CN101378791A - 组织粘合材料 - Google Patents
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Abstract
多层组织粘合片包括结合到组织接触层的结构层或叠层。所述结构层或叠层包括具有成膜性能的一种或多种合成聚合物,且材料的组织接触层包含组织反应性基团。具有成膜性质的合成聚合物优选生物可降解的聚酯,且所述组织反应性基团最优选NHS-酯基。
Description
发明领域
本发明涉及适于用作组织粘合封闭剂的柔性片,该柔性片预期用于治疗目的而局部应用到身体的内表面和外表面。本发明还涉及用于制备这种片的方法以及使用这种片的方法。具体地,本发明涉及自粘合的、生物相容的且能水合的聚合物片,所述聚合物片可以用于治疗目的如伤口愈合、接合、封闭以及增强衰弱组织,且用于递送治疗剂,且本发明涉及用于制备这种片的方法和使用这种片的方法。本发明进一步涉及涂敷有与所述片的材料相似的材料的可植入医疗装置。
发明背景
黏附到生物组织的材料在许多外科或其它治疗应用中的用途是相当引人关注的,例如作为使用如缝合线、U形钉等机械紧固件的替代物。至今已经提出的这类材料的制剂包括粘性溶液或凝胶,所述粘性溶液或凝胶或是以粘性溶液或凝胶的形式被生产,或是在即将使用前通过混合组分而制备。然后,使用如注射器的适当施用装置将这类制剂应用到组织表面。
上述类型的制剂有许多缺点。如果制剂是低粘度的,其可能从所应用的区域蔓延开,因此很难精确地应用到所希望的组织区域。另一方面,如果制剂较粘,其可能难以配药。在两种情况下,以水合形式制备的所述制剂可能具有有限的使用期限,并可能易受过早固化。因此,对于整个制剂可能必须立刻使用,否则丢弃。而且,在即将使用前通过混合组分来制备制剂显然是费力的和耗时的,且可能需要使用附属设备。除了这些缺点外,由这些制剂提供的组织表面间的粘合程度可能低于所希望的。
组织粘合材料的制剂已经施加至适用于组织表面的载体(support)。广泛的医疗应用中大量记录了用于局部施用至身体内部或外部器官的以片剂、贴剂(patch)或膜形式的治疗性材料的用途。然而,至今所提出的产品的缺点是,除了它们的粘合强度外,对其下面组织的粘合程度也可能是不充分的,特别是在更长期间内。虽然初始粘合力可能是令人满意的,但是所述片可能随后经常在仅仅几秒或几分钟后与组织分离开,例如由于所述片在其应用后的水合作用。另外,产品的柔性可能不足以使其容易地顺应其所应用的表面,这也可能对其粘合力具有不利影响。
由于这些产品的不充分粘合,可能有必要提供进一步的增强,如通过使用缝合线、U形钉或其类似物的机械附件。可选地,可以应用能量(如光或热能)以引起粘合制剂化学结合到在下面的组织,并因此使组织表面互相结合。显然,这类方法引入了其他缺点。如缝合线或U形钉的机械紧固件的使用常常正是想要替代或避免使用这类产品。在许多情况下,使用这样的紧固件不是完全无效(如在肺上)就是不合需要的,因为它们的引入产生了更多的组织衰弱区域。使用外部能量需要提供和操作这样的能源。这样的能源可能是昂贵的且难以操作,特别是在手术室或类似环境范围内。此外,使用外部能量用于连接可能是耗时的,且(在某些情况下)需要由外科医生作出非常谨慎的判断,以评估什么时候已经递送了足以实现连接而不损害在其下面的组织的能量。
用于上述应用的片型产品的缺点是它们可能缺乏柔软度,所述柔软度对于许多应用是必要的或所希望的。这特别是对于用于日益重要的内窥镜(锁孔(keyhole))手术领域的产品更是如此,所述内窥镜(锁孔)手术可能需要产品在引入体内之前折叠或卷成紧密结构。例如通过夹杂增塑剂来使这样的产品更柔性的尝试可能具有降低产品的粘性的效果。
现已设计出对上述一般类型的组织粘合片或其类似物的改进以及对组织粘合材料的相关应用的改进,其克服了或基本上减少了现有技术的上述的和/或其它的缺点。
发明概述
依据本发明的第一个方面,提供了包括结构层或叠层的多层组织粘合片,所述结构层或叠层包括具有成膜性能的一种或多种合成聚合物,且所述结构层或叠层被结合到包含组织反应性基团的材料的组织接触层。
