NZ615820B2 - Rolled collagen carrier - Google Patents
Rolled collagen carrier Download PDFInfo
- Publication number
- NZ615820B2 NZ615820B2 NZ615820A NZ61582012A NZ615820B2 NZ 615820 B2 NZ615820 B2 NZ 615820B2 NZ 615820 A NZ615820 A NZ 615820A NZ 61582012 A NZ61582012 A NZ 61582012A NZ 615820 B2 NZ615820 B2 NZ 615820B2
- Authority
- NZ
- New Zealand
- Prior art keywords
- collagen carrier
- collagen
- carrier
- coiled
- rolled
- Prior art date
Links
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61F13/00—Bandages or dressings; Absorbent pads
- A61F13/02—Adhesive plasters or dressings
- A61F13/0276—Apparatus or processes for manufacturing adhesive dressings or bandages
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K38/00—Medicinal preparations containing peptides
- A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
- A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
- A61K38/36—Blood coagulation or fibrinolysis factors
- A61K38/363—Fibrinogen
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K38/00—Medicinal preparations containing peptides
- A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
- A61K38/43—Enzymes; Proenzymes; Derivatives thereof
- A61K38/46—Hydrolases (3)
- A61K38/48—Hydrolases (3) acting on peptide bonds (3.4)
- A61K38/482—Serine endopeptidases (3.4.21)
- A61K38/4833—Thrombin (3.4.21.5)
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
- A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
- A61K47/42—Proteins; Polypeptides; Degradation products thereof; Derivatives thereof, e.g. albumin, gelatin or zein
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/70—Web, sheet or filament bases ; Films; Fibres of the matrix type containing drug
- A61K9/7007—Drug-containing films, membranes or sheets
-
- 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
- A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
- A61L24/04—Surgical adhesives or cements; Adhesives for colostomy devices containing macromolecular materials
- A61L24/043—Mixtures of macromolecular materials
-
- 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
- A61L31/04—Macromolecular materials
- A61L31/041—Mixtures of macromolecular compounds
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P7/00—Drugs for disorders of the blood or the extracellular fluid
- A61P7/04—Antihaemorrhagics; Procoagulants; Haemostatic agents; Antifibrinolytic agents
Abstract
process for coiling a collagen carrier, the collagen carrier comprising (i) a collagen layer and (ii) a coating layer comprising fibrinogen and thrombin, said process comprising the sequential steps of: (a)?humidifying at least part of said collagen carrier, (b)?coiling said collagen carrier by gripping the collagen carrier between a pair of elongated members, and rotating the pair of elongated members about an axis being parallel to a longitudinal extension of the elongated members in order to coil the collagen carrier on the members, while the collagen carrier is supported by a support device and (c) drying the coiled collagen carrier, thereby providing a form-stable coiled collagen carrier. There may be a solvent and it may be ethanol. The disclosure also relates to the coiled collagen carrier product and the use of it in the treatment of a human or animal tissue, for example in surgical adhesions. ipping the collagen carrier between a pair of elongated members, and rotating the pair of elongated members about an axis being parallel to a longitudinal extension of the elongated members in order to coil the collagen carrier on the members, while the collagen carrier is supported by a support device and (c) drying the coiled collagen carrier, thereby providing a form-stable coiled collagen carrier. There may be a solvent and it may be ethanol. The disclosure also relates to the coiled collagen carrier product and the use of it in the treatment of a human or animal tissue, for example in surgical adhesions.
Description
ROLLED EN R
Technical field of the invention
One aspect of the present ion relates to a process for coiling a collagen
carrier. Another aspect of the present invention relates to a form-stable coiled
collagen carrier. The present invention further relates to a method for delivering
the coiled collagen carrier to a target location, and to methods of treatment or
surgery using the coiled collagen r, such as a method for ming
minimally invasive surgery. The present invention also relates to a coiled collagen
carrier for use in therapy and/or a method of surgery, such as a method for
performing lly invasive surgery. A further aspect of the present invention
relates to an apparatus for ing a coiled collagen carrier.
The present invention also relates to a process for the preparation of a rolled
collagen carrier, or a compressed collagen carrier or a rolled compressed collagen
In addition, the t invention relates to a rolled compressed collagen carrier,
said rolled compressed collagen carrier being obtainable by said process.
Further, the present invention relates to a process of un-rolling a rolled collagen
carrier, or a rolled compressed collagen carrier. Further, the present invention
relates to an unrolled rolled ssed collagen r, said rolled/unrolled
compressed collagen carrier being obtainable by said process.
In r embodiment the present invention relates to a rolled collagen carrier or
a compressed en carrier or a rolled compressed collagen carrier. In yet
another embodiment the present ion relates to an unrolled rolled collagen
carrier or an unrolled rolled compressed collagen carrier. Further, the present
invention relates to an unrolled rolled compressed collagen carrier, said unrolled
rolled compressed collagen carrier being able by said process.
In another embodiment the invention relates to a rolled compressed collagen
carrier for use in minimally invasive surgery.
WO 59635
In particular, the present invention relates to a rolled compressed collagen carrier
for use in the prevention and/or treatment of injury to tissues and organs during
open and especially minimally invasive y.
ound of the invention
Medicated sponges are used during open surgery to stop local bleeding
(hemostasis/haemostasis). They react upon contact with blood, other body fluids
or saline to form a clot that glues the sponge to the tissue surface and hemostasis
is reached in a few minutes. Medicated sponges are sponges, such as a collagen
r as defined below, such as a cellulose sponge as disclosed in EP2052746.
Collagen has been used as a tatic agent for decades. A product that
combines the haemostatic features of fibrin glue with the asset of collagen as a
carrier has been developed and manufactured under the trademark TachoSil®.
TachoSil® is a to-use collagen carrier with a coating of the active
components of fibrin glue: human fibrinogen and human thrombin. The product is
described in WC 02/058 749, WO 02/070 594 and WO 02/058 750.
TachoSil® contains fibrinogen and in as a dried coating on the e of a
collagen sponge. In contact with body fluids, e.g. blood, lymph or physiological
saline solution the ents of the coating dissolve and partly diffuse into the
wound surface. This is followed by the fibrinogen-thrombin reaction which initiates
the last phase of physiological blood coagulation. Fibrinogen is converted into
fibrin monomers which spontaneously polymerise to a fibrin clot, which holds the
collagen sponge tightly to the wound surface.
TachoSil® has been sold since 2004 by Nycomed and is used in open surgery for
asis and sealing. Traditional open surgery usually requires a long incision
of the skin.
Contrary to open surgery, a minimally invasive procedure is any procedure
cal or otherwise) that is less invasive than open surgery used for the same
purpose. Minimally invasive surgery (MIS) procedures are performed through one
or more access orifices e.g. short incisions ('keyhole surgery') or through natural
body openings. Hence, MIS procedures require specially designed al
instruments which are placed through these access orifices. In abdominal surgery,
the access of the instruments is usually done through so-called trocars, which are
mostly rigid tubes with a typical inner diameter of 5 to 12 mm. The small size of
the access es used in M15 cts what can be inserted into the orifices.
Therefore, all surgical tools and materials used in M15 procedures must be of a
size and condition that allow for their ion through the access orifices and
they need, of course, as all medical tools to be sterile. Hence, tools and materials
are most often lly designed for use in M15.
WO 83 (Nycomed Arzneimittel GmbH) discloses a surgical instrument
comprising an applicating member, wherein the applicating member comprises a
rodshaped n so as to allow a sheet of surgical material such as, e.g.
TachoComb® (coated equine collagen sponge/Nycomed) to be rolled up to form a
carpetlike roll of surgical material on the rod-shaped portion of the applicating
member. However, this manual instrument for hand-rolling surgical materials,
such as collagen carriers, has several disadvantages as described below. WO
02/058749 discloses the non-sterile insertion of TachoComb® into an endoscopic
equipment, wherein the sample is flattened manually to be able to wrap it
manually around a guiding “pin”. WO 02/058749 teaches that the collagen
product "has to stay flexible enough in dry condition to be bent and rolled up"
(p29, lines 19-20). Thus WO 02/058749 only relates to manual (i.e. hand-rolled),
non-sterile rolling of TachoComb® and further teaches that the rolling process
must be "dry". One significant problem with the above methods which use an
ating member or guiding pin for oiling the collagen carrier arises in
case application of multiple rolled/coiled collagen carriers is necessary in quick
succession (e.g. either e one collagen carrier is insufficient to completely
stop the bleeding, or due to an error in application of the first en carrier(s)).
In this instance the same ating member cannot be used to apply the second
collagen carrier: instead, multiple applicating members must be prepared. This is
because in order to apply collagen-based products such as the TachoComb®
product correctly, the applicating member must be completely dry in order to
avoid activating the adhesive properties of the en carrier. If the collagen
carrier s prematurely wet by contacting a wet application member or
g pin, the carrier will stick to the applicating /guiding pin and/or
become an unusable sticky lump of material. Another way of rolling up en-
based surgical sheets is for the surgeon to use his/her hands in the same way as
for rolling up a cigarette, however for this and all the manually-rolled cases above
the rolled surgical product is not table and is therefore more difficult to
manipulate in a lled manner after insertion into the body: the non-form-
stable product may "spring open" in an uncontrolled way during the unrolling
process and adhere incorrectly. This is a particular issue for MIS surgery, where it
is harder to manipulate the product once it is in the body as one only has indirect
access to the surgical sheet via opic surgical instruments. One way of
lessening the effect of the rolled collagen-based surgical product being non-form-
stable is to tie the rolled t together with a suture, however this solution is
only relevant where the coiled carrier in not unrolled in vivo but rather maintained
in the patient in a coiled state (e.g. in a partial ctomy procedure).
For applications such as MIS there is thus a need to produce an improved coiled
collagen-based surgical product, which has dimensions useful for MIS applications
and useful properties for promoting coagulation and wound sealing, but which
allows easy application of more than one collagen carrier in quick succession and
furthermore gives the surgeon improved control of the x process of moving
the carrier to the desired tissue site and applying it.
A further problem with all the above types of manual coiling processes for
collagen carriers is that the results are of course highly dependent on the skills of
the dual medical practitioner carrying out the coiling process, and therefore
highly variable in reproducibility, and may lead to a non-sterile product, un-even
and thus un-reproducible coiling/rolling of the collagen carrier, and un-predictable
loss of coating.
Thus, there exists a need in the art for a collagen carrier coated with human
fibrinogen and human thrombin especially designed for use in minimally invasive
surgery that is ready-to-use, maintains sterility, and which has an acceptable
hemostatic and tissue sealing iveness and adhesive strength to living tissue,
and also which allows easy application of more than one collagen carrier in quick
succession for MIS ques, and also allows the surgeon more control on
application to the desired tissue during an M15 procedure in order to avoid
adhesion of the collagen carrier to an incorrect site, would be advantageous.
Hence, a ready-to-use collagen carrier coated with human fibrinogen and human
thrombin designed particularly for use in MIS, such as designed to fit an access
tube and/or orifice in MIS, preferably such as to be inserted into endoscopic
devices would be advantageous, and in particular a ready-to-use collagen carrier
coated with human fibrinogen and human thrombin having an acceptable
hemostatic effectiveness, ve strength to living tissue and sterility that is
to-use in MIS, allows easy application of more than one collagen carrier in
quick succession for MIS techniques, and also allows the surgeon more control on
application to the desired tissue during an M15 procedure in order to avoid
adhesion of the collagen carrier at the incorrect site, would be advantageous.
Summary of the invention
It is an object of the present invention to provide a ready-to-use collagen carrier
coated with human fibrinogen and human thrombin designed e.g. for use in
minimally invasive surgery, such as designed preferably to be inserted into
opic s, that solves the above mentioned problems.
One aspect of the present ion relates to a process for coiling a en
carrier, the collagen carrier comprising (i) a collagen layer and (ii) a coating layer
comprising fibrinogen and thrombin, said process comprising the sequential steps
. humidifying at least part of said collagen carrier,
. coiling said collagen carrier by gripping the collagen carrier between a pair of
elongate members, and rotating the pair of elongate members about an axis
being el to a longitudinal extension of the ted members in order to
coil the en carrier on the members, while the collagen carrier is
supported by a support device,
. drying the coiled en carrier,
thereby providing a table coiled en carrier.
One embodiment of the present invention relates to a process for coiling a
collagen carrier, the collagen carrier comprising (i) a collagen layer and (ii) a
g layer comprising mostly solid ogen and mostly solid thrombin, said
process comprising the sequential steps of:
. humidifying at least part of said collagen carrier,
. coiling said collagen carrier by gripping the collagen carrier between a pair of
elongate members, and ng the pair of elongate members about an axis
being parallel to a longitudinal extension of the elongated members in order to
coil the collagen carrier on the members, while the en carrier is
supported by a support device,
. drying the coiled collagen carrier,
thereby providing a form-stable coiled collagen r.
The present invention further relates to a coiled collagen r obtainable by - or
atively obtained by - the process of the present invention.
A further aspect of the present invention relates to a coiled collagen r
- comprising a collagen layer and a g layer on top of the collagen layer,
the coating layer comprising thrombin and fibrinogen, and
- having the shape of an elongate element with a number of windings of the
collagen carrier about the longitudinal axis of the elongate element and at
least the outer winding(s) being orientated so that the coating layer
constitutes the outer surface of each of said outer winding(s),
wherein
- the coiled collagen carrier is form-stable and defines a en carrier in a
coiled configuration where said outer winding(s) d along a spiral in a
cross section of the collagen carrier.
The present invention further relates to a method for delivering the coiled collagen
carrier of the present invention to a target location, sing the step of passing
said coiled collagen carrier through an orifice or access tube to the target location.
The present invention further relates to the use of the coiled collagen carrier
according to the present invention in therapy and/or a method of surgery.
A further aspect of the present invention is an apparatus for providing a coiled
collagen carrier, the tus comprising
a device for applying moisture to a collagen carrier prior to coiling of the
collagen carrier,
a coiling device comprising
rotatable gripping means for gripping the collagen carrier along an
edge and coiling the collagen carrier, and
a support device supporting the collagen carrier while being .
Another aspect of the invention relates to a process for the preparation of a rolled
compressed en carrier comprising the steps of
a) ing a collagen r having a coating comprising solid ogen
and solid thrombin evenly distributed and fixed upon said collagen
carrier
b) optionally humidifying at least part of said collagen r providing an
optionally fied collagen carrier,
C) compressing said optionally humidified collagen carrier providing a
compressed collagen carrier,
d) g said compressed collagen r,
e) obtaining a rolled compressed collagen carrier,
f) optionally drying the rolled compressed collagen carrier of step e),
9) optionally sterilizing the rolled compressed collagen carrier of step e) or
h) optionally packing the rolled compressed collagen carrier of step e), f)
or g) into a suitable container,
and thereby obtaining a rolled compressed collagen carrier having at least
one of the following physical ties:
a diameter of at the most 10 mm
II. an adhesive strength of at least 30 mm Hg, such as at least 35 mmHg,
such as preferably 40 mmHg as measured by a re test (PCT)
after un-rolling of said rolled compressed collagen carrier, and
III. a sterility assurance level (SAL) of 106.
Another aspect of the present invention relates to a process for the preparation of
a compressed collagen carrier, comprising the steps of
providing a collagen carrier having a coating sing solid fibrinogen
and solid in evenly buted and fixed upon said collagen
carrier
optionally humidifying at least part of said collagen r providing an
optionally humidified collagen carrier,
compressing said ally humidified collagen carrier providing a
compressed collagen carrier
. optionally drying said compressed collagen carrier of step c),
optionally sterilizing said compressed collagen carrier of step c) or d),
packing said compressed collagen carrier of step c), d) or e) into a
suitable ner,
and thereby obtaining a compressed collagen carrier having at least one of
the following physical properties:
I. a thickness of at the most 4 mm
II. an adhesive strength of at least at least 30 mm Hg, such as at least 35
mmHg, such as preferably 40 mmHg as measured by a pressure test
(PCT)
III. a sterility assurance |eve| (SAL) of 106.
Yet another aspect of the present invention is to provide a process for the
preparation of a rolled collagen carrier comprising the steps of
a. providing a collagen carrier having a coating comprising solid fibrinogen
and solid thrombin evenly distributed and fixed upon said collagen
carrier
optionally humidifying at least part of said collagen carrier ing an
optionally humidified collagen carrier,
rhmap rolling said collagen carrier providing a rolled collagen carrier,
optionally drying the rolled collagen carrier of step c),
optionally sterilizing the rolled en carrier of step c) or d),
ally packing the rolled collagen carrier of step c), d) or e) into a
suitable container,
and thereby obtaining a rolled en carrier having at least one of the
ing physical properties:
I. a diameter of at the most 10 mm
II. an adhesive strength of at least at least 30 mm Hg, such as at least 35
mmHg, such as preferably 40 mmHg as measured by a pressure test
(PCT) after un-rolling of said rolled collagen carrier, and
III. a sterility assurance level (SAL) of 106.
Still another aspect of the present invention is to provide a process of un-rolling a
rolled ssed collagen carrier, comprising the steps of
a) providing a rolled compressed collagen carrier prepared according to the
invention,
b) un-packing said rolled compressed collagen carrier from said suitable
container,
c) g said rolled compressed collagen carrier through an access
orifice, such as a ,
d) un-rolling said rolled compressed collagen r upon exit from said
access orifice,
e) obtaining an unrolled rolled compressed en carrier having an
adhesive strength of at least 40 mmHg as measured by a re test
(PCT), and a sterility assurance |eve| (SAL) of 106.
Another aspect of the present invention is to provide a s of un-rolling a
rolled collagen carrier, comprising the steps of:
a) providing a rolled collagen carrier prepared according to the invention,
b) un-packing said rolled collagen carrier from said suitable container,
c) passing said rolled collagen carrier through an access orifice, such as a
trocar
d) un-rolling said rolled collagen carrier upon exit from said access orifice,
e) ing an unrolled rolled collagen carrier having an adhesive strength
of at least 40 mmHg as measured by a re test (PCT), and a
sterility assurance |eve| (SAL) of 106.
A further aspect of the present invention is to e a rolled compressed
collagen carrier prepared according to the process of the invention, said rolled
compressed collagen r having a coating comprising solid fibrinogen and solid
thrombin that is evenly distributed and fixed upon said collagen carrier, and
having at least one of the following physical properties:
WO 59635
I. a diameter of at the most 10 mm
II. an adhesive strength of at least 40 mmHg as measured upon un-
rolling by a pressure test (PCT)
III. a sterility assurance level (SAL) of 106.
Another aspect of the present invention is to provide a rolled compressed collagen
carrier obtainable by a s comprising the steps of
a. ing a collagen carrier having a g comprising solid ogen
and solid thrombin that is evenly distributed and fixed upon said
en carrier,
b. optionally humidifying at least part of said collagen carrier providing an
optionally humidified collagen carrier,
c. compressing said optionally humidified collagen carrier providing a
compressed collagen carrier,
d. g said compressed collagen carrier,
e. ing a rolled compressed collagen carrier
f. optionally drying the rolled compressed collagen carrier of step e),
g. optionally sterilizing said rolled compressed collagen carrier of step e) or
h. optionally packing said rolled compressed collagen carrier of step e), f)
or g) into a le container
and thereby obtaining a rolled compressed en having at least one of
the following physical properties:
I. a diameter of at the most 10 mm
II. an adhesive strength of at least 40 mmHg as measured by a
pressure test (PCT) after un-rolling of said collagen carrier
III. a sterility assurance level (SAL) of 106.
Still another aspect of the invention relates to an unrolled rolled compressed
collagen carrier according the invention having at least one of the following
physical properties:
I. a thickness of at the most 4 mm
II. an adhesive strength of at least 40 mmHg as measured by a
pressure test (PCT)
III. a sterility assurance |eve| (SAL) of 10'6
IV. said rolled compressed collagen carrier is capable of adhering to the
tissue while being unrolled without recoiling.
Yet another aspect of the invention relates to an ed rolled compressed
collagen carrier according to the invention having a coating comprising solid
ogen and solid thrombin evenly distributed and fixed upon said collagen
carrier, and having at least one of the following physical properties:
I. a thickness of at the most 4 mm
II. an adhesive strength of at least 40 mmHg as ed by PCT
chamber
III. a sterility assurance |eve| (SAL) of 10'6
IV. said rolled compressed collagen carrier is capable of ng to the
tissue while being unrolled without recoiling
r aspect of the invention s to a compressed collagen carrier according
to the ion having a coating comprising solid fibrinogen and solid thrombin
that is evenly distributed and fixed upon said collagen carrier, and having at least
one of the following physical properties:
I. a thickness of at the most 4 mm
II. an ve strength of at least 40 mmHg as measured by a
pressure test (PCT)
III. a sterility assurance level (SAL) of 106.
Another aspect of the invention relates to a rolled collagen carrier according to the
ion having a coating comprising solid fibrinogen and solid thrombin that is
evenly distributed and fixed upon said collagen carrier, and having at least one of
the ing physical properties:
I. a diameter of at the most 10 mm
II. an adhesive strength of at least 40 mmHg as measured by a
pressure test (PCT) after un-rolling of said collagen carrier
III. a sterility assurance level (SAL) of 106.
Still another aspect of the invention relates to a rolled compressed collagen carrier
according to the invention for use in tissue sealing, tissue gluing and haemostasis.
Yet another aspect of the ion relates to a rolled compressed collagen carrier
according the invention for use in lly invasive y.
Another aspect of the invention relates to a rolled compressed collagen carrier
according to the invention for use in endoscopic surgery.
A further another aspect of the invention relates to an unrolled rolled compressed
collagen carrier ing to the invention for use in tissue sealing, tissue gluing
and haemostasis.
Another aspect of the invention relates to an unrolled rolled compressed collagen
carrier according to the invention for use in lly invasive surgery.
An aspect of the invention relates to an unrolled rolled compressed collagen
carrier according the invention for use in endoscopic surgery.
Still another aspect of the invention relates to an unrolled at least partly
mechanically rolled compressed collagen carrier according to the invention for use
in tissue sealing, tissue gluing and haemostasis.
Yet another aspect of the ion s to an unrolled at least partly
mechanically rolled compressed collagen carrier according to the invention for use
in minimally invasive y.
An aspect of the invention relates to an unrolled at least partly mechanically rolled
ssed collagen carrier according to the invention for use in endoscopic
surgery.
Another aspect of the invention relates to a rolled compressed collagen carrier
ing to the invention for use in the prevention or treatment of tissue in need
of sealing and/or gluing.
An aspect of the invention relates to a rolled compressed en carrier
according to the invention for use in the prevention or treatment of bleeding in
tissue in need of haemostasis.
A further aspect of the invention relates to a rolled compressed collagen carrier
according to the invention for use in the prevention or ent of injury
associated with performing minimally invasive surgery.
Still another aspect of the invention relates to a rolled compressed collagen carrier
according to the invention for use in the prevention or treatment of injury
associated with performing endoscopic treatment, scopy treatment, or
thoracoscopy treatment.
Still further aspects of the present invention relates to a process for coiling a
en carrier, the collagen carrier comprising (i) a collagen layer and (ii) a
coating layer ably comprising fibrinogen and in, said process
comprising the sequential steps of:
. humidifying at least part of said collagen carrier,
. coiling said en r
. drying the coiled collagen carrier,
thereby providing a form-stable coi|ed collagen carrier.
