US20130028975A1 - Hemostatic sponge - Google Patents

Hemostatic sponge Download PDF

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Publication number
US20130028975A1
US20130028975A1 US13/639,490 US201113639490A US2013028975A1 US 20130028975 A1 US20130028975 A1 US 20130028975A1 US 201113639490 A US201113639490 A US 201113639490A US 2013028975 A1 US2013028975 A1 US 2013028975A1
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Prior art keywords
sponge
hemostatic
matrix
collagen
composite
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Abandoned
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US13/639,490
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English (en)
Inventor
Hans Christian Hedrich
Joris Hoefinghoff
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Baxter Healthcare SA
Baxter International Inc
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Baxter Healthcare SA
Baxter International Inc
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Application filed by Baxter Healthcare SA, Baxter International Inc filed Critical Baxter Healthcare SA
Priority to US13/639,490 priority Critical patent/US20130028975A1/en
Publication of US20130028975A1 publication Critical patent/US20130028975A1/en
Assigned to BAXTER INTERNATIONAL INC., BAXTER HEALTHCARE S.A. reassignment BAXTER INTERNATIONAL INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: HOEFINGHOFF, JORIS, HEDRICH, HANS CHRISTIAN
Abandoned legal-status Critical Current

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    • 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
    • A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
    • A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
    • A61L15/42—Use of materials characterised by their function or physical properties
    • A61L15/44—Medicaments
    • A—HUMAN NECESSITIES
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    • 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
    • A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
    • A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
    • A61L15/42—Use of materials characterised by their function or physical properties
    • A61L15/425—Porous materials, e.g. foams or sponges
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F13/00—Bandages or dressings; Absorbent pads
    • A61F13/00051—Accessories for dressings
    • A61F13/00063—Accessories for dressings comprising medicaments or additives, e.g. odor control, PH control, debriding, antimicrobic
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    • A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
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    • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
    • A61L24/001—Use of materials characterised by their function or physical properties
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    • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
    • A61L24/0047—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
    • A61L24/0073—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material with a macromolecular matrix
    • A61L24/0094—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material with a macromolecular matrix containing macromolecular fillers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A61P17/02—Drugs for dermatological disorders for treating wounds, ulcers, burns, scars, keloids, or the like
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Y—ENZYMES
    • C12Y304/00—Hydrolases acting on peptide bonds, i.e. peptidases (3.4)
    • C12Y304/21—Serine endopeptidases (3.4.21)
    • C12Y304/21005—Thrombin (3.4.21.5)
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F13/00—Bandages or dressings; Absorbent pads
    • A61F2013/00089—Wound bandages
    • A61F2013/00106—Wound bandages emergency bandages, e.g. for first aid
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Definitions

  • the present invention relates to the field of hemostatic sponges, a method of producing said sponges and their various uses.
  • tissue adhesives based on fibrinogen and factor XIII have been described in U.S. Pat. No. 4,362,567, U.S. Pat. No. 4,298,598 and U.S. Pat. No. 4,377,572.
  • the tissue adhesives are usually applied together with a separate component containing thrombin, which is enzymatically acting on fibrinogen to form fibrin, and on factor XIII to form the active factor XIIIa, which cross-links the fibrin to obtain a stable fibrin clot.
  • Collagen pads have been used for many years to improve wound healing or to stop bleeding. Their mechanism of action in hemostasis is based on platelets aggregation and activation, the formation of thrombin on the surface of activated platelets and the formation of a hemostatic fibrin clot by the catalytic action of thrombin on fibrinogen. To improve the hemostatic action of collagen pads or sheets it has been suggested to include factors of hemostasis within such pads.
  • WO 97/37694 discloses a hemostatic sponge based on collagen and an activator or proactivator of blood coagulation homogeneously distributed therein.
  • This sponge is provided in a dry form, which could be air-dried or lyophilized. However, it still contains a water content of at least 2%.
  • U.S. Pat. No. 5,614,587 discusses bioadhesive compositions comprising cross-linked collagen using a multifunctionally activated synthetic hydrophilic polymer, as well as methods of using such compositions to effect adhesion between a first surface and a second surface, wherein at least one of the first and second surfaces can be a native tissue surface.
  • WO2004028404 describes a tissue sealant composed of a synthetic collagen or gelatin and a electrophilic cross-linking agent which are provided in a dry state. Upon wetting of this composition at an appropriate pH a reaction between the 2 components takes place and a gel with sealing properties is formed.
  • a sealant works in essential analogously to other known two component sealants (composed of a reagent with multiple electrophilic—and a reagent with multiple nucleophilic groups) which are known in the state of the art or which are available on the market, e.g. CosealTM.
  • the two components of the sealant are coated onto a biomaterial.
  • Collagen-containing compositions which have been mechanically disrupted to alter their physical properties are described in U.S. Pat. No. 5,428,024, U.S. Pat. No. 5,352,715, and U.S. Pat. No. 5,204,382. These patents generally relate to fibrillar and insoluble collagens.
  • An injectable collagen composition is described in U.S. Pat. No. 4,803,075.
  • An injectable bone/cartilage composition is described in U.S. Pat. No. 5,516,532.
  • a collagen-based delivery matrix comprising dry particles in the size range from 5 ⁇ m to 850 ⁇ m which may be suspended in water and which has a particular surface charge density is described in WO 96/39159.
  • a collagen preparation having a particle size from 1 ⁇ m to 50 ⁇ m useful as an aerosol spray to form a wound dressing is described in U.S. Pat. No. 5,196,185.
  • Other patents describing collagen compositions include U.S. Pat. No. 5,672,336 and U.S. Pat. No. 5,356,614.
