U.S. patent application number 16/393378 was filed with the patent office on 2019-08-15 for articles and methods of treating vascular conditions.
The applicant listed for this patent is W. L. Gore & Associates, Inc.. Invention is credited to Robert L. Cleek, Paul D. Drumheller, Theresa A. Holland.
Application Number | 20190247306 16/393378 |
Document ID | / |
Family ID | 42246137 |
Filed Date | 2019-08-15 |
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United States Patent
Application |
20190247306 |
Kind Code |
A1 |
Cleek; Robert L. ; et
al. |
August 15, 2019 |
ARTICLES AND METHODS OF TREATING VASCULAR CONDITIONS
Abstract
The present invention relates to articles and methods of
treating vascular conditions with a thixotropic, turbid, bioactive
agent-containing gel material capable of being essentially removed
from an implantation site upon re-establishment of fluid flow at
the implantation site.
Inventors: |
Cleek; Robert L.;
(Flagstaff, AZ) ; Drumheller; Paul D.; (Flagstaff,
AZ) ; Holland; Theresa A.; (Flagstaff, AZ) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
W. L. Gore & Associates, Inc. |
Newark |
DE |
US |
|
|
Family ID: |
42246137 |
Appl. No.: |
16/393378 |
Filed: |
April 24, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14466459 |
Aug 22, 2014 |
10314783 |
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16393378 |
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12404083 |
Mar 13, 2009 |
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14466459 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61K 31/573 20130101;
A61K 47/26 20130101; A61L 2300/802 20130101; A61P 9/00 20180101;
A61L 2300/416 20130101; A61L 29/14 20130101; A61K 47/40 20130101;
A61K 47/32 20130101; A61L 29/16 20130101; A61K 47/36 20130101; A61K
9/0024 20130101; A61L 27/52 20130101; A61K 31/565 20130101; A61L
29/145 20130101; A61K 47/10 20130101; A61L 27/50 20130101; A61L
27/54 20130101; A61K 9/06 20130101; A61K 45/06 20130101 |
International
Class: |
A61K 9/06 20060101
A61K009/06; A61K 45/06 20060101 A61K045/06; A61K 9/00 20060101
A61K009/00; A61K 31/565 20060101 A61K031/565; A61K 31/573 20060101
A61K031/573; A61K 47/10 20060101 A61K047/10; A61L 29/16 20060101
A61L029/16; A61L 29/14 20060101 A61L029/14; A61L 27/54 20060101
A61L027/54; A61L 27/52 20060101 A61L027/52; A61L 27/50 20060101
A61L027/50; A61K 47/40 20060101 A61K047/40; A61K 47/36 20060101
A61K047/36; A61K 47/32 20060101 A61K047/32; A61K 47/26 20060101
A61K047/26 |
Claims
1. A catheter-based implantable medical vascular device having a
first diameter and a first surface area, and expandable to a second
diameter and a second surface area within a vascular structure, in
use; the device comprising at least one thixotropic, turbid,
hydrogel material applied to at least a portion of said medical
device, wherein the hydrogel material is applied to a surface of
the device to create an applicated device of the first diameter and
the first surface area; the hydrogel material comprising
cyclodextrin, an aqueous solvent component and a polymer chain
component, and at least one bioactive agent capable of treating
vascular tissue upon release of said bioactive agent from said
hydrogel material.
2. The catheter-based implantable medical vascular device as
claimed in claim 1, the hydrogel material comprising a
pharmacologically effective amount of the at least one bioactive
agent, wherein the polymer chain component comprises ethylene
glycol units that form the hydrogel with the cyclodextrin, wherein
the cyclodextrin and the polymer chain unit self-assemble to form
the hydrogel by spontaneous association and are present in the
composition in respective amounts effective to make the hydrogel
thixotropic.
3. The catheter-based implantable medical vascular device of claim
1 wherein catheter-based implantable medical vascular device is a
nitinol wire reinforced expanded polytetrafluoroethylene-based
vascular prosthesis.
4. The catheter-based implantable medical vascular device of claim
1 wherein catheter-based implantable medical vascular device is an
endovascular angioplasty balloon.
5. The catheter-based implantable medical vascular device of claim
1, further comprising a surface having the hydrogel material
impregnated therein.
6. The catheter-based implantable medical vascular device of claim
1, wherein the polymer chain component comprises polyethers such as
polyethylene glycol, polypropylene glycol, poly(ethylene
glycol-co-propylene glycol), copolymers of polyethylene glycol, and
copolymers of polypropylene glycol; polyols such as polyvinyl
alcohol and polyallyl alcohol; polyanions such as polyacrylic acid
and poly(methacrylic acid); polyanionic polysaccharides such as
alginate, heparin, heparin sulfate, dextran sulfate, xanthan,
carrageenan, gum arabic, tragacanth, arabinogalactan, and pectin;
neutral polysaccharides such as agar, agarose, hyaluronic acid,
carboxymethylcellulose, and dextran; macrocyclic polysaccharides
such as cyclodextrin and hydroxypropyl cyclodextrin; polycations
such as poly(lysine), poly(allylamine), poly(ethyleneimine),
poly(guanidine), polyvinylamine),
.alpha.,.omega.-polyethyleneglycol-diamine, and poly(quaternary
amine); polyanionic polysaccharides such as chitin and chitosan;
polyacrylonitriles such as hydrolyzed polyacrylonitrile,
poly(acrylamide-co-acrylonitrile), and their copolymers; and/or
protein based polymers such as gelatin, collagen, thrombin, and
fibrin.
7. The catheter-based implantable medical vascular device according
to claim 1, wherein the hydrogel material comprises
.alpha.-cyclodextrin (.alpha.CD) and polyethylene glycol (PEG).
8. The catheter-based implantable medical vascular device according
to claim 1, wherein the hydrogel material comprises polyethylene
glycol, .alpha.-cyclodextrin (.alpha.CD), and
hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD).
9. The catheter-based implantable medical vascular device according
to claim 1, wherein the hydrogel material comprises polyvinyl
alcohol, sodium borate, and polyoxyethylene sorbitol ester.
10. The catheter-based implantable medical vascular device
according to claim 1, wherein the hydrogel material comprises
sodium alginate, calcium chloride, and
hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD).
11. The catheter-based implantable medical vascular device
according to claim 1, wherein the hydrogel material comprises
dextran, potassium chloride, and hydroxypropyl-.beta.-cyclodextrin
(HP.beta.CD).
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. application Ser.
No. 14/466,459, filed Aug. 22, 2014, which is a divisional of U.S.
application Ser. No. 12/404,083, filed Mar. 13, 2009, both of which
are herein incorporated by reference in their entireties for all
purposes.
FIELD OF THE INVENTION
[0002] The present invention relates to articles and methods of
vascular-based therapies to treat a variety of vascular
conditions.
BACKGROUND OF THE INVENTION
[0003] Vascular conditions arise from a variety of causes, and in
some cases, necessitate surgical or endovascular intervention.
Trauma to the vascular system may also necessitate surgical
intervention to treat the traumatized anatomy. The long-term
implantation of vascular prostheses including vascular grafts,
stent-grafts, and stents, and the application of treatment
modalities, including balloon angioplasty are often undertaken to
treat vascular conditions including vascular disease and vascular
trauma.
[0004] Consequences of surgical intervention have been observed
following implantation of vascular prostheses including vascular
grafts, stent-grafts, stents, and other prostheses, particularly
when an anastomosis is formed. The consequences of surgical
intervention include, but are not limited to, inflammation, intimal
hyperplasia, stenosis, and restenosis of the treated blood vessel
near the formed anastomosis. Inflammation is a physiological
response by a mammalian body to surgery, injury, irritation, or
infection. An inflammatory response involves complex biological
activities at chemical, cellular, tissue, and organ levels.
Generally, an inflammatory response is a protective attempt to
remove an injurious stimulus, as well as to initiate a healing
process for the diseased or traumatized tissue. Intimal hyperplasia
is a pathological condition in which an overabundant inflammatory
response is initiated involving stimulation, migration, and
proliferation of numerous cell types. Stenosis and restenosis are
constrictions of the blood vessel lumen and may be caused by
mechanisms including, but not limited to, compliance mismatch
between the native vessel and the implanted vascular prosthesis,
host tissue response to an implanted material, prior disease
states, and infection. Stenosis and restenosis can progress to a
point where additional surgical intervention is required to enlarge
the blood vessel lumen diameter of the blood vessel or the
implanted vascular prosthesis to establish a less restrictive
conduit for blood flow.
[0005] Additional vascular conditions that may require surgical or
endovascular intervention include, but are not limited to, vascular
injury, vascular prophylactic intervention, vascular disease,
phlebitis, intimal hyperplasia, vulnerable plaques, carotid
plaques, coronary plaque, vascular plaque, aneurismal disease,
vascular dissections, atherosclerotic plaques, atherosclerotic
lesions, vascular infection, and vascular sepsis.
[0006] One approach to treatment of these vascular conditions
involves local delivery of a suitable pharmaceutical or
biologically active agent in a liquid vehicle within luminal spaces
of a blood vessel at or near the site of the vascular condition.
The liquid vehicle containing the pharmaceutical or biologically
active agent is contacted with tissues of the luminal space at a
vascular treatment site for a determined length of time (dwell
time). However, this approach often requires extensive dwell times
at the vascular treatment site to ensure adequate delivery and
retention of the bioactive agent at the vascular treatment site to
treat the vascular condition. Even with extensive dwell times, the
delivery and retention of the bioactive agent at the vascular
treatment site using this approach may be insufficient to treat the
vascular condition.
[0007] Another therapeutic approach is the implantation of vascular
prostheses having a pharmaceutical-containing coating to deliver a
pharmaceutical to a lumen of a blood vessel or other vascular
conduit. Examples of vascular prostheses having a
pharmaceutical-containing coating include, but are not limited to,
stents, stent grafts, grafts, and angioplasty balloons. Other
examples of vascular prostheses having a pharmaceutical-containing
coating are drug eluting stents and drug eluting stent grafts
(DESs). DESs are used in the treatment of coronary artery disease
and peripheral artery disease. A high degree of physician skill is
often required to implant DESs without damaging or traumatizing
surrounding vascular tissue. The treatment of a vascular condition
by the implantation of DESs may require long term implantation of
the vascular prosthesis. The long term implantation of the vascular
prosthesis may also result in mechanical trauma to the vascular
treatment site due to a nonlubricious nature of the
pharmaceutical-containing coating. The long term implantation of
the vascular prosthesis may also result in an unwanted tissue
reaction at the vascular treatment site due to the components of
the vascular prosthesis and/or the pharmaceutical-containing
coating. Therefore it is desirable to have an improved method for
treating vascular conditions that requires minimal physician skill
to perform. It is desirable to have an improved method for treating
vascular conditions that avoids long term implants.
