WO2018012605A1 - 癒着防止用組成物 - Google Patents
癒着防止用組成物 Download PDFInfo
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- WO2018012605A1 WO2018012605A1 PCT/JP2017/025614 JP2017025614W WO2018012605A1 WO 2018012605 A1 WO2018012605 A1 WO 2018012605A1 JP 2017025614 W JP2017025614 W JP 2017025614W WO 2018012605 A1 WO2018012605 A1 WO 2018012605A1
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- alginic acid
- metal salt
- monovalent metal
- sponge
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
-
- 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
-
- 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
- A61L31/12—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
-
- 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
- A61L31/12—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
- A61L31/125—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix
- A61L31/128—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix containing other specific inorganic fillers not covered by A61L31/126 or A61L31/127
-
- 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
- A61L31/12—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
- A61L31/125—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix
- A61L31/129—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix containing macromolecular 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
- 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
-
- 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
- A61L31/146—Porous materials, e.g. foams or sponges
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0815—Implantable devices for insertion in between organs or other soft tissues
- A61B2090/0816—Implantable devices for insertion in between organs or other soft tissues for preventing adhesion
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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
- A61L2420/00—Materials or methods for coatings medical devices
- A61L2420/08—Coatings comprising two or more layers
Definitions
- the present invention relates to an adhesion preventing material, a method for producing the same, and a sponge-like laminate.
- Adhesion refers to a state where the surfaces of tissues that should be separated from each other are connected or fused with a fibrous tissue. Adhesion occurs when exudate containing fibrin is generated on the surface of the tissue due to trauma or inflammation, and the exudate is organized and the tissue surfaces are connected or fused. Injuries that occur on the surface of tissues during surgery, inflammation caused by the trauma, and inflammation caused by drying of the tissue surface during surgery cause adhesions.
- Adhesion can sometimes cause infertility, bowel passage problems and chronic pelvic pain.
- another surgical operation may be required in order to peel off the adhesion that has occurred after the surgical operation.
- multiple operations are effective for patients with liver cancer recurrence, but the determination of whether or not re-operation is possible, the risk of treatment, the amount of bleeding at the time of surgery, the operation time, etc. It largely depends on the prevention of later adhesions. For these reasons, it is necessary to prevent adhesion, and various measures have been taken to prevent adhesion.
- Some such means for preventing adhesions are to place a physical barrier between the site of trauma or inflammation and its adjacent tissue to prevent tissue connection or fusion.
- a physical barrier a sheet-like one is known.
- the sheet-like material contains a polytetrafluoroethylene (PTFE) film (Prelude (trade name) (WL Gore and Associates, Inc.)), hyaluronic acid (HA) and carboxymethyl cellulose (CMC). Sheet (Seprafilm (trade name) (Genzyme GmbH)), regenerated oxidized cellulose sheet (INTERCEED (trade name) (Johnson & Johnson)) and the like.
- PTFE polytetrafluoroethylene
- Prelude trade name
- HA hyaluronic acid
- CMC carboxymethyl cellulose
- Sheet Seprafilm (trade name) (Genzyme GmbH)
- INTERCEED regenerated oxidized cellulose sheet
- the PTFE film is not biodegradable and has a problem of remaining in the body.
- the sheet containing HA and CMC and the regenerated oxidized cellulose sheet are biodegradable, serious adhesion such as adhesion occurring after hepatectomy cannot be completely prevented, and there is room for improvement in terms of the effect of preventing adhesion. was there.
- a biocompatible material selected from proteins such as collagen and polysaccharides such as carboxymethylcellulose, hyaluronic acid, and alginic acid is formed into sheets and particles, and is used as a medical absorbent, medical patch, and anti-adhesion material. It is known to be used as a biological tissue reinforcing material (Patent Documents 1 to 6).
- an anti-adhesive material having at least one performance, such as being easy to apply via a trocar in endoscopic surgery, being able to be re-adhered after adjusting the affixing position.
- the present inventors have developed an adhesion prevention material that combines the advantages of a film (sheet) adhesion preventive material with the advantages of a spray (liquid / gel) adhesion prevention material in an animal adhesion model that assumes various types of surgery in clinical practice.
- a sponge-like anti-adhesive material applicable to a living body having different dissolution rates of the first layer and the second layer specifically, a low endotoxin alginic acid having a relatively high weight average molecular weight Sponge-like first layer containing a monovalent metal salt of the above and a sponge-like second layer containing a monovalent metal salt of low endotoxin alginic acid having a relatively low weight average molecular weight.
- the present inventors have found that the anti-adhesive material including the laminate has an anti-adhesion effect not only in the surgical local adhesion prevention but also in a wide range of application areas, and has completed the present invention.
- a monovalent metal salt of alginic acid of the first layer comprising a sponge-like first layer and a second layer of a monovalent metal salt of low endotoxin alginic acid that is at least partially crosslinked with a curing agent
- the weight average molecular weight of 10,000 to 2,000,000, the monovalent metal salt of alginic acid of the second layer is 1,000 to 1,000,000, and the weight average molecular weight is Measured by GPC-MALS method after decrosslinking treatment, the weight average molecular weight of the monovalent metal salt of alginic acid in the first layer is higher than the weight average molecular weight of the monovalent metal salt of alginic acid in the second layer
- An anti-adhesion material comprising a sponge-like laminate that is sterilized and applicable to a living body.
- An anti-adhesion material comprising a sponge-like laminate having a molecular weight higher than that of the second layer and applicable to a living body.
- the curing agent of the first layer and the second layer is at least one metal ion compound selected from the group consisting of CaCl 2 , CaSO 4 , ZnCl 2 , SrCl 2 , FeCl 3 and BaCl 2.
- the adhesion preventing material according to any one of the above [1-1] to [1-6].
- [1-8] The antiadhesive material according to any one of [1-1] to [1-7] above, wherein the first layer is applied toward the wound side surface.
- the anti-adhesive material according to Item. [1-10] comprising a sponge-like laminate applicable to a living body, comprising a first layer and a second layer each containing a monovalent metal salt of low endotoxin alginic acid at least partially crosslinked with a curing agent, An adhesion preventing material in which the dissolution rate of one layer is slower than that of the second layer.
- [1-10a] including a sponge-like laminate that can be applied to a living body including a first layer and a second layer, each of which includes a monovalent metal salt of low endotoxin alginic acid, and the dissolution rate of the first layer is Anti-adhesion material, slower than the layer of.
- the first layer contains 25 ⁇ 10% by weight of the monovalent metal salt of alginic acid.
- the second layer is eluted within 4 hours, and 70 ⁇ 10% by weight of the monovalent metal salt of alginic acid is eluted within 1 hour.
- [1-13] The adhesion preventing material according to any one of the above [1-1] to [1-12], wherein the sponge-like laminate is pressed.
- the weight average molecular weight of 10,000 to 2,000,000, the monovalent metal salt of alginic acid of the second layer is 1,000 to 1,000,000, and the weight average molecular weight is Measured by GPC-MALS method after decrosslinking treatment, the weight average molecular weight of the monovalent metal salt of alginic acid in the first layer is higher than the weight average molecular weight of the monovalent metal salt of alginic acid in the second layer
- An anti-adhesion method comprising applying a sterilized, sponge-like laminate applicable to a living body to a subject in need of anti-adhesion, with the first layer facing the surface on the wound site side.
- a method for preventing adhesion comprising applying a sponge-like laminate that is higher than the second layer and applicable to a living body to a subject that requires prevention of adhesion.
- the adhesion prevention method according to any one of the above [2-1] to [2-6].
- An anti-adhesion method comprising applying a slower sponge-like laminate applicable to a living body to a subject that requires anti-adhesion.
- a sponge applicable to a living body comprising a first layer and a second layer each containing a monovalent metal salt of low endotoxin alginic acid, wherein the dissolution rate of the first layer is slower than that of the second layer
- a method for preventing adhesion comprising applying a laminate to a subject in need of adhesion prevention.
- the elution amount of the monovalent metal salt of alginic acid in the second layer is 100%.
- the ratio of the dissolution amount of the monovalent metal salt of alginic acid in the first layer is less than 50% at 1 hour from the start of measurement and less than 70% at 2 hours [2-9a] anti-adhesion material.
- the first layer contains 25 ⁇ 10% by weight of the monovalent metal salt of alginic acid.
- the second layer is eluted within 4 hours, and 70 ⁇ 10% by weight of the monovalent metal salt of alginic acid is eluted within 1 hour.
- a method for producing an adhesion preventing material including a sponge-like laminate applicable to a living body including the following steps. (1) a step of curing a monovalent metal salt of low endotoxin alginic acid having a weight average molecular weight of 10,000 to 2,000,000 with a curing agent; (2) freezing the cured monovalent metal salt of alginic acid, (3) On the monovalent metal salt of alginic acid obtained in (2), a monovalent metal salt of low endotoxin alginic acid having a weight average molecular weight of 1,000 to 1,000,000 is cured with a curing agent, and a laminate.
- the sponge-like laminate comprises a sponge-like first layer containing a monovalent metal salt of low endotoxin alginic acid having a weight average molecular weight of 10,000 to 2,000,000, and a weight average molecular weight of 1,000 to 1,000,000. And a sponge-like second layer containing a monovalent metal salt of low endotoxin alginic acid of 000, and the weight average molecular weight of the monovalent metal salt of alginic acid of the first layer is higher than that of the second layer.
- a sponge-like laminate applicable to a living body obtained by the following steps (1) to (4).
- (1) a step of curing a monovalent metal salt of low endotoxin alginic acid having a weight average molecular weight of 10,000 to 2,000,000 with a curing agent; (2) freezing the cured monovalent metal salt of alginic acid, (3) On the monovalent metal salt of alginic acid obtained in (2), a monovalent metal salt of low endotoxin alginic acid having a weight average molecular weight of 1,000 to 1,000,000 is cured with a curing agent, and a laminate.
- the sponge-like laminate comprises a sponge-like first layer containing a monovalent metal salt of low endotoxin alginic acid having a weight average molecular weight of 10,000 to 2,000,000, and a weight average molecular weight of 1,000 to 1,000,000. And a sponge-like second layer containing a monovalent metal salt of low endotoxin alginic acid of 000, and the weight average molecular weight of the monovalent metal salt of alginic acid of the first layer is higher than that of the second layer.
- [4-2] The sponge-like laminate according to [4-1], which is used as an adhesion preventing material.
- [4-3] The sponge-like laminate according to the above [4-1] or [4-2], wherein the sponge-like laminate is sterilized by electron beam and / or ⁇ irradiation with an absorbed dose of 10 kGy to 150 kGy. Laminated body.
- [4-4] The sponge-like laminate according to any one of [4-1] to [4-3], further including a step of pressing the laminate obtained in (4).
- [5-1] A first raw material containing a monovalent metal salt of low endotoxin alginic acid having a weight average molecular weight of 10,000 to 2,000,000, and a low endotoxin alginic acid having a weight average molecular weight of 1,000 to 1,000,000 And a second raw material containing the monovalent metal salt, wherein the first raw material has a weight average molecular weight higher than that of the second raw material, and is a combination of raw materials for producing an adhesion preventing material.
- a combination of raw materials according to the above [5-1] which is used for producing a sponge-like laminate.
- the adhesion prevention effect is high, both wound adhesion and de novo adhesion can be suppressed, the applied living body is not adversely affected, wound healing is not hindered, intestinal anastomosis, etc. It is possible to provide an anti-adhesive material having at least one performance that can be used, is easy to apply through a trocar in endoscopic surgery, can be re-adjusted by adjusting the affixing position, and the like.
