U.S. patent application number 11/068735 was filed with the patent office on 2006-02-16 for compositions and methods for coating medical devices.
Invention is credited to Jeffrey F. Bonadio, Steven Goldstein, Vinod Labhasetwar, Robert J. Levy.
Application Number | 20060035854 11/068735 |
Document ID | / |
Family ID | 24657324 |
Filed Date | 2006-02-16 |
United States Patent
Application |
20060035854 |
Kind Code |
A1 |
Goldstein; Steven ; et
al. |
February 16, 2006 |
Compositions and methods for coating medical devices
Abstract
The present invention provides compositions and methods for
coating medical devices with pharmaceutical agents and devices
coated with the compositions. The coated devices provide controlled
or sustained release of pharmaceutical agents for the treatment of
wounds or disease.
Inventors: |
Goldstein; Steven; (Ann
Arbor, MI) ; Levy; Robert J.; (Ann Arbor, MI)
; Labhasetwar; Vinod; (Ann Arbor, MI) ; Bonadio;
Jeffrey F.; (Ann Arbor, MI) |
Correspondence
Address: |
SEED INTELLECTUAL PROPERTY LAW GROUP PLLC
701 FIFTH AVE
SUITE 6300
SEATTLE
WA
98104-7092
US
|
Family ID: |
24657324 |
Appl. No.: |
11/068735 |
Filed: |
February 28, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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09616585 |
Jul 14, 2000 |
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11068735 |
Feb 28, 2005 |
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08662341 |
Jun 12, 1996 |
6143037 |
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09616585 |
Jul 14, 2000 |
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Current U.S.
Class: |
514/44R ; 424/45;
424/46 |
Current CPC
Class: |
A61F 2310/00017
20130101; A61L 31/16 20130101; A61F 2310/00023 20130101; A61F
2/30767 20130101; A61F 2310/00293 20130101; A61F 2310/0097
20130101; A61L 27/34 20130101; A61F 2002/30064 20130101; A61L
17/145 20130101; Y10S 977/915 20130101; A61L 27/54 20130101; A61L
2300/412 20130101; A61F 2002/3084 20130101; Y10S 977/931 20130101;
A61L 31/10 20130101; A61B 17/86 20130101; A61L 2300/622 20130101;
Y10S 977/89 20130101; A61L 2300/258 20130101; A61L 2300/624
20130101; A61B 17/06166 20130101 |
Class at
Publication: |
514/044 ;
424/045; 424/046 |
International
Class: |
A61K 48/00 20060101
A61K048/00; A61K 9/14 20060101 A61K009/14; A61L 9/04 20060101
A61L009/04 |
Claims
1. A composition for coating medical devices comprising at least
one biocompatible biodegradable polymer in an amount of about 0.01%
to 15% (w/v) and at least one pharmaceutical agent in an amount of
about 0.01% to 10% (w/v) and having a viscosity of about 30 to 50
centipoise.
2. The composition according to claim 1, wherein the pharmaceutical
agent is a nucleic acid that stimulates or promotes wound
healing.
3. The composition according to claim 2, wherein the nucleic acid
is a DNA molecule operably linked to a DNA sequence encoding a
therapeutic protein selected from the group consisting of:
transforming growth factor-.beta. (TGF-.beta.); fibroblast growth
factor (FGF); platelet derived growth factor (PDGF); insulin-like
growth factor (IGF); bone morphogenic growth factor (BMP); growth
hormone (GH) and human parathyroid hormone (PTH).
4. The composition according to claim 1, further including a
liquified propellant.
5. A composition for coating medical devices comprising a
suspension of about 0.01% (w/v) to 80% (w/v) microspheres and/or
nanospheres and having a viscosity of about 30 to 50 centipoise,
wherein the microspheres and/or nanospheres are comprised of a
biocompatible biodegradable polymeric core and at least one
pharmaceutical agent in an amount of about 0.01% to 20% (w/w).
6. The composition according to claim 5, wherein the pharmaceutical
agent is a nucleic acid that stimulates or promotes wound
healing.
7. The composition according to claim 5, further including a
bioadhesive.
8. The composition according to claim 5, further including a
liquefied propellant.
9. A method for coating a medical device with a polymeric matrix
containing at least one pharmaceutical agent, the method comprising
the steps of: (a) preparing an emulsion comprising at least one
biocompatible biodegradable polymer in an amount of about 0.01% to
15% (w/v) and at least one pharmaceutical agent in an amount of
about 0.01% to 10% (w/v) and having a viscosity of about 30 to 50
centipoise; and (b) coating a medical device with a
pharmaceutically effective amount of the emulsion.
10. The method according to claim 9, wherein the emulsion is a
water-in-oil emulsion.
11. The method according to claim 9, wherein the pharmaceutical
agent is a hydrophobic pharmaceutical agent and preparing the
emulsion comprises the steps of: (a) dissolving the hydrophobic
pharmaceutical agent in a water-immiscible organic solvent to yield
an organic phase; and (b) emulsifying the organic phase with an
aqueous phase to yield a milky emulsion.
12. The method according to claim 9, wherein the pharmaceutical
agent is a hydrophilic pharmaceutical agent and preparing the
emulsion comprises the steps of: (a) dissolving at least one
biocompatible biodegradable polymer in a water-immiscible organic
solvent to yield an organic phase; (b) dissolving the hydrophilic
pharmaceutical agent in water to yield an aqueous phase; and (c)
emulsifying the organic and aqueous phases to yield a milky
emulsion.
13. The method according to claim 9, wherein the pharmaceutical
agent is a semi-polar and/or hydrophilic pharmaceutical agent and
preparing the emulsion comprises the steps of: (a) dissolving at
least one biodegradable biocompatible polymer in a water-immiscible
organic solvent; (b) dissolving at least one semi-polar and/or
hydrophilic pharmaceutical agent in a water-miscible organic
solvent; (c) admixing the solutions from steps (a) and (b) to yield
an organic phase; and (d) emulsifying the organic phase with an
aqueous phase to yield a milky emulsion.
14. The method according to claim 9, wherein the pharmaceutical
agent is a nucleic acid that stimulates or promotes wound
healing.
15. The coated medical device produced by the method of claim
9.
16. A method for coating a medical device with microspheres and/or
nanospheres containing pharmaceutical agents, the method comprising
the steps of: (a) preparing a suspension comprising about 0.01% to
80% (w/v) microspheres and/or nanospheres and having a viscosity of
about 30 to 50 centipoise, wherein the microspheres and/or
nanospheres are comprised of a biocompatible biodegradable
polymeric core and at least one pharmaceutical agent in an amount
of about 0.01% to 10% (w/w); and (b) coating a medical device with
a pharmaceutically effective amount of the suspension.
17. The method according to claim 16, wherein the pharmaceutical
agent is a nucleic acid that stimulates or promotes wound
healing.
18. The coated medical device produced by the method of claim
16.
19. A medical device coated with a polymeric matrix containing
pharmaceutical agents, wherein the polymeric matrix comprises at
least one biocompatible biodegradable polymer and a
pharmaceutically effective amount of at least one pharmaceutical
agent.
20. The device according to claim 19, wherein the pharmaceutical
agent is hydrophilic.
21. The device according to claim 19, wherein the pharmaceutical
agent is a nucleic acid.
22. The device according to claim 19, wherein the polymeric matrix
is in the form of microspheres and/or nanospheres.
23. A medical device having improved wound healing characteristics,
comprising a medical device coated with a biocompatible
biodegradable polymeric matrix containing a therapeutically
effective amount of a nucleic acid that stimulates wound
healing.
24. The device according to claim 19 or 23, wherein the device is
selected from the group consisting of surgical implants, surgical
sutures and wound dressings.
25. A method for delivering pharmaceutical agents to a region of a
body having wounded or diseases tissue, the method comprising the
steps of: (a) providing a medical device coated with a polymeric
matrix containing pharmaceutical agents, wherein the polymeric
matrix comprises at least one biocompatible biodegradable polymer
and a pharmaceutically effective amount of at least one
pharmaceutical agent; and (b) placing the coated device proximal to
a wound or diseased tissue.
26. The method according to claim 25, wherein the nucleic acid is a
nucleic acid that stimulates or promotes wound healing when taken
up by cells.
27. The method according to claim 25, wherein the medical device is
selected from the group consisting of surgical implants, surgical
sutures and wound dressings.
Description
1.INTRODUCTION
[0001] The present invention relates to compositions for coating
medical devices with a polymeric matrix containing pharmaceutical
agents, methods for coating the medical devices and medical devices
coated therewith. The coated devices are useful for targeted local
delivery of pharmaceutical agents at a site of medical intervention
for the treatment of wounds and disease.
2. BACKGROUND OF THE INVENTION
[0002] The desirability of coating medical devices such as, inter
alia, surgical implants, sutures and wound dressings with
pharmaceutical agents is well documented in the art. Such coated
devices could theoretically provide a means for locally delivering
pharmaceutical or therapeutic agents at the site of medical
intervention to treat a variety of diseases. For example, surgical
implants or sutures coated with antibiotics can provide local
delivery of antibiotic directly at an implantation or suture site,
thereby decreasing the onset of infection following the surgical
intervention.
[0003] Polymer compositions and methods for coating implants,
especially sutures, are well-known in the art. Such coatings have
been applied to surgical sutures to improve fiber lubricity, knot
snug-down and tie-down performance, and for local delivery of
pharmaceutical agents such as antibacterial agents. For example,
there has been extensive application of the homopolymer
poly(glycolic acid) (see for example U.S. Pat. No. 3,277,033) and
copolymers of glycolic acid with a variety of other monomers which
produce absorbable polymer (see for example U.S. Pat. No.
3,839,297). Other polymers that have been used to coat sutures
include U.S. Pat. No. 5,378,540 (polycaprolactones); U.S. Pat. No.
5,312,437 (poly(oxypropylene)glycol/lactide/glycolide copolymer);
U.S. Pat. No. 5,147,383 (polyvinyl esters); U.S. Pat. No. 5,123,912
(poly(alkylene)glycol/lactide/glycolide copolymer); U.S. Pat. No.
5,102,420 (polyetheramide); U.S. Pat. No. 5,100,433
(p-dioxanone/.epsilon.-caprolactone copolymer); U.S. Pat. No.
5,032,638 (homopolymer of hydroxy butyrate linkages); U.S. Pat. No.
4,857,602 (triblock polymers of
glycolide/poly(alkyleneoxide)/trimethylene carbonate); U.S. Pat.
No. 4,844,067 (sucrose fatty esters); U.S. Pat. No. 4,711,241
(glycolic acids): U.S. Pat. No. 4,649,920 (poly(alkylene oxides));
U.S. Pat. No. 4,532,929 (fatty acids); and U.S. Pat. No. 4,433,688
(isocyanate capped polyhydroxylated polyesters).
[0004] It has been suggested that several of these biodegradable
polymer coatings can theoretically be used to coat sutures and
implants with pharmaceutical agents, with the biodegradable
polymeric coating providing controlled release of the
pharmaceutical agent at the site of surgical intervention. For
example, U.S. Pat. No. 5,378,540 describes compositions for coating
a surgical suture with a biodegradable polylactone polymeric
sheath, optionally containing a pharmaceutical agent. The suture is
coated by dipping it in an organic solvent containing the polymer
and pharmaceutical agent and allowing the suture to dry.
[0005] However, prior art methods for coating sutures and implants
have typically been limited with respect to the types of
pharmaceutical agents that can be incorporated into the coating
sheath. Generally, the pharmaceutical agents must be hydrophobic,
as they must be soluble in the organic solvent used to dissolve the
polymer prior to coating the suture.
[0006] While methods have been developed to coat implants with
water soluble pharmaceutical agents, especially anti-bacterial
agents, these methods are not readily adaptable to easily and
efficiently coat medical devices with a wide variety of
pharmaceutical agents, especially nucleic acids, as they either
require complex, expensive machinery or suffer from other
undesirable limitations. These methods are also not suitable for
providing coatings exhibiting controlled or sustained release of
pharmaceutical agents.
[0007] For example, U.S. Pat. No. 5,474,797 describes a process for
dry-coating implants with bactericidal agents involving depositing
a 0.5-10 .mu.m thick layer of bactericidal agent onto the implant
in the form of ionized atoms via ion-beam-assisted deposition in a
vacuum chamber. In addition to requiring expensive equipment, this
method also suffers from the limitation that the pharmaceutical
agent to be administered must be readily ionizable. Furthermore,
the coated implants do not provide controlled or sustained release
of bactericidal agent.
[0008] U.S. Pat. No. 4,952,419 describes a method for coating
implants with bactericidal agents that involves applying a film of
silicone oil to the implant surface followed by contacting the
oiled surface with powdered antibacterial agents. While relatively
simple, this method requires several manipulations and does not
allow for sustained delivery of bactericidal agents. The method
also requires that the pharmaceutical agent be available in
powdered form.
[0009] U.S. Pat. No. 4,024,871 describes sutures impregnated with
water soluble antimicrobial agents. The sutures are impregnated by
soaking in a dilute solution of antimicrobial agent. The sutures
are dried, leaving a residue of antimicrobial agent distributed
substantially throughout the suture filament. The suture is then
top-coated with polyurethane to prevent the antimicrobial agent
from leeching out of the suture. As is readily apparent, this
method is not suitable for coating devices that do not readily take
up, or become impregnated with, the desired pharmaceutical agent.
Furthermore, because the suture is top-coated with polyurethane,
this method is not useful for the controlled delivery of
pharmaceutical agents at the site of surgical intervention. Rather,
the suture is impregnated with an antimicrobial agent to insure its
sterility.
[0010] Accordingly, there remains a need in the art for
compositions and methods which allow medical devices to be easily
and efficiently coated with a wide variety of pharmaceutical
agents, especially hydrophilic pharmaceutical agents, and that
further provide controlled or sustained release of the
pharmaceutical agents into the local area surrounding the site of
medical intervention.
[0011] The prior art methods for coating implants and sutures also
typically deposit a sheath or layer of polymer, optionally
containing a pharmaceutical agent, tens of microns thick onto the
implant or suture. As the biodegradable polymeric coating
dissolves, the pharmaceutical agent is released into the area
surrounding the implant, where it may be taken up by the
surrounding cells. Thus, implants and sutures coated with the prior
art compositions and methods deliver pharmaceutical agents
extracellularly.
[0012] Oftentimes, it is desirable to deliver pharmaceutical agents
intracellularly rather than, or in addition to, extracellularly.
Such applications are useful where, for example, the pharmaceutical
agent cannot easily penetrate or traverse the cellular membrane.
Examples of such pharmaceutical agents include oligonucleotides
such as antisense DNA and RNA, ribozymes, DNA for gene therapy,
transcription factors, growth factor binding proteins, signalling
receptors and the like.
[0013] Microspheres and/or nanospheres are a widely used vehicle
for delivering drugs intracellularly. Generally, microspheres
and/or nanospheres comprise a biodegradable polymeric core having a
pharmaceutical agent incorporated therein. Microspheres are
typically spherical and have an average diameter of about 1 to 900
.mu.m. Nanospheres are typically spherical and have an average
diameter of less than 1 .mu.M, usually less than about 300 nm.
