WO1996002209A1 - Tissue injectable composition and method of use - Google Patents

Tissue injectable composition and method of use Download PDF

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Publication number
WO1996002209A1
WO1996002209A1 PCT/US1995/007454 US9507454W WO9602209A1 WO 1996002209 A1 WO1996002209 A1 WO 1996002209A1 US 9507454 W US9507454 W US 9507454W WO 9602209 A1 WO9602209 A1 WO 9602209A1
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WO
WIPO (PCT)
Prior art keywords
composition
particles
carbon
substrate particles
carrier
Prior art date
Application number
PCT/US1995/007454
Other languages
French (fr)
Inventor
Timothy Paul Lawin
Jeffrey Michael Williams
Original Assignee
Advanced Uroscience, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Family has litigation
First worldwide family litigation filed litigation Critical https://patents.darts-ip.com/?family=23049577&utm_source=google_patent&utm_medium=platform_link&utm_campaign=public_patent_search&patent=WO1996002209(A1) "Global patent litigation dataset” by Darts-ip is licensed under a Creative Commons Attribution 4.0 International License.
Application filed by Advanced Uroscience, Inc. filed Critical Advanced Uroscience, Inc.
Priority to AT95923819T priority Critical patent/ATE246475T1/en
Priority to EP95923819A priority patent/EP0771179B1/en
Priority to DE69531450T priority patent/DE69531450T2/en
Priority to CA002194909A priority patent/CA2194909C/en
Publication of WO1996002209A1 publication Critical patent/WO1996002209A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/0059Cosmetic or alloplastic implants
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/0004Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse
    • A61F2/0031Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra
    • A61F2/0036Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra implantable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/04Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/042Urinary bladders
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS 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
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/02Inorganic materials
    • A61L27/04Metals or alloys
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS 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
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/28Materials for coating prostheses
    • A61L27/30Inorganic materials
    • A61L27/303Carbon
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS 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
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/40Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
    • A61L27/44Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix
    • A61L27/446Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix with other specific inorganic fillers other than those covered by A61L27/443 or A61L27/46
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS 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
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/50Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389The prosthesis being coated or covered with a particular material
    • A61F2310/00574Coating or prosthesis-covering structure made of carbon, e.g. of pyrocarbon
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS 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
    • A61L2400/00Materials characterised by their function or physical properties
    • A61L2400/06Flowable or injectable implant compositions

