JP2008525102A - 電気的な迷走神経刺激による炎症性障害の処置 - Google Patents
電気的な迷走神経刺激による炎症性障害の処置 Download PDFInfo
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Abstract
Description
本願は、米国仮特許出願第60/639,332号(2004年12月27日出願)の利益を主張する。上記出願の教示全体は、本明細書中に参考として援用される。
脊椎動物は、炎症誘発経路の活動と抗炎症経路の活動とのバランスをとることによって、感染または傷害の間の体内のホメオスタシスを達成する。しかし、多くの疾患状態において、この体内のホメオスタシスは、バランスを失う。例えば、全てのグラム陰性菌によって産生されるエンドトキシン(リポ多糖類、LPS)は、マクロファージを活性化して、死をもたらす可能性のあるサイトカインを放出させる(非特許文献1;非特許文献2;非特許文献3;非特許文献4)。
Tracey,K.J.ら、Science、1986年、第234巻、p.470−74 Dinarello,C.A.、FASEB J.、1994年、第8巻、p.1314−25 Wang,H.ら、Science、1999年、第285巻、p.248−51 Nathan,C.F.、J.Clin.Invest.、1987年、第79巻、p.319−26
本発明は、サイトカイン媒介性の炎症性状態を処置するための方法およびデバイスである。
本明細書中で使用される場合、「被験体」は、好ましくは哺乳動物であり、より好ましくはヒト患者であるが、コンパニオンアニマル(companion animal)(例えば、イヌまたはネコ)であっても、家畜(例えば、ウマ、ウシ、またはヒツジ)であっても、実験動物(例えば、ラット、マウス、またはモルモット)であってもよい。好ましくは、上記被験体は、ヒトである。
(実施例1.減少した刺激強度および刺激持続時間を使用する電気的な迷走神経刺激は、コリン作動性抗炎症経路の活性化に十分である)
減少した刺激パラメータが抗炎症作用を達成し得るか否かを決定するために、インタクトな迷走神経を、致死的な内毒素血症の設定において、漸減する刺激強度および刺激持続時間で電気的に刺激した。8週齢〜12週齢の雄BALB/cマウス(25〜30g;Taconic)を、12時間の明/暗周期において25℃にて飼育した。動物を、実験操作の前に少なくとも7日間その設備に順応させた。標準的なマウスの食餌および水は、自由に利用可能であった。全ての動物実験を、Institutional Animal Care and Use Committee of the North Shore−Long Island Jewish Research Instituteによって承認されたプロトコルの下で、National Institutes of Health (NIH)Guidelinesに従って行なった。
最後の刺激の終了から、迷走神経刺激の抗炎症作用がどの程度長く持続するかを決定するために、マウスは、30秒間(1mA、0.5ms、30Hz)の電気刺激を受け、そしてそのマウスを、LPS投与の前に規定の時間回復させた。コントロールマウスは、0時間にて偽外科手術を受け、そしてそのコントロールマウスに、刺激したマウスと同一の時間にてLPSを負荷(challenge)した。4つの実験群についての結果を、図5に示す。VNSと、その後のリポ多糖類(LPS)投与との間に2時間待機することによって、TNFの71%の抑制(コントロール=1606±326pg/ml対VNS=474±157pg/ml、p=0.01)が生じた。VNSとLPS投与との間に1日間待機することによって、TNFの72%の抑制(コントロール=2813±503pg/ml対VNS=783±87pg/ml、p=0.004)が生じた。VNSとLPSとの間に2日待機することによって、TNFの44%の抑制(コントロール=1590±351pg/ml対VNS=892±85pg/ml、p=0.09)が生じた。最後に、3日間の待機は、TNFの抑制が生じなかった(コントロール=1253±202pg/ml対VNS=1393±263pg/ml、p=0.7)。動物を、LPS投与の2時間後に安楽死させた。
