U.S. patent application number 12/612133 was filed with the patent office on 2010-03-04 for implantable biosensor devices for monitoring cardiac marker molecules.
This patent application is currently assigned to Medtronic, Inc.. Invention is credited to Tommy D. Bennett, Ven Manda, Zhongping Yang.
Application Number | 20100056885 12/612133 |
Document ID | / |
Family ID | 34217759 |
Filed Date | 2010-03-04 |
United States Patent
Application |
20100056885 |
Kind Code |
A1 |
Manda; Ven ; et al. |
March 4, 2010 |
IMPLANTABLE BIOSENSOR DEVICES FOR MONITORING CARDIAC MARKER
MOLECULES
Abstract
An implantable biosensor system is disclosed for determining
levels of cardiac markers in a patient to aid in the diagnosis,
determination of the severity and management of cardiovascular
diseases. The sensor includes nanowire sensor elements having a
biological recognition element attached to a nanowire transducer
that specifically binds to the cardiac marker being measured. Each
of the sensor elements is associated with a protective member that
prevents the sensor element from interacting with the surrounding
environment. At a selected time, the protective member may be
disabled, thereby allowing the sensor element to begin sensing
signals within a living body.
Inventors: |
Manda; Ven; (Stillwater,
MN) ; Bennett; Tommy D.; (Shoreview, MN) ;
Yang; Zhongping; (Woodbury, MN) |
Correspondence
Address: |
MEDTRONIC, INC.
710 MEDTRONIC PARKWAY NE
MINNEAPOLIS
MN
55432-9924
US
|
Assignee: |
Medtronic, Inc.
Minneapolis
MN
|
Family ID: |
34217759 |
Appl. No.: |
12/612133 |
Filed: |
November 4, 2009 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
10652837 |
Aug 29, 2003 |
7632234 |
|
|
12612133 |
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Current U.S.
Class: |
600/309 |
Current CPC
Class: |
A61B 5/0031 20130101;
A61N 1/36514 20130101; A61B 5/14532 20130101; A61B 5/14865
20130101 |
Class at
Publication: |
600/309 |
International
Class: |
A61B 5/145 20060101
A61B005/145 |
Claims
1. A method for determining the presence or amount of an analyte
present in a patient, comprising: a. implanting in the patient a
sensor element comprising a biological recognition element
associated with a portion or portions of a transducer, the
biological recognition element being capable of specifically
binding to a substance in the patient in an amount related to the
presence or amount of the analyte and wherein when the substance is
bound to the biological recognition element a detectable signal is
produced; and a controller connected to the sensor element adapted
to measure detectable signal produced and that can relate the
amount of detectable signal measured with the presence or amount of
analyte present in the patient; b. contacting the biological
recognition element to tissue or fluid in the patient to allow the
substance to bind to the biological recognition element; c.
measuring the amount of detectable signal produced when the
substance binds to the biological recognition element; and d.
relating the amount of detectable signal produced to the amount or
presence of analyte present in the patient.
2. The method of claim 1, wherein the substance that specifically
binds to the biological recognition element is the analyte being
measured.
3. The method of claim 1, further including providing a protective
member is located adjacent the sensor element to shield the
biological recognition member from a surrounding environment for a
selectable time period and removing the protective member or a
portion thereof so that the biological recognition element can
contact tissue or fluid in the patient.
4. The method of claim 1, wherein the transducer comprises a
nanowire and a detector constructed and arranged to determine a
property associated with the nanowire and the biological
recognition element is positioned relative to the nanowire such
that an interaction between the biological recognition element and
the substance in the patient produces a detectable change in the
property to produce the detectable signal.
5. The method of claim 4, wherein the nanowire comprises a gated
nanowire field effect transistor wherein an electrical property of
the nanowire is sensitive to a change on a surface of the
nanowire.
6. The method of claim 4, wherein the sensor element is implanted
within the intra-cardiac circulatory system of the patient's heart
and the analyte is a cardiac marker.
7. The method of claim 6, wherein the sensor element is implanted
within the coronary sinus.
8. The method of claim 6, wherein the sensor element is implanted
within a cardiac vein.
9. The method of claim 6, wherein the cardiac marker is a marker
selected from the group consisting of BNP, pre proBNP, NT pro BNP,
C-type reactive protein, Troponin I, Troponin T, Myoglobin, D-Dimer
and cytokines and the biological recognition element specifically
binds the analyte.
10. The method of claim 6, wherein the cardiac marker is BNP or a
marker related to BNP levels.
11. The method of claim 6, further comprising providing a plurality
of sensor elements and a plurality of protective members coupled to
a controller, and disabling at least one of the protective members
to activate one or more of the sensor elements.
12. The method of claim 6, wherein one or more of a first set of
sensor elements comprise a biological recognition element that
specifically binds to a first substance in an amount related to the
presence or amount of a first cardiac marker and one or more of a
second set of sensor elements comprise a biological recognition
element that specifically binds to a second substance in an amount
related to the presence or amount of a second cardiac marker.
