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
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/14—Macromolecular materials
  • A61L27/22—Polypeptides or derivatives thereof, e.g. degradation products
  • A61L27/24—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
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/02—Inorganic materials
  • A61L27/12—Phosphorus-containing materials, e.g. apatite
• • 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
  • A61L27/40—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
  • A61L27/44—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix
  • A61L27/46—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix with phosphorus-containing inorganic fillers
• • 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
  • A61L27/505—Stabilizers
• • 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
  • A61L27/54—Biologically active materials, e.g. therapeutic substances
• • 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
  • A61L27/56—Porous materials, e.g. foams or sponges
• • 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
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/20—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices containing or releasing organic materials
  • A61L2300/258—Genetic materials, DNA, RNA, genes, vectors, e.g. plasmids
• • 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
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
  • A61L2300/402—Anaestetics, analgesics, e.g. lidocaine
• • 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
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
  • A61L2300/404—Biocides, antimicrobial agents, antiseptic agents
  • A61L2300/406—Antibiotics
• • 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
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
  • A61L2300/41—Anti-inflammatory agents, e.g. NSAIDs
• • 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
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
  • A61L2300/412—Tissue-regenerating or healing or proliferative agents
  • A61L2300/414—Growth factors
• • 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
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/60—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a special physical form
  • A61L2300/602—Type of release, e.g. controlled, sustained, slow
• • 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
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/60—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a special physical form
  • A61L2300/64—Animal cells
• • 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
  • A61L2430/02—Materials or treatment for tissue regeneration for reconstruction of bones; weight-bearing implants

Definitions

• the present invention relates to an improved bone void filler, which includes a porous, collagen scaffolding admixed with calcium phosphate and at least one stabilizer agent.
• bone graft substitutes for treatment of bone injuries/illnesses is continuously expanding with an increasingly active and aging population.
• clinical indications that bone graft substitutes are being used for are bone fractures, bone cysts, prosthetic joint revision procedures involving bone loss, avascular necrosis of the femoral head, spinal fusions due to degenerative disc disease, oral maxillofacial bone defects and reconstructions, and osteoporotic fractures. All these clinical indications may cause limited mobility and often, particularly in the elderly, can, in extreme cases, result in death.
• These clinical indications often require surgical bone grafting to prevent delayed or non-unions from occurring. Revision surgery should be avoided if possible because bone healing rates are typically lower after a delayed or non-union has developed. Therefore, effective bone graft substitutes are an important treatment option for repair of bone defects and fractures.
• the major problem associated with bone regeneration is the lack of a suitable scaffolding materials which can retain its shape and stay within the bone defect during the healing process but which is also compatible with the body.
• Properties which the bone regeneration material should possess include biocompatibility, porosity, strength, cohesiveness, shape retention, durability, and elasticity, in order to facilitate consistent regeneration of bone in the desired location, amount, and volume. Therefore, such material must have approximately the same porosity and structure of normal bone, but must not be susceptible to over hydration and diffusion from the surgical site.
• the graft substance has an inherent cohesive consistency preventing it from becoming diluted with bodily fluids, such as blood, and losing its original implanted shape.
• carrier matrices to promote the formation of bone at a site in a patient is well known, and related products are currently available on the market, such as Mastergraft ® Putty, by Medtronic Sofamor Danek (Memphis, TN). These matrices are typically in the form of a relatively large, soft collagen sponge or dry cake. Before insertion into the target site, the sponge is wetted, usually with sterile water or bone marrow aspirated from the patient, at a ratio of about 1 : 1 to about 1 :2 by volume.
• the bone marrow is permitted to soak into the scaffolding provided by the sponge, and the sponge is then kneaded by hand, thereby obtaining a pliable putty consistency that may subsequently be gently packed into the target site.
• the collagen in the sponge provides a malleable putty, non- water soluble carrier that permits accurate placement and retention of biological factors at the implantation site.
• the putty may lose some of its cohesiveness, which may cause some of the implant to flow out of the target site. Accordingly, there is a need for improved bone void fillers suitable for repair of bone defects.
• a bone void filler which includes collagen, calcium phosphate, and at least one stabilizer agent.
• the collagen provides about 5% to about 30% of the weight of the bone void filler; the calcium phosphate provides about 55% to about 94% of the weight of the bone void filler; the one or more stabilizer agents make up about 1% to about 15% of the weight of the bone void filler.
• This stabilizer agent provides increased cohesiveness of the putty in the presence of over hydrated conditions and or causes the putty to actually set-up.
• the one or more stabilizer agents include calcium sulfate.
• the bone void filler may further include at least one bioactive agent.
