Patent Application
20110206768
This invention relates to a medical preparation, and methods of manufacturing same.
In particular, the present invention relates to the preparation of bone material for implantation. It should be appreciated that the ultimate goal of using bone grafts or a bone substitute is to initiate a healing response that will produce new bone as an end product in an area where new bone is required.
The present specification will now be written with reference to the bone implants as being in relation to cancellous bone which is the internal spongy bone. In contrast, cortical bone makes up a large proportion of the skeletal mass, and is the structural bone.
Bone implants impregnated with titanium (and/or other metals such as aluminium and vanadium) have previously been used to replace cortical bone deficits or provide a structural support to allow healing.
However, there are significant concerns about the toxicity of these implants, particularly if an analogue is used in relation to cancellous bones which fit into the interior of a cortical bone.
When cancellous or cortical bone becomes damaged or lost, it is common to use a bone graft as part of the surgical repair the bone or bone deficit. Correct porosity and internal pore architecture have been shown to greatly enhance the healing, regenerative processes within the body. This is why it is desired to use bone based implants with similar architecture, rather than synthetic equivalents.
One procedure is the use of autogenous bone which is bone taken from the patient's own body. With this option, patients usually undergo two separate surgical procedures—one to remove the healthy bone and then another to implant it into the damaged area.
Autogenous bone is an ideal implant as it is highly compatible with the patient, is a long term match and has the required strength and biological functions. In particular the advantages include:
This procedure however has a number of limitations such as
Another option is the use of cadaver bones, these are bones which have been harvested from other humans who have died and chosen to donate their bodies tissues and organs. Unfortunately, with these bones there is concern about the product's supply and purity. For example, it may be possible for the surgeons or donor banks to overlook potential diseases within the bone, such as HIV, cancer and hepatitis, which may then be passed onto the recipient. Also, patients can have psychological issues or religious issues with using bones from this source.
There are a wide range of synthetic materials available in the market however few have physical properties (similar to human bone), zero disease risk, biocompatibility, osteo-conduction combined with the bone regeneration (osteo-induction) possibilities available through this process.
One example of a synthetic product is Vitoss® blocks. These are made from β tri-calcium phosphate which is a highly soluble material in vitro which is not desirable. While this material has its uses, it does not have the same structural integrity as does natural bone. Further, these products are very expensive to produce in comparison to natural bone.
Other examples of synthetic products include Cerabone® and Endobon® implants. These do not undergo the same degradation as Vitoss® and have the advantage of retaining the interconnecting pore structure of original bone. However, these still have disadvantages when used as bone implants, for example there is no biological function provided such as oestoinduction provided by autogenous bone implants.
Another attempt to find a suitable cancellous bone implant is described in PCT/GB1989/01020. This patent specification describes a process by which bovine bones are ground up and then mixed with gelatin to create an implant. This product however does not retain the internal architecture of natural bone which enhances integration, healing and regenerative processes within the body.
Further the steps of grinding the bone and then re-assembling the ground bone into an implant is a time consuming and expensive process.
In addition, the use of multiple bone pieces means that the implant has less strength, is harder to integrate into the body, and is more difficult to manufacture.
The use of gelatin is also of concern as it is not necessarily a prion-free material.
Having prion-free material is of considerable importance given the incidence of BSE. This is one reason why a ready source of natural bone material (bovine) has not been adopted widely despite their abundance as a ‘waste product’ from the meat industry. If bovine (and perhaps other animals) material could be used, then this could solve a number of problems in the prior art, namely finding material which is sufficiently bone-like to give the sufficient strength, architecture and integration in the body.
European Patent No. 1338291 uses bovine and porcine bones in an attempt to produce a bone matrix used in implants. However, like the invention disclosed in PCT/GB1989/01020 this relies on the grinding of the bone to form a sponge and mixing this with gelatin to form a sponge mass that can be implanted. Again, this does not have the same structure or strength as natural bone.
All references, including any patents or patent applications cited in this specification are hereby incorporated by reference. No admission is made that any reference constitutes prior art. The discussion of the references states what their authors assert, and the applicants reserve the right to challenge the accuracy and pertinency of the cited documents. It will be clearly understood that, although a number of prior art publications are referred to herein, this reference does not constitute an admission that any of these documents form part of the common general knowledge in the art, in New Zealand or in any other country.