13. The method of claim 12, further including disabling one or more
protective members shielding sensor elements of the first set to
activate one or more of the sensor elements in that set and
simultaneously or sequentially disabling one or more protective
members shielding sensor elements of the second set to activate one
or more of the sensor elements in that set.
14. The method of claim 13, wherein the first and second cardiac
marker being measured is chosen because the level of one cardiac
marker is a marker of cardiac cell injury and the other cardiac
marker is a marker that indicates a pressure or volume change or
stress of the patient's heart.
15. The method of claim 11, wherein each of the sensor elements
includes a known amount of biological recognition element attached
to the nanowire, and wherein the biological recognition element in
each sensor element is the same and each sensor element is shielded
from the surrounding environment by one or more protective members,
and further including adjusting the sensitivity of the measurement
of cardiac marker being measured by disabling one or more
protective members to activate a desired number of sensor elements
for a selected period of time.
16. The method of claim 6, further including a therapy delivery
system coupled to a controller and the sensor to provide therapy to
the patient, wherein the parameters of the therapy will vary based
on the measurements of levels of the cardiac marker in the
patient.
17. The method of claim 11, including one or more protective
members formed of a material that substantially dissolves within a
living body over the selectable time period.
18. The method of claim 11, wherein one or more protective members
are associated with a controller connected to a cathode and an
anode capable of causing a current to flow through and disable one
or more protective members, and further including disabling one or
more protective members by flowing current therethrough at a
desired time.
19. The method of claim 16, wherein the cardiac marker is BNP or a
marker related to BNP levels.
20. The method of claim 19, including one or more protective
members formed of a material that substantially dissolves within a
living body over the selectable time period and further including
measuring the level of BNP at a first desired time when one or more
protective members is substantially dissolved after a selected time
period and the sensor element activated, comparing the measured
levels of BNP to preselected levels and varying the parameters of
the therapy based on the comparison.
21. The method of claim 20, wherein the therapy delivery system is
a cardiac resynchronization system and wherein the parameter of
therapy varied is the AV interval of the system, comparing the
measured levels of BNP to preselected levels and varying the
parameters of the therapy based on the comparison.
22. A method of diagnosing, determining the severity of or managing
cardiovascular disease in a patient comprising; a. implanting into
the patient a sensor comprising a plurality of sensor elements each
sensor element comprising a biological recognition element
associated with a portion or portions of a transducer, the
biological recognition element being capable of specifically
binding to a substance in the patient in an amount related to the
level of a cardiac marker and wherein when the substance is bound a
detectable signal is produced, b. activating one or more of the
sensor elements by disabling one or more protective members located
adjacent the sensor to shield the biological recognition member
from a surrounding environment; c. measuring the amount of
detectable signal produced; d. relating the amount of detectable
signal produced to the level of the cardiac marker present in the
patient; e. comparing the measured level of the cardiac marker to
preselected levels of such cardiac marker to diagnosis, determine
the severity of or manage cardiovascular disease.
23. The method of claim 22, wherein the cardiac marker is BNP.
24. The method of claim 22, further including a therapy delivery
system connected to a controller that is associated with one or
more sensor elements, wherein the therapy delivery system is
providing therapy to the patient based on a set of preselected
parameters as part of the management of the patient's
cardiovascular disease, and when the measured level of cardiac
marker as compared to the preselected level of the cardiac marker
indicate a worsening in symptoms of the patient's cardiovascular
disease, further including varying the parameters of the
therapy.
25. The method of claim 24 wherein the therapy delivery system is a
cardiac resynchronization therapy system.
Description
RELATED APPLICATION
[0001] This application is a divisional of U.S. patent application
Ser. No. 10/652,837, filed Aug. 29, 2003 entitled "IMPLANTABLE
BIOSENSOR DEVICES FOR MONITORING CARDIAC MARKER MOLECULES", herein
incorporated by reference in its entirety.
FIELD OF THE INVENTION
[0002] The present invention relates to sensors for detecting,
measuring and/or monitoring levels of physiological analytes in a
patient, and particularly, to biosensors suitable for implantation
to provide in vivo detection and/or monitoring of one or more
cardiac markers.
BACKGROUND OF THE INVENTION
[0003] Heart disease, including myocardial infarction, is a leading
cause of death and impaired activity in human beings, particularly
in the western world. Ischemic heart disease is the major form of
heart failure. A common symptom of cardiac ischemia is chest pain
that may lead to heart attack (acute myocardial infarction or AMI)
and sudden death.
