Patent Application
20080188837
The present invention relates to a gastrointestinal tract drug delivery system and, more particularly, to an ingestible drug-delivery facilitation system which enhances the absorption of a drug through the gastrointestinal wall.
The absorption of a drug (or of a drug precursor) into the systemic circulation is determined by the physicochemical properties of the drug, its formulations, and the route of administration, whether oral, rectal, topical, by inhalation, or by intravenous administration. Oral administration includes swallowing, chewing, sucking, as well as buccal administration, i.e., placing a drug between the gums and cheek, and sublingual administration, i.e., placing a drug under the tongue. A prerequisite to absorption is drug dissolution.
Absorption of orally-administered drugs into the internal environment generally occurs almost exclusively in the small intestine. The small intestine is lined with a layer of epithelial cells joined by tight junctions. In order to pass from the lumen of the small intestine into the internal environment and, therefrom into the systemic circulation, a dissolved drug must either pass through the semi-permeable membranes of the epithelial cells (transcellular passage), or through the tight junctions between the epithelial cells. The rate of transcellular passage is generally low except for small, lipid-soluble molecules. In addition, the tight junctions generally prevent the passage of most dissolved molecules. A drug may cross the biological barrier by passive diffusion, or by other naturally-occurring transfer modes, for example, facilitated passive diffusion, active transport, or pinocytosis. Alternatively, a drug may be artificially assisted to cross the biological barrier.
In passive diffusion, transport depends on the concentration gradient of the solute across the biological barrier. Since the drug molecules are rapidly removed by the systemic circulation, drug concentration in the blood in the vicinity of the administration site is low compared with that at the administration site, producing a large concentration gradient. The drug diffusion rate is directly proportional to that gradient. The drug diffusion rate also depends on other parameters, for example, the molecule's lipid solubility and size. Because the cell membrane is lipoid, lipid-soluble drugs diffuse more rapidly than relatively lipid-insoluble drugs. Similarly, small drug molecules penetrate biological barriers more rapidly than large ones.
Another naturally occurring transfer mode is facilitated passive diffusion, which occurs for certain molecules, such as glucose. It is believed that a carrier component combines reversibly with a substrate molecule at the cell membrane exterior. The carrier-substrate complex diffuses rapidly across the membrane, releasing the substrate at the interior surface. This process is characterized by selectivity and saturability: The carrier is operative only for substrates with a relatively specific molecular configuration, and the process is limited by the availability of carriers.
Active transport, which is another naturally occurring transfer mode, appears to be limited to drugs that are structurally similar to endogenous substances. Active transport is characterized by selectivity and saturability and requires energy expenditure by the cell. It has been identified for various ions, vitamins, sugars, and amino acids.
Still another naturally occurring transfer mode is pinocytosis, in which fluids or particles are engulfed by a cell. The cell membrane encloses the fluid or particles, then fuses again, forming a vesicle that later detaches and moves to the cell interior. Like active transport, this mechanism requires energy expenditure. It is known to play a role in drug transport of protein drugs.
The foregoing discussion relates to naturally occurring transfer modes. Where these are insufficient, for example, in cases of macromolecules and polar compounds, which cannot effectively traverse the biological barrier, drug transport may be artificially induced.
Electrotransport refers generally to electrically induced passage of a drug (or a drug precursor) through a biological barrier. Several electrotransport mechanisms are known, as follows:
Iontophoresis involves the electrically induced transport of charged ions, by the application of low-level, direct current (DC) to a solution of the medication. Since like electrical charges repel, the application of a positive current drives positively charged drug molecules away from the electrode and into the tissues; similarly, a negative current will drive negatively charge ions into the tissues. Iontophoresis is an effective and rapid method of delivering water-soluble, ionized medication. Where the drug molecule itself is not water-soluble, it may be coated with a coating (for example, sodium lauryl sulfate (SLS)), that may form water-soluble entities.
Electroosmosis involves the movement of a solvent with the agent through a membrane under the influence of an electric field.
Electrophoresis is based on migration of charged species in an electromagnetic field. Ions, molecules, and particles with charge carry current in solutions when an electromagnetic field is imposed. Movement of a charged species tends to be toward the electrode of opposite charge. The voltages for continuous electrophoresis are rather high (several hundred volts).
Electroporation is a process in which a biological barrier is subjected to a high-voltage alternating-current (AC) surge, or pulse. The AC pulse creates temporary pores in the biological membrane. The pores allow large molecules, such as proteins, DNA, RNA, and plasmids to pass through the biological barrier.
Iontophoresis, electroosmosis, and electrophoresis are diffusion processes, in which diffusion is enhanced by electrical or electromagnetic driving forces. In contrast, electroporation physically punctures the biological barriers, along cell boundaries, enabling passage of large molecules through the epithelium.
Generally, during electrotransport a combination of more than one of these processes occurs, together with passive diffusion and other naturally-occurring transfer modes. Therefore, electrotransport refers to at least one, and possibly a combination of the aforementioned transport mechanisms, which supplement the naturally-occurring transfer modes.
Medical devices that include drug delivery by electrotransport are described, for example, in U.S. Pat. No. 5,674,196 to Donaldson et al., U.S. Pat. No. 5,961,482 to Chien et al, U.S. Pat. No. 5,983,131 to Weaver et al., U.S. Pat. No. 5,983,134 to Ostrow, U.S. Pat. No. 6,477,410 to Henley et al., and U.S. Pat. No. 6,490,482 to Mori et al., all of whose disclosures are incorporated herein by reference.
In addition to the aforementioned electrotransport processes, there are other electrically assisted drug delivery mechanisms, including:
Sonophoresis, i.e., the application of ultrasound, induces growth and oscillations of air pockets, a phenomenon known as cavitation. These disorganize lipid bilayers thereby enhancing transport. For effective drug transport, a low frequency of between 20 kHz and less than 1 MHz, rather than the therapeutic frequency, should be used. Sonophoresis devices are described, for example, in U.S. Pat. Nos. 6,002,961, 6,018,678, and 6,002,961 to Mitragotri et al., U.S. Pat. Nos. 6,190,315 and 6,041,253 to Kost et al., U.S. Pat. No. 5,947,921 to Johnson et al., and U.S. Pat. Nos. 6,491,657 and 6,234,990 to Rowe et al., all of whose disclosures are incorporated herein by reference.
Ablation is another method of facilitating drug passage through a biological barrier. In addition to mechanical ablation, for example using hypodermic needles, ablation techniques include laser ablation, cryogenic ablation, thermal ablation, microwave ablation, radiofrequency ablation, liquid jet ablation, or electrical ablation.
U.S. Pat. No. 6,471,696 to Berube et al. describes a microwave ablation catheter, which may be used as a drug delivery device. U.S. Pat. No. 6,443,945 to Marchitto et al. describes a device for pharmaceutical delivery using laser ablation. U.S. Pat. No. 4,869,248 to Narula describes a catheter for performing localized thermal ablation, for purposes of drug administration. U.S. Pat. Nos. 6,148,232 and 5,983,135 to Avrahami describe drug delivery systems using electrical ablation. The disclosures of all of these patents are incorporated herein by reference.
Oral drug administration is a common drug delivery route. Drug bioavailability of orally administered drugs, i.e., the degree to which the drug is available to the target tissue, is affected by drug dissolution, drug degradation in the gastrointestinal (GI) tract, and drug absorption.
Drug dissolution is affected by whether the drug is in salt, crystal, or hydrate form. To improve dissolution, disintegrants and other excipients, such as diluents, lubricants, surfactants (substances which increase the dissolution rate by increasing the wettability, solubility, and dispersibility of the drug), binders, or dispersants are often added during manufacture.
Drug degradation in the GI tract is due to GI secretions, low pH values, and degrading enzymes. Since luminal pH varies along the GI tract, the drug must withstand different pH values. Interaction with blood, food staff, mucus, and bile may also affect the drug. Reactions that may affect the drug, and reduce bioavailability, include: (a) complex formations, for example, between tetracycline and polyvalent metal ions; (b) hydrolysis by gastric acid or digestive enzymes, for example, penicillin and chloramphenicol palmitate hydrolysis; (c) conjugation in the gut wall, for example, sulfoconjugation of isoproterenol; (d) adsorption to other drugs, for example, digoxin and cholestyramine; and (e) metabolism by luminal microflora.
Drug absorption of orally-administered drugs relates to transport of drugs across biological barriers presented by the epithelial cells in the GI tract. The nature of intestinal epithelium tends to inhibit drug absorption. As seen in
Overall, low bioavailability is most common with oral dosage forms of poorly water-soluble, slowly absorbed drugs. Insufficient time in the GI tract is another common cause of low bioavailability. An ingested drug is exposed to the entire GI tract for no more than 1 to 2 days, and to the small intestine for only about 2 to 4 hours. If the drug does not dissolve readily or cannot penetrate the epithelial membrane quickly, its bioavailability will be low. Age, sex, activity, genetic phenotype, stress, disease (e.g., achlorhydria, malabsorption syndromes), or previous GI surgery can further affect drug bioavailability.
Table 1 below (from Encyclopedia of Controlled Drug Delivery, edited by Edith Mathiowitz) summarizes some parameters of the oral route that affect drug bioavailability.
In addition to the physical barrier of the epithelial cells, chemical and enzymatic barriers affect drug absorption.
It is known to provide an ingestible capsule that includes a drug and a chemical that indirectly facilitates passage of the drug across the epithelial layer. For example, the chemical may induce a change in the epithelial layer that renders it transiently more permeable to the drug, whereupon the drug (indirectly facilitated by the action of the chemical), crosses the epithelial layer by diffusion.
Another important barrier to drug absorption is the pre-systematic, first-pass metabolism, primarily hepatic metabolism. The predominant enzymes in this metabolism are the multi-gene families of cytochrome P450, which have a central role in metabolizing drugs. It appears that variations in P450s between individuals lead to variations in their ability to metabolize the same drug.
Additionally, multidrug resistance (MDR) may be a barrier to drug absorption. MDR, which is a major cause of cancer treatment failure, is a phenomenon whereby cancer cells develop a broad resistance to a wide variety of chemotherapeutic drugs. MDR has been associated with overexpression of P-glycoprotein or multidrug resistance-associated protein (MRP), two transmembrane transporter molecules which act as pumps to remove toxic drugs from tumor cells. P-glycoprotein acts as a unidirectional efflux pump in the membrane of acute myeloid leukemia (AML) cells and lowers the intracellular concentration of cytotoxic agents, by pumping them out of leukemic cells. Yet it confers resistance to a variety of chemotherapy drugs, including daunorubicin.
Ingestible radio pills, which are ingestible capsules containing a transmitter and other electrical components are known. In 1964 researchers at Heidelberg University developed a pill for monitoring pH of the GI tract. (Noller, H. G., “The Heidelberg Capsule Used For the Diagnosis of Peptic Diseases,” Aerospace Medicine, February, 1964, pp. 115-117.)
U.S. Pat. No. 4,844,076 to Lesho et al., issued July 1989, entitled, “Ingestible size continuously transmitting temperature monitoring pill,” whose disclosure is incorporated herein by reference, describes a temperature responsive transmitter, encapsulated in an ingestible size capsule. The capsule is configured to monitor average body temperature, internally. The ingestible size temperature pill can be configured in a rechargeable embodiment. In this embodiment the pill uses the inductive coil in the tank circuit as the magnetic pickup to charge a rechargeable nickel cadmium battery.
U.S. Pat. No. 5,279,607 to Schentag et al., entitled, “Telemetry capsule and process,” whose disclosure is incorporated herein by reference, describes an ingestible capsule and a process for delivery, particularly repeatable delivery, of a medicament to the alimentary canal. The ingestible capsule is an essentially non-digestible capsule, which contains an electric energy emitting means, a radio signal transmitting means, a medicament storage means and a remote actuatable medicament releasing means. The capsule signals a remote receiver as it progresses through the alimentary tract in a previously mapped route and upon reaching a specified site is remotely triggered to release a dosage of medicament.
U.S. Pat. No. 5,395,366 to D'Andrea et al., entitled, “Sampling capsule and process,” whose disclosure is incorporated herein by reference, describes a similar ingestible capsule and a process for sampling of fluids in the alimentary canal.
The use of electrostimulating capsules for promoting peristalsis is known. PCT Publications WO 97/31679 to Dirin and WO 97/26042 to Terekhin, the disclosures of both of which are incorporated herein by reference, disclose ingestible capsules for electrostimulation of the alimentary tract, to be used, for example, as a post-surgical therapy, as a prophylactic measure of alimentary tract diseases, or for the promotion of peristalsis.
PCT Publication WO 97/31679 further discloses that USSR Inventor's Certificate No. 1223922, Int. Cl. A 61 N 1/36, Bulletin No. 14, by Pekarasky et al., entitled, “Gastrointestinal tract Electrostimulator,” which is incorporated herein by reference, describes a swallowable capsule adapted for electrostimulation of the alimentary tract, as post-surgical therapy, as a prophylactic measure of alimentary tract diseases, or for the promotion of peristalsis, which is further adapted for the dispensing of medication.
US Patent Application 2003/0125788 to Long, which is incorporated herein by reference, describes a capsule for introduction into a bodily lumen. The capsule includes a balloon filled with a conductive fluid, or a mechanism for actuating wings supporting electrodes. An umbilicus may attach to the trailing end of the capsule. A control unit controls propulsion of the capsule through the bodily lumen.
US Patent Application 2003/0093031 to Long, which is incorporated herein by reference, describes a drug-delivery system including: a capsule for introduction into a body lumen; an umbilicus attached to the capsule, which is flexible and of sufficient length to extend outside of the body lumen while the capsule is inside of the body lumen: and means for dispensing a medical agent into the lumen through the capsule. The capsule may include first and second electrodes. A channel may extend through the umbilicus to a plurality of weep holes in the capsule to fluidly connect the medical agent from outside the body lumen to the wall of the body lumen.
Methods of tracking ingestible devices, such as radio pills, are described, for example, in the above-mentioned U.S. Pat. No. 5,279,607 to Schentag et al., the above-mentioned U.S. Pat. No. 5,395,366 to D'Andrea et al., and U.S. Pat. No. 6,082,366 to Andrii et al., entitled, “Method and arrangement for determining the position of a marker in an organic cavity,” all of whose disclosures are incorporated herein by reference.
