WO2005020825A1 - Polyhydroxyalkanoate nerve regeneration devices - Google Patents

Polyhydroxyalkanoate nerve regeneration devices Download PDF

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Publication number
WO2005020825A1
WO2005020825A1 PCT/US2004/026932 US2004026932W WO2005020825A1 WO 2005020825 A1 WO2005020825 A1 WO 2005020825A1 US 2004026932 W US2004026932 W US 2004026932W WO 2005020825 A1 WO2005020825 A1 WO 2005020825A1
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WO
WIPO (PCT)
Prior art keywords
nerve
conduit
regeneration
polymer
devices
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2004/026932
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English (en)
French (fr)
Inventor
Giorgio Terenghi
Pari-Naz Mohanna
David P. Martin
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Tepha Inc
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Tepha Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Tepha Inc filed Critical Tepha Inc
Priority to AU2004268560A priority Critical patent/AU2004268560B2/en
Priority to JP2006524041A priority patent/JP2007503221A/ja
Priority to US10/568,649 priority patent/US20060287659A1/en
Priority to CA2536510A priority patent/CA2536510C/en
Priority to EP04781590A priority patent/EP1663017A1/en
Publication of WO2005020825A1 publication Critical patent/WO2005020825A1/en
Anticipated expiration legal-status Critical
Priority to US12/207,911 priority patent/US20090209983A1/en
Ceased legal-status Critical Current

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Classifications

    • 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
    • A61L31/14—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L31/148—Materials at least partially resorbable by the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/1128—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis of nerves
    • 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
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/14—Macromolecular materials
    • A61L27/18—Macromolecular materials obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds
    • 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
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L27/58—Materials at least partially resorbable by the body
    • 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
    • A61L31/06—Macromolecular materials obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00004—(bio)absorbable, (bio)resorbable or resorptive
    • 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
    • A61L2430/00—Materials or treatment for tissue regeneration
    • A61L2430/32—Materials or treatment for tissue regeneration for nerve reconstruction

