WO2000035374A1 - Method for tissue fixation - Google Patents
Method for tissue fixation Download PDFInfo
- Publication number
- WO2000035374A1 WO2000035374A1 PCT/US1999/029617 US9929617W WO0035374A1 WO 2000035374 A1 WO2000035374 A1 WO 2000035374A1 US 9929617 W US9929617 W US 9929617W WO 0035374 A1 WO0035374 A1 WO 0035374A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- epoxy compound
- tissue
- agent
- bioprosthetic tissue
- cross
- Prior art date
Links
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
- A61L27/36—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
- A61L27/3687—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 characterised by the use of chemical agents in the treatment, e.g. specific enzymes, detergents, capping agents, crosslinkers, anticalcification agents
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- 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
- A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
- A61L24/001—Use of materials characterised by their function or physical properties
-
- 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
- A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
- A61L24/04—Surgical adhesives or cements; Adhesives for colostomy devices containing macromolecular materials
- A61L24/046—Surgical adhesives or cements; Adhesives for colostomy devices containing macromolecular materials obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds
-
- 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
- A61L2400/00—Materials characterised by their function or physical properties
- A61L2400/02—Treatment of implants to prevent calcification or mineralisation in vivo
Definitions
- the present invention relates generally to tissue fixation, and m particular, to an epoxy compound and method for use m tissue fixation. 2 Description of the Prior Art
- Biological tissues such as autologous pericardium and homologous aortic valves have been used m various surgical applications because of their good mechanical properties and biocompatibility
- Biological tissue-derived, chemically-modified heterologous tissues have been provided as conduits for peripheral or coronary revascula ⁇ zation, patches, ligament substitutes, and prosthetic heart valves. It is well-known that collagen fibers constitute the fundamental structural framework of biological tissues .
- the physiochemical and biomechamcal properties of collagen matrices are directly related to the structure of the collagen fibrils.
- the collagen molecules are stabilized m the fibrils by covalent mtermolecular crosslinks, which provide the fibrillate matrices with an adequate degree of tensile strength and biostability .
- heterologous tissue After a prosthesis having heterologous tissue has been implanted m a living host environment, the biological tissue will be subject to a host response, which includes both cellular and enzymatic attack.
- phacocytes polymorphonuclear leukocytes, macrophages
- Phagocytes are known to be able to secrete collagenase and other proteases and oxygen free radicals.
- Heterologous biological tissues can be readily degraded by such proteolytic enzymes, and/or through an oxidation process, significantly reducing the strength and life span of the collagen fibrils.
- bioprostheses derived from heterologous tissues have to be chemically modified to increase their resistance to enzymatic degradation before they can be implanted into a human being for long term use. These chemical modifications include:
- Crosslinking to stabilize the collagen matrix such as enhancing the molecular interaction between collagen fibrils, elastin and other proteins; increasing tissue fatigue limit under stress; and maintaining the tissue integrity and preventing inflammatory cell infiltration;
- crosslinking and modification are preferably stable to achieve optimum long-term results.
- the extent of enzy atically catalyzed breakdown of fibrous collagen may be influenced by two factors: the availability to the enzyme of recognizable cleavage sites, and the extent of the helical integrity of the collagen. Previous works have suggested that tissue subjected to fixation and having greater crosslinking density will have a greater resistance to degradation.
- Fixation refers to the deactivation of the amino acid of a collagen by reaction with a chemical to minimize the antigenicity of the heterologous biological material and the possibility of enzymatic degradation by collagenase and other proteases. Thus, fixation would enhance the durability of the collagen.
- Two types of fixation treatment can be differentiated.
- the first type is crosslinking, in which one molecule of a fixation agent having multiple functional groups reacts with two or more groups in a collagen. After crosslinking, the mechanical properties of the tissue change.
- the second type of fixation treatment can be referred to as branching, in which the fixative reacts with a single group only, resulting in a branch produced by the reacted amino acid. In branching, the mechanical properties (e.g., flexibility) of the tissue will normally experience little change.