- Adhesion refers to a condition in which the surfaces of tissues that should be separated from each other are connected or fused with a fibrous tissue.
- causes of adhesion include trauma that can occur on the surface of a tissue during surgery, inflammation caused by the trauma, inflammation due to dry tissue surface during surgery, and the like. With these trauma and inflammation, exudate containing fibrin is generated on the surface of the tissue, and this exudate becomes organized and the tissue surface is connected or fused to form an adhesion.
- Anti-adhesion refers to reducing the formation of adhesions.
- the prevention of adhesion does not necessarily require completely preventing the formation of adhesion, and it is only necessary that the formation of adhesion is prevented as compared with the case where the adhesion preventing material of the present invention is not applied. That is, “adhesion prevention” may be rephrased as adhesion reduction. For example, it is sufficient that at least one selected from the frequency, range, and degree of adhesion is reduced.
- Anti-adhesion means, for example, that when the adhesion grade evaluation described in the Examples is performed, the average adhesion grade is lower than the average adhesion grade when the adhesion prevention material of the present invention is not applied. It only needs to be lower.
- “adhesion prevention” refers to, for example, when the extent evaluation of adhesion described in the examples is performed, compared to the extent of average adhesion when the adhesion prevention material of the present invention is not applied, the average adhesion It is sufficient that the extent is lower.
- “Anti-adhesion” is preferably prevention of adhesions resulting from surgery, more preferably peritoneal adhesions resulting from surgery. That is, “adhesion prevention” is preferably prevention of postoperative adhesion.
- the present invention relates to a low endotoxin having a relatively high weight average molecular weight, comprising a sponge-like first layer and a second layer of a monovalent metal salt of low endotoxin alginic acid at least partially crosslinked with a curing agent.
- Sponge-like first layer containing a monovalent metal salt of alginic acid and a sponge-like second layer containing a monovalent metal salt of low endotoxin alginic acid having a relatively low weight average molecular weight.
- An anti-adhesion material (hereinafter sometimes referred to as “adhesion prevention material A”) including a laminate is provided.
- the weight average molecular weights of the monovalent metal salts of low endotoxin alginic acid used in the first layer and the second layer are, for example, 10,000 to 2,000,000 and 1,000 to 1,000,000, respectively. is there. Such a weight average molecular weight is measured by a GPC-MALS method after dissolving in a decrosslinking treatment, for example, a chelating agent solution.
- a GPC-MALS method after dissolving in a decrosslinking treatment, for example, a chelating agent solution.
- ⁇ when the symbol “ ⁇ ” is used in a numerical range, it means “more than the lower limit value and less than the upper limit value”, and the numerical values at both ends of the symbol are included in the range.
- the adhesion preventing material A contains monovalent metal salts of low endotoxin alginic acid having different molecular weights in the first layer and the second layer of the sponge-like laminate. Specifically, the weight average molecular weight of the monovalent metal salt of alginic acid in the first layer is higher than that in the second layer.
- the layer containing the monovalent metal salt of alginic acid has a low dissolution rate if the weight average molecular weight of the monovalent metal salt of alginic acid is large, whereas the dissolution rate is high if the weight average molecular weight is small.
- the adhesion preventing material A of the present invention with the first layer facing the wound part and the second layer facing the abdominal cavity side, the first layer remains in the wound part and the second layer This layer can be expected to dissolve relatively quickly and suppress adhesion within the abdominal cavity.
- the present invention also includes a sponge-like laminate that can be applied to a living body and includes a first layer and a second layer each containing a monovalent metal salt of low endotoxin alginic acid that is at least partially crosslinked with a curing agent,
- An anti-adhesion material (“adhesion prevention material B”) in which the dissolution rates of the first layer and the second layer are different is provided.
- the dissolution rate of the first layer is slower than that of the second layer.
- the weight average molecular weight of the monovalent metal salt of alginic acid of the first layer as in the adhesion prevention material A is set.
- the degree of cross-linking of the monovalent metal salt of alginic acid in the first layer can be increased by changing the type of the cross-linking agent, changing the concentration of the cross-linking agent, or the like. Higher than that.
- the anti-adhesion material B has a first dissolution when the elution amount of the monovalent metal salt of alginic acid in the second layer is 100% in the dissolution test using elution of the monovalent metal salt of alginic acid as an index.
- the ratio of the elution amount of the monovalent metal salt of alginic acid in the layer is less than 50% at 1 hour from the start of measurement and less than 70% at 2 hours.
- the adhesion preventing material B is a dissolution test using elution of a monovalent metal salt of alginic acid as an index, and the first layer contains 25 ⁇ 10% by weight of the monovalent metal salt of alginic acid within 1 hour.
- 70 ⁇ 10% by weight of the monovalent metal salt of alginic acid is eluted within 1 hour, and 90 ⁇ 10% by weight. % Elute within 4 hours.
- the dissolution test is as described in Examples below.
- “adhesion prevention material A” and “adhesion prevention material B” may be collectively referred to as “adhesion prevention material”.
- the “first layer” is a lower layer when the sponge-like laminate is applied to a target, that is, a layer in contact with the surface of the tissue to be applied.
- the “second layer” is a layer that becomes an upper layer when the sponge-like laminate is applied to the object, that is, a layer that does not come into contact with the surface of the tissue to be applied.
- “Applicable to a living body” means that it can be placed on the surface of a tissue to be applied as a medical material.
- the sponge-like laminate applicable to a living body used as an adhesion preventing material may have a third layer containing an optional component in addition to the first layer and the second layer. And may have a multilayer structure. Further, a sponge-like laminate having a structure in which each layer does not have a clear boundary surface and the molecular weight gradually increases or decreases continuously is included.
- the adhesion preventing material 1 includes a sponge-like laminate 4 including a first layer 2 and a second layer 3.
- the first layer 2 and the second layer 3 are each sponge-like.
- “Sponge-like” means a state having porosity.
- the shape of the sponge-like laminate that can be applied to a living body is not particularly limited, and can be appropriately selected in consideration of the range, shape, unevenness, etc. of the surface to be applied.
- the shape of the sponge-like laminate may be, for example, a flat plate shape as shown in FIG. 1, or may be a disc shape, a cylindrical shape, a rectangular parallelepiped shape, or the like. A flat plate shape or a disk shape is preferable.
- the adhesion preventing material can be further cut and applied to the surface in accordance with the range, shape, unevenness, etc. of the surface to be applied, so the size of the flat plate or the disc is not particularly limited.
- the length of the length and width is not particularly limited, and the height (thickness) is preferably 0.2 mm to 30 mm. More preferably 0.3 mm to 15 mm, and still more preferably 0.5 mm to 10 mm. More preferably, in addition to such height (thickness), the vertical and horizontal lengths are 1 mm to 300 mm ⁇ 1 mm to 300 mm, respectively, particularly preferably 3 mm to 200 mm ⁇ 3 mm to 200 mm, More preferably, it is 5 mm to 150 mm ⁇ 5 mm to 150 mm. Note that the thickness may not be uniform, and an inclined structure in which one is thick and the other is thin may be used.
- the sponge-like laminate of the adhesion-preventing material of the present invention has a high flexibility and is difficult to break compared to Seprafilm (trade name).
- the sponge-like laminate is pressed. “Press” is as described later.
- its height (thickness) is preferably 0.02 mm to 3 mm, more preferably 0.03 mm to 1.5 mm, still more preferably 0.05 mm to 1 mm.
- the vertical and horizontal lengths are 1 mm to 300 mm ⁇ 1 mm to 300 mm, respectively, particularly preferably 3 mm to 200 mm ⁇ 3 mm to 200 mm, More preferably, it is 5 mm to 150 mm ⁇ 5 mm to 150 mm.
- the thickness after pressing is uniform.
- Monovalent metal salt of alginic acid is a water-soluble substance formed by ion exchange of the hydrogen atom of the 6-position carboxylic acid of alginic acid with monovalent metal ions such as Na + and K + . It is salt.
- Specific examples of the monovalent metal salt of alginic acid include sodium alginate and potassium alginate. In particular, sodium alginate that is commercially available is preferable.
- a solution of a monovalent metal salt of alginic acid forms a gel when mixed with a curing agent.
- Alginic acid used in the present invention is a biodegradable polymer polysaccharide, a polymer in which two types of uronic acids, D-mannuronic acid (M) and L-guluronic acid (G), are polymerized in a straight chain. It is. More specifically, D-mannuronic acid homopolymer fraction (MM fraction), L-guluronic acid homopolymer fraction (GG fraction), and D-mannuronic acid and L-guluronic acid are randomly arranged. This is a block copolymer in which the fractions (MG fraction) are bound arbitrarily.
- the composition ratio (M / G ratio) of D-mannuronic acid and L-guluronic acid of alginic acid varies depending on the type of organism mainly derived from seaweed, etc. It ranges from a high G type with an M / G ratio of about 0.4 to a high M type with an M / G ratio of about 5.
- monovalent metal salts of alginic acid are high molecular polysaccharides, and it is difficult to accurately determine the molecular weight, and in measuring the molecular weight of a high molecular weight substance derived from a natural product, the value may vary depending on the measurement method. ing.
- the absolute weight average molecular weight can be measured.
- the weight average molecular weight of the monovalent metal salt of alginic acid used as a raw material measured by the GPC-MALS method is, for example, 10,000 to 2,000,000 in the first layer of the sponge-like laminate, preferably 15,000 to 1,500,000, more preferably 20,000 to 1,000,000, and particularly preferably 25,000 to 500,000.
- the weight average molecular weight measured by the GPC-MALS method is, for example, 1,000 to 1,000,000 in the second layer, preferably 1 000 to 500,000, more preferably 2,000 to 250,000, and particularly preferably 3,000 to 100,000.
- the weight average molecular weight measured by GPC-MALS method is, for example, 10,000-10,000 for the first layer of the sponge-like laminate. 300,000, preferably 10,000 to 200,000, more preferably 10,000 to 100,000, and particularly preferably 10,000 to 80,000.
- the weight average molecular weight measured by the GPC-MALS method is, for example, 1,000 to 100,000, preferably 1,000, for the second layer. -80,000, more preferably 2,000-60,000, particularly preferably 3,000-60,000.
- the weight average molecular weight as a monovalent metal salt of non-crosslinked alginic acid is measured by GPC-MALS method after any decrosslinking treatment. Can be measured.
- the decrosslinking treatment include dissolution in an arbitrary chelating agent, for example, a chelating agent solution such as EDTA (ethylenediaminetetraacetic acid) or phytic acid. EDTA is preferred as the chelating agent used.
- the weight average molecular weight of the monovalent metal salt of alginic acid in the first layer of the sponge-like laminate is higher than that in the second layer.
- the weight average molecular weight of the raw material of the sponge-like laminate or the monovalent metal salt of alginic acid in the first layer contained in the sponge-like laminate is, for example, 1,000 to 1,000,000 higher than that of the second layer. , Preferably 2,000 to 500,000 higher, more preferably 3,000 to 300,000 higher.
- the molecular weight of the high molecular polysaccharide is calculated by the above-described method, a measurement error of 10 to 20% by weight can be caused. For example, 10,000 is 8,000 to 12,000, 100,000 is 80,000 to 120,000, 200,000 is 160,000 to 240,000, 400,000 If it is 320,000 to 480,000, 500,000, the value may vary in the range of about 400,000 to 600,000.