依据本发明的片的主要优势在于其有效地结合到组织,使其能够用于多种医疗应用。已经发现所述片提供改进的柔性且仍保留优良的粘性。在优选的实施方案中,所述片显示出对其所应用的组织的优良的初始粘合力(且可能因此被描述为“自粘合”),而且在更长的时间量程内保持对组织的良好的粘合。不希望受任何理论束缚,认为所述片对组织的初始粘合可归因于所述片对组织的电子结合,且这种电子结合由制剂的组织反应性官能团与组织之间、特别是组织表面的胺基和/或硫醇基与所述片的组织反应性官能团之间的共价化学结合所补充或代替。
认为所述片对组织表面的初始粘合是由于所述片和组织表面间的范德华力和/或氢键结合。一经与组织表面接触,所述片变成水合的,从而引起组织反应性官能团和在下面的组织表面间的反应。组织反应性官能团和在下面的组织间的这样的反应导致所述片和所述组织表面间的高度粘合。所述片可以吸收生理流体(因为应用到渗出组织表面)以及在应用后用于水合所述片的任何额外的溶液(这样的溶液可以是用于手术灌注的常用溶液),变得对组织表面更加顺应且黏着力更强,且因此提供具有止血和静气功能的粘合封闭剂。
使用该片减少或消除了对机械连接到组织的额外部件(如缝合线或U形钉)的需求,或者减少或消除了提供以热或光的形式的外部能量以使片粘附到在下面的组织的需求。依据本发明的片的另一个优势是其作为预制品应用到组织,而不是在即将使用前通过混合材料而制备。
另外,由于在与组织表面接触时以及接触后被水合之前,该片基本上是无活性的,因此该片没有过早反应的倾向并因此其存放期可以相当长,例如当在室温下适当地存储时六个多月。
术语“片”表示厚度远远小于它的其它尺度的制品。这样的制品可以可选地被描述为贴剂或膜。
在本发明的优选的实施方案中,所述结构层或叠层是包括结合在一起的两个或更多个分离的层(discrete layers)的叠层。在特别优选实施方案中,该叠层包括具有成膜性能的聚合物和包含反应性官能团的材料的交替层。已经发现,通常,在对组织的粘合和/或弹性和/或保持结构完整性方面,包括结构叠层的片比具有单个结构层的片表现得更好。
在这种情况下,依据本发明的片最优选包括偶数个层,且特别是成膜聚合物和包含反应性基团的材料的交替层。这时该片可以被认为包括结构叠层以及组织反应性材料的组织接触层,所述结构叠层含有n层成膜聚合物与散置其间的n-1层反应性材料。n的值可以是1,在这种情况下,所述片仅仅包括单个结构层和组织接触层。可选地,n可以是2或3,在这种情况下,所述片包括共4或6层。n=2的片是目前最优选的。
包含反应性官能团的材料可以与组织接触层的组织反应性材料相同或相似。
在本发明的另一方面,提供了适于植入人体内或动物体内的装置,该装置在其至少部分的外表面上带有包含一种或多种具有成膜性能的聚合物的涂层,至少部分的所述涂层结合到包含组织反应性官能团的材料层。在本发明的这一方面,成膜聚合物涂层提供了用于连接到包括组织反应性官能团的材料的装置的工具,所述材料提供了用于使该装置固定在体内其所希望的位置的工具。因此,本发明的这一方面对于可植入装置特别实用,所述可植入装置以其它方式难以固定在体内的位置,例如由于它们是由化学惰性材料制成且不受与周围组织反应或与化学连接基团反应的作用。
在下面本发明的详细描述中,主要提及了具有片形式的本发明的实施方案。然而应理解,如果适当,类似的阐述适用于包括可植入装置上的涂层的本发明的实施方案。
在另一方面,本发明还提供将组织表面结合到另一组织的方法,或封闭组织表面的方法,所述方法包括将依据本发明的第一个方面的片应用到组织表面。
依据本发明的片还可以用来将一种或多种治疗活性药剂或抗感染药递送到所述片被应用的部位。在这种情况下,药剂可以例如通过与用于制造所述片的其它成分混合而并入所述片中。可选地,药剂可以共价结合到所述片的组分。然而,在其它实施方案中,所述片不含治疗活性药剂。以类似的方式,一种或多种治疗的活性药剂可以并入被应用到依据本发明的第二个方面的可植入装置的外表面的材料中。
发明详述
缩写
AAc 丙烯酸
AIBN 偶氮异丁腈
DCC 二环己基碳二亚胺
DCM 二氯甲烷
DCU 二环己脲
DMF 二甲基甲酰胺
DMSO 二甲亚砜
DPBS Dulbecco的磷酸盐缓冲盐水
ENT 耳、鼻和喉
HPC 羟基丙基纤维素
IPA 异丙醇
Mn 数均分子量
Mw 重均分子量
MeOH 甲醇
NHS N-羟基琥珀酰亚胺
NVP N-乙烯基吡咯烷酮
PEG 聚乙二醇
PLG DL-丙交酯-乙交酯共聚物
(poly(DL-lactide-co-glycolide))
聚(VP-AAc) 乙烯基吡咯烷酮和丙烯酸的共聚物
聚(VP-AAc(NHS)) 乙烯基吡咯烷酮和丙烯酸NHS酯的共聚物
