U.S. patent application number 15/462643 was filed with the patent office on 2017-10-05 for methods of using adipose tissue-derived cells in the treatment of cardiovascular conditions.
The applicant listed for this patent is Cytori Therapeutics, Inc.. Invention is credited to Eric Daniels, John K. Fraser, Marc H. Hedrick, Brian M. Strem, Isabella Wulur, Min Zhu.
Application Number | 20170281771 15/462643 |
Document ID | / |
Family ID | 36181012 |
Filed Date | 2017-10-05 |
United States Patent
Application |
20170281771 |
Kind Code |
A1 |
Fraser; John K. ; et
al. |
October 5, 2017 |
METHODS OF USING ADIPOSE TISSUE-DERIVED CELLS IN THE TREATMENT OF
CARDIOVASCULAR CONDITIONS
Abstract
Adipose derived regenerative cells are used to treat patients,
including patients with cardiovascular conditions, diseases or
disorders. Methods of treating patients include processing adipose
tissue to deliver a concentrated amount of regenerative cells,
e.g., stem and/or progenitor cells, obtained from the adipose
tissue to a patient. The methods may be practiced in a closed
system so that the stem cells are not exposed to an external
environment prior to being administered to a patient. Accordingly,
in a preferred method, adipose derived regenerative cells are
placed directly into a recipient along with such additives
necessary to promote, engender or support a therapeutic
cardiovascular benefit.
Inventors: |
Fraser; John K.; (San Diego,
CA) ; Hedrick; Marc H.; (Solana Beach, CA) ;
Zhu; Min; (San Diego, CA) ; Strem; Brian M.;
(San Diego, CA) ; Daniels; Eric; (Encinitas,
CA) ; Wulur; Isabella; (West Hills, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Cytori Therapeutics, Inc. |
San Diego |
CA |
US |
|
|
Family ID: |
36181012 |
Appl. No.: |
15/462643 |
Filed: |
March 17, 2017 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
11138083 |
May 25, 2005 |
9597395 |
|
|
15462643 |
|
|
|
|
10783957 |
Feb 20, 2004 |
|
|
|
11138083 |
|
|
|
|
10877822 |
Jun 25, 2004 |
7514075 |
|
|
10783957 |
|
|
|
|
10316127 |
Dec 9, 2002 |
|
|
|
10877822 |
|
|
|
|
60449279 |
Feb 20, 2003 |
|
|
|
60462911 |
Apr 15, 2003 |
|
|
|
60482820 |
Jun 25, 2003 |
|
|
|
60496467 |
Aug 20, 2003 |
|
|
|
60338856 |
Dec 7, 2001 |
|
|
|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61K 35/28 20130101;
A61K 35/28 20130101; C12N 5/0653 20130101; A61K 2300/00 20130101;
A61K 45/06 20130101 |
International
Class: |
A61K 45/06 20060101
A61K045/06; A61K 35/28 20060101 A61K035/28; C12N 5/077 20060101
C12N005/077 |
Claims
1. A method for treating a disorder characterized by insufficient
cardiac function in a subject, comprising administering to the
subject a composition comprising adipose derived cells, such that
the disorder is treated.
Description
RELATED APPLICATIONS
[0001] This application is a continuation of U.S. application Ser.
No. 11/138,083, entitled METHODS OF USING ADIPOSE TISSUE-DERIVED
CELLS IN THE TREATMENT OF CARDIOVASCULAR CONDITIONS, filed on May
25, 2005, which is a continuation-in-part application of U.S.
application Ser. No. 10/783,957 entitled METHODS OF USING ADIPOSE
TISSUE-DERIVED CELLS IN THE TREATMENT OF CARDIOVASCULAR CONDITIONS,
filed on Feb. 20, 2004 (which claims priority to U.S. Provisional
Application No. 60/449,279, entitled METHODS OF USING ADIPOSE
TISSUE DERIVED CELLS IN THE TREATMENT OF CARDIOVASCULAR CONDITIONS,
filed Feb. 20, 2003, and U.S. Provisional Application No.
60/462,911, entitled METHODS OF USING ADIPOSE TISSUE DERIVED CELLS
IN THE TREATMENT OF CARDIOVASCULAR CONDITIONS, filed Apr. 15,
2003,), and a continuation-in-part of U.S. application Ser. No.
10/877,822, entitled SYSTEMS AND METHODS FOR SEPARATING AND
CONCENTRATING REGENERATIVE CELLS FROM TISSUE, filed Jun. 25, 2004
(which claims priority to U.S. Provisional Application No.
60/496,467, entitled SYSTEMS AND METHODS FOR SEPARATING CELLS FROM
ADIPOSE TISSUE, filed Aug. 20, 2003, and U.S. Provisional
Application No. 60/482,820, entitled SYSTEMS AND METHODS FOR
SEPARATING CELLS FROM ADIPOSE TISSUE, filed, 2003), both of which
are continuation-in-parts of U.S. application Ser. No. 10/316,127,
filed on Dec. 9, 2002, entitled SYSTEMS AND METHODS FOR TREATING
PATIENTS WITH PROCESSED LIPOASPIRATE CELLS (which claims the
benefit of U.S. Provisional Application No. 60/338,856, filed Dec.
7, 2001). The contents of all the aforementioned applications are
expressly incorporated herein by this reference.
BACKGROUND
Field of the Invention
[0002] This invention generally relates to regenerative cells
derived from adipose tissue, and more particularly, to
adipose-derived regenerative cells (e.g., adipose-derived stem and
progenitor cells), methods of using adipose-derived regenerative
cells, compositions containing adipose-derived regenerative cells,
and systems for preparing and using adipose-derived regenerative
cells, which are used to treat cardiovascular diseases and
disorders.
Description of Related Art
[0003] Cardiovascular diseases and disorders are the leading cause
of death and disability in all industrialized nations. In the
United States alone, cardiovascular disease accounts for about 40
percent of the mortality rate and affects 58 million Americans
(American-Heart-Association, 2002). One of the primary factors that
renders cardiovascular disease particularly devastating is the
heart's inability to repair itself following damage. Since cardiac
muscle cells are unable to divide and repopulate areas of damage,
cardiac cell loss as a result of injury or disease is largely
irreversible (Abbate et al., 2002; Remme, 2000).
[0004] Of the available forms of therapy, human to human heart
transplants have been the most effective in treating severe
cardiovascular diseases and disorders. In fact, the one-year and
five-year survival rate of the average cardiac transplant recipient
is currently over 70 percent. Unfortunately, however,
transplantation is a severely limited form of therapy for a number
of reasons, namely, the scarcity of suitable donors, the expense of
the procedure and the high likelihood of graft rejection and
associated problems such as infections, renal dysfunction and
immunosuppressant related cancers (American-Heart-Association,
2002).
[0005] An alternative to transplant therapy is the use of
regenerative medicine to repair and regenerate damaged cardiac
muscle cells. Regenerative medicine harnesses, in a clinically
targeted manner, the ability of stem cells (i.e., the unspecialized
master cells of the body) to renew themselves indefinitely and
develop into mature specialized cells. Stem cells are found in
embryos during early stages of development, in fetal tissue and in
some adult organs and tissue (Pera et al., 2000). Embryonic stem
cells (hereinafter referred to as "ESCs") are known to become all
of the cell and tissue types of the body. ESCs not only contain all
the genetic information of the individual but also contain the
nascent capacity to become any of the 200+ cells and tissues of the
body. Thus, these cells have tremendous potential for regenerative
medicine. For example, ESCs can be grown into specific tissues such
as heart, lung or kidney which could then be used to repair damaged
and diseased organs (Assady et al., 2001; Jacobson et al., 2001;
Odorico et al., 2001). However, ESC derived tissues have clinical
limitations. Since ESCs are necessarily derived from another
individual, i.e., an embryo, there is a risk that the recipient's
immune system will reject the new biological material. Although
immunosuppressive drugs to prevent such rejection are available,
such drugs are also known to block desirable immune responses such
as those against bacterial infections and viruses. Moreover, the
ethical debate over the source of ESCs, i.e., embryos, is
well-chronicled and presents an additional and, perhaps,
insurmountable obstacle for the foreseeable future.
[0006] Adult stem cells (hereinafter interchangeably referred to as
"ASCs") represent an alternative to the use of ESCs. ASCs reside
quietly in many non-embryonic tissues, presumably waiting to
respond to trauma or other destructive disease processes so that
they can heal the injured tissue (Arvidsson et al., 2002;
Bonner-Weir and Sharma, 2002; Clarke and Frisen, 2001; Crosby and
Strain, 2001; Jiang et al., 2002a). Notably, emerging scientific
evidence indicates that each individual carries a pool of ASCs that
may share with ESCs the ability to become many if not all types of
cells and tissues (Young et al., 2001; Jiang et al., 2002a; Jiang
et al., 2002b; Schwartz et al., 2002). Thus, ASCs, like ESCs, have
tremendous potential for clinical applications of regenerative
medicine.
[0007] ASC populations have been shown to be present in one or more
of bone marrow, skin, muscle, liver and brain (Jiang et al., 2002b;
Alison, 1998; Crosby and Strain, 2001). However, the frequency of
ASCs in these tissues is low. For example, mesenchymal stem cell
frequency in bone marrow is estimated at between 1 in 100,000 and 1
in 1,000,000 nucleated cells (D'Ippolito et al., 1999; Banfi et
al., 2001; Falla et al., 1993). Similarly, extraction of ASCs from
skin involves a complicated series of cell culture steps over
several weeks (Toma et al., 2001) and clinical application of
skeletal muscle-derived ASCs requires a two to three week culture
phase (Hagege et al., 2003). Thus, any proposed clinical
application of ASCs from such tissues requires increasing cell
number, purity, and maturity by processes of cell purification and
cell culture.
[0008] Although cell culture steps may provide increased cell
number, purity, and maturity, they do so at a cost. This cost can
include one or more of the following technical difficulties: loss
of cell function due to cell aging, loss of potentially useful
non-stem cell populations, delays in potential application of cells
to patients, increased monetary cost, and increased risk of
contamination of cells with environmental microorganisms during
culture. Recent studies examining the therapeutic effects of
bone-marrow derived ASCs have used essentially whole marrow to
circumvent the problems associated with cell culturing (Horwitz et
al., 2001; Orlic et al., 2001; Stamm et al., 2003; Strauer et al.,
2002). The clinical benefits, however, have been suboptimal, an
outcome almost certainly related to the limited ASC dose and purity
inherently available in bone marrow.
[0009] Recently, adipose tissue has been shown to be a source of
ASCs (Zuk et al., 2001; Zuk et al., 2002). Unlike marrow, skin,
muscle, liver and brain, adipose tissue is comparably easy to
harvest in relatively large amounts (Commons et al., 2001; Katz et
al., 2001b). Furthermore, adipose derived ASCs have been shown to
possess the ability to generate multiple tissues in vitro,
including bone, fat, cartilage, and muscle (Ashjian et al., 2003;
Mizuno et al., 2002; Zuk et al., 2001; Zuk et al., 2002). Thus,
adipose tissue presents an optimal source for ASCs for use in
regenerative medicine. Suitable methods for harvesting adipose
derived ASCs, however, are lacking in the art. The existing methods
suffer from a number of shortcomings. For example, the existing
methods lack the ability to optimally accommodate an aspiration
device for removal of adipose tissue. The existing methods also
lack partial or full automation from the harvesting of adipose
tissue phase through the processing of tissue phases (Katz et al.,
2001a). The existing methods further lack volume capacity greater
than 100 ml of adipose tissue. The existing methods yet further
lack a partially or completely closed system from the harvesting of
adipose tissue phase through the processing of tissue phases.
Finally, the existing methods lack disposability of components to
attenuate concomitant risks of cross-contamination of material from
one sample to another. In summary, the prior art methods for
harvesting ASCs from adipose tissue do not overcome the technical
difficulties associated with harvesting ASCs from skin, muscle,
liver and brain described above.
[0010] Accordingly, given the tremendous therapeutic potential of
ASCs, there exists an urgent need in the art for a device, system
or method for harvesting ASCs from adipose tissue that produces a
population of ASCs with increased yield, consistency and/or purity
and does so rapidly and reliably with a diminished or non-existent
need for post-extraction manipulation. Ideally, such a device,
system or method would yield ASCs in a manner suitable for direct
placement into a recipient. Access to such a device, system or
method in combination with methods and compositions using adipose
derived ASCs for the treatment of cardiovascular diseases and
disorders would revolutionize the treatment of such disorders.
Given the prevalence of cardiovascular disease and the scarcity of
current treatment options, such a treatment is urgently needed.
SUMMARY
[0011] The present invention relates to regenerative cells, e.g.,
adult stem and progenitor cells, that can be used for the treatment
of cardiovascular conditions, diseases and disorders. The present
invention also relates to systems and methods for separating and
concentrating regenerative cells from tissue, e.g., adipose tissue.
The present invention further relates to compositions of
regenerative cells for cardiovascular related therapeutic
applications. Accordingly, in a general embodiment, the present
invention is directed to compositions, methods, and systems for
using regenerative cells derived from tissue that are placed
directly into a recipient along with such additives necessary to
promote, engender, or support a therapeutic cardiovascular related
benefit.
[0012] In specific embodiments, the regenerative cells of the
present invention may be used to treat cardiovascular conditions,
diseases and disorders based on, for example, their ability to
synthesize and secrete growth factors stimulating new blood vessel
formation, their ability to synthesize and secrete growth factors
stimulating cell survival, proliferation and/or alteration of the
injury response of other cells, their ability to proliferate and/or
differentiate into cells directly participating in new blood vessel
formation, their ability to engraft damaged myocardium and alter
scar formation (collagen deposition, collagen degradation and
cross-linking), their ability to proliferate and differentiate into
cardiomyocytes or cardiomyocyte-like muscle cells capable of
contributing to myocardial contractility, their ability to
proliferate and differentiate into myocardial cells, their ability
to improve perfusion and regenerate damaged myocardium, and their
ability to prevent progression of hypertrophy (remodeling) post
myocardial infarct.
[0013] The regenerative cells administered to the cardiac patient
may be comprised of, e.g., stem cells, progenitor cells or
combination thereof. In certain embodiments, administration of
multiple doses and/or types of regenerative cells may be needed to
derive a therapeutic benefit. In addition, additives such as one or
more growth factors may be administered with the regenerative
cells. In a preferred embodiment, the regenerative cells are
administered with angiogenic, arteriogenic and/or cardiac specific
growth factors alone or in combination with other additives. The
regenerative cells may also be administered with one or more
immunosuppressive drugs.
[0014] The routes of administration for the regenerative cells are
known in the art and include direct administration of cells to the
site of intended benefit. This may be achieved by direct injection
into the myocardium through the external surface of the heart
(epicardial), direct injection into the myocardium through the
internal surface (endocardial) through insertion of a suitable
cannula, by arterial or venous infusion (including retrograde flow
mechanisms) or by other means disclosed herein or known in the art
such as pericardial injection. Routes of administration known to
one of ordinary skill in the art, include but are not limited to,
intravenous, intracoronary, endomyocardial, epimyocardial,
intraventicular, retrograde coronary sinus or intravenous.
[0015] Prior to administration to a patient, the regenerative cells
may be grown in cell culture to, for example, promote
differentiation towards a cardiac phenotype. Prior to
administration to a patient, the cells could also be modified by
gene transfer such that expression of one or more genes, e.g., a
cardiac gene, in the modified regenerative cells is altered.
[0016] The present invention also relates to highly versatile
systems and methods capable of separating and concentrating
regenerative cells, e.g., stem and progenitor cells, from a given
tissue that are suitable for re-infusion into a subject. In a
preferred embodiment, the system is automated. The system of the
present invention generally includes one or more of a collection
chamber, a processing chamber, a waste chamber, an output chamber
and a sample chamber. The various chambers are coupled together via
one or more conduits such that fluids containing biological
material may pass from one chamber to another in a closed, sterile
fluid/tissue pathway. In certain embodiments, the waste chamber,
the output chamber and the sample chamber are optional. In one
embodiment, the entire procedure from tissue extraction through
processing and placement of the device into the recipient would all
be performed in the same facility, indeed, even within the same
room of the patient undergoing the procedure.
[0017] Accordingly, in one embodiment, a method of treating
cardiovascular related disorder in a patient includes steps of: a)
providing a tissue removal system; b) removing adipose tissue from
a patient using the tissue removal system, the adipose tissue
having a concentration of regenerative cells; c) processing at
least a part of the adipose tissue to obtain a concentration of
regenerative cells other than the concentration of regenerative
cells of the adipose tissue before processing; and d) administering
the regenerative cells to a patient without removing the
regenerative cells from the tissue removal system before being
administered to the patient.
[0018] Any feature or combination of features described herein are
included within the scope of the present invention provided that
the features included in any such combination are not mutually
inconsistent as will be apparent from the context, this
specification, and the knowledge of one of ordinary skill in the
art. Additional advantages and aspects of the present invention are
apparent in the following detailed description
BRIEF DESCRIPTION OF THE DRAWINGS
[0019] FIG. 1. is an illustration of a system for separating and
concentrating regenerative cells from tissue which includes one
filter assembly.
[0020] FIG. 2 is an illustration of a system similar to FIG. 1
having a plurality of filter assemblies in a serial
configuration.
[0021] FIG. 3 is an illustration of a system similar to FIG. 1
having a plurality of filter assemblies in a parallel
configuration.
[0022] FIG. 4 is an illustration of a system for separating and
concentrating regenerative cells from tissue which includes a
centrifuge chamber.
[0023] FIG. 5 is a sectional view of a collection chamber including
a prefixed filter utilized in a system for separating and
concentrating regenerative cells from tissue.
[0024] FIG. 6 is a sectional view of a processing chamber of a
system for separating and concentrating regenerative cells from
tissue utilizing a percolative filtration system.
[0025] FIG. 7 is a sectional view of a processing chamber of a
system for separating and concentrating regenerative cells
utilizing a centrifuge device for concentrating the regenerative
cells.
[0026] FIG. 8 is another sectional view of the processing chamber
of FIG. 7.
[0027] FIGS. 9A, 9B, and 9C illustrate an elutriation component in
use with the system of the invention.
[0028] FIG. 10 is an illustration of a system for separating and
concentrating regenerative cells from tissue utilizing vacuum
pressure to move fluids through the system. A vacuum system can be
constructed by applying a vacuum pump or vacuum source to the
outlet of the system, controlled at a predetermined rate to pull
tissue and fluid through, using a system of stopcocks, vents, and
clamps to control the direction and timing of the flow.
[0029] FIG. 11 is an illustration of a system for separating and
concentrating regenerative cells from tissue utilizing positive
pressure to move fluids through the system. A positive pressure
system uses a mechanical means such as a peristaltic pump to push
or propel the fluid and tissue through the system at a determined
rate, using valves, stopcocks, vents, and clamps to control the
direction and timing of the flow.
[0030] FIG. 12A illustrates a filtration process in which the feed
stream of fluid flows tangentially to the pores of the filter. FIG.
12B illustrates a filtration process in which the feed stream of
fluid flows perpendicular to the pores of the filter.
[0031] FIG. 13 is an illustration of an exemplary disposable set
for a system of the invention.
[0032] FIGS. 14A and 14B are illustration of an exemplary re-usable
component for a system of the invention.
[0033] FIGS. 15A and 15B are illustrations of an exemplary device
of the invention assembled using the disposable set of FIG. 13 and
a re-usable component of FIGS. 14A and 14B.
[0034] FIG. 15C is a flowchart depicting exemplary pre-programmed
steps, implemented through a software program, that control
automated embodiments of a system of the present invention. Two
alternative processing parameters are shown indicating the
versatility of the system.
[0035] FIGS. 16A and 16B depict the expression of VEGF (5A) and
PIGF (5B) protein by cultured adipose derived regenerative
cells.
[0036] FIG. 17 depicts detection of endothelial progenitor cells
within adipose derived regenerative cell populations.
[0037] FIGS. 18A and 18B depict the in vitro development of
vascular structures in both normal (7A) and streptozotocin-treated
(7B) mice.
[0038] FIG. 19 depicts the increased average restoration of blood
flow in hindlimb ischemia mice treated with adipose derived
regenerative cells compared to a negative control.
[0039] FIGS. 20A and 20B shows that increasing adipose derived
regenerative cell dose improves graft survival and angiogenesis
(20A) and depicts the retention of adipose tissue architecture in
histologic specimen (20B).
[0040] FIG. 21 depicts the histological timeline of engraftment of
donor derived adipose derived regenerative cells in the area of
infarcted myocardium.
[0041] FIG. 22 depicts dual positive staining for both
beta-galactosidase and myosin heavy chain. Highlighted cells
exhibit both blue betagalactosidase staining, demonstrating their
origin from donor adipose tissue cells, and brown staining
indicating expression of the cardiac muscle protein myosin heavy
chain. Cells exhibiting both brown and blue staining (as indicated
by arrows) are adipose tissue-derived cells that have taken on the
phenotype of cardiac muscle cells.
[0042] FIG. 23 depicts clusters of donor derived adipose derived
regenerative cells in a region of infarcted myocardium following
occlusion/reperfusion injury in the rat.
[0043] FIG. 24 depicts significantly improved ejection fraction at
twelve weeks post myocardial infarction of rats treated with
adipose derived regenerative cells compared with saline based on
echo and contractility analysis.
[0044] FIG. 25 depicts significantly improved baseline
contractility at twelve weeks post myocardial infarction of rats
treated with adipose derived regenerative cells compared with
saline based on echo and contractility analysis.
[0045] FIG. 26 depicts significantly improved baseline relaxation
at twelve weeks post myocardial infarction of rats treated with
adipose derived regenerative cells compared with saline based on
echo and contractility analysis.
[0046] FIG. 27 depicts changes in remodeling parameters, i.e.,
reduced ventricular septal thickness, at twelve weeks post
myocardial infarction of rats treated with adipose derived
regenerative cells compared with saline.
[0047] FIG. 28 depicts prevention of the progression of ventricular
dilation as evident in reduced ventricular septal thickness
(systole) at twelve weeks post myocardial infarction of rats
treated with ADCs compared with saline.
[0048] FIGS. 29 and 30 depict prevention of the progression of
ventricular dilation as evident in reduced posterior wall thickness
in both diastole (FIG. 29) and systole (FIG. 30) at twelve weeks
post myocardial infarction of rats treated with adipose derived
regenerative cells compared with saline.
[0049] FIG. 31 depicts significant increase of left ventricle
ejection fraction (LVEF) in pigs in the cell infusion group
(3.0%.+-.6.0%, mean.+-.SD) versus the control group (-9.0%.+-.5.0%,
p=0.01). LVEF by cineangiography (n=12) showed a similar trend with
values of 3.7%.+-.5.0% vs. -2.0%.+-.7.5%, respectively
(p=0.16).