• suitable bioactive agents include growth factors, anti-inflammatory compounds, antibiotics, analgesic compounds, nucleic acid sequences, cells, and combinations thereof.
• the instant invention provides a kit that includes a bone void filler.
• the bone void filler includes collagen, calcium phosphate, and at least one stabilizer agent.
• the kit also includes a set of instructions.
• the dry weight of the collagen provides about 5% to about 30% of the weight of the bone void filler;
• the calcium phosphate provides between about 55% to about 94% of the weight of the bone void filler;
• the stabilizer agent provides between about 1% to about 15% of the weight of the bone void filler.
• the stabilizer agent includes calcium sulfate.
• the kit includes at least one bioactive factor. Suitable bioactive agents include growth factors, anti-inflammatory compounds, antibiotics, analgesic compounds, nucleic acid sequences, cells, and combinations thereof.
• Fig. 1 shows an embodiment kit.
• Fig. 2 shows hydrating an embodiment sponge.
• Figs. 3 and 4 show an embodiment implant injected into a target site to fill a bone void.
• An improved bone void filler which includes a stabilizer agent is disclosed.
• one embodiment provides a bone void filler, which includes collagen, calcium phosphate, and a stabilizer agent.
• a biological system can include, for example, an individual cell, a set of cells (e.g., a cell culture), an organ, or tissue. Additionally, the term “patient” can refer to animals, including, without limitation, humans. Definitions
• treating or “treatment” of an injury or disease refers to executing a protocol, which may include administering one or more drugs, implants or the like to a patient (human or otherwise), in an effort to repair the bone injury or alleviate signs or symptoms of a disease. Alleviation can occur prior to signs or symptoms of the disease appearing, as well as after their appearance. Thus, “treating” or “treatment” includes “preventing” or “prevention” of disease. In addition, “treating” or “treatment” does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes protocols which have only a marginal effect on the patient.
• a bone void filler may be in the form of a putty.
• a bone void filler includes collagen (10-30 % by dry wt.) and calcium phosphate (55-89 % by wt.).
• the calcium phosphate is provided in granules having a diameter of between 0.1-5 mm, or, more preferably, 0.5-1.6 mm.
• the calcium phosphate may be provided in one or more chemical forms.
• biphasic calcium phosphate is used.
• the calcium phosphate may contain hydroxyapatite.
• a biphasic calcium phosphate (BCP) bioceramic is used.
• BCP includes an intimate mixture of hydroxyapatite (HA), CaIo(PO 4 )O(OH) 2 , and beta-tricalcium phosphate (beta-TCP), Ca3(PO4)2, in varying HA/beta-TCP ratios.
• HA hydroxyapatite
• CaIo(PO 4 )O(OH) 2 CaIo(PO 4 )O(OH) 2
• beta-tricalcium phosphate beta-tricalcium phosphate
• Ca3(PO4)2 beta-tricalcium phosphate
• the preferred HA/beta-TCP ratios are in the range of about 15/85 to about 25/75.
• the composition of the collagen may also vary in different embodiments.
• the collagen consists of a fibular collagen. Fibular collagen is precipitated collagen into highly organized relatively strong fibular strands during it's processing from digested collagen donor tissues such as skin and tendon.
• the collagen includes about 20-40% by weight of soluble collagen and about 60-80% by weight of a more organized insoluble form of fibular collagen.
• the soluble collagen may increase the flowability and cohesiveness of the bone void filler.
• the collagen, admixed with the calcium phosphate may be freeze dried (i.e., lyophilized) in the form of a sponge 12 within a kit 10 for packaging, shipment and storage.
• the kit 10 may further include, for example, syringes 14, 15 for hydrating the sponge 10 and delivering a resulting putty to a target site, a knife or like cutting means for optionally cutting the sponge 12 into smaller sections, a connection tube 17 for fluidly connecting together the syringes 14, 15, and a delivery device 18 that may be connected to one of the syringes 14, 15 and used to inject the putty into the target site.
• syringes 14, 15 for hydrating the sponge 10 and delivering a resulting putty to a target site
• a knife or like cutting means for optionally cutting the sponge 12 into smaller sections
• a connection tube 17 for fluidly connecting together the syringes 14, 15, and a delivery device 18 that may be connected to one of the syring
• the dehydrated sponge 12 may be removed from the packaging 10, optionally sectioned with knife 16, and disposed in a first syringe 14.
• Second syringe 15 may be filled with a suitable hydrating material 20, such as sterile water (optionally containing a bioactive agent, such as BMP-2 or rhBMP-2, an anti-inflammatory, analgesic, etc.), bone marrow aspirate, or the like.