- the molecular weight of alginic acids can be measured according to a conventional method. Typical conditions when GPC-MALS is used for molecular weight measurement are as described in Example 1 of this specification.
- the detector for example, an RI detector and a light scattering detector (MALS) can be used.
- Alginic acids generally have a large molecular weight when initially extracted from brown algae, but the molecular weight gradually decreases in the course of drying and purification by heat.
- Alginic acids having different molecular weights can be produced by techniques such as temperature control in the production process, selection of brown algae as a raw material, and molecular weight fractionation in the production process. Furthermore, it is possible to obtain alginic acids having a target molecular weight by mixing with alginic acids of different lots having different molecular weights.
- the monovalent metal salt of alginic acid used in the present invention has been treated with a low endotoxin.
- the low endotoxin treatment can be performed by a known method or a method analogous thereto.
- the method of Takada et al. See, for example, JP-A-9-32001
- the method of Yoshida et al. Eg, JP-A-8-269102
- the low endotoxin treatment of the present invention is not limited thereto, but is washed, filtered with a filter (such as an endotoxin removal filter or a charged filter), ultrafiltration, a column (an endotoxin adsorption affinity column, a gel filtration column, a column with an ion exchange resin, etc.) ), Adsorption to hydrophobic substances, resin or activated carbon, organic solvent treatment (extraction with organic solvent, precipitation / precipitation by addition of organic solvent, etc.), surfactant treatment (for example, JP-A-2005-036036) It can be carried out by a known method such as a gazette) or a combination thereof. These processing steps may be appropriately combined with known methods such as centrifugation. It is desirable to select appropriately according to the type of alginic acid.
- a filter such as an endotoxin removal filter or a charged filter
- ultrafiltration such as an endotoxin removal filter or a charged filter
- a column an endotoxin
- the endotoxin level can be confirmed by a known method, and can be measured by, for example, a method using Limulus reagent (LAL), a method using Endspecy (registered trademark) ES-24S set (Seikagaku Corporation), or the like. .
- LAL Limulus reagent
- Endspecy registered trademark
- ES-24S set Seikagaku Corporation
- the endotoxin treatment method of the monovalent metal salt of alginic acid used in the present invention is not particularly limited.
- LAL Limulus reagent
- It is preferably 500 endotoxin units (EU) / g or less, more preferably 100 EU / g or less, particularly preferably 50 EU / g or less, and particularly preferably 30 EU / g or less.
- Low endotoxin-treated sodium alginate can be obtained from commercially available products such as Sea Matrix (registered trademark) (Mochida Pharmaceutical Co., Ltd.), PRONOVA TM UP LVG (FMCBioPolymer), and the like.
- the amount of the monovalent metal salt of alginic acid used in the sponge-like laminate can be appropriately selected in consideration of the adhesion preventing effect.
- the amount of monovalent metal salt of alginic acid, the sum of the first and second layers of sponge-like laminate for example, 0.1mg / cm 2 ⁇ 10.0mg / cm 2 and the like, preferably 0.1 mg / cm 2 to 3.0 mg / cm 2 , more preferably 0.5 mg / cm 2 to 2.5 mg / cm 2 , and still more preferably 1.8 mg / cm 2 to 2. 2 mg / cm 2 , particularly preferably 2.0 mg / cm 2 .
- the ratio (weight ratio) of the monovalent metal salt of alginic acid used in the first layer and the second layer is preferably 1:20 to 20: 1, more preferably 1: 5 to 5: 1, more preferably 1: 3 to 3: 1 and particularly preferably 1: 2 to 2: 1.
- either one of the first layer and the second layer may contain a curing agent (that is, either one of the first layer and the second layer does not contain a curing agent). Or both the first layer and the second layer may contain a curing agent. Alternatively, in the adhesion preventing material, neither the first layer nor the second layer may contain a curing agent.
- the first layer and the second layer are at least partially crosslinked with a curing agent.
- the curing agent include divalent or higher metal ion compounds such as Ca 2+ , Mg 2+ , Ba 2+ , Sr 2+ , Zn 2+ , and Fe 3+, and crosslinkable reagents having 2 to 4 amino groups in the molecule. Can be mentioned. More specifically, as a metal ion compound having a valence of 2 or more, CaCl 2 , MgCl 2 , CaSO 4 , ZnCl 2 , FeCl 3 , BaCl 2 , SrCl 2, etc.
- a crosslinkable reagent having 2 to 4 amino groups in the molecule, a lysyl group (—COCH (NH 2 ) — (CH 2 ) 4 on the nitrogen atom
- Diaminoalkanes that may have —NH 2
- diaminoalkanes and derivatives in which the amino group is substituted with a lysyl group to form a lysylamino group specifically include diaminoethane, diaminopropane, N— (Lysyl) -diaminoethane and the like can be mentioned.
- the amount of the curing agent used in the first layer and the second layer is appropriately adjusted according to the amount of monovalent metal salt of alginic acid and the molecular weight.
- the amount of the curing agent used in the first layer is, for example, 0.1 ⁇ mol / cm 2 to 100 ⁇ mol / cm 2 , preferably 0.5 ⁇ mol / cm 2 to 2.0 ⁇ mol / cm. 2 .
- the amount of the curing agent used in the second layer is, for example, 0.1 ⁇ mol / cm 2 to 10 ⁇ mol / cm 2 , preferably 0.6 ⁇ mol / cm 2 to 2.4 ⁇ mol / cm. 2 .
- An adhesion prevention material including a bio-applicable sponge-like laminate and a bio-applicable sponge-like laminate can be produced, for example, through the following steps.
- (1) a step of curing a monovalent metal salt of low endotoxin alginic acid having a weight average molecular weight of 10,000 to 2,000,000 with a curing agent; (2) freezing the cured monovalent metal salt of alginic acid, (3) On the monovalent metal salt of alginic acid obtained in (2), a monovalent metal salt of low endotoxin alginic acid having a weight average molecular weight of 1,000 to 1,000,000 is cured with a curing agent, and a laminate. Obtaining a step, (4) A step of freeze-drying the obtained laminate to obtain a sponge-like laminate.
- first alginate a solution of a monovalent metal salt of a low endotoxin alginic acid having a weight average molecular weight of 10,000 to 2,000,000 (hereinafter referred to as “first alginate”) and a curing agent solution are prepared.
- first alginate solution and the curing agent solution can be prepared by a known method or a method analogous thereto.
- the solvent is not particularly limited as long as it is a solvent applicable to a living body, but is preferably an aqueous solvent, for example, purified water, pure water (for example, distilled water, ion-exchanged water), milli-Q water, physiological saline, Phosphate buffered saline, DMSO, etc., more preferably pure water. These are preferably sterilized and preferably treated with a low endotoxin.
- an aqueous solvent for example, purified water, pure water (for example, distilled water, ion-exchanged water), milli-Q water, physiological saline, Phosphate buffered saline, DMSO, etc., more preferably pure water.
- the first alginate can be cured by mixing the first alginate solution and the curing agent solution.
- the first alginate hardened in the step (1) is frozen by a conventional method.
- the mixing ratio of the first layer and the second layer can be reduced.
- the freezing temperature and time are, for example, ⁇ 20 ° C. for 4 hours.
- step (3) first, a solution of a monovalent metal salt of low endotoxin alginic acid (hereinafter referred to as “second alginate”) having a weight average molecular weight of 1,000 to 1,000,000 and a solution of a curing agent are prepared.
- the solution of the second alginate and the solution of the curing agent can be prepared by a known method or a method analogous thereto.
- the solvent is the same as that described in the above step (1).
- the second alginate can be cured by mixing the second alginate solution and the curing agent solution.
- the hardened second alginate may be frozen before the step (4).
- the freezing temperature and time are, for example, ⁇ 20 ° C. for 4 hours.
- step (4) above the laminate obtained in step (3) is freeze-dried to obtain a sponge-like laminate.
- Freeze-drying can be performed by a known method. Freeze-drying conditions can be adjusted as appropriate, and a primary drying step, a secondary drying step, and the like may be provided.
- a first layer of alginate containing a first alginate and a curing agent, a second layer of a sponge containing a second alginate and a curing agent, and alginate of the first layer A sponge-like laminate having a higher weight average molecular weight than that of the second layer can be obtained, and an adhesion preventing material containing the sponge-like laminate can be obtained.
- a sponge-like first layer containing a first alginate and a curing agent is prepared, and a sponge-like second layer containing a second alginate and a curing agent is formed thereon.
- the second layer may be formed, and the first layer may be formed thereon.
- the sponge-like laminate can be produced through the following steps, for example. (1 ′) curing the second alginate with a curing agent; (2 ′) freezing the cured second alginate; (3 ′) a step of obtaining a laminate by curing the first alginate with a curing agent on the second alginate obtained in (2 ′); (4 ′) A step of freeze-drying the obtained laminate to obtain a sponge-like laminate.
- the specific description of each process is the same as that of the said method.
- the first alginate is cured and freeze-dried to produce a sponge-like first layer
- the second alginate is cured and freeze-dried separately to form a sponge-like second layer. It is also possible to obtain a sponge-like laminate by pasting together the obtained sponge-like layers. The specific description of each process is the same as that of the said method.
- a desired size can be obtained by using a container, mold, substrate, porous membrane, nonwoven fabric, woven fabric or the like having a desired size, height and shape.
- An anti-adhesion material including a sponge-like laminate having a height and shape can be obtained.
- the sponge-like laminate of the adhesion preventing material is further sterilized.
- Sterilization includes, but is not limited to, ⁇ -ray sterilization, electron beam sterilization, ethylene oxide gas sterilization, ethanol sterilization, and the like.
- the anti-adhesion material is sterilized by electron beam and / or ⁇ -ray irradiation. By irradiating the polymer material with ⁇ rays, electron beams or the like, it is preferable to obtain a biomaterial with high biocompatibility with controlled storage in vivo (see, for example, JP 2000-237294 A). .
- Examples of irradiation conditions for electron beam and / or ⁇ -ray sterilization include an absorbed dose of 10 kGy to 150 kGy, more preferably 20 kGy to 100 kGy, and still more preferably 40 kGy to 80 kGy.
- the absorbed dose is 20 kGy to 80 kGy, 20 kGy to 60 kGy, 40 kGy to 60 kGy, and the like.
- Electron beam sterilization is preferred over gamma ray sterilization.
- the method further includes a step of pressing the laminated body obtained in the above step (4) or the like.
- the pressing is performed manually or by sandwiching the laminate with a press and pressurizing.
- generally used processes such as compression and thinning are also included in the press referred to in the present invention.
- the pressing pressure include 1 kPa to 100 MPa, more preferably 10 kPa to 80 MPa, and still more preferably 100 kPa to 60 MPa.
- the manual pressing is performed through a material that can be pressed by hand so as to uniformly apply pressure to the laminate, for example, an acrylic ruler, an acrylic plate, a glass plate, a metal plate, or the like.
- a press machine to be used for example, a hot press machine (AH-1T manufactured by As One Co., Ltd.) can be cited.
- the anti-adhesion material is used by applying it to a subject in need of anti-adhesion.
- the anti-adhesion material is usually absorbed and decomposed after staying at the application site for about one week necessary for exhibiting the anti-adhesion effect, and finally is not metabolized or excreted in about one to two months. Excellent safety.
- the anti-adhesion material may be applied to the surface of a wound part, for example, the surface of a tissue related to surgery.
- tissue related to surgery refers to tissue that has been traumatically damaged during surgery, or tissue that is inflamed or may be inflamed due to dryness of the surface during surgery.
