JP2022528966A - 改質されたデバイス表面に薬物溶出コーティングを有する医療用デバイス - Google Patents
改質されたデバイス表面に薬物溶出コーティングを有する医療用デバイス Download PDFInfo
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Abstract
Description
[0007]本開示の実施形態は、特にバルーンカテーテル及びステントを含む医療用デバイスと関連し、そのために、医療用デバイスの外部表面は、該外部表面上に薬物放出コーティングが適用される前に、外部表面表面自由エネルギーを低下させるための表面改質が施される。更なる実施形態は、医療用デバイスを調製するための方法を含む。本開示の実施形態の目的は、デバイスを標的部位に一時的に留置する間、標的組織による薬物の迅速且つ効率的な取り込みを促進することにある。本開示の実施形態の更なる目的は、処置後最長14日間又は28日間にわたり、薬物の長期有効性を維持し又は増加させることにある。
[0019]非限定的な例としてバルーンカテーテル及びステントを含む、医療用デバイスの実施形態がここに記載される。医療用デバイスにおいて、薬物放出コーティングが外部表面上に適用される前に、医療用デバイスの外部表面に、該外部表面の表面自由エネルギーを低下させる表面改質が施される。医療用デバイスを調製するための方法に関する実施形態が引き続き記載される。
[0033]これまでに記載したように、医療用デバイス、例えばバルーンカテーテル10等は、例えば改質された外部表面25、すなわち薬物コーティング層30の適用前に、外部表面25の表面自由エネルギーを減少させる表面改質が施された表面を含む。
[0052]医療用デバイスの外部表面が、中間層40を含むように、複数の実施形態に基づき改質されるとき、中間層40は医療用デバイスの外部表面25を被覆する。いくつかの実施形態では、中間層40は、医療用デバイスの外部表面25と直接接触した状態にあり、又は医療用デバイスの外部表面25に直接コーティング若しくは適用される。いくつかの実施形態では、中間層40は、医療用デバイスの外部表面25に適用される界面化学により形成され、これにより医療用デバイスの材料の必須成分として機能する。いくつかの実施形態では、医療用デバイスはバルーンカテーテル10であり、また中間層40はバルーンカテーテル10のバルーン12の外部表面を被覆する。いくつかの実施形態では、医療用デバイスはバルーンカテーテル10であり、また中間層40は、バルーンカテーテル10のバルーンの外部表面25と直接接触した状態にあり、又はそれに直接適用される。いくつかの実施形態では、バルーンの外部表面に適用される界面化学により、中間層40がバルーンの外部表面25に形成され、これによりバルーン材料の必須成分として機能する。
薬物コーティング層治療剤
[0060]複数の実施形態に基づく医療用デバイスの薬物コーティング層30は、治療剤及び少なくとも1つの添加剤を含む。
[0066]本開示の実施形態で使用される薬物として、エベロリムス、ソマトスタチン、タクロリムス、ロキシスロマイシン、ズナイマイシン、アスコマイシン、バフィロマイシン、エリスロマイシン、ミデカマイシン、ジョサマイシン、コンカナマイシン、クラリスロマイシン、トロレアンドマイシン、ホリマイシン、セリバスタチン、シンバスタチン、ロバスタチン、フルバスタチン、ロスバスタチン、アトロバスタチン、プラバスタチン、ピタバスタチン、ビンブラスチン、ビンクリスチン、ビンデシン、ビノレルビン、エトポシド、テニポシド、ニムスチン、カルムスチン、ロムスチン、シクロホスファミド、4-ヒドロキシシクロホスファミド、エストラムスチン、メルファラン、イホスファミド、トロホスファミド、クロラムブシル、ベンダムスチン、ダカルバジン、ブスルファン、プロカルバジン、トレオスルファン、テモゾロミド、チオテパ、ダウノルビシン、ドキソルビシン、アクラルビシン、エピルビシン、ミトキサントロン、イダルビシン、ブレオマイシン、マイトマイシン、ダクチノマイシン、メトトレキサート、フルダラビン、フルダラビン-5’-ジヒドロゲンホスフェート、クラドリビン、メルカプトプリン、チオグアニン、シタラビン、フルオロウラシル、ゲムシタビン、カペシタビン、ドセタキセル、カルボプラチン、シスプラチン、オキサリプラチン、アムサクリン、イリノテカン、トポテカン、ヒドロキシカルバミド、ミルテホシン、ペントスタチン、アルデスロイキン、トレチノイン、アスパラギナーゼ、ペガスパルガーゼ、アナストロゾール、エキセメスタン、レトロゾール、ホルメスタン、アミノグルテチミド、アドリアマイシン、アジスロマイシン、スピラマイシン、セファランチン、smc増殖インヒビター-2w、エポチロンA及びB、ミトキサントロン、アザチオプリン、ミコフェノールアトモフェチル、c-myc-アンチセンス、b-myc-アンチセンス、ベツリン酸、カンプトテシン、ラパコール、β-ラパコン、ポドフィロトキシン、ベツリン、ポドフィリン酸-2-エチルヒドラジド、モルグラモスチム(rhuGM-CSF)、ペグインターフェロンa-2b、レノグラスチム(r-HuG-CSF)、フィルグラスチム、マクロゴール、ダカルバジン、バシリキシマブ、ダクリズマブ、セレクチン(サイトカインアンタゴニスト)、CETPインヒビター、カドヘリン、サイトカイニンインヒビター、COX-2インヒビター、NFkB、アンジオペプチン、シプロフロキサシン、カンプトテシン、フルロブラスチン、筋肉細胞増殖を阻害するモノクロナール抗体、bFGFアンタゴニスト、プロブコール、プロスタグランジン、1,11-ジメトキシカンチン-6-オン、1-ヒドロキシ-11-メトキシカンチン-6-オン、スコポレチン、コルヒチン、NOドナー、例えばペンタエリトリトール四硝酸塩及びシンドノエイミン、S-ニトロソ誘導体等、タモキシフェン、スタウロスポリン、β-エストラジオール、a-エストラジオール、エストリオール、エストロン、エチニルエストラジオール、ホスフェストロール、メドロキシプロゲステロン、エストラジオールシピオネート、エストラジオールベンゾエート、トラニラスト、カメバカウリン及びがんの療法に適用されるその他のテルペノイド、ベラパミル、チロシンキナーゼインヒビター(チルホスチン)、シクロスポリンA、6-a-ヒドロキシ-パクリタキセル、バッカチン、タキソテール及び亜酸化炭素のその他の大環状オリゴマー(MCS)及びその誘導体、モフェブタゾン、アセメタシン、ジクロフェナク、ロナゾラク、ダプソーン、o-カルバモイルフェノキシ酢酸、リドカイン、ケトプロフェン、メフェナム酸、ピロキシカム、メロキシカム、クロロキンホスフェート、ペニシラミン、ヒドロキシクロロキン、オーラノフィン、金チオリンゴ酸ナトリウム、オキサセプロール、セレコキシブ、β-シトステリン、アデメチオニン、ミルテカイン、ポリドカノール、ノニバミド、レボメントール、ベンゾカイン、エスシン(aescin)、エリプチシン、D-24851(Calbiochem)、コルセミド、サイトカラシンA~E、インダノシン、ノコダゾール、S100タンパク質、バシトラシン、ビトロネクチン受容体アンタゴニスト、アゼラスチン、メタルプロテイナーゼ-1及び-2のグアニジルシクラーゼスティミュレターテッシュインヒビター、遊離核酸、ウイルストランスミッターに組み込まれた核酸、DNA、tRNA、及びRNA断片、プラスミノーゲンアクチベーターインヒビター-1、プラスミノーゲンアクチベーターインヒビター-2、アンチセンスオリゴヌクレオチド、VEGF、VEGFインヒビター、IGF-1、IGF-2、成長ホルモン(GF)、抗生物質、例えばセファドロキシル、セファゾリン、セファクロル、セフォタキシム、トブラマイシン、ゲンタマイシン、ペニシリン等の群に由来する活性な薬剤、例えばジクロキサシリン、オキサシリン、スルホンアミド、メトロニダゾール等、抗血栓薬、例えばアルガトロバン、アスピリン、アブシキシマブ、合成抗トロンビン、ビバリルジン、クマジン、エノキサパリン、脱硫酸化され、N-再アセチル化されたヘパリン、組織プラスミノーゲンアクチベーター、GpIIb/IIIa血小板膜受容体、第Xa因子インヒビター抗体、ヘパリン、ヒルジン、r-ヒルジン、PPACK、プロタミン、プロウロキナーゼ、ストレプトキナーゼ、ワルファリン、ウロキナーゼ等、血管拡張薬、例えばジピラミドール、トラピジル、ニトロプルシド、PDGFアンタゴニスト、例えばトリアゾロピリミジン及びセラミン等、ACEインヒビター、例えばカプトプリル、シラザプリル、リシノプリル、エナラプリル、ロサルタン等、チオールプロテアーゼインヒビター、プロスタサイクリン、バピプロスト、インターフェロンa、β、及びy、ヒスタミンアンタゴニスト、セロトニン遮断薬、アポトーシスインヒビター、アポトーシス制御因子、例えばp65NF-kB又はBcl-xLアンチセンスオリゴヌクレオチド等、ハロフジノン、ニフェジピン、トラニラスト、モルシドミン、ティーポリフェノール、エピカテキンガラート、エピガロカテキンガラート、ボスウェリン酸及びその誘導体、レフルノミド、アナキンラ、エタネルセプト、スルファサラジン、エトポシド、ジクロキサシリン、テトラサイクリン、トリアムシノロン、ムタマイシン、プロカインアミド、レチノイン酸、キニジン、ジソピラミド、フレカイニド、プロパフェノン、ソタロール、アミドロン、天然及び合成的に取得されたステロイド、例えばブリオフィリンA、イノトジオール、マキロシド(maquiroside)A、グハラキノシド(ghalakinoside)、マンソニン、ストレブロシド(strebloside)、ヒドロコルチゾン、ベタメタゾン、デキサメタゾン等、非ステロイド系物質(NSAIDS)、例えばフェノプロフェン、イブプロフェン、インドメタシン、ナプロキセン等、フェニルブタゾン及びその他の抗ウイルス剤、例えばアシクロビル、ガンシクロビル、及びジドブジン等、抗真菌薬、例えばクロトリマゾール、フルシトシン、グリセオフルビン、ケトコナゾール、ミコナゾール、ナイスタチン、テルビナフィン等、抗原虫剤、例えばクロロキン、メフロキン、キニーネ等、更なる天然のテルペノイド、例えばヒポカエスクリン(hippocaesculin)、バリングトゲノール-C21-アンジェレート、14-デヒドロアグロスチスタチン、アグロスケリン、アグロスチスタチン、17-ヒドロキシアグロスチスタチン、オバトジオリド、4,7-オキシシクロアニソメル酸、バッカリノイドB1、B2、B3、及びB7、ツベイモシド、ブルセアノールA、B、及びC、ブルセアンチノシドC、ヤダンジオシドN及びP、イソデオキシエレファントピン、トメンファトピンAとB、コロナリンA、B、C、及びD、ウルソル酸、ヒプタチン酸A、ゼオリン、イソイリドゲルマナール、マイテンフォリオール(maytenfoliol)、エフサンチンA、エクスシサニンA及びB、ロンギカウリンB、スクルポネアチンC、カメバウニン、ロイカメニンA及びB、13、18-デヒドロ-6-a-セネシオイルオキシシャパリン、タクサマイリンA及びB、レジェニロール、トリプトリド等、更にシマリン、アポシマリン、アリストロキア酸、アノプテリン、ヒドロキシアノプテリン、アネモニン、プロトアネモニン、ベルベリン、塩化チェリブリン、シクトキシン、シノコクリン、ボムブレスタチンA及びB、クドライソフラボンA、クルクミン、ジヒドロニチジン、ニチジンクロリド、12-β-ヒドロキシプレグナジエン-3、20-ジオン、ビロボール、ギンゴール、ギンコール酸、ヘレナリン、インジシン、インジシン-N-オキシド、ラシオカルピン、イノトジオール、グリコシド1a、ポドフィロトキシン、ジュスチシジンA及びB、ラレアチン、マロテリン、マロトクロマノール、イソブチリルマロトクロマノール、マキロシド(maquiroside)A、マルカンチンA、マイタンシン、リコリジシン、マルゲチン、パンクラチスタチン、リリオデニン、ビスパルテノリジン、オキソウシンスニン、アリストラクタム-AII、ビスパルテノリジン、ペリプロコシドA、グハラキノシド、ウルソル酸、デオキシプソロスペルミン、サイコルビン、リシンA、サンギナリン、マヌー小麦酸(manwu