[0004] Myocardial ischemic disorders occur when blood flow in the
heart is restricted (ischemia) and/or when the oxygen supply to
heart muscle is compromised hypoxia) and the heart's demand for
oxygen is not met. Ischemia and hypoxia can be transient and
reversible, but can also lead to a heart attack. During such an
attack, cardiac tissue is damaged and the heart cells become
permeabilized, releasing a portion of their contents to the
surrounding environment, including cardiac enzymes and other
biochemical markers. These cellular markers, such as creatine
kinase (CK), lactic acid dehydrogenase (LDH) and creatine kinase-MB
(CKMB) and troponin (I and T) and myoglobin mass levels become
detectable in the blood of the patient. The use of these markers
and new forms of treatment has increased the survival rate of
patients having a heart attack. This factor combined with the
increased life expectancy has led to an increase in the prevalence
of congestive heart failure (CHF).
[0005] CHF causes significant morbidity and mortality, and the
health care expenditure for this disease is substantial. The need
exists for better diagnostic and prognostic methods for this
disease. Recently, assays for B-type natriuretic peptide (BNP)
which is secreted by the ventricles in response to ventricular
expansion and pressure overload resulting in an elevation of the
plasma concentration of BNP have been used in the diagnosis of CHF.
BNP levels have been found to increase in proportion to the degree
of left ventricular dysfunction and the severity of CHF symptoms
and monitoring the levels of circulating BNP has been used to
monitor the effectiveness of therapy. Significant decreases in BNP
levels correlate with a longer interval between admissions. Thus,
BNP monitoring allows therapy to be tailored to maximize the
desired effects in an individual patient. Levels of BNP precursor
molecules such as the N-terminal proBNP (NT-proBNP), which is
released when BNP is cleaved from its precursor, a 108 amino acid
molecule, referred to as "pre pro BNP) have also been measured in
assays to diagnose CHF, particularly when the patient's therapy
includes being treated which a synthetic BNP molecule.
[0006] The inability to determine when a patient's CHF is worsening
(before a patient gains several pounds in weight and/or edema is
greatly increased) until the patient has a doctor's appointment or
requires hospitalization will result in a delay of treatment. While
in vitro diagnostic assays measuring BNP levels are now in use,
these assessments are point-in-time assessments that do not provide
the clinician a complete profile of a patient's changing status.
Moreover, required changes to the patient's therapy will be
delayed.
[0007] A recent development in in vitro assays is the use of
biosensors as a substrate for the assay. Biosensors are electronic
devices that produce electronic signals as the result of biological
interactions. Biosensors are commonly divided into two groups.
Catalytic sensors that use enzymes, microorganisms, or whole cells
to catalyze a biological interaction with a target substance.
Affinity systems use antibodies, receptors, nucleic acids, or other
members of a binding pair to bind with a target substance, which is
typically the other member of the binding pair. Biosensors may be
used with a blood sample to determine the presence of an analyte of
interest without the need for sample preparation and/or separation
steps typically required for the automated immunoassay systems.
[0008] Implantable electrochemical biosensors have recently become
an important tool for analyzing and quantifying the chemical
composition of a patient's blood. For example, glucose sensors are
generally employed to measure blood glucose levels in patients
having diabetes. Such biosensors are described in U.S. Published
Application No. 2002/0120186, the teachings of which are
incorporated herein by reference.
[0009] It would be desirable to have implantable biosensors for use
in in vivo detection and monitoring of biologically relevant
markers in the diagnosis and treatment of cardiovascular diseases,
including heart failure and myocardial infarction.
SUMMARY OF THE INVENTION
[0010] The present invention provides an implantable sensor system
for detecting and/or monitoring the presence and concentration of a
desired analyte in a patient. In one embodiment of the invention,
the system includes a biochemical sensor to detect levels of a
desired cardiac marker or markers such as BNP in the intra-cardiac
circulatory system or cardiac tissue, a controller and processor to
measure the levels of the cardiac marker and optionally to store
the data, and an external user-interface system to display the
data. In one embodiment, the system further includes circuitry to
trigger a patient alert if the level of the measured cardiac marker
exceeds a predetermined critical level.
[0011] The sensor system of the invention may be deployed on an
intra-cardiac lead or other delivery device as a stand-alone system
or incorporated into an implantable medical device such as a
pacemaker, defibrillator or cardiac resynchronization therapy (CRT)
system. When incorporated into an implantable medical device, the
sensor may also be used in cooperation with the device in the
therapeutic treatment provided by the device. In some embodiments,
the sensor system is deployed on an intra-cardiac lead placed in
the coronary sinus orifice of the right atrium of the heart.
[0012] In one embodiment of the invention, the sensor is a
nanoscale device. The sensor system includes a biological
recognition element attached to a nanowire and a detector able to
determine a property associated with the nanowire. The biological
recognition element is one member of a binding pair where the
cardiac marker or analyte being measured is the other member of the
binding pair. Preferably, the nanowire sensor includes a
semiconductor nanowire with an exterior surface formed thereon to
form a gate electrode and a first end in electrical contact with a
conductor to form a source electrode and a second end in contact
with a conductor to form a drain electrode. In one aspect of the
invention the sensor is a field effect transistor comprising a
substrate formed of an insulating material, a source electrode, a
drain electrode and a semiconductor nanowire disposed there between
with a biological recognition element attached on a surface of the
nanowire. When a binding event occurs between the biological
recognition element and its specific binding partner a detectable
change is caused in a current-voltage characteristic of the field
effect transistor.
