Patent Application
20200359618
The invention relates to a device for transport and preservation of an ex vivo biological sample comprising a chamber for containing the biological sample, delimitated by walls made of a thermal insulating material and cooling means for keeping the temperature inside the chamber below the temperature outside the device, as well as to a corresponding method for preservation of the biological sample.
The invention also relates to the use of the device according to the invention for transport and preservation of an ex vivo biological sample and subsequent transplant in a living human being or animal, or for subsequent laboratory research.
In the invention, the concept of “ex vivo biological sample” relates to an organ or tissue that can be transported for subsequent transplant in a living human being or animal, or for subsequent laboratory research.
For example, it is well known in the field of transplants that ischemia/reperfusion (FR) syndrome is one of the main causes of both primary graft dysfunction (PGD) and primary graft failure (PGF), another transplantation being necessary in the latter case. Despite the advances achieved in surgical techniques in the past few decades, the injury the graft sustains during the period in which the donor organ is transported until it is implanted in the recipient (cold ischemia time) is still a major socially and clinically relevant problem yet to be solved. The incidence of PGF is 5-10% and the incidence of PGD is 20-30% among transplanted organs. This all negatively results in a poor quality of life for the patient, the need for transplanting again, and more problems in the availability of organs for transplant.
There are different methods for storing a graft from the time it is removed from the donor until it is implanted in the recipient. In the case of dynamic normothermic preservation, in vivo conditions of the graft are imitated to the greatest extent possible throughout the entire preservation period. To that end, hypothermia is avoided, and the entrance of oxygen into the graft to prevent hypoxia and a reservoir for the exit of waste product are provided.
In static hypothermic preservation, which is the conventional preservation method, before the donor graft is transplanted in a recipient, the donor's organ or organs and tissues are subjected to an inherent ischemia time. Under such conditions, the method used for preserving the organ and tissues must comply with the following requirements: removing blood from the graft and rapidly cooling the graft by means of perfusion of the graft with the solution at 4° C., covering the graft with ice to assure cold conditions (2-6°) and ischemic conditions. As a result, the injury the graft sustains during cold ischemia, i.e., due to a lack of blood supply and oxygen delivery under cold conditions, is reduced.
From the time the organ is removed from the donor, the graft is placed in a cooler, immersed in the preservation solution, and it is usually kept at 4 C until it is implanted in the recipient. The solution most widely used in the art is the University of Wisconsin solution, hereinafter UW solution.
The injury the graft sustains during transport in the cooler until it is implanted in the recipient (cold ischemia time, which is not usually less than 6 hours) is a key factor. This factor is responsible for PGD and PGF and negatively affects post-operative results, the quality of life and survival of the patient. It is known that the longer the time the organs remain in the cooler, the lower the viability of the graft that will be transplanted. The injury grafts sustain during the cold ischemia stage is the primary reason that a considerable number of organs (35%) cannot be considered suitable for transplant given their pathological conditions (kidney grafts from elderly, diabetic and/or hypertensive donors, fatty liver grafts, etc. . . . ). Such organs are extremely vulnerable to the injury they sustain during transport, before being implanted in the recipient, and have a higher risk of experiencing PGD and PGF. They are therefore not viable for transplant. These observations indicate that there is a need to find alternatives for reducing the injury grafts sustain during cold ischemia before being implanted in the recipient.
Many of the components present in preservation fluids, the objective of which is to protect the graft under cold ischemia conditions in the cooler during the transport thereof until it is implanted in the recipient, do not enter the graft and if they do, they do not reach the site of action at optimal concentrations in order to protect it. In fact, it has been found that when some of the components are removed from such preservation fluids, postoperative and post-transplant results are the same as if they were not removed.
