WO2018167536A1 - Implantable material and method for preserving - Google Patents
Implantable material and method for preserving Download PDFInfo
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- WO2018167536A1 WO2018167536A1 PCT/IB2017/051504 IB2017051504W WO2018167536A1 WO 2018167536 A1 WO2018167536 A1 WO 2018167536A1 IB 2017051504 W IB2017051504 W IB 2017051504W WO 2018167536 A1 WO2018167536 A1 WO 2018167536A1
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- WIPO (PCT)
- Prior art keywords
- tissue
- glycerol
- solution
- vol
- polyols
- Prior art date
Links
- 239000000463 material Substances 0.000 title claims abstract description 43
- 238000000034 method Methods 0.000 title claims description 48
- PEDCQBHIVMGVHV-UHFFFAOYSA-N Glycerine Chemical compound OCC(O)CO PEDCQBHIVMGVHV-UHFFFAOYSA-N 0.000 claims abstract description 228
- 210000001519 tissue Anatomy 0.000 claims abstract description 166
- 229920005862 polyol Polymers 0.000 claims abstract description 39
- 150000003077 polyols Chemical class 0.000 claims abstract description 39
- 102000010834 Extracellular Matrix Proteins Human genes 0.000 claims abstract description 25
- 108010037362 Extracellular Matrix Proteins Proteins 0.000 claims abstract description 25
- 210000002744 extracellular matrix Anatomy 0.000 claims abstract description 25
- DNIAPMSPPWPWGF-GSVOUGTGSA-N (R)-(-)-Propylene glycol Chemical compound C[C@@H](O)CO DNIAPMSPPWPWGF-GSVOUGTGSA-N 0.000 claims description 34
- DNIAPMSPPWPWGF-UHFFFAOYSA-N monopropylene glycol Natural products CC(O)CO DNIAPMSPPWPWGF-UHFFFAOYSA-N 0.000 claims description 34
- 229960004063 propylene glycol Drugs 0.000 claims description 34
- 235000013772 propylene glycol Nutrition 0.000 claims description 34
- WERYXYBDKMZEQL-UHFFFAOYSA-N butane-1,4-diol Chemical compound OCCCCO WERYXYBDKMZEQL-UHFFFAOYSA-N 0.000 claims description 30
- 210000003709 heart valve Anatomy 0.000 claims description 24
- 230000001954 sterilising effect Effects 0.000 claims description 22
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 claims description 21
- LFQSCWFLJHTTHZ-UHFFFAOYSA-N Ethanol Chemical compound CCO LFQSCWFLJHTTHZ-UHFFFAOYSA-N 0.000 claims description 18
- IAYPIBMASNFSPL-UHFFFAOYSA-N Ethylene oxide Chemical compound C1CO1 IAYPIBMASNFSPL-UHFFFAOYSA-N 0.000 claims description 12
- UOQHWNPVNXSDDO-UHFFFAOYSA-N 3-bromoimidazo[1,2-a]pyridine-6-carbonitrile Chemical compound C1=CC(C#N)=CN2C(Br)=CN=C21 UOQHWNPVNXSDDO-UHFFFAOYSA-N 0.000 claims description 10
- JVTAAEKCZFNVCJ-UHFFFAOYSA-N lactic acid Chemical compound CC(O)C(O)=O JVTAAEKCZFNVCJ-UHFFFAOYSA-N 0.000 claims description 10
- 229940099563 lactobionic acid Drugs 0.000 claims description 10
- 230000005865 ionizing radiation Effects 0.000 claims description 8
- 238000001035 drying Methods 0.000 claims description 7
- 150000003839 salts Chemical class 0.000 claims description 7
- 239000000203 mixture Substances 0.000 claims description 6
- KIUKXJAPPMFGSW-DNGZLQJQSA-N (2S,3S,4S,5R,6R)-6-[(2S,3R,4R,5S,6R)-3-Acetamido-2-[(2S,3S,4R,5R,6R)-6-[(2R,3R,4R,5S,6R)-3-acetamido-2,5-dihydroxy-6-(hydroxymethyl)oxan-4-yl]oxy-2-carboxy-4,5-dihydroxyoxan-3-yl]oxy-5-hydroxy-6-(hydroxymethyl)oxan-4-yl]oxy-3,4,5-trihydroxyoxane-2-carboxylic acid Chemical compound CC(=O)N[C@H]1[C@H](O)O[C@H](CO)[C@@H](O)[C@@H]1O[C@H]1[C@H](O)[C@@H](O)[C@H](O[C@H]2[C@@H]([C@@H](O[C@H]3[C@@H]([C@@H](O)[C@H](O)[C@H](O3)C(O)=O)O)[C@H](O)[C@@H](CO)O2)NC(C)=O)[C@@H](C(O)=O)O1 KIUKXJAPPMFGSW-DNGZLQJQSA-N 0.000 claims description 5
- 229940031723 1,2-octanediol Drugs 0.000 claims description 5
- OWEGMIWEEQEYGQ-UHFFFAOYSA-N 100676-05-9 Natural products OC1C(O)C(O)C(CO)OC1OCC1C(O)C(O)C(O)C(OC2C(OC(O)C(O)C2O)CO)O1 OWEGMIWEEQEYGQ-UHFFFAOYSA-N 0.000 claims description 5
- FBPFZTCFMRRESA-FSIIMWSLSA-N D-Glucitol Natural products OC[C@H](O)[C@H](O)[C@@H](O)[C@H](O)CO FBPFZTCFMRRESA-FSIIMWSLSA-N 0.000 claims description 5
- FBPFZTCFMRRESA-KVTDHHQDSA-N D-Mannitol Chemical compound OC[C@@H](O)[C@@H](O)[C@H](O)[C@H](O)CO FBPFZTCFMRRESA-KVTDHHQDSA-N 0.000 claims description 5
- FBPFZTCFMRRESA-JGWLITMVSA-N D-glucitol Chemical compound OC[C@H](O)[C@@H](O)[C@H](O)[C@H](O)CO FBPFZTCFMRRESA-JGWLITMVSA-N 0.000 claims description 5
- 239000004386 Erythritol Substances 0.000 claims description 5
- UNXHWFMMPAWVPI-UHFFFAOYSA-N Erythritol Natural products OCC(O)C(O)CO UNXHWFMMPAWVPI-UHFFFAOYSA-N 0.000 claims description 5
- 239000005715 Fructose Substances 0.000 claims description 5
- 229930091371 Fructose Natural products 0.000 claims description 5
- RFSUNEUAIZKAJO-ARQDHWQXSA-N Fructose Chemical compound OC[C@H]1O[C@](O)(CO)[C@@H](O)[C@@H]1O RFSUNEUAIZKAJO-ARQDHWQXSA-N 0.000 claims description 5
- WQZGKKKJIJFFOK-GASJEMHNSA-N Glucose Natural products OC[C@H]1OC(O)[C@H](O)[C@@H](O)[C@@H]1O WQZGKKKJIJFFOK-GASJEMHNSA-N 0.000 claims description 5
- GUBGYTABKSRVRQ-PICCSMPSSA-N Maltose Natural products O[C@@H]1[C@@H](O)[C@H](O)[C@@H](CO)O[C@@H]1O[C@@H]1[C@@H](CO)OC(O)[C@H](O)[C@H]1O GUBGYTABKSRVRQ-PICCSMPSSA-N 0.000 claims description 5
- 229930195725 Mannitol Natural products 0.000 claims description 5
- TVXBFESIOXBWNM-UHFFFAOYSA-N Xylitol Natural products OCCC(O)C(O)C(O)CCO TVXBFESIOXBWNM-UHFFFAOYSA-N 0.000 claims description 5
- WQZGKKKJIJFFOK-PHYPRBDBSA-N alpha-D-galactose Chemical compound OC[C@H]1O[C@H](O)[C@H](O)[C@@H](O)[C@H]1O WQZGKKKJIJFFOK-PHYPRBDBSA-N 0.000 claims description 5
- WQZGKKKJIJFFOK-VFUOTHLCSA-N beta-D-glucose Chemical compound OC[C@H]1O[C@@H](O)[C@H](O)[C@@H](O)[C@@H]1O WQZGKKKJIJFFOK-VFUOTHLCSA-N 0.000 claims description 5
- GUBGYTABKSRVRQ-QUYVBRFLSA-N beta-maltose Chemical compound OC[C@H]1O[C@H](O[C@H]2[C@H](O)[C@@H](O)[C@H](O)O[C@@H]2CO)[C@H](O)[C@@H](O)[C@@H]1O GUBGYTABKSRVRQ-QUYVBRFLSA-N 0.000 claims description 5
- UNXHWFMMPAWVPI-ZXZARUISSA-N erythritol Chemical compound OC[C@H](O)[C@H](O)CO UNXHWFMMPAWVPI-ZXZARUISSA-N 0.000 claims description 5
- 235000019414 erythritol Nutrition 0.000 claims description 5
- 229940009714 erythritol Drugs 0.000 claims description 5
- 229930182830 galactose Natural products 0.000 claims description 5
- 239000008103 glucose Substances 0.000 claims description 5
- 229920002674 hyaluronan Polymers 0.000 claims description 5
- 229960003160 hyaluronic acid Drugs 0.000 claims description 5
- 235000014655 lactic acid Nutrition 0.000 claims description 5
- 239000004310 lactic acid Substances 0.000 claims description 5
- JCQLYHFGKNRPGE-FCVZTGTOSA-N lactulose Chemical compound OC[C@H]1O[C@](O)(CO)[C@@H](O)[C@@H]1O[C@H]1[C@H](O)[C@@H](O)[C@@H](O)[C@@H](CO)O1 JCQLYHFGKNRPGE-FCVZTGTOSA-N 0.000 claims description 5
- 229960000511 lactulose Drugs 0.000 claims description 5
- PFCRQPBOOFTZGQ-UHFFFAOYSA-N lactulose keto form Natural products OCC(=O)C(O)C(C(O)CO)OC1OC(CO)C(O)C(O)C1O PFCRQPBOOFTZGQ-UHFFFAOYSA-N 0.000 claims description 5
- 239000000594 mannitol Substances 0.000 claims description 5
- 235000010355 mannitol Nutrition 0.000 claims description 5
- HEBKCHPVOIAQTA-UHFFFAOYSA-N meso ribitol Natural products OCC(O)C(O)C(O)CO HEBKCHPVOIAQTA-UHFFFAOYSA-N 0.000 claims description 5
- AEIJTFQOBWATKX-UHFFFAOYSA-N octane-1,2-diol Chemical compound CCCCCCC(O)CO AEIJTFQOBWATKX-UHFFFAOYSA-N 0.000 claims description 5
- 239000000600 sorbitol Substances 0.000 claims description 5
- 235000010356 sorbitol Nutrition 0.000 claims description 5
- 239000000811 xylitol Substances 0.000 claims description 5
- 235000010447 xylitol Nutrition 0.000 claims description 5
- HEBKCHPVOIAQTA-SCDXWVJYSA-N xylitol Chemical compound OC[C@H](O)[C@@H](O)[C@H](O)CO HEBKCHPVOIAQTA-SCDXWVJYSA-N 0.000 claims description 5
- 229960002675 xylitol Drugs 0.000 claims description 5
