The invention is generally directed to wound dressings applied on a site of tissue injury, or tissue burns, or tissue trauma, or tissue access to ameliorate bleeding, fluid seepage or weeping, or other forms of fluid loss, as well as provide a protective covering over the site, and to provide antibacterial properties to the site of the tissue injury.
HemCon® Bandages made and sold by HemCon Medical Technologies Inc. (Portland, Oreg.) incorporate a chitosan sponge matrix having superior adhesive properties and resistance to dissolution in high blood flow, which make them well suited for stanching of severe arterial blood flow.
The invention provides wound dressing assemblies, systems and methods that utilize nanomaterials such as silver nanoparticles incorporated into hydrophilic polymer sponge structures, such as chitosan.
Other features and advantages of the invention shall be apparent based upon the accompanying description, drawings, and claims.
Although the disclosure hereof is detailed and exact to enable those skilled in the art to practice the invention, the physical embodiments herein disclosed merely exemplify the invention which may be embodied in other specific structures. While the preferred embodiment has been described, the details may be changed without departing from the invention, which is defined by the claims.
I. Overview of the Chitosan/Nanomaterial
The present invention provides wound dressing assemblies that incorporate nanomaterials, and, in particular, silver nanoparticles into a chitosan wound dressing matrix.
Generally speaking, silver nanoparticles are mixed with a chitosan solution, to form a chitosan/silver nanoparticle solution, which is then subjected to a freeze-drying process, to form a chitosan/silver nanoparticle matrix suitable for use as a wound dressing. The presence of the silver nanoparticles enhances the antibacterial properties of the matrix.
II. Manufacture of the Chitosan/Silver Nanoparticle Matrix
With reference to
1. Preparation of a Chitosan Solution
A portion of the chitosan/silver nanoparticle matrix comprises poly [β-(1→4)-2-amino-2-deoxy-D-glucopyranose, commonly referred to as chitosan. The chitosan selected for the matrix preferably has a weight average molecular weight of at least about 100 kDa, and more preferably, of at least about 150 kDa. Most preferably, the chitosan has a weight average molecular weight of at least about 300 kDa and is derived from chitin obtained from crustacean sources, such as shell fish.
The chitosan used to prepare the chitosan solution preferably has a fractional degree of deacetylation greater than 0.78 but less than 0.97. Most preferably the chitosan has a fractional degree of deacetylation greater than 0.85 but less than 0.95. Preferably the chitosan selected for processing into the matrix has a viscosity at 25° C. in a 1% (w/w) solution of 1% (w/w) acetic acid (AA) with spindle LVI at 30 rpm, which is about 100 centipoise to about 2000 centipoise. More preferably, the chitosan has viscosity at 25° C. in a 1% (w/w) solution of 1% (w/w) acetic acid (AA) with spindle LVI at 30 rpm, which is about 125 centipoise to about 1000 centipoise. Most preferably, the chitosan has viscosity at 25° C. in a 1% (w/w) solution of 1% (w/w) acetic acid (AA) with spindle LV1 at 30 rpm, which is about 400 centipoise to about 800 centipoise.
As depicted in
The chitosan/water solution 18 is further processed by the addition of an acid to the chitosan/water solution, as depicted in
The acid component is added and mixed through the dispersion to cause dissolution of the chitosan solid. The rate of dissolution will depend on the temperature of the solution, the molecular weight of the chitosan and the level of agitation. Preferably the dissolution step is performed within a closed tank reactor with agitating blades or a closed rotating vessel (see
As noted,
2. Preparation of the Nanomaterial Solution
In the illustrated embodiment, the nanomaterial comprises silver nanoparticle material comprising a nanocrystalline silver material, such as SmartSilver, manufactured by NanoHorizons, Inc., State College, Pa., or material received from NanoSense, located in Galway, Ireland. This silver nanoparticle material normally is supplied in dry, flake form. The silver nanoparticle material consists of metallic silver nanoparticles that are combined with a polymer stabilizer, but other nanomaterials, such as silver salt compounds, could be utilized.