  • the subject of the invention is a hemostatic porous composite sponge comprising
  • the sponge according to the present invention improves hemostasis. Furthermore, the sponge according to the present invention shows a strong adherence to the tissue when applied to a wound. The sponge of the present invention further shows improved swelling behavior, i.e. low swelling, after application to a wound.
  • a further aspect relates to a method of treating an injury comprising administering a hemostatic porous composite sponge to the site of injury.
  • kits for preparing a wound coverage comprising a sponge as herein disclosed and a buffer solution.
  • This kit and its components are in particular for the manufacture of a medical sponge for the treatment of an injury.
  • the object of the invention is a hemostatic porous composite sponge comprising a hemostatic porous composite sponge comprising
  • impregnated includes the term absorption of polymeric material in a matrix of a biomaterial.
  • sponge, pad and fleece are used interchangeably in the description of the present invention.
  • the biomaterial is collagen, a protein, a biopolymer, or a polysaccharide.
  • a biomaterial selected from the group consisting of collagen, gelatin (especially cross-linked gelatin), fibrin, a polysaccharide (especially chitosan, oxidized cellulose, aldehyde activated dextrans, starch based polyaldehydes (obtainable by periodate oxidation)), a synthetic biodegradable biomaterial (especially polylactic acid or polyglycolic acid, and derivatives thereof, more preferred collagen.
  • porous composite material comprising a water insoluble matrix of a biomaterial with hemostatic properties and a hydrophilic polymeric cross-linking agent in association therewith is provided.
  • a cross-linking reaction of the hydrophilic polymeric cross-linker with the blood proteins leads to formation of a gel with sealing and hemostatic properties.
  • Cross-linking also occurs to the tissue surface proteins and, depending on the nature of the water insoluble matrix biomaterial, may also occur to the matrix biomaterial. The latter reaction contributes to an improved adhesion of the composite material to the wounded tissue surface.
  • the matrix of the biomaterial has soaking capabilities, i.e. is able to soak/absorb liquids such as blood, serum, plasma.
  • Such soaking capabilities are especially dependent on the hydrophilic nature of the polymer the matrix is made of, and a three-dimensional structure of open interconnected pores, or of a three-dimensional meshwork of hydrophilic fibers.
  • the pore size and the elasticity of the matrix are also important for the soaking capacity.
  • Elasticity means that the matrix can be compressed in aqueous solution and returns to its initial volume after the force causing compression is relieved.
  • the sponge is a porous network of a biomaterial able to absorb body fluids when applied to the site of an injury. This allows the blood of a wound (including all the blood components, such as blood cells or coagulation proteins) to enter into the sponge.
  • the porous sponge according to the present invention has therefore an inside volume which is accessible for external fluids, such as blood, when applied to a patient.
  • a porous collagen sponge can be made by lyophilization of a collagen gel, suspension or solution by freeze-drying (whereas normal air-drying leads to a collagen film). It follows that in the case of collagen, the resulting porous sponge according to the present invention has typically from 5 to 100 mg collagen/cm 3 , whereas collagen films have from 650 to 800 mg collagen/cm 3 .
  • the hydrophilic polymeric component comprising reactive groups can react with the blood components and/or with the surface of the matrix of the biomaterial so as to crosslink the components which bind to the (at least two) reactive groups.
  • the sponge is usually flexible and suitable to be applied on diverse tissues and locations with various shapes.
  • the collagen used for the present invention can be from any collagen material including liquid, pasty, fibrous or powdery materials that can be processed to a porous, especially a porous and fibrous matrix.
  • the preparation of a collagen gel for the production of a sponge is e.g. described in the EP 0891193 (incorporated herein by reference) and may include acidification until gel formation occurs and subsequent pH neutralization.
  • the collagen may be (partially) hydrolyzed or modified, as long as the property to form a stable sponge when dried is not diminished.
  • the collagen or gelatin of the sponge matrix is preferably of animal origin, preferably bovine or equine.
  • human collagen might be used in case of a hypersensitivity of the patient towards xenogenic proteins.
  • synthetic or recombinant collagen may be used.
  • the further components of the sponge are preferably of human origin, which makes the sponge suitable especially for the application to a human.
  • the porous collagen sponge contains about 5 to about 50, e.g. about 10 to about 30, preferably about 25 mg collagen/cm 3 of dry sponge.
  • the biomaterial may be non-crosslinked or crosslinked, preferably the biomaterial has been crosslinked.
  • the hydrophilic polymeric component of the sponge according to the present invention is a hydrophilic crosslinker which is able to react with its reactive groups once the sponge is applied to a patient (e.g. to a wound of a patient or another place where the patient is in need of a hemostatic activity). Therefore it is important for the present invention that the reactive groups of the polymeric component are reactive when applied to the patient. It is therefore necessary to manufacture the sponge according to the present invention so that the reactive groups of the polymeric component which should react once they are applied to a wound are retained during the manufacturing process.
  • hydrophilic polymeric components have reactive groups which are susceptible to hydrolysis after contact with water. Accordingly, premature contact with water or aqueous liquids has to be prevented before administration of the sponge to the patient, especially during manufacture.
  • processing of the hydrophilic polymeric component during manufacturing may be possible also in an aqueous medium at conditions where the reactions of the reactive groups are inhibited (e.g. at a low pH). If the hydrophilic polymeric components can be melted, the melted hydrophilic polymeric components can be sprayed or printed onto the matrix of the biopolymer. It is also possible to sprinkle a dry form (e.g. a powder) of the hydrophilic polymeric component onto the matrix.
  • these hydrophilic polymeric components can be taken up into inert organic solvents (inert vis-à-vis the reactive groups of the hydrophilic polymeric components) and brought onto the matrix of the biomaterial.
  • organic solvents are dry ethanol, dry acetone or dry dichloromethane (which are e.g. inert for hydrophilic polymeric components, such as NHS-ester substituted PEGs).
