1. Technical Field
The present disclosure relates to implantable medical devices, and more particularly, to implantable medical devices including at least one polymeric film layer made from a mixture of glycerol and a biopolymer.
2. Background of Related Art
A variety of medical conditions may be treated, at least in part, by implanting a medical device into the body of an afflicted patient. Medical devices may be implanted into the body temporarily or left in the body for extended periods of time, even indefinitely. For example, a surgical mesh may be made from non-biodegradable materials and may be implanted into the abdomen of a patient to repair any type of hernia. The mesh may be either placed over the defect (anterior repair) or under the defect (posterior repair).
In another example, an implantable film made from a bioabsorbable material may be combined with another medical device for delivery of a therapeutic agent. However, these films may include any number of optional ingredients. For instance, viscosity enhancers, emulsifiers, pH modifiers and the like may be added as optional ingredients to the films to enhance the durability of the device and/or alter the delivery characteristics of a therapeutic agent. Typically, optional ingredients represent up to about 10% by weight of the device. In many instances, higher concentrations of optional ingredients may provide detrimental effects to the films overall characteristics. For instance, the addition of a plasticizer in concentrations higher than about 10% often make the film too flexible to be useful as an implantable film.
It would be beneficial to provide an implantable film, alone or in combination with a medical device, capable of providing immediate or sustained release of a therapeutic agent following implantation without compromising the overall characteristics of the films.
Accordingly, the present disclosure describes implantable medical devices which include at least one polymeric film layer made from a mixture of glycerol and at least one biopolymer, wherein the glycerol and the at least one biopolymer represent a weight ratio ranging from about 3:1 to about 1:3, respectively. In embodiments, the polymeric film layer may include at least one therapeutic agent.
In embodiments, the implantable medical devices described herein may include a medical device having a substrate, at least one polymeric film layer attached to the substrate, the polymeric film layer being made from a mixture of glycerol and at least one biopolymer, wherein the glycerol and the at least one biopolymer represent a weight ratio ranging from about 3:1 to about 1:3, respectively, and at least one therapeutic agent. The polymeric layer may be continuous or discontinuous on the substrate of the device.
Also disclosed are methods of delivery of a therapeutic agent which include implanting a medical device into tissue. The medical device including at least one polymeric film layer made from a mixture of glycerol and at least one biopolymer, wherein the glycerol and the at least one biopolymer represent a weight ratio ranging from about 3:1 to about 1:3, respectively, and, at least one therapeutic agent included in the at least one polymeric film layer.
These and other characteristics of the present invention will be more fully understood by reference to the following detailed description in conjunction with the attached drawings, in which:
The present disclosure relates to an implantable medical device which includes at least one polymeric film layer made from a mixture of glycerol and at least one biopolymer. The glycerol and the at least one biopolymer represent a weight ratio ranging from about 3:1 to about 1:3, respectively. In some embodiments, glycerol may represent a predominant amount of the polymeric film layer by weight. In some embodiments, the implantable medical device may be used for delivery of at least one therapeutic agent.
By implantable, the medical devices described herein may be positioned, for any duration of time, at a location within a body, such as within a portion of the abdominal cavity. Furthermore, the terms “implantation” and “implanted” refer to the positioning, for any duration of time, of a medical device at a location within a body, such as within a portion of the abdominal cavity.
Glycerol, also known as glycerin or glycerine, is a polyol which includes three hydrophilic hydroxyl groups. The hydroxyl groups allow glycerol to be soluble in water, as well as hygroscopic in nature.
The glycerol may represent from about 25 weight percent to about 75 weight percent of the polymeric film layer. In some embodiments, glycerol may represent from about 33 weight percent to about 67 weight percent of the polymeric film layer. In certain embodiments, the polymeric film layers described herein may include more than 50 weight percent glycerol.
The glycerol used to form the polymeric films described may be in a solid or liquid form prior to mixing with the at least one biopolymer. By solid, the glycerol may be in a form such as particulate, powder, granulized, and the like. By liquid, the glycerol may be in a form such as a solution, suspension, emulsion, dispersion, slurry, gel, and the like.
