NOVEL GLUE FOR EMBOLIZATION OF LYMPHATIC LEAKAGE
20220296772 · 2022-09-22
Inventors
- Ghassan S. Kassab (La Jolla, CA)
- Ali Dabiri (La Jolla, CA, US)
- Niki Bayat (Los Angeles, CA, US)
- Roby Menefee (Los Angeles, CA, US)
Cpc classification
A61L24/0089
HUMAN NECESSITIES
C08L33/26
CHEMISTRY; METALLURGY
A61L2430/36
HUMAN NECESSITIES
A61L2300/102
HUMAN NECESSITIES
A61L24/0089
HUMAN NECESSITIES
A61L24/06
HUMAN NECESSITIES
International classification
A61L24/00
HUMAN NECESSITIES
Abstract
A novel glue for embolization of lymphatic leakage. An optimized lymphatic embolization agent (LEA) as described herein comprises a NAM hydrogel and tantalum at a mixture of at or about 1:3 tantalum to NAM hydrogel, wherein said LEA is radiopaque.
Claims
1. An optimized lymphatic embolization agent (LEA), comprising a NAM hydrogel and tantalum at a mixture of at or about 1:3 tantalum to NAM hydrogel, wherein said LEA is radiopaque.
2. The LEA of claim 1, wherein the NAM hydrogel comprises N.sub.93Am.sub.7.
3. The LEA of claim 2, wherein the N.sub.93Am.sub.7 is produced by dissolving NIPAM, Am and 2,2′ azobisisobutryonitrile in tetrahydrofuran, degassing under elevated temperature, and isolating the resultant product, wherein the resultant product comprises N.sub.93Am.sub.7.
4. The LEA of claim 2, wherein the N.sub.93Am.sub.7 is synthesized by free radical polymerization.
5. The LEA of claim 1, configured for injection into a mammalian subject through a 3 Fr catheter.
6. The LEA of claim 1, configured to solidify within 45 seconds at a temperature of 37° C.
7. The LEA of claim 1, configured to solidify within 30 seconds at a temperature of 37° C.
8. The LEA of claim 1, configured to solidify within 15 seconds at a temperature of 37° C.
9. The LEA of claim 1, configured to resist displacement under 800 mmHg of pressure after 60 seconds at 37° C.
10. The LEA of claim 1, configured as a lymphatic sealant.
11. A method of occluding a lymphatic vessel, comprising: introducing the LEA of claim 1 into a mammalian patient at or near a lymphatic vessel to occlude said vessel.
12. The method of claim 11, wherein the step of introducing comprises introducing at or about 3 ml of the LEA so that at or about 1 ml of solid glue forms at or about 37° C.
13. The method of claim 11, wherein the solid glue resists migration.
14. A method of treating lymphatic leakage, comprising introducing the LEA of claim 1 into a mammalian patient at or near a lymphatic vessel to treat the lymphatic leakage.
15. The method of claim 14, wherein the step of introducing comprises introducing at or about 3 ml of the LEA so that at or about 1 ml of solid glue forms at or about 37° C.
16. The method of claim 14, wherein the solid glue resists migration.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0035] The disclosed embodiments and other features, advantages, and disclosures contained herein, and the matter of attaining them, will become apparent and the present disclosure will be better understood by reference to the following description of various exemplary embodiments of the present disclosure taken in conjunction with the accompanying drawings, wherein:
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[0056] As such, an overview of the features, functions and/or configurations of the components depicted in the various figures will now be presented. It should be appreciated that not all of the features of the components of the figures are necessarily described and some of these non-discussed features (as well as discussed features) are inherent from the figures themselves. Other non-discussed features may be inherent in component geometry and/or configuration. Furthermore, wherever feasible and convenient, like reference numerals are used in the figures and the description to refer to the same or like parts or steps. The figures are in a simplified form and not to precise scale.
DETAILED DESCRIPTION
[0057] For the purposes of promoting an understanding of the principles of the present disclosure, reference will now be made to the embodiments illustrated in the drawings, and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of this disclosure is thereby intended.
Determination of Mechanical Criteria
[0058] The transition from a malleable form to solid is a universal property of embolic agents. They each accomplish this mechanical transition slightly differently, but of chief importance for all of them is a reliable transition stimulus and window. In a clinical setting, the ability to produce a consistent behavior from an occlusive agent makes the difference between a catheter glued to a vessel wall and a procedure without any adverse events.
