Patent Application
20120130480
1. Field of the Invention
The present invention relates to the local administration of therapeutic agents and/or therapeutic agent combinations for reducing myocardial injury following an acute myocardial infarction, and more particularly to intraluminal medical devices for the local delivery of therapeutic agents and/or therapeutic agent combinations for reestablishing perfusion and reducing myocardial injury following an acute myocardial infarction.
2. Discussion of the Related Art
Many individuals suffer from circulatory or vascular disease caused by a progressive blockage or narrowing of the blood vessels that perfuse the heart and other major organs. More severe blockage of blood vessels in such individuals often leads to hypertension, ischemic injury, stroke, or myocardial infarction. Atherosclerotic lesions, which limit or obstruct coronary blood flow, are the major cause of ischemic heart disease. Alternatively, spontaneous rupture of inflammatory atherosclerotic lesions or vulnerable plaque may lead to intermittent or complete thrombotic occlusion of an artery causing ischemic injury such as stroke and/or acute myocardial infarction. Percutaneous transluminal coronary angioplasty is a medical procedure for which the purpose is to increase blood flow through an artery. Percutaneous transluminal coronary angioplasty is the predominant treatment for coronary artery stenosis. The increasing use of this procedure is attributable to its relatively high success rate and its minimal invasiveness compared with coronary bypass surgery. A limitation associated with percutaneous transluminal coronary angioplasty is the abrupt closure of the vessel, which may occur immediately after the procedure and restenosis, which occurs gradually following the procedure. Additionally, restenosis is a chronic problem in patients who have undergone saphenous vein bypass grafting. The mechanism of acute occlusion appears to involve several factors and may result from vascular recoil with resultant closure of the artery and/or deposition of blood platelets and fibrin along the damaged length of the newly opened blood vessel.
Restenosis after percutaneous transluminal coronary angioplasty is a more gradual process initiated by vascular injury. Multiple processes, including thrombosis, inflammation, growth factor and cytokine release, cell proliferation, cell migration and extracellular matrix synthesis each contribute to the restenotic process.
Upon pressure expansion of an intracoronary balloon catheter during angioplasty, smooth muscle cells and endothelial cells within the vessel wall become injured, initiating a thrombotic and inflammatory response. Cell derived growth factors such as platelet derived growth factor, basic fibroblast growth factor, epidermal growth factor, thrombin, etc., released from platelets, invading macrophages and/or leukocytes, or directly from the smooth muscle cells provoke a proliferative and migratory response in medial smooth muscle cells. These cells undergo a change from the contractile phenotype to a synthetic phenotype characterized by only a few contractile filament bundles, extensive rough endoplasmic reticulum, Golgi and free ribosomes. Proliferation/migration usually begins within one to two days' post-injury and peaks several days thereafter (Campbell and Campbell, 1987; Clowes and Schwartz, 1985).
Daughter cells migrate to the intimal layer of arterial smooth muscle and continue to proliferate and secrete significant amounts of extracellular matrix proteins. Proliferation, migration and extracellular matrix synthesis continue until the damaged endothelial layer is repaired at which time proliferation slows within the intima, usually within seven to fourteen days post-injury. The newly formed tissue is called neointima. The further vascular narrowing that occurs over the next three to six months is due primarily to negative or constrictive remodeling.
Simultaneous with local proliferation and migration, inflammatory cells adhere to the site of vascular injury. Within three to seven days post-injury, inflammatory cells have migrated to the deeper layers of the vessel wall. In animal models employing either balloon injury or stent implantation, inflammatory cells may persist at the site of vascular injury for at least thirty days (Tanaka et al., 1993; Edelman et al., 1998). Inflammatory cells therefore are present and may contribute to both the acute and chronic phases of restenosis.
