Systems and methods for tissue processing and preparation of cell suspension therefrom
11124752 · 2021-09-21
Assignee
Inventors
- Andrew Perry QUICK (Valencia, CA, US)
- David Allen Fencil (Valencia, CA, US)
- William Ford Dolphin (Topanga, CA, US)
Cpc classification
C12M45/02
CHEMISTRY; METALLURGY
C12M21/08
CHEMISTRY; METALLURGY
International classification
Abstract
The present invention provides for methods and at least partially automated devices suitable for producing a transplantable cellular suspension of living tissue suitable for promoting tissue regeneration in an epithelium-related procedure, as well as compositions produced therefrom. Tissue regeneration in humans is extremely limited and constitutes a major challenge to the repair of damaged organ function. Wound treatment is a typical area where tissue regeneration is required. Wounds (lacerations or openings) in mammalian tissue can result in tissue disruption and coagulation of the microvasculature at the wound face.
Claims
1. A device for preparing cells for transplant, the device comprising: a tissue processing chamber configured to receive a tissue and a chemical reagent, wherein the chemical reagent chemically dissociates the tissue; a reciprocating-rotating pestle in the tissue processing chamber, wherein the reciprocating-rotating pestle is actuatable to exert a grinding force on the tissue, wherein the force mechanically dissociates the tissue; and a cell collection chamber configured to collect a cell suspension comprising the chemically and mechanically dissociated tissue from the tissue processing chamber.
2. The device of claim 1, further comprising a disintegrator separating the tissue processing chamber from the cell collection chamber.
3. The device of claim 2, wherein the disintegrator comprises a mesh, screen, grid, blade, or any combination thereof.
4. The device of claim 2, further comprising a filter arranged between the disintegrator and the cell collection chamber.
5. The device of claim 1, further comprising a cap removably placed on or hinged to the tissue processing chamber.
6. The device of claim 5, wherein the reciprocating-rotating pestle is connected to the cap.
7. The device of claim 1, wherein the grinding force exerted by the reciprocating-rotating pestle comprises compression and a rotational force on the tissue.
8. The device of claim 1, further comprising an applicator in fluid communication with the cell collection chamber and configured to receive the cell suspension.
9. The device of claim 8, further comprising at least one pump configured to drive the cell suspension from the cell collection chamber to the applicator.
10. The device of claim 8, further comprising a filter arranged between the cell collection chamber and the applicator.
11. The device of claim 8, wherein the applicator is capable of dispensing, spraying, or dripping the cell suspension.
12. The device of claim 8, wherein the applicator comprises a pivoting head.
13. The device of claim 8, wherein the applicator is removable from fluid communication with the cell collection chamber.
14. The device of claim 1, further comprising a support in fluid communication with the cell collection chamber and configured to receive the cell suspension, wherein the support comprises a matrix, a scaffold, a dressing, or any combination thereof.
15. The device of claim 1, further comprising a container comprising the chemical reagent and in fluid communication with the tissue processing chamber.
16. The device of claim 15, wherein the chemical reagent comprises an enzyme capable of breaking down extracellular matrix in the tissue, and the container comprises a first compartment and a second compartment separated by a breakable seal, the first compartment containing water and the second compartment containing lyophilized enzyme powder, and wherein when the seal is broken the enzyme powder dissolves in the water.
17. The device of claim 16, wherein the enzyme comprises trypsin, trypsin-EDTA, dispase, collagenase, thermolysin, pronase, hyaluronidase, elastase, papain, pancreatin, or any combination thereof.
18. The device of claim 1, further comprising a container comprising a buffer solution, wherein the container is in fluid communication with the tissue processing chamber.
19. The device of claim 1, further comprising a container comprising an exogenous agent, wherein the container is in fluid communication with the tissue processing chamber.
20. The device of claim 19, wherein the exogenous agent comprises a heat shock protein or a fragment thereof, hyaluronic acid, platelet-enriched plasma, a growth factor, adipose stem cells, or any combination thereof.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
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DETAILED DESCRIPTION
(10) Those skilled in the art will appreciate that the invention described herein is adaptable to variations and modifications other than those specifically described. It is to be understood that the invention includes all such variation and modifications. The invention also includes all of the steps, features, compositions and compounds referred to or indicated in the specification, individually or collectively and any and all combinations or any two or more of the steps or features.
(11) The present invention is not to be limited in scope by the specific embodiments described herein, which are intended for the purpose of exemplification only. Functionally equivalent products, compositions and where appropriate methods are clearly within the scope of the invention as described herein.
(12) Throughout this specification and the claims that follow, unless the context requires otherwise, the word “comprise”, or variations such as “comprises” or “comprising”, will be understood to imply the inclusion of a stated integer or group of integers but not the exclusion of any other integer or group of integers.
(13) Having regard to the above, this invention provides a unique method and device suitable for producing a cellular suspension of living tissue suitable for application to a patient in an epithelium-related procedure. In applying the method and/or in using the device, a donor tissue (e.g., skin epithelium such as glabrous epithelium, respiratory epithelium, vascular epithelium, corneal epithelium, and glandular epithelium) is harvested from a patient and subjected to a tissue dissociating means, and cells suitable for applying back to a recipient site of the same patient are collected. In some embodiments, the cells so collected can be cultured and expanded in vitro before applying to a recipient site. The cells can also be seeded to a scaffold or matrix where the cells can grow and/or proliferate into an artificial tissue or organ.
(14) The cells may be presented in the form of a cell suspension (used interchangeably with “cellular suspension” herein) in a solution that is suitable for immediate dispersion (e.g., immediately after harvesting and/or filtering without in vitro culturing of the cells) over the recipient site. The cell suspension can be dispersed (immediately after harvesting or after in vitro culturing) to the recipient site alone or in combination with additional factor(s) such as heat shock protein(s), hyaluronic acid, platelet-enriched plasma, growth factor(s), and/or adipose stem cells, to facilitate, for example, wound healing, skin re-surfacing, or other epithelial treatments. The cell suspension can be dispersed via spraying, dripping, or any other application process. The cell suspension can also be injected directly into a tissue.
