WO2005115494A2 - Utilisation de fibrine et trousse associee - Google Patents

Utilisation de fibrine et trousse associee Download PDF

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Publication number
WO2005115494A2
WO2005115494A2 PCT/IT2005/000288 IT2005000288W WO2005115494A2 WO 2005115494 A2 WO2005115494 A2 WO 2005115494A2 IT 2005000288 W IT2005000288 W IT 2005000288W WO 2005115494 A2 WO2005115494 A2 WO 2005115494A2
Authority
WO
WIPO (PCT)
Prior art keywords
substance
fibrin
kit
needle
fibrinogen
Prior art date
Application number
PCT/IT2005/000288
Other languages
English (en)
Other versions
WO2005115494A3 (fr
Inventor
Pierpaolo Graziotti
Original Assignee
Humanitas Mirasole S.P.A.
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 Humanitas Mirasole S.P.A. filed Critical Humanitas Mirasole S.P.A.
Priority to EP05750086A priority Critical patent/EP1748803A2/fr
Priority to US11/596,620 priority patent/US20070225208A1/en
Publication of WO2005115494A2 publication Critical patent/WO2005115494A2/fr
Publication of WO2005115494A3 publication Critical patent/WO2005115494A3/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • 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
    • A61L24/001—Use of materials characterised by their function or physical properties
    • 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
    • A61L24/10—Polypeptides; Proteins
    • A61L24/102—Collagen
    • 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
    • A61L24/10—Polypeptides; Proteins
    • A61L24/106—Fibrin; Fibrinogen
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N2005/1092—Details
    • A61N2005/1094—Shielding, protecting against radiation