wheat acid)、メチルソルビホリン、スファテリアクロメン、スチゾフィリン、マンソニン、ストレブロシド(strebloside)、アカゲリン、ジヒドロウサンバレンシン、ヒドロキシウサンバリン、ストリクノペンタミン、ストリクノフィリン、ウサムバリン、ウサンバレンシン、ベルベリン、リリオデニン、オキソウシンスニン、ダフノレチン、ラリシレシノール、メトキシラリシレシノール、シリンガレシノール、ウンベリフェロン、アフロモソン、アセチルビスミオンB、デスアセチルビスミオンA、並びにビスミオンA及びBも挙げられる。
[0076]治療剤又は治療剤の組み合わせ物に加えて、複数の実施形態に基づくは医療用デバイスの薬物コーティング層30は、少なくとも1つの添加剤を含む。
[0084]界面活性剤は、医薬組成物での使用に適する任意の界面活性剤であり得る。そのような界面活性剤は、アニオン性、カチオン性、双性イオン性、又はノニオン性であり得る。界面活性剤の混合物もまた、界面活性剤とその他の添加剤との組み合わせ物と同様に、本開示の範囲内にある。界面活性剤は、1つ又は複数の長鎖脂肪族鎖、例えば細胞膜の脂質二重層中に直接入り込んで脂質構造の一部分を形成し得る一方、界面活性剤のその他の成分は脂質構造を緩め、そして薬物の侵入及び吸収を強化する脂肪酸等を多くの場合有する。造影剤のイオプロミドはこのような特性を有さない。
[0087]ポリエチレングリコール(PEG)そのものは、界面活性剤として機能しないものの、様々なPEG-脂肪酸エステルが有用な界面活性剤特性を有する。PEG-脂肪酸モノエステルの中でも、ラウリン酸、オレイン酸、及びステアリン酸、ミリストレイン酸、パルミトオレイン酸、リノール酸、リノレン酸、エイコサペンタエン酸、エルシン酸、リシノール酸、及びドコサヘキサエン酸のエステルは、本開示の実施形態において最も有用である。好ましい親水性界面活性剤として、PEG-8ラウレート、PEG-8オレエート、PEG-8ステアレート、PEG-9オレエート、PEG-10ラウレート、PEG-10オレエート、PEG-12ラウレート、PEG-12オレエート、PEG-15オレエート、PEG-20ラウレート、及びPEG-20オレエートが挙げられる。PEG-15 12-ヒドロキシステアレート(Solutol HS15)は、注射溶液で使用されるノニオン性界面活性剤である。Solutol HS15は、室温で白色ペーストであり、室温より高く体温より低い約30℃において液体となるので、本開示の特定の実施形態において好ましい添加剤である。HLB値は、4~20の範囲である。
[0091]好ましい親水性界面活性剤は、PEG-20グリセリルラウレート、PEG-30グリセリルラウレート、PEG-40グリセリルラウレート、PEG-20グリセリルオレエート、及びPEG-30グリセリルオレエートである。
[0092]疎水性又は親水性の程度の異なる多数の界面活性剤が、アルコール又は多価アルコールと様々な天然オイル及び/又は水素化オイルとの反応により調製され得る。最も一般的には、使用されるオイルは、ひまし油若しくは水素化ひまし油、又は食用植物油、例えばコーンオイル、オリーブオイル、ピーナッツオイル、パームカーネルオイル、アプリコットカーネルオイル、若しくはアーモンドオイル等である。好ましいアルコールとして、グリセロール、プロピレングリコール、エチレングリコール、ポリエチレングリコール、ソルビトール、及びペンタエリトリトールが挙げられる。これらのアルコール-オイルエステル交換型界面活性剤のなかでも、好ましい親水性界面活性剤は、PEG-35ひまし油、ポリエチレングリコール-グリセロールリシノレエート(Incrocas-35、及びCremophor EL&ELP)、PEG-40水素化ひまし油(Cremophor RH40)、PEG-15水素化ひまし油(Solutol HS15)、PEG-25トリオレエート(TAGAT.RTM.TO)、PEG-60コーングリセリド(Crovol M70)、PEG-60アーモンドオイル(Crovol A70)、PEG-40パームカーネルオイル(Crovol PK70)、PEG-50ひまし油(Emalex C-50)、PEG-50水素化ひまし油(Emalex HC-50)、PEG-8カプリリック/カプリックグリセリド(Labrasol)、及びPEG-6カプリリック/カプリックグリセリド(Softigen767)である。このクラスに含まれる好ましい疎水性界面活性剤として、PEG-5水素化ひまし油、PEG-7水素化ひまし油、PEG-9水素化ひまし油、PEG-6コーンオイル(Labrafil.RTM.M2125CS)、PEG-6アーモンドオイル(Labrafil.RTM.M1966CS)、PEG-6アプリコットカーネルオイル(Labrafil.RTM.M1944CS)、PEG-6オリーブオイル(Labrafil.RTM.M1980CS)、PEG-6ピーナッツオイル(Labrafil.RTM.M1969CS)、PEG-6水素化パームカーネルオイル(Labrafil.RTM.M2130BS)、PEG-6パームカーネルオイル(Labrafil.RTM.M2130CS)、PEG-6トリオレイン(Labrafil.RTM.bM2735CS)、PEG-8コーンオイル(Labrafil.RTM.WL2609BS)、PEG-20コーングリセリド(Crovol M40)、及びPEG-20アーモンドグリセリド(Crovol A40)が挙げられる。
