Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
  • A61L31/14—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
  • A61L31/148—Materials at least partially resorbable by the body
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/40—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
  • A61L27/44—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix
  • A61L27/48—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix with macromolecular fillers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
  • A61L27/58—Materials at least partially resorbable by the body
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
  • A61L31/12—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
  • A61L31/125—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix
  • A61L31/129—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix containing macromolecular fillers

Definitions

• the invention relates to a composite matrix comprising a reinforcing textile part covered in whole or in part by at least one macromolecule, in particular a resorbable bio-polymer.
• this matrix can be used in the field of surgery and prostheses.
• This matrix can thus make it possible to form prostheses that can be used in surgery, in particular in cardiovascular surgery, for example to replace arteries, in visceral surgery, for example to treat hernias or eventrations, particularly as a parietal reinforcement, or in surgery.
• orthopedic for example to replace all or part of tendons or ligaments.
• Medical textiles are generally implantable materials from the textile industry. These medical textiles may be intended to physically strengthen damaged tissue, especially after surgery or trauma. For example, they can be used to repair supportive tissues, such as the peritoneum, muscle walls, or primordial tissues in the joints, such as tendons or ligaments. In particular for these types of tissues, hard medical devices, in particular made of metal, are generally unusable because their mechanical properties are too different from those of the surrounding tissues and the so-called soft medical devices, most often resorbable, generally have a resistance. insufficient mechanical.
• Medical textiles can in particular be used in cardiovascular surgery, in particular to replace arteries, in visceral surgery, particularly as a parietal reinforcement, for example for the treatment of hernias and eventrations, and in orthopedic surgery, in particular to replace tendons or ligaments.
• the first parietal reinforcements appeared after the Second World War.
• the materials used in surgery were, for example, polyvinyl alcohols, polyethylene, polypropylene (Prolene ®), fluorinated organic polymers, for example polytetrafluoroethylene, or PTFE, polyamides, such as nylon, and of high molecular weight unsaturated polyesters, such as Mersilene ®.
• the reinforcement can be placed in pre-peritoneal position, that is to say in the deep muscle layers of the peritoneum, or in the intraperitoneal position.
• the method can be chosen according to the type of repair to be performed, in general, the treatment of the incision is done rather with positioning of the material in an intra-peritoneal way, because of the complete rupture of the tissues, whereas the hernias are treated rather by a preperitoneal positioning, because it is the inner muscle layers that relax without necessarily breaking the peritoneum.
• intra-peritoneal positioning implies that the textile face in contact with the abdominal wall is firmly anchored in the wall, as for the pre-peritoneal position, and that the external face limits the formation of adhesions, in particular with the surrounding viscera and tissues.
• the current products in general, are not satisfactory with regard to these characteristics, and in particular do not have both such characteristics and characteristics allowing satisfactory reinforcement and healing.
• a synthetic substance such as PET, silicone or PTFE, and / or
• a release biological product such as collagen or polysaccharide derivatives, such as the Parietex Composite ®, a product the most used today, which is a prosthesis formed of a three-dimensional polyester textile coated with a non-stick collagen film on one of its faces.
• Products coated with synthetic materials involve the implantation of non-absorbable products. These are not integrated and become foreign bodies flush in the abdominal wall. This can in particular cause undesirable reactions. Indeed, this has been observed especially in the case of prostheses whose synthetic coating was based on silicone.
• the products covered on one side, and in particular those coated with a biological non-stick product use as an anchoring mechanism the inflammation, or this can lead (as seen above) to undesirable reactions.
• the coating with a rapid release non-adherent biological product can be detrimental, for example to ensure the anti-adherent effect long enough and / to allow to finish the integration of the textile by the formation of a thin layer of peritoneum on its surface.
• sprain a ligament injury that does not result in permanent loss of normal joint relationships. This distinguishes the sprain of dislocation for which the joint loses its normal relationship permanently.
• DIDT in English "Hamstring tendon" which removes a purely tendon graft on the lower end of the internal right and semi-tendinous muscles to the inner side of the thigh.
• the graft is an inert element, deprived of its vascularization and innervation, its initial resistance is sufficient to quickly do without splint and walk cautiously.
• Biological processes of "ligamentization” will allow to integrate the graft in the joint by making it the robustness necessary for the stabilization of the knee.
• allografts especially in the United States where there are many FDA-accredited tissue banks, avoid the use of an autologous donor site.