  • the hydrophilic polymer component is a single hydrophilic polymer component and is a polyalkylene oxide polymer, esp. preferred a PEG comprising polymer, in the following called “the material”.
  • the reactive groups of said material are preferably electrophilic groups.
  • the material may be a multi-electrophilic polyalkylene oxide polymer, e.g. a multi-electrophilic PEG.
  • the material can include two or more electrophilic groups such as —CON(COCH 2 ) 2 , —CHO, —N ⁇ C ⁇ O, and/or —N(COCH 2 ) 2 , e.g. a component as disclosed in the WO2008/016983 (incorporated herein by reference in its entirety) and one of the components of the commercially available ones under the trademark CoSeal®.
  • Preferred electrophilic groups of the hydrophilic polymeric crosslinker according to the present invention are groups reactive to the amino-, carboxy-, thiol- and hydroxy-groups of proteins, or mixtures thereof.
  • Preferred carboxy-group specific reactive groups are amino-groups in the presence of carbodiimides.
  • Preferred thiol group-specific reactive groups are maleiimides or haloacetyls.
  • Preferred hydroxy group-specific reactive group is the isocyanate group.
  • the reactive groups on the hydrophilic cross-linker may be identical (homo-functional) or different (hetero-functional).
  • the hydrophilic polymeric component can have two reactive groups (homo-bifunctional or heterobifunctional) or more (homo/hetero-trifunctional or more).
  • the material is a synthetic polymer, preferably comprising PEG.
  • the polymer can be a derivative of PEG comprising active side groups suitable for cross-linking and adherence to a tissue.
  • the hydrophilic polymer has the ability to cross-link blood proteins and also tissue surface proteins. Cross-linking to the biomaterial is also possible.
  • the multi-electrophilic polyalkylene oxide may include two or more succinimidyl groups.
  • the multi-electrophilic polyalkylene oxide may include two or more maleimidyl groups.
  • the multi-electrophilic polyalkylene oxide is a polyethylene glycol or a derivative thereof.
  • the polymeric component e.g. COH102
  • the coating is a discontinuous coating, e.g. such as shown in FIG. 6 .
  • the coating is a thin continuous coating, as obtained e.g. by spraying the polymeric component from the melt onto the matrix of biomaterial.
  • a coating is comparable to a film-like or glass-like structure, e.g. such as shown in FIG. 7 .
  • the molecular weight of the polymeric component is preferably in a range of 500 to 50000, most preferred about 10000.
  • the amount of coating of polymeric component on the sponge of said biomaterial is preferably from about 1 mg/cm 2 to about 20 mg/cm 2 , more preferred about 2 mg/cm 2 to about 14 mg/cm 2 for the coated sponge.
  • the concentration of polymeric component is preferably from about 5 mg/cm 3 to about 100 mg/cm 3 , more preferred from about 10 mg/cm 3 to about 70 mg/cm 3 for an impregnated sponge.
  • the sponge of the present invention comprises a combination of impregnated and coated forms.
  • the sponge according to the present invention preserves reactivity of the reactive groups of the hydrophilic polymeric component comprising reactive groups by being dry, e.g. having an overall water content of below 10%, especially below 2%, and especially below 1% in case the polymeric component has hydrolysable reactive groups, e.g. NHS-PEG.
  • Higher water contents e.g. higher than 10%
  • water contents of below 2% (w/w) are preferred; below 1% is even more preferred; below 0.5% is specifically preferred.
  • a further layer of a further biomaterial is present.
  • the further layer can be from the same biomaterial as the matrix or it can be a different biomaterial, e.g. matrix of biomaterial is collagen and the further layer is oxidized cellulose. All combinations of biomaterials as mentioned above may be included.
  • the sponge as a whole can be biodegradable, being suitable for biological decomposition in vivo, or bioresorbable, i.e. able to be resorbed in vivo, e.g. via degradation by proteases which are present in vivo and groups which are hydrolysable in vivo. Full resorption means that no significant extracellular fragments remain.
  • a biodegradable material differs from a non-biodegradable material in that a biodegradable material can be biologically decomposed into units which may either be removed from the biological system and/or chemically incorporated into the biological system.
  • the particular material, the matrix material or sponge as a whole can be degraded by a subject, in particular a human subject, in less than 6 month, less than 3 month, less than 1 month, less than 2 weeks.
  • the sponge may further comprise an activator or proactivator of blood coagulation, including fibrinogen, thrombin or a thrombin precursor, as e.g. disclosed in U.S. Pat. No. 5,714,370 (incorporated herein by reference).
  • thrombin or the precursor of thrombin is understood as a protein that has thrombin activity and that induces thrombin activity when it is contacted with blood or after application to the patient, respectively. Its activity is expressed as thrombin activity (NIH-Unit) or thrombin equivalent activity developing the corresponding NIH-Unit.
  • the activity in the sponge can be 100-10.000, preferably 500-5.000. In the following thrombin activity is understood to comprise both, the activity of thrombin or any equivalent activity.
  • a protein with thrombin activity might be selected from the group consisting of alpha-thrombin, meizothrombin, a thrombin derivative or a recombinant thrombin.
  • a suitable precursor is possibly selected from the group consisting of: prothrombin, factor Xa optionally together with phospholipids, factor IXa, activated prothrombin complex, FEIBA, any activator or a proactivator of the intrinsic or extrinsic coagulation, or mixtures thereof.
  • the hemostatic sponge according to the invention might be used together with further physiologic substances.
  • the sponge preferably further comprises pharmacologically active substances, among them antifibrinolytics, such as a plasminogen activator-inhibitor or a plasmin inhibitor or an inactivator of fibrinolytics.