DETAILED DESCRIPTION
[0050] The present invention provides systems and methods for
treating cardiovascular conditions, diseases and disorders using
adipose derived regenerative cells, e.g., stem and progenitor
cells. Specifically, the present invention demonstrates that the
adipose derived regenerative cells of the invention (1) express
angiogenic and arteriogenic growth factors, including PIGF, VEGF,
bFGF, IGF-II, Eotaxin, G-CSF, GM-CSF, IL-12 p40/p70, IL-12 p70,
IL-13, IL-6, IL-9, Leptin, MCP-1, M-CSF, MIG, PF-4, TIMP-1, TIMP-2,
TNF-.alpha., and Thrombopoetin, (2) comprise endothelial progenitor
cells (EPC) which have a well-established function in blood vessel
formation, (3) develop into blood vessels in vitro, and (4) support
ischemic tissue survival in vivo. (2) contain endothelial
progenitor cells (EPC) which have a well-established function in
blood vessel formation, (3) develop into blood vessels in vitro,
(4) support ischemic tissue survival in vivo, (5) restore perfusion
following occlusion/reperfusion injury of the hind limb, (6) when
injected into animals after heart injury home to the heart, (7)
when injected into an animals after heart injury differentiate into
cells expressing markers consistent with their differentiation into
cardiac myocytes or cardiac myocyte like cells, (8) improve
perfusion post myocardial infarct in a surgical models of hind limb
ischemia in mice, (9) prevent progression of remodeling and (10)
improve function in a small and large animal models of myocardial
infarction. Accordingly, the instant disclosure demonstrates that
the regenerative cells of the present invention are useful for the
treatment of cardiovascular diseases and disorders.
[0051] In order that the present invention may be more readily
understood, certain terms are first defined. Additional definitions
are set forth throughout the detailed description.
[0052] As used herein, "regenerative cells" refers to any
heterogeneous or homologous cells obtained using the systems and
methods of the present invention which cause or contribute to
complete or partial regeneration, restoration, or substitution of
structure or function of an organ, tissue, or physiologic unit or
system to thereby provide a therapeutic, structural or cosmetic
benefit. Examples of regenerative cells include: adult stem cells,
endothelial cells, endothelial precursor cells, endothelial
progenitor cells, macrophages, fibroblasts, pericytes, smooth
muscle cells, preadipocytes, differentiated or de-differentiated
adipocytes, keratinocytes, unipotent and multipotent progenitor and
precursor cells (and their progeny), lymphocytes, neutrophils,
histiocytes (tissue macrophages), lymphatic system related cells,
neurons, neuronal precursor cells and Schwann cells.
[0053] One mechanism by which the regenerative cells may provide a
therapeutic, structural or cosmetic benefit is by incorporating
themselves or their progeny into newly generated, existing or
repaired tissues or tissue components. For example, ASCs and/or
their progeny may incorporate into newly generated bone, muscle, or
other structural or functional tissue and thereby cause or
contribute to a therapeutic, structural or cosmetic improvement.
Similarly, endothelial cells or endothelial precursor or progenitor
cells and their progeny may incorporate into existing, newly
generated, repaired, or expanded blood vessels to thereby cause or
contribute to a therapeutic, structural or cosmetic benefit.
[0054] Another mechanism by which the regenerative cells may
provide a therapeutic, structural or cosmetic benefit is by
expressing and/or secreting molecules, e.g., growth factors, that
promote creation, retention, restoration, and/or regeneration of
structure or function of a given tissue or tissue component. For
example, regenerative cells may express and/or secrete molecules
which result in enhanced growth of tissues or cells that then
participate directly or indirectly in improved structure or
function. Regenerative cells may express and/or secrete growth
factors, including, for example, Vascular Endothelial Growth Factor
(VEGF), Placental Growth factor (PlGF), bFGF, IGF-II, Eotaxin,
G-CSF, GM-CSF, IL-12 p40/p70, IL-12 p70, IL-13, IL-6, IL-9, Leptin,
MCP-1, M-CSF, MIG, PF-4, TIMP-1, TIMP-2, TNF-.alpha.,
Thrombopoetin, and their isoforms, which may perform one or more of
the following functions: stimulate development of new blood
vessels, i.e., promote angiogenesis; improve oxygen supply of
pre-existent small blood vessels (collaterals) by expanding their
blood carrying capacity; induce mobilization of regenerative cells
from sites distant from the site of injury to thereby enhance the
homing and migration of such cells to the site of injury; stimulate
the growth and/or promote the survival of cells within a site of
injury thereby promoting retention of function or structure;
deliver molecules with anti-apoptotic properties thereby reducing
the rate or likelihood of cell death and permanent loss of
function; and interact with endogenous regenerative cells and/or
other physiological mechanisms.
[0055] The regenerative cells may be used in their `native` form as
present in or separated and concentrated from the tissue using the
systems and methods of the present invention or they may be
modified by stimulation or priming with growth factors or other
biologic response modifiers, by gene transfer (transient or stable
transfer), by further sub-fractionation of the resultant population
on the basis or physical properties (for example size or density),
differential adherence to a solid phase material, expression of
cell surface or intracellular molecules, cell culture or other ex
vivo or in vivo manipulation, modification, or fractionation as
further described herein. The regenerative cells may also be used
in combination with other cells or devices such as synthetic or
biologic scaffolds, materials or devices that deliver factors,
drugs, chemicals or other agents that modify or enhance the
relevant characteristics of the cells as further described
herein.
[0056] As used herein, "regenerative cell composition" refers to
the composition of cells typically present in a volume of liquid
after a tissue, e.g., adipose tissue, is washed and at least
partially disaggregated. For example, a regenerative cell
composition of the invention comprises multiple different types of
regenerative cells, including ASCs, endothelial cells, endothelial
precursor cells, endothelial progenitor cells, macrophages,
fibroblasts, pericytes, smooth muscle cells, preadipocytes,
differentiated or de-differentiated adipocytes, keratinocytes,
unipotent and multipotent progenitor and precursor cells (and their
progeny), and lymphocytes. The regenerative cell composition may
also contain one or more contaminants, such as collagen, which may
be present in the tissue fragments, or residual collagenase or
other enzyme or agent employed in or resulting from the tissue
disaggregation process described herein.
[0057] As used herein, "regenerative medicine" refers to any
therapeutic, structural or cosmetic benefit that is derived from
the placement, either directly or indirectly, of regenerative cells
into a subject. As used herein, the phrase "cardiovascular
condition, disease or disorder" is intended to include all
disorders characterized by insufficient, undesired or abnormal
cardiac function, e.g., ischemic heart disease, hypertensive heart
disease and pulmonary hypertensive heart disease, valvular disease,
congenital heart disease, toxic or infectious cardiomyopathies and
any condition which leads to heart failure, e.g., congestive heart
failure, in a subject, particularly a human subject. Insufficient
or abnormal cardiac function can be the result of disease, injury
and/or aging. By way of background, a response to myocardial injury
follows a well-defined path in which some cells die while others
enter a state of hibernation where they are not yet dead but are
dysfunctional. This is followed by infiltration of inflammatory
cells and a deposition of collagen as part of scarring, all of
which happen in parallel with in-growth of new blood vessels and a
degree of continued cell death. As used herein, the term "ischemia"
refers to any tissue ischemia (e.g., localized tissue ischemia or
generalized tissue ischemia such as in cases of shock) caused by
the reduction of the inflow of blood and/or by the reduction in the
supply of oxygen and/or other nutrients. The term "myocardial
ischemia" refers to circulatory disturbances caused by coronary
atherosclerosis and/or inadequate blood, oxygen and/or nutrient
supply to the myocardium. The term "myocardial infarction" refers
to an ischemic insult to myocardial tissue resulting from a lack of
blood flow. Specifically, this insult results from an occlusive
(e.g., thrombotic or embolic) event in the coronary circulation and
produces an environment in which the myocardial metabolic demands
exceed the supply of oxygen and or nutrients to the myocardial
tissue.
[0058] As used herein, the term "angiogenesis" refers to the
process by which new blood vessels are generated from existing
vasculature and tissue (Folkman, 1995). The term "repair" refers to
the reformation of damaged vasculature and tissue. The alleviation
of tissue ischemia is critically dependent upon angiogenesis. The
spontaneous growth of new blood vessels provides collateral
circulation in and around an ischemic area, improves blood flow,
and alleviates the symptoms caused by the ischemia. As used herein,
the term "angiogenic factor" or "angiogenic protein" refers to any
known protein, peptide or other agent capable of promoting growth
of new blood vessels from existing vasculature ("angiogenesis").
Suitable angiogenic factors for use in the invention include, but
are not limited to, Placenta Growth Factor (Luttun et al., 2002),
Macrophage Colony Stimulating Factor (Aharinejad et al., 1995),
Granulocyte Macrophage Colony Stimulating Factor (Buschmann et al.,
2003), Vascular Endothelial Growth Factor (VEGF)-A, VEGF-A, VEGF-B,
VEGF-C, VEGF-D, VEGF-E (Mints et al., 2002), neuropilin (Wang et
al., 2003), fibroblast growth factor (FGF)-1, FGF-2(bFGF), FGF-3,
FGF-4, FGF-5, FGF-6 (Botta et al., 2000), Angiopoietin 1,
Angiopoietin 2 (Sundberg et al., 2002), erythropoietin (Ribatti et
al., 2003), BMP-2, BMP-4, BMP-7 (Carano and Filvaroff, 2003),
TGF-beta (Xiong et al., 2002), IGF-1 (Shigematsu et al., 1999),
Osteopontin (Asou et al., 2001), Pleiotropin (Beecken et al.,
2000), Activin (Lamouille et al., 2002), Endothelin-1 (Bagnato and
Spinella, 2003) and combinations thereof. Angiogenic factors can
act independently, or in combination with one another. When in
combination, angiogenic factors can also act synergistically,
whereby the combined effect of the factors is greater than the sum
of the effects of the individual factors taken separately. The term
"angiogenic factor" or "angiogenic protein" also encompasses
functional analogues of such factors. Functional analogues include,
for example, functional portions of the factors. Functional
analogues also include anti-idiotypic antibodies which bind to the
receptors of the factors and, thus, mimic the activity of the
factors in promoting angiogenesis and/or tissue repair. Methods for
generating such anti-idiotypic antibodies are well known in the art
and are described, for example, in WO 97/23510, the contents of
which are incorporated by reference herein.
[0059] Angiogenic factors used in the present invention can be
produced or obtained from any suitable source. For example, the
factors can be purified from their native sources, or produced
synthetically or by recombinant expression. The factors can be
administered to patients as a protein composition. Alternatively,
the factors can be administered in the form of an expression
plasmid encoding the factors. The construction of suitable
expression plasmids is well known in the art. Suitable vectors for
constructing expression plasmids include, for example, adenoviral
vectors, retroviral vectors, adeno-associated viral vectors, RNA
vectors, liposomes, cationic lipids, lentiviral vectors and
transposons.
[0060] As used herein, the term "arteriogenesis" refers to the
process of enhancing growth of collateral arteries and/or other
arteries from pre-existing arteriolar connections (Carmeliet, 2000;
Scholz et al., 2001; Scholz et al., 2002). More particularly,
arteriogenesis is the in situ recruitment and expansion of arteries
by proliferation of endothelial and smooth muscle cells from
pre-existing arteriolar connections supplying blood to ischemic
tissue, tumor or site of inflammation. These vessels largely grow
outside the affected tissue and are important for the delivery of
nutrients to the ischemic territory, the tumor or the site of
inflammation. Arteriogenesis is part of the normal response to
myocardial ischemia (Mills et al., 2000; Monteiro et al., 2003). In
addition, the common surgical technique of a coronary artery bypass
graft (CABG) is, in effect, no more than creation of an artificial
collateral vessel (Sergeant et al., 1997). Thus, processes which
enhance arteriogenesis following an infarct will improve blood flow
to ischemic tissue resulting in decreased cell death and decreased
infarct size. These improvements will result in improved cardiac
function and therapeutic benefit.
[0061] As used herein, "stem cell" refers to a multipotent
regenerative cell with the potential to differentiate into a
variety of other cell types, which perform one or more specific
functions and have the ability to self-renew. Some of the stem
cells disclosed herein may be multipotent.
[0062] As used herein, "progenitor cell" refers to a multipotent
regenerative cell with the potential to differentiate into more
than one cell type and has limited or no ability to self-renew.
"Progenitor cell", as used herein, also refers to a unipotent cell
with the potential to differentiate into only a single cell type,
which performs one or more specific functions and has limited or no
ability to self-renew. In particular, as used herein, "endothelial
progenitor cell" refers to a multipotent or unipotent cell with the
potential to differentiate into vascular endothelial cells.
[0063] As used herein, "precursor cell" refers to a unipotent
regenerative cell with the potential to differentiate into one cell
type. Precursor cells and their progeny may retain extensive
proliferative capacity, e.g., lymphocytes and endothelial cells,
which can proliferate under appropriate conditions.
[0064] As used herein "stem cell number" or "stem cell frequency"
refers to the number of colonies observed in a clonogenic assay in
which adipose derived cells (ADC) are plated at low cell density
(<10,000 cells/well) and grown in growth medium supporting MSC
growth (for example, DMEM/F12 medium supplemented with 10% fetal
calf serum, 5% horse serum, and antibiotic/antimycotic agents).
Cells are grown for two weeks after which cultures are stained with
hematoxylin and colonies of more than 50 cells are counted as
CFU-F. Stem cell frequency is calculated as the number of CFU-F
observed per 100 nucleated cells plated (for example; 15 colonies
counted in a plate initiated with 1,000 nucleated regenerative
cells gives a stem cell frequency of 1.5%). Stem cell number is
calculated as stem cell frequency multiplied by the total number of
nucleated ADC cells obtained. A high percentage (-100%) of CFU-F
grown from regenerative cells express the cell surface molecule
CD105 which is also expressed by marrow-derived stem cells (Barry
et al., 1999). CD105 is also expressed by adipose tissue-derived
stem cells (Zuk et al., 2002).
[0065] As used herein, the term "adipose tissue" refers to fat
including the connective tissue that stores fat. Adipose tissue
contains multiple regenerative cell types, including ASCs and
endothelial progenitor and precursor cells.
[0066] As used herein, the term "unit of adipose tissue" refers to
a discrete or measurable amount of adipose tissue. A unit of
adipose tissue may be measured by determining the weight and/or
volume of the unit. Based on the data identified above, a unit of
processed lipoaspirate, as removed from a patient, has a cellular
component in which at least 0.1% of the cellular component is stem
cells; that is, it has a stem cell frequency, determined as
described above, of at least 0.1%. In reference to the disclosure
herein, a unit of adipose tissue may refer to the entire amount of
adipose tissue removed from a patient, or an amount that is less
than the entire amount of adipose tissue removed from a patient.
Thus, a unit of adipose tissue may be combined with another unit of
adipose tissue to form a unit of adipose tissue that has a weight
or volume that is the sum of the individual units.
[0067] As used herein, the term "portion" refers to an amount of a
material that is less than a whole. A minor portion refers to an
amount that is less than 50%, and a major portion refers to an
amount greater than 50%. Thus, a unit of adipose tissue that is
less than the entire amount of adipose tissue removed from a
patient is a portion of the removed adipose tissue.
[0068] As used herein, the term "processed lipoaspirate" refers to
adipose tissue that has been processed to separate the active
cellular component (e.g., the component containing regenerative)
from the mature adipocytes and connective tissue. This fraction is
referred to herein as "adipose-derived cells" or "ADC." Typically,
ADC refers to the pellet of regenerative cells obtained by washing
and separating and concentrating the cells from the adipose tissue.
The pellet is typically obtained by centrifuging a suspension of
cells so that the cells aggregate at the bottom of a centrifuge
chamber or cell concentrator.
[0069] As used herein, the terms "administering," "introducing,"
"delivering," "placement" and "transplanting" are used
interchangeably herein and refer to the placement of the
regenerative cells of the invention into a subject by a method or
route which results in at least partial localization of the
regenerative cells at a desired site. The regenerative cells can be
administered by any appropriate route which results in delivery to
a desired location in the subject where at least a portion of the
cells or components of the cells remain viable. The period of
viability of the cells after administration to a subject can be as
short as a few hours, e.g., twenty-four hours, to a few days, to as
long as several years.
[0070] As used herein, the term "treating" includes reducing or
alleviating at least one adverse effect or symptom of a disease or
disorder.
[0071] As used herein, "therapeutically effective dose of
regenerative cells" refers to an amount of regenerative cells that
are sufficient to bring about a beneficial or desired clinical
effect. Said dose could be administered in one or more
administrations. However, the precise determination of what would
be considered an effective dose may be based on factors individual
to each patient, including, but not limited to, the patient's age,
size, type or extent of disease, stage of the disease, route of
administration of the regenerative cells, the type or extent of
supplemental therapy used, ongoing disease process and type of
treatment desired (e.g., aggressive vs. conventional
treatment).
[0072] As used herein, the term "subject" includes warm-blooded
animals, preferably mammals, including humans. In a preferred
embodiment, the subject is a primate. In an even more preferred
embodiment, the subject is a human.
[0073] As previously set forth herein, regenerative cells, e.g.,
stem and progenitor cells, can be harvested from a wide variety of
tissues. The system of the present invention may be used for all
such tissues. Adipose tissue, however, is an especially rich source
of regenerative cells. Accordingly, the system of the present
invention is illustrated herein using adipose tissue as a source of
regenerative cells by way of example only and not limitation.
[0074] Adipose tissue can be obtained by any method known to a
person of ordinary skill in the art. For example, adipose tissue
may be removed from a patient by liposuction (syringe or power
assisted) or by lipectomy, e.g., suction-assisted lipoplasty,
ultrasound-assisted lipoplasty, and excisional lipectomy or
combinations thereof. The adipose tissue is removed and collected
and may be processed in accordance with any of the embodiments of a
system of the invention described herein. The amount of tissue
collected depends on numerous factors, including the body mass
index and age of the donor, the time available for collection, the
availability of accessible adipose tissue harvest sites,
concomitant and pre-existing medications and conditions (such as
anticoagulant therapy), and the clinical purpose for which the
tissue is being collected. For example, the regenerative cell
percentage of 100 ml of adipose tissue extracted from a lean
individual is greater than that extracted from an obese donor
(Table 1). This likely reflects a dilutive effect of the increased
fat content in the obese individual. Therefore, it may be
desirable, in accordance with one aspect of the invention, to
obtain larger amounts of tissue from overweight donors compared to
the amounts that would be withdrawn from leaner patients. This
observation also indicates that the utility of this invention is
not limited to individuals with large amounts of adipose
tissue.
TABLE-US-00001 TABLE 1 Effect of Body Mass Index on Tissue and Cell
Yield Amount of Tissue Total Regenerative Cell Body Mass Index
Status Obtained (g) Yield (.times.10.sup.7) Normal .sup. 641 .+-.
142 2.1 .+-. 0.4 Obese 1,225 .+-. 173 2.4 .+-. 0.5 p value 0.03
0.6
[0075] After the adipose tissue is processed, the resulting
regenerative cells are substantially free from mature adipocytes
and connective tissue. For example, the resulting regenerative
cells may be substantially free of collagen and extracellular
matrix components but may be comprised of fibroblasts which are
present in connective tissue. Accordingly, the system of the
present invention generates a heterogeneous plurality of adipose
derived regenerative cells which may be used for research and/or
therapeutic purposes. In a preferred embodiment, the cells are
suitable for placement or re-infusion within the body of a
recipient. In other embodiments, the cells may be used for
research, e.g., the cells can be used to establish stem or
progenitor cell lines which can survive for extended periods of
time and be used for further study.
[0076] Reference will now be made in detail to the presently
preferred embodiments of the invention, examples of which are
illustrated in the accompanying drawings. Wherever possible, the
same or similar reference numbers are used in the drawings and the
description to refer to the same or like parts. It should be noted
that the drawings are in simplified form and are not to precise
scale. In reference to the disclosure herein, for purposes of
convenience and clarity only, directional terms, such as, top,
bottom, left, right, up, down, over, above, below, beneath, rear,
front, distal, and proximal are used with respect to the
accompanying drawings. Such directional terms should not be
construed to limit the scope of the invention in any manner.
[0077] Although the disclosure herein refers to certain illustrated
embodiments, it is to be understood that these embodiments are
presented by way of example and not by way of limitation. The
intent of the following detailed description, although discussing
exemplary embodiments, is to be construed to cover all
modifications, alternatives, and equivalents of the embodiments as
may fall within the spirit and scope of the invention as defined by
the appended claims. The present invention may be utilized in
conjunction with various medical procedures that are conventionally
used in the art.
[0078] Referring now to the Figures, a system 10 of the present
invention is generally comprised of one or more of a tissue
collection chamber 20, a processing chamber 30, a waste chamber 40,
an output chamber 50 and a sample chamber 60. The various chambers
are coupled together via one or more conduits 12 such that fluids
containing biological material may pass from one chamber to another
while maintaining a closed, sterile fluid/tissue pathway. The
conduits may comprise rigid or flexible bodies referred to
interchangeably herein as lumens and tubing, respectively. In
certain embodiments, the conduits are in the form of flexible
tubing, such as polyethylene tubing conventionally used in clinical
settings, silicone or any other material known in the art. The
conduits 12 can vary in size depending on whether passage of fluid
or tissue is desired. The conduits 12 may also vary in size
depending on the amount of tissue or fluid that is cycled through
the system. For example, for the passage of fluid, the conduits may
have a diameter ranging from about 0.060 to about 0.750 inches and
for the passage of tissue, the conduits may have a diameter ranging
from 0.312 to 0.750 inches. Generally, the size of the conduits is
selected to balance the volume the conduits can accommodate and the
time required to transport the tissue or fluids through said
conduits. In automated embodiments of the system, the foregoing
parameters, i.e., volume and time for transport, must be identified
such that the appropriate signals can be transmitted to the
processing device of the system. This allows the device to move
accurate volumes of liquid and tissue from one chamber to another.
The flexile tubing used should be capable of withstanding negative
pressure to reduce the likelihood of collapse. The flexible tubing
used should also be capable of withstanding positive pressure which
is generated by, for example, a positive displacement pump, which
may be used in the system.
[0079] All the chambers of the system may be comprised of one or
more ports, e.g., outlet 22 or inlet 21 ports, which accept
standard IV, syringe and suction tubing connections. The ports may
be a sealed port such as a rubber septum closed syringe needle
access port 51. The inlet ports may be coupled to one or more
cannulas (not shown) by way of conduits. For example, a tissue
inlet port 21 may be coupled to an integrated single use
liposuction cannula and the conduit may be a flexible tubing. The
conduits are generally positioned to provide fluid passageways from
one chamber of the system to another. Towards this end, the
conduits and ports may be coupled to, for example, a suction device
(not shown) which may be manually or automatically operated. The
suction device may be, e.g., a syringe or an electric pump. The
suction device should be capable of providing sufficient negative
pressure to aspirate tissue from a patient. Generally, any suitable
suction device known to one of ordinary skill in the art, e.g., a
surgeon, may be used.