[0093]脂肪酸のポリグリセロールエステルも、本開示の実施形態での使用にとって好適な界面活性剤である。ポリグリセリル脂肪酸エステルの中でも、好ましい疎水性界面活性剤として、ポリグリセリルオレエート(Plurol Oleique)、ポリグリセリル-2ジオレエート(Nikkol DGDO)、ポリグリセリル-10トリオレエート、ポリグリセリルステアレート、ポリグリセリルラウレート、ポリグリセリルミリステート、ポリグリセリルパルミテート、及びポリグリセリルリノレートが挙げられる。好ましい親水性界面活性剤として、ポリグリセリル-10ラウレート(Nikkol Decaglyn 1-L)、ポリグリセリル-10オレエート(Nikkol Decaglyn 1-O)、及びポリグリセリル-10モノ、ジオレエート(Caprol.RTM.PEG860)、ポリグリセリル-10ステアレート、ポリグリセリル-10ラウレート、ポリグリセリル-10ミリステート、ポリグリセリル-10パルミテート、ポリグリセリル-10リノレート、ポリグリセリル-6ステアレート、ポリグリセリル-6ラウレート、ポリグリセリル-6ミリステート、ポリグリセリル-6パルミテート、及びポリグリセリル-6リノレートが挙げられる。ポリグリセリルポリリシノールエート(Polymuls)も好ましい界面活性剤である。
[0094]プロピレングリコールと脂肪酸のエステルが、本開示の実施形態での使用にとって好適な界面活性剤である。この界面活性剤クラスにおいて、好ましい疎水性界面活性剤として、プロピレングリコールモノラウレート(Lauroglycol FCC)、プロピレングリコールリシノレエート(Propymuls)、プロピレングリコールモノオレエート(Myverol P-O6)、プロピレングリコールジカプリレート/ジカプレート(Captex.RTM.200)、及びプロピレングリコールジオクタノエート(Captex.RTM.800)が挙げられる。
[0095]ステロール及びステロールの誘導体が、本開示の実施形態での使用にとって好適な界面活性剤である。好ましい誘導体として、ポリエチレングリコール誘導体が挙げられる。このクラスに含まれる好ましい界面活性剤は、PEG-24コレステロールエーテル(Solulan C-24)である。
[0096]様々なPEG-ソルビタン脂肪酸エステルが利用可能であり、また本開示の実施形態において、界面活性剤として使用するのに適する。PEG-ソルビタン脂肪酸エステルの中でも、好ましい界面活性剤として、PEG-20ソルビタンモノラウレート(ツイーン20)、PEG-4ソルビタンモノラウレート(ツイーン21)、PEG-20ソルビタンモノパルミテート(ツイーン40)、PEG-20ソルビタンモノステアレート(ツイーン60)、PEG-4ソルビタンモノステアレート(ツイーン61)、PEG-20ソルビタンモノオレエート(ツイーン80)、PEG-4ソルビタンモノオレエート(ツイーン81)、PEG-20ソルビタントリオレエート(ツイーン85)が挙げられる。オレイン酸エステルと比較して短い脂質鎖を有し、薬物吸収が増加するので、ラウリン酸エステルが好ましい。
[0097]ポリエチレングリコールとアルキルアルコールのエーテルが、本開示の実施形態での使用にとって好適な界面活性剤である。好ましいエーテルとして、ラネス(ラネス-5、ラネス-10、ラネス-15、ラネス-20、ラネス-25、及びラネス-40)、ラウレス(ラウレス-5、ラウレス-10、ラウレス-15、ラウレス-20、ラウレス-25、及びラウレス-40)、オレス(オレス-2、オレス-5、オレス-10、オレス-12、オレス-16、オレス-20、及びオレス-25)、ステアレス(ステアレス-2、ステアレス-7、ステアレス-8、ステアレス-10、ステアレス-16、ステアレス-20、ステアレス-25、及びステアレス-80)、セテス(セテス-5、セテス-10、セテス-15、セテス-20、セテス-25、セテス-30、及びセテス-40)、PEG-3オレイルエーテル(Volpo3)、及びPEG-4ラウリルエーテル(Brij30)が挙げられる。
[0098]糖誘導体が、本開示の実施形態での使用にとって好適な界面活性剤である。このクラスに含まれる好ましい界面活性剤として、スクロースモノパルミテート、スクロースモノラウレート、デカノイル-N-メチルグルカミド、n-デシル-β-D-グルコピラノシド、n-デシル-β-D-マルトピラノシド、n-ドデシル-β-D-グルコピラノシド、n-ドデシル-β-D-マルトシド、ヘプタノイル-N-メチルグルカミド、n-ヘプチル-β-D-グルコピラノシド、n-ヘプチル-β-D-チオグルコシド、n-ヘキシル-β-D-グルコピラノシド、ノナノイル-N-メチルグルカミド、n-ノニル-β-D-グルコピラノシド、オクタノイル-N-メチルグルカミド、n-オクチル-β-D-グルコピラノシド、及びオクチル-β-D-チオグルコピラノシドが挙げられる。
ポリエチレングリコールアルキルフェノール
[0099]いくつかのPEG-アルキルフェノール界面活性剤、例えばPEG-10-100ノニルフェノール及びPEG-15-100オクチルフェノールエーテル、チロキサポール、オクトキシノール、ノノキシノール等が利用可能であり、また本開示の実施形態での使用に適する。