迷走神経刺激が、ラットのコラーゲン誘導性関節炎モデルにおいて関節炎の重症度を改善し得るか否かを決定するために、ラットは、コラーゲン免疫化の後、数日間、移植した電極を介する迷走神経刺激を繰り返し受容し、そしてそのラットを、関節炎の重症度について評点した。
Claims (82)
- 電気信号によって被験体中の迷走神経を刺激する工程を包含する、炎症性障害を罹患するか、またはそれについての危険性がある被験体を処置するための方法であって、ここで信号電圧は、0.01ボルト〜1ボルトであるが、但し状態は、イレウスでも、喘息でも、嚢胞性線維症でもない、方法。
- 前記信号電圧は、0.01ボルト〜0.05ボルトである、請求項1に記載の方法。
- パルス幅は、0.1ms〜5msであり、信号周波数は、0.1Hz〜30Hzであり、そして信号持続時間は、1秒間〜120秒間である、請求項1に記載の方法。
- 信号電圧は、0.01ボルト〜0.05ボルトであり、パルス幅は、0.1ms〜0.5msであり、信号周波数は、10Hz〜30Hzであり、そして信号持続時間は、20秒間〜40秒間である、請求項1に記載の方法。
- 前記炎症性障害は、虫垂炎、消化性潰瘍、胃潰瘍、十二指腸潰瘍、腹膜炎、膵炎、潰瘍性大腸炎、偽膜性腸炎、急性腸炎、虚血性大腸炎、憩室炎、喉頭蓋炎、アカラシア、胆管炎、胆嚢炎、肝炎、クローン病、腸炎、ホウィップル病、アレルギー、アナフィラキシーショック、免疫複合体病、器官の虚血、再灌流傷害、器官の壊死、枯草熱、セプシス、敗血症、エンドトキシンショック、悪液質、異常高熱症、好酸球性肉芽腫、肉芽腫症、サルコイドーシス、敗血性流産、精巣上体炎、膣炎、前立腺炎、尿道炎、気管支炎、気腫、鼻炎、肺炎、塵肺症、肺胞炎、細気管支炎、咽頭炎、胸膜炎、静脈洞炎、インフルエンザ、RSウイルス感染、HIV感染、B型肝炎ウイルス感染、C型肝炎ウイルス感染、播種性菌血症、デング熱、カンジダ症、マラリア、フィラリア症、アメーバ症、包虫嚢胞、熱傷、皮膚炎、皮膚筋炎、日焼け、じんま疹、いぼ、膨疹、脈管炎、血管炎、心内膜炎、動脈炎、アテローム硬化症、血栓性静脈炎、心外膜炎、心筋炎、心筋虚血、結節性動脈周囲炎、リウマチ熱、アルツハイマー病、セリアック病、うっ血性心不全、成人呼吸促進症候群、髄膜炎、脳炎、多発性硬化症、脳梗塞、脳塞栓、ギヤン−バレー症候群、神経炎、神経痛、脊髄損傷、麻痺、ブドウ膜炎、関節炎、関節痛、骨髄炎、筋膜炎、パジェット病、痛風、歯周疾患、慢性関節リウマチ、滑膜炎、重症筋無力症、甲状腺炎、全身性エリテマトーデス、グッドパスチャー症候群、ベーチェット症候群、同種移植拒絶、対宿主性移植片病、I型糖尿病、強直性脊椎炎、バージャー病、ライター症候群およびホジキン病、からなる群より選択される、請求項1に記載の方法。
- 前記状態は、セプシス、エンドトキシンショック、同種移植拒絶、慢性関節リウマチ、成人呼吸促進症候群、喘息、全身性エリテマトーデス、膵炎、腹膜炎、熱傷、心筋虚血、同種移植拒絶、対宿主性移植片病、うっ血性心不全、器官の虚血、再灌流傷害、悪液質および嚢胞性線維症から選択される、請求項5に記載の方法。
- 前記状態は、虫垂炎、潰瘍性大腸炎、クローン病、アレルギー、再灌流傷害、全身性エリテマトーデス、肝炎、ベーチェット症候群、多発性硬化症およびアテローム硬化症から選択される、請求項5に記載の方法。
- 前記状態は、エンドトキシンショックである、請求項5に記載の方法。
- 前記状態は、セプシスである、請求項5に記載の方法。
- 前記状態は、虫垂炎である、請求項5に記載の方法。
- 前記状態は、潰瘍性大腸炎である、請求項5に記載の方法。
- 前記状態は、クローン病である、請求項5に記載の方法。
- 前記状態は、アレルギーである、請求項5に記載の方法。
- 前記状態は、器官の虚血である、請求項5に記載の方法。
- 前記状態は、再灌流傷害である、請求項5に記載の方法。
- 前記状態は、同種移植拒絶である、請求項5に記載の方法。
- 前記状態は、対宿主性移植片病である、請求項5に記載の方法。