Patent document WO 2007/143715 A2 relates to applying ultrasound to allow delivering oxygen to wounds and to aid wound healing. By way of example, the patent document very briefly discloses a device for preserving organs after they have been removed from the donor. To that end, the organ is placed in a vessel which is supplied with a gas or liquid supersaturated with oxygen. It is a dynamic preservation system because the oxygen or liquid solutions saturated with oxygen contained therein gradually enter at controlled flow from an oxygen reservoir into the vessel, and waste products are gradually removed. The organ vessel is placed inside a semi-rigid container. The outer container further comprises an ultrasound system for directing ultrasound on the container. There are no means for transmitting ultrasound between the inner vessel and the outer container, so the system cannot work as well as if the ultrasound was applied directly on a wound for the purpose of wound healing.
Studies indicating that application of ultrasound aids in delivering drugs and substances through tissues, such as the skin, and into the bloodstream, are also known. Nevertheless, in said studies ultrasound is applied in vivo, i.e., in the presence of blood flow. Patent document U.S. Pat. No. 4,767,402 A, relating to the field of transdermal drug delivery by means of applying ultrasound, also relates to the risks associated with the use thereof. The patent document particularly advises against the prolonged use of ultrasound due to the risks associated with the increase in skin temperature and the possible damage this technique can cause. The same patent document also discloses that ultrasound is poorly transmitted through air and that the preferred application thereof therefore requires a liquid medium. As a result, applying ultrasound for organ and tissue preservation is not advisable due to the mentioned factors of: local heating of the tissue, difficulty in penetrating considerable tissue or organ thicknesses, and transmission difficulty in gaseous media.
Patent document U.S. Pat. No. 5,267,985 A discloses a method and apparatus for enhancing the diffusion of a substance to a local area of a material or tissue by means of ultrasound at two or more distinct frequencies. This patent document also discloses that the local temperature increase when ultrasound is applied is beneficial for aiding in increasing penetration of the substances to be diffused.
The article (Sen Wang et al, Medial hypothesis, 74, 2010; 147-149) suggests applying ultrasound at a medium intensity (0.3-1.2 W/cm2) in vivo in order to damage a specific area of the donor organ such that only stem cells are activated and the organ can be regenerated, forming a hybrid organ that can be more compatible with the recipient.
Patent document WO 2005/013799 A1 discloses a method based on applying ultrasound in vivo during reperfusion, i.e., blood supply enters the tissue, after an ischemia time. Ultrasound is only applied for a short time span (not more than 15 minutes) to favor the entrance of blood and oxygen into a tissue and to reduce microcirculation disorders caused by reperfusion.
Therefore, it can be inferred from the art that applying ultrasound generates heat in both aqueous media and tissues. Ultrasound applied for only between 1-10 minutes (times used in most medical applications) and at frequencies and intensities that are usual in the art alone causes the heating of tissues, which is interpreted as a negative factor for proper storage of an ex vivo biological sample. When the temperature exceeds 38° C., exposure to ultrasound is usually interrupted because it damages tissues. For example, patent document U.S. Pat. No. 5,267,985 discloses the possibility of using ultrasound for 15-30 minutes to achieve tissue penetration between 1 and 2 cm.
In fact, ultrasound has often been applied in clinical practice precisely as therapy to cause the heating of tissue. Besides the heating caused by ultrasound alone, ceramic transducers tend to heat up with vibration, even further increasing the thermal effect on tissue (Watson T et al, 2008, 48: 321-329; Baker K G, et al, 2001; 81: 1351-1358; Legay M et al.; 2011, ID670108; 1-17).
It is an object of the invention to provide a device for transport and preservation of an ex vivo biological sample and a method of the type indicated above that reduces injury to the biological sample, and accordingly increases viability thereof in comparison to what could be obtained with known devices. The invention also considers, in the case of transplants, the problem of improving the quality of life of transplant patients, and in the worst cases, of significantly reducing the need for another transplant.
This objective is achieved by means of a device for ex vivo transport of the type indicated above, characterized in that it further comprises at least an ultrasound system suitable for generating and applying ultrasound on said biological sample. Applying ultrasound combined with cooling the inner chamber can therefore be carried out such that local heating of the biological sample, and the subsequent increase in temperature that would cause damage therein, are prevented. Particularly, the device also comprises an auxiliary container containing a preservation solution, without external oxygen delivery and for containing said biological sample immersed in said preservation solution.