聚(VP-AAc-AAc(NHS)) 乙烯基吡咯烷酮、丙烯酸和丙烯酸NHS酯
的三元共聚物
结构层或叠层的性质
依据本发明的第一个方面的片包括含有至少一种成膜聚合物的结构层或叠层。该结构层或叠层可以完全或大体上完全由成膜聚合物组成。在其它实施方案中,该结构层或叠层主要由成膜聚合物组成。例如,该结构层或叠层可以包括超过80%w/w、超过90%w/w或超过95%w/w的成膜聚合物。
可以使用多种合适的成膜聚合物来形成第一层,条件是成膜聚合物表现出合适的成膜性能以及对于医疗应用的适用性,所述医疗应用的适用性特别是无毒性、生物相容性和通常的生物可降解性。
最常见的,第一层只包括一种成膜聚合物。可选地,第一层可以由多于一种的成膜聚合物来形成。
成膜聚合物可以是合成的,或其可以是天然存在的材料或可以源自天然存在的材料。
可能适合用于本发明的特别优选的合成聚合物的组是生物可降解的聚酯。这样的聚合物的具体实例是聚乳酸和聚乙醇酸以及其共聚物和共混物。其它的实例包括聚己内酯和聚羟基链烷酸酯,例如聚羟基丁酸酯、聚羟基戊酸酯和聚羟基己酸酯。
用于本发明的当前最优选的聚酯聚合物是丙交酯-乙交酯共聚物(poly(lactide-co-glycolide))[也称为乳酸-乙醇酸共聚物],其通常是生物可降解的和生物相容的,且可溶于多种有机溶剂。
在包括结构叠层的片的目前最优选的实施方案中,特别优选的实施方案是那些包括生物可降解的聚酯材料和包含反应性官能团的材料的交替层的实施方案。因此,在本发明的一个具体方面,提供了包括结构叠层以及组织反应性材料的组织接触层的多层的组织粘合片,所述叠层包括n层生物可降解的聚酯和散置其间的n-1层包含反应性官能团的材料,其中n的值为1、2或3,最优选2。
在这样的实施方案中,组织接触层远端的层是聚酯层,该聚酯层基本上对组织没有粘性。因此,这样的片通常只粘着到靶组织(包含组织反应性官能团的组织接触层所应用到的组织),且不粘着到周围组织(如胸膜壁或腹膜壁)。
可能适合的合成聚合物的其它实例是胺化的聚合物,例如胺化的PEG(包括那些以商品名JEFFAMINE出售的胺化PEG)和聚烯丙胺。
可能适合用于本发明的另外的成膜聚合物是多糖,特别是碱性多糖。
组织接触层的性质
依据本发明的第一个方面的片具有包括含有组织反应性官能团的材料的组织接触层。该材料优选包括一种或多种含有组织反应性官能团的聚合物。
“组织反应性官能团”是指能够与在组织表面上存在的其它官能团反应以与该组织形成共价键的官能团。通常,组织部分地由通常包含硫醇和伯胺部分的蛋白质组成。许多官能团可以与硫醇或伯胺反应,因此构成“组织反应性官能团”,所述官能团例如亚氨酸酯、对硝基苯基碳酸酯、NHS酯、环氧化物、异氰酸酯、丙烯酸酯、乙烯基砜、正吡啶基二硫化物(orthopyridyl-disulfide)、马来酰亚胺、醛、碘乙酰胺等。如在此使用,术语NHS或NHS酯意指不仅包含N-羟基琥珀酰亚胺本身,还包含其中琥珀酰亚胺基环被取代的衍生物。这样的衍生物的实例是N-羟基磺基琥珀酰亚胺基(N-hydroxysulfosuccinimidyl)及其盐,特别是钠盐,其可以增加组织反应性材料的溶解性。
在本发明中可能具有实用性的组织反应性官能团是能够与存在于组织表面的官能团反应(在制剂被应用到组织时的普遍条件下,也就是在含水的环境下且没有应用大量的热能或其它外能)的任何官能团。存在于组织表面的官能团的种类包括硫醇基和胺基,因此组织反应性官能团包括与硫醇基和/或胺基反应的基团。实例为:
亚氨酸酯;
对硝基苯基碳酸酯;
NHS酯;
环氧化物;
异氰酸酯;
丙烯酸酯;
乙烯基砜;
正吡啶基二硫化物;
马来酰亚胺;
醛;以及
碘乙酰胺。
NHS酯是特别优选的组织反应性官能团。
除了组织反应性官能团外,组成第二层材料的聚合物可以包含这样的官能团,虽然它们自身对所述片所应用的组织没有反应性,但确实提供了所述片和组织之间的优良的接触粘合力。这样的官能团在这里被称为“非反应性官能团”。非反应性官能团的实例包括羟基、杂环胺或酰胺(如在乙烯基吡咯烷酮残基中)以及特别是羧基(如在丙烯酸残基中)。
特别优选的是,组织反应性官能团为非反应性官能团的活化衍生物。在某些实施方案中,所有的非反应性官能团可以被活化以形成组织反应性官能团。在其它实施方案中,只有一些非反应性官能团可以被活化以形成组织反应性官能团。在后一种情况下,所述片对其所应用的组织的初始接触粘合强度以及通过组织反应性官能团与所述组织中的官能团的共价反应而产生的更长时期的粘合强度可以是变化的,且可以通过改变活化形式的非反应性基团的比例来控制。