[0059] There are many responsive materials capable of producing this reliable change in behavior, but one of the most notable is poly(n-isopropylacrylamide) (PNIPAM). It is uniquely suited for the targeted deployment to a higher temperature region where aggregation is desired. Further, having been widely studied, it boasts a biocompatibility and customizability rarely observed with other synthetic molecules. PNIPAM was first synthesized in 1956 and was soon recognized as a smart, biostable polymer. It undergoes a reversible transition from a hydrophilic coil state to a hydrophobic globule state at a specified temperature known as the Lower Critical Solution Temperature (LCST) (such as shown in
[0060] NIPAM homopolymers are well understood, but their suitability for use as embolic agents has not been widely pursued. The primary criteria defining their suitability as embolic agents are their phase transition dynamics and the material properties on either side of the LCST. To isolate these parameters, a 20% (w/w) solution of PNIPAM (PNI), well-documented to have a phase transition at 32° C., was created to examine preliminary suitability for delivery via a 3 Fr catheter. A temperature-controlled benchtop model was used to test suitability for controlled deployment via catheter. A 40 cm of catheter was submerged in a temperature-controlled water bath to simulate a lymphatic embolization operation. Though a 3 Fr catheter with internal diameter 0.46 mm was not able to deploy the hydrogel at 37° C., a 4 Fr with a larger internal diameter (0.89 mm) was able to effectively deliver the hydrogel through the catheter (as shown in
[0061] The ideal material properties for the sealant were also examined qualitatively. Embolic agents must provide long-term occlusion, resisting pressure, compression, and other forces for an indefinite timeframe. This task requires cohesive strength and durability not observed in PNIPAM hydrogels. These homopolymer hydrogels have a characteristic fragility that can be observed easily in the semi-solid state above LCST. These PNI hydrogels can easily be crumbled between fingers and are generally not suitable for biomedical sealants. Increasing concentration can help in this regard, but the limited ability to deploy even a 20% PNI hydrogel demonstrated that simply using a homopolymer would not work. Following these qualitative observations, the third design input of increased hydrogel strength was identified. In order to strengthen the material properties of the hydrogel, molecular modification or cross linkers must be used. Based on the previous work of Bayat et. al., comonomer selection has been shown to produce both the LCST shift and an increase in strength, providing a natural starting point.
Comonomer Selection and Characterization
[0062] Initially, three hydrophilic comonomers were identified with co-monomers suitable for increasing the hydrogel LCST: Acrylamide, Acrylic Acid, and Methacrylic Acid. Acrylamide was chosen as the preferred candidate due to concerns about hydrogel pH. Further, a mouse toxicity assessment for a copolymer of NIPAM and Acrylamide has already shown preliminary biocompatibility and safety. These traits offered a promising first LEA attempt and so a N.sub.93Am.sub.7 (NAM) (by mass) conformation was synthesized by Free Radical Polymerization. In comparison to PNI homopolymers, this copolymer contains a greater proportion of hydrophilic subunits, but also provides more hydrogen bonding sites by way of the dual hydrogens on the amide group. This increased capacity for supramolecular linkage has been linked to the formation of stronger gel networks (
[0063] To assess the viability of the NAM hydrogel, oscillatory rheology was performed to record gel responses across a range of strains and temperatures. Overall mechanical properties were then observed in the Loss (G″) and Storage (G′) moduli, quantifications of viscous and elastic behavior. These characteristics play a significant role in LCST-triggered phase transitions. Prior to gelation, a loss modulus that is too high can indicate a material that is too viscous and unable to be easily injected. At higher temperatures, a storage modulus that is too low indicates that the material is not sufficiently cohesive and may deform or break under physiological pressures. The comparison of these two indicators can provide further clues about supramolecular structure. A dominant loss modulus is characteristic of a primarily viscous fluid. On the other hand, a dominant storage modulus occurs when the material resists deformation, a sign of material strength and molecular networking. This strengthening can be observed in frequency and strain sweeps applied to a 30% NAM hydrogel. At temperatures above (40° C.) and below (20° C.) LCST, the amount (amplitude) and frequency of strain were increased to determine the critical points and regions of linearity for hydrogel analysis. At 40° C. above the LCST, tight hydrogel structure gave way to very clear regions of linearity and critical points of structural breakdown around 10% strain (See
[0064] Temperature sweeps were conducted to determine the effects of concentration and structural modification on the phase transition. Previous research has already demonstrated an inverse relationship between polymer concentration and hydrogel LCST, and a direct relationship between polymer concentration and hydrogel material strength (viscosity). Our results using a comparison of two PNI hydrogels with different concentrations confirmed these earlier findings and further illustrated the need for precise tuning of hydrogel behavior (as shown in
