IONTOPHORESIS DRUG DELIVERY SYSTEM AND METHOD FOR DENERVATION OF THE RENAL SYMPATHETIC NERVE AND IONTOPHORETIC DRUG DELIVERY

Abstract

An iontophoresis drug delivery system and method for denervation of the renal sympathetic nerve and iontophoresis drug delivery. The system includes an iontophoresis catheter fitted with a drug coated balloon. The iontophoresis catheter includes a balloon near its distal tip or end that contacts the vessel wall circumferentially when inflated. One or more electrodes are associated with a surface of the balloon, and may be disposed on an outer surface of the balloon. The electrodes are operably coupled to an energy source configured to produce a bipolar or monopolar electric field between two balloon electrodes and/or between one balloon electrode and another electrode placed in contact with a part of the patient's body. During use, the disclosed drug-delivery catheter produces an electric potential gradient within adjacent tissue, that, in turn, facilitates iontophoresis delivery of a drug. The disclosed catheter can also include a store of one or more drugs to be delivered to the targeted tissue.

Claims

1-30. (canceled)

31. An iontophoresis drug delivery system for treatment of a human patient, the drug delivery system comprising: a catheter shaped and sized for intravascular delivery to a renal blood vessel of the patient; an expandable member at a distal region of the catheter; one or more electrodes disposed on the expandable member, wherein the one or more electrodes are configured to be coupled to an energy source external to the patient; and a drug supply operatively associated with the balloon and configured to selectively release a drug, wherein the drug is selected from a group including guanethidine, epinephrine, dimethyl sulfoxide (DMSO), and combinations thereof.

32. The iontophoresis drug delivery system of claim 31 wherein the catheter is shaped and sized for intravascular delivery within a lumen of a renal artery of the patient between the descending aorta and one or more renal artery branches adjacent to a kidney of the patient.

33. The iontophoresis drug delivery system of claim 31 wherein the expandable member comprises a frame.

34. The iontophoresis drug delivery system of claim 31 wherein the expandable member comprises a balloon.

35. The iontophoresis drug delivery system of claim 34 wherein an outer surface of the balloon includes a plurality of wells for storing the drug supply.

36. The iontophoresis drug delivery system of claim 35, further comprising a covering layer over the wells, and wherein the covering layer is configured to be disrupted as the balloon transforms between a low-profile delivery configuration and an expanded treatment configuration.

37. The iontophoresis drug delivery system of claim 34 wherein the drug supply comprises a coating on an outer surface of the balloon.

38. The iontophoresis drug delivery system of claim 34 wherein the balloon comprises one or more lumens to allow blood to flow therethrough.

39. The iontophoresis drug delivery system of claim 34 wherein, when inflated, the balloon is sized and shaped to circumferentially engage an inner vessel wall of the renal blood vessel.

40. The iontophoresis drug delivery system of claim 34 wherein the balloon comprises a weeping balloon a plurality of perforations positioned to deliver the drug therethrough.

41. The iontophoresis drug delivery system of claim 31 wherein the drug is in ionic form.

42. The iontophoresis drug delivery system of claim 31 wherein the one or more electrodes disposed on the expandable member comprises two electrodes adapted for delivery of a bipolar electric field to target tissue to facilitate delivery of the drug via iontophoresis.

43. The iontophoresis drug delivery system of claim 31 wherein the one or more electrodes are adapted for delivery of a monopolar electric field to target tissue to facilitate delivery of the drug via iontophoresis.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0021] These and other advantages will become more apparent from the following detailed description of the various embodiments of the present disclosure with reference to the drawings wherein:

[0022] FIG. 1 is a block diagram of an iontophoresis catheter system for denervation of the renal nerve having an iontophoresis catheter according to an embodiment of the present disclosure wherein the catheter is fitted with a drug coated balloon having one or more electrodes;

[0023] FIG. 2 is an enlarged view of the distal end of an iontophoresis catheter of the iontophoresis catheter system in accordance with an embodiment of the present disclosure;

[0024] FIG. 3 is a cross-sectional view of the distal end of the iontophoresis catheter shown in FIG. 2;

[0025] FIG. 4 is an enlarged view of the distal end of an iontophoresis catheter in accordance with another embodiment of the present disclosure; and

[0026] FIG. 5 is an enlarged view of the distal end of iontophoresis catheter in accordance with yet another embodiment of the present disclosure.