A glycerol solution maybe formed using any suitable technique within the purview of those skilled in the art. For example, a glycerol solution may be formed by mixing a glycerol solid with a suitable solvent to form a glycerol solution or liquid. Some non-limiting examples of solvents suitable for forming the glycerol solutions may include polar and non-polar solvents such as methylene chloride, chloroform, N-methylpyrrolidone, tetrahydrofuran, dimethylformamide, methanol, ethanol, hexanes, acetone, water, saline buffers and combinations thereof.
The glycerol may be mixed with at least one biopolymer. Some non-limiting examples of suitable biopolymer materials include polysaccharides, proteins, peptides, and combinations thereof. In some embodiments, the polysaccharide may include cellulose, dextran, chitin, chitosan, alginate, pectin, mucilage, pullalan, methylcellulose, carboxymethylcellulose (CMC), hydroxypropyl methylcellulose, hydroxyethyl methylcellulose, arabinoxylans, bacterial polysaccharides and combinations thereof. In certain embodiments, the polymeric film layer may consist of glycerol and carboxymethylcellulose.
In other embodiments, the polymeric film layer may include proteins, such as collagen, elastin, fibrin, albumin, fibrinogen, thrombin, silk, and combinations thereof. In certain embodiments, the polymeric film layer may consist of glycerol and collagen. In other embodiments, the implant has a collagen layer and a carboxymethylcellulose/glycerol layer.
The term “collagen” is meant to include any type of collagen, whether natural or synthetic, of human or animal origin, such as, for example, enriched human collagen of type I, human collagen of type III, also enriched, human collagen of type I+III or of type IV or other collagens such as animal collagen of type I or of type I+III. The collagen may be oxidized or non-oxidized.
In certain embodiments, the collagen may be oxidized without crosslinking. For example, native collagen may be dipped in an acid solution and/or washed, to eliminate the telopeptides, notably by pepsin digestion.
The collagen may also be modified by oxidative cleavage. For this purpose periodic acid or one of its salts can be used, applying the technique described by M. TARDY et al. (FR-A-2 601 371 and U.S. Pat. No. 4,931,546, the entire contents of which are hereby incorporated by reference).
It is recalled briefly that this technique consists of mixing the collagen in acid solution with a solution of periodic acid or one of its salts at a concentration of between 1 and 10−5M, preferably between 5 10−3 and 10−1M, at a temperature of between 10 and 25° C. for 10 minutes to 72 hours.
This process breaks down some of the collagen's components, these being hydroxylysine and the sugars, thus creating reactive sites without causing crosslinking.
The oxidative cleavage of collagen allows moderate cross-linking later in the collagenic material but does not exclude the possibility of providing this function by other means of moderate cross-linking, for example by beta or gamma irradiation, or other agents of moderate cross-linking, for example chemical reagents at suitably low and non-toxic doses.
For some applications, the polymer film layers described herein may include collagen which is not oxidized or a mixture in any proportions of non-oxidized and oxidized collagens.
In some embodiments, the biopolymer may represent from about 25 weight percent to about 75 weight percent of the polymeric film layer. In other embodiments, the biopolymer may represent from about 33 weight percent to about 67 weight percent of the polymeric film layer. In certain embodiments, the polymeric film layers described herein may include less than 50 weight percent biopolymer.
The biopolymer used to form the polymeric films described may be in a solid or liquid fowl prior to mixing with the glycerol. By solid, the biopolymer may be in a form such as particulate, powder, granulized, and the like. By liquid, the biopolymer may be in a form such as a solution, suspension, emulsion, dispersion, slurry, gel, and the like.
In particularly useful embodiments, a biopolymer solution maybe formed using any suitable technique within the purview of those skilled in the art. For example, a biopolymer solution may be formed by mixing a biopolymer solid with a suitable solvent to form a biopolymer solution or liquid. For example, carboxymethylcellulose powder may solubilized in water to form a carboxymethylcellulose solution. Some non-limiting examples of solvents suitable for forming the biopolymer solutions may include polar and non-polar solvents, such as methylene chloride, chloroform, N-methylpyrrolidone, tetrahydrofuran, dimethylformamide, methanol, ethanol, hexanes, acetone, water, saline, buffers and combinations thereof.
The polymeric film layers described herein may include glycerol and at least one biopolymer at a weight ratio ranging from about 3:1 to about 1:3. In some embodiments, the glycerol and the biopolymer may represent a weight ratio ranging from about 2:1 to about 1:2. In still other embodiments, the glycerol and the biopolymer may represent a weight ratio greater than about 1.01:1.