- the tissue associated with the surgery is preferably an organ wrapped in the peritoneum (eg, stomach, jejunum, ileum, appendix, colon, liver, spleen, duodenum, and pancreas).
- the adhesion preventing material according to a preferred embodiment of the present invention can effectively prevent serious adhesion such as adhesion occurring after hepatectomy.
- “apply” means that an adhesion preventing material is placed on the surface of a wound part (for example, the surface of a tissue related to a surgical operation).
- the surface of the first layer of the sponge-like laminate is in contact with the surface on the wound part side (for example, the surface of the tissue), and the surface of the second layer is the surface on the wound part side (for example, the surface of the tissue)
- the anti-adhesive material is placed on the wound side surface (for example, the surface of the tissue related to the surgical operation) so as to face the opposite side (for example, the abdominal side).
- the first layer of the sponge-like laminate Since the first layer of the sponge-like laminate has a relatively high weight average molecular weight, it remains undegraded on the surface of the tissue for a time sufficient to prevent adhesion and acts as a physical barrier to the wound surface. On the other hand, since the second layer of the sponge-like laminate has a relatively low weight average molecular weight, it quickly melts and spreads, and plays a role in preventing adhesion on the non-wound surface.
- the sponge-like laminate of anti-adhesion material has higher flexibility and is hard to break compared to Seprafilm (trade name).
- the anti-adhesion material is not defined on the surface of the tissue to be applied, and can be used by being wrapped around the intestinal tract, for example, during an intestinal anastomosis.
- the surgical instrument can be easily inserted from a passage through which the surgical instrument is taken in and out of the subject during a surgical operation using an endoscope.
- the adhesion preventing material can be reapplied.
- the sponge laminate of the anti-adhesive material has a broad range of anti-adhesion targets as compared to INTERCEED (trade name).
- an anti-adhesion material having an appropriate size is prepared according to the range, shape, unevenness, etc. of the surface to be applied, and is applied to the surface of the tissue related to the surgical operation to be prevented from adhesion.
- a “subject” is a human or non-human organism, such as avian and non-human mammals (eg, cows, monkeys, cats, mice, rats, guinea pigs, hamsters, pigs, dogs, rabbits, sheep, and horses). is there.
- the sponge laminate of the anti-adhesive material especially the sponge laminate
- the anti-adhesive material is relatively applied to the affected area via a trocar or the like. Can be easily applied.
- the anti-adhesive material applied to the affected area preferably absorbs moisture present in the affected area or moisture applied to the affected area to recover the thickness.
- the anti-adhesion material can be used safely on the subject, similar to Seprafilm (trade name) and INTERCEED (trade name).
- stitching of the anti-adhesive material and the surgical-related tissue surface is usually not necessary, but if necessary, the anti-adhesive material and surgical-related tissue The surface may be sutured.
- an adhesion prevention method comprising applying a sponge-like laminate to a subject in need of adhesion prevention.
- a specific method is as described above.
- a sponge-like laminate for preventing adhesion is provided.
- the specific sponge-like laminate is as described above.
- Concomitant drugs Before, simultaneously with, or after applying the anti-adhesion material of the present invention to a tissue related to surgery, antibiotics such as streptomycin, penicillin, tobramycin, amikacin, gentamicin, neomycin, and amphotericin B, aspirin, Concomitant drugs such as non-steroidal antipyretic analgesics (NSAIDs) and anti-inflammatory drugs such as acetaminophen may be administered. These agents may be used by being mixed in the adhesion preventing material of the present invention.
- antibiotics such as streptomycin, penicillin, tobramycin, amikacin, gentamicin, neomycin, and amphotericin B, aspirin
- Concomitant drugs such as non-steroidal antipyretic analgesics (NSAIDs) and anti-inflammatory drugs such as acetaminophen may be administered. These agents may be used by being mixed in the adhesion preventing material of the present invention.
- the sponge-like laminate is porous and has a water-absorbing power, for example, compared with nonporous Seprafilm (trade name), it is easy to carry a drug by adjustment at the time of use.
- a drug solution in a sponge By impregnating and administering a drug solution in a sponge, adhesion prevention and local sustained release of the drug can be achieved simultaneously in the abdominal cavity, thoracic cavity, heart chamber and the like. Furthermore, by loading the drug in layers having different dissolution rates, it becomes possible to release the drug at a high sustained release rate and a slow sustained release rate.
- Each reagent used for the preparation of the alginate laminated sponge is as follows.
- Low endotoxin sodium alginate was obtained from Mochida Pharmaceutical. -AL10: (Lot NO. 5K12202), endotoxin amount 4 EU / g.
- AL500 (Lot NO. BL150713-500), endotoxin amount 19 EU / g.
- Calcium chloride was obtained from Wako Pure Chemical Industries, Ltd. (product code: 036-00485).
- Preparation procedure (1) Preparation of solution AL500 was dissolved in pure water at a concentration of 1.0 wt% to prepare an AL500 solution. Similarly, AL10 was dissolved in pure water at a concentration of 1.0 wt% to prepare an AL10 solution. Further, calcium chloride was dissolved in pure water to prepare 10 mM and 15 mM calcium chloride aqueous solutions, respectively.
- the target alginate laminated sponge includes a sponge-like lower layer (ie, first layer) containing AL500 and calcium chloride, and a sponge-like upper layer (ie, second layer) containing AL10 and calcium chloride.
- the total amount of sodium alginate used in the upper and lower layers was about 2.0 mg / cm 2 .
- the ratio (weight ratio) of the usage-amount in the upper layer and lower layer of sodium alginate was 1: 1.
- the amount of calcium chloride, the upper layer is about 1.0 [mu] mol / cm 2, at the lower, it was about 1.5 ⁇ mol / cm 2.
- EDTA ethylenediaminetetraacetic acid
- Example 3 and Examples 3-2 and 4 described later the laminated sponge obtained was sterilized by electron beam (20 kGy).
- a non-sterile one was used as the laminated sponge.
- Example 1-2 Preparation of Alginate Stacked Sponge (1) Preparation of Sponge Using alginic acid described in [Reagent] below, using AL100 or AL500 as a lower layer material and AL10 or AL20 as an upper layer material In accordance with the method described in Example 1, each alginate laminated sponge was produced by a combination of AL10 (upper layer) -AL100 (lower layer), AL20 (upper layer) -AL100 (lower layer), AL20 (upper layer) -AL500 (lower layer). .
- Example 2 Measurement of Dissolution Rate of Each Layer of Alginic Acid Laminated Sponge Laminated sponges in which the upper layer or the lower layer was fluorescently modified were prepared, and the dissolution rate was measured. A specific method is shown below.
- As the fluorescent labeling reagent FTSC (Fluorescein-5-Thiochemicalcarbazide) was used, and alginic acid was labeled by a conventional method.
- a laminated sponge was produced in accordance with the method described in Example 1 using fluorescently labeled alginic acid.
- Low endotoxin sodium alginate is as described in Example 1.
- Phosphate buffer solutions are sodium dihydrogen phosphate (Wako Pure Chemicals, 197-09705 (trade name)), potassium dihydrogen phosphate (Wako Pure Chemicals, 166-04255 (trade name)), sodium chloride (Japanese Kojun Pure Chemical Industries, 191-01665 (trade name)) and potassium chloride (Wako Pure Chemical Industries, 166-17945 (trade name)) were used.
- Sodium ethylenediaminetetraacetate (N001) was purchased from Dojindo.
- Diameter 8mm biopsy trepan (Kai medical BP-80F (trade name)) 96-well black microplate (Nunc 137101 (trade name)) Fluorescent plate reader (Perkin Elmer ARVO X3 (trade name))
- the fluorescence-modified laminated sponge was punched with a biopsy trepan (Kai medical BP-60F (trade name)) having a diameter of 8 mm. This was immersed in 10 mL of 150 mM phosphate buffer (pH 7.5), and 200 ⁇ L of the immersion solution was collected at regular intervals. The collected solution was transferred to a 96-well plate, and the amount of dissolved alginic acid was quantified by measuring the fluorescence intensity with a fluorescence plate reader.
- the ratio of the elution amount of the monovalent metal salt of the lower layer alginic acid is 36% (less than 50%) at one hour from the start of measurement. ) 55% (less than 70%) at 2 hours.
- the dissolution rate of the upper layer was faster than that of the lower layer.
- Example 1-2 Each of the laminated sponges prepared in Example 1-2 (AL10 (upper layer) -AL100 (lower layer); AL20 (upper layer) -AL100 (lower layer); AL20 (upper layer) -AL500 (lower layer)) was dissolved in the same manner. As a result of measuring the speed, the same dissolution behavior as that of the laminated sponge (AL10 (upper layer) -AL500 (lower layer)) produced in Example 1 was shown.
- Example 3 Rat partial hepatectomy model
- the rat partial hepatectomy model was used to evaluate the formation of adhesions.
- the rat partial hepatectomy model is a model capable of reproducibly observing the formation of adhesions that cause severe inflammation and have high strength (Shimizu A et al., (2014) Surg Today. (44): 314-314. 323). Specifically, the formation of adhesions was evaluated as follows.
- Seprafilm (trade name) is a sheet-like material obtained by mixing carboxymethylcellulose (CMC) and hyaluronic acid, and was obtained from Genzyme GmbH.
- Interlaced (trade name) is a regenerated oxidized cellulose sheet and was obtained from Johnson & Johnson.
- 500-10 laminated sponge group (n 8): The alginate sponge produced in Example 1 was applied as an adhesion preventing material.
- Seprafilm group (n 8): 2 ⁇ 3 cm of Seprafilm was applied as an adhesion prevention material.
- Interleaved group (n 8): 2 ⁇ 3 cm of Interceed was applied as an anti-adhesion material.
- Rats were anesthetized by intraperitoneal administration equivalent to 35 mg / kg pentobarbital, and the body weight was measured with an electronic balance. The rats were then laparotomized with a midline incision. Next, the abdominal wall was pinched with tweezers and lifted to cut the abdominal wall. As a preparation prior to performing a hepatectomy, a left lateral lobe was drawn from the back of the abdominal cavity and a gauze was laid under it. Next, we moved on to actual hepatectomy. Specifically, a ruler was applied to the liver, a position where the separation cross-section was 3 cm was searched, and both ends were cauterized by bipolar and marked. A straight line was cut between the marked two points.
- the abdomen was immediately closed and the treatment was terminated.
- the anti-adhesive material was applied after removing the gauze.
- the abdominal wall and skin were sutured twice and closed.
- a biodegradable thread was used for suturing the abdominal wall, and a non-absorbable thread was used for suturing the skin.
- the rats were euthanized by overdosing with about 2 mL of pentobarbital as an excessive amount of anesthesia, and the body weight was measured with an electronic balance.
- the abdomen was opened again, and the adhesion was evaluated as follows. The spleen weight was measured with an electronic balance after removing the spleen from the abdominal cavity.
- Adhesion was evaluated as follows.
- Non-separation section Other than the hepatic section, the following evaluations (a) and (b) were performed on the liver surface, omentum, peritoneum, small intestine, directly under the midline, and the like.
- Adhesion grade Adhesion was evaluated visually. Adhesion scores were assigned based on the following scoring method for sites other than the hepatic section. The site was not specified, and the maximum value of the observed adhesion score was recorded as the adhesion score of the test animal. Adhesion score: Grade 0: No adhesion is seen at all.