  • antifibrinolytics such as a plasminogen activator-inhibitor or a plasmin inhibitor or an inactivator of fibrinolytics.
  • a preferred antifibrinolytic is selected from the group consisting of aprotinin or an aprotinin derivative, alpha2-macroglobulin, an inhibitor or inactivator of protein C or activated protein C, a substrate mimic binding to plasmin that acts competitively with natural substrates, and an antibody inhibiting fibrinolytic activity.
  • an antibiotic such as an antibacterial or antimycotic might be used together with the sponge according to the invention, preferably as a component homogeneously distributed in the sponge.
  • Further bioactive substances such as growth factors and/or pain killers may be also present in the inventive sponge.
  • Such a sponge might be useful in e.g. wound healing.
  • enzymes or enzyme inhibitors which may regulate, i.e. accelerate or inhibit, the resorption of the sponge.
  • specific enzymes or enzyme inhibitors which may regulate, i.e. accelerate or inhibit, the resorption of the sponge.
  • those are collagenase, its enhancers or inhibitors.
  • a suitable preservative may be used together with the sponge or may be contained in the sponge.
  • hemostatic sponge which contains the activator or proactivator of blood coagulation as the only active component
  • further substances that influence the velocity of blood coagulation, hemostasis and quality of the sealing such as tensile strength, inner (adhesive) strength and durability might be comprised.
  • Procoagulants that enhance or improve the intrinsic or extrinsic coagulation such as factors or cofactors of blood coagulation, factor XIII, tissue factor, prothrombin complex, activated prothrombin complex, or parts of the complexes, a prothrombinase complex, phospholipids and calcium ions, protamin, might be used.
  • factors or cofactors of blood coagulation factor XIII, tissue factor, prothrombin complex, activated prothrombin complex, or parts of the complexes, a prothrombinase complex, phospholipids and calcium ions, protamin
  • the sponge according to the invention further comprises inhibitors of blood coagulation in appropriate amounts.
  • Inhibitors, such as antithrombin III optionally together with heparin, or any other serine protease inhibitor are preferred.
  • thrombin stabilizers preferably selected from the group consisting of a polyol, a polysaccharide, a polyalkylene glycol, amino acids or mixtures thereof might be used according to the invention.
  • sorbitol glycerol
  • polyethylene glycol polypropylene glycol
  • mono- or disaccharides such as glucose or saccharose or any sugar or sulfonated amino acid capable of stabilizing thrombin activity is preferred.
  • a sponge of the present invention may further contains a dye, e.g. riboflavin, or other dye known from the prior art to be biocompatible.
  • the dye may be included e.g. as a further layer (coating) and may especially help the surgeon to identify which one of the surfaces of a coated sponge of the present invention is the active or inactive surface, respectively.
  • the sponge of the present invention preferably has an overall thickness of less than 3 cm, preferably about 1 mm to about 3 cm, more preferably about 1 mm to about 2 cm, most preferred about 1 mm to about 2 mm.
  • the thickness of the coating is preferably from about 0.01 mm to about 1 mm.
  • the sponge of the present invention is preferably used in minimal invasive surgery, e.g. for laparoscopic application.
  • the sponge may be dried and after drying, the sponge may have a water content of at least 0.5 (percentages given in w/w here). In certain embodiments the sponge can be freeze-dried or air-dried.
  • the present invention also provides a wound coverage comprising a sponge according to the invention.
  • the sponge and all additional layers can be provided in a ready to use wound coverage in suitable dimensions.
  • the sponge and/or the coverage can be a pad or a sheet, preferably having a thickness of at least 1 mm or at least 2 mm a or at least 5 mm and/or up to 20 mm, depending on the indication.
  • Fixing may be achieved by melting the polymeric component onto the sponge in a pre-heated oven, e.g. at temperatures between 30° C. to 80° C., preferably between 60° C. to 65° C., for a time period sufficient for fixing, e.g. between 1 minute to 10 minutes, preferably about 4 minutes.
  • fixing can be achieved by an infrared heater or any other heat source.
  • the distance between the pad and the heater, the intensity of the heater and the time of exposure to infrared irradiation are adjusted to achieve melting of the coating at a minimum of heat exposure.
  • a) providing a sponge comprising a matrix of a biomaterial in dried form b) providing one reactive polymeric material in the form of a solution, e.g. an aqueous solution with a pH of lower than 5, preferably about 3 or a water free organic solvent based solution, e.g. based on ethanol, acetone, methylenechloride and the like, c) contacting a) and b) so that the material of a) is impregnated with b), and d) drying the material obtained in step c).
  • a solution e.g. an aqueous solution with a pH of lower than 5, preferably about 3 or a water free organic solvent based solution, e.g. based on ethanol, acetone, methylenechloride and the like
  • Contacting for achieving impregnation may be done by placing the polymeric solution on top of the sponge and let the solution be soaked into said sponge for a time period sufficient for said absorption, e.g. from about 2 minutes to about 2 hours, preferably 30 minutes.
  • Drying may include freeze drying or air drying and comprises removing volatile components of the fluid.
  • the present invention provides a hemostatic sponge obtainable by a method of manufacturing according to process (I) or (II).
  • Another aspect of the invention relates to the use of a sponge of the present invention for the treatment of an injury selected from the group consisting of a wound, a hemorrhage, damaged tissue and/or bleeding tissue.
  • a sponge of the present invention is used for the sealing of tissues, e.g. lung, spleen, liver; and for hemostasis.
  • the composite of the present invention can also be used as a ready to use tissue sealant, wherever the concentration of body fluids in proteins is high enough to allow the formation of a sealing gel as described above.
  • the sponge of the present invention is especially indicated in open and endoscopic/laparoscopic/thoracoscopic/MIS (minimal invasive surgery) surgical procedures as an adjunct to hemostatsis, to address surgical bleeding, from oozing to active, when control of bleeding by ligature or conventional procedures is ineffective or impractical.