Visual examination of the GI tract by ingestible devices is known. U.S. Pat. No. 5,984,860 to Shan, entitled, “Pass-through duodenal enteroscopic device,” whose disclosure is incorporated herein by reference, describes a tethered ingestible, enteroscopic video camera, which utilizes the natural contraction wave of the small intestine to propel it through the small intestine at about the same speed as any other object therein. The video camera includes an illumination source at its forward end. Covering the camera lens and illumination source is a transparent inflatable balloon, adapted to gently expand the small intestine immediately forward the camera for better viewing. A small diameter communication and power cable unwinds through an aperture in the rear of the camera as it moves through the small intestine. Upon completion of movement through the small intestine the cable is automatically separated, permitting the cable to be withdrawn through the stomach and intestine. The camera continues through the large intestine and passes from the patient through the rectum.
U.S. Pat. No. 5,604,531 to Iddan et al., entitled, “In vivo video camera system,” whose disclosure is incorporated herein by reference, describes a video camera system, encapsulated within an ingestible capsule, arranged to pass through the entire digestive tract, operating as an autonomous video endoscope. The ingestible capsule includes a camera system and an optical system for imaging an area of interest onto the camera system, and a transmitter, which relays the video output of the camera system to an extracorporeal reception system. A light source is located within a borehole of the optical system.
Similarly, US Patent Application 2001/0035902 to Iddan et al., entitled, “Device and system for in vivo imaging,” whose disclosure is incorporated herein by reference, describes a system and method for obtaining in vivo images. The system contains an imaging system and an ultra low power radio frequency transmitter for transmitting signals from a CMOS imaging camera to a receiving system located outside a patient.
Additionally, U.S. Pat. No. 6,428,469 to Iddan et al., entitled, “Energy management of a video capsule,” whose disclosure is incorporated herein by reference, describes an energy saving device for acquiring in vivo images of the gastrointestinal tract. The device, such as an autonomous capsule, includes at least one imaging unit, a control unit connected to the imaging unit, and a power supply connected to the control unit. The control unit includes a switching unit, and an axial motion detector connected to the switching unit, which disconnects the power supply thereby preventing the acquisition of redundant images.
U.S. Pat. No. 6,632,216 to Houzego et al. and US Patent Application Publication 2005/0075559 to Houzego et al., which are incorporated herein by reference, describe an ingestible device for delivering a substance to a chosen location in the GI tract. The device includes a receiver of electromagnetic radiation for powering an openable part of the device to an opened position for dispensing of the substance. The receiver includes a coiled wire that couples the energy field, the wire having an air or ferrite core. The device optionally includes a latch defined by a heating resistor and a fusible restraint. The device may also include a flexible member that may serve one or both the functions of activating a transmitter circuit to indicate dispensing of the substance, and restraining of a piston used for expelling the substance.
PCT Publication WO 02/094369 to Walla, which is incorporated herein by reference, describes a device for applying substances such as medicaments having a liquid, ointment or gel-like consistency through the skin, especially by means of iontophoresis. The resorption of the substance occurs by application of a DC current. The publication also describes a capsular, hermetically sealed container for insertion into body orifices, which has at least two electrodes for generating a continuous electric field on its outer side. A device for receiving the substance to be applied is provided above the electrodes. The container is positioned to be in contact with the mucous membrane and/or the skin in a body orifice, especially in the urogenital, vaginal, and/or anal tract, and/or in the cavities of the mouth, ear, and/or nose.
U.S. Pat. No. 5,217,449 to Yuda et al., which is incorporated herein by reference, describes a capsule having an outer cylinder and a piston movable in the outer cylinder, the piston being activated by an externally given signal so as to discharge a medicine to the outside of the capsule or to suck a humor for a sampling purpose. The capsule has a remote-controllable means including a normally-opened lead switch which connects a power supply to an activating means in response to an externally given magnetic signal thereby initiating activation of the capsule.
U.S. Pat. No. 5,464,395 to Faxon et al., which is incorporated herein by reference, describes a catheter for delivering therapeutic and/or diagnostic agents directly into the tissue surrounding a bodily passageway. The catheter comprises at least one needle cannula able to be projected outboard of the catheter so as to deliver the desired agents to the tissue. The catheter also preferably includes one or more inflatable balloons.
U.S. Pat. No. 5,925,030 to Gross et al., which is incorporated herein by reference, describes an oral drug delivery device having a housing with walls of water permeable material, and having at least two chambers separated by a displaceable membrane. The first chamber receives a drug and has an orifice through which the drug is expelled under pressure. The second chamber contains at least one of two spaced apart electrodes forming part of an electrical circuit which is closed by the ingress of an aqueous ionic solution into the second chamber. When current flows through the circuit, gas is generated and acts on the displaceable membrane to compress the first chamber and expel the active ingredient through the orifice for progressive delivery to the GI tract.
U.S. Pat. No. 4,239,040 to Hosoya et al., which is incorporated herein by reference, describes a capsule for discharging drugs into a body or collecting samples from the body. The capsule comprises an external cylinder having slidably mounted therein an internal cylinder. The internal cylinder is retained by a meltable thread at one end of the external cylinder against the biasing force of a compression spring. Upon melting of the thread, the spring effects sliding of the internal cylinder to the other end of the external cylinder, and, during this sliding movement, a drug is pushed out of the external cylinder ahead of the moving internal cylinder or a body sample is withdrawn into the external cylinder behind the moving internal cylinder. An electric circuit including a tunable receiver responds to an externally-transmitted electric signal to energize a heater for melting the thread to thereby effect sliding movement of the internal cylinder at the desired time.
U.S. Pat. No. 4,425,117 to Hugemann et al., which is incorporated herein by reference, describes a capsule for the release of a substance at a defined or desired location in the alimentary tract. The capsule has a separating wall therein, which forms a first chamber and a second chamber, the first chamber having a hole in a wall thereof. A compression spring, in a compressed state, is affixed to a body located in the second chamber. A needle is mounted on the compression spring facing the separation wall. A resonant circuit in the second chamber is tuned to an electromagnetic field of high frequency. The resonant circuit has a coupling coil, positioned around the body, a capacitor, connected to the other end of the coil and extending away from the first chamber, and a resistance wire, attached to the coupling coil and the capacitor. A fuse wire is connected to the compression spring, extends through the longitudinal passageway of the body and is connected to the body end facing away from the first chamber. The fuse wire contacts the resistance wire. A balloon in the expanded state is positioned in the first chamber. When the device is subjected to an external electromagnetic field having the high frequency to which the resonant circuit is tuned, the fuse wire heats up and breaks. The compressed spring is released pushing the point of the needle through the separating wall and the balloon, which bursts releasing any substance contained in the first chamber.
U.S. Pat. No. 4,507,115 to Kambara et al., which is incorporated herein by reference, describes a capsule that comprises a capsule body having a chamber formed inside and a communicating path for communicating the chamber with outside, a movable member arranged in the chamber and movable between a liquid-receiving position at which the volume of said chamber is made largest and a liquid-pushing position at which the volume of said chamber is made smallest, and a coiled operating member made of shape memory alloy heated by ultrasonic wave to move the movable member to liquid-receiving and—pushing positions selectively.
U.S. Pat. No. 5,951,538 to Joshi et al., which is incorporated herein by reference, describes a controlled delivery device for holding and administering a biologically active agent. The device includes a housing having a first end portion, a second end portion, and a port associated with the housing. Enclosed within the housing is a displacing member, a chemical or electrochemical gas generating cell, and activation and control circuitry. The electrochemical or chemical cell generates gas within the housing, forcing the displacing member against the beneficial agents contained within the housing and forcing the beneficial agents through an outlet port and into a body cavity at a predetermined rate. An anchoring mechanism may be associated with the housing for securing the housing inside the body cavity.
U.S. Pat. Nos. 5,167,626 and 5,170,501 to Casper at al., which are incorporated herein by reference, describe a capsule for releasing a substance at a defined location in the GI tract. The body of the capsule defines one or more apertures in the circumferential wall thereof, and a sleeve valve rotatably positioned therein has one or more corresponding apertures in the circumferential wall thereof. The sleeve valve comprises a coil and electrically connected heatable resistor which are operatively associated with an actuator member formed of a shape memory alloy responsive to heat and which will move from a non-heated first shape to a heated second shape. Actuator stop means are provided in the capsule body for being engaged by the actuator member during movement from the non-heated first shape to the heated second shape so that the actuator member movement serves to rotate the sleeve valve to an open position.
PCT Publication WO 01/45552 to Houzego et al., which is incorporated herein by reference, describes a closure member for a substance reservoir of a site-specific drug delivery capsule (SSDC). The SSDC includes a retainer that provides a non-linear force resisting opening of the closure member. The non-linear force is described as ensuring that the closure member unseals the reservoir only when an opening force exceeds a maximal value of the resisting force, thereby preventing premature or accidental emptying of the reservoir. The preferred means of providing the resistive force is a rolling, elastomeric o-ring that additionally seals the closure member into an aperture.
U.S. Pat. No. 6,344,027 to Goll, which is incorporated herein by reference, describes techniques for delivering and injecting fluid into heart tissue utilizing high pressure injection to increase injectate (fluid) retention in the heart tissue. A catheter is described which includes a shaft having an infusion lumen extending therethrough, wherein the proximal end of the shaft connected to a pressurized fluid source capable of generating a transient pressure of more than 1000 psi. The distal end of the shaft includes a nozzle having an injection port in fluid communication with the infusion lumen such that fluid from the pressurized fluid source may be delivered to the heart tissue at a sufficiently high exit velocity to partially penetrate the heart tissue.
U.S. Pat. No. 6,369,039 to Palasis et al., which is incorporated herein by reference, describes a method for site-specifically delivering a therapeutic agent to a target location within a body cavity, vasculature or tissue. The method comprises: providing a medical device having a substantially saturated solution of therapeutic agent associated therewith; introducing the medical device into the body cavity, vasculature or tissue; releasing a volume of the solution of therapeutic agent from the medical device at the target location at a pressure of from about 0 to about 5 atmospheres for a time of up to about 5 minutes; and withdrawing the medical device from the body cavity, vasculature or tissue. The patent also describes a system for delivering a therapeutic agent to a body cavity, vasculature or tissue, comprising a medical device having a substantially saturated solution of the therapeutic agent associated therewith.
U.S. Pat. No. 5,964,726 to Korenstein et al., which is incorporated herein by reference, describes techniques for introducing molecules and macromolecules into a membrane vesicle, a cell, or a tissue by (a) applying a train of low unipolar or alternating voltage pulses to molecules/macromolecules and cells, (b) increasing the concentration of the molecules/macromolecules at the surface of the cells, leading to an increased interaction of the molecules/macromolecules with the membrane of the cell while also causing electrophoretic movement of charged proteins and lipids in the cell membrane, and (c) causing the destabilization of the cell membrane whereby the molecules/macromolecules penetrate into the cytosol via an endocytic process and via diffusion through structural defects in the membrane lipid bilayer.
PCT Publication WO 02/098501 to Keisari et al., which is incorporated herein by reference, describes a method for treating tumor tissue, including applying to cells of the tumor tissue electrical field pulses having a strength, a repetition frequency, and a pulse width selected capable of inducing endocytosis-mediated cell death, thereby treating the tumor tissue.
U.S. Pat. No. 3,659,600 to Merrill, which is incorporated herein by reference, describes an implantable capsule activated by magnetic force to release a drug. U.S. Pat. Nos. 3,485,235 to Felson, 3,315,660 to Abella, 3,118,439 to Perrenoud, and 3,057,344 to Abella et al., which are incorporated herein by reference, describe capsules for insertion into the GI tract for treatment and/or diagnostic purposes.
U.S. Pat. No. 6,572,740 to Rosenblum et al., which is incorporated herein by reference, describes electrolytic cells comprising (a) the electrolyte K2HPO4, or a less alkaline phosphate buffer solution, (b) electrodes having a modified composition, or (c) a combination of the electrolyte and a modified composition electrode. The K2HPO4 electrolyte, or less alkaline phosphate buffer solution, and modified electrodes can be used in liquid delivery devices which deliver a liquid agent at a constant rate or a controlled variable rate over a period of time.
US Patent Application Publication 2004/0162501 to Imran, which is incorporated herein by reference, describes techniques for mapping, diagnosing and treating conditions of the intestinal tract, using a capsule passing through the intestinal tract. A capsule tracking system is described for tracking a capsule's location along the length of an intestinal tract as various treatment and/or sensing modalities are employed. Treatment modalities described include active or passive drug delivery or gene therapy treatment at specific portions of the tract. Also described is delivery of electrical signals to intestinal tract tissue, for example, to cause a smooth muscle response, i.e., stimulation or inhibition of contraction or peristaltic motion.
U.S. Pat. No. 6,709,388 to Mosse et al., which is incorporated herein by reference, describes a self-propelling device that is adapted to travel through a passage having walls containing contractile tissue, the device comprising a body and at least one contractile tissue-stimulating means for stimulating the walls to urge the device selectively in both a forward direction. The stimulating means may be electrodes, and the passage can be the gut of an animal or human. The device is described as being particularly useful as an enteroscope.
US Patent Application Publication 2005/0158246 to Takizawa et al., which is incorporated herein by reference, describes a capsule medication administration system including: a first capsule for internal body marking; a second capsule for medication; a marking device which makes a marking within a living body; a drug retention section which retains a drug: a release device which releases the drug; a detection device which detects the marking; a decision device which decides whether or not a marking which has been detected by the detection device is a specified marking; and a release control device which operates the release device, if it has been decided by the decision device that it is the specified marking; wherein the first capsule comprises the marking device. The second capsule comprises the drug retention section and the release device.
U.S. Pat. No. 6,951,536 to Yokoi et al., which is incorporated herein by reference, describes a capsule-type medical device including a plurality of hard units and a soft linking unit which links the plurality of hard units, and has a diameter less than that of any of the hard units, wherein one of the plurality of hard units is different in size from other hard units.
U.S. Pat. No. 6,958,034 to Iddan, which is incorporated herein by reference, describes a sensing device including a propulsion system that is typically substantially or completely within the sensing device. The propulsion system may include, for example, a rotatable propeller. The sensing device may be an in-vivo autonomous capsule with an imager.
US Patent Application Publication 2003/0167000 to Mullick et al., which is incorporated herein by reference, describes a miniature ingestible capsule capable of performing multiple therapeutic or diagnostic functions, which are controlled by a combination of an outside control, a pose beacon, and information relayed from an imagining array and transmitter.