Unlike systemic pharmacologic therapy, stents have proven useful in significantly reducing restenosis. Typically, stents are balloon-expandable slotted metal tubes (usually, but not limited to, stainless steel or cobalt-chromium alloys, which, when expanded within the lumen of an angioplastied coronary artery, provide structural support through rigid scaffolding to the arterial wall. This support is helpful in maintaining vessel lumen patency. In two randomized clinical trials, stents increased angiographic success after percutaneous transluminal coronary angioplasty, by increasing minimal lumen diameter and reducing, but not eliminating, the incidence of restenosis at six months (Serruys et al., 1994; Fischman et al., 1994). In addition, stents have become the treatment of choice for revascularization of a thrombosed coronary artery (acute myocardial infarction) in which rapid restoration of blood flow to ischemic myocardial tissue is the primary determinant of long term clinical benefit . Full restoration of coronary blood flow with a stent within 6 hours of presentation of symptoms, and preferably under 3 hours, has been shown to produce superior clinical outcomes over administration of a thrombolytic agent (tPA, streptokinase, etc.) to dissolve a thrombotic occlusion.
Stents utilized for the local delivery of rapamycins, including sirolimus, everolimus and other rapamycin analogs and derivatives (mTOR inhibitors), have proved more successful in significantly reducing restenosis and related complications following percutaneous transluminal angioplasty and other similar arterial/venous procedures than bare metal stents. Rapamycins may be incorporated onto or affixed to the stent in a number of ways. For example, the rapamycins may be incorporated into a polymeric matrix and then affixed to the surface of the stent by any suitable means. Alternately, the rapamycins may be incorporated into a polymeric matrix and then loaded into reservoirs on or in the stent. Either way, the rapamycins elute from the polymeric matrix over a given period of time and into the surrounding tissue.
Additionally, heparin coating of stents appears to have the added benefit of producing a reduction in sub-acute thrombosis after stent implantation. Thus, sustained mechanical expansion of a stenosed coronary artery with a stent has been shown to provide some measure of restenosis prevention, and the coating of stents with rapamycins and heparin has demonstrated both the feasibility and the clinical usefulness of delivering drugs locally, at the site of injured tissue.
Given that the feasibility and the desirability of local delivery of drugs via a stent has been demonstrated, stents as well as other implantable medical devices may be utilized to deliver other drugs or therapeutic agents to arteries as well as organs downstream of the placement of the stent or other medical device to treat other conditions. For example, there exists a need for the local delivery of agents for reducing myocardial injury following an acute myocardial infarction. More generally, there exists a need for the local administration of therapeutics to reduce ischemic injury.
The local delivery, via a stent or other suitable device, of a selective adenosine receptor agonist in accordance with the present invention may be utilized to overcome the drawbacks of treatments set forth above.
In accordance with one aspect, the present invention is directed to a medical device for the local delivery of a selective adenosine receptor agonist for the treatment of myocardial injury following an acute myocardial infarction. The medical device comprising a stent having through-hole reservoirs, and a selective adenosine receptor agonist deposited in at least one of the through-hole reservoirs and configured to elute into the bloodstream at a rate of at least ten micrograms per hour for at least four (4) hours after the reestablishment of blood flow in the vessel.
A stent or other implantable medical device for the local delivery of an adenosine A2A receptor agonist may be utilized to reduce myocardial injury following an acute myocardial infarction. As soon as possible following an acute myocardial infarction, a stent or other suitable device comprising and capable of delivering an adenosine A2A receptor agonist is positioned in the blood vessel with the occlusion responsible for causing the infarct. Once in position , the stent or other intraluminal device is deployed to remove the occlusion and reestablish blood flow to the specific area, region or tissue volume of the heart. Over a given period of time described in detail subsequently, the adenosine A2A receptor agonist elutes from the stent or other device into the downstream coronary blood flow into the hypoxic cardiac tissue for a time sufficient to reduce the level of myocardial injury. As described herein, the present invention may also be utilized to treat other organs.