  • MIS minimal invasive surgery
  • the sponge of the present invention is applied together with a buffer solution, e.g. an alkaline buffer solution, such as a bicarbonate solution, such as 8.4% NaHCO 3 , pH 8.3, e.g. on a gauze.
  • a buffer solution e.g. an alkaline buffer solution, such as a bicarbonate solution, such as 8.4% NaHCO 3 , pH 8.3, e.g. on a gauze.
  • the present invention further provides a kit comprising a sponge of any one claims 1 to 5 and a buffer solution, e.g. an alkaline buffer solution, such as a bicarbonate or carbonate, together with instructions for its use.
  • a buffer solution e.g. an alkaline buffer solution, such as a bicarbonate or carbonate, together with instructions for its use.
  • the alkaline buffer solution preferably has a pH about 8, such as 8.3.
  • a hemostatic composite comprising a water insoluble haemostatic material (matrix) and a hydrophilic polymeric cross-linker with reactive groups, said composite comprising pores which allow external fluids, especially human blood, to access into said composite.
  • the haemostatic material may be any material mentioned above as “matrix of a biomaterial” which by itself already has a certain haemostatic property. Such materials are known in principle in the art as well as their haemostatic property.
  • the composite material according to the present invention has pores which allow external fluids to access the inner part of the composite so that e.g. if applied to a wound, blood of this wound can enter the composite. The composite can get soaked by these pores.
  • this haemostatic material is a collagen sponge, a fabric of oxidized regenerated cellulose, a fibrin sponge or a gelatin sponge. It is specifically preferred, that the collagen sponge is essential native collagen (i.e. native collagen fiber structure is to a large extend preserved or regenerated by fibrillogenesis during processing).
  • the reactivity of the hydrophilic polymeric crosslinker in the composite according to the present invention is retained. This means that the reactive groups of the crosslinker have not yet reacted with the (surface of the) haemostatic material and are not hydrolyzed by water. This can be achieved by combining the hemostatic material with the crosslinker in a way which does not lead to reaction of the reactive groups of the crosslinker with the hemostaic material or with water, e.g. as disclosed herein by melting, spraying, soaking under inert conditions, etc. Usually, this includes the omitting of aqueous conditions (or wetting), especially wetting without the presence of acidic conditions (if crosslinkers are not reactive under acidic conditions). This allows the provision of reactive haemostatic materials.
  • the haemostatic composite according to the present invention contains a polyethylene glycol (PEG) as hydrophilic polymeric crosslinker with reactive groups, especially a PEG comprising two or more, preferably 4, reactive groups selected from succinimidylesters (—CON(COCH 2 ) 2 ), aldehydes (—CHO) and isocyanates (—N ⁇ C ⁇ O), especially preferred succinimidylesters, such as component COH102 as defined below of Coseal.
  • PEG polyethylene glycol
  • reactive groups especially a PEG comprising two or more, preferably 4, reactive groups selected from succinimidylesters (—CON(COCH 2 ) 2 ), aldehydes (—CHO) and isocyanates (—N ⁇ C ⁇ O), especially preferred succinimidylesters, such as component COH102 as defined below of Coseal.
  • the matrix material which forms the porous network of the sponge constitutes of between 1-50%, 1-10%, or about 3% of the dried porous sponge (w/w-%).
  • the matrix of a biomaterial, especially the collagen, according to the present invention in general is not soluble, in particular not water-soluble.
  • the sponge is be porous and/or hygroscopic, it is allowed to swell when it is brought together with aqueous fluids, especially blood, serum, plasma, etc. or other fluids present in wounds and takes up these fluids.
  • the hemostatic sponge according to the present invention is fluid absorbing.
  • Fluid absorbing shall be considered as the physical process to hold fluids upon contacting which may or may not provoke swelling of the sponge.
  • the sponge can hold an amount of a fluid, in particular blood, of at least 1 time, at least 2 times, at least 4 times or at least 10 times and/or up to 100 times, up to 20 times or up to 10 of the dry weight of the sponge.
  • the sponge material according to the present invention can take up fluids even under pressure.
  • the porous sponge material according to the present invention preferably has a pore size of 5 to 500 ⁇ m, preferably of 10 to 200 ⁇ m. This pore size can properly be adjusted in the course of production of the sponge biomaterial, especially by way of directing a drying process in the course of such production.
  • the sponge according to the present invention is preferably provided in a “ready-to-use” form so that it is directly applicable to a patient in need thereof, e.g. to a wound of this patient (whereafter crosslinking starts).
  • the sponge according to the present invention is therefore packed into a sterile package which protects the sponge from contamination (e.g. by moisture or microorganisms) during storage. Before use, the package can be opened (preferably also under sterile conditions) and the sponge can directly be applied to the patient (“ready-to use”).
  • the hydrophilic polymeric component is a hydrophilic crosslinker.
  • this crosslinker has more than two reactive groups for crosslinking (“arms”), for example three, four, five, six, seven, eight, or more arms with reactive groups for crosslinking.
  • arms for example, NHS-PEG-NHS is an effective hydrophilic crosslinker according to the present invention.
  • a 4-arm polymer e.g. 4-arms-p-NP-PEG
  • an 8-arm polymer e.g. 8-arms-NHS-PEG
  • multi-reactive crosslinking is beneficial.
  • the hydrophilic crosslinker according to the present invention is a polymer, i.e. a large molecule (macromolecule) composed of repeating structural units which are typically connected by covalent chemical bonds.
  • Polymers according to the present invention should have a molecular weight of at least 1000 Da (to properly serve as crosslinkers for the sponge according to the present invention); preferably the crosslinking polymers according to the present invention has a molecular weight of at least 5000 Da, especially of at least 8000 Da.
