the metal nanowires are at least partially aligned in at least one direction.
Each collagen rich tissue, i.e. cornea, tendon, skin and bone, has a unique arrangement of collagen fibers compatible with tissue requirements. The ability to duplicate these structures using purified collagen according to the present invention offers new opportunities to bridge damage, to deliver cells to specific sites and to incorporate factors into the materials which aid repair. Embodiments of the present invention provide novel constructs prepared from collagenous materials reconstituted from soluble collagen to prevent or minimize post surgical or post-traumatic adhesion, and to reduce scar formation and fibrotic reaction on the injured surface of a mammal tissue. Of significant advantage, the inventive constructs more closely replicate the structures of various normal tissue and influence non-scarring cell phenotype.
The foregoing and other aspects of embodiments of the present disclosure will be apparent upon consideration of the following detailed description, taken in conjunction with the accompanying drawings, in which like reference characters refer to like parts throughout, and in which:
It is to be understood that both the foregoing general description and the following description are exemplary and explanatory only and are not restrictive of the methods and devices described herein. In this application, the use of the singular includes the plural unless specifically state otherwise. Also, the use of “or” means “and/or” unless stated otherwise. Similarly, “comprise,” “comprises,” “comprising,” “include,” “includes,” “including,” “has,” “have,” and “having” are not intended to be limiting.
Example embodiments are described herein in the context of medical devices and biocompatible constructs, and methods of making. Those of ordinary skill in the art will realize that the following description is illustrative only and is not intended to be in any way limiting. Other embodiments will readily suggest themselves to such skilled persons having the benefit of this disclosure. Reference will now be made in detail to various implementations of the example embodiments as illustrated in the accompanying drawings. The same reference indicators will be used to the extent possible throughout the drawings and the following description to refer to the same or like items.
Various embodiments of the devices and constructs of the present invention are also sometimes referred to as scaffolds, collagen scaffolds, membranes, implants and/or bio-devices. The terms biocompatible polymer and biopolymer are sometimes used interchangeably. The terms layer(s) and membrane(s) are sometimes used interchangeably.
Embodiments of the present invention describe methods to produce medical devices, constructs or implants comprised of compatible polymers for implantation or applied to various tissues to provide an anti-adhesion barrier and thus enhance repair and regeneration, among other uses. In some embodiments the biopolymer constructs are comprised of at least one layer or membrane of oriented collagen. In some embodiments the biopolymer constructs are comprised of multiple layers or membranes of oriented collagen. Of particular advantage, the multiple layers can be constructed with selected orientation to provide desired properties.
In another aspect, biopolymer constructs are provided comprised of at least one collagen layer and having a conductive element formed therein. In some embodiments the conductive element is one or more metal nanowires. Of particular advantage the conductivity of such devices, materials or implants may be selectively controlled by inducing magnetic fields which can be detected and monitored.
As used herein the term “fibrillar nanoweave biopolymer membrane” or simply “nanoweave membrane” means a fibrillar biopolymer membrane or layer where the filling fibrils or fibril bundles pass under and over alternate warp fibrils or fibril bundles, and the typical fibrils or fibril bundles have a helical or crimp shape in the unloaded state. Examples of various fibrillar nanoweave collagen membranes are shown in
The diameter of fibrils can be of any suitable size. In some embodiments, the diameter of the fibrils are in a range of 20 nm to 500 nm, depending on the tissue requirement. Methods of making these highly organized fibrillar biopolymer membranes or layers are described in U.S. patent application Ser. Nos. 11/951,324, 11/986,263, 12/106,214, and 12/539,563, the disclosures of all of which are incorporated by reference herein in their entirety.
One aspect of the present disclosure relates to devices and methods for preventing post-surgical or post-traumatic adhesion between wounded tissue and adjacent tissues, thus reducing scar and adhesion formation. In one example a method is provided comprising the steps of covering the wounded tissue and separating the wounded tissue from other surrounding tissues with a biopolymer based multilayer construct which guides repair.