[0008] Drug eluting balloons (DEBs) are additional examples of
vascular prostheses having a pharmaceutical-containing coating. The
literature discloses the use of DEBs for the treatment of coronary
artery disease and peripheral artery disease (see e.g., U.S. Pat.
No. 5,102,402, issued to Dror et al.). Dror et al. disclose placing
a DEBs in a blood vessel lumen to treat the vessel wall, inflating
the balloon, and contacting the balloon surface with the luminal
vessel wall to deliver a pharmaceutical into the blood vessel wall.
Another example of treatment using DEBs involves an angioplasty
balloon having microneedles (see e.g., U.S. Pat. Nos. 5,171,217;
5,538,504; and 6,860,867). DEBs often require a high degree of
physician skill to implement. The implantation of the DEBs may also
result in mechanical trauma to the vascular treatment site due to
the components of the DEBs and/or the pharmaceutical-containing
coating. It is desirable to have improved methods for treating and
preventing vascular conditions that are simple and easy to
implement. It is also desirable to have methods for treating and
preventing vascular conditions that avoid mechanical trauma to the
vascular treatment site and are compatible with the delivery of a
wide variety of pharmaceuticals.
[0009] In addition to delivering drugs to blood vessels from
stents, stent-grafts, grafts, and other prostheses, intraluminal
drug delivery methods include methods that chemically "pave"
luminal surfaces of a blood vessel (see e.g., U.S. Pat. Nos.
5,213,580; 5,674,287; 5,749,922; and 5,800,538). These "paving"
methods involve fixation, polymerization, and bonding of a drug
delivery system to the lumen of a blood vessel. Degradation of such
delivery systems ranges from days to weeks. The methods can be
challenging as they involve chemical reactions with the blood
vessel lumen. These chemical reactions may induce trauma to the
vascular treatment site. It is desirable to have improved methods
for treating and preventing vascular conditions which avoid
"paving" of the luminal surfaces of the blood vessel.
[0010] Methods of delivering drugs to perivascular locations are
described. U.S. Pat. No. 6,726,923, issued to Iyer, and U.S. Pat.
No. 5,527,532, issued to Edelman, disclose perivascular drug
eluting wraps and matrices applied to adventitial surfaces of a
blood vessel to treat vascular inflammation.
[0011] U.S. Pat. No. 5,893,839, issued to Johnson, discloses a
method of treating restenosis involving the delivery of a
biologically active substance percutaneously.
[0012] U.S. Pat. No. 6,730,313, issued to Helm us et al., discloses
a method for treating intimal hyperplasia involving contacting an
exterior surface of a blood vessel with a "flowable" drug delivery
vehicle.
[0013] These methods usually require complex procedural techniques,
often implemented through invasive surgical techniques. In
addition, these methods may require long term implantation of a
vascular prosthesis, drug eluting wraps, matrices, and flowable
drug delivery vehicles. Long term implantation of the vascular
prosthesis, drug eluting wraps, matrices, and flowable drug
delivery vehicles may also result in an unwanted tissue reaction at
the vascular treatment site due to the nature of their components.
It is desirable to have improved methods for treating and
preventing vascular conditions that allow delivery of a wide
variety of pharmaceuticals and biologics to diseased or traumatized
vascular tissue without the need for long term implants, that are
easily implemented, and that are applied through surgical and
endovascular techniques.
[0014] Li et al. (U.S. Patent Application Publication 2002/0019369)
disclose an injectable cyclodextrin polymer-based composition made
from cyclodextrin, polyethylene glycol, and a pharmacologically
effective amount of at least one drug. Li et al. further disclose
their composition can be used subcutaneously, intramuscularly,
intradermally, or intracranially. However, Li et al. do not teach
their composition can be injected into the vasculature or into
flowing blood.
[0015] As is disclosed to the literature, compositions made of
cyclodextrin and polyethylene glycol form inclusion complexes. The
inclusion complexes have the form of hydrogels, turbid solutions,
and precipitates (Li, J Biomed Mater Res, 65A, 196, 2003; Harada,
Macromolecules, 26, 5698, 1993; Harada, Macromolecules, 23, 2821,
1990).
[0016] Indeed, as indicated by the literature, injection of
particles in the form of hydrogel materials, turbid solutions, and
precipitates into the vasculature or into flowing blood can have
adverse consequences, including decreased drug effectiveness,
phlebitis, embolism, and blockage of capillaries (Nemec, Am J Heath
Syst Pharm, 65, 1648, 2008; Wong, Adv Drug Del Rev, 60, 939, 2008;
Minton, Nutrition, 14, 251, 1998; Tian, Polym Int, 55, 405, 2006).
Instructions for use of an injectable pharmaceutical solution
contraindicate injection into the vasculature or flowing blood if
the injectable pharmaceutical solution is turbid or contains
precipitates.
[0017] There remains a need for improved vascular-based therapies
to treat a variety of vascular conditions. The improved therapies
would be easily implemented and would obviate mechanically or
chemically induced trauma to the vascular treatment site. The
improved therapies would allow for administration of thixotropic,
turbid, bioactive agent-containing gel materials to vascular tissue
at a vascular treatment site. The gel material would readily
release one or more bioactive agents contained by the gel material
to vascular tissue in need of treatment or repair. The gel material
would dissolve in the flowing blood without occluding vascular
structures located distally (i.e., downstream) to the
administration site. The therapies could be applied
prophylactically, interventionally, surgically, or
endovascularly.
SUMMARY OF THE INVENTION
[0018] The present invention relates to methods of treating or
preventing a vascular condition with a thixotropic, turbid,
bioactive agent-containing gel material. The method can also be
used to treat or repair traumatized vascular structures. The gel
material will readily deliver one or more bioactive agents
contained by the gel material to a diseased or disease-prone
vascular treatment site in need of treatment or repair. In the
method, the gel material is capable of being directly injected into
luminal spaces of blood vessels and other fluid-conducting
anatomical structures with little or no mechanical or chemical
trauma to vascular tissues of the vascular treatment site. After
contact with the vascular tissues, the gel material will
substantially dissolve in flowing blood without occluding vascular
structures located distally (i.e., downstream) to the
administration site. The method could be applied prophylactically,
interventionally, surgically, or endovascularly. The method does
not require a high degree of skill to perform. On the contrary, the
method relies on simple injection of the gel material within a
vascular structure for delivery of a pharmaceutical or other
bioactive agent to vascular tissue in need of treatment.
[0019] The gel material used in the method is a thixotropic,
turbid, gel material, having high viscosity at low shear, and
therefore, coherently resides in luminal spaces of a blood vessel
under conditions of low or no blood flow. Upon resumption of
flowing blood in the treated blood vessel, the resultant fluid
shear force converts the gel material to a low viscosity,
blood-soluble composition that is substantially dissolved in
flowing blood. Consequently, the gel material is readily and
essentially removed from the vascular treatment site upon
re-establishment of flowing blood without obstructing vascular
structures located downstream of the treatment site.
[0020] The method allows for surgical, endovascular, and
minimally-invasive delivery of a wide variety of pharmaceuticals
and biologics for prophylactic and interventional vascular therapy.
Preferred bioactive agents are pharmacologically and biologically
active entities that inhibit a variety of vascular pathologies
including, but not limited to, intimal hyperplasia. The gel
material can be delivered through needle and catheter based devices
including, but not limited to, balloon catheters, infusion
catheters, and micro-injection systems. In addition to placement of
the gel material within a blood conduit, the composition can be
applied to blood contacting surfaces of medical devices, including,
but not limited to, vascular grafts, stents, stent-grafts, and
balloons.
[0021] One embodiment of the present invention relates to a method
of treating a vascular condition by providing a thixotropic,
turbid, gel material containing at least one bioactive agent
capable of treating vascular tissue in sufficient amounts to treat
said vascular condition in said vascular tissue upon release of
said bioactive agent from said gel material, administering said gel
material to a vascular treatment site within an interior space of a
blood vessel, and allowing said gel material to remain at said
vascular treatment site for a dwell time sufficient to release said
bioactive agent from said gel material. In addition, the gel
material does not occlude vascular structures upon introduction
into flowing blood.
[0022] Another embodiment of the present invention relates to a
method of treating a vascular condition by providing a thixotropic,
turbid, gel material containing at least one bioactive agent
capable of treating intimal hyperplasia in sufficient amounts to
inhibit intimal hyperplasia upon release of said bioactive agent
from said gel material, administering said gel material to a
vascular treatment site within an interior space of a blood vessel,
and allowing said gel material to remain at said vascular treatment
site for a dwell time sufficient to release said bioactive agent
from said gel material. In addition, the gel material does not
occlude vascular structures upon introduction into flowing
blood.
[0023] Another embodiment of the present invention relates to a
method of treating a vascular condition by providing a cyclodextrin
polymer-based composition comprising cyclodextrin, a polymer, and a
pharmacologically effective amount of at least one drug; wherein
the polymer comprises ethylene glycol units that can form a
hydrogel with the cyclodextrin, wherein the cyclodextrin and the
polymer self-assemble to form a hydrogel by spontaneous association
and are present in the composition in respective amounts effective
to make the hydrogel thixotropic and injectable into the body of a
person through a needle, and wherein the hydrogel forms a matrix
for the drug such that when the composition is injected into the
body of the person, the drug is released from the hydrogel in a
sustained manner, administering said hydrogel material to a
vascular treatment site within an interior space of a blood vessel,
and allowing said hydrogel material to remain at said vascular
treatment site for a dwell time sufficient to release said
bioactive agent from said hydrogel material.
[0024] Other embodiments of the present invention relate to medical
devices having thixotropic, turbid, gel materials, as described
herein, applied to at least a portion of the medical device. The
medical devices are either implantable devices or are devices used
to deliver one or more bioactive agents to a specific site in the
body. A preferred medical device of the present invention comprises
a cyclodextrin polymer-based composition comprising cyclodextrin, a
polymer, and a pharmacologically effective amount of at least one
drug, wherein the polymer comprises ethylene glycol units that can
form a hydrogel with the cyclodextrin, wherein the cyclodextrin and
the polymer self-assemble to form a hydrogel by spontaneous
association and are present in the composition in respective
amounts effective to make the hydrogel thixotropic, and wherein
said hydrogel is attached, or otherwise applied, to at least a
portion of a medical device. Further embodiments include at least
one bioactive agent combined with the hydrogel. Preferably, the
bioactive agent is capable of treating vascular tissue and is
present in the hydrogel in sufficient amounts to treat a vascular
condition upon release of the bioactive agent from the hydrogel
combined therewith.
[0025] Other features and advantages of the invention will be
apparent from the following description and from the claims.