The early and sustained release of the adenosine A2A receptor agonist may reduce myocardial injury be reducing the size or amount of infarcted myocardial tissue, reducing the level of myocellular death, reduce the extent of reperfusion injury, preserve more function in the myocapillary bed and or mitigate the so-called “no-reflow” condition. These effects should, in turn, improve cardiac output, ejection fraction and cardiac wall motion post infarct. The delivery of the adenosine A2A receptor agonist from the stent or other device to the hypoxic tissue will begin immediately after the occluded vessel has been made patent by deployment of the device, or more specifically, the delivery of the agent from the device will not begin until blood flow is reestablished to the treatment site as the blood carries the therapeutic agent downstream. In the case of a surface coated drug eluting stent or reservoir eluting stent, delivery of the adenosine A2A receptor agonist will begin immediately upon expansion of the stent and removal of the balloon which will allow the agonist to elute. If a self expanding stent is utilized, agonist delivery will begin upon deployment of the stent and contact with the blood.
Local delivery may be utilized in combination with systemic delivery of the same and/or different therapeutic agents.
The foregoing and other features and advantages of the invention will be apparent from the following, more particular description of preferred embodiments of the invention, as illustrated in the accompanying drawings.
While exemplary embodiments of the invention will be described with respect to treating or reducing myocardial injury following an acute myocardial infarction, it is important to note that the local delivery of drug/drug combinations may be utilized to treat a wide variety of conditions utilizing any number of medical devices, or to enhance the function and/or life of the device. For example, intraocular lenses, placed to restore vision after cataract surgery is often compromised by the formation of a secondary cataract. The latter is often a result of cellular overgrowth on the lens surface and can be potentially minimized by combining a drug or drugs with the device. Other medical devices which often fail due to tissue in-growth or accumulation of proteinaceous material in, on and around the device, such as shunts for hydrocephalus, dialysis grafts, colostomy bag attachment devices, ear drainage tubes, leads for pace makers and implantable defibrillators can also benefit from the device-drug combination approach. Devices which serve to improve the structure and function of tissue or organ may also show benefits when combined with the appropriate agent or agents. For example, improved osteointegration of orthopedic devices to enhance stabilization of the implanted device could potentially be achieved by combining it with agents such as bone-morphogenic protein. Similarly other surgical devices, sutures, staples, anastomosis devices, vertebral disks, bone pins, suture anchors, hemostatic barriers, clamps, screws, plates, clips, vascular implants, tissue adhesives and sealants, tissue scaffolds, various types of dressings, bone substitutes, intraluminal devices, and vascular supports could also provide enhanced patient benefit using this drug-device combination approach. Perivascular wraps may be particularly advantageous, alone or in combination with other medical devices. The perivascular wraps may supply additional drugs to a treatment site. Essentially, any type of medical device may be coated or loaded in some fashion with a drug or drug combination which enhances treatment over use of the singular use of the device or pharmaceutical agent.
In addition to various medical devices, the coatings on these devices may be used to deliver therapeutic and pharmaceutic agents including: anti-proliferative/antimitotic agents including natural products such as vinca alkaloids (i.e. vinblastine, vincristine, and vinorelbine), paclitaxel, epidipodophyllotoxins (i.e. etoposide, teniposide), antibiotics (dactinomycin (actinomycin D) daunorubicin, doxorubicin and idarubicin), anthracyclines, mitoxantrone, bleomycins, plicamycin (mithramycin) and mitomycin, enzymes (L-asparaginase which systemically metabolizes L-asparagine and deprives cells which do not have the capacity to synthesize their own asparagine); antiplatelet agents such as glycoprotein (GP) IIb/IIIa inhibitors and vitronectin receptor antagonists; anti-proliferative/antimitotic alkylating agents such as nitrogen mustards (mechlorethamine, cyclophosphamide and analogs, melphalan, chlorambucil), ethylenimines and methylmelamines (hexamethylmelamine and thiotepa), alkyl sulfonates-busulfan, nirtosoureas (carmustine (BCNU) and analogs, streptozocin), trazenes—dacarbazinine (DTIC); anti-proliferative/antimitotic antimetabolites such as folic acid analogs (methotrexate), pyrimidine analogs (fluorouracil, floxuridine, and cytarabine), purine analogs and related inhibitors (mercaptopurine, thioguanine, pentostatin and 2-chlorodeoxyadenosine {cladribine}); platinum coordination complexes (cisplatin, carboplatin), procarbazine, hydroxyurea, mitotane, aminoglutethimide; hormones (i.e. estrogen); anti-coagulants (heparin, synthetic heparin salts and other inhibitors of thrombin); fibrinolytic agents (such as tissue plasminogen activator, streptokinase and urokinase), aspirin, dipyridamole, ticlopidine, clopidogrel, abciximab; antimigratory; antisecretory (breveldin); anti-inflammatory: such as adrenocortical steroids (cortisol, cortisone, fludrocortisone, prednisone, prednisolone, 6α-methylprednisolone, triamcinolone, betamethasone, and dexamethasone), non-steroidal agents (salicylic acid derivatives i.e. aspirin; para-aminophenol derivatives i.e. acetaminophen; indole and indene acetic acids (indomethacin, sulindac, and etodalac), heteroaryl acetic acids (tolmetin, diclofenac, and ketorolac), arylpropionic acids (ibuprofen and derivatives), anthranilic acids (mefenamic acid, and meclofenamic acid), enolic acids (piroxicam, tenoxicam, phenylbutazone, and oxyphenthatrazone), nabumetone, gold compounds (auranofin, aurothioglucose, gold sodium thiomalate); immunosuppressives: (cyclosporine, tacrolimus (FK-506), azathioprine, mycophenolate mofetil); angiogenic agents: vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF); angiotensin receptor blockers; nitric oxide donors; antisense oligionucleotides and combinations thereof; cell cycle inhibitors, mTOR inhibitors such as sirolimus, everolimus and other rapamycin analogs, and growth factor receptor signal transduction kinase inhibitors; retenoids; cyclin/CDK inhibitors; HMG co-enzyme reductase inhibitors (statins); and protease inhibitors.
A stent is commonly used as a tubular structure left inside the lumen of a duct to relieve an obstruction. Commonly, stents are inserted into the lumen in a non-expanded form and are then expanded autonomously, or with the aid of a second device in situ. A typical method of expansion occurs through the use of a catheter-mounted angioplasty balloon which is inflated within the stenosed vessel or body passageway in order to shear and disrupt the obstructions associated with the wall components of the vessel and to obtain an enlarged lumen. However, self-expanding stents may be utilized without the need for a balloon.
The stent 100 generally comprises first and second ends with an intermediate section therebetween. The stent 100 has a longitudinal axis and comprises a plurality of longitudinally disposed bands 102, wherein each band 102 defines a generally continuous wave along a line segment parallel to the longitudinal axis. A plurality of circumferentially arranged links 104 maintain the bands 102 in a substantially tubular structure. Essentially, each longitudinally disposed band 102 is connected at a plurality of periodic locations, by a short circumferentially arranged link 104 to an adjacent band 102. The wave associated with each of the bands 102 has approximately the same fundamental spatial frequency in the intermediate section, and the bands 102 are so disposed that the wave associated with them are generally aligned so as to be generally in phase with one another. As illustrated in the figure, each longitudinally arranged band 102 undulates through approximately two cycles before there is a link to an adjacent band 102.
The stent 100 may be fabricated utilizing any number of methods. For example, the stent 100 may be fabricated from a hollow or formed stainless steel tube that may be machined using lasers, electric discharge milling, chemical etching or other means. The stent 100 is inserted into the body and placed at the desired site in an unexpanded form. In one exemplary embodiment, expansion may be affected in a blood vessel by a balloon catheter, where the final diameter of the stent 100 is a function of the diameter of the balloon catheter used as well as the design (expansion ratio) of the stent.
It should be appreciated that a stent 100 in accordance with the present invention may be embodied in a shape-memory material, including, for example, an appropriate alloy of nickel and titanium or stainless steel. Structures formed from stainless steel may be made self-expanding by configuring the stainless steel in a predetermined manner, for example, by twisting it into a braided configuration. In this embodiment, after the stent 100 has been formed it may be compressed so as to occupy a space sufficiently small as to permit its insertion in a blood vessel or other tissue by insertion means, wherein the insertion means include a suitable catheter, or flexible rod. On emerging from the catheter, the stent 100 may be configured to expand into the desired configuration where the expansion is automatic or triggered by a change in pressure, temperature or electrical stimulation.