Brief ption of the figures
Figure 1 shows adherence of a collagen carrier (in uncoi|ed state) of the present
invention on a piece of liver tissue (see description in Example 2).
Figure 2 shows the appearance of prerolled collagen carriers (in uncoi|ed state)
applied in vivo in a pig liver, 7 days after y (see description in Example 7).
Figure 3 shows pre-rolled collagen carriers according to the invention in a trocar
besides a tape measure (upper picture). The lower picture shows the length and
width of pre-rolled collagen carriers according to the invention. The fleeces are
midi sized (batch 10419312 and 10431721).
Figure 4 shows PCT g chambers and a blood pressure apparatus.
Figure 5 shows a TachoSil® that has g open” from the coiled configuration
after having been rolled using an applicating member (shown in the left side of
the figure) as disclosed in WO 97/21383. The coiled TachoSil® that has “sprung
open” from the coiled configuration is shown in the right side of the . Pieces
of coating that have fallen of the coiled TachoSil® are visible in the figure.
Figure 6 shows il® (collagen carriers with a weight of about 1000 mg) that
have been coiled directly i.e. without being previously humidified and compressed.
Note the cracked surface of the coating. By the “weight” of the collagen carriers is
meant the weight of the collagen carrier excluding the weight of the coating layer.
Figure 7 shows an example of how a coiled collagen carrier is applied inside e.g. a
cavity or hole in an organ or tissue, such as in lung surgery. An application
member is shown in the upper right part of the figure.
Figure 8 shows an un-rolled coiled collagen carrier onto a target location in an
organ or tissue, such as in lung surgery. The un-rolled collagen carrier is abutted
and maintained to the target location using forceps. An ation member is
shown to the left in the picture.
Figure 9 shows the moistening of a coiled en carrier (in an uncoiled state)
applied inside e.g. a cavity or hole in an organ or tissue, such as in lung surgery.
The moistening is performed using e.g. saline on, and/or the application of
pressure on the collagen carrier using saline-moistened swabs or wipes. Figure 9
shows a wipe moistened with saline held by forceps, used for moulding the
TachoSil® t onto the application site, and a swab moistened with saline is
used in cases where a wipe is insufficient and additional g and compression
is required.
Figure 10 shows a coiled collagen carrier (in an uncoiled state) applied inside e.g.
a cavity or hole in an organ or , such as in lung surgery being un-packed
from a sterile plastic bag with a minimal amount of air inside using two sets of
forceps.
Figure 11 discloses schematically a preferred embodiment of an apparatus for
providing coiled collagen carrier according to the t invention.
In the figures, same es are labeled with cal numerals — refer e.g. to
the detailed description of figure 11 for the numerals.
The present invention will now be described in more detail in the ing.
Detailed description of the invention
Definitions
Prior to discussing the present invention in further details, the following terms and
tions will first be defined:
The term gen carrier” is in the present context any suitable carrier
comprising collagen that can have a coating layer that comprises/consist of a
collagen layer and/or a coating layer. The collagen r can in one embodiment
be rolled or coiled (the words "rolled" and "coiled" are used interchangeably
herein). The collagen r can in another embodiment be in an unrolled or
uncoiled state after coiling, i.e. as an unrolled or uncoiled collagen carrier (the
terms "unroll" or "uncoil" are used interchangeably herein). The coiled collagen
carrier of the present ion can in one embodiment be a compressed, coiled
collagen carrier, or in another embodiment an unrolled version of a compressed,
coiled collagen carrier. ably, the en carrier is a collagen sponge
comprising or consisting essentially of collagen type I fibres and a coating.
Although the carrier material is preferably a collagen sponge which ses
collagen type I material from mammalian, transgenic or recombinant sources, it
can also comprise another type of collagen, for example one or more of collagen
type I, II, III, IV, VII and/or X. Preferably the collagen carrier, such as a collagen
, is coated with the human coagulation factors fibrinogen and thrombin and
optionally also riboflavin (a yellow colouring agent used to aid in identifying the
active side of the collagen carrier). Thus in one embodiment of the t
invention, the collagen carrier is a collagen sponge consisting essentially of
collagen type I fibres and a coating of fibrinogen, thrombin and riboflavin.
Fibrinogen and thrombin can for example be human fibrinogen and thrombin, and
can be purified from a natural source, or can alternatively be e.g. transgenic or
recombinant human fibrinogen and thrombin, or can be manufactured by other
methods such as e.g. chemical sis. ogen and thrombin are preferably
solid or mostly solid and in one embodiment can be human of origin. In another
embodiment, at least one and more preferably both of the components fibrinogen
and thrombin have the human amino acid sequence and can be produced by
recombinant technology, ion bodies or chemical synthesis. The thrombin and
fibrinogen are in one embodiment dry, such as containing less than 5% water,
such as less than 4% water, such as less than 3% water, such as less than 2%
water, such as less than 1% water, such as less than 0.8% water, such as less
than 0.6% water, such as less than 0.4% water, such as less than 0.2% water,
such as less than 0.1% water.
In one embodiment of the present invention, the collagen carrier ses or
consists of (i) a collagen layer and (ii) a coating layer sing fibrinogen and
optionally a colouring agent such as e.g. riboflavin. The collagen carrier may in an
embodiment r comprise other peptides, such as other peptides capable of
causing haemostasis.
In one embodiment of the present invention, the expressions collagen sponge,
collagen fleece, collagen patch or simply fleece or patch are terms that are used
synonymously to mean a collagen carrier. A carrier may alternatively to collagen
comprise a biodegradable co-polymer or a polymer such as a polyhyaluronic acid,
polyhydroxy acid, e. g. lactic acid, glucolic acid, hydroxybutanoic acid, a ose,
or gelatine. Another alternative carrier may be po|yg|actin 910, Le. a synthetic,
adsorbable copolymer of 90% ide (CZHZOZ) and 10% lactide (C6H804); such
as e.g. with molecular formula (C2H202)m and (CgH4OZ)n. A further alternative carrier
may be equine collagen, such as e.g. native equine collagen extracted from
sinews.
Thus, the collagen part of the collagen carrier can in one embodiment of the
present invention be substituted with a non-collagen matrix that is coated in the
same way as for the en carrier as described herein, i.e. in one ment
of the present invention is provided a carrier comprising or consisting of a non-
collagen matrix coated with a coating comprising or consisting of fibrinogen and
thrombin. One example of a suitable non-collagen matrix is a ose . In
one embodiment of the present invention, the non-collagen matrix is an oxidized
regenerated cellulose fabric sheet ed to a non-woven po|yg|actin 910 felt.
However, it is ably a en carrier preferably having a shape suitable for
a medicated . In an embodiment of the invention, the collagen carrier
which is to undergo the g process of the present invention is identical to
Tachosil® or TachoComb® available from Nycomed, such as described in WC
02/058 749, WO 02/070 594 and WO 02/058 750.
A preferred collagen layer is preferably used to mean a collagen sponge ed
by the method according to the invention as disclosed in WC 02/070594. The
collagen layer used in the t invention preferably ls at least one, such as
at least two or at least three, of the following criteria:
- pH-value between 5.0 and 6.0,
- lactic acid content at the most 5%,
- ammonium content at the most 0.5%,
- soluble protein content, calculated as albumin content, at the most 0.5%,
- sulphate ashes content at the most 1.0%,
- heavy metal content at the most 20 ppm,
- microbiological purity, at the most 103 CFU/g,
- collagen content of 75% to 100%,
- density of 1-10 mg/cm3, such as 2-7 mg/cm3,
- elasticity module of 5-100 N/cmz, such as 10-50 N/cmz, and wherein when
isolating parts of the sponge, the sponge will have the following properties:
- elasticity module in the range of 5 to 100 N/cmz,
- density in the range of 1 to 10 ,
- chamber diameter of more than 0.75 mm and less than 4 mm, or a chamber
diameter average of at most 3 mm.
Please note that the y of a collagen carrier is the density of the collagen
carrier excluding the coating layer.
Preferably the collagen layer fulfills at least the following:
- pH-value between 5.0 and 6.0,
- lactic acid content at the most 5%,
- ammonium content at the most 0.5%,
- soluble protein content, calculated as albumin content, at the most 0.5%,
- sulphate ashes content at the most 1.0%,
- heavy metal content at the most 20 ppm,
- microbiological purity, at the most 103 CFU/g,
- collagen content of 75% to 100%,
- density of 1-10 , such as 2-7 mg/cm3.
Further, the collagen layer is air and liquid tight in the sense that, once the
collagen sponge is applied to a wound, it will not allow air or liquid to pass
through the collagen layer. Liquids are absorbed in the layer. This effect is
primarily achieved due to the fact the collagen layer has a three-dimensional
ure with stacked chambers separated and substantially totally enclosed by
walls of collagen al, in contradiction to known collagen sponges which have
a fibre structure.
In the present context, the term "chamber diameter" should be understood as the
largest ht-line wall-to-wall distance in a chamber, i. e. as the t
diagonal straight-line distance of a r. The chambers may be of a polygonal
shape, such as of an octagonal shape. Thus, when the carrier is cut, the chambers
are divided and cut to caverns.
It has been found that a chamber diameter of more than 0.75 mm and less than 4
mm, or a chamber diameter average of at most 3 mm, renders the collagen
sponge ularly useful for being coated with a fibrin glue preparation. When
the r is cut, the chambers are divided and cut to caverns. The preferably
solid fibrinogen and the preferably solid thrombin is fixed to the collagen layer and
most of it is present in the caverns thus providing a substantially even distribution
of the preferably solid thrombin and preferably solid fibrinogen. Due to this and
the fixation, it is possible to introduce substantial amounts of fibrinogen and
thrombin on the carrier in contrast to the situation where liquid compositions of
thrombin and fibrinogen are e. g. dropped or sprayed onto the material.
Each coated collagen carrier as well as the uncoated collagen layer is inspected
visually for the “pore size distribution” — no pores wider than 4 mm and deeper
than 2 mm are allowed. These sizes are measured with a ruler if necessary.
By fixation of the coating layer to the collagen layer is preferably meant that the
coating layer adheres through mechanical ctions i.e. by ion onto the
collagen carrier pore e and within the coating layer.
In a preferred embodiment of the present invention, the amount of fibrinogen and
thrombin/cm2 in the coating layer can be:
. Thrombin 1.3-2.7 IU/cm2 and/or
. Fibrinogen 3.6-7.4 mg/ cm2
In an ment, the above mentioned amounts of fibrinogen and in/cm2
are identical to Tachosil® or TachoComb® available from Nycomed, such as
described in WC 02/058 749, WO 02/070 594 and WO 02/058 750.
By substantially even distribution of the solid thrombin and solid fibrinogen is
meant that the coating layer is substantially evenly distributed across the collagen
layer meaning that local changes in thickness of the coating layer is observed
visually by SEM cross sections i.e. the coating layer may be located on the surface
and sometimes at a lower level in an open cell. There should not be any through-
going cracks (fissures) on the coating layer.
In an embodiment a collagen carrier according to the present invention may have
a size of 92-98 mm * 46-50 mm * 4-7 mm and this carrier is called a large size
collagen r and has the shape of a box of rectangular cross-section with all
sides flat. Hence, the area of the largest rectangular cross-section is about 42.3 —
49.0 cm2. In another embodiment a midi size collagen carrier according to the
present invention is 46-49 mm * 46-50 mm * 4-7 mm, and has the shape of a
square box of quadrant cross-section. Hence, the area of the quadrant cross-
section is about 21.2 - 24.5 cm2. A midi size collagen carrier according to the
invention is preferred. In yet another embodiment a mini size collagen r
according to the ion is 28-33 mm * 23-27 mm * 4-7 mm, and has the
shape of a box of gular cross-section with all sides flat. Hence, the area of
the largest rectangular cross-section is about 6.4 — 8.9 cm2.
In an embodiment of the invention, a collagen r has at least one of the
following physical properties, such as at least two of the following physical
properties, such as at least three of the following physical properties, such as at
least four of the following physical properties: elasticity module in the range of 5-
2012/050178
100 N/cmz, density of 1-10 mg/cm3, chamber diameter of more than 0.75 mm
and less than 4 mm and/or having a chamber diameter average below 3 mm and
evenly buted and fixed upon said collagen carrier solid fibrinogen and solid
thrombin. Please note that the density of a collagen carrier is the density of the
collagen carrier excluding the coating layer.
According to the invention, a en carrier may become manipulated e.g. such
as by manual and/or mechanical manipulation (i.e. humidification, compression,
rolling, unrolling, and passage through an access orifice, such as a trocar)
resulting in various different manipulated collagen carriers such as:
1. A fied collagen carrier
2. A compressed collagen r, optionally a humidified ssed en
carrier
3. A rolled collagen carrier, optionally a humidified rolled collagen carrier
4. A rolled compressed collagen carrier, optionally a humidified rolled
compressed en carrier
. An at least partly mechanically humidified collagen carrier
6. An at least partly mechanically compressed collagen carrier, ally an
at least partly ically humidified compressed collagen carrier
7. An at least partly mechanically rolled collagen carrier, optionally an at least
partly mechanically humidified rolled collagen carrier
8. An at least partly mechanically rolled compressed collagen carrier,
optionally an at least partly mechanically humidified rolled compressed
collagen carrier
It should be noted that all aspects relating to collagen carriers as ned
above also apply to an at least partly mechanically prepared collagen carriers.
The term “mechanically” is meant to refer to any non-manual way of producing,
obtaining or providing a medicated sponge, such as a rolled and/or compressed
collagen carrier of the present invention by way of an at least semiautomatic
process, such as a fully automatic process.
“Mechanically stable” is meant to refer to “form-stable”.
Form-stable as used in form-stable coiled collagen carrier is preferably used to
mean a coiled collagen carrier which ins its geometrical shape without
being fixated by aining or constriction elements not forming part of the
collagen carrier. For example, a form-stable coiled collagen carrier may maintain
its geometrical shape because the coating layer and/or the collagen layer has no
tension acting to distort — such as uncoil — the coiled collagen carrier. A further
characteristic of table is that the coiled collagen carrier may be elastic
deformed and revert to the shape it had before being elastic deformed by the
ing the tension provided by the elastic deformation. A furthermore
characteristic of a form-stable coiled en r is that it is preferably
hardened in the coiled shape.
Solid as used e.g. solid fibrinogen and solid thrombin is used in a manner being
ordinary to the skilled person to mean a material in solid state. Most/y solid is
preferably used to that a minor fraction of the material in question may be in a
state being different from solid state (such as less than 5%, such as less than 3%,
preferably less than 1%, such as less than 0.5%). Alternatively, mostly solid is
preferably used to mean that the material in question may n , such as
less than 5% liquid, or less than 1% liquid.
The term “manual” is meant to refer to any manual way of producing, obtaining or
providing a carrier, such as medicated sponge or such as a rolled and/or
compressed collagen carrier of the present invention. Thus, by "manual" is meant
any way in which at least one step of the production method (for example, the
rolling step and/or the compression step) is carried out using at least one human
hand(s), for example rolling the collagen fleece round a "pin" by hand or
compressing the collagen fleece using hand power, for example compressing the
fleece directly by application of one or more human hands. In a preferred
embodiment of the present invention, at least the rolling step and/or the
compression step are not carried out manually, i.e. are not carried out by using
human ). Thus in a preferred embodiment of the present invention, the
collagen fleece is not rolled around an object (such as a pin) by hand and/or the
collagen fleece is not compressed by the application of at least one human hand.
The term “at least partly mechanically prepared/manipulated is meant to mean a
process wherein at least a part of a process step is performed mechanically e.g.
when a en carrier is compressed mechanically but the collagen carrier is
placed by hand into the compressing device such as through a set of rollers for
ro|ler compaction.
By the term “rolling” is meant any well known process for rolling an object i.e. by
hand, mechanically or by a combination thereof.
Coiling as used e.g. in coiling said collagen carrier is preferably used to mean the
process of winding the en carrier into an t preferably having spiral
shaped cross sections. The coiled collagen carrier may have an S-shaped core.
In one embodiment ing to the invention, when a collagen carrier is
mechanically , the process for rolling comprises the steps of gripping at least
one outer edge of a collagen carrier by using at least one gripping device, such as
tweezers, such as mechanical fingers, and coiling said at least one gripping device
around its centre axis and thereby also coiling said collagen carrier, and releasing
said mechanically rolled collagen carrier from said at least one ng device.
The process for rolling a collagen carrier ing to the invention also comprises
rolling preferably a compressed collagen carrier, such as an at least partly
ically compressed collagen r, such as a humidified collagen carrier,
such as a humidified compressed collagen carrier. Hence, the rolling can be
applied to any collagen carrier, such as a medicated sponge, which is used directly
t being previously exposed to one or more physical manipulations such as
e.g. humidification, compression, elevated room temperature and humidity or
gamma radiation. Preferably, the rolling process can be d to any collagen
carrier which has been previously exposed to one or more of said physical
manipulations. In the present context the words to roll, spool, rotate or spin are
used hangeably.
By the term “compressed collagen carrier” is preferably meant a compressed
collagen carrier, which has been subjected to an evenly distributed pressure (i.e.
ssion) to achieve the ing physical properties: a coating comprising
solid fibrinogen and solid thrombin that is evenly distributed and fixed upon said
collagen carrier, and having at least one of the following physical properties in the
unrolled state:
I. a thickness of at the most 4 mm
II. an adhesive strength of at least 40 mmHg as measured upon un-
rolling by a pressure test (PCT)
III. a ity assurance level (SAL) of 106.
In one embodiment of the present invention, said ssed collagen carrier has
optionally been humidified either before or optionally after the ssion step
to at least one side of said collagen carrier. Said compressed collagen carrier has
optionally been at least partly mechanically processed.
By the term “compressing” is meant the process for compressing an object such
as a collagen carrier and it refers in the present context to the process when the
collagen carrier when being compressed is subjected to an evenly distributed
pressure. The words ssion or compaction are used interchangeably.
Likewise, the expressions explaining that an object can be compressed, d or
compacted are used hangeably herein. The collagen carrier can e.g. become
compressed when it passes through a set of s using a certain gap size. The
collagen carrier being pressed is preferably a humidified collagen carrier or a non-
humidified collagen carrier. The use of a roller compactor is preferred (mechanical
compression). Hence, a compression can be made by any conventional manual or
mechanical way of compressing an object by subjecting it to an evenly distributed
pressure i.e. preferably by passing it h a set of rollers by roller compaction,
by placing the carrier between two sets of even/flat plates where the top plate is a
plunger, or rolling a cylindrical object over said carrier which is placed on a flat,
even bottom plate.
The expression “gap size” refers in the t context to the shortest distance
ed in mm between the rollers in a roller compactor. Preferably, the
ssion is performed by roller compaction using a gap size between the
rollers of no more than 0.30 mm, such as no more than 0.35 mm, such as no
more than 0.40 mm, such as no more than 0.45 mm, such as no more than 0.50
mm, such as no more than 0.55, such as no more than 0.60 mm, such as no
more than 0.65 mm, such as no more than 0.70 mm, such as preferably no more
than 0.75 mm, such as no more than 0.80 mm, such as no more than 0.85 mm,
such as no more than 0.90 mm, such as no more than 0.95 mm and such as no
more than 1.00 mm. Using a gap size between the s of about .75 mm
is preferred, such as about 0.45-0.70 mm, such as about 0.45-0.65 mm, such as
about 0.45-0.60 mm, such as about 0.45-0.55 mm, such as about 0.45-0.50 mm,
such as about 0.50-0.75 mm, such as about 055-075 mm, such as about 0.60-
0.75 mm, such as about 0.65-0.75 mm such as about 0.70-0.75 mm, such as
about 0.50-0.70 mm, such as about 0.50-0.65 mm, such as about 0.50-0.60 mm,
such as about 0.60-0.70 mm, such as about 0.60-0.65 mm. A gap size of about
0.40 mm results in a strong compression, whereas a gap size of about 0.75
mm results in a gentle compression.
ably, the rollers performing said ro||er compaction have a diameter of about
100 mm, such as about 80 mm, such as about 70 mm, such as about 38-62 mm,
such as about 43-57 mm, such as ably about 48-52 mm. Said rollers are
preferably made out of an ible and inert material which does not transfer
ro||er material to said compressed collagen rs upon compaction, i.e. the
surface of the rollers are important. In an embodiment, the rollers are polished.
In one embodiment, the term “rolled collagen carrier” ably is a rolled
collagen carrier characterized by the following physical properties: a coating
comprising solid fibrinogen and solid thrombin that is evenly distributed and fixed
upon said collagen carrier, and having at least one of the following physical
properties:
I. a diameter of at the most 10 mm
II. an adhesive strength of at least 40 mmHg as measured upon un-
rolling by a pressure test (PCT)
III. a sterility assurance level (SAL) of 106.
For example, the rolled collagen carrier can have a diameter of at the most 12
mm, such as at the most 11 mm, such as at the most 10 mm, for example at the
most 8 mm, such as at the most 6 mm, for example at the most 4 mm, together
with an adhesive strength of at least 30 mm Hg, such as at least 35 mmHg, such
as ably 40 mmHg as measured upon un-rolling by a pressure test (PCT),
and optionally a sterility assurance |eve| (SAL) of 106.
It should be noted that the rolled collagen carrier may optionally have been
humidified prior to ng rolled to at least one side of said collagen carrier
(i.e. the carrier has been rolled after being humidified on at least one side),
preferably to the front side comprising said coating resulting in a rolled collagen
carrier having the coating externally oriented. Said rolled collagen carrier has
optionally been at least partly ically processed, optionally also at least
partly ically humidified.
By the term “rolled compressed collagen carrier” is meant a rolled compressed
collagen carrier characterized by the following physical properties: a coating
comprising solid fibrinogen and solid thrombin that is evenly distributed and fixed
upon said collagen carrier, and having at least one of the ing al
properties:
I. a diameter of at the most 10 mm
II. an adhesive strength of at least 40 mmHg as measured upon un-
rol|ing by a pressure test (PCT)
III. a sterility assurance level (SAL) of 106.
It should be noted that said rolled compressed collagen carrier may optionally
have been humidified prior to becoming compressed and/or optionally at least
partly mechanically rolled.
Thus, an advantage of the invention is that said rolled ssed collagen carrier
is ready to use in minimally invasive surgery, such as ready to be inserted into
endoscopic devices.
By the term nically rolled compressed collagen carrier” is meant a collagen
carrier that has been ically compressed and thereafter mechanically rolled
and which is characterized by the following physical properties: a coating
comprising solid fibrinogen and solid thrombin that is evenly distributed and fixed
upon said mechanically rolled compressed en carrier, and having at least
one of the following physical properties:
I. a diameter of at the most 10 mm
II. an adhesive strength of at least 40 mmHg as measured upon un-
rolling by a pressure test (PCT)
III. a sterility assurance level (SAL) of 106.
Optionally, said mechanically rolled compressed collagen carrier has been
mechanically humidified during processing.
By the term “humidifying or humidification” is meant the process of
fying/moisturizing at least part of a collagen carrier with at least one liquid
solvent to preferably at least one side of said carrier which has at least one side
coated with a coating comprising biologically active substances. If more than one
side of the carrier is coated with a coating comprising ically active
substances, then the term may comprise humidifying such as at least two sides,
such as at least three sides, such as at least four sides, such as at least five sides,
such as all sides of said collagen carrier. The humidified side is preferably the side
comprising a coating, but it may also be a side that does not se a coating.
