JP2010503482A - 内部人工器官 - Google Patents

内部人工器官 Download PDF

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JP2010503482A
JP2010503482A JP2009528478A JP2009528478A JP2010503482A JP 2010503482 A JP2010503482 A JP 2010503482A JP 2009528478 A JP2009528478 A JP 2009528478A JP 2009528478 A JP2009528478 A JP 2009528478A JP 2010503482 A JP2010503482 A JP 2010503482A
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biodegradable
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implantable endoprosthesis
endoprosthesis
stent
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エス. スティンソン、ジョナサン
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Boston Scientific Limited
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    • 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
    • A61F2/82Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/90Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
    • A61F2/91Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes
    • 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
    • A61F2/82Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/90Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
    • A61F2/91Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes
    • A61F2/915Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
    • 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
    • A61L31/00Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
    • A61L31/02Inorganic materials
    • A61L31/022Metals 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
    • A61L31/00Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
    • A61L31/14Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L31/148Materials at least partially resorbable by the body
    • 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
    • A61F2/82Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/90Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
    • A61F2/91Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes
    • A61F2/915Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure made from perforated sheet material or tubes, e.g. perforated by laser cuts or etched holes with bands having a meander structure, adjacent bands being connected to each other
    • A61F2002/9155Adjacent bands being connected to each other
    • 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
    • A61F2210/00Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0004Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof bioabsorbable
    • 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
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0001Means for transferring electromagnetic energy to 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
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/003Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in adsorbability or resorbability, i.e. in adsorption or resorption time
    • 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
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0054Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in corrosion resistance
    • 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
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0067Means for introducing or releasing pharmaceutical products into the body