BRIEF DESCRIPTION OF THE DRAWINGS
[0026] FIG. 1 shows a table of data.
[0027] FIG. 2 shows two photographs (a) and (b), each containing
histological data.
[0028] FIG. 3 shows two photographs (a) and (b), each containing
histological data.
[0029] FIG. 4 shows a table of data.
[0030] FIG. 5 shows four photographs (a), (b), (c), and (d).
[0031] FIG. 6A shows a medical device having at least one
thixotropic, turbid, gel material applied to at least a portion of
the medical device.
[0032] FIG. 6B shows a medical device having at least one
thixotropic, turbid, gel material applied to at least a portion of
the medical device.
[0033] FIG. 6C shows a medical device having at least one
thixotropic, turbid, gel material applied to at least a portion of
the medical device.
[0034] FIG. 7A shows a catheter-based device having at least one
thixotropic, turbid, gel material applied to at least a portion of
the catheter-based device.
[0035] FIG. 7B shows a catheter-based device having at least one
thixotropic, turbid, gel material applied to at least a portion of
the catheter-based device.
DETAILED DESCRIPTION OF THE INVENTION
[0036] The present invention relates to methods of treating or
preventing a vascular condition with a thixotropic, turbid,
bioactive agent-containing gel material.
[0037] The invention utilizes turbid gel materials having
thixotropic properties. The thixotropic properties of the gel
materials permit the compositions to undergo changes in viscosity
in response to the presence or absence of shear forces applied to
the compositions. When a shear force is applied to the gel material
by injection of the gel material from a needle-containing syringe,
the viscosity of the composition is altered to a point where the
composition can easily pass through the needle-containing syringe.
When the shear force is removed from the gel material, the
viscosity of the composition is altered to a point where the
composition will not flow under the influence of its own weight. A
suitable gel material for use in the present invention is a
material that can be made to flow under shear force, but exhibits
no flow under the influence of its own weight under non-shear
conditions.
[0038] When the gel material containing a bioactive agent is placed
inside a blood vessel to form an indwelling composition, the
bioactive agent moves from the indwelling composition to tissues of
the blood vessel--independent of the viscosity of the gel material
Once sufficient time has elapsed for a desired amount of bioactive
agent to be delivered from the indwelling composition to a vascular
treatment site in need of treatment or repair, the indwelling
composition is exposed to shear forces to decrease the viscosity of
the gel material and begin a process of dissolution of the gel
material into flowing blood. In the present invention, shear force
is applied to the indwelling composition by permitting blood to
flow through the vascular treatment site containing the indwelling
composition. As the viscosity of the gel material is reduced, the
indwelling composition begins to substantially dissolve in the
flowing blood. Substantial dissolution of the gel material in
flowing blood continues until essentially all of the gel material
has been removed from the treatment site and is present in a
substantially to completely dissolved state in flowing blood. Once
present in flowing blood, the gel material does not diminish,
limit, occlude, or otherwise interfere with the flow of blood in
vascular structures located distally (i.e., downstream) to the
vascular treatment site.
[0039] In a preferred embodiment, a thixotropic, turbid, bioactive
agent-containing gel material is administered to a vascular
treatment site within an isolated interior space of an
exsanguinated fluid conduit. The gel material is allowed to reside
in the isolated interior space for a period of time ("dwell time").
The dwell time for the gel material is primarily determined by the
rate at which a bioactive agent is delivered from the gel material
to vascular tissues at a treatment site. The dwell time for the gel
material can also be determined by the timing and sequencing of a
similar procedure at another vascular treatment site or other
medical procedures being performed at the same time. Transfer of
bioactive agents from a gel material used in the present invention
to vascular and other tissues occurs in a range of about 5 seconds
to greater than about one hour. Regardless of the delivery rate of
bioactive agents to a vascular treatment site in need of treatment
by the present invention, a similar or different surgical procedure
to another vascular treatment site can increase the dwell time of
the gel material at the vascular tissue treatment site.
[0040] Once sufficient bioactive agent has been delivered to a
vascular treatment site in need of treatment according to methods
of the present invention, blood is allowed to re-enter the isolated
interior space of the fluid conduit. Shear forces applied to the
thixotropic gel material by the flowing blood cause the viscosity
of the indwelling composition to decrease. The decrease in
viscosity of the gel material causes the indwelling composition to
dissolve substantially in blood flowing through the treated fluid
conduit. Substantial dissolution of the gel material in flowing
blood is sufficient to prevent blockage, or occlusion, of vascular
structures located distally (i.e., downstream) of the vascular
treatment site.
[0041] A "gel material" is a material that includes at least two
components, a solvent component and a polymer chain component. The
term "hydrogel" as used herein means a material that includes at
least two components, an aqueous solvent component, and a polymer
chain component. The gel material of the present invention does not
flow under the influence of its own weight. This property is
observable by the unaided eye when about 5 ml of gel material is
placed into a 13 mm by 100 mm standard glass test tube and inverted
180 degrees for a few seconds.
[0042] In addition to thixotropy, the gel material employed in the
present invention is turbid. The term "turbid" means the gel
material appears hazy, translucent, cloudy, opalescent, or opaque
to the unaided eye. The turbidity of gel materials used in the
present invention can be determined when about 5 ml of gel material
is placed into a 13 mm by 100 mm standard glass test tube and
viewed by the unaided eye at a right angle to an illuminating light
source and against a dark background.
[0043] The terms "thixotropic" and "thixotropy" refer to physical
properties of particular chemical entities. A chemical entity is
thixotropic when the chemical entity exhibits behavior in which
viscosity of the chemical entity decreases under an applied shear
force and then increases in viscosity when the applied shear force
is removed. Shear forces can be applied to thixotropic gel
materials by methods including, but not limited to, shaking,
stirring, exposure to fluid flow, and mechanical expansion in
surface area. Thixotropy can be assessed using methods such as
rheometry and viscometry.
[0044] The term "vascular condition" includes, but is not limited
to, vascular injury, vascular prophylactic intervention, vascular
disease, intimal hyperplasia, phlebitis, vulnerable plaques,
carotid plaques, coronary plaque, vascular plaque, aneurismal
disease, vascular dissections, atherosclerotic plaques,
atherosclerotic lesions, vascular infection, and vascular
sepsis.
[0045] The term "inflammation" as used herein refers to a
physiological response by a mammalian body to surgery, injury,
irritation, or infection. An inflammatory response involves complex
biological activities at chemical, cellular, tissue, and organ
levels. Generally, an inflammatory response is a protective attempt
to remove an injurious stimulus, as well as to initiate a healing
process for the diseased or traumatized tissue.
[0046] Suitable polymer chain components for the thixotropic turbid
gel materials in the present invention are natural and synthetic
polymers that are capable of forming a thixotropic, turbid, gel.
The polymer chain components include but are not limited to
polyethers such as polyethylene glycol, polypropylene glycol,
poly(ethylene glycol-co-propylene glycol), copolymers of
polyethylene glycol, and copolymers of polypropylene glycol;
polyols such as polyvinyl alcohol and polyallyl alcohol; polyanions
such as polyacrylic acid and poly(methacrylic acid); polyanionic
polysaccharides such as alginate, heparin, heparin sulfate, dextran
sulfate, xanthan, carrageenan, gum arabic, tragacanth,
arabinogalactan, and pectin; neutral polysaccharides such as agar,
agarose, hyaluronic acid, carboxymethylcellulose, and dextran;
macrocyclic polysaccharides such as cyclodextrin and hydroxypropyl
cyclodextrin; polycations such as poly(lysine), poly(allylamine),
poly(ethyleneimine), poly(guanidine), poly(vinyl amine),
.alpha.,.omega.-polyethylene glycol-diamine, and poly(quaternary
amine); polyanionic polysaccharides such as chitin and chitosan;
polyacrylonitriles such as hydrolyzed polyacrylonitrile,
poly(acrylamide-co-acrylonitrile), and their copolymers; and
protein based polymers such as gelatin, collagen, thrombin, and
fibrin.
[0047] In one embodiment, the gel materials are composed of
.alpha.-cyclodextrin (.alpha.CD) and polyethylene glycol (PEG).
Such gel materials are thixotropic and turbid.
[0048] Suitable bioactive agents in the thixotropic turbid gel
materials in the present invention are biologically and
pharmaceutically active entities that exert a desired effect upon
the native cells, microbes, intercellular environments, and tissues
of the vascular treatment site. The gel material may include a
solubilizing agent to improve or otherwise alter the solubility of
the bioactive agent in the gel material. The gel material may
include a permeability agent to improve or otherwise alter the
delivery of the bioactive active agent to vascular tissues. The
bioactive agent may consist of simple molecules, macromolecules,
inorganic molecules, and complex biological entities such as cells,
tissues, or tissue aggregates.
[0049] Bioactive agents suitable for use in the present invention
include, but are not limited to, protein based molecules such as
enzymes, growth factors, proteases, glycoproteins, and cytokines;
nucleic acid based molecules such as DNA, RNA, genes, gene
fragments, ribozymes, and nucleic acids; carbohydrate based
molecules such as glucose, glycogen, cyclodextrin, and heparin;
lipid based molecules such as cholesterol and prostaglandin;
complex biological entities such as extracellular matrix, viruses,
virenos, prions, cells, tissues, and tissue aggregates; and organic
molecules such as hormones, organic catalysts, organometallics, and
oleophobics. Other bioactive agents include drugs including, but
not limited to, cardiovascular agents, chemotherapeutics,
antimicrobials, antibiotics, anesthetics, anticoagulants, hem
ostatics, antihistamines, antitumors, antilipids, antifungals,
antimycotics, antipyretics, vasodilators, hypertensive agents,
oxygen free radical scavengers, antivirals, analgesics,
antiproliferatives, antiinflammatories, diagnostic agents,
visualization agents, angiographic contrast agents, phase contrast
agents, and radiopaque agents. Other bioactive agents include but
are not limited to antirestenotic drugs including, but not limited,
to pimecrolimus, cytochalasin, dicumarol, cyclosporine, latrunculin
A, methotrexate, tacrolimus, halofuginone, mycophenolic acid,
genistein, batimistat, dexamethasone, cudraflavone, simvastatin,
prednisolone, doxorubicin, bromopyruvic acid, carvedilol,
mitoxantrone, tranilast, etoposide, hirudin, trapidil, mitomycin C,
abciximab, cilostazol, irinotecan, estradiol, diaziquone,
dipyridamole, melatonin, colchicine, nifedipine, vitamin E,
paclitaxol, diltiazem, vinblastine, verapamil, vincristine,
rapamycin, angiopeptin, everolimus, heat shock proteins,
zotarolimus, nitroglycerin, and prednisone.