Definitions

  • the present invention relates to the use of coagulant or gellifying substances for administration into body sites and, particularly, relates to the use of fibrin and a related administration kit.
  • Prostate carcinoma is currently the most frequently diagnosed neoplasia in males.
  • Treatment of the neoplasia provides various therapeutic possibilities depending on the clinical stage of the disease, the patient's age and psychological disposition.
  • the technical problem at the heart of the present invention is contriving a system which allows the patient to be prepared to receive a suitable dose of radiation aimed at the prostate without incurring the above mentioned drawbacks.
  • the concept at the heart of the present invention is that of temporarily separating the prostate from the rectum during the entire duration of radiotherapy treatment, so that the radiation directed to the prostate does not also have negative effects on the rectum.
  • Figure 1 represents a schematic idsagittal sectional view of human prostate and rectum relative to the adjacent organs
  • FIG. 2 represents a schematic view as in figure 1, during a first stage of the operation, in accordance with the invention
  • FIG. 3 represents a schematic view as in figure 1, during a second stage of the operation, in accordance with the invention; - Figure 3a represents a detail of figure 3.
  • the prostate 1 is a glandular organ enclosing the initial tract of the male urethra 2 and has a conical-pyramidal shape with a larger base 11 ⁇ and smaller apex 12, a front face 13, a rear face 14 and two side faces (not shown in the drawing-s) .
  • the base 11 of the prostate 1 tightly adheres to the base 31 of the urinary bladder 3 forming the neck, while the apex 12 terminates just before the urogenital trigonal muscle 4.
  • the front face 13 is oriented towards the posterior side 51 of the pubic symphysis 5, while the rear face 14 is in close contact with the intestinum rectum (rectum) 6 through the interposition of the periprostatic fascia 7 and the recto-vesical fascia 8 (or Denonvarriatoperitoneal fascia) .
  • the periprostatic fascia 7 consists of a parietal sheet, in contact with and enclosing the prostate 1.
  • the rectovesical fascia 8 encloses the periprostatic fascia 7 and separates the rectum and prostate by arranging itself between the two organs.
  • both fascias may be joined near the apex 12 of the prostate 1 creating said virtual space 16, as represented in figures la, 2a and 3a.
  • the seminal vesicles 9 depart from the junction 15 between the base 11 and the rear face 14 of the prostate 1 (only one is shown in the figures) and extend towards the posterior on the outer surface of the base 31 of the urinary bladder 3.
  • Figures 2, 2a, 3 and 3a depict two stages of the method of administration of the biocompatible substance, allowing operation in the described manner.
  • the method herein is a method for the separation of organs which are normally in contact, consisting of a stage with the administration of a coagulant or gellifying substance directly into a target site between said organs, such that said substance interposes itself between said organs and herein coagulates or gellifies, temporarily forming a dividing body.
  • the patient is initially made to lie on one side with the knees folded on the chest (lateral decubitus) and a transrectal probe is applied, of the type conventionally used for echoradiographic monitoring of the prostate and the fascias thereof.
  • a multiplanar transrectal ultrasound probe 21 equipped with a 7.0 MHz transducer (21 mm diameter at the apex, 24 mm at the base) as represented schematically in the figures, may be used.
  • the guide 22 may be represented by any device suited to being reversibly applied to the probe 21 so as to allow the positioning of the tip of the needle 20 as close as possible to the end 23 of the probe itself.
  • the probe 21 is introduced into the anus 60 until its end 23 is close to the apex 12 of the prostate 1. Said position will be observed and monitored by the end itself which will be equipped with a standard echoradiographic detection system. Furthermore, the position of the tip of the needle 20 will be observed and followed, by means of a monitor connected to the probe.
  • the needle 20 is gently pushed against the rectal wall 6 until it penetrates through it, in the periapical area of the prostate 1, at its median line.
  • the advancement of the needle 20 is monitored by means of echography in order to be able to observe the moment in which the tip of the needle 20 reaches the plane delimited anteriorly by the periprostatic fascia 7 and posteriorly by the rectovesical fascia 8.
  • the biocompatible substance is injected into the virtual space 16 between said fascias. The injected fluid causes the progressive detachment of the two periprostatic 7 and rectovesical 8 fascias.
  • the prostate 1 is separated from the rectum 6 due to the interposition of said substance which, by being injected between said fascias until gradually reaching the seminal vesicles 9, forms a kind of pouch or bolus 40.
  • the needle 20 may be introduced transperineally. By this means of access, still guided by means of echographic monitoring, the anatomical area of interest is equally reachable.
  • the transperineal alternative may be used in cases of high risk of infection associated with various clinical pathologies (drabetes, immunosuppression etc.) or in cases where the patient has a congenital or post- surgical anal inperforation. Indeed, it is obvious that the rectal wall is not sterile and may result in infections following manipulation.
