Patent Grant
9801976
Embodiments of the present invention are directed in general to the field of wound treatments, and in particular to flowable human tissue compositions, and methods of their use and manufacture.
Human tissue compositions, which may be derived from cadaveric donors, have been used for many years in various surgical procedures, including treatments for abrasions, lacerations, burns, and other wounds. Although human tissue compositions and methods are presently available and provide real benefits to patients in need thereof, many advances may still be made to provide improved dressing systems and methods for treating patients. The flowable matrix compositions and treatment and manufacture methods described herein provide further solutions and answers to these outstanding needs.
Embodiments of the present invention provide flowable matrix compositions and methods suitable for use in advanced wound management, including acute and chronic wound treatment, general surgery, plastic and reconstructive surgery, uro-gynecological surgery, and numerous surgical procedures where an irregular tissue defect repair may be beneficial.
An exemplary flowable matrix composition can be produced from a soft tissue, such as an allograft human dermis which has been recovered from a tissue donor. The tissue can be aseptically processed to remove cells, while preserving natural biologic components and structural features of the tissue. The soft tissue can be further processed to yield a putty-like, pliable, matrix. The flowable matrix can be supplied for surgical use as a sterile product. In some cases, the flowable matrix can be loaded in an applicator, such as a syringe. An applicator or syringe can be of any size or volume. For example, a 6 c.c. syringe may be used. In use, a surgeon or other medical personnel may deliver the flowable matrix to an irregularly shaped wound site of a patient. In some cases, a decellularized or partially decellularized matrix may be used for the repair or replacement of damaged or inadequate integumentary tissue. In some instances, the soft tissue matrix is prepared from a tissue containing an amount of water or hydration. In some cases, water may be added to the matrix during processing. In some cases, the preparation may be processed without the incorporation of additional water. In some cases, the matrix can be processed without removing water therefrom. In some instances, the soft tissue matrix composition is at least partially hydrated when packaged. The surgeon or medical professional may use the matrix composition directly upon opening the packaged product, without performing additional mixing or rehydration steps.
Flowable matrix embodiments of the present invention are well suited for a variety of therapeutic applications, including wound care and burn case. Exemplary wound care applications may involve treatment of chronic wounds, tunneling, channel, or invaginated wounds, wounds presenting a deep and irregular wound bed, and the like. The flowable, putty-like, compliant properties of the matrix render it particularly suitable for such indications. The flowable matrix or scaffold can be placed into the tunnels and tracts of chronic non-healing wounds which include, but are not limited to, venous leg ulcers and diabetic foot ulcers, acute wounds which include drained abscesses, and cysts. In some cases, the flowable matrix can be administered to a patient via a delivery cannula. In some cases, the flowable matrix can be delivered or syringed percutaneously through a large gauge needle to the patient. In some cases, the flowable matrix can be administered to a patient as part of a surgical procedure for treating a rotator cuff injury or tear.
In one aspect, embodiments of the present invention encompass methods for producing a soft tissue matrix composition for use in a patient treatment. Exemplary production methods may include obtaining a portion of soft tissue material, and processing the portion of soft tissue material according to a protocol which comprises cryofracturing the portion of soft tissue material. The processing protocol may provide the soft tissue matrix composition. In some instances, the soft tissue material is acellular. In some instances, the soft tissue material is at least partially decellularized. In some instances, the soft tissue material is not partially or completely decellularized. According to some embodiments, a processing protocol may include triturating the cryofractured soft tissue material. For example, a triturating step may include milling a cryofractured portion of soft tissue material. In some cases, a processing protocol may include adding a wetting agent to the triturated soft tissue material. In some cases, the wetting agent may include a saline solution. In some cases, the soft tissue matrix composition may have a putty consistency. In some cases, the portion of soft tissue material is in a naturally hydrated state prior to processing according to the protocol. In some cases, the portion of soft tissue material is in a partially hydrated state prior to processing according to the protocol. In some cases, the soft tissue material is non-immunogenic or has reduced immunogenicity. In some cases, the soft tissue material is reduced in cytotoxicity. In some cases, the soft tissue material includes epidermal tissue, a dermal tissue, a placental derived tissue, an amnion tissue, a chorionic tissue, a tendon tissue, an umbilical cord tissue, an intestine tissue, or a musculoskeletal non-osseous tissue. In some cases, the soft tissue material includes human soft tissue, an equine soft tissue, a bovine soft tissue, a porcine soft tissue, an ovine soft tissue, a caprine soft tissue, or an avian soft tissue. In some cases, the soft tissue material includes a human dermal tissue. In some cases, the cryofracturing step includes treating the portion of soft tissue material with liquid nitrogen. In some cases, the cryofracturing step includes treating the soft tissue material with liquid nitrogen for a period of about less than one hour. In some cases, the cryofracturing step includes treating the soft tissue material with liquid nitrogen for a period within a range from about 10 second to about 1 minute. In some cases, the cryofracturing step renders the portion of soft tissue material stiff and friable. According to some embodiments, methods may include combining the soft tissue material matrix composition with a biocompatible carrier, a thickener, an adhesive, or any mixture, combination, or sub-combination thereof. Some methods may include loading the soft tissue material matrix composition into an applicator assembly. According to some embodiments, an applicator assembly may include a syringe mechanism or a cannula mechanism. In some cases, the cryofracturing partially disrupts extracellular matrix tissue macro architecture within the soft tissue material. In some cases, the cryofracturing step partially disrupts extracellular matrix tissue macro architecture within the soft tissue material, and the triturating step further disrupts extracellular matrix tissue macro architecture within the soft tissue material. In some cases, the soft tissue material includes a delaminated dermal tissue. In some cases, the soft tissue material includes a non-delaminated dermal tissue. In some cases, methods may include combining the soft tissue matrix composition with a stromal volume fraction, a progenitor cell population, or a stem cell population.