- 前記状態は、慢性関節リウマチである、請求項5に記載の方法。
- 前記状態は、全身性エリテマトーデスである、請求項5に記載の方法。
- 前記状態は、膵炎である、請求項5に記載の方法。
- 前記状態は、腹膜炎である、請求項5に記載の方法。
- 前記状態は、熱傷である、請求項5に記載の方法。
- 前記状態は、ベーチェット病である、請求項5に記載の方法。
- 前記状態は、多発性硬化症である、請求項5に記載の方法。
- 前記状態は、悪液質である、請求項5に記載の方法。
- 前記状態は、肝炎である、請求項5に記載の方法。
- 前記状態は、アテローム硬化症である、請求項5に記載の方法。
- 前記被験体は、ヒトである、請求項5に記載の方法。
- 前記迷走神経の活動が、末梢の遠位位置にて刺激される、請求項5に記載の方法。
- 前記迷走神経の活動が、頸部領域において刺激される、請求項5に記載の方法。
- 神経節または節後ニューロンが、刺激される、請求項5に記載の方法。
- 前記迷走神経が、脳において刺激される、請求項5に記載の方法。
- 遠心性の迷走神経が、刺激される、請求項5に記載の方法。
- 求心性の迷走神経が、刺激される、請求項5に記載の方法。
- 電気信号によって被験体中の迷走神経を刺激する工程を包含する、炎症性障害を罹患するか、またはそれについての危険性がある被験体を処置するための方法であって、ここで信号電圧は、0.01ボルト〜1ボルトであり、パルス幅は、0.1ms〜5msであり、信号周波数は、0.1Hz〜30Hzであり、信号持続時間は、1秒間〜120秒間であり、そして信号停止時間は、2時間を上回る、方法。
- 前記信号停止時間は、2時間〜24時間である、請求項35に記載の方法。
- 炎症性障害を罹患するか、またはその危険性がある被験体を処置するための電気信号発生器であって、
電気信号を該被験体の迷走神経に送達するための電極アセンブリ;および
信号電圧を0.01ボルト〜1ボルトの範囲に制限することによって該電気信号を制御するコントローラー;
を備える、電気信号発生器。 - 前記信号電圧は、0.01ボルト〜0.05ボルトの範囲に制限される、請求項37に記載の信号発生器。
- 前記コントローラーが、パルス幅を0.1ms〜5msの範囲に制限し、信号周波数を0.1Hz〜30Hzの範囲に制限し、そして信号持続時間を1秒間〜120秒間の範囲に制限する、請求項37に記載の信号発生器。
- 前記コントローラーが、信号電圧を0.01ボルト〜0.05ボルトの範囲に制限し、パルス幅を0.1ms〜0.5msの範囲に制限し、信号周波数を10Hz〜30Hzの範囲に制限し、そして信号持続時間を20秒間〜40秒間の範囲に制限する、請求項37に記載の信号発生器。
- 炎症性障害を罹患するか、またはその危険性がある被験体を処置するための電気信号発生器であって、
電気信号を該被験体の迷走神経に送達するための電極アセンブリ;および
信号電圧を0.01ボルト〜1ボルトの範囲を制限し、パルス幅を0.1ms〜5msの範囲に制限し、信号周波数を0.1Hz〜30Hzの範囲に制限し、信号持続時間を1秒間〜120秒間の範囲に制限し、そして信号停止時間を2時間を上回る範囲に制限することによって該電気信号を制御する、コントローラー;
を備える、電気信号発生器。 - 前記コントローラーが、前記信号停止時間を2時間〜24時間の範囲に制限する、請求項41に記載の信号発生器。
- 炎症性障害を罹患するか、またはその危険性がある被験体を処置するための医用デバイスを構築するための電気信号発生器の使用であって、該電気信号発生器は、
電気信号を該被験体の迷走神経に送達するための電極アセンブリ;および
信号電圧を0.01ボルト〜1ボルトの範囲に制限することによって該電気信号を制御する、コントローラー;
を備えるが、但し、状態は、イレウスでも、喘息でも、嚢胞性線維症でもない、使用。 - 前記コントローラーが、前記信号電圧を0.01ボルト〜0.05ボルトの範囲に制限する、請求項43に記載の信号発生器の使用。
- 前記コントローラーが、パルス幅を0.1ms〜5msの範囲に制限し、信号周波数を0.1Hz〜30Hzの範囲に制限し、そして信号持続時間を1秒間〜120秒間の範囲に制限する、請求項43に記載の信号発生器の使用。