Therefore, contrary to what was expected, it has been verified in the invention that applying ultrasound, which is applied such that it does not generate local heating in the sample, does not negatively affect the positive effect of cooling the biological sample, and accordingly does not damage it either. Furthermore, however, it has surprisingly been verified that a very significant improvement is achieved with ultrasound, so much so that as will be seen later in the description, a synergistic effect between applying cold conditions inside the chamber of the device and applying ultrasound could be confirmed. To that end, there are many possible configurations, such as applying ultrasound close to the biological sample at a low intensity, or arranging the transducers away from the sample at higher intensities and in contact with a preservation fluid containing the sample.
Furthermore, also contrary to what was expected, problems with the duration of applying ultrasound were not verified in the invention. In other words, the need to keep the sample under cold ischemia conditions for several hours is known in organ transport. According to the invention, ultrasound can be continuously applied at suitable intensities, and despite what would be expected, it does not damage the biological sample either.
Therefore, by applying ultrasound, and preventing local heating of the sample, a significant reduction of cell damage has been verified. Furthermore, based on the assays conducted, it has been verified that protection of the organ against injury induced by cold ischemia by simultaneously applying both treatments is unexpectedly better than the sum of all the protection obtained through the treatments separately.
Furthermore, the invention covers a series of preferred features which are the object of dependent claims and the usefulness of which will be highlighted below in the detailed description of an embodiment of the invention.
Preferably said auxiliary container is closable.
In a preferred embodiment, it has been verified that said ultrasound system is suitable for emitting said ultrasound at a frequency comprised between 25 kHz and 1 MHz and a sound intensity comprised between 0.01 and 2 W/cm2, and preferably between 0.02 and 1 W/cm2, and particularly preferably between 0.02 and 0.1 W/cm2. These frequency and intensity ranges have been verified to be particularly beneficial in reducing cell damage. Particularly at a lower intensity, better results are obtained and less cooling of the sample and/or separation of the transducers with respect to the biological sample is necessary, which allows the device to be more compact.
It can also preferably be envisaged that the ultrasound is applied in a continuous manner or alternatively in a pulsed manner. Furthermore, the invention does not rule out simultaneously applying ultrasound having different frequencies by means of the corresponding individual control of each of the transducers of the device.
It has also been verified that the lower the temperature, the greater the synergistic effect obtained with the ultrasound. Therefore, in a particularly preferred manner, the cooling means are suitable for keeping the temperature inside said chamber between 0 and 15° C., and preferably between 2 and 10° C., and particularly preferably between 2 and 6° C. So much so that as has been verified, the combination of cold conditions and ultrasound together provides better results than what would be expected in the best case of the sum of the effects of cold conditions and ultrasound separately.
In a preferred embodiment, the device according to the invention comprises a sheet-like support in said chamber suitable for supporting the biological sample, said sheet-like support being able to vibrate freely when said ultrasound is applied, and the ultrasound system comprises at least one transducer mounted on at least one of the walls of said sheet-like support. As a result, the damping effect of the support is minimized and ultrasound is introduced in the biological sample in a more efficient manner, improving the effect thereof in bulkier biological samples provided that excessive local heating in the biological sample is prevented.
In a particularly preferred manner, said at least one transducer is mounted on the face of said sheet-like support opposite the support surface for said biological sample to apply said ultrasound towards said support surface. A more homogenous ultrasonic field is thereby obtained, even further favoring the combined effect of cold conditions and ultrasound on the biological sample. It may be appropriate for the sheet-like support to be a tray and for such tray to allow containing a fluid, such as water, to improve transmission of the applied ultrasound. The function of the fluid is on one hand to act as a coolant, and to simultaneously favor transmitting ultrasound to the biological sample.