[0050] Bioactive agents used in the present invention inhibit or
prevent pathological vascular conditions. In certain embodiments,
the bioactive agents have anti-inflammatory properties, inhibit
proliferation of smooth muscle cells, and/or influence gene
expression in vascular tissue. In one embodiment, the bioactive
agent is dexamethasone. Dexamethasone is considered both a smooth
muscle cell anti-proliferative agent and an anti-inflammatory
agent.
[0051] In an embodiment of the present invention, a need for
treating one or more vascular structures is determined. The
vascular structure, or other body fluid conduit, designated for
treatment is surgically exposed using conventional techniques. Once
the vascular structure is surgically exposed, means for stopping
blood flow in the structure are applied to isolate the structure,
thus defining the vascular treatment site. Such means include, but
are not limited to, ligatures, ties, clamps, sutures, staples, or
other devices capable of applying a compressive force to a vascular
structure sufficient to stop flow of blood in the vascular
structure.
[0052] The vascular treatment site is accessed with a
needle-containing syringe and any blood or other fluid residing in
the vascular treatment site is removed through the
needle-containing syringe.
[0053] A thixotropic, turbid, bioactive agent-containing gel
material, prepared as described herein, is placed in a
needle-containing syringe. To administer the gel material to a
vascular treatment site at a vascular structure, the open end of
the needle is inserted inside the exsanguinated, vascular treatment
site, and the gel material is injected inside the vascular
structure and allowed to reside for a determined dwell time. As
shear force is applied to the gel material during injection, the
viscosity of the gel material decreases and the gel material flows
through the needle into the interior space (luminal space) of the
vascular treatment site. As the gel material fills the vascular
treatment site, the shear forces applied to the gel material during
injection diminish. As shear forces on the gel material diminish,
the viscosity of the gel material increases, and the gel material
will not flow under the influence of its own weight.
[0054] Once the gel material is inside a vascular treatment site,
any bioactive agents associated with the gel material can move from
the gel material to tissues of the vascular treatment site. The
delivery of bioactive agent from the gel material to vascular
tissue can occur within a range of about 5 seconds to greater than
about one hour (see e.g. Example 4, infra). The dwell time of the
gel material can be chosen to be longer than is needed to deliver
sufficient amounts of bioactive agent to vascular tissue of a
vascular treatment site to treat a vascular condition.
[0055] Following a dwell time sufficient for substantial bioactive
agent to be delivered to a vascular treatment site to treat the
vascular tissue, the means for stopping blood flow in the isolated
vascular structure are removed. Once the means are removed, flowing
blood through the vascular treatment site is re-established. As
flowing blood is re-established in the vascular treatment site,
shear force is once again applied to the gel material. As shear
force is applied to the gel material, the viscosity of the gel
material is decreased causing the gel material to begin
substantially dissolving in the flowing blood. If the isolated,
exsanguinated, vascular treatment site is transparent or
translucent, then substantial dissolution of the gel material in
flowing blood can be observed through the vascular treatment site
with the naked eye. Substantial dissolution of the gel material
continues until essentially all the gel material is removed from
the vascular treatment site and is substantially dissolved in the
blood stream. The substantially dissolved gel material does not
limit, occlude, or otherwise diminish blood flow in vascular
structures located distally (i.e., downstream) to the vascular
treatment site.
[0056] Once flowing blood is re-established in the treated vascular
treatment site, the vascular treatment site is surgically closed,
and any other necessary surgical procedures performed.
[0057] Another embodiment of the method of the present invention
can be practiced using interventional techniques. Interventional
techniques routinely involve minimally invasive procedures. Often
this technique is initiated by a puncture or cut-down of a vascular
structure and insertion of a catheter through an interventional
access site into the vascular structure. Interventional access
sites may include, but are not limited to, access through an
implanted vascular prosthesis, brachial artery, carotid artery,
iliac artery, femoral artery, aorta, and other arterial or venous
sites.
[0058] After insertion of a catheter through an interventional
access site into the vascular structure, the catheter can then be
guided to a site with a vascular condition in need of vascular
treatment (i.e., a vascular treatment site), from the
interventional access site. The vascular treatment site may
include, but is not limited to, vascular conduits such as a blood
vessel, a vascular graft, a vascular stent, a vascular filter, a
vascular anastomosis, and a vascular stent graft.
[0059] One embodiment of the method of the present invention
relates to an interventional treatment of a vascular condition
involving the administration of a gel material to a vascular
treatment site by injection through a catheter. The gel material
may be injected directly to the vascular treatment site with or
without prior occlusion of flowing blood at the vascular treatment
site.
[0060] Another embodiment of the present invention relates to
catheter injection of a thixotropic, turbid, bioactive
agent-containing gel material through a medical device, including,
but not limited to, commercially available catheters, single
balloon catheters, needle-studded catheters, infusion catheters,
balloon catheters, double balloon catheters, angioplasty balloon,
weeping balloon catheters, infusion balloon catheters, and needle
studded balloon catheters.
[0061] In another embodiment, the thixotropic, turbid, bioactive
agent-containing gel material may be pre-applied to an implantable
medical device, vascular prosthesis, or catheter-based device prior
to catheter insertion into a vascular structure. For example, the
thixotropic, turbid, bioactive agent-containing gel material may be
applied manually to an implantable medical device, vascular
prosthesis, or catheter-based device including, but not limited to,
a stent, stent graft, vascular graft, angioplasty balloon, needle
studded balloon, and other vascular prosthesis. The application may
be continuous or discontinuous, covering at least a portion of the
implantable medical device. Interventional vascular access is then
used to place the catheter-based device at a vascular treatment
site. The catheter-based device is then placed at the vascular
treatment site allowing for delivery of the thixotropic, turbid,
bioactive agent-containing gel material to the vascular treatment
site.
[0062] FIG. 6A depicts a cross section of a medical device 16 as
from a stent, stent-graft, graft, balloon, or other vascular
prosthesis, having a thixotropic, turbid gel material 12 of the
present invention applied to the medical device 16. Gel material 12
is applied to the entire surface of the medical device 16 to create
an applicated medical device 10. The application may be continuous
or discontinuous.
[0063] FIG. 6B depicts a cross section of a medical device 16 as
from a stent, stent-graft, graft, balloon, or other vascular
prostheses, having a thixotropic, turbid gel material 12 of the
present invention applied to the medical device 16. Gel material 12
is applied to one surface of the medical device 16 to create an
applicated medical device 10. The application may be continuous or
discontinuous
[0064] FIG. 6C depicts a cross section of a medical device 16,
having a first application 12c and a second application 12d of the
gel material of the present invention. Gel material 12c and 12d is
applied to opposing sides of the medical device 16 to create an
applicated medical device 10. The application may be continuous or
discontinuous.
[0065] In another embodiment, the thixotropic, turbid, bioactive
agent-containing gel material may be pre-applied to a
catheter-based device prior to catheter insertion into a vascular
structure. For example, the thixotropic, turbid, bioactive
agent-containing gel material may be applied manually to a
catheter-based device including, but not limited to, a stent, stent
graft, angioplasty balloon, needle studded balloon, and other
vascular prosthesis. The application may be continuous or
discontinuous, covering at least a portion of the implantable
medical device. Catheter-based devices have a first diameter and a
first surface area prior to and during insertion of the
catheter-based devices into a vascular structure. After insertion
into the vascular structure, the catheter-based devices are
mechanically expanded to a second diameter and a second surface
area within the vascular structure. The thixotropic properties of
the gel materials permit the compositions to undergo changes in
viscosity in response to the presence or absence of shear forces
applied to the compositions. When a shear force is applied to the
gel material during mechanical expansion of the catheter-based
device, the viscosity of the composition is decreased to a point
where the composition can readily deform from the first surface
area to the second surface area as the catheter-based device is
mechanically expanded. When the shear force is removed from the gel
material after mechanical expansion of the catheter-based device,
the viscosity of the composition is altered to a point where the
composition will not flow under the influence of its own weight and
will remain at the second surface area. The catheter-based device
is placed at a vascular treatment site allowing for delivery of the
thixotropic, turbid, bioactive agent-containing gel material to the
vascular treatment site during and/or after expansion of the
catheter-based device. A suitable gel material for use in the
present invention is a material that can be made to flow under
shear force, but exhibits no flow under the influence of its own
weight under non-shear conditions.
[0066] FIG. 7A depicts a cross section of catheter-based device 16
as from a stent, stent-graft, balloon, or other vascular
prosthesis, surrounding catheter 14, and having a thixotropic,
turbid gel material 12 of the present invention applied to the
catheter-based device 16. Gel material 12 is applied to a surface
of catheter-based device 16 to create an applicated catheter-based
device 10 of a first diameter and a first surface area. The
application may be continuous or discontinuous
[0067] FIG. 7B depicts a cross section of the same catheter-based
device shown by FIG. 7A, except that catheter-based device 16 is
expanded to a second diameter and a second surface area.
[0068] In another embodiment, incorporation of a bioactive agent in
the form of an angiographic contrast agent within the thixotropic,
turbid, bioactive agent-containing gel material permits an
angiographic visualization of the gel material at a vascular
treatment site. The contrast agent may be incorporated within the
thixotropic, turbid, bioactive agent-containing gel material
through admixing, reformulation, combination, direct solubilization
of the agent within the gel material, or other methods of
incorporating said contrast agent in said gel material. These
thixotropic, turbid, bioactive agent-containing gel materials are
visualized at a vascular treatment site using angiography.
[0069] Other embodiments of thixotropic, turbid, bioactive
agent-containing gel materials capable of treating vascular tissue
in sufficient amounts to treat a vascular condition may include but
are not limited to gel materials made from polyethylene glycol,
.alpha.-cyclodextrin, hydroxypropyl-.beta.-cyclodextrin
(HP.beta.CD), and a bioactive agent; polyvinyl alcohol, sodium
borate, polyoxyethylene sorbitol ester, and a bioactive agent;
sodium alginate, calcium chloride,
hydroxypropyl-.beta.-cyclodextrin, and a bioactive agent; and
dextran, potassium chloride, hydroxypropyl-.beta.-cyclodextrin
(HP.beta.CD), and a bioactive agent.
[0070] A preferred thixotropic, turbid, bioactive agent-containing
gel material for use in the present invention is disclosed by Li et
al. (U.S. Patent Application Publication 2002/0019369), which is
incorporated herein by reference.
EXAMPLES
Example 1
[0071] This Example describes the preparation of a thixotropic,
turbid gel material that contains a bioactive agent capable of
treating vascular tissue in sufficient amounts to treat a vascular
condition.
