WO2022269215A1 - Implants corporels tridimensionnels - Google Patents
Implants corporels tridimensionnels Download PDFInfo
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- WO2022269215A1 WO2022269215A1 PCT/FR2022/051265 FR2022051265W WO2022269215A1 WO 2022269215 A1 WO2022269215 A1 WO 2022269215A1 FR 2022051265 W FR2022051265 W FR 2022051265W WO 2022269215 A1 WO2022269215 A1 WO 2022269215A1
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- Prior art keywords
- implant
- implant according
- implants
- hydrogel
- micrometers
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Classifications
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- B29C64/106—Processes of additive manufacturing using only liquids or viscous materials, e.g. depositing a continuous bead of viscous material
- B29C64/118—Processes of additive manufacturing using only liquids or viscous materials, e.g. depositing a continuous bead of viscous material using filamentary material being melted, e.g. fused deposition modelling [FDM]
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- B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
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- A—HUMAN NECESSITIES
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- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
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Definitions
- the present invention relates to the general field of bio-materials and in particular implants, intended to be introduced into the human body/living organism, in particular as a replacement and/or augmentation of a more or less soft tissue and/or as a filling. of a space between the skeleton and the skin, or sutured to the skin.
- the present invention relates to three-dimensional body implants comprising a hydrogel which comprises cross-linked alginate and gelatin, and in particular to temporary or permanent implants.
- the implants of the invention have a determined and particularly advantageous porosity and mechanical strength. These implants are also acellular, that is to say that no cell, and in particular no living cell is integrated into the implant during its manufacture.
- the hydrogel may further comprise fibrinogen.
- Hydrogel-based structures comprising alginate and gelatin are known in the state of the art, but they lack satisfactory mechanical strength, because these constituents most often have limited elasticity (low Young's modulus, in particular), which makes the resulting structures difficult to manipulate.
- One of the aims of the invention is to overcome the drawbacks of the implants of the prior art, and to make it possible to provide biocompatible implants, the main constituents of which are of natural origin.
- the implants of the invention indeed have particularly advantageous and innovative characteristics, in particular in terms of (i) the mechanical strength of the constituents, which is similar to that of the native tissues when they are introduced, (ii) the stability in the time, (iii) flexibility, (iv) remarkable resistance to tearing and impact and (v) colonization by cells of the host organism.
- the invention proposes a three-dimensional body implant which comprises a hydrogel comprising cross-linked gelatin and cross-linked alginate, in which said hydrogel has a mechanical strength of 1 kPa to 1000 kPa and in which said implant comprises at at least one porous area, the porous area comprising a plurality of pores each having a pore size, the porous area having a overall porosity between 100 ⁇ m and 10,000 ⁇ m, the overall porosity corresponding to an average of the pore sizes measured in the porous zone.
- the pores of the porous zone may have homogeneous pore sizes, i.e. not differing by more than 15% from each other.
- the pores of the porous zone can be distributed homogeneously, that is to say regular.
- the pores of the porous zone can extend along central axes respectively presenting homogeneous orientations, that is to say not differing by more than 20° from each other.
- the central axes of the pores of the porous zone can be arranged with homogeneous spacings, that is to say not differing by more than 15% from each other.
- the pores of the porous zone can respectively present homogeneous geometries, that is to say whose contours are superimposable with more than 50% of merged or parallel portions.
- the pores of the porous zone can be separated from each other by cords of material having respectively homogeneous thicknesses, that is to say not differing by more than 15% from each other.
- the gelatin can be cross-linked by an enzyme, preferably a transglutaminase.
- the implant may comprise a plurality of porous zones.
- Said plurality of porous zones can comprise at least two porous zones in which the pores have different pore sizes and/or shapes.
- the porous zones can be arranged to form a gradient of pore sizes distributed over the implant, the porous zones succeeding one another along a gradient direction following an order chosen from an increasing order and a decreasing order of the pore sizes.
- the implant may include:
- a first porous zone forming a base representing 5% to 40%, preferably 20% to 40%, of a total volume of the implant, and having a pore size of between 500 micrometers and 5000 micrometers, in particular 250 micrometers at 800 micrometers,
- a second porous zone forming a heart representing 20% to 70%, preferably 30% to 50%, of the total volume of the implant and having a pore size of between 500 micrometers to 2500 micrometers, in particular 100 micrometers to 250 micrometers ,
- a third porous zone forming a shell representing 5% to 40%, preferably 10% to 40%, of the total volume of the implant, and having a pore size between
- the implant may comprise at least one non-porous zone, the non-porous zone having a filling rate greater than 99%.
- Said at least one non-porous zone can comprise a perimeter surrounding the porous zone.
- Said at least one porous zone can cover an essential part of the implant, that is to say at least 50%, preferably at least 75%, in particular at least 90%, for example at least 95%.
- the implant may be made up of a plurality of layers each having a mesh made up of a plurality of meshes, the layers being stacked on top of each other in such a way that the meshes form the pores.
- the meshes of each layer can have homogeneous mesh sizes, that is to say not differing by more than 15% from each other.
- the meshes of each layer can be distributed homogeneously, that is to say evenly.
- the meshes of each layer can extend around central mesh axes respectively having homogeneous orientations, that is to say not differing by more than 20° with respect to each other.
- the central mesh axes of the meshes of each layer can be arranged with homogeneous spacings, that is to say not differing by more than 15% from each other.
- the meshes of each layer can respectively present homogeneous geometries, that is to say whose contours are superimposable with more than 50% of merged or parallel portions.
- the meshes of each layer can be separated from each other by cords of material having respectively homogeneous thicknesses, that is to say not differing by more than 15% from each other.
- the implant may have a volume in a range from 0.05 mL to 3 L, preferably from 100 mL to 600 mL.
- the implant may be a breast implant.
- the invention proposes a three-dimensional body implant, in particular as defined previously, capable of being obtained by a manufacturing process comprising successively:
- a step of preparing a hydrogel comprising gelatin and alginate - a step of three-dimensional shaping of the hydrogel so as to form at least one porous zone, the porous zone comprising a plurality of pores having each a pore size, the porous zone having an overall porosity of between 100 ⁇ m and 10,000 ⁇ m, the overall porosity corresponding to an average of the pore sizes measured in the porous zone, and - a step of crosslinking the hydrogel with at least one divalent cation, preferably calcium, and transglutaminase, said hydrogel having a mechanical strength of 1 kPa to 1000 kPa.
- the divalent cation and the transglutaminase can be added concomitantly.
- the hydrogel may include 0.5% to 3% alginate and 1% to 17.5% gelatin.
- the hydrogel may additionally comprise cross-linked fibrinogen, and preferably up to 2% cross-linked fibrinogen.
- the manufacturing process may also provide for the use of thrombin during the crosslinking step.
- the manufacturing process may plan to implement an additive manufacturing process, in particular 3D printing.
- the manufacturing process may further comprise a sterilization step.
- the invention relates to a method for implementing the implant as defined above in the context of reconstructive or aesthetic surgery, comprising a step of implanting the implant, in particular of a breast implant, in the body of a subject, in particular the chest of a subject.
- Crosslinking agent in the context of the present invention, means an agent capable of crosslinking the components of the hydrogel, in particular alginate, gelatin and fibrinogen.
- Biodegradable means the ability to be destroyed by a living organism. In particular when the implant is implanted in the host, said implant is biodegradable if it is capable of being destroyed by said host.
- Fibers in the context of the present invention, denotes any element of filamentary appearance, generally in the form of bundles.
- Shape in the context of the present invention, consists in giving the hydrogel a particular shape and structure or architecture, and in particular adapted to the destination of the hydrogel once consolidated.
- “Overall porosity” or “overall pore size”, in the context of the present invention, corresponds to the average of the pore size values measured on the porous zone(s) of the implant. It is not about the porosity of the hydrogel itself.
- the present invention makes it possible to provide three-dimensional body implants, which have particularly advantageous mechanical characteristics, in particular in terms of the mechanical strength of the constituents, which is similar to that of native tissues, stability over time and remarkable resistance. to tearing and impact.
- the implants according to the present invention can be used instead and in place (replacement of all or part) or in addition (increase) of various organs or tissues of the animal body and more particularly of the human body, permanently or temporarily.
- the implants according to the invention are suitable for contact with living fluids or living tissues. They are in particular intended to be implanted under the skin, or else on the skin, in particular for the regeneration and/or the healing of the skin.