[0014] Advantages of microsphere and/or nanosphere pharmaceutical
formulations include their ability to enter cells and penetrate
intracellular junctions. Another advantage of microspheres and/or
nanospheres is their ability to provide sustained or controlled
release of pharmaceutical agents. Thus, microspheres and/or
nanospheres provide a means for intracellular as well as
extracellular controlled or sustained delivery of pharmaceutical
agents.
[0015] Accordingly, it would be extremely advantageous to have
available methods and compositions for coating medical devices with
microspheres and/or nanospheres containing pharmaceutical agents.
Such coated devices would facilitate intracellular as well as
extracellular local controlled or sustained release of
pharmaceutical agents at the site of medical intervention. These
devices would be particularly advantageous for delivering drugs
that do not readily penetrate or traverse cellular membranes.
[0016] Gene therapy is generally understood to refer to techniques
designed to deliver nucleic acids, including antisense DNA and RNA,
ribozymes, viral fragments and functionally active therapeutic
genes into targeted cells (Culver, 1994, Gene Therapy: A Handbook
for Physicians, Mary Ann Liebert, Inc., New York, N.Y.). Such
nucleic acids may themselves be therapeutic, as for example
antisense DNAs that inhibit mRNA translation, or may encode
therapeutic proteins that promote, block or replace cellular
functions.
[0017] Perhaps one of the greatest problems associated with current
gene therapy strategies, whether ex vivo or in vivo, is the
inability to transfer nucleic acids efficiently into a targeted
cell population and to achieve a high level of expression of the
gene product in vivo. Viral vectors are regarded as the most
efficient system, and recombinant replication-defective viral
vectors have been used to transduce (i.e., infect) cells both ex
vivo and in vivo. Such vectors have included retroviral,
adenovirus, adeno-associated viral vectors and herpes viral
vectors. While highly efficient at gene transfer, the major
disadvantages associated with the use of viral vectors include the
inability of many viral vectors to infect non-dividing cells;
problems associated with insertional mutagenesis; problems
associated with the ability to "turn on" gene expression over time
in the few cells that are transfected; potential helper virus
production and/or production and transmission of harmful virus to
other human patients.
[0018] In addition to the low efficiency of most cell types to
uptake and expression of foreign nucleic acids, many targeted cell
populations are found in such low numbers in the body that the
efficiency of transformation of these specific cell types is even
further diminished. Therefore, any gene therapy method which
increases the efficiency with which nucleic acids are transferred
into targeted cells would greatly enhance the overall usefulness of
gene therapy protocols.
[0019] Recently, it has been discovered that proliferating repair
cells active in the wound healing process are surprisingly
efficient at taking up and expressing nucleic acids (copending
attorney docket no. 8464-007-999, filed Apr. 8, 1996). These
proliferating repair cells could provide an efficient means for
administering gene therapy directly at a surgical or implantation
site. It would therefore be extremely advantageous to have
available methods and compositions for coating medical devices with
a polymeric matrix containing nucleic acids. Such coated devices
would provide a convenient means for efficiently transferring
therapeutic nucleic acids to proliferating repair cells directly at
a wound or site of surgical intervention. The proliferating repair
cells would then act as local "bioreactors" for production of
therapeutic gene products, such as therapeutic proteins. Of
particular significance would be the availability of nucleic
acid-coated sutures, as sutures de facto will always be surrounded
by injured tissue.
[0020] In some circumstances, it may be advantageous for the
devices to be coated with microspheres and/or nanosphere containing
nucleic acids, as described above. However, transfer of nucleic
acids into wounded tissue need not be mediated via microspheres
and/or nanospheres.
[0021] The difficulty of wound healing and tissue regeneration
following surgical intervention is also well documented in the art.
In addition, it is well-known that many fragile tissue types, such
as normal and diseased liver tissue, tissues in patients suffering
from certain metabolic disorders such as diabetes, and tissues that
have been irradiated such as tissues following cancer surgery, have
difficulty holding sutures.
[0022] Currently available wound healing therapies involve the
administration of therapeutic proteins. Such therapeutic proteins
may include regulatory factors involved in the normal healing
process such as systemic hormones, cytokines, growth factors and
other proteins that regulate proliferation and differentiation of
cells. Growth factors, cytokines and hormones reported to have such
wound healing capacity include, for example, the transforming
growth factor-# superfamily (TGF-.beta.) of proteins (Cox, D. A.,
1995, Cell Biology International 19:357-371); acidic fibroblast
growth factor (FGF) (Slavin, J., 1995, Cell Biology International
19:431-444); macrophage-colony stimulating factor (M-CSF); and
calcium regulatory agents such as parathyroid hormone (PTH).
[0023] A number of problems are associated with the use of
therapeutic proteins in wound healing therapies. For example, the
purification and/or recombinant production of therapeutic proteins
is often an expensive and time-consuming process. Once purified,
most protein preparations are unstable making storage and use
cumbersome.
[0024] Additionally, because of the short half-life in the body due
to proteolytic degradation, repeated administration of high doses
of protein are required to ensure that sufficient amounts of the
protein reach the tissue.
[0025] Finally, for a variety of proteins such as membrane
receptors, biological activity is dependant on correct expression
and localization in the cell. For many proteins, correct cellular
localization occurs as the protein is post-translationally
modified. Therefore, such proteins cannot be administered in such a
way as to be taken up and properly localized inside the cell.
[0026] It would therefore be particularly advantageous to have
available medical devices, especially surgical sutures, coated with
nucleic acids that stimulate wound healing. Such coated devices
would provide for the controlled or sustained release of the
nucleic acids into a wound or site of surgical intervention. As
described above, proliferating repair cells will take up and
express the nucleic acids, thereby stimulating local wound
healing.
[0027] The coated devices would be particularly useful for
difficult surgical situations where compromised wound healing may
be a problem, such as surgery in patients having diabetes. Coated
sutures would not only enable mechanical juxtaposition of tissues,
but through repair cell-mediated nucleic acid transfer would
stimulate wound healing along the suture line as well.
Illustratively, such sutures would essentially "spot weld" the
tissue together. Such sutures would also be useful for
re-establishing normal functional tissue architecture at the suture
line and in nearby regions.
[0028] Nucleic acid-mediated wound healing strategies overcome many
of the shortcomings of current wound healing strategies. Unlike
proteins, nucleic acids, particularly DNA, are extremely stable for
prolonged periods of time under a variety of storage conditions. In
addition, since the transfected cells act as bioreactors to produce
encoded proteins, administration of even small amounts of nucleic
acids would provide therapeutic benefit. Furthermore, since the
encoded proteins are expressed in the mammalian cell, they may be
post-translationally modified and/or spliced to yield active
protein.
[0029] As is readily apparent from the above discussion, presently
there are no methods and/or compositions available which allow
medical devices to be easily and efficiently coated with a wide
variety of pharmaceutical agents, especially water-soluble or
hydrophilic pharmaceutical agents, that permit local controlled or
sustained release of such agents at a site of medical intervention
for the treatment of wounds or disease.
[0030] There are also presently no methods or compositions
available for coating medical devices with microsphere and/or
nanosphere pharmaceutical formulations that permit easy and
efficient intracellular as well as extracellular local delivery of
pharmaceutical agents that do not readily traverse or penetrate
cell membranes for the treatment of wounds or disease.
[0031] Furthermore, there are currently no compositions or methods
available for coating medical devices with nucleic acids,
especially nucleic acids that stimulate wound healing, that permit
easy and efficient targeted local delivery of nucleic acids in
vivo.
[0032] Accordingly, these and other deficiencies in the art are
objects of the present invention.
3. SUMMARY OF THE INVENTION
[0033] These and other objects are afforded by the present
invention, which in one aspect provides compositions for coating
medical devices with a polymeric matrix containing pharmaceutical
agents, especially water-soluble or hydrophilic pharmaceutical
agents. The polymeric matrix provides for the controlled or
sustained release of pharmaceutical agents at a site of medical
intervention. The coated devices are useful for targeted local
delivery of pharmaceutical agents for the treatment of wounds or
disease.
[0034] The coating composition is generally in the form of an
emulsion or suspension and comprises at least one biocompatible
biodegradable polymer and at least one pharmaceutical agent.
[0035] When in the form of an emulsion, the coating composition
usually comprises about 0.01% to 15% (w/v), typically about 0.1% to
10% (w/v) and preferably about 1% to 5% (w/v) total polymer, and
about 0.001% to 15% (w/v), typically about 0.01% to 10% and
preferably about 0.1% to 0.5% (w/v) pharmaceutical agent.
[0036] When in the form of a suspension, the coating composition
usually comprises about 0.01% to 80% (w/v), preferably about 10% to
30% (w/v), pre-formed or partially formed microspheres and/or
nanospheres, and has a viscosity of about 1 to 100 centipoise.
Preferably the suspension has a viscosity of about 30 to 50
centipoise. The microspheres and/or nanospheres are comprised of a
biocompatible biodegradable polymeric core and have about 0.001% to
30% (w/w) of at least one pharmaceutical agent entrapped,
entrained, embedded or otherwise incorporated therein. Preferably,
the spheres contain about 1% to 15% (w/w) pharmaceutical agent.
[0037] The coating compositions of the invention may further
include a propellant for aerosol application.
[0038] In a preferred embodiment of the invention, the
pharmaceutical agent comprising the coating composition is a
nucleic acid.
[0039] In another aspect, the present invention relates to methods
for coating medical devices with a polymeric matrix containing
pharmaceutical agents, especially water soluble or hydrophilic
pharmaceutical agents. The methods generally involve preparing a
coating composition and coating the medical device with the coating
composition. The coating composition may be in the form of an
emulsion, suspension or aerosol, as previously described. The
composition is applied to the device by any convenient means,
including dipping, rolling, brushing, aerosol spraying, etc.
[0040] In still another aspect, the present invention relates to
medical devices coated with a biocompatible biodegradable polymeric
matrix containing at least one pharmaceutical agent. The polymeric
matrix coated medical devices are useful for locally delivering
pharmaceutical agents to a site of medical intervention for the
treatment of wounds or disease. Preferably, the device is coated
with a polymeric matrix containing a therapeutically effective
amount of pharmaceutical agent.
[0041] In one illustrative embodiment, the polymeric matrix coating
is in the form of a sheath, encasing the device (or a portion
thereof) in a layer of polymeric matrix. When used in a medical
procedure, body fluids contact the polymeric matrix sheath, causing
it to biodegrade. As the matrix biodegrades pharmaceutical agents
are released into the local area surrounding the site of medical
intervention. The released pharmaceutical agents are taken up by
surrounding cells, where the agents effect therapeutic benefit.
[0042] In another illustrative embodiment, the polymeric matrix
coating is in the form of microspheres and/or nanospheres, as
previously described. When used in a medical procedure, body fluids
contact the polymeric matrix coating causing the microspheres
and/or nanospheres to biodegrade and release pharmaceutical agents
into the local area surrounding the site of medical intervention.
In addition, microspheres and/or nanospheres detach from the
device. The spheres may be taken up by surrounding cells where they
provide controlled or sustained intracellular release of
pharmaceutical agents as the spheres biodegrade within the
cell.
[0043] In a preferred embodiment, the pharmaceutical agent
comprising the polymeric matrix coating is a nucleic acid. The
nucleic acid-polymeric matrix coating may be in the form of a
sheath or microspheres and/or nanospheres, as previously described.
When placed in proximity to wounded tissue, such coated devices are
useful for locally delivering nucleic acids to cells for, inter
alia, local gene therapy. Proliferating repair cells active in the
healing process take up the nucleic acids, where they effect
therapeutic benefit.
[0044] In a particularly preferred embodiment, the nucleic acid is
a nucleic acid that stimulates or promotes wound healing. Such
coated medical devices exhibit improved wound healing
characteristics.
[0045] In yet another aspect, the invention relates to methods of
locally delivering pharmaceutical agents. The methods generally
involve providing a medical device coated with a polymeric matrix
containing at least one pharmaceutical agent and using the coated
device in a medical procedure. The device is coated with the
coating compositions and methods described herein. Preferably, the
device is coated with a therapeutically effective amount of
pharmaceutical agent.
[0046] When used in a medical procedure the polymeric matrix
coating the device biodegrades, releasing pharmaceutical agents
into the local area surrounding the site of medical intervention,
where they may be taken up by surrounding cells and effect
therapeutic benefit.
[0047] In a preferred embodiment, the methods provide local
delivery of nucleic acids into wounded tissues. The preferred
methods involve providing a polymeric matrix coated medical device
wherein the pharmaceutical agent is a nucleic acid and placing the
coated device in or on an area of the body having wounded tissue.
As the polymeric matrix biodegrades, proliferating repair cells
take up the released nucleic acids, as previously described.
4. BRIEF DESCRIPTION OF THE FIGURES
[0048] FIG. 1 provides a graph comparing the heat stable alkaline
phosphatase activity of tissue repaired with coated sutures and
tissue repaired with un-coated sutures;
[0049] FIG. 2 provides Scanning Electron Micrographs of coated and
uncoated sutures;
[0050] FIG. 3 provides Scanning Electron Micrographs of coated and
uncoated stainless steel screws;
[0051] FIG. 4 provides Scanning Electron Micrographs of coated and
uncoated titanium screws;
[0052] FIG. 5 provides Scanning Electron Micrographs of coated and
uncoated hydroxyapatite-tricalcium phosphate ceramic particles;
and
[0053] FIG. 6 provides an illustrative reaction scheme for the
preparation of block copolymers having a hydrophobic PCL segment
and a hydrophilic segment.
5. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0054] 5.1 Definitions
[0055] As used herein, the following terms will have the meanings
indicated below.
[0056] "Medical Device:" As used herein, "medical device" means any
device that may be used during medical intervention including, but
not limited to, surgical implants, surgical sutures and wound
dressings such as bandages.
[0057] "Microsphere:" As used herein, a "microsphere" is a
generally spherical particle comprised of a biocompatible
biodegradable polymeric core having at least one pharmaceutical
agent entrapped, entrained, embedded or otherwise incorporated
therein. Microspheres generally have an average diameter of about 1
to 900 .mu.m, typically about 5 to 10 .mu.m.
[0058] "Nanosphere:" As used herein, a "nanosphere" is a generally
spherical particle comprised of a biocompatible biodegradable
polymeric core having at least one pharmaceutical agent entrapped,
entrained, embedded or otherwise incorporated therein. Nanospheres
generally have an average diameter of less than about 1 .mu.m,
typically less than about 300 nm. As used herein, "nanosphere" is
synonymous with other art-recognized terms for nanometer-sized
pharmaceutical formulations such as, for example,
"nanoparticle."
[0059] "Biocompatible:" As used herein, a material is
"biocompatible" if it is suitable for in vivo uses in a human or
animal. Thus a material is biocompatible if it is biologically
inert, physiologically acceptable, non-toxic and does not induce
adverse biological responses when placed in mammalian tissue.