[0072] A first solution (referred herein as Solution 1A) was
prepared by mixing phosphate buffered saline (PBS) (0.15M NaCl, pH
7.4, Invitrogen Corporation Carlsbad, Calif.) with 0.40 g/ml
hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD) (Sigma-Aldrich, St.
Louis, Mo.) and 0.20 g/ml alpha-cyclodextrin (.alpha.CD)
(Sigma-Aldrich) through stirring and heating (60.degree. C.),
followed by adding dexamethasone (Pharmacia & Upjohn Company,
Kalamazoo, Mich.) at 20 mg/ml with stirring and heating (60.degree.
C.). Solution 1A did not form a gel material and was not
turbid.
[0073] A second solution (referred herein as Solution 1B) was
prepared by dissolving polyethylene glycol (PEG, Dow Chemical,
Midland, Mich.) of average Mn=8 kDa (0.26 g/ml) with PBS. Solution
1B did not form a gel material and was not turbid.
[0074] Equal volumes of Solution 1A and Solution 1B were combined
with mixing to form Gel Material A. Gel Material A was turbid, and
was opaque and white in appearance.
Example 2
[0075] This Example describes preparation of a thixotropic, turbid
gel material that contains a bioactive agent capable of treating
vascular tissue in sufficient amounts to treat a vascular
condition.
[0076] A first solution (Solution 2A) was prepared by mixing PBS
(0.15M NaCl, pH 7.4, Invitrogen) with 0.40 g/ml
hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD) (Sigma-Aldrich, St.
Louis, Mo.) and 0.20 g/ml alpha-cyclodextrin (.alpha.CD)
(Sigma-Aldrich) through stirring and heating (60.degree. C.),
followed by adding 17.beta.-estradiol (20 mg/ml) (Sigma-Aldrich) by
stirring and heating (60.degree. C.). Solution 2A did not form a
gel material and was not turbid.
[0077] A second solution (Solution 2B) was prepared by dissolving
PEG (Dow Chemical, Midland, Mich.) of average Mn=8 kDa (0.26 g/ml)
in PBS. Solution 2B did not form a gel material and was not
turbid.
[0078] Equal volumes of Solution 2A and Solution 2B were combined
with mixing to form Gel Material B. Gel Material B was turbid, and
was opaque and white in appearance.
Example 3
[0079] This Example describes preparation of a thixotropic, turbid
gel material that contains a bioactive agent capable of treating
vascular tissue in sufficient amounts to treat a vascular
condition.
[0080] A first solution (Solution 3A) was prepared by mixing PBS
(0.15M NaCl, pH 7.4) with 0.40 g/ml
hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD) (Sigma-Aldrich, St.
Louis, Mo.) and 0.20 g/ml alpha-cyclodextrin (.alpha.CD)
(Sigma-Aldrich) through stirring and heating (60.degree. C.),
followed by adding dicumarol (0.67 mg/ml) (Sigma-Aldrich) by
stirring and heating (60.degree. C.). Solution 3A did not form a
gel material and was not turbid.
[0081] A second solution (Solution 3B) was prepared by dissolving
of PEG (Dow) of average Mn=8 kDa (0.26 g/ml) in PBS. Solution 3B
did not form a gel material and was not turbid.
[0082] Equal volumes of solutions 3A and 3B were combined with
mixing to form Gel Material C. Gel Material C was turbid, and was
opaque and white in appearance.
Example 4
[0083] This Example describes in vivo delivery of dexamethasone to
venous tissue ("treated vascular tissue") according to a method of
the present invention.
[0084] A thixotropic, turbid gel material (herein referred to as
Gel Material 4A) was made by the following steps.
[0085] A first solution (referred herein as Solution 4A) was
prepared by mixing phosphate buffered saline (PBS) (0.15M NaCl, pH
7.4, Invitrogen Corporation Carlsbad, Calif.) with 0.40 g/ml
hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD) (Sigma-Aldrich, St.
Louis, Mo.) and 0.20 g/ml alpha-cyclodextrin (.alpha.CD)
(Sigma-Aldrich) through stirring and heating (60.degree. C.).
Solution 4A did not form a gel material and was not turbid.
[0086] Then, a dexamethasone mixture was made by combining
tritium-labeled dexamethasone (Perkin Elmer, Waltham, Mass. and
unlabeled dexamethasone (Pharmacia & Upjohn Company) at a ratio
of approximately 18 .mu.g/g. Solution 4B was formed by solubilizing
approximately 20 mg/ml of the dexamethasone mixture in Solution 4A.
Solution 4B did not form a gel material and was not turbid.
[0087] Solution 4C was prepared by dissolving polyethylene glycol
(PEG, Dow Chemical, Midland, Mich.) of average Mn=8 kDa (0.26 g/ml)
with PBS. Solution 4C did not form a gel material and was not
turbid.
[0088] Equal volumes of Solution 4B and Solution 4C were combined
with mixing to form Gel Material 4A. Gel Material 4A was turbid,
and was opaque and white in appearance.
[0089] Healthy canines were anaesthetized. A five centimeter (5 cm)
segment of canine femoral vein was surgically exposed. Blood flow
in the segment was stopped by constriction of the vein with rubber
ties positioned at the proximal and distal ends of the segment. A
vascular tissue treatment site was the length of vessel between the
rubber ties. The vascular treatment site was cannulated. Blood
within the vessel lumen was withdrawn at the cannulation using a
syringe. The lumen of the vascular treatment site was irrigated
three times with saline applied with a syringe at the cannulation.
One to three milliliters (1 to 3 ml) of Gel Material 4A was
injected at the cannulation and allowed to contact the blood vessel
lumen for a treatment period of two (2), ten (10), or forty (40)
minutes. No leakage of the Gel Material 4A from any treated vessel
segment was observed during the treatment period.
[0090] After the designated treatment period, the ties were removed
from each blood vessel segment, and blood flow was permitted to
resume in the vascular treatment site for one hour (1 hr). Canine
veins are relatively transparent, enabling observation with the
unaided eye of Gel Material 4A administration and removal from the
vascular treatment site. Upon re-establishment of blood flow in the
vascular treatment site, Gel Material 4A was observed to
substantially dissolve within approximately one minute (1 min).
After one hour (1 hr) of blood flow, the vascular treatment site
was harvested and washed thoroughly with saline.
[0091] Tissue sections (approximately 1 cm in length) were taken
from each vascular treatment site and digested overnight in five
milliliters (5 ml) of Solvable digestion fluid (Perkin Elmer).
Fifteen milliliters (15 ml) of HiSafe 2 (Perkin Elmer), a
scintillation cocktail, was added to the tissue sections to permit
scintillation counting and quantification of beta radiation emitted
by the tritium-labeled dexamethasone within each section.
[0092] A second group of healthy canines was anaesthetized. Control
vein sections (approximately 1 cm in length) were obtained from
these canines. The control vein sections were digested overnight in
5 ml of Solvable digestion fluid (Perkin Elmer). Known amounts of
tritium-labeled dexamethasone were added to the digestion fluid.
Fifteen milliliters (15 ml) of HiSafe 2 (Perkin Elmer), was added
to the control vein sections to permit scintillation counting and
quantification of the beta-radiation emitted by the tritium-labeled
dexamethasone within each control vein section.
[0093] A scintillation counter (Perkin Elmer) was used to measure
the beta radiation (disintegrations per minute) emitted by each
control vein section and to generate a linear standard curve of
disintegrations per minute as a function of the tritium-labeled
dexamethasone within each section. Radiation levels
(disintegrations per minute) from the tissue section were then
compared to the standard curve to calculate tritium-labeled
dexamethasone retention. The total amount of dexamethasone retained
in each tissue section was determined by correlation of the total
amount of dexamethasone in Gel Material 4A to the measured amount
of tritium-labeled dexamethasone in each experimental tissue
section.
[0094] FIG. 1 shows the resulting amount of total dexamethasone in
the experimental tissue sections. As shown, when Gel Material 4A
containing dexamethasone was allowed to contact a blood vessel
lumen devoid of blood for two minutes (2 min), an average of 9.3
.mu.g dexamethasone/g tissue remained in the tissue section after 1
h blood flow. The vascular treatment site included the tissue
sections. Therefore, an average of 9.3 .mu.g dexamethasone/g tissue
was retained at the vascular treatment site at 1 h.
Example 5
[0095] This Example demonstrates the use of a thixotropic, turbid
gel material in canine jugular veins ("treated vascular tissue").
This example also illustrates dissolution of a gel material in the
blood stream that does not occlude vascular structures upon
introduction to flowing blood.
[0096] Healthy canines were anaesthetized. A five centimeter (5 cm)
segment of canine jugular vein was surgically exposed. Blood flow
in the segment was stopped by constriction of the vein with rubber
ties positioned at the proximal and distal ends of the segment. A
vascular tissue treatment site was the length of vessel between the
rubber ties. The vascular treatment site was cannulated. Blood
within the vessel lumen was withdrawn at the cannulation using a
syringe. The lumen of the vascular treatment site was irrigated
three times with saline applied with a syringe at the cannulation.
Three to four milliliters (3 to 4 ml) of Gel Material A (described
in Example 1, supra) was injected at the cannulation and allowed to
contact the blood vessel lumen for a treatment period of forty (40)
minutes. No leakage of the Gel Material A from any treated vessel
segment was observed during the treatment period.
[0097] After the designated treatment period, the ties were removed
from each blood vessel segment, and blood flow was permitted to
resume in the vascular treatment site for one hour (1 hr). Canine
veins are relatively transparent, enabling observation with the
unaided eye of Gel Material A administration and removal from the
vascular treatment site. Upon re-establishment of blood flow in the
vascular treatment site, Gel Material A was observed to
substantially dissolve within approximately one minute (1 min). All
canines remained in-life for one hour (1 h) after re-establishment
of blood flow in treatment site.
[0098] After one hour (1hr) of blood flow, the vascular treatment
site was harvested and washed thoroughly with saline. Upon visible
inspection, no Gel Material A was observable on luminal surfaces of
any treatment site. Tissue sections (approximately 1 cm in length)
were taken from each vascular treatment site. A histological
examination (see FIG. 2) of these sections revealed a normal
appearance of these sections.
[0099] The heart and lungs of canines treated with Gel Material A
in the present Example were surgically excised. A pathological
examination of the heart and lungs revealed no evidence of embolism
or occlusion in these organs, indicating that Gel Material A
dissolution in the blood stream did not limit blood flow in
vascular structures located distal (i.e., downstream) to the
vascular tissue treatment site. These results demonstrate that the
method of administering the gel material did not occlude vascular
structures upon introduction into flowing blood.
Example 6
[0100] This Example demonstrates the use of a thixotropic, turbid
gel material in canine femoral veins ("treated vascular tissue").
This example also illustrates dissolution of a gel material in the
blood stream that does not occlude vascular structures upon
introduction to flowing blood.