NHS酯是特别优选的组织反应性官能团,因此优选的组织反应性聚合物是富含NHS酯的聚合物。特别优选的组织反应性聚合物是聚(VP-AAc(NHS))和聚(VP-AAc-AAc(NHS))三元共聚物。
片借助生物黏附聚合物与组织的初始粘合程度的充足量可以在体外定量测定,例如通过进行粘合强度试验来测定。该试验通过允许所述片粘着到适当的基材(固定于固定的位置)来进行,同时将所述片本身在单独的点被物理连接到拉力试验仪的载荷,所述载荷在试验前被置于使所述片不欠载(under load)的状态。载荷元件(load cell)沿着大体上垂直于基材被安置的轴向的轴是可移动的。该试验包括载荷元件以恒定的预定速率远离基材的运动,直到所述片从基材脱离。试验的结果是所述片的粘合能量的定量量度-即破坏所述片与其所粘着的基材之间的相互作用所需能量的累积量。对于依据本发明的片,适当的累积粘合能量不小于0.5mJ。
在本发明的某些实施方案中,优选的组织反应性聚合物是聚(VP-AAc-AAc(NHS))三元共聚物。聚(VP-AAc)上的羧基可以通过在DCC存在下与NHS反应转变为NHS酯(见实施例9)。如果聚(VP-AAc)的酸含量被测定了(以摩尔表示),转变为组织反应性基团的酸基的比例可以通过加入所希望的摩尔百分比的NHS来控制。
另一种可以使用的包含羟基的组织反应性聚合物是活化形式的HPC琥珀酸酯,如HPC琥珀酸酯-NHS。在这种情况下,一些羟基通过琥珀酸键合被NHS活化(见实施例11)。
组织粘合片的性能可以通过加入其它聚合物和添加剂而被最佳化。
增强性能的添加剂
虽然依据本发明的第一个方面的片通常具有足够的柔性,但是可能希望通过将一种或多种增塑剂和弹性体添加到结构层或叠层和/或组织接触层来进一步改善所述片的柔性、弹性和/或湿强度。特别地,如甘油和低分子量PEG的低分子量组分可以被加入制剂中以增加柔性。可以加入产品中的合适的弹性体的实例包括聚己内酯、聚氨酯和聚硅氧烷(poly(silicones))。当按组成所述片的组分的重量计,加入可达30%的水平的这样的材料,可以增加所述片的柔性和/或弹性。然而,加入高水平的这样的材料可能对所述片的粘合性能具有有害影响。为了抵消这个缺点,添加剂可以被官能化以包括可以参与组织粘合的组织反应性官能团。
缓冲液
所述片上的组织反应性官能团和组织表面上的官能团之间的反应可以随pH而变化。因此,可以优选在即将应用前缓冲组织表面,或更优选地,在用于制备所述片、特别是所述片的组织接触层的制剂中加入缓冲液。依据本发明的某些片到移植出的猪肝的平均粘合功(work of adhesion)可以通过用pH10.5的磷酸盐/碳酸盐缓冲液缓冲组织表面来改善。
制造过程中片的组分的结合
结构层或叠层和/或组织接触层的材料可以在制造过程中被结合。这样的结合可以增加所述片的物理强度并可以最佳化所述片的性能,特别是在所述片被应用后其生物降解所需要的时间的方面的性能。
结合可以通过多种方法产生,包括从普通溶剂浇铸组分层。另一方法涉及制备结构层或叠层和/或组织接触层的制剂,该制剂含有能够与存在于将要被结合的材料中的官能团反应的至少两个官能团。因此该组分可作为交联剂。优选地,交联剂包含相同形式的至少两个官能团。因此,交联剂最优选为同型双官能团(homobifunctional)的交联剂或同型多官能团(homopolyfunctional)的交联剂。
片的物理形状
所述片通常可以具有总厚度0.01mm到1mm,一般0.01mm到0.5mm,且更普通0.015mm到0.2mm或0.015mm到0.1mm,例如0.015mm到0.05mm。
在当前优选的实施方案中,组织接触层的厚度大于结构层或叠层的厚度。例如,组织接触层可以具有占所述片总厚度的50%多或60%多的厚度。
所述片可以制备成或者随后切成从几平方毫米到几十平方厘米的尺寸。
所述片的制造
最方便地,依据本发明的片可以通过逐步形成组成所述片的单独的层来制备。
组织接触层远端的结构层或(如优选的)结构叠层的层可以首先制备,如通过将组成所述层的材料在合适的溶剂中的溶液浇铸到合适的板或模具上或者浇铸到合适的如有机硅涂布的(silicone-coated)剥离纸的剥离纸上。然后干燥或允许干燥浇铸溶液,任选地在升高的温度和/或减压条件下。