- 前記コントローラーが、信号電圧を0.01ボルト〜0.05ボルトの範囲に制限し、パルス幅を0.1ms〜0.5msの範囲に制限し、信号周波数を10Hz〜30Hzの範囲に制限し、そして信号持続時間を20秒間〜40秒間の範囲に制限する、請求項43に記載の信号発生器の使用。
- 炎症性サイトカインカスケードによって媒介される前記状態は、虫垂炎、消化性潰瘍、胃潰瘍、十二指腸潰瘍、腹膜炎、膵炎、潰瘍性大腸炎、偽膜性腸炎、急性腸炎、虚血性大腸炎、憩室炎、喉頭蓋炎、アカラシア、胆管炎、胆嚢炎、肝炎、クローン病、腸炎、ホウィップル病、アレルギー、アナフィラキシーショック、免疫複合体病、器官の虚血、再灌流傷害、器官の壊死、枯草熱、セプシス、敗血症、エンドトキシンショック、悪液質、異常高熱症、好酸球性肉芽腫、肉芽腫症、サルコイドーシス、敗血性流産、精巣上体炎、膣炎、前立腺炎、尿道炎、気管支炎、気腫、鼻炎、肺炎、塵肺症、肺胞炎、細気管支炎、咽頭炎、胸膜炎、静脈洞炎、インフルエンザ、RSウイルス感染、HlV感染、B型肝炎ウイルス感染、C型肝炎ウイルス感染、播種性菌血症、デング熱、カンジダ症、マラリア、フィラリア症、アメーバ症、包虫嚢胞、熱傷、皮膚炎、皮膚筋炎、日焼け、じんま疹、いぼ、膨疹、脈管炎、血管炎、心内膜炎、動脈炎、アテローム硬化症、血栓性静脈炎、心外膜炎、心筋炎、心筋虚血、結節性動脈周囲炎、リウマチ熱、アルツハイマー病、セリアック病、うっ血性心不全、成人呼吸促進症候群、髄膜炎、脳炎、多発性硬化症、脳梗塞、脳塞栓、ギヤン−バレー症候群、神経炎、神経痛、脊髄損傷、麻痺、ブドウ膜炎、関節炎、関節痛、骨髄炎、筋膜炎、パジェット病、痛風、歯周疾患、慢性関節リウマチ、滑膜炎、重症筋無力症、甲状腺炎、全身性エリテマトーデス、グッドパスチャー症候群、ベーチェット症候群、同種移植拒絶、対宿主性移植片病、I型糖尿病、強直性脊椎炎、バージャー病、ライター症候群およびホジキン病からなる群より選択される、請求項43に記載の電気信号発生器の使用。
- 前記状態は、セプシス、エンドトキシンショック、同種移植拒絶、慢性関節リウマチ、成人呼吸促進症候群、喘息、全身性エリテマトーデス、膵炎、腹膜炎、熱傷、心筋虚血、同種移植拒絶、対宿主性移植片病、うっ血性心不全、器官の虚血、再灌流傷害、悪液質および嚢胞性線維症から選択される、請求項43に記載の電気信号発生器の使用。
- 前記状態は、虫垂炎、潰瘍性大腸炎、クローン病、アレルギー、再灌流傷害、全身性エリテマトーデス、肝炎、ベーチェット症候群、多発性硬化症およびアテローム硬化症から選択される、請求項43に記載の電気信号発生器の使用。
- 前記状態は、エンドトキシンショックである、請求項43に記載の電気信号発生器の使用。
- 前記状態は、セプシスである、請求項43に記載の電気信号発生器の使用。
- 前記状態は、虫垂炎である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、潰瘍性大腸炎である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、クローン病である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、アレルギーである、請求項43に記載の電気信号発生器の使用。
- 前記状態は、器官の虚血である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、再灌流傷害である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、同種移植拒絶である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、対宿主性移植片病である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、慢性関節リウマチである、請求項43に記載の電気信号発生器の使用。
- 前記状態は、全身性エリテマトーデスである、請求項43に記載の電気信号発生器の使用。