DETAILED DESCRIPTION

[0027] Particular embodiments of the present disclosure are described hereinbelow with the accompanying notes and drawings; however, it is to be understood that the disclosed embodiments are merely examples of the disclosure, which may be embodied in various forms. The terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting Well-known and/or repetitive functions and constructions are not described in detail to avoid obscuring the present disclosure in unnecessary or redundant detail. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present disclosure in virtually any appropriately detailed structure.

[0028] As used herein, the term proximal, as is traditional, shall refer to the end of the instrument that is closer to the user, while the term distal shall refer to the end that is farther from the user. As used herein, terms referencing orientation, e.g., top, bottom, up, down, left, right, o'clock, and the like are used for illustrative purposes with reference to the figures and corresponding axes and features shown therein. It is to be understood that embodiments in accordance with the present disclosure may be practiced in any orientation without limitation. As used herein, the term iontophoresis refers to a drug delivery method in which an electrical current is used to stimulate drug-carrying ions to pass through intact tissue, such as a vessel wall. Like reference members may represent elements which may perform the same, similar, or equivalent functions.

[0029] In embodiments in accordance with the present disclosure, iontophoresis drug delivery systems and methods are provided. Each drug delivery system includes an iontophoresis catheter which may be introduced into a body lumen to deliver a drug, medicament, or other therapeutic substance to targeted tissue via iontophoresis. In one non-limiting example, the disclosed catheter may be introduced into the femoral artery, advanced into the renal artery, and positioned adjacent to the renal nerve bundle. Advantageously, an iontophoresis catheter in accordance with the present disclosure may enable the attenuation of renal sympathetic nerve function for the treatment of hypertension by targeted delivery of guanethidine to the renal nerve bundle. Other applications and other drugs are also envisioned.

[0030] With reference to FIGS. 1, 2 and 3, there is shown an example embodiment of a iontophoresis drug delivery system for denervation of the renal nerve having an iontophoresis catheter fitted with a drug coated balloon in accordance with the present disclosure. The iontophoresis drug delivery system is designated generally by reference numeral 100. The system 100 includes the iontophoresis catheter 110 that is configured to be placed in the lumen of the renal artery between the descending aorta, and/or the one or more of the renal artery branches adjacent to the kidney.

[0031] In the embodiment shown by FIG. 1, the catheter 110 includes an expandable member or balloon 112 at or near its distal end 114 that, when inflated, circumferentially contacts the vessel wall 116, such as the wall of the renal artery 117 in proximity to the renal nerve 119. One or more electrodes 118 are associated with a surface of the balloon 112. In the present embodiment, the electrodes 118 are disposed on an outer surface 120 of the balloon 112. The electrodes 118 are operably coupled to an energy source 122 via at least one wire 123. The energy source 122 is configured to produce a bipolar or monopolar electric field between two balloon electrodes 118 (e.g., bipolar mode) and/or between one balloon electrode 118 and another balloon electrode 118 placed in contact with a part of the patient's body, such as without limitation, the skin, a blood vessel, etc. (e.g., monopolar mode).

[0032] The energy source 122 may include a control system that is configured to regulate and monitor energy delivery and/or monitor a related parameter (tissue impedance, contact temperature, tissue temperature, and so forth). In some embodiments, the energy source 122 provides constant-current DC energy. A return electrode 124 may be included as shown in FIG. 1.