[0013] In one embodiment the sensor system includes an array of
sensors. One or more of the sensors in the array is associated with
a protective member that prevents the associated sensor from
interacting with the surrounding environment. At a selected time,
the protective member may be disabled, thereby allowing the sensor
to begin operating to interact with the surrounding fluid or tissue
so that the biological recognition element can interact with the
other member of its binding pair if that pair member is
present.
[0014] In another aspect of the invention, the protective member is
formed of a conductive material that can oxidize, is biocompatible,
bio-absorbable, and that may be dissolved in solution such as blood
upon application of an electric potential. For example, a sensor
may be formed within a well of a substrate that is capped by a
conductive material such as a biocompatible metal or an
electrically-erodible polymer. In another embodiment, the
protective member is formed using a material that dissolves over a
predetermined period of time.
[0015] At a given time, one or more activated sensors from the
sensor array may be utilized to determine levels of desired
analytes by detecting a detectable signal generated when a
substance binds to a biological recognition element of the sensor.
The data is then processed and compared to stored data to provide a
more accurate indication of a biological or other condition.
Another processing scheme may be utilized to obtain a measurement
that may then be used to monitor a patient's condition, or modify
therapy delivery.
[0016] In one embodiment, the sensor system includes a therapy
delivery system for providing therapy based on the levels of one or
more of the cardiac markers being measured. The therapy delivery
system may include a drug pump, a circuit to provide electrical
stimulation to tissue, or any other type of therapy delivery means
known in the art.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] FIG. 1 is a diagram illustrating one embodiment of a sensor
according to the current invention.
[0018] FIG. 2 is a flow chart illustrating one method of attaching
a biological recognition element to a sensor such as that shown in
FIG. 1.
[0019] FIG. 3 is a diagram illustrating one embodiment of a sensor
system according to the current invention.
[0020] FIG. 4 is a diagram illustrating one embodiment of a sensor
system according to the current invention including a therapy
delivery system.
[0021] FIG. 5 is a system block diagram of one embodiment of a
controller that may be used with the sensor system of the
invention.
[0022] FIG. 6 is a diagram illustrating an embodiment of a sensor
of the invention.
[0023] FIG. 7 is a diagram illustrating one embodiment of a sensor
of the invention having a protective member and a plurality of
individual nanowire sensor elements.
[0024] FIG. 8 is a flow chart illustrating one embodiment of a
method as may be practiced with the current invention.
DETAILED DESCRIPTION OF THE INVENTION
[0025] The present invention relates to an implantable affinity
biosensor system for continuous in vivo monitoring of levels of
analytes, such as cardiac markers, as a stand-alone system or as
part of an implanted or implantable medical device ("IMD"), such as
a pacemaker, defibrillator, CRT system and the like. Preferably,
the biosensor includes a nanowire field effect transistor substrate
having a biological recognition element attached thereto capable of
binding to a cardiac marker of interest.
[0026] A "nanowire" as used herein refers to an elongated nanoscale
semiconductor that, at any point along its length, has at least on
cross-sectional dimension and, in some embodiments, two orthogonal
cross-sectional dimensions less than 1,000 nanometers. In some
embodiments the nanowire has at least one cross-sectional dimension
ranging from about 0.5 nanometers to about 200 nanometers. In one
embodiment, the nanowire refers to an overlayer row resulting from
the deposition of a metal on a silicon surface. Such a nanowire
desirably has a width of about 1 to 4 nm and a length of 10 nm or
longer.
[0027] Nanowires useful in the sensor system of the invention
includes any nanowires, including carbon nanowires, organic and
inorganic conductive and semiconducting polymers. Other conductive
or semiconducting elements of various nanoscopic-scale dimensions
can be used in some instances. U.S. Published Application No.
2002/0117659, the teachings of which are herein incorporated by
reference, describes nanowires and nanotubes that may be used with
the invention.
[0028] A primary criteria for selection of nanowires and other
conductors or semiconductors for use in the invention is whether
the nanowire itself is able to non-specifically bind a substance in
the area where the sensor system will be implanted and whether the
appropriate biological recognition element, i.e. specific binding
pair member, can be attached to the surface of the nanowire. The
nanowire used in the sensor system is desirably an individual
nanowire. As used herein, "individual nanowires" means a nanowire
free of contact with another nanowire (but not excluding contact of
a type that may be desired between individual nanowires in a
crossbar array). Generally, each sensor element of the invention
will include an individual nanowires. When multiple sensor elements
are located or arranged together in one housing, for example in an
array, a row or column of individual nanowire sensor elements may
be associated together that each specifically bind the same analyte
so that they provide a nanowire sensor element set. In one
embodiment, each individual nanowire sensor element within a sensor
element set will be activated simultaneously and the detectable
signal produced by each individual sensor will be detected
simultaneously. Methods of making individual nanowires is
known.