- 238000005507 spraying Methods 0.000 claims description 3
- 230000007480 spreading Effects 0.000 claims description 3
- 238000003892 spreading Methods 0.000 claims description 3
- 239000003795 chemical substances by application Substances 0.000 claims description 2
- 230000005855 radiation Effects 0.000 claims description 2
- 239000000243 solution Substances 0.000 description 75
- 238000011282 treatment Methods 0.000 description 65
- 238000004659 sterilization and disinfection Methods 0.000 description 15
- 238000007654 immersion Methods 0.000 description 9
- 210000003516 pericardium Anatomy 0.000 description 9
- 150000001299 aldehydes Chemical class 0.000 description 7
- 210000004027 cell Anatomy 0.000 description 7
- 239000004744 fabric Substances 0.000 description 7
- 230000008569 process Effects 0.000 description 7
- 239000000126 substance Substances 0.000 description 7
- 241000283690 Bos taurus Species 0.000 description 6
- 238000004132 cross linking Methods 0.000 description 5
- 238000012986 modification Methods 0.000 description 5
- 230000004048 modification Effects 0.000 description 5
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 description 4
- 239000003463 adsorbent Substances 0.000 description 4
- 239000007788 liquid Substances 0.000 description 4
- 238000004519 manufacturing process Methods 0.000 description 4
- 229920000642 polymer Polymers 0.000 description 4
- 238000007634 remodeling Methods 0.000 description 4
- 102000008186 Collagen Human genes 0.000 description 3
- 108010035532 Collagen Proteins 0.000 description 3
- 229920001436 collagen Polymers 0.000 description 3
- 229940099584 lactobionate Drugs 0.000 description 3
- JYTUSYBCFIZPBE-AMTLMPIISA-N lactobionic acid Chemical compound OC(=O)[C@H](O)[C@@H](O)[C@@H]([C@H](O)CO)O[C@@H]1O[C@H](CO)[C@H](O)[C@H](O)[C@H]1O JYTUSYBCFIZPBE-AMTLMPIISA-N 0.000 description 3
- 238000009958 sewing Methods 0.000 description 3
- 241000283073 Equus caballus Species 0.000 description 2
- SXRSQZLOMIGNAQ-UHFFFAOYSA-N Glutaraldehyde Chemical compound O=CCCCC=O SXRSQZLOMIGNAQ-UHFFFAOYSA-N 0.000 description 2
- 239000004775 Tyvek Substances 0.000 description 2
- 229920000690 Tyvek Polymers 0.000 description 2
- 230000009471 action Effects 0.000 description 2
- 230000015556 catabolic process Effects 0.000 description 2
- 230000006378 damage Effects 0.000 description 2
- 238000006731 degradation reaction Methods 0.000 description 2
- 239000003599 detergent Substances 0.000 description 2
- 230000028993 immune response Effects 0.000 description 2
- 239000007943 implant Substances 0.000 description 2
- 238000001727 in vivo Methods 0.000 description 2
- 238000011221 initial treatment Methods 0.000 description 2
- 239000002953 phosphate buffered saline Substances 0.000 description 2
- 230000002629 repopulating effect Effects 0.000 description 2
- 230000000717 retained effect Effects 0.000 description 2
- 238000003860 storage Methods 0.000 description 2
- VZSRBBMJRBPUNF-UHFFFAOYSA-N 2-(2,3-dihydro-1H-inden-2-ylamino)-N-[3-oxo-3-(2,4,6,7-tetrahydrotriazolo[4,5-c]pyridin-5-yl)propyl]pyrimidine-5-carboxamide Chemical compound C1C(CC2=CC=CC=C12)NC1=NC=C(C=N1)C(=O)NCCC(N1CC2=C(CC1)NN=N2)=O VZSRBBMJRBPUNF-UHFFFAOYSA-N 0.000 description 1
- DBMJMQXJHONAFJ-UHFFFAOYSA-M Sodium laurylsulphate Chemical compound [Na+].CCCCCCCCCCCCOS([O-])(=O)=O DBMJMQXJHONAFJ-UHFFFAOYSA-M 0.000 description 1
- 101710172711 Structural protein Proteins 0.000 description 1
- 239000002250 absorbent Substances 0.000 description 1
- 230000002745 absorbent Effects 0.000 description 1
- 238000007792 addition Methods 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- 230000008901 benefit Effects 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000001124 body fluid Anatomy 0.000 description 1
- 239000010839 body fluid Substances 0.000 description 1
- 230000001413 cellular effect Effects 0.000 description 1
- 239000003153 chemical reaction reagent Substances 0.000 description 1
- 238000007796 conventional method Methods 0.000 description 1
- 239000003431 cross linking reagent Substances 0.000 description 1
- 230000003013 cytotoxicity Effects 0.000 description 1
- 231100000135 cytotoxicity Toxicity 0.000 description 1
- 229940009976 deoxycholate Drugs 0.000 description 1
- KXGVEGMKQFWNSR-LLQZFEROSA-N deoxycholic acid Chemical compound C([C@H]1CC2)[C@H](O)CC[C@]1(C)[C@@H]1[C@@H]2[C@@H]2CC[C@H]([C@@H](CCC(O)=O)C)[C@@]2(C)[C@@H](O)C1 KXGVEGMKQFWNSR-LLQZFEROSA-N 0.000 description 1
- 238000011161 development Methods 0.000 description 1
- LOKCTEFSRHRXRJ-UHFFFAOYSA-I dipotassium trisodium dihydrogen phosphate hydrogen phosphate dichloride Chemical compound P(=O)(O)(O)[O-].[K+].P(=O)(O)([O-])[O-].[Na+].[Na+].[Cl-].[K+].[Cl-].[Na+] LOKCTEFSRHRXRJ-UHFFFAOYSA-I 0.000 description 1
- 210000001951 dura mater Anatomy 0.000 description 1
- 210000002889 endothelial cell Anatomy 0.000 description 1
- 230000006862 enzymatic digestion Effects 0.000 description 1
- 230000001771 impaired effect Effects 0.000 description 1
- 230000036512 infertility Effects 0.000 description 1
- 210000004347 intestinal mucosa Anatomy 0.000 description 1
- 210000003041 ligament Anatomy 0.000 description 1
- 238000012423 maintenance Methods 0.000 description 1
- 210000004962 mammalian cell Anatomy 0.000 description 1
- 239000011159 matrix material Substances 0.000 description 1
- 238000010899 nucleation Methods 0.000 description 1
- 238000011017 operating method Methods 0.000 description 1
- 210000000056 organ Anatomy 0.000 description 1
- 238000004806 packaging method and process Methods 0.000 description 1
- 210000003491 skin Anatomy 0.000 description 1
- 210000002435 tendon Anatomy 0.000 description 1
- 230000002110 toxicologic effect Effects 0.000 description 1
- 231100000759 toxicological effect Toxicity 0.000 description 1
- 210000003462 vein Anatomy 0.000 description 1
- 238000005406 washing Methods 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
- A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
- A61L27/505—Stabilizers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
- A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
- A61L27/3604—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix characterised by the human or animal origin of the biological material, e.g. hair, fascia, fish scales, silk, shellac, pericardium, pleura, renal tissue, amniotic membrane, parenchymal tissue, fetal tissue, muscle tissue, fat tissue, enamel
- A61L27/3633—Extracellular matrix [ECM]
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
- A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
- A61L27/3683—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix subjected to a specific treatment prior to implantation, e.g. decellularising, demineralising, grinding, cellular disruption/non-collagenous protein removal, anti-calcification, crosslinking, supercritical fluid extraction, enzyme treatment
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L2430/00—Materials or treatment for tissue regeneration
- A61L2430/20—Materials or treatment for tissue regeneration for reconstruction of the heart, e.g. heart valves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L2430/00—Materials or treatment for tissue regeneration
- A61L2430/40—Preparation and treatment of biological tissue for implantation, e.g. decellularisation, cross-linking
Definitions
- the present invention relates to implantable materials. More specifically, the invention relates to decellularized implantable materials or tissue engineered implantable materials and methods for producing and preserving such implantable materials.