[0100]POE-POPブロックコポリマーは、ポリマー界面活性剤のユニークなクラスである。比及び位置が十分に定義された親水性POE部分と疎水性POP部分とを有する界面活性剤のユニークな構造が、本開示の実施形態での使用に適する多種多様な界面活性剤を提供する。このような界面活性剤は、Synperonic PEシリーズ(ICI);Pluronic.RTM.シリーズ(BASF)、Emkalyx、Lutrol(BASF)、Supronic、Monolan、Pluracare、及びPlurodacを含め、様々な商標名で入手可能である。これらのポリマーに対する一般的な用語は、「ポロキサマー」(CAS9003-11-6)である。これらのポリマーは、式:HO(C2H4O)a(C3H6O)b(C2H4O)aHを有し、式中、「a」及び「b」は、それぞれポリオキシエチレンユニット及びポリオキシプロピレンユニットの数を表す。
[0102]ポリエチレングリコール-ポリエステルブロックコポリマーは、ポリマー界面活性剤のユニークなクラスである。比及び位置が十分に定義された親水性ポリエチレングリコール(PEG)部分及び疎水性ポリエステル部分を有する界面活性剤のユニークな構造は、本開示の実施形態での使用にとって好適である多種多様な界面活性剤を提供する。ブロックポリマー内のポリエステルとして、ポリ(L-ラクチド)(PLLA)、ポリ(DL-ラクチド)(PDLLA)、ポリ(D-ラクチド)(PDLA)、ポリカプロラクトン(PCL)、ポリエステルアミド(PEA)、ポリヒドロキシアルカノエート、ポリヒドロキシブチレート(PHB)、ポリヒドロキシブチレート-co-ヒドロキシバレレート(PHBV)、ポリヒドロキシブチレート-co-ヒドロキシヘキサノエート(PHBHx)、ポリアミノ酸、ポリグリコリド又はポリグリコール酸(PGA)、ポリグリコリド及びそのコポリマー(乳酸とのポリ(乳酸-co-グリコール酸)、ε-カプロラクトンとのポリ(グリコリド-co-カプロラクトン)、及びトリメチレンカーボネートとのポリ(グリコリド-co-トリメチレンカーボネート))、及びそのコポリエステルが挙げられる。例は、PLA-b-PEG、PLLA-b-PEG、PLA-co-PGA-b-PEG、PCL-co-PLLA-b-PEG、PCL-co-PLLA-b-PEG、PEG-b-PLLA-b-PEG、PLLA-b-PEG-b-PLLA、PEG-b-PCL-b-PEG、並びにその他のジ、トリ、及び複数のブロックコポリマーである。親水性ブロックは、その他の親水性又は水溶性ポリマー、例えばポリビニルアルコール、ポリビニルピロリドン、ポリアクリルアミド、及びポリアクリル酸等であり得る。
[0103]グラフトコポリマーの1例は、Soluplus(BASF、German)である。Soluplusは、ポリビニルカプロラクタム-ポリビニルアセテート-ポリエチレングリコールグラフトコポリマーである。コポリマーは、両親媒性化学構造を有する可溶化剤であり、水性媒体中で難溶性薬物、例えばパクリタキセル、ラパマイシン、及びその誘導体等を可溶化する能力を有する。コポリマーの分子量は、90,000~140000g/molの範囲である。
[0105]脂肪酸のソルビタンエステルが、本開示の実施形態での使用にとって好適な界面活性剤である。このエステルの中でも、好ましい疎水性界面活性剤として、ソルビタンモノラウレート(Arlacel20)、ソルビタンモノパルミテート(Span-40)、及びソルビタンモノオレエート(Span-80)、ソルビタンモノステアレートが挙げられる。
[0107]イオン性界面活性剤(カチオン性、アニオン性、及び双性イオン性界面活性剤を含む)が、本開示の実施形態での使用にとって好適な親水性界面活性剤である。
[0111]好ましいイオン性界面活性剤として、ラウリル硫酸ナトリウム、ドデシル硫酸ナトリウム、ラウリルエーテル硫酸ナトリウム、セトステアリル硫酸ナトリウム、セテアリル硫酸ナトリウム、テトラデシル硫酸ナトリウム、硫酸化ひまし油、コレステリル硫酸ナトリウム、テトラデシル硫酸ナトリウム、ミリスチル硫酸ナトリウム、オクチル硫酸ナトリウム、その他の中間鎖分岐型又は非分岐型アルキル硫酸、ドクサートナトリウム、スルホコハク酸ジオクチルナトリウム、ラウリルスルホ酢酸ナトリウム、アルキルベンゼンスルホン酸ナトリウム、ドデシルベンゼンスルホン酸ナトリウム、塩化ベンザルコニウム、塩化ベンゼトニウム、塩化セチルピリジニウム、ドセシルトリメチルアンモニウムブロミド、ドセシル硫酸ナトリウム(Sodium docecylsulfate)、ジアルキルメチルベンジルアンモニウムクロリド、エドロホニウムクロリド、ドミフェンブロミド、スルホコハク酸ナトリウム、ジオクチルスルホコハク酸ナトリウム、コール酸ナトリウム、及びタウロコール酸ナトリウムのジアルキルエステルが挙げられる。これら四級アンモニウム塩が好ましい添加剤である。これらは、有機溶媒(例えばエタノール、アセトン、及びトルエン等)及び水の両方に溶解し得る。これは、調製及びコーティングプロセスを簡素化し、また良好な接着特性を有するので、医療用デバイスコーティングに特に有用である。水不溶性薬物は有機溶媒に一般的に溶解する。これら界面活性剤のHLB値は、一般的に20~40の範囲であり、例えばドデシル硫酸ナトリウム(SDS)は38~40のHLB値を有する。