- the implants of the invention are therefore substitutes or additions, replacing and/or augmenting and/or reinforcing, soft or flexible, and sometimes elastic tissues. They preferably make it possible to completely or partially replace, increase, or strengthen connective tissues, skin, fatty tissues.
- the implants according to the invention are therefore intended both for plastic, reconstructive or regenerative surgery.
- the implants according to the invention are therefore bodily implants, such as, for example, breast implants, pectoral implants, buttock implants, facial implants or any other implant making it possible to compensate for the loss of a volume of tissue.
- the implants of the present invention are breast implants.
- the implants of the invention can be large, both in volume since they can in particular reach a volume of 0.05 mL to 3 L, and preferably from 100 mL to 600 mL, but also in size, which can range from 0.5x0, 5x0, 2 to 20x15x15, i.e. a size within the following ranges of length x width x thickness: length from 0.5 cm to 20 cm x width from 0.5 cm to 15 cm x thickness of 0.2 cm to 15 cm.
- the size of implants for tissue filling generally does not exceed 20x15x15. It is preferably of the order of 12x12x3 or 12x12x4 for a breast implant.
- the implants of the invention have a volume greater than 0.05 mL, and preferably a volume of 0.05 mL to 3 L.
- the implants can be of any shape associated with the volumes mentioned in the present description.
- the implants can be in the form of half-spheres, half-drops, or any other shape that can be personalized according to the subject.
- the implants according to the invention are temporary because they are resorbable due to their composition, and disappear over time after their implantation in the body, leaving in their place cells and neo-tissues naturally vascularized by the living host organism.
- These temporary implants are therefore more precisely those which can be colonized by the cells of the host organism, in particular due to the existence of a determined porosity (using a maximum value) and/or the use of a constituent material of the implant which preserves cell viability and which is conducive to cell proliferation.
- These implants therefore define an internal space, a kind of skeleton/framework/matrix (or "scaffold") allowing colonization by cells, in particular the cells of the recipient organism.
- the implants according to the invention are biodegradable due to their composition, and are therefore suitable for implantation in the animal body, in particular the human body.
- the implants according to the invention comprise at least one porous zone.
- said at least one porous zone that is to say the porous zone when there is only one or all of the porous zones when there are several, represents , by volume, about 5% to 100% of the implant, preferably about 50% to 100% of the implant, more preferably about 90% to 100% of the implant.
- the porous zone or all of the porous zones represent more than 90% of the implant.
- the porous zone or all of the porous zones represent approximately 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% of the implant.
- the porous zone or all of the porous zones represent the entire implant.
- the porosity of the porous zone of the implant is a key parameter to be adjusted according to the tissues or organs concerned which are in particular to be replaced and/or augmented. Indeed, the porosity translates the empty space present in the porous zone of the implant which it is possible to adapt in order to bring more or less material and thus to confer a certain mechanical resistance approaching closer to that of the native tissue of the implantation zone.
- the overall porosity corresponding to an average of the pore sizes measured on each porous zone.
- the implants are characterized at the level of their structure by the porosity of the porous zone, expressed here in two different but correlated and therefore equivalent or alternative ways: the pore size expressed in micrometers and/or the hydrogel filling rate expressed as a percentage (volume of hydrogel / total volume of the implant).
- the porous zone comprises a plurality of pores each having a pore size.
- a large overall pore size in the porous zone of the implant of the order of 1000 mhi to 10000 mhi, in particular from 1000 mhi to 5000 mhi, and/or a rate filling of the porous area of the implant, from 5% to 50% will be preferred, because the resulting implant, containing less material, will be more flexible.
- the porous area of the implant will have a filling rate of 5% to 50%, and even more preferably, 15% to 50%.
- a low overall pore size in the porous zone of the implant in particular less than 1000 mhi, and/or a filling rate of the porous zone of the implant, of 50 % to 99%, in particular from 50% to 95%, will be preferred because it will give said implant high mechanical strength for rigid tissues.
- the porous area of the implant will have a filling rate of 50% to 99%, and even more preferably, 50% to 90%.
- the pore size can be adapted according to the different cell types present in the tissue.
- a dense and low-porous environment with a pore size of the implant, in particular less than 1000 mhi and/or a high filling rate of the implant, from 50% to 99%, in particular 50% at 95%, will then be preferred for osteoblast-type cells evolving in a very rigid matrix, while a flexible and more porous environment, with a pore size of the implant, located in particular between 1000 mhi to 5000 mhi and/or an implant filling rate of 5% to 50% will promote the survival, proliferation and metabolism of fibroblast and adipocytes type cells evolving in a flexible matrix.
- the choice of the pore size makes it possible to adjust the degradation time of the implant in the body.
- An implant having small pores, in particular less than 1000 mhi, and/or whose filling rate is 50% to 99%, in particular 50% to 95%, will be composed of more material, the total degradation will be then more or less long depending on the size of the implant.
- a rapid degradation of the implant for example less than 12 months, the more one will prefer large pores in the implant, in particular between 1000 ⁇ m and 5000 mhi and/or a filling rate of the implant, from 5% to 50%.
- the pore sizes as indicated above correspond to the length between the filaments of hydrogel deposited, and in particular to the distance void between these filaments.
- the present disclosure relates to a three-dimensional body implant which comprises a hydrogel comprising cross-linked alginate and cross-linked gelatin, characterized in that said hydrogel has a mechanical strength of 1 kPa to 1000 kPa and that said implant comprises at least one porous zone, the porous zone comprising a plurality of pores each having a pore size, the porous zone having an overall porosity of at most 5000 ⁇ m.
- the present invention also relates to a three-dimensional body implant which comprises a hydrogel comprising cross-linked alginate and cross-linked gelatin, characterized in that said hydrogel has a mechanical resistance of 1 kPa to 1000 kPa and that said implant comprises at least one porous zone, the porous zone comprising a plurality of pores each having a pore size, the porous zone having an overall porosity comprised between 100 mhi and 10000 mhi, in particular at most 5000 ⁇ m, the overall porosity corresponding to an average of the pore sizes measured on the porous zone.
- the hydrogel has a mechanical strength of 1 kPa to 1000 kPa.
- the implants according to the invention in view of their constituents and their structure, preferably have an apparent mechanical strength of 10 kPa to 800 kPa, even more preferably of 10 kPa to 300 kPa, or even more preferably of 50 kPa. at 300kPa.
- the implants of the invention therefore have mechanical properties which are similar to those of native tissues which it is sought to replace or augment.
- the mechanical resistance in question here can also be called elasticity or Young's modulus.
- elasticity or Young's modulus we mean the longitudinal modulus of elasticity or tensile modulus which is the constant which connects the tensile (or compressive) stress and the beginning of the deformation of an isotropic elastic material.
- the Young's modulus is therefore the mechanical stress causing an elongation of 100% of the initial length of a material, i.e. a doubling of its length.
- the implants of the present invention have at least one porous zone comprising a multitude of pores each having a pore size.
- the porous zone has an overall porosity of at most 10,000 ⁇ m. According to one embodiment, the porous zone has an overall porosity of at most 5000 ⁇ m.
- the porous zone may have an overall porosity of at least 10 micrometers, for example of at least 50 micrometers. According to one embodiment, the porous zone has an overall porosity of at least 100 micrometers, and even more preferably of at least 500 micrometers.
- the overall porosity of the porous zone of the implants according to the invention can range from 10 micrometers to 1000 micrometers, or else from 20 micrometers to 1000 micrometers or even from 1000 micrometers to 5000 micrometers.
- the overall porosity of the porous zone of the implants according to the invention can range from 100 micrometers to 10,000 micrometers, preferably from 500 micrometers to 2,500 micrometers, more preferably from 500 micrometers to
- the implants according to the invention may have a plurality of porous zones, said porous zones possibly having different pore sizes within their three-dimensional structure, for example in the form of a porosity gradient distributed over the implant.
- the porous zones then follow one another in a gradient direction following an order chosen from an increasing order and a decreasing order of the pore sizes.
- a gradient of pore sizes allows, for example, a selection of cell types colonizing the implant.
- the implants according to the present invention comprise a plurality of porous zones.
- the implants according to the present invention comprise at least two porous zones, preferably three porous zones, of different pore sizes, for example in the form of a porosity gradient, each porous zone having a size of overall pore defined. This makes it possible, for example, to define more or less rigid zones depending on the type of tissue to be regenerated or in contact with the implant in the host organism.
- the porous areas can also include different pore shapes.