- Biological prostheses are medical devices that use mammalian donor tissues.
- suitable mammalian tissues include, for example, bovine, porcine, ovine, equine, and human tissues.
- the donor tissue may include, for example, cardiac valves, pericardium, tendons, ligaments, dura mater, skin, and veins.
- tissues used in biological prostheses undergo a series of chemical treatments in order to give biological and mechanical stability to the tissue itself and to sterilize the final device that incorporates the tissue.
- These chemical treatments typically involve aldehydes able to crosslink the tissue to alter its mechanical properties, reduce in vivo enzymatic digestion and immune response after implant and, in combination with other chemicals, to sterilize the device.
- Aldehyde treatments result in a stable device that is resistant to remodeling or degradation by the patient's body after implant. This stability in general is seen as an advantage, but for certain advanced applications it represents a drawback.
- a biological heart valve implanted within a child able to be remodeled and grow with the child may reduce the need to replace the heart valve as the child grows.
- Recent technical development in tissue engineering and in native tissue decellularization are devoted to producing new tissues that are not fixed so that the recipient organism can remodel donor tissue in some way, by repopulating it with the recipient's own cells.
- Example 1 is an implantable material including decellularized sterilized mammalian tissue having an extracellular matrix, wherein a plurality of interstitial spaces of the extracellular matrix include a solution of one or more polyols other than glycerol and, optionally, glycerol.
- Example 2 the implantable material of Example 1 , wherein the glycerol is present in an amount of about 1 vol. % to about 50 vol. % of the mixture and the one or more polyols other than glycerol are present in an amount of about 50 vol. % to about 99 vol. % of the mixture.
- Example 3 the implantable material of either of Examples 1 or 2, wherein the solution in the plurality of interstitial spaces of the extracellular matrix consists essentially of the one or more polyols other than glycerol and glycerol.
- Example 4 the implantable material of any of Examples 1 -3, wherein the one or more polyols other than glycerol includes at least one of 1 ,2 propanediol, 1 ,2 octanediol, 1 ,4 butanediol, fructose, xylitol, mannitol, sorbitol, lactulose, lactic acid, maltose, glucose, galactose, erythritol, lactobionic acid or its salts, and hyaluronic acid.
- the one or more polyols other than glycerol includes at least one of 1 ,2 propanediol, 1 ,2 octanediol, 1 ,4 butanediol, fructose, xylitol, mannitol, sorbitol, lactulose, lactic acid, maltose, glucose, galactose, eryth
- Example 5 the implantable material of any of Examples 1 -4, wherein the one or more polyols other than glycerol are selected from the group consisting of 1 ,2 propanediol, 1 ,4 butanediol, lactobionic acid and its salts, and combinations thereof.
- Example 6 the implantable material of any of Examples 1 -5, wherein the one or more polyols other than glycerol consists essentially 1 ,2 propanediol.
- Example 7 the implantable material of any of Examples 1 -6, wherein the implantable material is substantially free of water.
- Example 8 the implantable material of any of Examples 1 -6, wherein the implantable material is non-fixed.
- Example 9 the implantable material of any of Examples 1 -8, wherein the implantable material forms a portion of an engineered heart valve.
- Example 10 is method for making an implantable material.
- the method includes decellularizing mammalian tissue, treating the decellularized mammalian tissue with a solution; drying the treated tissue, and sterilizing the dried tissue.
- the treatment solution includes one or more polyols other than glycerol, glycerol and, optionally, water.
- Example 1 1 the method of Example 10, wherein the solution includes the glycerol at a concentration from about 15 vol. % to about 35 vol. %, the one or more polyols other than glycerol at a concentration of about 65 vol. % to about 85 vol. % of the solution, and the balance water.
- Example 12 the method of either of Examples 10 or 1 1 , wherein the solution consists essentially of the one or more polyols other than glycerol, glycerol, and, optionally, water.
- Example 13 the method of any of Examples 10-12, wherein sterilizing includes at least one of exposing the dried tissue to ethylene oxide gas, exposing the dried tissue to ionizing radiation, and exposing the dried tissue to ultraviolet light.
- Example 14 the method of any of Examples 10-13, wherein drying the treated tissue includes drying until substantially all water is removed from the treated tissue.
- Example 15 the method of any of Examples 10-14, wherein treating the tissue includes immersing the tissue in the solution.
- Example 16 the method of Example 15, wherein the tissue is immersed in the solution for a time ranging from 2 to 100 hours and at a temperature ranging from 5°C to 35°C.
- Example 17 the method of either of Examples 15 or 16, wherein the tissue is immersed in the solution more than once.
- Example 18 the method of Examples 10-14, wherein treating the tissue includes one of spraying the solution on the tissue and spreading the solution on the tissue.
- Example 19 the method of any of Examples 10-18, wherein the one or more polyols other than glycerol includes at least one of 1 ,2 propanediol, 1 ,2 octanediol, 1 ,4 butanediol, fructose, xylitol, mannitol, sorbitol, lactulose, lactic acid, maltose, glucose, galactose, erythritol, lactobionic acid or its salts, and hyaluronic acid.
- the one or more polyols other than glycerol includes at least one of 1 ,2 propanediol, 1 ,2 octanediol, 1 ,4 butanediol, fructose, xylitol, mannitol, sorbitol, lactulose, lactic acid, maltose, glucose, galactose, erythrito
- Example 20 the method of any of Examples 10-19, wherein the one or more polyols other than glycerol are selected from the group consisting of 1 ,2 propanediol, 1 ,4 butanediol, lactobionic acid, and combinations thereof.
- Example 21 the method of any of Examples 10-20, wherein solution includes the glycerol at a concentration from about 15 vol. % to about 35 vol. %, the one or more polyols other than glycerol at a concentration of about 65 vol. % to about 85 vol. % of the solution, and the balance ethanol.
- Example 22 the method of any of Examples 10-21 , wherein the tissue is not treated with a fixing agent.
- Example 23 is a preserved tissue engineered heart valve including decellularized, non-fixed, sterilized mammalian tissue having an extracellular matrix, wherein a plurality of interstitial spaces of the extracellular matrix includes a solution consisting essentially of one or more polyols other than glycerol and glycerol, wherein the glycerol is no more than 50 vol. % of the solution.
- FIG. 1 is a photograph of a non-fixed decellularized tissue sample treated with pure glycerol.
- FIG. 2 is a photograph of a non-fixed decellularized tissue sample treated with pure 1 ,2 propanediol, according to embodiments.
- FIG. 3 is a photograph of a non-fixed decellularized tissue sample treated with a solution of 1 ,2 propanediol and glycerol, according to embodiments.
- FIG. 4 is a photograph of a stented valve made of non-fixed decellularized pericardium and treated with a solution of 1 ,2 propanediol and glycerol, according to embodiments.
- FIG. 5 is a photograph of a fixed tissue sample treated with pure glycerol.
- FIG. 6 is a photograph of a fixed tissue sample treated with pure 1 ,2 propanediol, according to embodiments.
- FIG. 7 is a photograph of a fixed tissue sample treated with a solution of 1 ,2 propanediol and glycerol, according to embodiments.
- FIG. 8 is a photograph of a fixed tissue sample treated with a solution of 1 ,4 butanediol and glycerol, according to embodiments.
- FIGS. 9A and 9B are photographs showing opposite sides of a heart valve made of fixed tissue treated with pure glycerol.
- FIGS. 10A and 10B are photographs showing opposite sides of a heart valve made of fixed tissue treated with pure 1 ,2 propanediol, according to embodiments.