    • A61F2250/0068Means for introducing or releasing pharmaceutical products into the body the pharmaceutical product being in a reservoir

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Veterinary Medicine (AREA)
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  • Biomedical Technology (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Cardiology (AREA)
  • Transplantation (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Optics & Photonics (AREA)
  • Surgery (AREA)
  • Epidemiology (AREA)
  • Chemical & Material Sciences (AREA)
  • Inorganic Chemistry (AREA)
  • Prostheses (AREA)
  • Materials For Medical Uses (AREA)

Abstract

生体内分解性である、または生体内分解性である部分を含む、ステント等の内部人工器官を開示する。

Description

本発明は内部人工器官ならびに内部人工器官を作製および送達する方法に関する。
身体は、動脈、その他の血管およびその他の体内の管腔等の種々の通路を含む。これらの通路は、時に、閉塞または弱化する。例えば、通路は、腫瘍により閉塞する場合、プラークにより制限される場合、または動脈瘤により弱化する場合がある。こうしたことが生じた場合、通路を、医療用の内部人工器官を用いて再開または補強することができる。内部人工器官は、典型的には、体内の管腔中に留置される管状の部材である。内部人工器官の例として、ステント、被覆型ステントおよびステント内挿型人工血管(stent−graft)が挙げられる。
内部人工器官が所望の部位に輸送される間は内部人工器官を圧縮または縮小された形態で支持するカテーテルによって、内部人工器官を身体の内部に送達することができる。内部人工器官が当該の部位に到達したら、内部人工器官を、例えば、内部人工器官が管腔の壁に接触することができるように拡大する。
拡大の機構は、内部人工器官を半径方向に拡大させることを含むことができる。例えば、拡大の機構は、バルーンを担持するカテーテルを含むことができ、このカテーテルが、バルーンにより拡大可能な内部人工器官を運ぶ。バルーンを膨張させて、変形させ、拡大した内部人工器官をあらかじめ決定した位置で、管腔の壁と接触させて固定することができる。次いで、バルーンを収縮させて、カテーテルを管腔から引き抜くことができる。
米国仮特許出願第60/845,341号 米国特許第6,991,709号 米国特許出願第11/355,392号 米国特許出願第11/355,368号 米国特許第6,120,660号 米国特許第6,287,332号 米国特許出願公開第2002/0004060号 米国特許出願公開第2003/0221307号 米国特許第3,687,135号 米国特許第6,908,506号 米国特許第6,953,594号 米国特許出願公開第2005/0251249号 米国特許第6,730,699号 米国特許第6,964,817号 米国特許第6,117,592号 米国特許第5,976,454号 米国特許第5,195,969号 米国特許第5,270,086号 米国特許第6,726,712号
フェランド(Ferrando),J.Mater.Eng.,11,299(1989) ワングら(Wang et al.),Thin Solid Films,471,86−90(2005) ストローマルら(Straumal et al.),Thin Solid Films,383,224−226(2001) グレイら(Gray et al.),Journal of Alloys and Compounds,336,88−113(2002) ブラクナーおよびクツェンコ(Brukner and Kutsenko),Acta Materialia,52,4329−4335(2004) パーク(Park),Science and Technology of Advanced Materials,2,73−78(2001)
本発明の目的は改良された内部人工器官を提供することにある。
本開示は、一般に、被浸食性もしくは生体内分解性である内部人工器官、または被浸食性もしくは生体内分解性である部分を含む内部人工器官に関する。
1態様では、本開示は、第1の生体内分解性の材料を含む生体内分解性の本体を含む埋込み型の内部人工器官を特徴とする。生体内分解性の本体は、第1の生体内分解性の材料とは異なる第2の生体内分解性の材料を含む、複数の別個の相隔たる生体内分解性の領域を担持する。
実施形態では、それぞれの別個の相隔たる領域が、生体内分解性の本体の外側表面から延出する。そのような実施形態では、そこから領域が延出する生体内分解性の本体の外側表面に沿って測定した場合、すぐに隣接している領域間の長手方向の間隔は、例えば、約1.0μmと約35μmとの間であってよく、かつ/またすぐに隣接している領域間の横方向の間隔は、例えば、約1.0μmと約35μmとの間であってよい。また、そのような実施形態では、生体内分解性の本体の厚さは、例えば、約0.5mmから約5.0mmまでであってよく;それぞれの領域の厚さは、例えば、約0.01μmから約5μmまでであってよく;かつ/またはそれぞれの領域の最も外側の上端の表面は、例えば、約25μm以下の面積を有してよい。
実施形態では、それぞれの別個の相隔たる領域が、生体内分解性の本体の最も外側の表面を越えて内側に向かって延出する。そのような実施形態では、生体内分解性の本体の外側表面に沿って測定した場合、すぐに隣接している領域間の長手方向の間隔は、例えば、約1.0μmと約35μmとの間であってよく、かつ/またすぐに隣接している領域間の横方向の間隔は、例えば、約1.0μmと約35μmとの間であってよい。また、そのような実施形態では、生体内分解性の本体の厚さは、例えば、約0.5mmから約5.0mmまでであってよく;それぞれの領域の厚さは、例えば、約0.01μmから約5μmまでであってよく;かつ/またはそれぞれの領域の最も外側の上端の表面は、約25μm以下の面積を有してよい。
実施形態では、内部人工器官は、内部人工器官の周りの被覆をさらに含む。所望により、被覆は、例えば、治療剤、例として、再狭窄を阻害する治療剤を、その上および/またはその中に含むことができる。
生体内分解性の本体は、例えば、管の形態であることができる。
生体内分解性の本体は、例えば、生体内分解性の金属材料、例として、鉄、マグネシウ
ム、亜鉛、アルミニウム、カルシウムまたはそれらの合金を含むことができる。
それぞれの領域は、例えば、生体内分解性の金属材料を含むことができる。
実施形態では、生体内分解性の本体およびそれぞれの領域は、生体内分解性の金属を含む。金属が異なる場合、生体内分解性の本体およびそれぞれの領域が、一緒になってガルバニック対(galvanic couple)を画定することができる。そのような場合、ガルバニック対のための標準的な電池電位は、例えば、少なくとも+1.0Vであることができる。