[0080] The conduits 12 may further comprise one or more clamps (not
shown) to control the flow of material among various components of
the system. The clamps are useful for maintaining the sterility of
the system by effectively sealing different regions of the system.
Alternatively, the conduits 12 may comprise one or more valves 14
that control the flow of material through the system. The valves 14
are identified as open circles in the Figures. In preferred
embodiments, the valves may be electromechanical pinch valves. In
another embodiment, the valves may be pneumatic valves. In yet
other embodiments, the valves may be hydraulic valves or mechanical
valves. Such valves are preferably activated by a control system
which may be coupled to levers. The levers may be manually
manipulated such that the levers are activated. In automated
embodiments, the control system may be coupled to the levers as
well as to a processing device which may activate the valves at
pre-determined activation conditions. In certain automated
embodiments, activation of the valves may be partially automated
and partially subject to the user's preference such that the
process may be optimized. In yet other embodiments, certain valves
may be activated manually and others automatically through the
processing device. The valves 14 may also be used in conjunction
with one or more pumps, e.g., peristaltic pumps 34 or positive
displacement pumps (not shown). The conduits 12 and/or the valves
14 may also be comprised of sensors 29, e.g., optical sensors,
ultrasonic sensors, pressure sensors or other forms of monitors
known in the art that are capable of distinguishing among the
various fluid components and fluid levels that flow through the
system. In a preferred embodiment, the sensors 29 may be optical
sensors.
[0081] The system may also include a plurality of filters 36. In
certain embodiments, the filters may be within a chamber of the
system 28. Different chambers within the system may be comprised of
different filters. The filters are effective to separate the
regenerative cells, e.g., stem cells and/or progenitor cells, from
undesirable cells and disaggregation agents that may be used in
accordance with the system. In one embodiment, a filter assembly 36
includes a hollow fiber filtration device. In another embodiment, a
filter assembly 36 includes a percolative filtration device, which
may or may not be used with a sedimentation process. In a further
embodiment, the filter assembly 36 comprises a centrifugation
device, which may or may not be used with an elutriation device and
process. In yet another embodiment, the system comprises a
combination of these filtering devices. The filtration functions of
the present invention can be two-fold, with some filters removing
things from the final concentration such as collagen, free lipid,
free adipocytes and residual collagenase, and with other filters
being used to concentrate the final product. The filters of the
system may be comprised of a plurality of pores ranging in
diameters and/or length from 20 to 800 .mu.m. In a preferred
embodiment, the collection chamber 20 has a prefixed filter 28 with
a plurality of pores ranging from 80 to 400 .mu.m. In another
preferred embodiment, the collection chamber 20 has a prefixed
filter 28 with a plurality of 265 .mu.m pores. In other
embodiments, the filters may be detachable and/or disposable.
[0082] The system may also be comprised of one or more temperature
control devices (not shown) that are positioned to adjust the
temperature of the material contained within one or more chambers
of the system. The temperature control device may be a heater, a
cooler or both, i.e., it may be able to switch between a heater and
a cooler. The temperature device may adjust the temperature of any
of the material passing through the system, including the tissue,
the disaggregation agents, the resuspension agents, the rinsing
agents, the washing agents or the additives. For example, heating
of adipose tissue facilitates disaggregation whereas the cooling of
the regenerative cell output is desirable to maintain viability.
Also, if pre-warmed reagents are needed for optimal tissue
processing, the role of the temperature device would be to maintain
the pre-determined temperature rather than to increase or decrease
the temperature.
[0083] To maintain a closed, sterile fluid/tissue pathway, all
ports and valves may comprise a closure that maintains the sealed
configuration of the system. The closure may be a membrane that is
impermeable to fluid, air and other contaminants or it may be any
other suitable closure known in the art. Furthermore, all ports of
the system may be designed such that they can accommodate syringes,
needles or other devices for withdrawing the materials in the
chambers without compromising the sterility of the system.
[0084] As set forth herein, tissue may be extracted from a patient
via any art recognized method. The aspirated tissue may be
extracted prior to being placed in the system for processing. The
aspirated tissue is typically transferred to the collection chamber
20 through conduits 12 via a sealed entry port, such as a rubber
septum closed syringe needle access port (not shown on collection
chamber). Alternatively, the tissue extraction step may be part of
the system. For example, the collection chamber 20 may be comprised
of a vacuum line 11 which facilitates tissue removal using a
standard cannula inserted into the patient. Thus, in this
embodiment, the entire system is attached to the patient. The
tissue may be introduced into the collection chamber 20 through an
inlet port 21 via a conduit such as 12a which are part of a closed
sterile pathway. The collection chamber 20 may be comprised of a
plurality of flexible or rigid canisters or cylinders or
combinations thereof. For example, the collection chamber 20 may be
comprised of one or more rigid canisters of varying sizes. The
collection chamber 20 may also be comprised of one or more flexible
bags. In such systems, the bag is preferably provided with a
support, such as in internal or external frame, that helps reduce
the likelihood that the bag will collapse upon the application of
suction to the bag. The collection chamber 20 is sized to hold the
requisite amount of saline to appropriately wash and disaggregate
the tissue prior to the wash and concentrate stage of the process
performed in the processing chamber 30. Preferably, the volume of
tissue or fluid present in the collection chamber 20 is easily
ascertainable to the naked eye. For example, to obtain regenerative
cells from adipose tissue, a suitable collection chamber has the
capacity to hold 800 ml of lipoaspirate and 1200 ml of saline.
Accordingly, in one embodiment, the collection chamber 20 has a
capacity of at least 2 liters. In another embodiment, to separate
and concentrate red blood cells from blood, the collection chamber
20 has a capacity of at least 1.5 liters. Generally, the size of
the collection chamber 20 will vary depending on the type and
amount of tissue collected from the patient. The collection chamber
20 may be sized to hold as little as about 5 ml to up to about 2
liters of tissue. For smaller tissue volumes, e.g., 5 mls to 100
mls, the tissue may be gathered in a syringe prior to transfer to
the collection chamber 20.
[0085] The collection chamber 20 may be constructed using any
suitable biocompatible material that can be sterilized. In a
preferred embodiment, the collection chamber 20 is constructed of
disposable material that meets biocompatibility requirements for
intravascular contact as described in the ISO 10993 standard. For
example, polycarbonate acrylic or ABS may be used. The fluid path
of the collection chamber 20 is preferably pyrogen free, i.e.,
suitable for blood use without danger of disease transmittal. In
one embodiment, the collection chamber 20 is constructed of a
material that allows the user to visually determine the approximate
volume of tissue present in the chamber. In other embodiments, the
volume of tissue and/or fluid in the collection chamber 20 is
determined by automated sensors 29. The collection chamber 20 is
preferably designed such that in an automated embodiment, the
system can determine the volume of tissue and/or fluid within the
chamber with a reasonable degree of accuracy. In a preferred
embodiment, the system senses the volume within the collection
chamber with an accuracy of plus or minus fifteen percent.
[0086] In a particular embodiment provided by way of example only,
the collection chamber 20 is in the form of a rigid chamber, for
example, a chamber constructed of a medical grade polycarbonate
containing a roughly conical prefixed filter 28 of medical grade
polyester with a mesh size of 265 .mu.m (see FIG. 5). The rigid
tissue collection container may have a size of approximately eight
inches high and approximately five inches in diameter; the wall
thickness may be about 0.125 inches. The interior of the cylinder
may be accessed through, for example, one or more ports for suction
tubing, one or more ports with tubing for connection through
sterile docking technology, and/or one or more ports for needle
puncture access through a rubber septum. The prefixed filter 28 in
the interior of the collection chamber 20 is preferably structured
to retain adipose tissue and to pass non-adipose tissue as, for
example, the tissues are removed from the patient. More
specifically, the filter 28 may allow passage of free lipid, blood,
and saline, while retaining fragments of adipose tissue during, or
in another embodiment after, the initial harvesting of the adipose
tissue. In that regard, the filter 28 includes a plurality of
pores, of either the same or different sizes, but ranging in size
from about 20 .mu.m to 5 mm. In a preferred embodiment, the filter
28 includes a plurality of 400 .mu.m pores. In a preferred
embodiment, the filter 28 is a medical grade polyester mesh of
around 200 .mu.m thickness with a pore size of around 265 .mu.m and
around 47% open area. This material holds the tissue during rinsing
but allows cells to pass out through the mesh following tissue
disaggregation. Thus, when the tissues are aspirated from the
patient, non-adipose tissue may be separated from adipose tissue.
The same functionality could be achieved with different materials,
mesh size, and the number and type of ports. For example, mesh pore
sizes smaller than 100 .mu.m or as large as several thousand
microns would achieve the same purpose of allowing passage of
saline and blood cells while retaining adipose tissue aggregates
and fragments. Similarly, the same purpose could be achieved by use
of an alternative rigid plastic material, or by many other
modifications that would be known to those skilled in the art
[0087] The system 10 may also be comprised of one or more solution
sources 22. The solution source may comprise a washing solution
source 23, and a tissue disaggregation agent source 24, such as
collagenase. The collection chamber 20 is comprised of closed fluid
pathways that allows for the washing and disaggregating solutions
or agents to be added to the tissue in an aseptic manner.
[0088] The containers for the washing solution 23 and the
disaggregation agents 24 may be any suitable container that can
hold their contents in a sterile manner, e.g., a collapsible bag,
such as an IV bag used in clinical settings. These containers may
have conduits 12, such as conduit 12e, coupled to the collection
chamber 20 so that the washing solution and the disaggregation
agent may be delivered to the interior of the collection chamber
20. The washing solution and the disaggregation agent may be
delivered to the interior of the collection chamber 20 through any
art-recognized manner, including simple gravity pressure applied to
the outside of the containers for the saline 23 and/or the
disaggregation agents 24 or by placement of a positive displacement
pump on the conduits, e.g., conduit 12d in FIG. 4. In automated
embodiments, the processing device of the system calculates various
parameters, e.g., the volume of saline and time or number of cycles
required for washing as well as the concentration or amount of
disaggregation agent and the time required for disaggregation based
on information initially entered by the user (e.g., volume of
tissue being processed). Alternatively, the amounts, times etc. can
be manually manipulated by the user.
[0089] The tissue and/or fluid within the collection chamber should
be maintained at a temperature ranging from 30 degrees Celsius to
40 degrees Celsius. In a preferred embodiment, the temperature of
the suspension inside the collection chamber is maintained at 37
degrees Celsius. In certain embodiments, if the surgical procedure
or therapeutic application needs to be delayed, the selected tissue
may be stored in the collection chamber for later use. The tissue
may be stored at or about room temperature or at about 4 degrees
Celsius for up to 96 hours.
[0090] The washing solution may be any solution known to one of
skill in the art, including saline or any other buffered or
unbuffered electrolyte solution. The types of tissue being
processed will dictate the types or combinations of washing
solutions used. Typically, the washing solution, such as saline,
enters the collection chamber 20 after the adipose tissue has been
removed from the patient and placed in the collection chamber.
However, the washing solution may be delivered to the collection
chamber 20 before the adipose tissue is extracted, or may be
delivered to the collection chamber 20 concurrently with the
adipose tissue. In the collection chamber 20, the washing solution
and the extracted adipose tissue may be mixed by any means
including the methods described below.
[0091] For example, the tissue may be washed by agitation (which
maximizes cell viability and minimizes the amount of free lipid
released). In one embodiment, the tissue is agitated by rotating
the entire collection chamber 20 through an arc of varying degrees
(e.g., through an arc of about 45 degrees to about 90 degrees) at
varying speeds, e.g., about 30 revolutions per minute. In other
embodiments, the tissue is agitated by rotating the entire
collection chamber 20, wherein the collection chamber 20 is
comprised of one or more paddles or protrusions rigidly attached to
an inside surface of the collection chamber, through an arc of
varying degrees (e.g., through an arc of about 45 degrees to about
90 degrees) at varying speeds, e.g., about 30 revolutions per
minute. The rotation of the collection chamber 20 described above
may be accomplished by a drive mechanism attached to or in
proximity with the collection chamber 20. The drive mechanism may
be a simple belt or gear or other drive mechanism known in the art.
The speed of the rotation may be, for example, 30 revolutions per
minute. Generally, higher speeds have been found to generate larger
volumes of free lipids and may not be optimal.
[0092] In other embodiments, the tissue is agitated by placing a
rotatable shaft 25 inside the collection chamber 20, wherein the
rotatable shaft is comprised of one or more paddles 25a or
protrusions rigidly attached to the rotatable shaft 25 which pass
through the mixture as the shaft is being rotated. In certain
embodiments, the rotatable shaft 25 with rigidly attached 25a
paddles may be rested on the bottom of the collection chamber 20.
This may be accomplished, for example, by placing the paddle-like
device into a spinning magnetic field (e.g., magnetic stirrer).
Alternatively, agitating of the tissue may be accomplished using a
simple agitator known in the art, i.e. a device implementing
shaking up and down without rotation. The tissue may also be washed
using any other art-recognized means including rocking, stirring,
inversion, etc.
[0093] After a desired amount of wash cycles, a tissue
disaggregation agent may be delivered to the collection chamber 20
to separate the regenerative cells from the remaining adipose
tissue components. The disaggregation agent may be any
disaggregation agent known to one of skill in the art.
Disaggregation agents that may be used include neutral proteases,
collagenase, trypsin, lipase, hyaluronidase, deoxyribonuclease,
members of the Blendzyme enzyme mixture family, e.g., Liberase H1,
pepsin, ultrasonic or other physical energy, lasers, microwaves,
other mechanical devices and/or combinations thereof. A preferred
disaggregation agent of the invention is collagenase. The
disaggregation agents may be added with other solutions. For
example, saline, such as saline delivered from a saline source 23
as described above, may be added to the adipose tissue along with
or immediately followed by addition of collagenase. In one
embodiment, the washed adipose tissue is mixed with a
collagenase-containing enzyme solution at or around 37.degree. C.
for about 20-60 minutes. In other embodiments, a higher
concentration of collagenase or similar agent may be added to
decrease the digestion time. The washed adipose tissue and the
tissue disaggregation agent may then be agitated in manners similar
to the agitation methods described above, until the washed adipose
tissue is disaggregated. For example, the washed adipose tissue and
the tissue disaggregation agent may be agitated by rotating the
entire collection chamber through an arc of approximately 90
degrees, by having a shaft which contains one or more paddles which
pass through the solution as the shaft is being rotated, and/or by
rotating the entire collection chamber which contains paddles or
protrusions on the inside surface of the collection chamber.
[0094] Depending on the purpose for which the adipose derived cells
will be used, the adipose tissue may either be partially
disaggregated, or completely disaggregated. For example, in
embodiments in which the adipose derived cells are to be combined
with a unit of adipose tissue, it may be desirable to partially
disaggregate the harvested adipose tissue, to remove a portion of
the partially disaggregated adipose tissue, and then continue
disaggregating the remaining portion of adipose tissue remaining in
the collection chamber. Alternatively, a portion of washed adipose
tissue may be removed and set aside in a sample container prior to
any digestion. In another embodiment, harvested adipose tissue is
partially disaggregated to concentrate cells before being
reintroduced back into the patient. In one embodiment, the adipose
tissue is mixed with a tissue disaggregation agent for a period of
time generally less than about 20 minutes. A portion of the
partially disaggregated tissue may then be removed from the
collection chamber, and the remaining partially disaggregated
tissue may be further disaggregated by mixing the adipose tissue
with a tissue disaggregation agent for another 40 minutes. When the
adipose derived cells are to be used as an essentially pure
population of regenerative cells, the adipose tissue may be fully
disaggregated.
[0095] After digestion, the tissue and disaggregation agent
solution is allowed to settle for a period of time sufficient to
allow the buoyant and non-buoyant components of the solution to
differentiate within the collection chamber. Typically, the time
ranges from about 15 seconds to several minutes but other times may
be implemented in modified embodiments. The buoyant layer is
comprised of the regenerative cells that require further washing
and concentrating. The non-buoyant layer comprises blood, collagen,
lipids and other non-regenerative cell components of the tissue.
The non-buoyant layer must be removed to the waste chamber.
[0096] Accordingly, the collection chamber 20 is preferably
comprised of an outlet port 22 at the lowest point of the chamber
such that blood and other non-buoyant components of the tissue may
be drained to one or more waste containers 40 via one or more
conduits 12. The collection chamber 20 is generally in (or may be
placed in) an upright position such that the outlet ports 22 are
located at the bottom of the collection chamber. The draining may
be passive or active. For example, the non-buoyant components
described above could be drained using gravity, by applying
positive or negative pressure, by use of pumps 34 or by use of
vents 32. In automated embodiments, the processing device can
signal certain valves and/or pumps to drain the non-buoyant layer
from the collection chamber 20. The automated embodiments may also
be comprised of sensors 29 which can detect when the interface
between the buoyant and non-buoyant liquids has been reached. The
automated embodiments may also be comprised of a sensor 29, e.g.,
an optical sensor, which may be capable of detecting a change in
the light refraction of the effluent which is flowing in the
conduit leading out of the collection chamber. The appropriate
change in the light refraction may signal the presence of the
buoyant layer in the outgoing conduits which indicates that the
non-buoyant layer has been drained. The sensor 29 can then signal
the processing device to proceed with the next step.
[0097] In certain embodiments however, the tissue may be processed
to retrieve the non-regenerative cell component of the tissue. For
example, in certain therapeutic or research applications, collagen,
proteins, matrix or stromal components, lipids, adipocytes or other
components of the tissue may be desired. In such embodiments, it is
the buoyant layer comprising the regenerative cells that must be
removed as described above to the waste chamber. The non-buoyant
layer is then retained in the system for further processing as
needed.
[0098] Once the non-buoyant layer is removed, the buoyant layer
comprising the regenerative cells may be washed one or more times
to remove residual contaminants. Accordingly, the collection
chamber 20 typically includes one or more ports 21 for permitting
the washing solution to be delivered to the interior of the
chamber, and one or more ports 22 for permitting waste and other
materials to be directed out from the collection chamber 20. For
example, the collection chamber may include one or more sealed
entry ports as described herein. The collection chamber 20 may also
include one or more caps (not shown), such as a top cap and a
bottom cap to further ensure that the system remains sterile while
washing solution is delivered into the collection chamber and/or
waste is transported out. The ports 21 may be provided on the caps
of the collection chamber or on a sidewall of the collection
chamber.
[0099] The process of washing with fresh wash solution may be
repeated until the residual content of non-buoyant contaminants in
the solution reaches a pre-determined level. In other words, the
remaining material in the collection chamber 20, which comprises
the buoyant material of the mixture described above, including
adipose tissue fragments, may be washed one or more additional
times until the amount of undesired material is reduced to a
desired pre-determined level. One method of determining the end
point of the washing is to measure the amount of red blood cells in
the tissue solution. This can be accomplished by measuring the
light absorbed on the 540 nm wavelength. In a preferred embodiment,
a range between about 0.546 and about 0.842 is deemed
acceptable.
[0100] During the washing and/or disaggregation, one or more
additives may be added to the various containers as needed to
enhance the results. Some examples of additives include agents that
optimize washing and disaggregation, additives that enhance the
viability of the active cell population during processing,
anti-microbial agents (e.g., antibiotics), additives that lyse
adipocytes and/or red blood cells, or additives that enrich for
cell populations of interest (by differential adherence to solid
phase moieties or to otherwise promote the substantial reduction or
enrichment of cell populations). Other possible additives include
those that promote recovery and viability of regenerative cells
(for example, caspase inhibitors) or which reduce the likelihood of
adverse reaction on infusion or emplacement (for example,
inhibitors of re-aggregation of cells or connective tissue).
[0101] After a sufficient settling time has elapsed, the
non-buoyant fraction of the resulting mixture of washed adipose
tissue fragments and tissue disaggregation agents will contain
regenerative cells, e.g., stem cells and other adipose derived
progenitor cells. As discussed herein, the non-buoyant fraction
containing the regenerative cells will be transferred to the
processing chamber 30 wherein the regenerative cells of interest,
such as the adipose derived stem cells, will be separated from
other cells and materials present in the non-buoyant fraction of
the mixture. This non-buoyant fraction is referred to herein as the
regenerative cell composition and comprises multiple different
types of cells, including stem cells, progenitor cells, endothelial
precursor cells, adipocytes and other regenerative cells described
herein. The regenerative cell composition may also contain one or
more contaminants, such as collagen and other connective tissue
proteins and fragments thereof, which were present in the adipose
tissue fragments, or residual collagenase from the tissue
disaggregation process.
[0102] The processing chamber 30 of the invention is preferably
positioned within the system such that the regenerative cell
composition moves from the collection chamber 20 to the processing
chamber 30 by way of tubing 12, valves 14 and pump 34 in a sterile
manner. The processing chamber is sized to accommodate tissue/fluid
mixtures ranging from 10 mL to 1.2 L. In a preferred embodiment,
the processing chamber is sized to accommodate 800 mLs. In certain
embodiments, the entire regenerative cell composition from the
collection chamber 20 is directed to the processing chamber 30.
However, in other embodiments, a portion of the regenerative cell
composition is directed to the processing chamber 30, and another
portion is directed to a different region of the system, e.g., the
sample chamber 60, to be recombined with cells processed in the
processing chamber 30 at a later time.
[0103] The processing chamber 30 may be constructed using any
suitable biocompatible material that can be sterilized. In a
preferred embodiment, the processing chamber 30 is constructed of
disposable material that meets biocompatibility requirements for
intravascular contact, as described in the ISO 10993 standard. For
example, polycarbonate, acrylic, ABS, ethylene vinyl acetate or
styrene-butadiene copolymers (SBC) may be used. In another
embodiment, the fluid path of the disposable processing chamber is
pyrogen free. The processing chamber may be in the form of a
plastic bag, such as those conventionally used in processing blood
in blood banks; or in other embodiments, it may be structurally
rigid (FIG. 6). In one embodiment, the processing chamber 30 may be
similar to the processing chamber disclosed in commonly owned U.S.
application Ser. No. 10/316,127, filed Dec. 7, 2001 and U.S.
application Ser. No. 10/325,728, filed Dec. 20, 2002, the contents
of which in their entirety are hereby incorporated by
reference.