Humidifying as used in e.g. humidifying at least a part of said en carrier is
preferably also used to mean the step of applying a liquid substance to a collagen
carrier.
Thus, the term “humidified collagen carrier“ is meant to mean a collagen r
that has been exposed to at least one liquid solvent to preferably at least one side
of said carrier, such as at least two sides, such as at least three sides, such as at
least four sides, such as at least five sides, such as all sides, to achieve a
humidified collagen carrier.
In one embodiment of the t invention the collagen carrier is preferably
humidified on at least one side of said carrier (i.e. the front) which has at least
one side coated with a coating comprising biologically active substances before
being compressed and/or before being rolled. The words fied and
moisturized are used interchangeably. In another embodiment it is preferred to
humidify both the front and back of a collagen r of the t invention,
wherein the front ses said coating. Said humidified collagen carrier has
optionally been at least partly mechanically processed.
In an embodiment of the present ion said humidified collagen carrier has a
coating comprising solid fibrinogen and solid thrombin that is evenly distributed
and fixed upon said collagen carrier, and having at least one of the following
physical properties:
I. a diameter of at the most 10 mm
II. an adhesive strength of at least 40 mmHg as measured upon un-
rolling by a pressure test (PCT)
III. a sterility assurance level (SAL) of 106.
By the term “solvent” is meant any suitable solvent such as physiological ,
purified water, aqueous vapour or any suitable organic solvent such as ethanol,
ated ethanol with a maximum content of 0.1% water, isopropanol or
methanol. An alcohol is selected from the group consisting of ethanol, dehydrated
ethanol with a maximum t of 0.1% water, anol, 2-propanol, 2-
methylpropanol, ethylene , 1-butanol, 2-butanol or any combination
thereof. In an embodiment a solvent is selected from ethanol, ated ethanol
with a maximum content of 0.1% water, isopropanol, 1-propanol, 2-methyl
propanol, water or any combination thereof. In a further embodiment, a solvent is
selected from ethanol, ated ethanol with a maximum content of 0.1%
water, isopropanol, water or combinations thereof. In a embodiment the ethanol
is dehydrated ethanol with a maximum content of 0.1% water. In one
embodiment of the applied solvent, the amount of applied solvent is about 0.8-
.75 mg/cm2 collagen r, such as about .75 mg/cm2 collagen carrier,
such as about 0.8-10.4 mg/cm2 collagen carrier, such as about 0.8-6.1 mg/cm2
collagen carrier, such as about 1.2-4.7 mg/cm2 collagen carrier, such as about
.24 mg/cmz. An alcohol - preferably ethanol - is a preferred solvent. In an
embodiment, the solvent essentially consist of a mixture of ethanol or dehydrated
ethanol with a maximum content of 0.1% water and water or isopropanol and
water, wherein the amount of water is up to 20 %, such as up to 18 %, such as
up to 16 %, such as up to 14 %, such as up to 12 %, such as up to 10 %, such as
up to 8%, such as up to 6 %, such as up to 5 %, such as up to 4 %, such as up to
3 %, such as 2.4 %, such as up to 2 %, such as up to 1.5 %, such as up to 1 %,
such as up to 0.5 %. The solvent may also contain fibrinogen and/or thrombin
and/or albumin and/or some salt. In a further embodiment, ethanol or dehydrated
ethanol with a maximum content of 0.1% water is the preferred t and is
used in an amount of about 9 mg ethanol/cm2 collagen carrier, such as about 8
mg ethanol/cm2 en carrier, such as about 7 mg ethanol/cm2 collagen carrier,
such as about 6 mg ethanol/cm2 collagen r, such as about 5 mg ethanol/cm2
collagen carrier, such as about 4 mg ethanol/cm2 collagen r, such as about 3
mg ethanol/cm2 collagen carrier, such as about 2 mg ethanol/cm2 collagen carrier,
such as about 1.2 mg ethanol/cm2 collagen carrier, such as about 1 mg
ethanol/cm2 collagen carrier, such as about 0.5 mg l/cm2 collagen carrier.
Without being bound by theory, it is speculated that using more than about 10.75
mg ethanol or dehydrated ethanol with a maximum content of 0.1% cm2
collagen carrier, such as about 10.4, mg ethanol/cm2 collagen carrier could make
said en carriers become sticky when being compressed. Hence, using an
ethanol level of no more than 10.75 mg ethanol/cm2 collagen fleece is preferred.
By the term “relative humidity (RH)” is meant the amount of water vapor in a
mixture of air and water vapor.
In an embodiment, the process according to the present invention is performed at
-75% RH, such as 30-50 % RH, such as 30-60 %, such as 30-64 % RH, such
as 30-65 % RH, such as 30-70 % RH, such as 40-60% RH, such as 40-64% RH,
such as 40-70 % RH and optionally at a temperature of 5-30°C, such as 18-22 °C,
such as 18-25 °C. In a preferred embodiment, RH is 30-50 % and the
temperature is 18-22 °C which is the preferred relative humidity range and
temperature range of the room (e.g. manufacturing facility) where the rolled
and/or compressed en carriers are sed. See further below when the
term “drying” is defined. In another embodiment the relative humidity range and
temperature of the room (e.g. manufacturing facility) where the rolled and/or
compressed collagen carriers are processed is about 25 °C and 64-70 % RH.
By the term “elasticity ” is meant the cy of an object to be deformed
elastically i.e., non-permanently when a force is applied to it. In the present
context the elasticity module is used to describe the elasticity of a en carrier
of the present invention. The elasticity module is in the present invention
measured in N/cmz. The elasticity module is preferably 5-100 N/cmz, such as 15-
90 N/cmz, such as 25-80 N/cmz, such as 35-70 N/cmz, such as 45-60 N/cmz, such
as 50-55 N/cmz. The elasticity module is a well known parameter in the art to
measure elasticity, as disclosed in e.g. the book by J.E. Gordon, The New e
of Strong Materials or Why You Don 't Fall Through the Floor page 38-43 and EP 1
053 757 Bl. Elasticity module thus represents the elastic flexibility of a material,
the flexibility of any given .
By “elasticity module” is meant Youngs modul, E, the physical constant,
characterized by the stiffness of an elastic material. E is force (N) divided with
area (mmz), written as N/mm2 or MPa.
By the term ty” or the mass density of a material is meant the material’s
mass per unit volume. The symbol most often used for density is p but in the
present context, density is defined as weight per unit volume mg/cm3, which is
also called specific weight. The method and the equipment used for determining
the density are sed in further detail in the example n below. The
y of a en carrier according to the present invention is the density of
the collagen carrier excluding the g layer.In an embodiment of the present
invention, the density of the collagen carrier before humidification and/or rolling
and/or compression, such as for the collagen r provided in step (a) of the
present invention, is in the range of 1-10 mg/cm3, such as in the range of 1-9
mg/cm3, such as in the range of 1-8 mg/cm3, such as in the range of 1-7 mg/cm3,
such as in the range of 1-6 mg/cm3, such as in the range of 1-5 mg/cm3, such as
in the range of 1-4 mg/cm3, such as in the range of 1-3 mg/cm3, such as in the
range of 1-2 mg/cm3, such as in the range of 2-9 mg/cm3, such as in the range of
2-8 mg/cm3, such as in the range of 2-7 mg/cm3, such as in the range of 2-6
mg/cm3, such as in the range of 2-5 mg/cm3, such as in the range of 2-4 mg/cm3,
such as in the range of 3-9 mg/cm3, such as in the range of 3-8 mg/cm3, such as
in the range of 3-7 mg/cm3, such as in the range of 3-6 mg/cm3, such as in the
range of 3-5 mg/cm3, preferably such as in the range of 3.0-4.5 mg/cm3, such as
in the range of 3.0-4.4 , such as in the range of 3.0-4.3 mg/cm3, such as
in the range of 3.0-4.2 mg/cm3, such as in the range of 3.0-4.1 mg/cm3, such as
in the range of 3.0-4.0 , such as in the range of 3.0-3.9 mg/cm3, such as
in the range of 3.0-3.8 mg/cm3, such as in the range of 3.0-3.7 , such as
in the range of 3.0-3.6 , such as in the range of 3.0-3.5 , such as
in the range of 3.0-3.4 mg/cm3, such as in the range of 3.0-3.3 mg/cm3, such as
in the range of 3.0-3.2 mg/cm3, such as in the range of 3.0-3.1 mg/cm3, such as
in the range of 3.1-4.5 mg/cm3, such as in the range of 3.2-4.5 mg/cm3, such as
in the range of 3.3-4.5 mg/cm3, such as in the range of 5 mg/cm3, such as
in the range of 3.5-4.5 mg/cm3, such as in the range of 3.6-4.5 mg/cm3, such as
in the range of 3.7-4.5 mg/cm3, such as in the range of 3.8-4.5 mg/cm3, such as
in the range of 5 mg/cm3, such as in the range of 4.0-4.5 mg/cm3, such as
in the range of 5 mg/cm3, such as in the range of 4.2-4.5 mg/cm3, such as
in the range of 4.3-4.5 mg/cm3, such as in the range of 4.4-4.5 mg/cm3.
The density of a humidified and/or compressed and/or rolled collagen carrier of
the present invention is preferably in the range of 1-15 mg/cm3, such as in the
range of 2-15 mg/cm3, such as in the range of 3-15 mg/cm3, such as in the range
of 4-15 mg/cm3, such as in the range of 5-15 mg/cm3, such as in the range of 6-
mg/cm3, such as in the range of 7-15 mg/cm3, such as in the range of 8-15
mg/cm3, such as in the range of 9-15 mg/cm3, such as in the range of 10-15
mg/cm3, such as in the range of 11-15 mg/cm3, such as in the range of 12-15
mg/cm3, such as in the range of 13-15 mg/cm3, such as in the range of 14-15
mg/cm3, such as in the range of 3-14 mg/cm3, such as in the range of 3-12
mg/cm3, such as in the range of 3-10 mg/cm3, such as in the range of 3-9
mg/cm3, such as in the range of 3-8 mg/cm3, such as in the range of 3-7 mg/cm3,
such as in the range of 3-6 mg/cm3, such as in the range of 3-5 mg/cm3, such as
in the range of 3.0-4.5 mg/cm3, such as in the range of 3.0-4.4 mg/cm3, such as
in the range of 3.0-4.3 mg/cm3, such as in the range of 3.0-4.2 mg/cm3, such as
in the range of 3.0-4.1 mg/cm3, such as in the range of 3.0-4.0 mg/cm3, such as
in the range of 3.0-3.9 mg/cm3, such as in the range of 3.0-3.8 , such as
in the range of 3.0-3.7 mg/cm3, such as in the range of 3.0-3.6 mg/cm3, such as
in the range of 3.0-3.5 mg/cm3, such as in the range of 3.0-3.4 mg/cm3, such as
in the range of 3 mg/cm3, such as in the range of 3.0-3.2 , such as
in the range of 3.0-3.1 mg/cm3, such as in the range of 3.1-4.5 mg/cm3, such as
in the range of 3.2-4.5 mg/cm3, such as in the range of 3.3-4.5 mg/cm3, such as
in the range of 3.4-4.5 , such as in the range of 5 mg/cm3, such as
in the range of 3.6-4.5 mg/cm3, such as in the range of 3.7-4.5 mg/cm3, such as
in the range of 3.8-4.5 mg/cm3, such as in the range of 3.9-4.5 mg/cm3, such as
in the range of 4.0-4.5 mg/cm3, such as in the range of 4.1-4.5 mg/cm3, such as
in the range of 4.2-4.5 mg/cm3, such as in the range of 4.3-4.5 mg/cm3, such as
in the range of 4.4-4.5 mg/cm3.
The density of a fied and/or compressed and rolled collagen r of the
present invention is measured upon unro||ing said rolled collagen carrier of the
present invention. Please note that the density of a collagen carrier of the present
invention is the density of the collagen carrier excluding the coating layer.
It is presently preferred to determine the density by weighing a collagen carrier of
known volume, such as a rolled and/or compressed collagen r of a certain
size (see the examples section), such as a large size collagen carrier (also called a
strip or a ). The density is calculated by dividing the mass of the collagen
carrier by the volume of the collagen carrier. The method and the ent used
for ining the density are disclosed in further detail in the example section
below.
By the term “coating” is preferably meant a coating either comprising or
essentially ting of the biologically active substances fibrinogen and thrombin
that are evenly distributed and fixed upon at least one side of a collagen carrier of
the present invention, such as a rolled and/or compressed collagen r, such
as an unro||ed rolled and/or compressed collagen carrier. The g may also
include e.g. riboflavin (yellow color as marker of coated area). In one embodiment
of the present invention, the active substances are preferably solid human
fibrinogen, solid human thrombin and optionally solid riboflavin. Thus in one
embodiment of the invention, the coating essentially ts of solid human
fibrinogen, solid human thrombin and solid ribof|avin.The coating is present on at
least one side of the collagen carrier, such as a rolled and/or compressed collagen
carrier, such as an unro||ed rolled and/or compressed collagen carrier. Hence, in
one embodiment the collagen carrier, such as a rolled and/or compressed collagen
carrier, such as an unro||ed rolled and/or compressed en carrier comprises
one or more active sides wherein fibrinogen is present in an amount of 1.3-10
mg/cm2, such as 2-10 mg/cmz, such as 4.3-6.7 , ably about 3.6-7.4
mg/cmz, such as about 5.5 mg/cmz, and thrombin is t in an amount of 0.9
— 201U/cm2, such as 0.9 — 15 IU/cm2, such as 0.9 — 10 IU/cm2, such as 1.0-5.5
IU/cmz, preferably such as about 1.3-2.7 IU/cmz, such as about 2.0 IU/cmz. Said
coating is preferably applied to at least one side of said collagen carrier, such as a
rolled and/or compressed collagen carrier, such as an ed rolled and/or
compressed collagen carrier.
When the en carrier, such as a rolled and/or compressed collagen carrier,
such as an unrolled rolled and/or compressed collagen carrier, has a coating on
one side of said carrier and when it is rolled the side coated with the biologically
active substances can be externally oriented on said rolled collagen carrier, or the
side coated with the biologically active substances can be internally oriented on
the rolled en carrier. Presently, the first alternative is preferred for a rolled
compressed collagen carrier of the present invention, i.e. external orientation of
said coating.
By the term “diameter” of e.g. the rolled collagen carrier is meant the diameter of
the cross section of any type of en carrier that has been rolled or coiled
according to the present invention. Thus, the er of the ing rolled
collagen carrier as measured on the cross section (e.g. the shortest side) is about
-12 mm, such as about 6-11, such as about 7-10 mm such as about 8-9 mm,
such as at the most 11 mm, preferably such as at the most 10 mm, preferably
such as at the most 9 mm, such as at the most 8 mm, such as at the most 7 mm,
such as at the most 6 mm, such as at the most 5 mm, such as at the most 4.5
mm, such as at the most 4 mm, such as at the most 3.5 mm, such as at the most
3 mm, such as at the most 2.5 mm, such as at the most 2.0 mm, such as at the
most 1.5 mm, such as at the most 1.0 mm. The preferred diameter is less than
mm for midi sized fleeces, i.e. midi sized fleeces have the dimensions 46-49
mm * 46-50 mm * 4-7 mm. In figure 3 the length and width of a lled
collagen carriers according to the invention is shown.
By the term “thickness” is meant the shortest measurable distance across any
collagen carrier of the invention that is ed or nonrolled, which means that
the thickness depends on whether the collagen r has been previously rolled
or not and/or whether it has been previously compressed, humidified or not.
When the term thickness is used to describe any type of unrolled or nonrolled
collagen carrier according to the present invention the thickness is meant to mean
the thickness which is about 1-10 mm, such as about 2-8, such as about 4-6,
such as at the most 10 mm, such as at the most 9 mm, such as at the most 8
mm, such as at the most 7 mm, such as at the most 6 mm, such as at the most 5
mm, such as at the most 4 mm, such as at the most 3 mm, such as at the most 2
mm, such as at the most 1 mm. In an embodiment the preferred thickness of a
collagen carrier is 4-7 mm. In another embodiment, the preferred ess of an
unrolled collagen carrier is at the most 4 mm.
By the term “adhesive strength” is meant the capability of a en carrier, such
as a rolled and/or compressed collagen carrier, to adhere to living tissue and thus
adhesive strength reflects the pharmaceutical ty of a collagen carrier
ing to the invention i.e. the capability of a en carrier, such as a rolled
and/or compressed collagen carrier to provide tissue sealing, tissue gluing and
haemostasis. Adhesive th can be measured by an in vitro measurement
such as the PCT test, and has the unit mmHg. The PCT test is described in
example 4. The adhesive strength of a en carrier, such as a rolled and/or
compressed collagen carrier can be measured using various pressure test
s that overall investigate how much pressure a /medical device can
withstand before rupture/burst. Thus, these methods are used for determining
adhesive strength/sealing of a patch, such as a medicated sponge, preferably
such as a en carrier, such as a rolled and/or compressed collagen carrier
according to the present invention. Hence, these methods simulate the adhesive
strength/sealing capability of a medicated sponge in a living organism such as a
mammal, e.g. rat, dog or human undergoing a surgery such as minimally ve
surgery. These methods comprise methods known to a person skilled in the art,
such as e.g. Hydraulic Burst Leak Test (HBLT) (Crescent Design), such as ATC's
Pressure Burst Tester (ATC Inc.), such as Evolution lic Burst Tester (AE
Solutions, Inc.). In the present context, a pressure test ca||ed “PCT” is used to
simulate in vitro adhesive strength of a collagen carrier, such as a rolled and/or
ssed collagen carrier of the present invention to a tissue sample or a
simulated tissue sample. Hence, the PCT is preferred in the present invention.
By ”PCT” is meant a pressure test that is used for ing adhesive
strength/sealing of a collagen carrier, such as a rolled and/or compressed collagen
carrier to a synthetic membrane mimicking the adhesion to mammal tissue. The
test is performed e.g. with a rolled collagen carrier sample that after unrolling is
cut into a square of 3 x 3 cm. The active side of the cut samples are wetted with
saline and placed onto the synthetic membrane that has been provided with a
hole in the centre (Q 1 cm). The membrane with the adhered sample of collagen
carrier, such as a rolled and/or compressed collagen carrier is placed and fixed
over an airtight r into which air is pumped. The pressure required to
disrupt/burst the seal formed by the collagen carrier, such as a rolled and/or
compressed en carrier is ed in mmHg and is called “adhesive
strength” as defined above. The test is described in further details in example 4.
An embodiment of the present invention relates to a s according to the
invention, wherein each individual collagen carrier, such as a rolled and/or
compressed collagen carrier out of a sample of 10 collagen carriers have an
adhesive strength of more than about 40 mmHg and wherein the average of 10
collagen rs, such as a rolled and/or compressed en carrier in said
sample has an ve strength of more than about 50 mmHg as measured by
pressure test (PCT).
By the term “adherence” is meant the in vitro capability of a collagen carrier, such
as a rolled and/or compressed collagen carrier to adhere to living tissue according
to the t ion. Adherence is investigated qualitatively by visual
inspection of adherence of a collagen carrier to a tissue and thus adherence
approximates a part of the pharmaceutical activity of a collagen carrier, such as a
rolled and/or compressed collagen carrier according to the invention i.e. the
capability of a collagen carrier, such as a rolled and/or ssed collagen
carrier to adhere to an ed organ or piece of tissue. An example of an
nce test is shown in example 2 and Figure 1 illustrates adherence.
By the term “loss of coating” is meant the strength of adhesion/fixation of the
coating layer to the collagen layer, such as of the coating layer to a coiled/rolled
and/or compressed collagen carrier. Loss of coating is described in further detail
WO 59635
in example 1. This term should not be confused with “adherence” as discussed
above.
Loss of coating layer is ed indirectly by weighing e.g. a rolled collagen
carrier of a predetermined size prior to un-rolling it and weighing it immediately
again after it has been unrolled, whereby an amount of coating that may have
been lost is expressed in mg/cmzor in percentage, see below.
Harsh ng of a en carrier of the invention such as by mechanical
manipulation (i.e. humidification, compression, rolling, unrolling, and passage
through an access orifice, such as a trocar) may lead to coating falling off the
collagen r, such as a rolled and/or compressed collagen carrier. Such a
harsh handling is shown in figure 5. A method that can be used for determining
the loss of coating is disclosed in example 1. The rolled compressed collagen
carrier is substantially unchanged upon exit from said trocar or simply upon un-
rol|ing not passing it through a trocar and has lost less coating material than 20%,
such as less than 18%, such as less than 16%, such as less than 14%, such as
less than 12%, such as less than 10%, such as less than 8%, such as less than
6%, such as less than 4%, such as less than 2%, such as less than 1.5 %, such
as less than 1 %, such as less than 0.5 %, such as less than 0.2 %, such as 0%
as an indication of the flexibility of the collagen carrier and the coating. In one
embodiment of the present invention the percentages are calculated as follows: a
rolled collagen carrier of the ion is weighed before it is passed through a
trocar. After exit from said trocar said rolled collagen carrier is unrolled and
weighed again immediately thereafter, whereby an amount of coating that may
have been lost is expressed in percentage. It should be noted that an unrolled
en carrier of the present invention has an able PCT-value even if it
loses less than 20% g material.
The loss of coating is preferably less than 1.0 mg/cmz, such as less than 0.9
mg/cmz, such as less than 0.8 mg/cmz, such as less than 0.7 mg/cmz, preferably
such as less than 0.6 mg/cmz, such as less than 0.5 mg/cmz, such as less than
0.4 mg/cmz, such as less than 0.3 mg/cmz, such as less than 0.2 mg/cmz, such
as less than 0.1 mg/cmz, such as 0.01 mg/cmz.
Obviously, it is not possible to measure the in vivo loss of g upon exit of a
rolled or rolled compressed collagen carrier of the invention from an access orifice,
such as a trocar within a living organism.
By the term “sterility assurance level (SAL)” is meant a term used in microbiology
to describe the probability of a single unit being non-sterile after it has been
subjected to a sterilization process. For example, medical device manufacturers
design their sterilization processes for an extremely low SAL leading to a 10'6
microbial survivor probability, i.e. assurance of less than or equal to 1 chance in 1
million that viable microorganisms are t in the sterilized device, as d
in USP 34 <1211> (United States Pharmacopeia version 32, chapter 1211. SAL is
also used to describe the killing efficacy of a sterilization process, where a very
effective ization process has a very low SAL.
Sterilisation can occur before and/or after any packaging steps.