U.S. Pat. No. 6,535,764 to Imran et al., which is incorporated herein by reference, describes techniques for diagnosing and treating gastric disorders. A functional device resides within the patient's stomach and is secured to the stomach wall by an attachment device. The functional device may be a sensor for sensing various parameters of the stomach or stomach environment, or may be a therapeutic delivery device. In an embodiment, stimulating electrodes for applying gastric electrical stimulation are secured to the wall of the stomach by the attachment device or otherwise. An endoscopic delivery system delivers the functional device through the esophagus and into the stomach where it is attached the stomach wall. The endoscopic instruments attach or remove the attachment devices and functional devices from the stomach and may be used to assist in determining the optimal attachment location.
Implantable electrodes have been described for controlling GI motility. For example, U.S. Pat. No. 6,327,503 to Familoni, which is incorporated herein by reference, describes techniques for providing on-demand stimulation of the GI tract using an implantable pulse generator is described which may be coupled to the gastric system through one or more medical electrical leads, and U.S. Pat. No. 6,238,423 to Bardy, which is incorporated herein by reference, describes anticonstipation techniques including using an implanted stimulus generator that supplies electrical stimuli to the muscles associated with a target portion of the patient's gut, from the esophagus to the anus, through an electrical lead and several pairs of electrodes.
Chemicals have also been described for controlling GI motility. For example, U.S. Pat. No. 4,987,136 to Kreek et al., which is incorporated herein by reference, describes a method for controlling gastrointestinal dysmotility in humans by administration of opioid antagonists, and U.S. Pat. No. 4,959,485 to Youssefyeh et al., which is incorporated herein by reference, describes certain dibenzofurancarboxamides and their use as 5HT3 antagonists for treating disorders related to impaired gastro-intestinal motility.
US Patent Application Publication 2004/0127942 to Tomtov et al., which is incorporated herein by reference, describes techniques for electrical stimulation of neural tissue and controlled drug delivery to a patient. A device includes an implantable drug delivery module which comprises a plurality of reservoirs, a release system comprising at least one drug contained in each of the reservoirs, and control means for selectively releasing a pharmaceutically effective amount of drug from each reservoir, a neural electrical stimulator which comprises a signal generator connected to at least one stimulation electrode for operable engagement with a neural tissue of the patient, and at least one microcontroller for controlling operational interaction of the drug delivery module and the neural electrical stimulator. The microcontroller may control the signal generator and the control means of the drug delivery module. The device may further include a sensor operable to deliver a signal to the microcontroller, for example to indicate when to deliver electrical stimulation, drug, or both.
An undated research proposal by Cheung E et al., entitled, “Endoscopic microcapsule,” NanoRobotics Lab at Carnegie Mellon University, available at http://www.me.cmu.edu/faculty1/sitti/nano/projects/capsules/, which is incorporated herein by reference, describes a proposal to develop a control system for a micro-capsule for allowing the capsule to attach to the GI tract and to locomote within the digestive system.
An article by Lambert et al., entitled, “Autonomous telemetric capsule to explore the small bowel,” Med Biol Eng Comput 29(2):191-6 (1991), which is incorporated herein by reference, describes an intestinal telemetric capsule developed to study the small bowel in man. It consists of a cylinder (11 mm in diameter and 39 mm in length) containing a location detector, a radiotransmitter, a lithium battery and an interchangeable tip. After having been swallowed by the patient, the capsule passes through the whole gut and is recovered in the stool. During the transit through the small bowel, the information provided by the radiotransmitter allows continuous monitoring of the distance covered from the pylorus, as well as the direction and the velocity of progression. Moreover, according to the type of interchangeable tip, it is possible, by remote control, to sample 0.5 ml of intraluminal fluid for subsequent analysis or to release 1 ml of any liquid substance in a precisely-determined place for pharmacological studies.
Conway B R, in “Drug delivery strategies for the treatment of Helicobacter pylori infections,” Curr Pharm Des 11(6):775-90 (2005), which is incorporated herein by reference, reviews drug delivery strategies for the treatment of H. pylori. He writes, “Drug delivery to the site of residence in the gastric mucosa may improve efficacy of the current and emerging treatments. Gastric retentive delivery systems potentially allow increased penetration of the mucus layer and therefore increased drug concentration at the site of action. Proposed gastric retentive systems for the enhancement of local drug delivery include floating systems, expandable or swellable systems and bioadhesive systems. Generally, problems with these formulations are lack of specificity, limited to mucus turnover or failure to persist in the stomach. Gastric mucoadhesive systems are hailed as a promising technology to address this issue, penetrating the mucus layer and prolonging activity at the mucus-epithelial interface.”
The following articles, which are incorporated herein by reference, may be of interest:
U.S. Pat. No. 6,600,953 to Flesler et al., which is incorporated herein by reference, describes apparatus for treating a condition such as obesity. The apparatus includes a set of one or more electrodes, which are adapted to be applied to one or more respective sites in a vicinity of a body of a stomach of a patient. A control unit is adapted to drive the electrode set to apply to the body of the stomach a signal, configured such that application thereof increases a level of contraction of muscle tissue of the body of the stomach, and decreases a cross-sectional area of a portion of the body of the stomach for a substantially continuous period greater than about 3 seconds. In an embodiment (
U.S. Pat. No. 6,676,657 to Wood, which is incorporated herein by reference, describes techniques for occluding the lumen of a hollow organ by delivering radiofrequency energy to the inner wall of the hollow organ. Radiofrequency electrodes are described that expand, in a deployed condition, to contact the walls of the organ. In some embodiments, the electrodes substantially conform to the inner wall to enhance therapeutic contact. The '657 patent also states that, in addition to occluding lumens of hollow organs, under some clinical circumstances it may be therapeutically desirable to increase lumen diameter, such as to reduce a stricture or stenosis in a bronchus, esophagus, a segment of intestine, or a blood vessel.
In some embodiments of the present invention, an ingestible active drug-delivery system comprises electrical means to enhance the absorption of a drug provided to the gastrointestinal (GI) tract. For some applications, such means includes a device for performing electrotransport of the drug, in order to actively deliver the drug through the wall of the GI tract. Typically, the drug-delivery system comprises a pill-shaped and—sized capsule that comprises the delivery means, and holds the drug until it is released to the GI tract.
Typically, the active driving of the drug through the GI tract wall is accomplished by: (a) driving the drug through the wall by passage of the drug through tight junctions of the epithelial layer of the small intestine, and/or (b) driving the drug through the wall by penetrating the epithelial cells themselves. Typically, a therapeutically-significant portion of the drug is thereby passed into direct contact with the capillary supply of the GI tract, and therefrom into the systemic circulation. It is noted that this embodiment therefore typically allows entry into the bloodstream of drug molecules which would normally be largely excluded (e.g., due to size or chemical properties).
In some embodiments of the present invention, the drug-delivery system comprises an electrical signal generator and at least two electrodes, designed for facilitating electrotransport. For some applications, electrotransport is facilitated by applying a “low intensity time-varying” (LITV) signal, which is to be understood in the present application, including the claims, as including an electrical signal that is selected from the list consisting of:
Alternatively or additionally, the electrotransport includes any one of, or a combination of, iontophoresis, electroosmosis, and electrophoresis, which enhance diffusion processes through the epithelial cells, and/or electroporation. Electroporation is to be understood in the present application, including the claims (notwithstanding any other definitions which may be found in any of the patents, patent applications, or articles incorporated herein by reference), as electrotransport, which, typically using high voltage, creates transient permeable structures or micropores in the epithelial cell membranes, enabling passage of large molecules through the epithelium.
In some embodiments of the present invention, parameters for effecting the electrotransport are selected based at least in part on the particular properties of the drug. Drugs comprising larger molecules typically require stronger stimulation. Alternatively or additionally, the parameters are selected based at least in part on the portion of the GI tract to which the drug is to be delivered. Typically, parameters are selected that apply the lowest amount of energy sufficient to achieve drug passage through the GI tract wall.
In some embodiments of the present invention, the drug-delivery system comprises a mechanism that is operative to be responsive to its environment, such as, for example, a pH-sensitive coating. The coating is typically configured, using techniques known in the art, to dissolve upon entering a small intestine of a patient. In accordance with other embodiments of the present invention, the environmentally-responsive mechanism comprises, for example, a sensor (such as an electronic sensor, and/or a temperature sensor or a pH sensor), a timer, a transmitter/receiver, or a camera.
In some embodiments of the present invention, the dissolving of the coating triggers activation of the driving means, which, in turn, actively drives drug through the wall of the GI tract wall. For some applications, the coating is configured to dissolve in a pH range typical of the small intestine.
In some embodiments of the present invention, the coating is applied at a first thickness over a first portion of the capsule, and at a second thickness over a second portion of the capsule. Alternatively or additionally, different types of coatings are applied to different portions of the capsule, e.g., in order to provide for the respective portions of the capsule to be exposed to the small intestine at different times.
In some embodiments of the present invention, the functionality for activating the driving mechanism, described hereinabove as being provided by a coating, is supplemented or replaced by other activating functionalities. For some applications, the capsule comprises a bio-sensor that detects a biological or physiological parameter, and activates the driving mechanism responsive thereto. As appropriate, the bio-sensor may comprise one or more of the following: an enzymatic sensor, a temperature sensor, a pH sensor, or a timer (the timer typically comprising chemicals that react in a known manner to activate the driving mechanism at a predetermined time following an event such as the patient squeezing the capsule or the patient ingesting the capsule). Alternatively or additionally, the capsule comprises a camera, which records an image of the GI tract for on-board analysis and, if appropriate, activation of the driving mechanism in response to the image.
For some applications, the capsule comprises a transmit/receive unit, adapted to transmit a signal responsive to an image recorded by the camera and/or responsive to a reading by the bio-sensor. The transmitted data are typically analyzed in real-time, and a decision is made (e.g., by a physician or by a computer external to the patient) whether and when to administer drug.
In some embodiments of the present invention, an ingestible, electrically-assisted drug-delivery facilitation system comprises electrical means to enhance the absorption of a drug contained in a commercially-available drug pill that is ingested by a patient in conjunction with ingesting the drug-delivery system, e.g., before, simultaneously with, or after ingesting the system. The system thus serves to enhance absorption of the drug released from the drug pill in the GI tract. In these embodiments, the drug-delivery system does not contain the drug, and is not assembled in an integral unit with the drug.
In some embodiments of the present invention, an ingestible, electrically-assisted drug-delivery facilitation system comprises electrical means to enhance the absorption of a drug contained in a commercially-available drug pill coupled to the system. The pill may be coupled to the system by a manufacturer, the patient, or a healthcare worker, depending, for example, on medical, safety, commercial, or other considerations.
In some embodiments of the present invention, an ingestible, electrically-assisted, drug-delivery or drug-delivery facilitation system is adapted to prolong the period of time during which the system is in the small intestine, in order to prolong a delivery time of a drug in the small intestine. For some applications, the drug is delivered substantially continuously during the prolonged drug-delivery period, while for other applications, the drug is delivered in a pulsatile manner. For some applications, a controlled-release form of the drug is used, the release curve of which is configured to correspond with the prolonged time period that the system and drug are in the small intestine. The resulting longer and flatter release curve often improves the efficacy and/or safety of the drug.
In some embodiments, the drug-delivery system is configured to prolong the drug delivery period by applying an electrical current to the GI tract, and configuring the current to induce local contraction of smooth muscle around the drug-delivery system, thereby reducing (i.e., stopping, slowing, or reversing) movement of the system within the GI tract. As a result, the travel time of the drug-delivery system and/or the dwelling time of the drug in the GI tract is prolonged. The drug-delivery system applies the current using electrodes dedicated for this purpose, or using the electrodes that also apply the LITV signal. Alternatively or additionally, the drug-delivery system is configured to prolong the drug delivery period by using mechanical means to slow the movement of the drug-delivery system in the GI tract. For some applications, the drug-delivery system comprises one or more expandable elements, which are adapted to expand to increase the resistance applied by the wall of the GI tract to the system.
In some embodiments of the present invention, a velocity-reduction element comprises a self-expansible flexible structure that is adapted to be delivered to the GI tract in conjunction with a drug-delivery element. For some applications, the drug-delivery element includes (a) an ingestible, electrically-assisted, drug-delivery system or drug-delivery facilitation system (e.g., as described herein), (b) a conventional drug pill, and/or (c) a slow-release drug reservoir. Once at the appropriate location in the GI tract, the structure expands, and the resulting contact with the GI tract slows the motion of the structure through the GI tract, and thus the motion of the drug-delivery element. Typically, the structure is coupled to the drug-delivery element, or is an integrated component of the drug-delivery element.
For some applications, the structure is delivered to the GI tract in a collapsed form, in a capsule that is configured to dissolve at a certain location in the GI tract, such as in a certain location in the small intestine, using techniques known in the art. The naturally-occurring alignment of the capsule with the GI tract typically serves to properly align the structure with the GI tract.
Typically, the self-expansible structure is adapted to lose its shape a certain period of time after expanding in the GI tract. For example, all or a portion of the structure may comprise a material that dissolves in a controlled manner upon contact with fluids of the GI tract. For some applications, the self-expansible structure comprises three or more rings (e.g., four), joined by at least as many connecting elements. Typically, the elements comprise a solid, slowly-dissolving material, adapted to dissolve in a controlled manner upon contact with fluids of the GI tract. When the elements dissolve, the structure breaks into separate rings, which pass through the GI tract at substantially the normal velocity associated with passage through the GI tract, substantially without further blocking or slowing passage of the drug-delivery system or other materials in the GI tract. The structure is typically foldable for compact storage before it expands in the GI tract. For example, the structure may be folded and stored in a dissolvable capsule.
There is therefore provided, in accordance with an embodiment of the present invention, apparatus for drug administration, including an ingestible capsule, which includes:
a drug, stored by the capsule;
an environmentally-sensitive mechanism, adapted to change a state thereof responsively to a disposition of the capsule within a gastrointestinal (GI) tract of a subject;
first and second electrodes; and
a control component, adapted to facilitate passage of the drug, in response to a change of state of the environmentally-sensitive mechanism, through an epithelial layer of the GI tract by driving the first and second electrodes to apply a series of pulses at a current of less than about 5 mA, at a frequency of between about 12 Hz and about 24 Hz, and with a pulse duration of between about 0.5 milliseconds and about 3 milliseconds.
For some applications, the pulses include monophasic rectangular pulses, and the control component is adapted to drive the first and second electrodes to apply the series of monophasic rectangular pulses.