In another aspect, embodiments of the present invention encompass methods for producing a soft tissue matrix composition for use in a patient treatment. Exemplary methods may include obtaining a portion of soft tissue material, and partially homogenizing the portion of soft tissue material so as to produce the soft tissue matrix composition.
In another aspect, embodiments of the present invention encompass soft tissue matrix compositions for use in a patient treatment. Exemplary compositions may include a soft tissue material having a mechanically disrupted macrostructure and a partially disrupted collagen microfibrillar architecture. In some cases, a soft tissue matrix composition may include a wetting agent. In some cases, the wetting agent may include a saline solution. In some cases, the composition is present in an applicator assembly. In some cases, the soft tissue material is acellular. In some cases, the soft tissue material is at least partially decellularized. In some cases, the soft tissue material is not partially or completely decellularized. In some cases, the soft tissue matrix composition does not adhere to a surgical glove material. In some cases, the surgical glove material comprises a member selected from the group consisting of latex, neoprene, vinyl, and Nitrile. In some cases, a matrix composition may also include a stromal volume fraction, a progenitor cell population, or a stem cell population.
In still a further aspect, embodiments of the present invention encompass methods for treating a soft tissue of a patient. Exemplary methods may include obtaining a soft tissue matrix composition, and administering the soft tissue matrix to the soft tissue of the patient. In some cases, the soft tissue material is acellular. In some cases, the soft tissue comprises a defect. In some cases, the soft tissue defect is a skin void, and an administering step includes at least partially filling the skin void with the soft tissue matrix composition. In some cases, an administering step includes delivering the soft tissue matrix with an applicator assembly to the soft tissue, and the applicator assembly includes a cannula mechanism or a syringe mechanism. In some cases, an administering step includes manually delivering the soft tissue matrix with a gloved hand. In some cases, the soft tissue defect is a skin void, a channel wound, an ulcer, a surgical wound, a trauma wound, a chronic wound, an acute wound, or an exsanguinating site. In some cases, the soft tissue defect is an ulcer wound such as a pressure ulcer, a venous ulcer, a diabetic ulcer, or a chronic vascular ulcer. In some cases, the soft tissue defect is a surgical wound such as a general surgery wound, a plastic surgery wound, a reconstructive surgery wound, a urological surgery wound, or a gynecological surgery wound. In some cases, methods may also include at least partially covering the matrix, the tissue, or both, with a wound dressing. In some cases, methods may also include forming the soft tissue matrix composition into a shape suitable for placement at or within the soft tissue. In some cases, the soft tissue defect is an exsanguinating site, and administration of the soft tissue matrix activates a hemostatic cascade at the exsanguinating site. In some cases, the soft tissue matrix composition also includes a stromal volume fraction, a progenitor cell population, or a stem cell population.
The above described and many other features and attendant advantages of embodiments of the present invention will become apparent and further understood by reference to the following detailed description when considered in conjunction with the accompanying drawings.
Embodiments of the present invention encompass flowable matrix compositions and methods. Exemplary compositions may include a flowable, putty-like form of acellular human dermal matrix that can be delivered from a syringe. In some cases, compositions may include a moldable acellular collagen extracellular matrix. In use, the matrix compositions can be used to fill or treat skin voids, channel wounds, and other soft tissue deficiencies.