然后,结构叠层的连续层可以被浇铸到预成型的第一层上,随后在每种情况下,通过干燥以除去溶剂,且在适当时固化以得到希望的交联度。固化最优选通过应用高温来促进(通常在可达60℃或更高的温度下可达一个小时或更长)。
最后,组织接触层可以被浇铸在结构层或叠层上。同样,优选随后干燥以除去溶剂,且固化以得到希望的交联度。优选至少部分地在高温下发生固化(一般在可达60℃的温度下超过10分钟且可达一个小时或更长)。
所述片的每一层可以一次操作浇铸。可选地,特别对于相对厚的层(即相对于所述片的其它层厚的层),可以通过连续浇铸较薄的亚层(sublayer)来形成层。
一旦被制造,以及在使用前,依据本发明的所述片通常将具有小于10%w/w的含水量,且更普遍地,小于5%w/w的含水量。
在制造过程中,可以将图像或文字数字标记印到所述片的单独层的表面上。该标记可以用来区别组织粘合表面与非粘合表面,可选地,其可以用来表示产品或制造商的身份。可以用作标记剂的生色团包括亚甲基蓝。
一般地,依据本发明的可植入的装置可以通过将涂层应用到所述装置的任何便利的方法来制备。例如,以与上述结构层或叠层和组织接触层的材料被浇铸的方式类似的方式将涂层的层浇铸到所述装置上。可选地,涂层可以通过将装置浸在液体制剂中或通过用液体制剂喷涂所述装置来应用。
片的治疗应用
依据本发明的片适于应用到身体的内表面和外表面,即其可以局部应用到身体外部(如到皮肤)或局部应用到内部表面例如在包括常规手术和微创手术的外科手术过程中被暴露的内部器官的表面。
依据本发明的片特别适于下面领域的外科手术应用:
胸的/心血管的
普通外科
ENT
泌尿科学
口的/上颌面的
矫形术的
神经学上的
胃肠病学
眼科学
妇科学/产科学
下面更详细描述了可能的用途。
伤口愈合
所述片的可降解性质意味着其可以在内部过程和局部过程中支持和促进伤口愈合。一旦所述片开始降解,成纤维细胞将移入且开始沉积细胞外基质的组分。因此,所述片可以用作内部敷料或外部敷料。另外,如生长因子和cAMP的已知促进皮肤细胞增殖的因子可以加入到制剂中以辅助愈合过程。所述片可以设计为控制湿气和传染物的传播,因此在烧伤治疗中特别有用。
皮肤闭合
可以局部地应用所述片以促进伤口闭合(作为缝合线的替代物)。这可能具有的有益效果,因为其可以减少结疤,因此制剂和片可以在小手术(如在急诊室中)过程中用于美容的目的。所述片的自粘合性能可以使其易于快速应用。
疝修补
可以使用所述片以在疝修补过程中提供增强。自粘合连接克服了常规手术的增强网状产品所面临的潜在问题,其需要在已经衰弱的区域中缝合或加钉。用于这一过程的所述片可以被设计为具有短期或长期耐久性,这取决于所需要的组织修复的程度。所述片还可以能够避免U形钉的应用。
本发明还可以在向疝网状装置提供粘性涂层方面找到应用。
吻合
所述片提供用于快速封闭和预防在如血管的联结的管状结构、血管移植物和膀胱移植物以及肠胃道中的泄漏的工具。如果用于神经修复,所述片支持组织修复的能力可能有特别的价值。
封闭大区域的组织
所述片的优良的封闭性能和操纵性能与其自粘合性能与具有覆盖大的表面区域的能力相结合,意味着所述片可以特别地用于封闭被切除的组织表面-特别是那些扩散出血成问题的被切除的组织表面(如肝)。所述片还提供用于在这些位置的组织修复的理想的支持基质(support matrix)。这还可以适用于限制神经外科之后的脑脊髓流体的泄漏。
封闭气漏
除了上述修补性能外,所述片的高拉伸强度和优良的固有弹性(在组织反应性官能团的水合及反应后)使其特别适用于封闭肺中的气漏,特别是在肺切除后。同样,在实现封闭后,所述片提供用于在这些位置的组织修复的理想的支持基质。
止血
所述片可以作为物理障碍应用到出血区域。片中的组织反应性材料可以固定蛋白质,从而促进止血。
治疗剂给药
在制造所述片过程中,药物、抗感染药和其它治疗剂(包括如生长因子的生物活性剂、以及甚至细胞和细胞成分)可以加入到用于形成所述片的组分的溶液,或者在它们使用前共价连接到组分。在应用到所希望的位置后,所述片一旦就位,药物将通过扩散或者通过操纵所述片而被缓慢释放,例如通过控制所述片内的交联度,以致所述片随时间降解时药物被释放。释放速率可以通过所述片的适当的设计来控制。因此,所述片可以提供用于系统地递送已知量的药物或将已知量的药物递送到精确位置的工具。所述药物可以直接结合到用于制造所述片的溶液的组分,或简单地分散到所述溶液中。