Definitions

  • This invention relates to an injectable composition of physiologically compatible and
  • composition is formulated to be delivered into the body to a tissue site through a small-bore instrument to strengthen, bulk-up and otherwise augment the tissue site and surrounding area.
  • Urinary incontinence and vesicourethral reflux are urological disorders that have
  • U.S. Patent No's. 5,007,940; 5,158,573; and 5,116,387 to Berg disclose biocompatible compositions comprising discrete, polymeric and silicone rubber bodies injectable into urethral tissue for the purpose of treatment of urinary incontinence by tissue bulking. The most serious adverse effect that may occur
  • nonmigration is the administration of properly sized particles. If the particle is too small, it is likely to enter the microvasculature system and travel until it reaches a site of greater constriction.
  • Target organs for reposition include the lungs, liver, spleen, brain, kidney, and
  • biocompatible, nonmigratory particles that are effectively delivered to the desired tissue site in a lubricative, biocompatible fluid or gel carrier.
  • the preferred carrier shall not cause any deleterious effects at or near the site of particle delivery and will be removed from the site by
  • composition comprised of a plurality of discrete, physiologically compatible, carbon-coated particles of a pr-* etermir ⁇ ed size range and a lubricative fluid or gel in which the particles are
  • the carrier is preferably a biologically compatible solution or suspension.
  • particles range in size from 100 microns to 1,000 microns in transverse, cross-sectional dimension.
  • composition is designed to be delivered into the body through a small-bore needle
  • cannula or catheter and to a tissue site for the purpose of augmenting the tissue site and
  • su ⁇ ounding area thereby correcting a defect, filling a void or strengthening the support structures of the tissue.
  • the invention is comprised of two components.
  • the first is a plurality of carbon-coated particles ranging in size as microbeads or
  • microparticles from a minimum of 100 microns to a maximum of 1 ,000 microns.
  • the particles are subjected to a coating process in which carbon is deposited as a thin coating or film on an appropriate, paniculate substrate, thereby creating a particle that has a highly
  • Zirconium oxide has been found to be especially suitable as such a substrate.
  • other metallic substrates including but not limited to
  • the second component acts as the lubricative carrier for the carbon-coated particles
  • biologically compatible carriers include but are not limited to beta-glucan, hyaluronic acid and derivatives thereof, polyvinyl pyrrolidone or a
  • hydrogel derivative thereof dextrans or a hydrogel derivative thereof, glycerol, polyethylene glycol, succinaylated collagen, liquid collagen, and other polysaccharides or biocompatible polymers either singly or in combinations with one or more of the above-referenced solutions.
  • the preferred carrier must be capable of being formulated into a viscous fluid or into a self-
  • the carrier shall be of sufficient viscosity to provide sufficient viscosity to
  • the invention consists of an injectable composition that is a combination of a plurality
  • a lubricative fluid or gel that is preferably comprised of a biologically compatible, lubricous solution, suspension, other fluid or gel.
  • the particles comprise microbeads or microparticles of a hard, material serving as a
  • the substrate material is preferably radiopaque. Different types of carbon coating processes may be utilized, with the particulate substrate being a metallic substance
  • LTI Low temperature isotropic pyrolytic carbon
  • Pyrolytic derives from the term pyrolysis, which is a thermal decomposition of hydrocarbons to produce a carbon material. Pyrolytic carbon is produced in a process in which
  • hydrocarbons and alloying gases are decomposed in a fluidized or floating bed.
  • the hydrocarbon pyrolysis results in high carbon, low hydrogen content spheres, which deposit as solids upon the substrate in the
  • the spheres may coalesce
  • the prefened particulate material is the prefened particulate material.
  • Zirconium oxide has been found to be especially suitable as
  • Ultra-low-temperature isotropic carbon may be applied as a coating in vacuum vapor
  • Carbon can be deposited effectively utilizing ion beams generated from the disassociation of CO 2 , reactive disassociation in vacuum of a hydrocarbon as a result of a
  • Vitreous or glass carbons may also serve as the coating material. These are also possible.
  • isotropic, monolithic carbons which are formed by pyrolysis of carbonaceous preforms, during which gaseous pyrolysis products diffuse through the shape and are liberated.
  • pyrolitic LTI carbon or vitreous carbon is similar to graphite, the common form of carbon, but the alignment between hexagonal planes of atoms
  • Pyrolitic caibon is characterized by a more chaotic atomic structure
  • the coating process is applied to small substrate particles to produce final, rounded particles that have a smooth carbon-coated surface in the form of a thin, black film.
  • pyrolytic carbon renders it particularly suitable for the anticipated body tissue applications. After the carbon coating has been applied, the particles are subjected to a cleaning and sieving
  • the particles may range in size from 100 microns to 1,000 microns in average, transverse cross-sectional dimension, and a preferred size range is between 200 and
  • the substrate particles are initially milled, extruded or otherwise formed to the desired particle size, in a substantially rounded shape prior to being
  • the particles are randomly shaped and rounded, ranging
  • the sieving process is such that the minimum particle dimension will pass through a U.S. No. 18 Screen Mesh (1000 micron grid size opening) but will not pass through a U.S. No. 140 Screen Mesh (106 micron grid size). That minimum dimension will be the transverse, cross-sectional dimension on oblong or elongated particles,
  • the carrier is preferably an aqueous suspension or solution, other fluid or gel of
  • polymeric chains of B-D-glucose commonly referred to as B-glucan.
  • the glucose units are linked to each other at the 1-3, 1-4, or 1-6 positions and form polymeric chains ranging to
  • B-glucan is a naturally occurring constituent of cell walls in essentially all living
  • B-glucan when administered in experimental studies, elicits and augments host defense mechanisms including the steps required to promote healing by first intent, thereby stimulating the reparative processes in the host system. B-glucan is rapidly removed from tissue sites through macrophagic phagocytosis or by enzymatic destruction by serous
  • Aqueous solutions, suspensions, fluids, or gels of B-glucan can be produced that have
  • the viscosity can be any suitable viscosity.
  • the B-glucan has excellent lubricity, thereby creating a particle-carrier composition which is easily
  • the carrier will be of sufficient viscosity to assure that the carbon-coated particles
  • Suitable carriers include hyaluronic acid, polyvinyl pyrrolidone or a hydrogel derivative thereof, dextran or a hydrogel derivative
  • glycerol polyethylene glycol
  • succinylated collagen liquid collagen
  • emulsions such as corn oil or safflower, or other polysaccharides or biocompatible organic polymers either singly or in combination with one or more of the above-referenced solutions.
  • the above-described composition will be injected in a fluid state, e.g., as a slurry, fluid suspension or emulsion, or as a gel through a syringe needle or cannula into a fluid state, e.g., as a slurry, fluid suspension or emulsion, or as a gel through a syringe needle or cannula into a fluid state, e.g., as a slurry, fluid suspension or emulsion, or as a gel through a syringe needle or cannula into a
  • the preferred B-glucan carrier When deposited into a soft tissue site, the preferred B-glucan carrier will disperse or be destroyed as set forth above.
  • the particles are of an optimum size which will
  • the composition may be injected into the tissue of the urinary tract, wherein the selected site may be, for example, the bladder neck, the urethra or urethral
  • a syringe was utilized to contain and inject a fluid composition comprised of:
  • pyrolytic isotropic LTI carbon-coated zirconium oxide particles in a size range from 200 to 500 microns of a total mass of 400 mg suspended in;
  • B-glucan formulated as a 1 % weight by weight aqueous suspension, as the
  • test composition was administered by periurethral injection into dogs. Injections were performed such that the bulk of the bladder neck/periurethral tissue was increased but such that the urethral lumen diameter was not compromised. One or more injections of the
  • test material were administered in total volumes ranging from 1.9 to 2.5 milliliters.