- FIGS. 1 1A and 1 1 B are photographs showing opposite sides of a heart valve made of fixed tissue treated with a solution of 1 ,2 propanediol and glycerol, according to embodiments.
- crosslinking or "fixing" of the extracellular matrix improves the strength and biological durability of the tissue.
- Aldehyde based processes are a typical example of this approach. Aldehyde based processes are also used to provide chemical sterilization to the bioprosthesis. Applied to a decellularized tissue or to a material obtained via tissue engineering, these crosslinking/sterilization methods reduce the ability of the tissue to remodel. In some applications, crosslinking or "fixing" of the extracellular matrix improves the strength and biological durability of the tissue, but the use of the crosslinking agent usually destroys the potential for the patient's body to favorably remodel the tissue.
- Remodeling refers to the action by the host body to replace some or all of the extracellular matrix of the implanted tissue, with new tissue produced by host cells of the patient's body repopulating the implanted tissue.
- the extracellular matrix acts as a scaffold to guide the growth of the new tissue.
- a tissue engineered heart valve implanted within a child may be remodeled and grow with the child, reducing the need to replace the heart valve as the child grows.
- Fixed (i.e., crosslinked) tissue cannot be remodeled by the body because of the structural fixation and/or cytotoxicity imparted by crosslinking the collagen of the extracellular matrix of the donor tissue.
- Embodiments of this disclosure include an implantable material including decellularized, non-fixed mammalian tissue that is sterilized and preserved sterile and dry without impairing the ability of the extracellular matrix to be remodeled.
- Other embodiments include an implantable material including decellularized mammalian tissue that has been fixed. In either case, the decellularized tissue may be made by removing the cells from mammalian tissue, such as a porcine heart valve, leaving behind the extracellular matrix.
- Other mammalian tissues may include bovine pericardium, equine pericardium or other porcine tissues such as the intestinal mucosa.
- the tissue may be made by seeding a polymeric mold with mammalian cells which grow along the polymeric mold to produce the extracellular matrix of collagen or of other structural proteins. Once completed, the cells are removed, leaving behind the extracellular matrix.
- the decellularized tissue (or polymer with attached extracellular matrix, in alternative embodiments) is treated with a solution in order to reduce the retained water in the tissue.
- the treatment solution includes one or more polyols, other than glycerol. As shown below, embodiments treated with solutions described herein are less swollen and rigid than those treated with glycerol alone.
- the one or more polyols can include at least one of 1 ,2 propanediol, 1 ,2 octanediol, 1 ,4 butanediol, fructose, xylitol, mannitol, sorbitol, lactulose, lactic acid, maltose, glucose, galactose, erythritol, lactobionic acid or its salts, and hyaluronic acid of various molecular weights and crosslinked to various degrees or not crosslinked.
- the one or more other polyols are selected from the group consisting of 1 ,2 propanediol, 1 ,4 butanediol, and lactobionic acid, or combinations thereof.
- the treatment solution may consist of about 50 volume percent (vol. %) 1 ,2 propanediol and about 50 vol. % 1 ,4 butanediol; or the treatment solution may consist of 1 ,2 propanediol and lactobionate at saturation in the solution.
- the one or more polyols consists essentially of 1 ,2 propanediol.
- the treatment solution may further include glycerol.
- glycerol is present in the treatment solution at a concentration ranging from about 1 volume percent (vol. %) to about 50 vol. %, and the one or more other polyols are present at a concentration of about 50 vol. % to about 99 vol. %.
- the treatment solution consists of 90 vol. % 1 ,2 propanediol and about 10 vol. % glycerol.
- the treatment solution consists of 85 vol. % 1 ,4 butanediol and about 15 vol. % glycerol.
- the glycerol is present in the solution at a concentration from about 20 vol. % to about 50 vol. %, and the one or more polyols are present at a concentration from about 50 vol. % to about 80 vol. %.
- the treatment solution consists of about 50 vol. % 1 ,2 propanediol and about 50 vol. % glycerol.
- the treatment solution may further include water.
- water is present in the treatment solution at concentration of about 1 vol. % to about 20 vol. %.
- the treatment solution can include glycerol ranging from about 15 vol. % to about 35 vol. %, one or more other polyols ranging from about 65 vol. % to about 85 vol. %, and the balance water.
- the treatment solution includes about 10 vol. % water, about 30 vol. % glycerol, about 60 vol. % 1 ,2 propanediol, and lactobionate at saturation in the solution.
- the treatment solution may include ethanol.
- ethanol is present in the treatment solution at concentration of about 1 vol. % to about 20 vol. %.
- the treatment solution can include glycerol ranging from about 15 vol. % to about 35 vol. %, one or more other polyols ranging from about 65 vol. % to about 85 vol. %, and the balance ethanol.
- the treatment solution includes about 10 vol. % ethanol, about 30 vol. % glycerol, about 60 vol. % 1 ,2 propanediol, and lactobionate at saturation in the solution.
- the decellularized tissue (or polymer with attached extracellular matrix, in alternative embodiments) is soaked in the treatment solution as described below. Excess treatment solution can be mechanically removed from the tissue, which helps remove the major part of the retained water.
- the tissue is stored dry and used for fabrication or manufacturing of a bioprosthesis, for example, a heart valve. The foregoing process can be applied, for example, to decellularized pericardium of a mammalian donor for use in heart valve manufacturing. The valve may then be sterilized using ethylene oxide gas, ionizing radiation, and/or ultraviolet (UV) light.
- UV ultraviolet
- Sterilization with ethylene oxide gas, ionizing radiation, or UV light does not impair remodeling because neither method induces tissue fixation. Also, these sterilization methods are more robust and less complex from an industrial perspective than traditional aldehyde based sterilization processes, that involve set up and maintenance of controlled environments, with critical operating procedures.
- the treatment solution can be applied to a bioprosthesis, for example a heart valve made of fresh decellularized tissue or of tissue produced via tissue engineering.
- a bioprosthesis for example a heart valve made of fresh decellularized tissue or of tissue produced via tissue engineering.
- the valve is soaked in the treatment solution one or more times for several hours, as described below. When removed from the treatment solution, a small amount of the treatment solution remaining in the valve is easily removed.
- Some polyols such as 1 ,2 propanediol and 1 ,4 butanediol, are less viscous than glycerol, which helps in removing them from the valve.
- the valve may be sterilized using ethylene oxide, ionizing radiation, and/or UV light and then stored dry until use.
- the treatment with the solution includes immersing the tissue in the treatment solution at a temperature ranging from about 5°C to about 35°C for a time ranging from about 2 hours to about 100 hours.
- treatment with the solution includes repeated immersions two to three times, each immersion time ranging from about 1 hour to about 20 hours.
- the treatment with the solution may include spreading the treatment solution on the tissue or spraying it on the tissue.
- the tissue and the treatment solution can be held under pressure greater than about 100 kPa to enhance movement of the treatment solution into the tissue.
- the pressure under which the tissue and the treatment solution are held during the treatment can range from about 200 kPa to about 10,000 kPa.
- the pressure under which the tissue and the treatment solution are held during the treatment can range from about 300 kPa to about 1 ,000 kPa.
- the excess treatment solution can be removed mechanically from the treated tissue by, for example, contact with an absorbent fabric.
- the treatment solution includes water
- the treatment solution may remain, for example, within interstitial spaces of the extracellular matrix.
- the treated tissue may be completely dried by exposing it to air for a time ranging from about 2 hours to about 96 hours at a temperature ranging from about 20°C to about 45°C.
- the treated tissue of the implantable material may be dried to remove substantially all of the water, so that the implantable material is substantially free of water.
- the treatment solution of one or more polyols and, optionally, glycerol remains within the interstitial spaces of the extracellular matrix, and preserves the integrity and flexibility of the implantable material without the need of storing it in a water based storage solution.
- the dried tissue can be sterilized.
- sterilizing the dried tissue may include exposing the dried tissue to ethylene oxide gas, avoiding temperatures above 50°C in order not to damage the tissue itself.
- sterilizing the dried tissue may include exposing the dried tissue to ionizing radiation, such as gamma radiation.
- sterilizing the dried tissue may include exposing the dried tissue to UV light.
- the dried tissue may be sterilized by exposure to any combination of ethylene oxide gas, ionizing radiation, and UV light. As noted above, none of these sterilization methods induces tissue fixation, so remodeling is not impaired.
- tissue is preserved in a stable, pliable state and may be stored for an extended period of time.
- the methods described herein provide an alternative to aldehydes for sterilization and storage of fixed tissue, and increase the shelf life of non-fixed tissue.
- Non-fixed tissue not treated according to the methods provided herein must be used within a few days or weeks from production or it quickly degenerates.
- tissue/devices of the present disclosure can be sterilized in its final packaging and then stored at room temperature.
- the preserved implantable material may be made ready for implanting by immersing the implantable material in a physiologic saline solution.