Definitions

  • the present invention generally relates to nerve regeneration devices derived from poly-4-hydroxybutyrate and its copolymers. This application claims priority to U.S.S.N. 60/497,173 filed August 22, 2003.
  • Several reports have described the use of alternative methods to repair severed nerves to restore both motor and sensory function that are lost when a nerve is injured.
  • Existing microsurgical techniques attempt to align the severed nerve endings in a tension-free manner by suturing. If the defect is large, a nerve graft is utihzed.
  • tubular conduits have also been tested as a method to provide a channel that can prevent or retard the infiltration of scar-forming tissue, potentially increase the concentration of nerve growth factor locally within the conduit, and also to bridge larger defects without the use of a graft.
  • the severed nerve endings are drawn into proximity in a manner that minimizes additional trauma by placing them inside opposite ends of the nerve guide channel.
  • Various materials have been tested as candidates for nerve channel conduits, and some have been used clinically. These include silicone rubber, polyglactin mesh, acrylic copolymer tubes, and other polyesters.
  • PCT WO 88/06866 It has been reported by PCT WO 88/06866 by Aebischer et al., however, that there are significant shortcomings with devices prepared from these materials. These include inflammatory responses, formation of scar tissue, and loss of sensory or motor function.
  • PPB poly-3-hydroxybutrate
  • tubular piezoelectric nerve conduits including a device formed from PHB.
  • Hazari et al. in Vol. 24B J. Hand Surgery, pp. 291-295 (1999), Ljungberg et al. in Vol.19 Microsurgery, pp. 259-264 (1999), and Hazari et al. in Vol. 52 British J. Hand Surgery, pp. 653-657 (1999) also disclose PHB conduits for nerve regeneration.
  • PCT WO 03/041758 to Wiberg discloses a nerve repair unit comprising PHB and an alginate matrix containing human Schwann cells
  • PCT WO 01/54593 also discloses PHB conduits that include Schwann cells.
  • 653-657 (1999) discloses a rate of axonal regeneration using a PHB conduit to bridge a 10 mm nerve gap in a rat sciatic nerve of approx. 10% at 7 days, 50% at 14 days, and complete regeneration at 30 days.
  • a rate of axonal regeneration using a PHB conduit to bridge a 10 mm nerve gap in a rat sciatic nerve of approx. 10% at 7 days, 50% at 14 days, and complete regeneration at 30 days.
  • Nerve regeneration devices are provided with improved rates of axonal regeneration, and methods for their manufacture are also disclosed.
  • the devices are formed from a biocompatible, absorbable polymer, known as poly-4-hydroxybutyrate. Growth factors, drugs, or cells that improve nerve regeneration may be incorporated into the devices.
  • the devices are administered by implantation preferably without the use of sutures.
  • the device is in the form of a wrap that can be used easily to capture the severed nerve bundle ends during surgery, and formed into a conduit in situ.
  • the edges of the wrap can be melted together to seal the conduit, and hold it in place.
  • a major advantage of the device is that it does not need to be removed after use since it is slowly degraded and cleared by the patient's body, yet remains functional in situ beyond the time required for nerve regeneration, and helps exclude scar tissue.
  • the device also degrades in a cell-friendly manner, and does not release highly acidic or inflammatory metabolites.
  • the device is flexible, strong, does not crush the regenerating nerve, is easy to handle, reduces surgical time by eliminating the need to harvest an autologous graft, and allows the surgeon to repair the nerve without a prolonged delay.
  • Detailed Description of the Invention Devices for the repair of severed or damaged nerves are provided. These devices can be used instead of suture-based repairs, grafts to repair nerves, and/or where it is desirable to administer locally nerve cells, growth factors or other substances that promote nerve regeneration.
  • Poly-4-hydroxybutyrate means a homopolymer comprising
  • Copolymers of poly-4-hydroxybutyrate mean any polymer comprising 4-hydroxybutyrate with one or more different hydroxy acid units.
  • Biocompatible refers to materials that are not toxic, and do not elicit prolonged inflammatory or chronic responses in vivo. Any metabolites of these materials should also be biocompatible.
  • Biode gradation means that the polymer must break down in vivo, preferably in less than two years, and more preferably in less than one year. Biode gradation refers to a process in an animal or human. The polymer may break down by surface erosion, bulk erosion, hydrolysis, or a combination of these mechanisms.
  • the polymers should be biocompatible and biode radable.
  • the polymers are typically prepared by fermentation.
  • Preferred polymers are poly-4-hydroxybutyrate and copolymers thereof. Examples of these polymers are produced by Tepha, Inc. of Cambridge, MA using transgenic fermentation methods, and have weight average molecular weights in the region of 50,000 to 1,000,000.
  • Poly-4-hydroxybutyrate (PHA4400) is a strong pliable thermoplastic that is produced by a fermentation process (see U.S. Patent No. 6,548,569 to Williams et al.). Despite its biosynthetic route, the structure of the polyester is relatively simple.
  • the polymer belongs to a larger class of materials called polyhydroxyalkanoates (PHAs) that are produced by numerous microorganims (for reviews see: Steinb ⁇ chel, A. (1991) Polyhydroxyalkanoic acids, in Biomaterials, (Byrom, D., Ed.), pp. 123-213. New York: Stockton Press. Steinb ⁇ chel, A. and Valentin, H.E. (1995) FEMS Microbial. Lett. 128:219-228; and Doi, 1990 in Microbial Polyesters, New York: VCH). In nature these polyesters are produced as storage granules inside cells, and serve to regulate energy metabolism. They are also of commercial interest because of their thermoplastic properties, and relative ease of production.
  • PHAs polyhydroxyalkanoates
  • PHAs are known to be useful to produce a range of medical devices.
  • U.S. Patent No. 6,514,515 to Williams discloses tissue engineering scaffolds
  • U.S. Pat. Nos. 6,555,123 and 6,585,994 to Williams and Martin discloses soft tissue repair, augmentation and viscosupplementation
  • U.S. Patent No. 6,592,892 to Williams discloses flushable disposable polymeric products