Abstract

An improved biocompatible composition consisting of physiologically stable microparticles carried in a lubricative suspension, solution, other fluid or gel is presented. The composition is intended to be delivered into the body through a small-bore needle, cannula, or catheter and to a tissue site for the purpose of augmenting the tissue site and surrounding area, thereby correcting a defect, filling a void, or strengthening the support structures of the tissue. The particles are a hard, metallic substance and are carbon-coated.

Description

TISSUE INJECTABLE COMPOSITION AND MKTHOΩ OF USE
BACKGROUND OF THE INVENTION
This invention relates to an injectable composition of physiologically compatible and
appropriately sized particles carried in a lubricative, biologically compatible fluid or gel. The
composition is formulated to be delivered into the body to a tissue site through a small-bore instrument to strengthen, bulk-up and otherwise augment the tissue site and surrounding area.
The percutaneous injection of substances into tissues to augment, support, or reconfigure anatomic structure has been the subject of significant research and product
development and is well known in the art. See, for example, U.S. Patent No's. 4,803,075 and 5,204,382 to Wallace et al and 5,258,028 to Ersek et al. Procedures have been described in
the medical literature for correction of dermatological, otolaryngological problems and for
treatment of urological disorders, e.g., Walker et al., "Injectable Bioglass as a Potential Substitute for Injectable Polytetrafluoroethylene," J. Urol.. 148:645-7, 1992 and the references
cited therein.
Urinary incontinence and vesicourethral reflux are urological disorders that have
responded to treatments with augumentive materials. U.S. Patent No's. 5,007,940; 5,158,573; and 5,116,387 to Berg disclose biocompatible compositions comprising discrete, polymeric and silicone rubber bodies injectable into urethral tissue for the purpose of treatment of urinary incontinence by tissue bulking. The most serious adverse effect that may occur
from therapies of this type relates to the migration of the solid materials from the original site of placement and into repository sites in various body organs. An important factor in assuring
nonmigration is the administration of properly sized particles. If the particle is too small, it is likely to enter the microvasculature system and travel until it reaches a site of greater constriction. Target organs for reposition include the lungs, liver, spleen, brain, kidney, and
lymph nodes.
The primary focus of this invention has been directed toward the development of
biocompatible, nonmigratory particles that are effectively delivered to the desired tissue site in a lubricative, biocompatible fluid or gel carrier. The preferred carrier shall not cause any deleterious effects at or near the site of particle delivery and will be removed from the site by
normal biological or biochemical processes such as excretion or metabolic breakdown.
BRIEF SUMMARY OF THE INVENTION
In accordance with the present invention there is provided an injectable, biocompatible
composition comprised of a plurality of discrete, physiologically compatible, carbon-coated particles of a pr-* etermirιed size range and a lubricative fluid or gel in which the particles are
carried. The carrier is preferably a biologically compatible solution or suspension. The
particles range in size from 100 microns to 1,000 microns in transverse, cross-sectional dimension.
The composition is designed to be delivered into the body through a small-bore needle,
cannula, or catheter and to a tissue site for the purpose of augmenting the tissue site and
suπounding area, thereby correcting a defect, filling a void or strengthening the support structures of the tissue.
The invention is comprised of two components.
The first is a plurality of carbon-coated particles ranging in size as microbeads or
microparticles from a minimum of 100 microns to a maximum of 1 ,000 microns. The particles are subjected to a coating process in which carbon is deposited as a thin coating or film on an appropriate, paniculate substrate, thereby creating a particle that has a highly
biocompatible surface. A hard, metallic substance capable of withstanding the high temperature conditions of the coating process for low temperature isotropic (LTI), pyrolytic
carbon is the preferred paniculate material. Zirconium oxide has been found to be especially suitable as such a substrate. However, other metallic substrates, including but not limited to
medical grade (504) stainless steel, titanium and titanium alloys are also quite acceptable as the substrate material. Gold and silver, which have lower melting temperatures, may be
utilized as the paniculate substrate in the vacuum vapor deposition process for ultra low temperature isotropic carbon.
The second component acts as the lubricative carrier for the carbon-coated particles and