[0104] The processing chamber 30 may be constructed in any manner
suitable for separating and concentrating cells, including
filtration and centrifugation and/or combinations thereof. In
certain embodiments, the regenerative cell composition from the
collection chamber 20 is introduced into the processing chamber 30
where the composition can be filtered to separate and/or
concentrate a particular regenerative cell population. Cell
filtration is a method of separating particular components and
cells from other different components or types of cells. For
example, the regenerative cell composition of the invention
comprises multiple different types of cells, including stem cells,
progenitor cells and adipocytes, as well as one or more
contaminants, such as collagen, which was present in the adipose
tissue fragments, or residual collagenase from the tissue
disaggregation process. The filters 36 present in the processing
chamber 30 may allow for separation and concentration of a
particular subpopulation of regenerative cells, e.g., stem cells or
endothelial progenitors cells etc.
[0105] Some variables which are associated with filtration of cells
from a liquid include, but are not limited to, pore size of the
filter media, geometry (shape) of the pore, surface area of the
filter, flow direction of the solution being filtered,
trans-membrane pressure, dilution of the particular cell
population, particulate size and shape as well as cell size and
cell viability. In accordance with the disclosure herein, the
particular cells that are desired to be separated or filtered are
typically adipose derived stem cells. However, in certain
embodiments, the particular cells may include adipose derived
progenitor cells, such as endothelial precursor cells, alone or in
combination with the stem cells.
[0106] The regenerative cell composition may be directed through a
filter assembly, such as filter assembly 36. In certain
embodiments, the filter assembly 36 comprises a plurality of
filters which are structured to perform different functions and
separate the regenerative cell composition into distinct parts or
components. For example, one of the filters may be configured to
separate collagen from the regenerative cell composition, one of
the filters may be configured to separate adipocytes and/or lipid
components from the regenerative cell composition, and one of the
filters may be configured to separate residual enzymes, such as the
tissue disaggregation agent, from the regenerative cell
composition. In certain embodiments, one of the filters is capable
of performing two functions, such as separating collagen and the
tissue disaggregation agent from the composition. The plurality of
filters are typically serially arranged; however, at least a
portion of the filters may be arranged in parallel, as well. A
serial arrangement of the filters of the filter assembly 36 is
shown in FIG. 2. A parallel arrangement of the filters of the
filter assembly 36 is shown in FIG. 3.
[0107] In one embodiment, the filter assembly 36 comprises a first
filter, a second filter, and a third filter. The first filter is
configured to remove collagen particles present in the regenerative
cell composition. These collagen particles are typically
approximately 0.1 microns in diameter and can be up to 20 microns
long. The collagen particles may be of varying sizes depending on
the digestion. They also may be fibrils, meaning they have twists
and turns. Any of the filters described herein may be made from
polyethersulfone, polyester, PTFE, polypropylene, PVDF, or possibly
cellulose. There are two possibilities for filtering the collagen.
One is to try to remove the larger particles first, letting the
cells go through, which would require for example a filter probably
in the 10 micron range. The second method is to use a smaller size
filter, such as 4.5 micron, with the intent that the collagen would
be well digested, so as to trap the cells, and let the collagen
pass through. This would require a means to float the cells back
off the filter. There may also be a possibility of implementing a
filter which would attract and hold the collagen fibers.
[0108] The second filter is configured to remove free immature
adipocytes which are not buoyant in the regenerative cell
composition. In one embodiment the second filter can be constructed
of polyester and have a pore size between about 30 and about 50
microns with a preferred pore size being about 40 microns. Although
referred to as a second filter, placement of such a device may be
in a first, rather than second, position to facilitate an initial
removal of larger cells and particles. The third filter is
configured to remove the unused or residual collagenase or other
tissue disaggregation agent present in the composition. In a
preferred implementation, the collagenase may degenerate over time.
In one embodiment, the third filter comprises a plurality of pores
having a diameter, or length less than 1 .mu.m. In certain
embodiments, the pores may have diameters that are smaller than 1
.mu.m. In other embodiments, the pores have diameters between 10 kD
and 5 microns. In certain embodiments, the third filter may be
configured to concentrate the regenerative cell population into a
small volume of saline or other washing solution, as discussed
herein. As presently preferred, only the final filter is the hollow
fiber unit. It is not necessary for any of the filters to be of the
hollow fiber type. The hollow fiber unit is used for the final
filter in a preferred implementation because it is the most
efficient in removing the collagenase with the smallest detrimental
effect to the regenerative cells. In an embodiment wherein the
device is a collection of off the shelf items, the three filters
are in separate housings. It is feasible to have the first and
second filters combined into one housing if a hollow fiber unit is
used for the third filter. If the final filter is not a hollow
fiber set-up then all three filters can be contained in one
housing.
[0109] The filters of the filter assembly 36 may be located in the
processing chamber 30 or may be provided as components separate
from the processing chamber 30. In addition, the filters of the
filter assembly 36 may be provided in multiple processing chambers
or in an inline fashion. In certain embodiments, the conduits or
tubing may act as a processing chamber or chambers. The processing
chamber can be reduced in size such that it becomes the inside
volume of the conduits which connect the filters. This type of
system will function correctly if the volume of tissue solution is
sized appropriately. Thus, the conduits may act as the processing
chamber by containing the fluid with cells as it is being run
through the filters. Care may be taken to minimize the volume of
the conduits so that cells/tissue are not unnecessarily lost in the
process of priming and running the system.
[0110] Referring to the embodiment described above, the
regenerative cell composition, containing the washed cells and
residual collagen, adipocytes, and/or undigested tissue
disaggregation agent, may be directed through the first filter to
remove at least a portion of and preferably substantially all of
the collagen particles from the composition so that fewer, and
preferably no, collagen particles are present in the filtered
solution. The filtered regenerative cell composition containing the
adipocytes and/or undigested tissue disaggregation agent, may then
be directed through the second filter to remove at least a portion
of and preferably substantially all of the free adipocytes from the
filtered regenerative cell composition. Subsequently, the twice
filtered regenerative cell composition, containing the undigested
tissue disaggregation agent, may be directed through the third
filter, such as a hollow fiber filtration device, as discussed
herein, to remove or reduce the undigested tissue disaggregation
agent from the regenerative cell composition.
[0111] The thrice-filtered regenerative cell composition (i.e., the
composition remaining after being passed through the first, second,
and third filters) may then be directed to multiple outlets, which
may include a portion of the processing chamber 30 comprising
multiple outlets. These outlets can serve to maintain the necessary
pressure, as well as to provide connections via conduits to other
containers which may include the collection chamber 20, the output
chamber 50, and/or the waste container 40.
[0112] In one embodiment, a filter of the filter assembly 36
comprises a hollow-fiber filtration member. Or, in other words, the
filter comprises a collection of hollow tubes formed with the
filter media. Examples of filter media which can be used with the
disclosed system 10 include polysulfone, polyethersulfone or a
mixed ester material, and the like. These hollow fibers or hollow
tubes of filter media may be contained in a cylindrical cartridge
of the filter assembly 36. The individual tubes or fibers of filter
media typically have an inside diameter which ranges from about 0.1
mm to about 1 mm with a preferred value being about 0.5 mm. The
diameter and length of a suitable cylindrical cartridge will
determine the number of individual tubes of filter media which can
be placed inside the cartridge. One example of a suitable hollow
fiber filter cartridge is the FiberFlo.RTM. Tangential Flow Filter,
catalog #M-C-050-K (Minntech, Minneapolis, Minn.). Pore sizes of
the filter media can range between about 10 kiloDaltons and about 5
microns with a preferred pore size being about 0.5 microns.
[0113] In the hollow-fiber filter, each hollow tube has a body with
a first end, a second end, and a lumen located in the body and
extending between the first end and second end. The body of each
hollow tube includes a plurality of pores. The pores are generally
oriented in the body so that a regenerative cell composition is
filtered by flowing through the lumen of the body, and the products
to be filtered tangentially pass through the pores, as shown in
FIG. 12A. In other words, the smaller particles in the liquid pass
tangentially through the pores relative the flow of fluid through
the lumen of the body. The composition with the regenerative cells
passes through the lumen of each hollow tube when the composition
is being filtered. Preferably, the flow of the composition is
tangential to the pores of the body of each hollow tube.
[0114] By using a tangential flow of fluid, the efficiency of
filtration of the stem cells may be enhanced relative to other
filtration techniques. For example, in accordance with some
filtration techniques, the pores of the filter media are placed in
such a manner that the filter is orientated perpendicular to the
flow of the fluid so that the Filter media blocks the path of the
fluid being filtered, as illustrated in FIG. 12B. In this type of
filtration, the particles which are being filtered out of the
regenerative cell composition, e.g., the stem cells, tend to build
up on one side of the filter and block the flow of the fluid
through the pores. This blockage can reduce the efficiency of the
filter. In addition, the cells are constantly compressed by the
pressure of the fluid flow as well as the weight of the cells
accumulating on the upstream side of the filter. This can lead to
increased lysis of stem cells. Thus, in such filtration techniques
wherein the flow of fluid is parallel to the orientation of the
pores in the filter, both large cells and small particles can be
undesirably directed against the filter media as the fluid is
passed through the pores. Consequently, larger products in the
liquid such as cells may block the pores, thereby decreasing the
filtering effect and increasing an occurrence of cell rupture or
injury.
[0115] In contrast, in the hollow fiber configuration of the
present system 10, the fluid which is being filtered flows inside
the lumen of the hollow tube. The portion of the fluid which has
the ability to pass through the pores of the body of the filter
does so with the aid of the positive pressure of the fluid on the
inside of the body as well as a negative pressure which is applied
on the outside of the body. In this embodiment, the cells typically
are not subjected to the pressure of the fluid flow or the weight
of other cells, and therefore, the shear forces on the stem cells
are reduced Thus, the efficiency and effectiveness of the
filtration can be enhanced by the reduction in clogging rates and
the reduction in regenerative cell lysis. Due to the size of the
saline and unwanted protein molecules, during filtration, these
molecules and other small components pass through the pores of the
bodies of the hollow tubes to the outside of the hollow tubes and
are directed to the waste container 40. In one embodiment,
filtration is enhanced by generating a vacuum on the outside of the
hollow tube filter media. Due to the size of the regenerative
cells, e.g., stem cells or progenitor cells, these cells typically
cannot pass through the pores of the body and therefore remain on
the inside of the hollow tube filter (e.g., in the lumens of the
tubes) and are directed back to the processing chamber 30 via a
conduit between the filter and the processing chamber, or to the
output chamber 50.
[0116] In one specific embodiment, the hollow fiber filter has
about a 0.05 micron pore size, and contains approximately 550
cm.sup.2 surface area of filter media. An individual media tube
typically has a diameter of about 0.5 mm. In processing 130 ml of
the regenerative cell composition, approximately 120 ml of
additional saline may be added to the composition. The processing
or filter time may be approximately 8 minutes. The differential of
the pressures on either side of the body of the hollow fiber tube
(e.g., the pressure inside the lumen of the body, and outside the
body) is considered the trans-membrane pressure. The trans-membrane
pressure can range from about 1 mmHg to about 500 mmHg with a
preferred pressure being about 200 mmHg. The average nucleated cell
recovery and viability using hollow fiber filtration can be
approximately 80% of viable cells.
[0117] The amount of collagenase which is typically removed in such
a system equates to a three log reduction. For example if the
initial concentration of collagenase in the regenerative cell
composition which is transferred from the collection chamber to the
processing chamber is 0.078 U/ml the collagenase concentration of
the final regenerative cell composition would be 0.00078 U/ml. The
collagenase is removed in the hollow fiber filter, and the hollow
fiber filter corresponds to the third filter discussed above.
[0118] Processing chambers illustrating one or more cell filtration
methods described above are shown in the Figures, particularly
FIGS. 1-3. With reference to FIGS. 1-3, between the processing
chamber 30 and the filtering chamber of the filter assembly 36, a
pump may be provided, such as pump 34. In addition, vent and
pressure sensors, such as vent 32, and pressure sensor 39, may be
provided in line with the processing chamber 30 and the filter
assembly 36. Fittings for the output chamber 50 may also be
provided. These optional components (e.g., the pump 34, the vent
32, the pressure sensor 39, and the fittings for the output chamber
50) may be provided between the processing chamber 30 and the
filter assembly 36 so that liquid contained in the processing
chamber 30 may flow to one or more of these optional components
before flowing through the filter assembly 36. For example, liquid
may flow through the pump 34 before it is passed to the filter
assembly 36. Or, liquid may pass through the pressure sensor 39
before passing through the filter assembly to obtain a pre-filter
liquid pressure in the system. In certain situations, one or more
of these components may also be provided as an element of the
processing chamber 30, such as the vent 32 as illustrated in FIG.
6. In the illustrated embodiment, the pressure sensor 39 is in line
to determine the pressure of the regenerative cell composition
which is generated by the pump 34 as it enters the filtering
chamber of the filter assembly 36. This construction can facilitate
monitoring of the trans-membrane pressure across the filter
membrane. Additional saline or other buffer and washing solution
can be added to the regenerative cell composition to assist in the
removal of unwanted proteins as the composition is being filtered
through the filter assembly 36. This repeated washing can be
performed multiple times to enhance the purity of the regenerative
cells. In certain embodiments, the saline can be added at any step
as deemed necessary to enhance filtration.
[0119] In one specific embodiment, which is provided by way of
example and not limitation, the unwanted proteins and saline or
other washing solution is removed in the following manner. The
composition with the regenerative cells, as well as collagen and
connective tissue particles or fragments, adipocytes, and
collagenase, is cycled through a series of filters until a minimum
volume is reached. The minimum volume is a function of the total
hold up volume of the system and some predetermined constant. The
hold up volume is the volume of liquid which is contained in the
tubing and conduits if all of the processing chambers are empty. In
one embodiment, the minimum volume is 15 ml. When the minimum
volume is reached, a predetermined volume of washing solution is
introduced into the system to be mixed with the regenerative cell
composition. This mixture of washing solution and the regenerative
cell composition is then cycled through the filters until the
minimum volume is reached again. This cycle can be repeated
multiple times to enhance the purity of the regenerative cells, or
in other words, to increase the ratio of regenerative cells in the
composition to the other materials in the composition. See FIGS. 10
and 11.
[0120] After it has been determined that the regenerative cell
composition has been cleansed of unwanted proteins and concentrated
sufficiently (in exemplary embodiments, minimum concentrations
within a range of about 1.times.10.sup.5 to about 1.times.10.sup.7
cells/ml can be used and, in a preferred embodiment the minimum
concentration can be about 1.times.10.sup.7 cells/ml), an output
chamber 50, such as an output bag, may be connected to an outlet
port of the processing chamber 30 and/or the filter assembly 36,
depending on the specific embodiment. A vent, such as the vent 32,
may then be opened to facilitate the output of the concentrated
regenerative cells. In one implementation, this determination of
when a minimum concentration has been reached is made empirically
after experiments have been run and programmed into the electronic
controls of the device. The determination can be an input into the
process of what is desired to yield, i.e., how many stem/progenitor
cells are desired, or range of cell concentration. Based on
scientific data, a predefined amount of adipose tissue needs to be
obtained and placed into the system to achieve the desired output.
With the vent 32 open, a pump, such as the pump 34, can function to
transfer the concentrated regenerative cells into the output bag.
In one embodiment, the output bag 50 is similar to an empty blood
bag which has a tube with a fitting on one end. In a sterile
fashion, the fitting on the output bag may be attached to the
outlet port, and the concentrated regenerative cells may be
transferred to the output bag.
[0121] As illustrated in FIGS. 1-3, a vacuum pump 26 may be
provided in the system 10 to change the pressure in the system,
among other things. For example, the vacuum pump 26 may be coupled
to the collection chamber 20 via a conduit, such as conduit 12b, to
cause a decrease in pressure within the collection chamber 20.
Vacuum pump 26 may also be coupled to the processing chamber 30 by
way of a conduit, such as conduit 12g. Regarding the operation of
vacuum pump 26 in connection with pump 34, two separate vacuum
pumps or sources may be implemented, or a single one may be
implemented by using valves which direct the vacuum pull to the
different conduits that need it at specific points in the process.
In addition, vacuum pump 26 may be coupled to the waste container
40 via a conduit, such as conduit 12f.
[0122] With reference to FIGS. 10 and 11, the pressure generated by
the vacuum pump 26 can be used to direct the flow of fluids,
including the regenerative cells, through the conduits 12. This
pressure can be supplied in multiple directions, for example, by
automatically or manually controlling the position of one or more
valves 14 in the system 10. The system 10 can be made to function
properly with the use of positive pressure or through the use of
negative pressure, or combinations thereof. For instance, the
regenerative cells can be pulled through the first and second
filters described above into a soft sided container which is
connected to the third filter. The soft-sided container can be in
line (serial) connected ahead of the third filter. The final output
chamber may be a soft sided container which is on the other side
(e.g., the downstream side) of the third filter. In this
embodiment, pressure is used to move the regenerative cells from
one soft sided container to a second soft sided container through
the filter.
[0123] In another embodiment of the system 10, the filtration of
the stem cells and/or adipose derived progenitor cells may be
accomplished using a combination of percolative filtration and
sedimentation. For example, such a system uses saline that is
passed through a tissue regenerative cell composition (e.g., the
composition containing the stem cells and/or adipose derived
progenitor cells) and then through a filter. Some of the variables
which are associated with percolative filtration of cells from a
regenerative cell composition include, but are not limited to, pore
size of the filter media, pore geometry or shape, surface area of
the filter, flow direction of the regenerative cell composition
being filtered, flow rate of the infused saline, trans-membrane
pressure, dilution of the cell population, cell size and
viability.
[0124] In one embodiment of the system 10, the processing chamber
30 uses a filter assembly 36 which implements percolative
filtration and sedimentation to separate and concentrate the
regenerative cells. By way of example, and not by way of
limitation, the processing chamber 30 is defined as a generally
cylindrical body having a sidewall 30a, a top surface 30b, and a
bottom surface 30c, as shown in FIG. 6. A sterile vent 32 is
provided in the top surface 30b.
[0125] In the embodiment of FIG. 6, the processing chamber 30 is
illustrated as including a filter assembly 36, which includes two
filters, such as large pore filter 36a, and small pore filter 36b.
The pore sizes of the filters 36a and 36b typically are in a range
between about 0.05 microns and about 10 microns. The large pore
filter 36a may comprise pores with a diameter of about 5 .mu.m, and
the small pore filter 36b may comprise pores with a diameter of
about 1-3 .mu.m. In one embodiment, the filters have a surface area
of about 785 mm.sup.2. Filters 36a and 36b divide an interior of
the processing chamber 30 to include a first chamber 37a, a second
chamber 37b, and a third chamber 37c. As shown in FIG. 6, first
chamber 37a is located between second chamber 37b and third chamber
37c. In addition, first chamber 37a is shown as being the region of
the processing chamber 30 having an inlet port 31a and an outlet
port 31b. The illustrated processing chamber 30 includes a
plurality of ports providing communication paths from an exterior
of the processing chamber 30 to the interior of the processing
chamber 30, such as ports 31a, 31b, and 31c. The ports 31a, 31b,
and 31c, are illustrated as being disposed in the sidewall 30a of a
body of the processing chamber 30. However, the ports 31a, 31b, and
31c could be positioned in other regions, as well. Port 31a is
illustrated as a sample inlet port, which is constructed to be
coupled to a conduit so that a composition containing regenerative
cells can be passed into the interior of the processing chamber 30.
Port 31b is illustrated as an outlet port constructed to be coupled
to a conduit so that the separated and concentrated cells may be
removed from the interior of the processing chamber 30. Port 31c is
illustrated as an inlet port constructed to be coupled to a conduit
for delivery of a fresh washing solution, such as saline into the
interior of the processing chamber 30.
[0126] In use, the regenerative cells may be introduced into the
central chamber 37a via inlet port 31a. Saline or other buffer is
introduced into the bottom chamber 37b through inlet port 31c. The
saline may be directed through the regenerative cell composition in
chamber 37a at a rate of about 10 ml/min. The flow rate of the
saline is such that it counteracts the force of gravity. The flow
of saline gives the cells in the chamber the ability to separate
based on the density of the cells. Typically, as the saline is
forced up through the composition the larger cells in the
composition will settle to the bottom of the central chamber 37a,
and the smaller cells and proteins will be carried away through the
second filter 36b into the top chamber 37c. This filtering is
accomplished by adjusting the flow rate of the saline such that the
larger cells are rolled in place which allows the smaller particles
to be liberated and carried off with the saline. The sterile vent
32 is included in the chamber 30 to ensure that the correct
pressure gradient is maintained in the three chambers within the
processing unit. The upper chamber 37c can comprise an absorbent
media 33. The purpose of the absorbent media is to trap the
unwanted proteins in the solution to ensure that they do not cross
the filter media back into the processing solution, if, for
example, the saline flow rate decreases. An absorbent media can be
a type of filter material that is absorbent, or attracts materials
or components to be filtered out. An outflow port can be added
above the top filter to help draw off the waste. Another embodiment
of this may be to apply a gentle vacuum from the top to help pull
off waste. Absorbent media can be implemented when, as in the
illustrated embodiment, the flow rates are relatively small. Excess
saline and proteins are then carried away to a waste container.
[0127] When the larger cells, (e.g., the adipose derived stem cells
and/or progenitor cells) have been sufficiently separated from
smaller cells and proteins, the composition containing the
separated cells may be concentrated, as discussed herein. The
composition may be further concentrated after it has been removed
from chamber 37a through outlet port 31b, or while it is in the
chamber 37a. In one embodiment, the concentration of cells in the
composition is increased in the following manner. After the cells
have been sufficiently separated the filters, such as filters 36a
and 36b, may be moved towards each other. This movement has the
effect of reducing the volume between the two filters (e.g., the
volume of chamber 37a). A vibrating member may also be provided in
connection with the processing chamber 30 to facilitate
concentrating of the cells in the composition. In one embodiment,
the vibrating member may be coupled to the filter 36b (e.g., the
small pore filter). Vibrating can reduce an incidence of cells
becoming trapped in the filters. The reduction in volume of the
composition allows the excess saline to be removed as waste and the
cells to be concentrated in a smaller volume.
[0128] In another embodiment, the concentration of the regenerative
cells is accomplished in the following manner. After the cells have
been sufficiently separated, the regenerative cell composition can
be transferred to another chamber (not shown) which uses gravity to
filter out the excess saline. In a preferred embodiment, the
sedimentation can occur at the same time as the percolation. This
sedimentation may be accomplished by introducing the composition on
top of a filter which has a pore size ranging from about 10 kD to
about 2 microns. In one embodiment, a suitable filter has a pore
size of about 1 micron. The force of gravity will allow the saline
and smaller particles to be passed through the filter while
preventing the cells in the composition to flow through the filter.