(15) Aspects of the present invention include a system for cell harvesting and transplant, which can include: a cartridge for processing a tissue, comprising a tissue processing chamber, a disintegrator situated therein and a cell collection chamber separated from the tissue processing chamber by the disintegrator, wherein after dissociating the tissue placed in the tissue processing chamber mechanically and/or chemically and passing the dissociated tissue through the disintegrator, a cell suspension is collected in the cell collection chamber; and a programmable console for housing the cartridge and for providing motive power to supply a mechanical force and/or a chemical reagent to the tissue, wherein the console comprises a processor for controlling the console to supply the mechanical force and/or chemical reagent.
(16) In some embodiments, the system of the present invention can be ReCell Next Generation (NG) product system. The system can include a re-usable Console, a disposable Cartridge (used herein interchangeably with “cassette”) and optionally, a disposable Applicator. The applicator may reside in the cartridge until use. The cartridge with applicator can be a sterile packaged disposable. The cartridge carries the tissue processing chamber and the required materials (fluids and or solids) to treat and process the skin sample. The cartridge and applicator are passive devices which are acted upon mechanically by the console (after the cartridge is inserted into it) to achieve the required mechanical tissue working and fluid movements. All power sources and controls can reside in the console.
(17) In some embodiments, the basic functions of the process are to 1) pre-treat the skin sample by soaking in heated enzyme, 2) rinse it with buffer, 3) mechanically grind it while submerged in additional buffer solution to disassociate the required cells, 4) suspend the cells in buffer, then 5) to convey the product suspension to the applicator so that the applicator can be used manually by an operator to apply the cell suspension to the patient's prepared wound bed.
(18) Tissue processing may be accomplished by a number of methods or combination of methods. In the embodiment described herein, the grinding process involves exerting a compression and/or rotational force on the skin sample through a specially designed member (“Pestle Surface”) while applying a partial rotational motion to the member. The fluid handling process involves automatic reconstitution of an enzyme powder with sterile water before introduction of the enzyme solution to the processing chamber, then removal of the enzyme to a waste container followed by one or multiple introductions of buffer or other solution to the chamber during the remainder of the process. Finally, the product fluid, a suspension of skin cells, is pumped to an applicator or other vessel or matrix for introduction to a wound.
(19) Below is a description of the ReCell® NG, one possible embodiment of the invention. The system is designed, developed and manufactured in order to provide users a new and improved, automated, safe, efficient, predictable, reliable, and easy-to-use device for the treatment of areas larger than the manual ReCell kit (
(20) Some advantages of the automated systems include: Minimize the time to process Eliminate manual process steps, minimize user interaction and provide an automated process At the end of the process, provide the cell suspension to the user in a vessel or applicator, the exterior of which remains sterile Improve applicator and nozzle application for more intuitive use Provide users with confidence in the consistency of suspension
(21) Further features of the present invention are described below. It is to be understood, however, that these examples are included solely for the purposes of exemplifying the present invention. It should not be understood in any way as a restriction on the broad description of the invention as set out above.
(22) The following description is put forth so as to provide those of ordinary skill in the art with an exemplary description of how the compositions and/or methods claimed herein are made and evaluated, and are intended to be purely exemplary of the invention and are not intended to limit the scope of what the inventors regard as their invention. Modifications and variations of various aspects of the following examples will be apparent to those skilled in the art and are included within the scope of the present invention. For example, while some examples are described in connection with a skin-related procedure, the same can be applied to non-skin epithelial tissues (such as respiratory epithelium, vascular epithelium, glandular epithelium, corneal epithelium, and the like) with slight modifications that are well within the level of ordinary skills in the art.
(23) Below are some exemplary designs of the system and various components therein.
(24) 1. Overview
(25) The ReCell NG system is an autologous cell harvesting and transplant system used to treat a variety of skin or other epithelium-related conditions by application of a liquid suspension of harvested cells to the treatment area. This cell suspension is prepared from a sample of the patient's own skin or other epithelial tissue in an automated, autologous process.
(26) The process employs enzyme and/or mechanical action to dissociate cells from the tissue sample, and put them into suspension in a buffer solution.
(27) The system includes a disposable Cartridge or Cassette (
(28) The Cassette can be provided sterile and contain the process materials and a chamber that holds the tissue sample. It is sealed against microbial penetration. The Applicator is filled with the cell suspension while housed in the Cassette during the process, and is then removed for use after the Cassette is removed from the Console. The Console provides some or all of the motive power and control. In addition to the console, the cartridge may also have a mechanism for providing motive power (e.g., heat) so as to supply a mechanical force and/or a chemical reagent to the tissue.
(29) The Applicator is capable of dispensing, spraying or dripping the cell suspension therein onto a recipient site or a support. For example, the Applicator can either spray or drip the cell suspension fluid on the treatment area or allow application beneath a contact layer dressing already in place, at the option of the physician. As an alternative or in addition to the Applicator, the system can include a support for receiving the cell suspension, wherein the support, after receiving the cell suspension, is presented for transplant or culturing. The support may be a matrix, a scaffold, a dressing, or any combination thereof; the support may be solid, semi-solid, porous or fragmented.
(30) 2. Manual ReCell
(31) The ReCell NG system is an at least partially automated version of the previously developed ReCell manual process.
(32) The manual process employs a ReCell Kit (
(33) Once the skin sample has completed treatment in the enzyme, it is rinsed in buffer by dipping in the rinsing well. The sample is then set out on the kit “tray”, epidermal side up. A scalpel is used to manually scrape off the epidermal and junction cell layers, to collect the cells in a small pool of buffer solution. While scraping, the sample is moistened with drops of Buffer solution to carry off the disaggregated cells into suspension. The correct total amount of Buffer solution is used in order to create the desired cell suspension volume.