For some applications, the first and second electrodes include stainless steel.
For some applications, the environmentally-sensitive mechanism includes a sensor adapted to sense an indication of a distance traveled by the capsule in the GI tract, and the environmentally-sensitive mechanism is adapted to undergo the change of state responsive to the distance. Alternatively or additionally, the environmentally-sensitive mechanism includes a camera, adapted to image the GI tract, and the control component is adapted to drive the first and second electrodes to apply the series of pulses in response to an image acquired by the camera.
For some applications, the disposition of the capsule includes a temperature in a vicinity of the capsule, the environmentally-sensitive mechanism includes a temperature sensor, and the control component is adapted to drive the first and second electrodes to apply the series of pulses in response to the temperature sensed by the temperature sensor. Alternatively or additionally, the disposition of the capsule includes a pH in a vicinity of the capsule, the environmentally-sensitive mechanism includes a pH sensor, and the control component is adapted to drive the first and second electrodes to apply the series of pulses in response to the pH sensed by the pH sensor.
For some applications, the environmentally-sensitive mechanism includes a sensor, adapted to sense a characteristic of the GI tract, and the control component is adapted to drive the first and second electrodes to apply the series of pulses in response to the sensed characteristic.
For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses, and to drive an iontophoretic current between the first and second electrodes.
For some applications, the control component is adapted to configure the series of pulses using parameters selected at least in part responsively to the disposition of the capsule within the GI tract. Alternatively or additionally, the control component is adapted to configure the series of pulses using parameters selected at least in part responsively to a property of the drug.
For some applications, the capsule includes a central portion, intermediate the first and second electrodes, a shape of the central portion being such as to reduce current flow within a lumen of the GI tract. For some applications, the capsule includes a central portion, intermediate the first and second electrodes, the central portion having a diameter that is such as to bring the central portion in contact with the epithelial layer of the GI tract, whereby to reduce current flow within a lumen of the GI tract. For some applications, the capsule includes a self-expansible central portion, intermediate the first and second electrodes, the central portion adapted to expand, in response to being in the GI tract, to have a diameter that is such as to bring the central portion in contact with the epithelial layer of the GI tract, whereby to reduce current flow within a lumen of the GI tract. For some applications, the capsule includes a central portion, intermediate the first and second electrodes, an outer surface of the central portion including a hydrophobic material. For some applications, the capsule includes a central portion, intermediate the first and second electrodes, an outer surface of the central portion including a lipophilic material.
For some applications, the environmentally-sensitive mechanism is essentially entirely biodegradable. For some applications, the first and second electrodes and the control component are essentially entirely biodegradable.
For some applications, at least 80% of the mass of the capsule is biodegradable. For some applications, at least 95% of the mass of the capsule is biodegradable. For some applications, essentially the entire capsule is biodegradable.
For some applications, the environmentally-sensitive mechanism includes a coating on a surface of the capsule. For some applications, the coating includes a pH-sensitive coating.
In an embodiment, the control component is adapted to apply the series of pulses at a current of between about 2 mA and about 4 mA. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a current of about 3 mA.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of between about 16 Hz and about 20 Hz. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of about 18 Hz.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of between about 0.5 milliseconds and about 1.5 milliseconds. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of about 1 millisecond.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 1 and about 360 minutes. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 60 and about 240 minutes.
There is also provided, in accordance with an embodiment of the present invention, apparatus for administration of a drug, including an ingestible capsule adapted to store the drug, the capsule including:
an environmentally-sensitive mechanism, adapted to change a state thereof responsively to a disposition of the capsule within a gastrointestinal (GI) tract of a subject;
first and second electrodes; and
a control component, adapted to facilitate passage of the drug, in response to a change of state of the environmentally-sensitive mechanism, through an epithelial layer of the GI tract by driving the first and second electrodes to apply a series of pulses at a current of less than about 5 mA, at a frequency of between about 12 Hz and about 24 Hz, and with a pulse duration of between about 0.5 milliseconds and about 3 milliseconds.
In an embodiment, the control component is adapted to apply the series of pulses at a current of between about 2 mA and about 4 mA. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a current of about 3 mA.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of between about 16 Hz and about 20 Hz. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of about 18 Hz.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of between about 0.5 milliseconds and about 1.5 milliseconds. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of about 1 millisecond.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 1 and about 360 minutes. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 60 and about 240 minutes.
There is further provided, in accordance with an embodiment of the present invention, apparatus for facilitating administration of a drug contained in a pill, the apparatus including an ingestible housing, which is not adapted to contain the drug or to be assembled in an integral unit with the drug, the housing including:
an ingestible environmentally-sensitive mechanism, adapted to change a state thereof responsive to a disposition thereof within a gastrointestinal (GI) tract of a subject;
first and second electrodes; and
a control component, adapted to facilitate passage of the drug, in response to a change of state of the environmentally-sensitive mechanism, through an epithelial layer of the GI tract by driving the first and second electrodes to apply a series of pulses at a current of less than about 5 mA, at a frequency of between about 12 Hz and about 24 Hz, and with a pulse duration of between about 0.5 milliseconds and about 3 milliseconds.
For some applications, the environmentally-sensitive mechanism includes a sensor adapted to sense an indication of a distance traveled by the housing in the GI tract, and the environmentally-sensitive mechanism is adapted to undergo the change of state responsive to the distance.
For some applications, the environmentally-sensitive mechanism includes a camera, adapted to image the GI tract, and the control component is adapted to drive the first and second electrodes to apply the series of pulses in response to an image acquired by the camera.
For some applications, the disposition of the environmentally-sensitive mechanism includes a temperature in a vicinity of the environmentally-sensitive mechanism, the environmentally-sensitive mechanism includes a temperature sensor, and the control component is adapted to drive the first and second electrodes to apply the series of pulses in response to the temperature sensed by the temperature sensor.
For some applications, the disposition of the environmentally-sensitive mechanism includes a pH in a vicinity of the environmentally-sensitive mechanism, the environmentally-sensitive mechanism includes a pH sensor, and the control component is adapted to drive the first and second electrodes to apply the series of pulses in response to the pH sensed by the pH sensor.
For some applications, the environmentally-sensitive mechanism includes a sensor, adapted to sense a characteristic of the GI tract, and the control component is adapted to drive the first and second electrodes to apply the series of pulses in response to the sensed characteristic.
For some applications, the environmentally-sensitive mechanism is adapted to undergo the change of state generally at an expected time of release of the drug from the drug pill.
For some applications, the environmentally-sensitive mechanism includes a coating on a surface of the housing. For some applications, the coating includes a pH-sensitive coating.
In an embodiment, the control component is adapted to apply the series of pulses at a current of between about 2 mA and about 4 mA. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a current of about 3 mA.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of between about 16 Hz and about 20 Hz. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of about 18 Hz.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of between about 0.5 milliseconds and about 1.5 milliseconds. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of about 1 millisecond.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 1 and about 360 minutes. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 60 and about 240 minutes.
There is additionally provided, in accordance with an embodiment of the present invention, apparatus for use with a drug pill, the apparatus including:
a coupling mechanism, adapted to couple the drug pill to the apparatus;
first and second electrodes; and
a control component, adapted to facilitate passage of a drug contained in the drug pill through an epithelial layer of a gastrointestinal (GI) tract of a subject by driving the first and second electrodes to apply a series of pulses at a current of less than about 5 mA, at a frequency of between about 12 Hz and about 24 Hz, and with a pulse duration of between about 0.5 milliseconds and about 3 milliseconds.
For some applications, the drug pill includes a commercially-available drug pill, and the coupling mechanism is adapted to couple the commercially-available drug pill to the apparatus. For some applications, the coupling mechanism includes an adhesive.
For some applications, the coupling mechanism includes at least one of the electrodes. For some applications, the at least one of the electrodes is configured to surround a portion of the drug pill once the drug pill has been coupled to the apparatus.
In an embodiment, the control component is adapted to apply the series of pulses at a current of between about 2 mA and about 4 mA. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a current of about 3 mA.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of between about 16 Hz and about 20 Hz. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of about 18 Hz.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of between about 0.5 milliseconds and about 1.5 milliseconds. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of about 1 millisecond.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 1 and about 360 minutes. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 60 and about 240 minutes.
There is yet additionally provided, in accordance with an embodiment of the present invention, apparatus for facilitating administration of a drug to a subject, the apparatus including:
a sensor unit, which includes:
an ingestible capsule, which includes:
For some applications, the substance includes the drug, and the sensor is adapted to detect the indication of the concentration of the drug in the blood circulation.
For some applications, the substance includes a calibrating substance, the sensor is adapted to detect the indication of the concentration of the calibrating substance in the blood circulation, and the control component is adapted to facilitate the passage of the calibrating substance and the drug through the epithelial layer of the GI tract, responsively to the received indication.
For some applications, the sensor includes a noninvasive external sensor.
Alternatively, the sensor includes an invasive sensor.
For some applications, the ingestible capsule is adapted to store the drug.
Alternatively, the ingestible capsule is not adapted to contain the drug or to be assembled in an integral unit with the drug.
For some applications, the drug is contained in a drug pill, and the ingestible capsule includes a coupling mechanism, adapted to couple the drug pill to the ingestible capsule.
For some applications, the ingestible capsule includes an environmentally-sensitive mechanism, adapted to change a state thereof responsively to a disposition of the capsule within the GI tract, and the control component is adapted to facilitate the passage of the drug through the epithelial layer in response to a change of state of the environmentally-sensitive mechanism.
For some applications, the indication includes respective first and second indications, sensed at respective first and second times, the wireless transmitter is adapted to transmit the first indication subsequent to the first time, and to transmit the second indication subsequent to the second time, and the control component is adapted to drive the first and second electrodes to apply first and second series of pulses, responsive to the first and second indications. For some applications, the sensor unit is adapted to space the first and second times by at least 10 minutes. For some applications, the control component is adapted to regulate a parameter of at least one of the series of pulses, responsive to at least one of the indications.
For some applications, the ingestible capsule includes a capsule wireless transmitter, the sensor unit includes a sensor unit wireless receiver, and the ingestible capsule is adapted to wirelessly notify the sensor unit of a property of the capsule, via the capsule wireless transmitter and the sensor unit wireless receiver. For some applications, the property is selected from the list consisting of: a location of the capsule, a status of the control component, a pH level of the GI tract, and a temperature of the GI tract, and the capsule is adapted to wirelessly notify the sensor of the selected property.
For some applications, the substance includes a chemical, the blood concentration of which is affected by a blood concentration of the drug, and the sensor is adapted to detect the indication of the concentration of the chemical in the blood circulation. For some applications, the chemical is selected from the list consisting of: glucose, growth hormone, and hemoglobin-bound oxygen, and the sensor is adapted to detect the indication of the concentration of the selected chemical in the blood circulation.
In an embodiment, the control component is adapted to apply the series of pulses at a current of between about 2 mA and about 4 mA. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a current of about 3 mA.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of between about 16 Hz and about 20 Hz. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of about 18 Hz.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of between about 0.5 milliseconds and about 1.5 milliseconds. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of about 1 millisecond.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 1 and about 360 minutes. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 60 and about 240 minutes.
There is still additionally provided, in accordance with an embodiment of the present invention, apparatus for facilitating administration of a drug to a subject, the apparatus including:
a sensor unit, which includes:
an ingestible capsule, which includes:
For some applications, the indication includes an indication of blood pressure of the subject, and the sensor is adapted to sense the indication of blood pressure. Alternatively or additionally, the indication includes an indication of a heart-related parameter of the subject, and the sensor is adapted to sense the indication of the heart-related parameter. Further alternatively or additionally, the indication includes an indication of a level of activity of the subject, and the sensor is adapted to sense the indication of the level of activity.
For some applications, the indication includes an indication of a temperature of the subject, and the sensor is adapted to sense the indication of the temperature. Alternatively or additionally, the indication includes an indication of a circadian cycle of the subject, and the sensor includes clock circuitry adapted to sense the indication of the circadian cycle.
In an embodiment, the control component is adapted to apply the series of pulses at a current of between about 2 mA and about 4 mA. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a current of about 3 mA.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of between about 16 Hz and about 20 Hz. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of about 18 Hz.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of between about 0.5 milliseconds and about 1.5 milliseconds. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of about 1 millisecond.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 1 and about 360 minutes. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 60 and about 240 minutes.
There is still further provided, in accordance with an embodiment of the present invention, apparatus for facilitating administration of a drug to a subject, the apparatus including:
first and second electrodes; and
a control component, adapted to facilitate passage of the drug through an epithelial layer of a gastrointestinal (GI) tract of the subject by driving the first and second electrodes to apply a series of pulses at a current of less than about 5 mA, at a frequency of between about 12 Hz and about 24 Hz, and with a pulse duration of between about 0.5 milliseconds and about 3 milliseconds.
In an embodiment, the control component is adapted to apply the series of pulses at a current of between about 2 mA and about 4 mA. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a current of about 3 mA.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of between about 16 Hz and about 20 Hz. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses at a frequency of about 18 Hz.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of between about 0.5 milliseconds and about 1.5 milliseconds. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses with a pulse duration of about 1 millisecond.
In an embodiment, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 1 and about 360 minutes. For some applications, the control component is adapted to drive the first and second electrodes to apply the series of pulses for a period of between about 60 and about 240 minutes.
There is also provided, in accordance with an embodiment of the present invention, a method for administration of a drug, including:
administering to a subject an ingestible capsule that includes the drug;
detecting a disposition of the capsule within a gastrointestinal (GI) tract of the subject; and
in response to detecting the disposition, facilitating, by the capsule, passage of the drug through an epithelial layer of the GI tract, by applying a series of pulses at a current of less than about 5 mA, at a frequency of between about 12 Hz and about 24 Hz, and with a pulse duration of between about 0.5 milliseconds and about 3 milliseconds.
There is further provided, in accordance with an embodiment of the present invention, a method for administration of a drug contained in a pill, including:
orally administering the pill to a subject;
orally administering to the subject an ingestible capsule that does not include the drug;
detecting a target location of the capsule within a gastrointestinal (GI) tract of the subject; and
in response to detecting the target location, facilitating, by the capsule, passage of the drug through an epithelial layer of the GI tract, by applying a series of pulses at a current of less than about 5 mA, at a frequency of between about 12 Hz and about 24 Hz, and with a pulse duration of between about 0.5 milliseconds and about 3 milliseconds.