In a particularly preferred manner, said sheet-like support is made of metal in order to increase the rigidity thereof and prevent damping to the greatest extent, and to achieve more direct transmission of the ultrasound on the biological sample.
In a particularly preferred embodiment, the device comprises a closable auxiliary container containing a preservation solution. Again, it has been verified that the combination of cold conditions and ultrasound plus immersion of the biological sample in a preservation solution provides better results than the sum of their individual effects as regards reducing damage to the biological sample.
In an embodiment of the device according to the invention, the sheet-like support is a tray adapted for containing a fluid.
In another preferred embodiment, the sheet like support is a tray containing water.
In another embodiment the auxiliary container comprises a false bottom located away from the base of said auxiliary container, and said false bottom being in fluid communication with the rest of said auxiliary container.
Also in a particularly preferred manner, the auxiliary container can incorporate a false bottom intended for keeping the biological sample away from the support surface of the container, said false bottom being in fluid communication with the rest of the auxiliary container. As a result, the sample can be placed in the auxiliary container as if it were floating in the preservation solution. The sample therefore does not receive such a direct action of the ultrasound and can work at higher intensities.
Furthermore, the invention also considers a method for transport and preservation of an ex vivo transplantable biological sample characterized in that it comprises the steps of removing and washing blood out of the biological sample, placing the biological sample in a chamber delimitated by walls made of a thermal insulating material without external oxygen delivery and irradiating the sample with ultrasound. More particularly, in the method according to the invention the biological sample is kept immersed in a preservation solution without external oxygen delivery by placing said biological in a chamber delimitated by walls made of a thermal insulating material.
Preferably, said biological sample is placed immersed in an auxiliary container, which is preferably closable, containing said preservation solution, and said auxiliary container is placed in said chamber.
In one embodiment of the method, in the irradiation step for irradiating said biological sample the ultrasound has frequencies comprised between 25 kHz and 1 MHz and a sound intensity comprised between 0.01 and 2 W/cm2, and particularly preferably between 0.02 and 1 W/cm2, and particularly preferably between 0.02 and 0.1 W/cm2.
In another embodiment, the method comprises a cooling step for cooling the temperature in the chamber to a temperature between 0 and 15° C., and more preferably between 2 and 10° C., and in a particularly preferred manner from 2 to 6° C.
In another embodiment, the method further comprises a step consisting of keeping said biological sample immersed in a preservation solution.
Finally the method further comprises a step of placing said auxiliary container on a sheet-like support that is a tray adapted for containing a fluid and said tray being able to vibrate freely when said ultrasound is applied.
The invention also refers to the use of a device for transport and preservation of an ex vivo biological sample. With the device, the biological sample is maintained immersed in a preservation solution without oxygen delivery under hypothermal conditions and said sample is irradiated with ultrasound such that the viability, functionality and interaction between the different cells of said biological sample are preserved for said biological sample to be used in subsequent laboratory research.
Furthermore, the invention also covers other detail features illustrated in the detailed description of an embodiment of the invention and in the attached drawings.
Further advantages and features of the invention will become apparent from the following description, in which, without any limiting character, preferred embodiments of the invention are disclosed, with reference to the accompanying drawings in which:
As has already been previously indicated, the biological sample 100 comprises both organs that can be transplanted between donor and recipient, which can be human or animal, and tissues. Furthermore, the biological sample can also be intended for research without necessarily having to be transplanted.
The device 1 for transport and preservation according to the invention has a parallelepiped-shaped main isothermal container 16 open on the upper face. The walls 4 made of a thermal insulating material of the main container 16, including its upper lid, delimitate a chamber 2 intended for containing the biological sample 100.
Cooling means 6 suitable for keeping the temperature inside the chamber 2 below the temperature outside said device 1 are provided inside the main container 16. These cooling means 6 can comprise solutions as different as ice blocks, cooling gel packs or more complex solutions comprising a compressor and a heat exchanger. The device 1 could also consist of a transportable cooler with or without an external power supply. Nevertheless, it is desirable for the solution to be as light as possible in order to not affect transportability of the assembly. The cooling means 6 allow keeping the temperature inside the chamber 2 between 0 and 15° C. In another preferred embodiment, the temperature inside the chamber 2 is kept between 2 and 10° C., and particularly preferably between 2 and 6° C.