• a suitable hydrating material 20 such as sterile water (optionally containing a bioactive agent, such as BMP-2 or rhBMP-2, an anti-inflammatory, analgesic, etc.), bone marrow aspirate, or the like.
• the syringes 14, 15 may then be connected together with connection tube 17, and then their respective contents may be driven back and forth to hydrate the sponge 12.
• the sponge 12 may be provided a concave or depressed surface 11.
• Concave or depressed surface 11 may serve as a reservoir that can accept the hydrating material 20, rather than using the second syringe 15.
• the hydrating material 20 may be allowed to soak within the concave or depressed surface 11 , and a surgeon may subsequently knead the sponge 12 into a putty- like consistency.
• hydration of the collagen within the sponge 12 results in a flowable, putty-like material 60 that the surgeon can place into an irregular defect 32 in bone 30.
• the surgeon may use the delivery device 18, connected to the first syringe 14, to inject the putty 60 into the defect 32; alternatively, the surgeon may manually apply the putty 60 to the defect 32.
• this material 60 may continue to absorb blood leaching from the defect 32 and thereby lose some of its cohesiveness after placement into the surgical site 32; this may be particularly true if the surgeon over-manipulates the putty 60.
• the inventors have found that the addition of a stabilizer agent improves the cohesiveness of the putty material 60 under these extreme conditions, and, if desired, can cause the putty 60 to "set-up" in place, such as in the target site 32.
• the stabilizer agent is added to the putty at the time of manufacture so it is mixed in with the collagen and calcium phosphate and then freeze dried.
• Suitable stabilizer agents include, without limitation, calcium sulfate, alginate, chytosan, hyaluronic acid, gelatin, fibrin, elastin, silk, or any combination of them.
• the stabilizer agents are calcium-based agents with a reaction chemistry that provides cohesiveness or set-up properties.
• the stabilizer agent is calcium sulfate.
• the amount of calcium sulfate added could vary between about 1% and about 15% of the bone void filler by dry weight (i.e., 1% and about 15% by weight of the dry sponge 12), with the preferred amount being between about 2% and about 5% by dry weight.
• a large amount (e.g., over about 15%) is not needed since the calcium sulfate will act to bind the fibular collagen strands together.
• the calcium sulfate slowly reacts, holding the putty 60 in a cohesive mass that is less susceptible to blood diluting and washing the putty 60 out of the bone defect 32.
• the stabilizer agent may also make the material 60 less sticky to the surgeon's gloves, and may improve flowability of the putty 60 out of a syringe 14.
• the bone void filler 60 maintains its porosity, thus allowing for rapid cell infiltration and bone formation.
• the compounds for the bone void filler may be commercially purchased.
• calcium sulfate may be obtained from Noah Technology Corp. (San Antonio, TX).
• a suitable mixture of the fibular collagen, the soluble collagen and the calcium phosphate may be obtained in the form of the MASTERGRAFT® Putty supplied by Medtronic Sofamor Danek, Inc. (Memphis, TN).
• the fibular collagen, the soluble collagen and the calcium phosphate may be obtained separately.
• kit 10 may include the stabilizer agent separately from the sponge 12 so that a surgeon may optionally mix in a suitable amount of the stabilizer when hydrating the sponge 12 to form the putty 60.
• MASTERGRAFT® Putty is supplied as a boat-shaped dry cake and comes in 5 volumes i.e., 0.75 cc, 1.5 cc, 3 cc, 6 cc, and 9 cc.
• MASTERGRAFT® Putty may be hydrated with sterile water or bone marrow aspirate.
• the sterile water solution which may further include a growth factor, such as BMP-2 is slowly absorbed by the cake and once all solution is absorbed is manually kneaded into a putty consistency.
• the at least one stabilizer agent e.g., calcium sulfate
• the stabilizer agent may be dissolved and blended with the collagen and the calcium phosphate.
• the resulting composition may then be freeze- dried into the desired shape to form the sponge 12.
• This embodiment of making the bone void filler may ensure a more uniform mixture of the components.
• the freeze-dried material 12 is wetted with a solvent 20 (e.g., water, saline, or a bone marrow aspirate), which may optionally contain at least one bioactive agent, to form a viscous mass 60 which can be injected or manually packed into the patient's bone void 32.
• a solvent 20 e.g., water, saline, or a bone marrow aspirate
• the bone void filler of the instant invention also allows for optimal loading of its porous structure with bioactive agents, such as, for example, growth factors or cells.