- Both cross-linking and branching will alter the antigenicity of the collagenous tissue if there is modification of a sufficient amount of amino acids, and if the grafting structure (i.e., branching) is large enough to change the local molecular conformation (i.e., both sequential and conformatial antigen determination sites/epitopes) .
- a higher degree of fixation of the fixed biomaterial (tissue) will generally result in lower antigenicity.
- Collagenous tissue for blood-contacting applications such as for heart valves and conduits, should also have excellent hemocompatibility . Hydrophilicity, charge, surface texture and other surface characteristics on the blood-contacting surface can significantly impact the performance and durability of the tissue when used in these applications. Some trends can be observed in relation to surface tension and hemocompatibility/ bioadhesion.
- hypothetical zone of biocompatability which surface tension ranges from 20 to 30 dynes/cm (hydrophobic surface) . This zone is the range of surface tensions that most natural arteries possess and is descriptive of relatively nonthrombogenic surfaces.
- a second zone which ranges from 33 to 38 dynes/cm and comprises the surface tensions of most commonly available polymers, which surprisingly, excludes the most commonly used polymers for vascular grafts (i.e., ePTFE and
- a third zone which ranges from 40 to 72 dynes/cm and known as the zone of "good bioadhesion" .
- This "good bioadhesion" zone would be favored by prostheses in which good ingrowth is required, such as orthopedic and dental implants.
- Critical surface tensions m the range of 20 to 30 dynes/cm, which correlate to surfaces dominant with methyl (CH-,) groups, do indicate inherent thromboresistance for implanted specimens
- Biological tissues can be chemically modified or fixed with formaldehyde (FA) or glutaraldehyde (GA) Heterologous and homologous tissues have been fixed and implanted as prostheses for over the past thirty years.
- GA has been the most common fixative. GA modifies most lysyl 1-am ⁇ no groups, forms cross-linkage between nearby structures, and t polymerizes and gains stability through Schiff base interaction. GA provides adequate modification to minimize the antigenicity of the prosthesis while making the prosthesis hydrophobic and negatively- charged on the surface for good blood interaction.
- GA has been linked to a number of prosthesis failures.
- U.S. Patent No 5,080,670 to Imamura et al discloses a number of polyglycidl ethers (sold under the trademark DENACOL by Nagasi Chemicals, Osaka, Japan) for cross-linking tissue heart valves.
- Imamura et al believe that the existence of the ether linkage (C-O) m the backbone of the fixative will allow the oxygen arm to work as a flexible joint m the cross-linking bridge, so that the cross-linked tissue can be more flexible and hydrophilic.
- Biological tissues cross-linked with polyglycidl ethers have shown great flexibility (pliability) and resistance to calcification when compared with GA fixation as used with tissue heart valves. Further, the epoxy compound is less cytotoxic than GA solutions.
- hydrophilic material has a tendency for water to attach thereto.
- more protein and cellular activation has been observed on such hydrophilic surfaces. These interactions may affect or reduce hemocompatibility of the biological tissue .
- Another possible drawback with Imamura et al . ' s approach is that ether linkages may be highly susceptible to oxidation and thereby lose their cross-linkage within a matter of days after in vivo implantation, especially under stress. See M.A. Schubert, M.J. Wiggins, M.P. Schaefer, A. Hiltner, and J.M. Anderson, "Oxidative Biodegradation Mechanisms of Biaxially Strained Poly (etherurethane urea) Elastomers", J. Biomed. Mater.
- the hydroperoxide subsequently dehydrates to form an ester, which will then hydrolyze due to esterases, leading to chain scission and resulting in the formation of carboxylic acid and alcohol groups. This is illustrated on the left side of the chain in
- autoxidation Another form of degradation (autoxidation) can take place by way of a variety of reaction paths, all involving radical mechanisms.
- the propagation reactions of this autoxidation consist of the formation and decomposition of hydroperoxide groups on the polymer backbone.
- Homolysis of the hydroperoxide leads to hydroxyl and alcoxy radicals (PO) .