[0101] Healthy canines were anaesthetized. A five centimeter (5 cm)
segment of canine femoral vein was surgically exposed. Blood flow
in the segment was stopped by constriction of the vein with rubber
ties positioned at the proximal and distal ends of the segment. A
vascular tissue treatment site was the length of vessel between the
rubber ties. The vascular treatment site was cannulated. Blood
within the vessel lumen was withdrawn at the cannulation using a
syringe. The lumen of the vascular treatment site was irrigated
three times with saline applied with a syringe at the cannulation.
One to three milliliters (1 to 3 ml) of Gel Material A (described
in Example 1, supra) was injected at the cannulation and allowed to
contact the blood vessel lumen for a treatment period of forty (40)
minutes. No leakage of the Gel Material A from any treated vessel
segment was observed during the treatment period.
[0102] After the designated treatment period, the ties were removed
from each blood vessel segment, and blood flow was permitted to
resume in the vascular treatment site. Canine veins are relatively
transparent, enabling observation with the unaided eye of Gel
Material A administration and removal from the vascular treatment
site. Upon re-establishment of blood flow in the vascular treatment
site, Gel Material A was observed to substantially dissolve within
approximately one minute (1 min).
[0103] After re-establishment of blood flow in the treatment site,
subcutaneous tissue and skin surrounding the treatment site were
closed with sutures. All canines remained in-life for fourteen days
(14 d).
[0104] After fourteen days (14 d), all canines were euthanized.
Then, the vascular treatment site was harvested and washed
thoroughly with saline. Upon visible inspection, no Gel Material A
was observable on luminal surfaces of any treatment site. Tissue
sections (approximately 1 cm in length) were taken from each
vascular treatment site. Histological examination of these sections
indicated evidence of a pharmacological effect of the delivered
dexamethasone. Specifically, a delayed healing response to the
surgical trauma of vein cannulation was observed. Tissue sections
from uncannulated lengths of the vascular treatment site displayed
normal morphology as show in FIG. 3. These findings demonstrated
the ability of thixotropic, turbid, bioactive agent-containing gel
materials to deliver an effective amount of a biological agent to a
vascular treatment site.
[0105] The heart and lungs of canines treated with Gel Material A
in the present Example were also surgically excised at the time of
euthanasia. A pathological examination of the heart and lungs
revealed no evidence of embolism or occlusion in these organs,
indicating that Gel Material A dissolution in the blood stream did
not limit blood flow in vascular structures located distal (i.e.,
downstream) to the vascular tissue treatment site. These results
demonstrate that the method of administering the gel material did
not occlude vascular structures upon introduction into flowing
blood.
Example 7
[0106] This Example describes in vivo delivery of estradiol to
venous tissue ("treated vascular tissue") according to a method of
the present invention.
[0107] A thixotropic, turbid gel material (herein referred to as
Gel Material 7A) was made by the following steps.
[0108] A first solution (referred herein as Solution 7A) was
prepared by mixing phosphate buffered saline (PBS) (0.15M NaCl, pH
7.4, Invitrogen Corporation Carlsbad, Calif.) with 0.40 g/ml
hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD) (Sigma-Aldrich, St.
Louis, Mo.) and 0.20 g/ml alpha-cyclodextrin (.alpha.CD)
(Sigma-Aldrich) through stirring and heating (60.degree. C.).
Solution 7A did not form a gel material and was not turbid.
[0109] Then, an estradiol mixture was made by combining
tritium-labeled estradiol (Perkin Elmer) and unlabeled estradiol
(Sigma) at a ratio of approximately 27 .mu.g/g. A second solution
(referred herein as Solution 7B) was formed by solubilizing
approximately 20 mg/ml of the estradiol mixture in Solution 7A.
Solution 7B did not form a gel material and was not turbid.
[0110] A third solution (referred herein as Solution 7C) was
prepared by dissolving polyethylene glycol (PEG, Dow Chemical) of
average Mn=8 kDa (0.26 g/ml) with PBS. Solution 7C did not form a
gel material and was not turbid. Equal volumes of Solution 7B and
Solution 7C were combined with mixing to form Gel Material 7A. Gel
Material 7A was turbid, and was opaque and white in appearance.
[0111] Healthy canines were anaesthetized. A five centimeter (5 cm)
segment of canine left femoral vein was surgically exposed. Blood
flow in the segment was stopped by constriction of the vein with
rubber ties positioned at the proximal and distal ends of the
segment. A vascular tissue treatment site was the length of vessel
between the rubber ties. The vascular treatment site was
cannulated. Blood within the vessel lumen was withdrawn at the
cannulation using a syringe. The lumen of the vascular treatment
site was irrigated three times with saline applied with a syringe
at the cannulation. One to three milliliters (1 to 3 ml) of Gel
Material 7A was injected at the cannulation and allowed to contact
the blood vessel lumen for a treatment period of forty (40)
minutes. No leakage of the Gel Material 7A from any treated vessel
segment was observed during the treatment period.
[0112] After the designated treatment period, the ties were removed
from each blood vessel segment, and blood flow was permitted to
resume in the vascular treatment site. Canine veins are relatively
transparent, enabling observation with the unaided eye of Gel
Material 7A administration and removal from the vascular treatment
site. Upon re-establishment of blood flow in the vascular treatment
site, Gel Material 7A was observed to substantially dissolve within
approximately one minute (1 min).
[0113] After re-establishment of blood flow in the treatment site,
subcutaneous tissue and skin surrounding the treatment site were
closed with sutures. All canines remained in-life for fourteen days
(14 d).
[0114] After fourteen days (14 d), all canines treated previously
with Gel Material 7A were again anaesthetized. The vascular
treatment site from the left femoral vein of each canine was then
harvested and washed thoroughly with saline.
[0115] With the canines still remaining in-life, a five centimeter
(5 cm) segment of the contralateral right femoral vein was
surgically exposed. Blood flow in the segment was stopped by
constriction of the vein with rubber ties positioned at the
proximal and distal ends of the segment. A vascular tissue
treatment site was the length of vessel between the rubber ties.
The vascular treatment site was cannulated. Blood within the vessel
lumen was withdrawn at the cannulation using a syringe. The lumen
of the vascular treatment site was irrigated three times with
saline applied with a syringe at the cannulation. One to three
milliliters (1 to 3 ml) of Gel Material 7A was injected at the
cannulation and allowed to contact the blood vessel lumen for a
treatment period of forty (40) minutes. No leakage of the Gel
Material 7A from any treated vessel segment was observed during the
treatment period.
[0116] After the designated treatment period, the ties were removed
from each blood vessel segment, and blood flow was permitted to
resume in the vascular treatment site for one hour (1 h). Canine
veins are relatively transparent, enabling observation with the
unaided eye of Gel Material 7A administration and removal from the
vascular treatment site. Upon re-establishment of blood flow in the
vascular treatment site, Gel Material 7A was observed to
substantially dissolve within approximately one minute (1 min).
[0117] After one hour (1 hr) of blood flow, the vascular treatment
site from the right femoral vein was harvested and washed
thoroughly with saline.
[0118] Tissue sections (approximately 1 cm in length) were taken
from all vascular treatment sites (from the left and right femoral
veins) and digested overnight in five milliliters (5 ml) of
Solvable digestion fluid (Perkin Elmer). Fifteen milliliters (15
ml) of HiSafe 2 (Perkin Elmer), a scintillation cocktail, was added
to the tissue sections to permit scintillation counting and
quantification of beta radiation emitted by the tritium-labeled
estradiol within each section.
[0119] A second group of untreated, healthy canines were
anaesthetised. Control vein sections (approximately 1 cm in length)
were obtained from these canines. The control vein sections were
digested overnight in 5 ml of Solvable digestion fluid (Perkin
Elmer). Known amounts of tritium-labeled estradiol were added to
the digestion fluid. Fifteen milliliters (15 ml) of HiSafe 2
(Perkin Elmer), was added to the control vein sections to permit
scintillation counting and quantification of the beta-radiation
emitted by the tritium-labeled estradiol within each control vein
section.
[0120] A scintillation counter (Perkin Elmer) was used to measure
the beta radiation (disintegrations per minute) emitted by each
control vein section and to generate a linear standard curve of
disintegrations per minute as a function of the tritium-labeled
estradiol within each section. Radiation levels (disintegrations
per minute) from the tissue section were then compared to the
standard curve to calculate tritium-labeled estradiol retention.
The total amount of estradiol retained in each tissue section was
determined by correlation of the total amount of estradiol in Gel
Material 7A to the measured amount of tritium-labeled estradiol in
each experimental tissue section.
[0121] FIG. 4 shows the resulting amount of total estradiol in the
experimental tissue sections. As shown, when Gel Material 7A
containing estradiol was allowed to contact a blood vessel lumen
devoid of blood for 40 minutes (40 min), an average of 9.8 .mu.g
estradiol/g tissue remained in the tissue section after one hour (1
h blood flow). The vascular treatment site included the tissue
sections. Therefore, an average of 9.8 .mu.g estradiol/g tissue was
retained in the vascular treatment site at 1 h.
[0122] As shown in FIG. 4, when Gel Material 7A containing
estradiol was allowed to contact a blood vessel lumen devoid of
blood for 40 minutes (40 min), an average of 0.3 .mu.g estradiol/g
tissue remained in the tissue section after fourteen days (14 d).
The vascular treatment site included the tissue sections.
Therefore, an average 0.3 .mu.g estradiol/g tissue was retained in
the vascular treatment site at fourteen days (14 d).
Example 8
[0123] This Example describes preparation of a thixotropic, turbid
gel material that contains a first bioactive agent capable of
treating vascular tissue in sufficient amounts to treat a vascular
condition and a second bioactive agent in the form of a phase
contrast agent to assist angiographic visualization of the gel
material. This example demonstrates visualization of the gel
material using angiography.
[0124] A first solution (referred herein as Solution 8A) was
prepared by mixing PBS with 0.40 g/ml
hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD) (Sigma-Aldrich, St.
Louis, Mo.) and 0.20 g/ml alpha-cyclodextrin (.alpha.CD)
(Sigma-Aldrich, St. Louis, Mo.) through stirring and heating
(60.degree. C.), followed by adding dexamethasone at 20 mg/ml and
600 mg/ml of iohexol (Hovione, Loures, Portugal) with stirring and
heating (60.degree. C.). Solution 8A did not form a gel material
and was not turbid.
[0125] A second solution (referred herein as Solution 8B) was
prepared by dissolving PEG of average Mn=8kDa (0.26 g/ml) with PBS.
Solution 8B did not form a gel material and was not turbid.
[0126] Equal volumes of Solution 8A and Solution 8B were combined
with mixing to form Gel Material D. Gel Material D was turbid, and
was opaque and white in appearance.