[0113]1つ又は複数のヒドロキシル、アミノ、カルボニル、カルボキシル、酸、アミド、又はエステル部分を有する化学物質として、アミノアルコール、ヒドロキシルカルボン酸、エステル、及び無水物、ヒドロキシルケトン、ヒドロキシルラクトン、ヒドロキシルエステル、糖リン酸、糖硫酸、糖アルコール、エチルオキシド、エチルグリコール、アミノ酸、ペプチド、タンパク質、ソルビタン、グリセロール、多価アルコール、リン酸塩、硫酸塩、有機酸、エステル、塩、ビタミン、アミノアルコールと有機酸との組み合わせ、及びその置換型分子が挙げられる。1つ又は複数のヒドロキシル、アミノ、カルボニル、カルボキシル、酸、アミド、又はエステル部分を有する、分子量が5,000~10,000未満の親水性化学物質が、特定の実施形態において好ましい。その他の実施形態では、1つ又は複数のヒドロキシル、アミノ、カルボニル、カルボキシル、酸、アミド、又はエステル部分を有する添加剤の分子量は、好ましくは1000~5,000未満、又はより好ましくは750~1,000未満、又は最も好ましくは750未満である。これらの実施形態では、添加剤の分子量は、送達される薬物の分子量未満であるのが好ましい。
[0122]酸化防止剤は、その他の分子に対して酸化遅延又は防止能力を有する分子である。酸化反応は、連鎖反応を開始するフリーラジカルを生成し得るが、また敏感な治療剤、例えばラパマイシン及びその誘導体の分解を引き起こすおそれがある。酸化防止剤は、フリーラジカルを除去することによりこの連鎖反応を終了させ、また更に、それ自体が酸化されることにより活性な薬剤の酸化を阻害する。酸化防止剤は、特定の実施形態において、医療用デバイスのためのコーティングに含まれる治療剤の酸化を防止し又は低速化させるための添加剤として用いられる。酸化防止剤は、フリーラジカルスカベンジャーの類である。酸化防止剤は、単独で、又は特定の実施形態ではその他の添加剤と組み合わせて使用され、また滅菌処理中、又は使用前の保管中に活性な治療剤が分解するのを防止し得る。
[0125]ビタミンA、D、E、及びKは、その様々な形態及びプロビタミン形態の多くにおいて、脂溶性ビタミンと考えられており、またこれらに加えて、いくつかのその他のビタミン及びビタミン源又は近縁物も脂溶性であり、また極性基及び比較的高いオクタノール-水分配係数を有する。明らかに、そのような化合物の一般的なクラスは、安全使用の歴史及び高い損益比を有し、本開示の実施形態における添加剤として有用なものとなしている。
[0127]ビタミンB、C、U、パントテン酸、葉酸、及びメナジオン関連ビタミン/プロビタミンの一部は、その様々な形態の多くにおいて、水溶性ビタミンと考えられる。これらは、疎水性部分又は多価イオンとコンジュゲート又は複合体形成して、比較的高いオクタノール-水分配係数及び極性基を有する両親媒性の形態となり得る。やはり、そのような化合物も低毒性及び高損益比の化合物であり得、本開示の実施形態における添加剤として有用なものとなしている。これらの塩も、本開示における添加剤として有用であり得る。水溶性ビタミン及び誘導体の例として、非限定的に、アセチアミン、ベンフォチアミン、パントテン酸、セトチアミン、シコチアミン、デクスパンテノール、ナイアシンアミド、ニコチン酸、ピリドキサール-5-ホスフェート、ニコチンアミドアスコルベート、リボフラビン、リボフラビンホスフェート、チアミン、葉酸、メナジオールジホスフェート、メナジオン亜硫酸水素ナトリウム、メナドキシム、ビタミンB12、ビタミンK5、ビタミンK6、ビタミンK6、及びビタミンUが挙げられる。上記したように、葉酸もまた、生理学的pHを含む幅広いpH範囲にわたり、水溶性(塩として)である。
[0129]アラニン、アルギニン、アスパラギン、アスパラギン酸、システイン、シスチン、グルタミン酸、グルタミン、グリシン、ヒスチジン、プロリン、イソロイシン、ロイシン、リジン、メチオニン、フェニルアラニン、セリン、トレオニン、トリプトファン、チロシン、バリン、及びその誘導体は、本開示の複数の実施形態におけるその他の有用な添加剤である。
オリゴペプチド、ペプチド、及びタンパク質
[0133]疎水性アミノ酸及び親水性アミノ酸は容易にカップリングすることができるので、オリゴペプチド及びペプチドは添加剤として有用であり、そして様々な配列のアミノ酸が薬物による組織への浸透を最大限に促進するためにテストされ得る。
[0136]例は、酢酸と無水物、安息香酸と無水物、ジエチレントリアミンペンタ酢酸二無水物、エチレンジアミンテトラ酢酸二無水物、マレイン酸と無水物、コハク酸と無水物、ジグリコール酸無水物、グルタル酸無水物、アスコルビン酸、クエン酸、酒石酸、乳酸、シュウ酸、アスパラギン酸、ニコチン酸、2-ピロリドン-5-カルボン酸、アロイリチン酸、シェロール酸、及び2-ピロリドンである。アロイリチン酸及びシェロール酸は、シェラックと呼ばれる樹脂を形成することができる。パクリタキセル、アロイリチン酸、及びシェロール酸の組み合わせが、バルーンカテーテル用の薬物放出コーティングとして使用可能である。
[0138]複数の実施形態に基づく添加剤は、環状及び直鎖状の脂肪族基及び芳香族基の両方において、アミノアルコール、アルコール、アミン、酸、アミド、及びヒドロキシル酸を含む。例は、L-アスコルビン酸とその塩、D-グルコアスコルビン酸とその塩、トロメタミン、トリエタノールアミン、ジエタノールアミン、メグルミン、グルカミン、アミンアルコール、グルコヘプトン酸、グルコム酸、ヒドロキシルケトン、ヒドロキシルラクトン、グルコノラクトン、グルコヘプトノラクトン、グルコオクタン酸ラクトン、グロン酸ラクトン、マンノン酸ラクトン、リボン酸ラクトン、ラクトビオン酸、グルコサミン、グルタミン酸、ベンジルアルコール、安息香酸、ヒドロキシ安息香酸、プロピル-4-ヒドロキシベンゾエート、リジン酢酸塩、ゲンチジン酸、ラクトビオン酸、ラクチトール、ソルビトール、グルシトール、糖ホスフェート、グルコピラノースホスフェート、糖サルフェート、糖アルコール、シナピン酸、バニリン酸、バニリン、メチルパラベン、プロピルパラベン、キシリトール、2-エトキシエタノール、糖、ガラクトース、グルコース、リボース、マンノース、キシロース、スクロース、ラクトース、マルトース、アラビノース、リキソース、フルクトース、シクロデキストリン、(2-ヒドロキシプロピル)-シクロデキストリン、アセトアミノフェン、イブプロフェン、レチノイン酸、リジンアセテート、ゲンチジン酸、カテキン、カテキンガラート、チレタミン、ケタミン、プロポフォール、乳酸、酢酸、任意の有機酸と上記アミンの塩、ポリグリシドール、グリセロール、マルチグリセロール、ガラクチトール、ジ(エチレングリコール)、トリ(エチレングリコール)、テトラ(エチレングリコール)、ペンタ(エチレングリコール)、ポリ(エチレングリコール)オリゴマー、ジ(プロピレングリコール)、トリ(プロピレングリコール)、テトラ(プロピレングリコール)、及びペンタ(プロピレングリコール)、ポリ(プロピレングリコール)オリゴマー、ポリエチレングリコールとポリプロピレングリコールのブロックコポリマー、並びにその誘導体及び組み合わせである。