- the preserved implantable material may be implanted as is and the host's blood and body fluids relied upon to rehydrate the material.
- pericardium tissue was decellularized by immersion in a solution of 0.5% deoxycholate and 0.5% sodium dodecyl sulfate for 24 hours at 22°C with continuous shaking. Then the tissue was washed with phosphate buffered saline solution (PBS) for 24 hours (10 solution changes) at 22°C with continuous shaking (ref.: Cebotari, S. et al., Detergent Decellularization of Heart Valves for Tissue Engineering: Toxicological Effects of Residual Detergents on Human Endothelial Cells, Artificial Organs, 34: 206-210 (2010)). Other decellularization methods or tissue engineering techniques can be used.
- PBS phosphate buffered saline solution
- tissue sample 10 was immersed in pure glycerol for 16 hours at room temperature.
- tissue sample 20 was immersed in pure 1 ,2 propanediol for 16 hours at room temperature.
- tissue sample 30 was immersed in a solution of about 50 vol. % 1 ,2 propanediol and about 50 vol. % glycerol for 16 hours at room temperature.
- each of the three tissue samples 10, 20, and 30 were blotted on adsorbent fabric and put as a sandwich between two sheets of adsorbent polymeric fabric and gently squeezed under a press to mechanically remove excess liquid. Then the three tissue samples were dried at room temperature for 24 hours, sealed in Tyvek® pouches, and sterilized by exposure to ethylene oxide gas.
- FIGS. 1 -3 The three tissue samples after sterilization are shown in FIGS. 1 -3 for treatments A, B, and C, respectively.
- the tissue sample 10 that received treatment A was observed to be more swollen and rigid with respect to the other two samples, but was still pliable.
- the tissue sample 20 that received treatment B and the tissue sample 30 that received treatment C were perfectly pliable, soft and elastic. All the three tissue samples 10, 20, and 30 preserved their initial dimension and were soft enough to sew into a heart valve bioprosthesis. When put in physiologic saline solution they were observed to immediately recover their initial appearance.
- decellularized bovine pericardium tissue was obtained as described above in Example 1 . This tissue was then used to prepare a stented valve 40.
- valve 40 was then immersed in a solution of about 70 vol. % 1 ,2 propanediol and about 30 vol. % glycerol for 16 hours at room temperature. During immersion the valve leaflets were kept in the correct shape using soft polymer clips.
- valve 40 after sterilization is shown in FIG. 4. After sterilization, the valve 40 was observed to be perfectly pliable and in a good shape.
- patches of freshly harvested bovine pericardium tissue was washed several times in saline solution and selected to obtain suitable tissue for sewing tissue heart valves. The patches were then submitted to an initial treatment with a glutaraldehyde solution at low concentration 0.1 - 0.3% w/v for few hours at room temperature to fix the tissue.
- tissue patches, a tissue patch 50, at tissue patch 60, a tissue patch 70, and a tissue patch 80 were submitted to different treatments A, B, C, and D, respectively.
- treatment A the tissue patch 50 was immersed in pure glycerol for 16 hours at room temperature.
- treatment B the tissue patch 60 was immersed in pure 1 ,2 propanediol for 16 hours at room temperature.
- treatment C the tissue patch 70 was immersed in a solution of about 50 vol. % 1 ,2 propanediol and about 50 vol. % glycerol for 16 hours at room temperature.
- treatment D the tissue patch 80 was immersed in a solution of about 85 vol. % 1 ,4 butanediol and about 15 vol. % glycerol for 16 hours at room temperature.
- the four tissue patches 50, 60, 70 and 80 were blotted on adsorbent fabric and put as a sandwich between two sheets of adsorbent polymeric fabric and gently squeezed under a press to mechanically remove excess liquid. Then the three tissue patches were dried at room temperature for 24 hours, sealed in Tyvek® pouches, and sterilized by exposure to ethylene oxide gas.
- FIGS. 5-8 The four tissue patches 50, 60, 70, and 80 after sterilization are shown in FIGS. 5-8 for treatments A, B, C, and D, respectively.
- the tissue patches 50, 60, 70, and 80 were all observed to be soft and pliable.
- patches of freshly harvested bovine pericardium tissue was washed several times in saline solution and selected to obtain suitable tissue for sewing tissue heart valves.
- the patches were then submitted to an initial treatment with a glutaraldehyde solution at low concentration 0.1 - 0.3% w/v for few hours at room temperature to fix the tissue. These patches were then used for heart valve sewing.
- valve 90 Three different heart valves, a valve 90, a valve 100, and a valve 1 10, made from the patches were submitted to different treatments A, B, and C, respectively.
- treatment A the valve 90 was immersed in pure glycerol for 16 hours at room temperature.
- treatment B the valve 100 was immersed in pure 1 ,2 propanediol for 16 hours at room temperature.
- treatment C the valve 1 10 was immersed in a solution of about 50 vol. % 1 ,2 propanediol and about 50 vol. % glycerol for 16 hours at room temperature.
- the valve leaflets were kept in the correct shape using soft polymer clips.
- FIGS. 9A-1 1 B are photographs showing opposite sides of the valve 90 that received Treatment A.
- FIGS. 10A and 10B are photographs showing opposite sides of the valve 100 that received Treatment B.
- FIGS. 1 1A and 1 1 B are photographs showing opposite sides of the valve 1 10 that received Treatment C.
- the valves 90, 100, and 1 10 were observed to be perfectly pliable and in a good shape.
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Abstract
An implantable material includes decellularized, sterilized mammalian tissue having an extracellular matrix, wherein a plurality of interstitial spaces of the extracellular matrix include a solution of one or more polyols other than glycerol and, optionally, glycerol.
Description
IMPLANTABLE MATERIAL AND METHOD FOR PRESERVING
TECHNICAL FIELD
[0001] The present invention relates to implantable materials. More specifically, the invention relates to decellularized implantable materials or tissue engineered implantable materials and methods for producing and preserving such implantable materials.
BACKGROUND
[0002] Biological prostheses are medical devices that use mammalian donor tissues. Examples of suitable mammalian tissues include, for example, bovine, porcine, ovine, equine, and human tissues. Depending on the various medical uses of a biological prosthesis, the donor tissue may include, for example, cardiac valves, pericardium, tendons, ligaments, dura mater, skin, and veins.
[0003] Currently, tissues used in biological prostheses, especially cardiac valves, undergo a series of chemical treatments in order to give biological and mechanical stability to the tissue itself and to sterilize the final device that incorporates the tissue. These chemical treatments typically involve aldehydes able to crosslink the tissue to alter its mechanical properties, reduce in vivo enzymatic digestion and immune response after implant and, in combination with other chemicals, to sterilize the device. Aldehyde treatments result in a stable device that is resistant to remodeling or degradation by the patient's body after implant. This stability in general is seen as an advantage, but for certain advanced applications it represents a drawback. For example, a biological heart valve implanted within a child able to be remodeled and grow with the child may reduce the need to replace the heart valve as the child grows. Recent technical development in tissue engineering and in native tissue decellularization are devoted to producing new tissues that are not fixed so that the recipient organism can remodel donor tissue in some way, by repopulating it with the recipient's own cells.
[0004] Despite the significant improvements provided with these innovative techniques, a number of critical issues remain. For example, in the case of decellularized tissue, before use in a biological prosthesis, the donor tissues are
subjected to numerous washing steps and mechanical action to remove donor cells. However, even after such decellularization processes, some cells or cellular residues may remain trapped within the tissue. After a biological prosthesis incorporating the tissue is implanted in the patient, any remaining cells may cause an immune response that can lead to the degradation or destruction of the prosthesis. Other relevant issues to be taken into account are how to insure sterility and how to store the bioprosthesis. Thus, it is important to address these issues, but without the use of aldehydes-based sterilization processes that would destroy their potential to remodel in vivo.
SUMMARY
[0005] Example 1 is an implantable material including decellularized sterilized mammalian tissue having an extracellular matrix, wherein a plurality of interstitial spaces of the extracellular matrix include a solution of one or more polyols other than glycerol and, optionally, glycerol.
[0006] In Example 2, the implantable material of Example 1 , wherein the glycerol is present in an amount of about 1 vol. % to about 50 vol. % of the mixture and the one or more polyols other than glycerol are present in an amount of about 50 vol. % to about 99 vol. % of the mixture.
[0007] In Example 3, the implantable material of either of Examples 1 or 2, wherein the solution in the plurality of interstitial spaces of the extracellular matrix consists essentially of the one or more polyols other than glycerol and glycerol.
[0008] In Example 4, the implantable material of any of Examples 1 -3, wherein the one or more polyols other than glycerol includes at least one of 1 ,2 propanediol, 1 ,2 octanediol, 1 ,4 butanediol, fructose, xylitol, mannitol, sorbitol, lactulose, lactic acid, maltose, glucose, galactose, erythritol, lactobionic acid or its salts, and hyaluronic acid.