(34) The tray is manually tilted to move the cell suspension into a corner, from where it is drawn off with a syringe. The cell suspension is aspirated several times to rinse the tray and collect the maximum number of cells. The cell suspension is then dispensed from the syringe into a cell strainer basket (e.g., 40, 80, 100 or 200 micron size mesh, or any other size depending on the desired filtering application) sitting in a third well in the ReCell processing unit. The strainer is removed and the filtered cell suspension is then aspirated and drawn from the well with a new, sterile syringe. A spray head is then fitted to this syringe, thus creating an applicator which is used to spray or drip the cell suspension onto the treatment area. Alternately, a blunt needle is used to introduce suspension beneath a dressing.
(35) 3. ReCell NG System
(36) The ReCell NG automated process includes three sub-systems: Fluid Handling (optional), Tissue Processing and Application.
(37) The Fluid Handling and Tissue Processing Systems have components that enclose and contact the tissue sample and fluids within the Cassette. These components form a sealed system. Magnetic and/or mechanical components of the Console exert forces on components of the sealed system, causing movements within the sealed system without mechanically breaching the system seal. This achieves the mechanical working of the tissue sample and fluid movements, while maintaining a microbial barrier.
(38) The system is sealed against microbes. The Tissue Processing chamber may be vented with a “Tortuous Path” vent or anti-microbial filter within the system to allow air to leave and to enter without carrying microbes into the system. This is necessary to accommodate volume and pressure changes as the fluid moves through the system.
(39) The basic mechanical working of the tissue sample can be achieved using a disintegrating member. In various embodiments, the disintegrating member may be part of the console (e.g., connected to the actuating mechanism) or part of the cartridge (e.g., situated in the tissue processing chamber and, e.g., connected to the cap). The disintegrating member can be a pestle or grinder.
(40) In one exemplary system, mechanical working is achieved by a reciprocating—rotating member, the “Pestle” (
(41) Alternative to or in combination with a pestle motion, mechanical working can be achieved by vigorously agitating the tissue sample which is placed in a bath of buffer (e.g., a compound sodium lactate buffer). For example, the tissue sample may be placed in a bath of buffer together with a sterile magnetic stirrer in the Cassette. The Console can provide a magnetic force to drive movement (e.g., rotation) of the magnetic stirrer, thereby physically disrupting the cellular stratum and disassociating the cells.
(42) An outer surface of the Applicator can be sealed in a sterile packaging before transport to a sterile field for cell transplant. For example, the Applicator can be housed in a compartment in the Cassette, which is sealed with a peel-off film or any other sterile packaging, such that the exterior of the Applicator is maintained within a microbial barrier. The applicator can be a part of the system or a stand-alone device. The Applicator may be pressurized or spring-loaded. The Applicator may have a pivoting head for axial application of the cell suspension. The Applicator can be filled with cell suspension through a sealed path from the Fluid Handling System during the process, so that the cell suspension is not exposed until it is sprayed on the treatment area by the physician in the sterile field.
(43) As an alternative or in addition to the Applicator, the system can include a support for receiving the cell suspension, wherein the support, after receiving the cell suspension, is presented for transplant or culturing. The support may be a matrix, a scaffold, a dressing, or any combination thereof; the support may be solid, semi-solid, porous or fragmented.
(44) 4. Fluid Handling System
(45) The Fluid Handling System is optional. For example, if the tissue sample has been partially processed (e.g., incubated with an enzyme such as trypsin solution and washed and placed in a buffer) before being placed in the Cassette, the Fluid Handling System can be eliminated. An exemplary Fluid Handling System is shown in
(46) In various embodiments, the cartridge comprises a first packet for providing an enzyme solution and a second packet for providing a buffer solution, both packets in fluid communication with the tissue processing chamber, wherein the enzyme solution breaks down extracellular matrix in the tissue thereby chemically dissociating the tissue, and wherein the buffer solution washes the dissociated tissue and suspends cells in the cell suspension. For example, the first packet can have a first and a second container separated by a breakable seal, the first container containing sterile water and the second container containing lyophilized enzyme powder, wherein when the seal is broken, the lyophilized enzyme powder meets the sterile water and dissolves therein. Such first or second container can be a pouch, a vial or a syringe. To deliver the reagents to the tissue, the console can further comprise a first pressurizing mechanism for driving the enzyme solution and a second pressurizing mechanism for driving the buffer solution out of the first packet and the second packet, respectively, into the tissue processing chamber. In some embodiments, the first packet further collects waste enzyme solution after use and the second packet further collects waste buffer solution after use. The first packet can be in fluid communication with a first pump for pumping the enzyme solution and the waste enzyme solution. The second packet can also be in fluid communication with a second pump for pumping the buffer solution and the waste buffer solution. In some embodiments, the cartridge further comprises a pump for drawing the cell suspension from the cell collection chamber, and subsequently after filled, pumping the cell suspension into the applicator, the third pump in fluid communication with the cell collection chamber and the applicator. Two or all of the first, second and third pumps can be the same pump. The first, second or third pump may be peristaltic, syringe, or other type of pump and may be disposable or reusable. In some embodiments, the cartridge further comprises a first syringe for collecting waste enzyme solution and a second syringe for collecting waste buffer solution, both syringes in fluid communication with the cell collection chamber. The cartridge can also further comprise a third syringe for drawing the cell suspension from the cell collection chamber, and subsequently after filled, pumping the cell suspension into the applicator, the third syringe in fluid communication with the cell collection chamber and the applicator. In certain embodiments, the cartridge further comprises a fluid detector for controlled metering of the enzyme solution and the buffer solution. As an alternative to the pouches, the cartridge can include three containers for providing an enzyme solution, sterile water and lyophilized enzyme powder, respectively.