[0127] A healthy canine was anaesthetized. A segment of canine
jugular vein, approximately five centimeters (5 cm) in length, was
surgically exposed. Blood flow in the segment was stopped by
constriction of the vein with clamps positioned at the proximal and
distal ends of the segment. A vascular tissue treatment site was
the length of vessel between the clamps. The vascular treatment
site was cannulated. Blood within the vessel lumen was withdrawn at
the cannulation using a syringe. One to three milliliters (3 to 4
ml) of Gel Material D was injected at the cannulation and
visualized by angiography (FIG. 5c).
[0128] After angiography, the clamps were removed from the blood
vessel segment, and blood flow was permitted to resume in the
vascular treatment site for approximately five minutes (5 min).
Then, blood flow in the segment was again stopped by constriction
of the vein with clamps positioned at the proximal and distal ends
of the segment. A vascular tissue treatment site was the length of
vessel between the clamps. The vascular treatment site was
cannulated. Blood within the vessel lumen was withdrawn at the
cannulation using a syringe. One to three milliliters (3 to 4 ml)
of Gel Material A (as described in Example 1, supra, and which
contained no phase contrast agent) was injected at the cannulation
and visualized by angiography (FIG. 5b) as a control.
[0129] After angiography, the clamps were removed from the blood
vessel segment, and blood flow was permitted to resume in the
vascular treatment site for approximately five minutes (5 min).
Then, blood flow in the segment was again stopped by constriction
of the vein with clamps positioned at the proximal and distal ends
of the segment. A vascular tissue treatment site was the length of
vessel between the clamps. The vascular treatment site was
cannulated. Blood within the vessel lumen was withdrawn at the
cannulation using a syringe. One to three milliliters (3 to 4 ml)
of saline (Sigma) was injected at the cannulation and visualized by
angiography (FIG. 5a) as a control.
[0130] This example demonstrates visualization of the thixotropic
turbid gel material using angiography.
Example 9
[0131] This Example describes preparation of a thixotropic, turbid
gel material that contains a first bioactive agent capable of
treating vascular tissue in sufficient amounts to treat a vascular
condition and a second bioactive agent in the form of a phase
contrast agent to assist angiographic visualization of the gel
material. This example demonstrates visualization of the gel
material using angiography.
[0132] A first solution (referred herein as Solution 9A) was
prepared by mixing PBS with 0.40 g/ml
hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD) (Sigma-Aldrich, St.
Louis, Mo.) and 0.20 g/ml alpha-cyclodextrin (.alpha.CD)
(Sigma-Aldrich, St. Louis, Mo.) through stirring and heating
(60.degree. C.), followed by adding dexamethasone at 20 mg/ml and
600 mg/ml of iopamidol (Hovione, Loures, Portugal) with stirring
and heating (60.degree. C.). Solution 9A did not form a gel
material and was not turbid.
[0133] A second solution (referred herein as Solution 9B) was
prepared by dissolving PEG of average Mn=8kDa (0.26 g/ml) with PBS.
Solution 9B did not form a gel material and was not turbid.
[0134] Equal volumes of Solution 9A and Solution 9B were combined
with mixing to form Gel Material E. Gel Material E was turbid, and
was opaque and white in appearance.
[0135] A healthy canine was anaesthetized. A segment of canine
jugular vein, approximately five centimeters (5 cm) in length, was
surgically exposed. Blood flow in the segment was stopped by
constriction of the vein with clamps positioned at the proximal and
distal ends of the segment. A vascular tissue treatment site was
the length of vessel between the clamps. The vascular treatment
site was cannulated. Blood within the vessel lumen was withdrawn at
the cannulation using a syringe. One to three milliliters (3 to 4
ml) of Gel Material E was injected at the cannulation and
visualized by angiography (FIG. 5d).
[0136] After angiography, the clamps were removed from the blood
vessel segment, and blood flow was permitted to resume in the
vascular treatment site for approximately five minutes (5 min).
Then, blood flow in the segment was again stopped by constriction
of the vein with clamps positioned at the proximal and distal ends
of the segment. A vascular tissue treatment site was the length of
vessel between the clamps. The vascular treatment site was
cannulated. Blood within the vessel lumen was withdrawn at the
cannulation using a syringe. One to three milliliters (3 to 4 ml)
of Gel Material A (as described in Example 1, supra, and which
contained no phase contrast agent) was injected at the cannulation
and visualized by angiography (FIG. 5b) as a control.
[0137] After angiography, the clamps were removed from the blood
vessel segment, and blood flow was permitted to resume in the
vascular treatment site for approximately five minutes (5 min).
Then, blood flow in the segment was again stopped by constriction
of the vein with clamps positioned at the proximal and distal ends
of the segment. A vascular tissue treatment site was the length of
vessel between the clamps. The vascular treatment site was
cannulated. Blood within the vessel lumen was withdrawn at the
cannulation using a syringe. One to three milliliters (3 to 4 ml)
of saline (Sigma) was injected at the cannulation and visualized by
angiography (FIG. 5a) as a control.
[0138] This example demonstrates visualization of the thixotropic
turbid gel material using angiography.
Example 10
[0139] This Example describes delivery through a medical device of
a thixotropic, turbid gel material containing a bioactive agent
capable of treating vascular tissue in sufficient amounts to
inhibit a vascular condition.
[0140] Gel Material A (as described in Example 1, supra) was
injected through three different medical devices under hand
compression of a syringe attached to each medical device: a 4
French catheter (100 cm in length) (Cordis, Warren, N.J.); a 6
French catheter (90 cm in length) (Cordis); and a 20 Gauge needle
(2.54 cm in length) (Monoject, Mansfield, Mass.). The medical
device was attached to a five milliliter (5 ml) luer lock syringe
(Becton Dickinson, Franklin Lakes, N.J.). Gel Material A passed
through all three medical devices with hand compression of the
attached syringe. This example demonstrates the method of
administering the gel material by injection through a needle. This
example also demonstrates the method of administering the gel
material by endovascular delivery via a catheter.
Example 11
[0141] This Example describes in vivo delivery of dexamethasone to
arterial tissue ("treated vascular tissue") according to a method
of the present invention.
[0142] A thixotropic, turbid gel material (herein referred to as
Gel Material 11A) was made by the following steps.
[0143] A first solution (referred herein as Solution 11A) was
prepared by mixing phosphate buffered saline (PBS) (0.15M NaCl, pH
7.4, Invitrogen Corporation Carlsbad, Calif.) with 0.57 g/ml
hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD) (Sigma-Aldrich, St.
Louis, Mo.) and 0.20 g/ml alpha-cyclodextrin (.alpha.CD)
(Sigma-Aldrich) through stirring and heating (60.degree. C.).
Solution 11A did not form a gel material and was not turbid.
[0144] Then, a dexamethasone mixture was made by combining
tritium-labeled dexamethasone (Perkin Elmer, Waltham, Massachusetts
Perkin Elmer) and unlabeled dexamethasone (Pharmacia & Upjohn
Company) at a ratio of approximately 9 .mu.g/g. Solution 11B was
formed by solubilizing approximately 20 mg/ml of the dexamethasone
mixture in Solution 11A. Solution 11B did not form a gel material
and was not turbid.
[0145] Solution 11C was prepared by dissolving polyethylene glycol
(PEG, Dow Chemical, Midland, Mich.) of average Mn=8 kDa (0.26 g/ml)
with PBS. Solution 11C did not form a gel material and was not
turbid.
[0146] Equal volumes of Solution 11B and Solution 11C were combined
with mixing to form Gel Material 11A. Gel Material 11A was turbid,
and was opaque and white in appearance.
[0147] Healthy canines were anaesthetized. A five centimeter (5 cm)
segment of canine femoral artery was surgically exposed. Blood flow
in the segment was stopped by constriction of the artery with
rubber ties positioned at the proximal and distal ends of the
segment. A vascular tissue treatment site was the length of vessel
between the rubber ties. The vascular treatment site was
cannulated. Blood within the vessel lumen was withdrawn at the
cannulation using a syringe. The lumen of the vascular treatment
site was irrigated three times with saline applied with a syringe
at the cannulation. One to three milliliters (1 to 3 ml) of Gel
Material 11A was injected at the cannulation and allowed to contact
the blood vessel lumen for a treatment period of two (2) minutes.
No leakage of the Gel Material 11A from any treated vessel segment
was observed during the treatment period.
[0148] After the designated treatment period, the ties were removed
from each blood vessel segment, and blood flow was permitted to
resume in the vascular treatment site for one hour (1 hr). Canine
arteries are relatively transparent, enabling observation with the
unaided eye of Gel Material 11A administration and removal from the
vascular treatment site. Upon re-establishment of blood flow in the
vascular treatment site, Gel Material 11A was observed to
substantially dissolve within approximately one minute (1 min).
[0149] After approximately one hour (1hr) of blood flow,
post-injection contrast angiography was performed to demonstrate
the patency of capillaries and other vascular structures located
distal to the treatment site after Gel Material 11A dissolution in
the blood stream. Angiography of arteries distal to the treatment
site demonstrated normal blood perfusion after gel material
dissolution in the blood stream. These results demonstrate that the
method of administering the gel material did not occlude vascular
structures upon introduction into flowing blood.
[0150] Following angiography, the vascular treatment site was
harvested and washed thoroughly with saline. Tissue sections
(approximately 1 cm in length) were taken from each vascular
treatment site and digested overnight in five milliliters (5 ml) of
Solvable digestion fluid (Perkin Elmer). Fifteen milliliters (15
ml) of HiSafe 2 (Perkin Elmer), a scintillation cocktail, was added
to the tissue sections to permit scintillation counting and
quantification of beta radiation emitted by the tritium-labeled
dexamethasone within each specimen.
[0151] A second group of healthy canines was anaesthetised. Control
artery sections (approximately 1 cm in length) were obtained from
these canines. The control artery sections were digested overnight
in 5 ml of Solvable digestion fluid (Perkin Elmer). Known amounts
of tritium-labeled dexamethasone were added to the digestion fluid.
Fifteen milliliters (15 ml) of HiSafe 2 (Perkin Elmer), was added
to the control artery sections to permit scintillation counting and
quantification of the beta-radiation emitted by the tritium-labeled
dexamethasone within each control artery section.
[0152] A scintillation counter (Perkin Elmer) was used to measure
the beta radiation (disintegrations per minute) emitted by each
control artery section and to generate a linear standard curve of
disintegrations per minute as a function of the tritium-labeled
dexamethasone within each section. Radiation levels
(disintegrations per minute) from the tissue section were then
compared to the standard curve to calculate tritium-labeled
dexamethasone retained in the tissue section. The total amount of
dexamethasone retained in each tissue section was determined by
correlation of the total amount of dexamethasone in Gel Material
11A to the measured amount of tritium-labeled dexamethasone in each
experimental tissue section.