[0060] "Biodegradable:" As used herein, a material is
"biodegradable" if it hydrolyses and/or is absorbed into tissues
when in contact with tissue and/or tissue fluids.
[0061] "Biocompatible Biodegradable Polymeric Matrix:" As used
herein, a biocompatible biodegradable polymeric matrix is a
material comprised of biocompatible biodegradable polymers in which
additional agents, including but not limited to pharmaceutical
agents and emulsifying agents, are entrained, entrapped, embedded
or otherwise incorporated. Biocompatible biodegradable polymeric
matrix specifically includes microspheres and/or nanospheres.
[0062] "Pharmaceutical Agent:" As used herein, a pharmaceutical
agent is a chemical compound, or combination of compounds,
naturally occurring or synthetic, which possesses the property of
influencing the normal and/or pathologic behavior of living
systems. Pharmaceutical agents include organic molecules, peptides,
proteins, nucleic acids and the like. A pharmaceutical agent can be
therapeutic, diagnostic, prophylactic, cosmetic, nutritional, etc.
A pharmaceutical agent may also be an excipient, filler or adjuvant
that acts in conjunction or combination with one or more other
pharmaceutical agents.
[0063] "Operably Linked:" As used herein, "operably linked" refers
to a juxtaposition such that the normal function of the linked
components can be performed. Thus, a promoter sequence "operably
linked" to a coding sequence refers to a configuration wherein the
promoter sequence promotes expression of the coding sequence. The
promoter sequence may be constitutive and/or inducible.
[0064] "Therapeutically Effective Amount:" A "therapeutically
effective amount" of a pharmaceutical agent is an amount effective
to provide therapeutic benefit. Thus, for example, for nucleic
acids encoding therapeutic proteins, a "therapeutically effective
amount" of nucleic acid is an amount effective to provide expressed
protein in an amount effective to provide therapeutic benefit.
[0065] "Repair Cell:" As used herein, a "repair cell" is any cell
which is stimulated to migrate and proliferate in response to
tissue injury. Repair cells are a component of the wound healing
response. Such cells include fibroblasts, capillary endothelial
cells, capillary pericytes, mononuclear inflammatory cells,
segmented inflammatory cells and granulation tissue cells.
[0066] 5.2 The Invention
[0067] The present invention relates to compositions for coating
medical devices such as, inter alia, surgical implants, sutures and
wound dressings, with a biocompatible biodegradable polymeric
matrix containing pharmaceutical agents, especially water-soluble
or hydrophilic pharmaceutical agents, methods for coating medical
devices, and medical devices coated therewith. The coated devices
provide for controlled or sustained release of pharmaceutical
agents selected to be useful to treat wounds or disease into the
local area surrounding the site of medical intervention.
[0068] The methods of the invention comprise preparing a coating
composition and coating a medical device with the coating
composition. Generally, the coating composition is in the form of
an emulsion or suspension and comprises at least one biocompatible
biodegradable polymer and at least one pharmaceutical agent. When
in the form of an emulsion the coating composition is usually
comprised of about 0.01% to 15% (w/v), typically about 0.1% to 10%
(w/v) and preferably about 1% to 5% (w/v) total polymer, and about
0.001% to 15% (w/v), typically about 0.01% to 10% and preferably
about 0.1% to 0.5% (w/v) pharmaceutical agent. In preferred
embodiments the emulsion is a water-in-oil ("W/O") emulsion.
[0069] When in the form of a suspension, the coating composition is
usually comprised of about 0.01% to 80% (w/v), preferably about 10%
to 30% (w/v), pre-formed or partially formed microspheres and/or
nanospheres and has a viscosity of about 1 to 100 centipoise,
preferably about 30 to 50 centipoise. The microspheres and/or
nanospheres are comprised of a biocompatible biodegradable
polymeric core and have about 0.001% to 30% (w/w), preferably about
1% to 15% (w/w) of at least one pharmaceutical agent entrapped,
entrained, embedded or otherwise incorporated therein.
[0070] The coating compositions of the invention may further
include a propellant for aerosol application. Optionally, the
coating compositions may include about 0.1% to 10% (w/v), typically
about 1% to 3% (w/v) emulsifying agent and/or about 0.1% to 1%
(w/v) of a preservative against microbial contamination.
[0071] The composition is applied to the device to deliver a
uniform coating and the device allowed to dry. As the device dries,
the solvents comprising the coating composition evaporate,
depositing a biocompatible biodegradable polymeric matrix
containing pharmaceutical agents on the surface of the device. When
the device contacts tissue fluids, as when the device is implanted
in a patient or used to dress a wound, the polymeric matrix
biodegrades, releasing pharmaceutical agents into the local area.
Preferably, the polymeric matrix allows for the controlled or
sustained release of pharmaceutical agents over prolonged periods
of time.
[0072] In a preferred embodiment, the compositions and methods of
the invention coat medical devices with microspheres and/or
nanospheres containing pharmaceutical agents. When the microsphere
and/or nanosphere-coated device is placed within or on a patient,
the polymeric matrix biodegrades releasing pharmaceutical agents
into the local area. Additionally, the microspheres and/or
nanospheres detach from the coated device, where they may penetrate
into or be taken up by surrounding cells. Thus, devices coated with
microspheres and/or nanospheres provide intracellular as well as
extracellular controlled or sustained delivery of pharmaceutical
agents. This is particularly important for locally delivering
pharmaceutical agents that do not readily traverse the cell
membrane.
[0073] These aspects of the invention are based, in part, on
discovery that emulsions suitable for preparing microsphere and/or
nanosphere pharmaceutical formulations can be readily adapted to
easily, efficiently and durably coat medical devices with a
plethora of pharmaceutical agents, particularly water soluble or
hydrophilic pharmaceutical agents. The compositions may be used
directly or in the form of aerosols to coat a wide variety of
medical devices.
[0074] Coatings prepared with such compositions are durable in that
they are not removed by normal handling of the coated device. Quite
surprisingly, it has been discovered that microsphere and/or
nanosphere coatings are durable. For example, a polymeric coating
comprising sub-micron sized particles did not get stripped from a
surgical suture as the suture was passed through skeletal
muscle.
[0075] The compositions and methods of the invention provide myriad
advantages over other current coating techniques. Significantly,
the present compositions and methods allow virtually any medical
device to be easily and efficiently coated with virtually any
pharmaceutical agent, including water-soluble or hydrophilic
pharmaceutical agents such as nucleic acids. Thus, the coated
medical devices of the invention can be used to locally deliver a
wide variety of pharmaceutical agents, alone or in combination,
into the local area surrounding a site of medical intervention for
the treatment of wounds or disease.
[0076] Targeted drug delivery via coated medical devices provides a
particularly convenient means for treating wounds or disease. For
example, in many instances systemic administration of
pharmaceutical agents at therapeutically effective concentrations
results in undesirable or toxic side effects. In such instances,
targeted local delivery via coated medical devices permits delivery
of local concentrations effective to provide therapeutic benefit
while avoiding toxicities associated with effective systemic levels
of drug. Targeted local delivery via coated medical devices is also
advantageous in cases where pharmaceutical agents delivered via
other modes of administration do not readily reach the target cell
population.
[0077] Targeted administration of microsphere and/or nanosphere
pharmaceutical formulations via coated medical devices offers
myriad advantages over other modes of administering microspheres
and/or nanospheres. For example, intravenously delivered
microspheres having a size of 4-7 .mu.m are mechanically filtered
and retained in the lungs (Troster et al., 1990, Int. J. Pharm.
61:85-100). Smaller sized spheres pass through the lungs, but are
rapidly taken up by macrophages of the reticuloendothelial system,
mainly Kupfer cells of the liver and macrophages of the spleen
(Muller et al., 1993, Int. J. Pharm. 89:25-31). In many instances,
as much as 90% of injected spheres are taken up by the liver and
2-5% are taken up by the spleen and removed from circulation within
the five minutes following injection (Muller, 1991, Colloidal
Carriers for Controlled Drug Delivery and Targeting,
Wissenschaftliche Verlagsgesellschaft, Stutgart). Thus, when
administered systemically, many spheres are prevented from reaching
their targeted delivery site. By locally administering microspheres
and/or nanospheres directly at the site of medical intervention the
spheres can be taken up by local surrounding cells, bypassing entry
into the blood stream and concomitant sequestration in the lungs,
liver and spleen.
[0078] In another preferred embodiment, the pharmaceutical agent
comprising the compositions of the invention is a nucleic acid.
Nucleic acid-coated devices provide targeted controlled or
sustained in vivo delivery of nucleic acids to cells surrounding
the site of medical intervention for, inter alia, local gene
therapy.
[0079] This aspect of the invention is based, in part, on the
discovery that proliferating repair cells involved in the wound
healing process are surprisingly efficient at taking up, and
optionally expressing, nucleic acids (copending attorney docket no.
8464-007-999, filed Apr. 8, 1996). These repair cells, which are
normally difficult to efficiently transfect both in vitro and in
vivo, are extremely efficient at taking-up and expressing nucleic
acids when induced to proliferate by the wound healing process. The
repair cells migrate to a site of tissue injury, infiltrate
matrices containing nucleic acids placed at the injury and take up
and express the nucleic acids. For example, a collagen sponge
containing plasmid DNA encoding mouse BMP-4 (an osteoconductive
factor normally expressed by progenitor cells during fracture
repair) placed within a 5 mm osteotomy in rats was found to promote
bone growth across the gap (id).
[0080] A synergistic effect was observed in rats receiving collagen
sponges containing two plasmids: one plasmid encoding mouse BMP-4,
the other plasmid encoding the PTH1-34 peptide, a 34 amino acid
peptide fragment of parathyroid hormone known to interact
synergistically with BMP-4 (Ahrens et al., 1993, J. Bone Min. Res.
12:871-880).
[0081] The present invention capitalizes on these discoveries.
Medical devices coated with a polymeric matrix containing nucleic
acids provide a convenient means for easy and efficient transfer,
and optionally expression, of nucleic acids into proliferating
repair cells. For example nucleic acid-coated medical devices
placed in proximity to wounded tissue provide an easy and efficient
means for transferring nucleic acids to cells for local gene
therapy. Coated surgical sutures provide a particularly convenient
means of transferring nucleic acids, as the suturing process itself
induces tissue injury which in turn induces proliferation of repair
cells that can readily take up, and optionally express, the nucleic
acids released from the coating.
[0082] Virtually any nucleic acid may be taken up by the repair
cells, including anti-sense DNA and RNA, plasmid DNA and viral
fragments. The nucleic acid itself may be therapeutic, or it may
encode therapeutic proteins. Preferably, the device is coated with
an amount of nucleic acid effective to provide therapeutic benefit,
i.e., an amount effective to achieve an intended effect, such as,
inter alia, amelioration or treatment of disease, amelioration of
symptoms associated with disease, stimulation or promotion of wound
healing, etc. For nucleic acids that are themselves therapeutic,
such as for example anti-sense DNAs and RNAs, a therapeutically
effective amount refers to an amount of antisense DNA or RNA
effective to provide therapeutic benefit. For nucleic acids
encoding therapeutic gene products, a therapeutically effective
amount refers to an amount of nucleic acid that when expressed,
provides an amount of gene product effective to provide therapeutic
benefit. A person skilled in the medical arts could readily
determine a therapeutically effective amount without undue
experimentation.
[0083] Since the uptake and expression of nucleic acids by repair
cells requires repair cell proliferation induced by tissue injury,
it is understood that devices coated with the nucleic acid-polymer
compositions of the invention are to be placed in proximity to
tissue where a fresh wound is present. As will be readily apparent
to those having ordinary skill in the art, while it may be
advantageous to coat medical devices with microspheres and/or
nanospheres containing nucleic acids so that the microspheres
and/or nanospheres may facilitate intracellular delivery, for
delivery of nucleic acids into wounded tissues microspheres and/or
nanospheres are not required. The proliferating repair cells
efficiently take up nucleic acids delivered into the extracellular
matrix.
[0084] Locally delivering nucleic acids via coated medical devices
overcomes many of the problems associated with currently available
in vivo and ex vivo gene therapy protocols. For example, in vivo
methods for gene therapy require some form of targeting which, very
often does not work. For the coated devices of the invention
targeting is not a problem--the nucleic acid in the matrix serves
as "bait" that is only taken up by cells that participate in the
wound healing process and are resident at the wound site. Ex vivo
gene therapy often requires a source of target cells that is either
unavailable or resistant to transduction. For coated devices of the
invention transduction is not a problem--nucleic acids are
efficiently taken up by proliferating repair cells active in the
wound healing process.
[0085] In a particularly preferred embodiment of the invention, the
nucleic acid stimulates or promotes wound healing. Such a nucleic
acid may itself be therapeutic or may encode therapeutic gene
products that stimulate or promote wound healing in vivo.
Preferably, the nucleic acid is a DNA molecule having a promoter
sequence operably linked to a DNA sequence encoding therapeutic
proteins that stimulate wound healing.
[0086] Medical devices coated with nucleic acids that stimulate or
promote wound healing will generally exhibit improved healing
characteristics. For example, orthopedic surgical implants, such as
pins commonly used to set broken or fractured bones, coated with
nucleic acids that stimulate wound healing will accelerate bone
tissue regeneration in addition to providing mechanical
juxtaposition of the injured bone.
[0087] Sutures coated with nucleic acids that stimulate or promote
wound healing also exhibit improved healing properties. Such coated
sutures, in addition to providing mechanical juxtaposition of
healing tissues, will stimulate or promote tissue healing through
transfer, and optionally expression, of nucleic acids that
stimulate or promote wound healing to proliferating repair cells in
proximity of the suture line. Illustratively, by stimulating wound
healing around the suture, such sutures essentially "spot weld" the
suture to the tissue. The coated sutures are particularly useful
for suturing fragile or damaged tissues such as normal or diseased
liver tissue, tissue that has been irradiated, and tissue in
patients suffering from metabolic disorders such as diabetes.
[0088] One particularly important feature of the preferred
embodiment is that the repair process may be engineered to result
in either the formation of scar tissue or tissue regeneration. For
example, overexpression of therapeutic proteins at a wound or
surgical site may result in regeneration of the injured tissue
without formation of scar tissue. In many instances, such as in the
case of bone repair, such regeneration is desirable because scar
tissue is not designed to support normal mechanical function.
[0089] For sutures, it may be desirable to form scar tissue to hold
inherently weak tissues together, as previously discussed.
[0090] Alternatively, in many instances the formation of scar
tissue around a suture is undesirable. Such instances include, for
example, ocular surgery, where formation of corneal scar tissue may
result in blocked vision.
[0091] Thus, the compositions and methods of the invention may be
used to coat medical devices with nucleic acids that stimulate
wound healing either with or without the formation of scar tissue,
depending on the type and level of gene products expressed.
[0092] The present compositions, methods and coated devices
overcome many of the shortcomings in the art involving wound
therapy. First, unlike proteins, high doses of nucleic acids, which
are both stable and non-toxic, can be safely administered in vivo.
Second, repeated administration, while possible, is not required.