埋込み型の内部人工器官は、例えば、ステント、ステント内挿型人工血管またはフィルターであってよい。
所望により、生体内分解性の本体および/または領域のうちの1つもしくは複数を、例えば、電池に電気的に接続することができる。そのような実施形態は、例えば、内部人工器官の全体的な生体内分解速度を増加させることができる。そのような実施形態では、例えば、約1μAから約250μAまでの電流を、生体内分解性の本体および/または領域のうちの1つもしくは複数ならびに電池を含む回路を通して流すことができる。
別の態様では、本開示は、生体内分解性の本体を含む埋込み型の内部人工器官を特徴とする。約25μm以下の最大寸法を有する断片が、埋込み型の内部人工器官のリンゲル液中での浸食の間に生じる。
例えば、生体内分解性の本体は、第1の生体内分解性の材料を含むことができ、第1の生体内分解性の材料とは異なる第2の生体内分解性の材料を含む、複数の別個の相隔たる生体内分解性の領域を担持することができる。
好ましくは、最大寸法は、約10μm以下、約5μm以下または約1μm以下である。
別の態様では、本開示は、生体内分解性の本体および生体内分解性の本体の周りの被覆を含む埋込み型の内部人工器官を特徴とする。被覆は、生体内分解性の本体の断片が生体内分解の間に内部人工器官から分離するのを実質的に阻止する。
実施形態では、生体内分解性の本体は、金属材料を含み、かつ/または生体内分解性の本体は、第1の生体内分解性の材料を含み、かつ生体内分解性の本体は、第1の生体内分解性の材料とは異なる第2の生体内分解性の材料を含む、複数の別個の相隔たる生体内分解性の領域を担持する。所望により、それぞれの別個の相隔たる領域が、生体内分解性の本体の外側表面から延出することができる。
実施形態では、被覆は、相隔たる領域間に配置される。
別の態様では、本開示は、埋込み型の内部人工器官を作製する方法を特徴とする。この方法は、第1の生体内分解性の材料を含む生体内分解性の本体を提供する工程と;第1の生体内分解性の材料とは異なる第2の生体内分解性の材料を含む、複数の別個の相隔たる生体内分解性の領域を形成する工程とを含む。領域を、生体内分解性の本体が生体内分解性の領域を担持するように形成する。いくつかの実施形態では、被覆を、生体内分解性の本体上に形成する。
態様および/または実施形態は、以下の利点のうちの1つまたは複数を有する場合がある。内部人工器官を、対象、例えば、ヒト対象中への埋込み後に、あらかじめ決定した様式でかつ/またはあらかじめ決定した時点で浸食するように構成することができる。例えば、浸食のあらかじめ決定した様式は、内部人工器官の内部から、内部人工器官の外部に向けてであっても、または内部人工器官の第1の末端から内部人工器官の第2の末端に向けてであってもよい。内部人工器官の多くは、生体物質と接触することが望まれるまで、
生体物質との接触から保護される部分を有する。内部人工器官は、未制御の断片化の可能性の低下を示すことができる。断片化の様式および断片の大きさを制御することができる。内部人工器官は、埋込み後に身体から取り出す必要がない場合がある。そのような内部人工器官を埋め込まれた管腔は、再狭窄の低下を示すことができる。内部人工器官は、低い血栓形成性を有することができる。内部人工器官のいくつかは、治療剤を送達するように構成することができる。内部人工器官のいくつかは、細胞の増殖を支持する表面を有する(内皮化)。
被浸食性または生体内分解性の内部人工器官、例えば、ステントは、患者、例えば、ヒトの患者中に導入した後に、相当な質量もしくは密度の減少または化学的変質を示す装置またはその一部を指す。質量の減少は、例えば、装置を形成する材料の溶解および/または装置の断片化によって生じることができる。化学的変質は、装置またはその一部を作製する材料の酸化/還元反応、加水分解反応、置換反応、電気化学的反応および/もしくは付加反応、またはその他の化学反応を含むことができる。浸食は、装置を埋め込んだ生体環境、例えば、身体自体もしくは体液との装置の化学的および/もしくは生物学的な相互作用の結果である場合があり、かつ/または浸食を、化学反応物質等の誘発性の影響もしくはエネルギーを装置に適用して反応速度を増加させることによって引き起す場合がある。例えば、装置またはその一部を、活性金属、例えば、MgもしくはCaまたはそれらの合金から形成してよく、これらの金属は、水との反応によって浸食して、対応する金属酸化物および水素ガスを発生させる(酸化還元反応)。例えば、装置またはその一部を、水による加水分解によって浸食させることができる被浸食性もしくは生体内分解性のポリマーまたは合金または被浸食性もしくは生体内分解性のポリマーのブレンドから形成することができる。浸食が、望ましい程度で、治療の利益を提供することができる時間枠内に生じる。例えば、実施形態では、装置の機能、例として、管腔の壁の支持または薬物送達が最早必要でないか、望まれない時点に達すると、装置は、相当な質量の減少を示す。特定の実施形態では、装置は、埋め込んでから1日以上、例えば、約60日以上、約180日以上、約600日以上または約1000日以下の期間の後に、約10パーセント以上、例えば、約50パーセント以上の質量の減少を示す。実施形態では、装置は、浸食工程による断片化を示す。例えば、装置のいくつかの領域が、その他の領域よりも迅速に浸食するので、断片化が生じる。より速く浸食する領域は、内部人工器官の本体およびより緩慢に浸食する領域からの断片を通してより急速に浸食することによって弱化する。より速く浸食する領域およびより緩慢に浸食する領域は、無作為であっても、またはあらかじめ画定してもよい。例えば、より速く浸食する領域を、領域を処理して領域の化学反応性を増強することによってあらかじめ画定することができる。別法として、領域を処理して、例えば、被覆を使用することによって、浸食速度を低下させることができる。実施形態では、装置の部分のみが、被浸食性を示す。例えば、外側の層または被覆が被浸食性であることができ、一方、内側の層または本体は非被浸食性である。実施形態では、内部人工器官は、非被浸食性の材料の内部に分散した被浸食性の材料から形成され、それによって、浸食後には、装置は、被浸食性の材料の浸食によって空隙率を増加させている。
浸食速度を、0.2m/秒の速度で流れるリンゲル液の流れの中に浮遊させた試験装置を用いて測定することができる。試験の間、試験装置の全ての表面を、流れに暴露させてよい。本開示の目的では、リンゲル液は、最近沸騰させた蒸留水の、1リットルあたり8.6グラムの塩化ナトリウム、0.3グラムの塩化カリウムおよび0.33グラムの塩化カルシウムを含有する溶液である。
本願明細書で使用する場合、「金属材料」は、純粋な金属、金属合金または金属複合材料を意味する。
本願明細書で言及する全ての刊行物、特許出願、特許およびその他の参照文献は、それらの全体を本願明細書に援用する。
その他の態様、特徴および利点は、説明および図面、ならびに特許請求の範囲から明らかであろう。