Upon mixing of the glycerol and the biopolymer, the polymeric film layers may be formed using any suitable method known to those skilled in the art. Some non-limiting examples include casting, extruding, spraying and the like. In embodiments, the mixture containing the biopolymer and the glycerol may be cast in a mold and allowed to dry to form a polymeric film layer. The drying may take place at an ambient or elevated temperatures and pressures.
The polymeric film layers described herein may be sufficient in strength to be implanted without an additional device for mechanical support. However, in some embodiments, the polymeric film layers described herein may be combined with another implantable substrate, i.e., a mesh, to provide additional support.
Any implantable substrate suitable for insertion into a patient's body, whether on a temporary or a permanent basis, may be combined with the polymeric films described herein. Some non-limiting examples include soft tissue repair devices such as sutures, staples, meshes, patches, pledgets, buttresses, clips, clamps, screws, and pins. Other suitable devices include staple line reinforcements, tissue fillers, tissue wraps for solid organs or luminal structures, sealing devices, cavity wall and floor reinforcements, intramuscular conduits, access site closure devices, and the like. The implantable substrates and the films described herein may be porous or non-porous.
In certain embodiments, the implantable substrate is a surgical mesh. The surgical mesh described herein may include porous fabrics made from intertwined filaments. The filaments may extend horizontally and vertically in a manner which produces sections where the filaments cross-over one another creating points of common intersection. The surgical mesh may be woven, non-woven, knitted or braided. In some embodiments, the filaments may form two-dimensional or three-dimensional meshes. Some examples of two-dimensional and/or three-dimensional mesh substrates may be found in U.S. Pat. No. 7,021,086, U.S. Pat. No. 6,596,002, U.S. Pat. No. 7,331,199, the entire contents of which are incorporated by reference herein.
The filaments may be monofilaments or multi-filaments and, in embodiments, a plurality of multi-filaments may be combined to form yarns. It is envisioned that the mesh may be configured to any size and/or shape suitable for hernia repair. The filaments may comprise core/sheath constructs.
In certain embodiments, the implantable substrate may be a surgical mesh knitted on a warp knitting machine, of the tricot or Raschel type, with at least three sheets or warps of yarn and as many guide bars.
The knitted mesh may be created by threading a rear bar, one guide full and one guide empty, with first mono- or multi-filaments 10 of a biocompatible polymer as represented as a solid line in
The rear bar places the first filament or yarn in partial weft under the chain stitch and “thrown” onto the needle not forming a chain stitch. For this reason, at the next row, the needle not forming a chain stitch not being supplied permits escape of the filament which forms a loop 14a projecting from the front face of the mesh.
The threading—one guide full, three guides empty—in the intermediate bar, associated with the displacement, makes it possible to form a light ground texture, stable in width, and open-worked to permit good tissue integration.
The mesh 14 thus obtained may be provided with loops 14a (
On leaving the loom, mesh 14 may be subjected to a thermosetting operation which stabilizes the mesh length and width. The mesh may then be subjected to a phase of formation of the spiked naps consisting, as is shown in
This control as well as that of the temperature of the resistor placed in cylinder 13 and of the speed of movement of mesh 14 across cylinder 13 make it possible to melt the head of each of loops 14a so that each loop 14a forms two spiked naps 17.
Each spiked nap 17 thus may have a substantially rectilinear body protruding perpendicularly with respect to mesh 14 and, at the free end of this body, a head 17a of greater width than that of the body. Head 17a has a generally spheroidal shape or a mushroom shape. Spiked naps 17 gives mesh 14 the ability to attach to tissue when implanted. In addition, spiked naps 17 may attach to other portions of mesh 14 when folded or rolled.
In embodiments, the polymeric films described herein may be positioned on any portion of the mesh. In some embodiments, the polymeric films may be positioned on a portion of the mesh which does not include the spiked naps. Alternatively, the film may be positioned on a portion of the mesh having spiked naps.