The silver nanoparticle material 30 is added to a container 32 of deionized water 34, as shown in
3. Forming the Chitosan/Nanomaterial Solution
As depicted in
It is possible that the nanosilver material can be added directly to the chitosan solution, without first making it into a mixture. However, adding the dry material directly to the chitosan solution can form insoluble precipitates, which are not necessarily beneficial and can effect measuring the final concentration of silver within the final dressing assembly.
4. Degassing the Aqueous Chitosan/Nanomaterial Chitosan Solution
If desired, the chitosan/nanosilver biomaterial can be degassed of general atmospheric gases. Degassing can remove sufficient residual gas from the chitosan/nanosilver biomaterial so that, on undergoing a subsequent freezing operation, the gas does not escape and form unwanted large voids or large trapped gas bubbles in the subject wound dressing product. The degassing step may be performed by heating a chitosan/nanosilver biomaterial, typically in the form of a chitosan solution having a nanosilver material evenly suspended or dispersed through the chitosan solution, and then applying a vacuum thereto. For example, degassing can be performed by heating a chitosan/nanosilver solution to about 45° C. immediately prior to applying vacuum at about 500 mTorr for about 5 minutes while agitating the solution.
In one embodiment, certain gases can be added back into the solution to controlled partial pressures after initial degassing. Such gases would include but are not limited to argon, nitrogen and helium. An advantage of this step is that solutions containing partial pressures of these gases form micro-voids on freezing. The microvoid is then carried through the sponge as the ice-front advances. This leaves a well defined and controlled channel that aids sponge pore interconnectivity.
5. Freezing the Aqueous Chitosan/Nanosilver Solution
The form producing steps for the chitosan/nanomaterial matrix are typically carried out from the chitosan/nanomaterial dispersion. The form producing steps can he accomplished employing techniques such as freezing (to cause phase separation), non-solvent die extrusion (to produce a filament), electro-spinning (to produce a filament), phase inversion and precipitation with a non-solvent (as is typically used to produce dialysis and filter membranes) or solution coating onto a preformed sponge-like or woven product.
In the illustrated embodiment, the chitosan/nanomaterial biomaterial—now in acid solution, thoroughly mixed and optionally degassed, as described above—is subjected to a form producing step that includes a controlled freezing process. The controlled freezing process is carried out by cooling the chitosan/nanomaterial biomaterial mixture within a mold 122 or 122′.
The mold 122 or 122′ can be variously constructed. As shown in
In a representative embodiment for creating a chitosan/nanomaterial matrix 112 like that shown in
As
As
The mold 122 or 122′ and chitosan/nanomaterial biomaterial dispersion are then located on flat stainless-steel heating/cooling shelves 130 within a freeze dryer 132 (
Within the freezer 132, under the control of the controller 134, the temperature of the chitosan/nanomaterial biomaterial dispersion is ultimately lowered from room temperature (e.g., about 20° C.) to a final temperature well below the freezing point (e.g., minus 40° C.). The chitosan/nanomaterial biomaterial dispersion within each mold chamber 124(1), 124 (2), and 124 (3) or 124(1)′ to 124(n)′ loses heat uniformly through the shelf cooling surface and freezes. In this process, the chitosan/nanomaterial biomaterial dispersion undergoes phase separation, which begins to form the desired structure of the matrix.
As shown in
4. Freeze Drying the Chitosan/Nanomaterial/Ice Matrix
The frozen chitosan/nanomaterial/ice matrix desirably undergoes water removal from within the interstices of the frozen material. This water removal step may he achieved without damaging the structural integrity of the frozen chitosan/nanomaterial biomaterial. This may be achieved without producing a liquid phase, which can disrupt the structural arrangement of the ultimate chitosan/nanomaterial matrix 112 and 112′. Thus, the ice in the frozen chitosan/nanomaterial biomaterial passes from a solid frozen phase into a gas phase (sublimation) without the formation of an intermediate liquid phase. The sublimated gas is trapped as ice in an evacuated-condenser chamber at substantially lower temperature than the frozen chitosan/nanomaterial biomaterial. Since the spherulitically nucleated structures that are desirably present within the matrix 112 and 112′ often retain considerable moisture due to an impermeable shell structure that forms around the ice core, conditions must be maintained during the water removal step to keep the matrix temperature below its collapse temperature, i.e., the temperature at which the ice core within the structure could melt before it is sublimated.