预防术后粘连
在邻近组织间形成不希望的结缔组织的术后粘连是个严重的问题,其可以引起严重的术后并发症。术后粘连在肠道手术中是个特别的问题,其能引起例如肠扭转,所述肠扭转需要进一步外科手术。根据本发明的片材料应用到在外科手术过程中被暴露的组织能够有效地预防该组织与邻近组织间的术后粘连。
微创操作
用于通过活组织检查获得组织样品、插入装置、递送治疗剂和进行外科手术操作的微创技术正作为传统的“开放”外科手术的替代选择迅速发展着。一般地,微创操作使得对于患者的较少的疼痛、结疤、较快的恢复时间以及较少的术后并发症,同时使得医疗保健费的减少。使用特别设计的仪器进行操作,所述仪器通过小的锁孔尺寸的外科手术切口被插入。可以通过现有的和特别设计的微创外科手术仪器和套针系统将所述片引入身体内,且所述片可以成形或制备为适当的尺寸和结构,包括用于与封缝钉(stapling device)一起使用的支持物(Buttress)。所述片的柔性使其能够成形为尺寸减小的结构,例如通过折叠或卷起所述片,且因此促进了所述片用于微创外科手术操作和/或其中进入受限制的其他操作。所述片对其所应用的组织的优良的初始接触粘合力也可以在这样的操作中特别有用。
附图简述
图1示意性地而非按比例地示出依据本发明的组织粘合片的一个实施方案的结构。
图2阐明N-乙烯基吡咯烷酮50-丙烯酸25-丙烯酸-N-羟基琥珀酰亚胺酯25共聚物(poly(N-vinyl pyrrolidone50-co-acrylic acid25-co-acrylic acid-N-hydroxysuccinimide ester25)的合成。
优选实施方案的详述
现在将参考下面的实施例,仅通过示例来更详细的说明本发明。实施例1和2描述了依据本发明的组织粘合片的制造。实施例3到5描述了这些片的性能和特征。实施例6和7描述了用于实施例1和2的片的、含有组织反应性基团的材料的合成。实施例8描述了一种替代形式的组织反应性材料的合成。
实施例1
制备多层片
依据本发明的多层组织粘合片在图1示意性的示出。所述片包括结构叠层和组织接触层。
结构叠层具有以下形式:
a)PLGA的第一层1;
b)聚(VP-AAc-AAc(NHS))的第二层2;以及
c)PLGA的第三层3。
组织接触层4被结合到第三层3且包含聚(VP-AAc-AAc(NHS))。
第一层1和第三层3各自具有大约4μm的厚度,第二层2具有大约3μm的厚度。组织接触层4具有大约22μm的厚度,且由厚度大致相等的三个亚层4a-c组成。
所述片如下制备:
1.1 制备溶液
制备如下三种溶液:
溶液A是10g PLG溶于100ml DCM。
溶液B是7.5g聚(VP-AAc-AAc(NHS))溶于100ml DCM/MeOH 15/4。
溶液C是2.5g亚甲基蓝溶于50ml水。
1.2 浇铸层1
使用称为K棒(bar)的装置将溶液A浇铸在背面为有机硅的剥离纸上。在20℃/大气压下干燥膜30分钟。该膜不从剥离纸上除去。
1.3 浇铸层2
使用K棒将溶液B浇铸在层1上。在20℃/大气压下干燥膜30分钟。该膜不从剥离纸上除去。
1.4 应用标识
将溶液C印到层2的表面上以形成商业/可见的标识。
1.5 浇铸层3
使用K棒将溶液A浇铸在层2上。在20℃/大气压下干燥膜30分钟。该膜不从剥离纸上除去。
1.6 浇铸层4a到4c
使用K棒将溶液B浇铸在层3上。在20℃/大气压下干燥膜30分钟。该膜不从剥离纸上除去。
使用K棒将溶液B浇铸在层4a上。在20℃/大气压下干燥膜30分钟。该膜不从剥离纸上除去。
使用K棒将溶液B浇铸在层4b上。在20℃/减压下干燥膜16小时。该膜不从剥离纸上除去。
1.7 裁剪
使用特别设计的刀具将该产品切割成所需尺寸,且将其从剥离纸上剥离下来。
1.8 最后干燥
该产品在20℃/减压下干燥24小时。
实施例2
可选的多层片的制备
依据本发明的两层组织粘合片包括结构层和组织接触层。
结构层具有单个的PLGA的第一层1的形式。
组织接触层2被结合到第一层1且包含聚(VP-AAc-AAc(NHS))。
第一层1具有大约15μm的厚度。组织接触层2具有大约22μm的厚度。
所述片如下制备:
2.1 制备溶液
制备如下三种溶液:
溶液A是10g PLG溶于100ml DCM。