Material composition embodiments of the invention may include an acellular human dermal matrix (e.g. a collagenous matrix derived from full-thickness or partial-thickness human skin that has been subjected to a gentle decellularization process) and a moistening solution such as normal saline, phosphate buffered saline, Lacted Ringers solution, or a similar physiological compatible moistening solution. In some cases, the material may include only the dermal matrix and the moistening solution.
According to some embodiments, a composition may include any suitable biocompatible extracellular matrix material derived from humans, animals, sources such as allograft material (human derived tissue), placental material, xenograft material including bovine, ovine, caprine, porcine, equine, avian, or other animal sourced tissue. In addition to these materials, matrix compositions may include any collagenous material capable of being delivered through a cannula. In addition to human tissue allograft compositions for transplantation, other materials as noted herein can be used, for transplantation and other therapeutic purposes.
Flowable matrix compositions, such as a human collagenous matrix, can be used in the surgical fields, for example where it may be desirable to fill or treat an acute incisional defect or chronic wound with the matrix for the purpose of allowing cellular infiltration and angiogenesis to occur in order to affect a post-surgical healing response. In some cases, a primary medical indications for use may include the management of wounds or conditions, including without limitation partial and full-thickness wounds, pressure ulcers, venous ulcers, diabetic ulcers, chronic vascular ulcers, tunneled/undermined wounds, surgical wounds, donor sites/grafts, post-Mohs surgery, post laser surgery, podiatric, wound dehiscence, and trauma wounds such as abrasions, lacerations, second-degree burns, and skin tears. In some embodiments, a matrix composition may be intended for a one-time use.
Relatedly, flowable matrix compositions may be use in the therapeutic intervention of chronic and acute wounds. In some cases, matrix compositions may permit or facilitate the in situ delivery of a hemostatic material to an exsanguinating site. In some cases, a flowable matrix composition may provide a vehicle for the delivery of collagen, as a hemostatic material, to hard to reach bleeding sites. The collagen can operate to activate the hemostatic cascade by the mechanism of platelet aggregation. Subsequent to platelet adhesion and aggregation initiated by collagen, the hemostatic effect of fibrinogen being activated to form a fibrin clot ensues thereby forming a clot and diminishing or stopping the flow of blood from the injured site.
In clinical applications, matrix compositions can be used for soft tissue integumental repair. For example, a putty-like, moldable acellular dermal matrix can be delivered through a cannula or other syringe attachment to a treatment site. In some cases, matrix compositions can be used to deliver a hemostatic material (e.g. collagen) to a bleeding site. Matrix compositions can be used to treat channeling wounds, deep full-thickness integumental defects, and other wounds or conditions where a putty-like, moldable matrix is suitable for application. In some case, matrix compositions provide a beneficial therapeutic use for achieving hemostasis at a bleeding site.
Embodiments of the present invention encompass matrix compositions which can be molded or otherwise handled by a gloved hand without sticking to the glove. Relatedly, exemplary matrix compositions can be used without sticking to operative instruments which may come into contact with the matrix. Hence, matrix compositions can be easily applied with a gloved hand without sticking to the gloves or other surfaces.
According to some embodiments, matrix compositions can be applied to a soft tissue defect such as a channeling wound in similar fashion to a “putty-like” material wherein a medical practitioner may mold a portion of the matrix composition into an irregularly shaped soft tissue void with a gloved finger. In some cases, a syringe equipped with a standard medical cannula of appropriate length can be used to deliver the matrix composition to a treatment site. Relatedly, in some cases a matrix composition can be supplied in pre-loaded syringe assembly. Optionally, a surgeon or practitioner may use the syringe and cannula as a directed delivery device whereby the matrix composition is delivered to an irregular or channel wound site or other soft tissue defect.
Matrix compositions can be applied to a patient or individual so as to fill irregular wounds or soft tissue defects in a complete fashion, which may otherwise be difficult to treat with rigid flat or rectangular devices. By providing a flowable material which completely contacts a wound bed, improvement in healing can be realized. Such enhanced or complete contact with the wound bed promotes proper revascularization, angiogenesis, and wound healing. Matrix compositions are particularly well suited for use in treating an irregularly shaped wound bed, due to the enhanced contact between the matrix and the wound.
According to some embodiments, a full-thickness human skin can be treated to remove the epidermal layer, and optionally further treated to at least partially remove the cellular contents and nucleic detritus. The resultant human dermal matrix, optionally in acellular form or at least partially in acellular form, can then be treated by a cryofracturing technique to render it stiff and friable. The friable matrix can then be triturated, for example by milling. The resultant composition matrix material can provide a putty-like consistency, optionally upon thawing. In some cases, the matrix composition is not in a powder form, and hence is not as susceptible to the build up of static electrical charges. According to some embodiments, the soft tissue matrix composition is provided to the surgeon or administered to the patient in a native form, without the presence of other materials or additives.