- the pore sizes of said porous zones preferably range from 100 micrometers to 7000 micrometers, in particular from 100 micrometers to 3000 micrometers.
- these areas can be defined as each having a sub-range of pore size, since the size of the pores obtained in all porous areas remains in a range from 100 micrometers to 10,000 micrometers, and preferably, from 100 micrometers to 3,000 micrometers.
- the sub-ranges of pore sizes are preferably of the order of 100 micrometers to 250 micrometers, 250 micrometers to 800 micrometers and 1000 micrometers to 2500 micrometers when the implant contains three zones of sizes of different pores or of the order of 100 micrometers to 250 micrometers and 250 micrometers to 3000 micrometers when the implant contains only two zones of different pore sizes.
- these sub-ranges constitute a gradient from 100 micrometers to 3000 micrometers.
- the pore size sub-ranges are preferably of the order of 500 micrometers to 2500 micrometers, 500 micrometers to 5000 micrometers and 1000 micrometers to 10,000 micrometers when the implant contains three zones of pore size different or else of the order of 500 micrometers to 5000 micrometers and 1000 micrometers to 10,000 micrometers when the implant contains only two zones of different pore size.
- the architecture of the implants according to the invention can be broken down into 3 distinct zones.
- a base of the implant (5% to 40% of the total volume of the implant, preferably 20% to 40%) is preferably placed directly in contact with muscle tissue, and has an intermediate pore size (500 micrometers to 5000 micrometers, especially 250 micrometers to 800 micrometers) promoting colonization by endothelial cells and the surrounding vascular structures. Endothelial cells will easily migrate through this pore size and organize themselves into vascular/microvascular structures allowing neovascularization of the implant and thus better integration with adjacent tissues. The easy vascularization of the structure also makes it possible to limit the risk of necrosis of the tissues having colonized the implant.
- a core of the implant (20% to 70% of the total volume of the implant, preferably 30% to 50%) is not in direct contact with the host tissues of the implantation zone.
- This zone has a fine pore size (500 micrometers to 2500 micrometers, in particular 100 micrometers to 250 micrometers), and has a supporting role in tissue regeneration.
- This area is made up of more material than the other areas, so biodegradation in the body will take place more slowly in order to provide the cells with a support matrix to proliferate.
- a shell of the implant (5% to 40% of the total volume of the implant, preferably 10% to 40%) is preferably placed so as to be the first part in contact in the event of shocks and/or stresses compression.
- the shell has a large pore size (1000 micrometers to 10000 micrometers, in particular 1000 micrometers to 2500 micrometers) allowing the easy migration of cells towards the heart of the implant.
- This shell has a role of mechanical protection for the heart of the implant.
- the pore size sub-ranges can be combined to constitute a gradient whose pore size in all the porous zones evolves between 100 micrometers to 10000 micrometers.
- the gradient evolves preferably from 500 ⁇ m to 7000 ⁇ m.
- the existence of pores in the implants can then be associated with a structure three-dimensional in the form of "lattices" (mesh), preferably gyroids, cubic or flat hexagonal, whose size in the XY plane is given by the pore size and the height by the diameter of the printing filament, and in particular 200 micrometers to 1500 micrometers, preferably 200 micrometers to 1000 micrometers.
- the pores of the porous zone(s) have a gyroid, cubic or flat hexagonal shape.
- the pores of the porous zone(s) have an identical shape between them within each porous zone.
- the pores of each of the porous zones can have homogeneous pore sizes, that is to say not differing by more than 15% from each other.
- the pores are distributed in a homogeneous, regular manner, that is to say located equidistant from each other, in the entire volume of the porous zone(s). More particularly, the pores of the porous zone can extend along central axes respectively having homogeneous orientations, that is to say not differing by more than 20° with respect to each other. The central axes of the pores of the porous zone can be arranged with homogeneous spacings, that is to say not differing by more than 15% with respect to each other.
- the pores of the porous zone can respectively present homogeneous geometries, that is to say whose contours are superimposable with more than 50% of merged or parallel portions.
- the pores of the porous zone can be separated from each other by cords of material having respectively homogeneous thicknesses, that is to say not differing by more than 15% from each other.
- the organization of the pores is characterized by the repetition of the same pattern, a pattern being composed of one or more meshes, via the translation of this same pattern according to at least a direction of space.
- the implants according to the invention further comprise one or more non-porous zone(s), called solid zones.
- the solid zones are zones having a degree of filling greater than 99%, in particular 100% (pore size of 0 mhi), which can in particular be obtained by using a manufacturing technique such as molding for example.
- the non-porous zone represents, by volume, around 0% to 50% of the implant, preferably around 0% to 25% of the implant, preferably around 0% to 10% of the implant. According to one embodiment, the non-porous zone represents less than 10% of the implant. According to one embodiment, the non-porous zone represents 0%, 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9% or 10% of the implant.
- One or more perimeters may also be present in the structure over one or more layers of thickness. This addition makes it possible to limit the phenomena of irritation and inflammation in the body which may possibly occur in the case of a crumbling of the edges of the implant.
- Solid areas forming channels crossing the implant can also be present in the structure in order to confer additional mechanical resistance to the implant. These channels have a role of mechanical reinforcement of the structure. In the context of breast reconstruction, these channels are largely inspired by Cooper's ligaments with a view to biomimicry.
- the particular porosity and structure of the implant thus allow the vascularization of newly formed and/or grafted tissues, promotes the diffusion of nutrients and metabolites, provides support and a mechanical environment suitable for the cells, thus creating an environment favorable to colonization. and tissue regeneration by limiting the phenomena of ischemia and necrosis of newly formed and/or grafted tissues.
- the implant can also comprise a void zone, that is to say a volume with a degree of filling equal to 0.
- the void zone represents, by volume, approximately 0% to 25% of the implant, preferably about 0% to 10% of the implant.
- this void zone allows the injection of cells from the subject during the implantation of the implant in said subject. These cells will thus be able to colonize the implant.
- the present invention relates to an implant, in particular a breast implant, which comprises a porous zone. According to one embodiment, said porous zone represents the entire implant.
- the present invention relates to an implant, in particular a breast implant, which comprises a porous zone and a non-porous zone, such as, for example, a perimeter as defined above.
- said porous zone represents, by volume, more than 90% of the implant.
- said non-porous zone represents, by volume, less than 10% of the implant.
- the present invention relates to an implant, in particular a breast implant, which comprises two porous zones.
- the present invention relates to an implant, in particular a breast implant, which comprises three porous zones.
- said implant further comprises a non-porous zone, such as, for example, a perimeter as defined above.
- the present invention relates to an implant, and in particular a breast implant, which has different pore sizes distributed over three zones, for example in the form of a porosity gradient, as mentioned below in Table 2 and illustrated in FIG. 1. TABLE 2
- the implants according to the present invention have very particular advantages in the context of breast reconstruction, since the implants must be strong enough to withstand high compressive stresses on this anatomical zone which is very regularly subjected to this type of stress. Due to their mechanical characteristics, in particular elasticity and flexibility, the implants of the invention make it possible to produce fewer mechanical stresses on the tissues of the host in direct contact, and thus to reduce the phenomena of inflammation.
- the empty volume of the implant (inverse of the rate of filling) can be measured by weighing (using material density), volume displacement (Archimedes method), etc.
- the ranges given here correspond to a measurement of the pore size by optical microscopy.
- the porosity or the pore size is measured by optical microscopy.
- the porosity or pore size is measured by electron microscopy.
- the porosity characteristic of the porous zones of the implants of the invention can also be expressed by the degree of filling of the structure of the hydrogel implant, since the variation of the degree of filling makes it possible to act on the porosity of the implants and vice versa.
- This filling rate can, for example, be obtained by measuring the volume of the implant and measuring the empty volume.
- the chosen filling parameters allow to obtain a given range of pore sizes. Conversely, a given range of pore sizes correlates with particular filling parameters.
- the implants of the invention can have a hydrogel filling rate ranging from 5% to 99% of the total volume of the implant.
- the porosity of the implants of the invention promotes colonization by cells.
- the three-dimensional structure as well as the particularly advantageous mechanical properties of the implants according to the invention are maintained after sterilization, and in particular by irradiation or by plasma.
- Different methods well known to those skilled in the art can be used to measure the mechanical strength of implants, such as dynamic mechanical analysis (DMA) or compression, traction and/or flexion tests. Examples of methods for measuring the mechanical strength of implants are described in the examples.