Gamma radiation can be used as a ization method to kill living organisms in a
process called ation. Applications of irradiation include sterilizing medical
equipment as an alternative to autoclaves or chemical means. In one embodiment
of the present invention, a collagen carrier, such as a rolled and/or compressed
en carrier, is subjected to gamma radiation. The gamma radiation may
reduce the ed PCT-value of the collagen carrier, such as no more than
0.5%, such as no more than 1%, such as no more than 2% such as no more
than 3%, such as no more than 4%, such as no more than 5%, such as no more
than 6%, such as no more than 7%, such as no more than 8%, such as no more
than 9%, such as preferably no more than 10%, such as no more than 11%, such
as no more than 12%, such as no more than 13%, such as no more than 14%,
such as no more than 15%, such as no more than 16%, such as no more than
17%, such as no more than 18%, such as no more than 19%, such as no more
than 20%, such as no more than 25%. This was evaluated in vitro by visual
inspection of nce of a rolled collagen carrier according to the invention on
liver tissue. Fibrinogen is preferably present in an amount of 2-10 mg/cm2 and
thrombin is preferably present in an amount of 1.0-5.5 IU/cm2 after the
irradiation process and it is preferred that the levels may exceed their respective
levels such as no more than 0.5%, such as no more than 1%, such as no more
than 2%, such as no more than 3%, such as no more than 4%, such as no more
than 5%, such as no more than 6%, such as no more than 7%, such as no more
than 8%, such as no more than 9%, such as preferably no more than 10%, such
as no more than 11%, such as no more than 12%, such as no more than 13%,
such as no more than 14%, such as no more than 15%, such as no more than
16%, such as no more than 17%, such as no more than 18%, such as no more
than 19%, such as no more than 20%, such as no more than 25%. It is noted
that “exceeding their respective levels” means that the values may either increase
or decrease.
It is red that the rolled and/or compressed collagen carrier can be stored for
an acceptable duration of time whilst maintaining their biological and
physiochemical properties, i.e. preferably, storage neither affects the physical and
al properties of said rolled and/or compressed collagen carrier nor the in
vitro adherence (to liver tissue) and adhesive strength (PCT-value) of the rolled
and/or compressed collagen carriers.
An acceptable shelf-life is preferably up to 60 months, such as up to 54 months,
such as up to 48 months, such as up to 42 months, such as up to 36 months,
such as up to 30 months, such as up to 24 months, such as up to 18 months,
such as up to 12 months, such as up to 6 , such as up to 5 months, such
as up to 4 , such as up to 3 months, such as up to 2 months, such as up to
1 month. Hence, it is preferred that rolled and/or compressed collagen carriers of
the present invention are stable.
By the word “stable” is meant that said rolled and/or compressed collagen rs
are physiochemical and biologically stable meaning that they retain the same
properties as they had when they were prepared. Hence, said rolled and/or
compressed collagen carriers retain their ity under transport, warehousing
(storage), logistics, sales, and up to and including the end use of said rolled
and/or compressed collagen carriers i.e. the collagen carriers maintain regulations
and all end-use requirements.
By the term “drying” is meant any well known method of drying an object such as
by passive evaporation, desiccation, blowing air with a ty lower than the
object that needs drying over said , applying heat etc. In one embodiment
drying is performed in a drying tunnel i.e. tunnel comprises a conveyor belt
orting the trays that ns the rolled collagen carriers through the tunnel
with an airflow ng the drying. In one embodiment the passage through the
tunnel, i.e. the length of the drying takes around 30 min. In another embodiment
the drying tunnel dries off the solvent such as dries off ethanol, e.g. dries off
isopropanol, e.g. dries off isopropanol and ethanol. Water is dried off using a
dessicant, such as e.g. silica gel. The drying off of water may take up to about 48
hours, such as up to about 36 hours, such as up to about 24 hrs, such as up to
about 18 hours, such as up to about 12 hours, such as up to about 6 hours, such
as up to about 2 hours. The drying off of water preferably takes up to about 24
hours.
Silica gel is preferably used to mean a granular, vitreous, porous form of silicon
dioxide made synthetically from sodium silicate. Silica gel is a commonly used
desiccant as beads packed in a permeable bag.
Endoscopic instrument: by copic instrument" is meant herein any
endoscopic instrument known to one skilled in the art, for example opic
grab tongs, endoscopic pincet, endoscopic dissector, endoscopic s,
ons clamp or other endoscopic clamp, endoscopic scissors, an endoscopic
grasper, two or more graspers, laparoscopic swabs (preferably fastened to long
pins or fixed to graspers), or another suitable endoscopic instrument.
In one embodiment of the present invention, the drying of an optionally
humidified rolled and/or compressed collagen carrier ing to the invention
r affects the physical and chemical properties of said en carrier nor
the in vitro adherence (to liver tissue) and adhesive strength (PCT-value) of said
collagen carrier. In one embodiment of the present invention, an optionally
humidified rolled and/or compressed collagen carrier is dried by passive
evaporation of a solvent, preferably ethanol, by controlling the room temperature
and room humidity to within the ranges of which is 3-35 °C, 5-80% RH, such as
13-35 °C, 36-65% RH, such as 23-35 °C, 36-65% RH, such as 33-35 °C, 36-65%
RH, such as 3-25 °C, 36-65% RH, such as 3-15 °C, 36-65% RH, such as 3-5 °C,
36-65% RH, preferably 18-22 °C, 40-60% RH, such as 18-22 °C, 36-65% RH,
such as at 20-25 °C, 40-60% RH, such as at 22-25 °C, 40-60% RH, such as at
24-25 °C, 40-60% RH, such as at 18-23 °C, 40-60% RH, such as at 18-21 °C, 40-
60% RH, such as at 18-19 °C, 40-60% RH, such as at 18-25 °C, 35-60% RH,
such as at 18-25 °C, 30-60% RH, such as at 18-25 °C, 40-65% RH, such as at
18-25 °C, 40-70% RH, such as at 18-25 °C, 40-75% RH, such as at 18-25 °C, 40-
80% RH, such as at 18-25 °C, 45-80% RH, such as at 18-25 °C, 50-80% RH,
such as at 18-25 °C, 55-80% RH, such as at 18-25 °C, 60-80% RH, such as at
18-25 °C, 65-80% RH, such as at 18-25 °C, 70-80% RH, such as at 18-25 °C, 75-
80% RH. Said optionally fied rolled and/or compressed collagen carrier is
preferably dried 30 minutes by blowing air with a humidity lower than said
collagen carrier (such as a rolled and/or ssed collagen carrier that needs
drying) over said collagen carrier followed by passive evaporation of the solvent
by placing said collagen carrier in a dessicator.
An evaporation and/or a drying time of up to 24 hours is preferred, such as up to
hours, such as up to 15 hours, such as up to 10 hours, such as up to 5 hours,
such as up to 1 hour, such as up to 50 minutes, such as up to 40 minutes,
preferably such as up to 30 minutes, such as up to 20 s, such as up to 10
minutes, such as up to 5 minutes, such as up to 1 minute, such as up to 50
seconds, such as up to 40 seconds, such as up to 30 seconds, such as up to 20
seconds, such as up to 10 s, such as up to 5 seconds.
A residual amount of the applied at least one liquid solvent to the collagen carrier,
such as a rolled and/or ssed collagen carrier is acceptable such as no more
than 0.1% w/w, or such as no more than 0.2% w/w, or such as no more than
0.5% w/w, or such as no more than 0.8% w/w or such as no more than 1.0%
w/w, or such as no more than 1.2% w/w, or such as no more than 1.4% w/w, or
preferably such as no more than 1.6% w/w, or such as no more than 1.8% w/w,
or such as no more than 2.0% w/w, or such as no more than 2.5% w/w, or such
as no more than 3.0% w/w, or such as no more than 3.5% w/w, or such as no
more than 4.0% w/w, or such as no more than 5.0% w/w, or such as no more
than 8.0% w/w, or such as no more than 10.0% w/w, or such as no more than
12.5% w/w, or such as no more than 15.0% w/w, or such as no more than 17.5%
w/w, or such as no more than 20.0% w/w, or such as no more than 22.5% w/w,
or such as no more than 25.0% w/w, or such as no more than 27.5% w/w, or
such as no more than 30.0% w/w, or such as no more than 32.5% w/w, or such
as no more than 35.0% w/w. When the applied liquid solvent is ethanol, no more
than 1.6% w/w residual ethanol is preferred and/or when the d liquid
solvent is water no more than 8.0% w/w residual water is preferred, preferably
such as no more than 5.0% w/w. A residual amount of the applied at least one
liquid solvent, such as at least two liquid solvents, such as at least three liquid
solvents to the collagen carrier, such as a rolled and/or compressed collagen
carrier is acceptable.
It may happen that one or more solvents or moisture from the room (aqueous
vapour) is absorbed passively by a collagen carrier, such as a rolled and/or
ssed collagen carrier during processing. In one ments, if such
passive tion of moisture, such as water, has taken place a residual amount
of said moisture is able such as no more than 0.1% w/w, such as no more
than 0.2% w/w, such as no more than 0.5% w/w, such as no more than 0.8%
w/w such as no more than 1.0% w/w, such as no more than 1.2% w/w, such as
no more than 1.4% w/w, such as no more than 1.6% w/w, such as no more than
1.8% w/w, such as no more than 2.0% w/w, such as no more than 2.5% w/w,
such as no more than 3.0% w/w, such as no more than 3.5% w/w, such as no
more than 4.0% w/w, preferably such as no more than 5.0% w/w, such as no
more than 8.0% w/w, such as no more than 10.0% w/w, such as no more than
12.5% w/w, such as no more than 15.0% w/w, such as no more than 17.5% w/w,
such as no more than 20.0% w/w, such as no more than 22.5% w/w, such as no
more than 25.0% w/w, such as no more than 27.5% w/w, such as no more than
.0% w/w, such as no more than 32.5% w/w, such as no more than 35.0% w/w.
When the passively absorbed solvent is water no more than 8.0% w/w residual
water is preferred, preferably such as no more than 5.0% w/w. Residual solvent is
measured by conventional methods known to the person skilled in the art, such as
by using gas chromatography (GC). GC is a common type of chromatography
used in analytical chemistry for separating and analyzing compounds that can be
vaporized without decomposition. In the present invention, GC is used to
determine one or more ts or moisture from the room (aqueous vapour) in
the collagen r.
Residual solvent and its passive uptake by a collagen carrier is bed in
further details in example 9.
By the term lizing” is meant any well known method of sterilizing an object
such as in the present invention a collagen carrier, such as a rolled and/or
compressed collagen carrier. Any such appropriate sterilization method should
result in the required probability of a single unit being non-sterile after it has been
subjected to the sterilization process. Hence, preferably not more than one
en carrier, such as a rolled and/or compressed collagen carrier in a million
should be nonsterile after the sterilization process. An example of a sterilization
process is gamma radiation. Sterilization can also be achieved by ng the
proper combinations of heat, als, irradiation, and high pressure, but these
are less preferred methods. In a preferred embodiment the sterilization is
performed using gamma ation.
By the term “packing” is meant any well known method of packaging an object
such as in the present invention a collagen r, such as a rolled and/or
compressed collagen carrier. Packaging and packing are words that are used
interchangeably within this context. Packaging is meant to mean a coordinated
system of preparing goods for transport, warehousing, logistics, sales, and end
use. Packaging can for example contain, protect, preserve, transport, inform, and
sell an object, preferably such an object as the collagen carrier, such as a rolled
and/or compressed collagen carrier of the present invention. A suitable ner
is used for packing the collagen carrier, such as a rolled and/or compressed
collagen r of the present invention.
By the term “suitable container” is meant in one embodiment any container that is
suitable for transport, warehousing (storage), ics, sales, and for the end use
of a collagen carrier, such as a rolled and/or compressed collagen carrier of the
present invention. Hence, said suitable container encloses and/or protects said
collagen carrier. Thus preferably said collagen carrier, such as a rolled and/or
ssed collagen carrier retains its properties substantially as they were at the
time of packaging. An example of a suitable container is a tray made of PET
(polyethylene terephthalate) or polystyrene shaped to fit the rolled collagen
carrier of the t invention. A le container according to the present
invention is further sealed with a lid, such as e.g. a Tyvec lid. In an embodiment
of the invention, the closed tray with a lid is further placed inside a double
aluminium foil, preferably with a dessicant. In an even further embodiment of the
invention, the double aluminium foil is marked to indicate that the content has
been sterilized (see r below). Other suitable containers are well known in
the art.
In an embodiment package g is conducted and documented to ensure that
packages meet regulations and all end-use requirements. Manufacturing
processes are controlled and validated to ensure consistent performance.
Preferably, a suitable container of the present invention is sterilized in the
package. Medical device packaging is highly regulated and the sterility must be
maintained throughout distribution to allow immediate use by physicians. A series
of special packaging tests is well known in the art and used to measure the ability
of the package to maintain sterility. Relevant standards include: ASTM D1585 —
Guide for Integrity Testing of Porous Medical Packages, ASTM F2097 — Standard
Guide for Design and Evaluation of Primary Flexible Packaging for l
Products, EN 868 ing materials and systems for medical devices which are
to be sterilized. General requirements and test methods, ISO 11607 Packaging for
terminally ized medical s, and others.
In an embodiment the container is a foil packaging material, such as a single or
double aluminium foil or a plastic packaging material, such as a yrene or
PET (polyethylene terephthalate) or a combination of a foil and plastic ing
material, such as a single or double aluminium foil and as a polystyrene or PET
(polyethylene terephthalate).
lly invasive surgery (M15) is a relatively new type of surgical ure
that induce less trauma to the body, thus usually resulting in quicker recovery of
the patient and less pain for the patient. The MIS procedures are usually more
technically demanding than open y, and the surgeon may need to proceed
to open surgery if complications occur.
MIS procedures require specially designed al instruments such as
laparoscopic devices and remote-control manipulation of instruments with indirect
ation of the surgical field through an endoscope or similar device. These
instruments are placed through small incisions or natural orifices (openings).
In for e nal surgery the access of the instruments is usually done
through so-called trocars, which are a type of access tube. Trocars are tubes,
such as rigid tubes, and preferably have a typical inner diameter of 5 to 12 mm,
such as 5-10 mm.
In the present invention, trocars preferably have a diameter of no more than 12
mm, such as preferably no more than 10 mm, such as no more than 8 mm, such
as no more than 6 mm, such as no more than 4 mm, such as no more than 2
mm. In the present t a trocar may also be a flexible tube. The trocar allows
the insertion of instruments and material while creating room for vision (using
video endoscopes) and surgical lation. MIS procedures also include robotic
surgery. The small size of the orifices used in M15 restricts what can be inserted
into the orifices. All surgical tools and materials used during MIS procedures must
be of a size and ion that allow for their insertion through the access orifices.
The tools and materials are for the most part especially designed for use in
minimally invasive surgery.
Hence, by the term “minimal or minimally invasive surgery (MIS)” is meant any
procedure cal or otherwise) that is less invasive than open y used for
the same purpose. Many medical procedures are called minimally invasive, such
as hypodermic injection, air-pressure injection, subdermal implants, endoscopy,
aneous surgery, laparoscopic surgery, thoracoscopic surgery arthroscopic
surgery, cryosurgery, microsurgery, keyhole surgery, scular surgery (such
as lasty), coronary catheterization, permanent spinal and brain electrodes,
tactic surgery, The Nuss ure, radioactivity-based medical imaging
methods, such as gamma camera, Positron emission tomography and SPECT
(single photon emission tomography). Related procedures are image-guided
surgery, c surgery and interventional radiology.
Minimally invasive procedures are performed through one or more short incisions
('keyhole surgery') or through natural body openings. The terminology varies
depending on the route of surgical access, the type of surgery, and the tools used,
e.g. endoscopy, laparoscopy, or thoracoscopy.
Endoscopy means looking inside and typically refers to looking inside the body for
medical reasons using an endoscope, an instrument used to examine the or
of a hollow organ or cavity of the body. Hence, the words “endoscopic surgery” is
meant to mean any surgery performed by using endoscopy such as endoscopy
involving the gastrointestinal tract (GI tract): esophagus, stomach and duodenum
agogastroduodenoscopy), small intestine (enteroscopy)large intestine/colon
(colonoscopy, sigmoidoscopy), magnification endoscopybile duct endoscopic
retrograde cholangiopancreatography (ERCP), duodenoscope-assisted
cholangiopancreatoscopy, intraoperative cholangioscopy, an anoscope, a
proctoscope, and a rectoscope with approximate lengths, rectum (rectoscopy) and
anus (anoscopy), both also referred to as (proctoscopy). It r includes the
respiratory tract: The nose (rhinoscopy), the lower respiratory tract
(bronchoscopy), the ear (otoscope), the urinary tract (cystoscopy), the female
reproductive system (gynoscopy), the cervix (colposcopy), the uterus
(hysteroscopy), and the fallopian tubes poscopy). Normally closed body
cavities may be viewed through a small incision: The nal or pelvic cavity
(laparoscopy), the interior of a joint (arthroscopy), organs of the chest
(thoracoscopy and mediastinoscopy), during pregnancy: the amnion
(amnioscopy), the fetus (fetoscopy). It further includes plastic surgery
panendoscopy (or triple opy) which es laryngoscopy,
goscopy, and bronchoscopy. In addition, orthopedic surgery and hand
surgery, such as endoscopic carpal tunnel release and epidural space
roscopy) is also a form of endoscopy.
Laparoscopic surgery includes operations within the abdominal or pelvic cavities,
whereas keyhole surgery performed on the thoracic or chest cavity is called
thoracoscopic surgery. Laparoscopic and oscopic surgery both belong to the
broader field of endoscopy.
WO 59635
By an “access e” or "orifice" is meant the point of entry through which the
coiled collagen carrier of the invention is passed prior to reaching the target
location. For embodiments of the present invention relating to MIS procedures,
the term "orifice" or "access orifice" means the point on entry of the surgical tools
and materials used during MIS procedures. Hence, such surgical tools and
materials must be of a size and condition that allow for their insertion through the
access orifices. The access orifice can e.g. be a natural e in the body or can
e.g. be in a trocar. However, the access e or orifice is not arily a
narrow entry point, it may also be a wide area, such as an access orifice created
during open surgery, such as open abdominal surgery or the access e/orifice
created during open heart surgery.
By the words “hemostasis or tasis” is meant e.g. a complex process which
causes a bleeding process to stop. It refers to the process of keeping blood within
a damaged blood vessel (the opposite of hemostasis is hemorrhage). Most of the
time this includes the changing of blood from a fluid to a solid state (coagulation)
or for example by physically sealing open vessels.
By the expression “injury” is meant damage to a biological organism, such as
injury ated with performing MIS. Tissue injury may include conditions where
leakage of e.g. blood, lymph, bile, cerebrospinal fluid or air/gas is present, thus
needing local treatment to control the bleeding (haemostasis) or stop the
exhudate (tissue sealing).
By the terms "organ" or "tissue" is meant any organ or tissue in the human or
animal body, either having been ed from the human or animal body or
alternatively in vivo, for example an organ or tissue that is operated on during a
surgical procedure. For example, the term "organ" as used herein can refer to e.g.
any of the organs on the following miting list:- heart, blood vessels, salivary
glands, esophagus, stomach, liver, gallbladder, pancreas, ines, colon,
rectum, anus, hypothalamus, pituitary, pituitary gland, pineal body, pineal gland,
thyroid, parathyroids, adrenal glands, , ureter, bladder, urethra, lymph
node, lymph vessel, tonsils, adenoids, thymus, spleen, skin, hair, nails, muscles,
brain, spinal cord, nerves, ovaries, fallopian tubes, uterus, vagina, mammary
glands, testes, vas deferens, seminal vesicles, prostate, penis, spleen, pharynx,
larynx, trachea, bronchi, lungs, diaphragm, bones, age, ligaments and
tendons. The term "tissue" as used herein can for example refer to e.g. any of the
tissue types on the following non-limiting list:- epithelial tissue, connective tissue,
muscle tissue and/or nerve tissue.
By the term “weight-weight percentage” or “% w/w” is meant grams substance
per grams of another substance in percent (per 100 gram). Thus, if e.g. residual
water is present in an amount of 2% w/w in a en carrier, it is meant to
mean 2 grams of water is present with 98 grams of collagen carrier. The total
weight will be 100 grams of the collagen carrier including the al water but
the volume of the 100 grams of residual may be different from 100 ml.
Note that by the “weight” of the collagen rs is meant the weight of the
collagen carrier excluding the weight of the coating layer.
It should be noted that embodiments and features described in the context of one
of the aspects of the present ion also apply to the other aspects of the
invention i.e. all aspects relating to a rolled compressed collagen carrier also apply
to a compressed collagen carrier or a rolled collagen r or an unrolled rolled
compressed collagen carrier or a coiled collagen carrier (as the terms "coiled" and
"rolled" are used hangeably herein), and similarly for the process aspects.
An aspect of the present invention relates to a process for coiling a collagen
carrier, the collagen carrier comprising (i) a collagen layer and (ii) a g layer
comprising fibrinogen and thrombin, said process comprising the sequential steps
. humidifying at least part of said collagen carrier,
. coiling said en carrier by gripping the collagen carrier between a pair of
elongated members, and rotating the pair of elongated members about an axis
being parallel to a longitudinal extension of the elongate members in order to
coil the en carrier on the members, while the collagen carrier is
supported by a support device,
. drying the coiled collagen r,
thereby providing a form-stable coiled collagen carrier.
Another aspect of the present invention relates to a process for coiling a en
carrier, the collagen carrier comprising (i) a en layer and (ii) a coating layer
preferably comprising fibrinogen and thrombin, said process comprising the
sequential steps of:
. humidifying at least part of said collagen carrier,
. coiling said collagen carrier
. drying the coiled collagen r,
thereby providing a form-stable coiled collagen carrier.
Any type of fibrinogen and/or thrombin can be used in the coating layer,
preferably the ogen and/or thrombin used in the coating layer is mostly solid
and/or solid. It is preferred that the fibrinogen and/or thrombin are dry.
Preferably, said sequential steps are consecutive steps. In an embodiment of the
present invention, the process consists of the above-mentioned process steps. In
another ment, the process comprises or consists of the above-mentioned
process steps and a further packing step wherein the coiled product is sealed in a
container, and sterilized. In an embodiment of the present invention, the coiling is
performed by gripping the collagen carrier using at least one gripping device. In
an embodiment of the present ion, the coiling is med by gripping the
collagen carrier using at least one pair of tweezers or pincers.
The drying of the coiled collagen carrier can be done using any suitable drying
process, such as e.g. by blowing air with a humidity lower than the coiled collagen
carrier and optionally applying heat to the air. Preferably, said drying is at least 5
minutes long, such as between 5 minutes and 1 hour, such as n 20
minutes and 40 minutes long, such as between 25 and 35 minutes long. A
ation tunnel can for example be used for the drying step.
Any surface of the collagen carrier can be humidified. Preferably, at least the
coating layer of said collagen carrier is humidified. In one embodiment of the
present invention only the coating layer is humidified, in r embodiment of
the invention both the top and bottom sides of the collagen carrier are humidified.
In another embodiment of the present invention, the surface humidified is the
en layer.
Preferably, the collagen carrier is fied by a solvent. Any suitable t can
be used, such as an organic solvent or water. In an embodiment of the present
invention, the solvent comprises or consists of ethanol, such as dehydrated
ethanol with a maximum content of 0.1% water. In another ment, the
solvent comprises or consists of ethanol, such as dehydrated ethanol with a
maximum content of 0.1% water, and water. The solvent can also comprise or
consist of isopropanol. The solvent can alternatively be a mixture of at least 70 %
ethanol such as dehydrated ethanol with a maximum content of 0.1% water and
another solvent (such as water), such as at least 80 % ethanol, such as at least
90% l, such as at least 95 % ethanol. The solvent can in another
embodiment be a mixture of at least 80 % isopropanol and another solvent (such
as water), such as at least 90% or 95% isopropanol. The solvent can also
comprise fibrinogen and/or thrombin and/or other factors. In a preferred
embodiment the ethanol may be dehydrated ethanol with a maximum content of
0.1% water.