• the disadvantages of allografts are the risks associated with their source, organ donor patients, the necessary logistics, their slower maturation, infections and potential rejections, as well as the deterioration of the graft by sterilization treatments. , preservation and decrease of immunogenicity.
• Synthetic grafts often based on textiles, such as Nylon, Dacron or GoreTex, or carbon were widely used in the 1980s but their low resistance to abrasion by bone, the frequent induction of synovitis, their weak integration capacity has made their use anecdotal to date.
• the present invention therefore aims to solve all or part of the problems mentioned above.
• the subject of the invention is a composite matrix comprising a reinforcing textile part whose two faces are covered at least 90% of their respective surfaces by at least a first layer, comprising, or even consisting of, at least a resorbable macromolecule.
• the first layer can be composed of two identical layers on both sides of the textile or on the contrary of different layers on each side. In this last case :
• the resorbable macro-molecule may be identical, in which case it may, for example, be associated with different components or be present in each layer at different contents, or
• the resorbable macromolecule may be different in each layer.
• These resorbable macromolecules are in particular of biological origin, of synthetic or semisynthetic or semisynthetic origin, in particular having a synthetic part grafted to a macromolecule of biological origin.
• the term "macromolecule of biological origin” is intended to mean a polymer extracted from living material or a synthetic equivalent thereof, which may be modified in their chemical structures by physical, chemical or enzymatic routes, without these The modifications do not substantially modify the properties useful in the present invention.
• the macromolecule of biological resorbable origin can be chosen from: proteins, in particular having a molecular weight greater than or equal to 10,000 Da, or polyamino acids, in particular having a molecular weight greater than or equal to 1,000 Da,
• polysaccharides in particular having at least 10 saccharide units and / or a molecular weight greater than or equal to 1500 Da, and
• nucleic acids in particular having at least 40 nucleotides and / or a molecular weight greater than or equal to 10,000 Da.
• synthetic macromolecule means a polymer obtained by chemical synthesis and which is not extracted from living matter, in particular which is not a synthetic equivalent of a macromolecule of biological origin. .
• the resorbable synthetic macromolecule can be chosen from:
• polylactic acids polyglycolic acids, a mixture thereof, and
• the term "resorbable” is intended to mean a macro molecule capable of being degraded in a given time by the cellular and enzymatic systems of living organisms, in particular either by hydrolysis in contact with biological fluids and in response to chemical modifications in its environment, for example pH modification, or by enzymatic attack, leading to the release of oligomers, monomer, monomer fragments and / or constituent elements.
• a resorbable material according to the invention may be a material which, when placed in its place of destination or subcutaneously, especially in a rat, eventually disappears completely, especially in 18 months or less, in particular in 12 months or less, especially in 8 months or less, or 4 months or less, and in some cases in 2 months or less.
• the resorbable material may retain at least 80%, in particular at least 90% of its dry weight relative to its initial dry weight, after subcutaneous implantation in a rat for 10 days, in particular for 20 days, in particular during 30 days, or even 40 days.
• the evolution of the resorbable material can in particular be measured by implanting subcutaneously, in a mouse or a rat, 1 cm 2 of the matrix to be tested and then to measure certain parameters, in particular the loss of mass as a function of the implantation time. , in particular to check if the material evolves in the manner defined in the present description.
• the reinforcing textile may have a density greater than or equal to 10 g / m 2 , especially greater than or equal to 15 g / m 2 , and in particular greater than or equal to 20 g / m 2 .
• the reinforcing textile may have a density of less than or equal to 400 g / m 2 , especially less than or equal to 300 g / m 2 , and in particular less than or equal to 200 g / m 2 .
• the reinforcing textile may have a density ranging from 15 g / m 2 to 400 g / m 2 , in particular ranging from 20 g / m 2 to 200 g / m 2 .
• the reinforcing textile may be non-absorbable, in particular the textile comprises, or consists of, polypropylene, polyester and / or polyurethane.
• the reinforcing textile is absorbable, in particular the textile comprises, or consists of, at least one macromolecule of resorbable biological origin and / or at least one synthetic or natural polymer such as collagen, chitosan, silk, polylactic acid, or PLA and / or polyglycolide, or PGA, and mixtures thereof.
• the textile comprises, or consists of, at least one macromolecule of resorbable biological origin and / or at least one synthetic or natural polymer such as collagen, chitosan, silk, polylactic acid, or PLA and / or polyglycolide, or PGA, and mixtures thereof.