There is still further provided, in accordance with an embodiment of the present invention, a method for administration of a drug, including:
coupling, to an ingestible capsule, a drug pill containing the drug;
administering the capsule to a subject;
detecting a target location of the capsule within a gastrointestinal (GI) tract of the subject; and
in response to detecting the target location, facilitating, by the capsule, passage of the drug through an epithelial layer of the GI tract, by applying a series of pulses at a current of less than about 5 mA, at a frequency of between about 12 Hz and about 24 Hz, and with a pulse duration of between about 0.5 milliseconds and about 3 milliseconds.
There is additionally provided, in accordance with an embodiment of the present invention, a method for facilitating administration of a drug to a subject, the method including:
administering an ingestible capsule to the subject;
detecting an indication of a concentration of a substance in a blood circulation of the subject;
wirelessly transmitting the indication;
receiving the indication at the ingestible capsule; and
responsively to the received indication, facilitating, by the capsule, passage of the drug through an epithelial layer of a gastrointestinal (GI) tract of the subject, by applying a series of pulses at a current of less than about 5 mA, at a frequency of between about 12 Hz and about 24 Hz, and with a pulse duration of between about 0.5 milliseconds and about 3 milliseconds.
There is yet additionally provided, in accordance with an embodiment of the present invention, a method for facilitating administration of a drug to a subject, the method including:
administering an ingestible capsule to the subject;
detecting an indication of a physiological parameter of the subject;
wirelessly transmitting the indication;
receiving the indication at the ingestible capsule; and
responsively to the received indication, facilitating, by the capsule, passage of the drug through an epithelial layer of a gastrointestinal (GI) tract of the subject, by applying a series of pulses at a current of less than about 5 mA, at a frequency of between about 12 Hz and about 24 Hz, and with a pulse duration of between about 0.5 milliseconds and about 3 milliseconds.
For some applications, the indication includes an indication of a circadian cycle of the subject, and detecting the indication includes detecting the indication of the circadian cycle. For some applications, the drug includes an antithrombotic drug, and facilitating the passage of the drug includes facilitating the passage of the antithrombotic drug through the epithelial layer.
For some applications, the indication includes an indication of a temperature of the subject, and detecting the indication includes detecting the indication of the temperature. For some applications, the drug includes an antibiotic, and facilitating the passage of the drug includes facilitating the passage of the antibiotic through the epithelial layer.
There is also provided, in accordance with an embodiment of the present invention, a method for administration of a drug, including:
administering the drug to a gastrointestinal (GI) tract of a subject; and
facilitating passage of the drug through an epithelial layer of the GI tract by applying a series of pulses at a current of less than about 5 mA, at a frequency of between about 12 Hz and about 24 Hz, and with a pulse duration of between about 0.5 milliseconds and about 3 milliseconds.
There is further provided, in accordance with an embodiment of the present invention, apparatus for drug administration, including an ingestible capsule, which includes:
a drug, stored by the capsule;
an environmentally-sensitive mechanism, adapted to change a state thereof responsively to a disposition of the capsule within a gastrointestinal (GI) tract of a subject;
one or more drug-passage facilitation electrodes;
a control component, adapted to facilitate passage of the drug, in response to a change of state of the environmentally-sensitive mechanism, by driving the drug-passage facilitation electrodes to apply an electrical current; and
a velocity-reduction element adapted to reduce a velocity of the capsule through the GI tract for at least a portion of the time that the control component is facilitating the passage of the drug.
For some applications, the velocity-reduction element includes one or more velocity-reduction electrodes, and the control component is adapted to drive the velocity-reduction electrodes to apply an electrical current to the GI tract capable of inducing local contraction of smooth muscle around the drug-delivery system, thereby reducing movement of the capsule within the GI tract, so as to reduce the velocity. For some applications, the velocity-reduction electrodes include the drug-passage facilitation electrodes. Alternatively or additionally, the velocity-reduction element includes one or more expandable elements, adapted to expand so as to reduce the velocity.
There is additionally provided, in accordance with an embodiment of the present invention, apparatus for drug administration, including:
an ingestible drug-delivery element, adapted to store and release a drug; and
a velocity-reduction element adapted to reduce a velocity of the drug-delivery element through a gastrointestinal (GI) tract of a subject for at least a portion of the time that the drug-delivery element is releasing the drug.
There is yet additionally provided, in accordance with an embodiment of the present invention, apparatus for use in conjunction with a drug delivered to a gastrointestinal (GI) tract of a subject, the apparatus including an ingestible capsule, adapted to induce vasoconstriction of blood vessels of the subject in the GI tract in a vicinity of the drug.
For some applications, the capsule is adapted to store a chemical, and to release the chemical to induce the vasoconstriction. Alternatively or additionally, the capsule includes one or more vasoconstriction-inducing electrodes, adapted to apply an electrical current to the GI tract capable of inducing the vasoconstriction. Further alternatively or additionally, the capsule includes one or more vasoconstriction-inducing mechanical actuators, adapted to apply one or more mechanical forces to the GI tract capable of inducing the vasoconstriction.
In an embodiment, the capsule is adapted to store and release the drug.
In an embodiment, the apparatus includes one or more drug-passage facilitation electrodes, and a control component, adapted to facilitate passage of the drug by driving the drug-passage facilitation electrodes to apply an electrical current.
There is still additionally provided, in accordance with an embodiment of the present invention, apparatus for use in a gastrointestinal (GI) tract of a subject, the apparatus including an ingestible capsule, adapted to induce vasoconstriction of GI tract blood vessels of the subject to a greater extent than any induction of vasoconstriction of non-GI-tract blood vessels by the capsule.
In an embodiment, the capsule includes a drug. Alternatively, the capsule does not include a drug.
For some applications, the apparatus includes a plurality of the ingestible capsules and the capsules are adapted to induce the vasoconstriction of the GI tract blood vessels to a sufficient extent that ingestion by the subject of at least one of the capsules per day induces weight loss of the subject, due to the vasoconstriction, of at least 1 kg per week.
For some applications, the capsule is adapted to store a chemical, and to release the chemical to induce the vasoconstriction. Alternatively or additionally, the capsule includes one or more vasoconstriction-inducing electrodes, adapted to apply an electrical current to the GI tract capable of inducing the vasoconstriction. Further alternatively or additionally, the capsule includes one or more vasoconstriction-inducing mechanical actuators, adapted to apply one or more mechanical forces to the GI tract capable of inducing the vasoconstriction.
There is still further provided, in accordance with an embodiment of the present invention, apparatus for use in conjunction with a drug delivered to a gastrointestinal (GI) tract of a subject, the apparatus including an ingestible capsule, which includes:
one or more electrodes; and
a control component, adapted to drive the electrodes to apply an electrical current that induces local delivery of the drug in target tissue of the GI tract.
In an embodiment, the capsule includes an environmentally-sensitive mechanism, adapted to change a state thereof responsive to a disposition of the capsule at a site within the GI tract, and the control component is adapted to drive the electrodes in response to the change of state.
For some applications, the capsule includes a velocity-reduction element adapted to reduce a velocity of the capsule through the GI tract for at least a portion of the time that the control component is driving the electrodes.
For some applications, the drug includes an anti-inflammatory drug, and the control component is adapted to drive the electrodes to apply the current that induces the local delivery of the anti-inflammatory drug. Alternatively or additionally, the drug includes a chemotherapy agent, and the control component is adapted to drive the electrodes to apply the current that induces the local delivery of the chemotherapy agent. Further alternatively or additionally, the drug includes an anti-bacterial agent, and the control component is adapted to drive the electrodes to apply the current that induces the local delivery of the anti-bacterial agent.
For some applications, the target tissue includes a mucosal layer of the small intestine, and the control component is adapted to drive the electrodes to apply the current that induces the local delivery of the drug in the mucosal layer. Alternatively or additionally, the target tissue includes a submucosal layer of the small intestine, and the control component is adapted to drive the electrodes to apply the current that induces the local delivery of the drug in the submucosal layer. Further alternatively or additionally, the target tissue includes a muscular layer of the small intestine, and the control component is adapted to drive the electrodes to apply the current that induces the local delivery of the drug in the muscular layer.
In an embodiment, the capsule is adapted to store and release the drug.
For some applications, the capsule is adapted to induce vasoconstriction of blood vessels of the subject in the GI tract in a vicinity of the drug.
In an embodiment, at least one interelectrode distance between the one or more electrodes is sufficiently small so as to induce the local delivery of the drug. For example, the at least one interelectrode distance may be less than 5 mm, e.g., less than 3 mm.
In an embodiment, the control component is configured to drive the electrodes to apply a low intensity time-varying (LITV) signal having an amplitude sufficiently low so as to induce the local delivery of the drug. For example, the control component may be configured to set the amplitude of the LITV signal to be less than 0.8 mA.
In an embodiment, the control component is configured to drive the electrodes to apply an LITV signal with a duty cycle having (a) “on” period durations sufficient to enable the drug to penetrate tight junctions and enter an upper epithelial layer of the GI tract, but insufficient to transport the drug into deeper layers and blood vessels, and (b) “off” period durations sufficient to enable the drug to reach the target tissue. For example, the control component may be configured to set each of the “on” periods to have a duration of between 0.5 and 2 seconds, and each of the “off” periods to have a duration of between 5 and 20 seconds.
There is also provided, in accordance with an embodiment of the present invention, apparatus including an ingestible capsule, which includes:
first and second drugs, stored by the capsule;
one or more electrodes; and
a control component, adapted to:
drive a first set of two or more of the electrodes to apply a first electrical current that induces systemic delivery of the first drug, and
drive a second set of two or more of the electrodes to apply a second electrical current that induces local delivery of the second drug in target tissue of a gastrointestinal (GI) tract of the subject.
For some applications, the first and second sets of electrodes include at least one common electrode.
For some applications, at least one interelectrode distance between the two or more electrodes of the second set is sufficiently small so as to induce the local delivery of the drug. Alternatively or additionally, the control component is configured to drive the second set of electrodes to apply a low intensity time-varying (LITV) signal having an amplitude sufficiently low so as to induce the local delivery of the drug. Further alternatively or additionally, the control component is configured to drive the second set of electrodes to apply an LITV signal with a duty cycle having (a) “on” period durations sufficient to enable the drug to penetrate tight junctions and enter an upper epithelial layer of the GI tract, but insufficient to transport the drug into deeper layers and blood vessels, and (b) “off” period durations sufficient to enable the drug to reach the target tissue.
For some applications, the capsule is adapted to induce vasoconstriction of blood vessels of the subject in the GI tract in a vicinity of the second drug.
In an embodiment, the first drug includes a systemic antibiotic for treating an infection of the GI tract, and the second drug includes an agent for topical treatment of the infection. For some applications, the infection includes an infection by Helicobacter pylori, the systemic antibiotic includes a systemic antibiotic for treating the H. pylori infection, and the agent for topical treatment includes an agent for topical treatment of the H. pylori infection.
There is further provided, in accordance with an embodiment of the present invention, apparatus including an ingestible capsule, which includes:
a drug, stored by the capsule;
one or more electrodes;
an environmentally-sensitive mechanism, adapted to change a first state thereof responsive to a disposition of the capsule at a first segment within a gastrointestinal (GI) tract of a subject, and a second state thereof responsive to a disposition of the capsule at a second segment within the GI tract; and
a control component, adapted to:
in response to the change of the first state, drive the electrodes, for a first period of time, to apply a current that facilitates passage of the drug in the first segment, and
in response to the change of the second state, drive the electrodes, for a second period of time, to apply a current that facilitates passage of the drug in the second segment.
For some applications, the control component is adapted to, during at least one of the first and second periods of time, configure the current to induce local delivery of the drug in target tissue of the GI tract.
For some applications, the capsule is adapted to, during at least one of the first and second periods of time, induce vasoconstriction of blood vessels of the subject in the GI tract in a vicinity of the drug.
For some applications, the drug includes a drug for treatment of gastric ulcers.
Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, suitable methods and materials are described below. In case of conflict, the patent specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting.
The invention is herein described, by way of example only, with reference to the accompanying drawings. With specific reference now to the drawings in detail, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of embodiments of the present invention only, and are presented in the cause of providing what is believed to be the most useful and readily understood description of the principles and conceptual aspects of the invention. In this regard, no attempt is made to show structural details of the invention in more detail than is necessary for a fundamental understanding of the invention, the description taken with the drawings making apparent to those skilled in the art how the several forms of the invention may be embodied in practice.
In the drawings:
Some embodiments of the present invention comprise a typically ingestible, electrically-assisted, drug-delivery system. Specifically, these embodiments of the present invention act as a medication carrier, which utilizes electrically-induced means to enhance the absorption of the medication through the gastrointestinal (GI) tract walls.
The principles and operation of the typically ingestible, electrically-assisted, drug-delivery system, according to these embodiments of the present invention, may be better understood with reference to the drawings and accompanying descriptions.
Before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and the arrangement of the components set forth in the following description or illustrated in the drawings. The invention is capable of other embodiments or of being practiced or carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein is for the purpose of description and should not be regarded as limiting.
Referring now to the drawings,
For some applications, apparatus 17 comprises an electrical signal generator 15 and at least two electrodes 16, designed for electrotransport. Alternatively, four or more electrodes 16 may be provided. Apparatus 17 may be designed, for example, as an electrotransport device, as described in any one, or a combination of, U.S. Pat. No. 5,674,196, to Donaldson et al., U.S. Pat. No. 5,961,482 to Chien et al., U.S. Pat. No. 5,983,131 to Weaver et al., U.S. Pat. No. 5,983,134 to Ostrow, and U.S. Pat. No. 6,477,410 to Henley et al., all of which are incorporated herein by reference. For some applications, electrodes 16 comprise stainless steel type 316S leads. Alternatively, the electrodes comprise other materials. For some applications, electrodes 16 have a surface area of between about 1 and about 100 mm2, such as between about 10 and about 50 mm2, e.g., 36 mm2 or 42 mm2.
Additionally or alternatively, apparatus 17 is designed for performing sonophoresis, or for performing a combination of sonophoresis and electrotransport, and comprises at least one ultrasound transducer 22. Apparatus 17 may be designed, for example, as a sonophoresis device, as described in any one, or a combination of, U.S. Pat. Nos. 6,002,961, 6,018,678, and 6,002,961 to Mitragotri et al., U.S. Pat. Nos. 6,190,315 and 6,041,253 to Kost et al., U.S. Pat. No. 5,947,921 to Johnson et al., and U.S. Pat. Nos. 6,491,657 and 6,234,990 to Rowe et al., all of which are incorporated herein by reference.
