FI81265B - MICROPARTICLAR OCH GASBLAOSOR INNEHAOLLANDE ULTRALJUDCONTRASTMELEL - Google Patents

Abstract

1. Contrast medium containing microparticles and gas bubbles for ultrasound diagnostics, characterised in that it contains microparticles of a mixture of a semi-solid or liquid surface-active substance and a non-surface-active solid in a liquid carrier.

Description

1 81265

Ultrasonic contrast agent containing microparticles and gas bubbles

The invention relates to a contrast agent containing microparticles and gas bubbles for use in ultrasound diagnostics. The invention also relates to a package for the preparation of such a contrast agent.

Ultrasound examination of organs (sonography) is a diagnostic method that has been introduced and practiced for a few years. Ultrasonic waves in the mega-10 hertz range (above 2 megahertz at wavelengths between 1 and 0.2 mm) are reflected from the interfaces of different tissue species. The echoes thus formed are amplified and made visible. Of great importance in this case is the examination of the heart by this method, called ecocar-15 biography (Haft, JI et al .: Clinical echocardiography, Futura, Mount Kisco, New York 1978; Köhler, E. Klinische Echocardiography, Enke, Stuttgart 1979; Stefan , G. et al., Echocardiography, Thieme, Stuttgart-New York 1981; G. Biamino, L. Lange Echocardiography, Hoechst AG, 20 1983.)

Since fluids - including blood - only produce ultrasound shade when there are differences in density with the environment, opportunities were sought to make blood and its flow visible to ultrasound, which is also possible by adding tiny small gas bubbles.

Several methods for making and stabilizing gas bubbles are known in the literature. They can be produced, for example, by vigorously shaking or stirring solutions, such as saline solutions, dye solutions, or previously recovered blood.

Although this achieves an ultrasonic shadow effect, these methods have serious drawbacks in the form of poor reproducibility, a large variation in the size of the gas bubbles and, due to the proportion of large gas bubbles of visible size, a certain plug. These disadvantages have been partially eliminated by other methods, cf. for example, U.S. Patent No. 3,640,271, which produces reproducibly sized bubbles by filtering or using a direct current electrode arrangement. In this case, the advantage of the possibility of producing kaa-5 genera of reproducible sizes is offset by considerable technical costs.

U.S. Patent No. 4,276,885 describes a method of making gas bubbles of a certain size surrounded by a protective gelatin coating. The finished bubbles 10 can only be stored in a frozen state, for example at a refrigerator temperature, in which case they must be brought back to body temperature for use.

U.S. Patent No. 4,265,251 describes the manufacture of solid-shell gas bubbles of a certain size from saccharides, which gas bubbles may be filled with pressurized gas. If they are at normal pressure, they can be used as an ultrasonic contrast agent; when used with increased internal pressure, they function in your blood pressure measurement. Although the storage of fixed gas bubbles does not present any problems, the technical costs of manufacture are a considerable cost factor.

The risks of prior art contrast agents arise from two factors, namely the size and number of solid particles and gas bubbles.

25 Ultrasonic contrast agents manufactured to date have always had only a few of the required properties: 1.) plug-out exclusion - gas bubbles (size and number) 30 - solid particles (size and number) 2.) reproducibility 3.) sufficiently long stability 4.) lung permeability, e.g., to obtain ultrasound shading of the left half of the heart 35 5.) capillary permeability 3 81265 6.) sterility and pyrogen-free nature of the preparation 7.) reasonably easy to prepare 8.) and trouble-free storage.

5 It is true that European application 52575 describes the manufacture of gas bubbles which meet the required characteristics. To prepare them, microparticles of a solid crystalline substance, such as galactose, are suspended in a carrier liquid, whereby the gas adsorbed on the surface of the particles is enclosed in the interparticle cavities or in the cavities inside the crystals, forming gas bubbles. The suspension of gas bubbles and microparticles thus formed is injected within 10 minutes. Although European Application Publication No. 52575 15 claims that a suspension prepared according to the described method is suitable for peripheral venous injection to appear in both the right half of the heart and through the lung after passing to the left half of the heart and for blood and blood flow to be seen by ultrasound. Thus, it was found that the contrast agent prepared according to the method described in European Application Publication No. 52575 and injected into the peripheral vein did not produce any ultrasound echoes in the left half of the heart.