After the desired concentration of cells has been obtained, and
after the filtered smaller particles have been removed from below
the filter, the regenerative cell composition may be agitated to
remove the cells from the filter and, subsequently, the
concentrated regenerative cells may be transferred to the output
bag. The smaller particles can be drawn off as waste through an
outlet.
[0129] In a particular embodiment, the regenerative cell
composition from the collection chamber 20 is transported to the
processing chamber 30 wherein the composition can be centrifuged to
separate and concentrate regenerative cells. Centrifugation
principles are well know in the art and will be not be repeated
herein in the interest of brevity. Standard, art-recognized
centrifugation devices, components and parameters are utilized
herein. An exemplary processing chamber for use as part of a
centrifuge device is shown in FIGS. 7 and 8. Typically, a
centrifuge device causes a centrifuge chamber (such as the one
shown in FIG. 7) to spin around an axis to thereby increasing the
force on the cells in the solution to be greater than gravity. The
denser or heavier materials in the solution typically settle to one
end of the centrifuge chamber, i.e., an output chamber 50 of FIG.
7, to form a regenerative cell pellet. The pellet may then be
re-suspended to obtain a solution with a desired concentration of
cells and/or a desired volume of cells and medium. The processing
chamber shown in FIG. 7 is constructed to separate and concentrate
cells using both centrifugal and gravitational forces.
Specifically, during centrifugation, centrifugal force directs the
denser components of the regenerative cell composition, e.g., the
regenerative cells, towards the outermost ends of the centrifuge
chamber. As the centrifuge chamber slows down and eventually stops,
gravitational force helps the regenerative cells to remain in the
outermost ends of the centrifuge chamber and form a cell pellet.
Accordingly, the unwanted components of the regenerative cell
composition, i.e., the waste, can be removed without disturbing the
cell pellet.
[0130] In yet another embodiment of the invention, the processing
chamber may be comprised of a cell concentrator in the form of a
spinning membrane filter. In a further embodiment of the
centrifugation process, centrifugal elutriation may also be
applied. In this embodiment, the cells may be separated based on
the individual cell sedimentation rate such that the directional
(e.g., outward) force applied by centrifugation causes cells and
solutes to sediment at different rates. In elutriation, the
sedimentation rate of the target cell population is opposed by an
opposite (e.g., inward) flow rate applied by pumping solution in
the opposite direction to the centrifugal force. The counterflow is
adjusted so that the cells and particles within the solution are
separated. Elutriation has been applied in many instances of cell
separation (Inoue, Carsten et al. 1981; Hayner, Braun et al. 1984;
Noga 1999) and the principles and practices used to optimize flow
and centrifugal parameters can be applied herein in light of the
present disclosure by one skilled in the art.
[0131] FIG. 9 illustrates principles associated with an elutriation
implementation in accordance with the present invention. The
elutriation embodiment can be similar to a centrifugation
implementation to the extent that a force is applied to the
solution using a spinning rotor. Some of the variables which are
associated with the presently embodied elutriation separation
include, but are not limited to, the size and shape of the spinning
chamber, the diameter of the rotor, the speed of the rotor, the
diameter of the counter flow tubing, the flow rate of the counter
flow, as well as the size and density of the particles and cells
which are to be removed from solution. As in centrifugation, the
regenerative cells can be separated based on individual cell
densities.
[0132] In one embodiment the regenerative cell composition, e.g.,
the solution containing the regenerative cells and the collagenase,
is introduced into a chamber of a spinning rotor, as shown in FIG.
9A. After the solution is added to the chamber additional saline is
added to the chamber at a predetermined flow rate. The flow rate of
the saline can be predetermined as a function of the speed of the
rotor, the cell diameter, and the chamber constant which has been
established empirically. The flow rate will be controlled for
example with a device similar to an IV pump. A purpose of the
additional saline is to provide a condition inside the rotor
chamber where the larger particles will move to one side of the
chamber and the smaller particles will move to the other, as
illustrated in FIG. 9B. The flow is adjusted so that, in this
application, the smaller particles will exit the chamber and move
to a waste container, as shown in FIG. 9C. This movement results in
the solution in the rotor chamber having a substantially homogenous
population of cells, such as stem cells. After it has been
determined that the stem cells have been separated from the rest of
the items in the solution (with unwanted proteins and free lipids
having been removed from the chamber), the counter flow is stopped.
The cells inside the chamber will then form a concentrated pellet
on the outside wall of the chamber. The counter flow is reversed
and the cell pellet is transferred to the output bag.
[0133] As previously set forth herein, the processing chamber 30 or
the output chamber 50 may include one or more ports, e.g., ports 51
or 52. One or more of these ports may be designed to transport the
regenerative cells obtained using any combination of methods
described above, or a portion thereof, via conduits to other
surgical devices, cell culturing devices, cell marinading devices,
gene therapy devices or purification devices. These ports may also
be designed to transport the regenerative cells via conduits to
additional chambers or containers within the system or as part of
another system for the same purposes described above. The ports and
conduits may be also be used to add one or more additives, e.g.,
growth factors, re-suspension fluids, cell culture reagents, cell
expansion reagents, cell preservation reagents or cell modification
reagents including agents that transfer genes to the cells. The
ports and conduits may also be used to transport the regenerative
cells to other targets such as implant materials (e.g., scaffolds
or bone fragments) as well as other surgical implants and
devices.
[0134] Further processing of the cells may also be initiated by
reconfiguring the interconnections of the disposable sets of the
existing system, re-programming the processing device of the
existing system, by providing different or additional containers
and/or chambers for the existing system, by transporting the cells
to a one or more additional systems or devices and/or any
combinations thereof. For example, the system can be reconfigured
by any of the means described above such that the regenerative
cells obtained using the system may be subject to one or more of
the following: cell expansion (of one or more regenerative cell
types) and cell maintenance (including cell sheet rinsing and media
changing); sub-culturing; cell seeding; transient transfection
(including seeding of transfected cells from bulk supply);
harvesting (including enzymatic, non-enzymatic harvesting and
harvesting by mechanical scraping); measuring cell viability; cell
plating (e.g., on microtiter plates, including picking cells from
individual wells for expansion, expansion of cells into fresh
wells); high throughput screening; cell therapy applications; gene
therapy applications; tissue engineering applications; therapeutic
protein applications; viral vaccine applications; harvest of
regenerative cells or supernatant for banking or screening,
measurement of cell growth, lysis, inoculation, infection or
induction; generation of cells lines (including hybridoma cells);
culture of cells for permeability studies; cells for RNAi and viral
resistance studies; cells for knock-out and transgenic animal
studies; affinity purification studies; structural biology
applications; assay development and protein engineering
applications.
[0135] For example, if expansion of a regenerative cell population
is required for a particular application, an approach using culture
conditions to preferentially expand the population while other
populations are either maintained (and thereby reduced by dilution
with the growing selected cells) or lost due to absence of required
growth conditions could be used. Sekiya et al have described
conditions which might be employed in this regard for bone
marrow-derived stem cells (Sekiya et al., 2002). This approach
(with or without differential adherence to the tissue culture
plastic) could be applied to a further embodiment of this
invention. In this embodiment the final regenerative cell pellet is
removed from the output chamber and placed into a second system
providing the cell culture component. This could be in the form of
a conventional laboratory tissue culture incubator or a
Bioreactor-style device such as that described by Tsao et al., U.S.
Pat. No. 6,001,642, or by Armstrong et al., U.S. Pat. No.
6,238,908. In an alternative embodiment, the cell expansion or cell
culture component could be added to the existing system, e.g., into
the output chamber, allowing for short-term adherence and/or cell
culture of the adipose derived cell populations. This alternate
embodiment would permit integration of the cell culture and/or cell
expansion component to the system and remove the need for removing
the cells from this system and placement within another.
[0136] During the processing, one or more additives may be added to
or provided with the various chambers or containers as needed to
enhance the results. These additives may also be provided as part
of another system associated with the existing system or separate
from the existing system. For example, in certain embodiments, the
additives are added or provided without the need for removing the
regenerative cells from the system. In other embodiments, the
additives are added or provided by connecting a new container or
chamber comprising the additives into an unused port of the system
in a sterile manner. In yet other embodiments, the additives are
added or provided in a second system or device that is not
connected to the system of the present invention. Some examples of
additives include agents that optimize washing and disaggregation,
additives that enhance the viability of the active cell population
during processing, anti-microbial agents (e.g., antibiotics),
additives that lyse adipocytes and/or red blood cells, or additives
that enrich for cell populations of interest (by differential
adherence to solid phase moieties or to otherwise promote the
substantial reduction or enrichment of cell populations) as
described herein.
[0137] For example, to obtain a homogenous regenerative cell
population, any suitable method for separating and concentrating
the particular regenerative cell type may be employed, such as the
use of cell-specific antibodies that recognize and bind antigens
present on, for example, stem cells or progenitor cells, e.g.,
endothelial precursor cells. These include both positive selection
(selecting the target cells), negative selection (selective removal
of unwanted cells), or combinations thereof. Intracellular markers
such as enzymes may also be used in selection using molecules which
fluoresce when acted upon by specific enzymes. In addition, a solid
phase material with adhesive properties selected to allow for
differential adherence and/or elution of a particular population of
regenerative cells within the final cell pellet could be inserted
into the output chamber of the system.
[0138] An alternate embodiment of this differential adherence
approach would include use of antibodies and/or combinations of
antibodies recognizing surface molecules differentially expressed
on target regenerative cells and unwanted cells. Selection on the
basis of expression of specific cell surface markers (or
combinations thereof) is another commonly applied technique in
which antibodies are attached (directly or indirectly) to a solid
phase support structure (Geiselhart et al., 1996; Formanek et al.,
1998; Graepler et al., 1998; Kobari et al., 2001; Mohr et al.,
2001).
[0139] In another embodiment the cell pellet could be re-suspended,
layered over (or under) a fluid material formed into a continuous
or discontinuous density gradient and placed in a centrifuge for
separation of cell populations on the basis of cell density. In a
similar embodiment continuous flow approaches such as apheresis
(Smith, 1997), and elutriation (with or without counter-current)
(Lasch et al., 2000) (Ito and Shinomiya, 2001) may also be
employed.
[0140] Other examples of additives may include additional
biological or structural components, such as cell differentiation
factors, growth promoters, immunosuppressive agents, medical
devices, or any combinations thereof, as discussed herein. For
example, other cells (e.g. cardiospheres), tissue (e.g., heart
tissue), tissue fragments, growth factors such as VEGF and other
known angiogenic or arteriogenic growth factors, biologically
active or inert compounds (e.g., cardiogenol C), resorbable
scaffolds, or other additives intended to enhance the delivery,
efficacy, tolerability, or function of the population of
regenerative cells may be added.
[0141] The regenerative cell population may also be modified by
insertion of DNA (e.g., encoding the Id proteins, the WNT family of
proteins, signaling proteins e.g., the RXR family of proteins and
gp130 and/or growth factors, e.g., IGF-1) or by placement in a cell
culture system (as described herein or known in the art) in such a
way as to change, enhance, or supplement the function of the
regenerative cells for derivation of a structural or therapeutic
purpose. For example, genetic engineering could be used to
customize the pacing rate of the regenerative cells that
differentiate into cardiac myocytes or cardiac myocyte like cells
prior to reinfusion into the patient to ensure optimal beating
rate.
[0142] Gene transfer techniques for stem cells are known by persons
of ordinary skill in the art, as disclosed in (Morizono et al.,
2003; Mosca et al., 2000), and may include viral transfection
techniques, and more specifically, adeno-associated virus gene
transfer techniques, as disclosed in (Walther and Stein, 2000) and
(Athanasopoulos et al., 2000). Non-viral based techniques may also
be performed as disclosed in (Muramatsu et al., 1998). A gene
encoding one or more cellular differentiating factors, e.g., a
growth factor(s) or a cytokine(s), could also be added. Examples of
various cell differentiation agents are disclosed in (Gimble et
al., 1995; Lennon et al., 1995; Majumdar et al., 1998; Caplan and
Goldberg, 1999; Ohgushi and Caplan, 1999; Pittenger et al., 1999;
Caplan and Bruder, 2001; Fukuda, 2001; Worster et al., 2001; Zuk et
al., 2001). Genes encoding anti-apoptotic or anti-necrotic factors
or agents could also be added. Addition of the gene (or combination
of genes) could be by any technology known in the art including but
not limited to adenoviral transduction, "gene guns,"
liposome-mediated transduction, and retrovirus or
lentivirus-mediated transduction, plasmid, adeno-associated virus.
These regenerative cells could then be implanted along with a
carrier material bearing gene delivery vehicle capable of releasing
and/or presenting genes to the cells over time such that
transduction can continue or be initiated in situ.
[0143] When the cells and/or tissue containing the cells are
administered to a patient other than the patient from whom the
cells and/or tissue were obtained, one or more immunosuppressive
agents may be administered to the patient receiving the cells
and/or tissue to reduce, and preferably prevent, rejection of the
transplant. As used herein, the term "immunosuppressive drug or
agent" is intended to include pharmaceutical agents which inhibit
or interfere with normal immune function. Examples of
immunosuppressive agents suitable with the methods disclosed herein
include agents that inhibit T-cell/B-cell costimulation pathways,
such as agents that interfere with the coupling of T-cells and
B-cells via the CTLA4 and B7 pathways, as disclosed in U.S. Patent
Pub. No. 20020182211. A preferred immunosuppressive agent is
cyclosporine A. Other examples include myophenylate mofetil,
rapamicin, and anti-thymocyte globulin. In one embodiment, the
immunosuppressive drug is administered with at least one other
therapeutic agent. The immunosuppressive drug is administered in a
formulation which is compatible with the route of administration
and is administered to a subject at a dosage sufficient to achieve
the desired therapeutic effect. In another embodiment, the
immunosuppressive drug is administered transiently for a sufficient
time to induce tolerance to the regenerative cells of the
invention.
[0144] In these embodiments, the regenerative cells may be
contacted, combined, mixed or added to the additives through any
art recognized manner, including devices such as the agitation
devices and associated methods described herein. For example,
rocking, inversion, compression pulsed or moving rollers may be
used.
[0145] In another aspect, the cell population could be placed into
the recipient and surrounded by a resorbable plastic sheath or
other materials and related components such as those manufactured
by MacroPore Biosurgery, Inc. (see e.g., U.S. Pat. Nos. 6,269,716;
5,919,234; 6,673,362; 6,635,064; 6,653,146; 6,391,059; 6,343,531;
6,280,473).
[0146] In all of the foregoing embodiments, at least a portion of
the separated and concentrated regenerative cells may be
cryopreserved, as described in U.S. patent application Ser. No.
10/242,094, entitled PRESERVATION OF NON EMBRYONIC CELLS FROM NON
HEMATOPOIETIC TISSUES, filed Sep. 12, 2002, which claims the
benefit of U.S. Provisional Patent Application 60/322,070 filed
Sep. 14, 2001, which is commonly assigned, and the contents of
which in their entireties are expressly incorporated herein by
reference.
[0147] At the end of processing, the regenerative cells may be
manually retrieved from the output chamber. The cells may be loaded
into a delivery device, such as a syringe, for placement into the
recipient by either, subcutaneous, intramuscular, or other
technique allowing delivery of the cells to the target site within
the patient. In other words, cells may be placed into the patient
by any means known to persons of ordinary skill in the art.
Preferred embodiments include placement by needle or catheter, or
by direct surgical implantation. In other embodiments, the cells
may be automatically transported to an output chamber which may be
in the form of a container, syringe or catheter etc., which may be
used to place the cells in the patient. The container may also be
used to store the cells for later use or for cryopreservation. All
retrieval methods are performed in a sterile manner. In the
embodiment of surgical implantation, the cells could be applied in
association with additives such as a preformed matrix or scaffold
as described herein.
[0148] In preferred embodiments of the invention (e.g., the
embodiment shown in FIG. 4), the system is automated. In another
embodiment, the system has both automated and manual components.
The system may be comprised of one or more disposable components
connected to or mounted on a re-usable hardware component or
module. The automated systems of the invention provide screen
displays (see FIG. 16) that prompt proper operation of the system.
The automated systems may also provide a screen that provides
status of the procedure and/or the step by step instructions as to
the proper setup of the disposable components of the system. The
screen may also indicate problems or failures in the system if they
occur and provide "troubleshooting" guidance if appropriate. In one
embodiment, the screen is a user interface screen that allows the
user to input parameters into the system through, e.g., a touch
screen.
[0149] The partial and fully automated systems may include a
processing device (e.g., microprocessor or personal computer) and
associated software programs that provide the control logic for the
system to operate and to automate one or more steps of the process
based on user input. In certain embodiments, one or more aspects of
the system may be user-programmable via software residing in the
processing device. The processing device may have one or more
pre-programmed software programs in Read Only Memory (ROM). For
example, the processing device may have pre-programmed software
tailored for processing blood, another program for processing
adipose tissue to obtain small volumes of regenerative cells and
another program for processing adipose tissue to obtain larger
volumes of regenerative cells. The processing device may also have
pre-programmed software which provides the user with appropriate
parameters to optimize the process based on the user's input of
relevant information such as the amount of regenerative cells
required, the type of tissue being processed, the type of
post-processing manipulation required, the type of therapeutic
application, etc.
[0150] The software may also allow automation of steps such as
controlling the ingress and egress of fluids and tissues along
particular tubing paths by controlling pumps and valves of the
system; controlling the proper sequence and/or direction of
activation; detecting blockages with pressure sensors; mixing
mechanisms, measuring the amount of tissue and/or fluid to be moved
along a particular pathway using volumetric mechanisms; maintaining
temperatures of the various components using heat control devices;
and integrating the separation and concentration process with
timing and software mechanisms. The processing device can also
control centrifuge speeds based on the tissue type being processed
and/or the cell population or sub-population being harvested, and
the types of procedures to be performed (e.g., tissue enhancement
using adipose tissue augmented with regenerative cells, or
processing of cells for bone repair applications using regenerative
cell coated bone grafts). The processing device may also include
standard parallel or serial ports or other means of communicating
with other computers or networks. Accordingly, the processing
device can be a stand alone unit or be associated one or more
additional devices for the further processing methods described
herein.
[0151] The software may allow for automated collection of "run
data" including, for example, the lot numbers of disposable
components, temperature and volume measurements, tissue volume and
cell number parameters, dose of enzyme applied, incubation time,
operator identity, date and time, patient identity, etc. In a
preferred embodiment of the device a character recognition system,
such as a bar code reading system would be integrated to permit
data entry of these variables (for example disposable set lot
number and expiration date, lot number and expiration date of the
Collagenase, patient/sample identifiers, etc.) into the processing
device as part of documentation of processing. This would reduce
the opportunity for data entry errors. Such a bar code reading
system could be easily incorporated into the processing device
using a USB or other interface port and system known to the art. In
this way the device would provide integrated control of the data
entry and documentation of the process. A print-out report of these
parameters would be part of the user-defined parameters of a
programmed operation of the system. Naturally this would require
integration of a printer component (hardware and driver) or printer
driver in software plus an interface output connector for a printer
(e.g., a USB port) in the hardware of the device.
[0152] In certain embodiments, the system is a fully automated
system. For example, the user may initially select the amount of
tissue to be processed, attach the system to the patient and the
system may automatically aspirate the required tissue and separate
and concentrate regenerative cells in an uninterrupted sequence
without further user input. The user may also input the amount of
regenerative cells required and allow the system to aspirate the
requisite amount of tissue and process the tissue. A fully
automated system also includes a system which is capable of being
reconfigured based on a number of (e.g., two or more) user input
parameters, e.g., number of wash cycles, speed of centrifugation
etc. The system can also be run in semi-automatic mode during which
the system goes through certain steps without user intervention but
requires user intervention before certain processes can occur. In
other embodiments, the system is a single integrated system that
displays instructions to guide the user to perform predetermined
operations at predetermined times. For example, the processing
device may prompt users through the steps necessary for proper
insertion of tubing, chambers and other components of the system.
Accordingly, the user can ensure that the proper sequence of
operations is being performed. Such a system can additionally
require confirmation of each operational step by the user to
prevent inadvertent activation or termination of steps in the
process. In a further embodiment, the system may initiate automated
testing to confirm correct insertion of tubing, chambers, absence
of blockages etc. In yet another embodiment, the system of the
present invention is capable of being programmed to perform
multiple separation and concentration processes through automated
control of tissue flow through the system. This feature may be
important, for example, during surgery on a patient where tissue
that would otherwise be lost is collected into the system, and
regenerative cells from the tissue are separated and concentrated
and returned to the patient.
[0153] As set forth above, components of the system may be
disposable (referred to herein as "disposable set(s)"), such that
portions of the system can be disposed of after a single use. This
implementation can help ensure that any surface which comes in
contact with the patient's tissue will be disposed of properly
after being used. An exemplary disposable set is illustrated in
FIG. 13. In a preferred embodiment, the disposable components of
the system are pre-sterilized and packaged so as to be usable "off
the shelf" that are easy to use and easy to load and that eliminate
the need for many tubing connections and complex routing of tubing
connections. Such disposable components are relatively inexpensive
to manufacture, and therefore, do not create a substantial expense
due to their disposal. In one embodiment, the disposable system
(referred to interchangeably herein as "disposable set(s)")
comprises, consists essentially of, or consists of, the collection
chamber 20, the processing chamber 30, the waste chamber 40, the
output chamber 50, the filter assemblies 36, the sample bag 60 and
the associated conduits 12 or tubing. In preferred embodiments of
the disposable sets of the system, the collection chamber 20 and
the processing chamber 30 are connected by way of conduits 12 that
are housed in a rigid frame. The rotating seal network (FIGS. 7
& 8) of a processing chamber 30 may also be housed in the same
rigid frame. In another preferred embodiment, the various chambers
and containers of the disposable set are comprised of the necessary
interfaces that are capable of communicating with the processing
device of the system such that the pumps, valves, sensors and other
devices that automate the system are appropriately activated or
de-activated as needed without user intervention. The interfaces
also reduce the time and expertise required to set up the system
and also reduce errors by indicating how to properly set up the
system and alerting the user in the event of an erroneous
setup.
[0154] Most of the disposable sets of the invention will have many
common elements. However, the ordinarily skilled artisan will
recognize that different applications of the system may require
additional components which may be part of the disposable sets.
Accordingly, the disposable sets may further comprise one or more
needles or syringes suitable for obtaining adipose or other tissue
from the patient and returning regenerative cells to the patient.
The type number and variety of the needles and syringes included
will depend on the type and amount of tissue being processed. The
disposable sets may further comprise one or more rigid or flexible
containers to hold washing fluids and other processing reagents
used in the system. For example, the disposable sets may comprise
containers to hold saline, enzymes and any other treatment or
replacement fluids required for the procedure. In addition,
suitable washing solutions, re-suspension fluids, additives, agents
or transplant materials may be provided with the disposable sets
for use in conjunction with the systems and methods of the
invention.