[0029] The biological recognition element refers to any agent that
is capable of binding to a cardiac marker of interest. Preferably,
the element is a binding pair member that binds to a desired
analyte with specificity, i.e., has a higher binding affinity
and/or specificity to the analyte than to any other moiety. Such
binding pairs are well known and include the following:
antigen-antibody, growth factor-receptor, nucleic acid-nucleic acid
binding protein, complementary pairs of nucleic acids and the like.
Preferably, the biological recognition element is an antibody or an
effective portion thereof retaining specific binding activity for
the analyte. Effective portions include, for example Fv, scFv, Fab,
Fab.sub.2 and heavy chain variable regions or a chimeric molecule
or recombinant molecule or an engineered protein comprising any of
the portions. The biological recognition element is attached to the
nanowire. As used herein, "attached to," encompasses all mechanisms
for binding antibodies and proteins, directly or indirectly to
surfaces so that when the sensor is implanted and the biological
recognition element interacts with its surrounding environment the
element remains associated with the surface. Such mechanisms
chemical or biochemical linkage via covalent attachment, attachment
via specific biological binding (e.g., biotin/streptavidin),
coordinative bonding such as chelate/metal binding, or the
like.
[0030] Illustrative embodiments of the invention are shown in the
Figures. As will be readily apparent to those skilled in the art
upon a complete reading of the present application, the present
methods and systems are applicable to a variety of systems other
than the embodiments illustrated herein.
[0031] FIG. 1 shows one example of an implantable affinity
nanosensor of the invention. The sensor system 10 includes a single
nanowire 20 positioned above upper surface 32 of the substrate 30.
A housing 40 that may be a hermetic sensor integrated circuit
package. The sensor system also includes electrodes 35 and 37,
respectively, that are connected with electrical connections, which
in this embodiment are located in the housing. The sensor system is
deployed on a lead 50 that may be connected to a user interface
and/or to an IMD.
[0032] The substrate 30 is typically made of a polymer, silicon,
quartz or glass. The electronic circuitry may be powered by one or
more batteries, or alternatively, may receive power via implanted
medical electrical leads coupled to another implantable medical
device (IMD) as will be described below. Any electronic circuitry
adapted to provide long-term continuous monitoring may be used in
conjunction with the device of the present invention. In some
embodiments, the electronic circuitry may be powered by external
means.
[0033] The housing of the sensor systems of the present invention
may use a packaging technique that protects the components of the
system in aqueous media. For example, the top and bottom portions
of the housing may be manufactured from a thermoformed high-density
polyethylene. The area inside the housing surrounding the
electronic circuitry and other components may be filled with a
material that cushions the system while not interfering with
circuit operation. The filling material may be a mixture of
petroleum wax and low melting temperature resins, for instance.
[0034] FIG. 2 is a schematic illustrating the steps for attaching
the biological recognition element to the surface of a nanowire
sensor 10 such as that shown in FIG. 1. The surface of the nanowire
is chemically activated as shown and a biomolecular linker chosen
to bind the antibody of interest is added and allowed to react with
the chemically activated surface to facilitate binding of antibody
or other biological recognition element to the surface.
[0035] The method of attaching the biological recognition element
will differ depending on the material of nanosensor surface and the
binding pair used. When the element is an antibody or protein may
be performed by covalently bonding the protein to the surface with
bi-functional molecules such as glutaraldehyde, carbodiimides,
biotin-avidin, and other molecules with one or more functional
groups on each of at least two ends as are well known to those
skilled in the art. Additionally, bi-functional spacer molecules
such as N-hydroxysuccinimide derivatized polyethylene glycols may
be used to bind the protein.
[0036] FIG. 3 is a block diagram showing an example of a nanosensor
system of the invention. The affinity nanowire sensor 300 such as
that shown is FIG. 1 is carried on a medical lead for implantation
in a patient. Desirably, the sensor is located in cardiac tissue or
in the intra-cardiac circulatory system of the patient or elsewhere
in the blood stream where levels of certain cardiac markers
associated with cardiovascular diseases may be measured. In one
aspect of the invention, the cardiac markers being detected include
without limitation, BNP, pre proBNP, NT pro BNP, C-type reactive
protein, Troponin I and T, respectively, Myoglobin, D-Dimer,
cytokines, such as tissue necrosis factor alpha, and other cardiac
markers known in the art. Sensor 300 is connected to a detector 310
that will measure the detectable signal generated by the sensor
when one or more molecules of the cardiac marker or markers being
measure binds to the biological recognition element attached to the
nanowire, where the amount of signal generated can be used to
determine the level of the cardiac marker present in the patient.