- the mechanical resistance of the implants is measured by dynamic mechanical analysis (DMA).
- the mechanical strength of the implants is measured by compression, traction and/or bending tests.
- Alginate is a linear polysaccharide extracted from seaweed, mainly from the brown seaweed species Phaeophyceae.
- This biocompatible polymer is composed of homopolymeric blocks of 1,4 b -D mannuronic acid (M) and its epimer C-5 a-L guluronic acid (G).
- M 1,4 b -D mannuronic acid
- G a-L guluronic acid
- This biopolymer consists of sequences of M-blocks, of G-blocks, intercalated with sequences of MG-blocks. Only G units seem to be involved in intermolecular cross-linking during polymerization.
- Sodium alginate is widely used as a hydrogel.
- an alginate enriched in M unit will be more flexible because the chain will have a more linear configuration, while a gel containing more G units will be more rigid because more polymerized.
- the alginate used has, for example, an M/G ratio of between 1 and 2, in particular between 1 and 1.9 or between 1 and 1.5.
- the alginate used has, for example, an M/G ratio of 1.9.
- the gelatin contained in the hydrogel is of type A.
- Gelatin is a collagen-derived macromolecule that contains bioactive sequences like the RGD (arginine-glycine-aspartic acid) motif for cell adhesion. It is obtained by denaturing the native triple helix structure of collagen via an acid (type A gelatin) or alkaline (type B gelatin) treatment.
- the amino acid composition of gelatin is similar to but different from that of collagen following denaturation (deamination of glutamine to glutamic acid in the process of making type B gelatin). The structure of gelatin changes during gelation.
- hydrogels The preparation of hydrogels is well known in the art (E.M. Ahmed; Journal of Advanced Research, 2015, 6, 105-121), as well as the polymerization and crosslinking of alginate and gelatin (Chen Q, Tian X , Fan J, Tong H, Ao Q, Wang X. An Interpenetrating Alginate/Gelatin Network for Three-Dimensional (3D) Cell Cultures and Organ Bioprinting. Molecules. 2020;25(3):756.)).
- the alginate is crosslinked using a crosslinking agent chosen from divalent cations, in particular non-toxic.
- the divalent cation is chosen from the group comprising or consisting of calcium, strontium, barium, zinc, copper, iron and nickel.
- the divalent cation is selected from the group comprising or consisting of calcium, strontium and barium.
- the divalent cation is calcium.
- the gelatin is cross-linked using any enzymatic, physical method such as UV light, or chemical, and in particular by an enzymatic method carried out using an agent capable of forming covalent bonds between the lysine and glutamine residues, and very particularly preferably by a transglutaminase.
- the enzyme transglutaminase is an extracellular aminoacyltransferase. It is a monomeric protein that has a single cysteine catalytic residue (active site).
- the gelatin of the hydrogel is preferably cross-linked with a type 2 transglutaminase.
- This TAG is in particular produced commercially as a recombinant microbial protein by the fermentation of the microorganism Streptoverticillium moboarense.
- the alginate and the gelatin which are in the hydrogel which is included in the implant are cross-linked, that is to say transformed from a linear polymer into a three-dimensional polymer thanks to the action of a crosslinking agent among those mentioned above.
- the implant according to the invention comprises a hydrogel comprising from 0.5% to 3% of alginate and from 1% to 17.5% of gelatin, and even more preferably from 1 % to 2.5% alginate and 2% to 10% gelatin.
- the hydrogel comprises 2% alginate and 5% gelatin. Unless otherwise indicated, the percentages mentioned in the present description are expressed in mass/volume and relate to the total composition.
- the crosslinked alginate and gelatin are present in a mass ratio ranging from 1:0.3 to 1:35, and most particularly in a mass ratio of 1: 2.5, respectively.
- the hydrogel of the implants of the invention may also comprise, in addition to alginate and gelatin, also cross-linked fibrinogen.
- the fibrinogen monomer is composed of two repetitions of three chains a, b and g linked by a central E domain and of two fibrinopeptides A and B (FpA, FpB) linking the a chains to the E domain. It has a large number of motifs. of cell adhesion and thus allows an increased development of cells within the hydrogel.
- the hydrogel will preferably comprise from 0.0001% to 6% of cross-linked fibrinogen, and in particular 2% of cross-linked fibrinogen.
- the hydrogel of the implants of the invention is composed of crosslinked alginate and gelatin, or even crosslinked alginate, gelatin and fibrinogen, without any other constituent capable of forming a gel.
- the hydrogel of the implants of the present invention contains cross-linked alginate, gelatin and fibrinogen in a mass ratio ranging from 1:0.3:0.00003 to 1:35:12, and any particularly in a mass ratio of 1:1:2, 5, respectively.
- Fes implants of the invention advantageously contain alginate, gelatin and optionally fibrinogen as natural constituents of the hydrogel.
- implants of the invention may also be present in implants of the invention, among which mention may be made in particular of: chitin, chitosan, cellulose, agarose, chondroitin sulphate, hyaluronic acid, glycogen, starch, pullulan, carrageenan, heparin, collagen, albumin, fibrin, fibroin, dextran, xanthan, gellan, any component extracted from the extracellular matrix such as collagens, laminin, proteoglycans of the Matrigel type, gelatin methacrylate of the GelMa type.
- said natural components are present at concentrations varying from 0.001% to 50%, preferably from 0.01% to 25%, or even preferably from 0.1% to 10%.
- the implants of the present invention may also contain synthetic components, such as polyolefins (PE, PP, PTFE, PVC), silicone (PDMS), polyacrylates ( PMMA, pHEMA), polyester (PET, dacron, PGA, PLLA, PLA, PDLA, PDO, PCL), polyethers (PEEK, PES), polyamides, polyurethanes, PEG, pluronic F127.
- said synthetic components are present at concentrations varying from 0.001% to 50%, preferably from 0.01% to 25%, or even preferably from 0.1% to 10%.
- Textile fibers of natural or synthetic origin may also be present in the composition of the implants.
- Naturally occurring fibers include, but are not limited to, cellulose fibers.
- fibers of synthetic origin include, without limitation, polyester fibers, nylon fibers, polyethylene fibers, polypropylene fibers, and acrylic fibers. According to one embodiment, said fibers are present at a concentration of less than 20%, preferably less than 10%, preferably less than 5%. According to one embodiment, the implants of the invention do not comprise fibers, whether of natural or synthetic origin.
- the implants according to the invention are acellular, that is to say they are free of any cell, and in particular of any living cell, during their manufacture.
- the implants of the invention can quite well be colonized by living cells, after their manufacture, which makes it possible both to overcome any manufacturing constraints linked to the preservation of survival, proliferation and/or cell differentiation, and to carry out an in vitro colonization of the implant once manufactured but before its implantation in the host organism to optimize its integration.
- hydrogel consisting solely of alginate and gelatin, without fibrinogen
- hydrogel made up of alginate, gelatin and fibrinogen
- hydrogel made up of alginate, gelatin and collagen
- the implants of the invention are obtained by a manufacturing process during which Talginate and gelatin are consolidated by crosslinking with at least one divalent cation, preferably calcium, and transglutaminase.
- said consolidation is done sequentially, that is to say that the crosslinking agents mentioned above are not added at the same time during the consolidation.
- the hydrogel, once prepared is brought into contact with a solution comprising a divalent cation, preferably calcium, then with a solution comprising transglutaminase.
- the hydrogel, once prepared is brought into contact with a solution comprising transglutaminase, then with a solution comprising a divalent cation, preferably calcium.
- said consolidation is done concomitantly, that is to say that the crosslinking agents mentioned above are added at the same time during the consolidation.
- the implants of the invention are obtained by a manufacturing process during which the alginate and the gelatin are consolidated by crosslinking using a solution comprising at least one divalent cation, preferably calcium, and transglutaminase.
- the solution can be obtained by alternative but nevertheless equivalent methods.
- the consolidation solution can be obtained by adding the various elements, ie at least one divalent cation, preferably calcium, and transglutaminase, in the same solution, or else by mixing at least two solutions: a solution comprising at least a divalent cation, preferably calcium, and a solution comprising at least transglutaminase.
- the bringing into contact of the hydrogel with the solution(s) mentioned above is carried out by immersion, during which the hydrogel is immersed in the all of the solution(s) mentioned above. It can also be carried out by imbibition, by spraying, using a drip system, trickling, or the like.