• the absorbable reinforcing textile may be a textile which, when it is placed in its place of destination or subcutaneously, in particular in a mouse or in a rat, eventually disappears completely, especially in 18 months,
• the evolution of the resorbable reinforcing textile can in particular be measured by implanting subcutaneously or intramuscularly, in a mouse or a rat, 1 cm 2 of the matrix to be tested, or reinforcement textile alone, then to measure certain parameters, including mass loss.
• the reinforcing textile, resorbable or not may be two-dimensional or three-dimensional.
• three-dimensional is meant a fabric comprising several thicknesses of son.
• the reinforcing textile may be non-woven, woven or knitted.
• the first layer may cover at least 90%, in particular at least 95%, especially at least 99%, or even 100% of the surface of the reinforcing textile part.
• the first layer may be directly in contact with the textile or may be separated from it by an intermediate layer.
• This intermediate layer can be of any kind.
• the first layer and / or the intermediate layer is not a mixture of hyaluronic acid and carboxymethylcellulose.
• the first layer can be obtained by coating or by coating or "coating”.
• the coating can lead to a matrix in which the first layer covers the textile reinforcement and the coating can lead to a matrix in which the first layer is both integrated in the textile reinforcement and covers it.
• the textile can be 3D.
• the first layer may be nonwoven.
• the first layer comprises, or even consists of, fibers, and in particular does not include fil (s).
• One way of determining whether the fabric is completely covered is to hydrate the product or matrix, in the case where the coating is complete or total it is no longer able to feel the textile to the touch.
• the textile is estimated to be completely covered if the final product is impervious to liquid water at 20 ° C for at least 5 minutes.
• the first layer may comprise, or consist of, type I, III, III and / or IV collagen, polyamino acids, for example polyaspartic and polyglutamic acids, glycosaminoglycans, in particular sulfated glycosaminoglycans, and native or modified polysaccharides, such as glycogen and amylopectins, especially other than hyaluronic acid and carboxymethylcellulose.
• polyamino acids for example polyaspartic and polyglutamic acids
• glycosaminoglycans in particular sulfated glycosaminoglycans
• native or modified polysaccharides such as glycogen and amylopectins, especially other than hyaluronic acid and carboxymethylcellulose.
• the first layer may comprise, or consist of, acidic fibrous tendon collagen, in particular as described in the patent application FR 09/52768, filed on April 28, 2009, of the acidic fibrous collagen of skin containing variable proportions of acid collagen. -soluble and / or atelocollagen. Said collagen as described in patent application FR 09/52768, and below, may make it possible to obtain a release layer.
• the first layer may comprise a content of collagen, in particular collagen as described according to patent application FR 09/52768, ranging from 50 to 100% by weight, in particular ranging from 75 to 100% by weight, and in particular ranging from 90 to 100% by weight relative to the total weight of the first layer.
• the collagen of the first layer is crosslinked, in particular with glutaraldehyde, formaldehyde or with oxidized polysaccharides, in particular as described in the patent application FR 09/52768.
• the first layer in particular when it is anti-adherent, can comprise, or consist of, collagen, in particular as described in the patent application FR 09/52768, in particular supplemented with poly-L-glutamic acid. and / or poly-L-aspartic in a content ranging from 0.001 to 50% by weight, in particular from 0.001 to 30% by weight relative to the total weight of the first layer.
• Collagen as described in the patent application FR 09/52768 is a non-stick material within the meaning of the present description.
• the first layer comprises collagen, in particular as described in the patent application FR 09/52768, it may also comprise succinylated collagen, in particular particular mixed together.
• This succinylated collagen can make it possible to improve the anti-adhesive qualities and / or to make the surface more "repulsive" with respect to cell colonization.
• the outer face of the surface of the first layer may be covered, in particular grafted with, or comprise in its structure, a product improving the anti-adhesive power of the first layer, in particular the product may be chosen from synthetic triglycerides, collagen, denatured or otherwise, grafted with fatty acids, in particular as described in patent application FR 2,877,669, most particularly by succinylated collagen, and / or collagen grafted with stearic acid, acid poly-L-glutamic and / or poly-L-aspartic.
• the first layer may have a dry thickness ranging from 10 to 200 ⁇ , in particular from 30 to 120 ⁇ . Dry thickness means that the water content is less than or equal to 25% by weight relative to the total weight of the first layer.