As illustrated in
The exemplary embodiments of the stent of the present invention illustrated in
In accordance with exemplary embodiments of the present invention, single beneficial agents may be loaded into the reservoirs or holes in the stent or coated onto the surface thereof. In addition, multiple beneficial agents may be loaded into the reservoirs or holes in the stent or coated onto the surface thereof. The use of reservoirs or holes for drug or agent release as described above with respect to
The two or more different beneficial agents provided in the devices described herein may comprise (1) different drugs; (2) different concentrations of the same drug; (3) the same drug with different release kinetics, i.e., different matrix erosion rates; or (4) different forms of the same drug. Examples of different beneficial agents formulated comprising the same drug with different release kinetics may use different carriers to achieve the elution profiles of different shapes. Some examples of different forms of the same drug include forms of a drug having varying hydrophilicity or lipophilicity.
In addition to the use of different beneficial agents in different openings to achieve different drug concentrations at different defined areas of tissue or in the bloodstream, the loading of different beneficial agents in different openings may be used to provide a more even spatial distribution of the beneficial agent delivered in instances where the expandable medical device has a non-uniform distribution of openings in the expanded configuration.
The use of different drugs in different openings in an interspersed or alternating manner allows the delivery of two different drugs which may not be deliverable if combined within the same polymer/drug matrix composition. For example, the drugs themselves may interact in an undesirable way. Alternatively, the two drugs may not be compatible with the same polymers for formation of the matrix or with the same solvents for delivery of the polymer/drug matrix into the openings.
Given that the openings in the stent of
The methods for loading beneficial agents into the different openings in an expandable medical device may include known techniques such as dipping and coating and also known piezoelectric micro-jetting techniques. Micro-injection devices may be computer controlled to deliver precise amounts of one or more liquid formulated beneficial agents to precise locations on the expandable medical device in a known manner. For example, a dual agent jetting device or process may deliver two agents simultaneously or sequentially into the openings. When the beneficial agents are loaded into through openings in the expandable medical device, a luminal side of the through openings may be blocked during loading by a resilient mandrel allowing the beneficial agents to be delivered in liquid form, such as with a solvent. The beneficial agents may also be loaded by manual injection devices.
In accordance with the present invention, a stent with holes or reservoirs comprising a selective adenosine receptor agonist is described herein. When utilizing a stent with reservoirs, it may be possible to achieve various release rates and various agent concentrations or doses. For example, the drug may be selectively released in different phases and/or at different dosages depending on time. This may be achieved by filling the different reservoirs with material that can alter the elution rate of the drug, by utilizing different concentrations of the same drug and/or different forms of the same drug.
Adenosine receptors comprise four member subfamilies of G protein coupled receptors designated as A1, A2A, A2B and A3. Each of the four subtypes have selective agonists of which over a dozen are in, are undergoing or have been in clinical trials for the treatment of various conditions. In the exemplary embodiments described herein, the selective adenosine receptor agonist is an adenosine A2A receptor agonist. However, it is important to note that the other selective adenosine receptor agonists may be utilized.
A stent or other implantable medical device for the local delivery of an adenosine A2A receptor agonist may be utilized to reduce myocardial injury following an acute myocardial infarction. As soon as possible following an acute myocardial infarction a stent or other suitable device comprising and capable of delivering an adenosine A2A receptor agonist is positioned in the blood vessel with the occlusion responsible for causing the infarct. Once in position, the stent or other intraluminal device is deployed to remove the occlusion and reestablish blood flow to the specific area, region or tissue volume of the heart. Over a given period of time described in detail subsequently, the adenosine A2A receptor agonist elutes from the stent or other device into the downstream coronary blood flow into the hypoxic cardiac tissue for a time sufficient to reduce the level of myocardial injury.