- the hydrogel once prepared, is brought into contact with a consolidation solution comprising at least one divalent cation, preferably calcium, and transglutaminase.
- a consolidation solution comprising at least one divalent cation, preferably calcium, and transglutaminase.
- the contacting of the hydrogel with the consolidation solution can be carried out by immersion, during which the hydrogel is immersed in its entirety in the consolidation solution. She can also be carried out by imbibition, by spraying, using a drip system, trickling, or the like.
- consolidation further includes the cross-linking of fibrinogen with thrombin.
- This crosslinking can be done sequentially with the crosslinking of the alginate and the gelatin (e.g. before or after the crosslinking of the alginate and the gelatin) or concomitantly.
- the hydrogel when the hydrogel contains fibrinogen in addition to alginate and gelatin, the hydrogel once prepared is brought into contact with a solution comprising a divalent cation, preferably calcium, then with a solution comprising transglutaminase, then with a solution comprising thrombin.
- a solution comprising a divalent cation preferably calcium
- the hydrogel when the hydrogel contains fibrinogen in addition to alginate and gelatin, the hydrogel once prepared is brought into contact with a solution comprising a divalent cation, preferably calcium, then with a solution comprising thrombin, then with a solution comprising transglutaminase.
- a solution comprising a divalent cation preferably calcium
- the hydrogel once prepared when the hydrogel contains fibrinogen in addition to alginate and gelatin, the hydrogel once prepared is brought into contact with a solution comprising transglutaminase, then with a solution comprising a divalent cation , preferably calcium, followed by a solution comprising thrombin.
- the hydrogel once prepared when the hydrogel contains fibrinogen in addition to alginate and gelatin, the hydrogel once prepared is brought into contact with a solution comprising transglutaminase, then with a solution comprising thrombin , then with a solution comprising a divalent cation, preferably calcium.
- the hydrogel once prepared when the hydrogel contains fibrinogen in addition to alginate and gelatin, the hydrogel once prepared is brought into contact with a solution comprising thrombin, then with a solution comprising transglutaminase , then with a solution comprising a divalent cation, preferably calcium.
- the hydrogel once prepared when G hydrogel contains fibrinogen in addition to alginate and gelatin, the hydrogel once prepared is brought into contact with a solution comprising thrombin, then with a solution comprising a divalent cation, preferably calcium, then with a solution comprising transglutaminase.
- the consolidation solution comprises at least one divalent cation, preferably calcium, transglutaminase, and thrombin.
- the implants of the invention are obtained by a manufacturing process during which the consolidation step, which consists in bringing the hydrogel into contact with the consolidation solution(s), is carried out at a temperature ranging from 15°C to 40°C, and preferably from 20°C to 40°C and even more preferably from 21°C to 37°C.
- the implants of the invention are obtained by a manufacturing process during which the consolidation step which consists in putting contact G hydrogel with the consolidation solution(s), is carried out for a period ranging from 10 minutes to 6 hours, in particular from 30 minutes to 6 hours, and ideally for 1 hour to 3 hours.
- the implants of the invention are obtained by a manufacturing process during which the consolidation step is carried out at 37° C. for 1 hour 30 minutes.
- the hydrogel is shaped prior to its consolidation.
- the implants of the present invention can be manufactured and shaped simultaneously, in particular by any volume structuring process (in particular 3D), and in particular by addition or agglomeration of material by stacking layers or successive deposition.
- the implant of the invention is obtained by an additive manufacturing process.
- the implant of the invention is obtained by material extrusion, preferably 3D printing.
- the implant can then be made up of a plurality of layers each having a mesh made up of a plurality of meshes, the layers being stacked on top of each other in such a way that the meshes form the pores.
- said implant consists of a number of layers comprised between 2 and 3000.
- the meshes of each layer can have homogeneous mesh sizes, that is to say not differing by no more than 15% from each other.
- the meshes of each layer can be distributed homogeneously, that is to say evenly. More particularly, the meshes of each layer can extend around central mesh axes having respectively homogeneous orientations, that is to say not differing by more than 20° with respect to each other. The central mesh axes of the meshes of each layer can be arranged with homogeneous spacings, that is to say not differing by more than 15% from each other. The meshes of each layer can respectively present homogeneous geometries, that is to say whose contours are superimposable with more than 50% of merged or parallel portions.
- the meshes of each layer can be separated from each other by cords of material having respectively homogeneous thicknesses, that is to say not differing by more than 15% from each other.
- the person skilled in the art will take care to choose a process which allows the shaping of materials with high viscosity, since a hydrogel consisting solely of alginate and gelatin can have a viscosity ranging from 50 Pa.s to 6000 Pa. s., for a measurement at a temperature of 5°C to 45°C.
- the implants are preferably obtained by a 3D printing process. This technique also makes it possible to give an adequate shape to the implant. Indeed, as indicated previously, the implants according to of the invention have advantageous mechanical properties, and quite particularly adapted to their destination.
- the implant can be “shaped” to match the physiognomy and/or the wishes of the host.
- the implants of the invention therefore provide "tailor-made” structured solutions whose dimensions and/or filling/porosity are defined with regard to the needs of the host body intended to receive the bodily implant and the role/ the function it will have to play in this recipient organism.
- the present invention also relates to a three-dimensional body implant obtainable by a manufacturing method as described above.
- the body implant is capable of being obtained by a manufacturing process comprising successively:
- This method may further comprise a sterilization step.
- the disclosure also relates to an implant that may have one or more of the following characteristics:
- - a three-dimensional body implant which may have an overall porosity of at most 5000 LHTI and comprises a hydrogel comprising cross-linked alginate and cross-linked gelatin, said hydrogel having a mechanical resistance, also called here elasticity or Young's modulus, of 1kPa to 1000kPa, - a three-dimensional body implant which may have zones of different porosities within their three-dimensional structure, in particular in the form of a gradient distributed over more than one zone of the implant,
- a three-dimensional body implant which may also contain cross-linked fibrinogen
- a three-dimensional body implant which may be a breast implant which, preferably, has at least two zones, and in particular three, each of different porosity
- a three-dimensional body implant which may comprise a hydrogel comprising cross-linked gelatin and cross-linked alginate, said hydrogel having a mechanical strength of 1 kPa to 1000 kPa and said implant having an overall porosity of at most 5000 ⁇ m,
- a three-dimensional body implant which may have a porosity gradient distributed over more than one area of the implant, - a three-dimensional body implant which may have a volume comprised in a range ranging from 0.05 mL to 3 L, preferably 100 mL to 600 mL,
- a three-dimensional body implant which may be a breast implant
- the hydrogel of the implant which may comprise from 0.5% to 3% of alginate and from 1% to 17.5% of gelatin
- the hydrogel of the implant which may also comprise cross-linked fibrinogen, and preferably from 0.0001% to 6% fibrinogen
- a three-dimensional body implant obtainable by a process which comprises a step of crosslinking the hydrogel carried out using a solution containing a divalent cation, preferably calcium, and an agent capable of forming covalent bonds between lysine and glutamine residues such as an enzyme, preferably a transglutaminase.
- a solution may also comprise thrombin when the hydrogel comprises fibrinogen,
- the invention also relates to a method for implementing the implant as described above in the context of reconstructive or aesthetic surgery, comprising a step of implanting the implant in the body of a subject.
- said implant is a breast implant.
- Said invention therefore relates to a method of breast reconstruction comprising the implantation in a subject who needs it, of an implant according to the invention.
- Said method may further comprise a step of injecting cells, preferably autologous, into said implant before its implantation in the subject.
- the subject is a woman. According to one embodiment, the subject is a woman having undergone a mastectomy.
- FIG. 1 is a diagrammatic representation of an implant according to the invention, of breast type, which has a pore size gradient distributed over three zones.
- Figure 2 represents the comparison of the Young's modulus (A) and the viscosity (B) of AG and F AG hydrogels which constitute the implants according to the invention.
- FIG. 3 represents the comparison of the Young's moduli E0 (Pa) of an AG hydrogel in which the gelatin is crosslinked with and without transglutaminase and stored for up to 7 days at 37°C.
- FIG. 4 represents the comparison of the Young's moduli E0 (Pa) of an AG hydrogel and of commercial hydrogels crosslinked or not with transglutaminase. *: Liquid compound at 37°C; +: visible polymerization but insufficient gel rigidity at 37° C. for DMA measurement vitro by fibroblasts, after their manufacture.