in the preferred embodiment is comprised of a suspension, solution, or other biologically
compatible fluid or a gel. Examples of biologically compatible carriers include but are not limited to beta-glucan, hyaluronic acid and derivatives thereof, polyvinyl pyrrolidone or a
hydrogel derivative thereof, dextrans or a hydrogel derivative thereof, glycerol, polyethylene glycol, succinaylated collagen, liquid collagen, and other polysaccharides or biocompatible polymers either singly or in combinations with one or more of the above-referenced solutions. The preferred carrier must be capable of being formulated into a viscous fluid or into a self-
supporting gel. For purposes of this invention, the carrier shall be of sufficient viscosity to
suspend the particles.
DESCRIPTION OF THE PREFERRED EMBODIMENT The invention consists of an injectable composition that is a combination of a plurality
of small, smooth-surfaced particles that are carried in a lubricative fluid or gel that is preferably comprised of a biologically compatible, lubricous solution, suspension, other fluid or gel.
The particles comprise microbeads or microparticles of a hard, material serving as a
substrate and having a thin coating or film of biocompatible, isotropic carbon deposited on
their surfaces. The substrate material is preferably radiopaque. Different types of carbon coating processes may be utilized, with the particulate substrate being a metallic substance
selected for compatibility with the coating process.
Low temperature isotropic (LTI) pyrolytic carbon is a preferred carbon coating. Pyrolytic derives from the term pyrolysis, which is a thermal decomposition of hydrocarbons to produce a carbon material. Pyrolytic carbon is produced in a process in which
hydrocarbons and alloying gases are decomposed in a fluidized or floating bed. Inert gas flow
is used to float the bed and the substrate particles. The hydrocarbon pyrolysis results in high carbon, low hydrogen content spheres, which deposit as solids upon the substrate in the
fluidized bed. As they deposit at temperatures of 1200-1500°C, the spheres may coalesce,
deform, or grow due to atom movement, resulting in a high density coating. A hard, metallic
substance capable of withstanding the high temperature conditions of the coating process is the prefened particulate material. Zirconium oxide has been found to be especially suitable as
such a substrate. However, other metallic substrates, including but not limited to medical grade stainless steel, titanium and titanium alloys and all oxide derivatives of each, are also quite acceptable as the substrate material. Ultra-low-temperature isotropic carbon may be applied as a coating in vacuum vapor
deposition processes. Carbon can be deposited effectively utilizing ion beams generated from the disassociation of CO2, reactive disassociation in vacuum of a hydrocarbon as a result of a
glow discharge, sublimation of a solid graphite source or cathode sputtering of a graphite source, as examples of such processes. Gold has been found to be suitable as a substrate
material ideal for vacuum vapor deposited carbon, however, other substrates, including but not
limited to nickel, silver, stainless steel, or titanium are also quite acceptable as the substrate
material.
Vitreous or glass carbons may also serve as the coating material. These are also
isotropic, monolithic carbons, which are formed by pyrolysis of carbonaceous preforms, during which gaseous pyrolysis products diffuse through the shape and are liberated.
The atomic structure of either pyrolitic LTI carbon or vitreous carbon is similar to graphite, the common form of carbon, but the alignment between hexagonal planes of atoms
is not as well ordered. Pyrolitic caibon is characterized by a more chaotic atomic structure
with warped hexagonal planes, missing atoms and generally a more turbostatic appearance. This results in better bonding between layer planes.
The coating process is applied to small substrate particles to produce final, rounded particles that have a smooth carbon-coated surface in the form of a thin, black film. The
resulting smooth surface on the particles enhances their passage through an injection needle, cannula or catheter and into body tissue. The high strength, resistance to breakdown or
corrosion, and durability of the carbon coating insures the effective, long term functioning of
the particles in tissue augmentation at the injection site. The established biocompatibility of
pyrolytic carbon renders it particularly suitable for the anticipated body tissue applications. After the carbon coating has been applied, the particles are subjected to a cleaning and sieving
process to remove contaminants and to separate out particles of a size less than or greater than the desired size range. The particles may range in size from 100 microns to 1,000 microns in average, transverse cross-sectional dimension, and a preferred size range is between 200 and