生体内分解性の本体の外側表面から延出する複数の別個の相隔たる生体内分解性の領域を担持する生体内分解性の本体を含むステントの送達を示す長手方向の横断面図。分解した状態のステントを示す図。 生体内分解性の本体の外側表面から延出する複数の別個の相隔たる生体内分解性の領域を担持する生体内分解性の本体を含むステントの送達を示す長手方向の横断面図。ステントの拡大を示す図。 生体内分解性の本体の外側表面から延出する複数の別個の相隔たる生体内分解性の領域を担持する生体内分解性の本体を含むステントの送達を示す長手方向の横断面図。ステントの配置を示す図。 図1Aの未拡大のステントの斜視図。 2A−2Aに沿って見た図2のステントの横断面図。 2B−2Bに沿って見た図2のステントの長手方向の横断面図。 図2のステントの1実施形態の生体内分解を示す横断面図。 図2のステントの1実施形態の生体内分解を示す横断面図。 図2のステントの1実施形態の生体内分解を示す斜視図。 図2のステントの1実施形態の生体内分解を示す斜視図。 図2のステントの1実施形態の生体内分解を示す平面図。 生体内分解性の本体の最も外側の表面を越えて内側に向かって延出する複数の別個の相隔たる生体内分解性の領域を担持する生体内分解性の本体を含むステントの代替の実施形態の斜視図。 4A−4Aに沿って見た図4のステントの横断面図。 別個の相隔たる領域間の間隔を充填する被覆を有する図2のステントの横断面図。 図5のステントの1実施形態の生体内分解を示す、一連の横断面図。 図5のステントの1実施形態の生体内分解を示す、一連の横断面図。 図5のステントの1実施形態の生体内分解を示す、一連の横断面図。 ステントの1つの製造方法を示す一連の斜視図。
図1A〜1Cおよび2〜2Bを参照すると、ステント10は、第1の生体内分解性の材料を含む管状の生体内分解性の本体11を含む。生体内分解性の本体11は、横断面が環状であり、本体11の外側表面15から外側に向かって延出する、複数の別個の相隔たる生体内分解性の領域13を担持する。示すように、それぞれの領域13は、上から見ると長方形である突出部を画定するが、領域は、その大きさのために裸眼では見ることができない場合がある。いくつかの実施形態では、領域を、光学顕微鏡または走査型電子顕微鏡を用いて、視覚化する必要がある場合がある。領域13は、第1の生体内分解性の材料とは異なる第2の生体内分解性の材料を含む。ステント10を、カテーテル14の遠位末端の付近に担持されるバルーン12の上に置き、管腔16を通して(図1A)、バルーン12およびステント10を運ぶ部分が閉塞領域18に到達するまで導く。次いで、ステント10を、バルーンを膨張させることによって半径方向に拡大させて、血管壁に対して押し付け、その結果、閉塞が押し付けられて、閉塞を囲む血管壁が、半径方向に拡大する(図1B)。次いで、圧力をバルーン12から解放し、カテーテル14を、血管から引き抜き(図1C)、拡大したステント10’を管腔16中に残留させる。
領域13を形成する材料、領域の厚さT、生体内分解性の本体11を形成する材料、
本体の厚さT、領域間の横方向の間隔S、および領域間の長手方向の間隔Sを選んで、所望の機械的な特性を、所望の生体内分解速度、生体内分解の様式および断片の大きさ、例えば、約25μ以下と共に提供する。実施形態では、断片は、大きな白血球細胞のおよその大きさ以下である、例えば、約15μm以下の最大寸法を有する。好ましい実施形態では、最大寸法は、約10μm以下、約5μm以下または約1μm以下である。
ここで図3A〜3Eも参照すると、これらの図は、本体11を、例えば、鉄で形成し、領域13を、例えば、マグネシウムで形成した図2に示したステントの1実施形態の生体内分解を示す。生体内分解の初期の段階(図3A)では、マグネシウムで形成した領域は、比較的急速に浸食し、それらの浸食速度は、本体の鉄とマグネシウムとの間のガルバニック反応によって増強される。生体内分解のこれらの初期の段階では、割れ目30が、領域の近位の本体中に出現し、領域の真下の部分32が、ガルバニック反応によって弱化する。割れ目30は、割れ目中の反応性のイオンの濃度がより高く、より速い反応速度をもたらすために、鉄の本体の浸食速度を増強すると考えられている。生体内分解が続く(図3B)と、深いくぼみ36が、鉄の本体中に形成される。くぼみの中の浸食が増強され、その結果、くぼみが、鉄の本体中に画定された開口部40となる(図3C)。開口部の大きさが広がり(図3D)、本体が、最大寸法M、例えば、15μm、10μm、5μm以下または1μm以下を有する断片45(図3E)に崩壊するのに至る(図3D)。
実施形態では、生体内分解性の本体11の外側表面15に沿って測定した場合、すぐに隣接している領域間の横方向のS間隔は、約1.0μmと約35μmとの間、例えば、約1.0μmと約20μmとの間または約2.0μmと約15μmとの間であり;すぐに隣接している領域間の長手方向の間隔Sは、約1.0μmと約35μmとの間、例えば、約1.0μmと約20μmとの間または約2.0μmと約15μmとの間である。実施形態では、それぞれの領域の最も外側の上端の表面17(図2)は、約25μm以下、例えば、約15μm以下または約5μm以下の面積を有する。実施形態では、領域13を、生体内分解性の金属材料またはセラミック材料で形成し、領域の厚さTは、例えば、約0.01μmと約10μmとの間、例えば、約0.05μmと約7.5μmとの間または約0.1μmと約5μmとの間である。実施形態では、生体内分解性の本体11を、生体内分解性の金属材料またはセラミック材料から形成し、横方向の厚さTは、例えば、約0.1mmと約2.5mmとの間、例えば、約0.25mmと約2.0mmとの間または約0.3mmと約1.5mmとの間である。
実施形態では、領域13および本体11を、実質的に異なる標準的な還元電位を有する実質的に異なる金属で形成して、異なる金属間におけるガルバニック反応を誘発する。例えば、ガルバニック対のための標準的な電池電位は、約2.00V超、例えば、1.75V、1.50V、1.00V、0.5V超であっても、または約0.25V超であってもよい。そのような場合、金属のうちの一方が、他方の金属の浸食を増強し;一方、同時に、他方の金属が、他方の金属による浸食から保護される。例えば、特定の実施形態では、本体を鉄で形成し、それぞれの領域をマグネシウムで形成する。この場合、マグネシウムの浸食は鉄によって増強され;一方、同時に、鉄の浸食は抑制される。そのようなステントの構成は、全ステントの全体的な分解時間を短縮させ、かつ/またはステントに沿って分解が始まる場所の制御を増強することができる。マグネシウムおよびマグネシウム合金の浸食は、(非特許文献1)で概説されている。所望により、生体内分解性の本体および/または領域のうちの1つもしくは複数を、電池に電気的に接続して、例えば、ステントまたはステントの一部の浸食速度を増強することができる。例えば、約1μAから約250μAまでの電流、例えば、約5μAから約175μAまでまたは約10μAから約100μAまでの電流を、生体内分解性の本体および/または領域のうちの1つもしくは複数ならびに電池を含む回路を通して流すことができる。
実施形態では、本体11を、領域13よりも遅い生体内分解速度を有する材料で形成する。例えば、本体の材料は、例えば、領域の材料の浸食速度の約50パーセント未満、約35パーセント未満、約20パーセント未満、約15パーセント未満、約10パーセント未満、約5パーセント未満、約2.5パーセント未満、または領域の材料の浸食速度の約1パーセント未満さえである速度で浸食することができる。例えば、特定の実施形態では、本体11を鉄で形成し、領域13を、例えば、生体内分解性の本体11の外側表面15上にスパッタすることによって堆積させたマグネシウムで形成する。ステントを25℃の0.2m/秒の速度で流れるリンゲル液の流れの中に浮遊させて、浸食の間に形成された断片を測定することによって、ステントを試験することができる。断片の数および大きさを、レーザー光散乱を使用して決定することができる。本開示の目的では、リンゲル液は、最近沸騰させた蒸留水の、1リットルあたり8.6グラムの塩化ナトリウム、0.3グラムの塩化カリウムおよび0.33グラムの塩化カルシウムを含有する溶液である。