[0065] Further examination of the NAM hydrogel mechanical properties indicated that an almost ideal candidate was found for the LEA. Complex viscosity comparisons during temperature ramp or earlier strain/frequency sweeps constantly deformed the sample but still demonstrated a significant increase in the strength of the gel. Before the transition however, the LEA hydrogel was noted to have a much lower viscosity despite having 150% of the PNI benchmark's concentration. It was theorized that the acrylamide co-monomer played two roles in this regard. By offering more hydrogen bonding sites, the copolymer was more hydrophilic, more readily dissolving below LCST. Above LCST, however, those hydrogen bonding sites provided more networking opportunities after a transition to the globule state (as shown in
LEA Optimization
[0066] The cohesiveness of the NAM hydrogel established its suitability for use as a preliminary LEA. Even so, it still lacked radiopacity. This presented a potential design challenge as the addition of various additives to NIPAM hydrogels can vastly alter their behavior and strength. Tantalum, a well-known radiopaque element that can be mixed with sealants proved to only slightly alter hydrogel material properties. Ratios of 1:8, 1:4, and 1:2 tantalum to 30% NAM hydrogel were created to determine the optimal formulation (
Benchtop Validation
[0067] A combination of controlled temperature catheter injection and pressure testing allowed for a rapid determination of design inputs. While the 20% PNI sample was suitable for catheter delivery at 37° C. and could withstand 4× maximum lymphatic pressure (ave:200, test:800 mm Hg), the transition occurred to quickly for the gel to be useful. Further, concerns were raised about the overall cohesivity of the hydrogel for a long-term use case.
[0068] To validate the LEA candidate, more benchtop proof-of concept testing was performed. In greater detail, LEA was injected through 3 Fr catheter, 40 cm of which was at a range of controlled temperatures of 37° C. This provided preliminary determination of suitability for deployment in a simulated use case. PNI, NAM, and NAM+Ta hydrogels were all tested using this method. These tests were useful for determining target concentration and formulation viability. It took 10-15 sec to deliver 1.0 ml of NAM and solidification took place within 15-20 sec (
[0069] Results from these tests also reinforced material analysis. At temperatures below LCST, NAM hydrogel viscosity increased slightly as result of tantalum addition. At higher temperatures, however, there were no significant differences between viscosity or moduli, indicating that the tantalum did not have any adverse effects on hydrogel cohesion (
[0070] The successful occlusion of a simulated vessel indicated that the LEA identified herein is suitable for validation in biological models, but significant work must be performed to fully characterize the material and establish suitability. Long-term shape retention and degradation timelines must be studied. Additionally, the impact of any unreacted monomer on the hydrogel as a cross linking agents should be explored. Tolerances for material suitability will also need to be established via robust methods to ensure long-term efficacy without adverse effects.
Materials and Methods
Homopolymer Source and Copolymer Synthesis
[0071] Poly(N-isopropylacrylamide) homopolymer Mn=40 k was purchased from Sigma Aldrich for initial hydrogel preparation. Copolymers of NIPAM and Acrylamide (Am) were synthesized using free radical polymerization. For N.sub.93Am.sub.7, a solution of NIPAM (9.3 g), Am(0.7 g) and 2,2′ azobisisobutyronitrile (10 mg) were dissolved in tetrahydrofuran (THF). The solution was then degassed under nitrogen and heated to 55° C. for 24 hours. Copolymer product was isolated using hexanes, filtered, washed, and dried under vacuum. Target monomer ratios were derived from literature and information on copolymers that may be purchased from common chemical vendors.
Rheological Analysis
[0072] A TA Instruments DHR 2 Rheometer was used to measure the rheological properties of the hydrogels. A 0.15 ml of hydrogel was injected via syringe onto a temperature-controlled plate. Strain-Amplitude and Frequency sweeps were used to identify linear regions and critical points for the hydrogels at temperatures below (20° C.) and above (40° C.) LCST. Amplitude sweeps for parameter determination were performed with a frequency of 10 rad/s. Angular frequency sweeps were performed with an amplitude of 1% strain. After linear regions were identified, strain of 1% and frequency of 1 rad/s were used for all subsequent testing. Temperature ramp experiments were performed with a ramp rate of 1° C./min, spanning 30° C. to 45° C. Fixed temperature oscillatory tests were performed at fixed temperatures of 20° C. and 37° C. (body temperature). All experiments use a 20 mm parallel plate (0°) fitted with a solvent trap, 500 μm gap, and 2-minute temperature incubation period. N=3 for all rheological experiments. Samples tested include 20%, 30% PNI, 30% NAM, and 30% NAM+tantalum.