In an embodiment of the present invention, the rolling/coiling up step is
med after the coating layer has been ed.
Preferably, the coating layer of the collagen carrier is humidified using a solvent.
In an embodiment of the present invention, the collagen r is humidified on
the coating layer by a solvent in an amount between 0.1 and 25 cm2 surface of
the coating layer, such as e.g. 1.2-10.75 mg/cm2 surface of the coating layer. For
rolled versions of the standard TachoSil® sizes available on the market (such as
e.g. midi sized fleeces), the ing solvent amounts are preferred on the
coating layer: 30 — 160 mg solvent (such as ethanol) per collagen carrier, such as
30 — 100 mg solvent (such as l) per collagen carrier, such as preferably 90
— 100 mg solvent (such as ethanol) per collagen carrier, such as for a collagen
carrier with a 25 cm2 coating surface such as for the small or midi sized Tachosil®
collagen carrier. In an ment of the present invention, the solvent
comprises or consists of ethanol or dehydrated ethanol with a maximum content
of 0.1% water.
In an embodiment of the process for coiling a collagen carrier, the process further
comprises the step of compressing the collagen carrier to reduce the thickness of
the collagen carrier. For e, the collagen carrier can be compressed with a
compression ratio between 2 and 18, such as e.g. 4-14, such as preferably
between 6-12. The compression step can in one embodiment be performed by
passing the humidified collagen carrier through a set of rollers having a gap size
being smaller than the thickness of the collagen carrier before passing through the
set of rollers. An example gap size is between 0.2 mm and 2 mm, such as e.g.
0.4-1.6 mm, such as between 0.5-1.0 mm, or no more than 0.75 mm, such as
e.g. 0.5-0.75. One preferred gap size is 0.6 mm. The compression is preferably
performed prior to the g of the collagen carrier.
During the drying step of the coiling process, the coiled collagen carrier can be
supported by a support device, e.g. by contacting the support device. For
example, at least an edge of the coiled collagen carrier is fixed by the support
device relatively to the coiled collagen carrier during drying, i.e. the edge of the
coiled collagen carrier is pushed against the support device. The support device
can be any le shape, such as e.g. a "U" shape, a rounded shape, a tubular
shape or any other shape capable of supporting and maintaining the coiled shape
of the collagen r while it is drying, prior to the product becoming form-stable
in the dry state. In one preferred embodiment, the t device is a cavity
shaped as a segment of a er having at least one open end, and wherein the
curved part of the cylinder segment extends at least 180° (see e.g. figure 11). In
one embodiment of the present ion, the edge of the coiled collagen carrier
is arranged inside the segment of the cylinder and the edge abuts the inner
surface of the cylinder.
Preferably, the process of the present invention further comprises the step of
ting the elongated members from the coiled en r. For example,
the extraction of the ted members is performed before drying of the coiled
collagen carrier. The elongated members can be a pair of tweezers, so for
example the extraction of the at least one pair of tweezers can be performed
before drying of the coiled collagen carrier. Preferably the ted members
form a gripping device.
In an embodiment of the present invention, the process further comprises the
step of arranging the form-stable coiled collagen carrier in a ner and
subsequently sealing the container. For example, the coiled carrier can be
arranged in an inner container and the inner container can be arranged in an
outer container, further optionally comprising the step of arranging a desiccator
inside the outer container prior to sealing of the container.
The process of the present invention preferably comprises the step of sterilizing
the coiled collagen carrier. This can for e be done using gamma ion.
One embodiment of the present invention comprises the step of sterilizing the
coiled collagen carrier to a sterility assurance level (SAL) of 10'6 using gamma
radiation.
The s of the present invention can comprise a step wherein a label with
information relating to the product of the t invention, such as e.g. relating
to the sterilization level, is placed on the outside of the outer container.
In one embodiment of the present invention, the process for coiling a collagen
carrier has the e that the atmosphere surrounding the collagen carrier and
humidification device while being humidified, compressed and coiled, is
maintained at a set temperature and/or ty. The temperature and/or
humidity can for example be in the range of 10-40° C and 10-70% RH. Preferably,
the ature is 18-22° C and the relative humidity is 30-50%.
In an embodiment the temperature is 5-30° C, such as 10-25° C, such as 10-300
C, such as 15-30° C. In another embodiment the relative humidity is 2-60% RH,
such as 10-55% RH, such as 20-55% RH, such as 30-55% RH, such as 40-55%
RH. Preferably the ve humidity is 30-50% RH.
Another aspect of the present invention s to a coiled collagen r
obtainable by any of the coiling or rolling process described herein (the terms
"coiling" and "rolling" are used interchangeably herein). For example, the present
invention relates in one embodiment to a coiled collagen carrier obtained by the
process of the present invention.
Another aspect of the present invention relates to a coiled collagen carrier
- comprising a collagen layer and a g layer on top of the collagen layer,
the coating layer comprising a (preferably mostly solid) thrombin and
(preferably mostly solid) fibrinogen, and
- having the shape of a elongate element with a number of windings of the
collagen carrier about the longitudinal axis of the elongate element and at
least the outer g(s) being orientated so that the coating layer
constitutes the outer surface of each of said outer windings,
- the coiled collagen carrier is table and defines a collagen carrier in a
coiled configuration where said outer winding(s) proceed along a spiral in a
cross section of the collagen carrier.
The gs being referred to as the outer gs are preferably each winding
of the coiled collagen carrier except the inner most winding which typically is
coiled to define an “S” when seen in a cross sectional view. In some embodiments
the coiled collagen carrier may sing only one outer winding and in such
instances the winding being referred to as outer windings is preferably this single
outer g.
The coiled collagen carrier comprises a collagen layer. The collagen layer can be
made from any suitable collagen, such as e.g. a collagen foam or sponge, such as
e.g. the cially available Nycomed "TachoTop" product. A preferred
collagen type is human collagen, such as a fied human collagen foam. The
coiled collagen carrier also comprises a coating layer on top of the collagen layer,
which comprises in and fibrinogen. The thrombin is preferably mostly solid
or solid. The fibrinogen is preferably mostly solid or solid. Preferably both the
thrombin and fibrinogen are solid. Preferably the coating also comprises riboflavin,
which provides a yellow colour and enables the medical tioner to determine
which side of the collagen carrier is the active side.
In preferred embodiments of the present invention,at least the outer windings or
each winding of the coiled collagen carrier is orientated so that the coating layer
tutes the inner surface of each winding. In other embodiments of the
present invention, each winding or at least the outer windings of the coiled
collagen carrier is/are orientated so that the coating layer constitutes the outer
surface of each of said windings.
In an embodiment of the present invention, the collagen carrier is ably a
layered construction, for example consisting of a layer of collagen and a coating
layer on top of the collagen layer.
The coiled collagen carrier of the present ion is table. This can for
example mean that the coiled collagen carrier is form-stable in the sense that it
does not un-coi I\\when at rest”. In one embodiment of the present invention, the
tability of the coiled collagen r diminishes when moisture is applied to
it by which is meant that the product becomes more flexible (i.e. less form-
stable). In a preferred embodiment of the present invention, the form-stability of
the coiled collagen r is provided substantially only by the coating. At least
some of the form-stability of the coiled collagen carrier can in one embodiment be
provided by the outer most winding of the r. In one ment of the
present invention, the form-stability of the coiled collagen carrier is provided by a
region at the edge of the coiled collagen carrier adhering to the subjacent
winding. In another ment, the form-stability of the coiled collagen carrier is
provided by an nce between the windings. In an embodiment of the
present invention, the form-stability of the coiled collagen carrier is provided by
the coiled collagen carrier having no mechanical tension. In an embodiment of the
present invention, the form-stability of the coiled collagen carrier is provided by
outbalancing mechanical tension acting to un-coil the coiled collagen carrier by an
adherence between the windings. In an embodiment of the present invention, the
form-stability of the coiled collagen r is provided by the coil having a
elasticity module of 5-100 N/cmz.
In one embodiment of the present invention, the form-stability is provided by the
coiled collagen carrier forming a brittle coi| which, when subjected to stress,
breaks without significant deformation.
In a preferred embodiment of the present ion, the coiled collagen carrier in
an unro|led uration is a (preferably rectangular or square-shaped) sheet,
preferably having a width, a length and a thickness. Preferably, said unro|led
collagen carrier is a rectangular or square sheet. Preferably the sheet has a
thickness of between 0.5 mm and 10 mm, such as e.g. 0.5-8 mm, for example
0.5-6 mm. In a red embodiment of the t invention, said thickness is
preferably 1-4 mm. such as preferably 1-3 mm. The thickness can in one
embodiment be at the most 4 mm, or at the most 5 mm, or at the most 6 mm, or
at the most 7 mm. The unrolled collagen carrier preferably has a surface area on
its top surface (which preferably is coated with the coated layer) of 4-100 cm2,
more preferably 5-75 cmz' such as 10-50 cm2, such as e.g. 20-30 cm2, for
example 25 cm2 which can e.g. be given by a top surface of a 5 cm X 5 cm square
en sheet.
In an embodiment of the present invention, the coiled collagen carrier comprises
or consists of three, four or five windings.
In an embodiment of the present ion, the coiled collagen carrier has a
cylindrical shape with an outer diameter of less than 12 mm, such as less than 11
mm, such as less than 10 mm, such as less than 9 mm, such as less than 8 mm,
such as less than 7 mm, such as less than 6 mm, such as less than 5 mm, such as
less than 4 mm, such as less than 3 mm. For example, the coiled en carrier
has an outer diameter of 1-12 mm, such as e.g. 3-11 mm, such as e.g. 5-10 mm,
such as preferably 5-9 mm, such as e.g. 6-8 mm.
In an embodiment of the present invention, the coiled en carrier has an s-
shaped inner most winding about the longitudinal axis of the coiled en
carrier.
It is preferred that the coating of the coiled collagen carrier coating layer has no
through-going cracks, such as through-going cracks visible by the naked eye.
The present invention further relates to a packed coiled en carrier,
comprising the coiled collagen carrier according to the present ion arranged
in a container. The container can for example be sealed to prevent contamination
and/or degradation and/or to maintain form-stability of the coiled collagen carrier.
ably the ner is sealed to prevent contamination and/or absorption of
liquid solvents such as e.g. water. The container can in one embodiment further
comprise a desiccant, such as silica gel, arranged in the container.
The container can in an embodiment comprise an inner container and an outer
container. Preferably, the inner container comprises a cavity shaped as a segment
of a cylinder, and wherein the curved part of the cylinder segment extends at
least 180°, the cavity being sealed by a tear-off or breakable foil. It is preferred
that the outer container comprises a sealed pouch inside which the sealed inner
ner is arranged together with a dessicant.
The packed coiled collagen carrier according to the invention can also further
comprise a label arranged to be visually inspected without opening the package
and indicating whether the package with coiled collagen carrier has been exposed
to ion sterilization, such as to X-rays, such as to high-energy X-rays, or such
as to gamma radiation, or such as to electron beams, or such as to ultraviolet
light. The label can for example be arranged on the outside of the outer container.
The packed coiled collagen carrier according to the invention can also comprise a
sterile plastic bag with a minimal amount of air , preferably with no air being
in the bag, the bag being especially suited for protecting the coiled collagen
r from being activated by bodily fluids when using it in e.g. surgery. This is
illustrated in figure 10. This thin c bag may optionally be used after having
un-packed the packed coiled collagen carrier according to the invention.
One aspect of the invention relates to a s for the preparation of a rolled
compressed collagen carrier comprising the steps of
a) providing a collagen carrier having a coating comprising solid fibrinogen
and solid thrombin evenly distributed and fixed upon said collagen
carrier
b) optionally humidifying at least part of said collagen carrier providing an
optionally humidified collagen carrier,
c) compressing said optionally humidified collagen r providing a
compressed en carrier,
d) rolling said ssed collagen r,
e) obtaining a rolled compressed en carrier,
f) optionally drying the rolled ssed collagen carrier of step e),
g) optionally sterilizing the rolled compressed collagen carrier of step e) or
h) optionally packing the rolled compressed en carrier of step e), f)
or g) into a suitable container,
and thereby ing a rolled compressed collagen carrier having at least
one of the following al properties:
a diameter of at the most 10 mm
II. an adhesive strength of at least 40 mmHg as measured by a pressure
test (PCT) after un-rolling of said rolled compressed collagen carrier,
III. a sterility assurance |eve| (SAL) of 106.
An embodiment of the invention relates to a process according to the invention,
wherein the steps of ing said rolled compressed collagen carrier comprises
the steps of
a) humidifying at least part of said collagen carrier providing a humidified
collagen carrier,
b) compressing said humidified collagen carrier providing a compressed
collagen carrier,
C) rolling said compressed collagen carrier providing a rolled compressed
collagen carrier,
d) drying said rolled compressed collagen r,
optionally sterilizing said rolled compressed collagen r of step c) or
d),
f) optionally packing said rolled ssed collagen carrier of step c), d)
or e) into a suitable container.
An ment of the invention relates to a process according to the invention,
wherein the steps of preparing said rolled compressed collagen carrier comprises
the steps of
a) humidifying at least part of said collagen carrier providing a humidified
collagen r,
b) compressing said humidified collagen carrier providing a compressed
collagen carrier,
C) rolling said ssed collagen carrier providing a rolled ssed
collagen carrier,
d) drying said rolled compressed en carrier,
sterilizing said rolled compressed collagen carrier of step c) or d),
f) optionally packing said rolled compressed collagen carrier of step d), d)
or e) into a le container.
An embodiment of the invention s to a process according to the invention,
n the steps of preparing said rolled compressed collagen carrier comprises
the steps of
a) humidifying at least part of said collagen carrier providing a humidified
collagen carrier,
b) compressing said humidified collagen carrier providing a compressed
en carrier,
c) rolling said compressed collagen carrier providing a rolled compressed
collagen carrier,
d) drying said rolled compressed collagen carrier,
e) sterilizing said rolled compressed collagen carrier,
f) packing said rolled compressed en carrier into a le
container.
An embodiment of the invention relates to a process according to the invention,
wherein said rolled compressed collagen r has an adhesive strength of at
least 50 mmHg as measured by a pressure test (PCT) after un-rolling said rolled
compressed collagen carrier.
An embodiment of the invention s to a process according to the invention,
wherein said rolled compressed collagen carrier has an adhesive strength of at
least 60 mmHg as measured by a pressure test (PCT) after un-rolling said rolled
compressed collagen carrier.
An embodiment of the invention relates to a process ing to the invention,
wherein ethanol is used for humidifying at least part of said collagen carrier.
An embodiment of the invention relates to a process ing to the invention,
wherein said ethanol is applied in an amount of about 0.8-10.4 mg/cm2 of
collagen carrier.
An ment of the invention relates to a process according to the invention,
wherein said ethanol is applied in an amount of about 0.8-6.1 mg/cm2 of said
collagen carrier.
An embodiment of the invention relates to a process according to the invention,
wherein said ethanol is applied in an amount of about 1.2-4.7 mg/cmzof said
collagen r.
An embodiment of the invention relates to a process according to the invention,
wherein said ethanol is applied to at least one side of said collagen carrier that
does se said coating, e.g said ethanol is applied to at least one side of said
collagen carrier, wherein said at least one side comprises a coating.
An embodiment of the ion relates to a process according to the invention,
wherein said ethanol is applied to at least one side of said collagen carrier that
does not comprise said coating.
An embodiment of the invention relates to a s ing to the invention,
wherein said ethanol is applied to at least two opposing sides of said collagen
carrier wherein at least one of said sides comprises said coating.
An embodiment of the invention relates to a process according to the invention,
wherein said coating is externally ed upon said rolled compressed collagen
carrier.
An embodiment of the invention relates to a process according to the invention,
wherein said coating is internally oriented upon said rolled compressed collagen
carrier.
An embodiment of the invention relates to a process according to the ion,
wherein said ssion is med using roller compaction with a gap size
between the rollers of no more than 0.75 mm and wherein the diameter of the
rollers are about 10-100 mm.
An embodiment of the invention relates to a process according to the invention,
wherein said sterilization is performed using gamma radiation.
An embodiment of the ion s to a s ing to the invention,
wherein said collagen carriers are processed at 3-35°C and 5-80% RH (relative
humidity).
An embodiment of the ion relates to a process according to the invention,
wherein said collagen carriers are processed at 18-22°C and 36-65% RH ive
ty).
An embodiment of the invention relates to a process according to the invention,
wherein said drying results in said rolled compressed collagen carrier comprising
no more than 2.0% w/w (residual) ethanol.
An embodiment of the invention relates to a s according to the invention,
wherein said drying results in said rolled compressed collagen carrier having no
more than 1.6% w/w (residual) l.
An embodiment of the invention relates to a process according to the invention,
wherein said drying results in said rolled compressed collagen carrier comprising
no more than 10.0% w/w (residual) water.
An embodiment of the invention relates to a process according to the invention,
wherein said drying results in said rolled compressed collagen carrier comprising
no more than 8.0% w/w (residual) water.
An embodiment of the invention s to a process according to the invention,
wherein said coating comprises solid human fibrinogen in an amount of about 5.5
mg/cmzand solid human in in an amount of about 2.0 IU/cmz.
An embodiment of the invention relates to a process according to the invention,
wherein said rolled compressed collagen carrier has a loss of coating immediately
after un-rolling of less than 0.6 mg/cm2 as measured by weighing.
An embodiment of the invention s to a process according to the invention,
wherein said rolled compressed collagen r is at least partly mechanically
processed, thereby providing an at least partly mechanically rolled compressed
collagen carrier, such as a mechanically rolled compressed collagen carrier.
An embodiment of the invention relates to a process according to the invention,
wherein said collagen carrier has a y in the range of 3.0-4.5 mg/cm3. The
density of a collagen carrier of the present invention is the y of the en
carrier excluding the coating layer.
An aspect of the invention relates to a process for the preparation of a
compressed collagen carrier, comprising the steps of
a. providing a en carrier having a coating comprising solid
fibrinogen and solid thrombin evenly distributed and fixed upon
said collagen carrier
b. ally humidifying at least part of said collagen carrier
providing an optionally humidified collagen carrier,
c. compressing said optionally humidified collagen carrier providing
a compressed collagen carrier
d. optionally drying said compressed collagen r of step c),
e. optionally sterilizing said compressed collagen carrier of step c)
or d),
f. packing said compressed collagen carrier of step c), d) or e) into
a suitable container,
and thereby obtaining a compressed collagen carrier having at least one of
the ing physical properties:
I. a thickness of at the most 4 mm
II. an adhesive strength of at least 40 mmHg as measured by a pressure
test (PCT)
III. a sterility assurance level (SAL) of 106.
An embodiment of the ion relates to a process according to the invention,
wherein said compressed collagen carrier has an adhesive th of at least 50
mmHg as measured by a pressure test (PCT).
An embodiment of the invention relates to a process according to the invention,
wherein said ssed collagen carrier has an adhesive strength of at least 60
mmHg as measured by a pressure test (PCT).
An embodiment of the invention relates to a process according to the invention,
wherein said collagen carrier has a density in the range of 3.0-4.5 mg/cm3. Please
note that the density of a collagen carrier of the present invention is the y of
the collagen carrier excluding the coating layer.
An aspect of the ion relates to a s for the preparation of a rolled
collagen r comprising the steps of
a. ing a collagen r having a coating comprising solid
fibrinogen and solid thrombin evenly distributed and fixed upon
said collagen carrier
b. optionally humidifying at least part of said collagen carrier
providing an optionally humidified collagen carrier,
c. g said collagen carrier providing a rolled collagen carrier,
d. optionally drying the rolled collagen carrier of step c),
e. optionally sterilizing the rolled collagen carrier of step c) or d),
f. optionally g the rolled collagen carrier of step c), d) or e)
into a suitable container,
and thereby obtaining a rolled collagen r having at least one of the
following physical ties:
I. a diameter of at the most 10 mm
II. an adhesive strength of at least 40 mmHg as measured by a pressure
test (PCT) after un-rolling of said rolled collagen carrier, and
III. a sterility assurance level (SAL) of 106.
An embodiment of the invention relates to a process according to the invention,
wherein said rolled collagen carrier has an adhesive strength of at least 50 mmHg
as measured by a pressure test (PCT) after un-rolling said collagen carrier.
An ment of the invention relates to a process according to the invention,
wherein said rolled collagen carrier has an adhesive strength of at least 60 mmHg
as measured by a pressure test (PCT) after un-rolling said en carrier.
An embodiment of the invention s to a process according to the invention,
n said rolled collagen carrier has a loss of coating immediately after un-
rol|ing of less than 0.6 mg/cm2 as measured by weighing.
An embodiment of the invention relates to a process according to the invention,
wherein the collagen r has at least one of the following physical properties:
city module in the range of 5-100 N/cmz,
density of 1-10 mg/cm3,
chamber diameter of more than 0.75 mm and less than 4 mm
and/or having a chamber diameter average below 3 mm
and evenly distributed and fixed upon said collagen carrier
a) solid fibrinogen
b) solid thrombin.
An ment of the invention relates to a process according to the invention,
wherein said collagen carrier has a y in the range of 3.0-4.5 mg/cm3.
Please note that the density of a collagen carrier of the present invention is the
density of the collagen carrier excluding the coating layer.
An aspect of the invention relates to a s of un-rolling a rolled compressed
collagen carrier, comprising the steps of
a) providing a rolled ssed collagen carrier prepared according to the
process of the invention,
b) un-packing said rolled compressed collagen carrier from said suitable
container,
c) passing said rolled compressed collagen carrier through an access
orifice, such as a trocar
d) un-rolling said rolled compressed collagen carrier upon exit from said
access orifice,
e) obtaining an unrolled rolled compressed collagen carrier having an
adhesive strength of at least 40 mmHg as measured by a pressure test
(PCT), and a ity assurance |eve| (SAL) of 106.
An embodiment of the invention relates to a process according to the ion,
wherein said rolled compressed collagen carrier has a loss of coating immediately
after un-rolling of less than 0.6 mg/cm2 as measured by weighing.
An embodiment of the invention relates to a process according to the invention,
wherein the rolled compressed collagen carrier has an adhesive strength of at
least 50 mmHg as measured by a pressure test (PCT) after un-rolling.
An embodiment of the invention relates to a process according to the invention,
wherein the rolled compressed collagen carrier has an adhesive strength of at
least 60 mmHg as measured by a re test (PCT) after un-rolling .
An aspect of the invention relates to a process of un-rolling a rolled collagen
carrier, comprising the steps of:
a) providing a rolled collagen carrier prepared ing to the process of
the invention,
b) un-packing said rolled collagen carrier from said suitable container,
c) passing said rolled collagen r through an access e, such as a
trocar
d) un-rolling said rolled collagen carrier upon exit from said access orifice,
e) obtaining an unrolled rolled collagen carrier having an adhesive strength
of at least 40 mmHg as measured by a pressure test (PCT), and a
sterility assurance |eve| (SAL) of 106.
A process according to the ion, wherein said rolled collagen carrier has a
loss of coating ately after ling of less than 0.6 mg/cm2 as measured
by weighing.
An embodiment of the invention relates to a s according to the invention,
wherein said rolled collagen carrier has an adhesive th of at least 50 mmHg
as measured by a pressure test (PCT) after un-rolling .