In some cases, a matrix composition, such as a flowable collagenous matrix material, may include various biocompatible carriers, thickeners, or adhesives, including but not limited to carboxymethylcellulose, poloxymer, and fibrin sealant. Likewise, the friable matrix can be triturated by any of a variety of triturative methodologies, such as partial homogenization of a non-cryotreated acellular matrix and variations thereof. Such triturations can be performed so as to provide particular matrix particle sizes, in some instances.
Turning now to the drawings,
In some cases, an exemplary flowable matrix preparation may be deliverable or flowable through an 18 g needle (1.27 mm; 0.050 inches) but not a 26 g needle (0.4636 mm; 0.01825 inches).
According to some embodiments, the portion of soft tissue material may be in a naturally hydrated state prior to processing according to the protocol of step 120. In some instances, the portion of soft tissue material may be in a partially hydrated state prior to processing according to the protocol of step 120. In some instances, the processing protocol of step 120 may include triturating a cryofractured soft tissue material. Trituration may be accomplished by blending or milling techniques, for example. In some instances, a blender, mill, or other trituration process may be selected or performed so as to provide matrix particles of various sizes. Relatedly, different administration techniques may involve the delivery of different particle sizes. For example, the particle size of the of the matrix can be increased or decreased to allow the product to be delivered through a cannula (e.g. larger particles) or through a needle (e.g. smaller particles), respectively.
According to some embodiments, the matrix composition presents a consistency or degree of flowability, such that it can be easily dispensed or extruded through syringe opening (e.g 3 mm orifice) or a catheter or tube (e.g. inner diameter less than 4 mm) upon application of a standard amount of syringe pressure which may be applied manually in the surgical setting.
In some cases, the soft tissue material or matrix composition is non-immunogenic, or has reduced immunogenicity in comparison to a tissue material which has not been processed according to embodiments described herein. For example, the material or composition may elicit no immune response, or a limited immune response, when introduced into a patient. In some cases, the soft tissue material or matrix composition is non-cytotoxic, or has reduced cytotoxicity in comparison with a tissue material which has not been processed according to embodiments described herein. Techniques for the decellularization processes may entail the use of detergents, surfactants, acids, bases, salts, and other chemical entities which result in the presence of detectable residual chemicals in the acellular tissue matrix. According to some embodiments, it may be desirable to sufficiently remove these residuals, which may otherwise in some cases exhibit a cytotoxic response if they still remain in certain amounts following decellularization. In this way, removal of the residuals can reduce the possibility of a cytotoxic response. In some cases, such cytotoxicity may prevent, stop, or otherwise inhibit successful incorporation of the matrix into the implanted host. Therefore it may be desirable to remove as much of any residual decellularizing process chemicals as possible. According to some embodiments, the trituration or comminution of the tissue followed by successive washing steps can maximize the surface area of the tissue particles that are exposed to the washing solution, thereby significantly reducing the presence of any potential residual process chemicals. This significant reduction of residuals will minimize or prevent a potentially cytotoxic response of the final matrix product. Such washing agents may include any of the several solvents that are miscible with a hydrated medium and may exhibit hydrophobic or hydrophilic solvation characteristics depending upon the decellularization agent used and may be exemplified by sterile water, sterile physiological saline, sterile phosphate buffered saline, or any number of mixtures of these with organic solvents such as 1-propanol, 2-propanol, acetone, methanol or similar minimally polar solvents.
Soft tissue material, such as the material obtained in step 110, may include an epidermal tissue, a dermal tissue (e.g. full-thickness or partial-thickness), a placental derived tissue, an amnion tissue, a chorionic tissue, a tendon tissue, an umbilical cord tissue, an intestine tissue, a musculoskeletal non-osseous tissue, or the like. In some cases, soft tissue material may include a human soft tissue, an equine soft tissue, a bovine soft tissue, a porcine soft tissue, an ovine soft tissue, a caprine soft tissue, an avian soft tissue, or the like. According to exemplary embodiments, the soft tissue material includes a human dermal tissue. For example, the soft tissue material may include full-thickness or partial-thickness human skin. In some cases, soft tissue material may include a cartilage tissue or a muscle tissue.