In some embodiments the biopolymer constructs are multi-layered. Multi-layered constructs may be made from fibrillar nanoweave biopolymer membranes or layers which may exhibit different structural characteristics, such structural characteristics being selected in order to promote regeneration in the wounded tissue and block further cell migration in the direction of surrounding tissues. For example, the construct may be formed by several cross-linked collagen layers configured such that in the vicinity of the wounded tissue one or more of the collagen layers have selected porosity and mechanical properties that promote repair and regeneration, while the outer collagen layers (or collagen layers remote from the wounded tissue) are designed to ensure the mechanical strength of the whole construct. Additionally, one or more of the outer collagen layers may exhibit selected properties that promote suturability of the construct, and/or provide a water-tight covering to prevent cell migration though the construct during the time required for the wound to repair and regenerate. Example of the nanoweave collagen layers with different porosity are illustrated in
In some embodiments a fibrillar nanoweave layer has uniaxial or unidirectional orientation of the fibrils (e.g., tendon-like or cornea-like membrane). In some cases a fibrillar nanoweave layer has biaxial orientation of the fibrils (e.g., basket-weave membrane) over all, or a portion of, the layer. Additionally, the fibrillar nanoweave layer can exhibit a skin-like multi domain fibril orientation over all, or a portion of, the layer.
Different forms or collagen may be used. In some embodiments, monomeric collagen is used. One example of monomeric collagen is monomeric collagen I with cleaved telopeptydes or atellocollagen which has extremely low immunogenicity.
It is understood that fibrillar nanoweave collagen layer may influence non-scarring cell phenotype via mechanotransduction.
Biopolymer constructs according to the present disclosure are preferably biocompatible, mechanically stable, elastic, drapable, and suturable. In some embodiments, the construct or portion of the construct include a porosity gradient to provide enhance healing in the wound area and to promote a temporary barrier against uncontrolled distribution of blood, fibrinogen, necrotic material and damaged tissues.
Referring to
Of particular advantage, the composition and/or structure of the various layers that comprise the construct may be specifically selected to provide certain desired properties and/or function. In one example, layers 101 are comprised of a porous membrane or layer similar to that shown in
Nanowires may be disposed within or on one of more of the layers in the construct. Suitable nanowires include, for example, metal nanowires, silver nanowires, piezoelectric nanowires, high density plastic nanowires, and combinations thereof.
In another embodiment the biopolymer construct comprises two multilayer sub-constructs wherein each sub-construct is configured with a different porosity gradient such that one sub-construct will degrade at a higher rate than the other sub-construct. Referring again to
Referring to
When the biopolymer construct contains a planar network of nanowires, in situ monitoring the location of the construct using non-invasive magnetic induction spectroscopy (MIS) or other means is enabled. MIS requires an alternating magnetic excitation field which is coupled from an excitation coil to the object under investigation as shown in
The presence of piezoelectric nanowires in the planar network of metal nanowires imbedded in a multilayer construct turns the multilayer construct into a smart device. The mechanical deformation caused by cell adhesion and migration excites electric current in the piezoelectric nanowires, which generate a magnetic field detected by receiving coil. In response, the excitation coil generates a magnetic field which causes an electric field in metal nanowires to release a suitable drug and/or stop cell proliferation.
Of significant advantage, in another embodiment deformation of the nanowire network under different mammal body positions may be used as an indication of post surgical or post-traumatic adhesion. The deformation can be measured, for example, by x-ray stereotactic device. Suitable nanowires in this embodiment are, for example, comprised of high density plastic nanowires or metal nanowires.
In one example of the present disclosure the construct preventing cell adhesion by the method according to the present disclosure can be applied to medical or veterinarian uses.
Methods disclosed herein of covering and separating tissue with a multilayer construct may be carried out during the treatment of any injuries or defects, for example, the dura mater covering the brain or the spinal column. In one example of the present disclosure, the step of covering and separating the tissue with a multilayer construct may be carried out during abdominal surgery.
A number of experiments were conducted as described below. These examples are shown for illustration purposes only and are not intended to limit the invention in any way.
Multiplayer constructs were prepared by the following method: liquid fibrillar biopolymer (e.g. purified medical grade collagen to substrate (glass or plastic, e.g. PET film)) was deposited to form a solid film (matrix) according to the procedure described in the patent applications: WO2010/019625A2, US2009/0069893A1, WO/2008/070166A1, WO/2008/063631A2. The typical film thickness is in the range from 1 μm to 10 μm.
The film was removed from the substrate in the direction of the collagen fibrils (deposition direction, see
The multiple collagen films were Cross-laminated as shown in
The resulting multilayer construct can be placed into dehydration unit (e.g., vacuum of at least 50 millitorr and temperature 90° C. for 72 hours).
The construct should be further sterilized (e.g. E-beam sterilization) and it is ready for use for biomedical applications.
In this experiment, multilayer constructs were prepared by depositing the liquid biopolymer (e.g. collagen) to substrate (glass or plastic, e.g. PET film) to form a solid film (matrix) according to the procedure described in the patent applications: WO2010/019625A2, US2009/0069893A1, WO/2008/070166A1, WO/2008/063631 A2. The typical film thickness is in the range from 1 μm to 10 μm.