  • both organs i.e. the prostate 1 and the rectum 6, can be separated from each other, by a distance which may vary between 1 to 3 cm, allowing targeted irradiation of the prostate at appropr ⁇ ate doses while significantly limiting, if not even eliminating, irradiation of the anterior part of the rectum.
  • the substance injected to form the separating pouch 40 comprises any type of biocompatible substance capable of forming a gelatinous or solid coagulate or clot when injected into the target site.
  • this substance should have the capacity to be progressively reabsorbed by the body upon completion of treatment. Specifically, the treatment normally lasts up to 2 months .
  • the amount of substance to be injected may range between 10 and 40 ml, preferably between 20 and 30 ml depending on the anatomical characteristics of the patient and the physico-chemical characteristics of the substance itself. Generally, it has been observed that, on average, the amount used is 20 ml. [0028] .
  • One particularly preferred example of this type of substance is represented by fibrin.
  • Fibrin allows the formation of an entirely natural, and hence perfectly biocompatible coagulate, advantageously allowing itself to be gradually reabsorbed over time by the surrounding tissues, without causing any complications.
  • Fibrin may preferably consist of a formulation of its precursors such as fibrinogen and thrombin, in separate formulations. When the two separate formulations are injected into the target site, the corresponding precursors come into contact, mimicking the final stages of the blood coagulation cascade process, in order to form the well known coagulate, fibrin.
  • the fibrinogen formulation may comprise synthetic or naturally derived fibrinogen selected from commercially available sources. The amount may range between 0mg/ml and 150 mg/ml, preferably ranging between 60 and 130 mg/ml, still more preferably between 70 and 110 mg/ml. [0032] .
  • the thrombin formulation comprises synthetic or naturally derived thrombin from 250 UI to 2500 UI in amounts ranging between 15mg/ml and 250 mg/ml, preferably ranging between 25 and 100 mg/ml, still more preferably between 50 and 70 mg/ml. [0033] .
  • the formulation may comprise antifibrinolytic ions and/or calcium ions in order to block or at least delay the fibrinolytic effect of endogenous substances such as plasmin.
  • Factor XIII in amounts ranging between 5 Ul/ml and 50 Ul/ml, preferably between 10 Ul/ml and 20 Ul/ml, may advantageously be useful for promoting or accelerating the polymerisation of fibrin monomers .
  • An additional component, allowing inhibition of the fibrinolytic action of plasmin may be represented by the enzyme aprotinin.
  • Aprotinin may be present in amounts ranging between 1.5 UPE/ l and 20 UPE/ml, preferably between 3.5 UPE/ml and 15 UPE/ml, still more preferably between 5 UPE/ml and 10 UPE/ml.
  • the addition of said components to the fibrin precursors allows the delaying of the natural dissolution of the fibrin coagulate, and hence allows a more prolonged action over time.
  • fibronectin and plasminogen are well known components of the blood coagulation cascade, and for that reason may promote the formation of the coagulate in an entirely natural manner.
  • the fibronectin may be present in amounts ranging between 2 mg/ml and 30 mg/ml, preferably between 5 mg/ml and 20 mg/ml, still more preferably between 7 and 10 mg/ml.
  • the amount of plasminogen may range between 0.02 mg/ml to 0.8 mg/ml, preferably from 0.08 mg/ml and 0.4 mg/ml, more preferably between 0.1 mg/ml and 0. 2 mg/ml.
  • the formulations may be prepared depending on the patients anatomical and physiological characteristics. Furthermore, the amounts may be adapted in accordance with the reabsorption times desired, which in turn will depend upon the radiotherapy treatment times. In any case, such adjustments are known by those skilled in the art.
  • the fibrinogen in order to obtain a coagulate adapted to the previously described method, must preferably have a multimeric, dimeric or trimeric structure, more preferably quadri eric or quintomeric, still more preferably octameric or nonameric.
  • Certain products containing the above described substances as active ingredients are present on the market as fibrin giues.
  • Fibrin glues are products which are considered to be scar-forming drugs, used in various medical sectors as adjuvants for stopping bleeds, for sealing tissues or for protecting sutures.
  • biocompatible coagulation precursors colloidal substances
  • one or more biocompatible coagulation precursors for the preparation of one or more formulations which can be injected into body sites for in si tu coagulate formation, is particularly effective in the separation of body organs .
  • coagulation means any process which causes the transformation of a liquid into a gelatinous substance or a coagulate through the action of endogenous and/or exogenous chemical or physical agents. Consequently, the coagulate to which we are referring may be represented by the result of the coagulation of fibrin from its precursors, but may also refer to substances capable of gellifying, or rather giving rise to a coagulate in gel form.
  • One example of said substances which form a coagulate in gel form may be represented by collagen or the precursors thereof.
  • collagen particularly, bovine collagen, autologous collagen, hyaluronic acid and polylactic acid may be cited. All such substances are already widely used in aesthetic medicine or in ocular surgery, hence they are highly biocompatible substances and have body reabsorption times comprised of between 60 days and 12 months.
  • the substance may be used in pure or mixed form.