It is acknowledged that the term ‘comprise’ may, under varying jurisdictions, be attributed with either an exclusive or an inclusive meaning. For the purpose of this specification, and unless otherwise noted, the term ‘comprise’ shall have an inclusive meaning—i.e. that it will be taken to mean an inclusion of not only the listed components it directly references, but also other non-specified components or elements. This rationale will also be used when the term ‘comprised’ or ‘comprising’ is used in relation to one or more steps in a method or process.
It is an object of the present invention to address the foregoing problems or at least to provide the public with a useful choice.
Further aspects and advantages of the present invention will become apparent from the ensuing description which is given by way of example only.
According to one aspect of the present invention there is provided a bone matrix including
a bone matrix material, which has had organic material removed, and
a replacement material that has replaced the organic material
characterised in that the bone matrix material is formed from a single piece of bone.
According to one aspect of the present invention there is provided a method of producing a bone matrix including the following steps.
In a preferred embodiment the bone matrix of the present invention may be used as a bone implant, and shall be referred to as such herein.
However, one skilled in the art would readily realize that the bone matrix of the present invention could also be used for other purposes, for example the bone matrix could be used for filling voids (or augmentation) in other structures.
Also, while not bone related, the material could be shaped to use as an ocular implant.
In a preferred embodiment the bone matrix material may be of a type that can be used to replace cancellous bone within the body. However, one skilled in the art would realise that the present invention may also have uses in relation to replacing cortical bone in some instances.
In a preferred embodiment the bone matrix material may be natural bone, and shall be referred to as such herein.
It should be appreciated that the bone matrix material preserves through its original process, numerous macropores and interconnected canals between macroporous cavities, which allows that a rapid colonization of cells at the center of the biomaterial.
An adapted porous structure is necessary to obtain a bone substitute capable to be degraded by bone cells and so to be replaced by new bone.
In a preferred embodiment the bone matrix material may be cancellous bone.
In a preferred embodiment the bone matrix material may have a bulk density of substantially, or greater than 0.8 g/cm3 (as measured by gravimetric (weighing of cube) analysis together with the physical dimensions of the cubes).
Below this level the bulk density value the inventors have found that the sintered bone has little intrinsic mechanical strength.
In a preferred embodiment the bone matrix material may be bone sourced from a variety of sources, including porcine, cervine, ovine and human cadavers.
In a particularly preferred embodiment the bone matrix material may be sourced from bovine, and shall be referred to as such herein.
One reason for using bone matrix material from a bovine source is that there is a plentiful supply, especially from abattoirs and animal/meat processing plants.
Another significant advantage of using bone sourced from bovine is that a key aspect of the present invention is the use of a single bone piece to produce an implant.
Bovine bone is of sufficient size that samples can be cut therefrom, treated in accordance of the present invention and then cut to size and shape without requiring more than one bone piece to do so. Further, any left over treated bone can be used as void filler.
One skilled in the art would appreciate that the source bone may be cut and shaped to the desired implant size and shape either before or after processing to remove organic material, and replace same with a replacement material.
However, this should not be seen as limiting, as a range of other bone matrix material may also be utilised with the present invention, for example from horses or other larger animals.
It should be appreciated that some bone implants may not be large, and therefore, sourcing the bone matrix material from other animal sources may be possible.
A significant problem with bovine bone is that in many countries there have been outbreaks of BSE (Bovine Spongiform Encephalopathy) otherwise known as Mad Cow Disease. This can be introduced to humans through the ingestion or introduction to the body of proteins known as prions obtained from beef products. The human form of this disease is known as Creutzfeldt-Jakob Disease (CJD).
In preferred embodiments of the invention the bone material is sourced from certified BSE free countries such as New Zealand and Australia.
Bovine bone sourced from New Zealand is BSE free. Bovine bone sourced from a certified BSE free country is an ostensibly cheaper material due to the heavy agricultural practices and high volumes of bovine bone being the waste product of abattoirs and meat processing plants.
Bovine bone is normally used as a low grade fertilizer. Alternatively, the bone must be disposed of into the environment.
Bovine bone from certified BSE free countries can be sourced from mainstream herds and meat processing plants. This is a significant advantage, as there is no requirement to develop a ‘safe’ herd of cattle to supply clean BSE free bone.
If bone is sourced from non BSE free countries, for example Europe or even the USA, a number of disadvantages are present, these include the following:
The use of waste bone material also provides advantages in lower disposal costs and lower volumes of waste having to be disposed of.