[0009] In Example 5, the implantable material of any of Examples 1 -4, wherein the one or more polyols other than glycerol are selected from the group consisting of 1 ,2 propanediol, 1 ,4 butanediol, lactobionic acid and its salts, and combinations thereof.
[0010] In Example 6, the implantable material of any of Examples 1 -5, wherein the one or more polyols other than glycerol consists essentially 1 ,2 propanediol.
[0011] In Example 7, the implantable material of any of Examples 1 -6, wherein the implantable material is substantially free of water.
[0012] In Example 8, the implantable material of any of Examples 1 -6, wherein the implantable material is non-fixed.
[0013] In Example 9, the implantable material of any of Examples 1 -8, wherein the implantable material forms a portion of an engineered heart valve.
[0014] Example 10 is method for making an implantable material. The method includes decellularizing mammalian tissue, treating the decellularized mammalian tissue with a solution; drying the treated tissue, and sterilizing the dried tissue. The treatment solution includes one or more polyols other than glycerol, glycerol and, optionally, water.
[0015] In Example 1 1 , the method of Example 10, wherein the solution includes the glycerol at a concentration from about 15 vol. % to about 35 vol. %, the one or more polyols other than glycerol at a concentration of about 65 vol. % to about 85 vol. % of the solution, and the balance water.
[0016] In Example 12, the method of either of Examples 10 or 1 1 , wherein the solution consists essentially of the one or more polyols other than glycerol, glycerol, and, optionally, water.
[0017] In Example 13, the method of any of Examples 10-12, wherein sterilizing includes at least one of exposing the dried tissue to ethylene oxide gas, exposing the dried tissue to ionizing radiation, and exposing the dried tissue to ultraviolet light.
[0018] In Example 14, the method of any of Examples 10-13, wherein drying the treated tissue includes drying until substantially all water is removed from the treated tissue.
[0019] In Example 15, the method of any of Examples 10-14, wherein treating the tissue includes immersing the tissue in the solution.
[0020] In Example 16, the method of Example 15, wherein the tissue is immersed in the solution for a time ranging from 2 to 100 hours and at a temperature ranging from 5°C to 35°C.
[0021] In Example 17, the method of either of Examples 15 or 16, wherein the tissue is immersed in the solution more than once.
[0022] In Example 18, the method of Examples 10-14, wherein treating the tissue includes one of spraying the solution on the tissue and spreading the solution on the tissue.
[0023] In Example 19, the method of any of Examples 10-18, wherein the one or more polyols other than glycerol includes at least one of 1 ,2 propanediol, 1 ,2 octanediol, 1 ,4 butanediol, fructose, xylitol, mannitol, sorbitol, lactulose, lactic acid, maltose, glucose, galactose, erythritol, lactobionic acid or its salts, and hyaluronic acid.
[0024] In Example 20, the method of any of Examples 10-19, wherein the one or more polyols other than glycerol are selected from the group consisting of 1 ,2 propanediol, 1 ,4 butanediol, lactobionic acid, and combinations thereof.
[0025] In Example 21 , the method of any of Examples 10-20, wherein solution includes the glycerol at a concentration from about 15 vol. % to about 35 vol. %, the one or more polyols other than glycerol at a concentration of about 65 vol. % to about 85 vol. % of the solution, and the balance ethanol.
[0026] In Example 22, the method of any of Examples 10-21 , wherein the tissue is not treated with a fixing agent.
[0027] Example 23 is a preserved tissue engineered heart valve including decellularized, non-fixed, sterilized mammalian tissue having an extracellular matrix, wherein a plurality of interstitial spaces of the extracellular matrix includes a solution consisting essentially of one or more polyols other than glycerol and glycerol, wherein the glycerol is no more than 50 vol. % of the solution.
[0028] While multiple embodiments are disclosed, still other embodiments of the present invention will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative embodiments of the invention. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not restrictive.
BRIEF DESCRIPTION OF THE DRAWINGS
[0029] FIG. 1 is a photograph of a non-fixed decellularized tissue sample treated with pure glycerol.
[0030] FIG. 2 is a photograph of a non-fixed decellularized tissue sample treated with pure 1 ,2 propanediol, according to embodiments.
[0031] FIG. 3 is a photograph of a non-fixed decellularized tissue sample treated with a solution of 1 ,2 propanediol and glycerol, according to embodiments.
[0032] FIG. 4 is a photograph of a stented valve made of non-fixed decellularized pericardium and treated with a solution of 1 ,2 propanediol and glycerol, according to embodiments.
[0033] FIG. 5 is a photograph of a fixed tissue sample treated with pure glycerol.
[0034] FIG. 6 is a photograph of a fixed tissue sample treated with pure 1 ,2 propanediol, according to embodiments.
[0035] FIG. 7 is a photograph of a fixed tissue sample treated with a solution of 1 ,2 propanediol and glycerol, according to embodiments.
[0036] FIG. 8 is a photograph of a fixed tissue sample treated with a solution of 1 ,4 butanediol and glycerol, according to embodiments.
[0037] FIGS. 9A and 9B are photographs showing opposite sides of a heart valve made of fixed tissue treated with pure glycerol.
[0038] FIGS. 10A and 10B are photographs showing opposite sides of a heart valve made of fixed tissue treated with pure 1 ,2 propanediol, according to embodiments.
[0039] FIGS. 1 1A and 1 1 B are photographs showing opposite sides of a heart valve made of fixed tissue treated with a solution of 1 ,2 propanediol and glycerol, according to embodiments.
[0040] While the invention is amenable to various modifications and alternative forms, specific embodiments have been shown by way of example in the drawings and are described in detail below. The intention, however, is not to limit the invention to the particular embodiments described. On the contrary, the invention is intended to cover all modifications, equivalents, and alternatives falling within the scope of the invention as defined by the appended claims.
DETAILED DESCRIPTION
[0041] Many processes and chemicals employed to treat tissue for a bioprosthesis result in crosslinking of the extracellular collagen matrix within the tissue.
Crosslinking or "fixing" of the extracellular matrix improves the strength and biological durability of the tissue. Aldehyde based processes are a typical example of this approach. Aldehyde based processes are also used to provide chemical sterilization to the bioprosthesis. Applied to a decellularized tissue or to a material obtained via tissue engineering, these crosslinking/sterilization methods reduce the ability of the tissue to remodel. In some applications, crosslinking or "fixing" of the extracellular matrix improves the strength and biological durability of the tissue, but the use of the crosslinking agent usually destroys the potential for the patient's body to favorably remodel the tissue.
[0042] However, in some applications, such as tissue engineering, it is desirable for the implanted biological prosthesis to be remodeled by the host's body. Remodeling refers to the action by the host body to replace some or all of the extracellular matrix of the implanted tissue, with new tissue produced by host cells of the patient's body repopulating the implanted tissue. In tissue engineering, the extracellular matrix acts as a scaffold to guide the growth of the new tissue. For example, a tissue engineered heart valve implanted within a child may be remodeled and grow with the child, reducing the need to replace the heart valve as the child grows. Fixed (i.e., crosslinked) tissue cannot be remodeled by the body because of the structural fixation and/or cytotoxicity imparted by crosslinking the collagen of the extracellular matrix of the donor tissue.
[0043] Embodiments of this disclosure include an implantable material including decellularized, non-fixed mammalian tissue that is sterilized and preserved sterile and dry without impairing the ability of the extracellular matrix to be remodeled. Other embodiments include an implantable material including decellularized mammalian tissue that has been fixed. In either case, the decellularized tissue may be made by removing the cells from mammalian tissue, such as a porcine heart valve, leaving behind the extracellular matrix. Other mammalian tissues may include bovine pericardium, equine pericardium or other porcine tissues such as the intestinal mucosa. Alternatively, the tissue may be made by seeding a polymeric mold with mammalian cells which grow along the polymeric mold to produce the extracellular matrix of collagen or of other structural proteins. Once completed, the cells are removed, leaving behind the extracellular matrix.
[0044] After decellularization, the decellularized tissue (or polymer with attached extracellular matrix, in alternative embodiments) is treated with a solution in order to reduce the retained water in the tissue. In some embodiments, the treatment solution includes one or more polyols, other than glycerol. As shown below, embodiments treated with solutions described herein are less swollen and rigid than those treated with glycerol alone. In some embodiments, the one or more polyols can include at least one of 1 ,2 propanediol, 1 ,2 octanediol, 1 ,4 butanediol, fructose, xylitol, mannitol, sorbitol, lactulose, lactic acid, maltose, glucose, galactose, erythritol, lactobionic acid or its salts, and hyaluronic acid of various molecular weights and crosslinked to various degrees or not crosslinked. In some embodiments, the one or more other polyols are selected from the group consisting of 1 ,2 propanediol, 1 ,4 butanediol, and lactobionic acid, or combinations thereof. For example, the treatment solution may consist of about 50 volume percent (vol. %) 1 ,2 propanediol and about 50 vol. % 1 ,4 butanediol; or the treatment solution may consist of 1 ,2 propanediol and lactobionate at saturation in the solution. In some embodiments, the one or more polyols consists essentially of 1 ,2 propanediol.