  • hydrophilic crosslinkers For some hydrophilic crosslinkers, the presence of basic reaction conditions (e.g. at the administration site) is preferred or necessary for functional performance (e.g. for a faster cross-linking reaction at the administration site).
  • carbonate or bicarbonate ions e.g. as a buffer with a pH of 7.6 or above, preferably of 8.0 or above, especially of 8.3 and above
  • may be additionally provided at the site of administration e.g. as a buffer solution or as a fabric or pad soaked with such a buffer), so as to allow an improved performance of the sponge according to the present invention or to allow efficient use as a hemostatic and/or wound adherent material.
  • FIG. 1 Hemostatic efficacy of a collagen pad coated with NHS-PEG A hemostatic pad is produced according to example 2 and coated with 14 mg/cm 2 COH102 (as defined below). The hemostatic efficacy is evaluated according to the animal as described below. The bleeding is stopped 2 min after the pad application. No rebleeding is observed.
  • FIG. 2 Hemostatic efficacy of a collagen pad impregnated with NHS-PEG A hemostatic pad is produced according to example 3 and impregnated with 8 mg/cm 2 COH102. The hemostatic efficacy is evaluated according to the animal as described below. The bleeding is stopped 2 min after the pad application. No rebleeding is observed.
  • FIG. 3 Hemostatic efficacy of a collagen pad containing oxidized cellulose fabric coated with NHS-PEG A hemostatic pad is produced according to example 5 and coated with 14 mg/cm 2 COH102. The hemostatic efficacy is evaluated according to the animal as described below. The bleeding is stopped 2 min after the pad application. No rebleeding is observed.
  • FIG. 4 Hemostatic efficacy of an oxidized cellulose fabric coated with NHS-PEG A hemostatic pad is produced according to example 6 and coated with 14 mg/cm 2 COH102. The hemostatic efficacy is evaluated according to the animal as described below. The bleeding is stopped 2 min after the pad application. No rebleeding is observed.
  • FIG. 5 Hemostatic efficacy of a collagen pad containing fucoidan as hemostasis enhancing substance coated with NHS-PEG A hemostatic pad is produced according to example 7 and coated with 14 mg/cm 2 COH102. The hemostatic efficacy is evaluated according to the animal as described below. The bleeding is stopped 2 min after the pad application. No rebleeding is observed.
  • FIG. 6 Scanning electron microscopy image (magnification: ⁇ 500) of the surface of a discontinuously coated collagen sponge
  • FIG. 7 Scanning electron microscopy image (magnification: ⁇ 500) of the surface of a continuously coated collagen sponge
  • FIG. 8 Gelfoam coated with 14 mg/cm 2 COH102 in the liver lobe abrasion model
  • FIG. 9 Chitoskin coated with 14 mg/cm 2 COH102 in the liver lobe abrasion model
  • the present invention is further exemplified by the following examples without being limited thereto.
  • the collagen concentration of the material obtained is determined by gravimetry.
  • a chemical crosslinking with glutaraldehyde may be carried out in that a 1% aq. collagen suspension is prepared and 5000 ppm of glutaraldehyde are added at 12° C. The suspension obtained is stirred overnight. Crosslinked collagen obtained is filtered and washed with H 2 O. The collagen concentration of the material obtained is determined as described above.
  • COH102 powder is homogeneously distributed onto one surface of a commercially available collagen sponge (Matristypt®, Dr. Suwelack Skin—and Healthcare, Germany, thickness 1 mm or 2 mm). COH102 amounts of 2 mg/cm 2 , 7 mg/cm 2 , 10 mg/cm 2 , 14 mg/cm 2 , 20 mg/cm 2 are used for the coating.
  • the COH 102 powder is fixed on the surface of the sponge by melting. This is performed at 60° C. to 65° C. for 4 min by placing the sponge with the PEG powder mixture into a preheated oven.
  • a dried sponge obtained is sealed together with a sachet of desiccant in a gas-impermeable pouch and ⁇ -sterilized at 25 kGray.
  • Aq. acidic solutions (pH 3.0, AcOH) of COH102 with concentrations of 10 mg/cm 3 , 20 mg/cm 3 , 30 mg/cm 3 and 40 mg/cm 3 are prepared and filled into 9 ⁇ 7 cm PET-trays.
  • Commercial available bovine collagen sponges (Matristypt®), 9 ⁇ 7 ⁇ 0.1 or 0.2 cm, with the same volume as the previously filled COH102 solution are placed on the top of the solutions for impregnation for 20 min.
  • COH102 solution is absorbed and the collagen material obtained is lyophilized. Sponges obtained can be additionally coated with COH102 as described in example 2.
  • each dried sponge obtained is sealed together with a sachet containing desiccant in a gas impermeable pouch and sterilized by ⁇ -irradiation at 25 kGray.
  • Traumastem® P powder (Bioster, Czech Republic) is homogenously distributed into 22 ml of neutral aqueous collagen suspension (2.15 mg/ml; 4.3 mg/ml and 10 mg/ml) produced according to example 1.
  • the mixture obtained is filled into flat 9 ⁇ 7 cm PET-trays and lyophilized.
  • a fleece obtained has a thickness of about 3-4 mm and is coated with COH102 as described in example 2.
  • each sponge obtained is sealed together with a sachet containing desiccant in a gas impermeable pouch and sterilized by ⁇ -irradiation at 25 kGray.
  • a 6 ⁇ 5 cm Traumastem® TAF light-fabric (Bioster, Czech Republic) is immersed into a 1% bovine collagen suspension as described in example 1.
  • the 6 ⁇ 5 cm oxidized cellulose fabric retains approximately 6 g of the collagen suspension.