[0153] When Gel Material 11A containing dexamethasone was allowed
to contact a blood vessel lumen devoid of blood for two minutes (2
min), an average of 9.1 .mu.g dexamethasone/g tissue was retained
in each tissue section after one hour (1 h) blood flow. The
vascular treatment site included the tissue sections. Therefore, an
average of 9.1 .mu.g dexamethasone/g tissue was retained in the
vascular treatment site at one hour (1 h).
Example 12
[0154] This Example describes preparation of a thixotropic, turbid
gel material that contains a bioactive agent capable of treating
vascular tissue in sufficient amounts to treat a vascular
condition.
[0155] A thixotropic, turbid gel material (herein referred to as
Gel Material F) made from polyvinyl alcohol (PVA, Spectrum,
Gardena, Calif.), sodium borate (Borax, Sigma), polyoxyethylene
sorbitol ester (Tween.RTM.20, Sigma), and dexamethasone (Pharmacia
& Upjohn Company) was made by the following steps.
[0156] Three solutions were separately formed:
[0157] Solution 12A: 0.03 g PVA per milliliter water
[0158] Solution 12B: 10 mg dexamethasone per milliliter
polyoxyethylene sorbitol ester
[0159] Solution 12C: 10 mg borax per milliliter water
[0160] Then, 0.5 ml of Solution 12B was thoroughly mixed with 9.5
ml Solution 12A to form Solution 12D. Next, 0.5 ml of Solution 12C
was added to 5 ml of Solution D. Upon mixing, a Gel Material F was
formed and was turbid.
Example 13
[0161] This Example describes preparation of a thixotropic, turbid
gel material that contains a bioactive agent capable of treating
vascular tissue in sufficient amounts to treat a vascular
condition.
[0162] A thixotropic, turbid gel material (herein referred to as
Gel Material G) made from polyvinyl alcohol (PVA, Spectrum,
Gardena, Calif.) and sodium borate (Borax, Sigma), and HP.beta.CD
(Sigma), and dexamethasone (Pharmacia & Upjohn Company) was
made by the following steps.
[0163] Three solutions were separately formed:
[0164] Solution 13A: 0.05 g PVA per milliliter water
[0165] Solution 13B: 0.20 g HP.beta.CD per milliliter
[0166] Solution 13C: 10 mg borax per milliliter water
[0167] Then, Solution 13D was formed by solubilizing approximately
12 mg dexamethasone per milliliter in Solution 13B. Next, 2.5 ml
Solution 13A, 2.5 ml Solution 13D, and 0.25 ml Solution 13C were
thoroughly combined. Upon mixing, a Gel Material G was formed and
was turbid.
Example 14
[0168] This Example describes in vivo delivery of dexamethasone to
venous tissue ("treated vascular tissue") according to a method of
the present invention using Gel Material Gas described in Example
13.
[0169] Healthy canines were anaesthetized. A five centimeter (5 cm)
segment of canine jugular vein was surgically exposed. Blood flow
in the segment was stopped by constriction of the vein with rubber
ties positioned at the proximal and distal ends of the segment. A
vascular tissue treatment site was the length of vessel between the
rubber ties. The vascular treatment site was cannulated. Blood
within the vessel lumen was withdrawn at the cannulation using a
syringe. The lumen of the vascular treatment site was irrigated
three times with saline applied with a syringe at the cannulation.
One to three milliliters (3 to 4 ml) of Gel Material G was injected
at the cannulation and allowed to contact the blood vessel lumen
for a treatment period of forty (40) minutes. No leakage of the Gel
Material G from any treated vessel segment was observed during the
treatment period.
[0170] After the designated treatment period, the ties were removed
from each blood vessel segment, and blood flow was permitted to
resume in the vascular treatment site for one hour (1 hr). Canine
veins are relatively transparent, enabling observation with the
unaided eye of Gel Material G administration and removal from the
vascular treatment site. Upon re-establishment of blood flow in the
vascular treatment site, Gel Material G was observed to
substantially dissolve within approximately one minute (1 min).
After one hour (1 hr) of blood flow, the vascular treatment site
was harvested and washed thoroughly with saline.
[0171] Tissue sections (approximately 1 cm in length) were taken
from each vascular treatment site. A histological examination of
these sections revealed a normal appearance of these sections.
Three additional sections of the vascular treatment site were
analyzed for dexamethasone content by tissue extraction and
quantified with high performance liquid chromatography combined
with dual mass spectroscopy. Dexamethasone levels in these tissue
sections were approximately 15.9.+-.9.8 .mu.g per gram tissue,
demonstrating that the method of the present invention delivers a
bioactive agent to a vascular tissue treatment site.
Example 15
[0172] This Example describes the preparation of a thixotropic,
turbid gel material that contains a bioactive agent capable of
treating vascular tissue in sufficient amounts to treat a vascular
condition.
[0173] A thixotropic, turbid gel material (herein referred to as
Gel Material H) made from sodium alginate (Sigma), calcium chloride
(Sigma), hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD) (Sigma),
and dexamethasone (Pharmacia & Upjohn Company) was made by the
following steps.
[0174] Three solutions were separately formed:
[0175] Solution 15A: 1.7 mg calcium chloride per milliliter
water
[0176] Solution 15B: 0.40 g HP.beta.CD per milliliter water
[0177] Solution 15C: 20 mg sodium alginate per milliliter water
[0178] Then, Solution 15D was formed by solubilizing approximately
20 mg dexamethasone per milliliter of Solution 15B. Next, 2.5 ml
Solution 15A, 2.5 ml Solution 15D, and 2.5 m I Solution 15C were
combined. Upon mixing, a Gel Material H was formed and was
turbid.
Example 16
[0179] This Example describes the preparation of a thixotropic,
turbid gel material that contains a bioactive agent capable of
treating vascular tissue in sufficient amounts to treat a vascular
condition.
[0180] A thixotropic, turbid gel material (herein referred to as
Gel Material X) made from dextran (Mn=4kDa, Sigma) and potassium
chloride (Sigma) and hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD)
(Sigma), and dexamethasone (Pharmacia & Upjohn Company) is made
by the following steps.
[0181] Two solutions are separately formed:
[0182] Solution 16A: 0.40 g HP.beta.CD per ml water
[0183] Solution 16B: 0.22 g potassium chloride per g water
[0184] Then, Solution 16C is formed by solubilizing 10 mg/ml
dexamethasone in Solution 16A. Next, 0.5 g dextran is solubilized
by 0.5 ml of Solution 16C. Finally, 0.5 ml Solution 16B is added.
Upon mixing, Gel Material X is formed and was turbid.
Example 17
[0185] This Example describes characterization of a thixotropic,
turbid gel material that contains a bioactive agent capable of
treating vascular tissue in sufficient amounts to treat a vascular
condition. Thixotropy of Gel Material A was demonstrated by
rheometry.
[0186] The viscosity of Gel Material A was characterized over a
range of shear rates using a rheometer (Model AR-G2, TA
Instruments, New Castle, Del.). This analysis technique involved
measurement of shear stress during shear rate "ramp up" and
subsequent "ramp down." Samples were analyzed at 25.degree. C. with
a forty millimeter (40 mm) cone and plate geometry. About one
milliliter (1 ml) of Gel Material A was injected from a needle-less
syringe onto the plate and allowed to equilibrate for 3 minutes.
Then, a shear "ramp up" step was performed, whereby the shear rate
was increased from 0.1 to 1.0 s.sup.-1 over two minutes (2 min).
Subsequently, a "ramp down" step was performed, whereby the shear
rate was decreased from 1.0 to 0.1 s.sup.-1 over two minutes (2
min).
[0187] Apparent viscosity at each point was calculated as the ratio
of shear stress to shear rate. Initial viscosity at 0.1 s.sup.-1
was approximately 90 Pas. The viscosity of Gel Material A was
observed to decrease with increasing shear (during the shear "ramp
up"). At 1.0 s.sup.-1, the viscosity of Gel Material A was
approximately 17 Pas. As the shear rate was then decreased (the
"ramp down" step), the viscosity of Gel Material A was seen to
increase. At the conclusion of the ramp down step, the viscosity of
Gel Material A at 0.1 s.sup.-1 was approximately 55 Pas.
Example 18
[0188] This Example describes an implantable medical device having
a thixotropic, turbid, gel material containing a bioactive agent
capable of treating vascular tissue in sufficient amounts to treat
a vascular condition applied to at least a portion of the
implantable medical device.
[0189] The implantable medical device used in this example was in
the form of a nitinol wire reinforced tube made of a porous,
expanded, polytetrafluoroethylene (ePTFE) material obtained from
W.L. Gore & Associates, Inc., Flagstaff, Ariz. under the
tradename VIABAHN.RTM. Endoprosthesis. The tubular device was
fifteen centimeters (15 cm) in length and six millimeters (6 mm) in
diameter.
[0190] Gel Material A (described in Example 1, supra) was applied
to an exterior surface of the implantable medical device using a
needle-containing syringe. Once applied, the gel material was seen
to adhere to the exterior surface of the implantable medical
device.
[0191] The implantable medical device was mechanically expanded.
Upon expansion, the implantable medical device expanded from a
first diameter and a first surface area to a second diameter and a
second surface area. A substantial portion of Gel Material A
applied to the exterior surface of the implantable medical device
was seen to remain adherent to the exterior surface of the
implantable medical device during expansion of the implantable
medical device.
Example 19
[0192] This Example describes an implantable medical device having
a thixotropic, turbid, gel material containing a bioactive agent
capable of treating vascular tissue in sufficient amounts to treat
a vascular condition applied to at least a portion of the
implantable medical device.
[0193] The implantable medical device used in this example was in
the form of a catheter-based device. The catheter-based device was
in the form of an endovascular angioplasty balloon (POWERFLEX.RTM.
P3, Cat. No. 420-4040L, Cordis Corporation). The restraining sheath
of the balloon was removed from the implantable medical device.
Then, Gel Material A (described in Example 1, supra) was applied to
an exterior surface of the balloon of the implantable medical
device using a needle-containing syringe. Once applied, the gel
material was seen to adhere to the exterior surface of the
balloon.
[0194] The balloon was mechanically expanded according to
instructions for use provided with the packaging. Upon mechanical
expansion, the balloon expanded from a first diameter and a first
surface area to a second diameter and a second surface area. A
substantial portion of Gel Material A applied to the exterior
surface of the implantable medical device was seen to remain
adherent to the exterior surface of the implantable medical device
during and after mechanical expansion of the implantable medical
device.
* * * * *