[0045] In some embodiments, the treatment solution may further include glycerol. In some embodiments, glycerol is present in the treatment solution at a concentration ranging from about 1 volume percent (vol. %) to about 50 vol. %, and the one or more other polyols are present at a concentration of about 50 vol. % to about 99 vol. %. For example, in one embodiment, the treatment solution consists of 90 vol. % 1 ,2 propanediol and about 10 vol. % glycerol. In another embodiment, the treatment solution consists of 85 vol. % 1 ,4 butanediol and about 15 vol. % glycerol. In other embodiments, the glycerol is present in the solution at a concentration from about 20 vol. % to about 50 vol. %, and the one or more polyols are present at a concentration from about 50 vol. % to about 80 vol. %. For example, in one embodiment, the treatment solution consists of about 50 vol. % 1 ,2 propanediol and about 50 vol. % glycerol.
[0046] In some embodiments, the treatment solution may further include water. In some embodiments, water is present in the treatment solution at concentration of about 1 vol. % to about 20 vol. %. In some embodiments, the treatment solution can
include glycerol ranging from about 15 vol. % to about 35 vol. %, one or more other polyols ranging from about 65 vol. % to about 85 vol. %, and the balance water. For example, in one embodiment, the treatment solution includes about 10 vol. % water, about 30 vol. % glycerol, about 60 vol. % 1 ,2 propanediol, and lactobionate at saturation in the solution.
[0047] In some embodiments, the treatment solution may include ethanol. In some embodiments, ethanol is present in the treatment solution at concentration of about 1 vol. % to about 20 vol. %. In some embodiments, the treatment solution can include glycerol ranging from about 15 vol. % to about 35 vol. %, one or more other polyols ranging from about 65 vol. % to about 85 vol. %, and the balance ethanol. For example, in one embodiment, the treatment solution includes about 10 vol. % ethanol, about 30 vol. % glycerol, about 60 vol. % 1 ,2 propanediol, and lactobionate at saturation in the solution.
[0048] In some embodiments, the decellularized tissue (or polymer with attached extracellular matrix, in alternative embodiments) is soaked in the treatment solution as described below. Excess treatment solution can be mechanically removed from the tissue, which helps remove the major part of the retained water. In some embodiments, the tissue is stored dry and used for fabrication or manufacturing of a bioprosthesis, for example, a heart valve. The foregoing process can be applied, for example, to decellularized pericardium of a mammalian donor for use in heart valve manufacturing. The valve may then be sterilized using ethylene oxide gas, ionizing radiation, and/or ultraviolet (UV) light.
[0049] Sterilization with ethylene oxide gas, ionizing radiation, or UV light does not impair remodeling because neither method induces tissue fixation. Also, these sterilization methods are more robust and less complex from an industrial perspective than traditional aldehyde based sterilization processes, that involve set up and maintenance of controlled environments, with critical operating procedures.
[0050] Alternatively, the treatment solution can be applied to a bioprosthesis, for example a heart valve made of fresh decellularized tissue or of tissue produced via tissue engineering. In some embodiments, the valve is soaked in the treatment solution one or more times for several hours, as described below. When removed from the
treatment solution, a small amount of the treatment solution remaining in the valve is easily removed. Some polyols, such as 1 ,2 propanediol and 1 ,4 butanediol, are less viscous than glycerol, which helps in removing them from the valve. The valve may be sterilized using ethylene oxide, ionizing radiation, and/or UV light and then stored dry until use.
[0051] In some embodiments, the treatment with the solution includes immersing the tissue in the treatment solution at a temperature ranging from about 5°C to about 35°C for a time ranging from about 2 hours to about 100 hours. In other embodiments, treatment with the solution includes repeated immersions two to three times, each immersion time ranging from about 1 hour to about 20 hours. In other embodiments, the treatment with the solution may include spreading the treatment solution on the tissue or spraying it on the tissue.
[0052] In some embodiments, during the treatment with the solution, the tissue and the treatment solution can be held under pressure greater than about 100 kPa to enhance movement of the treatment solution into the tissue. In some embodiments, the pressure under which the tissue and the treatment solution are held during the treatment can range from about 200 kPa to about 10,000 kPa. In some embodiments, the pressure under which the tissue and the treatment solution are held during the treatment can range from about 300 kPa to about 1 ,000 kPa.
[0053] After treatment with the treatment solution, the excess treatment solution can be removed mechanically from the treated tissue by, for example, contact with an absorbent fabric. In embodiments in which the treatment solution includes water, this results in reduced water content in the treated tissue. The treatment solution may remain, for example, within interstitial spaces of the extracellular matrix. The treated tissue may be completely dried by exposing it to air for a time ranging from about 2 hours to about 96 hours at a temperature ranging from about 20°C to about 45°C. In some embodiments, the treated tissue of the implantable material may be dried to remove substantially all of the water, so that the implantable material is substantially free of water. The treatment solution of one or more polyols and, optionally, glycerol, remains within the interstitial spaces of the extracellular matrix, and preserves the
integrity and flexibility of the implantable material without the need of storing it in a water based storage solution.
[0054] After drying, the dried tissue can be sterilized. In some embodiments, sterilizing the dried tissue may include exposing the dried tissue to ethylene oxide gas, avoiding temperatures above 50°C in order not to damage the tissue itself. In some embodiments, sterilizing the dried tissue may include exposing the dried tissue to ionizing radiation, such as gamma radiation. In some embodiments, sterilizing the dried tissue may include exposing the dried tissue to UV light. In some embodiments, the dried tissue may be sterilized by exposure to any combination of ethylene oxide gas, ionizing radiation, and UV light. As noted above, none of these sterilization methods induces tissue fixation, so remodeling is not impaired.
[0055] Once sterilized, the decellularized or tissue engineered, tissue is preserved in a stable, pliable state and may be stored for an extended period of time. The methods described herein provide an alternative to aldehydes for sterilization and storage of fixed tissue, and increase the shelf life of non-fixed tissue. Non-fixed tissue not treated according to the methods provided herein must be used within a few days or weeks from production or it quickly degenerates. Advantageously, tissue/devices of the present disclosure can be sterilized in its final packaging and then stored at room temperature. By allowing non-chemical sterilization (e.g., ethylene oxide gas, ionizing radiation, and/or UV light), methods of the present disclosure provide tissue and/or bioprostheses that may be stored for long time periods in a simplified way. The preserved implantable material may be made ready for implanting by immersing the implantable material in a physiologic saline solution. Alternatively, the preserved implantable material may be implanted as is and the host's blood and body fluids relied upon to rehydrate the material.
EXAMPLES
[0056] The present invention is more particularly described in the following examples that are intended as illustrations only, since numerous modifications and variations within the scope of the present invention will be apparent to those of skill in the art. Unless otherwise noted, all parts, percentages, and ratios reported in the
following examples are on a weight bases, and all reagents used in the examples were obtained, or are available, from the chemical suppliers, or may be synthesized by conventional techniques.
Example 1
[0057] In one example, freshly harvested bovine pericardium tissue was decellularized by immersion in a solution of 0.5% deoxycholate and 0.5% sodium dodecyl sulfate for 24 hours at 22°C with continuous shaking. Then the tissue was washed with phosphate buffered saline solution (PBS) for 24 hours (10 solution changes) at 22°C with continuous shaking (ref.: Cebotari, S. et al., Detergent Decellularization of Heart Valves for Tissue Engineering: Toxicological Effects of Residual Detergents on Human Endothelial Cells, Artificial Organs, 34: 206-210 (2010)). Other decellularization methods or tissue engineering techniques can be used.
[0058] Samples of the decellularized tissue, a tissue sample 10, a tissue sample 20, and a tissue sample 30, were submitted to different treatments A, B, and C, respectively. In treatment A, the tissue sample 10 was immersed in pure glycerol for 16 hours at room temperature. In treatment B, the tissue sample 20 was immersed in pure 1 ,2 propanediol for 16 hours at room temperature. In treatment C, the tissue sample 30 was immersed in a solution of about 50 vol. % 1 ,2 propanediol and about 50 vol. % glycerol for 16 hours at room temperature.
[0059] At the end of the immersion time, each of the three tissue samples 10, 20, and 30 were blotted on adsorbent fabric and put as a sandwich between two sheets of adsorbent polymeric fabric and gently squeezed under a press to mechanically remove excess liquid. Then the three tissue samples were dried at room temperature for 24 hours, sealed in Tyvek® pouches, and sterilized by exposure to ethylene oxide gas.
[0060] The three tissue samples after sterilization are shown in FIGS. 1 -3 for treatments A, B, and C, respectively. The tissue sample 10 that received treatment A was observed to be more swollen and rigid with respect to the other two samples, but was still pliable. The tissue sample 20 that received treatment B and the tissue sample 30 that received treatment C were perfectly pliable, soft and elastic. All the three tissue samples 10, 20, and 30 preserved their initial dimension and were soft enough to sew
into a heart valve bioprosthesis. When put in physiologic saline solution they were observed to immediately recover their initial appearance.