[0033] The electric field generated by the system 100 and illustrated by the broken lines in FIG. 1 may be continuous or pulsed direct current. The electrodes 118 may be positioned in any pattern on the outer surface 120 of the balloon 112 to provide particular configurations of the electric field. The electrodes 118 may be positioned in a equally spaced pattern as shown by FIGS. 2 and 3, and/or the electrodes 118 can be positioned in random locations on the outer surface 120 of the balloon 112.

[0034] The electrodes 118 may be arranged in a manner such that the majority of the electric field generated penetrates the renal nerve 119 for optimum denervation of the renal nerve 119. The electrodes 118 can also be arranged as shown in FIG. 1, such that a tail end of the electric field generated penetrates the renal nerve 119. As such, according to the present disclosure the electrodes 118 can be positioned on the outer surface 120 of the balloon 112 in accordance with the amount of electric field desired to penetrate the renal nerve 119.

[0035] The balloon 112 or distal end 114 of the catheter 110 may also be moved along the interior of the vessel, such as the renal artery 117, by pushing and pulling the catheter shaft 126. The balloon 112 can be moved along the interior of the vessel prior to activation of the electrodes 118 or during activation of the electrodes 118. The balloon 112 may also be moved along the interior of the vessel while it is fully inflated, partially inflated or deflated.

[0036] The balloon 112 and/or catheter, such as the catheter shaft 126, can include one or more lumens to allow blood to flow from one side of the balloon 112 to the other in order to maintain kidney perfusion during denervation of the renal nerve and/or iontophoresis drug delivery. The one or more lumens, such as lumen 128 shown in FIG. 3, allow the balloon 112 to be kept inflated for as long as needed to complete the denervation procedure, or any other desired procedure. Additionally, the depth of drug penetration in iontophoresis drug delivery is dependent in part upon the duration of the applied current.

[0037] During use, the disclosed catheter 110 produces an electric potential gradient within adjacent tissue (e.g., blood vessel wall, nerves, and surrounding tissues), that, in turn, facilitates iontophoresis delivery of a drug.

[0038] The disclosed iontophoresis drug delivery systems also include a store of one or more drugs to be delivered to the targeted tissue. Preferably, at least one drug is in an ionic form. For example, and without limitation, guanethidine is a drug known to attenuate the function of sympathetic nerves by inhibiting the release of norepinephrine (also known as noradrenaline). Guanethidine may be formulated in an ionic form with a +2 charge. Additionally or alternatively, other drugs may be utilized. For example, and without limitation, a drug may be combined with one or more secondary drugs to improve the speed of drug uptake (e.g. penetration or permeation enhancers such as dimethyl sulfoxide (DMSO)) or to prolong the local drug effect (e.g., vasovasorum constrictors such as epinephrine).

[0039] In some embodiments, the catheter 110 includes a supply of a drug (e.g., prior to drug delivery) and may be configured to facilitate the release thereof for iontophoresis delivery into a body lumen and/or surrounding tissue. In some embodiments, additionally or alternatively to other embodiments, the drug may be incorporated into a coating 130 (FIG. 1) surrounding the outer surface 120 of the balloon 112.

[0040] Additionally or alternatively to other embodiments, a balloon 140 of the iontophoresis drug delivery system 100 can be perforated (e.g., a weeping balloon), as shown by FIG. 4, such that administration of the drug to a balloon lumen 142 from a drug supply via, for example, the catheter shaft 126, causes a transfer of the drug from the inner volume of the balloon 140 to the outer surface 144 at or adjacent to the electrode(s) 146 via a plurality of perforations 149. The drug supply may be external or outside the patient.

[0041] In the embodiment shown by FIG. 4, the catheter shaft 126 can be sized to have approximately the same diameter as the inner surface of the balloon 140. The inner surface of the balloon 140 includes at least one opening in fluid communication with an inner lumen 141 of the shaft 126. The drug is delivered under pressure through the shaft 126 to the balloon 140 via the at least one opening (not explicitly shown). The drug is then forced out of the plurality of perforations 149 to the outer surface of the balloon 140. The drug can also be delivered to the balloon 140 through a lumen other than the catheter shaft 126.