[0155] Any combination of system components, equipment or supplies
described herein or otherwise required to practice the invention
may be provided in the form of a kit. For example, a kit of the
invention may include, e.g., the optimal length and gage needle for
the syringe based liposuction and sterile syringes which contain
the preferred filter media which allows for the processing of small
volumes of tissue. Other exemplary equipment and supplies which may
be used with the invention and may also be included with the kits
of the invention are listed in Tables II and III.
[0156] Table II below identifies examples of supplies that can be
used in to obtain adipose derived regenerative cell in accordance
with the systems and methods of the present invention:
TABLE-US-00002 TABLE II Description Vendor Quantity Note 10 ml
syringe Becton- as req'd Optional, used for liposuction Dickinson
14 GA blunt as req'd Optional, used for liposuction tip needle
Single Blood Baxter 1 Main cell processing bag; has Pack (600 ml)
Fenwal spike adaptor on line and two free spike ports Transfer pack
Baxter 1 Quad bag set with coupler Fenwal (150 ml) Transfer pack
Baxter 1 Waste bag with coupler Fenwal (1 L) Sample Site Baxter 2
Coupler Fenwal 0.9% saline Baxter 1 (for injection) Fenwal 14 GA
sharp Monoject as req'd For adding liposuction needle tissue to bag
20 GA sharp Monoject 3 For adding collagenase and needle removing
PLA cells 0.2 .mu.m Sterflip Millipore 1 For filtering collagenase
filter Teruflex Terumo 4 ME*ACS121 for temporary Aluminium tube
sealing sealing clips Povidone Triadine as req'd 10-3201 Iodine
prep pad Liberase H1 Roche See Procedure Note 1 Collagenase TSCD
wafers Terumo 2 1SC*W017 for use with TSCD Sterile Tubing
Welder
[0157] Table III, below, identifies equipment that may be used with
the systems and methods disclosed herein.
TABLE-US-00003 TABLE III Description Vendor Quantity Note Sorvall
Legend T Fisher 1 75-004-367 Easy Set Centrifuge Scientific Rotor
Kendro/Sorvall 1 TTH-750 rotor Rotor buckets Kenro/Sorvall 4
75006441 round buckets Adaptor for 150 ml bags Kendro/Sorvall 4
00511 Plasma Expressor Baxter Fenwal 1 4R4414 Tube Sealer Sebra 1
Model 1060 TSCD Sterile Tubing Terumo 1 3ME*SC201AD Welder LabLine
Thermal LabLine 1 4637 Rocker `Disposable` plastic Davron 3
hemostat-style clamp Balance Bags Sets 2 Water-filled bags used to
balance centrifuge Biohazard Sharps 1 Chamber Biohazard Waste 1
Chamber
[0158] The re-usable component of the system comprises, consists
essentially of, or consists of the agitation mechanism for the
collection chamber, the pump, and assorted sensors which activate
valves and pump controls, the centrifuge motor, the rotating frame
of the centrifuge motor, the user interface screen and USB ports,
an interlocking or docking device or configuration to connect the
disposable set such that the disposable set is securely attached to
and interface with the re-usable hardware component and other
associated devices. An exemplary re-usable component is illustrated
in FIGS. 14A and 14B. In preferred embodiments, the re-usable
component includes a means for separating and concentrating the
regenerative cells from the regenerative cell composition, e.g., a
rotating centrifuge. In this embodiment, the re-usable component is
designed connect to and interface with a portion of the processing
chamber (comprising a centrifuge chamber) of the disposable set as
shown in FIGS. 15A and 15B. It is understood that the means for
separating and concentrating regenerative cells in the re-usable
component is not limited to a rotating centrifuge but may also
include any other configuration described herein, including a
spinning membrane filter. The re-usable component may also house
the processing device described herein which contains
pre-programmed software for carrying out several different tissue
processing procedures and selectively activating the various pumps
and valves of the system accordingly. The processor may also
include data storage capability for storing donor/patient
information, processing or collection information and other data
for later downloading or compilation. The re-usable component may
be used with a variety of disposable sets. The disposable set is
connected to the re-usable component through, e.g., an interlocking
device or configuration to connect the disposable set such that the
disposable set is securely attached to and interfaces with the
re-usable hardware component in a manner that the processing device
present on the re-usable component can control, i.e., send and
receive signals to and from the various components of the
disposable set as well as various components of the re-usable
component and other associated devices and systems.
[0159] In one embodiment, a disposable set for use in the system is
comprised of a collection chamber 20 which can accommodate about
800 mL of tissue; a processing chamber 30 which can process the
regenerative cell composition generated by about 800 mL of tissue
washed and digested in the collection chamber 20; an output chamber
50 which can accommodate at least 0.5 mL of regenerative cells; and
a waster container 40 which can accommodate about 10 L of waste. In
this embodiment, the hardware device is no larger than
24''L.times.18''W.times.36''H. Alternative dimensions of the
various components of the disposable sets as well as the hardware
device may be constructed as needed and are intended to be
encompassed by the present invention without limitation.
[0160] The disposable components of the system are easy to place on
the device. An illustration of a disposable set utilized assembled
together with a corresponding re-usable component is illustrated in
FIGS. 15A and 15B. The system is preferably designed such that it
can detect an improperly loaded disposable component. For example,
the components of each disposable set may have color-guided marks
to properly align and insert the tubing, chambers etc. into
appropriate places in the system. In additional embodiments, the
system disclosed herein is a portable unit. For example, the
portable unit may be able to be moved from one location where
adipose tissue harvesting has occurred, to another location for
adipose tissue harvesting. In certain implementations, the portable
unit is suitable for harvesting and processing of adipose tissue by
a patient's bedside. Thus, a portable unit may be part of a system
which can be moved from patient to patient. Accordingly, the
portable unit may be on wheels which lock in place and, thus, can
be easily placed and used in a convenient location in a stable and
secure position throughout the procedure. In other embodiments, the
portable unit is designed for set-up and operation on a flat
surface such as a table top. The portable unit may also be enclosed
in a housing unit. The portable unit may further be comprised of
hangers, hooks, labels, scales and other devices to assist in the
procedure. All of the herein described re-usable components of the
system such as the centrifuge, processing device, display screen
may be mounted on the portable unit of the system.
[0161] Alternate manual embodiments for obtaining regenerative
cells are also within the scope of this invention. For example, in
one embodiment, adipose tissue may be processed using any
combination of the components of the system, equipment and/or
supplies described herein.
[0162] A manual embodiment of the system of the invention may be
practiced in accordance with the following steps and information,
which are provided by way of example and not by way of limitation.
First, adipose tissue is collected from a patient. A tissue
retrieval line, or sampling site coupler, is opened and a spike is
inserted into a side port of the 600 ml blood bag. Approximately 10
ml of adipose tissue is collected in a 10 ml syringe through the
blunt cannula. The blunt cannula is replaced with a relatively
sharp needle (14G). The sampling site is wiped with an iodine wipe.
The adipose tissue is injected into the 600 ml bag through the
sampling site. The syringe and needle are then discarded in a
sharps chamber. These steps are repeated to place sufficient tissue
into the bag. Sufficient tissue is determined on a case-by case
basis based on the clinical specifics of the patient and
application.
[0163] Second, the aspirated adipose tissue is washed. A pre-warmed
(37.degree. C.) saline bag is hooked above the work surface. A blue
hempostat clamp is placed on the tubing between the 600 ml bag and
the spike. The clamp is closed to seal the tubing. The spike on the
600 ml bag is used to enter the saline bag (in this setting use the
needle on the 600 ml bag to enter the saline bag through the rubber
septum, wipe the septum with iodine prior to insertion of needle).
The blue clamp is released and approximately 150 ml of saline is
allowed to enter the 600 ml bag. The blue clamp is closed when the
desired volume of saline has entered the 600 ml bag. The 600 ml bag
is inverted 10-15 times over approximately 15 seconds. A second
blue clamp is applied to the tubing leading from the 3 L waste bag
to the spike. The spike on the 3 L bag is used to enter the 600 ml
bag. The 600 ml bag is hung inverted over the work surface, and is
allowed to sit for approximately 1 minute. The blue clamp leading
to the 3 L bag is released. Waste fluid is allowed to flow into the
3 L bag. The blue clamp is applied to stop the flow before tissue
enters the tubing. The 600 ml bag is lowered to the work surface.
These steps are repeated two more times. If the saline waste still
appears noticeably red, a third additional cycle is indicated. A
heat sealer is used to seal the tubing between the 3 L waste bag
and the 600 ml bag. The seal is made at approximately the half way
point on the tubing. The 3 L waste bag is removed and discarded.
The 600 ml bag is returned to the work surface.
[0164] Third, the washed adipose tissue is digested. The blue clamp
on the tubing between the saline and the 600 ml bag is released to
allow approximately 150 ml of saline to enter the 600 ml bag. The
sampling site on the 600 ml bag is wiped with an iodine wipe.
Collagenase is injected through the sampling site to the 600 ml
bag. The collagenase is prepared by thawing one collagenase vial in
a 37.degree. C. water bath or equivalent, other than microwaving. A
1 ml syringe with a 22G needle is inserted into the vial. The
collagenase is withdrawn into the needle. The needle is removed and
replaced with a 0.2 .mu.m filter and second 22G needle. The
collagenase is then expelled from the syringe through the 0.2 .mu.m
filter and needle. Digestion of the adipose tissue is performed at
a final collagenase concentration of 0.1-0.2 Wunsch units/ml. The
heating pad is placed on the rocker. During this time, the saline
bag, while still attached, is set to the side of the rocker. Care
is taken to ensure that the tubing leading to the saline bag is
positioned in such a way that it does not get caught on the rocker
when in motion. The heating pad controller is set to 37.degree. C.
The 600 ml bag is placed on the rocker. The rocker is set to
maximum. The bag is observed to ensure that it is stable, and is
allowed to rock for approximately 1 hour (55.+-.10 mins).
[0165] Fourth, the regenerative cell composition is retrieved. The
bag is removed from the rocker. A blue clamp is applied to the
closed tubing formerly leading to the waste bag. The sterile
connecting device is used to attach the quad bag set (pre-prepared
according to the following instructions) to the tubing that was
formerly attached to the waste bag. The quad pack can be seen as
two linked quad packs. Identify the tubing splitting it into two
packs, fold the tubing back on itself, and slip a metal loop over
the folded tubing (over both pieces of tubing). Slide the loop down
approx 0.5 inch. The crimp formed at the bend acts to seal the
tubing. Use a hemostat to partially crimp the loop closed. The loop
is not crimped too tightly because the loop will need to be removed
during processing. The 600 ml bag is hung inverted over the work
surface and is allowed to sit for approximately 3 minutes. The blue
clamp on tubing leading to the quad set is released to drain the
cell fraction (the layer under the yellow/orange fat layer) into
the quad set. Care is taken to prevent the fat layer to enter the
tubing. During this process, the tubing can be crimped manually to
slow the flow as the fat layer gets close to the tubing. The tubing
leading to the quad bag set is then closed with a blue clamp, the
600 ml bag is returned to the work surface, and the saline bag is
hung. The blue clamp on the tubing between the saline and the 600
ml bag is released to allow approximately 150 ml of saline to enter
the 600 ml bag. The 600 ml bag is inverted approximately 10-15
times over approximately 15 seconds. The 600 ml bag is then hung
inverted over the work surface and is allowed to sit for about 3-5
minutes. The blue clamp on tubing leading to the quad set is
released, and the cell fraction (the layer under the yellow/orange
fat layer) is drained into the quad set. Care is taken to prevent
the fat layer from entering the tubing. For example, the flow can
be slowed as the fat layer gets close to the tubing by crimping the
tubing manually. The tubing leading to the quad bag set is closed
with a blue clamp. The tubing leading from the quad set to the 600
ml bag is then heat sealed. The 600 ml bag is then removed and
discarded.
[0166] Fifth, the regenerative cell composition is washed. A metal
clip is placed on the tubing between the two full bags to seal the
tubing. The quad set is placed on a balance. Water is added to a
second "dummy" quad set to balance the quad set. The quad set and
balanced set are placed on opposite buckets of the centrifuge. For
the hollow filter, the cells are washed and placed in the bag, and
tubing is sealed between the bag and the hollow fiber filter
assembly described above. Using a peristaltic pump, the fluid is
run through the filter assembly and the cell concentrate is
collected in a bag on the downstream end. Care is taken to make
sure the quad set bags are not compressed and are upright. The
centrifuge is operated at 400.times.g for 10 minutes. The quad set
is removed from the centrifuge and placed in the plasma expressor.
Care is taken to place the bags in the expressor in such a way that
the hard tubing at the top of the bag is just at the top of the
backplate. If the bag is too high, too much saline will be
retained, if it is too low the tubing will interfere with the front
plate's ability to close and again too much saline will be
retained. A blue clamp is applied to each of the lines leading from
the full quad set to the empty one. The metal loops and blue clamps
are removed to allow supernatant to flow into the empty quad set.
As much saline as possible is expressed off, but care is taken not
to dislodge the cell pellet. The tubing running into each of the
bags containing supernatant is heat sealed. The waste bags
containing the supernatant are removed. Blue clamps are applied to
the tubing leading to each of the quad set bags containing cells.
The bags are taken out of the plasma expressor. A sterile
connecting device is used to connect the tubing leading to the quad
pack to the saline bag. The blue clamp leading to one of the quad
set bags is removed to allow approximately 150 ml saline to flow
into the bag, and then the clamp is reapplied to stop the flow of
saline. The full quad set bag is then inverted approximately 10-15
times for approximately 15 seconds. The blue clamp leading to the
empty quad set bag is then removed and all of the contents of full
bag are drained into the empty bag. The metal loop clamp is
reapplied to seal the tubing between two quad set bags. The tubing
is then heat sealed and the saline bag is removed. The full quad
set bag is then inverted approximately 10-15 times over
approximately 15 seconds. Another dummy quad set is placed on a
balance and is re-balanced to the cell quad set. The quad set bags
(one full, one empty) are then placed into the centrifuge so that
the quad set bags are not compressed and are upright.
[0167] The centrifuge is operated at about 400.times.g for 10
minutes. The quad set is then removed from the centrifuge and is
placed carefully in the plasma expressor in such a way that the
hard tubing at the top of the bag is just at the top of the
backplate. If the bag is too high too much saline will be retained,
if it is too low the tubing will interfere with the front plate's
ability to close and again too much saline will be retained. The
metal loop is removed to express all the supernatant from the full
bag into the empty bag taking care not to dislodge the regenerative
cell pellet. The tubing between the bags is sealed, and the full
(waste) bag is removed and discarded. A new sampling site coupler
is then inserted into the remaining bag. The cells of the cell
pellet are then resuspended in the residual saline (if any) to
obtain a concentration of regenerative cells. The resuspension can
be performed by gentle manipulation of the bag (e.g., squeezing and
rubbing).
[0168] A particular example of the system embodying the present
invention is shown in FIG. 4. FIG. 4 illustrates an automated
system and method for separating and concentrating regenerative
cells from tissue, e.g., adipose tissue, suitable for re-infusion
within a patient. In certain embodiments of the system shown in
FIG. 4, the system further includes an automated step for
aspirating a given amount of tissue from the patient. The system
shown in FIG. 4 is comprised of the disposable set shown in FIG. 13
which is connected to the re-usable component of the system shown
in FIGS. 14A and 14B to arrive at an automated embodiment of the
system shown in FIGS. 15A and 15B. The disposable set is connected
to the re-usable component through, e.g., an interlocking or
docking device or configuration, which connects the disposable set
to the re-usable component such that the disposable set is securely
attached to and associated with the re-usable hardware component in
a manner that the processing device present on the re-usable
component can control and interface with, i.e., send and receive
signals to and from the various components of the disposable set as
well as various components of the re-usable component and other
associated devices and systems.
[0169] The user may connect the disposable set to the re-usable
component, input certain parameters using the user interface, e.g.,
the volume of tissue being collected, attach the system to the
patient, and the system automatically performs all of the steps
shown in FIG. 4 in an uninterrupted sequence using pre-programmed
and/or user input parameters. One such sequence is illustrated in
FIG. 15C. Alternatively, the tissue may be manually aspirated from
the patient by the user and transported to system for processing,
i.e., separation and concentration of regenerative cells.
[0170] Specifically, as shown in FIG. 4, tissue, e.g., adipose
tissue, may be withdrawn from the patient using conduit 12 and
introduced into collection chamber 20. A detailed illustration of
the collection chamber of FIG. 4 is shown in FIG. 5. As illustrated
in FIG. 5, the collection chamber 20 may be comprised of a vacuum
line 11 which facilitates tissue removal using a standard cannula.
The user may enter the estimated volume of tissue directed to the
collection chamber 20 at this point. The tissue is introduced into
the collection chamber 20 through an inlet port 21 which is part of
a closed fluid pathway that allows the tissue, saline and other
agents to be added to the tissue in an aseptic manner. An optical
sensor of the system, e.g., sensor 29, can detect when the user
input volume of tissue is present in the collection chamber 20. In
certain embodiments, if less tissue is present in the collection
chamber than the user input, the user will have the option to begin
processing the volume of tissue which is present in the collection
chamber 20. In certain embodiments, a portion of the tissue removed
from the patient may be directed to the sample chamber 60 through
the use of a pump, e.g., a peristaltic pump, via a conduit, which
may be activated via user input utilizing the user interface.
[0171] A sensor 29 can signal the processing device present in the
re-usable component to activate the steps needed to wash and
disaggregate the tissue. For example, the processing device may
introduce a pre-set volume of washing agent based on the volume of
tissue collected using automated valves and pumps. This cycle may
be repeated in the collection chamber until the optical sensor
determines that the effluent liquid is sufficiently clear and
devoid of unwanted material. For example, an optical sensor 29
along the conduit leading out of the collection chamber 12b or 12d
can detect that the unwanted materials have been removed and can
signal the processing device to close the required valves and
initiate the next step.
[0172] Next, the processing device may introduce a pre-programmed
amount of disaggregation agent based on the volume of tissue
collected. The processing device may also activate agitation of the
tissue in the collection chamber for a preset period of time based
on the initial volume of tissue collected or based on user input.
In the embodiment shown in FIG. 4, once the disaggregation agent,
e.g., collagenase, is added to the collection chamber 20 through
the collagenase source 24, the motor in the collection chamber 20
is activated via the processing device. The motor activates the
rotatable shaft 25 which is comprised of a magnetic stirrer and a
paddle-like device wherein one or more paddles 25a are rigidly
attached to the filter cage 27 of a filter prefixed to the
collection chamber 28. The paddles agitate the in the presence of
the disaggregation agent such that the regenerative cells separate
from the tissue.
[0173] The solution in the collection chamber 20 is allowed to
settle for a preset period of time. The buoyant portion of the
solution is allowed to rise to the top of the solution. Once the
preset period of time elapses, the necessary valves and pumps are
activated by the processing device to remove the non-buoyant
portion to the waste chamber 40. The transfer into the waste
chamber 40 continues until a sensor 29 along the conduit leading
out of the collection chamber 12b or 12d can detect that the
buoyant fraction of the solution is about to be transferred to the
waste chamber 30. For example, a sensor 29 along the conduit
leading out of the collection chamber 12b or 12d can detect that
the unwanted materials have been removed and can signal the
processing device to close the required valves.
[0174] At this time the non-buoyant fraction of the solution, i.e.,
the regenerative cell composition, is moved to the processing
chamber 30. This is accomplished through the use of the necessary
valves and peristaltic pumps. In certain embodiments, before
transfer of the regenerative cell composition to the processing
chamber 30, an additional volume of saline may be added to the
buoyant fraction of solution remaining in the collection chamber
20. Another wash cycle may be repeated. After this cycle, the
solution is allowed to settle and the non-buoyant fraction (which
contains the regenerative cells) is transported to the processing
chamber 30 and the buoyant fraction is drained to the waste chamber
40. The additional wash cycle is used to optimize transfer of all
the separated regenerative cells to the processing chamber 30.
[0175] Once the regenerative cell composition is transported to the
processing chamber 30 by way of conduits 12, the composition may be
subject to one or more additional washing steps prior to the start
of the concentration phase. This ensures removal of waste and
residual contaminants from the collection chamber 20. Similarly,
subsequent to the concentration step, the regenerative cell
composition may be subjected to one or more additional washing
steps to remove residual contaminants. The unwanted materials may
be removed from the processing chamber 30 to the waste chamber 40
in the same manner, i.e., control of valves and pumps via signals
from the processing device, as described above.
[0176] The various embodiments of the processing chamber 30 shown
in FIG. 4 are described in detail below. The processing chamber 30
shown in FIG. 4 is in the form of a centrifuge chamber. A detailed
illustration of the processing chamber of FIG. 4 is shown in FIGS.
7 and 8. Such a processing chamber 30 is generally comprised of a
rotating seal network 30.1 comprising an outer housing 30.2, one or
more seals 30.3, one or more bearings 30.4 and an attachment point
30.6 for connecting the processing chamber to the centrifuge device
present in the re-usable component of the system; one or more fluid
paths 30.5 in the form of conduits extending out from the rotating
seal and ending in a centrifuge chamber on each end which is in the
form of an output chamber 50 housed in a frame 53 wherein the frame
is comprised of one or more ports 52 and one or more handles to
manually re-position the output chamber 50.
[0177] The rotating seal network 30.1 is included to ensure that
the fluid pathways of the processing chamber can be maintained in a
sterile condition. In addition, the fluid pathways of the
processing chamber can be accessed in a sterile manner (e.g., to
add agents or washing solution) at any time, even while the
centrifuge chamber of the processing chamber is spinning.
[0178] The rotating seal network 30.1 shown in FIGS. 7 and 8
includes a rotating shaft comprised of two or more bearings 30.4,
three or more lip seals 30.3, and an outer housing 30.2. In this
embodiment, the bearings 30.4 further comprise an outer and inner
shaft (not shown) referred to herein as races. These races may be
separated by precision ground spheres. The races and spheres
comprising the bearings are preferably fabricated with material
suitable for contact with bodily fluid, or are coated with material
suitable for contact with bodily fluid. In a preferred embodiment,
the races and spheres are fabricated using, for example, silicone
nitride or zirconia. Furthermore, in this embodiment, the three lip
seals are comprised of a circular "U" shaped channel (not shown) as
well as a circular spring (not shown). The circular "U" shaped
channel is preferably fabricated using flexible material such that
a leakage proof junction with the rotating shaft of the rotating
seal network 30.1 is formed. Additionally, the lip seals are
preferably oriented in a manner such that pressure from the
regenerative cell composition flowing through the processing
chamber causes the seal assembly to tighten its junction with the
rotating shaft by way of increased tension. The seals may be
secured in position by way of one or more circular clips (not
shown) which are capable of expanding and/or collapsing as needed
in order to engage a groove in the outer housing 30.2 of the
rotating seal network 30.1. The heat generated by or near the
rotating seal network 30.1 must be controlled to prevent lysis of
the cells in the solution which is being moved through the passage.