- Grade 1 Adhesion to the extent that it peels off due to its own weight (physiological adhesion)
- Grade 2 Adhesion that can be peeled off with tweezers (blunt adhesion)
- Grade 3 Adhesion that cannot be removed without using scissors and scalpel (sharp adhesion)
- Example 3-2 Rat partial hepatectomy model using Pean forceps Except for using Pean forceps at the time of transection of the liver, the same materials, experimental groups, procedures and adhesion evaluation methods as in Example 3 were used. Used to evaluate the adhesion grade and adhesion extent of the hepatic section and non-separated section.
- the separation of the liver using the Pean forceps was performed as follows. That is, in the [Procedure] of Example 3, “to linearly cut between two marked points” was performed by crushing the liver parenchyma with Pean forceps and cauterizing the exposed blood vessel with bipolar. .
- Example 4 Visualization of each layer of an alginate laminated sponge by fluorescent labeling Visualization test by fluorescent labeling of each layer of an alginate laminated sponge was performed as follows.
- the AL10 layer was widely distributed on the surface of the peritoneum in addition to the separated surface.
- the second layer of the sponge-like laminate has a relatively low weight average molecular weight of the monovalent metal salt of alginic acid, so that it quickly melts and spreads in the peritoneal cavity.
- the AL500 layer was partially observed on the abdominal wall, fluorescence from the separated surface was observed more conspicuously.
- the first layer of the sponge-like laminate has a relatively high weight average molecular weight of the monovalent metal salt of alginic acid, so that it remains on the separated surface and becomes a physical barrier.
- Example 5 Winding test In order to show the follow-up property to the curved surface of the alginate laminated sponge, the winding test was performed as follows.
- Low endotoxin sodium alginate is as described in Example 1.
- Agar (010-08725) was purchased from Wako Pure Chemical.
- the anti-adhesion material containing the sponge-like laminate can be used for intestinal anastomosis and the like.
- Example 6 Sponge Press and Swelling Test Pressing of an alginate-laminated sponge, measurement of thickness after pressing, and swelling test were performed as follows.
- Alginate laminated sponge (AL10 (upper layer) -AL500 (lower layer) is as described in Example 1.
- Table 1 shows the measurement results of the thickness after pressing.
- the average thickness of the sponge was about 1.5 mm before pressing, about 0.33 mm after manual pressing, and about 0.16 mm after pressing with a press.
- the pressed sponge maintained the above thickness without increasing in thickness over time.
- the change in the thickness of the sponge over time in the swelling test is shown in FIG. From the result of the swelling test, it was confirmed that the pressed alginate laminated sponge absorbs water and has a thickness almost equal to that of the alginate sponge not pressed. This suggests that the sponge, which is an adhesion preventing material, can be applied relatively easily to the affected area through a trocar or the like in endoscopic surgery because the sponge can be compacted by pressing. Furthermore, it was also suggested that the pressed sponge applied to the affected area absorbs moisture present in the affected area or applied to the affected area, and the thickness is restored. When the thickness is restored, the function as a laminated sponge can be exhibited.
- Example 7 Spraying test The following tests were conducted on an alginate laminated sponge and Seprafilm (trade name) in order to evaluate the fragility during water absorption.
- the alginate laminated sponge is as described in Example 1, and Seprafilm (trade name) is as described in Example 3. Moreover, what was pressed with the press as described in Example 6 was used as an alginate laminated sponge with a press.
- test piece of 1 cm ⁇ 2 cm was prepared from an alginate laminated sponge and Seprafilm (trade name).
- a double-sided tape was affixed to 1 cm ⁇ 1 cm of one end of the test piece and was gripped on the end of the test stand. In this way, the test piece was fixed so that the other end 1 cm ⁇ 1 cm was hollow.
- Each test piece was sprayed with pure water five times using a spray bottle. The process of bending the specimen downward as it wets was filmed with a video. Both the height and the angle from the test stand at the tip of the test piece were calculated by image analysis of the obtained moving image, and the change with time was plotted.
- the alginic acid laminated sponge had a height drop of 2 mm or less until 50 seconds after spraying, and was about 3 mm even after 90 seconds (FIG. 10A). Also, the alginic acid laminated sponge with press had a height drop of about 9 mm even after 90 seconds after spraying.
- Seprafilm trade name
- a significant decrease in height was observed immediately after spraying (FIG. 10A).
- the angle was similar to the height result (FIG. 10B). This suggests that the alginate laminated sponge maintains its shape and strength for a while even in the water-absorbing state regardless of the presence or absence of pressing.
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Abstract
Description
[1-1] 少なくとも一部が硬化剤で架橋された低エンドトキシンアルギン酸の1価金属塩のスポンジ状の第1の層および第2の層を含み、第1の層のアルギン酸の1価金属塩の重量平均分子量が10,000~2,000,000であり、第2の層のアルギン酸の1価金属塩の重量平均分子量が1,000~1,000,000であり、前記重量平均分子量が脱架橋処理後にGPC-MALS法により測定したものであり、第1の層のアルギン酸の1価金属塩の重量平均分子量が、第2の層のアルギン酸の1価金属塩の重量平均分子量よりも高い、滅菌された、生体に適用可能なスポンジ状積層体を含む、癒着防止材。
[1-1a] 重量平均分子量10,000~2,000,000の低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第1の層と、重量平均分子量1,000~1,000,000の低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第2の層を含み、前記重量平均分子量はGPC-MALS法により測定したものであり、第1の層のアルギン酸の1価金属塩の重量平均分子量が第2の層よりも高い、生体に適用可能なスポンジ状積層体を含む、癒着防止材。
[1-2] 第1の層および第2の層のいずれか一方が、硬化剤を含む上記[1-1]または[1-1a]に記載の癒着防止材。
[1-3] 第1の層および第2の層の両方が、硬化剤を含む上記[1-1]~[1-2]のいずれか1項に記載の癒着防止材。
[1-4] 低エンドトキシンアルギン酸の1価金属塩の第1の層と第2の層での使用量の合計が、0.1mg/cm2~3mg/cm2の範囲である、上記[1-1]~[1-3]のいずれか1項に記載の癒着防止材。
[1-5] 第1の層と第2の層のアルギン酸の1価金属塩のエンドトキシン含有量が、500EU/g以下である、上記[1-1]~[1-4]のいずれか1項に記載の癒着防止材。
[1-6] 第1の層と第2の層のアルギン酸の1価金属塩が、アルギン酸ナトリウムまたはアルギン酸カリウムである、上記[1-1]~[1-5]のいずれか1項に記載の癒着防止材。
[1-7] 第1の層と第2の層の硬化剤が、CaCl2、CaSO4、ZnCl2、SrCl2、FeCl3およびBaCl2からなる群より選択される少なくとも1つの金属イオン化合物である、上記[1-1]~[1-6]のいずれか1項に記載の癒着防止材。
[1-8] 第1の層を創傷部側の表面に向けて適用するための、上記[1-1]~[1-7]のいずれか1項に記載の癒着防止材。
[1-9] スポンジ状積層体が、吸収線量として10kGy~150kGyの電子線および/またはγ線照射により滅菌されたものである、上記[1-1]~[1-7]のいずれか1項に記載の癒着防止材。
[1-10] 少なくとも一部が硬化剤で架橋された低エンドトキシンアルギン酸の1価金属塩をそれぞれ含む第1の層および第2の層を含む生体に適用可能なスポンジ状積層体を含み、第1の層の溶解速度が、第2の層よりも遅い、癒着防止材。
[1-10a] 低エンドトキシンアルギン酸の1価金属塩をそれぞれ含む第1の層および第2の層を含む生体に適用可能なスポンジ状積層体を含み、第1の層の溶解速度が、第2の層よりも遅い、癒着防止材。
[1-11] pH7.5のリン酸緩衝液に対するアルギン酸の1価金属塩の溶出を指標とする溶解試験において、第2の層のアルギン酸の1価金属塩の溶出量を100%としたときの、第1の層のアルギン酸の1価金属塩の溶出量の割合が、測定開始から1時間の時点で50%未満、2時間の時点で70%未満である、上記[1-10]または[1-10a]の癒着防止材。