500 microns. That size avoids particle migration from the injection site and facilitates
injection through a small bore instrument. The substrate particles are initially milled, extruded or otherwise formed to the desired particle size, in a substantially rounded shape prior to being
subjected to the coating process. The particles are randomly shaped and rounded, ranging
from oblong to generally spherical. The sieving process is such that the minimum particle dimension will pass through a U.S. No. 18 Screen Mesh (1000 micron grid size opening) but will not pass through a U.S. No. 140 Screen Mesh (106 micron grid size). That minimum dimension will be the transverse, cross-sectional dimension on oblong or elongated particles,
with that dimension coinciding with the particle diameter on generally spherical particles.
The carrier is preferably an aqueous suspension or solution, other fluid or gel of
polymeric chains of B-D-glucose, commonly referred to as B-glucan. The glucose units are linked to each other at the 1-3, 1-4, or 1-6 positions and form polymeric chains ranging to
several thousand daltons in weight.
B-glucan is a naturally occurring constituent of cell walls in essentially all living
systems including plants, yeast, bacteria, and mammalian systems. Its effects and modulating
actions on living systems have been studied extensively (see Abel, G. , and Czop, J. K. ,
"Stimulation of Human Monocyte B-Glucan Receptors by Glucan Particles Induces Production of TNF-d and 1L-B" Int. J. Immunopharmacol.. 14(8): 1363-1373, 1992 and references
included therein). B-glucan, when administered in experimental studies, elicits and augments host defense mechanisms including the steps required to promote healing by first intent, thereby stimulating the reparative processes in the host system. B-glucan is rapidly removed from tissue sites through macrophagic phagocytosis or by enzymatic destruction by serous
enzymes. The rapid destruction or removal of B-glucan, as well as its available viscosity and
lubricous nature, makes it an optimum carrier for the particles.
Aqueous solutions, suspensions, fluids, or gels of B-glucan can be produced that have
favorable physical characteristics as a carrier for carbon-coated particles. The viscosity can
vary from a thin liquid to a firm, self-supporting gel. Irrespective of viscosity, the B-glucan has excellent lubricity, thereby creating a particle-carrier composition which is easily
administered by delivery to a predetermined body site through a small bore needle, cannula,
or catheter. The carrier will be of sufficient viscosity to assure that the carbon-coated particles
remain suspended therein. Other examples of appropriate carriers include hyaluronic acid, polyvinyl pyrrolidone or a hydrogel derivative thereof, dextran or a hydrogel derivative
thereof, glycerol, polyethylene glycol, succinylated collagen, liquid collagen, oil based
emulsions such as corn oil or safflower, or other polysaccharides or biocompatible organic polymers either singly or in combination with one or more of the above-referenced solutions.
In use, the above-described composition will be injected in a fluid state, e.g., as a slurry, fluid suspension or emulsion, or as a gel through a syringe needle or cannula into a
body tissue site. When deposited into a soft tissue site, the preferred B-glucan carrier will disperse or be destroyed as set forth above. The particles are of an optimum size which will
prevent their being carried away by capillary blood flow. They will thus remain at the site and
will serve to fill voids, provide additional support, or correct other soft-tissue defects. For
urological applications, the composition may be injected into the tissue of the urinary tract, wherein the selected site may be, for example, the bladder neck, the urethra or urethral
sphincter. The resulting bulking or augmentation of the urethral tissue will restrict the size of the urethra or urinary passage and thus assist in overcoming incontinence.
In an experimental study, a syringe was utilized to contain and inject a fluid composition comprised of:
pyrolytic isotropic LTI carbon-coated zirconium oxide particles in a size range from 200 to 500 microns of a total mass of 400 mg suspended in;
B-glucan formulated as a 1 % weight by weight aqueous suspension, as the
carrier.
The test composition was administered by periurethral injection into dogs. Injections were performed such that the bulk of the bladder neck/periurethral tissue was increased but such that the urethral lumen diameter was not compromised. One or more injections of the
test material were administered in total volumes ranging from 1.9 to 2.5 milliliters.
The study was conducted in accordance with good laboratory practices and confirmed that the handling characteristics of the test material were favorable, as the material was easily
injected with minimal to moderate resistance. No evidence of migration of the implant
material was noted.