This may be accomplished by, for example, selecting a hard material
for constructing the rotating shaft, polishing the area of the
rotating shaft which comes in contact with the seals and minimizing
contact between the rotating shaft and the seal.
[0179] In another embodiment the rotating seal network 30.1 is
comprised of a single rubber seal 30.3 and an air gasket (not
shown). This seal and gasket provide a tortuous path for any
biologic matter which could compromise the sterility of the system.
In another embodiment the rotating seal network 30.1 is comprised
of multiple spring loaded seals 30.3 which isolate the individual
fluid paths. The seals 30.3 are fabricated of a material which can
be sterilized as well as seal the rotating shaft without lubricant.
In another embodiment the rotating seal network 30.1 is compromised
of a pair of ceramic disks (not shown) which create the different
fluid paths and can withstand the rotation of the system and not
cause cell lysis. In another embodiment the fluid pathway is
flexible and is allowed to wind and unwind with respect to the
processing chamber. This is accomplished by having the flexible
fluid pathway rotate one revolution for every two revolutions of
the processing chamber 30. This eliminates the need for a rotating
seal altogether.
[0180] The regenerative cell composition is pumped from the
collection chamber 20 along a fluid path through the axis of
rotation of the rotating seal network 30.1 and then divides into a
minimum of two fluid pathways 30.5 each of which radiate outward
from the central axis of the processing chamber 30 and terminate
near the outer ends of the processing chamber 30, i.e., within the
centrifuge chambers which house the output chambers 50 (FIGS. 7 and
8). Accordingly, in a preferred embodiment, the processing chamber
30 is comprised of two or more output chambers 50 as shown in FIGS.
7 and 8. These output chambers 50 are positioned such that they are
in one orientation during processing 30.7 and another orientation
for retrieval of concentrated regenerative cells 30.8. For example,
the output changes are tilted in one angle during processing and
another angle for cell retrieval. The cell retrieval angle is more
vertical than the processing angle. The two positions of the output
chamber 50 may be manually manipulated through a handle 53 which
protrudes out of the processing chamber 30. The regenerative cells
can be manually retrieved from the output chambers 50 when they are
in the retrieval orientation 30.8 using a syringe. In another
embodiment, fluid path 30.5 is constructed such that it splits
outside the processing chamber and then connects to the outer ends
of the processing chamber 30, i.e., within the centrifuge chambers
which house the output chambers 50 (not shown). In this embodiment,
large volumes of regenerative cell composition and/or additives,
solutions etc. may be transported to the centrifuge chamber and/or
the output chambers directly.
[0181] With reference to FIGS. 4 and 7-9, between the collection
chamber 20 and the processing chamber 30, a pump 34 and one or more
valves 14 may be provided. In a preferred embodiment, the valves 14
are electromechanical valves. In addition, sensors, such as
pressure sensor 29, may be provided in line with the processing
chamber 30 and the collection chamber 20. The valves, pumps and
sensors act in concert with the processing device present on the
re-usable component (FIGS. 14A and 14B) to automate the
concentration steps of the system.
[0182] The sensors detect the presence of the regenerative cell
composition in the centrifuge chambers and activate the centrifuge
device through communication with the processing device of the
system. The regenerative cell composition is then subjected to a
pre-programmed load for a pre-programmed time based on the amount
of tissue originally collected and/or user input. In certain
embodiments, this step may be repeated either automatically or
through user input. For example, the composition is subjected to a
load of approximately 400 times the force of gravity for a period
of approximately 5 minutes. The output chamber 50 is constructed
such that the outer extremes of the chamber form a small reservoir
for the dense particles and cells. The output chamber 50 retains
the dense particles in what is termed a `cell pellet`, while
allowing the lighter supernatant to be removed through a fluid
path, e.g., a fluid path which is along the axis of rotation of the
rotating seal network 30.1 and travels from the low point in the
center of the processing chamber 30 through the rotating seal
network 30.1 to the waste container 40. The valves 14 and pumps 34
signal the processing device to activate steps to remove the
supernatant to the waste container 40 without disturbing the cell
pellet present in the output chamber 50.
[0183] The cell pellet that is obtained using the system shown in
FIG. 4 comprises the concentrated regenerative cells of the
invention. In some embodiments, after the supernatant is removed
and directed to the waste chamber 40, a fluid path 30.5 may be used
to re-suspend the cell pellet that is formed after centrifugation
with additional solutions and/or other additives. Re-suspension of
the cell pellet in this manner allows for further washing of the
regenerative cells to remove unwanted proteins and chemical
compounds as well as increasing the flow of oxygen to the cells.
The resulting suspension may be subjected to another load of
approximately 400 times the force of gravity for another period of
approximately 5 minutes. After a second cell pellet is formed, and
the resulting supernatant is removed to the waste chamber 40, a
final wash in the manner described above may be performed with
saline or some other appropriate buffer solution. This repeated
washing can be performed multiple times to enhance the purity of
the regenerative cell solution. In certain embodiments, the saline
can be added at any step as deemed necessary to enhance processing.
The concentrations of regenerative cells obtained using the system
shown in FIG. 4 may vary depending on amount of tissue collected,
patient age, patient profile etc. Exemplary yields are provided in
Table 1.
[0184] The final pellet present in the output chamber 50 may then
be retrieved in an aseptic manner using an appropriate syringe
after the output chamber 50 is positioned in the orientation
appropriate for cell removal. In other embodiments, the final
pellet may be automatically moved to a container in the in the
output chamber 50 which may be removed and stored or used as
needed. This container may be in any appropriate form or size. For
example, the container may be a syringe. In certain embodiments,
the output container 50 itself may be heat sealed (either
automatically or manually) and isolated from the other components
of the processing chamber for subsequent retrieval and use of the
regenerative cells in therapeutic applications as described herein
including re-infusion into the patient. The cells may also be
subject to further processing as described herein either prior to
retrieval from the output chamber or after transfer to a second
system or device. The re-usable component shown in FIGS. 14A and
14B is constructed such that it can be connected to one or more
additional systems or devices for further processing as needed.
[0185] As described herein, the adipose derived regenerative cells
obtained using the systems and methods of the present invention can
be used for the treatment of cardiovascular diseases and disorders.
based on their properties as described in the Examples.
Accordingly, in one aspect of the present invention, adipose
tissue-derived cells are extracted from a donor's adipose tissue
and are used to elicit a therapeutic benefit to damaged or
degenerated myocardium or other cardiovascular tissue through one
or more of the mechanisms demonstrated herein. In a preferred
embodiment the cells are extracted from the adipose tissue of the
person into whom they are to be implanted, thereby reducing
potential complications associated with antigenic and/or
immunogenic responses to the transplant. Patients are typically
evaluated to assess myocardial damage or disease by one or more of
the following procedures performed by a physician or other clinical
provider: patient's health history, physical examination, and
objective data including but not limited to EKG, serum cardiac
enzyme profile, and echocardiography.
[0186] In one embodiment, the harvesting procedure is performed
prior to the patient receiving any products designed to reduce
blood clotting in connection with treatment of the myocardial
infarction. However, in certain embodiments, the patient may have
received aspirin and/or other antiplatelet substances (i.e.
Clopidogrel) prior to the harvesting procedure. In addition, one
preferred method includes collection of adipose tissue prior to any
attempted revascularization procedure. However, as understood by
persons skilled in the art, the timing of collection is expected to
vary and will depend on several factors including, among other
things, patient stability, patient coagulation profile, provider
availability, and quality care standards. Ultimately, the timing of
collection will be determined by the practitioner responsible for
administering care to the affected patient.
[0187] The volume of adipose tissue collected from the patient can
vary from about 0 cc to about 2000 cc and in some embodiments up to
about 3000 cc. The volume of fat removed will vary from patient to
patient and will depend on a number of factors including but not
limited to: age, body habitus, coagulation profile, hemodynamic
stability, severity of infarct, co-morbidities, and physician
preference.
[0188] Cells may be administered to a patient in any setting in
which myocardial function is compromised. Examples of such settings
include, but are not limited to, acute myocardial infarction (heart
attack), congestive heart failure (either as therapy or as a bridge
to transplant), non-ischemic cardiomyopathies (i.e. toxic or
infectious) and supplementation of coronary artery bypass graft
surgery, among other things. The cells may be extracted in advance
and stored in a cryopreserved fashion or they may be extracted at
or around the time of defined need. As disclosed herein, the cells
may be administered to the patient, or applied directly to the
damaged tissue, or in proximity of the damaged tissue, without
further processing or following additional procedures to further
purify, modify, stimulate, or otherwise change the cells. For
example, the cells obtained from a patient may be administered to a
patient in need thereof without culturing the cells before
administering them to the patient. In one embodiment, the
collection of adipose tissue will be performed at a patient's
bedside. Hemodynamic monitoring may be used to monitor the
patient's clinical status.
[0189] In accordance with the invention herein disclosed, the
adipose derived cells can be delivered to the patient soon after
harvesting the adipose tissue from the patient. For example, the
cells may be administered immediately after the processing of the
adipose tissue to obtain a composition of adipose derived
regenerative cells. In one embodiment, the preferred timing of
delivery should take place on the order of hours to days after the
infarction to take advantage of the neurohormonal and inflammatory
environment which exists after cardiac injury. Ultimately, the
timing of delivery will depend upon patient availability and the
time required to process the adipose tissue. In another embodiment,
the timing for delivery may be relatively longer if the cells to be
re-infused to the patient are subject to additional modification,
purification, stimulation, or other manipulation, as discussed
herein. Furthermore, adipose derived cells may be administered
multiple times after the infarction. For example, the cells may be
administered continuously over an extended period of time (e.g.,
hours), or may be administered in multiple bolus injections
extended over a period of time. In certain embodiments, an initial
administration of cells will be administered within about 12 hours
after an infarction, such as at 6 hours, and one or more doses of
cells will be administered at 12 hour intervals.
[0190] The number of cells administered to a patient may be related
to, for example, the cell yield after adipose tissue processing or
the size or type of the injury. A portion of the total number of
cells may be retained for later use or cryopreserved. In addition,
the dose delivered will depend on the route of delivery of the
cells to the patient. Fewer cells may be needed when epicardial or
endocardial delivery systems are employed, as these systems and
methods can provide the most direct pathway for treating
cardiovascular conditions. In one embodiment of the invention, a
number of cells, e.g., unpurified cells, to be delivered to the
patient is expected to be about 5.5.times.10.sup.4 cells. However,
this number can be adjusted by orders of magnitude to achieve the
desired therapeutic effect.
[0191] The cells may also be applied with additives to enhance,
control, or otherwise direct the intended therapeutic effect. For
example, in one embodiment, and as described herein, the cells may
be further purified by use of antibody-mediated positive and/or
negative cell selection to enrich the cell population to increase
efficacy, reduce morbidity, or to facilitate ease of the procedure.
Similarly, cells may be applied with a biocompatible matrix which
facilitates in vivo tissue engineering by supporting and/or
directing the fate of the implanted cells. In the same way, cells
may be administered following genetic manipulation such that they
express gene products that are believed to or are intended to
promote the therapeutic response(s) provided by the cells. Examples
of manipulations include manipulations to control (increase or
decrease) expression of factors promoting angiogenesis or
vasculogenesis (for example VEGF), expression of developmental
genes promoting differentiation into specific cell lineages (for
example MyoD) or that stimulate cell growth and proliferation (for
example bFGF-1).
[0192] The cells may also be subjected to cell culture on a
scaffold material prior to being implanted. Thus, tissue engineered
valves, ventricular patches, pericardium, blood vessels, and other
structures could be synthesized on natural or synthetic matrices or
scaffolds using ADC prior to insertion or implantation into the
recipient (Eschenhagen et al., 2002; Zimmermann et al., 2004;
Zimmermann et al., 2002; Nerem and Ensley, 2004).
[0193] In one embodiment, direct administration of cells to the
site of intended benefit is preferred. This may be achieved by
direct injection into myocardium through the external surface of
the heart (epicardial), direct injection into the myocardium
through the internal surface (endocardial) through insertion of a
suitable cannula, by arterial or venous infusion (including
retrograde flow mechanisms) or by other means disclosed herein or
known in the art such as pericardial injection. Routes of
administration known to one of ordinary skill in the art, include
but are not limited to, intravenous, intracoronary, endomyocardial,
epimyocardial, intraventicular, retrograde coronary sinus or
intravenous.
[0194] As mentioned above, cells may be applied by several routes
including systemic administration by venous or arterial infusion
(including retrograde flow infusion) or by direct injection into
the heart muscle or chambers. Systemic administration, particularly
by peripheral venous access, has the advantage of being minimally
invasive relying on the natural perfusion of the heart and the
ability of adipose tissue-derived cells to home to the site of
damage. Cells may be injected in a single bolus, through a slow
infusion, or through a staggered series of applications separated
by several hours or, provided cells are appropriately stored,
several days or weeks. Cells may also be applied by use of
catheterization such that the first pass of cells through the heart
is enhanced; the application may be improved further by using
balloons to manage myocardial blood flow. As with peripheral venous
access, cells may be injected through the catheters in a single
bolus or in multiple smaller aliquots. Cells may also be applied
directly to the myocardium by epicardial injection. This could be
employed under direct visualization in the context of an open heart
procedure (such as a Coronary Artery Bypass Graft Surgery) or
placement of a ventricular assist device. Catheters equipped with
needles may be employed to deliver cells directly into the
myocardium in an endocardial fashion which would allow a less
invasive means of direct application.
[0195] In one embodiment, the route of delivery will include
intravenous delivery through a standard peripheral intravenous
catheter, a central venous catheter, or a pulmonary artery
catheter. In other embodiments, the cells may be delivered through
an intracoronary route to be accessed via currently accepted
methods. The flow of cells may be controlled by serial
inflation/deflation of distal and proximal balloons located within
the patient's vasculature, thereby creating temporary no-flow zones
which promote cellular engraftment or cellular therapeutic action.
In another embodiment, cells may be delivered through an
endocardial (inner surface of heart chamber) method which may
require the use of a compatible catheter as well as the ability to
image or detect the intended target tissue. Alternatively, cells
may be delivered through an epicardial (outer surface of the heart)
method. This delivery may be achieved through direct visualization
at the time of an open heart procedure or through a thoracoscopic
approach requiring specialized cell delivery instruments.
Furthermore, cells could be delivered through the following routes,
alone, or in combination with one or more of the approaches
identified above: subcutaneous, intramuscular, sublingual,
retrograde coronary perfusion, coronary bypass machinery,
extracorporeal membrane oxygenation (ECMO) equipment and via a
pericardial window.
[0196] In one embodiment, cells are administered to the patient as
an intra-vessel bolus or timed infusion. In another embodiment,
cells may be resuspended in an artificial or natural medium or
tissue scaffold prior to be administered to the patient.
[0197] The cell dose administered to the patient will be dependent
on the amount of adipose tissue harvested and the body mass index
of the donor (as a measure of the amount of available adipose
tissue). The amount of tissue harvested will also be determined by
the extent of the myocardial injury or degeneration. Multiple
treatments using multiple tissue harvests or using a single harvest
with appropriate storage of cells between applications are within
the scope of this invention.
[0198] Portions of the processed lipoaspirate may be stored before
being administered to a patient. For short term storage (less than
6 hours) cells may be stored at or below room temperature in a
sealed container with or without supplementation with a nutrient
solution. Medium term storage (less than 48 hours) is preferably
performed at 2-8.degree. C. in an isosmotic, buffered solution (for
example Plasmalyte.RTM.) in a container composed of or coated with
a material that prevents cell adhesion. Longer term storage is
preferably performed by appropriate cryopreservation and storage of
cells under conditions that promote retention of cellular function,
such as disclosed in commonly owned and assigned PCT application
number PCT/US02/29207, filed Sep. 13, 2002 and U.S. Provisional
application No. 60/322,070, filed Sep. 14, 2001, the contents of
both of which are hereby incorporated by reference.
[0199] In accordance with one aspect of the invention, the
adipose-tissue derived cells that are administered to a patient can
act as growth factor delivery vehicles. For example, by engineering
the cells to express one or more growth factors suitable for
alleviating symptoms associated with a cardiovascular disorder or
disease, the cells can be administered to a patient, and engineered
to release one or more of the growth factors. The release can be
provided in a controlled fashion for extended periods of time. For
example, the release can be controlled so that the growth factor(s)
are released in a pulsed or periodic manner such that there are
local elevations in growth factor, and/or local recessions in the
amount of growth factor in proximity to an injured area of
tissue.
[0200] The cells that are administered to the patient not only help
restore function to damaged or otherwise unhealthy tissues, but
also facilitate repair of the damaged tissues.
[0201] Cell delivery may take place but is not limited to the
following locations: clinic, clinical office, emergency department,
hospital ward, intensive care unit, operating room, catheterization
suites, and radiologic suites.
[0202] In one embodiment, the effects of cell delivery therapy
would be demonstrated by, but not limited to, one of the following
clinical measures: increased heart ejection fraction, decreased
rate of heart failure, decreased infarct size, increased
contractility (dP/dT), reduced ventricular stiffness (increase in
-dP/dT), decreased associated morbidity (pulmonary edema, renal
failure, arrhythmias, target vessel revascularization) improved
exercise tolerance or other quality of life measures, and decreased
mortality. The effects of cellular therapy can be evident over the
course of days to weeks after the procedure. However, beneficial
effects may be observed as early as several hours after the
procedure, and may persist for several years.
[0203] Patients are typically monitored prior to and during the
delivery of the cells. Monitoring procedures include, and are not
limited to: coagulation studies, oxygen saturation, hemodynamic
monitoring, and cardiac rhythm monitoring. After delivery of cells,
patients may require an approximate 24 hour period of monitoring
for adverse events. Follow-up studies to assess functional
improvements from the procedures may include and are not limited
to: patient functional capacity (e.g., dyspnea on exertion,
paroxysmal nocturnal dysnpea, angina), echocardiography, nuclear
perfusion studies, magnetic resonance imaging, postiron emission
topography, and coronary angiography.
[0204] As previously set forth above, in a preferred embodiment,
the ADC, i.e., the active adipose derived regenerative cell
population, is administered directly into the patient. In other
words, the active cell population (e.g., the stem cells and/or
endothelial precursor cells) are administered to the patient
without being removed from the system or exposed to the external
environment of the system before being administered to the patient.
Providing a closed system reduces the possibility of contamination
of the material being administered to the patient. Thus, processing
the adipose tissue in a closed system provides advantages over
existing methods because the active cell population is more likely
to be sterile. In such an embodiment, the only time the stem cells
and/or endothelial precursor cells are exposed to the external
environment, or removed from the system, is when the cells are
being withdrawn into an application device and being administered
to the patient. In one embodiment, the application device can also
be part of the closed system. Thus, the cells used in these
embodiments are not processed for culturing or cryopreservation and
may be administered to a patient without further processing, or may
be administered to a patient after being mixed with other tissues
or cells.
[0205] In other embodiments, at least a portion of the active cell
population is stored for later implantation/infusion. The
population may be divided into more than one aliquot or unit such
that part of the population of stem cells and/or endothelial
precursor cells is retained for later application while part is
applied immediately to the patient. Moderate to long-term storage
of all or part of the cells in a cell bank is also within the scope
of this invention, as disclosed in U.S. patent application Ser. No.
10/242,094, entitled PRESERVATION OF NON EMBRYONIC CELLS FROM NON
HEMATOPOIETIC TISSUES, filed Sep. 12, 2002, which claims the
benefit of U.S. Provisional Patent Application 60/322,070 filed
Sep. 14, 2001, which is commonly assigned, and the contents of
which are expressly incorporated herein by reference. At the end of
processing, the concentrated cells may be loaded into a delivery
device, such as a syringe, for placement into the recipient by any
means known to one of ordinary skill in the art.
[0206] The active cell population may be applied alone or in
combination with other cells, tissue, tissue fragments, growth
factors such as VEGF and other known angiogenic or arteriogenic
growth factors, biologically active or inert compounds, resorbable
plastic scaffolds, or other additive intended to enhance the
delivery, efficacy, tolerability, or function of the population.
The cell population may also be modified by insertion of DNA or by
placement in cell culture in such a way as to change, enhance, or
supplement the function of the cells for derivation of a structural
or therapeutic purpose. For example, gene transfer techniques for
stem cells are known by persons of ordinary skill in the art, as
disclosed in (Morizono et al., 2003; Mosca et al., 2000), and may
include viral transfection techniques, and more specifically,
adeno-associated virus gene transfer techniques, as disclosed in
(Walther and Stein, 2000) and (Athanasopoulos et al., 2000).
Non-viral based techniques may also be performed as disclosed in
(Muramatsu et al., 1998).
[0207] In another aspect, the cells could be combined with a gene
encoding pro-angiogenic and/or cardiomyogenic growth factor(s)
which would allow cells to act as their own source of growth factor
during cardiac repair or regeneration. Genes encoding
anti-apoptotic factors or agents could also be applied.
[0208] In certain embodiments of the invention, the cells are
administered to a patient with one or more cellular differentiation
agents, such as cytokines and growth factors. Examples of various
cell differentiation agents are disclosed in (Gimble et al., 1995;
Lennon et al., 1995; Majumdar et al., 1998; Caplan and Goldberg,
1999; Ohgushi and Caplan, 1999; Pittenger et al., 1999; Caplan and
Bruder, 2001; Fukuda, 2001; Worster et al., 2001; Zuk et al.,
2001).
[0209] The present invention is further illustrated by the
following examples which in no way should be construed as being
further limiting, The contents of all cited references, including
literature references, issued patents, published patent
applications, and co-pending patent applications, cited throughout
this application are hereby expressly incorporated by
reference.
EXAMPLES
[0210] The adipose derived regenerative cells used throughout the
examples set forth below were obtained by the method(s) described
in the instant disclosure and/or incorporated herein by
reference.
Example 1: Expression of Angiogenic Growth Factor, Vegf, by ADC
[0211] Vascular Endothelial Growth Factor (VEGF) is one of the key
regulators of angiogenesis (Nagy et al., 2003; Folkman, 1995).
Placenta Growth Factor, another member of the VEGF family, plays a
similar role in both angiogenesis as well as in arteriogenesis, the
process by which collateral vessels are recruited and expanded in
response to increased perfusion and shear force (Nagy et al., 2003;
Pipp et al., 2003; Scholz et al., 2003). Specifically, transplant
of wild-type (PlGF+/+) cells into a PlGF knockout mouse restores
ability to induce rapid recovery from hind limb ischemia (Scholz et
al., 2003).