The processing protocol illustrated in step 120 may include subjecting the tissue material to a cryofracturing technique. For example, step 120 may include treating the portion of soft tissue material with liquid nitrogen. In some cases, a cryofracturing step may include treating the soft tissue material with liquid nitrogen for a period of about less than one hour. In some cases, the cryofracturing step may include treating the soft tissue material with liquid nitrogen for a period within a range from about 10 second to about 1 minute. According to exemplary embodiments, the cryofracturing step may render the portion of soft tissue material stiff and friable. For example, cryofracturing processes, which may include immersion in liquid nitrogen that applied to a soft tissue material can render it suitably friable for subsequent trituration. A soft tissue material matrix composition, such as that obtained in step 130, may be combined with a biocompatible carrier, a thickener, or an adhesive. Exemplary carriers or thickeners may include any of the Generally Recognized as Safe (GRAS) excipients such as carboxy methyl cellulose (CMC), methylcellulose, agar, carrageenan, modified starch, pectin, poloximers or similar materials. Optionally, adhesives such as fibrin glue may be employed. Such fibrin glue can be derived from recombinant human fibrin combined with human or bovine derived thrombin. A soft tissue matrix composition may also be loaded into an applicator assembly, for subsequent use by a surgeon or other medical personnel. In some cases, an applicator assembly may include a syringe mechanism and a cannula mechanism.
The processing protocol of step 120 may include cryofracturing the soft tissue material so as to at least partially physically disrupt extracellular matrix collagen or tissue macro architecture within the soft tissue material. In some cases, as further discussed elsewhere herein, a cryofracturing process may partially disrupt extracellular matrix collagen or tissue macro architecture within the soft tissue material, and a subsequent triturating process may further disrupt extracellular matrix collagen bundles within the soft tissue material.
Either or both of the cryofracturing and triturating processes may be applied to any of a variety of tissue types, including without limitation amnion tissue, umbilical cord tissue, intestine tissue, or other soft tissues. Any of these tissues may be similarly treated either with or without a prior decellularization treatment. Hence, for example, skin, amnion, tendon, or other tissues can be cryofractured and rendered into a putty-like medium. In some embodiments, such tissues may be rendered non-immunogenic prior to manufacturing them into a putty, for example if the end use is implantation within a patient. According to some embodiments, a decellularization treatment may render the tissue non-immunogenic. In some cases, a decellularization treatment may at least partially reduce or eliminate immunogenicity in the tissue. Hence, where a matrix material is intended for use in a topical treatment, embodiments may involve at least partially decellularizing the tissue, or processing the tissue without performing a decellularization step. Relatedly, where a matrix material is intended for use in an implantation procedure, embodiments may involve at least partially or fully decellularizing the tissue. In other words, i the intended medical use for the soft tissue matrix composition is that of a temporary covering or product, and not a permanent implantation, the matrix may be suitable for use after being subjected to a partial decellularization regimen or no decellularization regime at all. In some cases, the decellularization techniques can be applied to any of a variety of human and/or heterograft derived matrices.
According to some embodiments, a stromal vascular fraction (SVF) from adipose tissue (see e.g. Gimble et al.; Circulation Research. 2007; 100: 1249-1260 , the contents of which are incorporated herein by reference), or other compositions containing progenitor cell populations, stem cell populations, or mixed populations thereof, may be added to the soft tissue matrix. Such fractions or populations may be obtained from cadaveric human tissue or other suitable sources. In some instances, when added to the flowable matrix composition, mesenchymal stem cells may adhere to the flowable matrix substrate. Exemplary techniques for obtaining stromal vascular fractions, progenitor cells, and stem cells from tissue are described in PCT Publication WO 2010/059565 to Shi, the contents of which are incorporated herein by reference.
In some cases, the soft tissue material may be a delaminated dermal tissue. In some cases, the soft tissue material may be a non-delaminated dermal tissue. For example, dermal tissue may have an intact epidermal layer. Alternatively, dermal tissue may be treated to remove the epidermal layer, either partially or completely. Delamination or deepidermization may be accomplished by any of the typical methods known in the field including mechanical debridement of the epidermis by repeated scraping with a sharp instrument such as a surgical scalpel. Alternatively deepidermization may be chemically induced by any of the hypotonic or hypertonic saline methods such as Wilsteed, E M et al.; “An ultrastructural comparison of dermo-epidermal separation techniques”, J. Cutan. Pathol. 18: 8-12 (1991), the content of which is incorporated herein by reference.
According to some embodiments, a soft tissue matrix composition may be produced without treating the source soft tissue material with a cryofracturing protocol.