- 前記状態は、膵炎である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、腹膜炎である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、熱傷である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、ベーチェット病である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、多発性硬化症である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、悪液質である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、肝炎である、請求項43に記載の電気信号発生器の使用。
- 前記状態は、アテローム硬化症である、請求項43に記載の電気信号発生器の使用。
- 前記被験体は、ヒトである、請求項43に記載の電気信号発生器の使用。
- 前記迷走神経の活動が、末梢の遠位位置にて刺激される、請求項43に記載の電気信号発生器の使用。
- 前記迷走神経の活動が、頸部領域において刺激される、請求項43に記載の電気信号発生器の使用。
- 神経節または節後ニューロンが、刺激される、請求項43に記載の電気信号発生器の使用。
- 前記迷走神経が、脳において刺激される、請求項43に記載の電気信号発生器の使用。
- 遠心性の迷走神経が、刺激される、請求項43に記載の電気信号発生器の使用。
- 求心性の迷走神経が、刺激される、請求項43に記載の電気信号発生器の使用。
- 被験体において炎症性障害を処置するための治療用物品の製造における、請求項43に記載の電気信号発生器の使用であって、デバイスが、運転中に迷走神経を直接刺激して該炎症性障害を処置する、使用。
- 被験体において炎症性状態を処置するための治療用物品の製造における、請求項43に記載の電気信号発生器の使用であって、デバイスが、炎症性障害を処置する目的のために、単独で使用されて迷走神経を刺激する、使用。
- 炎症性障害を罹患するか、またはその危険性がある被験体を処置するための医用デバイスを構築するための電気信号発生器の使用であって、該電気信号発生器は、
信号電圧を0.01ボルト〜1ボルトの範囲に制限し、パルス幅を0.1ms〜5msの範囲に制限し、信号周波数を0.1Hz〜30Hzの範囲に制限し、信号持続時間を1秒間〜120秒間の範囲に制限し、そして信号停止時間を2時間を上回る範囲に制限することによって、電気信号を制御するコントローラー;
を備える、使用。 - 前記コントローラーが、前記信号停止時間を2時間〜24時間の範囲に制限する、請求項79に記載の使用。
- 被験体において炎症性障害を処置するための治療用物品の製造における、請求項79に記載の電気信号発生器の使用であって、デバイスが、運転中に迷走神経を直接刺激して該炎症性障害を処置する、使用。
- 被験体において炎症性状態を処置するための治療用物品の製造における、請求項79に記載の電気信号発生器の使用であって、デバイスが、炎症性障害を処置する目的のために、単独で使用されて迷走神経を刺激する、使用。
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CN102793972A (zh) | 2012-11-28 |
EP1833559B1 (en) | 2010-11-24 |
CA2593079C (en) | 2014-08-19 |
AU2010200759B2 (en) | 2012-03-08 |
AU2005323463B2 (en) | 2009-11-19 |
EP2298410A1 (en) | 2011-03-23 |
AU2005323463A1 (en) | 2006-07-13 |
ATE489132T1 (de) | 2010-12-15 |
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