領域13を、ディップ塗布、吹き付け塗装、パルスレーザー堆積、物理気相成長(例えば、スパッタリング)、化学気相成長、真空アーク蒸着、電気化学めっき、粉末塗装、塗装、電解被覆、ゾル−ゲル被覆およびポリマーめっき(例えば、プラズマ重合)をはじめとする、多様な技術によって作製することができる。パルスレーザー堆積は、(非特許文献2)に記載されており;真空アーク蒸着は、(非特許文献3)に記載されており;スパッタリングは、ゴパルラジャら(Gopalraja et al.)によって(特許文献2)に記載されており;マグネシウム上への被覆は、(非特許文献4)に概説されている。
ここで図4および4Aを参照すると、ある実施形態では、ステント80は、第1の生体内分解性の材料を含む管状の生体内分解性の本体82を含む。生体内分解性の本体82は、横断面が環状であり、生体内分解性の本体82の外側表面86を越えて内側に向かって延出する、複数の別個の相隔たる生体内分解性の領域84を担持する。示すように、それぞれの領域84は、上から見ると長方形であり、その端部上に生体内分解性の本体82の外側表面86と滑らかな移行部を形成する。領域は、その大きさのためまたは本体の材料と領域の材料との間のわずかな視覚的な差のために裸眼では見ることができない場合がある。場合によっては、領域を、光学顕微鏡または走査型電子顕微鏡を用いて、視覚化する必要がある場合がある。領域84は、第1の生体内分解性の材料とは異なる第2の生体内分解性の材料を含む。ステント80を、図2のステントに関して上記で議論したように送達することができる。
実施形態では、領域84および本体82を、実質的に異なる標準的な還元電位を有する実質的に異なる金属で形成して、異なる金属間におけるガルバニック反応を誘発する。例えば、本体82を鉄で形成することができ、領域84をマグネシウムまたはマグネシウム合金で形成することができる。上記で議論したように、生体内分解性の本体および/または領域のうちの1つもしくは複数を、電池に電気的に接続して、例えば、ステントまたはステントの一部の浸食速度を増強することができる。厚さT’、生体内分解性の本体82を形成する材料、厚さT’、間隔S’および間隔S’は、図2のステントに関して上記で議論した値のうちのいずれかを有することができる。それぞれの領域の最も外側の上端の表面90は、約25μm以下、例えば、約15μm以下または約5μm以下の面積を有することができる。
領域を、ステントの本体中に開口部をエッチングして、開口部を第2の生体内分解性の材料で充填することによって形成することができる。領域84を、ステントの本体を別個の領域において改変するイオン注入(例えば、プラズマ浸漬イオン注入)、レーザー処理および化学処理をはじめとする技術によって作製することができる。プラズマ浸漬イオン注入(PIII)は、ウェーバーら(Weber et al.)によって“Medic
al Balloons And Methods Of Making The Same”、2006年2月16日出願の(特許文献3)および“Bioerodible Endoprostheses And Methods Of Making The
Same”、2006年2月16日出願の(特許文献4)に;チュー(Chu)によって(特許文献5)に;かつ(非特許文献5)に記載されている。
ここで図5を参照すると、1実施形態では、図2のステントは、領域13間の間隔を充填するが、領域13を被覆しない被覆110を含むことができる。示す特定の実施形態では、被覆の厚さTは、領域13の厚さTを超えて延出することがないようになす。被覆110は、生体内分解性であっても、または非生体内分解性であってもよい。被覆110が、非生体内分解性の場合、これは、ポリマー性材料、金属材料(例えば、金属もしくは金属合金)またはセラミック材料であってもよいし、あるいはそれらを含んでもよい。
ここで図5A〜5Cも参照すると、特定の実施形態では、本体11は鉄であり、領域13を、マグネシウムで形成し、被覆110は非生体内分解性であり、被覆は、生体内分解性の本体11を形成する材料とステントが埋め込まれている管腔との間の直接的な接触を阻止し、また、ステントが生体内分解する様式に対する追加の制御も可能にする。生体内分解の初期の段階(図5A)では、マグネシウムで形成した領域および領域の下の密接に接近している部分は、比較的急速に浸食し、それらの浸食速度は、本体の鉄とマグネシウムとの間のガルバニック反応によって増強される。生体内分解が続くと、深いくぼみが、被覆110が真下の本体の生体内分解性の材料の生体内分解を阻止するので、大きさが外部へ広がることがない開口部120になる(図5B)。次いで、生体内分解が、内部から外部に向けて進み、被覆110は、ステントが管腔の内部で断片化するのを防ぐための「糊」として作用する。
ここで図6を参照すると、ステントを、空洞の管状のステント前駆体50を提供し、次いで、マスク52をステント前駆体50の周りに置くことによって作製することができる。マスク52は、領域13の厚さTにほぼ等しい厚さを有する、MYLAR(登録商標)ポリエステルのフィルムまたは熱収縮性ポリオレフィンのフィルム等の薄板材料で作製することができる。マスク52は、領域13に位置関係的に対応する、マスクの壁60の中に画定された複数の開口部58を有する。さらに、マスク52は、ミシン目62を含み、それによって、領域13を形成した後に、マスク52を取り外すことができる。開口部およびミシン目を、リソグラフィー、レーザー切断または切断によって形成することができる。領域は、上記の技術によって形成することができる。例えば、アセンブリ70を回転させながら、材料をアセンブリ上にスパッタすることができる。スパッタする材料は、ステント前駆体に、開口部を介して接触できるが、マスクした領域中では、ステント前駆体と接触することが阻止される。領域を形成した後、ミシン目62に沿って引き裂くことによってマスク52を取り外して、ステントを解放する。
上記したように、浸食速度を増加させる領域を、ステント上にパターン形成することができる。実施形態では、浸食速度を低下させる領域を、ステント上にパターン形成することができる。例えば、ステントの部分を体液への暴露またはガルバニックな腐食から保護する被浸食性もしくは非被浸食性の金属、セラミックまたはポリマーの被覆を、ステント上に提供し、一方、腐食を進めるその他の部分は暴露させる。被覆は、被浸食性または非被浸食性のポリマーまたは材料であってよい。被覆は、ステントの外側上のみ、内側上のみ、または外側上および内側上の両方に提供してよい。
実施形態では、生体内分解性の本体を、生体内分解性のポリマー性材料から形成し、横方向の厚さTは、例えば、約0.5mmと約5.0mmとの間、例えば、約0.5mmと約3.0mmとの間または約1mmと約2.5mmとの間であることができる。領域を生
体内分解性のポリマー性材料で形成する実施形態では、領域の厚さTは、例えば、約1μmと約100μmとの間、例えば、約1μmと約50μmとの間または約5μmと約35μmとの間であることができる。
種々の生体内分解性の材料、ポリマーおよびセラミックを、本願明細書に記載する実施形態において使用することができる。