It was an object of the present invention to provide a contrast agent for ultrasound diagnostics capable of visualizing blood and its flow rates not only in the right half of the heart but also through the lung capillary tissue after passing through the left half of the heart when administered intravenously. In addition, it should also be used to study blood flow through other organs such as the heart muscle, liver, spleen and kidneys.

The novel agents of the invention have all the properties expected of such a contrast agent and are listed above.

4,81265

The invention relates to a contrast agent containing microparticles and gas bubbles for ultrasound diagnostics. The contrast agent is characterized in that it contains microparticles of a mixture of a semi-solid or liquid surfactant and a non-5 interfacial solid in a liquid carrier, the amount of the semi-solid or liquid interface being 0.01 to 10% by weight. -% and the amount of non-interfacial solid is 5-50% by weight.

The invention also relates to a package for the preparation of an ultrasonic contrast agent comprising microparticles and gas bubbles. The package is characterized in that it comprises a) a container with a volume of 5-10 ml and provided with a closure which allows the contents to be removed under sterile conditions and which container is filled with 4 ml of liquid carrier; a container with a volume of 5 to 10 ml, fitted with a closure which allows the contents to be removed or the mixture to be added under sterile conditions, and which is filled with microparticles of a mixture of semi-solid or liquid surfactant and non-surfactant solid having an average particle size of <1-10 μm, wherein the weight ratio of interfacial agent to non-interfacial solid is 0.01-5: 100 and the amount of microparticles is 5-50% by weight, preferably 9-40. weight-%.

Surprisingly, it has been found that by suspending microparticles of a mixture of a semi-solid or liquid surfactant and a non-interfacial solid in a carrier liquid, an ultrasound contrast agent is obtained which allows an ultrasound image of blood in the left artery of the heart to be reproduced after injection into a peripheral vein. Thus, since the ultrasound contrast agent of the invention can reach the left half of the heart after intravenous administration, ultrasound shadows of 5,81265 other organs maintained by the blood from the aorta are also possible after intravenous administration, e.g., myocardium, liver, spleen, kidney, e.g. It is self-evident that the ultrasound contrast agent according to the invention so-5 also serves as a contrast agent for the right half of the heart and for all other uses of ultrasound contrast agent.

Suitable semi-solid or liquid interface active ingredients, which are a component in the mixture necessary for the preparation of microparticles, are all substances which are physiologically acceptable in the amounts used, i.e. having low toxicity and / or biodegradability and a melting point lower than room temperature, m.p. which are semi-solid or liquid at room temperature. A particularly 15 suitable are lecithin, lesitiinijakeet and derivatives, byproducts, polyoxyethylene fatty acid esters such as acid-lyoksietyleenirasva alcohol ethers, polyoxyethylated sorbitan fatty acid esters, glycerin polyetyleeniglyko-lioksistearaatti, glyseriinipolyetyleeniglykolirisiini-20 oleate, ethoxylated soijasteriinit, ethoxylated castor oils and the hydrogenated derivatives thereof, polyoxyethylene-rasvahappostearaatit and polyoxyethylene polyoxypropylene nipolymers, sucrose esters or sucrose glycerides and xyloglycerides such as soybean oil sucrose glyceride and palm oil xylide, unsaturated (C4-C20) fatty alcohols or (f4-C20) fatty acid esters, -sucrose glyceride, wood oil sucrose glyceride, with butyl stearate, soybean oil sucrose glyceride and polyethylene glycol sorbitan monostearate being preferred Liset.

The interfacial agent is used in a concentration of 0.01 to 10% by weight, preferably 0.04 to 0.5% by weight.

