JP5015160B2 - 再吸収可能な角膜ボタン(resorbablecorneabutton) - Google Patents
再吸収可能な角膜ボタン(resorbablecorneabutton) Download PDFInfo
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Description
内皮の機能不全は、米国の角膜視野損失の主要な原因であり、1年で実施される38,000の角膜移植の半分以上の原因である[Aintablian, 2002 #1]。角膜は、透明で、凸面な、目の外側のほとんどの部分であり、視覚のシステムの主な屈折の要素である。体の大部分の組織とは異なり、角膜は適切に光を屈折させるために透明なままでなければならず、ほんの少しの結果の存在がこのプロセスを妨害することができるので、角膜は、栄養を与え、感染から防御する血管を含まない。代わりに、角膜は、その後ろの室を満たす涙および房水から栄養を受ける。角膜組織は、5つの基本的な層で配置され、ネイ比が最も内側の層である。内皮細胞は、角膜を綺麗に保つために必須である。通常、液は、目の中から中間の角膜層(間質)へゆっくり漏れる。内皮の主な仕事は、この過剰な液を間質から汲み出すことである。このポンプ作用がなければ、ストローマは水で膨潤し、かすみ、および最終的に不透明になる。健康な目では、角膜への液の移動と角膜からの液の汲み出しの間に完璧なバランスがある。一旦、内皮細胞が、疾患、外傷または加齢により破壊されると、それらは永久に損失する。内皮細胞の破壊が多すぎれば、浮腫および失明となり、角膜移植が唯一現在利用可能な治療である。
現代の角膜移植が直面する主な挑戦は、移植用に利用可能なドナー角膜組織の世界規模の不足である。本明細書で開示されるデバイスは、ドナー角膜の代用としての、生物分解性ポリマーフィルムおよび培養された細胞の組み合わせを利用することにより、この不足を補う。このポリマーフィルムは、培養された細胞層のための担体として機能する。一旦移植されると、ポリマーフィルムは溶解し、その場所に細胞層を残す。
図1は、好ましい実施態様の正面図および側面図を示す。
図2は、本発明の実施態様の斜位像を示す。
図3は、角膜解剖の概略図を示す。
図4は、伝統的なDLEK手技の概略図を示す。
図5Aは、内皮細胞層が取り除かれ、そして移植片が直接的にデスメ膜上に置かれる、修飾されたDLEK手技の概略図を示す。
図5Bは、内皮細胞層が取り除かれず、そして移植片が残される内皮細胞上に置かれる、修飾されたDLEK手技の概略図を示す。
本発明の好ましい実施態様を記載するにおいて、特定の用語が明確性のために再分類される。しかしながら、本発明は、そのように選択された特定の用語に限定されることを意図されないし、各々の特定の用語は、同様の目的を達成するために同様な方法で操作する技術的同等物の全てを含むことは理解され得る。
好ましい実施態様では、薄いポリマー層が、支持マトリックスのために使用され得、ヒアルロン酸から形成される。内皮細胞は、移植を必要とする患者から回収され得る。これらの細胞は、成長し、拡大し、そして、特許出願PCT/US04/32933に記載された技術を用いてポリマー層上にシート化されてRCBを形成する。一旦、細胞がポリマー上でコンフルエントに達すれば、RCBは移植される状態にある。
軟骨細胞、および骨芽細胞系統経路に沿って分化できることを示した(Erickson et al 2002, Biochem Biophys Res Commun. Jan. 18, 2002; 290(2): 763-9; Gronthos et al 2001, Journal of Cellular Physiology, 189:54-63; Halvorsen et al 2001, Metabolism 50:407-413; Halvorsen et al, 2001, Tissue Eng. Dec. 7, 2001(6):729-41; Harp et al 2001, Biochem Biophys Res Commun 281:907-912; Saladin et al 1999, Cell Growth & Diff 10:43-48; Sen et al 2001, Journal of Cellular Biochemistry 81:312-319; Zhou et al 1999, Biotechnol. Techniques 13: 513-517; Zuk et al 2001, Tissue Eng. 7: 211-228)。
1.Ko WW, Feldman ST, Frueh BE, et al. Experimental posterior lamellar transplantation of the rabbit cornea. Invest Ophthalmol Vis Sci. 1993; 34(suppl): 1102.
2.Melles GR, Eggink FA, Lander F, et al. A surgical technique for posterior lamellar keratoplasty. cornea. 1998; 17:618-626.
3.Melles GR, Lander F, van Dooren BR, et al. Preliminary clinical results of posterior lamellar keratoplasty through a sclerocorneal pocket incision. Ophthalmology. 2000; 107:1850-1856.
4.Terry MA, Ousley PJ. Endothelial replacement without surface corneal incisions or sutures: topography of the deep lamellar endothelial keratoplasty procedure. cornea. 2001; 20:14-18.
5.Terry MA, Ousley PJ. Deep lamellar endothelial keratoplasty in the first United States patients: early clinical results. cornea. 2001; 20:239-243.
6.Terry MA, Ousley PJ. Replacing the endothelium without surface corneal incisions or sutures: first US clinical series with the deep lamellar endothelial keratoplasty procedure. Ophthalmology. 2003; 110:755-764.
7.Terry MA. Endothelial replacement: the limbal pocket approach. Ophthalmol Clin North Am. 2003; 16:103-112.
8.Terry MA, Ousley PJ. corneal endothelial transplantation: advances in the surgical management of endothelial dysfunction. Contemporary Ophthalmology. 2002; 1:26:1-9.
9.Terry MA, Ousley PJ. Rapid visual rehabilitation with deep lamellar endothelial keratoplasty. cornea. 2004; 23:143-153.