[0139]添加剤の組み合わせ物も、本開示の目的にとって有用である。
[0140]1つの実施形態は、2つの添加剤の組み合わせ物又は混合物を含み、例えば第1の添加剤は界面活性剤を含み、そして第2の添加剤は、1つ又は複数のヒドロキシル、アミン、カルボニル、カルボキシル、アミド、又はエステル部分を有する化学物質を含む。
[0149]固体添加剤が、薬物コーティングされた医療用デバイスで多くの場合使用される。イオプロミド(ヨウ素造影剤)が、バルーンカテーテルをコーティングするのにパクリタキセルと共に使用されてきた。この種のコーティングは、液体化学物質を含有しない。コーティングは、バルーンカテーテルの表面上のパクリタキセル固体及びイオプロミド固体からなる凝集物である。コーティングは、医療用デバイスに対する接着性を欠いており、またハンドリング及び介入手技の間にコーティング粒子が脱落する。水不溶性薬物は、多くの場合、固体化学物質、例えばパクリタキセル、ラパマイシン等、及びその類似体である。本開示の実施形態では、液体添加剤が、コーティングの完全性を改善するために医療用デバイスコーティングにおいて使用可能である。固体薬物及び/又はその他の固体添加剤の適合性を改善することができる液体添加剤を有するのが好ましい。2つ又はそれより多くの固体粒子からなる凝集物ではなく、固体コーティング溶液を形成可能な液体添加剤を有するのが好ましい。別の添加剤及び薬物が固体であるとき、少なくとも1つの液体添加剤を有するのが好ましい。
[0152]1つの実施形態では、薬物コーティング層30、及び任意選択で中間層40(存在するとき)は、2つ以上の添加剤、例えば2、3、又は4つの添加剤を含む。1つの実施形態では、薬物コーティング層30は少なくとも1つの添加剤を含み、該少なくとも1つの添加剤は、第1の添加剤と第2の添加剤を含み、及び第1の添加剤は、第2の添加剤よりも親水性である。別の実施形態では、薬物コーティング層30、及び任意選択で中間層40(存在するとき)は、少なくとも1つの添加剤を含み、該少なくとも1つの添加剤は、第1の添加剤と第2の添加剤を含み、及び第1の添加剤は、第2の添加剤の構造とは異なる構造を有する。別の実施形態では、薬物コーティング層30、及び任意選択で中間層40(存在するとき)は、少なくとも1つの添加剤を含み、該少なくとも1つの添加剤は、第1の添加剤と第2の添加剤を含み、及び第1の添加剤のHLB値は、第2の添加剤のHLB値よりも高い。なおも別の実施形態では、薬物コーティング層30、及び任意選択で中間層40(存在するとき)は、少なくとも1つの添加剤を含み、該少なくとも1つの添加剤は、第1の添加剤と第2の添加剤を含み、及び第1の添加剤のlog(P)値は、第2の添加剤のそれよりも低い。例えば、ソルビトール(log(P)は-4.67)は、ツイーン20(log(P)は約3.0)よりも親水性である。PEG脂肪酸エステルは脂肪酸よりも親水性である。ブチル化ヒドロキシアニソール(BHA)(log(P)は1.31)は、ブチル化ヒドロキシトルエン(BHT)(log(P)は5.32)よりも親水性である。
[0170]コーティング層を調製するための溶媒として、例として次の(a)水、(b)アルカン、例えばヘキサン、オクタン、シクロヘキサン、及びヘプタン等、(c)芳香族溶媒、例えばベンゼン、トルエン、及びキシレン等、(d)アルコール、例えばエタノール、プロパノール、及びイソプロパノール、ジエチルアミド、エチレングリコールモノエチルエーテル、Trascutol、及びベンジルアルコール等(e)エーテル、例えばジオキサン、ジメチルエーテル、及びテトラヒドロフラン等、(f)エステル/アセテート、例えば酢酸エチル及び酢酸イソブチル等、(g)ケトン、例えばアセトン、アセトニトリル、ジエチルケトン、及びメチルエチルケトン等、並びに(h)水と有機溶媒の混合物、例えば水/エタノール、水/アセトン、水/メタノール、水/テトラヒドロフラン等のうちの1つ又は複数の任意の組み合わせを挙げることができる。トップコート層において好ましい溶媒はアセトンである。
[0185]本開示の特定の実施形態のデバイス上に薬物-添加剤含有層を積層した後、ジメチルスルホキシド(DMSO)又はその他の溶媒が、ディッピング若しくはスプレーイング、又はその他の方法により、コーティングの仕上がり面に適用され得る。DMSOは薬物を容易に溶解し、また膜を容易に貫通し、そして組織吸収を増強し得る。
[0193]これまでに記載したように、医療用デバイス、例えばバルーンカテーテル10等は、例えば、改質された外部表面25、すなわち薬物コーティング層30の適用前に外部表面25の表面自由エネルギーを減少させる表面改質が施された表面を含む。該表面改質は、薬物コーティング層30が適用される前に、外部表面25上への中間層40の適用を含み得る。中間層40の適用は、中間層40を形成するための単量体化合物のプラズマ重合を含み得る。医療用デバイスの外部表面に中間層40が適用されると、医療用デバイスの改質された外部表面25は、中間層40を含み、そして薬物コーティング層30が中間層40を被覆する。