The cells which take up and express the nucleic acids act as local
bioreactors to provide a continuous supply of encoded gene product
at the site of the wound. Third, the nucleic acids can be delivered
in a way that addresses the temporal requirements of dosing.
[0093] 5.3 Coating Compositions
[0094] According to the present invention, a novel process has been
discovered which makes it possible to adapt compositions commonly
used in the art for preparing microsphere and/or nanosphere
pharmaceutical sustained release dosage formulations to coat
medical devices such as, inter alia, implants, sutures and wound
dressings, with a biocompatible biodegradable polymeric matrix
containing pharmaceutical agents. The coated devices provide
controlled or sustained local delivery of the pharmaceutical
agents.
[0095] Contrary to the coating compositions and methods described
in the literature, which are suitable only for coating medical
devices with hydrophobic pharmaceutical agents, the present methods
and compositions are suited for coating devices with a wide variety
of pharmaceutical agents, whether hydrophilic or hydrophobic in
nature.
[0096] Generally, the coating compositions of the invention
comprise at least one biocompatible biodegradable polymer and at
least one pharmaceutical agent. In one embodiment of the invention
the coating composition is in the form of an emulsion. One of the
advantages of the present invention is that any of the prior art
emulsions used to prepare microsphere and/or nanosphere
pharmaceutical formulations may be adapted to coat medical devices.
Such emulsions include, by way of example and not limitation,
water-in-oil emulsions ("W/O"), water-in-oil-in-water ("W/O/W")
emulsions, and co-solvent emulsions. Methods of preparing such
emulsions are known in the art, for example, as described in U.S.
Pat. No. 5,478,564 to Wantier et al.; European Patent Application
EP 190,833 to Yamamoto et al.; U.S. Pat. No. 5,480,656 to Okada et.
al.; and Allemann et al., 1992, Intl. J. Pharmaceutics 87:247-253.
Of course, it will be recognized that the type of emulsion prepared
will depend in part on the properties of the pharmaceutical agent
to be incorporated into the polymeric matrix.
[0097] In a preferred embodiment, the coating compositions of the
invention comprise a W/O emulsion. While it is to be understood
that any methods of preparing W/O emulsions are specifically
contemplated by the invention, a typical W/O emulsion may be
prepared by emulsifying an organic phase with an aqueous phase to
yield an emulsion that appears milky.
[0098] For hydrophobic pharmaceutical agents the organic phase
comprises at least one polymer and at least one hydrophobic
pharmaceutical agent dissolved in an organic solvent that is
immiscible with water. Thus, for hydrophobic pharmaceutical agents,
coating compositions of the invention may be prepared by dissolving
at least one polymer and at least one pharmaceutical agent in a
water-immiscible organic solvent to yield an organic phase and
emulsifying the organic phase with an aqueous phase to yield a
milky emulsion.
[0099] As will be readily appreciated by those having skill in the
art, one of the advantages of coating medical devices with
hydrophobic pharmaceutical agents using emulsions is the reduced
residual organic solvent content of the coating as compared to
coatings achieved with prior art compositions and methods. Thus,
medical devices coated with the compositions and methods of the
present invention are less toxic than medical devices coated with
prior art compositions and methods. This is especially important
when the organic solvent is a toxic solvent such as methylene
chloride. Notwithstanding this advantage, since the compositions of
the invention are intended for application in humans and animals,
water-immiscible organic solvents exhibiting low toxicity are
preferred.
[0100] In another preferred embodiment of the invention, the
pharmaceutical agent is water-soluble or hydrophilic. For
hydrophilic pharmaceutical agents the organic phase comprises at
least one biodegradable biocompatible polymer dissolved in a
water-immiscible organic solvent and the aqueous phase comprises at
least one water soluble or hydrophilic pharmaceutical agent
dissolved in water.
[0101] Thus, for water-soluble or hydrophilic pharmaceutical
agents, the coating compositions of the invention may be prepared
by dissolving at least one biocompatible biodegradable polymer in a
water-immiscible organic solvent to yield an organic phase,
dissolving at least one water-soluble or hydrophilic pharmaceutical
agent in water to yield an aqueous phase and emulsifying the
organic phase with the aqueous phase to yield a milky emulsion.
[0102] The aqueous phase may further comprise other agents that
enhance the stability of the pharmaceutical agent in water, as will
be apparent to those having skill in the art. For example, the
aqueous phase may further comprise pharmaceutically acceptable
buffering agents for adjustment or maintenance of pH; salts; and
the like.
[0103] Since the compositions of the invention are intended for
human or animal application, they also may contain from about 0.1%
to about 1% (w/v) of a preservative against microbial
contamination. Such agents include, by way of example and not
limitation, methylparaben, ethylparaben, propylparaben,
butylparaben, imidurea, quaternium 15, sorbic acid,
2-bromo-2-nitropropane-1,2-diol, dehydroacetic acid, benzoic acid,
benzalkonium chloride, benzethonium chloride, phenoxyethanol,
benzyl alcohol, cetylpyridinium chloride and chlorobutanol.
[0104] Optionally, the aqueous phase may further comprise one or a
plurality of emulsifying agents. Such agents are useful to adjust
the viscosity of the coating compositions, as will be discussed
further below. When present, the emulsifying agent will generally
comprise about 0.1% to 10% (w/v) and preferably about 1% to 3%
(w/v) of the aqueous phase.
[0105] Suitable emulsifying agents useful in the present invention
include, by way of example and not limitation, fatty alcohols such
as polyvinyl alcohol, lauryl alcohol, myristyl alcohol, cetyl
alcohol, stearyl alcohol and oleyl alcohol; fatty acids such as
lauric acid, myristic acid, palmitic acid, stearic acid, isostearic
acid and oleic acid; fatty acid esters such as glycerol
monostearate; polyoxyethylene sorbitan fatty acid esters sold
commercially under the trademark TWEEN.TM. (registered trademarks
of Hercules Inc., Wilmington, Del.; available from Sigma Chemical
Co., St. Louis, Mo.); polyalkylene glycols such as polyethylene
glycol; triethanolamine fatty acid esters such as triethanolamine
oleate; fatty acid salts such as sodium oleate; sodium dodecyl
sulfate (SDS); cellulose acetate; polaxomers such as block
copolymers of ethylene oxide and propylene oxide sold under the
trademarks PLURONIC F-68.TM. and PLURONIC F-127.TM. (registered
trademarks of BASF; available from Sigma Chemical Co., St. Louis,
Mo.); quaternary ammonium compounds such as didodecyldimethyl
ammonium bromide (DMAB); and oils such as mineral oil, petrolatum,
cottonseed oil, coconut oil, sesame seed oil, peanut oil, isopropyl
myristate and isopropyl palmitate.
[0106] Water-immiscible organic solvents useful in the present
invention are typically volatile at room temperature, either under
reduced air pressure, or more preferably at atmospheric pressure.
Suitable water-immiscible solvents include, by way of example and
not limitation, chloroform, methylene chloride, ethyl acetate, amyl
alcohol, amyl acetate, and the like. Combinations of methylene
chloride with acetone, dimethylsulfoxide, acetonitrile and/or
tetrahydrofuran may also be used to form an organic phase to
dissolve polymer or hydrophobic pharmaceutical agents.
[0107] It is to be understood that the choice of water-immiscible
organic solvent will depend in part on the stability of the
pharmaceutical agents in the solvent. For particularly preferred
compositions comprising nucleic acid pharmaceutical agents
(discussed in more detail below), the solvent preferably does not
induce damage to nucleic acids. Such solvents include, by way of
example and not limitation, halogenated hydrocarbons such as
methylene chloride; polyhalogenated hydrocarbons such as
chloroform; aromatics; halogenated aromatics; and others as will be
apparent to ordinarily skilled artisans. Solvents used to prepare
particularly preferred compositions will preferably be free of
nucleases.
[0108] Biocompatible biodegradable polymers useful in the present
invention are those typically employed in the art of preparing
microsphere and/or nanosphere pharmaceutical formulations. In
preferred embodiments, the biocompatible biodegradable polymer will
allow for the sustained release of pharmaceutical agents over
prolonged periods of time. Suitable polymers include, by way of
example and not limitation, polyesters such as polyglycolides,
polylactides and polylactic polyglycolic acid copolymers ("PLGA");
polyethers such as polycaprolactone ("PCL"); polyanhydrides;
polyalkyl cyanoacrylates such as n-butyl cyanoacrylate and
isopropyl cyanoacrylate; polyacrylamides; poly(orthoesters);
polyphosphazenes; polypeptides; polyurethanes; and mixtures of such
polymers.
[0109] It is to be understood that virtually any biocompatible
biodegradable polymer that is now known or that will be later
developed that is suitable for the sustained or controlled release
of pharmaceutical agents may be employed in the present
invention.
[0110] The choice of polymer will depend on the particular
application, pharmaceutical agent to be delivered, and medical
device to be coated. Factors to be considered in choosing a
particular polymer include the solubility of the polymer in the
solvents used to prepare the coating composition, the period of
time over which the pharmaceutical agent is to be released, the
biocompatibility of the polymer, the ability of the polymer to
adhere to the medical device being coated, and other considerations
as will be apparent upon review of the disclosure. For sutures,
additional considerations include the knot tie-down and snug-down
properties of the coated sutures under both wet and dry suturing
conditions. An ordinarily skilled artisan will be able to choose a
polymer or mixture of polymers suitable for a particular
application without undue experimentation.
[0111] The compositions will usually comprise about 0.01% to 15%
(w/v), typically about 0.1% to 10% (w/v) and preferably about 1% to
5% (w/v) total polymer. The viscosity of the composition will
usually be from about 1 to 100 centipoise, preferably about 30 to
50 centipoise, as measured by Otswald viscometer.
[0112] In preferred embodiments, the biocompatible biodegradable
polymer is a copolymer of glycolic acid and lactic acid ("PLGA")
having a proportion between the lactic acid/glycolic acid units
ranging from about 100/0 to about 25/75. The average molecular
weight ("MW") of the polymer will typically range from about 6,000
to 700,000 and preferably from about 30,000 to 120,000, as
determined by gel-permeation chromatography using commercially
available polystyrene of standard molecular weight, and have an
intrinsic viscosity ranging from 0.5 to 10.5.
[0113] The length of the period of continuous sustained or
controlled release of pharmaceutical agent from the coated medical
devices according to the invention will depend in part on the
composition ratio of lactic acid/glycolic acid. Generally, a higher
ratio of lactic acid/glycolic acid, such as for example 75/25, will
provide for a longer period of controlled or sustained release of
pharmaceutical agent, whereas a lower ratio of lactic acid/glycolic
acid will provide for more rapid release of pharmaceutical agent.
Preferably, the lactic acid/glycolic acid ratio is 50/50.
[0114] The length of period of sustained or controlled release is
also dependent on the MW of the polymer. Generally, a higher MW
polymer will provide for a longer period of controlled or sustained
release.
[0115] Blends of low and high MW polymers may also be employed to
control the release kinetics of pharmaceutical agents. Such blend
ratios can range from about 5/100 of low MW polymer/high MW polymer
to about 50/50 of low MW polymer/high MW polymer.
[0116] Compositions comprising particular polymer ratios, polymer
MWs and polymer blends suitable for a particular application will
be apparent to those having skill in the art (see, e.g., Bodmer et
al., 1992, J. Controlled Release 21:129-138).
[0117] The coating properties of the compositions of the invention
are affected by the volumetric ratio of the organic phase to
aqueous phase comprising the composition. Compositions suitable for
most coating applications will generally comprise about 55% to
99.9% (v/v), typically about 75% to 95% (v/v) and preferably about
80% to 90% (v/v) organic phase. These ratios correspond to a
viscosity range of about 1.5 to 3.5 poise.
[0118] The concentration of pharmaceutical agent comprising the
coating composition may also affect its coating properties. In
addition, it may affect the amount of pharmaceutical agent
incorporated into the polymeric matrix. While it will be
appreciated that the amount of pharmaceutical agent that can be
incorporated into the coating composition will depend on the MW of
the pharmaceutical agent and its solubility in the solvents, it has
been found that compositions comprising about 0.001% to 15% (w/v),
typically about 0.01% to 10% (w/v) and preferably about 0.1% to
0.5% (w/v) pharmaceutical agent provide suitable coatings.
[0119] Generally, the coating composition will be emulsified to
achieve an emulsion that appears milky. Any suitable means may be
used to achieve the milky emulsion including, by way of example and
not limitation, vigorous stirring, vortexing and sonication. Of
course, the method selected to achieve the milky emulsion will
depend in part upon the stability of the pharmaceutical agent to
the emulsification method, as will be apparent to those having
ordinary skill in the art. Vortexing the coating composition for
about one minute followed by sonicating the composition for about
30 seconds at about 0.degree. C. using a probe-type sonicator
reproducibly yields a very milky and stable emulsion satisfactory
for most coating applications.
[0120] Particularly preferred compositions comprising nucleic acid
pharmaceutical agents (discussed in more detail below) may also be
prepared using vortexing, homogenization or sonication. There is
significant literature suggesting that applying high shear forces
to nucleic acids, especially plasmid and chromosomal DNAs, via
vortexing, homogenization or sonication causes significant damage
to the DNA (see, e.g., Kondo et al., 1985, Radiation Research
104:284-292; Miller et al., 1991, Ultrasound in Medicine and
Biology 17:729-735; Miller et al., 1991, Ultrasound in Medicine and
Biology 17:401-406; Nicolau et al., Methods in Enzymology
149:157-175). Quite surprisingly, however, it has been discovered
that applying high shear forces via vortexing or sonication to
coating compositions of the invention containing nucleic acid
pharmaceutical agents does cause significant damage to the nucleic
acids. For example, while sonicating plasmid DNA in absence of
polymer caused significant damage to the DNA, sonicating a plasmid
DNA-polymer composition in the emulsion form of the invention did
not cause significant damage to the DNA (see, e.g., Example 6
demonstrating expression of sonicated plasmid DNA). Accordingly,
coating compositions of the invention containing nucleic acid
pharmaceutical agents, especially DNAs, can be prepared using
vortexing, homogenization, and sonication as described above
without causing significant damage to the nucleic acid. It is also
likely that other procedures used for formulating emulsion in
pharmaceutical preparations could also be used for making emulsion
containing nucleic acids.
[0121] In an alternative embodiment, a co-solvent system may be
used to prepare the W/O emulsion for coating medical devices with
hydrophilic and/or semi-polar pharmaceutical agents. In this
alternative embodiment the organic phase of the W/O emulsion
comprises at least one biocompatible biodegradable polymer and at
least one semi-polar and/or hydrophilic pharmaceutical agent
dissolved in a co-solvent comprising a water-immiscible organic
solvent and a water-miscible organic solvent. The coating
composition is prepared by: [0122] (a) dissolving at least one
biodegradable biocompatible polymer in a water-immiscible organic
solvent; [0123] (b) dissolving at least one hydrophilic and/or
semi-polar pharmaceutical agent in a water-miscible organic
solvent; [0124] (c) admixing the solutions from steps (a) and (b)
to yield an organic phase; and [0125] (d) emulsifying the organic
phase with an aqueous phase to yield a milky emulsion.