Decellularized tissue material can be subjected to a cryo-hardening treatment, as indicated by step 330. For example, the tissue may be immersed in liquid nitrogen, so as to freeze or cryofractured the tissue. In some cases, the soft tissue is treated with liquid nitrogen for a duration of about one minute, or longer. As depicted by step 340, the frozen or cryo-treated soft tissue material may be triturated in a blender. In some instances, the tissue is processed in the blender for a duration of about one minute. In some instances, a wetting agent, or any other additive, may be added to the soft tissue material before, during, or after the trituration process. Exemplary additives may include any of the pharmaceutical excipients that are classified by FDA as generally recognized as safe (GRAS). In some instances, the wetting agent is a 0.9% sterile saline solution. As depicted in step 350, the triturated soft tissue material may then be placed or loaded into a filler syringe. Thereafter, as depicted in step 360, the soft tissue material may be placed or loaded into applicator syringes, for example by extruding the soft tissue material from a filler syringe into an applicator syringe. The loaded applicator syringes can then be packaged, as indicated by step 370. Subsequently, the packaged applicator syringes can be sterilized, for example by exposure to e-beam. According to some embodiments, a 48 cm2 amount of decellularized soft tissue may yield approximately 10 c.c. to 15 c.c. of flowable matrix composition, which may in some instances provide enough product to load two or three syringes. The entire process shown in
According to some embodiments, a flowable acellular human dermal matrix material can be prepared and administered as follows. First, human skin can be recovered in a cutting operation. For example, human full-thickness skin can be severed from a donor, and cut into appropriately sized pieces. The skin can then be processes according to selected delamination, decellularization, or washing steps, or combinations thereof. Subsequently, the skin can be processed according to a cryofracturing procedure, which may involve exposing the skin to liquid nitrogen. Thereafter, the cryofractured skin can be milled or triturated. The resulting putty-like collagen matrix can then be loaded into a syringe for subsequent packaging and sterilization. An exemplary product may be provided as 5 cc syringe loaded with approximately 3 c.c. (or more) of the soft tissue matrix composition. The loaded syringe can be packaged in a TYVEK® peel inner clear plastic tub. This inner tub can be placed in a TYVEK® peel outer tub. The resulting package can be sterilized by e-beam and provided in a double sealed configuration for operating room (OR) use. The flowable matrix product may be indicated for replacement or repair of damaged or inadequate integumental tissue.
As shown in
With a flowable matrix composition, embodiments of the present invention provide therapeutic interventions that allow for complete contact of the matrix with an irregular or channeling wound bed. Such materials can be molded or formed, and placed in an irregular wound bed so that sufficient material coats the wound bed to allow for a revascularization and remodeling response to occur. Hence, embodiments provide a suitable matrix for facilitating a healing response. In some instances, matrix compositions of the present invention provide a flowable acellular human dermal matrix, suitable for tissue regeneration indications.
According to some embodiments, soft tissue material can include a structural entity referred to as the extracellular matrix (ECM). The ECM may surround and support cells which are located within the tissue. Often, the ECM may include collagen protein, present in a triple helix fibrillar configuration. Collagen fibers can provide tensile strength and elasticity to the structure of the ECM. During processing procedures as described herein, the macrostructure of the soft tissue, such as the human dermis, can be mechanically disrupted. It has been discovered that although the integrity of the tissue extracellular matrix may be compromised during certain processing procedures (e.g. cryofractured, trituration), the microstructure of the matrix composition can remain intact, or sufficiently intact, for treatment purposes. Relatedly, according to some embodiments, a cryofracturing step can partially disrupt extracellular matrix collagen bundles within the soft tissue material, and a triturating step can further disrupt extracellular matrix collagen bundles within the soft tissue material. Yet, the microfibrillar architecture or structure of the collagen remains sufficiently intact and is available for tissue regeneration. According to some embodiments, the terms microstructure and microarchitecture may be used interchangeably. Hence, the disrupted microstructure of the collagen may also be referred to as a disrupted or disturbed microarchitecture. The microstructure may be measured by histological analysis. For example, tissue material at various stages of the processing (e.g. as shown in
A single piece of decellularized human dermal tissue, prior to undergoing a sterilization process, was stored in liquid Nitrogen for a period of time to render the tissue friable. The frozen tissue was milled. The resulting matrix composition, which had the consistency of a putty or paste, was placed into a 5 cc syringe by means of a spatula. The plunger on the syringe was depressed upon the paste to minimize air pockets within the matrix composition. The loaded syringe was placed in a plastic inner tub and heat-sealed with a first TYVEK® cover. This assembly was placed in a larger outer tub, and heat-sealed with a second TYVEK® cover. The entire resulting syringe and package assembly was submitted to approximately 22 kGy electron beam radiation for sterility assurance. Upon subsequent evaluation of the soft tissue matrix composition, it was observed that the matrix composition provided excellent handling and ease of use characteristics.