  • the collagen is of type I, but either human or animal type II, III or IV may be used. Pure collagen is commercially available, for example under the brand names CosmoDerm® and CosmoPlast® .produced by INAMED Aesthetics and containing human collagen.
  • So-called mixed collagen is usually composed of a mixture of the aforementioned collagen types.
  • Commercially available, mixed collagen based products are known, for example under the brand names Zyder ® (95% type I collagen and 5% type III collagen) at a concentration of 35 mg/ml. (Zyderm® I, INAMED Aesthetics) and 65 mg/ml (Zyderm® II, INAMED Aesthetics) .
  • Zyplast® cross-linked collagen
  • An additional substance which may be used is known by the brand name BioPlastique, a biodegradable biphasic copolymer (Bioplatique: A new textured copolymer microparticle promises permanence in soft tissue augmentation, Robert A. Ersek et al., Plastic and Reconstructive Surgery, April 1991, 693-702) .
  • fibrin glues included among which are, for example, TISSUCOL®, TISSUCOL® DUO and TISSEEL® VH available from Baxter, BERIPLAST® available from Aventis, TACHOCOMB® and TACHOCOM® H available from Nyco ed Pharma or QUIXIL® available from Omrix Biopharmaceuticals Inc.
  • TISSUCOL® TISSUCOL®
  • TISSUCOL® DUO and TISSEEL® VH available from Baxter
  • BERIPLAST® available from Aventis
  • TACHOCOMB® available from Nyco ed Pharma or QUIXIL® available from Omrix Biopharmaceuticals Inc.
  • the substances in question may be sold in kit form for administration as illustrated above. [0048]-.
  • the kit comprises one or more container.s adapted to separately storing one or more biocompatible • coagulation precursors, a syringe with corresponding needle suitable for the injection of said precursor (s) into the target site, a sterile disposable guide to be applied to a transrectal probe for guiding, said needle into the target site and an information sheet explaining the use of the kit.
  • Precursors may be represented by fibrinogen and thrombin.
  • the fibrinogen and thrombin are stored in suitable containers in the form of ready-to- inject formulations.
  • said substances may be stored in • their corresponding containers in lyophilised form, and only dissolved in solution immediately prior to use.
  • the kit will additionally comprise containers containing a physiological liquid capable of dissolving the lyophilisates, possibly with the aid of agitation.
  • the kit may comprise one or more substances from among those previously described, each in an appropriate container, which may be used to promote the coagulation process and/or avoid the rapid degradation of the fibrin once the fibrinogen and thrombin have been injected into the target site.
  • the kit may also comprise sterile disposable pipettes or syringes to allow the mixing or the preparation of the corresponding fibrinogen and thrombin formulations with appropriate or preferred substances, such as those described above.
  • the syringe for the injection of the fibrin and thrombin solutions may consist of a dual cylinder and dual plunger syringe or more simply a syringe having a body adapted to housing the two containers of the ready to use fibrinogen and thrombin formulations and two corresponding plungers: [0052] .
  • the needle which may be applied to the syringe may be single barrelled or double barrelled - like a shotgun.
  • the needle must have sufficient length to permit it to reach the site of diffusion.
  • said needle has a length of between 30 cm and 20 cm, more preferably between 20 cm and 15 cm, still more preferably comprised of between 10 and 5 cm.
  • at least the tip of the needle must obligatorily have echoreflectance characteristics in order to allow the operator to constantly monitor its position while it is being introduced into the patient.
  • the echoreflectance may be provided by notches formed on the outer surface of the needle. [0053] .
  • a needle possessing such characteristics is commercially available and known as the Chiba needle.
  • the Chiba needle- such as that sold under the trade name Ago Temno (Temno Chiba Fine Needle Aspiration, REF CHI2220 22G x 20 cm) by Allegiance Healthcare Corporation, has a mandrel incorporated inside the needle barrel. Particularly, the mandrel is fitted with flared ends so as to close the corresponding flared bore of the barrel. [0054] .
  • the Chiba needle is 20 cm long and is used for performing local anaesthesia prior to echo- guided prostate biopsy operations. In this case, the mandrel might be removed from the needle in order to allow injection of the coagulant substance or gel. [0055] .
  • the needle guide may be a device such as that represented in the figures. Particularly, such device 22 comprises a distal end 221 connected to a proximal end 222 by means of a bridge 223. The proximal 221 and distal
  • ends are made such as to be reversibly coupled to a transrectal probe, such as that previously described.
  • said parts are shaped as part of a circular band which snaps onto the end of said probe.
  • the kit also comprises one or more sterile disposable condoms, for fitting over the end section of a transrectal probe.
  • the information sheet should contain all the useful information for the description of the kit components and the storage thereof. The preparation methods for the solutions and the manipulation thereof prior to application, as described previously for example, will also have to be specified- Finally, the information sheet must contain an explanation of the assembly of the syringe, precautions for the use thereof, any contraindications relating to the substances included and, preferably, a clear illustration of the method o.f administration.