The coated film is attached to a carrier (e.g., to a transparent flexible film with double-sided tape area at the film perimeter or a drum with vacuum/electrostatic holder) and removing the substrate as shown in
The multiple fibrillar films are transferred and laminated on a non-adhering substrate. The bonding material and additional materials including bioactive material can be sprayed or deposited between fibrillar layers (films), e.g. heparin, multi-arm activated PEG, metal or plastic nanowires can be deposited between layers.
The resulting multilayer construct can be placed into dehydration unit (e.g., vacuum of at least 50 millitorr and temperature 110° C. for 72 hours under pressure).
The construct should be further sterilized (e.g. E-beam sterilization).
In the two examples above the lamination process is conducted in a way to avoid wrinkles or bubbles. One modification of the above procedure (step 0053) includes a spray of microparticles (e.g. low molecular weight PEG particles of 40 micron diameter) together with cross-linking droplets, such that the PEG can be dissolved after the cross-linking of the multilayer construct (at the step 0054). The purpose of this modification is to modify the porosity at the interface between layers and to control the strength of adhesion between the layers.
In addition to being used as an anti-adhesion barrier during or after surgery, the multilayer construct/implant can be used as or with a tendon sheath or a dural barrier as shown in
Various laminated constructs can be made from the medical grade monomeric collagen solution by methods described above. The constructs may be formed of any number of layers. In one example, and without limitation, a construct with twelve cross-laminated layers is provided having six (6) layers with aligned fibrils in one direction and six (6) layers with aligned fibrils in an orthogonal direction. In one experiment such a twelve layer construct was formed and having weight of the sample in the dry state of 14 mg, size of 25×25×0.02 mm, and density of 1.12 mg/mm3. A sample with two cross-laminated layers was formed having weight is in the dry state of 2 mg, size of 25×25×0.0025 mm, and a density of 1.28 mg/mm3. Both samples are transparent in dry and wet state with transmittance at 630 nm more than 70% and about 90% respectively. The diffraction patterns of both samples were measured and are shown in
The typical collagen matrices on the market have low density and isotropic scattering/diffraction pattern. For example, typical dental collagen membrane has weight in the dry state—65 mg, size 20×30×0.1 mm, and density 1.08 mg/mm3.
A multilayer construct comprising a planar network of silver nanowires was prepared according to the procedure described in Example 1. An aqueous silver nanowire solution 2 wt % (SeaShell Technology, San Diego) was deposited between two laminated fibrillar collagen nanoweave membranes as shown in
Four types of multilayer collagen constructs are used in this experiment: constructs without additional treatment; constructs which have one side treated by activated PEG; constructs which have one side treated by heparin; and constructs which have one side treated by activated PEG and albumin such that albumin forms an external monolayer.
The goal of this experiment was to test the ease of handling of the multilayer constructs; and to test whether surface-modified multilayer constructs prevent formation of adhesions.
Experimental design: After induction of anesthesia, perform an adhesion induction by brushing the secum and peritoneal wall by a Perlon brush (tooth brush). In experimental animals, wrap the traumatized secum with multilayer collagen construct such that the treated surface of the construct faces peritoneal wall. In control animals, no wrapping is performed. Sacrifice in 12 days to check for adhesion formation.
Animals: Balb/c, female, DOB 4/26, 20 g; CD1, male, DOB 2/27, 40-42 g.
Experimental groups: A—control group (no wrap)—3 animals; B—collagen construct without treatment—3 animals; C—collagen construct treated by activated PEG—3 animals; D—collagen construct treated by heparin—3 animals; E—collagen construct treated by activated PEG and albumin—3 animals.
Anesthesia. Animals were anesthetized with isoflurane following 100 mg/kg ketamine and 5 mg/kg body weight xylazine.
Animal preparation. Animals were shaved on the abdominal side and the residual hair were removed with hair removal cream (diluted 1:1 w/H2O) application for 3 min. The site of the incision was disinfected with chlorhexidine gluconate.
Adhesion induction. Mice were placed in a supine position and the abdomen was exposed through a ventral midline incision. Standardized surgical injuries were applied to visceral and parietal peritoneum and the secum: a 1×1-cm area of the left sidewall peritoneum was brushed with a Perlon brush until punctuate bleeding occurred. The same trauma was applied to the secum. The animals were then randomized to their groups and treated accordingly. The collagen constructs were used to wrap the traumatized secum, so that it would form a barrier between the secum and the peritoneal wall. After traumatization, the abdomen was closed with Vetbond tissue adhesive. The skin was closed with easy-clips.