Six pieces of decellularized (donor derived full-thickness dermal tissue) were obtained (4 cm×8 cm in size). The pieces were each cut into long strips with a knife, and then frozen in liquid nitrogen. The frozen strips were processed in a 200 ml Waring blender. At the onset of blending, loud cracking emanated from the blender. Blending was continued until the loud cracking sounds ceased. 10 g of blended tissue was combined with 1.5 g of 0.9% saline, and the combination was mixed with a spatula, so as to form a matrix composition. The mixed matrix composition was loaded into an irrigation syringe having needle with a 3 mm bore. Upon depression of the syringe plunger, the matrix composition was observed to flow easily through the 3 mm bore needle. Upon additional testing, it was observed that the matrix composition flowed easily through needles having bore sizes of 3 mm and 1.5 mm. However, the matrix composition was not observed to flow easily through an 18 gauge needle. Five samples, each containing approximately 5 ml of matrix composition, were prepared for delivery to an e-beam sterilization facility.
Flow characteristics of skin, tendon, and decellularized dermal matrix materials were evaluated. Samples of each type were prepared, and loaded onto a syringe. The produce was delivered to a luer-loc tipped syringe onto which a luer lock needle could be attached securely. Each sample was loaded along with an amount of 0.9% saline. Each of the three samples were extrudable through a 16 gauge needle, but not a 23 gauge needle. A 1 cc sample of each material was diluted and dissolved in 9 cc of 0.9% saline, respectively. Each of the resulting 10 cc compositions were extrudable through an 18 gauge needle (1.27 mm; 0.050 inches), but not a 23 gauge needle (0.4636 mm; 0.01825 inches). Each of the three sample types were subject to 25-35 kGy E-beam sterilization, and after sterilization the extrudability of the contents in the syringe were compared to a sample that had not been e-beam sterilized. All three sterilized samples showed no difference in the ease of extrusion from the syringe with a 3 mm orifice.
Delivery and Tendon Embodiments 5
Tissue is generally not recognized to have the capability to deliver growth factors (GF). GF delivery can be important to retain the GF at the site of repair for sufficient time to allow repair/regeneration. Additionally, the repair process is a temporal process and the addition of GF over time can aid different stages of the repair process. In contrast, a bolus delivery of GF may have a short-term effect or may have no or minimal effect because the GF are rapidly removed from the repair site and cannot influence downstream stages of the repair process.
Platelet rich plasma (PRP) is derived from centrifuging whole blood, has a platelet concentration higher than that of whole blood, is the cellular component of plasma that settles after centrifugation, and contains numerous growth factors (such as vascular endothelial growth factor, transforming growth factor-β1 , and platelet-derived growth factor-BB). PRP can be used in sports medicine by directly applying the PRP to the injury site. However, there is a lack of evidence showing that PRP can facilitate the repair process. One potential explanation for this is that PRP may not be adequately retained or delivered over the appropriate time frame to permit biological activity. To circumvent this, some practitioners resort to multiple injections, although the obvious downside is multiple patient visits, incurred health care costs and pain/morbidity of the injection site.
Embodiments of the present invention combines the ground tendon as previously described with PRP. Appropriate processing of the ground tendon is beneficial to retain the physical properties of the collagen and extracellular matrix so as to allow slow activation of platelets and the retention of the growth factors that are released from the platelets on the tendon extracellular matrix. These growth factors may interact by hydrophobic, van der walls, ionic, and other means to bind to the ECM.
Controlled delivery of PRP has been previously described using a gelatin carrier (denatured collagen hydrogel). However, ground tendon more closely resembles the intended repair structure and may be preferred. Further, without being bound by any particular theory, it is believed that intact collagen and extracellular matrix can retain the ECM structures better to retain the GF. Exemplary embodiments of the instant invention encompass tendon and PRP compositions that provide for timed and/or controlled release of PRP therefrom, for a variety of tissue repair processes, including cartilage, bone, tendon, and the like.
According to embodiments of the present invention, it is possible to use autologous PRP rather than recombinant growth factors. Additionally, the PRP may be derived from an allogeneic source. In this case the PRP and ground tendon can be combined during the manufacturing process and lyophilized. Lyophilization can control the porosity such as to create a physical barrier to growth factor release. Such porosity could be controlled by methods such as freezing rate, NaCl concentration, and the like. Other allogeneic growth factors can be added to the ground tendon such as BMP-2 , -4 and -7 and TGFb-1 extracted from demineralized bone to allow for temporal release of a different set of GF.