The preferred manner of implementing the water removal step is by freeze-drying, or lyophilization within the freezer 132. Freeze-drying of the frozen chitosan/nanomaterial biomaterial can be conducted by further cooling the frozen chitosan/nanomaterial biomaterial. Typically, a vacuum is then applied. Next, the evacuated frozen chitosan/nanomaterial material is subject to ramped heating and/or cooling phases in the continued presence of a vacuum.
In a representative embodiment, following the freezing regime 140, freeze drying conditions are maintained for removing water without collapse of the matrix 112 and 112′. In a representative embodiment, for example, a prescribed freeze drying temperature, e.g., minus 50° C. is maintained for a preferred time period (e.g., between 1 and 3 hours), while a vacuum, e.g., in the amount of about 170 mTorr, is applied during this time.
Further freeze drying at higher temperatures may be conducted during subsequent drying phases, while maintaining vacuum pressure. The times and temperatures of the drying phase can change depending upon fill volume, mold configuration, lyophilizer capabilities, etc. Step changes are made to keep the matrix temperature below its collapse temperature. The temperature of the matrix 112 and 112′ is kept as high as possible during the drying phases, but still below the collapse temperature, to provide the shortest cycle time possible. The shelf temperature is ramped up and then down again because high rates of initial sublimation cools the matrix temperature, and as sublimation wanes, matrix temperature increases.
Further details of the freezing and freeze-drying process are disclosed in co-pending U.S. patent application Ser. No. 11/900,854, filed Sep. 23, 2007, which is incorporated herein by reference.
As shown in
When removed from the mold chamber, the chitosan/nanomaterial matrix 112 and 112′ has a density at or near about 0.03 g/cm3 as a result of the freezing regime 40. For purposes of description, this structure will be called an “uncompressed chitosan/nanomaterial matrix.”
5. Subsequent Processing of the Chitosan Matrix
If desired, either matrix 112 and 112′ can be subject to further processing to impart other physical characteristics and otherwise optimize the matrix 112 and 112′ for its intended end use.
For low bleeding hemostasis and/or targeted antibacterial/antiviral wound dressing situations, and/or for dental indications, further processing may not be warranted, because the supple uncompressed matrix 112′ (shown ready for use in
However, subsequent processing of the matrix may desired after drying and prior to packing and sterilization, for example, when the wound dressing assembly 110 is intended to be, in use, exposed to higher volume blood flow or diffuse bleeding situations, or when exposure to relatively high volume of fluids is otherwise anticipated, as shown in
Representative subsequent matrix processing steps can include, e.g., densification by heat and pressure to increase the density of the uncompressed dry chitosan/nanomaterial matrix to a density greater than or equal to 0.1 g/cm3, desirably between 0.1 g/cm3 and about 0.5 g/cm3, and most desirably about 0.2 g/cm3. For example, the uncompressed chitosan/nanomaterial matrix can be placed between heated platens, including one or more spacers of defined dimensions to ensure consistent thickness. The compression temperature is preferably not less than about 60° C., more preferably it is not less than about 75° C. and not more than about 85° C. The compression load of the heated platens reduces the thickness of the uncompressed chitosan/nanomaterial matrix from about 0.23 to 0.28 inches to about 0.036 inch (i.e., about 0.9 mm), thereby increasing the density of the matrix from about 0.03 g/cm3 to a target density of, e.g., about 0.2 g/cm3.
Other representative subsequent matrix processing steps can include, e.g., mechanical softening. The softening can be accomplished, e.g., by the mechanical manipulation of the matrix between an array of upper and lower rollers, which knead the matrix, thereby mechanically softening it. As shown in
Other representative subsequent matrix processing steps can include, e.g., preconditioned by heating in an oven at a temperature of preferably up to about 75° C., more preferably to a temperature of up to about 80° C., and most preferably to a temperature of preferably up to about 85° C. Preconditioning by heating can typically be conducted for a period of time up to about 0.25 hours, preferably up to about 0.35 hours, more preferably up to about 0.45 hours, and most preferably up to about 0.50 hours.
Further details of the subsequent matrix processing steps are disclosed in co-pending U.S. patent application Ser. No. 11/900,854, filed Sep. 23, 2007, which is incorporated herein by reference.