[1-12] pH7.5のリン酸緩衝液に対するアルギン酸の1価金属塩の溶出を指標とする溶解試験において、第1の層は、アルギン酸の1価金属塩の25±10重量%が1時間以内に溶出し、80±10重量%が4時間以内に溶出するものであり、第2の層は、アルギン酸の1価金属塩の70±10重量%が1時間以内に溶出し、90±10重量%が4時間以内に溶出するものである、上記[1-10]または[1-10a]の癒着防止材。
[1-13] スポンジ状積層体がプレスしたものである、上記[1-1]~[1-12]のいずれか1項に記載の癒着防止材。
[2-1a] 重量平均分子量10,000~2,000,000の低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第1の層と、重量平均分子量1,000~1,000,000の低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第2の層とを含み、前記分子量がGPC-MALS法により測定したものであり、第1の層のアルギン酸の1価金属塩の重量平均分子量が第2の層よりも高い、生体に適用可能なスポンジ状積層体を、癒着防止を必要とする対象に適用することを含む、癒着防止方法。
[2-2] 第1の層および第2の層のいずれか一方が、硬化剤を含む上記[2-1]または[2-1a]に記載の癒着防止方法。
[2-3] 第1の層および第2の層の両方が、硬化剤を含む上記[2-1]~[2-2]のいずれか1項に記載の癒着防止方法。
[2-4] 低エンドトキシンアルギン酸の1価金属塩の第1の層と第2の層での使用量の合計が、0.1mg/cm2~3mg/cm2の範囲である、上記[2-1]~[2-3]のいずれか1項に記載の癒着防止方法。
[2-5] 第1の層と第2の層のアルギン酸の1価金属塩のエンドトキシン含有量が、500EU/g以下である、上記[2-1]~[2-4]のいずれか1項に記載の癒着防止方法。
[2-6] 第1の層と第2の層のアルギン酸の1価金属塩が、アルギン酸ナトリウムまたはアルギン酸カリウムである、上記[2-1]~[2-5]のいずれか1項に記載の癒着防止方法。
[2-7] 第1の層と第2の層の硬化剤が、CaCl2、CaSO4、ZnCl2、SrCl2、FeCl3およびBaCl2からなる群より選択される少なくとも1つの金属イオン化合物である、上記[2-1]~[2-6]のいずれか1項に記載の癒着防止方法。
[2-8] スポンジ状積層体が、吸収線量として10kGy~150kGyの電子線および/またはγ照射により滅菌されたものである、上記[2-1]~[2-7]のいずれか1項に記載の癒着防止方法。
[2-9] 少なくとも一部が硬化剤で架橋された低エンドトキシンアルギン酸の1価金属塩をそれぞれ含む第1の層および第2の層を含み、第1の層の溶解速度が第2の層よりも遅い、生体に適用可能なスポンジ状積層体を、癒着防止を必要とする対象に適用することを含む、癒着防止方法。
[2-9a] 低エンドトキシンアルギン酸の1価金属塩をそれぞれ含む第1の層および第2の層を含み、第1の層の溶解速度が第2の層よりも遅い、生体に適用可能なスポンジ状積層体を、癒着防止を必要とする対象に適用することを含む、癒着防止方法。
[2-10] pH7.5のリン酸緩衝液に対するアルギン酸の1価金属塩の溶出を指標とする溶解試験において、第2の層のアルギン酸の1価金属塩の溶出量を100%としたときの、第1の層のアルギン酸の1価金属塩の溶出量の割合が、測定開始から1時間の時点で50%未満、2時間の時点で70%未満である、上記[2-9]または[2-9a]の癒着防止材。
[2-11] pH7.5のリン酸緩衝液に対するアルギン酸の1価金属塩の溶出を指標とする溶解試験において、第1の層は、アルギン酸の1価金属塩の25±10重量%が1時間以内に溶出し、80±10重量%が4時間以内に溶出するものであり、第2の層は、アルギン酸の1価金属塩の70±10重量%が1時間以内に溶出し、90±10重量%が4時間以内に溶出するものである、上記[2-9]または[2-9a]の癒着防止方法。
[2-12] スポンジ状積層体がプレスしたものである、上記[2-1]~[2-11]のいずれか1項に記載の癒着防止方法。
(1)重量平均分子量10,000~2,000,000の低エンドトキシンアルギン酸の1価金属塩を硬化剤により硬化させる工程、
(2)硬化したアルギン酸の1価金属塩を凍結する工程、
(3)(2)で得られたアルギン酸の1価金属塩の上で、重量平均分子量1,000~1,000,000の低エンドトキシンアルギン酸の1価金属塩を硬化剤により硬化して積層体を得る工程、
(4)得られた積層体を凍結乾燥してスポンジ状積層体を得る工程、
ここで、前記分子量がGPC-MALS法により測定したものであり、
前記スポンジ状積層体は、重量平均分子量10,000~2,000,000の低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第1の層と、重量平均分子量1,000~1,000,000の低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第2の層とを含み、第1の層のアルギン酸の1価金属塩の重量平均分子量が第2の層よりも高い。
[3-2] スポンジ状積層体が、吸収線量として10kGy~150kGyの電子線および/またはγ照射により滅菌されたものである、上記[3-1]に記載の癒着防止材の製造方法。
[3-3] (4)で得られた積層体をプレスする工程をさらに含む、上記[3-1]または[3-2]に記載の癒着防止材の製造方法。
(1)重量平均分子量10,000~2,000,000の低エンドトキシンアルギン酸の1価金属塩を硬化剤により硬化させる工程、
(2)硬化したアルギン酸の1価金属塩を凍結する工程、
(3)(2)で得られたアルギン酸の1価金属塩の上で、重量平均分子量1,000~1,000,000の低エンドトキシンアルギン酸の1価金属塩を硬化剤により硬化して積層体を得る工程、
(4)得られた積層体を凍結乾燥してスポンジ状積層体を得る工程、
ここで、前記分子量がGPC-MALS法により測定したものであり、
前記スポンジ状積層体は、重量平均分子量10,000~2,000,000の低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第1の層と、重量平均分子量1,000~1,000,000の低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第2の層とを含み、第1の層のアルギン酸の1価金属塩の重量平均分子量が第2の層よりも高い。
[4-2] 癒着防止材として用いる、上記[4-1]のスポンジ状積層体。
[4-3] スポンジ状積層体が、吸収線量として10kGy~150kGyの電子線および/またはγ照射により滅菌されたものである、上記[4-1]または[4-2]に記載のスポンジ状積層体。
[4-4] (4)で得られた積層体をプレスする工程をさらに含む、上記[4-1]~[4-3]のいずれか1項に記載のスポンジ状積層体。
[5-2]スポンジ状積層体の製造に用いるためのものである、上記[5-1]に記載の原料の組合せ。
「癒着」とは、互いに分離しているべき組織の表面が線維性の組織で連結または融合された状態のことをいう。癒着の原因は、外科手術において組織の表面にできる外傷や、外傷により引き起こされる炎症、外科手術において組織表面が乾燥することによる炎症などである。これらの外傷や炎症に伴い組織の表面にフィブリンを含む滲出液が生じ、この滲出液が器質化して組織表面が連結または融合されることにより癒着が形成される。
また、実施例に示したとおり、対象となる癒着としては、手術時の対象臓器の切除した部位の癒着およびde novo癒着(手術部位以外の周辺および腹腔および体内での広範な部位との癒着)がある。
本発明は、少なくとも一部が硬化剤で架橋された低エンドトキシンアルギン酸の1価金属塩のスポンジ状の第1の層および第2の層を含み、重量平均分子量が比較的高い低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第1の層と、重量平均分子量が比較的低い低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第2の層を含む生体に適用可能なスポンジ状積層体を含む、癒着防止材(以下、「癒着防止材A」という場合がある)を提供する。第1の層と第2の層で用いる低エンドトキシンアルギン酸の1価金属塩の重量平均分子量は、それぞれ、例えば、10,000~2,000,000と、1,000~1,000,000である。このような重量平均分子量は脱架橋処理、例えばキレート剤溶液に溶解した後にGPC-MALS法により測定したものである。
なお、本明細書において、数値範囲に「~」の記号を用いる場合、「下限値以上、上限値以下」を意味するものであり、記号の両端の数値は当該範囲に含まれる。
別の好ましい例として、癒着防止材Bは、アルギン酸の1価金属塩の溶出を指標とする溶解試験において、第1の層は、アルギン酸の1価金属塩の25±10重量%が1時間以内に溶出し、80±10重量%が4時間以内に溶出するものであり、第2の層は、アルギン酸の1価金属塩の70±10重量%が1時間以内に溶出し、90±10重量%が4時間以内に溶出するものである。溶解試験は、具体的には、後述の実施例に記載の通りである。
「アルギン酸の1価金属塩」は、アルギン酸の6位のカルボン酸の水素原子を、Na+やK+などの1価金属イオンとイオン交換することでつくられる水溶性の塩である。アルギン酸の1価金属塩としては、具体的には、アルギン酸ナトリウム、アルギン酸カリウムなどを挙げることができるが、特には、市販品により入手可能なアルギン酸ナトリウムが好ましい。アルギン酸の1価金属塩の溶液は、硬化剤と混合したときにゲルを形成する。
少なくとも一部が硬化剤で架橋されたアルギン酸の1価金属塩については、任意の脱架橋処理後にGPC-MALS法により測定することにより、架橋されていないアルギン酸の1価金属塩としての重量平均分子量を測定することができる。脱架橋処理としては、例えば、任意のキレート剤、例えばEDTA(エチレンジアミン四酢酸)、フィチン酸などのキレート剤溶液に溶解することが挙げられる。用いるキレート剤としてはEDTAが好ましい。
アルギン酸類の分子量の測定は、常法に従い測定することができる。分子量測定にGPC-MALSを用いる場合の代表的な条件は、本明細書の実施例1に記載のとおりである。検出器として、例えば、RI検出器と光散乱検出器(MALS)を用いることができる。
癒着防止材は、第1の層および第2の層のいずれか一方が硬化剤を含有してもよく(すなわち、第1の層および第2の層のいずれか一方が硬化剤を含有しなくてもよく)、あるいは、第1の層および第2の層の両方が硬化剤を含有してもよい。
あるいは、癒着防止材は、第1の層および第2の層のいずれもが硬化剤を含有していなくてもよい。
生体適用可能なスポンジ状積層体を含む癒着防止材や生体適用可能なスポンジ状積層体は、例えば、以下の工程を経て作製することができる。
(2)硬化したアルギン酸の1価金属塩を凍結する工程、
(3)(2)で得られたアルギン酸の1価金属塩の上で、重量平均分子量1,000~1,000,000の低エンドトキシンアルギン酸の1価金属塩を硬化剤により硬化して積層体を得る工程、
(4)得られた積層体を凍結乾燥してスポンジ状積層体を得る工程。
(1’)第2のアルギン酸塩を硬化剤により硬化させる工程、
(2’)硬化した第2のアルギン酸塩を凍結する工程、
(3’)(2’)で得られた第2のアルギン酸塩の上で、第1のアルギン酸塩を硬化剤により硬化して積層体を得る工程、
(4’)得られた積層体を凍結乾燥してスポンジ状積層体を得る工程。
各工程の具体的な説明は、前記の方法と同様である。
各工程の具体的な説明は、前記の方法と同様である。
電子線および/またはγ線滅菌する場合の照射条件として、例えば、吸収線量が10kGy~150kGyが挙げられ、より好ましくは20kGy~100kGyが挙げられ、さらに好ましくは40kGy~80kGyが挙げられる。電子線および/またはγ線滅菌する場合の照射条件の別の好ましい態様として、例えば、吸収線量が20kGy~80kGy、20kGy~60kGy、40kGy~60kGy等が挙げられる。γ線滅菌よりも電子線滅菌が好ましい。
癒着防止材は、癒着防止を必要とする対象に適用することにより使用される。好ましくは、癒着防止材は、通常、癒着防止効果を奏するのに必要な1週間程度、適用局所に滞留した後に吸収分解され、最終的には1~2カ月程度で代謝・排泄されてなくなるため、安全性に優れる。
また、好ましくは、癒着防止材のスポンジ積層体は、INTERCEED(商品名)と比較して、癒着防止対象が広範である。
本発明の癒着防止材を外科手術に関連した組織に適用する前に、あるいは同時に、あるいは後で、ストレプトマイシン、ペニシリン、トブラマイシン、アミカシン、ゲンタマイシン、ネオマイシン、およびアンホテリシンB等の抗生物質、アスピリン、非ステロイド性解熱鎮痛剤(NSAIDs)、アセトアミノフェン等の抗炎症薬等の併用薬を投与するようにしてもよい。これらの薬剤は本発明の癒着防止材に混入して用いてもよい。
スポンジ状積層体は多孔性で吸水力もあるため、例えば、無孔性のSeprafilm(商品名)に比べて、用時調整による薬物担持が容易である。薬剤溶液をスポンジに含浸させ、投与することで、腹腔、胸腔、心腔等において、癒着防止と薬物の局所徐放が同時に達成できる。さらに溶解速度が異なる層に薬物を担持することにより、速い徐放速度と遅い徐放速度での薬物の徐放も可能となる。
アルギン酸積層スポンジを、以下のように作製した。
アルギン酸積層スポンジの調製に用いた各試薬は以下の通りである。
低エンドトキシンアルギン酸ナトリウムは、持田製薬株式会社から入手した。
・AL10:(Lot NO.5K12202),エンドトキシン量4EU/g。
・AL500:(Lot NO.BL150713-500),エンドトキシン量19EU/g。
塩化カルシウムは、和光純薬工業株式会社から入手した(商品コード:036-00485)。
35mm無処理ディッシュ(IWAKI社 商品コード1000-035)
マイクロピペット(Gilson社 ピペットマン(商品名))
純水製造装置(メルクミリポア社 Elix Essential UV5(商品名))
冷凍庫(SHARP社 SJ-56S(商品名))
凍結乾燥器(TAITEC社 VD-550R(商品名))
(1)溶液の調製
AL500を1.0wt%の濃度で純水に溶解させて、AL500溶液を調製した。同様に、AL10を1.0wt%の濃度で純水に溶解させて、AL10溶液を調製した。さらに、塩化カルシウムを純水に溶解させ、10mMおよび15mMの塩化カルシウム水溶液をそれぞれ調製した。
AL500溶液1.0mLおよび10mM塩化カルシウム水溶液1.0mLをマイクロピペットを使用して35mm無処理ディッシュに加え、ピペッティングによって均一になるように混合した。これを一晩静置し、ゲル化させた。ディッシュを冷凍庫に移し、-20℃で4時間凍結させた。
ディッシュを冷凍庫から取り出し、凍結したAL500層の上に、AL10溶液1.0mLおよび15mM塩化カルシウム水溶液1.0mLをマイクロピペットで加え、ピペッティングによって均一になるように混合した。これを再びディッシュを冷凍庫に移し、-20℃で4時間凍結させた。
凍結後のディッシュを凍結乾燥器にセットし、2晩凍結乾燥を行って、目的のアルギン酸積層スポンジを得た。
製造原料として用いたアルギン酸について、以下のGPC-MALS法により重量平均分子量を測定した。
試料に溶離液を加え溶解後、0.45μmメンブランフィルター濾過したものを測定溶液とした。
示差屈折率計:Optilab T-rEX
測定波長:658nm
測定温度:40℃
溶媒:200mM硝酸ナトリウム水溶液
試料濃度:0.5~2.5mg/mL(5濃度)
カラム:TSKgel GMPW-XL×2+G2500PW-XL(7.8mm I.D.×300mm×3本)
溶離液:200mM硝酸ナトリウム水溶液
流量:1.0mL/min.