  • PCT WO 01/19361 to Williams and Martin discloses PHA prodrug therapeutic compositions.
  • the nerve regeneration devices are preferably manufactured in a porous form by methods such as particulate leaching, phase separation, lyophilization, compression molding, or melt extrusion into fibers and subsequent processing into a textile construct.
  • the device could be fabricated as a nonwoven, woven or knitted structure.
  • the pores of the device are between 5 and 500 ⁇ m in diameter.
  • the device should be slightly longer than the nerve gap to be repaired.
  • the device is about 2 mm longer at either end than the gap to be repaired.
  • the diameter of the device, if preformed, should be large enough so that it does not exert pressure on the re-growing nerve, but small enough to provide a good seal at the nerve endings. The exact size will depend on the diameter of the nerve to be repaired.
  • the device can be formed from a sheet like material of the polymer that can be wrapped around the nerve endings and secured into a nerve conduit channel to make it easier to bring the severed ends together (as opposed to insertion of nerve bundles into prefabricated tube ends).
  • the polymer may be pre- seeded with cells, such as Schwann cells, and/or combined with a drug or growth factor.
  • the latter is dispersed evenly throughout the device using a method such as solvent casting, spray drying, or melt extrusion.
  • the cells, growth factors or drugs may be encapsulated in the form of microspheres, nanospheres, microparticles and/or microcapsules, and seeded into the porous device.
  • Non-limiting examples demonstrate methods for preparing the nerve regeneration devices, and the rate of axonal regeneration that can be achieved with these devices.
  • EXAMPLE 1 Preparation of PHA Porous foam sheet by lyophilization, water extraction. PHA4400 (Mw 800 K by GPC) was dissolved in dioxane at 5% wt/vol.
  • the polymer solution was mixed with sodium particles that had been sieved between 100 and 250 Dm stainless steel sieves.
  • the mixture contained 1 part by weight salt particles and 2 parts polymer solution.
  • a 10-12 g portion of the salt/polymer mixture was poured onto a Mylar® sheet and covered with a second Mylar® sheet separated by a 300-500 steel spacers.
  • the salt/polymer mixture was pressed to a uniform thickness using a Carver press.
  • the mixture was frozen at -26°C between aluminum plates that had been pre-cooled to -26°C.
  • the top Mylar® sheet was removed while keeping the sample frozen.
  • Sample A The sample was transferred while frozen to a lyophilizer and was lyophilized overnight to remove the dioxane solvent and yield a PHA4400 foam containing salt particles.
  • the sample was removed from the bottom Mylar® sheet and the salt particles were leached out of the sample into deionized water to yield a sheet of highly porous PHA4400 foam, referred to as Sample A.
  • EXAMPLE 2 Preparation of PHA Porous foam sheet, lyophilization, surfactant extraction.
  • a porous foam sheet of PHA4400 was prepares as in example 1, except the salt was leached out into an aqueous solution containing 0.025% Tween 80, rather than water. This was referred to as Sample B.
  • EXAMPLE 3 Preparation of PHA Porous foam sheet, ethanol extraction of dioxane, water extraction of salt.
  • PHA4400 Mw 800 K by GPC
  • the polymer solution was mixed with sodium particles that had been sieved between 100 and 250 Dm stainless steel sieves.
  • the mixture contained 1 part salt particles and 2 parts by weight polymer solution.
  • a 10-12 g portion of the salt/polymer mixture was poured onto a Mylar® sheet and covered with a second Mylar® sheet separated by a 300-500 steel spacers.
  • the salt/polymer mixture was pressed to a uniform thickness using a Carver press.
  • the mixture was frozen at -26°C between aluminum plates that had been pre-cooled to -26°C.
  • the top Mylar® sheet was removed while keeping the sample frozen.
  • the sample was transferred while frozen into a bath of cold ethanol (95%) to remove the dioxane solvent and yield a PHA4400 foam containing salt particles.
  • the sample was removed from the bottom Mylar® sheet and the salt particles were leached out of the sample into deionized water to yield a sheet of highly porous PHA4400 foam, referred to as Sample C.
  • EXAMPLE 4 Formation of PHA Porous foam sheet, ethanol extraction of dioxane, surfactant extraction of salt.
  • a porous foam sheet of PHA4400 was prepared as in Example 3, except that the salt was leached out into an aqueous solution containing 0.025% Tween 80, rather than water. This was referred to as Sample D.
  • EXAMPLE 5 Implantation of Nerve grafts or PHA conduits. Thirty male Sprague-Dawley rats were divided into 5 groups of 6 animals.
  • a 10 mm segment of the sciatic nerve was exposed in each animal, resected, and then bridged with either an autologous nerve graft or a PHA4400 conduit that was prepared by wrapping the nerve endings with the foams derived from examples 1-4 and thermally melting the edge to form a seal.
  • One group received autologous nerve grafts, each of the remaining groups was implanted with conduits derived from Samples A, B, C or D.
  • Three animals from each group were sacrificed at 10 and 20 days post-operatively, and the repair sites harvested. After fixation the tissue was blocked, sectioned, and then stained with polyclonal antibody to PGP (a pan-neuronal marker) and S100 (an antibody marker for Schwann cells).
  • the axonal and SC (Schwann cell) regeneration distance and area of axonal regeneration were then quantified. All four samples of PHA4400 handled well, were flexible, had a good tensile strength and held sutures. At the time of harvest there was no evidence of wound infections, no macroscopic evidence of inflammation and no anastomotic failures. At both harvest points the PHA4400 tubes maintained their structure with no evidence of collapse, and the tubes had not adhered to the underlying muscles. Macroscopically there appeared to be no difference between the four PHA4400 samples. The distance reached into the conduits by the furthermost PGP and S100 positive fibers were measured at 10 and 20 days for each group.
  • Table 1 Percentage of axonal regeneration area in the distal stump at 10 and 20 days for the four different PHA4400 conduits used to repair a 10 mm gap in a rat sciatic nerve.