• the first layer may have a density greater than 1 mg / cm 2 to 20 mg / cm 2 , and in particular ranging from 3 mg / cm 2 to 12 mg / cm 2 .
• It may have a swelling rate of less than 6, in particular ranging from 2 to 6.
• the swelling rate can be measured as follows: 20mg of product is immersed in Phosphate Buffer Saline IX pH 7.4 for 60 min at 37 ° C. At the end of these 60 minutes, the excess water is removed with absorbent paper and the sample is weighed again. The degree of swelling is calculated by the ratio of the mass of the wet product to the mass of the dry product.
• the first layer in particular when it is cross-linked, alone, that is to say without textile support, may have a suture strength greater than IN, in particular ranging from IN to 2.5 N.
• the suture resistance is much higher.
• the first layer has an elasticity at least equal to that of the textile reinforcement. That is to say, the maximum elongation of the textile reinforcement does not cause the first layer to break.
• Such breaks can in particular be detected visually, in particular with the naked eye.
• the first layer in particular when it is crosslinked, alone, that is to say without a textile support, may have a tensile strength greater than 2 MPa, in particular ranging from 4 to 7 MPa.
• a tensile strength greater than 2 MPa, in particular ranging from 4 to 7 MPa.
• the (dry) weight of the first layer and, where appropriate, of the other layers relative to the textile may range from 10 to 600%, especially from 10 to 400% by weight relative to the weight of the textile.
• the first layer consists of crosslinked collagen, in particular with glutaraldehyde, formaldehyde or with oxidized polysaccharides, in particular as described in the patent application FR 09/52768.
• the composite matrix may comprise in its first layer collagen capable of being obtained by coagulation and concomitant crosslinking of collagen in acidic aqueous solution with a non-reactive aldehyde crosslinking agent at acidic pH by treatment with gaseous ammonia.
• collagen capable of being obtained by coagulation and concomitant crosslinking of collagen in acidic aqueous solution with a non-reactive aldehyde crosslinking agent at acidic pH by treatment with gaseous ammonia.
• the first layer in particular comprising or consisting of collagen, in particular crosslinked, especially with glutaraldehyde, formaldehyde or with oxidized polysaccharides, in particular as described in the patent application FR 09/52768, may optionally be coated with less a product improving the anti-adherence, especially as defined below.
• This first layer optionally coated with at least one anti-adhesion-enhancing product such as a modified collagen, for example succinylated collagen and / or polyamino acids, can have a dry weight ranging from 10 to 600%, especially from 10 to 400. % by weight relative to the weight of the textile.
• Measurements of mechanical stress can be measured on a humidified test specimen of 5mm width using a tensile test bench.
• suture resistance and stress can be measured on a humidified test specimen of 5mm width using a tensile test bench.
• a 3/0 polyamide braid suture was passed through the membrane and then the maximum force to be applied to break the suture was measured using a tensile test bench.
• the first layer has a percentage of trypsin enzymatic degradation of less than 60% depending on the thickness and the degree of crosslinking, in particular ranging from 20 to 35%.
• the textile has two faces, a so-called internal face and an external face, and the first outer layer, covering the outer face, is identical to the first inner layer, covering the inner face. In particular both sides are non-stick.
• the textile has two faces, a so-called inner face and an outer face
• the first outer layer covering the outer face is different from a first inner layer covering the inner face.
• the present "external" invention may mean the side intended to be positioned towards the viscera and “internal” the side intended to be positioned towards the muscles.
• one side is non-adherent and the other is adherent.
• the outer face is said to be anti-adherent, that is to say covered with a first antiadherent layer as defined above and the internal face is said to be adherent, that is to say covered with a adhering layer as defined below.
• the non-stick surface may comprise a first release layer as defined above and in the examples.
• the adherent face may comprise, or consist of, an adherent layer covering the surface of the textile part or possibly an adherent layer covering a release layer on the surface of the textile part.
• This adherent layer may especially not be smooth once moistened and / or exert a sticky power, that is to say once the product has been positioned, it is necessary to apply a perpendicular force to remove it and / or the product does not move when a force, notably reasonable, for example applied by a hand during a suture, parallel to the plane is applied.
• This adherent layer may especially allow cell colonization, or even promote cell colonization.