• bioactive agents include, without limitation, growth factors (including osteogenic and chondrogenic agents), anti-inflammatory agents, pain-reducing agents, antibiotics, cells, nucleic acid sequences, and any combinations thereof.
• growth factors suitable for use in the practice of the invention include but are not limited to bone morphogenic proteins, for example, BMP-2, rhBMP-2, BMP-4, rhBMP-4, BMP-6, rhBMP-6, BMP-7[OP-1], rhBMP-7, GDF-5, and rhGDF-5, as disclosed, for example, in the U.S. Patent Nos. 4,877,864; 5,013,649; 5,661,007; 5,688,678; 6,177,406; 6,432,919; 6,534,268, and 6,858,431, and in Wozney, J. M., et al. (1988) Science, 242(4885): 1528-1534.
• the bone void filler contains an effective amount of a BMP-2 protein, an rhBMP-2 protein, functional fragments thereof, or combinations thereof.
• Suitable antibiotics include, without limitation nitroimidazole antibiotics, tetracyclines, penicillins, cephalosporins, carbopenems, aminoglycosides, macrolide antibiotics, lincosamide antibiotics, 4-quinolones, rifamycins and nitrofurantoin.
• Suitable specific compounds include, without limitation, ampicillin, amoxicillin, benzylpenicillin, phenoxymethylpenicillin, bacampicillin, pivampicillin, carbenicillin, cloxacillin, cyclacillin, dicloxacillin, methicillin, oxacillin, piperacillin, ticarcillin, flucloxacillin, cefuroxime, cefetamet, cefetrame, cefixine, cefoxitin, ceftazidime, ceftizoxime, latamoxef, cefoperazone, ceftriaxone, cefsulodin, cefotaxime, cephalexin, cefaclor, cefadroxil, cefalothin, cefazolin, cefpodoxime, ceftibuten, aztreonam, tigemonam, erythromycin, dirithromycin, roxithromycin, azithromycin, clarithromycin, clindamycin, paldi
• Suitable anti-inflammatory compounds include both steroidal and non-steroidal structures.
• Suitable non-limiting examples of steroidal anti-inflammatory compounds are corticosteroids such as hydrocortisone, Cortisol, hydroxyltriamcinolone, alpha-methyl dexamethasone, dexamethasone -phosphate, beclomethasone dipropionates, clobetasol valerate, desonide, desoxymethasone, desoxycorticosterone acetate, dexamethasone, dichlorisone, diflorasone diacetate, diflucortolone valerate, fluadrenolone, fluclorolone acetonide, fludrocortisone, flumethasone pivalate, fluosinolone acetonide, fluocinonide, flucortine butylesters, fluocortolone, fluprednidene (fluprednylidene) acetate, flurandrenol
• Non- limiting examples of non-steroidal anti-inflammatory compounds include nabumetone, celecoxib, etodolac, nimesulide, apasone, gold, oxicams, such as piroxicam, isoxicam, meloxicam, tenoxicam, sudoxicam, and CP-14,304; the salicylates, such as aspirin, disalcid, benorylate, trilisate, safapryn, solprin, diflunisal, and fendosal; the acetic acid derivatives, such as diclofenac, fenclofenac, indomethacin, sulindac, tolmetin, isoxepac, furofenac, tiopinac, zidometacin, acematacin, fentiazac, zomepirac, clindanac, oxepinac, felbinac, and ketorolac; the fenamates,
• anti-inflammatories are well-known to those skilled in the art.
• anti-inflammatories are well-known to those skilled in the art.
• non-steroidal anti-inflammatory compounds may also be employed, as well as the pharmo logically acceptable salts and esters of these compounds.
• so-called "natural" anti-inflammatory compounds may be useful. Such compounds may suitably be obtained as an extract by suitable physical and/or chemical isolation from natural sources (e.g., plants, fungi, by-products of microorganisms).
• Suitable non-limiting examples of such compounds include candelilla wax, alpha bisabolol, aloe vera, Manjistha (extracted from plants in the genus Rubia, particularly Rubia Cordifolia), and Guggal (extracted from plants in the genus Commiphora, particularly Commiphora Mukul), kola extract, chamomile, sea whip extract, compounds of the Licorice (the plant genus/species Glycyrrhiza glabra) family, including glycyrrhetic acid, glycyrrhizic acid, and derivatives thereof (e.g., salts and esters).
• Suitable salts of the foregoing compounds include metal and ammonium salts.
• Suitable esters include C 2 -C 24 saturated or unsaturated esters of the acids, preferably CiO-C 24 , more preferably Ci 6 -C 24 .