[0126] The aqueous phase may optionally contain antimicrobial
agents and emulsifying agents, as described above.
[0127] Typical water-immiscible organic solvents are those
previously described. Suitable water-miscible organic solvents will
yield a co-solvent system with water having a low vapor pressure so
that it evaporates at low temperature and pressure. Preferably, the
water-miscible solvent will be semi-polar, non-toxic and will not
damage the pharmaceutical agent. Suitable water-miscible solvents
include, by way of example and not limitation, acetone,
acetonitrile, ethanol, dimethyl acetamide (DMA), tetrahydrofuran
(THF), dioxane, dimethylsulfoxide (DMSO) and dimethylformamide
(DMF).
[0128] The water-miscible organic solvent is put in proportion
relative to the water-immiscible organic solvent such that there is
no precipitation of the polymer in the aqueous phase. If the amount
of the water-miscible organic solvent is too high an emulsion is
not obtained. The organic phase and the aqueous phase become
miscible and the polymer precipitates in the aqueous phase.
[0129] An emulsion is achieved with ratios of water-miscible
organic solvent to water-immiscible organic solvent ranging from
about 5/95 up to about 70/30 by volume. The minimum proportion of
water-miscible organic solvent relative to water-immiscible organic
solvent is linked to the desired level of incorporation of
pharmaceutical agent into the polymeric matrix. The minimum
proportion will therefore depend on the particular application and
will be apparent to those having skill in the art.
[0130] In another embodiment, the coating compositions of the
invention may be formulated as aerosols for aerosol spray
application. Methods for preparing and dispensing aerosols are well
known in the art (see, e.g., Lachman et al., 1976, "Pharmaceutical
Aerosols," In: The Theory and Practice of Industrial Pharmacy
270-295 (Lea & Febiger, Philadelphia, Pa.); U.S. Pharmacopeia
National Formulary 23/NF 18:1760-1767 (1995); Ansel et al., 1995,
"Aerosols, Inhalations and Sprays," In: Pharmaceutical Dosage Forms
and Drug Delivery Systems 443-459 (Lea & Febiger, Philadelphia,
Pa.).
[0131] Aerosol compositions of the invention are essentially W/O
emulsions, as previously described, further comprising a liquified
propellant. The liquified propellant can be any pharmaceutically
acceptable liquified propellant having a vapor pressure alone or in
mixture from about 20 p.s.i.g. to about 130 p.s.i.g. and is
preferably selected from the group consisting of propane, butane,
isobutane, dichlorodifluoromethane, monochlorodifluoromethane,
dichlorotrifluoroethane, monochlorotetrafluoroethane,
tetrafluoroethane, dichloromonofluoroethane and difluoroethane.
[0132] The aerosol compositions of the invention may be prepared by
charging a coating composition of the invention with a liquified
propellant into an aerosol dispenser. The aerosol dispenser can be
any conventional aerosol can or bottle or other appropriate
container, as are well known in the art.
[0133] In another embodiment of the invention, the coating
composition is in the form of a suspension and comprises pre-formed
or partially-formed microspheres and/or nanospheres suspended in a
suitable solvent. Such compositions are particularly suited for
coating medical devices with microsphere and/or nanosphere
coatings, as will be described more thoroughly below.
[0134] Suspensions suitable for coating a device with microspheres
and/or nanospheres typically will have fluid properties that allow
formation of a uniform coating, and will generally comprise about
0.01% to 80% (w/v), preferably about 10% to 30% (w/v) microspheres
and/or nanospheres, depending on the viscosity of the solution.
Suspensions having a viscosity of about 1 to 100 centipoise, and
preferably about 30 to 50 centipoise, will typically yield a
uniform coating.
[0135] The suspension may optionally include emulsifying agents and
antimicrobial agents, as previously described. The suspension may
also be formulated as an aerosol, as previously described, for
aerosol spray application of microspheres and/or nanospheres onto a
medical device.
[0136] Microspheres and/or nanospheres comprising the suspension
are comprised of a biocompatible biodegradable polymeric core and
have at least one pharmaceutical agent entrapped, entrained,
embedded or otherwise incorporated therein. Typically, the
microspheres and/or nanospheres will comprise about 0.001% to 30%
(w/v) pharmaceutical agent, preferably about 1% to 15% (w/v)
pharmaceutical agent.
[0137] Pre-formed microspheres and/or nanospheres may be prepared
using methods commonly employed in the art, such as the methods
described in U.S. Pat. No. 5,478,564 to Wantier et al.; European
Patent Application EP 190,833 to Yamamoto et al.; U.S. Pat. No.
5,480,656 to Okada et. al.; and Allemann et al., 1992, Intl. J.
Pharmaceutics 87:247-253. Alternatively, microspheres and/or
nanopsheres may be obtained by stirring a coating emulsion of the
invention for about 18 hours at room temperature to evaporate
organic solvents. The spheres are recovered by ultracentrifugation,
washed several times with water and dried in a lyophilizer.
[0138] Suitable biocompatible biodegradable polymers for preparing
microspheres and/or nanospheres are those previously described.
[0139] Once formed, the microspheres and/or nanospheres may be
suspended in a suitable solvent to prepare the suspension. Solvents
useful for preparing suspensions of microspheres and/or nanospheres
should not substantially degrade the spheres prior to evaporation
of the solvent, and preferably will have a low enough vapor
pressure to be easily evaporated at about 25.degree. C. to
30.degree. C. Furthermore, the solvents should not substantially
degrade the pharmaceutical agents entrapped in the microspheres
and/or nanospheres. Suitable solvents include, by way of example
and not limitation, low MW alcohols such as methanol, ethanol,
propanol, isopropanol, etc.; acetonitrile; acetone; and co-solvents
such as water-acetone, water-acetonitrile, etc. Even water may be
used as a solvent; the water can be later removed from the coated
device under reduced pressure to hasten evaporation.
[0140] To improve adherence of the microspheres and/or nanospheres
to the device being coated, the spheres may further include a
bioadhesive polymer. The bioadhesive polymer is incorporated into
the spheres by adding the bioadhesive to the emulsion used to
prepare the microspheres and/or nanospheres. Typically, about 1% to
10% (w/v), preferably about 3% to 5% (w/v), bioadhesive is added to
the emulsion used to prepare the spheres.
[0141] Alternatively, the coating suspension may further include
about 3% to 5% (w/v) bioadhesive polymer. Preferably, the
bioadhesive polymer is soluble in the solvents used to prepare the
suspension. Suitable bioadhesive polymers for incorporating into
microspheres and/or nanospheres or for including in the coating
suspension include, by way of example and not limitation,
polaxomers such as block copolymers of ethylene oxide and propylene
oxide sold under the trademarks PLURONIC F-68.TM. and PLURONIC
F-127.TM. (registered trademarks of BASF; available from Sigma
Chemical Co., St. Louis, Mo.), methyl cellulose, carbopol,
cyanoacrylates, mucin, alginates, acacia, gelatin, collagen and the
like.
[0142] Optionally, the spheres or coating suspensions may further
include pharmaceutical agents that facilitate particulate
intracellular DNA and/or RNA processing. Such agents include, by
way of example and not limitation, compounds that block or disrupt
lysosomal action such as chloroquine, cytochalasin B, colchicine,
polyvinylpyrrolidone, sucrose, polylysine, and the like. Such
compounds will facilitate gene transfer and entry into the cell
nucleus.
[0143] Of course, it is to be understood that in many instances it
may be desirable to modify the surface of the microspheres and/or
nanospheres or to incorporate additional agents into the
microspheres and/or nanospheres. For example, it may be desirable
to impart the microspheres and/or nanospheres with the ability to
target and bind specific tissues or cells, to be retained at the
administration site, to protect incorporated pharmaceutical agents,
to exhibit antithrombogenic effects and/or to prevent
aggregation.
[0144] As a specific example, it may be desirable to incorporate
receptor-specific molecules, such as for example antibodies, into
the microspheres and/or nanospheres to mediate receptor-specific
particle uptake. Agents and methods for imparting microspheres and
nanospheres with these and additional desirable properties are well
known in the art (see, e.g., Troster et al., 1990, Intl. J.
Pharmaceutics 61:85-100; Davis et al., 1993, J. Controlled Release
24:157-163; Muller et al., 1993, Intl. J. Pharmaceutics 89:25-31;
Maruyama et al., 1994, Biomaterials 15:1035-1042; Leroux et al.,
1994, J. Biomed. Materials Res. 28:471-481). Any of these methods
may be used in conjunction with the present invention.
[0145] 5.4 Pharmaceutical Agents
[0146] One of the main advantages of the coating methods and
compositions of the present invention is that they may be used to
coat medical devices with virtually any pharmaceutical agent,
whether hydrophobic, hydrophilic, polar, semi-polar, small
molecule, protein, DNA, and the like.
[0147] Pharmaceutical agents useful in the present invention
include, by way of example and not limitation, cardiovascular
agents; agents capable of eliciting an immune response, such as
agents commonly found in vaccines; anti-cancer agents; antibiotics;
antimicrobial agents; steroidal and non-steroidal anti-inflammatory
agents; anti-proliferative agents; agents having anti-coagulant
characteristic, including anti-thrombin and anti-platelet agents;
specific enzyme inhibitors, including nitric oxide synthetase
inhibitors (N,N-dimethylarginine), tyrosine kinase inhibitors,
alkaline phosphatase inhibitors, angiotensin converting enzyme
inhibitors; unique anti-coagulants, including the Tissue Factor
Pathway Inhibitor (TFPI) peptide inhibitor; hormones; and the
like.
[0148] Cardiovascular agents may include simulators such as
platelet derived growth factor, endothelial cell growth factor,
fibroblast growth factor, smooth muscle cell-derived growth
factors, Interleukins 1 and 6, transforming growth factor .beta.,
and low density lipoprotein; vasoactive agents such as Angiotensin
II, epinephrine, norepinephrine, neuropeptide substances P and K,
endothelin, thrombin, leukitrins, prostaglandins, epidermal growth
factors, oncogenes (c-myb, c-myo, fos), and proliferating cell
nuclear antigen; inhibitors such as transforming growth
factor-.beta., heparin-like factors and vasorelaxants;
antithrombins such as heparin, hirudin and hirulog; antiplatelet
agents such as aspirin, dipyrimadole, sulfinpyrozone, salicylic
acid, eicosapentanoic acid, ciprostene and antibodies to platelet
glycoprotein IIb/IIIa; calcium channel blockers such as nifedipine,
verapamil, and diltiazem; antitensin converting enzymes (ACE)
inhibitors such as captopril and cilazapril; immunosuppressants
such as steroids and cyclosporin; fish oils; growth factor
antagonists such as angiopeptin and trapidil; cytoskeletal
inhibitors such as cytochalasins; anti-inflammatory agents such as
dexamethasone,; thrombolytic agents such as streptokinase and
urokinase; antiproliferatives such as colchicine and U-86983
(Upjohn Co., Kalamazoo, Mich.); genetic material suitable for DNA
and/or anti-sense treatment of cardiovascular disease; protein
kinase inhibitors such as staurosporin; smooth muscle migration
and/or contraction inhibitors such as cytochalasins, and suramin;
and nitric oxide-releasing compounds such as nitroglycerin and
analogues thereof.
[0149] Agents capable of eliciting an immune response include
protein-based bacterial vaccine components such as tetanus toxoid,
cholera toxin, Staphylococcus enterotoxin B, pertussis,
pneumococcus, Staphylococcus and Streptococcus antigens, and E.
Coli (enteropathogenic); and viral vaccine proteins such as AIDS
antigens, viral proteins (influenza, adenovirus, etc.), live
viruses (attenuated poliovirus, etc.), hepatitis viral components,
rotavirus components; viral and bacterial polysaccharides; and
DNA-based vaccines.
[0150] Anti-cancer agents include alkylating agents such as
mechlorethamine, cyclophosphamide, ifosfamide, mephalan,
chlorambucil, hexamethylamine, thiotepa, busulfan, carmustine,
lomustin, lomustine, semustine, streptozocin, and dicarbaine;
antimetabolites such as methotrexate, fluorouracil, floxuridine,
cytarabine, mercaptopurine, thioguanine, and pentostatin; natural
products such as alkaloids (vinblastine, vincristine, etc.), toxins
(etoposide, teniposide, etc.), antibiotics (dactinomycin,
daunorubicin, bleomycin, plicamycin, mitomycin, etc.) and enzymes
(L-asparaginase, etc.); biological response modifiers such as
Interferon-.alpha.; hormones and antagonists such as
adrenocorticoids (dexamethasone, etc.), progestins, estrogens,
anti-estrogens, androgens, and gonadotropin releasing hormone
analogues; anti-cancer genes such as tumor suppressor genes (Rb,
P.sup.53, etc.), cytokine genes, tumor necrosis factor-.alpha.
cDNA, carcinoembryonic antigen gene, and lymphokine gene;
toxin-mediated gene therapy; antisense RNA (anti-sense to E6 and E7
genes, etc.); adrenocortical suppressants (mitotane,
aminoglutethimide, etc.); and miscellaneous agents such as
cisplatin, mitoxantrone, hydroxyurea, and preocarabazine.
[0151] Other pharmaceutical agents include enzymes, cytokines, cell
adhesion molecules, transport proteins, biologically active
peptides, nucleic acids, protamines, collagen, elastin, matrix
proteins, carbohydrates, protoglycans, lipids, cholesterols,
triglycerides, lipoproteins, apolipoproteins, detergents, and the
like.
[0152] Of course, the above lists are for illustrative purposes
only. Those having skill in the art will recognize that any
pharmaceutical agent, or combinations of pharmaceutical agents,
that are now known or that will be later developed that can be
incorporated into a biocompatible, biodegradable polymeric matrix
according to the methods described herein are specifically
contemplated by the invention.
[0153] 5.4.1 Nucleic Acids
[0154] In a particularly preferred embodiment, the invention
provides coating compositions wherein the pharmaceutical agent is a
nucleic acid. Recently, it has been discovered that proliferating
repair cells active in the wound healing process are surprisingly
efficient at taking up and expressing nucleic acids (copending
attorney docket no. 8464-007-999, filed Apr. 8, 1996).
[0155] Thus, medical devices such as, inter alia, surgical
implants, sutures, wound dressings, may be coated with compositions
of the invention comprising nucleic acids to provide a convenient
means for easily and efficiently transferring, and optionally
expressing, therapeutic nucleic acids at the local site of medical
intervention. Such coated devices provide a convenient means for
targeted delivery of nucleic acids for, inter alia, gene
therapy.
[0156] The particularly preferred compositions of the invention can
be used to coat medical devices with a wide variety of therapeutic
nucleic acids. By "nucleic acid" is meant any nucleic acid, whether
composed of deoxyribonucleosides or ribonucleosides, and whether
composed of phosphodiester linkages or modified linkages such as
phosphotriester, phosphoramidate, siloxane, carbonate,
carboxymethylester, acetamidate, carbamate, thioether, bridged
phosphoramidate, bridged methylene phosphonate, bridged
phosphoramidate, bridged phosphoramidate, bridged methylene
phosphonate, phosphorothioate, methylphosphonate,
phosphorodithioate, bridged phosphorothioate or sulfone linkages,
and combinations of such linkages.