• This adhering layer can both prevent the matrix or the prosthesis from sliding on the tissues on which it is positioned, which makes it possible, for example, to perform the suture without having to maintain the matrix or the prosthesis by means additional. This may in particular make it possible to suture or staple the matrix or the prosthesis without maintaining or further attaching it to the tissues.
• this adherent layer allows the takeoff or peeling of the matrix or the prosthesis placed on the tissues.
• This adhering layer can also make it possible to obtain cellular recruitment on its side and in particular by activating the multiplication of fibroblasts. This may make it possible to obtain a more orderly and / or faster recruitment, and in particular to obtain more favorable properties. close to those of natural tissues. Without wishing to be bound by this theory, it appears that such an adherent layer causes "controlled" inflammation that leads to these improved characteristics.
• Said adherent layer may comprise, or even consist of, poorly structured collagen, such as gelatin, denatured collagen, atelocoUagene, optionally weakly crosslinked by conventional crosslinking means, polylysine, and / or polysaccharides, such as chitosan, in particular of low molecular weight, said polysaccharides being capable of being oxidized so that the degree of crosslinking is between 0.001 CHO / NH 2 of the collagen and 0.5, preferably between 0.005 and 0.2 CHO / NH 2 of the collagen.
• the adherent face may comprise a release layer as defined above and in the examples, and in particular described in the patent application FR 09/52768, coated with an adherent layer, for example as defined above.
• the first release layer can be smooth and / or nonporous.
• the majority macromolecule that is to say at least 50%, especially at least 75%, in particular at least 85%, or even at least 90% and especially at least 95% by dry weight, or single is collagen obtained by a process as described in the French patent application FR 09/52768.
• the process for preparing fibrous acidic collagen of tendons can include the following steps:
• step b) precipitating and washing the fibrous collagen from the aqueous suspension of step b), and
• the extraction of fibrous collagen can be carried out from young animal tendons having less than 10 months and more preferably from tendons of pigs having less than 10 months.
• the first step may include the removal of tendons from pigs less than 10 months old (tendons may also be taken from calves, lambs and foals), cleaning, maximum removal of connective tissues and other non-intact tissues. tendon then cut the tendons into pieces about 1 cm long and rinse with water.
• the swelling may be carried out for at least 7 days and up to 15 days, in particular 15 days in an acetic acid bath at a concentration of between 0.1 and 0.5M, and in particular 0.3M with stirring at a rate of 1kg of tendons in a volume between 20 and 30 L, especially 25L.
• the second step may include gentle grinding, allowing the release of long tendon fibers from the inflated fragments of tendons.
• the grinding of a volume of the swelling bath containing the pieces of inflated tendons is effected for example for 2 min at 3000 rpm and then each step comprising a dilution of the medium with water followed by grinding in the The same conditions are fulfilled until a dry matter concentration paste of between 4.8 and 6.5 g / kg is obtained.
• the third step may comprise the precipitation of the fibrous collagen from the pulp resulting from grinding, and its purification according to conventional methods.
• This step may comprise one or more precipitations with sodium chloride at a final concentration of between 0.45M and 1.2M and more particularly at the concentration of 0.6M and one or more steps of washing the collagen precipitated in a solution.
• 0.45-1.2 M NaCl in particular 0.6M.
• a viral inactivation step in 1N sodium hydroxide solution is also provided at 20 ° C for one hour. By its hydrolytic action on non-collagenic proteins, this step constitutes an additional purification.
• new washes with 0.6M NaCl can be carried out.
• acetone which leads to the production of a dry fiber.
• This particular method applied to tendons leads to a collagen differing from existing collagens by a high content of long fibers without containing tissue pieces and while retaining a share of collagen solubility.
• the acidic collagen may be shaped by a process comprising the following steps:
• the process for shaping coUagene comprises the following steps:
• the first step consists in the preparation of an aqueous coUagene solution.
• aqueous coUagene solution is also meant a suspension of coUagene.
• CoUagene in acid form means a coUagene whose majority of the carboxylic functions are protonated, and which gives an acidic pH in solution or suspension in water.
• the coUagene material may employ acidic fibrous coUagene.
• fibrous coUagene is meant a coUagene in which the coUagene molecules are not or very little individualized, which is therefore composed of fibers and fibrils consisting of coUagene molecules naturally linked together by weak and covalent bonds, and by aggregates of these structures. Fibrous coUagene, in particular, consists of particles of large sizes (predominantly greater than 5 ⁇ when hydrated) which give a homogeneous suspension by dispersion in an aqueous medium.