Additionally or alternatively, apparatus 17 is designed for performing ablation, or for performing a combination of ablation and electrotransport, ablation and sonophoresis, or ablation, electrotransport, and sonophoresis, and comprises at least one ablation apparatus 24. The ablation process may be, for example, any one of, or a combination of, laser ablation, cryogenic ablation, thermal ablation, microwave ablation, radiofrequency (RF) ablation, electrical ablation, and liquid jet ablation. Apparatus 17 may be designed, for example, as an ablation device, as described in any one, or a combination of, U.S. Pat. No. 6,471,696, to Berube et al. (which describes a microwave ablation catheter that may be used as a drug delivery device), U.S. Pat. No. 6,443,945 to Marchitto et al. (which describes a devices for pharmaceutical delivery using laser ablation), U.S. Pat. No. 4,869,248 to Narula (which describes a catheter for performing localized thermal ablation for drug administration), and U.S. Pat. Nos. 6,148,232 and 5,983,135 to Avrahami (which describe drug delivery systems using electrical ablation). All of these patents are incorporated herein by reference.
In accordance with some embodiments of the present invention, device 10 further comprises at least one sensor 18. Sensor 18 may be, for example, a physical sensor, such as a temperature sensor or a pressure sensor. Alternatively, sensor 18 may be a chemical sensor, such as a pH sensor or a drug-concentration sensor. Alternatively, sensor 18 may be a biological sensor, such as a glucose sensor or a bacterial-count sensor. For some applications, more than one sensor 15 is used. These may be of the same type or of different types.
In accordance with some embodiments of the present invention, device 10 further comprises a telemetry system 20, operative, for example, by RF, infrared radiation, or by ultrasound, for providing communication with an extracorporeal station 21, for example, a remote control. Alternatively or additionally, extracorporeal station 21 comprises a computer system. Alternatively or additionally, telemetry system 20 comprises a power transducer (such as a coil or a piezoelectric transducer), as is known in the art, adapted to receive electromagnetic radiation or ultrasonic energy, as appropriate, transmitted by extracorporeal station 21, and to transduce the radiation into a current for powering the operation of drug-delivery device 10. As appropriate, the power transducer may replace power supply 12, or supplement its operation.
In accordance with some embodiments of the present invention, device 10 further comprises at least one electronic valve 26 for dispensing medication, for example, responsive to input from sensor 18.
Reference is now made to
In the embodiment shown in
System 30 further comprises a drug 36, attached to device 10 and enclosed by a sheath 34, which encapsulates both device 10 and drug 36. Alternatively, sheath 34 encapsulates only drug 36. Drug 36 is held in drug-dispensing cavities 23, which typically are formed at two ends of system 30, or at one end. Sheath 34 typically comprises a biologically compatible, biologically inert polymeric material, such as cellulose acetate or ethyl cellulose, that allows diffusion of drug 36 to the GI tract. Alternatively, sheath 34 is formed of a mixture of water-soluble particles in a water-insoluble matrix, such as polyvinyl acetate, or acrylic acid copolymers, so that the water soluble particles dissolve in the GI tract, leaving micropores in matrix, and drug 36 diffuses through the micropores. Alternatively, sheath 34 is formed of biologically-degradable material, which degrades when in contact with water, or at a specific pH value, so as to release drug 36 to the GI tract, where drug 36 travels with device 10 until the drug is absorbed. For example, the biologically-degradable material may comprise hydroxypropylcellulose or glycerol behenate. As system 30 travels in the GI tract, electrodes 16 of device 10 provide for electrotransport, which enhances absorption across the intestinal epithelium.
In accordance with some embodiments of the present invention, the electrotransport may include any one of, or a combination of, iontophoresis, electroosmosis, and electrophoresis, which enhance diffusion processes through the epithelial cells, and, for some applications, additionally electroporation, which, typically using high voltage, creates transient permeable structures or micropores in the epithelial cell membranes, enabling passage of large molecules through the epithelium.
In accordance with some embodiments of the present invention, the electrotransport is facilitated by applying a “low intensity time-varying” (LITV) signal, as defined hereinabove.
For some applications, appropriate electrostimulation parameters may include a DC voltage of up to 3 volts, or square pulses of up to 3 volts at a low frequency of 1-50 Hz. These parameters are typically appropriate for iontophoresis. Alternatively, the parameters may include an AC voltage of between about 3 and about 50 Volts, at a frequency of between about 1 and about 300 Hz. These parameters are typically appropriate for electroporation. Further alternatively, such as for applying a LITV signal, the electrostimulation may be applied as a series of pulses, with parameters including (a) a current of less than about 5 mA, (b) a frequency of between about 1 and about 10 Hz, or between about 10 and about 100 Hz, (c) a pulse duration of between about 0.1 and about 1 millisecond, or between about 1 and about 10 milliseconds, and (d) a stimulation period of between about 1 and about 15 minutes, or between about 15 and about 120 minutes. The pulses may be monophasic or biphasic. The LITV signal is typically sufficiently weak so as not to cause local activation of smooth muscle, which may interfere with normally-occurring peristaltic movement. Application of a current of less than about 5 mA typically results in a voltage of between about 0.1 and about 8 Volts/cm (e.g., between about 0.5 and about 5 Volts/cm), depending upon the surface area of the electrodes, the portion of the GI tract to which drug 36 is to be delivered, the content of the GI tract, the individual physiology of the patient (e.g., of the patient's GI wall tissue), and other factors.
For some applications, the LITV signal is applied in a low-frequency train of high-frequency bursts. Typically, the train has a repetition frequency of between about 6 and about 30 Hz, i.e., between about 6 and about 30 bursts are applied per second. Each burst typically includes between 1 and about 4 pulses, with a delay of about 4 to about 8 milliseconds between the start of each successive pulse (i.e., a frequency of pulses within a burst of between about 125 and 250 Hz). Each pulse typically has a duration of between about 0.1 and about 2 milliseconds.
For some applications, a DC or low-frequency square-pulse voltage and an AC voltage are superimposed, in order to facilitate a combination of two or more electrotransport processes.
It will be appreciated that signals of other shapes and (or) duty cycles may similarly be used. Furthermore, the aforementioned parameters are provided as examples; in accordance with embodiments of the present invention, other parameters, which may be higher or lower, may be used.
It will be appreciated that, in general, electrotransport parameters appropriate for the transport of drugs across the epithelial cells of the GI tract are lower than parameters appropriate for transdermal drug transport, as the GI tract lacks the stratum corneum barrier found in the skin.
In an embodiment of the present invention, the stimulation parameters are selected based at least in part on:
For some applications, parameters are selected that apply the lowest amount of energy sufficient to achieve drug passage through the GI tract wall. The use of higher energy levels may in some cases increase the possibility of local irritation of the epithelial tissue (although actual damage to the tissue is unlikely even at the higher end of the range of energies used). In addition, lower energy levels may enable a longer stimulation period and increased drug absorption. Such increased drug absorption may allow a lower dosage of the drug, which may reduce the cost of the drug and/or the size of drug-delivery system 30 for some applications.
Alternatively, for other applications, parameters are selected that apply greater than this lowest amount of energy.
Reference is now made to
For some applications, device 10 comprises a central portion 33a comprising a self-expansible portion, disposed between self-expansible portions 33 that have electrodes 16 thereon. Typically, portion 33a is adapted to expand until it contacts the inner wall of the gastrointestinal tract. Thus, portion 33a is typically able to expand to at least the same diameter as self-expansible portions 33, and thereby inhibit current flow in the fluid of the lumen of the gastrointestinal tract, and (for constant voltage) facilitate higher current flow in the tissue of the gastrointestinal tract itself. As appropriate, similar central self-expansible portions may be integrated into the embodiments of the invention described with reference to one or more of the other figures of the present patent application.
Alternatively, portion 33a does not comprise a self-expansible portion, but is instead in the state shown by the dashed lines in
For some applications, an outer surface of portion 33a comprises a hydrophobic and/or lipophilic material, to minimize the extent to which current flowing between electrodes 16 passes within the gastrointestinal tract lumen itself. In an embodiment, portion 33a comprises the hydrophobic and/or lipophilic material, and has a smaller diameter than self-expansible portions 33.
Alternatively, sheath 34 of drug 36 may be formed as cellulose acetate combined with polyethylene glycol (PEG). After ingestion the PEG dissolves, leaving the drug 36 coated with a semi-permeable membrane that controls the release of the drug by osmotic mechanism. Osmognate additives, such as NaCl, added to the drug core, and/or perforation of the sheath 34, may contribute to better controlling the release patterns (osmognates are materials, usually salts, with high solubility and the ability to create high osmotic pressure, to attract water).
For other applications, the pH value is selected to be in the range commonly found in the stomach, e.g., between about 1.2 and about 3.5, such that film 46A dissolves in the stomach, releasing at least a portion 36A of drug 36. Optionally, system 30 comprises a second film 46B, which dissolves at a pH characteristic of a more distal portion of the GI tract, such as the small intestine, releasing a second portion 36B of drug 36 therein. Further optionally, system 30 comprises a third film 46C, which dissolves at a pH characteristic of a still more distal portion of the GI tract, such as the large intestine (e.g., a pH value of between about 7.5 and about 8.0 for the large intestine), thereby releasing a third portion 36C of drug 36. In this manner, specific drug portions, or even different drugs 36A, 36B, and 36C may be targeted to different portions of the GI tract. Alternatively or additionally, the pH values are selected to release a first portion of drug 36 in the small intestine, and a second portion in the large intestine.
Typically, RF ablation parameters include frequencies of about 50 to about 150 kHz, and potentials of about 3-100 volts. These parameters are provided as examples; in accordance with embodiments of the present invention, other parameters, which may be higher or lower, may be used.
Alternatively, ablation apparatus 24 performs microwave ablation, laser ablation, cryogenic ablation, thermal ablation, or liquid jet ablation.
When the half-life of a drug is less than desired, a controlled release dosage form may be designed, to reduce fluctuation in plasma drug concentration and to provide a more uniform therapeutic effect. Oral controlled-release forms are often designed to maintain therapeutic drug concentrations for at least 12 hours. Several controlled release mechanisms may be used, for example, as taught by Encyclopedia of Controlled Drug Delivery, volume 2, edited by Edith Mathiowitz, pp. 838-841. These are based on the use of specific substances, generally polymers, as a matrix or as a coating. These may be materials that degrade fast or slowly, depending on the desired effect.
In accordance with embodiments of the present invention, drug 36 is released in a controlled manner, using one or more of the following techniques:
Alternatively or additionally, other controlled release means known in the art are used.
As appropriate, some or all portions of the capsule are configured to be biodegraded by bacteria in the patient's colon.
It will be appreciated that in accordance with embodiments of the present invention drug release may take any of the following options: controlled release, delayed release, pulsatile release, chronotherapeutic release, immediate release, enterocoated release (activation starts at the small intestine, and the pH-dependent coating protects from the gastric acidic environment). The dosage forms may be chronotherapeutic (adaptation to the circadian rhythm) or colonic delivery type, based on multiple coatings system. The drug may be formed as a capsule of hard gelatin, as compressed powder, or as any other alternative known in the art, for example, hydroxypropyl methylcellulose (HPMC).
When the drug is a peptide formulation or a protein drug, functional additives may be used in order to enable oral delivery. Typical entities are: protease inhibitors, stabilizers, absorption enhancers, and PGP inhibitors, such as verapamil or quinidine.
Additionally, various additives may be used with drug 36. These may include protease inhibitors, which shield against luminal brush, border peptidases, such as Trypsin inhibitor, Chemostatin, Bowman Birk Inhibitor, Aprotinin, SBTI, and polycarbophyl.
Additionally, absorption enhancers, such as NSAIDs, decanoic acid, sodium salicylate, SLS, quaternary ammonium salts, Bile salts-na-cholate, octanoic acid, glycerides, saponins, and/or medium chain fatty acids may be used.
It will be appreciated that in many cases chemical enhancers interact with peptides and proteins. An advantage of some embodiments of the present invention is the ability to circumvent this interaction, by using electrically assisted absorption, in place of chemical enhancers.
Additionally, stabilizers, such as proteins, sugars, polyols, amino acids, inorganic salts, and/or surfactants, may be used.
Furthermore, other pharmaceutically adjuvant for peptides such as buffering agents and/or antioxidants may be used.
Suitable polymers for matrix formation for controlled or slowed release of oral drugs include Acrylates, acrylic acid copolymers, Eudragit, RL/RS type, cellulose derivatives like ethyl cellulose, HPMC, carboxymethylcellulose, carbomers, cellulose acetate. PVA, gums, and any other pharmaceutically acceptable polymers.
In addition to polymers, certain types of lipids may serve as matrix formers as well, for example, glycerol behenate, or glycerol monostearate.
It will be appreciated that the matrix forming polymers may be filled into capsules or compressed into tablets.
Suitable polymers for functional coatings of oral drugs for controlled or slowed drug release include Ethocel (ethyl cellulose), HPMC, Kollicoat (PVA, PVP combinations), CA esters, Eudragits, and enteric coating (pH-dependent) type polymers (Eudragit L,S, CAP, HPMCP, etc.). In addition, acceptable pharmaceutical fillers like MCC, lactose, and ca-phosphate may be used as well.
These coatings may be applied to both tablets and capsules.
It will be appreciated that the type of coating will be determined according to the drug and the desired release profile, such as slow release, enteric (mainly for peptide type), chronotherapeutic, colonic, osmotic, etc.
It will be further appreciated that the coating may be additional to matrix-based dosage forms, either for tablets or for capsules.
Drug candidates for some embodiments of the present invention include peptides, proteins, macromolecules, hormones, polar compounds, and poorly soluble compounds.
Some examples of drugs that may be used as drug 36, in accordance with embodiments of the present invention, include Interleukin 2, TGF-Beta 3, heparin, erythropoietin, cyclosporin, anticancer drugs, viral and non viral vectors for gene delivery, TNF, somatropin, interferones, copaxone, recombinant proteins, immune system modulators, monoclonal antibodies (Herceptin), vaccines, filgastrin, somatostatin, insulins, LHRH antagonists and analogs (Decapeptide, Leuprolide, Goseralin, calcitonin, triptorelin, oxytocin, and sandostatin.