[0157] The term nucleic acid also specifically includes nucleic
acids composed of bases other than the five biologically occurring
bases (adenine, guanine, thymine, cytosine and uracil).
[0158] Nucleic acids useful in the present invention include, by
way of example and not limitation, oligonucleotides such as
antisense DNAs and/or RNAs; ribozymes; DNA for gene therapy; viral
fragments including viral DNA and/or RNA; DNA and/or RNA chimeras;
various structural forms of DNA including single-stranded DNA,
double-stranded DNA, supercoiled DNA and/or triple-helix DNA;
Z-DNA; and the like. The nucleic acids may be prepared by any
conventional means typically used to prepare nucleic acids in large
quantity. For example, DNAs and RNAs may be chemically synthesized
using commercially available reagents and synthesizers by methods
that are well-known in the art (see, e.g., Gait, 1985,
Oligonucleotide Synthesis: A Practical Approach, IRL Press, Oxford,
England). RNAs may be produce in high yield via in vitro
transcription using plasmids such as SP65 (Promega Corporation,
Madison, Wis.).
[0159] In some circumstances, as where increased nuclease stability
is desired, nucleic acids having modified internucleoside linkages
may be preferred. Nucleic acids containing modified internucleoside
linkages may also be synthesized using reagents and methods that
are well known in the art. For example, methods for synthesizing
nucleic acids containing phosphonate phosphorothioate,
phosphorodithioate, phosphoramidate methoxyethyl phosphoramidate,
formacetal, thioformacetal, diisopropylsilyl, acetamidate,
carbamate, dimethylene-sulfide (--CH.sub.2--S--CH.sub.2),
dimethylene-sulfoxide (--CH.sub.2--SO--CH.sub.2),
dimethylene-sulfone (--CH.sub.2--SO.sub.2--CH.sub.2), 2'-O-alkyl,
and 2'-deoxy-2'-fluoro phosphorothioate internucleoside linkages
are well known in the art (see Uhlmann et al., 1990, Chem. Rev.
90:543-584; Schneider et al., 1990, Tetrahedron Lett. 31:335 and
references cited therein).
[0160] The nucleic acids may be purified by any suitable means, as
are well known in the art. For example, the nucleic acids can be
purified by reverse phase or ion exchange HPLC, size exclusion
chromatography or gel electrophoresis. Of course, the skilled
artisan will recognize that the method of purification will depend
in part on the size of the DNA to be purified.
[0161] The nucleic acid itself may act as a therapeutic agent, such
as for example an antisense DNA that inhibits mRNA translation, or
the nucleic acid may encode a variety of therapeutic transcription
or translation products that will be expressed by the repair cells.
Useful transcription products include antisense RNAs, ribozymes,
viral fragments and the like. Useful translation products include
proteins such as, for example, membrane proteins, transcription
factors, intracellular proteins, cytokine binding proteins, and the
like.
[0162] In a preferred embodiment of the invention, the nucleic acid
is a DNA molecule that encodes gene products that stimulate or
promote healing of wounded or damaged tissues in vivo. The DNA
molecules may include genomic or cDNAs that code for a variety of
factors that stimulate or promote healing, including extracellular,
cell surface and intracellular RNAs and proteins. Alternatively,
the DNA molecules may encode functional proteins which complement
absent or defective gene products arising from genetic defects.
[0163] Examples of extracellular proteins include growth factors,
cytokines, therapeutic proteins, hormones and peptide fragments of
hormones, inhibitors of cytokines, peptide growth and
differentiation factors, interleukins, chemokines, interferons,
colony stimulating factors, angiogenic factors and extracellular
matrix proteins such as collagen, laminin and fibronectin.
[0164] Specific examples of such proteins include, but are not
limited to, the superfamily of TGF-.beta. molecules including the
five TGF-.beta. isoforms and bone morphogenetic factors (BMP),
latent TGF-.beta. binding proteins (LTBP), keratinocyte growth
factor (KGF), hepatocyte growth factor (HGF), platelet derived
growth factor (PDGF), insulin-like growth factor (IGF), the basic
fibroblast growth factors (FGF-1, FGF-2), vascular endothelial
growth factor (VEGF), Factor VIII and Factor IX, erythropoietin
(EPO), tissue plasminogen activator (TPA), activins and
inhibins.
[0165] Examples of hormones that stimulate wound healing that may
be used in the practice of the invention include growth hormone
(GH) and parathyroid hormone (PTH).
[0166] Examples of cell surface proteins include the family of cell
adhesion molecules (e.g., the integrins, selectins, Ig family
members such as N-CAM and LI, and cadherins), cytokine signaling
receptors such as the type I and type II TGF-.beta. known in the
art. Such modifications include the deletion, insertion or
substitution of bases, and thus, changes in the amino acid
sequence. Changes may be made to increase the activity of a
protein, to increase its biological stability or half-life, to
change its glycosylation pattern, and the like. All such
modifications to the nucleotide sequences encoding such proteins
are encompassed by this invention.
[0167] The DNA encoding the transcription or translation products
of interest may be recombinantly engineered into a variety of host
vector systems that provide for replication of the DNA in large
scale for the preparation of coated medical devices. These vectors
can be designed to contain the necessary elements for directing the
transcription and/or translation of the DNA sequence taken up by
the repair cells at the wound in vivo.
[0168] Vectors that may be used include, but are not limited to,
those derived from recombinant bacteriophage DNA, plasmid DNA or
cosmid DNA. For example, plasmid vectors such as pcDNA3, pBR322,
pUC 19/18, pUC 118, 119 and the M13 mp series of vectors may be
used. Bacteriophage vectors may include .lamda.gt10, .lamda.gt11,
.lamda.gt18-23, .lamda.ZAP/R and the EMBL series of bacteriophage
vectors. Cosmid vectors that may be utilized include, but are not
limited to, pJB8, pCV 103, pCV 107, pCV 108, pTM, pMCS, pNNL,
pHSG274, COS202, COS203, pWE15, pWE16 and the charomid 9 series of
vectors.
[0169] Alternatively, recombinant virus vectors including, but not
limited to, those derived from viruses such as herpes virus,
retroviruses, vaccinia viruses, adenoviruses, deno-associated
viruses or bovine papilloma viruses may be engineered. While
integrating vectors may be used, non-integrating systems, which do
not transmit the gene product to daughter cells for many
generations are preferred for wound healing. In this way, the gene
product is expressed during the wound healing process, and as the
gene is diluted out in progeny generations, the amount of expressed
gene product is diminished.
[0170] In order to express a biologically active protein, the
nucleotide sequence coding for the protein may be inserted into an
appropriate expression vector, i.e., a vector which contains the
necessary elements for the transcription and translation of the
inserted coding sequences. Methods which are well known to those
skilled in the art can be used to construct expression vectors
having the protein coding sequence operatively associated with
appropriate transcriptional/translational control signals. These
methods include in vitro recombinant DNA techniques and synthetic
techniques. See, for example, the techniques described in Sambrook,
et al., 1992, Molecular Cloning. A Laboratory Manual, Cold Spring
Harbor Laboratory, N.Y. and Ausubel et al., 1989, Current
Protocolsin Molecular Biology, Greene Publishing Associates &
Wiley Interscience, N.Y.
[0171] The genes encoding the proteins of interest may be
operatively associated with a variety of different
promoter/enhancer elements. The promoter/enhancer elements may be
selected to optimize for the expression of therapeutic amounts of
protein. The expression elements of these vectors may vary in their
strength and specificities. Depending on the host/vector system
utilized, any one of a number of suitable transcription and
translation elements may be used. The promoter may be in the form
of the promoter which is naturally associated with the gene of
interest. Alternatively, the DNA may be positioned under the
control of a recombinant or heterologous promoter, i.e., a promoter
that is not normally associated with that gene. For example, tissue
specific promoter/enhancer elements may be used to regulate the
expression of the transferred DNA in specific cell types.
[0172] Examples of transcriptional control regions that exhibit
tissue specificity which have been described and could be used
include, but are not limited to, elastase I gene control region
which is active in pancreatic acinar cells (Swift et al., 1984,
Cell 38:639-646; Ornitz et al., 1986, Cold Spring Harbor Symp.
Quant. Biol. 50;399-409; MacDonald, 1987, Hepatology 7:42S-51S);
insulin gene control region which is active in pancreatic beta
cells (Hanahan, 1985, Nature 315:115-122); immunoglobulin gene
control region which is active in lymphoid cells (Grosschedl et
al., 1984, Cell 38:647-658; Adams et al., 1985, Nature 318:533-538;
Alexander et al., 1987, Mol. Cell. Biol. 7:1436-1444): albumin gene
control region which is active in liver (Pinkert et al., 1987,
Genes and Devel. 1:268-276) alpha-fetoprotein gene control region
which is active in liver (Krumlauf et al., 1985, Mol. Cell. Biol.
5:1639-1648; Hammer et al., 1987, Science 235:53-58);
alpha-1-antitrypsin gene control region which is active in liver
(Kelsey et al., 1987, Genes and Devel. 1:161-171); beta-globin gene
control region which is active in myeloid cells (Magram et al.,
1985, Nature 315:338-340; Kollias et al., 1986, Cell 46:89-94);
myelin basic protein gene control region which is active in
oligodendrocyte cells in the brain (Readhead et al., 1987, Cell
48:703-712); myosin light chain-2 gene control region which is
active in skeletal muscle (Shani, 1985, Nature 314:283-286); and
gonadotropic releasing hormone gene control region which is active
in the hypothalamus (Mason et al., 1986, Science 234:1372-1378).
Promoters isolated from the genome of viruses that grow in
mammalian cells, (e.g., vaccinia virus 7.5K, SV40, HSV,
adenoviruses MLP, MMTV, LTR and CMV promoters) may be used, as well
as promoters produced by recombinant DNA or synthetic
techniques.
[0173] In some instances, the promoter elements may be constitutive
or inducible promoters and can be used under the appropriate
conditions to direct high level or regulated expression of the gene
of interest. Expression of genes under the control of constitutive
promoters does not require the presence of a specific substrate to
induce gene expression and will occur under all conditions of cell
growth. In contrast, expression of genes controlled by inducible
promoters is responsive to the presence or absence of an inducing
agent.
[0174] Specific initiation signals are also required for sufficient
translation of inserted protein coding sequences. These signals
include the ATG initiation codon and adjacent sequences. In cases
where the entire coding sequence, including the initiation codon
and adjacent sequences are inserted into the appropriate expression
vectors, no additional translational control signals may be needed.
However, in cases where only a portion of the coding sequence is
inserted, exogenous translational control signals, including the
ATG initiation codon must be provided. Furthermore, the initiation
codon must be in phase with the reading frame of the protein coding
sequences to ensure translation of the entire insert. These
exogenous translational control signals and initiation codons can
be of a variety of origins, both natural and synthetic. The
efficiency of expression may be enhanced by the inclusion of
transcription attenuation sequences, enhancer elements, etc.
[0175] In addition to DNA sequences encoding therapeutic proteins
of interest, the scope of the present invention includes the use of
ribozymes or antisense DNA molecules that may be transferred into
or expressed by the mammalian repair cells. Such ribozymes and
antisense molecules may be used to inhibit the transcription of DNA
or translation of RNA encoding proteins that inhibit the healing
process.
[0176] Transferred or expressed anti-sense RNA molecules act to
directly block the translation of mRNA by binding to targeted mRNA
and preventing protein translation. Transferred or expressed
ribozymes, which are enzymatic RNA molecules capable of catalyzing
the specific cleavage of RNA may also be used to block protein
translation. The mechanism of ribozyme action involves sequence
specific hybridization of the ribozyme molecule to complementary
target RNA, followed by a endonucleolytic cleavage. Within the
scope of the invention are engineered hammerhead motif ribozyme
molecules that specifically and efficiently catalyze
endonucleolytic cleavage of RNA sequences. RNA molecules may be
generated by transcription of DNA sequences encoding the RNA
molecule.
[0177] It is also within the scope of the invention that multiple
genes, combined on a single genetic construct under control of one
or more promoters, or prepared as separate constructs of the same
or different types may be used. Thus, an almost endless combination
of different genes and genetic constructs may be employed. Certain
gene combinations may be designed to, or their use may otherwise
result in, achieving synergistic effects on cell stimulation and
regeneration for healing. Any and all such combinations are
intended to fall within the scope of the present invention. Indeed,
many synergistic effects have been described in the scientific
literature, so that one of ordinary skill in the art would readily
be able to identify likely synergistic gene combinations, or even
gene-protein combinations.
[0178] 5.5 Methods of Preparing Coated Devices
[0179] Medical devices such as implants, sutures, wound dressings,
etc. may be coated with the coating compositions of the invention
using conventional coating techniques as are well known in the art.
Such methods include, by way of example and not limitation, dipping
the device in the coating composition, brushing the device with the
coating composition and/or spraying the device with the aerosol
coating compositions of the invention. The device is then dried,
either at room temperature or with the aid of a drying oven,
optionally at reduced pressure. A preferred method for coating
surgical sutures is provided in the examples.
[0180] In some cases, the coating compositions of the invention may
not adhere well to the device being coated. Such may be the case
for orthopedic surgical implants such as titanium pins and other
devices constructed of metallic materials. In these cases, it may
be desirable to first coat the device with material having an
affinity for both the device and the compositions of the invention,
and then to further coat the device with the coating compositions
of the invention.
[0181] The aerosol coating compositions of the invention may be
dispensed in the form of a spray or a foam (British Patent No.
1,372,721), and may form a foam (U.S. Pat. No. 5,378,451) or a gel
(U.S. Pat. No. 4,534,958) on the application site. The density of
the coating can vary from a few micrometers to millimeters,
depending on the dose of the pharmaceutical agent to be
delivered.
[0182] Applying coating compositions in the form of aerosols is
particularly useful for coating medical devices just prior to using
the device, such as on-the-spot spraying of surgical implants just
prior to implantation or bandages just prior to applying the
bandage. This will reduce the possibility of removing the coating
through excessive handling.
[0183] It is important that the devices be coated with a polymeric
matrix containing a pharmaceutically effective amount of
pharmaceutical agent, and that the coat be relatively continuous
and uniform. To achieve a pharmaceutically effective uniform
coating, the device may be coated several times, typically with
drying in between each application of coating composition. Thus,
for example, the device may be dipped several times in a coating
composition, or sprayed several times with a coating composition.
The coating process may be repeated as many times as is required to
coat the device with a pharmaceutically effective coating.
[0184] The number of coats can be varied from a single coat to as
many as 100 or more. Typically, the number of coats will be in the
range of about 5 to 50, and preferably in the range of about 20 to
30. After each coating, the device is air dried for about 1 to 30
minutes, preferably about 5 to 10 minutes, before applying the next
coating.