• the fibrous coUagene may be in particular a fibrous skin coUagene or a fibrous couagene of tendons. Fibrous skin coUagene has relatively short fibers due to the natural organization of the tissue, acid-soluble coUagene and small aggregates. The coUagene of tendons has long fibers and very little soluble coUagene.
• the fibrous coUagene may be fibrous tendon coUagene, preferably with fibrous coUagene of pig tendons and more preferably with coUagene of pigs tendons younger than 10 months.
• the acid fibrous coUagene of tendons is prepared according to the method described above and has long fibers.
• the first step is therefore to dissolve the coUagene in water. It is carried out according to conventional methods described in the literature.
• the coUagene is an acidic fibrous coUagene
• this step allows the suspension of fibers surrounded by micro-fibrillar coUagene and soluble coUa seemingly having kept a structure necessary for the fibrilation.
• the aqueous coUagene solution comprises between 0.05% and 3% by weight of coUagene and preferably between 0.05, 0.1, 0.8%, 1, 1.5, 2, 2.5 and 3. % of coUagene.
• the aqueous solution comprises 0.8% of coUagene by weight.
• This dissolution is usually carried out in water by mechanical stirring, preferably under reduced pressure.
• the suspension or solution may also be heated at a temperature between 30 ° C and 100 ° C for 2 to 20 minutes to partially or completely denature the coUagene.
• the methods make it possible to obtain various materials in coUagene as a function of the shaping chosen during molding or pouring.
• the coUagene material can thus take the form of a membrane, a matrix, a film, a wire, a gel, a tube or a sponge.
• the second step is thus the casting or molding of the coUagene solution in molds, the thickness varying according to the desired material and depending on the surface of the mold.
• CoUagene membranes are two-dimensional materials resulting from the drying in a flat mold of a homogeneous suspension or a coUagene solution containing a proportion of fibers and fibrils.
• the coUagene may be crosslinked or not.
• the concentration of the dried suspension conditions the thickness of the final material. It can range from a few microns to several hundred microns.
• a coUagene film is a two-dimensional material resulting from the drying in a flat mold of a homogeneous solution of coUagene.
• the coUagene may be crosslinked or not.
• the concentration of the dried solution conditions the thickness of the final material.
• the films and membranes can be folded to form sleeves which can be closed if necessary by sutures or gluing.
• the thickness can vary from a few microns to several hundred microns.
• a coUagene tube is a hollow three-dimensional cylindrical object whose walls may be a coUagene film or membrane.
• the tubes can be obtained by molding around a mold or by extrusion.
• the coUagene may be crosslinked or not.
• the thickness of the walls is conditioned by the amount of coUagene deposited on the molds or involved in the extrusion solution.
• the coUagene solution is deposited on a flat mold to obtain a two-dimensional material after drying of the solution or suspension.
• the film or membrane is obtained by evaporation of the solvent.
• CoUagene tubes are obtained by depositing the solution or suspension on a cylindrical mold and drying or lyophilization.
• the removal of the solvent is carried out by lyophilization and not by evaporation of the solvent in liquid form.
• the third step is thus the coagulation of coUagene by treatment with ammonia for a time sufficient to allow both coagulation and fibrillation of coUagene.
• the treatment with ammonia is carried out for a period of 4, 8, 12, 24, 36, at 48 hours.
• the treatment time is greater than 24 or 36 hours.
• the amount of ammonia must be adjusted to allow a pH increase of the coUagene gel from an acidic pH to a pH of at least greater than 8. Indeed, the crosslinking of the coUagene begins when the coUagene gel reaches a pH at least greater than 8. This long treatment allows a gradual increase in the pH of the coUagene leading not only to coagulation but also to the fibrillation thereof. Depending on the length of the collagen fibers used, this fibrillation forms a mesh which gives the products both mechanical strength and elasticity.
• the gaseous ammonia is prepared from an ammonia solution from which it is evolved.
• gaseous ammonia is generally obtained with at least 30% ammonia solution at a temperature of between 10 ° C and 25 ° C.
• this step is carried out in a hermetically sealed enclosure so that the gaseous ammonia spreads inside the chamber and comes into contact with the collagen solution, which is not in contact with the solution of collagen. 'ammonia.
• the collagen gel obtained is treated to remove excess ammonia and is either preserved in the state or dehydrated.