濃度:0.05%
検出器:RI検出器、光散乱検出器(MALS)
カラム温度:40℃
注入量:200μL
AL10 : 55,000
AL500: 280,000
(電子線滅菌の照射線量が20kGyの場合)
AL10 :36,000
AL500:75,000
(電子線滅菌の照射線量が40kGyの場合)
AL10 :27,000
AL500:45,000
尚、後述の実施例6および7では、積層スポンジとして、非滅菌のものを用いた。
(1)スポンジの作製
以下の[試薬]に記載のアルギン酸を用い、AL100またはAL500を下層の原料として、AL10またはAL20を上層の原料として使用し、実施例1に記載の方法に準じて、AL10(上層)-AL100(下層)、AL20(上層)-AL100(下層)、AL20(上層)-AL500(下層)の組合せによる、各アルギン酸積層スポンジを作製した。
・AL10:実施例1と同じ
・AL20:(Lot NO.BL150713-20),エンドトキシン量13EU/g。
・AL100:(Lot NO.5G17201),エンドトキシン量6EU/g。
・AL500:実施例1と同じ
また、スポンジ作製に用いたアルギン酸のうち、AL20およびAL100について、実施例1に記載の方法を用いて、GPC-MALS法により重量平均分子量を測定した。
[結果]
AL20 : 82,000
AL100: 170,000
(電子線滅菌の照射線量が20kGyの場合)
AL20 :46,000
AL100:63,000
(電子線滅菌の照射線量が40kGyの場合)
AL20 :33,000
AL100:40,000
上層または下層が蛍光修飾された積層スポンジをそれぞれ作製し、溶解速度の測定を行った。具体的な方法を以下に示す。なお、蛍光標識試薬としてはFTSC(Fluorescein-5-Thiosemicarbazide)を使用し、アルギン酸の標識は常法により行った。
蛍光標識されたアルギン酸を用い、実施例1に記載の方法に準じて積層スポンジを作製した。
低エンドトキシンアルギン酸ナトリウムは、実施例1に記載の通りである。リン酸緩衝液は、リン酸二水素ナトリウム(和光純薬社、197-09705(商品名))、リン酸二水素カリウム(和光純薬社、166-04255(商品名))、塩化ナトリウム(和光純薬社、191-01665(商品名))、塩化カリウム(和光純薬社、166-17945(商品名))を用いて調整した。エチレンジアミン四酢酸ナトリウム(N001)はDojindo社から購入した。
直径8mm生検トレパン(Kai medical社 BP-80F(商品名))
96穴黒色マイクロプレート(Nunc社 137101(商品名))
蛍光プレートリーダー (Perkin Elmer社 ARVO X3(商品名))
まず、蛍光修飾された積層スポンジを直径8mmの生検トレパン(Kai medical社 BP-60F(商品名))で打ち抜いた。これを150mMリン酸緩衝液(pH7.5)10mL中に浸漬し、一定時間毎に浸漬液を200μLずつ回収した。回収した溶液を96穴プレートに移し、蛍光プレートリーダーによって蛍光強度を測定することで、溶解したアルギン酸量を定量化した。
積層スポンジの各層の溶解挙動の測定結果を、図2に示す。図2に示されているように、下層では、アルギン酸の1価金属塩の25±10重量%が1時間以内に溶出し、80±10重量%が4時間以内に溶出していた。一方、上層は、アルギン酸の1価金属塩の70±10重量%が1時間以内に溶出し、90±10重量%が4時間以内に溶出していた。また、上層のアルギン酸の1価金属塩の溶出量を100%としたときの、下層のアルギン酸の1価金属塩の溶出量の割合は、測定開始から1時間の時点で36%(50%未満)、2時間の時点で55%(70%未満)であった。
このように上層の溶解速度が、下層に比べて速いことが確認できた。下層を創傷部側、上層を腹腔側に向けてアルギン酸スポンジを適用することで、下層は、創傷部に残留して創傷部の癒着を防止することができるとともに、上層は比較的速く溶解して創傷部から遠く離れた場所にも多数形成されるde novo癒着、例えば、腹腔内全般の癒着等を抑えることができると考えられる。
ラット一部肝切除モデルを用いて、癒着の形成を評価した。ラット一部肝切除モデルは、重篤な炎症を惹起し高い強度を有する癒着の形成を再現性高く観察できるモデルである(Shimizu A et al.,(2014)Surg Today.(44):314-323)。具体的には、以下のように癒着の形成を評価した。
低エンドトキシンアルギン酸ナトリウムは、実施例1に記載の通りである。
Seprafilm(商品名)は、カルボキシメチルセルロース(CMC)とヒアルロン酸を混合したシート状材料であり、Genzyme GmbHより入手した。
Interceed(商品名)は、再生酸化セルロースシートであり、Johnson&Johnsonより入手した。
Control群(n=8):left lateral lobeの辺縁を3cm計測し切離し凝固止血した(無処置対照群)。
500-10積層スポンジ群(n=8):実施例1で作製したアルギン酸スポンジを癒着防止材として適用した。
Seprafilm群(n=8):2×3cmのSeprafilmを癒着防止材として適用した。
Interceed群(n=8):2×3cmのInterceedを癒着防止材として適用した。
ペントバルビタール35mg/kg相当の腹腔投与によりラットに麻酔をかけ、体重を電子天秤で測定した。その後、ラットを、正中切開で開腹した。次に、腹壁をピンセットでつまんで持ち上げ、腹壁を切断した。肝切除を行う前準備として、left lateral lobeを腹腔の奥から引き出し、その下にガーゼを敷いた。次に、実際の肝切除に移った。具体的には、ものさしを肝臓にあて、離断面が3cmになる位置を探し、その両端に、バイポーラで焼灼し、印をつけた。印をつけた2点の間を直線的に切除していった。Control群では、この後すぐ閉腹して処置を終了した。癒着防止材を適用する群では、この後、ガーゼを除去したのちに癒着防止材を適用した。次に、腹壁と皮膚を二回に分けて縫合し閉腹した。腹壁を縫合する際には生分解糸を用い、皮膚を縫合する際には非吸収糸を用いた。閉腹から一週間後に、ラットに過剰量の麻酔として約2mLのペントバルビタールの過剰投与によって安楽死させ、体重を電子天秤で測定した。その後、再び開腹し、以下の通り癒着を評価した。脾臓重量は、腹腔から脾臓を摘出した後、電子天秤で測定した。
以下の通り、癒着の評価を行った。
上記[手順]に記載した肝離断面について、以下の(a)、(b)の評価を行った。
(a)癒着グレード
癒着の評価は、目視により行った。肝離断面について、下記スコアリング法に基づき癒着スコアをつけた。
癒着スコア:
Grade0:癒着が全く見られない。
Grade1:自重により剥離する程度の癒着(生理的な癒着)
Grade2:ピンセットによる剥離が可能な癒着(鈍的な癒着)
Grade3:ハサミ、メスを使わないと剥離できない癒着(鋭的な癒着)
3cmの肝離断面のうち、癒着が形成された幅を定規(ものさし)にて計測し、長さ(単位:mm)で表した(従って、離断面の最大Extentは30mmとなる)。
肝離断面以外、具体的には肝表面、大網、腹膜、小腸、正中創直下、等について、以下の(a)、(b)の評価を行った。
(a)癒着グレード
癒着の評価は、目視により行った。肝離断面以外の部位について、下記スコアリング法に基づき癒着スコアをつけた。部位は特定せず、認められた癒着スコアの最大値を、その試験動物の癒着スコアとして記録した。
癒着スコア:
Grade0:癒着が全く見られない。
Grade1:自重により剥離する程度の癒着(生理的な癒着)
Grade2:ピンセットによる剥離が可能な癒着(鈍的な癒着)
Grade3:ハサミ、メスを使わないと剥離できない癒着(鋭的な癒着)
肝離断面以外の部位について、癒着が形成された組織部分について、定規(ものさし)にて、その接着している幅を計測し、長さ(単位:mm)で表した。上記(2)(a)と同様、部位は特定せず、認められた癒着が形成された幅の最大値を、その試験動物の癒着Extentとして記録した。
癒着の評価の結果を図3(離断面)および図4(非離断面)に示した。また、体重測定および脾臓重量測定の結果を図5に示した。
離断面においては、各群とも、Control群に比べて癒着が抑制される傾向が認められた(図3(A)~(C))。
非離断面において、500-10積層スポンジ群での顕著な癒着防止効果が確認された(図4(A)~(C))。陽性対照として用いたSeprafilm(商品名)およびInterceed(商品名)では癒着防止効果は認められず、Control群に比べて癒着が増悪する傾向が認められた。一方、500-10積層スポンジ群では顕著な癒着防止効果が確認された。
体重および脾臓重量については、Control群、Seprafilm群、Interceed群、および500-10積層スポンジ群間で有意差はなく、500-10積層スポンジを適用しても、生体に悪影響がないことが確認された(図5(A)および(B))。
ここで、実施例における有意差検定は、特に断りがない限りStudent’s t-testによって行い、Gradeの評価のみMann-Whitney U testで行った。
肝臓の離断の際にペアン鉗子を用いたことを除き、実施例3と同じ材料、実験群、手順および癒着の評価方法を用いて、肝離断面と非離断面の癒着グレードと癒着Extentを評価した。
癒着の評価の結果を図6(離断面)および図7(非離断面)に示した。また、体重測定および脾臓重量測定の結果を図8に示した。
離断面においては、各群(n=8)とも、Control群(n=8)に比べて癒着が抑制される傾向が認められ、500-10積層スポンジ群においては、Control群との間に統計的に有意な差が認められた(図6(A)~(C))。
非離断面において、500-10積層スポンジ群での顕著な癒着防止効果が確認された(図7(A)~(C))。陽性対照として用いたSeprafilm(商品名)については癒着防止効果が認められず、Interceed(商品名)についてはControl群に比べて癒着が増悪する傾向が認められた。一方、500-10積層スポンジ群では顕著な癒着防止効果が確認された。
体重および脾臓重量については、Control群、Seprafilm群、Interceed群、および500-10積層スポンジ群間で有意差はなく、500-10積層スポンジを適用しても、生体に悪影響がないことが確認された(図8(A)および(B))。
アルギン酸積層スポンジの各層について蛍光標識による可視化の試験を以下のように行った。
低エンドトキシンアルギン酸ナトリウムは、実施例1に記載の通りである。
ハンディー紫外線ランプ(UVP社 UVGL-58(商品名))
ラットの肝臓切除の手順は、実施例3に記載の通りである。作製された肝臓の離断面に、第1の層または第2の層が蛍光標識されたアルギン酸スポンジを貼付した。貼付には、材料の残存を観察しやすくするために、実施例1よりも多い4.0mg/cm2のアルギン酸を使用した積層スポンジを実施例1の方法に準じて作製し、使用した。その後、実施例3に記載の手順で閉腹し、1週間後に開腹を行った。露出した腹腔内にランプで紫外線を照射し、蛍光標識されたアルギン酸の腹腔内分布を可視化した。
また、AL500層は、一部腹壁などでも見られるものの、離断面からの蛍光がより際立って観察された。このことから、スポンジ状積層体の第1の層はアルギン酸の1価金属塩の重量平均分子量が比較的高いため、離断面に留まって物理的なバリアとなることが示唆された。