Additionally, small molecule drugs, such as statins, immunosuppressants (e.g., sirolimus, tacrolimus), galantanine, celebrex, and other poorly soluble drugs, or drugs of low availability, may be used. These drugs may be Cox 2 inhibitors, CNS drugs, antibiotics, and any others that require improvement in their oral bioavailability.
Additionally, other known drugs of poor absorption may be used.
Reference is now made to the following examples, which together with the above descriptions illustrate embodiments of the invention in a non-limiting fashion.
An electrically assisted, drug-delivery device 10.
Active drug: Insulin.
Filler: microcrystalline cellulose, lactose.
Protease inhibitor: chemostatin, trypsin inhibitor.
The components are mixed and compressed into tablets. An enterocoat is applied to protect from gastric environment. Eudragit L may be used.
Similar to Example 1, but additionally including an absorption enhancer, such as decanoic acid.
Capsule for oral delivery of copaxone, prepared as in Example 1. The components are dry-mixed and filled into capsules, which are coated with an enterocoat polymer like HPMCP.
A tablet for controlled release of cyclosporin.
Both device 10 and HPMC and the drug substance are mixed together, and compressed into tablets (See
An osmotic device. The tablet of Example 4 may be coated with cellulose acetate combined with PEG. After ingestion the PEG dissolves, leaving the tablet coated with a semi-permeable membrane that controls the release of the drug by an osmotic mechanism. Osmognate additives (defined hereinabove), such as NaCl, are added to the drug core, and perforation of the coating may contribute to better controlling the release patterns.
It will be appreciated that any known combination of drug-polymer, dosage form is acceptable, in accordance with embodiments of the present invention.
In accordance with some embodiments of the present invention, the electrically-assisted, drug-delivery system further comprises a visual imaging apparatus, for example, as described in U.S. Pat. No. 5,984,860 to Shan, U.S. Pat. Nos. 5,604,531 and 6,428,469 and US Patent Application 2001/0035902, all to Iddan et al., all of which are incorporated herein by reference
In accordance with some embodiments of the present invention, the electrically-assisted, drug-delivery system further increases the dissolution rate of drugs that dissolve slowly. For example, sonophoresis which produces cavitation has an abrasive effect, and may be operative to enhance the dissolution of drugs of poor solubility.
In accordance with some embodiments of the present invention, the electrically-assisted, drug-delivery system is ingestible. Typically, it is free to pass through the GI tract. Alternatively, it may be tethered to a portion of the patient's body, e.g., to a tooth or to a band placed around the patient's head. Alternatively, the electrically-assisted, drug-delivery system may be mounted on a catheter.
In an embodiment of the present invention, the electrically-assisted, drug-delivery system comprises an endoscope (e.g., a colonoscope). The endoscope comprises the stimulation electrodes, while the other elements of the system (e.g., the power source and the control unit) are coupled to the endoscope and are typically adapted to remain outside the body. In this embodiment, the drug typically is administered in a liquid solution. The endoscope further comprises a drug delivery mechanism, such as a flexible tube attached to the endoscope. The distal end of such a tube is typically positioned to release the drug near the stimulation electrodes. For some applications, the system of this embodiment is used to deliver drugs to a specific site that is identified using conventional endoscopic functionality, e.g., that is identified visually using the endoscope. The stimulation electrodes and distal end of the drug-delivery tube are typically positioned near the distal end of the endoscope, in order to enable visual observation and targeting of drug release.
Embodiments of the present invention are designed to achieve previously unmet efficiency and bioavailability of orally delivered protein and peptide drugs. It will be appreciated that the electrically-assisted improvement may be performed in addition to and synergistically with known drug enhancers and stabilizers. In an embodiment of the present invention, synergistic drug absorption enhancement achieved using at least one of the electrical enhancement techniques described herein, in combination with a low concentration of a chemical enhancer, is greater than the sum of (a) the enhancement achievable with electrical enhancement technique alone and (b) the enhancement achievable with the low concentration of the chemical enhancer alone.
Reference is now made to
However, unlike system 30, system 300 does not comprise drug 36. Instead, the patient typically ingests system 300 in conjunction with ingesting a commercially-available drug pill containing drug 36, e.g., before, simultaneously with, or after ingesting the drug pill. System 300 thus serves to enhance absorption of the drug released from the drug pill in the GI tract. For some applications, system 300 is configured to generally coordinate (e.g., synchronize) the application of electrostimulation with the expected release of the drug from the drug pill, such as by using one or more of the release-timing techniques described hereinabove. For example, system 300 may be coated with a controlled-release coating that generally matches the controlled-release timing of the drug pill. Numerous techniques for coordinating the electrostimulation with the drug release will be evident to those skilled in the art, having read the present patent application, and are within the scope of the present invention.
Reference is now made to
However, unlike system 30, system 350 does not comprise drug 36. Instead, system 350 comprises a coupling mechanism 360, which is adapted to couple a commercially-available drug pill 362 to system 350. For some applications, coupling mechanism 360 comprises an adhesive 364, which holds pill 362 in place. Other coupling mechanisms, such as clips or other pressure-fitting mechanisms (configuration not shown), will be evident to those skilled in the art, having read the present patent application, and are within the scope of the present invention. Pill 362 may be coupled to system 350 by a manufacturer, the patient, or a healthcare worker, depending, for example, on medical, safety, commercial, or other considerations.
System 350 further comprises a drug-passage facilitation mechanism, which is adapted to facilitate passage of the drug contained in the drug pill through the epithelial layer of the GI tract. For some applications, the drug-passage facilitation mechanism comprises at least two electrostimulating electrodes 366. In the configuration shown in
Reference is now made to
It is to be appreciated that the particular geometries shown in
Reference is now made to
In one of the diffusion chambers (which served as a control), permeation of octreotide via the tissue segment was measured without the application of electrical stimulation. In the other diffusion chamber, a train of 12 Hz monophasic pulses 1 millisecond long were generated using a Thurlby Thandar Instruments TGP110 pulse generator. The voltage output of the pulse generator was adjusted so that a 3 mA current flowed through the electrodes. An EZ Digital Co. DM330 Digital Multimeter, connected serially to the electrodes was used to measure current. The multimeter was operating as a current meter, set to be sensitive to mA-level currents. One milliliter samples were taken from each of the acceptor cells 30 minutes after the pulse train start and every 15 minutes thereafter, over a 90-minute period. The samples were analyzed by HPLC-UV 205 nm spectroscopy (Hewlett-Packard 1100, acetonitril: phosphate buffer (pH 7.4) (40:60), C18 column) for their content of octreotide.
As can be seen in the graph of
As will be apparent to one of ordinary skill in the art having read the present patent application, it is also possible to configure capsule 102 to control the quantity of drug 106 administered. For example, drug 106 may be stored in several chambers within capsule 102, and the signal sent to the transmit/receive unit instructs the driving mechanism to deliver the drug from none, one, some, or all of the chambers.
Reference is now made to
Sensor 416 is adapted to detect an indication of a concentration of the drug in the blood circulation of subject 414. For example, sensor 416 may comprise a noninvasive external sensor 418, e.g., a sensor adapted to be worn as a wristwatch. Noninvasive sensor 418 may, for example, utilize iontophoresis, infrared spectroscopy, or sonophoresis techniques for detecting the blood concentration of the drug, such as is known in the art for sensing blood glucose levels. Alternatively, sensor 416 comprises an invasive sensor, such as an implantable sensor, as is known in the art, e.g., for detecting blood glucose levels (configuration not shown).
Transmitter 417 is adapted to wirelessly transmit the detected indication to a receiver coupled to ingestible drug-delivery, device 410 (receiver not shown). Drug-delivery device 410 is configured to adjust the level of facilitation of drug passage, responsively to the received indication, in order to regulate the level of the drug in the blood circulation. Device 410 typically increases the level of facilitation when the blood drug level is lower than a target value, and decreases the level of facilitation when the blood drug level is greater than a target value. Such closed-loop control of the blood drug level allows a physician to precisely prescribe the blood level of the drug, rather than only the dosage of the drug. For some applications, drug-delivery device 410 additionally comprises a transmitter, and sensor unit 415 additionally comprises a receiver. The drug-delivery device is adapted to wirelessly notify sensor unit 415 of the location of the drug-delivery device (e.g., the arrival of the device in the small intestine), the status of facilitation of transport, a pH of the GI tract, a temperature of the GI tract, and/or other operational parameters of the drug-delivery device.
In an embodiment of the present invention, ingestible drug-delivery device 410, in addition to facilitating the trans-epithelial passage of the drug through the epithelial layer, facilitates the trans-epithelial passage of a calibrating substance. Depending upon the specific type of drug-delivery device 410 employed, the calibrating substance is typically contained in the device, in a pill coupled to the device, or in a pill administered in conjunction with the device, (For some applications, the drug and the calibrating substance are contained in the same pill. Alternatively, for some applications, the drug and the calibrating substance are contained in separate pills.) Sensor unit 415 measures the level of the calibrating substance in the blood circulation, as a proxy for the level of the drug in the blood circulation. The use of the calibrating substance generally allows for standardization of the blood concentration detection techniques of sensor 416, and enables the use of drug-delivery system 400 even in cases in which the blood concentration of a particular drug is not readily detectable by sensor 416.
For some applications, sensor 416 is adapted to detect a level in the blood of a chemical (e.g., glucose), in response to which a dose of drug 106 (e.g., insulin) is administered or withheld by drug-delivery device 410. Alternatively or additionally, a parameter of the LITV signal or another applied signal is varied in response to the detected level. Suitable parameters include signal amplitude, a frequency of bursts (i.e., a number of bursts per time), an intra-burst pulse frequency, and/or a pulse width of applied pulses. Intermittently (for example, every minute or every ten minutes), sensor 416 performs another reading, and the operation of drug-delivery device 410 is regulated responsively to the updated reading. For other applications, instead of measuring the chemical glucose in order to modulate insulin administration, other chemical/drug pairs are utilized, such as the blood concentration of growth hormone and an administered growth hormone inhibitor (e.g., Sandostatin), as well as blood oxygenation as measured by a pulse oximetry unit in sensor 416 and a vasodilating administered drug.
In an embodiment, sensor 416 measures a non-chemical parameter, in order to facilitate suitable regulation of the operation of drug-delivery device 410. For example, sensor 416 may measure blood pressure, and drug 106 may comprise a diuretic. In this example, if blood pressure levels are normal, then diuretic administration is typically reduced or withheld. In another application, sensor 416 comprises a heart monitor (e.g., a pulse monitor or an ECG monitor). In yet another application, sensor 416 comprises an accelerometer and/or an indicator of a stage in the circadian cycle of subject 414 (e.g., timing circuitry), and the operation of drug-delivery device 410 is regulated responsive thereto. For example, drug-delivery device 410 may increase administration of an antithrombotic drug (e.g., low molecular weight Heparin) during the day, and decrease administration thereof at night. In another application, sensor 416 comprises a temperature sensor, and drug 106 comprises an antibiotic (e.g., cefazolin).
With respect to each of the uses of drug-delivery system 400, it is noted that for some applications, subject 414 may swallow a capsule according to a schedule, but generally regardless of a current need for the drug. If a need arises, the drug is delivered, typically at a dose that is regulated in real time (i.e., while the capsule is in the subject's body). If no need arises, then no drug is administered.
Reference is now made to
Diffusion chamber 500 is shaped so as to define a donor cell 520 and an acceptor cell 522, connected by a 28 mm×8 mm window 524. Tissue segment 510 on the slide completely covered window 524. Tissue segment 510 was placed so as to completely cover window 524, thereby separating donor cell 520 and acceptor cell 522. Tissue segment 510 was oriented such that the mucosal side thereof faced donor cell 520, and the serosal side thereof faced acceptor cell 522. Donor cell 520 was filled with 15 ml of Hank's Balanced Salt Solution (HBSS) adjusted to a pH of 7.4 (in MM: 136.9 NaCl, 5.4 KCl, 0.5 MgCl2, 0.4 MgSO4, 4.5 KH2PO4, 0.35 Na2HPO4, 1.0 CaCl2, 4.2 NaHCO3, 5.5 D-Glucose). Acceptor cell 522 was filled with D-Glucose-supplemented Phosphate Buffered Saline (PBS) adjusted to a pH of 7.4 (in ml: 136.9 NaCl, 2.7 KCl, 0.5 MgCl2, 1.5 KH2PO4, 8.1 Na2HPO4, 0.7 CaCl2, 5.5 D-Glucose).
After tissue segment 510 was placed over window 524, the donor cell was divided into two separate compartments 526a and 526b by an electrically-insulating divider 528 positioned to slightly touch tissue segment 510 so that fluid passage between compartments 526a and 526b was slow (if not impossible). (Donor cell 520 was not divided into compartments 526a and 526b in the experiment described hereinbelow with reference to
A single square electrode 530 was placed in each of compartments 526a and 526b of donor cell 520, such that an electrode surface 532 of each electrode was parallel to the surface of tissue segment 510, at a 0.5 mm distance from tissue segment 510 (except for the experiment described hereinbelow with reference to
In each of the experiments described hereinbelow with reference to
One milliliter samples of the incubation medium were taken from acceptor cell 522 at 7 minutes and 14 minutes after replacement of the HBSS with octreotide, and every 15 minutes thereafter, over a 90-minute period. The samples were analyzed for their content of octreotide by HPLC-UV 205 nm spectroscopy (Hewlett-Packard 1100). Isocratic elution was performed with a phosphate buffer (pH 7.4) and acetonitril as a mobile phase (40:60 w/w), at a flow rate of 1.2 ml/minute. A 100×3 mm C18 column was used.
For each of the experiments, at least two tissue segments from different rats served as the experimental group or groups (no single rat donated more than one tissue segment to any experimental group of any of the experiments). Each tissue segment was separately placed in diffusion chamber 500, electrical pulses were applied, and permeation of octreotide via the tissue segment was measured. In addition, for each of the experiments, at least two (generally three) tissue segments from different rats served as a control group (no single rat donated more than one tissue segment to the control group of any of the experiments). The tissue segments of the control groups were separately placed in diffusion chamber 500, and permeation of octreotide via the tissue segments was measured without the application of an electrical signal.
For the experiments described hereinbelow with reference to
PE(%)=dQ/Qi×100%,
where dQ represents the amount of octreotide that has entered acceptor cell 522 of chamber 500 up to a given point in time, and Qi represents the initial amount of octreotide administered to donor cell 520 of chamber 500.