The films may be posited on any portion of the surface of the implantable substrate. In some embodiments, the films may form a continuous layer. For example, the polymeric films may form a continuous layer on the surface of a surgical mesh, wherein the porosity of the mesh is occluded by the continuous film. In other embodiments, the films may form a discontinuous layer covering intermittent portions of the surface of the implantable substrate. In one example, the polymeric films may form a discontinuous layer on the surface of a surgical mesh, wherein the porosity of the mesh is maintained by the discontinuous film.
In some embodiments, the polymeric films may be cast as a film directly on a portion of the implantable substrate surface. In other embodiments, the polymeric films may be spray coated directly on a portion of the implantable substrate surface. In still other embodiments, the polymeric films may be formed before being positioned onto the implantable substrate.
The implantable substrates described herein may be made from any biocompatible material suitable for implantation. For example, the implantable substrate may be made from any biodegradable polymer. The biodegradable polymer may be a homopolymer or a copolymer, including random copolymer, block copolymer, or graft copolymer. The biodegradable polymer may be a linear polymer, a branched polymer, or a dendrimer. The biodegradable polymers may be of natural or synthetic origin. Examples of suitable biodegradable polymers include, but are not limited to polymers such as those made from lactide, glycolide, caprolactone, valerolactone, carbonates (e.g., trimethylene carbonate, tetramethylene carbonate, and the like), dioxanones (e.g., 1,4-dioxanone), δ-valerolactone, 1,dioxepanones (e.g., 1,4-dioxepan-2-one and 1,5-dioxepan-2-one), ethylene glycol, ethylene oxide, esteramides, γ-hydroxyvalerate, β-hydroxypropionate, alpha-hydroxy acid, hydroxybuterates, poly(ortho esters), hydroxy alkanoates, tyrosine carbonates, polyimide carbonates, polyimino carbonates such as poly(bisphenol A-iminocarbonate) and poly(hydroquinone-iminocarbonate), polyurethanes, polyanhydrides, polymer drugs (e.g., polydiflunisol, polyaspirin, and protein therapeutics) and copolymers and combinations thereof.
In some embodiments, the polymeric films include a single layer containing glycerol, a biopolymer and a therapeutic agent. The thickness of the polymeric films described herein may on average measure between about 0.1 μm to about 1000 μm.
In other embodiments, the polymeric films comprise a multilayer film wherein the first layer contains glycerol and a biopolymer and a second layer contains a therapeutic agent. In still other embodiments, the polymeric films include a tri-layer structure wherein a second layer containing a therapeutic agent is positioned between a first layer containing glycerol and a biopolymer and a third layer containing glycerol and the same or different biopolymer. It is envisioned that the therapeutic agent may also be combined therein any layer of the polymeric films.
The term “therapeutic agent”, as used herein, is used in its broadest sense and includes any substance or mixture of substances that provides a beneficial, therapeutic, pharmacological, and/or prophylactic effect. The agent may be a drug which provides a pharmacological effect.
The term “drug” is meant to include any agent capable of rendering a therapeutic affect, such as, antimicrobial agents, anesthetics, analgesics, anticancer agents, angiogenic agents, fibrotic agents, antimitotics, chelating agents, peptides, proteins, DNA, RNA, nucleotides, liposomes, blood products, hormones, water-soluble silver salts, growth factors, antibodies, interleukins, cytokines, and the like. The term “drug’ is also intended to include any compound that affects or participates in tissue growth, cell growth, cell differentiation, anti-adhesion of tissue; or a compound that may be able to invoke a biological action such as an immune response; or a compound that could play any other role in one or more biological processes.