• the gel can be placed in an enclosure provided with a moisture removal system and / or an ammonia absorber. After removal of the excess ammonia, the membranes, films and tubes are obtained by dehydration of the gel under a stream of dry air, while the sponges, 3D dies or tubes are also obtained by lyophilization of the gel. The gels can be kept hydrated.
• the fibrillation process takes place in a highly viscous liquid medium. This fibrillation occurs from the outside to the inside of the solution and progresses in depth as pH increases due to the diffusion of ammonia. It occurs when the pH has reached a value greater than 4-5.
• the advantage of the ammonia vapor process is that the product does not need to be immersed in neutralization solutions, which saves time, profitability and homogeneity.
• the collagen material When it is desired to increase the resorption time of a collagenic medical device and also to enhance its mechanical properties, the collagen material must be crosslinked.
• crosslinking collagen There are many methods of crosslinking collagen well known to those skilled in the art. They are classified into two main categories: physical crosslinking, for example thermal dehydration and chemical crosslinking by addition or in the presence of crosslinking agents.
• the most well known collagen crosslinkers are aldehyde agents, in particular formaldehyde and glutaraldehyde. These crosslinking processes can of course be used on the collagen materials obtained above.
• This crosslinking step then takes place after the last step d) of the process leading to obtaining the collagen material. It is carried out for example by immersing the collagen material in a bath comprising a crosslinking agent selected from formaldehyde, glutaraldehyde, oxidized glycogen and oxidized amylopectin.
• a crosslinking agent selected from formaldehyde, glutaraldehyde, oxidized glycogen and oxidized amylopectin.
• the crosslinking can on the contrary be carried out in a single step but sequentially with the coagulation and the fibrillation of the coUagene.
• an aldehyde crosslinking agent which does not react with the coUagene at acidic pH is introduced into the starting coUagene solution and then the treatment is carried out with ammonia in order to obtain a pH of at least greater than 8.
• the aldehyde crosslinking agent is preferably chosen from polysaccharides and more particularly oxidized polysaccharides.
• the aldehyde crosslinking agent is chosen from oxidized glycogen and oxidized amylopectins.
• Crosslinking agents that can be used in the processes according to the present invention are, for example, oxidized starch, oxidized dextran or oxidized cellulose known to those skilled in the art.
• the aldehyde crosslinking agent is oxidized glycogen.
• the crosslinking agent is added in proportions ranging from 0.05, 0.1, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5 to 5 to the ratio CHO of the aldehyde crosslinking agent on NH 2 of coUagene.
• the proportions of crosslinking agent may be adjusted by those skilled in the art depending on the desired degree of crosslinking.
• the amount of crosslinking agent to be introduced into the coUagene solution can thus be determined using the general knowledge of those skilled in the art.
• a concentrated aqueous solution is then prepared.
• the oxidized polysaccharide chosen 15%) of the oxidized polysaccharide chosen.
• the oxidation rate and the amount of crosslinker to be added are to be evaluated according to the desired resorption and the desired mechanical properties. It is then possible to add the crosslinking agent to the coUagene in a perfectly controlled and reproducible quantity (unlike formalin vapor crosslinking for example or by immersion in baths). Here, only the introduced crosslinker can react.
• the crosslinking solution is added to the coUagene solution before casting or shaping, that is to say at the end of the homogenization under reduced pressure.
• the resulting medium is a homogeneous mixture of the coUagene and the crosslinking agent but the bonds between the two are not created until the whole has reached a basic pH.
• the following steps are identical to those of the fibridation of coUagene; the fibrillation and the crosslinking being done successively and in this order.
• crosslinking by aldehyde polysaccharides has already been described in the literature (Gagnieu CH and Forest PO, EP 0 862 468). This crosslinking can be done either by immersion of the products to be crosslinked in a solution of the oxidized polysaccharide or by introduction into the product of the oxidized polysaccharide and then immersion of the dry product in a bath for the crosslinking reaction (increase in pH).
• the change of pH is carried out by a buffer and, taking into account the well-known crosslinking principle (Maillard reaction - reaction of the CHO of the crosslinking agent with the NH 2 of collagen), it is avoided to carry out the pH change by means of bases presenting itself amino residues.
• the theory predicts that the oxidized polysaccharide will react with the amine of ammonia and therefore inactivate. Crosslinking can not take place.