The detector may be associated with a user interface display 320
that may be accessed by the patient and/or the patient's health
care provider either as a continuous display or stored in a
processor (shown as 520 in FIG. 5). In one embodiment, the detector
310 can be connected to a telemeter 330 that will transmit the
sensed information to receiver 340 that may be associated with a
server 350. The server 350 may include a patient database with
other patient information that may be relevant to monitoring the
patient's status. In the system of FIG. 3, the server 350 is
optionally accessible through an internet access management system
320 so that the health care provider can access information
obtained from the continuous monitoring of the levels of one or
more of the patient's cardiac markers.
[0037] FIG. 4 shows a block diagram of a nanosensor system of the
invention associated with an implanted medical device (IMD) and
optionally with an electrical stimulation system of the IMD. In
this embodiment, a nanosensor 400 such as that described in FIG. 1
is connected with a detector 410, which may also include an
electrical stimulator, and to electrical stimulation leads 420
associated with an IMD, including without limitation, a CRT,
pacemaker, or defibrillator. Detectable signal produced by the
nanosensor 400, the amount of which is related, directly or
indirectly, to the levels of one or more cardiac markers in the
patient are received by the detector and/stimulator and the levels
of desired cardiac markers determined. The information may be
processed by a controller (shown as 500 in FIG. 5) within the
detector to vary parameters of the IMD in response to changes in
the levels of the measure cardiac marker in the blood or tissue of
the patient. A telemeter 440 may be included that is associated
with the detector 410 to transmit information received by detector
to a receiver 430. The receiver 430 is in one embodiment connected
to a server 450 that provides for internet access to patient
information through a user interface 460 by the health care
provider or patient.
[0038] FIG. 5 is a system block diagram of one embodiment of a
controller of a nanosensor system of the invention. The controller
500 may be provided within any IMD known in the art, or may be part
of the detector or processor elements of the nanosensor systems,
such as the systems shown in FIGS. 3 and 4. The controller 500 may
include circuitry for delivering electrical stimulation for pacing,
cardioversion, and/or defibrillation purposes on electrical
stimulation outputs.
[0039] The controller 500 may include a communicator 510, such as a
telemetry system described in commonly-assigned U.S. Pat. No.
6,169,925, incorporated herein by reference in its entirety. The
use of this telemetry system would provide a system capable of
long-range communication with personal patient communication
devices. Such patient communication devices may have an alarm
function to alert the patient of sensor readings outside a range
considered acceptable. The alarm may also be included to inform the
user of actions that should be taken by the user in response to an
original alert. The level of urgency of the alarm could also be
encoded into the signal changes. The alarm may be of any type of
patient alert known in the art, including without limitation, an
audible alarm, a visual alarm, or an alarm that alerts the patient
through vibration. Additionally, the patient could be informed of
information through muscle or nerve stimulation from additional
electrodes on the device. In another embodiment, a telemetry signal
may be provided to an external device to deliver an automatic alert
in the event an emergency situation is detected. For example, if
levels of cardiac markers indicated that a patient was suffering a
heart attack, emergency workers may be automatically contacted via
an uplink to a communications system. Patient data may
automatically be provided to emergency health-care workers using
information stored with the data storage element 520. The
controller 500 may also include a data acquisition element 530 and
a data processor 540.
[0040] In one embodiment of the invention, the nanosensor of the
invention may include a protective member located adjacent the
sensor to shield the sensor from a surrounding environment for a
selectable time period. The controller 500 may include a protection
activator element 560 that would generate a signal that would
result in the protective member or a predetermined portion of the
protective member(s) to be oxidized, dissolved or otherwise removed
so that the nanosensor is allowed to become operational. When a
plurality of sensor elements are used, one or more protective
members can be associated with one or more sensor elements, where
the selectable time period differs. In one embodiment, one or more
protective members may be associated with one set of nanowire
sensor elements so such protective members may be disabled
simultaneously to simultaneously activate the individual nanowire
sensor elements within the set. In another embodiment, one or more
protective members may be associated with a first set of nanowire
sensor elements, wherein one or more first protective member(s)
will shield the set of sensor elements for a first selectable time
period and a second one or more protective members will shield a
second set of nanowire sensor elements for a second selectable time
period. The first set of sensor elements may be activated to
measure levels of an analyte at the first time, and the second set
of sensor elements may be activated at a second time and levels of
analyte measured. In yet another embodiment, first and second sets
of nanowire sensor elements may include first and second biological
recognition elements that specifically bind different substances.
In this embodiment, one protective member may be associated with
both sets of nanowire sensor elements and when that protective
member is disabled both sets of sensor elements are activated so
that that the level of more than one analyte may be determined
simultaneously. Alternatively, one or more protective members may
be associated with each set of sensor elements and the protective
members disabled sequentially. A person of ordinary skill in the
art will know how to optimize the activation of individual nanowire
sensor elements in desired numbers in a set to obtain a desired
sensitivity and specificity of analyte being measured. In one of
the preferred embodiments, the number of individual nanowire sensor
elements in a set will be chosen to provide nanogram to picogram
sensitivity.