[0185] After applying a sufficient number of coatings the coated
device is air-dried for a period of time sufficient to evaporate a
substantial amount of the organic solvents. Typically, the device
will be air-dried for about 12-48 hours, preferably for about 16-24
hours. Alternatively, the device is dried under reduced pressure,
e.g, at about 10 to 400 mmHg, preferably at about 50 to 100
mmHg.
[0186] For sutures coated with a polymeric matrix containing
plasmid DNA, it has been found that applying a coating composition
containing a total of about 0.01 to 10 mg plasmid DNA, and
preferably about 1 to 5 mg plasmid DNA, to a 70 cm length of suture
using about 5 to 100, preferably about 5 to 50, and more preferably
about 15 to 30 coating applications, yields a therapeutically
effective and uniform coating.
[0187] In a preferred embodiment of the invention a medical device
is coated with a polymeric matrix in the form of microspheres
and/or nanospheres. Such coated devices, by releasing microspheres
and/or nanospheres into the local area surrounding the coated
medical device are particularly suited for intracellular as well as
extracellular local delivery of pharmaceutical agents.
[0188] Coatings comprised of microspheres and/or nanospheres may be
obtained with either the emulsion or suspension coating
compositions of the invention. While not intending to be bound by
theory, it is believed that applying a milky emulsion suitable for
the preparation of microspheres and/or nanospheres to a medical
device may favor the formation of a polymeric matrix coating
comprising micrometer and/or nanometer sized particles rather than
the formation of a smooth polymer sheath.
[0189] The formation of a polymeric matrix coating comprised of
microspheres and/or nanospheres may be facilitated in several
fashions. For example, such a polymeric matrix can be facilitated
by "nucleating" the formation of microspheres and/or nanospheres in
the emulsion coating compositions of the invention prior to coating
the device. After the device has been coated, evaporation of
residual solvents deposits a coating of microspheres and/or
nanospheres containing pharmaceutical agents onto the device.
[0190] Microspheres and/or nanospheres may be nucleated by
preparing a coating composition wherein the components of the
composition are at "critical concentrations" for microsphere and/or
nanosphere formation. Such critical concentrations can be achieved
by preparing an emulsion coating composition, as previously
described, and partially evaporating the emulsion solvents with
stirring prior to coating the device. Generally, evaporating about
5% to 60% by volume of the coating composition prior to coating the
device yields a composition that favors the formation of
microsphere and/or nanospheres when applied to a medical device.
Preferably, about 15% to 50% by volume of the composition is
evaporated prior to coating the device.
[0191] The formation of a polymeric matrix coating comprised of
microspheres and/or nanospheres may also be facilitated by first
imparting the device to be coated with emulsifier characteristics,
as such characteristics are believed to enhance microsphere and/or
nanosphere formation. The device can be imparted with emulsifier
characteristics by first coating the device with a polymer having
emulsifier characteristics, such as polyurethane derivatized with
long chain fatty acids (Pitt and Cooper, 1988, J. Biomed. Res.:
359-382), or other fatty acid-derivatized polymers as are well
known in the art. Compositions containing fatty-acid derivatized
polymers suitable for coating the device may be prepared by the
methods described herein, or by methods known in the art. The
device is then coated with the coating compositions of the
invention as described herein.
[0192] Alternatively, the device can be imparted with emulsifier
characteristic by first coating the device with a polymeric matrix
containing an emulsifier, and then coating the device with the
coating compositions of the invention. Suitable compositions for
coating the device with an emulsifier can be prepared by the
methods described herein, generally without including a
pharmaceutical agent. In this case, the emulsifying agent is
typically included in the composition in an amount of about 1% to
10% (w/v), preferably about 1% to 5% (w/v).
[0193] In another embodiment, a medical device may be coated with a
polymeric matrix comprised of microspheres and/or nanospheres using
the coating suspensions of the invention. To coat a device, a
coating suspension comprising pre-formed microspheres and/or
nanospheres, prepared as previously described, is used to coat a
medical device. Once applied to the device, evaporation of the
solvents deposits microspheres and/or nanospheres onto the surface
of the device. The device may be coated with multiple applications,
as previously described. Adherence of the spheres to the device may
be improved by the use of bioadhesives, as previously 4'
described.
[0194] The microspheres and/or nanospheres may also be covalently
attached to the device using chemistries commonly employed in the
art of affinity chromatography (see, e.g. BioRad Laboratories,
Richmond, Calif. and Pharmacia BioTech, Uppsala, Sweden, products
catalogues and references cited therein). Reactive functional
groups suitable for covalent attachment of microspheres and/or
nanospheres to a device include, by way of example and not
limitation, aldehydes, amines, amides, anhydrides, carboxylic
acids, epoxides, hydrazides, hydroxyls, thiols and the like.
[0195] For covalent attachment, the spheres and the medical device
are "activated" to have free reactive functional groups on their
surfaces. The spheres and medical device will have complementary
reactive groups such that when the medical device is contacted with
the spheres under suitable conditions a covalent linkage forms.
Such complementary reactive groups include, by way of example and
not limitation, epoxides and hydroxyl, amino, sulfhydryl, carboxyl,
anhydride and phenol groups; carboxylic acids and hydroxyl or amine
groups; and others as will be readily apparent to those having
skill in the art of synthetic chemistry. Preferably, the
complementary functional groups will react to form covalent
linkages under relatively mild conditions.
[0196] Generally, activated microspheres and/or nanospheres will be
comprised of biocompatible biodegradable polymers having free
reactive functional groups, or alternatively, will have
incorporated therein or attached thereto an amount of polymer or
linker having free reactive functional groups sufficient to allow
covalent attachment of the microspheres and/or nanospheres to the
device.
[0197] Suitable polymers having free reactive functional groups are
known in the art and include, by way of example and not limitation,
PLGA, polyacrylic acid, poly(sodium acrylate), polyalkylacrylic
acid, poly(sodium alkylacrylate), poly(alkylene oxide), polystyrene
sulfonic acid, polystyrene carboxylic acid and the like (available
from Polymer Source, Inc., Dorval, Quebec, Canada). Suitable
linkers having free reactive functional groups are well known in
the art of affinity chromatography, as well as other arts.
[0198] Typically, when incorporated into or attached to the
spheres, an amount of linker or polymer that does not affect the
controlled release properties of the microspheres and/or
nanospheres is preferred. Generally, the microspheres and/or
nanospheres will contain about 0.1% to 10% (w/w), preferably about
1% to 5% (w/w), polymer or linker having free reactive functional
groups.
[0199] In one embodiment, the microspheres and/or nanospheres are
comprised of, or have incorporated therein in an amount suitable
for covalent attachment to a medical device, a hydroxy-terminated
or epoxide-terminated poly(.epsilon.-caprolactone)-polyether
multiblock copolymer (described in copending U.S. Ser. No.
08/389,893, filed Feb. 16, 1995, particularly at pp. 76-96, the
disclosure of which is incorporated herein by reference).
Hydroxy-terminated or epoxide-terminated
poly(.epsilon.-caprolactone)-polyether multiblock copolymers are
comprised of hydrophilic segments, which may be a hydrophilic
polyether such as poly(ethylene glycol), and hydrophobic
poly(.epsilon.-caprolactone) ("PCL") segments.
[0200] Block copolymers containing a hydrophobic PCL segments and
hydrophilic segments may be synthesized by multiple reactions
between hydroxyl end groups and epoxide groups, as illustrated in
FIG. 6. The illustrative reaction scheme of FIG. 6 can be used to
chemically link copolymer blocks in ABA-, BAB-, as well as
(AB).sub.n-type block copolymers such that the hydrophobicity and
MW of the block copolymers can be tailored as desired.
[0201] Referring to FIG. 6, compound 30 is polycaprolactone diol
("PCL-diol"). The highest MW PCL-diol commercially available has a
MW of 3000, which is not high enough to serve as a main segment in
a copolymer for sustained release of pharmaceutical agents. In
order to obtain a higher MW PCL-diol which will be a solid at the
contemplated temperatures of use, PCL-diol (compound 30) is reacted
with a polyfunctional epoxide compound (compound 31), such as the
difunctional epoxide sold under the trademark DENACOL EX252.TM.
(Nagasi Chemicals, Osaka, Japan). Using an excess of PCL-diol
(about a 2.5:1 molar ratio) yields a polymer chain having PCL-diol
as an end group. Reversing the molar ratio yields a polymer having
an epoxide end group. The result of the reaction is an expanded
PCL-diol, which in the case of FIG. 6 has the structure
HO-PCL-EX252-PCL-OH (compound 33).
[0202] Epoxide compounds suitable for preparing the block
copolymers described herein include epoxide monomers, polyepoxide
compounds and epoxide resins. Illustrative bifunctional or
polyfunctional epoxide compounds include, but are not limited to,
1,2-epoxides (e.g., ethylene oxide, 1,2-propylene oxide, etc.),
alkyldiol diglycidyl ethers (e.g., butanediol diglycidyl ether,
Aldrich Chemicals, St. Louis, Mo.), erythritol anhydride,
polyfunctional polyglycerol polyglycidyl ethers sold under the
trademark DENACOL (Nagasi Chemicals, Osaka, Japan), epichlorhydrin
(Alrich Chemical, St. Louis, Mo.), enzymatically-inducible epoxides
(Sigma Chemical Co., St. Louis, Mo.) and photo-polymerizable
epoxides (Pierce, Rockford, Ill.).
[0203] Expanded PCL-diol 33 is reacted with excess multifunctional
epoxide 31 to achieve end-capping of the expanded PCL-diol 33 with
epoxide groups, yielding epoxide-capped compound 34. Referring to
FIG. 6, one of the two epoxide groups in difunctional epoxide 31
reacts with the hydroxyl ends of PCL-diol compound 33, leaving the
other epoxide group free so that both ends of the PCL-diol are
capped with an epoxide group, resulting in an epoxide capped
polymer, EX252-PCL-EX252-PCL-EX252 (compound 34).
[0204] Compound 34 (Block A) is reacted with excess polyether diol
35 (Block B). In the embodiment illustrated in FIG. 6, polyether
diol 35 is polyethylene glycol (PEG; MW 4500). The resulting
copolymer is a BAB-type triblock copolymer 36 linked with epoxides
and terminated at both ends with hydroxyl groups. An ABA-type
triblock copolymer can be formed using excess Block A. Higher order
multiblock polymers may be made using ABA- or BAB-type triblock
copolymers as reactants (analogous to compound 33) in the general
reaction scheme of FIG. 6. A person of ordinary skill can devise a
multiplicity of hydroxy- and/or epoxide-terminated block polymers
using the techniques described herein.
[0205] Of course, other hydrophobic polymers may be used for Block
A, including, for example, polylactides, polyglycolides, PLGA,
polyanhydrides, polyamino acids and biodegradable polyurethanes.
Other hydrophilic polymers suitable for multiblock copolymers
include polaxomers such as block copolymers of ethylene oxide and
propylene oxide sold under the trademarks PLURONIC F-68.TM. and
PLURONIC F-127% (registered trademarks of BASF; available from
Sigma Chemical Co., St. Louis, Mo.) and poly(alkylene oxides) such
as poly(propylene oxide) ("PPO").
[0206] In choosing polymers for Blocks A and B a person of ordinary
skill in the art would choose an optimal balance of hydrophilic and
hydrophobic molecules for a particular application. More
hydrophilic polymers will have faster drug releasing properties and
vice versa. Other physical properties affecting the release
kinetics are those previously described. A person having ordinary
skill in the art will be able to choose a balance of desirable
properties suited to a particular application without undue
experimentation.
[0207] The MW of the above-described block copolymers is generally
in the range of about 30,000 to 700,000 as measured by gel
permeation as previously described. A MW of about 90,000 to 100,000
is preferred. Methods for preparing preferred block copolymers are
provided in the Examples.
[0208] A significant advantage of forming microspheres and/or
nanospheres for covalent attachment to a medical device with the
multiblock copolymers described above is their ability to form
spheres without the aid of an emulsifying agent. While not
intending to be bound by theory, it is believed that when
copolymers containing hydrophobic and hydrophilic blocks are added
to an aqueous phase, the hydrophilic block will orient towards the
aqueous phase and the hydrophobic block will orient towards the
center of the emulsion droplet. Thus, a microsphere and/or
nanosphere core consisting of a hydrophobic portion with a
hydrophilic surface is formed. The outwardly facing hydrophilic
segment, such as for example PEG, is a very good emulsifier and
will assist in the formation of an emulsion. Moreover, it is
believed that the PEG hydrophilic segment will also stabilize the
emulsion and prevent aggregation of the emulsion droplets.
[0209] In another embodiment, microspheres and/or nanospheres are
activated with reactive epoxide groups by covalently attaching a
multifunctional epoxide compound to the surface of the spheres. The
spheres are prepared using the methods described herein, or
conventional means, as previously described. The spheres are
comprised of PLGA or any biocompatible biodegradable polymer having
a free functional group capable of forming a covalent bond with an
epoxide, as previously described, such as for example the
hydroxy-terminated poly(.epsilon.-caprolactone)-polyether
multiblock copolymers described above.
[0210] The microspheres and/or nanospheres are contacted with a
multifunctional epoxide under conditions conducive to forming a
covalent bond between the epoxide compound and the free reactive
functional group on the biocompatible biodegradable polymer
comprising the spheres. Preferably, the reaction conditions are
relatively mild.
[0211] For example, the reaction may be carried out in mild
conditions by use of a catalyst. Suitable catalysts include, but
are not limited to, zinc tetrafluoroborate, tertiary amines,
guanidine, imidazole, boron trifluoride adducts (e.g., boron
trifluoride-monoethylamine), bisphosphonates, trace metals (e.g.,
zinc, tin, magnesium, aluminum, etc.) and ammonium complexes (e.g.,
PhNH.sub.3.sup.+ AsF.sub.6.sup.-).
[0212] Alternatively, the reaction can be initiated by UV light in
the presence of an appropriate catalyst. Suitable catalysts
include, but are not limited to, titanium tetrachloride, ferrocene
(dicyclopentadieneyliron), zirconocene chloride, carbon
tetrabromides and iodoform.
[0213] Of course, the actual reaction conditions used may depend on
the free reactive functional groups on the biocompatible
biodegradable polymer and the pharmaceutical agents contained in
the microspheres and/or nanospheres. Suitable reaction conditions
are well known in the art of organic chemistry (see, e.g.,
Streitwieser & Heathcock, Introduction to Organic Chemistry,
Macmillan Publishing Co., New York, latest edition; Smith, 1994,
Organic Synthesis, McGraw-Hill, Inc.), and will be readily apparent
to those having skill in the art.
[0214] Epoxide compounds useful for preparing epoxide activated
microspheres and/or nanospheres are those described above.
[0215] Preferred methods of preparing epoxide activated
microspheres and/or nanospheres suitable for covalent attachment to
medical devices are provided in the Examples.