Regardless of the bone source, (human, bovine or whatever) it has been recognised by the inventor that all of the organic material within the bone should be removed, not only to allay any concerns about the material containing prions, but also to remove other potential diseases such as HIV, cancer and hepatitis.
The organic material can be removed by a number of ways.
In one embodiment of the present invention the bone may be subjected to heat and pressure in an aqueous medium to remove the bulk of the protein in lipid organic material.
In a preferred embodiment the bone (as processed with heat and pressure) may then be sintered to burn off any remnant organic material.
The inventor has found that this process effectively sterilises the bone to guarantee a product completely free of prions and any other diseases.
It should be appreciated that this is a preferred method of organic material removal only.
One skilled in the art would readily appreciate that other methods may be used to remove organic material from the bone matrix material. These may include, for example treatment with a chemical reagent or solvent (such as, sodium hydroxide, hydrogen peroxide, or acetone), although it is thought that these alone would not provide the degree of sterilisation required.
It has been recognised that the inclusion of a bone matrix material with the organic matter removed is often chalky in consistency and correspondingly is of low strength. Collagen which forms part of the organic material removed strengthens the bone matrix and provides a framework for bone growth.
While the bone (with organic material removed) has the requisite pore architecture it does not have the internal material which allows for the ready integration of the bone implant with the physiology of the body into which the implant is being placed.
Therefore, the present invention includes the replacement of the original organic material with a replacement material.
Ideally the replacement material is one that has properties that to a degree mimic the functionality of autogenous gone. For example the replacement material may impart strength to the bone matrix and act as a reinforcing material. Alternatively, or additionally, the replacement material may supply biological functionality similar to that of autogenous bone.
This is because bone grafts serve a dual mechanical and biological function. Initially, some mechanical strength is important—mainly for handling, however, it is ultimately the biological activity that allows for incorporation into the host bone.
A variety of replacement materials can be utilised with the present invention. These include synthetic calcium phosphates (such as β-tri-calcium phosphate), synthetic hydroxyapatite or even algae or coral-derived hydroxyapatite.
Calcium phosphate (Hydroxyapatite) derived materials are known to be biocompatible and capable of bonding chemically to bone. They are widely used as bone repair materials in human surgery because their chemical composition is similar to that of bone. This is a preferred replacement material.
Calcium phosphate apatite (CPA) is known to be one of the most important implantable materials due to its biocompatibility. Natural bone is approximately 70% CPA including hydroxyapatite (HAP) by weight and 50% by volume
In preferred embodiments the replacement material may be an organic material based matrix as it has a number of advantages over synthetic derived products. These include the following:
Firstly, an organic matrix is less likely to have toxicity problems.
Secondly, an organic matrix provides additional strength to the bone structure.
Further, an organic material may enable, enhance or initiate integration of the bone into the transplantee's body. That is, it is believed the body could break down the organic structure and replace it with collagen fibres, further strengthening the position of the bone implant in the body and its overall strength.
There is a wide variety of suitable organic matrix materials that can be used with the present invention. These include (but are not limited to):
It should be appreciated that one problem with using animal sourced replacement materials is that there may be a risk of reintroducing some of the diseases that were removed by removing the original organic material from the bone matrix material in the first place. This is especially the case when the replacement material is derived from a land based animal. This must be taken into account and sufficient testing put in place to ensure sterile material is used, if the reinforcing material is sourced from animals. Rigorous treatment of the reinforcing material to ensure that they are sterile may increase the cost of manufacture and of the bone matrix product.
Another concern in using animal sourced reinforcing material, for example shark sourced materials, is that these could have toxicity problems associated with the high level of heavy metals they contain, which could then be introduced to the patient.
In another embodiment the reinforcing material may be derived from plants, for example oxycellulose.
In a preferred embodiment the replacement material may also be bio-active or contain bio-active materials. That is, the replacement material could initiate or enhance integration of the bone matrix into the patient's body. This significantly decreases recovery time, and increases the strength and integration of the implant.
For example the replacement material may have within it a number of bioactive components that help the bone integrate more readily into the body and/or encourage bone healing such as bone morphogenic proteins, bone and growth hormones or autogenous cells such as cells sourced from the recipient's bone marrow.
In one particularly preferred embodiment the preferred organic material may be chitosan which is derived from shellfish shells.