An embodiment of the invention relates to a process according to the invention,
wherein said rolled collagen carrier has an ve th of at least 60 mmHg
as measured by a pressure test (PCT) after un-rolling.
WO 59635
Another aspect of the invention relates to a rolled ssed collagen carrier
prepared according to the process of the invention, said rolled compressed
collagen carrier having a coating comprising solid fibrinogen and solid thrombin
that is evenly distributed and fixed upon said en carrier, and having at least
one of the following physical ties:
I. a diameter of at the most 10 mm
II. an adhesive strength of at least 40 mmHg as measured upon un-
rol|ing by a pressure test (PCT)
III. a sterility assurance level (SAL) of 106.
An embodiment of the invention relates to a rolled compressed collagen carrier
according to the invention, wherein said coating comprises solid human fibrinogen
in an amount of about 5.5 mg/cmzand solid human thrombin in an amount of
about 2.0 IU/cmz.
An ment of the invention s to a rolled compressed collagen carrier
according to the invention, wherein said collagen carrier has a diameter of at the
most 8 mm.
An embodiment of the invention relates to a rolled compressed collagen carrier
according to the invention, wherein said coating is externally oriented.
An embodiment of the ion s to a rolled compressed collagen r
according to the invention, wherein said coating is internally oriented.
An embodiment of the invention relates to a rolled compressed en carrier
according to the invention, wherein said drying results in said collagen carrier
comprising no more than 2.0% w/w (residual) ethanol.
An embodiment of the invention relates to a rolled compressed en carrier
according to the invention comprising no more than 1.6% w/w (residual) ethanol.
An embodiment of the invention relates to a rolled compressed collagen carrier
according to the invention comprising no more than 8.0% w/w (residual) water.
WO 59635
An embodiment of the invention relates to a rolled compressed collagen r
ing to the invention sing no more than 5.0% w/w (residual) water.
An embodiment of the invention relates to a rolled compressed collagen carrier
according to the invention, wherein said collagen carrier has been irradiated by
gamma radiation.
An embodiment of the invention relates to a rolled compressed collagen carrier
according to the invention, wherein said collagen carrier has an adhesive strength
of at least 50 mmHg as measured by a pressure test (PCT) after un-rolling said
collagen r.
An embodiment of the invention relates to a rolled ssed collagen carrier
according to the invention, wherein said collagen carrier has an adhesive strength
of at least 60 mmHg as measured by a pressure test (PCT) after un-rolling said
collagen carrier.
An embodiment of the ion relates to a product according to the invention,
wherein said rolled compressed collagen carrier is at least partly mechanically
processed, thereby ing an at least partly mechanically rolled compressed
collagen carrier, such as a mechanically rolled compressed en carrier.
An aspect of the invention relates to a rolled compressed collagen carrier
obtainable by a process comprising the steps of
a. providing a collagen carrier having a coating comprising
solid ogen and solid thrombin that is evenly
distributed and fixed upon said collagen carrier,
b. optionally humidifying at least part of said collagen carrier
providing an optionally fied collagen carrier,
c. compressing said optionally humidified collagen carrier
providing a compressed collagen carrier,
d. rol|ing said compressed collagen carrier,
e. obtaining a rolled compressed collagen carrier
f. optionally drying the rolled compressed collagen carrier of
step e),
g. optionally sterilizing said rolled compressed collagen
carrier of step e) or f),
h. optionally g said rolled compressed collagen carrier
of step e), f) or g) into a suitable container
and thereby obtaining a rolled compressed collagen having at least one of
the following physical properties:
I. a diameter of at the most 10 mm
II. an adhesive strength of at least 40 mmHg as measured by a
pressure test (PCT) after un-rolling of said collagen r
III. a sterility assurance level (SAL) of 106.
An ment of the invention relates to a rolled compressed en carrier
able by a process according to the invention, wherein said rolled
compressed collagen r is at least partly mechanically processed, thereby
providing an at least partly mechanically rolled compressed collagen carrier, such
as a mechanically rolled compressed en carrier.
An aspect of the invention relates to an unro|led rolled compressed collagen
carrier according to the invention having at least one of the following physical
properties:
I. a thickness of at the most 4 mm
II. an adhesive strength of at least 40 mmHg as measured by a
pressure test (PCT)
III. a sterility assurance |eve| (SAL) of 10'6
IV. said rolled compressed collagen carrier is capable of adhering to the
tissue while being unro|led without recoiling.
An embodiment of the ion relates to an unro|led rolled compressed collagen
carrier ing to the invention, wherein said unro|led rolled compressed
collagen carrier is at least partly mechanically processed, thereby providing an
ed at least partly ically rolled compressed collagen carrier, such as
an unro|led mechanically rolled compressed collagen carrier.
An aspect of the invention relates to an unrolled rolled compressed collagen
carrier ing to the invention having a g comprising solid fibrinogen and
solid thrombin evenly distributed and fixed upon said collagen carrier, and having
at least one of the following physical properties:
I. a thickness of at the most 4 mm
II. an adhesive strength of at least 40 mmHg as measured by PCT
chamber
III. a ity assurance level (SAL) of 10'6
IV. said rolled compressed collagen carrier is capable of adhering to the
tissue while being unrolled t recoiling
An embodiment of the invention relates to an unrolled rolled compressed collagen
carrier according to the invention, wherein said unrolled rolled compressed
collagen r is or has been at least partly mechanically processed, y
providing an ed at least partly mechanically rolled compressed collagen
carrier, such as an unrolled mechanically rolled compressed collagen carrier.
An aspect of the invention relates to a ssed collagen carrier according to
the invention having a coating comprising solid fibrinogen and solid thrombin that
is evenly distributed and fixed upon said collagen carrier, and having at least one
of the following physical properties:
I. a thickness of at the most 4 mm
II. an adhesive strength of at least 40 mmHg as measured by a
pressure test (PCT)
III. a sterility nce level (SAL) of 106.
An embodiment of the invention relates to a compressed collagen carrier
according to the invention, wherein said compressed collagen carrier is at least
partly mechanically processed, thereby providing an at least partly mechanically
ssed collagen carrier, such as a mechanically compressed collagen r.
An further aspect of the invention relates to a rolled collagen r according to
the invention having a coating comprising solid fibrinogen and solid thrombin that
is evenly distributed and fixed upon said collagen carrier, and having at least one
of the following physical properties:
I. a diameter of at the most 10 mm
II. an adhesive strength of at least 40 mmHg as measured by a
pressure test (PCT) after un-rolling of said en carrier
III. a sterility assurance level (SAL) of 106.
An embodiment of the invention relates to a rolled collagen carrier according
to the invention, n said rolled collagen carrier is at least partly
mechanically processed, thereby providing an at least partly mechanically
rolled collagen carrier, such as a mechanically rolled collagen carrier.
Delivery of the rolled/coiled collagen carrier according to the present in vention to
the target location
One aspect of the t invention relates to a method for delivering the coiled
collagen carrier according to the present invention to a target location. Said
method comprises the step of passing said coiled collagen carrier through an
orifice or access tube to the target location. Any suitable instrument or device, or
even the medical practitioner's hand, may be used for g the coiled collagen
carrier through the orifice or access tube. le instruments can e.g. be one or
more of: surgical scissors, graspers, forceps, dissectors or retractors.
In one ment of the present invention, an access tube is used, and it is
preferably dry (i.e. contains no moisture). Said access tube is preferably a
surgical trocar, such as a disposable trocar. By t location" is preferably
meant any location to which it is desired to contact and/or adhere the coiled
collagen r of the present invention. In one embodiment the target location is
a synthetic surgical model for demonstration/educational es. The target
location can in another embodiment be an organ or tissue. In one embodiment of
the present invention the target on is an organ or tissue which has been
isolated from a human or animal, such as a pig. In another embodiment of the
present invention said target location is in vivo in a human or animal, such as e.g.
an organ (for example selected from the group ting of: lung, kidney, liver,
blood vessel) or e.g. any of but not limited to the organs listed in earlier herein in
the definitions section.
After delivery to the target on the coiled collagen carrier can be maintained
in the coiled state and not unrolled. This can be advantageous for example in the
case of applying the coiled collagen carrier inside e.g. a cavity or hole in an organ
or tissue, such as in lung surgery as e.g. illustrated in figure 7. In another
embodiment of the present invention, the method for delivering the coiled
collagen carrier further comprises the step of un-rolling the coiled collagen carrier
before or during the application onto the target location. This unrolling step can
for example be carried out by abutting and maintaining the edge of the coiled
collagen carrier to the target location as e.g. rated in figure 8. In another
ment of the present invention, the coiled collagen carrier is uncoiled prior
to contacting the target location as e.g. rated in figure 10. In another
embodiment of the t invention, the coiled collagen carrier is packed in a
sterile plastic bag with a l amount of air inside especially suited for
protecting the coiled collagen carrier from being activated by bodily fluids when
using it in e.g. surgery. This is also illustrated in figure 10 although the c bag
type shown is a large one compared to the ones preferably used. The preferred
used e c bag with a minimal amount of air inside may optionally be
used after having un-packed the packed coiled collagen carrier according to the
invention but prior to passing the coiled collagen carrier through the orifice or
access tube.
One or more guiding device(s) suitable for g the un-coiling of the coiled
collagen carrier may be used to guide the uncoiling process, such as any le
standard surgical instrument, such as any suitable endoscopic instrument. In
another embodiment, a specific uncoiling device may be used, suitable for e.g.
gripping the coiled collagen carrier at one end and unrolling it at the other end. In
one preferred embodiment, the coiled collagen carrier is gripped at one end with a
g device (such as a pair of grip tongs or graspers or forceps), and another
guiding device (such as a pair of graspers) is used to carefully unro|| the en
carrier onto the target location.
In one embodiment of the present invention, the collagen carrier is positioned at
the target site using at least one grasper. Optionally, a further guiding device is
used to guide the unrolling process, such as by using a second instrument such as
graspers.
In one embodiment of the present invention, the coiled collagen r is used in
open surgery. For open surgery applications, the coiled carrier can for example be
ed using e.g. the medical practitioner's hands or any standard surgical
instrument, such as one or more of: surgical rs, graspers, forceps,
dissectors or retractors.
During the ing/uncoiling s for a coated collagen carrier, the guiding
device, surgical instrument or medical practitioner's hand(s) should preferably
only contact the non-coated side of the collagen carrier to prevent damage to the
coating side. During and after the unrolling process at the target on, the
surgeon may choose to further moisten the collagen carrier using e.g. saline
solution, and/or to apply pressure on the collagen carrier, for example using the
medical practitioner's hand or a swab or wipe, such as a moistened swab or wipe,
optionally applied using e.g. a grasper. Optional moistening of the collagen carrier
using a rinsing/sucking/spraying system may also be applied. In one embodiment,
multiple moistened swabs or wipes are applied (for example, applied using
multiple graspers), such as using two moistened swabs or wipes applied using two
sets of graspers as e.g. illustrated in figure 9. If pressure is applied to the collagen
carrier after application to the target location, this can for example be for n
seconds and 6 minutes, such as e.g. for 1-5 minutes, such as for example for
3-5 minutes or for 2-3 minutes or for 2 minutes or for 3 minutes. Multiple cycles
of moistening and compression can be applied to the collagen r. In case the
bleeding is not fully stopped by application of one en carrier, further
en carriers can be applied, for example 1 or 2 further en rs.
Preferably, if a coated collagen carrier (such as TachoSil®) is used in the unrolling
process, the collagen carrier is unrolled with the coated side of the collagen carrier
facing the target location.
After delivery to the target site the collagen carrier will preferably adhere to the
target site and cause tasis to occur at and around the target site. Any
swabs or wipes used are preferably removed carefully, optionally while g the
collagen carrier in place using a suitable surgical instrument, such as a pincet or
graspers.
2012/050178
In one preferred embodiment of the unrolling method, all s contacting the
coiled collagen carrier before the en carrier contacts the target location (for
example: surgical gloves, surgical instruments and the access tube or orifice) are
dry and contain no moisture or fluids. It is also preferred that the collagen carrier
remains dry until application to the target area. This can e.g. be achieved either
by very e and careful manipulation of the collagen carrier or by keeping the
collagen carrier inside a plastic bag up until delivery to the target location. Thus in
one ment of the present invention the coiled en carrier is delivered to
the target on in a sterile plastic bag with a minimal amount of air . The
coiled collagen carrier may have been pre-packed in a sterile plastic bag with a
minimal amount of air inside in the product packaging, or alternatively the
collagen r may be inserted into the sterile bag after removal from the
product packaging. The plastic bag can be removed after the collagen carrier
reaches the target location.
A sterile plastic bag with a minimal amount of air inside may be used to apply
pressure to the en carrier after ation to the target site. This plastic bag
may optionally be a part of the original product packaging, i.e. in one embodiment
of the present invention, the coiled collagen carrier is pre-packed in a sterile
plastic bag with a minimal amount of air inside.
In one embodiment of the herein-described ing/delivery method, the
collagen carrier roll has an outer diameter of not more than 12 mm and wherein
the e or access tube (such as a trocar), has a diameter of not more than 12
mm. The un-rolling/delivery method may furthermore comprise the step of un-
packing the coiled collagen carrier from the container. This can for example be
done using an un-packing device and/or gloved hands.
In particular, the rolled/coiled collagen carrier of the present invention is for use
in therapy and/or a method of surgery, such as e.g. practised on the human or
animal body. The terms "surgery" and "method of surgery" are used
interchangeably herein. Thus, one embodiment of the present invention relates to
the coiled collagen carrier according to the present invention for use in therapy.
2012/050178
Another embodiment of the present invention relates to the coiled collagen carrier
ing to the t invention for use in surgery.
For this therapy and/or method of surgery it is preferred to use at least some (or
all) of the features of one or more of the methods for delivering the coiled
collagen carrier to a target location as described herein.
One embodiment of use of the coiled collagen carrier of the present invention for
use in therapy and/or a method of surgery is a method of arresting rhage
associated with ming minimally invasive surgery using the coiled en
carrier according to the present invention. Another embodiment is a method of
treating injury associated with performing minimally invasive surgery using the
coiled collagen carrier according to the present invention. Another embodiment is
a method of treating injury associated with performing endoscopic treatment,
laparoscopy treatment, or thoracoscopy treatment using the coiled en
carrier according to the t invention. Another embodiment is a method of
treating and/or preventing injury associated with ming endoscopic surgery
using the coiled collagen r according to the t invention. Another
embodiment is a method of treating or preventing hemorrhage in human or
animal tissue or a tissue sample in need of tasis using the coiled collagen
carrier according to the present invention. Another embodiment is a method of
treating human or animal tissue or a tissue sample in need of sealing and/or
g|ueing using the coiled collagen carrier according to the present invention.
Another embodiment is use of the coiled collagen carrier according to the present
invention in keyhole surgery. Another embodiment is use of the coiled collagen
carrier according to the present ion in open surgery, wherein the coiled
en carrier can either be administered and left uncoiled in vivo, or wherein
the collagen carrier is ed (for example. using e.g. two or more sets of
ordinary surgical graspers). A further embodiment is a method of treating human
or animal tissue or a tissue sample in need of coverage to prevent the
development of post-surgical tissue adhesions. Another embodiment is use of the
coiled collagen carrier according to the present invention in endoscopy,
laparoscopy, or thoracoscopy.
Examples of suitable surgical procedures include but are not limited to: colon
resection, cryotherapy of the kidney, partial nephrectomay, lung surgery, video-
assisted thoracoscopic surgery, liver resection surgery, hypodermic injection, air-
re injection, subdermal implants, endoscopy, percutaneous surgery,
laparoscopic surgery, thoracoscopic surgery arthroscopic surgery, cryosurgery,
microsurgery, keyhole surgery, endovascular surgery (such as angioplasty),
coronary catheterization, permanent spinal and brain electrodes, stereotactic
y, The Nuss Procedure, radioactivity-based medical imaging methods, such
as gamma camera, Positron emission tomography and SPECT (single photon
emission tomography), image-guided surgery, robotic y, interventional
ogy, esophagogastroduodenoscopy, enteroscopy, colonoscopy,
sigmoidoscopy, magnification endoscopybile duct endoscopic retrograde
giopancreatography (ERCP), duodenoscope-assisted
cholangiopancreatoscopy, intraoperative cholangioscopy, rectoscopy, proctoscopy,
rhinoscopy, bronchoscopy, pe, cystoscopy, gynoscopy, colposcopy,
hysteroscopy, falloposcopy, laparoscopy, arthroscopy, thoracoscopy,
mediastinoscopy, amnioscopy, fetoscopy, plastic surgery panendoscopy,
laryngoscopy, esophagoscopy, bronchoscopy, orthopedic surgery, hand y
(such as endoscopic carpal tunnel release and epidural space (epiduroscopy)).
Preferably, the rolled/coiled collagen carrier of the t invention is for use as
supportive therapy in surgical procedures or as a prophylactis adjunct therapy in
surgical procedures. The rolled/coiled collagen carrier of the present ion can
also be used as an adjunct to haemostasis for use in y (such as e.g.
cardiovascular surgery), such as when l of bleeding by rd surgical
techniques (such as sututre, ligature or caurtery) are ineffective or impractical.
For example, the coiled collagen carrier can be used for improvement of
haemostasis and/or to promote tissue sealing, and/or for suture support (such as
in vascular surgery).
A further aspect of the invention relates to a rolled compressed collagen carrier
according to the ion for use in tissue sealing, tissue gluing and haemostasis.
An aspect of the invention relates to a rolled ssed en carrier
according to the invention for use in minimally invasive surgery.
An aspect of the invention relates to a rolled compressed collagen carrier
according to the invention for use in endoscopic surgery.
An embodiment of the invention is to provide an at least partly mechanically rolled
compressed collagen carrier according to the ion for use in tissue sealing,
tissue g|uing and haemostasis.
An ment of the invention is to provide an at least partly mechanically rolled
compressed collagen r according to the invention for use in minimally
ve surgery.
An embodiment of the invention is to provide an at least partly mechanically rolled
compressed collagen carrier according to the invention for use in endoscopic
surgery.
An aspect of the invention is to provide an unro|led rolled ssed collagen
carrier according to the ion for use in tissue g, tissue g|uing and
haemostasis.
An aspect of the invention is to provide an ed rolled compressed collagen
carrier according to the invention for use in minimally invasive surgery.
An aspect of the invention is to provide an unro|led rolled compressed collagen
carrier according to the invention for use in endoscopic surgery.
An embodiment of the invention is to provide an unro|led at least partly
mechanically rolled compressed collagen carrier according to the invention for use
in tissue sealing, tissue g|uing and haemostasis.
An ment of the invention is to provide an unro|led at least partly
mechanically rolled compressed collagen carrier according to the ion for use
in minimally invasive surgery.
An embodiment of the invention is to provide an unrolled at least partly
mechanically rolled compressed collagen carrier according to the invention for use
in endoscopic y.
An embodiment of the invention s to a method for prevention or treatment
of tissue in need of sealing and/or gluing, the method sing applying a rolled
compressed collagen carrier according to the invention to said tissue in need
thereof.
An embodiment of the invention relates to a method for prevention or treatment
of bleeding in tissue in need of haemostasis, the method comprising applying a
rolled compressed collagen carrier ing to the invention to said tissue in
need thereof.
An embodiment of the invention relates to a method for prevention or treatment
of injury associated with performing minimally invasive surgery, the method
comprising applying a rolled compressed collagen r according to the
invention to said injury in need thereof.
An embodiment of the invention relates to a method for prevention or treatment
of injury associated with performing endoscopic treatment, laparoscopy
treatment, or thoracoscopy treatment, the method comprising applying a rolled
compressed collagen carrier ing to the invention to said injury in need
thereof.
An embodiment of the ion relates to the use of a rolled compressed collagen
r according to the invention for the preparation of a ment for the
prevention or treatment of tissue in need of sealing and/or gluing.
An embodiment of the invention relates to the use of a rolled ssed collagen
carrier according to the invention for the preparation of a medicament for the
prevention or treatment of bleeding in tissue in need of haemostasis.
An embodiment of the invention relates to the use of a rolled compressed collagen
carrier according to the ion for the preparation of a medicament for the
2012/050178
prevention or treatment of injury associated with performing minimally invasive
surgery.
An embodiment of the invention relates to the use of a rolled compressed collagen
carrier according to the inventionfor the preparation of a medicament for the
prevention or treatment of injury associated with performing endoscopic
ent, |aparoscopy treatment, or thoracoscopy treatment.
Another aspect of the invention relates to a rolled ssed en carrier
ing to the ion for use in the prevention or treatment of tissue in need
of sealing and/or gluing.
An aspect of the invention relates to a rolled compressed collagen carrier
according to the invention for use in the prevention or treatment of bleeding in
tissue in need of haemostasis.
A further aspect of the invention relates to a rolled compressed collagen carrier
according to the invention for use in the prevention or treatment of injury
associated with performing minimally invasive surgery.
Still another aspect of the ion relates to a rolled compressed collagen carrier
according to the invention for use in the prevention or treatment of injury
associated with performing endoscopic treatment, |aparoscopy treatment, or
thoracoscopy ent.
A further embodiment of the ion relates to a coiled collagen carrier
according to the invention for use in the prevention or ent of hemorrhage
in human or animal tissue or a tissue sample in need of haemostasis.
A r embodiment of the invention relates to a coiled en carrier
according to the invention for use in the prevention or treatment of injury
associated with performing minimally invasive surgery.
A further embodiment of the invention relates to a coiled collagen carrier
according to the invention for use in the prevention or treatment of injury
associated with performing opic treatment or
, Iaparoscopy treatment,
thoracoscopy treatment.
A further embodiment of the invention relates to a coiled collagen carrier
according to the invention for use in the prevention or treatment of injury
associated with performing opic surgery.
A further embodiment of the invention relates to a coiled collagen carrier
according to the invention for use in the tion or treatment of post-surgical
tissue adhesions.
A further embodiment of the invention relates to a coiled collagen r
according to the invention for use in the prevention or treatment of post-surgical
tissue adhesions in human or animal tissue or a tissue sample in need of
cove rage.
A further embodiment of the invention relates to a coiled collagen carrier
ing to the invention for use in the prevention or treatment of tissue or a
tissue sample in need of sealing/glueing.
It should be noted that embodiments and features described in the context of one
of the aspects of the t invention also apply to the other aspects of the
ion i.e. all aspects relating to a rolled compressed collagen carrier also apply
to a compressed collagen carrier, or a rolled collagen carrier, or an unrolled rolled
compressed collagen r.
All patent and non-patent references cited in the present application, are hereby
incorporated by reference in their entirety.
The invention will now be described in further details in the following miting
examples.
Apparatus
Reference is made to figure 11, which shows schematically a preferred
embodiment of an apparatus 10 for providing a coiled collagen carrier. The
apparatus comprising a number of elements as shown in the figure and comprises
in particular a device for applying moisture 2 to a collagen carrier 3 prior to coiling
of a collagen carrier as disclosed herein.