(47) An exemplary Fluid Handling System includes: Two sealed packets which hold the fluids and enzyme powder (for chemically dissociating the tissue, which can include, for example, digestion with enzymes such as trypsin, dispase, collagenase, trypsin-EDTA, thermolysin, pronase, hyaluronidase, elastase, papain and pancreatin). Packet 1 has two chambers separated by a seal. The first chamber holds Sterile Water and the second holds lyophilized Enzyme powder. Packet 2 holds sodium lactate Buffer, or other solution to make up the cell suspension. Alternatively, three containers can be used for providing an enzyme solution, sterile water and lyophilized enzyme powder, respectively. The water and enzyme can be stored in separate containers connected by tubing or other means. Two Rollers (or other suitable pressurizing mechanism such as pressure plates) (part of the Console), being used to drive the fluids out of the packets. Two fluid paths connecting the two packets to the Tissue Processing Chamber. The Tissue Processing Chamber (also part of the Tissue Processing System). The Cell Collection Chamber below the Tissue Processing Chamber. A common fluid path comprising tubing that interfaces with a pump and fluid/air detector, for metering and moving the separate fluids. A fluid path to fill the Applicator. A set of pinch valves (or other valves such as rotary, piston, sliding gate valves; part of Console) which rise and fall to close or open each of the fluid paths when required in the process cycle. The Applicator (optional), which remains an integral part of the Fluid Handling System until it is removed from the Cassette for use by the physician in the sterile field. In various embodiments, the cartridge may further comprise at least one supplying container for providing an exogenous agent. For example, the exogenous agent can be a heat shock protein or a fragment thereof, hyaluronic acid, platelet-enriched plasma, a growth factor, adipose stem cells, or any combination of the foregoing.
(48) Where desirable or required, one or more components of the cartridge or the fluid handling system in contact with a biological material is removably assembled therein so that such component can be removed from the cartridge for biohazard disposal allowing the rest of the cartridge to be recycled.
(49) Where a pump is needed, the pump can be peristaltic, syringe, or other type of pump and may be disposable or reusable. The pump can be part of the console and be reusable, or can be part of the cassette and be disposable. For example, a peristaltic pump motor and actuators can be incorporated into the durable console and interface with a length of tubing. The peristaltic pump motor can have rollers attached to it in either a rotary or linear configuration. These rollers can contact the tubing, squeezing the tubing to occlude it and drive fluid along the tubing path.
(50) A disposable pump (e.g., peristaltic pump) can be advantageous as a complete, simple, inexpensive pump that is entirely enclosed within the consumable cassette part of the system. The disposable pump can mate via a simple, physical interface to a motor that is part of the durable console. An exemplary disposable pump is Quantex Pump available from Quantex Arc Ltd (London, UK).
(51) 5. Fluid Handling Process
(52) This is optional depending on whether the tissue sample has been processed or partially processed or not before being placed in the Cassette. Fluid handling can be omitted if the tissue sample has been at least partially processed before entering in the Cassette. Partial processing, in one example, includes incubating the tissue sample with an enzyme such as trypsin solution and washing and placing it in a buffer before placing the tissue sample in the Cassette.
(53) Where fluid handling is needed, all Valves close upon insertion of Cassette in Console. First Roller (“Enzyme Roller”) pushes forward, compressing the sterile water and breaking the seal with the enzyme powder pack. This joins the two chambers into one.
(54) First Roller stops to give Enzyme a delay period to dissolve in water Roller could either have a set percentage advance before pausing or be controlled by a pressure switch.
(55) A First Valve opens (on “Enzyme Feed Tube”). First Roller then continues to advance, breaking second seal between the combined Sterile Water/Enzyme packet and the “Enzyme Feed Tube” which leads to the Tissue Processing Chamber.
(56) First Roller resumes advancing to move enzyme solution out of the packet. A peristaltic pump (or any other pump) moves the solution into the combined Tissue Processing Chamber and Cell Collection chamber to fill it and cover the tissue. First Valve closes. A variable/settable delay while tissue sample soaks in Enzyme solution. (Note: Temperature can be maintained with a sensor and coil in the wall of the Tissue Processing Chamber or through a thermal pin extending up from the Console. During this period, Pestle may cycle up and down to help agitate Enzyme solution and promote tissue treatment. This may allow shorter soak period. Other means to move the fluid employed can also be used, such as rotating the pestle, with or without adding fins, and pumping small amounts of the solution in and out of the chamber.)
(57) The First Valve reopens and the peristaltic pump (or any other pump) draws Enzyme solution out of the combined Tissue Processing & Cell Collection Chamber through the Enzyme Drain Tube and stores it in packet #1 (the now empty enzyme pouch) for storage as waste. The First Valve closes. A Second Valve opens (on “Buffer Feed Tube”). Second Roller (“Buffer Roller”) advances partially, breaking seal. The peristaltic pump (or any other pump) both meters the volume and pumps Buffer solution through Buffer Feed Tube to rinse the tissue sample in the Tissue Processing Chamber. (Buffer may enter through multiple ports for surface coverage.) Sufficient Buffer is pumped in to completely fill the Tissue Processing/Cell Collection chamber combination. The Valve then closes.
(58) The First Valve opens again. The peristaltic pump (or any other pump) draws all rinse Buffer out of the processing chamber and into packet #1 for storage as waste.
(59) The volume of the Cell Collection Chamber can be adjusted for the tissue sample size and Buffer volume to be used.
(60) The disaggregation process then begins (See Tissue Processing Section below). The Second Valve opens, the Second Roller continues to advance, and the peristaltic pump (or any other pump) moves Buffer solution into the chamber once or several times during the Pestle movements to repeatedly douse the tissue sample with drops of Buffer solution, pausing in between in a fashion coordinated with the movements of the Pestle. The Valve closes between aliquots. (Note: The Buffer packet may be designed with stepped width to increase volumetric accuracy in the small volume applications. The Roller can be controlled with a flow control meter.