溶液B是10g聚(VP-AAc-AAc(NHS))溶于100ml DCM/MeOH 15/4。
溶液C是2.5g亚甲基蓝溶于50ml水。
2.2 浇铸层1
使用称为K棒的装置将溶液A浇铸在背面为有机硅的剥离纸上。在20℃/大气压下干燥膜30分钟。该膜不从剥离纸上除去。
2.3 浇铸层2
使用K棒将溶液B浇铸在层1上。在20℃/大气压下干燥膜30分钟。该膜不从剥离纸上除去。
2.4 应用标识
将溶液C印到层2的表面上以形成商业/可见的标识。
2.5 裁剪
使用特别设计的刀具将该产品切割成所需尺寸,且将其从剥离纸上剥离下来。
2.6 最后干燥
该产品在20℃/减压下干燥24小时。
实施例3
体外粘合性能
依据本发明的片对肝的体外粘合性能使用Zwick万能试验机(Zwickuniversal testing machine)来量化。浸入DPBS中5分钟后,平均粘合功一般为7mJ到14mJ。
实施例4
物理特征
该产品是具有通体可见的标识的清透的/不透明的膜。使用Zwick万能试验机,拉伸强度被量化为一般2MPa到9MPa。
实施例5
体内粘合性能
实施例1中呈现的类型的片已经被用于消除缘于对肺和肝组织的标准钻孔活组织检查损伤(standard punch biopsy injury)的血液、流体和气漏。在应用后,所述片牢固地黏附到组织表面,且使得损伤部位立即稳定,得到令人满意的止血和/或静气作用(pneumostasis)。
应用后14天,通过对组织的组织学检查宏观评价愈合,显示了最初的损伤部位和邻近所述片残留物的正常组织的良好的愈合和封闭。这些残留物被薄的纤维层包裹。该残留材料通过巨噬活性(macrophagic activity)和细胞侵润而继续被再吸收,其在50天内基本完成。
实施例6
(VP-AAc-AAc(NHS))三元共聚物的合成
该反应在图2中示意性的示出。
加热2000ml的脱氧DMSO到80℃。向DMSO中加入121.3g(1.09摩尔)NVP和78.7g(1.09摩尔)AAc,随后加入0.04g(2.44×10-4摩尔)AIBN。在80℃反应17-19小时,接着允许冷却到室温。125.6g(1.09摩尔)NHS溶于所得聚合物溶液,随后加入溶于225ml DMF的112.6g(0.545摩尔)DCC。在室温下搅拌反应96小时。使用烧结玻璃滤器在减压下过滤除去反应副产物DCU。通过与2000ml IPA混合、随后从13000ml乙醚沉淀、随后通过过滤来分离聚合物。所得聚合物在2500ml乙醚中洗涤三次,然后在减压下40℃干燥。
通过使用IPA进行Soxhlet提取进一步纯化该聚合物以除去微量的杂质。
Soxhlet提取的聚合物通过制备6%w/v的在DCM/MeOH(15/4v/v)中溶液、然后从50倍过量的乙醚中沉淀、随后在乙醚中洗涤来进一步纯化。在减压下在40℃干燥纯化的聚合物。
分子量大约为Mn=2-5,000,Mw=10-30,000。
实施例7
可选的(VP-AAc-AAc(NHS))三元共聚物的合成
加热400ml脱氧甲苯到80℃。向甲苯加入31.6g(0.28摩尔)NVP和20.6g(0.28摩尔)AAc,随后立刻加入0.1g(6.1×10-4摩尔)AIBN。在80℃反应17-19小时。通过在2000ml 1/1v/v的己烷/乙醚中沉淀、随后在减压下过滤来分离所得聚合物。所得聚合物用300ml乙醚洗涤三次,最后在真空下在40℃干燥。
(VP-AAc)共聚物的酸含量通过用1.0M氢氧化钠滴定来测定。50%摩尔的酸基通过在DCC的存在下与NHS反应转变为NHS酯。33.7g含有0.77摩尔丙烯酸官能度的聚(VP-AAc)和44.54g(0.38摩尔)NHS在25℃溶于1000ml DMF。79.77g(0.38摩尔)DCC溶于137ml DMF,然后加入到聚合物溶液,在25℃搅拌反应96小时。使用烧结玻璃滤器在减压下过滤除去反应副产物DCU。通过加入1250ml IPA、随后从5000ml乙醚沉淀、随后通过过滤来分离聚合物。聚合物在1000ml乙醚中洗涤三次,然后在减压下40℃干燥。
通过许多普遍已知的方法可以进一步纯化聚合物以除去微量的杂质,例如Soxhlet提取,透析或使用如IPA的适当的溶剂洗涤。此外,在减压下、高温干燥可以除去微量的溶剂和其它挥发性物质。
通过使用IPA进行Soxhlet提取进一步纯化聚合物以除去微量的杂质。