Some specific non-limiting examples of water-soluble drugs that may be used in the present self-supporting films include, lidocaine, bupivicaine, tetracaine, procaine, dibucaine, sirolimus, taxol, chlorhexidine, polyhexamethylene, thiamylal sodium, thiopental sodium, ketamine, flurazepam, amobarbital sodium, phenobarbital, bromovalerylurea, chloral hydrate, phenytoin, ethotoin, trimethadione, primidone, ethosuximide, carbamazepine, valproate, acetaminophen, phenacetin, aspirin, sodium salicylate, aminopyrine, antipyrine, sulpyrine, mepirizole, tiaramide, perixazole, diclofenac, anfenac, buprenorphine, butorphanol, eptazocine, dimenhydrinate, difenidol, dl-isoprenaline, chlorpromazine, levomepromazine, thioridazine, fluphenazine, thiothixene, flupenthixol, floropipamide, moperone, carpipramine, clocapramine, imipramine, desipramine, maprotiline, chlordiazepoxide, clorazepate, meprobamate, hydroxyzine, saflazine, ethyl aminobenzoate, chlorphenesin carbamate, methocarbamol, acetylcholine, neostigmine, atropine, scopolamine, papaverine, biperiden, trihexyphenidyl, amantadine, piroheptine, profenamine, levodopa, mazaticol, diphenhydramine, carbinoxamine, chlorpheniramine, clemastine, aminophylline, choline, theophylline, caffeine, sodium benzoate, isoproterenol, dopamine, dobutamine, propranolol, alprenolol, bupranolol, timolol, metoprolol, procainamide, quinidine, ajmaline, verapamil, aprindine, hydrochlorothiazide, acetazolamide, isosorbide, ethacrynic acid, captopril, enalapril, delapril, alacepril, hydralazine, hexamethonium, clonidine, bunitrolol, guanethidine, bethanidine, phenylephrine, methoxamine, diltiazem, nicorandil, nicametate, nicotinic-alcohol tartrate, tolazoline, nicardipine, ifenprodil, piperidinocarbamate, cinepazide, thiapride, dimorpholamine, levallorphan, naloxone, hydrocortisone, dexamethasone, prednisolone, norethisterone, clomiphene, tetracycline, methyl salicylate, isothipendyl, crotamiton, salicylic acid, nystatin, econazole, cloconazole, vitamin B1, cycothiamine, vitamin B2, vitamin B3, vitamin B5, vitamin B6, vitamin B7, vitamin B9, vitamin B12, vitamin C, nicotinic acid, folic acid, nicotinamide, calcium pantothenate, pantothenol, panthetin, biotin, ascorbic acid, tranexamic acid, ethamsylate, protamine, colchicine, allopurinol, tolazamide, glymidine, glybuzole, metofounin, buformin, orotic acid, azathioprine, lactulose, nitrogen mustard, cyclophophamide, thio-TEPA, nimustine, thioinosine, fluorouracil, tegafur, vinblastine, vincristine, vindesine, mitomycin C, daunorubicin, aclarubicin, procarbazine, cisplatin, methotrexate, benzylpenicillin, amoxicillin, penicillin, oxycillin, methicillin, carbenicillin, ampicillin, cefalexin, cefazolin, erythromycin, kitasamycin, chloramphenicol, thiamphenicol, minocycline, lincomycin, clindamycin, streptomycin, kanamycin, fradiomycin, gentamycin, spectinomycin, neomycin, vanomycin, tetracycline, ciprofloxacin, sulfanilic acid, cycloserine, sulfisomidine, isoniazid, ethambutol, acyclovir, gancyclovir, vidabarine, azidothymidine, dideoxyinosine, dideoxycytosine, morphine, codeine, oxycodone, hydrocodone, cocaine, pethidine, fentanyl, polymeric forms of any of the above drugs and any combinations thereof. The water-soluble drug may not need to be converted to a salt form, i.e., tetracycline hydrochloride. In some embodiments, the therapeutic agent may include an anesthetic, i.e., bupivicaine hydrochloride, lidocaine, benzocaine, and the like.
Although the above therapeutic agents have been provided for the purposes of illustration, it should be understood that the present disclosure is not so limited. In particular, although certain therapeutic agents are specifically referred to above, the present disclosure should be understood to include analogues, derivatives and conjugates of such agents.
The therapeutic agent may be combined with the polymeric film or the implantable substrate. In some embodiments, the therapeutic agent may be a top-coating on the film or implantable substrate to provide an immediate release of the therapeutic agent following implantation. In some embodiments, the therapeutic agent may be included in the film to provide sustained release of the therapeutic agent.
The therapeutic agents may be combined with any suitable solvent to form a therapeutic solution. Some useful non-limiting examples include organic solvents such as methylene chloride, chloroform, N-methylpyrrolidone, tetrahydrofuran, dimethylformamide, methanol, ethanol, hexanes, acetone, water and combinations thereof. In some embodiments, the solvent for the therapeutic agent is not a co-solvent for glycerol or the biopolymer.