  • a fabric soaked with the collagen suspension is obtained and laid in a tray and lyophilized.
  • a fleece obtained has a thickness of about 3-4 mm and is coated with COH102 as described in example 2.
  • each sponge obtained is sealed together with a sachet containing desiccant in a gas impermeable pouch and sterilized by ⁇ -irradiation at 25 kGray.
  • Traumastem® P fleece (Bioster, Czech Republic) is coated with 14 mg/cm 2 COH102 as described in example 2.
  • the thickness of the pad obtained is about 1-2 mm.
  • a bovine collagen sponge Matristypt® (9 ⁇ 7 ⁇ 0.2 cm) is impregnated with the same volume of a Fucoidan solution of A. nodosum (10 ⁇ M and 200 ⁇ M in 40 mM Ca 2+ -solution) and lyophilized.
  • a sponge obtained is coated with COH102 as described in example 2.
  • a bovine collagen sponge Matristypt® (9 ⁇ 7 ⁇ 0.2 cm) is impregnated with the same volume of a thrombin solution (500 IU/ml) and lyophilized.
  • a sponge obtained is coated with COH102 as described in example 2.
  • a hemostatic pad coated with 14 mg/cm 2 COH102 is produced according to example 2.
  • a lesion of around 1.5 to 2 cm in diameter is set by a scalpel on the lung of a pig.
  • a sample of 3 ⁇ 3 cm of the said pad is applied onto the wound and hold in place by exerting slight pressure with the aid of gauze for 2 min.
  • the gauze is pre-wetted either with saline or basic bicarbonate solution (pH 8.3).
  • the pad is adhering firmly to the lung surface (see FIG. 6 ).
  • the speed of obtaining adherence is increased using gauze wetted with bicarbonate.
  • the chest is filled with Ringer's solution after 10 min. No gas leakage or detachment of the pad is observed.
  • a hemostatic pad impregnated with 40 mg/cm 3 COH102 is produced according to example 3.
  • a lesion of around 1.5 to 2 cm in diameter is set by a scalpel on the lung of a pig.
  • a sample of 3 ⁇ 3 cm of the said pad is applied onto the wound and hold in place by exerting slight pressure with the aid of gauze for 2 min.
  • the gauze is pre-wetted with basic bicarbonate solution (pH 8.3). After application the pad is adhering firmly to the lung surface. Air tightness and pad-adherence to the tissue are determined as described in Example 9.
  • a mask made of a stainless steel plate (1 mm thickness) with a pattern of holes is placed on one side of a 1 or 2 mm thick collagen sponge (Matristypt®, Dr. Suwelack Skin- and Healthcare, Germany).
  • the holes of the mask have a diameter of 2 mm and are placed at a distance of 1 cm from each other in the nodes of an upright square lattice.
  • a 0.5% aqueous Erioglaucine (Fluke, Switzerland) solution is sprayed with a standard airbrush device over the holes of the mask.
  • the mask is removed and a collagen sheet with the blue dot pattern obtained is dried at ambient atmosphere, in a vacuum oven or in a desiccator.
  • the dot pattern on one side has the role to distinguish the active and inactive surface of a coated pad. It is possible to apply the coating either on the dotted side or the non-dotted side.
  • a solution of 2.5 mg/ml of fibrinogen, 10 mM Tris/HCl, 150 mM NaCl, pH 7.4 and an equal volume of 55 IU thrombin/ml, 10 mM CaCl 2 are mixed using a static mixer and immediately filled into a tray at a height of 0.7 cm. A fibrin clot is obtained in the tray. By freeze-drying of the clot a fibrin fleece is obtained.
  • 14mg/cm 2 8-arm-NHS-PEG (MW 15000, NOF Corporation, Japan) are homogeneously distributed and fixed by melting. This is performed at 65° C. for 4 min by placing the sponge with the PEG powder into a preheated oven.
  • a sponge obtained is sealed together with a sachet containing desiccant in a gas-impermeable pouch.
  • the hemostatic performance of said pad is tested in pig in the liver abrasion model as described above. After 2 minutes hemostasis is achieved. No rebleeding after 10 minutes is observed. The adherence of the pad on the tissue is sufficient.
  • a sponge obtained is sealed together with a sachet containing desiccant in a gas-impermeable pouch.
  • the hemostatic performance of the said pad is tested in pig in the liver abrasion model as described above. After 2 minutes hemostasis is achieved. No rebleeding after 10 minutes is observed. The adherence of the pad on the tissue is not sufficient.
  • the hemostatic performance of the pad as prepared in Ex. 15a is tested in pig in the liver abrasion model as described above but with the modification, that the pad is applied with gauze pre-wetted with basic 8% Na-bicarbonate solution. After 2 minutes hemostasis is achieved. No rebleeding after 10 minutes is observed. The adherence of the pad on the tissue is sufficient.
  • a 6 ⁇ 6 cm collagen pad made as described in example 11, 9.5 mg/cm 2 CHO-PEG-CHO (MW 3400, Interchim, France) are homogeneously distributed and fixed by melting. This is performed at 70° C. for 4 min by placing the sponge with the PEG powder into a preheated oven.
  • a sponge obtained is sealed together with a sachet containing desiccant in a gas-impermeable pouch.
  • the hemostatic performance of said pad is tested in pig in the liver abrasion model as described above. After 2 minutes hemostasis is achieved. No rebleeding after 10 minutes is observed. The adherence of the pad on the tissue is sufficient.
  • the hemostatic performance of the pad as prepared in Ex. 16a is tested in pig in the liver abrasion model as described above but with the modification, that the pad is applied with gauze pre-wetted with basic Na-bicarbonate solution. After 2 min hemostasis is achieved. No rebleeding after 10 min is observed. The adherence of the pad on the tissue is sufficient.