Claims

WHAT IS CLAIMED IS:
1. An injectable, biocompatible composition for tissue augmentation comprising: a plurality of discrete particles in a carrier, wherein the particles are substrate particles with a carbon coating and have an average, transverse cross-sectional dimension
of between 100 and 1,000 microns and the carrier is a biocompatible medium having sufficient fluidity to carry and deliver the particles, and has lubricative
qualities.
2. The composition of claim 1 wherein: said carbon coating is isotropic carbon.
3. The composition of claim 2 wherein: said isotropic carbon coating is low temperature isotropic (LΗ), pyrolytic carbon.
4. The composition of claim 3 wherein:
said substrate particles are zirconium oxide.
5. The composition of claim 2 wherein: said carbon coating is vitreous carbon.
6. The composition of claim 2 wherein: said isotropic carbon coating is ultra low temperature isotropic carbon which is vapor
deposited.
7. The composition of claim 6 wherein: said substrate particles are gold or silver.
8. The composition of claim 1 wherein:
said substrate particles are zirconium oxide.
9. The composition of claim 1 wherein: said carbon coating is pyrolytic, isotropic carbon.
10. The composition of claim 1 wherein:
the carrier is a solution, suspension or gel of polysaccharides.
11. The composition of claim 10 wherein:
the polysaccharide is beta-glucan.
12. The composition of claim 1 wherein: the carrier is a solution or suspension selected from the group comprised of hyaluronic
acid, polyvinyl pynolidone or a hydrogel derivative thereof, dextran or a
hydrogel derivative thereof, glycerol, polyethylene glycol, succinylated collagen, liquid collagen, or other polysaccharides or biocompatible orgamc polymers, either singly or in combination.
13. The composition of claim 1 wherein:
said carbon coating is a smooth surface film.
14. The composition of claim 13 wherein:
said substrate particles are zirconium oxide.
15. The composition of claim 2 wherein:
said coating is a smooth surface film.
16. The composition of claim 2 wherein:
said substrate particles are of rounded shape and said dimension is between 200
microns and 500 microns.
17. The composition of claim 1 wherein: the substrate particles are radiopaque.
18. The composition of claim 1 wherein: the substrate particles are selected from the group comprising stainless steel, titanium and titanium alloys, and their oxides.
19. A method for augmenting tissue in a human patient comprising injecting into
a tissue site in the patient a composition comprising a plurality of discrete, carbon coated substrate particles having an average, transverse, cross-sectional dimension of between 100 and 1 ,000 microns in a biocompatible carrier having sufficient fluidity to carry and deliver the particles and lubricative qualities.
20. The method of claim 19 wherein the tissue site is in the urinary tract.
21. The method of claim 20 wherein the tissue site is the urinary sphincter muscle.
22. The method of claim 20 wherein the tissue site is the urethra.
23. The composition of claim 1 wherein:
said substrate particles are a metallic substance.
PCT/US1995/007454 1994-07-14 1995-06-13 Tissue injectable composition and method of use WO1996002209A1 (en)

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AT95923819T ATE246475T1 (en) 1994-07-14 1995-06-13 COMPOSITIONS INJECTABLE INTO BODY TISSUE
EP95923819A EP0771179B1 (en) 1994-07-14 1995-06-13 Tissue injectable composition
DE69531450T DE69531450T2 (en) 1994-07-14 1995-06-13 COMPOSITIONS INJECTABLE IN BODY TISSUE
CA002194909A CA2194909C (en) 1994-07-14 1995-06-13 Tissue injectable composition and method of use

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CA2194909A1 (en) 1996-02-01
EP0771179A1 (en) 1997-05-07
DE69531450T2 (en) 2004-05-06
US5451406A (en) 1995-09-19
EP0771179A4 (en) 1998-07-08
EP0771179B1 (en) 2003-08-06
CA2194909C (en) 1999-07-13
ATE246475T1 (en) 2003-08-15
DE69531450D1 (en) 2003-09-11

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