The early and sustained release of the adenosine A2A receptor agonist may reduce myocardial injury be reducing the size or amount of infarcted myocardial tissue, reducing the level of myocellular death, reduce the extent of reperfusion injury, preserve more function in the myocapillary bed and or mitigate the so-called “no-reflow” condition which should in turn improve cardiac output, ejection fraction and cardiac wall motion post infarct. The delivery of the adenosine A2A receptor agonist from the stent or other device to the hypoxic tissue will begin immediately after the occluded vessel has been made patent by deployment of the device (reperfusion), or more specifically, the delivery of the agent from the device will not begin until blood flow is reestablished to the tissue of the treatment site as the blood caries the agent. In the case of a drug eluting stent or reservoir eluting stent, delivery of the adenosine A2A receptor agonist will begin immediately upon expansion of the stent and removal of the balloon which will allow the agonist to elute. If a self expanding stent is utilized, adenosine A2A receptor agonist delivery will begin upon deployment of the stent and contact with the blood.
The local delivery of the adenosine A2A receptor agonist to the tissue at risk may be continued from the time the artery is recanalized for a period of one (1) to seventy-two (72) hours. Preferably, the adenosine A2A receptor agonist is delivered for a period of between four (4) and twenty-four (24) hours post infarct. The amount of adenosine A2A receptor agonist delivered to the hypoxic tissue over the given time period is up to about 2 milligrams or 2000 micrograms. The adenosine A2A receptor agonist utilized in the present invention is preferably a high potency adenosine A2A receptor agonist with an activity greater than adenosine itself, such as ATL-359 available from PGxHealth LLC. Other adenosine A2A receptor agonists include ATL-1222 and/or ATL-146e both of which are also available from PGxHealth LLC. A detailed description of the elution profile as well as the therapeutic agent complex to be loaded into the stent is set forth subsequently.
Adenosine has a number of properties, including coronary vasodilator, anti-inflammatory, mediator of ischemic preconditioning and the reduction of no-reflow and infarct size. Adenosine receptor agonists, as set forth herein, have been identified that are over one hundred times more potent than adenosine as coronary vasodilators with the potential to improve coronary perfusion and reduce infarct size. However, it is important to note that the adenosine receptor agonists set forth therein may be locally delivered to treat ischemic tissue elsewhere in the body, including the brain.
In a typical drug eluting device, the drug is mixed with a number of constituents such as polymers. Any number of biocompatible polymers may be utilized. The polymer that serves to hold the drug in the reservoir cavity and modulate the elution rate of the drug is preferably a bioresorbable polymer. Examples of bioresorbable polymers include, but are not limited to, poly-α-hydroxy acid esters such as, polylactic acid (PLLA or DL-PLA), polyglycolic acid, polylactic-co-glycolic acid (PLGA), polylactic acid-co-caprolactone, poly (block-ethylene oxide-block-lactide-co-glycolide) polymers (PEO-block-PLGA and PEO-block-PLGA-block-PEO); polyethylene glycol (PEG) and polyethylene oxide (PEO), poly (block-ethylene oxide-block-propylene oxide-block-ethylene oxide), Poloxamers; polyvinyl pyrrolidone (PVP); polyorthoesters (POE); polysaccharides and polysaccharide derivatives such as polyhyaluronic acid, heparin, poly (glucose), poly(alginic acid), chitin, chitosan, chitosan derivatives, cellulose, methyl cellulose, hydroxyethylcellulose, hydroxypropylcellulose, carboxymethylcellulose; polypeptides, and proteins such as polylysine, polyglutamic acid, albumin; polyanhydrides; polyhydroxy alkonoates such as polyhydroxy valerate, polyhydroxy butyrate, and the like.
As described above, the reservoirs of the stent may be filled or loaded in any number of ways. In the exemplary embodiment, the compositions are filled or loaded into the reservoir wells or reservoirs in two separate and sequential series of steps, including firstly depositing a fluid filling solution composition into the reservoirs and secondly evaporating the majority, if not substantially all, of the filling solution solvent. Having no solvent is the ideal situation; however, current processes and materials do not result in an absolutely no residual solvent mix. The compositions in accordance with the present invention as described herein are the solid materials that remain in the reservoirs after removal of substantially all and preferably all of the solvent from the filling solution composition.