Claims (10)
- 以下を含む、移植可能かつ透明な、再吸収可能な角膜ボタン(corneal button):
a)内皮細胞の成長を支持することができる表面および底面を有する単離された生物分解性のポリマー支持マトリックス、ここで該ポリマー内には以下からなる群から選択される1以上の接着試薬が組み込まれている:ラニミン、フィブロネクチン、アルギニン−グリシン−アスパラギン酸−セリン テトラペプチド、ポリカルボフィルと結合したbFGF、ポリカルボフィルと結合したEGF、およびヘパリン;
b)該表面に配置された移植のために好適な生存可能な内皮細胞層;および、
c)該生物分解性のポリマー支持マトリックスは眼内に移植されると眼によって再吸収可能である、
ここで、該生物分解性のポリマー支持マトリックスの主要な構成ポリマーが架橋されたコラーゲンのとき、該生物分解性のポリマー支持マトリックスの厚さは5μm以上ではない。 - 生物分解性のポリマー支持マトリックスが、ヒアルロン酸、羊膜、キトサン、架橋されたコラーゲン、アルギン酸、脂肪組織、ゼラチン類、カルボキシメチルセルロースおよびそれらの組合せからなる群から選択される、請求項1に記載の再吸収可能な角膜ボタン。
- 内皮細胞が、角膜内皮細胞である、請求項1に記載の再吸収可能な角膜ボタン。
- 該生物分解性のポリマー支持マトリックスが、ヒアルロン酸を含み、そして、内皮細胞が角膜内皮細胞である、請求項2に記載の再吸収可能な角膜ボタン。
- 該生物分解性のポリマー支持マトリックスが、架橋されたコラーゲンを含み、そして、内皮細胞が角膜内皮細胞である、請求項2に記載の再吸収可能な角膜ボタン。
- さらに、ラニミン、フィブロネクチン、アルギニン−グリシン−アスパラギン酸−セリン テトラペプチド、ポリカルボフィルと結合したbFGF、ポリカルボフィルと結合したEGF、およびヘパリンからなる群から選択される1以上の接着試薬を含む、請求項1〜5のいずれかに記載の再吸収可能な角膜ボタン。
- 該接着試薬が、合成の間に該ポリマー支持マトリックス内に埋め込まれている、または組み込まれている、請求項6記載の再吸収可能な角膜ボタン。
- 内皮細胞が、移植が必要な患者から回収された角膜内皮細胞であるか、またはバンクに保存された内皮細胞である、請求項1〜7のいずれかに記載の再吸収可能な角膜ボタン。
- 以下を含む角膜修復方法に使用される、請求項1〜8のいずれかに記載の再吸収可能な角膜ボタン:
a)角膜の前房に接近する(access)ために、移植が必要な眼の角膜−強膜切開を実施すること;
b)移植された内皮細胞が角膜の前房の細胞と密に接触するように、角膜の前房に存在する内皮細胞の上に再吸収可能な角膜ボタンを移植すること;
c)前房にヒアルロナーゼ(hyaluronase)を注入すること;および
d)眼の切開を閉じること。 - 以下を含む角膜修復方法に使用される、請求項1〜8のいずれかに記載の再吸収可能な角膜ボタン:
a)角膜の前房に接近する(access)ために、移植が必要な眼の角膜−強膜切開を実施すること;
b)再吸収可能な角膜ボタンを受容する角膜の位置に存在する内皮細胞をスタニング(stunning)すること、
c)移植された内皮細胞が角膜の前房の細胞と密に接触するように、角膜の前房に存在する内皮細胞の上に再吸収可能な角膜ボタンを移植すること;
d)前房にヒアルロナーゼ(hyaluronase)を注入すること;および
e)眼の切開を閉じること。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US72528605P | 2005-10-12 | 2005-10-12 | |
US60/725,286 | 2005-10-12 | ||
PCT/US2006/040053 WO2007047425A1 (en) | 2005-10-12 | 2006-10-12 | Resorbable cornea button |
Publications (2)
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JP2009511197A JP2009511197A (ja) | 2009-03-19 |
JP5015160B2 true JP5015160B2 (ja) | 2012-08-29 |
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JP2008535703A Expired - Fee Related JP5015160B2 (ja) | 2005-10-12 | 2006-10-12 | 再吸収可能な角膜ボタン(resorbablecorneabutton) |
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US (1) | US20090222086A1 (ja) |
EP (1) | EP1945759A1 (ja) |
JP (1) | JP5015160B2 (ja) |
KR (1) | KR20080070820A (ja) |
CN (1) | CN101384704B (ja) |
CA (1) | CA2625848A1 (ja) |
WO (1) | WO2007047425A1 (ja) |
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-
2006
- 2006-10-12 US US12/083,360 patent/US20090222086A1/en not_active Abandoned
- 2006-10-12 WO PCT/US2006/040053 patent/WO2007047425A1/en active Application Filing
- 2006-10-12 KR KR1020087011316A patent/KR20080070820A/ko not_active Application Discontinuation
- 2006-10-12 CA CA002625848A patent/CA2625848A1/en not_active Abandoned
- 2006-10-12 CN CN200680046714XA patent/CN101384704B/zh not_active Expired - Fee Related
- 2006-10-12 JP JP2008535703A patent/JP5015160B2/ja not_active Expired - Fee Related
- 2006-10-12 EP EP06825895A patent/EP1945759A1/en not_active Withdrawn
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US20090222086A1 (en) | 2009-09-03 |
CN101384704B (zh) | 2012-02-08 |
CN101384704A (zh) | 2009-03-11 |
EP1945759A1 (en) | 2008-07-23 |
CA2625848A1 (en) | 2007-04-26 |
WO2007047425A1 (en) | 2007-04-26 |
KR20080070820A (ko) | 2008-07-31 |
JP2009511197A (ja) | 2009-03-19 |
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