Suitable non-surfactants which form part of the mixture necessary for the preparation of microparticles are organic and inorganic compounds, for example salts, such as sodium chloride, sodium citrate, sodium acetate or sodium tartrate, monosaccharides, such as glucose, fructose, galactose, disaccharides such as sucrose, lactose or maltose, pentoses such as arabinose, xylose or ribose or cyclodextrins such as α-, β- or β-cyclodextrin, with galactose, lactose and α-cyclodextrin being preferred. They are contained in the substance according to the invention in a concentration of 10 to 50% by weight, preferably 9 to 40% by weight.

To prepare the microparticles, the non-interfacial agent is recrystallized under sterile conditions. Next, the interfacial agent is mixed with the non-interfacial solid under sterile conditions and comminuted, e.g., by grinding in an air jet mill, until the desired particle size is reached. A particle size of <1-50, preferably 1-10 is achieved. The particle size is determined in a suitable measuring device. The weight ratio of interfacial agent to non-interfacial solid may range from 0.01 to 5: 100.

Both the size of the microparticles achieved by the comminution and the size of the gas bubbles contained in the contrast agent according to the invention ensure the passage through the innocuous capillary vein and the capillary tissue of the lung and exclude the formation of plugs.

The gas bubbles required to form the shadow pass through the partially suspended microparticles, absorbed on the outer surface of the microparticles, in the cavities between the microparticles or enclosed in crystals.

30 The volume of gas carried by the microparticles in the form of gas bubbles is 0.02-0.6 ml per gram of microparticles.

In addition to the transport operation, the carrier liquid must be used to stabilize the suspension of microparticles and gas bubbles, e.g. to prevent the sedimentation of the microparticles and the co-occurrence of the gas bubbles or to slow down the dissolution of the microparticles.

Suitable liquid carriers are water, aqueous solutions of one or more inorganic salts such as physiological saline and buffer solutions, aqueous solutions of mono-5 or disaccharides such as galactose, glucose or lactose, monohydric or polyhydric alcohols, if they are physiologically acceptable such as ethanol , polyethylene glycol, ethylene glycol, glycerol, propylene glycol, propylene glycol-10-methylmethyl ester or aqueous solutions thereof.

Preferred are water and physiological electrolyte solutions such as physiological saline and aqueous solutions of galactose and glucose. If solutions are used, the concentration of the solute is 0.1 to 30% by weight, preferably 0.5 to 15% by weight, in particular 0.9% aqueous saline or 20% aqueous galactose is used.

To prepare a ready-to-use ultrasound contrast agent, sterile carrier fluid is added to the microparticles of the mixture of semi-solid or liquid interfacial agent and non-interfacial solid and shaken until a homogeneous suspension is required, which takes about 5-10 seconds. The resulting suspension is injected immediately after preparation, but no later than 5 minutes thereafter, as a bolus into a peripheral vein or into a pre-made catheter at a dose of 0.01 ml to 1 ml / kg body weight.

For convenience, components required for the preparation of a substance of the invention, such as carrier liquid (A) and microparticles of a mixture of semi-solid or liquid surfactant and non-interfacial solid (B), are stored sterile in two separate containers to the extent necessary for the study. Both containers have stoppers that allow removal and insertion using a syringe under sterile 8,81265 conditions (vials). The size of the container B must be such that the contents of the container A can be transferred to the container B by means of a syringe and the combined components shaken.

Carrying out an ecocardiographic study on a 10 kg baboon demonstrates the use of a contrast agent according to the invention: 5 ml of carrier liquid (prepared according to Example IA) is taken from a vial with a syringe and added to 10 g of microparticles (prepared according to Example 1B) in another vial and shaken 5-10 s until a homogeneous suspension is formed. 2 ml of this suspension is injected into a peripheral vein (V. jugularis, brachialis, or saphena) via a 3-way tap at an in-15 infusion rate of at least 1 ml / s, preferably 2--3 ml / s. Contrast injection involves the immediate injection of 10 ml of physiological saline at the same rate to maintain the contrast bolus as far as possible up to the right half of the heart. Before and after, as well as during the injection, a commercial ecocardiography head is held on the thorax of the test animal so that a typical cross-section is obtained through the left and right halves of the heart. This experimental arrangement is in accordance with the state of the art and is known to a person skilled in the art.