アルギン酸積層スポンジの曲面への貼付追従性を示すために、巻き付け試験を以下のように行った。
低エンドトキシンアルギン酸ナトリウムは、実施例1に記載の通りである。寒天(010-08725)は、和光純薬から購入した。
寒天をお湯に溶解した後、円柱状の型に流し込んで冷やし、直径20mmのアガロースゲル円柱を作製した。これをモデル管状臓器とし、実施例1で作製したスポンジを巻き付けることで、巻き付けの追従性を検証した。
アルギン酸積層スポンジのプレス、プレス後の厚みの測定および膨潤試験を以下のように行った。
アルギン酸積層スポンジ(AL10(上層)-AL500(下層))は、実施例1に記載の通りである。
アガロースは、和光純薬工業株式会社から入手した(商品コード:010-08725)。
(1)プレスおよびプレス後の厚みの測定
(1-1)手動プレス
アルギン酸積層スポンジを平面上に静置し、手のひらで、アクリル定規を介してスポンジ全体に均一に圧がかかるよう押圧した。押圧前後のスポンジの厚みを電子ノギスにて計測し、平均値を算出した(n=4)。
アルギン酸積層スポンジをプレス機(アズワン株式会社製、製品名AH-1T)にセットした。10MPaの圧力で室温にてアルギン酸積層スポンジをプレスし、5分間保持した。プレス後のスポンジの厚みを電子ノギスで測定し、平均値を算出した(n=4)。
アガロースを熱湯に2重量%で溶解させ、室温まで冷却することでアガロースゲルを作製した。アガロースゲルを2cm×2cm角に切り取り、ガラスシャーレ上で純水に浸漬し、湿潤させた。
1cm×1cm角に切り取ったプレス前後のアルギン酸積層スポンジをアガロースゲル上に静置した。一定時間毎に横方向から撮影し、撮影した画像からスポンジの厚みを算出し、膨潤に及ぼすプレスの影響の有無を確認した(プレス前:n=3;プレス後:n=3。尚、膨潤試験では、プレスしたアルギン酸積層スポンジとして、プレス機によりプレスしたものを用いた。
プレス後の厚みの測定結果を表1に示す。
このことから、スポンジをプレスすることによりコンパクトにまとめることができるので、内視鏡手術においてトロッカー等を介して癒着防止材であるスポンジを患部に比較的容易に適用できることが示唆された。
さらに、患部に適用されたプレスしたスポンジは、患部に存在する、または患部に適用される水分を吸収して、厚みが回復することも示唆された。厚みが回復することにより、積層スポンジとしての機能を発揮し得る。
アルギン酸積層スポンジおよびSeprafilm(商品名)について、吸水時の脆弱性を評価するために以下の試験を行った。
アルギン酸積層スポンジは実施例1に、Seprafilm(商品名)は実施例3に記載の通りである。また、アルギン酸積層スポンジのプレス有りものとして、実施例6に記載のプレス機によりプレスしたものを用いた。
アルギン酸積層スポンジおよびSeprafilm(商品名)から1cm×2cmの試験片を作成した。試験片の片端1cm×1cmに両面テープを貼付し、試験台の端に把持した。これにより他方の端1cm×1cmが中空に出るように試験片を固定した。
各試験片に対し、霧吹きを用いて純水を5回噴霧した。試験片が湿潤に伴って下方に折れ曲がっていく過程を動画で撮影した。
得られた動画の画像解析によって、試験片先端の試験台からの高さと角度の両方を算出し、その時間変化をプロットした。
結果を図10に示した。
高さについては、アルギン酸積層スポンジは、霧吹き後50秒まで高さの低下は2mm以内であり、90秒後においても3mm程度であった(図10(A))。また、プレス有りのアルギン酸積層スポンジも、霧吹き後90秒後においても高さの低下は9mm程度であった。いっぽう、Seprafilm(商品名)は、霧吹き直後から著しい高さの低下が認められた(図10(A))。角度についても、高さの結果と同様の結果であった(図10(B))。
このことから、アルギン酸積層スポンジは、プレスの有無に関わらず吸水状態にあっても暫くはその形状、強度が維持されることが示唆された。このため、癒着防止材として患部に適用した際に、貼付位置を調整して貼り直すことが可能である、あるいは、内視鏡手術の際、トロッカー等を介して癒着防止材であるスポンジを患部に適用する際に、トロッカー内の水分を吸収して上手く広げることができない等の事態が避けられる、などの利点がある。なお、アルギン酸積層スポンジが、患部、あるいはそのモデル系に対して好適な圧着性を有することは、実施例3、実施例5等において確認している。
2 第1の層
3 第2の層
4 スポンジ状積層体
Claims (16)
- 少なくとも一部が硬化剤で架橋された、低エンドトキシンアルギン酸の1価金属塩のスポンジ状の第1の層および第2の層を含み、第1の層のアルギン酸の1価金属塩の重量平均分子量が10,000~2,000,000であり、第2の層のアルギン酸の1価金属塩の重量平均分子量が1,000~1,000,000であり、前記重量平均分子量が脱架橋処理後にGPC-MALS法により測定したものであり、第1の層のアルギン酸の1価金属塩の重量平均分子量が、第2の層のアルギン酸の1価金属塩の重量平均分子量よりも高い、滅菌された、生体に適用可能なスポンジ状積層体を含む、癒着防止材。
- 第1の層および第2の層のいずれか一方が、硬化剤を含む請求項1
に記載の癒着防止材。 - 第1の層および第2の層の両方が、硬化剤を含む請求項1または2に記載の癒着防止材。
- 低エンドトキシンアルギン酸の1価金属塩の第1の層と第2の層での使用量の合計が、0.1mg/cm2~3mg/cm2の範囲である、請求項1~3のいずれか1項に記載の癒着防止材。
- 第1の層と第2の層のアルギン酸の1価金属塩のエンドトキシン含有量が、500EU/g以下である、請求項1~4のいずれか1項に記載の癒着防止材。
- 第1の層と第2の層のアルギン酸の1価金属塩が、アルギン酸ナトリウムまたはアルギン酸カリウムである、請求項1~5のいずれか1項に記載の癒着防止材。
- 第1の層と第2の層の硬化剤が、CaCl2、CaSO4、ZnCl2、SrCl2、FeCl3およびBaCl2からなる群より選択される少なくとも1つの金属イオン化合物である、請求項1~6のいずれか1項に記載の癒着防止材。
- 第1の層を創傷部側の表面に向けて適用するための、請求項1~7のいずれか1項に記載の癒着防止材。
- 少なくとも一部が硬化剤で架橋された低エンドトキシンアルギン酸の1価金属塩をそれぞれ含む第1の層および第2の層を含む生体に適用可能なスポンジ状積層体を含み、第1の層の溶解速度が、第2の層よりも遅い、癒着防止材。
- pH7.5のリン酸緩衝液に対するアルギン酸の1価金属塩の溶出を指標とする溶解試験において、第2の層のアルギン酸の1価金属塩の溶出量を100%としたときの、第1の層のアルギン酸の1価金属塩の溶出量の割合が、測定開始から1時間の時点で50%未満、2時間の時点で70%未満である、請求項9の癒着防止材。
- pH7.5のリン酸緩衝液に対するアルギン酸の1価金属塩の溶出を指標とする溶解試験において、第1の層は、アルギン酸の1価金属塩の25±10重量%が1時間以内に溶出し、80±10重量%が4時間以内に溶出するものであり、第2の層は、アルギン酸の1価金属塩の70±10重量%が1時間以内に溶出し、90±10重量%が4時間以内に溶出するものである、請求項9の癒着防止材。
- スポンジ状積層体がプレスしたものである、請求項1~11のいずれか1項に記載の癒着防止材。
- 少なくとも一部が硬化剤で架橋された低エンドトキシンアルギン酸の1価金属塩のスポンジ状の第1の層および第2の層を含み、第1の層のアルギン酸の1価金属塩の重量平均分子量が10,000~2,000,000であり、第2の層のアルギン酸の1価金属塩の重量平均分子量が1,000~1,000,000であり、前記重量平均分子量が脱架橋処理後にGPC-MALS法により測定したものであり、第1の層のアルギン酸の1価金属塩の重量平均分子量が、第2の層のアルギン酸の1価金属塩の重量平均分子量よりも高い、滅菌された、生体に適用可能なスポンジ状積層体を、癒着防止を必要とする対象に、第1の層を創傷部側の表面に向けて適用することを含む、癒着防止方法。
- 以下の工程を含む、生体に適用可能なスポンジ状積層体を含む癒着防止材の製造方法。
(1)重量平均分子量10,000~2,000,000の低エンドトキシンアルギン酸の1価金属塩を硬化剤により硬化させる工程、
(2)硬化したアルギン酸の1価金属塩を凍結する工程、
(3)(2)で得られたアルギン酸の1価金属塩の上で、重量平均分子量1,000~1,000,000の低エンドトキシンアルギン酸の1価金属塩を硬化剤により硬化して積層体を得る工程、
(4)得られた積層体を凍結乾燥してスポンジ状積層体を得る工程、
ここで、前記分子量がGPC-MALS法により測定したものであり、
前記スポンジ状積層体は、重量平均分子量10,000~2,000,000の低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第1の層と、重量平均分子量1,000~1,000,000の低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第2の層とを含み、第1の層のアルギン酸の1価金属塩の重量平均分子量が第2の層よりも高い。 - 以下の工程(1)~(4)により得られる生体に適用可能なスポンジ状積層体。
(1)重量平均分子量10,000~2,000,000の低エンドトキシンアルギン酸の1価金属塩を硬化剤により硬化させる工程、
(2)硬化したアルギン酸の1価金属塩を凍結する工程、
(3)(2)で得られたアルギン酸の1価金属塩の上で、重量平均分子量1,000~1,000,000の低エンドトキシンアルギン酸の1価金属塩を硬化剤により硬化して積層体を得る工程、
(4)得られた積層体を凍結乾燥してスポンジ状積層体を得る工程、
ここで、前記分子量がGPC-MALS法により測定したものであり、
前記スポンジ状積層体は、重量平均分子量10,000~2,000,000の低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第1の層と、重量平均分子量1,000~1,000,000の低エンドトキシンアルギン酸の1価金属塩を含むスポンジ状の第2の層とを含み、第1の層のアルギン酸の1価金属塩の重量平均分子量が第2の層よりも高い。 - 癒着防止材として用いる、請求項15のスポンジ状積層体。
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US20190209260A1 (en) | 2019-07-11 |
US20230145308A1 (en) | 2023-05-11 |
CA3030111A1 (en) | 2018-01-18 |
US11890145B2 (en) | 2024-02-06 |
JP2022090089A (ja) | 2022-06-16 |
CN109641084A (zh) | 2019-04-16 |
EP3485921A4 (en) | 2020-03-11 |
JPWO2018012605A1 (ja) | 2019-04-25 |
JP7065769B2 (ja) | 2022-05-12 |
US11464597B2 (en) | 2022-10-11 |
JP7330327B2 (ja) | 2023-08-21 |
EP3485921A1 (en) | 2019-05-22 |
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