For the experiments described hereinbelow with reference to
Reference is made to
Although the parameters in these experiments were applied to rats, the inventors believe that similar parameters are appropriate for application to human subjects, given relevant physiological similarities between rats and humans.
In an embodiment of the present invention, an ingestible, electrically-assisted, drug-delivery or drug-delivery facilitation system is adapted to prolong the period of time during which the system is in the small intestine, in order to prolong a delivery time of a drug in the small intestine. For example, the drug-delivery system may comprise drug-delivery system 30 or drug-delivery system 350, described hereinabove with reference to
In an embodiment, the drug-delivery system is configured to prolong the drug delivery period by applying an electrical current to the GI tract, and configuring the current to induce local contraction of smooth muscle around the drug-delivery system, thereby reducing (i.e., stopping, slowing, or reversing) movement of the system within the GI tract. As a result, the travel time of the drug-delivery system and/or the dwelling time of the drug in the GI tract is prolonged. For some applications, a single set of electrodes is used both for applying the velocity-reducing current and the drug-delivery enhancement current (e.g., electrodes 16 of system 30 or 350, or electrodes 366 of system 300). Alternatively, separate sets of electrodes are used for each of these functions. Similarly, a single set or separate sets of other components of the system may be provided, such as the power source, control unit, and sensors. Typically, in order to prevent any potential blockage of the GI tract, movement of the drug-delivery system is only reduced for several hours. For some applications, techniques described in the above-mentioned U.S. Pat. No. 6,709,388 to Mosse et al. and/or the article by Mosse C A et al., mutatis mutandis, are used to reduce the movement of the drug-delivery system within the GI tract.
In an embodiment, the drug-delivery system is configured to prolong the drug delivery period by using mechanical means to slow the movement of the drug-delivery system in the GI tract. For some applications, the drug-delivery system comprises one or more expandable elements (e.g., one, two, or three), which are adapted to expand to increase the resistance applied by the wall of the GI tract to the system. For some applications, the expandable elements comprise one or more of the self-expansible elements described hereinabove, such as self-expansible portions 33, described hereinabove with reference to
Typically, the expandable elements increase a diameter of at least a portion of the drug-delivery system by between about 100% and about 300%. The expandable elements are typically, but not necessarily, configured to contract over a period of up to several hours, thereby allowing the drug-delivery system to resume its normal travel velocity through the GI tract. For some applications, the contraction takes longer than several hours.
In an embodiment of the present invention, a velocity-reduction element comprises a self-expansible flexible structure adapted to be delivered to the GI tract in conjunction with a drug-delivery element. For some applications, the drug-delivery element includes (a) an ingestible, electrically-assisted, drug-delivery system or drug-delivery facilitation system (e.g., as described herein), (b) a conventional drug pill, and/or (c) a slow-release drug reservoir. Once at the appropriate location in the GI tract, the structure expands, and the resulting contact with the GI tract slows the motion of the structure through the GI tract, and thus the motion of the drug-delivery element. Typically, the structure is coupled to the drug-delivery element, or is an integrated component of the drug-delivery element.
For some applications, the structure is delivered to the GI tract in a collapsed form in a capsule that is configured to dissolve at a certain location in the GI tract, such as in a certain location in the small intestine, using techniques known in the art. The naturally-occurring alignment of the capsule with the GI tract typically serves to properly align the structure with the GI tract.
Typically, the self-expansible structure is adapted to lose its shape a certain period of time after expanding in the GI tract. For example, all or a portion of the structure may comprise a material that dissolves in a controlled manner upon contact with fluids of the GI tract.
Reference is now made to
Reference is made to
For some applications, rings 462 of structure 450 or 470 serve as electrodes 16 of system 30 or 350, or as electrodes 366 of system 300.
Typically, elements 464 comprise a solid, slowly-dissolving material, adapted to dissolve in a controlled manner upon contact with fluids of the GI tract. When elements 464 dissolve, structure 450 breaks into separate rings 462, which pass through the GI tract at substantially the normal velocity of the GI tract, substantially without blocking or slowing passage of the drug-delivery system or other materials in the GI tract.
Structure 450 is typically foldable for compact storage before it expands in the GI tract. For example, structure 450 may be folded and stored in a dissolvable capsule. For some applications, each ring 462 has a diameter of 1.5 cm, and structure 450 is folded and stored in a standard size 0 capsule, with the central axis of the structure parallel to the central axis of the capsule.
In an embodiment of the present invention, system 30, 300, or 350 is adapted to facilitate local delivery of and reduce systemic delivery of drug molecules delivered by the system. For some applications, the system is adapted to facilitate local delivery of the drug molecules into target tissue of the GI tract, such as a mucosal layer, a submucosal layer, and/or a muscular layer of the small intestine. “Local delivery” of drug molecules, as used in the present application including the claims, is said to occur if at least one of the following conditions is fulfilled:
For some applications, the system facilitates (a) delivery of an anti-inflammatory drug into the mucosal layer, in order to treat intestinal ulcerative colitis, (b) delivery of an anti-inflammatory drug into the mucosa, submucosa, and/or muscular layers, in order to treat Crohn's disease, (c) local delivery of a chemotherapy agent, typically to a specific site in the GI tract, or (d) local delivery of an agent against a bacterial infection, e.g., Helicobacter pylori. Use of the active drug delivery techniques described herein typically overcomes the natural drug resistance of the GI tract to such agents. For some applications, the system is adapted to both facilitate local drug delivery and prolong the period of time during which the system is in the small intestine, such as by using prolonging techniques described hereinabove and/or in the above-mentioned PCT application filed on even date herewith, entitled, “Prolonged transit time of permeability-enhancing drug eluting pill.” For example, the system may comprise one or more of the velocity-reduction elements described hereinabove and/or in the above-mentioned PCT application.
According to a first technique for facilitating local delivery of and reducing systemic delivery of drug molecules, the distance between electrodes 16 of system 30 or 350, or electrodes 366 of system 300, is reduced. As a result, the effect of the electrical signal is concentrated in tissue layers closer to the electrodes, rather than in layers deeper in the wall of the GI tract. Drug molecules therefore are able to penetrate the epithelial layer, but are less able to penetrate deeper layers and enter blood vessels. Typical interelectrode distances are less than about 5 mm, e.g., between about 1 and about 3 mm.
According to a second technique for facilitating local delivery of and reducing systemic delivery of drug molecules, the amplitude of the LITV signal is reduced, thereby reducing transport of drug molecules into blood vessels. For example, the amplitude may be set to between about 0.3 and about 0.8 mA.
According to a third technique for facilitating local deliver of and reducing systemic delivery of drug molecules, the LITV signal is applied with a duty cycle having relatively short “on” periods. The stimulation is applied (a) with “on” period durations sufficient to enable the drug molecules to penetrate tight junctions and enter the upper epithelial layer, but insufficient to transport the molecules into deeper layers and blood vessels, and (b) with “off” period durations sufficient to enable the drug molecules to reach target therapeutic sites in the tissue. For some applications, the LITV signal is applied during alternating “on” and “off” periods, the duration of each of the “on” periods between about 0.5 and about 2 seconds, and the duration of each of the “off” periods between about 5 and about 20 seconds. Typically, the therapeutic effect of the drug molecules that penetrate the epithelial layer during each “on” period continues throughout at least a portion of the subsequent “off” period. Additional drug molecules then penetrate the epithelial layer during the following “on” period. When the drug-delivery system is peristaltically moving through the GI tract, such short “on” periods typically allow only small quantities of the drug to penetrate the epithelial layer in any given area of the GI tract.
According to a fourth technique for facilitating local delivery of and reducing systemic delivery of drug molecules, vasoconstriction is induced in the blood vessels of the GI tract in a vicinity of the drug molecules. Such vasoconstriction is induced (a) chemically, by providing a vasoconstrictor with the drug molecules, (b) mechanically, e.g., by application of vibration, and/or (c) electrically, by applying appropriately configured electrical signals to the GI tract. Vasoconstriction reduces the permeability of the blood vessels of the GI tract and/or reduces the quantity, of blood passing a given site of the GI tract containing the drug molecules. In this manner, vasoconstriction as provided herein typically increases the extent to which the drug molecules remain in tissue of the wall of the GI tract, and reduces systemic delivery of the drug molecules.
In an embodiment of the present invention, vasoconstriction is chemically, mechanically, and/or electrically induced in the blood vessels of the GI tract in the vicinity, of drug molecules, without necessarily applying an LITV signal. Typically, a pill-shaped system induces the vasoconstriction, either by applying an mechanical or electrical signal and/or by releasing a chemical vasoconstrictor. For some applications, the pill-shaped system stores and releases the drug molecules, while for other application the drug molecules are administered separately, such as in a conventional pill, and the pill-shaped system is swallowed in conjunction with the separate administration of the drug molecules. For some applications, the pill-shaped system comprises a drug pill that comprises a chemical vasoconstrictor, which pill is swallowed in conjunction with the separate administration of the drug molecules. Alternatively, a chemical vasoconstrictor is contained in a drug pill that comprises the drug molecules.
In an embodiment of the present invention, vasoconstriction is chemically, mechanically, and/or electrically induced in the blood vessels of the GI tract, in order to reduce absorption of nutrients (including fat) from the GI tract into the systemic blood circulation. The chemically-, mechanically-, and/or electrically-induced vasoconstriction is applied by a system swallowed by the patient, typically shortly before, during, or after the beginning or end of a meal. Such a reduction in absorption is typically used to treat obesity. For some applications, a plurality of vasoconstriction-inducing capsules are adapted to induce vasoconstriction of the GI tract blood vessels to a sufficient extent that ingestion by the subject of at least one of the capsules per day induces weight loss of the subject, due to the vasoconstriction, of at least 1 kg per week.
In an embodiment of the present invention, system 30, 300, or 350 is adapted to deliver first and second drugs for treatment of a condition of the GI tract. The first drug is delivered systemically via the GI tract, and the second drug is delivered locally to tissue of the wall of the GI tract. Typically, the two drugs are stored in separate drug-dispensing cavities of the system. The first, systemic drug is delivered using techniques described hereinabove for systemic delivery, while the second, local drug is delivered using the techniques described hereinabove for facilitating local delivery, optionally including one or more of the techniques described hereinabove for reducing systemic delivery. For example, for treating an infection by H. pylori of a site of the GI tract, the first drug may include an antibiotic for systemic delivery via the GI tract, and the second drug may include an agent for topical treatment of the infection by local delivery of the agent.
In an embodiment of the present invention, system 30, 300, or 350 is adapted to locally deliver a drug to a plurality of non-contiguous segments of the GI tract. The system delivers the drug to a first one of the segments for a certain period of time (e.g., between about 1 and about 2 hours, between about 30 minutes and 1 hour, between about 15 minutes and about 30 minutes, or between about 10 minutes and about 15 minutes), and then ceases delivery of the drug. When the system arrives at a second one of the segments, the system delivers the drug to the second segment for a certain period of time. This on/off delivery of the drug is repeated for each of the plurality of segments. For example, the system may deliver a drug for treatment of gastric ulcers in a plurality of segments of the GI tract. Exemplary drugs for treatment of gastric ulcers include growth factors and cox-2 specific inhibitors (see, for example, the above-mentioned article by Brzozowski T et al.). For some applications, the system uses one or more of the techniques described hereinabove for local delivery of the drug, and/or for reducing systemic delivery of the drug.
In an embodiment of the present invention, system 30, 300, or 350 is adapted to deliver an oral drug to specific segments of the GI tract. For example, the system may deliver local glucocorticosteroid therapy for treating Crohn's disease (see, for example, the above-mentioned article by Lundin P D et al.). The system typically uses one or more of the techniques described hereinabove for delivering the drug at the desired location within the GI tract.
Techniques described herein may be used, for example, for treating conditions including, but not limited to, ulcerative colitis, cancer of the GI system, Crohn's disease, and complications of gastric partitioning.
For some applications, techniques described hereinabove are practiced in combination with techniques described in one or more of the following patent applications, all of which are assigned to the assignee of the present application and are incorporated herein by reference:
For some applications, techniques described hereinabove are practiced in combination with techniques described in one or more of the articles, patents and/or patent applications mentioned hereinabove. By way of example and not limitation, embodiments of the present invention comprising a piston or spring may use spring-release techniques described in one or more of these patents or patent applications.
It is expected that during the life of this patent many relevant drugs will be developed and the scope of the term drug is intended to include all such new technologies a priori.
As used herein the term “about” refers to +/−10%.
In the description hereinabove of embodiments of the invention, various oral dosage forms are described, for example, capsules and tablets. In the claims, the word “capsule” is to be understood to refer to oral dosage forms generally, i.e., comprising capsules, tablets, and similar forms, for example, as shown in
As used in the context of the present patent application and in the claims, the word “drug” means any natural or synthetic chemical that may be administered as an aid in the diagnosis, treatment, cure, mitigation, or prevention of disease or other abnormal conditions, or to improve health.
It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable subcombination.
As appropriate, techniques described in the present patent application may be practiced in combination with techniques described in U.S. patent application Ser. No. 10/767,663 and PCT Patent Application PCT/IL2004/000093, both entitled, “Active drug delivery in the gastrointestinal tract,” and filed on Jan. 29, 2004, which are incorporated herein by reference, and assigned to the assignee of the present patent application.
Although the invention has been described in conjunction with specific embodiments thereof, it is evident that many alternatives, modifications and variations will be apparent to those skilled in the art. Accordingly, it is intended to embrace all such alternatives, modifications and variations that fall within the spirit and broad scope of the appended claims. All publications, patents and patent applications mentioned in this specification are herein incorporated in their entirety by reference into the specification, to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated herein by reference. In addition, citation or identification of any reference in this application shall not be construed as an admission that such reference is available as prior art to the present invention.
The present application claims the benefit of U.S. Provisional Patent Application 60/636,447 to Gross et al., filed Dec. 14, 2004, which is assigned to the assignee of the present application and is incorporated herein by reference. The present application is related to a PCT application filed on even date herewith, entitled, “Prolonged transit time of permeability-enhancing drug eluting pill,” which is assigned to the assignee of the present application and is incorporated herein by reference.
| Filing Document | Filing Date | Country | Kind | 371c Date |
|---|---|---|---|---|
| PCT/IL2005/001346 | 12/14/2005 | WO | 00 | 1/11/2008 |
| Number | Date | Country | |
|---|---|---|---|
| 60636447 | Dec 2004 | US |