- PO alcoxy radicals
- the latter can form an ester by hydrogen fragmentation or can lead to chain scission, resulting in the formation of aldehyde and ester groups.
- These reactions occur without the loss of radical activity, and the remaining radicals can continue the dehydration. Hydrolysis of the ester bonds will lead to the formation of alcohol and acid groups .
- modification to the tissue will be the same regardless of whether it is a mono- or poly-epoxide, and regardless of the type of polyglycidl ether used.
- the structure at the modification site is always either: -CH 2 -CH-COOH or -CH 2 -CH-CH 2 -OH
- the glycidyl ether is highly susceptible to oxidation at its ether linkage. Distintegrated linkage failed to protect the recognition of collagenase. Thus, the glycidyl ether did not provide the desired results.
- the present invention provides an epoxy compound that has a hydrocarbon backbone, that is water-soluble, and which does not contain an ether or ester linkage in its backbone.
- suitable epoxide agents include mono- or diepoxides that have the following basic formulas : Monoepoxide: CH 2 -CH- (CH 2 ) n -CH 3
- FIG. 1 illustrates proposed mechanisms for the in vivo degradation of polyethylene oxide.
- FIG. 2 is a flowchart illustrating a method for producing a bioprosthesis according to the present invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
- collagenous tissue refers to material which may be derived from different animals, such as mammals. Specific examples include, but are not limited to, porcine heart valves; bovine pericardium; connective tissue derived materials such as dura mater, tendons, ligaments, skin patches; arteries; veins; and the like.
- the present invention provides a cross-linking agent for use in tissue fixation of collagenous material .
- the agent is an epoxy compound that has a hydrocarbon backbone, that is water-soluble and which does not contain an ether or ester linkage in its backbone.
- suitable epoxide agents include mono- or diepoxides that have the following basic formulas: Monoepoxide: CH 2 -CH- (CH 2 ) n ⁇ CH 3
- n 1 to 10.
- a monoepoxide where n is equal to 3 is as follows: CH -CH ⁇ CH _ CH- ⁇ , -CH ⁇ - j -CH ⁇ j 0
- the cross-linking agent of the present invention can be used to fix or modify a wide variety of bioprosthetic tissues, including bovine pericardium and porcine aortic valves.
- the method of treating and preparing the bioprosthetic tissue is summarized in the flowchart of FIG. 2, and is set forth as follows .
- a collagenous tissue is harvested and processed.
- a suitable collagenous tissue such as an artery or vein, is harvested from a mammal, and excess muscle, fat and connective tissues are trimmed according to known methods.
- the collagenous tissue is cleaned and prepared in accordance with known methods.
- the blood vessel is washed inside and out with cold saline solution to remove any remaining blood.
- bioburden levels are reduced by immersing each tissue in 70% ethanol for about one hour.
- the tissues are then stored in 30% ethanol for any desired period of time.
- the cellular component is inflated. This can be done by injecting the lumen of each tissue vessel with fresh filtered water and then transferring them to a container of fresh filtered water. The tissue is then kept refrigerated for at least one hour while in the fresh filtered water prior to sonication.
- step 40 the tissue is sonicated in filtered water for a period of time sufficient to remove the cellular component. It is desirable to remove the cellular component because it has greater antigenicity. The tissue is then thoroughly washed with water.
- step 50 fixation is performed.
- the previously prepared collagenous tissue is immersed in an aqueous solution of the water-soluble epoxide cross- linking agent of the present invention at a pH of 8.5 to 10.5 for a time (e.g., 1 to 30 days) sufficient to permit irreversible cross-linking.
- the concentration of the epoxide crosslinking agent preferably ranges from 0.01 M to 1.0 M, and more preferably, is between 0.05 M to 0.5 M.
- the fixation solution is changed every two to three days .
- step 60 the collagenous tissue is removed from the fixation solution and is rinsed with a suitable rinsing solution such as phosphate buffered saline, with or without amino acid.