The device 1 comprises in the central part a sheet-like support 10 by way of a metal tray supported inside the chamber 2 such that it can vibrate freely. The tray of this first embodiment can be seen in detail in
Furthermore, the device comprises an ultrasound system suitable for generating and applying ultrasound on the biological sample 100. To that end, the ultrasound system according to the drawings has an electric signal generator 20, an amplifier 22, a battery 24, and in this case four piezoelectric transducers 8.
Vibrations are applied to the sheet-like support 10 by way of an aluminum tray through the four transducers 8. Said transducers 8 are mounted on the lower face of the tray. As a result of this configuration, transmission between the transducers and the biological sample 100 is more direct, because vibrations are generated directly below the lower part of the biological sample. In a particularly preferred manner, as can be seen in
In an alternative embodiment shown in
The ultrasound transducers 8 transmit mechanical waves having a frequency comprised between 25 kHz and 1 MHz and a sound intensity comprised between 0.1 and 2 W/cm2 into said chamber 2 during transport of said biological sample 100. The intensity can preferably be comprised between 0.02 and 1 W/cm2, and still more preferably between 0.02 and 0.1 W/cm2. The higher the sound intensity used, the further away the transducers 8 will be and/or the larger the amount of preservation fluid or coolant will be placed in the device 1 to meet the objective of preventing local heating in the biological sample 100. Furthermore, according to the invention the ultrasound can be applied continuously. Alternatively, the ultrasound can also be applied intermittently, i.e., it is not applied during the entire time transport lasts. Alternatively, it can also be applied in a pulsed manner and/or at different frequencies, either continuously or intermittently.
In a particularly preferred manner, the biological sample 100 is contained in a receptacle containing a preservation solution, which improves the results of applying ultrasound.
Other embodiments of the device 1 for transport according to the invention which share many of the same features described in the preceding paragraphs are shown below. Accordingly, only those elements that are different between such embodiments will be described hereinafter, whereas for common elements reference is made to the description of the first embodiment.
The embodiment of the device 1 of
Finally, in the embodiment of the device in
Finally, in a particularly preferred manner, the auxiliary container 14 contains a preservation fluid under sterile conditions from the group consisting of Lactated Ringer's preservation solution, Celsior preservation solution or University of Wisconsin preservation solution. This allows a much more hygienic handling of the biological sample under more suitable conditions for the proper preservation thereof.
The embodiments described up until now represent non-limiting examples, such that the person skilled in the art will understand that beyond the examples that are shown, a number of combinations of the claimed features are possible within the scope of the invention.
Different tests conducted to put the method according to the invention into practice are described below.
The experimental protocol was carried out from livers and kidneys of Landrace pigs. The kidney and liver were perfused with preservation solution at 4° C. to remove blood contained in the organ, and the organ was kept under cold conditions, bathed in ice until the organs were immersed in different preservation solutions. Next the biological samples were placed in the cooler and kept in the cooler with or without ultrasound for 8 hours (liver) and 24 hours (kidney). All the procedures were performed under anesthesia and the study respected the European Union regulations concerning experiments using animals (Directive 86/609/EEC).
Protocol 1
The experimental groups formed were the following:
Experiments were also performed to evaluate if other frequencies and/or intensities could provide more protection than what was achieved with frequencies of 25 kHz and an intensity of 0.04 W/cm2. To do this, the following experiments were performed.