The device for applying moisture 2 comprising a spray nozzle 4 directed towards
the surface of the coating layer of the collagen r, the spray nozzle 4 provides
droplets as a mist or a spray of solvent. Thus, the collagen carrier is orientated
with its coating surface facing upwardly towards the spray nozzle 4. The t
ates into the collagen carrier 3 and softens the collagen carrier 3. It has
been found that, it may be ient to humidify only the coating layer or a upper
part thereof of the collagen r, gh it may be red to soak the
whole collagen carrier 3, that is soaking both the coating layer and the collagen
layeh
The apparatus 10 r comprises a coiling device 5, which is adapted to grip
the moisturised collagen r 3 along an edge and coil it into a coiled collagen
r 1. The coiling device 5 comprises rotatable gripping means 6 for gripping
the en carrier along an edge 7 of the collagen carrier 3 and coil the collagen
carrier 3 by rotation of the gripping means 6 around an axis being el to the
longitudinal extension of the gripping means 6.
Gripping along the edge 7 and rotating the gripping means 6 may not provide a
coiling or a coiled collagen carrier 1 having a desired shape if the en carrier
is not supported during coiling. To assure coiling and assist in defining the shape
of the coiled collagen carrier 1, the coiling device 5 further comprises a support
device 8 supporting the collagen carrier while being coiled. The support device 8 is
typically a cavity arranged relatively to the gripping means 6 so that the surface
of the support device 8 acts as counter pressure means by at least a part of the
collagen carrier 3 abuts at least a part of the inner surface of the cavity during
coiling. As mentioned, the shape of the surface of the t device at least
assists in defining the shape of the coiled collagen carrier 1.
The gripping device 6 comprises a pair of elongated members 9, such as a pair of
tweezers or pincers. The elongated members 9 has a longitudinal extension
matching the width of the collagen carrier 1 - the width of the collagen carrier is
considered to be the dimension parallel to the extension of the elongated
members 9 — y the collagen carrier is gripped at the edge along the whole
width by the elongated members 9.
Gripping of the collagen carrier 3 is accomplished by decreasing the distance
between the two ted members 9 once the collagen carrier 3 is located in
between the elongated members 9 to an extent providing a gripping being
sufficient to provide coiling once the elongated s 9 are rotated.
As shown in figure 11, the support device 8 is a cavity comprising a bottom part
shaped as a segment of a cylinder having at least one open end through which the
elongated members extend, and wherein the curved part of the cylinder segment
extends at least 180°. The upper part of the cavity is constituted by two parallel
straight wall segments 8a so that the cavity has the shape of an open channel.
The elongated members 9 of the gripping device 6 extend into the cavity of the
support device 8 h the open end. The elongated members 9 are
furthermore extractable so that once the collagen carrier 3 has been coiled and is
located in the cavity of the support device 8, the elongated members 9 are
extracted from the coiled collagen carrier 1. The elongated members 9 are
extracted in a direction being parallel to the longitudinal ion of members.
When another collagen carrier 3 is to be coiled, the ted members 9 are
introduced back into the cavity of the support device 8 by moving the elongated
members 9 in the opposite direction than during the extraction.
As indicated in figure 11, the result of the coiling is an coiled collagen r in
the form of elongated member with an ed core. The two curves of the “S”
is defined by the ted members 9. Furthermore, the rotation of the gripping
device 6 is adapted to arrange the edge 14 so that it abuts the wall of the cavity
which fixate the edge 14 relatively to the remainder of the coiled collagen carrier
The apparatus 10 further comprises a ssing device 11. The compressing
device 11 being arranged to ss the moisturised collagen carrier 3 prior to
coiling of the moisturised collagen carrier, that is as indicated in figure 11, the
compressing device being arranged after the device for ng moisture 2 and
before the coiling device 5.
The compressing device comprises a pair of rollers 12 arranged to ss the
rised collagen carrier 3 prior to coiling of the moisturised collagen carrier.
The compression being provided e the gap in between the rollers is smaller
than the ess of the moisturised collagen carrier. As indicated in figure 11,
the rollers 12 rotate in opposite directions so as to transport the collagen carrier
through the pair of rollers 12 towards the coiling device 5.
After the collagen carrier 3 has been coiled into a coiled collagen carrier it is still
moisturised (contains solvent) and is still softened. To provide a form-stable
coiled collagen carrier 1, the en carrier is de-moisturised which is provided
by drying the coiled collagen carrier 1. The apparatus ingly further
comprising at least a drying means (not shown in the figure) for drying one or
more coiled collagen carriers subsequently to the coiling.
The drying means may typically be embodied as a drying tunnel h which
the coiled collagen carrier 1 passes and inside which drying tunnel the
temperature is elevated relatively to the temperature of the coiled collagen carrier
1 and the relative solvent content in the air is kept low. These two measures
(elevated temperature and low relative solvent content) promote transport of
solvent from the coiled collagen carrier 1 to the air inside the drying .
Forced circulation of the air may advantageously be applied to enhance removal of
solvent from the coiled collagen carrier 1.
The tus is advantageously embodied so as to provide an automated
production of coiled collagen carriers 1. As ted in figure 11, the apparatus is
embodied as an assembly line which s the collagen carriers 3 through the
various production stages.
Thus, apparatus 10 comprises a first conveyer device 13 which conveys collagen
carriers 3 prior to coiling past the moisturiser device 2 and to the coiling device 5.
WO 59635
On its way from the moisture device 2 and to the g device 5, the moisturised
collagen carriers 3 pass through the pair of s 12 arranged to compress the
moisturised en carrier prior to coiling of the moisturised collagen r, and
the first conveyer device 13 conveys the moisturised collagen carriers 3 to the
pair of rollers 12. It is noted that conveying of the moisturised collagen carrier 3
from the end of the first conveyer device 13 and to the gap between the pair of
rollers 12 can be ed by guides (not shown) which guides the moisturised
en carriers 3 to the pair of rollers 12. As a compression is performed by the
pair of rollers 12, the rotation of the rollers 12 conveys the moisturised collagen
carrier 3 through the compression device 11 and to the coiling device 5. Again,
suitable guiding means (not shown) may be applied to guide the collagen carriers
3 to the position in the cavity of the coiling device 5 in which the gripping means 6
may grip the en carrier along an edge and coil the collagen carrier 3. The
guides and guiding means are made from an inert material that does not
containimate the collagen carriers by e.g. rubbing off of material.
rmore, to assist the automated production of coiled collagen carriers 1, the
cavity of the coiling device 5 is formed in a second conveyer device. While the first
conveyer device 13 conveys the collagen carrier 3 at a constant speed, the second
conveyer device typically conveys coiled collagen rs 1 step wise; that is as
long as the coiling takes place, the second conveyer device is at rest and once
coiling is finished (the edge 14 is arranged so as to abut the surface of cavity and
the elongated members 9 extracted) the second er device moves to
arrange an empty cavity below the pair of rollers and in front of the extracted
elongated members 9.
The conveying speed of the first conveyer device is set in accordance with the
amount of solvent being applied from the nozzles 14 to obtain a predefined
amount solvent applied per surface area of the collagen carrier 3.
The orientations and mutual arrangements of the s parts presented in figure
11 are implemented in the apparatus as implemented in the figure. That is, the
first conveyer device 13 is arranged above the coiling device 5 with the pair of
rollers 12 arranged in between.
2012/050178
Contamination of the collagen carriers is often an issue that must be taken care of
during humidification, compression, coiling and drying. To avoid contamination,
the various parts used for producing the coiled collagen r are shielded from
the environment by a t. Thus, the apparatus may typically comprise a
cabinet g the moisturiser device 2, and/or the pair of rollers 12, and/or the
coiling device 5, and/or the support device 8, and/or the first 13 and/or the
second conveyer device.
The apparatuses disclosed herein are adapted to m a process for coiling a
collagen carrier comprising a collagen layer and a coating layer comprising mostly
solid fibrinogen and mostly solid thrombin. In the following, preferred
embodiments of processes according to the present invention will be disclosed.
Reference is made to figure 11 and the elements and parts presented therein are
referenced by nce numbers — this is not intended to limit the processes to
the apparatus disclosed in figure 11.
ses according to the invention typically comprise the sequential steps of
humidifying at least part of a collagen carrier 3, and coiling the collagen carrier 3
by gripping the collagen carrier 3 between a pair of elongated members 9, and
rotating the pair of elongated members 9 about an axis being parallel to a
longitudinal extension of the elongated members 9 in order to coil the collagen
carrier 3 on the members, while the collagen carrier 3 is supported by a support
device 8.
The humidifying and coiling steps are preferably executed as two separate steps
as disclosed above in on to the embodiment of the apparatus 10, which steps
are executed consecutively to each other. The time between humidifying and
coiling is selected so that the softening effect obtained by the humidification on
the collagen r 3 is t while the collagen carrier 3 is coiled.
After the collagen carrier 3 has been coiled, the process involves a step of drying
the coiled collagen r 1. The drying steps removes solvent from the coiled
collagen carrier and the drying step is lly and preferably performed while the
coiled en carrier is supported so as to in its coiled shape during
drying. The result of the process is a form-stable coiled collagen carrier 1.
The coiling is performed by ng the collagen carrier using at least one
gripping device and the collagen carrier is gripped along an edge of the en
carrier 3. The coiling is performed by gripping the collagen carrier using at least
one pair of tweezers or pincers 9.
Drying of the coiled en carrier 1 is typically performed by blowing air with
humidity lower than the coiled collagen carrier and optionally applying heat to the
air to enhance e.g. evaporation of the liquid used to humidify the collagen carrier
3. It is noted that the term ty is to be understood broadly and not limited
only to water. For instance, humidity is also used to cover the concentration in the
air of the t used to humidify the collagen carrier 3.
As noted above, the s involves humidifying at least a part of the collagen
carrier and in some embodiments of the invention the part being humidified is the
coating layer. Typically, the fication step is performed by spraying droplet
of liquid onto the surface of the coating layer, and the humidification is obtained
by the liquid penetrating into the g layer of the collagen carrier 3 e.g. by a
ary action. Thus, the amount of liquid present in e.g. the coating layer may
vary with the depth; however, as one aim of humidifying is to soften the collagen
carrier 3 such variations in liquid amounts are acceptable. In many preferred
embodiment, the the coating layer has been humidified using a solvent applied
onto the surface of the coating layer in an amount 1.2-10.75 mg/cm2 surface of
collagen carrier 3. The solvent used typically comprises or consists of ethanol.
A process according to the present invention may further comprise a step of
compressing the collagen carrier 3 which compression reduces the thickness of
the en carrier. While different compression ratio, i.e. ratio n the
thickness of the collagen carrier 3 before and after compression, may vary, the
collagen carrier is preferably compressed with a compression ratio between 6 and
12. The compression is performed after the humidifying step and before the
coiling step, that is the ssion is performed prior to coiling of the collagen
carrier.
An ent compression has proven to be performed by passing the humidified
collagen carrier through a set of rollers 12 having a gap size being r than
the thickness of the collagen carrier 3 before passing through the set of rollers 12.
The gap size is selected so as to provide the desired compression ratio. Typically
and preferred numbers for the gap size is no more than 0.5, preferably no more
than 0.6 or n 0.5-1.0 mm, or no more than 0.75 mm. However, the gap
size should be selected in accordance with the thickness of the collagen carrier 3
so as to obtain the desired compression ratio.
After the collagen carrier 3 has been humidified, optionally compressed and
coiled, the coiled collagen carrier 1 is still softened and may have a tendency to
un-coil during drying e.g. due to gravity effects and/or some mechanical tension
in coiled collagen carrier 1. To assure that the coiled collagen carrier 1 hardens in
the coiled shape, the edge (see number 14 in figure 11) of the coiled collagen
carrier 1 arranged on the outside of the coil after coiling is abutting the surface of
the cavity and y being fixated by the t device 8 relatively to the
coiled collagen carrier 1 during drying.
Once the coiled collagen carrier 1 has dried the softened parts of the collagen
carrier has ed and the coiled collagen carrier 1 is form-stable.
The support device 8 is as disclosed above with nce to figure 11 a cavity
having a bottom part shaped as a segment of a cylinder having at least one open
end through which the elongated members extend into the cavity, and wherein
the curved part of the cylinder segment extends at least 180°. During the coiling
process, the outer edge 14 of the collagen carrier is ed inside the part of
the cavity formed as a t of cylinder and the edge 14 abuts the inner
surface of the cavity. Once the edge 14 abuts the inner surface, the coiling
process is terminated and the gripping means in the form of a pair of elongated
members 9 is extracted from the coiled collagen carrier through the open end of
the cavity.
Extraction of the elongated s 9 from the coiled collagen r 1 may
involve securing of the coiled collagen carrier 1 inside the cavity if the elongated
members 9 do not slide easily out from the coiled en carrier 1. Such
securing may be provided by mechanically pressing the coiled collagen carrier
toward the bottom of the cavity while extracting the elongated members, or a
lattice structure may be arranged to prevent the coiled collagen member from
sliding out of the cavity h the open end of the cavity while allowing
extraction of the elongated members; thereby the dragging action from the
elongated members on the coiled collagen carrier 1 may be outbalanced by the
e structure, or the pressing action.
Once the ted members 9 are extracted, any securing may be released. The
extraction of the elongated members 9 is typically performed before drying of the
coiled collagen carrier. The pair of elongated members may be tuted by a
pair of tweezers and the process disclosed above is the same.
The atmosphere surrounding the collagen carrier 3 and humidification device 2
while the collagen carrier 3 being humidified, compressed and coiled is typically
maintained at a temperature of 18-220 C and a ve humidity of 30-50%.
After the coiled collagen carrier 1 has been dried to form a form-stable en
carrier, the process may include the step of arranging the table coiled
collagen carrier 1 in a container and subsequently g the container. The step
of arranging the coiled collagen r in a sealed container prevents the coiled
en carrier 1 from being humidified and/or contaminated. Furthermore, the
step of arranging the coiled collagen carrier 1 in a sealed container may also
comprise the steps of arranging the coiled collagen carrier 1 in an inner container
and arranging the inner container in an outer container. In addition, a desiccator
may be arranged inside the outer container prior to g of the container.
While an aim of the process is to provide a sterile coiled collagen carrier packed in
one or more containers, the process may also include a sterilizing step during
which the container(s) with coiled collagen carrier is exposed to a sterilizing
process. The sterilizing may typically be ion sterilization. To make it easy
detectable whether a given coiled collagen r 1 has been sterilized, a label
indicating whether sterilization has been carried out or not may be arranged on
the outside of the outer container — or container in general.
An often preferred sterilization step comprises izing the coiled collagen
carrier 1 using gamma radiation. The sterilization of the coiled collagen carrier 1 is
often performed to a sterility assurance level (SAL) of 10'6 using gamma
radiation.
Coiled collagen carrier
As outlined above, the processes and apparatuses are used to produce form-
stable coiled collagen carrier 1. The processes and apparatuses disclosed above
have proven to be efficient to produce the coiled en carrier 1; however
coiled collagen carriers 1 as such are ered within the scope of the t
invention.
Thus, the present invention comprising a coiled collagen carrier 1 having a
collagen layer and a coating layer on top of the collagen layer. The coating layer
comprising mostly solid thrombin and mostly solid ogen although all the
in and/or all the fibrinogen may be solid.
The coiled collagen carrier has typically the shape of a elongate element with a
number of windings of the collagen carrier 3 about the longitudinal axis of the
elongate element and at least the outer windings and preferable each winding
being orientated so that the coating layer constitutes the outer surface of each
the windings. A further characteristic of the coiled collagen carrier 1 is that it is
form-stable and defines a collagen carrier in a coiled configuration where at least
the outer windings proceed along a spiral in a cross n of the en carrier.
The form-stability is often provided by the collagen layer and/or the coating layer
has hardened in the coiled shape whereby no additional ts such as
constraints are needed to keep the coiled collagen carrier in its coiled shape.
The coiled collagen carrier 1 is in an unrolled configuration a rectangular sheet,
preferably having a width, a length and a thickness of the most 4 mm, such as at
the most 5 mm, preferably at the most 6 mm, such as at the most 7 mm. The
coiled collagen carrier is typically coiled around the width so that the width of the
coiled en carrier 1 is the width of the unrolled configuration. However coiled
collagen carriers being coiled around the length are also an option. A coiled
collagen carrier will often se three, four or five windings.
A preferred coiled collagen carrier 1 has a cylindrical shape with an outer diameter
of less than 12 mm, such as less than 11 mm, such as less than 10 mm, such as
less than 9 mm, such as less than 8 mm, such as less than 7 mm, such as less
than 6 mm, such as less than 5 mm, such as less than 4 mm, such as less than 3
mm. Furthermore, the coiled collagen carrier has an s-shaped inner most winding
about the longitudinal direction of the coiled collagen carrier as disclosed e.g. in
figure 11.
The coating layer of coiled collagen carriers 1 has no h-going cracks. Often
this is obtained by producing the coiled collagen carrier in a manner where the
g layer and/or the collagen layer is(are) softened by fication prior to
coiling which softening allows stretching of the coating layer and/or collagen layer
without producing crack or chips (frissures) during coiling. A subsequent drying
hardens the softened layer which fixes the coil shape in a form-stable shape.
Preferably the coating layer is humidified.
The coiled collagen carrier 1 is often arranged in a container. The container is
typically sealed to prevent contamination and/or degradation and/or to maintain
form-stability of the coiled collagen carrier. A ant, such as silica gel, may be
arranged in the container. Such containers with coiled collagen r 1 is
considered within the scope of the invention
In a particular preferred embodiment, the packed coiled collagen carrier 1
comprises an inner container and an outer container. The inner container
comprises a cavity having a bottom shaped as a segment of a cylinder, and
wherein the curved part of the cylinder segment extends at least 180° as
disclosed in figure 11 numeral 8. The cavity is sealed by a tear-off or ble
foil and the outer container comprising a sealed pouch inside which the sealed
inner container is arranged together with a desiccant.
Although the t invention has been bed in connection with the
specified embodiments, it should not be construed as being in any way limited to
the presented examples. The scope of the present ion is set out by the
accompanying claim set. In the context of the claims, the terms “comprising” or
“comprises” do not exclude other possible elements or steps. Also, the ning
of references such as “a” or “an” etc. should not be construed as excluding a
plurality. The use of reference signs in the claims with respect to elements
ted in the figures shall also not be construed as limiting the scope of the
invention. Furthermore, individual features mentioned in different claims, may
possibly be ageously ed, and the mentioning of these features in
different claims does not e that a combination of features is not possible
and advantageous.
Examples
Example 1 - loss of coating
Example 1.1 - loss of coating immediately after un-rolling
Loss of coating is determined immediately after un-rolling of a collagen carrier
according to the present invention. The collagen carrier may not loose more than
0.6 mg/cm2 as measured by weighing immediately after unrolling.
The un-rolling is performed by fixating one end of a pre-rolled TachoSil®, such as
a coiled collagen carrier according to the present ion between the fingers of
one gloved hand while the rest of the pre-rolled TachoSil®, such as a coiled
collagen carrier according to the present invention is unrolled with the aid of the
fingers of the ofter gloved hand assuring that the coating layer faces downwards
upon un-rolling. The un-rolling is performed in a standard tory g well
known to the person skilled in the art.
e 1.2 - loss of coating without unrolling
This analytical procedure describes determination of adhesion of the coating of a
pre-rolled TachoSil®, such as a coiled collagen carrier according to the invention
by gravimetry. In other words, the procedure describes the loss of coating of
coiled collagen carrier when exposed to a lled physical action as described
below. The ements is performed in a standard laboratory setting well
known to the person skilled in the art. As standard, gloved hands are always
used.
1.1 Analytical system
Analytical balance
Vortex mixer
Ruler with etre graduations
Reagent tube of about 2 cm internal diameter
1.2 s
Unpack the pre-rolled TachoSil®, such as a coiled collagen carrier according to the
invention from its e using gloved hands. Measure length and width of the
sample. The sample needs to fit into the reagent tube without folding.
1.3 Performance
Place the sample in a balanced reagent tube and shake on the vortex mixer
(frequency: about 1000 rpm) for 2 minutes. Remove the sample and reweigh the
residual quantity of coating material (mass of residual).
1.4 Calculation
Surface area (cmz) = length [cm] x width [cm])
Abrasion (mg/cmz) = mass of residual — tare rea ent tube x 1000
surface area [cmz]
Reported value: abrasion in mg/cmz; values S 0,1 mg/cm2 are reported as S 0,1
mg/cmz.
The pre-rolled TachoSil®, such as a coiled en r may not lose more
than 0.6 mg/cm2 as ed by weighing immediately after unpacking and
testing according to the analytical procedure described in this example.
Example 2 - measurement of adherence
By the term ence” is meant the in vitro capability of a collagen carrier to
adhere to living tissue according to the t invention. Adherence is
investigated qualitatively by visual inspection of adherence of an unrolled rolled
collagen carrier to a mammal tissue i.e. the capability of a collagen carrier to
adhere to a tissue.
A piece of freshly slaughtered porcine liver tissue is placed in a Petri dish and a
rolled collagen carrier of the present invention is placed by using gloved hands on
the liver tissue while being unrolled by using gloved hands and is then subjected
to light pressure by gloved hand. Figure 1 illustrates the adherence of the unrolled
en carrier to the living tissue.
Example 3 - measurement of density
Determination of the density was performed by weighing the collagen fleece
combined with knowledge of the size i.e. volumen of the fleece making it possible
to calculate the density of the collagen fleece. Standard laboratory equipment was
used for measuring the weight of the collagen fleeces (note that by the “weight”
of the collagen carriers is meant the weight of the collagen carrier excluding the
weight of the coating layer). The average density of compressed collagen carrier
are shown below in e 4. Please note that the y of a collagen carrier
of the t invention is the density of the en carrier excluding the coating
layeh
Example 4 — adhesive strength (PCT test)
In the following le 4.1) an in vitro pressure test for measuring adhesive
strength to a simulated tissue sample (latex membrane) of a coiled collagen
carrier of the t invention is described. The test may also be used when
assessing the adhesive strength of a pre-rolled TachoSil®.
Examples 4.2 — 4.3 demonstrate the ed PCT-values when ing un-
rolled coiled collagen carriers of the present invention wherein the coiled collagen
rs have different average densities 3.62 mg/cm3-4.05 mg/cm3. Example 4.4
demonstrates the adhesive strength of a collagen carrier that has not been
subjected to the humidification, compression and rolling process.
Example 4.1
Product to be tested: A pre-rolled TachoSil® or a coiled collagen carrier of the
present invention. The product to be tested has a midi size i.e. 46-49 mm * 46-50
mm * 4-7 mm.
4.1.1 uction
The protocol applies to the execution of a Pressure Chamber Test (PCT) to
ine the adhesiveness of a coiled collagen carrier of the present invention or
a pre-rolled TachoSil®, to a latex membrane.
4.1.2 Analysis and Conditions
When the coating layer of an un-rolled coiled collage carrier of the present
invention or an un-rolled pre-rolled TachoSil® is wetted, the maximal pressure the
carriers can withstand, their adhesive strengths and their air permeability’s can be
ed by a re Chamber.
4.1.3 Equipment
The pressure chamber (PCT chamber) is made from Plexiglas 20x20x20cm, from
MHM Morawitz, Nuremberg.
PCT-Test Membrane (Red THM with a standard hole Q 1cm; from MHM Morawitz,
Nuremberg) PCT-Test Membrane (Red THM without hole; from MHM Morawitz,
Nuremberg).
Blood Pressure Apparatus, GMP qualified equipment. Other suitable GMP ied
Blood Pressure Apparatus may be used.