- Figure 6 represents the cell viability and growth measured kinetically on FAG and AG hydrogels which constitute the implants according to the invention, and which have been colonized in vitro by adipose tissue stem cells, after their manufacture.
- Figure 7 represents the metabolic activity of AG implants according to the invention at different culture points following their colonization in vitro by a fraction of purified adipose tissue, after their manufacture.
- Figure 8 represents the histological analyzes by Hematoxyline, Phloxine, Safran (HPS) staining of AG implants according to the invention after 2 days (4 images on the left) or 7 days (2 images on the right) of in vitro incubation with a fraction of purified adipose tissue, after their manufacture (Top: external edges of the matrices; Bottom: internal pores of the matrices; images taken in white light; magnification 1000 ⁇ m; scale 100 ⁇ m).
- Figure 9 represents the immunolabeling of perilipin-1 and the staining of cell nuclei with Dapi, on AG implants according to the invention after 2 days (top image) or 7 days (bottom image) of incubation in vitro with a fraction of purified adipose tissue, after their manufacture (fluorescence imaging; magnification 200X; scale 50 ⁇ m).
- Figure 10 represents the comparison of the Young's moduli of AG implants for crosslinking of variable durations at 21° C. (B) and 37° C. (A).
- Figure 11 represents the comparison of the Young's moduli E0 and the viscosities of AG and FAG implants after crosslinking with different concentrations of CaCl2 (A, D), TAG (B, E) and thrombin (C, F).
- Figure 12 represents the comparison of Young's moduli E0 (AB) and viscosities (CD) of AG and FAG implants after sequential or concomitant cross-linking with CaCl2, TAG and thrombin.
- Figure 13 shows the comparison of Young's moduli E0 (A) and viscosities (B) of AG and FAG implants after crosslinking with a solution containing calcium chloride or barium chloride.
- Figure 14A illustrates the study of the variation in dimensions (A1-A2) and pores (A3-A4) of AG and FAG implants according to the invention before and after crosslinking.
- Figure 14B illustrates the impact of sterilization on the dimensions (B1-B2) and Young's modulus (B3-B4) of these implants.
- Figure 15 illustrates the repeatability of the production of AG implants according to the invention in terms of dimensions (A), volume (B) and pore size (C).
- Figure 16 illustrates the repeatability of the retraction of AG implants according to the invention after consolidation
- Figure 17 illustrates the repeatability of the retraction of AG implants according to the invention according to the sterilization method.
- Figure 18A illustrates the repeatability of the extrusion diameter.
- Figure 18B illustrates the repeatability of the pore length (B1-B2) of AG implants according to the invention.
- Figure 19 represents images of pores of variable size in an AG implant according to the invention.
- Figure 20 represents the surgical plan (left) of the in vivo subcutaneous implantation (right) of AG and FAG implants according to the invention.
- Figure 21 represents the histological analyzes after staining with Masson's trichrome on sections of AG implants according to the invention, after subcutaneous implantation in vivo in rat back sites for 3 weeks (low, medium and high magnification images ).
- Figure 22 shows the average pore length of implants produced with different pore sizes.
- Figure 23 represents the average pore length of implants produced with an increasing pore size gradient from the base to the apex.
- Figure 24 represents the apparent Young's modulus values of the different subparts of implants produced with different pore sizes.
- Figure 25 represents the compression tests on full prostheses with different architectures, force-displacement curves.
- Figure 26 represents a microscopic observation of the base of the implant without (left) or with (right) the addition of a perimeter.
- Figure 27A represents images of the 3D printing of a large volume A/G implant (implant 9 cm long, 7 cm wide, and 2.7 cm thick), the resulting implant after cross-linking and the large pores obtained in the structure.
- Figure 27B represents images of the 3D printing of a large volume A/G implant (implant 12.6 cm in diameter, and 5.3 cm thick), of the resulting implant after crosslinking and of the large pores obtained in structure.
- Figure 28 represents the macroscopic observation of the pores of implants with different filling rates.
- Figure 29 represents the average distance between the centers of the pores of implants with different filling rates.
- Protocol #1 Preparation of an AG hydrogel: In order to prepare the AG hydrogel, 2 g of alginate (very low viscosity, Alpha Aesar, France), 5 g of gelatin (Sigma-Aldrich, France) are dissolved at 37° C for 12 hours in 100 mL of a 0.1M NaCl solution (Labelians, France).
- Protocol #2 Preparation of a FAG hydrogel: In order to prepare the FAG hydrogel, 2 g of alginate (very low viscosity, Alpha Aesar, France), 5 g of gelatin (Sigma-Aldrich, France) and 2 g of fibrinogen (Sigma-Aldrich, France) are dissolved at 37° C. for 12 hours in 100 ml of a 0.1 M NaCl solution (Labelians, France). Protocol #3 Casting of an AG and FAG hydrogel: 1.8mL of the hydrogel prepared according to protocol #1 and #2 are placed in the wells of a 6-well culture plate and incubated at 21°C for 30 minutes .
- Protocol #4 Crosslinking of an AG hydrogel A crosslinking solution is prepared by dissolving 4 g of Transglutaminase (Ajinomoto, Japan), 3 g of CaCh (Sigma Aldrich, France) in lOOmL of a 0.1M NaCl solution (Labelians, France). The crosslinking solution is then brought into contact with the hydrogel for 1 hour 30 minutes at 37°C (unless otherwise indicated).
- a cross-linking solution is prepared by dissolving 4 g of Transglutaminase (Ajinomoto, Japan), 3 g of CaCh (Sigma Aldrich, France) and 400 Units of thrombin (Sigma Aldrich, France) in lOOmL of a 0 NaCl solution. IM. The crosslinking solution is then brought into contact with the hydrogel for 1 hour 30 minutes at 37°C (unless otherwise indicated).
- Protocol #6 Dynamic mechanical analysis (DMA) in compression The mechanical properties of FAG and AG hydrogels are measured in triplicate with a rotational rheometer (DHR2, TA Instrument, France), a Peltier plane (TA Instrument, France) and an 8mm geometry toothed (TA Instrument, France). Three 8mm diameter discs are cut from the molded hydrogels according to protocol #3. The disc is placed on the bottom geometry at 37°C for 60 seconds followed by a compression procedure of Oscillatory IOmih is performed from 0.1 to 10Hz at IOOmhi/s and at 37°C.
- DMA Dynamic mechanical analysis
- the values of the Young's modulus EO (Pa) and the viscosity hq (Pa.s) of the hydrogel are obtained from a modeling of the visco-hyperelastic solid using the values E' and E” acquired during the 'essay.
- Protocol #7 3D printing of hydrogels The hydrogels prepared according to protocol #1, #2 are transferred into a 30 mL cartridge (Nordson EFD) equipped with an extrusion nozzle 410 ⁇ m in diameter (Nordson EFD). The nozzle cartridge assembly is then placed in a 3D printer (BioassemblyBot, Advanced Solution Lifescience, USA) making it possible to apply a constant pressure to the cartridge while moving in the three directions of space.
- the printing parameters are a speed of 10mm/sec, a pressure of 25-35PSI and a temperature of 21°C. Obtaining different filling rates is performed by the internal slicer of the printer driver software (Tsim, Advanced Solution Lifescience, USA).
- Protocol #8 In vivo implantation in rats The in vivo implantation studies in rats were carried out on the BIO VIV O - Institut preclinical research technical platform.
- a bioprosthesis was implanted in the subcutaneous dorsal region of each animal.
- the control group was performed by performing only the incision and dissection.
- 4 surgical sites were made, three bioprostheses and a control sample.
- the surgical site was closed in layers using subcutaneous and cutaneous sutures with absorbable braided sutures (PDS® polidioxanone, 4/0 and Nylon 3/0, Ethicon J&J).
- PDS® polidioxanone absorbable braided sutures
- the animals were monitored for signs of pain, and surgical wounds were inspected daily for skin healing and infection. Explantation took place 21 days after implantation.
- Protocol #9 Histological analysis The implants are fixed for 24 hours in a 4% formalin solution (Alphapat, France) then dehydrated by successive baths of absolute ethanol (vwr Chemicals, France) and methylcyclohexane (vwr Chemicals, France) with a STP 120 dehydrator (Myr, Spain) then embedded in paraffin (Sakura, Japan). Sections 5 ⁇ m thick are made with an HM 340e microtome (Microm, France). Hematoxyline Phloxine Safran (HPS), Masson's Trichrome staining and D API staining were performed.