(61) During this process the Buffer picks up the cells being liberated from the tissue sample, and the Cell Suspension thus created drains by gravity into the Cell Collection chamber, passing through the 100 micron filter (or 40, 80, 150 or 200 micron size mesh, or any other size depending on the desired filtering application) mounted in the Cell Collection chamber. (See Section on Tissue Processing and
(62) After tissue processing is complete, a Valve opens (on “Cell Collection Tube”). The pump draws Cell Suspension out of Collection Chamber (through a filter) and into the applicator. The pump then reverses and pumps the Cell Suspension abruptly back into the Tissue Processing/Cell Collection chamber to wash cells off the Chamber and Pestle surfaces and further activate cells. This may be repeated. After this process the Suspension remains in the Applicator. The Valve then closes.
(63) Additional Buffer may be drawn from the Buffer packet and pumped to the chamber (as described above) to rinse it and collect additional disaggregated cells and to make up the volume of Cell Suspension needed. This may occur multiple times in order to completely capture all cells and achieve desired volume. This additional suspension is pumped to the applicator and the pump then reverses and pumps the Cell Suspension abruptly back into the Tissue Processing/Cell Collection chamber to wash cells off the Chamber and Pestle surfaces and further activate cells.
(64) 6. Tissue Processing System
(65) The Tissue Processing System is a combination of elements of the Cartridge and Console, shown in
(66) Tissue Processing Chamber: A vessel constructed of engineering resin (or any other suitable materials) with a steel mesh (or any other suitable disintegrator) over an opening at the bottom (“Tissue Processing Mesh”), supported by a strong rib structure or circumferentially. The top of the chamber is closed with a cap (“Chamber Cap”). One combined port or two separate ports in this chamber allow Enzyme Solution and Buffer Solution to be pumped in. (Buffer may enter through one or two or multiple ports for surface coverage.)
(67) Chamber Cap: A cap removably placed on or hinged to the Tissue Processing Chamber can be used to seal the top opening thereof, e.g., through a bayonet fitting. Once closed, the cap can be locked in place by a locking mechanism, such that the cap remains closed during processing and cannot be reopened or reused after first use. The body of the cap includes a flexible elastomer (e.g., polyurethane) seal, with a raised Pestle surface (spherical convex) fastened on the chamber side of the Cap, and a spline indentation on top. When the cap is fastened to the chamber, a tortuous path vent at the O-ring seal or elsewhere (or alternatively, an anti-microbial filter) allows air to pass, but seals against microbe intrusion. The Cap can also be substantially rigid with a form of vertical axil with o-ring or quad-seals or other sealing device.
(68) Tissue Processing Mesh: A stainless steel mesh with a concave spherical shape, covering an opening at the bottom of the Tissue Processing Chamber, separating it from the Cell Collection Chamber below. When the tissue sample is placed in the processing chamber it sits on the Tissue Processing Mesh. Any suitable tissue disintegrator (e.g., a sheet with holes, blade, grid, screen, etc.) can also be used.
(69) Cell Collection Chamber: A chamber beneath the Tissue Processing Chamber, with a filter (e.g., 100 micron, 200 micron, or larger or smaller) mounted such that the Cell Suspension draining from the Tissue Processing Chamber passes through it before passing into the bottom of the Cell Collection Chamber to remove or collect large aggregates or tissue pieces. In certain embodiments, the cartridge further comprises a filter situated between the disintegrator and the cell collection chamber, for filtering the processed tissue to remove large aggregates. A filter can be alternatively or additionally situated between the cell collection chamber and the applicator, for filtering the cell suspension to remove large aggregates. (Note: The volume of the Cell Collection Chamber may be variable to allow for various low volumes of Buffer solution to be used, while maintaining coverage of the tissue sample with Buffer by the end of tissue processing.)
(70) Actuating Mechanism (Console component): A member that allows forces to be passed through the cap to the tissue sample. The Actuating Mechanism will have a key that allows mating with the Chamber Cap to allow disaggregation. When the pivot arm is in the retracted position (
(71) The Actuating Mechanism can be rotated in an oscillation through an arc. This allows application of torsion to the tissue sample.
(72) Spring-loaded or mechanical, magnetic or other force on the Actuating Mechanism allows a steady force to be applied to the tissue sample, directly or through a membrane.
(73) Cyclic lifting and dropping of the Actuating Mechanism allows impact or varying forces to be applied to the tissue sample.
(74) All the applied forces discussed above are transmitted to the tissue sample directly (when the disintegrating member is a part of the Cartridge) or through the seal on the top of the Chamber Cap of the Cassette, without breaking the seal, so the microbial barrier around the tissue sample is maintained throughout the process.
(75) An alternative or additional design to the above Chamber Cap and Actuating Mechanism module is to provide a magnetic stirrer in the Tissue Processing Chamber, and to drive the magnetic stirrer by a magnetic force provided by the Console. The magnetic stirrer, upon sufficiently vigorous stirring, breaks down the tissue sample into a plume of cells which can then be filtered and collected in the Cell Collection Chamber.
(76) 7. Tissue Processing
(77) This process seeks to somewhat mimic the scraping action of the scalpel on the tray surface in the manual ReCell kit, with the added working elements of a metal mesh and impact from the Pestle. These additional working elements seek to provide enough action to disassociate the required cells regardless of the orientation of the sample.
(78) After the Buffer rinse described above, the Actuating Mechanism moves toward the cap to mate with the keyed Chamber Cap surface and apply force (directly or to the Pestle Surface) against the tissue sample. (See
(79) A mechanism to cyclically raise and drop and/or rotate the Actuating Mechanism at a proscribed frequency, can be applied to provide a cyclic impact or variable force of the Pestle Surface on the tissue sample.
(80) A linkage mounted on the Actuating Mechanism provides the ability to rotate the Pestle actuator. With the multiple ridges on the Pestle Surface, an oscillating motion at this arc can sweep the ridges to cover the whole sample surface.