Experiments were also performed to verify the effect of ultrasound at an intensity greater than 0.04. The following experiments were performed for that purpose:
The following experimental groups were further added to evaluate the effect of the preservation solution and the cold conditions:
Collecting and Processing Samples
At the end of ischemia, and in all the experimental groups and subgroups, liver and kidney perfusate samples were collected to assess the liver and kidney damage induced by ischemia using widely standardized techniques. Liver damage was evaluated by determining transaminase levels in the perfusate and by means of determining the caspase 3 activity in liver tissue. Kidney damage was evaluated by means of determining lactate dehydrogenase in the perfusate and caspase 3 activity in kidney tissue. MDA (malondialdehyde) levels were determined in liver and kidney tissue samples as an oxidative stress index, and ATP (adenosine triphosphate) levels were determined as an organ energy metabolism preservation index (Salahudeen A K, et al., Am. J. Transpl. 2003; 3:273-280; Omar R, et al., Gut 1989; 30:510-514; Peralta, et al., Am. J. Physiol. 2000; 279:G163-71).
The statistical study was conducted by means of an analysis of variance (ANOVA), and the level of statistical significance was then determined with a Student-Newman-Kels test.
The results obtained and shown schematically in the drawings are explained below in detail.
An ultrasound intensity of 0.04 W/cm2 was applied in all of cases 1 to 6.
Note: out of the preservation solutions used, the standard solution in clinical practice is UW (University of Wisconsin) preservation solution. Lactated Ringer's solution does not contain drugs and contains only mineral salts. Celsior solution contains glutathione, and UW solution contains more drugs, such as adenosine, glutathione and allopurinol.
Discussion of the Experimental Results
It is important to point out that as was expected, without applying ultrasound the temperature ranged between 2-6° C. inside the cooler, in the preservation fluid and in the organ. In addition, applying ultrasound under cold conditions (2-6° C.) did not modify the temperature inside the cooler, which was between 2-6° C. for all the experiments, but organ and preservation solution cooling was lost.
When applying ultrasound, the temperature ranged between 2-6° C. inside the cooler, the temperature of the preservation fluid ranged between 14-16° C. and the temperature of the organ between 16-18° C.
The effect of heating caused by the ultrasound is an expected result according to background documents of interest. Nevertheless, contrary to what would be expected, taking into account the vital importance of cooling the organ (4° C.) and keeping the temperature of the preservation fluid and the organ between 2-6° C. to store organs under hypothermal ischemia conditions, the results indicate that applying ultrasound does not negatively affect the effect of cooling the biological sample, and accordingly does not damage it.
Furthermore, however, it has surprisingly been verified that a very significant improvement is achieved, so much so that a synergistic effect between applying cold conditions inside the chamber of the device and applying ultrasound could be confirmed.
Accordingly, taking all the results into account, the combination of preservation solution, ultrasound and cold conditions can be an extremely efficient strategy for transport and preservation of organs during cold ischemia.
A method and equipment for transporting and storing biological samples under hypothermal conditions and without oxygen delivery under better conditions than those currently available, and with effective transmission of ultrasound to the organ or tissue inside the chamber, are provided. All this allows reducing the harmful effects of cold ischemia and increasing viability of grafts before they are implanted in the recipient, thereby preventing having to do another transplant.
The equipment and method for preservation could also be useful in secondary organs; the number of organs available for transplant could accordingly increase, thereby reducing waiting lists. Furthermore, since the injuries induced by cold ischemia during the conservation and transport of organs is reduced, the time during which organs are transported in the cooler until they are implanted in the recipient can be extended. Furthermore, the equipment is easy to transport in order to prevent, among other factors, logistic complications resulting from dynamic preservation of the organ.
| Number | Date | Country | Kind |
|---|---|---|---|
| 14382548.7 | Dec 2014 | EP | regional |
The present application is a divisional of U.S. patent application Ser. No. 15/625,611, filed Jun. 5, 2017, which is a U.S. National Stage of International Patent Application No. PCT/EP2015/080688, filed Dec. 18, 2015, which claims the benefit of European Patent Application No. 14382548.7, filed Dec. 19, 2014. The entirety of each of these application is hereby incorporated by reference.
| Number | Date | Country | |
|---|---|---|---|
| Parent | 15625611 | Jun 2017 | US |
| Child | 16985188 | US |
