WO2006101885A2

WO2006101885A2 - Soft tissue processing

Info

Publication number: WO2006101885A2
Application number: PCT/US2006/009286
Authority: WO
Inventors: Katherine Gomes Truncale; Carl Alexander Depaula; Jeffrey Stuart Cartmell; David J. Gocke; Carina Syring; Rüdiger VON VERSEN
Original assignee: Musculoskeletal Transplant Foundation
Priority date: 2005-03-16
Filing date: 2006-03-15
Publication date: 2006-09-28
Also published as: US20060275377A1; US20100304487A1; CA2602100A1; US7723108B2; US8557581B2; WO2006101885A3; EP1858319A2; AU2006227711A1

Abstract

The present invention is a process for preparing soft tissue such as tendons, ligaments, cartilage, fascia, dermis, human valves and human veins for implant in a human and removes cellular components and forms an decellular matrix having as major components collagens and elastins while sterilizing the tissue. The process comprises the following steps: (1) isolating from a suitable donor a desired soft tissue sample of the biological material; (2) processing and decellularizing the soft tissue including inspection for visual defects, trimming and soaking the tissue in a detergent depending on whether the tissue is fascia or dermis and rinsing same with sterile water; (3) sterilizing the soft tissue in a vacuum and soaking the tissue in an antibiotic composition or peracetic acid depending on whether the soft tissue is fascia or dermis and rinsing same; (4) processing the tissue by cutting the tissue to size and perforating the tissue; and (5) dipping the tissue in 70% ethanol and packaging the tissue.

Description

SOFT TISSUE PROCESSING

RELATED APPLICATIONS

The present application claims priority from U.S. Provisional Patent Application Number 60/662,078, filed March 16, 2005.

FIELD OF INVENTION

The present invention is generally directed toward methods of treatment of allograft soft tissue including decellularizing and sterilization for implantation into another human being.

BACKGROUND OF THE INVENTION

Techniques for restoring structure and function to damaged tissue are used routinely in the area of reconstructive surgery. Tissue transplantation is another way of restoring function by replacing or rebuilding the damaged tissue. However, problems exist when there is a transfer of biological material from one individual to another. Tissue rejection is a significant risk associated with transplantation, even with a good histocompatability match. Immunosuppressive drugs such as cyclosporin and FK506 are usually given to the patient to prevent rejection. These immunosuppressive drugs however, have a narrow therapeutic window between adequate immunosuppression and toxicity. Prolonged immunosuppression can weaken the immune system, which can lead to a threat of infection.

The present invention is directed toward a process for use in the preparation of acellular, i.e. (essentially lacking in living cells and/or non-living cells,) soft-tissue implants, in commercializable quantities. These implants are derived from tissue products derived from animal or human donors that contain or are devoid of cells. The decellularized grafts produced are significantly improved in long-term durability and function when used in clinical applications.

Various methods have been used in the treatment of soft tissue and such representative methods are disclosed in a number of prior art applications.

The advantages of retaining an acellular matrix, composed primarily of a collagenous component intact, has been explored by Klaus, and Duhamel (WO 84/0488)) for the production of sterile body implants. In this method, a variety of tissues were extracted sequentially with non-ionic and ionic detergents to yield structures essentially free of cellular membranes, nucleic acids, lipids and cytoplasmic components. The treatment consists of sequential extractions with a non-denaturing detergent and a denaturing detergent to form an acellular matrix of collagen.

U.S. Patent Number 4,776,853 issued October 11, 1988 is directed toward a process for preparing biological material for implant in a mammal's cardiovascular system, respiratory system or soft tissue. The process comprises: (1) isolating a desired tissue sample of the biological material from a donor; (2) extracting the tissue sample with an hypotonic buffer solution at a mild alkaline pH, the buffer solution including active amounts of proteolytic inhibitors and antibiotics; (3) extracting the tissue sample with a buffered solution having a high concentration of salt, the solution being at a mild alkaline pH and including a non-ionic detergent with protease inhibitors and antibiotics; (4) subjecting tissue sample to enzymatic digestion in a buffered saline solution, the enzymes consisting of purified protease-free dioxyribonuclease and ribonuclease; (5) extracting the tissue sample with an anionic detergent at a mild alkaline pH; and (6) storing the tissue sample in physiologic buffered solutions. Another soft tissue process is shown in U.S. Patent Number 6,734,018 issued May 11,

2004 which is directed toward a process for preparing an acellular soft tissue graft for implantation into a mammalian system. The process extracts a soft tissue sample with an extracting solution including one or more nonionic detergents and one or more endonucleases, to produce extracted tissue and treats the extracted tissue with a treating solution including one or more anionic detergents, to produce a treated tissue. The treated tissue is washed with a decontaminating solution including one or more decontaminating agents to produce the acellular soft tissue graft; and acellular soft tissue graft is then stored in a storage solution comprising one or more decontaminating agents.