Chitosan is particularly suitable for the present invention as some believe it is a bio-active that the body can break down and replace with collagen fibres.
In another embodiment the replacement material may be synthetic. One example of a suitable synthetic material is polycaprolactone (PCL) which is a biodegradable thermoplastic polymer derived from chemical synthesis of crude oil. Even though this material is synthetic, it has the advantage that it has already been used instead of titanium in repairing holes is skulls, thus is known to be bone compatible.
In another alternative embodiment, the replacement material may be a combination of above mentioned components, or a combination of one (or more) of these with other bio-compatible components.
An important aspect of the present invention is the use of a single bone piece to manufacture the bone matrix (implant). This is because of its associated strength, bio-compatibility and processing properties.
However, there are inherent problems with using larger pieces of bone which the inventors have needed to overcome in order to implement the present invention.
A significant problem having larger bone than used in the prior art (which generally utilises ground up bone) is that the replacement material needs to be impregnated throughout the natural bone structure.
This is relatively easily achieved with ground pieces of bone utilised in the prior art as a consequence of the natural diffusion process and the greater accessibility of pores.
However, the longer distances that the replacement material has to travel within larger bone pieces, and through the natural bone structure makes it difficult to achieve the full penetration and strength required and also makes rinsing the entire bone of impurities a challenge.
One way to address this problem is to lower the viscosity of the replacement material so that it flows through the porous bone structure more readily. However, this can also lead to decreased strength and the replacement material pouring out of the bone as well.
Therefore, according to one aspect of the present invention there is providing the step of curing the reinforcing material within the bone.
The term “curing” as used herein should be taken to mean any process that ensures that the replacement material can set within the bone.
Thus, the ‘curing’ process is most likely a process that causes the replacement material to change its viscosity after it has infiltrated the porous structure of the bone.
The curing process may be achieved by a variety of means depending on the material being infused.
For example, in one embodiment a vacuum process may be used to draw the replacement material through the bone sufficiently quickly that the material penetrates the bone before it has time to set/cure.
Setting of the replacement material, for example could be the result of evaporation, of a solvent, the action of a curative agent, and/or application of heat.
It is apparent that the present invention has a number of advantages over the prior art, these include:
Further aspects of the present invention will become apparent from the following description which is given by way of example only and with reference to the accompanying drawings in which:
An ideal bone matrix graft material includes the following characteristics many of which are physical and have been characterised by competing products.
Composition (Ratio of Hydroxyapatite and Chitosan)
One method of trying to achieve this is described below.
Cancellous bovine bone is acquired from the New Zealand meat industry (known to be prion free) as a waste feed stock.
Samples of bone are cut to a desired shape and size, and then subjected to heat and pressure in an aqueous medium to remove the bulk of the protein and lipid organic material.
The processed bone is subsequently sintered at 1000° C. for three hours to burn off remnant organic material, and as a means of sterilisation (by incineration) to guarantee a product completely free of prion material.
A chalky bone results of low strength.
A replacement material is prepared by dissolving 2.5 g of chitosan and 1.5 g CaHPO4 in 250 mL of water acidified with HCl to yield a 1% w/v solution of chitosan and a 0.6% w/v solution of calcium hydrogen phosphate.
This solution with viscosity marginally greater that that of water is infiltrated into the porous sintered cancellous bovine bone (SCBB) by placing the SCBB in a vacuum capable vessel and then inducing a vacuum. Once a sufficient vacuum has been reached, the line to the vacuum is shut off and a line to the infiltrate is opened allowing the liquid to flow into the sintered bone. The chitosan solution is forced into the SCBB pores and also into the microscopic crevasses within the SCBB's structural trabeculae.
After infiltration the sample is removed and placed in an atmosphere of NH3(g) as per the curing regime outlined below and then washed as per washing process outlined below.
The sample is air dried to yield a mechanically strengthened bone replacement bio-implant that is biocompatible and bio-absorbable while retaining comparable pore size and internal pore architecture to that of living bone tissue.
Correct porosity and internal pore architecture have been shown to greatly enhance the healing, regenerative processes within the body.
The chitosan infiltrating material on its own has been shown not to elicit antigenic responses when placed in the body, so making it an ideal candidate as a bone replacement biomaterial [11].
Although the yield strengths under compressive strain of these chitosan infiltrated SCBB samples tend to be less than that of raw bone, their subsequent compressive stress versus strain profiles are characteristic of bone.