Post-surgery management. All animals were administered with antibiotic (cefazolin, 15 mg/kg, s.c., day 0 and 1) and analgetic (Buprenex (buprenorphine hydrochloride), 2 mg/kg, s.c., days 0 and 1).
The best results with minimum adhesion were observed for the group E; the worst results with multiple adhesions were occurred in the group D. In all groups the multilayer constructs have shown excellent drapability and good mechanical strength.
Cells can be analyzed in a variety of models, such as in a blood vessel model, or cornea model, and the like (see, e.g.,
Embodiments of the present disclosure provide in-vitro modeling. Advantages of the present invention include: an option to use high transparency membrane; control the tension on the frame; control of rigidity and/or the structure of the nanoweave membrane. Referring again to
Additional application for the multilayer constructs include, without limitation: cell culture research applications, cell/drug delivery applications, and other tissue engineering applications.
In vitro assays using multilayer constructs of the present disclosure include, without limitation: stem cell attachment, proliferation on collagens 1, 4 or laminin, or fibronectin; factors inducing stem cell proliferation; quantitative stem cell migration assays/required factors; neurite formation in cells derived from neural stem cells; myoblast/cardiomyocyte differentiation and function; tubule formation by kidney derived and other cells; differentiation of IPS cells along epithelial or neuronal lines; co-culture of islets with stem cells.
In vivo assays using multilayer constructs of the present disclosure include, without limitation: multilayer constructs for stem cell/islet transplantation; sheets for transplantation of bioluminescent cells to certain sites for tracking their migration and survival; sheets for transplantation of tumor cells in vivo to specific sites; transparent constructs to facilitate imaging of implanted stem cells; device for growing stem cells in culture and transferring them to specific tissue sites; implantable biocompatible collagen/silver nanowire constructs to enhance the proliferation, differentiation and vascularization of implanted stem cells using PEMF signals.
Tissue damage to heart, striated muscle, skin, bone and cartilage, tendon and ligament, spinal cord and the like often progresses and causes the breakdown of normal surrounding tissue increasing the area of damage and seriously impairing tissue function. Current concepts suggest that various factors or cells could be introduced into the damaged area by direct injection and prevent further damage and even cause regeneration of the damaged area. Indeed, preclinical as well as clinical trials have shown improved heart function when mesenchymal stem cells are injected into the site of tissue damage. However, such studies have also shown that significant amounts of the injected cells leak out of the tissue and most of the cells remaining rapidly die. Thus there are uses for devices which allow delivery of various types of cells to specific sites in damaged tissue and maintain their survival and expansion. However, the physical properties of different tissues vary strikingly (compare heart muscle with striated muscle with skin or spinal cord). Thus, delivery vehicles should have sufficient strength to allow them to be placed in a specific tissue without causing alterations in tissue function due to poorly matched physical factors. This calls for materials whose physical properties are suitable for the tissue in which they are to be used. Also, cells require factors and surfaces to support their survival, migration and production of specific repair factors. In brief, the treatment of damaged tissues should be improved by novel devices which would deliver and maintain stem and other cells in specific sites to allow them to survive and produce factors that sustain tissue at risk.
Multilayer constructs of the present disclosure provide cell guiding and can be used for repair and regeneration of periodontal ligament. Top layer of the construct may have the fibril orientation which blocks a migration of gingival epithelial cells to the tooth. The bottom layer has the collagen fibrils orientation which promotes repair and regeneration of the periodontal ligament (vertical fibrils). Collagen-based construct can be used effectively for a wound treatment. They can be supplemented with small molecules, peptides, PRP (platelet reach plasma), stem cells, vanadate, etc. These examples are not limiting the applications of the above constructs.
The foregoing methods, materials, constructs and description are intended to be illustrative. In view of the teachings provided herein, other approaches will be evident to those of skill in the relevant art, and such approaches are intended to fall within the scope of the present invention.
| Number | Date | Country | Kind |
|---|---|---|---|
| 61403006 | Sep 2010 | US | national |
This patent application claims the benefit of, and priority to, U.S. Provisional Patent application Ser. No. 61/403,006 filed on Sep. 10, 2010, the entire disclosure of which is hereby incorporated by reference.
| Filing Document | Filing Date | Country | Kind | 371c Date |
|---|---|---|---|---|
| PCT/US11/51135 | 9/10/2011 | WO | 00 | 8/30/2013 |
