Wound healing agents derived from platelets

Abstract

Description

rt, including collagen, ADP and serotonin, may be utilized instead of or in addition to thrombin to activate the platelets, although thrombin is preferred.

DETAILED DESCRIPTION OF THE INVENTION

Blood obtained from the individual to be treated with the wound healing factors of the invention is stabilized in siliconized tubes containing acid-citrate dextrose (0.15M citrate, 2% glucose, pH 4.2) (hereinafter CPD) and is centrifuged in order to separate out, the platelet-rich plasma therefrom. Forty to sixth milliliters of blood combined with 4-6 ml of CPD is then centrifuged at about 135 .times. g for 20 minutes at about 4.degree. C to obtain platelet-rich plasma. The platelet rich plasma is removed and placed into another sterile, 50ml tube. A platelet count is then taken. The CDP is utilized to prevent activation of the clotting sequence by contact of the blood with the plastic in the syringe. The CPD is present in the syringe while the blood is withdrawn from the patient. The blood is continuously mixed with the CPD to prevent coagulation. The platelet-rich plasma in the tube is then centrifuged at 750 .times. g for 10 minutes at 4.degree. C.

The platelet-free plasma is removed and discarded. The platelet pellet is resuspended in a quantity of platelet buffer to produce a final ml. A lower concentration of about a million platelets per ml is useful, but is less preferred. The platelet buffer utilized contains 0.05 M HEPES (N-2-hydroxyethylpiperazine-n-2-ethanesulfonic acid), 0.03 M glucose, 0.004 M KCl, 0.1 M NaCl and about 0.35% human serum albumin adjusted to a pH of about 6.5. A sample is frozen at about -20.degree. C. for later testing of mitogenic activity. Another sample is streaked onto blood agar as a sterility test.

The platelet-rich plasma is the only blood fraction utilized in the processes and compositions of the invention. The PRP is then activated with purified thrombin at a rate of about 1 to about 10 units of thrombin per milliliter of PRP. Preferably, about 1 unit of thrombin per ml of platelet-rich plasma is utilized. The activity of the thrombin coagulates the fibrinogen and activates platelets causing them to release alpha granules containing platelet-derived growth factor and platelet-derived angiogenesis factor. The thrombin used was Thrombinar.TM. brand from Armour Pharmaceutical Co. of Kankakee, Ill. The platelets and thrombin are allowed to incubate at room temperature for about 5-10 minutes.

The PRP is then subjected to a removal of platelets and fibrin by centrifugation. The resulting supernatant contains both PDAF and PDGF after centrifuging at 950 .times. g for about 5 minutes at 4.degree. C. The pellet is discarded since the PDAF & PDGF have been extracted into the supernatant. PDGF has been isolated and characterized. It is a protein of 30,000 molecular weight which breaks down into two molecular weight species of 15,000 and 14,000 molecular weight.

In order to apply the PDAF and PDGF in the platelet-free supernatant thus obtained to a wound, it is desirable to utilize a carrier substance which is biologically compatible and acts as a temporary "depot". A macromolecular substance such as microcrystalline collagen provides a suitable carrier. An especially preferred carrier is Avitene.RTM. brand microcrystalline collagen from FMC Corp., Avicel Dept., Marcus Hook, Pa. 19061. The resultant composition is thicker and will tend to remain in position in contact with the wound. Debrisan.TM. brand wound dressing which contains Sepharose.TM. brand beads, trademarks of Pharmacia Fine Chemicals, Inc. of Piscataway, N.J., may be utilized as an alternative carrier. Preferably, about 8-10 ml of supernatant per gram of carrier is used to produce a paste.

Application of the wound treating composition is by physically applying the material over an into the wound as in applying a medicated salve. Treatments should be repeated on a daily basis as long as the wound remains open. A preferred treatment is to apply an approximately one mm thick dressing of the platelet factor/carrier complex to the wound in the morning. It is then dressed with a sterile, dry dressing. In the evening, the dressing is removed and the substance is removed by washing with sterile saline.

Although the clinical testing involving the wound treating compositions of the invention have been directed to wounds on the body exterior, the compositions may treat internal wounds as well. Sutures may be impregnated with the wound treating compositions to speed internal healing. The wound treating compositions may also be used in conjunction with biodegradable dressings, as a coating over implantable devices and biodegradable devices utilized in surgical procedures. Generally, any foreign body to be inserted into a patient may be coated with the composition to speed the healing process. Alternatively, the composition may be applied over the damaged tissue directly.