[0216] The epoxide-activated microspheres and/or nanospheres are
then contacted with an activated medical device under conditions
conducive to forming a covalent bond between the epoxide group(s)
on the spheres and the free reactive group(s) on the activated
medical device, such as the conditions previously described.
[0217] The medical device may be activated to have free reactive
functional groups by chemically treating the device to derivatize
the surface of the device with free reactive functional groups. The
chemical treatment methods will depend on the composition of the
device, and will be readily apparent to those having skill in the
art.
[0218] In cases where the device is difficult to derivatize with
reactive groups, the device may be activated by coating the device
with a coating composition comprising polymers or linkers having
free reactive functional groups complementary to the functional
groups on the activated microspheres and/or nanospheres. The device
is then contacted with activated microspheres and/or nanospheres
under conditions wherein the reactive groups on the activated
spheres react with the reactive groups on the device, forming a
covalent linkage. The coated device may be rinsed to remove excess
reagents and dried, as previously described. The device may be
coated multiple times, as previously described.
[0219] 5.6 Medical Devices
[0220] The compositions and methods of the invention can be used to
coat virtually any medical device. The coated devices will provide
a convenient means for local administration of a wide variety of
pharmaceutical agents. For example, the compositions of the
invention can be used to coat bandages and wound dressings; sutures
(degradable and non-degradable); orthopedic protheses such as
supporting rod implants, joint protheses, pins for stabilizing
fractures, bone cements and ceramics, and tendon reconstruction and
prosthetic implants; cardiovascular implants such as heart valve
prostheses, pacemaker components, defibrillator components,
angioplasty devices, intravascular stents, acute and in-dwelling
catheters, ductal arteriosus closure devices, and implants
deliverable by cardiac catheters such as atrial and ventricular
septal defect closure devices; urologic implants such as urinary
catheters; neurosurgical implants such as neurosurgical shunts;
ophthalmologic implants such as lens prosthesis, thin ophthalmic
sutures and corneal implants; dental prostheses; internal and
external wound dressings including bandages and hernia repair
meshes; and other devices and implants as will be readily apparent
to those having skill in the art.
[0221] In a particularly preferred embodiment, the invention
provides coated sutures, especially sutures coated with a polymeric
matrix containing nucleic acids that stimulate wound healing in
vivo. Sutures which may be coated in accordance with the methods
and compositions of the present invention include any suture of
natural or synthetic origin. Typical suture materials include, by
way of example and not limitation, silk; cotton; linen; polyolefins
such as polyethylene and polypropylene; polyesters such as
polyethylene terephthalate; homopolymers and copolymers of
hydroxycarboxylic acid esters; collagen (plain or chromicized);
catgut (plain or chromicized); and suture-substitutes such as
cyanoacrylates. The sutures may take any convenient form such as
braids or twists, and may have a wide range of sizes as are
commonly employed in the art.
[0222] The advantages of coated sutures, especially sutures coated
with a polymeric matrix containing nucleic acids that stimulate
wound healing, cover virtually every field of use for sutures in
humans and animals.
6. EXAMPLE
Preparation and Use of a Suture Coated with Marker DNA
[0223] To demonstrate the feasibility of the coating compositions
and methods of the invention, a surgical suture was coated with
marker plasmid DNA (encoding human placental alkaline phosphatase)
and used to suture rat muscle tissue. The experiment demonstrates
successful transfer and expression of DNA in the tissue repaired
with the coated suture.
[0224] 6.1 Preparation of DNA-PLGA Coating Composition
[0225] To 1.5 mL of a PLGA/chloroform solution (3% (w/v), 50/50
polylactic polyglycolic acid PLGA co-polymer, ave. MW 90,000,
inherent viscosity 1.07) was added 0.2 mL of a solution containing
marker plasmid DNA encoding human placental alkaline phosphatase (1
mg DNA, 0.5 mM Tris-EDTA, 0.5 mM EDTA, pH 7.3). The solution was
emulsified by vortexing for 2 minutes followed by sonicating for 30
seconds at about 0.degree. C. using a microtip probe-type sonicator
at 55 Watts output. This process yielded an emulsion that looked
very milky.
[0226] 6.2 Coating a Surgical Suture
[0227] A hole was pierced in a piece of Teflon-coated foil (Norton
Performance Plastic Corp., Akron, Ohio) using a 22-gauge needle. On
the hole was placed a drop (about 60 .mu.L) of the DNA-PLGA
emulsion. A 70 cm length of 3-0 chromic suture (Ethicon) was drawn
through the hole to coat the suture. As the suture passed through
the hole it became coated with a thin (ca. 30 .mu.m), uniform
coating of the coating composition. The suture was allowed to air
dry for about 3 minutes, and the coating process repeated 15 times,
allowing each coat to air dry.
[0228] The coated suture was examined by electron microscopy
(150.times.). Referring to FIG. 2, panel 1 shows an un-coated
suture; panel 2 shows a suture coated according to the method
described above; and panel 3 shows a coated suture that had been
passed through rat skeletal muscle about 25 to 30 times. The black
spots in panel 3 are red blood cells that adhered to the suture
after passing through the tissue; black spots in panel 3 are blood
clots. As is apparent in FIG. 2, the suture was coated with a
uniform coating of DNA-PLGA. Furthermore, the coating remained
intact even after passing the suture through tissue multiple
times.
[0229] 6.3 Repairing Skeletal Muscle with the Coated Suture
[0230] The suture prepared above was sewn into the skeletal muscle
tissue of adult male Sprague-Dawley rats using approved protocols
and standard methods. The suture exhibited good tie-down
properties. One week later, skeletal muscle was harvested, snap
frozen in liquid nitrogen and ground into a powder. The powder was
incubated in 200 .mu.L lysis buffer, exposed to three freeze-thaw
cycles and clarified. The clear liquid was assayed for heat stable
alkaline phosphatase activity after incubation at 65.degree. C.
using commercially available reagents and protocols
(Phospha-Lite.TM. Chemiluminescent Reporter Assay for Secreted
Alkaline Phosphatase, Tropix, Bedford, Mass.). The control group
consisted of animals that received uncoated suture. The data are
presented in FIG. 1.
[0231] 6.3.1 Results
[0232] As illustrated in FIG. 1, rat skeletal muscle sewn with
coated sutures and retrieved after one week exhibited heat stable
alkaline phosphatase activity, signifying that the marker alkaline
phosphatase gene was expressed in the muscle tissue. Control
retrievals showed no significant alkaline phosphatase activity.
These data demonstrate that emulsions can be used to effectively
coat sutures and deliver genes to proliferating repair cells in
vivo.
EXAMPLE
Preparation of Coated Screws and Ceramic Particles
[0233] To demonstrate the ability of the coating compositions of
the invention to coat a variety of materials a stainless steel
screw, titanium screw and hydroxyapatite-tricalcium phosphate
("HTP") ceramic particles were coated with the DNA-polymer emulsion
described in the above example.
[0234] FIG. 3 shows scanning electron micrographs (with carbon
sputtering) of a stainless steel screw before (panel A) and after
(panel B) coating. The grooves of the screw clearly have a
different contrast before and after coating, demonstrating that the
DNA-polymer emulsion covered the grooves with a uniform polymeric
coating. General surface defects visible in the uncoated screw were
fill in by the DNA-polymer coating.
[0235] FIG. 4 shows scanning electron micrographs of a standard
orthopedic titanium screw before (pane A) and after (panel B)
coating. The coating of the surface is very evident from
contrasting electron density of the uncoated screw (panel A) with
the relatively darker coated screw (panel B). These results
indicate a uniform coating was obtained.
[0236] FIG. 5 shows scanning electron micrographs of uncoated HTP
ceramic particles (panel A) and coated HTP ceramic particles (panel
B). As compared with the highly reflective uncoated particles,
coated particles appear less bright and densely covered with a
polymeric coating. The DNA-polymer coating allows retention of the
particulate formate while uniformly covering the particles with a
DNA-releasing polymeric matrix.
EXAMPLE
Preparation of a Suture Coated with Microspheres and/or Nanospheres
Containing Marker DNA
[0237] This example demonstrates a preferred method for preparing
epoxide-activated microspheres and/or nanospheres suitable for
covalent attachment to a medial device, and methods for covalently
attaching the activated spheres to a surgical suture.
[0238] 8.1 Preparation of DNA-PLGA Microspheres and/or
Nanospheres
[0239] A DNA-polymer composition is prepared as descried in Example
6.1. The DNA-polymer emulsion is further emulsified with an aqueous
solution of polyvinyl alcohol (2.5% w/w, 15 mL, 30,00-70,000 ave.
MW PVA) by sonication at 65 Watts for 10 min. at 0.degree. C. to
yield a W/O/W emulsion.
[0240] The W/O/W emulsion is stirred with a magnetic stirring bar
at room temperature for 18 hours to evaporate organic solvent. The
spheres are recovered by ultracentrifugation, washed three times
with water, resuspended in water by sonication for 30 seconds, and
the resultant suspension lyophilized.
[0241] 8.2 Preparation of Epoxide-Activated Spheres
[0242] Lyophilized spheres (8 mg) are suspended in borate buffer (1
mL, 50 mM, pH 5) by sonication for 3 min. Zinc tetrafluoroborate
hydrate (2.4 mg) is added to the suspension. A polyfunctional
epoxide, DENACOL EX520.TM. (Nagasi Chemicals, Osaka, Japan) is
dissolved in 0.4 mL borate buffer (50 mM, pH 5), and the epoxide
solution added to the suspension with stirring at room temp
(37.degree. C.). After 30 min., the spheres are recovered by
ultracentrifugation, washed three times with water to remove
unreacted epoxide, and lyophilized.
[0243] 8.3 Coating a Surgical Suture
[0244] A length of surgical suture is coated with PLGA polymer
using the method described in Example 6. Epoxide activated spheres
(200 mg) are suspended in borate buffer (1 mL, 50 mM, pH 5) by
sonication for 30 seconds. Zinc tetrafluoroborate hydrate (2.4 mg)
is added to the suspension. The PLGA-coated suture is coated with
the suspension using the method of Example 6.2, or alternatively,
by dipping the suture in the suspension. After 30 min. at room temp
(37.degree. C.) the suture is rinsed with water and dried. The
coating process may be repeated as described in Example 6.2.
[0245] 8.4 Repairing Skeletal Muscle with the Coated Suture
[0246] The microsphere and/or nanosphere coated suture may be used
to repair rat skeletal muscle tissue as described in Example 6.3.
It is expected that marker DNA will be taken up and expressed by
proliferating repair cells.
EXAMPLE
Preparation of Multiblock Copolymers
[0247] This example demonstrates methods of preparing preferred
hydroxy- or epoxide-terminated multiblock copolymers.
[0248] 9.1 Preparation of Expanded PCL-Diol (Compound 33)
[0249] PCL-diol (1.5 g, 0.5 mmol, MW 3000, Polyscience, Inc.,
Warrington, Pa.) was reacted with DENACOL EX252.TM. (0.21 g, 0.55
mmol, Nagasi Chemicals, Osaka, Japan) in 15 mL THF in the presence
of Zn(BF.sub.4).sub.2 catalyst (2% by weight according to epoxide
compound) at 37.degree. C. with stirring for 28 hours. To separate
the expanded PCL-diol from the non-expanded PCL-diol, gradient
precipitation was carried out using heptane and the precipitated,
higher MW expanded PCL-diol collected by centrifugation. The
product, HO-PCL-EX252-PCL-OH, was washed with 5 mL heptane to
remove unreacted epoxide compound and dried.
[0250] 9.2 Preparation of Compound 34
[0251] Compound 33 (0.75 g) was reacted with excess DENACOL
EX252.TM. (0.42 g; molar ratio of Compound 33 to DENACOL EX252.TM.
was 1:4) in 10 mL THF, in the presence of Zn (BF.sub.4).sub.2
catalyst, at 37.degree. C. with stirring for 5 hours. The
EX252-PCL-EX252-PCL-EX252 polymer product was precipitated with 30
mL heptane, washed with to mL heptane to remove unreacted epoxide
compound and dried.
[0252] 9.3 Preparation of Compound 36
[0253] Compound 34 (1 g) was dissolved in 15 mL THF to which excess
polyethylene glycol (PEG) (ave. MW 4500; molar ratio compound 34 to
PEG was 1:3) and 20 mg Zn(BF.sub.4) catalyst had been added. The
reaction proceeded for 48 hours on a shaker table at 37.degree. C.
Compound 36 was precipitated with heptane, collected by
centrifugation, washed twice with 50 mL water and dried.
[0254] 9.4 Preparation of Other ABA-Type Triblock Copolymers
[0255] Additional ABA-type and BAB-type triblock copolymers were
prepared using the general methods described above using the
following polyethers as Block A: PEG (ave. MW 4500); the polaxomers
PLURONIC F-68.TM. (F-68) and PLURONIC F-127.TM. (F-127); and poly
propylene oxide) (PPO). The various polyethers were incorporated
into ABA-type and BAB-type triblock copolymers with PCL-diol to
obtain polymers having varying hydrophilicity and mechanical
properties. PLURONICS.TM. are diblock copolymers having PPO as the
hydrophobic block and polyethylene oxide) (PEO) as the hydrophilic
block. PF-127 has a MW of about 12,600 and is 70% PPO and 30% PEO.
F-68 has a MW of about 6,000 and is 80% PPO and 20% PEO, and hence,
is less hydrophilic that F-127. PEG is the most hydrophilic
polyether in the group.
[0256] The various block copolymers prepared and their respective
physical properties are provided in Table 1, below. TABLE-US-00001
TABLE 1 ABA-Type and BAB-Type Triblock Copolymers Water
Film-Forming Polymer Type Morphology Solubility Properties
PCL/PEG/PCL crystallizable insoluble strong, flexible powder
PEG/PCL/PEG crystallizable swells flexible, breaks powder in water
PCL/F-68/PCL crystallizable insoluble strong, flexible powder
F-68/PCL/F-68 crystallizable insoluble flexible powder
PCL/F-127/PCL crystallizable swells brittle film powder PCL/PPO/PCL
sticky wax insoluble does not form film The "/" marks indicate
DENACOL EX252 .TM. epoxide linkages
[0257] Referring to Table 1, the most useful polymers, from the
viewpoint of sustained release of pharmaceutical agents, are
copolymers comprised of PCL and PEG or F-68. Polymers which do not
crystallize, such as those containing a high level of PPO, have
poor mechanical strength and are sticky. Polymers having a large
hydrophilic segment, such as the polymer containing PCL and F-127,
are difficult to separate from the aqueous phase and will not
maintain a solid shape in contact with water or body fluids.
[0258] Preferred copolymers are solid at body temperature and are
slowly biocompatible and slowly biodegradable in the presence of
body fluids.
[0259] The present invention is not to be limited in scope by the
exemplified embodiments which are intended as illustrations of
single aspects of the invention. Indeed, various modifications of
the invention in addition to those described herein will become
apparent to those killed in the art from the foregoing description
and accompanying drawings. Such modifications are intended to fall
within the scope of the appended claims.
[0260] All patents and publications cited herein are incorporated
herein in their entireties for all purposes.
* * * * *