(81) The above process continues for a prescribed number of cycles. When complete, some remnants of Dermis will be stuck in the mesh. The desired cells will be suspended in the Buffer in the Cell Collection Chamber.
(82) Alternatively or in combination with the above Actuating Mechanism, the Console can provide a magnetic force which drives the movement of a magnetic stirrer previously placed in the Tissue Processing Chamber. The movement of a magnetic stirrer can break down the tissue sample into a plume of cells.
(83) 8. Applicator
(84) The design of the Applicator is shown in
(85) The Applicator contains a spring-loaded syringe, with the spring oriented to resist filling of the syringe.
(86) An operating valve on the Applicator is positioned and set to allow the Applicator Syringe to fill, but to stop the fluid from exiting the spray nozzle on the Applicator.
(87) Alternatively, the applicator may include a septum or e.g., silicone rubber. This septum would be positioned adjacent to a fellow septum in the cartridge. When the cartridge is inserted into the console it mates with a boss that is stationary. This forces a spring loaded needle through both septa opening a fluid path from the cartridge plumbing to the applicator allowing it to be filled. When the cartridge is removed from the console, the spring loaded needle retracts resealing both septa and ensuring sterility.
(88) The spring compression maintains pressure on the fluid while it is in the Applicator and as it is later emptied onto the treatment surface.
(89) After the Applicator is filled, the Cassette is removed from the Console and the Cassette is carried to the Sterile Field, the circulating nurse opens the still sterile applicator chamber in the cartridge and presents it to the scrubbed-in nurse or physician, who aseptically retrieves it for application to the patient.
(90) The physician points the Applicator nozzle at the treatment area and opens the operating valve partially or fully to achieve the strength of flow desired, from a drip to a spray. (The operating valve may be any suitable valve.) The applicator may have a pivoting head for axial application of the cell suspension.
(91) As an alternative or in addition to the applicator, the system can include a support for receiving the cell suspension, wherein the support, after receiving the cell suspension, is presented for transplant or culturing. The support may be a matrix, a scaffold, a dressing, or any combination thereof; the support may be solid, semi-solid, porous or fragmented.
(92) 9. Console
(93) The console internal layout is shown in
(94) Some or all active, powered mechanical components and electrical components of the System reside in the console. (All Cassette components may be passive, mechanically driven by powered Console components, with the possible exception of a heating coil and sensor that may be placed in the Cassette.) The Console can have devices or means of recognizing that a Cassette is genuine and not previously used based on a passive signature device in the Cassette (authenticating, e.g., through a barcode or ID chip). Alternatively, the cartridge may also have some active components, such as a mechanism for providing motive power (e.g., heat) so as to supply a mechanical force and/or a chemical reagent to the tissue.
(95) In some embodiments, the console further comprises one or more of: a mechanism for drawing and ejecting the cartridge into or out of the console; an interlock to prevent removal of the cartridge during processing; an operator interface to control processing time, suspension volume needed, and activation of tissue processing; a display panel showing status of tissue processing; and an ejecting mechanism for ejecting the applicator when filled.
(96) In various embodiments, the system may include a custom control software for directing a processor or computer chip in the console to control the automated process. The system may also be connected to an external computer for collecting and processing data.
(97) Mechanical Systems: The main mechanical systems are described above and summarized below: Fluid Packet Rollers: These ride on lead screws driven by stepper motors, one motor for each roller. Pump: Interfaces with tubing in the cartridge for fluid movement. Actuating Mechanism: A mechanism for providing force and oscillation to the disintegrating member, and its rotation linkage. Valve Actuation: The Valves which control opening and closing of all tubing are to be actuated by solenoids.
(98) Control Electronics are also included to achieve the following: Operation of the ReCell NG Instrument internal subsystems can be monitored and controlled by an electronic system including one or more microcontrollers interfaced to various actuators, sensors, and user interface components. Additional resources for the microcontroller(s) may include flash memory, a real-time clock with battery back-up, and serial interfaces to external computers. Instructions for the microcontroller are contained in a firmware program loaded into flash memory, which allows for easy installation of updates/upgrades. Actuators, such as motors, are turned on or off by the microcomputer via Digital Output (DO) circuits. Alternatively, power to the motor (and hence speed) can be varied using digital outputs controlled by timers and counters, which is a technique called Pulse Width Modulation (PWM). Sensors may be used to measure or indicate important physical parameters, such as position of the roller mechanism, the force applied by a roller, or an internal temperature. Sensor outputs are read by the microcontroller using either analog-to-digital converter (ADC) or Digital Input (DI) circuits. The user interface (e.g., backlit color LCD touchscreen, fixed touch screen, simple buttons or knobs or LEDs, etc.) includes means of data input, means for outputting various data to displays, indicators or audio generators. These types of devices may be purchased as a module that includes circuitry to operate the more complex components (e.g., touch switches or displays) and often communicate with the microcontroller via an internal bus. A program executing on the microcomputer periodically scans the various inputs, such as the user interface switches, position sensors or a temperature sensor, and then determines the appropriate output actions, such as turning on or off a motor or heater. Software is discussed in detail below.