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  • Health & Medical Sciences (AREA)
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  • Heart & Thoracic Surgery (AREA)
  • Chemical & Material Sciences (AREA)
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  • Chemical Kinetics & Catalysis (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Medical Informatics (AREA)
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  • Materials For Medical Uses (AREA)
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PCT/US2004/026932 2003-08-22 2004-08-20 Polyhydroxyalkanoate nerve regeneration devices Ceased WO2005020825A1 (en)

Priority Applications (6)

Application Number Priority Date Filing Date Title
AU2004268560A AU2004268560B2 (en) 2003-08-22 2004-08-20 Polyhydroxyalkanoate nerve regeneration devices
JP2006524041A JP2007503221A (ja) 2003-08-22 2004-08-20 ポリヒドロキシアルカノエート神経再生デバイス
US10/568,649 US20060287659A1 (en) 2003-08-22 2004-08-20 Polyhydroxyalkanoate nerve regeneration devices
CA2536510A CA2536510C (en) 2003-08-22 2004-08-20 Polyhydroxyalkanoate nerve regeneration devices
EP04781590A EP1663017A1 (en) 2003-08-22 2004-08-20 Polyhydroxyalkanoate nerve regeneration devices
US12/207,911 US20090209983A1 (en) 2003-08-22 2008-09-10 Polyhydroxyalkanoate nerve regeneration devices

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US49717303P 2003-08-22 2003-08-22
US60/497,173 2003-08-22

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US12/207,911 Continuation US20090209983A1 (en) 2003-08-22 2008-09-10 Polyhydroxyalkanoate nerve regeneration devices

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WO2005020825A1 true WO2005020825A1 (en) 2005-03-10

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US (2) US20060287659A1 (enExample)
EP (1) EP1663017A1 (enExample)
JP (1) JP2007503221A (enExample)
AU (1) AU2004268560B2 (enExample)
CA (1) CA2536510C (enExample)
WO (1) WO2005020825A1 (enExample)

Cited By (9)

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WO2012064526A1 (en) 2010-11-09 2012-05-18 Tepha, Inc. Drug eluting cochlear implants
US8758374B2 (en) 2010-09-15 2014-06-24 University Of Utah Research Foundation Method for connecting nerves via a side-to-side epineurial window using artificial conduits
WO2015026964A1 (en) 2013-08-20 2015-02-26 Tepha, Inc. Closed cell foams including poly-4-hydroxybutyrate and copolymers thereof
US9302029B2 (en) 2013-10-31 2016-04-05 Tepha, Inc. Pultrusion of poly-4-hydroxybutyrate and copolymers thereof
US9931121B2 (en) 2011-10-17 2018-04-03 University Of Utah Research Foundation Methods and devices for connecting nerves
WO2018227264A1 (en) * 2017-06-13 2018-12-20 Dosta Anatoli D Implant for injured nerve tissue prosthetics, method of surgical treatment for injured nerve tissue and use of porous polytetrafluorethylene
US10842494B2 (en) 2011-10-17 2020-11-24 University Of Utah Research Foundation Methods and devices for connecting nerves
US11806447B2 (en) 2013-11-05 2023-11-07 Tepha, Inc. Compositions and devices of poly-4-hydroxybutyrate

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US7943683B2 (en) 2006-12-01 2011-05-17 Tepha, Inc. Medical devices containing oriented films of poly-4-hydroxybutyrate and copolymers
CN101979102B (zh) * 2010-09-30 2013-03-13 中山大学 制备具有各向异性孔结构的组织工程支架的方法和设备
ES2916298T3 (es) 2017-12-04 2022-06-29 Tepha Inc Implantes médicos de poli-4-hidroxibutirato termoformado con membrana al vacío
WO2023034614A1 (en) * 2021-09-02 2023-03-09 The Brigham And Women's Hospital, Inc. Systems and methods for stimulation, nerve repair and/or drug delivery

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