- Protocol #10 Dynamic mechanical analysis (DMA) in compression The mechanical properties of FAG and AG hydrogels are measured in triplicate with a rotational rheometer (DHR2, TA Instrument, France), a Peltier plane (TA Instrument, France) and a 25mm geometry (TA Instruments, France). Punches 25mm in diameter are cut from the implants produced according to protocol #9. The punch is placed on the lower geometry at 37°C for 60 seconds and then an oscillatory 1 OLHTI compression procedure is carried out from 0.1 to 10Hz at 100im/s and at 37°C.
- DMA Dynamic mechanical analysis
- the values of the Young's modulus E0 (Pa) and the viscosity hq (Pa.s) of the hydrogel are obtained from a modeling of the visco-hyperelastic solid using the values E' and E” acquired during the 'essay.
- Protocol #11 Total mechanical analysis of the implants in compression: Placement of the implants on a Lloyd traction/compression machine with an lkN sensor and compression plates, a test speed of 10 mm/min is used.
- Example 1 Mechanical properties of alginate/gelatin (AG) and fibrinogen/alginate/gelatin (F AG) hydrogels
- the molded samples of AG were prepared from protocols #1 and #3 and cross-linked from a variation of protocol #4.
- the crosslinking solution is composed of a solution of calcium chloride at 30mg/mF only or of a solution of calcium chloride at 30mg/ml and transglutaminase at 40mg/mF. 4 gels of each condition were molded and then tested in DMA the same day and respectively after 1, 4 and 7 days of storage at 37° C. with the aim of mimicking physiological conditions.
- Molded samples of AG were prepared from protocols #1 and #3 and cross-linked from protocol #4.
- the commercial hydrogel samples listed in Table 4 below were prepared according to the protocols provided by the suppliers and molded according to protocol #3.
- the hydrogels were cross-linked with a variant of protocol #4, using either a solution comprising only calcium at 30mg/mL (no TAG), or a solution of calcium at 30mg/mL and transglutaminase at 40mg/mL, in order to observe the impact of GAD.
- Non-crosslinked and crosslinked samples with TAG were then studied by DMA using protocol #6. The results are grouped on the LIG. 4. 6 of the 7 commercial hydrogels studied were cross-linked by transglutaminase.
- Collagen-based hydrogels (CoMCell, Rat Collagen) are not stiff enough to be analyzed by DMA but gelatin-based hydrogels (Gel4cell, Gel4cell-VEGL and GelMa) have a Young's modulus significantly higher after crosslinking with transglutaminase (respectively 7.3, 9.9 and 50 kPa). This study shows the effect of cross-linking with transglutaminase on the stiffness of commercial hydrogels.
- Example 4 Influence of the amount of alginate and gelatin in a fibrinogen/alginate/gelatin (F AG) hydrogel on the mechanical properties
- FAG hydrogels were prepared from a variant of protocol #2, molded according to protocol #3, then cross-linked using protocol #5, then their mechanical properties were studied by DMA using protocol #6.
- we studied these mechanical properties by preparing the FAG hydrogel, with 1 or 3 or 2 g of alginate, and 10 or 7.5 or 5 g of gelatin, respectively, and 2 g of fibrinogen.
- the implants were immersed with culture medium.
- the implants were cultured in culture medium composed of DMEM containing 10% calf serum supplemented with vitamin C and EGF (Epidermal Growth Factor) at 37°C, 5% C02.
- the implants were cultured with this same medium for 21 days, renewed every 3 days.
- the metabolic activity of the fibroblasts within the implants was studied by colorimetric analysis with Alamar Blue on culture days 3, 5, 8, 10, 14 and 21 after inoculation.
- the solution was produced by diluting to 10th a solution of Bleu Alamar (DAL 1100, Invitrogen) in DMEM. After 19 hours of incubation at 37°C, 100 m ⁇ of the supernatants were sampled and their absorbance at 570 nm and 600 nm was measured with a spectrophotometer (NanoQuant® infinité M200PRO, TECAN).
- Example 6 Evaluation of the colonization of fibrinogen/alginate/gelatin (F AG) and alginate/gelatin (AG) hydrogels by adipose tissue stem cells (ASC).
- F AG fibrinogen/alginate/gelatin
- AG alginate/gelatin
- ASC adipose tissue stem cells
- Normal human adipocytaircs stem cells in passage 2 to 5 are thawed and amplified in 175cm2 culture flasks in culture medium containing DMEM supplemented with 10% serum and 1% antibiotics.
- Each implant was seeded on its surface with a cell suspension of ASC at a concentration of 6, 12 or 24 million ACS/ml. 250 m ⁇ of these suspensions were deposited drop by drop on each implant, i.e. 1.5, 3 or 6 million ASC/implant. After 1 hour of adhesion, the implants were immersed with culture medium.
- the implants were cultured in culture medium containing DMEM supplemented with 10% serum and 1% antibiotics for 7 days then in medium containing DMEM supplemented with 10% serum, insulin, rosiglitasone and 1% antibiotics for 14 days.
- the culture media are renewed every 3 days.
- the metabolic activity of the fibroblasts within the implants was studied by colorimetric analysis with Alamar Blue on culture days 3, 5, 7, 14 and 21 after inoculation.
- the solution was produced by diluting to 10th a solution of Bleu Alamar (DAL 1100, Invitrogen) in DMEM. After 5 hours of incubation at 37°C, 100 m ⁇ of the supernatants were taken and their absorbance at 570 nm and 600 nm was measured with a spectrophotometer (NanoQuant® infinity M200PRO, TECAN). Cellular viability and growth was thus monitored over 21 days of culture using 6-point kinetics on days 3, 5, 7, 14 and 21. The results are grouped together in FIG. 6.
- Example 7 Evaluation of the colonization of alginate/gelatin (AG) hydrogels in contact with a fraction of purified adipose tissue
- hydrogels were prepared from protocol #1. Cubic implants 1.5 cm square and 0.8 cm thick were then printed according to protocol #7 and cross-linked using protocol #4. The printed implants are produced with a filling rate of 50% and an extrusion nozzle of 410 ⁇ m internal diameter.
- the lipoaspirate is centrifuged at 1500 RPM for 2 minutes then rinsed with PBS IX. The lipoaspirate was again centrifuged at 1500 RPM for 30 seconds then the PBS IX was eliminated. Lipoaspirate is considered purified. Each implant is then immersed in 6mL of purified lipoaspirate, then the whole was placed in a culture insert in a 6-well plate with incubation in medium containing DMEM supplemented with 10% serum and 1% antibiotics at 37°C 5% C02 for 2 days or 7 days.
- the implants were cultured in 6-well plates in culture medium containing DMEM supplemented with 10% serum, insulin, rosiglitasone and 1% antibiotics, with 3 renewals of the medium per week for up to 21 days.
- Histological analyzes were performed to complete this study according to protocol #9. The results are grouped on the LIG. 8. Images reveal the presence of agglomerated, polygonal, uniform, unilocular and voluminous adipocytes. These morphological characteristics are those of healthy adipocytes, which can be found in adipose tissue.
- Perilipin-1 immunostaining was also performed. Samples were included in OCT (CellPath, KMA-0100-00A), then stored at -80°C. Sections 16 ⁇ m thick were made for each sample with a cryostat (Microm, HM 520). The sections were then fixed in an Acetone/methanol (v/v) solution for 20 minutes and rinsed 3 times in PBS IX. A one-hour incubation at room temperature in a 4% PBS-BSA solution was carried out to saturate the aspecific sites. The sections were then incubated overnight at room temperature with a solution of primary antibody specific for perilipin-1.
- the images show adipocytes having large spherical or polygonal vacuoles depending on cell grouping.
- the adipocytes appear as unilocular and their size is also physiological since it is between 50 and 200 ⁇ m.
- Molded samples of AG were prepared from Protocol #1 and Protocol #3 and cross-linked from a variation of Protocol #4. During this variant, the crosslinking times and temperatures were modified, from 10 minutes to 2 p.m. and from 37°C to 21°C. The samples were then studied by DMA using protocol #6.
- Example 9 Impact of the concentration of the components of the crosslinking solution on the mechanical properties of alginate/gelatin (AG) and fibrinogen/alginate/gelatin (F AG) hydrogels once crosslinked
- Cast samples of AG and F AG were prepared from Protocols #1, #2, and #3, cross-linked from a variation of Protocols #4 and #5.