領域13を形成することができる生体内分解性の金属または金属合金の例として、鉄およびマグネシウムが挙げられる。鉄合金の例として、低炭素鋼(AISI 1018−1025)、中炭素鋼(AISI 1030−1055)、高炭素鋼(1060−1095)および二元Bi−Fe合金が挙げられる。合金のその他の例として、マグネシウム合金、例として、50〜98重量%マグネシウム、0〜40重量%リチウム、0〜5重量%鉄ならびに5重量%未満のその他の金属もしくは希土類元素;または79〜97重量%マグネシウム、2〜5重量%アルミニウム、0〜12重量%リチウムならびに1〜4重量%希土類元素(例として、セリウム、ランタン、ネオジムおよび/もしくはプラセオジム);または85〜91重量%マグネシウム、6〜12重量%リチウム、2重量%アルミニウムならびに1重量%希土類元素;または86〜97重量%マグネシウム、0〜8重量%リチウム、2〜4重量%アルミニウムならびに1〜2重量%希土類元素;または8.5〜9.5重量%アルミニウム、0.15〜0.4重量%マンガン、0.45〜0.9重量%亜鉛ならびに残りはマグネシウム;または4.5〜5.3重量%アルミニウム、0.28〜0.5重量%マンガンならびに残りはマグネシウム;または55〜65重量%マグネシウム、30〜40重量%リチウムならびに0〜5重量%のその他の金属および/もしくは希土類元素が挙げられる。マグネシウム合金は、AZ91D、AM50AおよびAE42の名で入手可能であり、これらは、マグネシウム−エレクトロンコーポレーション社(Magnesium−Elektron Corporation[英国])から入手できる。その他の被浸食性の金属または金属合金が、ボルツ(Bolz)によって(特許文献6)(例えば、亜鉛−チタン合金およびナトリウム−マグネシウム合金)に;ヒューブレイン(Heublein)によって(特許文献7)に;キーセ(Kaese)によって(特許文献8)に;ストロガノフ(Stroganov)によって(特許文献9)に;かつ(非特許文献6)に記載されている。
領域13を形成することができる生体内分解性のセラミックの例として、ベータ−第三リン酸カルシウム(β−TCP)、β−TCPとヒドロキシアパタイトとのブレンド、CaHPO、CaHPO−2HO、CaCOおよびCaMg(COが挙げられる。その他の生体内分解性のセラミックが、ツィーマーマン(Zimmermann)によって(特許文献10)で、かつリー(Lee)によって(特許文献11)で議論されている。
領域13を形成することができる生体内分解性のポリマーの例として、ポリカプロラクトン(PCL)、ポリカプロラクトン−ポリ乳酸コポリマー(例えば、ポリカプロラクトン−ポリ乳酸ランダムコポリマー)、ポリカプロラクトン−ポリグリコライドコポリマー(例えば、ポリカプロラクトン−ポリグリコライドランダムコポリマー)、ポリカプロラクトン−ポリ乳酸−ポリグリコライドコポリマー(例えば、ポリカプロラクトン−ポリ乳酸−ポリグリコライドランダムコポリマー)、ポリ乳酸、ポリカプロラクトン−ポリ(β−ヒドロキシ酪酸)コポリマー(例えば、ポリカプロラクトン−ポリ(β−ヒドロキシ酪酸)ランダムコポリマー)、ポリ(β−ヒドロキシ酪酸)、およびこれらのポリマーの混合物が挙げられる。生体内分解性のポリマーの追加の例が、サハシャンら(Sahatjian et.al.)によって(特許文献12)に記載されている。
被覆110を形成することができる非生体内分解性のポリマーの例として、ポリシクロオクテン(PCO)、スチレン−ブタジエンゴム、ポリ酢酸ビニル、ポリビニリデンフル
オライド(PVDF)、ポリメチルメタクリレート(PMMA)、ポリウレタン、ポリエチレン、ポリ塩化ビニル(PVC)、およびそれらのブレンドが挙げられる。非生体内分解性のポリマーの追加の例が、サハシャンら(Sahatjian et.al.)によって(特許文献12)に記載されている。被覆110を形成することができる非被浸食性の金属および金属合金の例として、ステンレス鋼、レニウム、モリブデンおよびモリブデン−レニウム合金が挙げられる。被覆110を形成することができる非生体内分解性のセラミックの例として、ケイ素の酸化物(例えば、二酸化ケイ素)、チタンの酸化物(例えば、二酸化チタン)、またはジルコニウムの酸化物(例えば、二酸化ジルコニウム)が挙げられる。
所望により、本願明細書に記載するステントのうちのいずれもが、治療剤を、ステントの上もしくは中および/またはステントの周りの被覆の上もしくは中に含むことができる。治療剤は、遺伝子治療剤、非遺伝子治療剤または細胞であってよい。治療剤は、単独でまたは組み合せて使用してよい。治療剤は、その性質が、例えば、非イオン性であってもよいし、またはアニオン性および/もしくはカチオン性であってもよい。好ましい治療剤は、再狭窄を阻害する治療剤である。再狭窄を阻害する1つのそのような治療剤の具体的な例は、パクリタキセルまたはその誘導体、例えば、ドセタキセルである。パクリタキセルの2’のヒドロキシル基をはずして、可溶化部分、例として、−COCHCHCONHCHCH(OCHOCH(nは、例えば、1から約100以上)をつなぐことによって、可溶性のパクリタキセル誘導体を作製することができる。リら(Li et al.)が、パクリタキセルの追加の水溶性誘導体を記載している(特許文献13)。
Figure 2010503482
例示的な非遺伝子治療剤として、(a)抗血栓剤、例として、ヘパリン、ヘパリン誘導体、ウロキナーゼ、PPack(デキストロフェニルアラニン・プロリン・アルギニン・クロロメチルケトン)およびチロシン;(b)抗炎症剤、例として、非ステロイド性抗炎症剤(NSAID)、具体的には、デキサメタゾン、プレドニゾロン、コルチコステロン、ブデソニド、エストロゲン、スルファサラジンおよびメサラミン;(c)抗悪性腫瘍剤/抗増殖剤/有糸***阻害剤、例として、パクリタキセル、5−フルオロウラシル、シスプラチン、ビンブラスチン、ビンクリスチン、エポチロン、エンドスタチン、アンジオスタチン、アンギオペプチン、ラパマイシン(シロリムス)、ビオリムス(biolimus)、タクロリムス、エベロリムス、平滑筋細胞の増殖を遮断することができるモノクローナル抗体およびチミジンキナーゼ阻害剤;(d)麻酔剤、例として、リドカイン、ブピバカインおよびロピバカイン;(e)抗凝血剤、例として、D−Phe−Pro−Argクロロメチルケトン、RGDペプチド含有化合物、ヘパリン、ヒルジン、抗トロンビン化
合物、血小板受容体アンタゴニスト、抗トロンビン抗体、抗血小板受容体抗体、アスピリン、プロスタグランジン阻害剤、血小板阻害剤およびダニ抗血小板ペプチド;(f)血管細胞成長促進物質、例として、増殖因子、転写活性化因子および翻訳促進物質;(g)血管細胞成長阻害剤、例として、増殖因子阻害剤、増殖因子受容体アンタゴニスト、転写抑制因子、翻訳抑制因子、複製阻害剤、抑制抗体、増殖因子に対して作られた抗体、増殖因子と細胞毒とからなる二機能性分子、抗体と細胞毒とからなる二機能性分子;(h)タンパク質キナーゼ阻害剤およびチロシンキナーゼ阻害剤(例えば、チロホスチン、ゲニステイン、キノキサリン);(i)プロスタサイクリン類似体;(j)コレステロール低下剤;(k)アンジオポエチン;(l)抗菌剤、例として、トリクロサン、セファロスポリン、アミノグリコシドおよびニトロフラントイン;(m)細胞障害剤、細胞***阻害剤および細胞増殖影響因子;(n)血管拡張剤;(o)内因性の血管作動性の機構を妨げる薬剤;(p)白血球動員阻害剤、例として、モノクローナル抗体;(q)サイトカイン、(r)ホルモン;ならびに(s)鎮痙剤、例として、アリベンドール(alibendol)、アンブセタミド(ambucetamide)、アミノプロマジン(aminopromazine)、アポアトロピン(apoatropine)、メチル硫酸ベボニウム、ビエタミベリン(bietamiverine)、ブタベリン(butaverine)、臭化ブトロピウム、臭化n−ブチルスコポラミン、カロベリン、臭化シメトロピウム、シンナメドリン(cinnamedrine)、クレボプリド、臭化水素酸コニイン(coniine