The degree of infiltration was established by Scanning Electron Microscopy, Dye Tracing and InfraRed Microscopy.
Mechanical strength was tested by compression testing on an Instron instrument. Comparison between pure sintered bone, raw bone and treated samples were made with regard to yield strength, Young's modulus and stress/strain profile. Due to the inherent natural variability in structure and density of the raw material (SCBB) a statistical approach was needed to make a comparison between this material and the infiltrated reinforced samples.
This statistical analysis was undertaken in a series of steps. First, compression testing was performed on a number of untreated SCBB samples. ‘Apparent’ density was calculated simply by dividing the mass of the sample by the volume. From this data, and the compression testing data, a correlation plot of maximum stress versus apparent density was produced.
Subsequent reinforced samples' test results were compared to this baseline value as a means of gauging improvements or otherwise to physical properties. Initial results indicated that some organic matrices led to slightly higher maximum stress values. Significantly the stress/strain profiles began to resemble those of raw cancellous bone rather than those of sintered bone as shown in
Other SCBB samples are made via similar processes to those described above but without the ‘curing’ process using NaOH solution described above.
Polycaprolactone (PCL) is dissolved in tetrahydrofuran (THF) and infiltrated into SCBB. The THF solvent is then allowed to evaporate to yield a reinforced sintered bone sample. PCL is a biocompatible polymer that is broken down in the body to non-toxic by-products.
Other strengthening materials such as oxycellulose and keratin derived from wool fibre can be in principle infiltrated into the SCBB by the processes described above.
Ultimately, a cheap, widely available raw material (waste bovine bone) is transformed into a highly biologically compatible bone replacement bio-implant material, with superior mechanical properties to that of unmodified sintered bone and without the risk of any bone-sourced prion transmission.
Biocompatibility
Sintered bovine bone has previously been shown to be biocompatible in vivo as shown by reference [1] in which sintered bone has been successfully used in spinal surgery.
Additionally, bovine cancellous bone, that has not been sintered but has been deproteinated has been shown to be osteoconductive in a sheep and a dog model [2, 3].
Furthermore, reinforcing materials such as polycaprolactone, chitosan and silica which can be utilised with the present invention have been shown to be individually biocompatible (or assisting biocompatibility when used in a hybrid material) on the basis of previous reports [4-6]
Range of Reinforcing Materials
The following replacement materials were utilised in experimentation on curing processing.
Curing Regime
Samples were cured by being placed in an atmosphere of NH3(g) generated from concentrated NH3(aq).
The NH3(g) diffuses and dissolves into the infiltrated solution occupying the pores of the bone matrix in which it hydrolyses to form hydroxide. The hydroxide then acts to cure the chitosan and accompanying materials when present.
For a sample of dimensions 12 mm diameter by 15 mm height this was seen to occur within 1 hour. Generally, samples were simply left overnight in a NH3(g) atmosphere to ensure complete curing.
Washing Process
After curing, samples were washed in distilled water to remove excess ammonia and ammonium salt of the acid used to dissolve the chitosan and other compounds.
Washing was carried out by placing samples in a vessel with gently stirred water. 400 mL of distilled water is used per sample and the water was replaced every 1 hour.
It was found that 3 repetitions were necessary to reduce residue ammonia and other residues to levels either approaching control levels or where no further reduction in the levels of these impurities could be detected.
In particular
Preferred Properties of the Bone Matrix
The preferred properties of the bone matrix are cancellous bovine bone having a bulk density greater than 0.8 g/cm3 (as measured by gravimetric (weighing of cube) analysis together with the physical dimensions of the cubes).
Below this bulk density value sintered bone proved to have little intrinsic mechanical strength.
Bone Cleaning Methods
Autoclaving is recommended for 6 hours in water at 15 psi with a change of water every two hours. This would be followed by drying then sintering in a muffler furnace for 3 hours at 1000° C.
Mechanical Data
In particular
Aspects of the present invention have been described by way of example only and it should be appreciated that modifications and additions may be made thereto without departing from the scope thereof of the appended claims.
| Number | Date | Country | Kind |
|---|---|---|---|
| 551965 | Dec 2006 | NZ | national |
| 552568 | Jan 2007 | NZ | national |
| Filing Document | Filing Date | Country | Kind | 371c Date |
|---|---|---|---|---|
| PCT/NZ07/00354 | 12/6/2007 | WO | 00 | 1/8/2010 |