The therapeutic agent may form a solution at a concentration ranging from about 1 microgram/ml to about 1 gram/ml. In certain embodiments, the concentration of the therapeutic solution may range from about 1 mg/ml to about 500 mg/ml. In still other embodiments, the concentration of the therapeutic solution may range from about 10 mg/ml to about 300 mg/ml. By solution, the therapeutic preparation is intended to include suspensions, emulsions, dispersions, and the like.
In certain embodiments, the therapeutic agent may be combined with the glycerol and biopolymer mixture prior to the formation of the polymeric film. In such embodiments the glycerol, biopolymer and therapeutic agent may be combined into a solution using a common solvent.
Turning now to
In
In still other embodiments, as those shown in
The implantable substrates and the polymeric films described herein may be formed by combining any combination of individual parts. For example, a polymeric film including glycerol and carboxymethylcellulose may be prepared via solution casting, and a three-dimensional mesh as shown in
In another example, the polymeric film layers and the implantable substrates may be formed together. The surface of the implantable substrates may be put into contact with the polymeric film layers prior to drying to attach the substrate to the polymeric film layer.
In yet another example, the substrate and the multiple polymeric film layers may be formed at the same time as a monolithic structure.
The medical devices described herein may be used to deliver therapeutic agents in the body. The delivery of the agents may be immediate or sustained over time. In embodiments, the polymeric film layer may consist essentially of a predominant amount of glycerol and a minor amount of a biopolymer, such as carboxymethylcellulose or collagen.
Two liters of a 2% medium viscosity carboxymethylcellulose (CMC) stock solution was prepared by mixing 40.0040 grams of CMC with deionized water. The CMC was placed into a two liter volumetric flask with magnetic stirrer and positioned on a magnetic stir plate. The deionized water was slowly added until a 2% CMC stock solution was formed.
The 2% CMC stock solution was mixed with varying amounts of glycerol syrup to form 8 separate 100 ml solutions of the following concentration ratios: 10:1 (CMC:glycerol); 5:1 (CMC:glycerol); 3:1 (CMC:glycerol); 1:1 (CMC:glycerol); 1:2 (CMC:glycerol); 1:3 (CMC:glycerol); 1:4 (CMC:glycerol); and 100% CMC-no glycerol.
Each of the eight CMC:glycerol solutions were then poured into silicone frames positioned on top of silicone sheets on a leveling table. Each of the silicone frames were about 0.5 cm thick and covered an area of about 221 cm2. Each of the silicone frames and the silicone sheets were clamped to the tables prior to the pouring of the CMC:glycerol solutions. The tables were placed into a convection oven set to room temperature and left overnight to dry and form films.
Each of the eight CMC:glycerol films are depicted in
In
The smoothness and flexibility of the films improved as larger amounts of glycerol were added to the films. As shown in
In
The 8 films formed of varying concentrations of CMC and glycerol, as depicted in
In the Tack test, the sample films were fixed to a piece of cardboard using double-sided tape. A sample holder was placed over a portion of the film to further secure the samples. A 57R TA probe (made by Texture Technologies Corporation, Scarsdale, N.Y.) was connected a load cell and prompted to approximate the film samples at a rate of 1 mm/sec and applied a force of 30 g for 5 seconds. After contact with the film samples, the probe was retracted from the film samples at a rate of 10 mm/sec. The maximum force of detachment for each group of 8 sample films was recorded.
The results are shown in
In the Ball Burst test, the sample films were placed over a TA-108s gel film fixture device (made by made by Texture Technologies Corporation, Scarsdale, N.Y.) and secured in place using a circular plate. A washer with a 9 mm ID was placed in between the film and the circular plate. A 3 mm circular ball probe was connected a load cell and prompted to travel at a compression direction at a rate of 1 mm/sec. The strength and elongation at burst each group of 8 sample films were recorded.
The results are shown in
It will be understood that various modifications may be made to the embodiments disclosed herein. For example, in embodiments the medical device may be rolled prior to being delivered into the body via a cannula, trocar or laparoscopic delivery device. In another example, the medical devices described herein may be sterilized and packaged into using any suitable sterilization process, i.e., gamma radiation, and any suitable medical device package, i.e., an injectable medical device package. Thus, those skilled in the art will envision other modifications within the scope and spirit of the claims.