hydrobromide)、塩酸コニイン(coniine hydrochloride)、ヨウ化シクロニウム、ジフェメリン、ジイソプロミン、酪酸ジオキサフェチル(dioxaphetyl butyrate)、臭化ジポニウム、ドロフェニン(drofenine)、臭化エメプロニウム、エタベリン(ethaverine)、フェクレミン(feclemine)、フェナラミド(fenalamide)、フェノベリン、フェンピプラン、臭化フェンピベリニウム、臭化フェントニウム、フラボキサート、フロプロピオン、グルコン酸、グアイアクタミン(guaiactamine)、ヒドラミトラジン(hydramitrazine)、ヒメクロモン、レイオピロール(leiopyrrole)、メベベリン、モキサベリン(moxaverine)、ナフィベリン(nafiverine)、オクタミルアミン(octamylamine)、オクタベリン(octaverine)、塩化オキシブチニン、ペンタピペリド(pentapiperide)、塩酸フェナマシド(phenamacide hydrochloride)、フロログルシノール、臭化ピナベリウム、ピペリレート(piperilate)、塩酸ピポキソラン(pipoxolan hydrochloride)、プラミベリン(pramiverin)、臭化プリフィニウム、プロペリジン(properidine)、プロピバン(propivane)、プロピロマジン(propyromazine)、プロザピン(prozapine)、ラセフェミン(racefemine)、ロシベリン、スパスモリトール(spasmolytol)、ヨウ化スチロニウム(stilonium iodide)、スルトロポニウム(sultroponium)、ヨウ化チエモニウム、臭化チキジウム、チロプラミド、トレピブトン(trepibutone)、トリクロミル(tricromyl)、トリホリウム(trifolium)、トリメブチン、トロペンジル(tropenzile)、塩化トロスピウム、臭化キセニトロピウム(xenytropium bromide)、ケトロラク、およびそれらの薬学的に許容される塩が挙げられる。
例示的な遺伝子治療剤として、アンチセンスDNAおよびRNA、さらに(a)アンチセンスRNA、(b)欠陥のあるまたは欠損した内因性の分子を置換するためのtRNAまたはrRNA、(c)増殖因子、例として、酸性および塩基性の線維芽細胞増殖因子、血管内皮増殖因子、上皮増殖因子、形質転換増殖因子αおよびβ、血小板由来内皮増殖因子、血小板由来増殖因子、腫瘍壊死因子α、肝細胞増殖因子ならびにインスリン様増殖因子をはじめとする血管新生因子、(d)CD阻害剤をはじめとする細胞周期阻害剤、さらに(e)チミジンキナーゼ(「TK」)、さらに細胞増殖を妨げるのに有用なその他の薬
剤をコードするDNAが挙げられる。また、骨形態形成タンパク質(「BMP」)ファミリー、例として、BMP−2、BMP−3、BMP−4、BMP−5、BMP−6(Vgr−l)、BMP−7(OP−1)、BMP−8、BMP−9、BMP−10、BMP−11、BMP−12、BMP−13、BMP−14、BMP−15およびBMP−16をコードするDNAも対象となる。現在のところ、好ましいBMPは、BMP−2、BMP−3、BMP−4、BMP−5、BMP−6およびBMP−7のうちのいずれかである。これらの二量体タンパク質を、ホモダイマー、ヘテロダイマーまたはそれらの組合せとして、単独でまたはその他の分子と一緒にして提供してよい。別法としてまたはそれに加えて、BMPの上流または下流の効果を誘発することができる分子を提供してもよい。そのような分子として、「ヘッジホッグ」タンパク質のうちのいずれか、またはそれらをコードするDNAが含まれる。
遺伝子治療剤を送達するためのベクターは、アデノウイルス、腸内アデノウイルス、アデノ随伴ウイルス、レトロウイルス、アルファウイルス(セムリキ森林、シンドビス等)、レンチウイルス、単純ヘルペスウイルス、自己複製能をもつウイルス(例えば、ONYX−015)およびハイブリッドベクター等のウイルスベクター;ならびに人工染色体およびミニ染色体、プラスミドDNAベクター(例えば、pCOR)、カチオン性ポリマー(例えば、ポリエチレンイミン、ポリエチレンイミン(PEI))、グラフトコポリマー(例えば、ポリエーテル−PEIおよびポリエチレンオキシド−PEI)、中性ポリマーであるPVP、SP1017(スプラテック社(SUPRATEK))、カチオン性脂質等の脂質、リポソーム、リポプレックス、ナノ粒子または微小粒子等の非ウイルスベクターを含み、これらは、タンパク質透過ドメイン(PTD)等の標的配列を有する場合とそうでない場合とがある。
使用する細胞は、全骨髄、骨髄由来の単核細胞、前駆細胞(例えば、血管内皮前駆細胞)、幹細胞(例えば、間葉系、造血、神経)、多能性幹細胞、線維芽細胞、筋芽細胞、サテライト細胞、周皮細胞、心筋細胞、骨格筋細胞もしくはマクロファージをはじめとする、ヒト起源の細胞(自己または同種)、または動物、細菌もしくは真菌を起源とする細胞(異種)を含み、これらを、所望により、対象とするタンパク質を送達するために遺伝子操作することができる。
ステントの本体、領域または被覆を形成するために使用する金属材料、セラミック材料またはポリマー性材料のうちのいずれであっても、多孔性に作製することができる。例えば、多孔性の金属材料を、例えば、約0.01ミクロンと約20ミクロンとの間の直径を有する金属粒子を焼結して、流体が流れることができる相互に接続している小さな(例えば、約0.05ミクロンから約0.5ミクロンまでの)空隙および大きな(例えば、約1ミクロンから約10ミクロンまでの)空隙を有する多孔性の材料を形成することによって作製することができる。多孔性の材料中の空隙は、例えば、多孔性の材料内にインタカレートしている治療剤のための保管場所として、またはその部分もしくは成分に関する浸食速度を増加させるために使用することができる。
そのような多孔性の材料は、水銀ポロシメータを使用して測定した場合、約80から約99パーセント、例えば、約80から約95パーセントまたは約85から約92パーセントの全空隙率、およびBET(ブルナウアー、エメットおよびテラー)を使用して測定した場合、約200cm/cmから約10,000cm/cmまで、例えば、約250cm/cmから約5,000cm/cmまでまたは約400cm/cmから約1,000cm/cmまでの比表面積を有することができる。生体内分解性の材料を利用する場合、材料の多孔性の性質が、材料の表面積を増加させることによって、材料の浸食を少なくとも部分的に促進することができる。さらに、生体内分解性の材料を利用する場合、材料の多孔性によって、断片の大きさを確実に小さくすることができる。
多孔性の材料および多孔性の材料を作製する方法が、デートら(Date et al.)によって(特許文献14)に;ホシノら(Hoshino et al.)によって(特許文献15)に;かつステルツェルら(Sterzel et al.)によって(特許文献16)に記載されている。
本願明細書に記載するステントは、体内の所望の部位に、いくつかのカテーテルによる送達システム、例として、上記のバルーンカテーテルのシステムによって送達することができる。例示的なカテーテルのシステムが、(特許文献17)、(特許文献18)および(特許文献19)に記載されている。ボストンサイエンティフィックサイメド社(Boston Scientific Scimed)[米国ミネソタ州メイプルグローブ(Maple Grove)所在]から入手可能なRadius(登録商標)システムおよびSymbiot(登録商標)システムもまた、カテーテルによる送達システムの例である。