25 If the ultrasound contrast agent reaches the right half of the heart, the 2-D sound image or M-mode sound image can monitor how the blood marked by the contrast agent first reaches the correct atrial height, then the right ventricle and pulmonary artery, with a homogeneous filling for about 10 s. While the cavities in the right half of the heart are again emptied on ultrasound, contrast-marked blood appears through the lungs after passing through the pulmonary veins, filling the left atrium, left ventricle, and aorta homogeneously, leaving the shadow 2-3 times 35 longer than the right half of the heart. In addition to the image of the blood flow in the cavities of the left half of the heart, there is also an image of the myocardium, which reflects back the flow.

However, the use of the ultrasound contrast agent according to the invention is not limited to visualizing the blood flow in the arterial part of the heart after intravenous administration, but is also used with great success in the study of the right half of the heart and other organs as a contrast agent.

Example 1 A. Preparation of Carrier Liquid Water for injection is filled into 4 ml bottles of 5 ml each and sterilized for 20 minutes at 120 ° C.

15 B. Preparation of microparticles

Under sterile conditions, apply a sterile-filtered solution of 0,5 g of butyl stearate in 40 g of isopropanol to 199,5 g of sterile galactose particles, dry at 40 oC and 27 kPa and grind with an air-jet mill until a particle size distribution of 1,9 is obtained: median pm min 99% <6 pm min 90% <3 pm

The particle size and its distribution are determined in a particle measuring device, e.g. suspended in isopropanol. The microparticles are packaged in 5 ml bottles of 2 g each.

C. To prepare 5 ml of ready-to-use ultrasound contrast agent, add the contents of the carrier liquid bottle 30 (water for injections, A) to the microparticle bottle B using a syringe and shake until a homogeneous suspension is formed (5-10 seconds).

35 10 81 265

Example 2 A. Preparation of carrier anesthetic

Fill the water for injections into 4 ml bottles of 5 ml each and sterilize at 120 ° C for 5 to 20 minutes.

B. Preparation of microparticles

Under sterile conditions, apply a sterile-filtered solution of 0,5 g of soybean oil sucrose glyceride in 40 g of isopropanol to 199,5 g of sterile ga-10 lactose particles, dry at 40 ° C and 27 kPa to remove isopropanol and grind in an air jet until the following particle size distribution: median value 1.9 pm min 99% <6 pm 15 min 90% <3 pm

The particle size and its distribution are determined in a particle measuring device, e.g. suspended in isopropanol. The microparticle is packaged in 5 ml bottles of 2 g each.

20 C. To prepare 5 ml of the reconstituted ultrasound contrast agent, add the contents of the vial containing the carrier liquid (water for injections, A) to the vial containing the microparticles (B) with a syringe and shake until a homogeneous suspension is formed (5-25 seconds).

Example 3 A. Preparation of carrier liquid

Dissolve 4.5 g of sodium chloride in water to a volume of 500 ml, filter the solution through a 0.2 mm filter at 30 pressure, fill 4 ml of this solution each time into 5 ml flasks and sterilize for 20 minutes at 120 ° C.

B. Preparation of microparticles

Under sterile conditions, apply a sterile-filtered solution of 0,5 g of polyethylene glycol sorbitan monos-35 in 40 g of isopropanol to 199,5 μl of 11 81265 g of sterile galactose particles, dry off the isopropanol at 40 ° C and 27 kPasl and grind in air until the following particle size distribution is reached: 5 median value 1.9 pm min 99% <6 pm min 90% <3 pm

The particle size and its distribution are determined in a particle measuring device, e.g. suspended in isopropanol. The microparticles are packaged in 5 ml bottles of 2 g each.

C. To prepare 5 ml of ready-to-use ultrasound contrast agent, add the contents of the carrier liquid bottle (water for injection. A) to the microparticle bottle (B) using a syringe and shake until a homogeneous suspension (5-10 seconds) is formed.

Example 4 A. Preparation of carrier liquid 20 Dissolve 4.5 g of sodium chloride in 500 ml of water, filter the solution through a 0.2 mm filter under pressure, fill 4 ml of this solution into 5 ml flasks and sterilize for 20 minutes at 120 ° C.