[0041] The processor may be a microprocessor or other processing
circuit as is known in the art. Storage device may comprise Random
Access Memory (RAM), Read-Only Memory, registers, a combination
thereof, or any other type of memory storage device suitable for
use in implantable medical devises. The controller 500 may also
include a sensor address 570.
[0042] The controller 500 may additionally include a protection
activator that will cause a protective member that may be formed
over the sensor in one embodiment to prevent the sensor from being
exposed to bodily fluids prior to a selected time to dissolve.
[0043] Protective members are described for use with sensors in
commonly assigned U.S. Published Patent Application No.
2002/0120186, the teachings of which are herein incorporated by
reference. In one embodiment, the protective member consists of a
thin film of conductive material. Any conductive material that can
oxidize, is biocompatible, bio-absorbable, and that may be
dissolved in solution such as blood upon application of an electric
potential can be used for the fabrication of a protective member.
Examples of such materials include copper, gold, silver, and zinc,
and some polymers.
[0044] Protective members may be formed by injection or spin
coating. In one embodiment, the nanosensor is positioned with a
well formed in the substrate. The protective member may be sized to
cover the well or may extend beyond the edge of the well to
partially cover the substrate. In one embodiment the well can be
capped with the protective member by capillary action, by drawing
the material partially into the well with a vacuum or other
pressure gradient, by melting the material in to the well, by
centrifugation and related processes, by inserting solids into the
well, or by any combination of these or similar methods.
[0045] In one aspect, the protective member is electrically and
mechanically coupled to a respective conductor referred to as the
anode. An additional "cathode" conductor is desirably located
adjacent to, but electrically and mechanically isolated from, a
respective reservoir. A voltage difference applied across the anode
and cathode when the protective member is placed in a conductive
solution causes electrons to pass from the anode conductor to the
cathode conductor through the conductive solution. This, in turn,
causes the protective member, which may be considered the anode of
the circuit, to oxidize and dissolve into the surrounding fluids,
exposing the sensor to surrounding body fluids so that the sensor
becomes operational and the biological recognition element may
interact with the surrounding environment.
[0046] Although the foregoing examples described protective members
that dissolve or erode through the use of a current, any
bio-absorbable material that will dissolve within a patient's body
in a predictable time period may be used. For example, in an
embodiment of the invention where more than one sensor element is
included in the system, one or more of the sensor elements may be
left unprotected, while one or more additional sensor elements may
be associated with a respective protective member that
substantially absorbs over a first time period. Yet another set of
sensor elements may each be associated with protective members
formed of another material known to substantially dissolve over a
second time period which is longer than the first time period, and
so on. Use of protective members with a plurality of sensor
elements to provide for sequential activation of one or more sensor
elements can increase the functional life of the sensor by reducing
the time period the biological recognition period is exposed to the
surrounding environment and reducing the likelihood of non-specific
binding of proteins and other materials present in the body to the
sensor element in a way that will interfere with the specific
binding of analyte or a substance related to the level of analyte
present in the patient. In some embodiments, protective members may
be used with a plurality of sensor elements to provide for
activation of a desired number of sensor elements necessary to
control the gain or signal to noise of the sensor elements. For
example, in order to obtain a meaningful measurement of levels of
an analyte of interest in a patient, it may be necessary to
activate more than one sensor element to increase the level of
detectable signal being produced.
[0047] FIG. 6 is a diagram illustrating an example of an
implantable nanosensor array 600 for monitoring of multiple
analytes. A plurality of nanowire field effect transistors 610 are
positioned on substrate 620. Substrate 620 is positioned over a
hermetic sensor integrated circuit package 630, which includes
electronic circuitry of the sensor. The sensor is arranged on or
connected to lead 640. Although six nanosensors are shown, any
other number of nanosensors as may be supported by substrate 620 is
possible.
[0048] FIG. 7 is a diagram illustrating an example of an
implantable nanosensor array 700 for monitoring of multiple
analytes or for monitoring of a single analyte over a selected
period of time or a combination thereof. The array shown in FIG. 7
includes a plurality of individual nanosensors 720, each positioned
within a well 740 formed in the substrate 750 and covered with
protective member 730. In one embodiment, each nanosensor includes
a biological recognition element for the same cardiac marker. In
use, the array may be implanted within a patient and a
predetermined number of nanosensors rendered operational by
dissolving the corresponding protective member. The number of
nanosensors rendered operational will be determined by the
specificity and sensitivity of the binding between the biological
recognition element and the cardiac marker of interest and how the
detectable signal data is processed. If, under certain conditions,
the levels of cardiac marker of interest increase significantly,
the specific binding of cardiac marker to the biological
recognition element in one nanosensor may not be sufficient to
accurately measure the change.