本願明細書に記載するステントは、血管の管腔または血管でない管腔のために構成することができる。例えば、これらを、食道または前立腺において使用するために構成することができる。その他の管腔は、胆管の管腔、肝臓の管腔、膵臓の管腔、尿道の管腔および尿管の管腔を含む。
本願明細書に記載するいずれのステントも、染色しても、あるいは例えば、硫酸バリウム、白金もしくは金等の放射線を通さない材料の添加によってまたは放射線を通さない材料を用いて被覆することによって放射線を通さないようにしてもよい。
本願明細書に記載するいずれのステントも、または本願明細書に記載するいずれのステントのいずれの部分も、生体内分解性の材料または非生体内分解性の材料を用いて被覆することができる。例えば、被覆を使用して、薬物を送達すること、ステントの一部を保護すること、未制御の断片化を低減させること、および/またはステントもしくはステントの一部と管腔の一部との間の接触を阻止することができる。
その他の実施形態
いくつかの実施形態を説明してきた。にもかかわらず、種々の改変形態を、本開示の精神および範囲から逸脱することなく作製することができることが理解されるであろう。
ステントを示してきたが、その他の内部人工器官も可能である。例えば、内部人工器官は、ステント内挿型人工血管またはフィルターの形態であってもよい。
生体内分解性の本体が、ステントの長手方向の軸に沿って真横から見ると、横断面が環状である管の形態をとる(例えば、図2)実施形態を示してきたが、管は、環状でない横断面を有してもよい。例えば、管は、ステントの長手方向の軸に沿って真横から見ると、正方形、長方形、六角形または八角形であってもよい。
生体内分解性の領域が、生体内分解性の本体の外側表面から延出する実施形態を示し、領域が、生体内分解性の本体の外側表面を越えて内側に向かって延出する実施形態も示してきたが、いくつかの実施形態では、領域が、生体内分解性の本体の外側表面を越えて内側に向かっておよびそこから外側に向かっての両方に延出する。
明確な境界を有する生体内分解性の領域を示してきたが、いくつかの実施形態では、境界は、PIIIを使用した場合に予想される境界等、より曖昧である。
単一の材料を含む生体内分解性の領域および本体を示してきたが、いくつかの実施形態では、それらは、複数の材料、例えば、材料のブレンドもしくは混合物または異なる材料の層を含む。
ここで図5に戻ってそれを参照すると、被覆110に加えて、ステントは、未被覆のステントの外側表面と被覆110との間に配置されたもう1つの被覆も含んでよい。この他方の被覆は、キレート化剤であっても、またはそれを含んでもよい。例えば、他方の被覆は、中に分散させたキレート化剤を含むポリマー性の被覆であってよい。キレート化剤は、例えば、ステントの本体の分解から生じたいずれかの金属イオンをキレート化して、治療剤の被覆110からの放出を金属イオンが妨げるのを阻止することができる。これは、例えば、キレートが、大き過ぎて被覆110内に拡散できない、またはキレートの溶解性が低過ぎて被覆内に拡散できないのいずれかであることによる。キレート化剤の例として、脂肪酸のナトリウム塩(例えば、通常のせっけん)、EDTAおよびポルフィリンが挙げられる。
さらなるその他の実施形態も、以下の特許請求の範囲に属する。

Claims (18)

  1. 第1の生体内分解性の材料からなる生体内分解性の本体からなる埋込み型の内部人工器官であって、該生体内分解性の本体が、該第1の生体内分解性の材料とは異なる第2の生体内分解性の材料からなる、複数の別個の相隔たる生体内分解性の領域を担持する、埋込み型の内部人工器官。
  2. それぞれの別個の相隔たる領域が、前記生体内分解性の本体の外側表面から延出する、請求項1に記載の埋込み型の内部人工器官。
  3. 被覆が、治療剤を、その上に、その中にまたはそれらの組合せに含む、請求項3に記載の埋込み型の内部人工器官。
  4. それぞれの別個の相隔たる領域が、前記生体内分解性の本体の最も外側の表面を越えて内側に向かって延出する、請求項1に記載の埋込み型の内部人工器官。
  5. すぐに隣接している領域間の長手方向の間隔が、約1.0μmと約35μmとの間であり;
    前記生体内分解性の本体の外側表面に沿って測定した場合、すぐに隣接している領域間の横方向の間隔が、約1.0μmと約35μmとの間であり;
    前記生体内分解性の本体の厚さが、約0.5mmから約5.0mmまでであり;
    それぞれの領域の厚さが、約0.01μmから約5μmまでであり;かつ
    それぞれの領域の最も外側の上端の表面が、約25μm以下の面積を有する、
    請求項2または4に記載の埋込み型の内部人工器官。
  6. 周りに被覆をさらに含む、請求項1または4に記載の埋込み型の内部人工器官。
  7. 前記生体内分解性の本体が、管の形態である、請求項1に記載の埋込み型の内部人工器官。
  8. 前記生体内分解性の本体が、生体内分解性の金属材料からなる、請求項1に記載の埋込み型の内部人工器官。
  9. 前記生体内分解性の金属材料が、鉄、マグネシウム、亜鉛、アルミニウム、カルシウムおよびそれらの合金からなる群から選択される、請求項8に記載の埋込み型の内部人工器官。
  10. 前記生体内分解性の本体およびそれぞれの領域が、生体内分解性の金属からなる、請求項1に記載の埋込み型の内部人工器官。
  11. 前記生体内分解性の本体およびそれぞれの領域が、一緒になってガルバニック対を画定し、かつ該ガルバニック対のための標準的な電池電位が、少なくとも+1.0Vである、請求項1または10に記載の埋込み型の内部人工器官。
  12. ステントの形態である、請求項1に記載の埋込み型の内部人工器官。
  13. 前記生体内分解性の本体、前記領域のうちの1つもしくは複数、またはそれらの組合せが、電池に電気的に接続される、請求項1に記載の埋込み型の内部人工器官。
  14. 約1μAから約250μAまでの電流が、前記生体内分解性の本体および電池、前記領域
    のうちの1つもしくは複数および電池、またはそれらの組合せからなる回路を通って流れる、請求項14に記載の埋込み型の内部人工器官。
  15. 前記生体内分解性の本体の断片が生体内分解の間に内部人工器官から分離するのを実質的に阻止する被覆を、前記生体内分解性の本体の周りにさらに含む、請求項1に記載の埋込み型の内部人工器官。
  16. それぞれの別個の相隔たる領域が、前記生体内分解性の本体の最も外側の表面から延出し;かつ
    被覆が、相隔たる領域間に配置される、請求項1に記載の埋込み型の内部人工器官。
  17. 第1の生体内分解性の材料からなる生体内分解性の本体を提供する工程と;
    該第1の生体内分解性の材料とは異なる第2の生体内分解性の材料からなる、複数の別個の相隔たる生体内分解性の領域を形成し、それによって、該生体内分解性の本体が、該生体内分解性の領域を担持するようになす工程と
    からなる請求項1に記載の埋込み型の内部人工器官を作製する方法。
  18. 被覆を、前記生体内分解性の本体の少なくとも一部の上に形成する工程をさらに含む、請求項17に記載の方法。
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US20080071350A1 (en) 2008-03-20
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