The fluid compositions used to form the solid composition comprising adenosine A2A receptor agonists include a bioresorbable or bioabsorbable polymer, preferably a poly(lactide-co-glycolide), PLGA, polymer, a suitable solvent such as dimethyl sulfoxide, DMSO, or N-methyl pyrrolidone, NMP, an adenosine A2A receptor agonist such as ATL-359 and optionally a stabilizer or anti-oxidant such as BHT. Alternatives for DMSO and NMP include dimethyl acetamide (DMAc) or dimethyl formamide (DMF). DMSO is preferred because ATL-359 is more stable in the presence of DMSO and DMSO is a more bio-friendly solvent.
Each sequential fluid composition that is deposited may comprise the same ingredients, or sequential filling solutions may be prepared from filling solutions comprising different ingredients. Preferably, the first series of filling solution deposits comprise polymer, therapeutic agent and solvent, which are dried after each filling step. This part of the process results in the formation or construct of the main therapeutic agent structure. The second series of filling solution deposits comprise only polymer and solvent, which are dried after each filling step. This manufacturing sequence will create a reservoir composition in which there is a higher concentration of ATL-359 in the area of the luminal face of the reservoir and a relatively lower concentration of ATL-359 in the area of the abluminal face of each reservoir. Such a configuration, as described in detail above, creates a longer path or higher resistance to elution of the drug to the abluminal face as compared to the luminal face and as such should result in substantially all of the ATL-359 being delivered to the luminal side of the stent and into the arterial bloodflow. In other words, the reservoirs that deliver ATL-359 in a predominantly luminal direction will have a design where the volume of the reservoir on and near the abluminal surface of the stent will be comprised predominantly of polymer and a minor amount of ATL-359, while the volume of the same reservoir at or near the luminal surface will be comprised predominantly of ATL-359 with a minor proportion of polymer.
The adenosine A2A receptor agonist composition within a reservoir will preferably comprise adenosine A2A receptor agonist, a bioresorbable polymer, a solvent and optionally a stabilizing agent, and be in certain proportions to one another. Preferably, the total dose or amount of ATL-359 available from the drug eluting stent is between 10 and 2000 micrograms and more preferably between 30 and 450 micrograms (for a 3.5×17 mm stent) which from a 3.5×17 mm stent would be between 0.2 and 2.75 micrograms per square millimeter of arterial tissue area, where the area of arterial tissue is defined as the area of the surface of a theoretical cylinder whose diameter and length are the diameter and length of the expanded stent as deployed in the artery. The total delivered dose of ATL-359 or other adenosine A2A receptor agonist will scale with the stent diameter and length.
As set forth above, the bioresorbable polymer utilized in the composition comprises PLGA. More preferably, the composition comprises a PLGA polymer where the molar ratio of lactide to glycolide residues (L:G) in the polymer chain is from about 85:15 to about 65:35. Even more preferably, the composition comprises a PLGA polymer where the molar ratio of lactide to glycolide residues (L:G) in the polymer chain is from about 80:20 to about 70:30. The PLGA should preferably have an intrinsic viscosity in the range from about 0.1 to about 0.9 dL/g. In the exemplary embodiment, the composition comprises a PLGA polymer where the molar ratio of lactide to glycolide (L:G) in the polymer chain is 75/25 in both the drug composition and the barrier layer with an intrinsic viscosity of 0.68 in the drug composition and 0.21 in the barrier layer. The weight ratio of ATL-359 to PLGA, designated as the D/P ratio, is preferably in the range from 95/5 with a four (4) percent volume cap and a dose of about 523 micrograms on a 3.5×17 mm stent for an overall D/P of 85.7/14.3 to about 60/40 with an eighteen (18) percent cap and dose of 275 micrograms for an overall D/P of 47.5/52.5. These values are scalable with dose and stent size. All ratios are weight percentages.