- concentrations of the components of the crosslinking solution were modified (transglutaminase, calcium chloride and thrombin).
- Example 12 Maintenance of the three-dimensional structure and mechanical properties of implants based on alginate/gelatin (AG) and fibrinogen/alginate/gelatin hydrogel
- the AG and F AG hydrogels were prepared using protocols #1, #2 and #3, cross-linked using protocols #4 and #5, observed optically and then studied by DMA using protocol #6.
- the printed shapes are half-spheres of 2 cm in diameter produced with variable filling rates (30, 50 and 75%).
- Sterilization was performed by IONISOS (France) by irradiating the implants with a variable dose (30 kGy and 40 kGy) of Gamma rays.
- the impact of the cross-linking step on the dimensions of alginate/gelatin and fibrinogen/alginate/gelatin hydrogel-based implants was studied. These dimensions were measured from macroscopic images.
- the dimensions of the pores obtained as a function of the filling rate were also studied. These dimensions were measured from images taken using a microscope (Olympus, magnification x4).
- FIG. 14 The results are grouped in FIG. 14 (A-B).
- the implants retract on average by 10% following the cross-linking step.
- the pore size does not vary significantly (FIG. 14A (A1-A4)).
- E0 sterilization does not lead to any change in the mechanics of the material for the two doses (FIG. 14B (B1-B4)).
- Example 13 Production quality of a large implant based on an alginate/gelatin (AG) hydrogel: repeatability of the printing dimensions, of the dimensions after consolidation and sterilization of the implant using several methods.
- AG alginate/gelatin
- hydrogels were prepared from protocol #1. Implants in the shape of a half-sphere 6cm in diameter and 2cm thick were then printed according to protocol #7 and cross-linked using protocol #4, then optically observed and measured. The printed forms are produced with variable fill rates (25 to 65%) and extrusion nozzles of 410 or 840 pm internal diameter. Sterilization was carried out by IONISOS (France) by irradiating the implants with 2 doses (30 kGy and 40 kGy) of Beta rays or a dose of range rays of 30 kGy.
- IONISOS France
- FIG. 15 The results after printing are grouped FIG. 15 (A-C). These results show a high repeatability of the dimensions of the large size 3D printed implants, reflecting a high production quality.
- results after consolidation of the implants are grouped together in FIG 16.
- This graph shows a high repeatability of the retraction of the large size implants after the consolidation step.
- results after sterilization of the implants using 3 methods are grouped together in FIG 17. These results show a lower shrinkage of large size implants with b-rays 30 and 40 kGy.
- FIG. 18A shows the high repeatability of the extruded bead size.
- FIG. 18B (Bl-B2) shows the variation in pore length as a function of the filling rate of the hydrogel. Images of pores of varying size were taken and are grouped in FIG. 19.
- Histological analyzes were performed using protocol #9, and the results are grouped in FIG. 21.
- the explantation made it possible to validate the resistance of the implants to skin tension.
- Histological analyzes made it possible to evaluate cellular colonization, vascularization, synthesis of extracellular matrix as well as the presence of areas of inflammation.
- Example 15 Quality of production of large size implants comprising various pore sizes and study of the impact of these porosities on the mechanical properties of said implants.
- Breast prosthesis type implants of semi-anatomical size (height: 8.83cm; Width: 6.37cm; Height: 2.86cm) are produced from protocol #1 and a variant of protocol #7 (use of 840 ⁇ m internal diameter nozzle) and then cross-linked from protocol #4. These implants are produced with different internal porosities: - Implants with a single pore size for their entire volume.
- the dimensions of the pores obtained were studied. These dimensions were measured from images taken using a microscope (Olympus, magnification x4). The results of these measurements are grouped together in figures 22 and 23. Pores of different and very reproducible sizes can be obtained in the different parts of the implant. A gradient of reproducible and increasing pore sizes from the base to the top can also be obtained.
- the mechanical properties of the subparts of these implants were studied by DMA according to protocol #11 and the mechanical properties of the implants were studied by total mechanical analysis according to protocol #12. The results of these measurements are grouped together in FIGS. 24 and 25. The Young's moduli observed vary inversely with respect to the pore size.
- the reduction in the size of the pores at the heart of the implants makes it possible to obtain a higher modulus, reflecting greater mechanical resistance.
- the variations in the sizes of the pores and the distribution of the pore size zones make it possible to obtain a wide range of Young's modulus and therefore to obtain more or less resistant implants.
- Concerning the compression tests on whole prostheses it is observed that each configuration of porosities brings different mechanical properties to the implants. Indeed, for a force of -35N, the prosthesis having only 1 zone of porosity was less deformed, unlike the prostheses having 3 zones of porosity which were more deformed. The curves also make it possible to identify different failure behaviors.
- Adding a perimeter to the base of the implant makes it possible to obtain a more cohesive base with less roughness around the periphery, which can thus limit inflammatory friction in vivo.
- Example 17 Production of large volume porous implants from an alginate/gelatin hydrogel
- Implant 1 200mL of AG hydrogels were prepared from protocol #1 then an anatomical breast type implant 12cm long, 10cm wide and 5cm thick was printed from a variant of protocol # 7 (840mhi internal diameter extrusion nozzle and 30mm/sec printing speed) with a single porosity zone, then cross-linked with protocol #4 (200mL instead of lOOmL of consolidation solution for a large implant) .
- protocol #4 200mL instead of lOOmL of consolidation solution for a large implant
- the average pore size of the resulting implant was measured with an optical microscope and the dimensions of the implant were measured with a caliper. After cross-linking, an implant 9 cm long, 7 cm wide and 2.7 cm thick is obtained with an average pore size of 1380 +/- 57 ⁇ m.
- Implant 2 500mL of AG hydrogels were prepared from protocol #1 then a semi-spherical breast-type implant 7 cm in radius and 6 cm in thickness was printed from a variant of protocol #7 ( extrusion nozzle of 840 ⁇ m internal diameter and printing speed of 30 mm/sec) with a single zone of porosity, then cross-linked with protocol #4 (700 mL instead of 100 mL of consolidation solution for a large implant). The average pore size of the resulting implant was measured with an optical microscope and the dimensions of the implant were measured with a caliper. After crosslinking, an implant 12.5 cm in diameter and 5.3 cm thick is obtained with an average pore size of 3354 ⁇ m +/- 273 ⁇ m. The images of these implants are grouped together in Figures 27A and 27B.
- Example 18 Measurement of the spatial distribution of pores in the same area of an implant.
- the distances separating the centers of the pores (of square shape) obtained were studied. These dimensions were measured from images taken using a microscope (Olympus, magnification x4). The results of these measurements are grouped in figures 28 and 29. The distance separating the centers of the pores proves to be reproducible for each filling rate and varies between the different rates. These observations reflect a homogeneous distribution of pores within an area of the implant with a defined filling rate.
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Abstract
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AU2022299598A AU2022299598A1 (en) | 2021-06-25 | 2022-06-24 | Three-dimensional body implants |
US18/029,290 US20230364306A1 (en) | 2021-06-25 | 2022-06-24 | Three-dimensional body implants |
CN202280044902.8A CN117561087A (zh) | 2021-06-25 | 2022-06-24 | 三维人体植入物 |
KR1020247002098A KR20240046163A (ko) | 2021-06-25 | 2022-06-24 | 삼-차원 신체 임플란트 |
CA3224136A CA3224136A1 (fr) | 2021-06-25 | 2022-06-24 | Implants corporels tridimensionnels |
EP22744283.7A EP4359025A1 (fr) | 2021-06-25 | 2022-06-24 | Implants corporels tridimensionnels |
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FR2106827A FR3124395A1 (fr) | 2021-06-25 | 2021-06-25 | Implants corporels tridimensionnels |
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EP (1) | EP4359025A1 (fr) |
KR (1) | KR20240046163A (fr) |
CN (1) | CN117561087A (fr) |
AU (1) | AU2022299598A1 (fr) |
CA (1) | CA3224136A1 (fr) |
FR (1) | FR3124395A1 (fr) |
WO (1) | WO2022269215A1 (fr) |
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KR20240046163A (ko) | 2024-04-08 |
AU2022299598A1 (en) | 2024-01-04 |
EP4359025A1 (fr) | 2024-05-01 |
CN117561087A (zh) | 2024-02-13 |
US20230364306A1 (en) | 2023-11-16 |
CA3224136A1 (fr) | 2022-12-29 |
FR3124395A1 (fr) | 2022-12-30 |
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