• Specific examples of the foregoing include oil soluble licorice extract, the glycyrrhizic and glycyrrhetic acids themselves, monoammonium glycyrrhizinate, monopotassium glycyrrhizinate, dipotassium glycyrrhizinate, 1-beta-glycyrrhetic acid, stearyl glycyrrhetinate, and 3-stearyloxy-glycyrrhetinic acid, and disodium 3-succinyloxy-beta- glycyrrhetinate.
• pain-reducing agents are included in the definition of pain-reducing agents because they provide pain relief.
• suitable pain-reducing agents include other types of compounds, such as, for example, opioids (such as, for example, morphine and naloxone), local anaesthetics (such as, for example, lidocaine), glutamate receptor antagonists, ⁇ -adrenoreceptor agonists, adenosine, canabinoids, cholinergic and GABA receptors agonists, and different neuropeptides.
• opioids such as, for example, morphine and naloxone
• local anaesthetics such as, for example, lidocaine
• glutamate receptor antagonists such as, ⁇ -adrenoreceptor agonists, adenosine, canabinoids, cholinergic and GABA receptors agonists
• ⁇ -adrenoreceptor agonists such as, for example, lidocaine
• canabinoids such as, for example,
• Suitable cells include, without limitations, stem cells, e.g., embryonic or adult stem cells, which can conveniently be derived from the blood or bone marrow of the patient or from an allogeneic source, which preferably is immunologically compatible with the patient.
• Other suitable cells may include chondrogenic or osteogenic precursor cells.
• the cells may be genetically modified (e.g., overexpressing certain proteins, or having expression of certain proteins inhibited). Methods of creating such genetically modified cells are within knowledge and expertise of the person of ordinary skill in the art.
• Suitable nucleic acid sequences include, without limitation, cDNA sequences encoding the at least one bioactive factor of a proteinaceous nature. These cDNAs may be included within respective vectors (e.g., AAV). In another embodiment, the nucleic acid sequences may be siRNAs or shRNAs or nucleic acid sequences encoding for such siRNAs or shRNAs. These siRNAs and shRNAs may be used in embodiments wherein it is desirable to inhibit expression of certain genes, such as, for example inflammatory protein genes such as TNF, IL-I, IL-6, and BMP inhibitor proteins such Noggin and Chordin, and intracellular BMP inhibitors SMADS.
• inflammatory protein genes such as TNF, IL-I, IL-6, and BMP inhibitor proteins such Noggin and Chordin
• BMP inhibitor proteins such Noggin and Chordin
• the bone void filler 12 may be soaked in a solution of the at least one bioactive factor before implantation. In some embodiments, depending on the properties of the at least one bioactive factor, the bone void filler may be soaked in the solution for 1-60 minutes before the implantation. The at least one bioactive factor may also be dripped, brushed, or sprayed onto the bone void filler of the instant invention.
• the cells may be re-suspended in a volume of media (e.g., Dulbecco's Modified Eagle's Medium) and cultured with the bone void filler of the instant invention. Due to the properties of the surface of the bone void filler and the porosity of the bone void filler, the cells will populate the external surfaces of the bone void filler and its internal voids. Optimal loading conditions (e.g., medium composition, shaking, if necessary) may be easily determined by the person of ordinary skill in the art. Further, the bone void filler may be wetted with an aspirate from the patient's bone marrow, thus allowing the bone marrow cells to populate the voids and pores within the bone void filler.
• media e.g., Dulbecco's Modified Eagle's Medium
• the kit 10 including the bone void filler according to any of the embodiments described above may further include a set of instructions.
• the kit 10 may be separately supplied with the at least one bioactive agent.
• Such embodiments may be preferable, since the storage conditions for the bone void filler 12 and the at least one bioactive factor may differ.
• the set of instructions includes information for safe and effective preparation and use of the kit.
• the information may include guidelines for delivery of the bone void filler and for the incorporation of the at least one bioactive factor into the bone void filler.
• the set of instruction may be provided is multiple formats, including, without limitations, written instructions, audiorecording, videorecording, digital media, and a combination thereof.
• the bone void fillers as described herein can be delivered in spinal fusion applications such as interbody fusions, oral maxillofacial applications such as ridge augmentation, the repair of cranial defects, iliac crest back-filling, acetabular defects, and in the repair of tibial plateau and long bone defects.
• spinal fusion applications such as interbody fusions, oral maxillofacial applications such as ridge augmentation, the repair of cranial defects, iliac crest back-filling, acetabular defects, and in the repair of tibial plateau and long bone defects.
• Such methods can be used to treat major or minor defects in these or other bones caused by trauma (including open and closed fractures), disease, or cogenital defects, for example.

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• 2008
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