[0042] In some embodiments, additionally or alternatively to the other embodiments, with reference to FIG. 5, the drug is stored in one or more wells 148 disposed on the surface of a balloon 150, each of which is covered by a covering layer 152. When this covering layer 152 is disrupted, the drug inside the wells 148 is released into the vicinity of the electrode(s) 154. The covering layer 152 may be disrupted by mechanical action (e.g., pressure applied by the balloon pressing against the blood vessel wall) or the application of heat (e.g., a metallic covering is melted by resistive heating through the application of electrical energy from the electrode(s) 154).

[0043] The covering layer 152 is shown in a non-disrupted state for the bottom two wells in FIG. 5, while the covering layer 152 for the top two wells has been disrupted, for illustrative purposes. In operation, all covering layers 152 are likely to be disrupted at or about the same time during operation of the drug delivery system.

[0044] When the drug to be delivered is situated adjacent to the electrodes 118, 146, 154, an electric field is applied between two or more electrodes. The ionic charge of the drug causes the drug molecules to follow the electric field, thereby entering the tissue at a faster rate than would occur by, e.g., simple diffusion. Rapid uptake of drug into the tissue may be enhanced by electroporation, whereby one or more high-voltage pulses are applied to open temporary pores in the tissue that, in turn, facilitate accelerated drug uptake. Additionally or alternatively, the direct current used for iontophoresis may be pulsed, since tissue impedance decreases with the frequency of the applied current. The delivery of current is primarily direct current, since the direction of ionic migration is dependent upon the polarity of the applied electric field. In some embodiments, an iontophoresis catheter in accordance with the present disclosure may advantageously be used to remove undesirable compounds, drugs, and toxins from targeted tissue.

[0045] The aforementioned embodiment describes a balloon catheter. Additional or alternative methods of producing approximately circumferential vessel wall apposition are also envisioned within the scope of the present disclosure. For example, and without limitation, in some embodiments the electrodes 118, 146, 154 may be mounted on an expandable wire frame resembling an umbrella frame. In some embodiments, the electrodes 118, 146, 154 may be mounted on a stent-like expandable member or frame.

[0046] Also disclosed is a method for the treatment of renal hypertension. The method includes placing a drug delivery catheter, such as the catheter 110 shown in FIG. 2, into the lumen of the renal artery 117. The method further includes producing an electric potential between the catheter and the nerves adjacent to the renal artery wall. The method further includes administering a drug, such as the drugs mentioned above, to the nerves via the electric potential, thereby attenuating the activity of the nerves.

[0047] Also disclosed is a method to determine if a hypertensive patient is likely to benefit from a renal denervation procedure. It is based upon the established properties of guanethidine, which may suppress sympathetic nerve function. The method include the steps of: (1) measuring a patient's blood pressure; (2) administering guanethidine to the patient, for example, oral tablet, injection, or intravascular delivery; (3) measuring changes in the patient's blood pressure following guanethidine administration; (4) comparing the change in blood pressure to a pre-determined value; and (5) performing a renal denervation procedure if the change in blood pressure exceeds the predetermined value.

[0048] The drug delivery systems and catheters in accordance with the present disclosure have at least the following advantages: (1) there is no heat produced and therefore the patient experiences no pain; (2) they do not produce flow-limiting stenosis; (3) the treatment is circumferential, and therefore only one application is needed to guarantee treatment of the renal nerve; and (4) the systems and catheters maintain apposition with the vessel wall during treatment.

[0049] The described embodiments of the present disclosure are intended to be illustrative rather than restrictive, and are not intended to represent every embodiment of the present disclosure. Further variations of the above-disclosed embodiments and other features and functions, or alternatives thereof, may be made or desirably combined into many other different systems or applications without departing from the spirit or scope of the disclosure as set forth herein and/or in the following claims both literally and in equivalents recognized in law.