• the crosslinking takes place at an effective rate because the Maillard reaction that should have occurred between the ammonia and the aldehydes of the crosslinking agent, inactivating the latter is either absent, low amplitude or uncompetitive with the crosslinking reaction of the aldehyde groups of the oxidized polysaccharide on the amines of the collagen lysines.
• the subject of the invention is also a method for preparing a matrix comprising at least the following steps:
• this method is used to obtain matrices according to the invention.
• the matrix may be obtained by a process comprising treating with ammonia gas the first layer comprising acidic collagen and a non-reactive aldehyde crosslinking agent at acidic pH. More specifically, the method of preparing the matrix may comprise the following steps:
• the layer comprising at least one resorbable macro-molecule is a release layer, in particular it comprises, or even consists of, coUagene, in particular coUagene making it possible to form a non-stick face.
• the first layer comprises, or even consists of, coUagene as obtained or obtainable by the process defined in the present description and / or in FR 09/52768, optionally coated and / or mixed with compounds having and / or improving the anti-adherent or adherent capacities according to the desired effect.
• the method may further comprise a step of casting a hydrophobic substance, in particular before step a) and / or after step d).
• the layer comprising at least one resorbable macromolecule is an adhesive layer.
• the method may further comprise a crosslinking step, in particular of the adhesive layer and / or of an anti-adherence layer, in particular the crosslinking is initiated or catalyzed by exposure to ammonia vapors.
• the crosslinking step can be carried out before or after step d). It is of course possible to carry out two crosslinking steps, one before step d) and the other after step d).
• the subject of the invention is a prosthesis comprising or consisting of a matrix according to the invention. Said prosthesis may be intended for surgery.
• the prosthesis is intended for parietal reinforcement or ligamentoplasty.
• the matrix used may very particularly have an adhesive internal face and an anti-adhesive outer surface.
• the matrix may be bicouhe and for example the reinforcing textile may be covered on one side by an anti-adhesive layer and on the other side by a different adherent layer.
• the prosthesis is intended to replace at least one part of the ligament, or even the entire ligament.
• the matrix may then have an identical internal face and an external face which are in particular adherent.
• the matrix may be "monolayer", that is to say that the reinforcing fabric may be included in a single layer of resorbable macromolecule.
• the matrix may also have an identical internal face and an external face which are in particular anti-adherent.
• the biological composition allows the attraction and adhesion of ligamentous cells for prosthetic integration and tissue regeneration of the ligament / tendon.
• the ligament prosthesis is obtained by rolling a "sheet" of matrix according to the invention to obtain a cylinder.
• the prosthesis comprises a matrix having an identical internal face and an external face which are anti-adherent.
• the subject of the invention is also the use of a matrix according to the invention for the preparation of a prosthesis, in particular intended for ligamentoplasty, in particular with a view to replacing all or part of a tendon or a ligament or parietal reinforcement, in particular intended to be placed in the preperitoneal or intraperitoneal position.
• the solution is then poured into a mold at a rate of 0.4 mg of grafted denatured coUagene / cm 2 .
• the solvent is evaporated under controlled airflow.
• the mold containing the coUagene solutions and the textile is placed in a sealed 3L chamber containing 2 ml of 30% ammonia for 24 hours at 20 ° C. Then, the gel obtained is placed in an enclosure for removing excess ammonia with an ammonia and moisture absorber so as to evaporate the water contained in the gel to obtain a material whose amount of water is less than 20%.
• Such a matrix may be used in particular as a parietal reinforcement.
• Example 2 Single-layer matrix
• an oxidized glycogen solution dissolved at 15%) in phosphate buffer pH 7.7 is added so as to obtain a ratio of 0.25 CHO of the glycogen oxidized per 1 NH 2 of coUagene.
• the viscous suspension is poured into a mold at a rate of 4 mg / cm 2 .
• a textile having a density of 250 g / m 2 equivalent in area to the surface of the mold is deposited on the solution.
• the mold is placed in a hermetically sealed enclosure of approximately 300L containing 160mL of 32% ammonia evenly distributed for 1 hour at 20 ° C.
• the molds are placed again in the hermetic enclosure for 48 hours at 20 ° C. to terminate fibrillation and crosslinking.
• the gels are then placed in an enclosure for removing excess ammonia with an ammonia absorber to obtain a textile included between two layers of collagen membranes.
• Such a matrix can in particular be used as a ligament reinforcement.

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