There are a number of medical applications. These include the repair of partial tendon tears in which the ground tendon/PRP composite can be delivered to the tear area to facilitate repair. The product composite can also be delivered to facilitate repair of meniscal tears. Typically, the product composite can be delivered to the repair site and the repair can be closed using bioresorbable pins, tacks or sutures. The product composite may also be applied to tendon—bone interface such as for rotator cuff repair. The product composite can be delivered to the interface or footprint area prior to the sutures being pulled tight to position the tendon and bone together with the ground tendon/PRP at the interface. Postoperative rotator cuff tears occur from 11-94% of rotator cuff surgeries. Because of the high retear rate, it is beneficial to explore techniques of biological augmentation of rotator cuff repair. The normal tendon to bone interface includes tendon, non-mineralized fibrocartilage, mineralized fibrocartilage and bone. The normal repair process produces substantial fibrovascular/scar tissue which leads to inferior repair zone and substandard biomechanical strength. Appropriate delivery of the PRP with the appropriate scaffold (ground tendon) can facilitate the appropriate tissue structure.
Hence, embodiments of the present invention encompass compositions and methods that involve flowable/ground tendon (e.g. allograft tissue), optionally for use in delivering drugs, growth factors, and the like.
Bone (or Bone with Mesenchymal Stem Cell) Embodiments
Tissue matrix compositions as disclosed herein, such as soft tissue matrix compositions and the like, may also include bone tissue material, optionally in combination with mesenchymal stem cells. For example, treatment compositions and methods may encompass the use of a flowable decellularized or de-epidermalized skin component (or other soft tissue matrix), in combination with a demineralized bone matrix (DBM) component. A DBM component may include, for example, bone (e.g. allograft) from which inorganic mineral has been removed. In some instances, a DBM component may include an organic collagen matrix material. Relatedly, treatment compositions and methods may encompass the use of a flowable decellularized or de-epidermalized skin component (or other soft tissue matrix), in combination with a material that includes both a bone material component and a mesenchymal stem cell component. For example, a flowable skin or soft tissue matrix material may include an amount of ALLOSTEM® Stem Cell Bone Growth Substitute. Relatedly, a flowable skin or soft tissue matrix material may include an amount of adipose-derived mesenchymal stem cells combined with partially demineralized cancellous bone. In some cases, the bone material and/or mesenchymal stem cells may be present in a morselized form. Hence, compositions and methods as disclosed herein may include a flowable soft tissue or skin matrix material combined with ALLOSTEM® morsels, so as to form a bone putty. Exemplary bone and mesenchymal stem cell compositions and methods for their preparation are described in US 2010/0124776 to Shi, the contents of which are incorporated herein by reference.
According to some embodiments, flowable decellularized skin or de-epidermilized skin (or other soft tissue) can be mixed or combined with DBM morsels or ALLOSTEM® morsels (adipose-derived mesenchymal stem cells combined with partially demineralized cancellous bone) to make a putty formulation with good handling characteristics. For example, such morsels or putty compositions may stay in place upon implantation. Relatedly, such morsels or putty compositions may persist at the site of application (e.g. bony defect area) and resist removal by irrigation and/or contact with blood. In some instances, flowable decellularized skin or de-epidermilized skin (or other soft tissue) can provide an effective carrier to hold DBM and/or mesenchymal stem cells in place and prevent their migration. Such carriers may provide enhanced performance over other carriers such as hyaluronic acid, chitosan, pluronic acid, ceramic cements, carboxymethylcellulose, calcium sulfate, which are typically synthetic, not derived from human tissue, or otherwise do not include flowable decellularized skin or de-epidermilized skin (or other soft tissue). Further, such morsels or putty compositions may remain sufficiently moist or hydrated, such that they are not too dry or crumbly. What is more, such morsels or putty compositions can be terminally sterilized at 15-35 kGy by e-beam for example, without compromising the handling characteristics, such that the putty can be molded into any desired shape, without being or becoming too thin or runny.
While exemplary embodiments have been described in some detail, by way of example and for clarity of understanding, those of skill in the art will recognize that a variety of modification, adaptations, and changes may be employed. Hence, the scope of the present invention should be limited solely by the claims.
This application is a continuation application of U.S. patent application Ser. No. 13/712,295, filed Dec. 12, 2012, which claims the benefit of the filing date of U.S. Prov. Patent Appl. No. 61/577,299, entitled “FLOWABLE MATRIX COMPOSITIONS AND METHODS,” filed Dec. 19, 2011, the entire disclosures of which are incorporated herein by reference for all purposes.
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| Child | 14858941 | US |