It may be desirable, to apply a backing to the chitosan/nanomaterial matrix. The backing isolates a caregiver's fingers and hand from the fluid-reactive chitosan/nanomaterial matrix.
Before use, the wound dressing assembly 110 is desirably vacuum packaged in an air-tight heat sealed foil-lined pouch. The wound dressing assembly 110 can be subsequently terminally sterilized within the pouch by use of gamma irradiation.
It should be appreciated that other nanomaterials, such as nanofibers, can be incorporated into a freeze-dried chitosan matrix. Nanofibers generally are defined as fibers with diameters less than 100 nanometers. They can be produced by conventional interfacial polymerization and electrospinning. Nanofibers can be chopped into small particles and suspended in or dispersed into a chitosan solution (in the same manner as the silver nanoparticles), which is then freeze-dried into a wound dressing matrix. The presence of the nanofibers increase the surface area and strength of the wound dressing matrix. As another example, chitosan can itself be electrospun into nanofiber form, then reacetylated into chitin, and dispersed in solution with chitosan (in the same manner as the silver nanoparticles), which is then freeze-dried into a wound dressing matrix.
III. Uses for the Chitosan/Silver Nanoparticle Matrix
The wound dressing assemblies comprising silver nanoparticles incorporated into a freeze-dried chitosan matrix can be used, e.g., (i) to stanch, seal, or stabilize a site of tissue injury, tissue burn, tissue trauma, or tissue access; or (ii) to form an anti-microbial barrier; or (iii) to form an antiviral patch; or (iv) to intervene in a bleeding disorder; or (v) to release a therapeutic agent; or (vi) to treat a mucosal surface; or (vii) to dress a staph or MRSA infection site; or (viii) in various dental surgical procedures, or (ix) combinations thereof.
The wound dressing assembly 110 can be readily sized and configured to be shaped, pushed, and/or stuffed into a wound track, as
Table 1 lists various different chitosan/nanosilver compositions that can be prepared according to the invention. Each of the groups was prepared with various combinations of acids and/or glycerol.
Group A was processed further to form a compressed matrix and further preconditioned by heating (as described above), while Groups B to D were not subjected to further processing after freeze-drying. While all of the groups demonstrated desirable wound healing characteristics in terms of antibacterial activity, resistance to dissolution, adhesion, and absorbency—Group D demonstrated the most favorable results. In Group D, the lactic acid and the acetic acid were used to dissolve the chitosan, and the citric acid was used as an ionic cross-linking agent to provide resistance for the final matrix composition of dissolving in fluids. Group D matrices were shown to absorb ≧15 times their weight in water. Visual observation of the matrices when exposed to fluid indicates that the glycerol content of the matrix may influence swelling, with higher glycerol levels associated with greater water absorption and swelling.
Dressing assemblies according to the present invention were tested to analyze the antimicrobial effects of the dressing assemblies. Specifically, the dressing assemblies were applied to mice that were subjected to the bacteria, P. aeruginosa ATCC 19660. The procedure and results are discussed below and with respect to
A. Test Animals Used (Mice)
Adult female BALB/c mice (Charles River, Wilmington, Mass.), 6-8 week old and weighing 17-21 g, were used in the study. The mice were housed one per cage and maintained on a 12-hour light/dark cycle with access to food and water ad libitum. All animal procedures were approved by the Subcommittee on Research Animal Care of Massachusetts General Hospital and met the guidelines of National Institutes of Health.
B. Bacteria Strain Tested P. aeruginosa ATCC 19660, which causes septicemia after intraperitoneal injection and has been shown to be invasive in mice with skin burns, was employed in the study. The stable bioluminescent variants of this strain carried the entire bacterial lux operon integrated in their chromosomes for stable luciferase expression that allowed them to be used for bioluminescent imaging (Xenogen Inc). Bacteria were grown in a brain-heart infusion (BHI) medium in an orbital incubator (37° C.; 100 rpm) to an optical density of 0.6 at 650 nm that corresponds to 108 cells/mL (mid-log phase). This suspension was centrifuged, washed with phosphate buffered saline (PBS), and re-suspended in PBS at the same density. Luminescence was routinely measured on 100-uL aliquots of bacterial suspensions in 96-well black-sided plates, by use of a Victor-2 1420 Multilabel Plate Reader (EG&G Wallac).