Example 2
[0061] In another example, decellularized bovine pericardium tissue was obtained as described above in Example 1 . This tissue was then used to prepare a stented valve 40.
[0062] The valve 40 was then immersed in a solution of about 70 vol. % 1 ,2 propanediol and about 30 vol. % glycerol for 16 hours at room temperature. During immersion the valve leaflets were kept in the correct shape using soft polymer clips.
[0063] At the end of the immersion the excess of polyols mixture was removed by a smooth spatula and gently blotted with polymeric fabric to mechanically remove excess liquid. The valve 40 was left to dry in an oven at about 35°C for 3 days and then was sterilized by exposure to ethylene oxide gas.
[0064] The valve 40 after sterilization is shown in FIG. 4. After sterilization, the valve 40 was observed to be perfectly pliable and in a good shape.
Example 3
[0065] In another example, patches of freshly harvested bovine pericardium tissue was washed several times in saline solution and selected to obtain suitable tissue for sewing tissue heart valves. The patches were then submitted to an initial treatment with a glutaraldehyde solution at low concentration 0.1 - 0.3% w/v for few hours at room temperature to fix the tissue.
[0066] The tissue patches, a tissue patch 50, at tissue patch 60, a tissue patch 70, and a tissue patch 80, were submitted to different treatments A, B, C, and D, respectively. In treatment A, the tissue patch 50 was immersed in pure glycerol for 16 hours at room temperature. In treatment B, the tissue patch 60 was immersed in pure 1 ,2 propanediol for 16 hours at room temperature. In treatment C, the tissue patch 70 was immersed in a solution of about 50 vol. % 1 ,2 propanediol and about 50 vol. % glycerol for 16 hours at room temperature. In treatment D, the tissue patch 80 was
immersed in a solution of about 85 vol. % 1 ,4 butanediol and about 15 vol. % glycerol for 16 hours at room temperature.
[0067] At the end of the immersion time, the four tissue patches 50, 60, 70 and 80 were blotted on adsorbent fabric and put as a sandwich between two sheets of adsorbent polymeric fabric and gently squeezed under a press to mechanically remove excess liquid. Then the three tissue patches were dried at room temperature for 24 hours, sealed in Tyvek® pouches, and sterilized by exposure to ethylene oxide gas.
[0068] The four tissue patches 50, 60, 70, and 80 after sterilization are shown in FIGS. 5-8 for treatments A, B, C, and D, respectively. The tissue patches 50, 60, 70, and 80 were all observed to be soft and pliable.
Example 4
[0069] In another example, patches of freshly harvested bovine pericardium tissue was washed several times in saline solution and selected to obtain suitable tissue for sewing tissue heart valves. The patches were then submitted to an initial treatment with a glutaraldehyde solution at low concentration 0.1 - 0.3% w/v for few hours at room temperature to fix the tissue. These patches were then used for heart valve sewing.
[0070] Three different heart valves, a valve 90, a valve 100, and a valve 1 10, made from the patches were submitted to different treatments A, B, and C, respectively. In treatment A, the valve 90 was immersed in pure glycerol for 16 hours at room temperature. In treatment B, the valve 100 was immersed in pure 1 ,2 propanediol for 16 hours at room temperature. In treatment C, the valve 1 10 was immersed in a solution of about 50 vol. % 1 ,2 propanediol and about 50 vol. % glycerol for 16 hours at room temperature. During immersion the valve leaflets were kept in the correct shape using soft polymer clips.
[0071] At the end of the immersion the excess of polyols mixture was removed from each of the valves 90, 100, and 1 10 by a smooth spatula and gently blotted with polymeric fabric to mechanically remove excess liquid. The valves were left to dry in an oven at about 35°C for 3 days and then were sterilized by exposure to ethylene oxide gas.
[0072] The heart valves 90, 100, and 1 10 after sterilization are shown in FIGS. 9A-1 1 B. FIGS. 9A and 9B are photographs showing opposite sides of the valve 90 that received Treatment A. FIGS. 10A and 10B are photographs showing opposite sides of the valve 100 that received Treatment B. FIGS. 1 1A and 1 1 B are photographs showing opposite sides of the valve 1 10 that received Treatment C. After sterilization, the valves 90, 100, and 1 10 were observed to be perfectly pliable and in a good shape.
[0073] Various modifications and additions can be made to the exemplary embodiments discussed without departing from the scope of the present invention. For example, while the embodiments described above refer to particular features, the scope of this invention also includes embodiments having different combinations of features and embodiments that do not include all of the described features. Accordingly, the scope of the present invention is intended to embrace all such alternatives, modifications, and variations as falling within the scope of the claims, together with all equivalents thereof.
Claims
1. An implantable material comprising: decellularized sterilized mammalian tissue having an extracellular matrix,
wherein a plurality of interstitial spaces of the extracellular matrix include a solution of one or more polyols other than glycerol and, optionally, glycerol.
2. The implantable material of claim 1 , wherein the glycerol is present in an amount of about 1 vol. % to about 50 vol. % of the mixture and the one or more polyols other than glycerol are present in an amount of about 50 vol. % to about 99 vol. % of the mixture.
3. The implantable material of claim 2, wherein the solution in the plurality of interstitial spaces of the extracellular matrix consists essentially of the one or more polyols other than glycerol and glycerol.
4. The implantable material of claim 1 , wherein the one or more polyols other than glycerol includes at least one of 1 ,2 propanediol, 1 ,2 octanediol, 1 ,4 butanediol, fructose, xylitol, mannitol, sorbitol, lactulose, lactic acid, maltose, glucose, galactose, erythritol, lactobionic acid or its salts, and hyaluronic acid.
5. The implantable material of claim 1 , wherein the one or more polyols other than glycerol are selected from the group consisting of 1 ,2 propanediol, 1 ,4 butanediol, lactobionic acid and its salts, and combinations thereof.
6. The implantable material of claim 1 , wherein the one or more polyols other than glycerol consists essentially 1 ,2 propanediol.
7. The implantable material of claim 1 , wherein the implantable material is substantially free of water.
8. The implantable material of claim 1 , wherein the implantable material is non- fixed.
9. The implantable material of claim 1 , wherein the implantable material forms a portion of an engineered heart valve.
10. A method for making an implantable material, the method comprising:
decellularizing mammalian tissue;
treating the decellularized mammalian tissue with a solution including one or more polyols other than glycerol, glycerol and, optionally, water;
drying the treated tissue; and
sterilizing the dried tissue.
1 1 . The method of claim 10, wherein the solution includes the glycerol at a concentration from about 15 vol. % to about 35 vol. %, the one or more polyols other than glycerol at a concentration of about 65 vol. % to about 85 vol. % of the solution, and the balance water.
12. The method of claim 10, wherein the solution consists essentially of the one or more polyols other than glycerol, glycerol, and, optionally, water.
13. The method of claim 10, wherein sterilizing includes at least one of: exposing the dried tissue to ethylene oxide gas; exposing the dried tissue to ionizing radiation; and exposing the dried tissue to ultraviolet radiation.
14. The method of claim 10, wherein drying the treated tissue includes drying until substantially all water is removed from the treated tissue.
15. The method of claim 10, wherein treating the tissue includes immersing the tissue in the solution.
16. The method of claim 15, wherein the tissue is immersed in the solution for a time ranging from 2 to 100 hours and at a temperature ranging from 5°C to 35°C.
17. The method of claim 15, wherein the tissue is immersed in the solution more than once.
18. The method of claim 10, wherein treating the tissue includes one of spraying the solution on the tissue and spreading the solution on the tissue.
19. The method of claim 10, wherein the one or more polyols other than glycerol includes at least one of 1 ,2 propanediol, 1 ,2 octanediol, 1 ,4 butanediol, fructose, xylitol, mannitol, sorbitol, lactulose, lactic acid, maltose, glucose, galactose, erythritol, lactobionic acid or its salts, and hyaluronic acid.
20. The method of claim 10, wherein the one or more polyols other than glycerol are selected from the group consisting of 1 ,2 propanediol, 1 ,4 butanediol, lactobionic acid, and combinations thereof.
21 . The method of claim 10, wherein solution includes the glycerol at a concentration from about 15 vol. % to about 35 vol. %, the one or more polyols other than glycerol at a concentration of about 65 vol. % to about 85 vol. % of the solution, and the balance ethanol.
22. The method of claim 10, wherein the tissue is not treated with a fixing agent.
23. A preserved tissue engineered heart valve comprising: decellularized, non-fixed, sterilized mammalian tissue having an extracellular matrix, wherein a plurality of interstitial spaces of the extracellular matrix includes a solution consisting essentially of one or more polyols other than glycerol and glycerol, wherein the glycerol is no more than 50 vol. % of the solution.
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