[0203]これまでに記載したように、医療用デバイス、例えばバルーンカテーテル10等は、改質された外部表面25、すなわち薬物コーティング層30の適用前に、外部表面25の表面自由エネルギーを減少させる表面改質が施された表面を含む。表面改質は、薬物コーティング層30が適用される前に、外部表面25上の中間層40のプラズマ重合を含み得る。任意選択で、表面改質は、中間層40及び薬物コーティング層30が適用される前に、外部表面25中にフッ素含有種を注入するフッ素プラズマ処理、例えばプラズマフッ素化等を更に含み得る。複数の実施形態では、改質された外部表面25は、複数のデポ又は表面特性(薬物コーティング層30が適用される前に中間層40をエッチングすることにより形成される)を更に含み得る。薬物コーティング層30は、デポ又は表面特性の少なくとも一部分を充填し得る。
Claims (20)
- マイクロパターニングされた表面と、マイクロパターニングされた表面を被覆するコーティング層とを含む医療用デバイスであって、
該マイクロパターニングされた表面が、複数の微細構造を含み、
ここで、微細構造は、マイクロパターニングを欠いているがそれ以外は同一の医療用デバイスを用いて罹患した管腔について同一の処置を行った場合と比較して、罹患した管腔内での治療剤の組織保持を増加させ、そして、
該コーティング層が、疎水性治療剤及び少なくとも1つの添加剤を含む、
上記医療用デバイス。 - 複数の微細構造が、デバイスの外部表面上、デバイスの外部表面を被覆する中間層上、又はその両方に直接形成される、請求項1に記載の医療用デバイス。
- 微細構造が、複数の凹部及び凸部を含む、請求項2に記載の医療用デバイス。
- 微細構造がデポを含み、及びコーティング層がデポの少なくとも一部分満たす、請求項1に記載の医療用デバイス。
- マイクロパターニングされた表面が、外部表面に接着したマイクロパターニングされたフィルムを含む、請求項1に記載の医療用デバイス。
- マイクロパターニングされた表面が、マイクロパターニングされたポリマーを含む、請求項1に記載の医療用デバイス。
- 中間層が、重合アルキルシクロヘキサン、重合トルエン、重合キシレン、パリレンC、パリレンN、パリレンD、パリレンX、パリレンAF-4、パリレンSF、パリレンHT、パリレンVT-4(パリレンF)、パリレンCF、パリレンA、及びパリレンAM、又はその組み合わせから選択される、請求項3~8のいずれか1項に記載の医療用デバイス。
- 治療剤が、パクリタキセル、パクリタキセルアナログ若しくは誘導体、ラパマイシン、ラパマイシンアナログ若しくは誘導体、又はその組み合わせを含む、先行する請求項のいずれか1項に記載の医療用デバイス。
- 少なくとも1つの添加剤が、ポリソルベート及び糖アルコールを含む、先行する請求項のいずれか1項に記載の医療用デバイス。
- バルーンカテーテルである、先行する請求項のいずれか1項に記載の医療用デバイス。
- 治療剤を必要としている患者の脈管構造内にある罹患した管腔の標的部位において、治療剤の組織保持量を増加させる医療用デバイスを調製する方法であって、
外部表面、中間層、又はその両方をマイクロパターニングして、マイクロパターニングされた表層を形成するステップと、
マイクロパターニングされた表層上に、疎水性治療剤及び少なくとも1つの添加剤を含むコーティング層を適用するステップと
を含む、上記方法。 - マイクロパターニングするステップが、デバイスの外部表面上に複数の凹部及び凸部を形成するステップを含む、請求項13に記載の方法。
- マイクロパターニングするステップが、中間層上に複数の凹部及び凸部を形成するステップを含む、請求項13に記載の方法。
- マイクロパターニングするステップがデポを形成し、及びコーティング層を適用するステップが、デポの少なくとも一部分を満たす、請求項13に記載の方法。
- 中間層が、重合アルキルシクロヘキサン、重合トルエン、重合キシレン、パリレンC、パリレンN、パリレンD、パリレンX、パリレンAF-4、パリレンSF、パリレンHT、パリレンVT-4(パリレンF)、パリレンCF、パリレンA、及びパリレンAM、又はその組み合わせから選択される、請求項11に記載の方法。
- 治療剤が、パクリタキセル、パクリタキセルアナログ若しくは誘導体、ラパマイシン、ラパマイシンアナログ若しくは誘導体、又はその組み合わせを含む、請求項11に記載の方法。
- 少なくとも1つの添加剤が、ポリソルベート及び糖アルコールを含む、請求項11に記載の方法。
- 医療用デバイスが、バルーンカテーテルである、請求項11に記載の方法。
- 対象において治療処置を提供する方法であって、
対象の罹患した管腔内に医療用デバイスを挿入するステップであって、
該医療用デバイスが、外部表面、外部表面を被覆する中間層、及び中間層を被覆するコーティング層を備え、中間層がマイクロパターニングを含み、及びコーティング層が疎水性治療剤及び少なくとも1つの添加剤を含むステップと、
医療用デバイスを拡張させて、罹患した管腔の壁中への治療剤の放出を引き起こすステップとを含み、
マイクロパターニングが、マイクロパターニングを欠いている以外は同一である医療用デバイスを用いて罹患した管腔について同一の処置を行った場合と比較して、罹患した管腔内での治療剤のより長期の組織保持を引き起こすのを促進する、
上記方法。 - 医療用デバイスを収縮させるステップと、罹患した管腔から医療用デバイスを除去するステップとを更に含む、請求項19に記載の方法。
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