(99) Operator Interface: An exemplary operator interface can be a control panel. The interface can also be a touchscreen. The following functions can be included: Able to visually determine key parameters from 3 meters distance and minimum 45° angle Progress (bar or other qualitative visual indicator as well as a countdown clock) Process complete and suspension ready indicator Fault or Error indicator AC Power indicator: lit when plugged in and power is available, regardless of whether the console is powered on or off On/off switch Status indications Power on/off Processing and run status Standby Fault/Error User interface shall be readable in varying lighting conditions, including lighting conditions encountered in a typical Operating Room Count-down timer to be precise to within one minute Audible and Visual indicator of process completion and of fault/error Buttons, keys, or touchpad for user input with audible feedback Provide instructions or prompts for the user Allow user to input suspension volume desired Allow user to enter process level Instruments shall provide positive feedback that the cartridge is properly seated. Instrument must ensure that cartridge remains properly seated throughout the procedure, detect if cartridge is bumped or moved out of operating position, and provide fault condition notification The cartridge shall automatically align with the interface of the console The cartridge shall mate with the console in only one orientation Cell processing does not have to be visible by operator Inactivity—instrument shall automatically turn off: After 120 minutes of inactivity (no button press, cassette insertion, etc.) after power on and before cycle started 90 minutes after cassette removed at end of cycle Visual and audible advance notice of shutdown 15 minutes before Provide an override option Do not power down if cassette is not removed at end of cycle but provide visual and auditory reminder signal at 2 minute intervals Alarms: Cartridge pack not seated properly Over temperature at the mortar Internal fault in processing Power failure
(100) In various embodiments, the system may include a custom control software for directing a processor or computer chip in the console to control the automated process. The system may also be connected to an external computer for collecting and processing data.
(101) Software: Software can be written in C/C++ or other programming language. A real-time operating system or executable may be utilized to provide support for timing and resource management. Some functionality could be implemented using programmable hardware solutions such as FPGAs, or combination hardware/software devices such as “Programmable System on a Chip”. The processing architecture can be determined by the processing and timing requirements, power consumption constraints, etc. A multi-processor design may also be utilized to partition functionality (e.g., separate processors for display, touch screen, battery monitoring, consumable interface). Development tools (e.g., cross compiler, JTAG debug interface) for each processor can be utilized in the instrument. Open-source tools such as Git, CVS, Bugzilla etc. can be used for software configuration management and defect tracking. Support software to perform instrument interface and debug functions can be included. The following functions are included: Monitoring and control of the consumable interface: Thermal control Fluidic control, including pumping, positioning, pouch roller positioning, valve actuation, and necessary sensors (air, pressure, position, etc.) Disaggregation control (control of pestle positioning and movement, necessary sensors, etc.) Consumable detection (prevent absent or improperly seated consumables) Consumable authentication (assure a genuine cassette and prevent reuse) User interface Cell processing workflow Hardware interface: graphical display, audio output, discrete status indicators and operator inputs Power Monitoring AC power status DC power status and control Monitoring of battery status Control of battery charging Control of system electronics to implement power saving mode of operation Instrument self-test as determined through risk analysis and control (independent monitor processor or watchdog timer, POST, etc.) Start-up self-test In process self-monitoring to maintain essential performance Monitoring and control of a real-time clock for date/time Duplex Communications to an external computer through a wired interface (USB 2.0, RS-232) Logging of instrument operation in an event log Logging of detected alarms, faults, etc., in a service log Configuration of instrument operation (e.g., language selection) A debug/Software upgrade mechanism implemented thru a wired communications port (USB, RS232, JTAG, etc)
(102) Power: The electronic system can be powered by a battery or a universal supply capable of converting AC line voltage into several DC levels that will be required by the various circuits. The supply is universal meaning that it can accept the range of input line voltages and frequencies used by most countries. A separate power cord will be used in order to accommodate the different wall outlet configurations in different countries. The power cord will plug into an entry module that includes a power switch and line filter that attenuates undesirable conducted line frequencies in order meet electromagnetic compatibility (EMC) regulations. A circuit breaker will be included to protect the Instrument from damage caused by certain fault conditions. The power supply must comply with safety regulations applying to medical electrical equipment, such as IEC 60601-1 and other related national variations (e.g., UL, CSA, EN). Various signals within the power supply will be monitored by the microcomputer to ensure reliable operation of the instrument.
10. System Context
(103) ReCell NG can be used to disaggregate cells from a patient's split-thickness skin sample and to collect these cells for reintroduction to a prepared wound bed of the patient.
(104) Indications: In a hospital setting: Burns, scalds and traumatic injuries Donor sites Large scar revision for improvement of texture and color In a clinic setting: Pigmentation disorders such as Vitiligo Epidermal defects such as acne scars, hairy nevi, and skin cancer scars Prophylactic use for healing of acute wounds Resurfacing by laser ablation, dermabrasion or deep chemical peels Chronic wounds (leg ulcers/hard to heal)
(105) Two instruments can be designed: Clinic Console: Capable of processing two or more samples in parallel, one skin sample using one consumable Shall accept only the small (e.g., 4 ml) cartridge and thus will be limited to a small amount (e.g., 4 ml) of cell suspension (CS) Operating room (OR) Console: Capable of processing two or more samples in parallel, one skin sample using one consumable Capable of producing up to 16 ml of CS Shall accept either small or large cartridge, but the small cartridge will be limited to a small amount (e.g., 4 ml) of CS
(106) Two consumable cartridges can be designed: The small (e.g., 4 ml) cartridge is intended for the clinic and shall deliver up to 4 ml of cell suspension The large (e.g., 16 ml) cartridge is intended for the OR and shall deliver up to 16 ml of cell suspension
11. Exemplary Workflow Analysis
(107) There are two separate workflows: one for the OR (
(108) ReCell Ng Operating Room Procedure: In one proposed scenario (
(109) Exemplary Process steps of ReCell NG: Tabletop unit is set up outside sterile field. Turn on tabletop unit. Device performs automatic self-test and start heater. If outcome of self-test is acceptable, instrument prompts for inputs, including desired suspension volume. Introduce sterile cartridge into sterile field Surgeon takes a skin sample (shave biopsy) which is inserted into cartridge Circulating nurse or technician inserts cartridge into the console, sets suspension volume and presses “run”. Instrument processes the tissue (presumptive process) Dissolve Enzyme in sterile water; dwell or agitate to mix (optional) Enzyme solution is pumped into the mortar to immerse skin sample (optional) Start timer when temperature of enzyme solution reaches 22° C. or above Heat to 37° C. After appointed time, turn off heaters and drain enzyme solution to waste. Rinse skin sample with buffer solution; drain rinse solution to waste. Add a small volume of buffer to collect cells, process skin sample to remove and collect cells Filter cells and generate the appropriate volume of suspension for treatment area size. Transfer suspension into delivery apparatus. Signal complete Cartridge removed from console and a circulating nurse or technician opens applicator compartment. Surgical nurse removes the delivery vessel, (the exterior surfaces of which remain sterile) from the still-sterile interior of the cartridge and hands to surgeon. Surgeon sprays drips or infuses suspension onto treatment area.