[0049] In another embodiment, each nanosensor must be activated
prior to use by applying signals on associated control and address
lines to remove a protective member adjacent to the nanosensor in a
manner discussed above. Prior to activation, a nanosensor is not
exposed to the surrounding environment, so degradation does not
occur. After the protective member is removed, sensing may be
performed with the sensor until such a time as the sensor
performance is determined to be degrading and outside a pre-defined
range of accuracy. Thereafter, the nanosensor may be left unused
and a different nanosensor activated in its place. In this manner,
the implanted sensor system may be used for long periods without
requiring replacement.
[0050] FIG. 8 is a flowchart illustrating an example of a
closed-loop nanosensor system that works in conjunction with
therapy delivered by and IMD. The type of therapy may involve
pacing, defibrillation, drug delivery, monitoring and/or patient
management therapies. In the embodiment exemplified in FIG. 8, the
therapy is provided by an IMD such as a pacemaker, defibrillator or
the like. Computer implemented software logic system in the
nanosensor system and/or in the implantable device activates one or
more nanosensors in implanted in a patient and begins to measure
the levels of a desired cardiac marker in the patient. When the
nanosensor determines that the levels of the cardiac marker or
markers being measured have increased or decreased to a level that
indicates that the patient's status is worsening, the therapy
parameters of the IMD may be adjusted accordingly. The nanosensor
continues to measure the levels of cardiac marker of interest and
appropriate adjustments made in the therapy.
[0051] When the IMD is a CRT system, an increase in levels of a
cardiac marker such as BNP may be used to optimize AV and VV
timing, to assess the impact of a therapeutic regime on reverse
remodeling of the heart or to assess the impact of concomitant drug
therapy. Operating under software and/or hardware control, a
processing circuit processes the received signal(s) to determine a
course of action. Alternatively, the processor may average one or
more nanosensor readings, or may use a voting scheme to discard
out-of-range signals or may correlate the levels of more than
cardiac marker prior to determining the course of action.
[0052] The nanosensor system of the invention is particularly
useful in monitoring levels of cardiac markers in patients with
cardiovascular diseases and particularly in monitoring levels of
BNP in such patients. Methods for determining the prognosis of a
patient diagnosed with heart failure or other cardiovascular
diseases are described in U.S. Published Patent Application No.
2003/0022235. Briefly, the method includes identifying a BNP level,
or the level of a marker related to BNP and associated with an
increase in symptoms associated with the patient's cardiovascular
disease. Once that level has been determined, a nanosensor system
of the invention having a biological recognition element that is a
binding pair member of BNP or related marker attached to a nanowire
field effect transistor is be implanted in the patient's
intra-cardiac circulatory system, either as a stand-alone device or
as part of an implantable medical device already implanted in the
patient or to be implanted in the patient. The nanosensor
controller will measure the patient's BNP levels at predetermined
intervals, store the measurements and compare them to the
prognostic level of BNP previously determined for the patient. If
the BNP level indicates that the patient's condition is worsening,
then a patient alert will be triggered so that the patient knows to
contact his or her health care provider. Optionally, if the BNP
level indicates that the patient's condition is worsening the
parameters of the therapy may be automatically be adjusted to a
more optimal setting.
[0053] Preferably the biological recognition element is an antibody
or a fragment thereof that specifically binds to peptide epitopes
within the BNP molecule. In one embodiment the antibody is a
monoclonal antibody. Antibodies and other elements that will
specifically bind to BNP or markers related to BNP are known. For
example, U.S. Pat. No. 6,124,430 describes antibodies that bind to
epitopes within the hBNP molecule, the teachings of which are
incorporated herein by reference.
[0054] In another embodiment of the invention, a nanosensor system
of the invention that includes an array of individual nanosensors
adapted to measure the levels of more than one cardiac marker may
be used in a method for diagnosing organ failure. Preferably, the
cardiac markers of interest include markers that indicated a
pressure, volume change and stress to the heart (e.g. BNP and
pro-BNP) and markers that are indicative of tissue damage (e.g.
cardiac Troponin I). Methods of correlating the measurements of
such marker levels obtained using in vitro diagnostic assays to the
diagnosis of heart failure are described in U.S. Pat. No.
6,461,828, the teachings of which are herein incorporated by
reference.
[0055] All patents and publications referenced herein are hereby
incorporated by reference in their entireties. It will be
understood that certain of the above-described structures,
functions and operations of the above-described preferred
embodiments are not necessary to practice the present invention and
are included in the description simply for completeness of an
exemplary embodiment or embodiments. In addition, it will be
understood that specifically structures, functions and operations
set forth in the above-referenced patents can be practiced in
conjunction with the present invention, but they are not essential
to its practice. It is therefore to be understood that within the
scope of the appended claims, the invention may be practiced
otherwise than as specifically described without actually departing
from the spirit and scope of the present invention.
* * * * *