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  • Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • Epidemiology (AREA)
  • Surgery (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Chemical & Material Sciences (AREA)
  • Materials Engineering (AREA)
  • Radiology & Medical Imaging (AREA)
  • Pathology (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
  • External Artificial Organs (AREA)

Abstract

La présente invention concerne l'utilisation de substances coagulantes ou gélifiantes destinées à être administrées dans des sites corporels en vue de l'obtention d'une séparation temporaire desdits organes. L'invention concerne également une méthode de séparation de sites corporels ainsi qu'une trousse d'administration associée faisant appel à ces substances.
PCT/IT2005/000288 2004-05-27 2005-05-20 Utilisation de fibrine et trousse associee WO2005115494A2 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
EP05750086A EP1748803A2 (fr) 2004-05-27 2005-05-20 Utilisation de fibrine et trousse associee
US11/596,620 US20070225208A1 (en) 2004-05-27 2005-05-20 Use of Fibrin for Separating Body Organs

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT2004000310 2004-05-27
ITPCT/IT2004/000310 2004-05-27

Publications (2)

Publication Number Publication Date
WO2005115494A2 true WO2005115494A2 (fr) 2005-12-08
WO2005115494A3 WO2005115494A3 (fr) 2005-12-29

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PCT/IT2005/000288 WO2005115494A2 (fr) 2004-05-27 2005-05-20 Utilisation de fibrine et trousse associee

Country Status (2)

Country Link
EP (1) EP1748803A2 (fr)
WO (1) WO2005115494A2 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8637081B2 (en) 2006-07-10 2014-01-28 Tetec Tissue Engineering Technologies Ag Use of gelatin and a cross-linking agent for producing a cross-linking therapeutic composition
US9295751B2 (en) 2006-07-10 2016-03-29 Gelita Ag Use of gelatin and a cross-linking agent for producing cross-linking medical glues

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0679404A2 (fr) * 1994-04-28 1995-11-02 Angelo Pinto Utilisation de colle fibrine dans le traitement de l'incontinence urinaire
US5733316A (en) * 1995-10-27 1998-03-31 Dornier Medical Systems, Inc. Organ separation for thermal therapy
WO2000072852A1 (fr) * 1999-06-01 2000-12-07 Bristol-Myers Squibb Company Prevention d'adherences post-chirurgicales utilisant un scellement de monomere de fibrine

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0679404A2 (fr) * 1994-04-28 1995-11-02 Angelo Pinto Utilisation de colle fibrine dans le traitement de l'incontinence urinaire
US5733316A (en) * 1995-10-27 1998-03-31 Dornier Medical Systems, Inc. Organ separation for thermal therapy
WO2000072852A1 (fr) * 1999-06-01 2000-12-07 Bristol-Myers Squibb Company Prevention d'adherences post-chirurgicales utilisant un scellement de monomere de fibrine

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8637081B2 (en) 2006-07-10 2014-01-28 Tetec Tissue Engineering Technologies Ag Use of gelatin and a cross-linking agent for producing a cross-linking therapeutic composition
US9295751B2 (en) 2006-07-10 2016-03-29 Gelita Ag Use of gelatin and a cross-linking agent for producing cross-linking medical glues
US9744218B2 (en) 2006-07-10 2017-08-29 Tetec Tissue Engineerging Technologies Ag Multi-chamber applicator for gelatin solution

Also Published As

Publication number Publication date
EP1748803A2 (fr) 2007-02-07
WO2005115494A3 (fr) 2005-12-29

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