Discussion
[0073] This work demonstrated that a NIPAM-based hydrogel has the potential for use as an internal embolic agent. By tailoring molecular structure, concentration, and additives an appropriate prototype was developed that showed sufficient durability and cohesion to withstand a basic model of a lymphatic use case. Structural modifications with acrylamide were sufficient to cause mega-fold increases in hydrogel viscosity, inviting many avenues of future research into the molecular dynamics that cause this significant supramolecular alteration. This work was initially motivated by the shortfalls of existing lymphatic embolization technologies. There are no sealants approved for this indication the resulting shortfalls of off-indication use have placed an unreasonable burden on patients. The drastic improvements in material properties and early validation data suggest that this technology could alleviate that burden.
Functional Requirements for LEA
[0074] A goal of the studies performed herein was to overcome the mechanical, biocompatibility, and delivery shortcomings of existing technologies while meeting standard requirements for efficacy. The results presented here demonstrate a temperature-responsive sealant that can be injected as a low-viscosity liquid via 3 Fr catheter to a site of lymphatic leakage, and then undergo a heat-induced solidification to create a form-fitted, non-biodegradable occlusion. This blockage can then prevent the loss of fluid to interstitial tissue and restore equilibrium to the circulatory systems of the body (
[0075] The LEA described in this report is the first hydrogel deployed to the lymphatic system as a sealant. Initial studies show that it takes 30-45 s to deliver the desired glue amount (3 ml is generally used to plug the lymphatic vessel which results in 1 ml of solid glue) through a 3 Fr catheter. A desirable goal is to complete the injection in less than 1 min with the hydrogel-imaging agent mixture through a 3 Fr catheter. Preliminary studies have also shown that a rapid transition to a shape-responsive ultra-cohesive material can ensure a stationary plug after the injection. The LEA described also resisted maximum lymphatic pressures with adequate opacity to be injected and monitored via radiography. Several experimental use cases have shown suitability of linear NIPAM copolymer hydrogels for use in medical devices. This study adds one more example of how molecular structure can be tailored to biomedical function.
[0076] The need for a smart alternative to existing technologies is further shown by the market size. The global transcatheter embolization and occlusion devices (TEO) market size was valued at $2.69 billion in 2016 and is expected to reach over $4.75 billion by 2022, according to a study by Grand View Research, Inc. The market has witnessed tremendous growth over the last decade. Paradigm shifts from clipping to coiling to liquid sealants have stimulated the demand for transcatheter embolization devices. A key driver of the market is the adoption of minimally invasive surgeries. Even so, costs have become a significant roadblock. Medical adhesives like cyanoacrylate, fibrin, and newer synthetics are significantly more expensive than conventional surgical technologies due to production costs. Stringent regulatory approval procedures, and the need for experienced healthcare professionals to perform TEO procedures are some factors that impede market growth. High costs for every type of embolization method are often cited as a disadvantage. By eliminating the need for complicated manufacturing processes, not requiring cure-resistant storage, and using only a few readily accessible components the preferred hydrogel(s) offer not only a competitive technical profile, but competitive overall costs.
[0077] The first set of experiments with the first generation of the glue has been promising. Future work will be to develop the second generation sealant, which would include chronic and acute disease swine testing, refining the sealant product, developing a commercialization plan, formal quality control with validation, GLP animal studies, and submission for an IDE first-in-man study. Future work on these technologies will also require examination of scalability. The simplicity of the manufacturing process offers a batch approach, but significant testing will still be required to show long term stability, suitably low levels of residual solvents and monomers, and reliable material properties. Should these various metrics be obtained with suitable results, it is anticipated that the technology will have many other biomedical applications that will be readily attainable with the map of chemical variables gained via this research.
[0078] While various embodiments and methods have been described in considerable detail herein, the embodiments are merely offered as non-limiting examples of the disclosure described herein. It will therefore be understood that various changes and modifications may be made, and equivalents may be substituted for elements thereof, without departing from the scope of the present disclosure. The present disclosure is not intended to be exhaustive or limiting with respect to the content thereof.
[0079] Further, in describing representative embodiments, the present disclosure may have presented a method and/or a process as a particular sequence of steps. However, to the extent that the method or process does not rely on the particular order of steps set forth therein, the method or process should not be limited to the particular sequence of steps described, as other sequences of steps may be possible. Therefore, the particular order of the steps disclosed herein should not be construed as limitations of the present disclosure. In addition, disclosure directed to a method and/or process should not be limited to the performance of their steps in the order written. Such sequences may be varied and still remain within the scope of the present disclosure.