C. Preparation of the Mice
As shown in
Five minutes after the creation of burn (to allow the burn to cool down), a suspension (40-μL) of bacteria in sterile PBS containing 108 cells was inoculated onto the surface of each burn with a yellow-tipped pipette and then was smeared onto the burn surface with an inoculating loop.
D. Treatment of the Mice
As shown in
To adhere the dressing assemblies to the burns, both dressing assemblies 112, 212 were moistened with MilliQ water before application. In contrast to human third degree burns, mouse third degree burns have a dry texture, irrespective of whether they have been contaminated or infected with bacteria. It was therefore necessary to regularly moisten both dressing assemblies to allow the active antimicrobial ingredient to percolate into the burned tissue. In order to not compromise the activity of the nanocrystalline silver from the silver dressing assemblies 112, pure water was used as a buffer. For the dressing assembly 212, it has been previously shown that pH 4.5 acetate buffer can be used to moisten the dressing assembly 212, without having the buffer have an antibacterial effect on P. aeruginosa in the short-term (i.e., within hours of application). Therefore, the dressing assemblies 212 adhering to the burns were then moistened daily with 100 uL of 50 mM sodium acetate buffer and the dressing assemblies 112 were moistened with MilliQ water, respectively.
E. Bioluminescence Imaging of the Mice
The low-light imaging system (Hamamatsu Photonics) consists of an intensified CCD camera mounted in a light-tight specimen chamber, fitted with a light-emitting diode, a set-up that allowed for a background gray-scale image of the entire mouse to be captured. In the photon-counting mode, an image of the emitted light from the bacteria was captured using an integration time of 2 min, at a maximum setting on the image-intensifier control module. By use of ARGUS software (Hamamatsu Photonics), the luminescence image was presented as a false-color image superimposed on top of the grayscale reference image. The image-processing component of the software calculated the total pixel values from the luminescence images of the infected wound area. The infection time was defined as the time during which any bioluminescence was present in the wound when measured at the most sensitive setting.
F. Monitoring of the Mice
During the experiment, mice underwent bioluminescence imaging immediately after adding bacteria and at 24 hourly intervals thereafter. Mice were also followed daily for weight and survival. When mice died, 5 mL sterile saline was injected into the abdominal cavity of mice, and then withdrawn and cultured on BHI agar plates to determine the presence of P. aeruginosa in the peritoneum of mice. Blood samples were also taken from the heart removed from dead mice and streaked on BHI agar plates.
G. Statistical Analysis
Survival curves were compared by the Kaplan-Meier log-rank test. P values <0.05 were considered statistically significant.
H. Results
The dressing assemblies 112 and 212 adhered extremely well to the surface of the burn when the assemblies had been previously moistened with acetate buffer or MilliQ water to render it flexible, as discussed above in section D. The adhesion time of dressing assemblies 112 and 212 was >16 days on all the mice that survived. The pieces of the dressing assemblies 112 and 212 were significantly bigger (>30 mm×30 mm,
At 3 weeks post-infection, the survival rates of the mice 90 treated with the dressing assembly 112 (n=14), the mice 90 treated with the dressing assembly 212 (n=14), and the untreated mice 90 (n=7) were 64.3%, 21.4%, and 0%, respectively (
The foregoing is considered as illustrative only of the principles of the invention. Furthermore, since numerous modifications and changes will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation shown and described. While the preferred embodiment has been described, the details may be changed without departing from the invention, which is defined by the claims.
This application is a continuation-in-part of co-pending application Ser. No. 10/743,052 filed 23 Dec. 2003, which is a continuation-in-part under 37 C.F.R. § 1.53(h) of U.S. patent application Ser. No. 10/480,827, filed on Dec. 15, 2003, for Wound Dressing and Method of Controlling Severe Life-Threatening Bleeding, which was a national stage filing under 37 C.F.R. § 371 of International Application No. PCT/U502/18757, flied on Jun. 14, 2002.
Number | Date | Country | |
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Parent | 10743052 | Dec 2003 | US |
Child | 12313530 | US | |
Parent | 10480827 | Oct 2004 | US |
Child | 10743052 | US |