Soxhlet提取的聚合物通过制备在DCM/MeOH(15/4v/v)中6%w/v的溶液、然后从50倍过量的乙醚沉淀、随后在乙醚中洗涤来进一步纯化。在减压下在40℃干燥纯化的聚合物。
实施例8
HPC-琥珀酸酯NHS的合成
在80℃下将10g HPC(Mw大约370,000)溶于350ml无水N-甲基吡咯烷酮。加入1.4g(0.014摩尔)琥珀酸酐和1.71g(0.014摩尔)4-二甲氨基吡啶。在80℃反应过夜。溶液冷却到室温,加入400ml IPA。聚合物从3000ml乙醚沉淀、过滤和接连用300ml乙醚洗涤。最后,在真空下40℃干燥聚合物。
然后,聚合物溶于DMF,在DCC存在下与NHS反应以生成胺-反应性NHS酯化合物和硫醇-反应性NHS酯化合物。
Claims (24)
1.一种多层组织粘合片,其包括结构层或叠层,所述结构层或叠层包括具有成膜性能的一种或多种合成聚合物,且所述结构层或叠层被结合到包含组织反应性基团的材料的组织接触层。
2.如权利要求1所述的片,其包括结构叠层,所述结构叠层包括结合在一起的两个或更多个分离的层。
3.如权利要求2所述的片,其中所述叠层包括具有成膜性能的聚合物和包含反应性官能团的材料的交替层。
4.如权利要求3所述的片,其包括结构叠层以及所述组织接触层,所述结构叠层包括两层成膜聚合物和插入其间的反应性材料层。
5.如权利要求4所述的片,其中所述反应性材料与所述组织接触层的材料相同。
6.如任一项前述权利要求所述的片,其中具有成膜性能的一种或多种聚合物是聚酯。
7.如权利要求6所述的片,其中所述聚酯选自由聚乳酸、聚乙醇酸、聚己内酯、聚羟基链烷酸酯及其任何的共聚物和共混物组成的组。
8.如权利要求7所述的片,其中所述聚酯选自由聚乳酸、聚乙醇酸及其共聚物和共混物组成的组。
9.如权利要求8所述的片,其中所述聚酯是丙交酯-乙交酯共聚物。
10.如任一项前述权利要求所述的片,其中所述组织反应性基团选自由亚氨酸酯、对硝基苯基碳酸酯、NHS酯、环氧化物、异氰酸酯、丙烯酸酯、乙烯基砜、正吡啶基二硫化物、马来酰亚胺、醛和碘乙酰胺组成的组。
11.如权利要求10所述的片,其中所述组织反应性官能团是NHS酯基。
12.如权利要求10所述的片,其中所述组织接触层包括选自由聚(VP-AAc(NHS))和(VP-AAc-AAc(NHS))三元共聚物组成的组的组织反应性聚合物。
13.如任一项前述权利要求所述的片,其具有0.01mm到1mm的总厚度。
14.如任一项前述权利要求所述的片,其具有0.015mm到0.05mm的总厚度。
15.如任一项前述权利要求所述的片,其中所述组织接触层占所述片总厚度的50%多。
16.如权利要求1所述的片,其包括结构叠层以及组织反应性材料的组织接触层,所述叠层包括n层生物可降解的聚酯和n-1层散置其间的包含反应性官能团的材料,其中n的值为1、2或3,最优选2。
17.如权利要求16所述的片,其中所述聚酯选自由聚乳酸、聚乙醇酸、聚己内酯、聚羟基链烷酸酯及其任何的共聚物和共混物组成的组。
18.如权利要求17所述的片,其中所述聚酯选自由聚乳酸、聚乙醇酸及其共聚物和共混物组成的组。
19.如权利要求18所述的片,其中所述聚酯是丙交酯-乙交酯共聚物。
20.如权利要求16到19中任一项所述的片,其中所述组织反应性材料是聚(VP-AAc-AAc(NHS))。
21.如权利要求16到20中任一项所述的片,其中所述包含反应性官能团的材料是聚(VP-AAc-AAc(NHS))。
22.一种制备如任一项前述权利要求所述的片的方法,所述方法包括逐步形成所述结构层或叠层的层,随后形成所述组织接触层。
23.一种适于植入人体内或动物体内的装置,所述装置在其至少部分的外表面上带有包含具有成膜性能的一种或多种聚合物的涂层,至少部分的所述涂层被结合到包含组织反应性官能团的材料层。
24.一种将组织表面结合到另一组织或者封闭组织表面的方法,所述方法包括将如权利要求1到21中任一项所述的片应用到所述组织表面。
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2006
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2007
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