12. Data
(110) The system, internally or externally, can include a data storage unit, sufficient to maintain operational logs. For example, the Console can contain provision for logging activity for reporting, troubleshooting and continual improvement. The Console can also be provided with ability to record self-test, ready mode, input parameters, time of cartridge insertion, time of start events, and temperature/time data for at least four procedures of maximum output size for console. In addition, time-stamped data with resolution of e.g., one-second, as well as means of accessing or displaying Log can also be included.
(111) 13. Processing parameters (Cell Suspension)
(112) Various skin or other epithelial tissue can be obtained for processing. The tissue sample can have maximum dimensions that fits into the tissue processing chamber (e.g., about 4 cm×4 cm), and can be as small as desirable (e.g., 1.0 cm.sup.2). Recommended thickness range is about 0.006-0.008″ (0.15-0.20 mm) and can be thinner or thicker (e.g., 0.1″ (2.54 mm)). The following is several exemplary sizes suitable to be processed by the system of the present invention: Standard time: up to 4 cm.sup.2, 0.006-0.008″ thick Medium time: up to 16 cm.sup.2, 0.010-0.012″ thick Long time: up to 16 cm.sup.2, up to 0.10″ thick
(113) The sample is likely to be irregularly shaped, not rectangular and may potentially be thicker.
(114) Exemplary Fluid delivery: Reconstituting Enzyme: 10±0.2 ml (e.g., avoiding foaming, recovery of enzyme solution from container, etc.) Rinsing skin sample with buffer after digestion: 10±1.0 ml (removing and deactivating Enzyme from skin sample) Creating cell suspension: Volume selected by user, per Table 1, Tolerance ±0.2 ml. Recommended skin sample sizes and the volume of buffer to be used to start is shown in Table 1.
(115) TABLE-US-00001 TABLE 1 Cell Suspension Volume Biopsy area Buffer used to make Desired (CSV) [BA] (cm.sup.2) suspension 1.0 1 1.5 1.5 2 2.0 2.0 4 2.5 2.5 4 3.0 3.0 4 3.5 3.5 4 4.0 4.0 4 4.5 5.0 9 5.5 6.0 9 6.5 7.0 9 7.5 8.0 9 8.5 9.0 16 9.5 10.0 16 10.5 11.0 16 11.5 12.0 16 12.5 13.0 16 13.5 14.0 16 14.5 15.0 16 15.5 16.0 16 16.5
(116) During incubation, device can maintain temperature at a minimum of 35° C. and a maximum of 42° C. (Ambient temperature in burn operating rooms may be as high as 42° C.) After incubation, elevated temperature not required and chamber may be allowed to move to ambient temperature. (Note that since OR temperature for burn procedures is often greater than 37° C., ambient may be greater than 37° C. There is no requirement for cooling below ambient.)
(117) Process timing: entire process can be complete in 20 minutes for standard process. Time may vary depending on the size and thickness of the sample.
(118) The resulting cell suspension (CS) includes various viable and functioning skin cells, including differentiated, differentiating and undifferentiated cells. Some cells are capable of dividing. Some are capable of providing normal functions. Keratinocytes, Langerhans cells, fibroblasts and melanocytes can be included. In some embodiments, 4 ml of CS can be used for maximum treatment areas up to 320 cm.sup.2 and 16 ml of CS for maximum treatment areas up to 1280 cm.sup.2.
(119) The output of cell disaggregation process can be filtered using a 100 μm or other size filter to remove larger particles. The resulting cell suspension (CS) fluid is transferred to Applicator. The volume of the output can be set by the operator.
(120) Waste from the process shall be contained within the consumable for disposal in line with guidance and practice for biologic materials for the region of use. Both expended cartridge and used applicator, or any components therein can be treated as biologic waste.
(121) 14. Environmental Requirements
(122) The ReCell NG System shall operate according to its defined specifications under the following operating conditions: Temperature: 10° C.-42° C. Relative Humidity: 5%-95%, non-condensing Atmospheric Pressure: From 1500 ft below sea level to 6500 ft above sea level (15.51 psiA-11.56 psiA or 106.9 kPa-79.7 kPa)
(123) The ReCell NG System shall operate according to its defined specifications after being exposed to the following transport conditions: Temperature Console: −20° C.-60° C. Cartridges: −4° C.-30° C. Relative Humidity: up to 95%, non-condensing Atmospheric Pressure: From 1500 ft below sea level to 19000 ft above sea level (15.51 psiA-7.04 psiA or 106.9 kPa-48.5 kPa)
(124) The ReCell NG System shall operate according to its defined specifications after being exposed to the following storage conditions: Temperature Console: −20° C.-60° C. Cartridges: 2° C.-30° C. Relative Humidity: up to 95%, non-condensing Atmospheric Pressure: From 1500 ft below sea level to 19000 ft above sea level (15.51 psiA-7.04 psiA or 106.9 kPa-48.5 kPa)
(125) The ReCell NG System shall operate according to its defined specifications after being exposed to the ASTM D 4728 Standard Test Method for Random Vibration Testing of Shipping Containers.
(126) Modifications and variations of the described methods and device of the invention will be apparent to those skilled in the art without departing from the scope and spirit of the invention. Although the invention has been described in connection with specific preferred embodiments, it should be understood that the invention as claimed should not be unduly limited to such specific embodiments. Indeed, various modifications of the described modes for carrying out the invention which are obvious to those skilled in the relevant field in which this invention resides are intended to be within the scope of the claims.