- step 70 final trimming and branch ligation are performed. Excess connective tissue is carefully trimmed away without damaging the vessel branches. Any tissue vessel having holes, avulsed branches, blood stains or other visual structural defects will not be used. All branches are suture-ligated using 4-0 or 5-0 Prolene suture.
- step 80 final sterilization is performed.
- the collagenous tissue is sterilized with a non-aldehyde sterilant, such as 0.1% iodine solution, and then stored in 30% ethanol solution until the tissue is to be implanted.
- a non-aldehyde sterilant such as 0.1% iodine solution
- a fresh bioprosthetic tissue such as a bovine artery
- a water-soluble polyepoxide cross-linking agent More specifically, a 1 , 2 , 7 , 8-diepoxyoctane at 0.2 M is buffered to a pH of 9.5 with carbonate-bicarbonate buffer with 5% ethanol.
- the artery is exposed to the solution for 14 days at room temperature (e.g., 25 degrees Celcius) to permit irreversible cross- linking.
- the fixation solution is changed every three days.
- a vein conduit having venous valves is incubated in an aqueous solution of a water-soluble polyepoxide cross-linking agent. More specifically, a 1 , 2-epoxyoctane at 0.2 M is buffered to a pH of 9.5 with carbonate-bicarbonate buffer with 10% ethanol. The vein is exposed to the solution for 14 days at 25 degrees Celcius to permit complete modification .
Abstract
Description
Claims
Priority Applications (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU24799/00A AU756173B2 (en) | 1998-12-15 | 1999-12-14 | Method for tissue fixation |
JP2000587696A JP2002532134A (en) | 1998-12-15 | 1999-12-14 | How to fix tissue |
CA2351216A CA2351216C (en) | 1998-12-15 | 1999-12-14 | Method for tissue fixation using epoxides |
DE69925632T DE69925632T2 (en) | 1998-12-15 | 1999-12-14 | METHOD FOR TISSUE FIXING BY MEANS OF EPOXIDES |
EP99968119A EP1139911B1 (en) | 1998-12-15 | 1999-12-14 | Method for tissue fixation using epoxides |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/212,328 US6106555A (en) | 1998-12-15 | 1998-12-15 | Method for tissue fixation |
US09/212,328 | 1998-12-15 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2000035374A1 true WO2000035374A1 (en) | 2000-06-22 |
Family
ID=22790540
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US1999/029617 WO2000035374A1 (en) | 1998-12-15 | 1999-12-14 | Method for tissue fixation |
Country Status (8)
Country | Link |
---|---|
US (2) | US6106555A (en) |
EP (1) | EP1139911B1 (en) |
JP (1) | JP2002532134A (en) |
CN (1) | CN1208030C (en) |
AU (1) | AU756173B2 (en) |
CA (1) | CA2351216C (en) |
DE (1) | DE69925632T2 (en) |
WO (1) | WO2000035374A1 (en) |
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US6214054B1 (en) | 1998-09-21 | 2001-04-10 | Edwards Lifesciences Corporation | Method for fixation of biological tissues having mitigated propensity for post-implantation calcification and thrombosis and bioprosthetic devices prepared thereby |
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- 1999-12-14 JP JP2000587696A patent/JP2002532134A/en active Pending
- 1999-12-14 DE DE69925632T patent/DE69925632T2/en not_active Expired - Lifetime
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Also Published As
Publication number | Publication date |
---|---|
EP1139911A4 (en) | 2003-07-23 |
EP1139911B1 (en) | 2005-06-01 |
DE69925632T2 (en) | 2006-05-04 |
AU756173B2 (en) | 2003-01-09 |
DE69925632D1 (en) | 2005-07-07 |
EP1139911A1 (en) | 2001-10-10 |
CN1208030C (en) | 2005-06-29 |
US6231614B1 (en) | 2001-05-15 |
AU2479900A (en) | 2000-07-03 |
CA2351216A1 (en) | 2000-06-22 |
US6106555A (en) | 2000-08-22 |
CN1330528A (en) | 2002-01-09 |
CA2351216C (en) | 2010-10-26 |
JP2002532134A (en) | 2002-10-02 |
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