  • Epoxy-PEG-Epoxy (MW 3400, Interchim, France) are homogeneously distributed and fixed by melting. This is performed at 70° C. for 4 min by placing the sponge with the PEG powder into a preheated oven.
  • a sponge obtained is sealed together with a sachet containing desiccant in a gas-impermeable pouch.
  • the hemostatic performance of said pad is tested in pig in the liver abrasion model as described above. After 2 min no hemostasis is achieved. The adherence of the pad on the tissue is not sufficient.
  • the hemostatic performance of the pad as prepared in Ex. 17a is tested in pig in the liver abrasion model as described above but with the modification, that the pad is applied with gauze pre-wetted with basic Na-bicarbonate solution. After 2 min hemostasis is achieved. No rebleeding after 5 min is observed. The adherence of the pad on the tissue is sufficient.
  • a sponge obtained is sealed together with a sachet containing desiccant in a gas-impermeable pouch.
  • the hemostatic performance of said pad is tested in pig in the liver abrasion model as described above, but with the modification, that the pad is applied with gauze pre-wetted with basic Na-bicarbonate solution. After 2 min hemostasis is achieved. No rebleeding after 5 min is observed. The adherence of the pad on the tissue is sufficient.
  • a sponge obtained is sealed together with a sachet containing desiccant in a gas-impermeable pouch.
  • the hemostatic performance of said pad is tested in pig in the liver abrasion model as described above. After 2 min hemostasis is achieved. No rebleeding after 10 min is observed. The adherence of the pad on the tissue is sufficient.
  • a sponge obtained is sealed together with a sachet containing desiccant in a gas-impermeable pouch.
  • the hemostatic performance of said pad is tested in pig in the abrasive liver lobe model as described above but with the modification, that the pad is applied with gauze pre-wetted with basic Na-bicarbonate solution. After 2 min hemostasis is achieved. No rebleeding after 10 min is observed. The adherence of the pad on the tissue is sufficient.
  • a sponge obtained is sealed together with a sachet containing desiccant in a gas-impermeable pouch.
  • the hemostatic performance of said pad is tested in pig in the abrasive liver lobe model as described above. After 2 min hemostasis is not achieved. The adherence of the pad on the tissue is not sufficient.
  • the hemostatic performance of the pad as prepared in Ex. 21 a is tested in pig in the abrasive liver lobe model as described above but with the modification, that the pad is applied with gauze pre-wetted with basic bicarbonate solution. After 2 min hemostasis is achieved. No rebleeding after 10 min is observed. The adherence of the pad on the tissue is sufficient.
  • a sponge obtained is sealed together with a sachet containing desiccant in a gas-impermeable pouch.
  • the hemostatic performance of said pad is tested in pig in the liver abrasion model as described above. After 2 min hemostasis is not achieved. The adherence of the pad on the tissue is not sufficient.
  • the hemostatic performance of the pad as prepared in Ex. 22a is tested in pig in the liver abrasion model as described above but with the modification, that the pad is applied with gauze pre-wetted with basic Na-bicarbonate solution. After 2 min hemostasis is achieved. No rebleeding after 10 min is observed. The adherence of the pad on the tissue is sufficient.
  • a sponge obtained is sealed together with a sachet containing desiccant in a gas-impermeable pouch.
  • the hemostatic performance of said pad is tested in pig in the liver abrasion model as described above. After 2 min hemostasis is achieved. No rebleeding after 10 min is observed. The adherence of the pad on the tissue is sufficient.
  • Example No. Cross-linker Adherence score 13 NHS-PEG-NHS 1 14 8-arms-NHS-PEG 1 15a 4-arms-p-NP-PEG 3 15b 4-arms-p-NP-PEG - basic application 2 16a CHO-PEG-CHO 1 16b CHO-PEG-CHO - basic application 2 17a Epoxy-PEG-Epoxy 3 17b Epoxy-PEG-Epoxy - basic application 2 18 4-arm-Epoxy-PEG - basic application 2 19 ISC-PEG-ISC 1 20 AA-dextran - basic application 1 21a DSS 3 21b DSS - basic application 2 22a EGS 3 22b EGS - basic application 2
  • chitosan/gelatin sponge (Chitoskin®, Beese Medical, Germany) 14 mg/cm 2 of COH102 are homogeneously distributed and fixed by melting. This is performed at 65° C. for 4 min by placing the sponge with the PEG powder into a preheated oven.
  • a sponge obtained is sealed together with a sachet containing desiccant in a gas-impermeable pouch
  • the hemostatic performance of said pad is tested in pig in the liver abrasion model as described above. After 2 min hemostasis is achieved. No rebleeding after 10 min is observed ( FIG. 9 ). The adherence of the pad on the tissue is sufficient.
  • the sponge obtained is sealed together with a sachet containing desiccant in a gas-impermeable pouch.
  • a 2 ⁇ 2 cm piece of a dry collagen sponge (Matristypt®, Dr. Suwelack, Germany) or of a dry cross-linked gelatin sponge (Gelfoam®, Pfizer) are placed onto the surface of distilled H 2 O into a beaker.
  • the dry sponges are floating on the water surface and take up water over the 2 ⁇ 2 cm contact surface. After 6 s Matristypt® is totally soaked by H 2 O and removed from the water surface. The thicker Gelfoam® sponge is not totally soaked by H 2 O after 13 s, but removed after 13 s from the water surface.
  • the initial water uptake velocities of the sponges are 35 mg ⁇ cm ⁇ 1 s ⁇ 1 for Matristypt® and 0.8 mg ⁇ cm ⁇ 1 s ⁇ 1 for Gelfoam®.

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US15/181,280 Active 2032-06-15 US10441674B2 (en) 2010-04-07 2016-06-13 Hemostatic sponge
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