B. Preparation of Microparticles Under sterile conditions, apply a solution of 0,5 palm oil xylitol in 40 g of isopropanol to 199.5 g of sterile galactose particles, dry at 40 ° C and 27 kPa to remove isopropanol and grind in an air jet mill until the following particle size-30 distribution is achieved: median value 1.9 pm min 99% <6 pm min 90% <3 pm

The determination of the particle size and its distribution takes place in 35 particle measuring devices, e.g. suspended in isopropanol. The microparticles are packed in 5 ml pxillos, each with 2 g.

C. To prepare 5 ml of ready-to-use ultrasound contrast agent, add the contents of bottle 5 containing carrier liquid (water for injection, A) to the bottle containing microparticles (B) using a syringe and shake until a homogeneous suspension is formed (5-10 seconds).

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Claims (12)

A microparticle and gas bubble contrast agent for ultrasound diagnostics, characterized in that it contains a mixture of semi-solid or liquid interfacial and non-interfacial solid microparticles in a liquid carrier, wherein the semi-solid or liquid interface the amount of the substance is 0.01 to 10% by weight and the amount of the non-interfacial solid is 5 to 50% by weight. Substance according to Claim 1, characterized in that it contains microparticles which contain lecithin, polyoxytylene fatty acid ester, glycerol polyethylene glycol glycine dioleate, polyoxyethylene polyoxypropylene polymer (esters), sucrose, sucrose, sucrose as semi-solid or liquid interface alcohols, unsaturated (C4-C20) fatty acids, polyoxyethylene fatty acid esters, mono-, di- and triglycerides or fatty acid esters. Substance according to Claim 1 or 2, characterized in that it contains microparticles which contain, as a semi-solid or liquid interface, butyl stearate, soybean oil sucrose glyceride or polyethylene glycol sorbitan monostearate in a concentration of 0.01 to 5% by weight, preferably 0% by weight. .04 -1% by weight. Substance according to Claim 1, characterized in that it contains microparticles which contain, as a non-interfacial solid, cyclodextrin, monosaccharides, disaccharides, trisaccharides, polyols or inorganic or organic salts. Substance according to Claim 1 or 4, characterized in that it contains microparticles which contain galactose, lactose or α-cyclodextrin as a non-interfacial solid in a concentration of 5 to 50% by weight, preferably 9 to 4% by weight. 40% by weight. Substance according to Claim 1, characterized in that it contains, as physiologically acceptable liquid carrier, water, a physiological electrolyte solution, an aqueous solution of a monohydric or polyhydric alcohol such as glycerin, polyethylene glycol or propylene glycol methyl ester or an aqueous solution of a mono- or disaccharide. Substance according to Claim 1 or 6, characterized in that it contains water or physiological saline solution as a physiologically acceptable liquid carrier. Substance according to Claim 1, characterized in that it contains microparticles of a mixture of butyl stearate and galactose in water. Substance according to Claim 1, characterized in that it contains microparticles of a mixture of soybean oil sucrose glyceride and galactose in water. Substance according to Claim 1, characterized in that it contains microparticles of a mixture of polyethylene glycol sorbitan monostearate and galactose in physiological saline. The substance according to claim 1, characterized in that it contains microparticles of a mixture of palm oil xylitol and galactose in physiological saline. 12. A kit for the manufacture of an ultrasound contrast agent comprising microparticles and gas bubbles, characterized in that it comprises a) a container having a volume of 5-10 ml and fitted with a closure which allows the contents to be removed under sterile conditions and which is filled 4 (b) a second container of 5 to 10 ml capacity, fitted with a closure which allows the contents to be removed or the mixture to be added under sterile conditions, and which is filled with a semi-solid or liquid interface. a mixture of active substance and non-interface-5 active solid with microparticles with an average particle size <1-10 μm, the weight ratio of interfacial substance to non-interfacial solid being 0.01-5: 100 and the number of microparticles is 5-50% by weight, preferably 9-40% by weight. 10 ie 81265