Teflon weight (150.0 g 0 3 cm).
An air tight plastic box with desiccant.
te for g out a piece of collagen carrier (3 x 3 cm).
Forceps, scalpel and scissors.
Stopwatch.
Figure 4 shows PCT testing chambers and blood re apparatus.
4.1.4 Reagents
0.9% NaCl solution (isotonic saline).
4.1.5 Samples
As a minimum it is recommended to perform 5-duplicate per batch/conditioning.
NB: It is very important to focus on zing the exposure to moisture from the
air of the coiled collage r of the present invention or the TachoSil®. Hence, it
is necessary to store the unpacked fleeces in an ht box with desiccant.
Before performing a PCT test a System lility test must be performed on all
the PCT chambers that are to be used.
4.1.6 Performance of the PCT test
. A ne (with hole) is placed onto the PCT test r
. The coiled collagen carrier of the present invention or the pre-rolled TachoSil® is
gently un-rolled and placed with the yellow side (i.e. the coating layer) facing
downwards. By using the template for cutting, a piece of 3 x 3 cm square collagen
carrier is cut out of the un-rolled collagen carrier.
. The collagen carrier cut-out is immediately placed inside the dry box if it is not
possible to place it on the membrane straight away.
. The coating layer is thoroughly wetted by immersing the coated w) side in
0.9% NaCl solution (for approximately 5 s). The collagen layer cut-out must not
get wet. Immediately thereafter, the collagen carrier cut-out is placed on the
membrane of the PCT chamber with the yellow side facing down against the
membrane. It is gently pressed with a finger on the edges where after the teflon
weight is carefully placed on top of it. The timer is set to 5 minutes.
. After 5 minutes the weight is carefully d and by using the pressure
device pressure is added to the PCT chamber.
. Maximum re is noted from the blood pressure apparatus and recorded in
a table (see below).
. To assess the adhesiveness, each corner of the cut-out is pulled with forceps.
The results are recorded in table 2 (see below).
. Air leakage through the collagen carrier cut-out (see table 1 below) is recorded
as well.
. The membrane used is discarded and a new one is put on.
4.1.7 ance Level
The average PCT value for the collagen carrier cut-outs must be above 50 mmHg.
No collagen carrier cut-out must be below at least 30 mm Hg, such as at least 35
mmHg, such as preferably 40 mmHg.
4.1.8 System Suitability Test
A System Suitability Test is carried out for all chambers that are used for
measuring the PCT. Each time a new membrane ut hole) is used, pressure
must be put on it one time (activation of the membrane) before the actual
re leak test is performed, as a new ne provides a higher PCT value
the first time it is used.
The activated membrane can be used approx. 4-6 times or until it bursts. It can
only be used within the same day. If the ne bursts, the measurement is
discarded. Another membrane is activated and used instead.
The test is carried out both before and after the PCT measurement of the
Activation of membranes:
1. A membrane is placed on a PCT chamber.
2. Pressure is applied to the chamber and the membrane is inflated.
Performing the Test:
1. The membrane is placed on the first PCT chamber.
2. Pressure is put on the chamber and the value is registered.
3. The test is repeated with all the chambers to be used.
Table for number of tests
Number of tests to be performed by use of one, two or three PCT
chamber(s) respectively (after activation of the membrane)
Number of
Three PCT
chambers One PCT chamber Two PCT chambers
chambers
Number of tests
Number of tests
taken before
samples per
chamber
Number of tests
taken after
samples per
chamber.
Requirements for the test: The value (after activation of the membrane) must be
> 75 mmHg.
The difference in the values between the ent chambers may not be higher
than 10 mmHg and not greater than 5 mmHg for the same r.
Example 4.2
In the following ment en rs with an average density of 3.62
mg/cm3 were compressed between two ro||ers (roller diameter 50 mm) after
ation of ethanol to the fibrinogen and thrombin coated side of the collagen
carrier. The compressed collagen carriers were rolled by use of a gripping device.
The rolled collagen carriers were then unrolled to be tested in an adhesive
strength test (PCT test). As can be seen from the table below the average PCT
value of the unrolled collagen carriers was 78 mmHg and all individual PCT values
were above 50 mm Hg. The results indicate that the collagen carriers according to
the invention can undergo the process of fication, compression and rolling
according to the invention while maintaining the adhesive strength. The value of
the adhesive strength is an indirect measurement of the haemostatic/sealing
properties of the rolled carrier.
The en carriers used for the experiment had initially at least one of the
following physical properties: city module in the range of 5-100 N/cmz,
density of 1-10 mg/cm3, chamber diameter of more than 0.75 mm and less than 4
mm and/or having a chamber diameter average below 3 mm and evenly
distributed and fixed upon said collagen carrier solid fibrinogen and solid
thrombin.
Table 1 — average y of collagen carriers was 3.62 mg/cm3
Average density of Ethanol applied Gap size between PCT value
collagen carrier rollers
mg/cm3 mg/cm2 mm Hg
3.62 4.3 0.6 92
3.62 4.3 0.6 79
3.62 4.3 0.6 77
3.62 4.3 0.6 81
3.62 4.3 0.6 52
3.62 4.3 0.6 101
3.62 4.3 0.6 81
3.62 4.3 0.6 70
3.62 4.3 0.6 72
3.62 4.3 0.6 71
Average: 78
The average density of the collagen carriers mentioned above is ated as the
average density of the collagen carrier excluding the coating layer.
Example 4.3
In the following experiment collagen carriers with an average density of 4.05
mg/cm3 were ssed between two rollers r diameter 50 mm) after
application of ethanol to the fibrinogen and in coated side of the en
carrier. The compressed collagen rs were rolled by use of a gripping device.
The rolled collagen carriers were then unrolled to be tested in an adhesive
strength test (PCT test). As can be seen from the table below the average PCT
value of the unrolled collagen carriers was 94 mmHg and all individual PCT values
were above 50 mm Hg. The results indicate that the collagen carriers according to
the invention can undergo the process of humidification, compression and rolling
according to the invention while maintaining the adhesive strength. The value of
the adhesive strength is an indirect measurement of the tatic/sealing
properties of the rolled carrier.
The collagen carriers used for the experiment had initially at least one of the
following physical properties: elasticity module in the range of 5-100 N/cmz,
density of 1-10 mg/cm3, chamber diameter of more than 0.75 mm and less than 4
mm and/or having a chamber diameter average below 3 mm and evenly
distributed and fixed upon said collagen r solid fibrinogen and solid
thrombin.
Table 2 — average density of collagen carriers was 4.05 mg/cm3.The average
density of the en carriers is calculated as the average density of the collagen
carrier excluding the coating layer.
Average density Ethanol applied Gap size between PCT value
of collagen rollers
carrier mg/cm3 mg/cm2 mm Hg
4.05 4.2 0.6 107
4.05 4.2 0.6 67
4.05 4.2 0.6 95
4.05 4.2 0.6 103
4.05 4.2 0.6 89
4.05 4.2 0.6 98
4.05 4.2 0.6 86
4.05 4.2 0.6 114
4.05 4.2 0.6 103
4.05 4.2 0.6 75
Average: 94
Example 4.4
The table 3 shows the s of the adhesive th of a collagen carrier as
measured by a PCT test. Please note that the carrier has not been subjected to
the fication, compression and rolling process as in the es above, i.e.
example 4.1 and 4.2.
WO 59635
The collagen carriers used for the experiment initially had at least one of the
following physical properties: elasticity module in the range of 5-100 N/cmz,
y of 1-10 mg/cm3, chamber diameter of more than 0.75 mm and less than 4
mm and/or having a chamber diameter e below 3 mm and evenly
distributed and fixed upon said collagen carrier solid fibrinogen and solid
thrombin.
Table 3 - average density of collagen carriers was 4.08 mg/cm3.The average
density of the en carriers is calculated as the average density of the collagen
carrier excluding the coating layer.
Average density of collagen carrier PCT value
mg/cm3 mm Hg
4.08 96
4.08 83
4.08 81
4.08 59
4.08 82
4.08 76
4.08 102
4.08 82
4.08 83
4.08 90
Average: 83
Example 5 — amounts of ethanol
The present example was made to test the influence on PCT values of the factors;
amount of ethanol applied and strip weight for a fixed gap size and fixed RH in the
room. By the “weight” of the collagen carriers is meant the weight of the collagen
carrier ing the weight of the coating layer.
Successful pre-rolled TachoSil®’s or successful coiled collagen carriers of the
present invention were the ones that had PCT mean value of 2 50 mm Hg and
PCT single values of 2 40 mm Hg.
.1 Material used
The test has been based on use of the following three batches of midi sized
fleeces (none of the fleeces have been gamma irradiated:
- 10622250 (strip weight: approx.: 920 mg based on measurement of 10 strips).
- 10634435 (strip weight: approx. 1180 mg).
- 10657586 (strip weight: approx.: 1261 — 1500 ated as: 1380 mg
Please note that the “weight” of the collagen carriers ned above means the
weight of the collagen carrier excluding the weight of the coating layer.
.2 Factors used
The design used was a full 32 factorial desing with three ation of the centre
point.
Fixed factors: Fixed Gap size: 0.6 mm. RH in room: S 50% (excursion to 55% is
allowed). Temperature in the room (18) 20-22°C.
Variable factors: Ethanol levels: 30-40 mg/fleece; 90 — 100 mg/fleece; 150 — 160
mg/fleece. Strip weight.
.3 Responses
PCT (mm Hg)
Fleece dimensions after rolling (diameter (cm) and length (cm))
.4 Results
Table demonstrating temperature and RH when sing the fleeces.
By “strip weight” is meant the weight of the collagen carrier ing the weight
of the coating layer.
Experiment Ethanol Strip weight Temp (°C) Temp (°C) Temp
{mg/fleece} RH % RH % (54,0%°C)
During Prior to RH %
rolling drying After drying
0 U1 21.8 -
22.1°C
ZA w0
ZI—l w
U'I 20.5-
.7°C
50.6-51.0
2 \l w0
N6 I
2 H H
Table demonstrating fleece dimensions after rolling (diameter (cm) and length
(cm)) and the obtained PCT average value in mmHg.
By “strip weight” is meant the weight of the collagen carrier excluding the weight
of the g layer.
Experiment Ethanol Length of Diameter of PCT average
{mg/fleece} weight rolled fleece rolled fleece — value
- average
N1 .
104 920 4.76
158 920 4.68
1 00
From the above results table it is clear that all tested fleeces are sful i.e.
they all have PCT mean value of 2 50 mm Hg and PCT single values of 2 40 mm
Hg (data not shown).
Further, as apparent from the above results, the diameter of coiled fleece—
averages is well below 10 mm and the length of the coiled fleeces well below 5
cm. Also, it was apparent from the above results that when using the process
according to the invention, ining the atmosphere surrounding the en
carrier and humidification device while being humidified compressed and coiled at
a ature of about 18-22° C and a relative humidity of about 30-50%
produces successful fleeces using ethanol levels of 30-40 mg/fleece; 90 — 100
mg/fleece; 150 — 160 mg/fleece.
Example 6 — direct coiling of TachoSil®
The present example investigates the steps of humidification and compression of
a collagen carrier of the present invention, Le. a TachoSil®.
1 0 1
A TachoSil® was ted to direct coiling without previous humidification and
compression. The coiling was performed within an apparatus according to the
invention excluding the steps of humidification and compression.
The ing ly coiled TachoSil®‘s had a “flossy” appearance and their
coating layer had through-going cracks that were visible to the naked eye (see
figure 6).
When comparing the ly coiled TachoSil®‘s with the coiled collagen carriers of
the t invention (see figure 3), it was easy to see the ences i.e. the
coiled collagen carriers of the present invention are form-stable in the sense that
they do not un-coil “when at rest”, such as when laying un-supported on a flat
surface. Further, their coating layers had no through-going cracks and they did
not look “flossy” but rather had a smooth, substantially even surface.
Example 7: Use of lled il® in minimally invasive surgery in a pig
model
In order to examine the haemostatic properties of the pre-rolled TachoSil®
t, a female pig model was operated by laparoscopy and haemostasis was
carried out using the pre-rolled ready-to-use TachoSil® product.
Protocol:
After orotracheal intubation the pneumoperitoneum was established in traditional
Hasson technique. We used a 12mm trocar. C02 gas was insufflated slowly till 12
mmHg maximum. After insertion of the optic, an open 12 mm trocar was placed in
the left upper quadrant, and one 5 mm trocar was placed in the right upper
quadrant under direct vision.
A 3x3 cm defect was surgically inflicted on the right liver lobe with a depth of 2
mm. Diffuse bleeding started. A pre-rolled TachoSil® was inserted at the bleeding
site by the use of a dissector via the 12 mm trocar. The insertion was easily done
without breaking the roll. Opening the roll with a tor and a grasper was
successful without any problems. The specimen of pre-rolled Tachosil® was
placed on the inflicted wounds and d onto the liver by use of a wet sponge
for 2 minutes. A similar procedure was carried out on a left liver site. Control of
bleeding at the wound sites showed that haemostasis was successful. Following
1 02
surgery the pig was observed for 7 days to check for any cations (none
were ed).
- 7 days after surgery the pig was sacrificed and the pre-rolled Tachosil® patches
on the liver surface were checked for any larities (see the photo in figure 2).
No irregularities appeared to be present compared to what would be expected
with a commercially-available (flat-packed, non-rolled) Tachosil® t.
Bleeding had been successfully controlled on both sites.
Example 8 — uptake of water into ethanol and impact on lue
In order to examine the amount of water absorbed in absolute ethanol as a
function of time when exposed the conditions of approx 50 % RH and 20 °C, the
following experiment was made:
The absolut ethanol had been exposed to moisture when kept in a open beaker
8.1 Results - uptake of water into ethanol
Interval from 1/2 to 11/2 hour: Approx. 0.5% (concentration of ethanol: approx
99.5%).
Interval up to approx. 20 hours: Maximum 2.4% (concentration of ethanol: 2
97.6%).
8.2 - impact on PCT-value
Based on the findings of uptake of water into ethanol it was investigated whether
the use of ethanol containing 2.4% of water would have any impact on the coiling
process or on the PCT value when tested after coiling and drying.
8.3 Test set up — PCT-value and coiling process
Batch No. 10657586 (strip weight: approx.: 1261 — 1500 designated as: 1380
mg. These fleeces have not been gamma irradiated.
By “strip weight” is meant the weight of the collagen r excluding the weight
of the coating layer.
Factors:
Fixed: Gap size = 0.6 mm, RH in room = S 50%, excursion to 55% is allowed),
l levels = 80 mg/fleece i 10 mg/fleece
Variable: Ethanol tration: 99.9% and 97.6 %.
Responses: PCT (mm Hg)
: 10 fleeces were coiled based on moisturizing with 97.6 % ethanol and
fleeces were coiled based on moisturizing with absolute ethanol (99.9 %)
8.4 Results - PCT-value and coiling process
Batch 10657586 ( z 1380 mg stripweight):
- 99,9% Ethanol used for moisturizing: Mean PCT-values: 107 mm Hg and
Single PCT-values: 107, 111, 108, 122, 112, 113, 119, 76, 98, 105 mm
- 97,6% Ethanol used for moisturizing: Mean PCT-values: 101 mm Hg and
Single PCT-values: 95, 110, 85, 113, 119, 100, 109, 90, 114, 71 mm Hg.
By “strip weight” is meant the weight of the collagen carrier excluding the weight
of the coating layer.
A t-test on possible difference between using 99.9% and 97.6% Ethanol: P (TSt )
= 0.32 indicated that a significant difference could not be found.
Thus, the addition of up to 2.4% of water in the l used for moisturizing in
the coiling process, that is approx 20 hours of exposure to RH up to 50% at 20
oC, did not have any significant impact on the PCT values or on the fleece
behaviour during rolling.
Example 9 — impact on collagen carrier of RH of surrounding air during sing
9.1 Objective
The present e demonstrates the impact on PCT values of room conditions
(20 — 22 oC / 40 — 60 %RH) during the manufacture of led TachoSil®
fleeces. The water content (KF values) were measured as support using a
standard Karl Fischer titration method.
1 04
Factors: Gap size: 0.6 mm and ethanol levels: 94 mg/fleece
9.2 Results - PCT (TachoSil® batch 10634435 — Not gamma irradiated):
Room conditions PCT values (mm Hg)
I °C / 45-49 %RH) Single values: 90, 112, 115, 41, 57,
104, 44, 71, 112, 68, 65
Mean value: 80 (std.: 28)
II (20-21°C/ 51-52 %RH) Single values: 66, 104, 77, 97, 75,
110, 95, 67, 87, 51, 74, 53, 89
Mean values: 80 (std.: 18)
III (20-21°C/ 57-58 %RH) Single values: 69, 61, 40, 59, 112, 60,
75, 64, 97, 39, 67, 73, 73
Mean value: 68 (std.: 20)
IV (20-21°C/ 61-63 %RH) Single values: 61, 67, 54, 51, 66, 89,
61, 74, 81, 60, 54, 66, 59
Mean value: 65 (std.: 11)
Comments: Rolls sticky when
unrolling at PCT measurements
As can be seen from the table above, 57-58% RH produces a single PCT-value of
less than 40 mm Hg i.e. room condition III.
Room ions KF, % water content; n = 2 — 4. Measured
immediately after 30 min of Ethanol dry off
I(20-21°C/45-49 %RH) Average: 11.21% (%RSD: 1.28)
II (20-21°C/ 51-52 Average: 12.48% (%RSD: 0.83)
%RH)
III °C/ 57-58 Average: 13.42% (%RSD: 4.02)
%RH)
IV (20-21°C/ 61-63 Average: 16.12% (%RSD: 0.61)
%RH)
As can be seen from the table above the % water content in the collagen
carriers increases as the RH increases, but the PCT-values were still
successful.
Throughout the specification and claims, unless the t requires
otherwise, the word “comprise” or variations such as “comprises” or
“comprising”, will be understood to imply the inclusion of a stated r or
group of integers but not the exclusion of any other integer or group of
integers.
Each document, reference, patent application or patent cited in this
text is expressly incorporated herein in their entirety by reference, which
means that it should be read and ered by the reader as part of this
text. That the document, reference, patent application or patent cited in this
text is not ed in this text is merely for reasons of conciseness.
Reference to cited material or information contained in the text should
not be understood as a concession that the al or information was part
of the common general knowledge or was known in Australia or any other
country.
Claims (24)
1. A process for coiling a collagen carrier, the collagen carrier comprising (i) a collagen layer and (ii) a coating layer comprising fibrinogen and thrombin, 5 said s comprising the sequential steps of: humidifying at least part of said collagen carrier, coiling said collagen carrier by gripping the collagen carrier n a pair of elongated members, and rotating the pair of elongated members about an axis being parallel to a longitudinal extension of the ted 10 s in order to coil the collagen r on the members, while the collagen carrier is supported by a support device, drying the coiled collagen carrier, thereby providing a form-stable coiled collagen carrier. 15
2. A process according to claim 1, wherein the coiling is performed by ng the collagen carrier using at least one pair of tweezers or pincers.
3. A process according to claim 1 or 2, wherein at least the coating layer of said collagen carrier is humidified, and wherein the coating layer has been 20 fied using a solvent.
4. A process according to claim 3, wherein the solvent comprises or consists of l. 25
5. A process according to any one of the preceding claims further comprising compressing the collagen carrier to reduce the thickness of the collagen carrier.
6. A process according to any one of the preceding claims further comprising 30 ing the form-stable coiled collagen carrier in a container and subsequently sealing the container.
7. A coiled collagen carrier ed by the process according to any one of claims 1-6.
8. A coiled collagen carrier - comprising a collagen layer and a coating layer on top of the collagen layer, the coating layer comprising thrombin and fibrinogen, and - having the shape of an elongate element with a number of windings of 5 the collagen carrier about the udinal axis of the elongate element and at least the outer winding(s) being orientated so that the g layer constitutes the outer surface of each of said outer winding(s), wherein - the coiled en carrier is form-stable and defines a collagen carrier 10 in a coiled configuration where said outer winding(s) proceed along a spiral in a cross section of the collagen carrier.
9. A coiled collagen carrier according to any one of claims 7 or 8, wherein the collagen carrier in an unrolled configuration is a rectangular sheet, preferably 15 having a width, a length and a thickness of the most 4 mm, such as at the most 5 mm, preferably at the most 6 mm, such as at the most 7 mm.
10. A coiled collagen carrier according to any one of claims 7-9, comprising three, four or five windings.
11. A coiled collagen carrier according to any one of claims 7-10, wherein the coiled collagen carrier has a rical shape with an outer er of less than 12 mm, such as less than 11 mm, such as less than 10 mm, such as less than 9 mm, such as less than 8 mm, such as less than 7 mm, such as less 25 than 6 mm, such as less than 5 mm, such as less than 4 mm, such as less than 3 mm.
12. A coiled collagen r according to any one of claims 7-11, wherein the coating layer has no through-going cracks.
13. A packed coiled collagen carrier, comprising a coiled collagen carrier ing to any one of claims 7-12 arranged in a container.
14. Use of a coiled collagen carrier according to any one of claims 7-12 in the 35 preparation of a ment for the treatment or prevention of injury to tissues, wherein said coiled collagen carrier is delivered to a target location by g said coiled collagen r through an orifice or access tube to the target location.
15. Use of the coiled collagen carrier according to any one of claims 7-13 in 5 the preparation of a ment for use in therapy.
16. Use of the coiled collagen carrier according to any one of claims 7-13 in the preparation of a medicament for use in surgery. 10
17. Use of the coiled collagen carrier according to any one of claims 7-13 in the preparation of a ment for use in the prevention or treatment of injury associated with performing minimally invasive surgery.
18. Use of the coiled en r according to any one of claims 7-13 in 15 the preparation of a medicament for use in the prevention or treatment of injury associated with performing endoscopic surgery.
19. Use of the coiled collagen carrier according to any one of claims 7-13 in the preparation of a medicament for use in the prevention or treatment of 20 tissue or a tissue sample in need of sealing/glueing.
20. An apparatus for providing a coiled collagen carrier, the apparatus comprising - a device for applying moisture to a en carrier prior to coiling of 25 the collagen carrier, - a coiling device comprising - rotatable gripping means for gripping the en carrier along an edge and coiling the collagen carrier, and - a support device supporting the collagen carrier while being 30 coiled.
21. An apparatus according to claim 20, wherein the gripping device comprises a pair of elongated members, such as a pair of tweezers or pincers.
22. An apparatus according to any one of claims 20 or 21, further comprising a compressing device arranged to compress the moisturised collagen carrier prior to coiling of the moisturised en carrier. 5
23. An apparatus according to any one of claims 20-22, further comprising at least a drying means for drying one or more coiled collagen carriers subsequently to the coiling.
24. A process according to claim 1 or a collagen r according to claim 10 8 substantially as herein before described with reference to the Examples. WO 59635
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP11167379 | 2011-05-24 | ||
EP11167379.4 | 2011-05-24 | ||
PCT/DK2012/050178 WO2012159635A1 (en) | 2011-05-24 | 2012-05-24 | Rolled collagen carrier |
Publications (2)
Publication Number | Publication Date |
---|---|
NZ615820A NZ615820A (en) | 2015-10-30 |
NZ615820B2 true NZ615820B2 (en) | 2016-02-02 |
Family
ID=
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