[0212] Given the importance of both angiogenesis and arteriogenesis
to the revascularization process, PlGF and VEGF expression by
adipose derived regenerative cells was examined using an ELISA
assay (R&D Systems, Minneapolis, Minn.) using cells from three
donors. One donor had a history of hyperglycemia and Type 2
diabetes (a condition highly associated with microvascular and
macrovascular disease, including patients with coronary artery
disease). ADC cells from each donor were plated at 1,000
cells/cm.sup.2 in DMEM/F-12 medium supplemented with 10% FCS and 5%
HS and grown until confluent. Supernatant samples were taken and
assayed for expression of PIGF and VEGF protein. As shown in FIGS.
16A and 16B, the results demonstrate robust expression of both VEGF
(FIG. 16A) and PIGF (FIG. 16B) by the adipose derived regenerative
cells of the invention.
[0213] In a separate study, the relative quantity of angiogenic
related cytokines secreted by cultured regenerative cells from
normal adult mice was measured. The regenerative cells were
cultured in alpha-MEM with 10% FBS to five days beyond cell
confluence, at which time the cell culture medium was harvested and
evaluated by antibody array analysis (RayBio.RTM. Mouse Cytokine
Antibody Array II (RayBiotech, Inc.). The following angiogenic
related growth factors were detected: Vascular Endothelial Growth
Factor (VEGF), bFGF, IGF-II, Eotaxin, G-CSF, GM-CSF, IL-12 p40/p70,
IL-12 p70, IL-13, IL-6, IL-9, Leptin, MCP-1, M-CSF, MIG, PF-4,
TIMP-1, TIMP-2, TNF-.alpha., and Thrombopoetin. The following
angiogenic related growth factors or cytokines were elevated at
least twice compare to blank control medium with 10% FBS: Vascular
Endothelial Growth Factor (VEGF), Eotaxin, G-CSF, IL-6, MCP-1 and
PF-4.
[0214] These data demonstrate that the regenerative cells of the
present invention express a wide array of angiogenic and
arteriogenic growth factors. These data also demonstrate that
adipose tissue derived stem and progenitor cells from both normal
and diabetic patients express angiogenic and arteriogenic growth
factors. This is important as patients with diabetes are at
increased risk of cardiovascular disease and these data indicate
that ADC cells retain their angiogenic ability in the diabetic
setting. The finding that a diabetic patient expressed VEGF and
PlGF at equivalent levels to those of normal patients suggest that
diabetic patients may be candidates for angiogenic therapy by
autologous adipose derived regenerative cells.
Example 2: ADC Contains Cell Populations that Participate in
Angiogenesis
[0215] Endothelial cells and their precursors, endothelial
progenitor cells (EPCs), are known to participate in angiogenesis.
To determine whether EPCs are present in adipose derived
regenerative cells, human adipose derived regenerative cells were
evaluated for EPC cell surface markers, e.g., CD-34.
[0216] ADCs were isolated by enzymatic digestion of human
subcutaneous adipose tissue. ADCs (100 .mu.l) were incubated in
phosphate saline buffer (PBS) containing 0.2% fetal bovine serum
(FBS), and incubated for 20 to 30 minutes at 4.degree. C. with
fluorescently labeled antibodies directed towards the human
endothelial markers CD-31 (differentiated endothelial cell marker)
and CD-34 (EPC marker), as well as human ABCG2 (ATP binding
cassette transporter), which is selectively expressed on
multipotent cells. After washing, cells were analyzed on a FACSAria
Sorter (Beckton Dickenson--Immunocytometry). Data acquisition and
analyses were then performed by FACSDiva software
(BD-Immunocytometry, CA). The results (not shown) showed that the
adipose derived regenerative cells from a healthy adult expressed
the EPC marker CD-34 and ABCG2, but not the endothelial cell marker
CD-31. Cells expressing the EPC marker CD-34 and ABCG2 were
detected at similar frequency in regenerative cells derived from a
donor with a history of diabetes.
[0217] To determine the frequency of EPCs in human adipose derived
regenerative cells after their culture in endothelial cell
differentiation medium, regenerative cells were plated onto
fibronectin-coated plates and cultured in endothelial cell medium
for three days to remove mature endothelial cells. Nonadherent
cells were removed and re-plated. After 14 days, colonies were
identified by staining with FITC-conjugated Ulex europaeus
Agglutinin-1 (Vector Labs, Burlingame, Calif.) and DiI-labeled
acetylated LDL (Molecular Probes, Eugene, Oreg.). As shown in FIG.
17, the results indicate an EPC frequency of approximately 500
EPC/10.sup.6 ADC cells.
[0218] The presence of EPCs within the adipose tissue derived
regenerative cells indicates that these cells can participate
directly in development of new blood vessels and enhance
angiogenesis and restore perfusion.
Example 3: In Vitro Development of Vascular Structures in ADC
[0219] An art-recognized assay for angiogenesis is one in which
endothelial cells grown on a feeder layer of fibroblasts develop a
complex network of CD31-positive tubes reminiscent of a nascent
capillary network (Donovan et al., 2001). Since adipose derived
regenerative cells contain endothelial cells, EPCs and other
stromal cell precursors, we tested the ability of these
regenerative cells to form capillary-like structures in the absence
of a feeder layer. Regenerative cells obtained from inguinal fat
pads of normal mice developed capillary networks two weeks after
culture (FIG. 18A). Notably, regenerative cells from hyperglycemic
mice with streptozotocin (STZ)-induced Type 1 diabetes eight weeks
following administration of STZ formed equivalent capillary
networks as those formed by cells from normal mice (FIG. 18B).
[0220] In a subsequent study, adipose derived regenerative cells
were cultured in complete culture medium (.alpha.-MEM supplemented
with 10% FCS) and no additional growth factors. These regenerative
cells also formed capillary networks. Furthermore, the vascular
structures formed stained positive for the endothelial cell markers
CD31, CD34, VE-cadherin and von Willebrand factor/Factor VIII, but
not the pan-lymphocyte marker, CD45.
[0221] To compare the ability of regenerative cells from young vs.
elderly mice to form capillary networks, regenerative cells from
normal young and elderly mice (aged 1, 12, or 18 months) were
cultured for 2 weeks in complete culture medium (.alpha.-MEM
supplemented with 10% FCS) and no additional growth factors.
Equivalent capillary-like networks were observed in cultures of
regenerative cells from all donors (not shown).
[0222] The foregoing data demonstrates that adipose derived
regenerative cells from normal and diabetic, as well as young and
elderly patients can form vascular structures consistent with the
formation of nascent capillary networks. Accordingly, the
regenerative cells of the invention may be used to treat angiogenic
insufficiencies.
Example 4: In Vivo Development of Vascular Structures in ADC
[0223] In vitro angiogenic potential, while promising, is of little
value if the cells do not exert in vivo angiogenic activity.
Surgical induction of critical limb ischemia in rodents is a
well-recognized model in which concurrent processes of
arteriogenesis (recruitment and expansion of collateral vessels
largely in response to increased shear force) and angiogenesis
(development of new vessels in response to ischemia) can be
observed {Schatteman, 2000; Scholz, 2002; Takahashi, 1999). This
model was developed in immunodeficient (NOD-SCID) mice in which the
ability of human cells to restore perfusion could be observed.
Specifically, animals were anesthetized with ketamine and xylazine
(80 mgkg; 7.5 mg/kg) and placed on the operating surface in the
supine position. Pre-operative blood flow values were determined
for both hind limbs as described below. Animals were prepped with
Betadine and draped in the usual sterile fashion and placed on a
circulating waterbath. A unilateral 1.5 cm incision was made
extending from the origin of the hind-limb to just proximal of the
knee to expose the iliac artery, proximal to its bifurcation into
the deep and superficial femoral arteries. The vasculature was tied
off with a 3-0 silk ligature at the following sites: 1) iliac
artery proximal to its bifurcation, 2) just distal to the origin of
deep femoral artery, 3) just proximal to branching of the
superficial femoral artery. After ligation, the vasculature was
removed en bloc. An effort was then made to identify any obvious
collateral circulation which was ligated and subsequently removed.
The wound and the muscle layer were closed with 4-0 vicryl and the
skin closed with 5-0 vicryl suture. Animals were treated
post-operatively with buprenorphine (0.5 mg/kg) and recovered on
the circulating water bath until spontaneously recumbent. Twenty
four hours after surgery animals were injected with
5.times.10.sup.6 ADC cells through the tail vein. NOD-SCID mice
were injected with human donor cells, including in one study, cells
from a patient with diabetes. Flow was imaged 14 days following
treatment.
[0224] In these studies, ADC-treated animals showed statistically
significant improvement in retention of limb structures (limb
salvage; 2/3 untreated mice lost all lower hind limb structures
compared with 0/5 ADC-treated animals) and restoration of flow
(FIG. 19). Most notably, in NOD SCID mice receiving diabetic human
donor cells, day 14 flow was restored to 50.+-.11% in treated
animals compared to 10.+-.10% in untreated animals (p<0.05). By
day 19 rebound had occurred such that perfusion in the experimental
limb was greater than that of the control (136.+-.37%). This
response is within the range observed with cells obtained from two
normal (non-diabetic) donors (50-90%).
[0225] In a similar experiment in immunocompetent mice (129S mice)
in which the effects of autologous cell transfer could be
determined ADC cell treated mice exhibited 80.+-.12% restoration of
flow at day 14 compared to 56.+-.4% in untreated mice.
[0226] In this model restoration of blood flow comes from the
recruitment and expansion of collateral vessels and by angiogenesis
in the lower limb. These processes also are key to restoration of
flow in the heart following infarct. Thus, the ability of ADC to
stimulate these processes in vivo strongly supports application of
ADC cells in the setting of a myocardial infarction. It is also
important to note that ADC cells obtained from a diabetic donor (a
member of a patient population at higher risk of cardiovascular
disease) also demonstrated this activity.
Example 5: Increasing Adc Dose is Associated with Improved Graft
Survival and Angiogenesis
[0227] Transplant of autologous adipose tissue is a relatively
common procedure in plastic and reconstructive surgery {Fulton,
1998; Shiffman, 2001}. However, this procedure is limited by the
fact that the adipose tissue fragments are transferred without a
vascular supply and, as a result, graft survival is dependent upon
neovascularization (Coleman, 1995; Eppley et al., 1990). Thus, in a
limited way, the transplanted tissue represents an ischemic
tissue.
[0228] A study in Fisher rats was performed in which adipose tissue
fragments were transplanted into the subcutaneous space over the
muscles of the outer thigh. The right leg was transplanted with 0.2
g of adipose tissue fragments alone, the left leg with 0.2 g of
adipose tissue fragments supplemented by addition of adipose
derived regenerative cells at three different doses
(1.7.times.10.sup.5-1.3.times.10.sup.6 cells/graft; three animals
per dose); in this way the contralateral leg acted as a control.
Animals were then maintained for one month after which the animals
were euthanized and the grafts recovered, weighed, fixed in
formalin and embedded in paraffin for histologic analysis.
[0229] As shown in FIG. 20A, the results show minimal retention of
grafted tissue in the control leg and a dose-dependent increase in
retention of graft weight in the treated leg. Further,
immunohistochemical analysis of the grafts showed considerable
neoangiogenesis and perfusion in the adipose derived regenerative
cell treated grafts (FIG. 20B, arrows). This was also associated
with retention of adipose tissue morphology (FIG. 20B).
[0230] As above, demonstration that ADC cells promote survival of
inadequately perfused, ischemic tissue is an important indicator of
clinical potential in cardiovascular disease.
Example 6: Myocardial Engraftment by ADC
[0231] Cryoinjury to the myocardium is a well established surgical
model to investigate the role of cellular therapy in myocardial
regeneration (Marchlinski et al., 1987). To demonstrate the ability
of ADC cells to engraft damaged myocardium and thereby inhibit scar
formation (collagen deposition and cross-linking), myocardial
cryoinjury in B6129SF1/J mice was performed. Immediately after
injury, 1 million (1.0.times.10.sup.6) ADC cells harvested from
ROSA26 mice which are transgenic for the lacZ gene were injected
via an intra-ventricular route. Recipient heart tissue stained with
B-galactosidase will detect the presence of donor adipose derived
regenerative cells by staining blue. Mice hearts were harvested and
processed at the following 5 time-points after injection: day 1,
day 7, day 14, day 28, day 84. As shown in FIG. 10, the results
demonstrate engraftment of donor derived adipose derived
regenerative cells in the area of infarcted myocardium at all
timepoints referenced above. FIG. 21 demonstrates a histological
timeline of engraftment.
[0232] Importantly, immunohistochemical analysis of donor-derived
(beta galactosidase-positive) cells at day 14 indicated that many
donor-derived cells expressed the cardiac myocyte markers
sarcomeric myosin heavy chain (FIG. 22), troponin I and nkx2.5.
This indicates that ADC cells are capable of homing to the site of
injury in a damaged heart and of differentiating into cardiac
myocytes or cardiac myocyte like cells. Thus, ADC cells may be
capable of replenishing cardiac myocytes or cardiac myocyte like
cells that are lost following a heart attack (myocardial
infarction).
[0233] To extend these findings across species, engraftment of
donor derived processed lipoaspirate in a rat occlusion/reperfusion
model of the heart was studied. In this experimental set-up, the
left anterior descending coronary artery of an immunocompetent
Wistar rat was temporarily occluded using a 7-0 prolene suture and
a small piece of silastic tubing acting as a snare over the artery.
After one hour, the occlusion was released and blood was allowed to
reperfuse the ischemic myocardium. This model more closely
represents the mechanisms of injury and repair present in the human
clinical paradigm. Immediately after reperfusion, approximately 1
million (1.times.10.sup.6) ADC cells obtained from Rosa 26 mice
were injected into the left ventricular chamber of the heart.
Hearts were harvested one week following injection. As shown in
FIG. 23, the results demonstrate engraftment of donor derived ADC
cells.
[0234] Thus, the regenerative cells of the present invention are
clinically relevant and have the potential to improve perfusion and
regenerate damaged myocardium.
Example 7: ADCS Improve Cardiac Function Post Acute Myocardial
Infarction in Rats
[0235] Acute Myocardial Infarction ("AMI") results in ischemic
myocardium that initiates a negative milieu of events eventually
leading to congestive heart failure. Cellular cardiomyoplasty using
ADCs has the potential to alter this progression by providing
regenerative cells to replace/repair those host cells damaged by
the ischemia. This example describes a small animal model of
myocardial infarction and demonstrates functional improvement in
those animals receiving a bolus of ADCs.
[0236] Myocardial infarction was induced by a 60 minute ligation of
the left anterior descending coronary artery (LAD) in female Lewis
rats (250-300 grams). Eighteen rats were randomly divided into two
groups: (1) ADC treated (n=10) or (2) saline treated (n=8). For ADC
treated animals, five million ADCs were introduced into the left
ventricular cavity, an approximation of intracoronary delivery, 15
minutes following reperfusion. Echocardiographic analysis was taken
prior to infarction, and 4, 8 and 12 weeks post AMI. Upon
completion of the study, invasive contractility measurements were
taken to analyze the contractility/relaxation of the left
ventricle. Hearts were then arrested in diastole and prepared for
histologic analysis.
[0237] Echo and contractility analysis at 12 weeks post MI revealed
that rats treated with ADCs compared with saline had a
significantly improved Ejection Fraction (76.0.+-.0.9% versus
68.3.+-.1.9%, p<0.01, FIG. 24); baseline contractility (+dP/dT:
5494.46.+-.550.76 mmHg versus 2837.61.+-.301.19 mmHg, p<0.05,
FIG. 25); baseline relaxation (-dP/dT: -6326.28.+-.544.61 versus
-2716.49.+-.331.83 mmHg, p<0.05, FIG. 26); and remodeling
parameters, including ventricular septal thickness (diastole:
1.23.+-.0.03 mm versus 1.50.+-.0.11 mm, p<0.05, FIG. 27). ADC
treatment also prevented the progression of ventricular dilatation,
evident in ventricular septal thickness (systole, FIG. 28) and
posterior wall thickness (in both diastole (FIG. 29) and systole
(FIG. 30)).
Example 8: ADCS Improve Function in a Porcine Model of AMI
[0238] As demonstrated above, ADCs can improve cardiac function
following AMI in small animals. This study demonstrates that some
of these functional benefits can also be observed in large animals.
This study also demonstrates that the intravascular delivery of
ADCs into the left anterior descending coronary artery ("LAD") is
safe and feasible.
[0239] An antero-apical myocardial infarction was induced in 13
juvenile pigs by balloon occlusion of the mid LAD. Forty-eight
hours after the infarction, adipose tissue was harvested through a
right groin lipectomy, autologous ADC's were isolated, and the pigs
were randomized to either an intracoronary infusion of saline
(control) or 40-140 million (mean 52.times.10.sup.6) ADC's infused
distal to the site of occlusion in the LAD. Coronary angiography,
left ventricular (LV) cineangiography, and 2D echocardiography were
performed at baseline, prior to infarction, immediately
post-infarction, and at six months.
[0240] All 13 pigs (7 ADC treated, 6 control) survived to the six
month follow-up period with TIMI-3 coronary flow in the LAD and
without major adverse cardiac events. As Figure demonstrates,
left-ventricular ejection fraction ("LVEF") by echocardiography,
measurable in 10 pigs, increased significantly in the cell infusion
group (3.0%.+-.6.0%, mean.+-.SD) versus the control group
(-9.0%.+-.5.0%, p=0.01). LVEF by cineangiography (n=12) showed a
similar trend with values of 3.7%.+-.5.0% vs. -2.0%.+-.7.5%,
respectively (p=0.16). The results are summarized in Table IV
below. In summary, these results show that ADCs cause significant
improvement in heart function in large animals and that delivery of
ADCs is safe and effective in preserving ventricular systolic
function.
TABLE-US-00004 TABLE IV Diagnostic LVEF at LVEF at Change Standard
P- Method Baseline 6-Months in LVEF Deviation value 2D
Echocardigraphy Treated 46% 49% +3% .+-.6% 0.01 Control 47% 38% -9%
.+-.5% Cineangiography Treated 51% 55% +4% .+-.5% 0.16 Control 49%
47% -2% .+-.7%
Example 9: Treatment of Acute Heart Damage
[0241] Acute myocardial infarct (heart attack) results in ischemic
injury to the myocardium. Tissue damage can be minimized by early
reperfusion of the damaged tissue and by regeneration of myocardial
tissue (Murry et al., 1996; Orlic et al., 2001; Orlic et al., 2003;
Rajnoch et al., 2001; Strauer et al., 2002; Assmus et al., 2002).
Adipose tissue derived cellular therapy, as disclosed herein, seeks
to provide a superior source of regenerative cells relative to
non-adipose tissue derived cellular therapies, due to for example
at least one of the use of a greater number of non-cultured cells
and more pure cells with attenuated morbidity associated with
non-adipose tissue derived therapies, such as bone marrow
harvesting.
[0242] A patient is suspected of having suffered from a myocardial
infarction. The patient is admitted within an hour of experiencing
the infarction. The patient is prescribed an adipose tissue derived
cellular therapy. The patient's habitus is examined for a site
suitable for adipose tissue collection. Harvest sites are
characterized by at least one of the following: potential space(s)
limited by normal anatomical structures, no major vascular or
visceral structures at risk for damage, and ease of access. Virgin
harvest sites are preferred, but a previous harvest site does not
preclude additional adipose tissue harvest. Potential harvest sites
include, but are not limited to, the following: lateral and medial
thigh regions of bilateral lower extremities, anterior abdominal
wall pannus, and bilateral flank regions.
[0243] The patient receives a subcutaneous injection of a tumescent
fluid solution containing a combination of lidocaine, saline, and
epinephrine in for example different standardized dosing regimens.
Using a scalpel (e.g., an 11-blade scalpel), a small puncture wound
is made in the patient's medial thigh region of his right and/or
left legs in order to transverse the dermis. The blade is turned
360 degrees to complete the wound. A blunt tip cannula (e.g.,
14-guage cannula) is inserted into the subcutaneous adipose tissue
plane below the incision. The cannula is connected to a power
assisted suction device. The cannula is moved throughout the
adipose tissue plane to disrupt the connective tissue architecture.
Approximately 500 cc of aspirate is obtained. After removal of the
adipose tissue, hemostasis is achieved with standard surgical
techniques and the wound is closed.
[0244] The lipoaspirate is processed in accordance with the methods
disclosed hereinabove to obtain a unit of concentrated adipose
tissue derived stem cells. Approximately six hours after the
infarction, the patient is administered the stem cells. Based on
the processing of the lipoaspirate, it is estimated that the
patient receives an initial dose of stem cells in a range of
between approximately 5.5.times.10.sup.4 stem cells and
5.5.times.10.sup.5 stem cells. The patient receives two
supplemental dosages at 12 hour intervals after the initial
administration. The stem cells can be administered to the patient
through a central venous catheter. In other embodiments, to promote
cellular engraftment in the target region, the flow of stem cells
is controlled by a balloon located downstream of the target site
and by a balloon upstream of the target site to create regions of
low or minimal blood flow.
[0245] Improvements in the patient are noted within approximately
six hours after the cell administration procedure. Several days
after the cell administration procedure further improvement of the
patient is noted evidenced by increased cardiac ejection fraction,
decreased rate of heart failure, decreased infarct size, improved
exercise tolerance and other quality of life measures.
[0246] Any feature or combination of features described herein are
included within the scope of the present invention provided that
the features included in any such combination are not mutually
inconsistent as will be apparent from the context, this
specification, and the knowledge of one of ordinary skill in the
art. For purposes of summarizing the present invention, certain
aspects, advantages and novel features of the present invention
have been described herein. Of course, it is to be understood that
not necessarily all such aspects, advantages or features will be
embodied in any particular embodiment of the present invention.
Additional advantages and aspects of the present invention are
apparent in the following detailed description and claims.
[0247] The above-described embodiments have been provided by way of
example, and the present invention is not limited to these
examples. Multiple variations and modification to the disclosed
embodiments will occur, to the extent not mutually exclusive, to
those skilled in the art upon consideration of the foregoing
description. Additionally, other combinations, omissions,
substitutions and modifications will be apparent to the skilled
artisan in view of the disclosure herein. Accordingly, the present
invention is not intended to be limited by the disclosed
embodiments, but is to be defined by reference to the appended
claims.
[0248] A number of publications and patents have been cited
hereinabove. Each of the cited publications and patents are hereby
incorporated by reference in their entireties.
EQUIVALENTS
[0249] Those skilled in the art will recognize, or be able to
ascertain using no more than routine experimentation, many
equivalents to the specific embodiments of the invention described
herein. Such equivalents are intended to be encompassed by the
following claims.
* * * * *