Initial clinical trials have been performed on eight patients, all with nonhealing wounds from periods of one to five years. All patients had maximal standardized care in attempts to heal the wounds. That therapy had failed. In all cases, administration of platelet-derived factors initiated a healing response as evidenced by granulation tissue formation (granulation tissue contains fibroblasts, endothelial cells and collagen). The wounds closed by contraction and epithelialization or by skin grafting. Stimulation of healing and eventual repair occurred in all applications.

While it is preferred to prepare activated PRP for wound treatment purposes directly from the injured animal's own blood, the advantages of the invention may be achieved by using blood or outdated platelets from animals of the same species. Utilization of blood from the injured individual to be treated is especially preferred since it avoids exposure to possible hepatitis or other contaminants from banked blood. The use of a patient's own blood would also eliminate any possible allergic reactions. A consistent source of the material may be obtained from washed, outdated human platelets. The substances may also be utilized in veterinary applications by utilizing platelets derived from the animal itself or another animal within the same species.

EXAMPLE I

A patient having an open wound on the left foot following debridement of dead tissue and transmetatarsal amputation was started on PDGF and PDAF obtained as described above from his own blood. After the treatment protocol, the wound was filled with new granulation tissue. A subsequent debridement showed completely covered metatarsal bones and contracture of the sizable wound.

EXAMPLE II

A patient underwent amputation of his right great toe and was treated with standard therapy for three weeks without any granulation tissue accumulating within the wound. He was then started on the platelet factor therapy of the invention. After three weeks of treatment, the wound contracted approximately 30-40% and was healing rapidly.

EXAMPLE III

A patient having two large wounds on the medial and lateral aspect of his transmatatarsal amputation stump had been treated for four months without healing using conventional therapy. Within two weeks of treatment with PDAF and PDGF as described above, the wound had cleared of an apparent infection and started producing granulation tissue.

Thirty-eight nonhealing ulcers from 28 diabetic patients were treated with the PRP paste. The average duration of the ulcers before treatment was 61/2 years. A paste prepared from PRP at a concentration of about 10.sup.9 platelets/ml was combined with Avitene brand collagen. The patients applied the PDGF and PDAF containing paste daily for 12 hour periods for an average of 8 weeks. Each day, the wounds were debrided of dead tissue. All of the wounds produced granulation tissue and closed an average of 83% when compared to starting wound area. Ninety-five percent of the ulcers were successfully treated resulting in either total wound epithlialization or successful skin grafting. Only two of these nonhealing wounds did not heal. The healed ulcers remain closed with no evidence of hypertrophic scar formation orneoplastic formation.

In considering this invention, it should be remembered that the disclosure is illustrative only, and that the scope of the invention should be determined by the appended claims.

Claims

1. A process for treating damaged, live, animal tissue which comprises applying over the damaged tissue an effective amount of a treating composition containing the materials released by platelets during the platelet release reaction and facilitating healing of the damaged tissue.

2. The method of claim 1 wherein the materials are applied topically in an amount sufficient to cause migration and/or division of fibroblast cells, capillary endothelial cells and/or epithelial cells.

3. The method of claim 1 wherein said platelets are isolated from blood prior to release of the materials.

4. The method of claim 1 wherein said tissue is mammalian tissue.

5. The method of claim 4 wherein said tissue is human tissue.

6. The method of claim 1 wherein said platelets are mammalian platelets.

7. The method of claim 6 wherein said platelets are human platelets.

8. The method of claim 7 wherein prior to release of the materials said platelets were removed from the person whose tissue is being treated.

9. The method of claim 7 wherein prior to release of the materials said platelets were removed from a person or persons other than the person whose tissue is being treated.

10. The method of claim 1 wherein the materials are released from said platelets by use of an activator selected from the group consisting of thrombin, adenosine diphosphate and collagen.

11. The method of claim 10 wherein said activator is thrombin.

12. A process for treating a wound of a live animal which comprises applying over the wound an effective amount of a treating composition containing the materials released by platelets during the platelet release reaction and facilitating healing of the wound.