In order to make the above-described constituents a solution for filling purposes, a suitable solvent is required. Dimethyl sulfoxide, DMSO is the preferred solvent and is preferably utilized in an amount of ATL-359 in the range from about 1 percent to about 30 percent by weight relative to the total weight of DMSO filling solution. Even more preferably ATL-359 is utilized in an amount in the range from about 10 percent to about 25 percent by weight relative to the total weight of DMSO filling solution. Even yet more preferably ATL-359 is utilized in an amount in the range from about 15 percent to about 21 percent by weight relative to the total weight of DMSO filling solution.
It is important to note that the drug loading or doses for each drug may be expressed in any number of ways, including those set forth above. In a preferred exemplary embodiment, the dose ranges may be expressed as nested absolute ranges of drug weight based on a standard 3.5 mm×17 mm stent size. In this way, the dose ranges would scale with stent size and reservoir count. For example, in a 3.5 mm×17 mm stent size the number of holes or reservoirs is 585. In other exemplary embodiments, the number of reservoirs for a given size stent may include 211 reservoirs for a 2.5 mm×8 mm stent, 238 for a 3.0 mm×8 mm stent, 290 reservoirs for a 3.5 mm×8 mm stent, 311 reservoirs for a 2.5 mm×12 mm stent, 347 for a 3.0 mm×12 mm stent, 417 reservoirs for a 3.5 mm×12 mm stent, 431 reservoirs for a 2.5 mm×17 mm stent, 501 for a 3.0 mm×17 mm stent, 551 reservoirs for a 2.5 mm×22 mm stent, 633 for a 3.0 mm×22 mm stent, 753 reservoirs for a 3.5 mm×22 mm stent, 711 reservoirs for a 2.5 mm×28 mm stent, 809 for a 3.0 mm×28 mm stent, 949 reservoirs for a 3.5 mm×28 mm stent, 831 reservoirs for a 2.5 mm×33 mm stent, 963 for a 3.0 mm×33 mm stent and 1117 reservoirs for a 3.5 mm×33 mm stent.
The data from which the curves 602 and 604 were generated were the result of an experimental protocol involving anesthetized domestic pigs. In this experiment, a single stent (3.0×17 mm) was implanted into the mid-LAD coronary artery under fluoroscopy via femoral access in a pig anesthetized using isoflurane gas. A total of nine pigs were utilized. In six of the pigs the stents contained ATL-359 as described above and in the remaining three pigs the same stents were utilized, but with no ATL-359. Once implanted with the stents, continuous hemodynamic recording was performed for four hours with the results illustrated in
Other selective agonists include Selodenoson (DT10009), Tecadenoson (CVT-510), CVT-2759, Binodenoson (MRE0470), Regadenoson (CVT-3146), MRE0094, BAY-60-6583), CF101 (IB-MECA), CF102 (CI-IB-MECA), CF502 (MRS3558) and AMP-579.
The drug eluting stent of the present invention may be utilized to treat a number of disease states as set forth above, including restenosis, thrombosis, acute myocardial infarction, reperfusion injury, capillary no-reflow conditions, and ischemic related conditions. In addition to the use of adenosine A2A receptor agonist, other drugs may be added to the device. For example, anti-thrombotic agents such as heparin, cilostazol or tirofiban may be added. The additional drugs may be included as coatings or in reservoirs. What is important to note is that any number of drugs and reservoir combinations as well as coatings may be utilized to tailor the device to a particular disease state. For example, sirolimus which is a known effective inhibitor of smooth muscle cell growth may be utilized in combination with a selective adenosine receptor agonist to provide an effective means for treating restenosis. Specifically, in the stent illustrated in
Although shown and described is what is believed to be the most practical and preferred embodiments, it is apparent that departures from specific designs and methods described and shown will suggest themselves to those skilled in the art and may be used without departing from the spirit and scope of the invention. The present invention is not restricted to the particular constructions described and illustrated, but should be constructed to cohere with all modifications that may fall within the scope of the appended claims.
This application claims the benefit of U.S. Provisional Patent Application Ser. No. 61/415,045 filed Nov. 18, 2010.
| Number | Date | Country | |
|---|---|---|---|
| 61415045 | Nov 2010 | US |