The soft tissue process of the '018 patent includes the steps of: isolating from a suitable donor a desired tissue sample of the biological material; extracting the tissue with mildly alkaline hypotonic buffered solution of an endonuclease such as Benzonase RTM and a nonionic detergent formulation such as Allowash Solution™ optionally treating the tissue with a hypertonic buffered salt solution; extracting and treating the tissue with a mildly alkaline hypotonic buffered solution of sodium dodecylsulfate, optionally with 0.1 to 0.5 M sodium chloride rendering the solution hypertonic; washing the tissue with ultrapure water followed by a water solution of chlorine dioxide; and storage in a sealed container in isotonic saline, chlorine dioxide or 70% isopropanol.

It can thus be seen that the prior art processes require extensive chemical treatment with a multitude of process steps in an attempt to obtain an acellular soft tissue specimen which has limited shelf life. SUMMARY OF THE INVENTION

The present invention is a process for preparing soft tissue for implant in a human and removes cellular components forming a decellular matrix having as major components; collagens and elastins while sterilizing the tissue. The process comprises the following steps:

(1) isolating from a suitable donor a desired soft tissue sample of the biological material;

(2) processing and decellularizing the soft tissue including inspection for visual defects, trimming and soaking the tissue in a detergent depending on whether the tissue is fascia or dermis and rinsing same with sterile water;

(3) sterilizing the soft tissue by soaking the tissue in an antibiotic composition and/or peracetic acid depending on the specific tissue and rinsing same to remove residual process chemicals;

(4) processing the tissue by cutting the tissue to size and perforating the tissue; and

(5) dipping the tissue in 70% ethanol and 30% water and packaging the tissue.

It is thus an object of the invention to provide decellularized allograft soft tissue for implantation into a human being.

It is another object of the invention to provide decellularized sterilized allograft soft tissue which is packaged for usage as an implant by a surgeon.

It is still another object of the invention to provide decellularized sterilized allograft soft tissue which can be stored for long periods of time for later use by a surgeon for implantation into a human being.

It is yet another object of the invention to provide decellularized sterilized allograft soft tissue which is flexible immediately upon removal from the package.

These and other objects, advantages, and novel features of the present invention will become apparent when considered with the teachings contained in the detailed disclosure along with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

Figure 1 is a schematic flow chart showing the soft tissue process; Figure 2 is a schematic flow chart showing the soft tissue process for fascia; Figure 3 is a schematic flow chart showing the soft tissue process for dermis; and Figure 4 is a top plan view of a soft tissue strip produced by the process.

DESCRIPTION OF THE INVENTION

The present invention is directed towards the preparation of allograft soft tissue such as thawed tissue which is processed and decellularized. The preferred mode and best embodiment of the invention is shown in Figures 1-3.

The process uses allograft human soft tissue which has been previously taken from a human donor and frozen for later use. The soft tissue which is envisioned as being used is facia, dermis, cartilage, pericardium, human valves and veins, tendons and ligaments. The soft tissue which has been previously obtained from a donor and frozen is taken from the freezer and thawed. Prior to processing, tissue is inspected for damage (holes or tears) and distinctive features (moles, warts, tattoos) which are removed using a scalpel. Tissue is inspected for hair and the same is removed using forceps. A visual inspection is performed to ensure the tissue has uniform thickness. Any region of non-uniformity or visibly low thickness is removed. Thickness is recorded using a thickness gauge. To identify the orientation (dermal or epidermal side) of tissue such as skin, the skin is positioned such that the epidermis faces the processor and an incision is cut into the upper left comer of each piece of tissue to indicate the epidermal side.

After thawing it is processed and decellularized. For tendons, ligaments, muscle, fascia, muscle, pericardium and dermis soft tissue, the tissue form is inspected for visual defects and then trimmed for procession.

When skin is used the epidermal layer is removed and the tissue is decellularized using a IM Sodium Chloride (NaCl) solution in a tissue flask and agitated at a speed of 65RPM on an orbital shaker for a minimum of 12 hours, up to a maximum of 48 hours. The epidermal layer of the skin is removed at this time and rinsed with sterile water. The remaining dermis is replaced in the tissue flasks filled with sterile water and agitated on the orbital shaker for 15 minutes. The sterile water is refreshed and the rinse procedure is repeated one more tune for a total of two rinses. Once the rinse is complete, the water is replaced with 0.1% Triton X-100 solution and agitated on the orbital shaker for a rninimum of 24 hours, up to a maximum of 48 hours. The dermis is then rinsed with sterile water, replaced in the tissue flasks filled with sterile water, and agitated on the orbital shaker at 65RPM for 15 minutes. The sterile water is refreshed and the rinse procedure is repeated a minimum of 5 more times. A residual detergent test is performed on the rinsate to ensure the detergent has been adequately removed. The two steps utilizing IM NaCl and 0.1% Triton soaks may be combined.

The decellularized dermis is subjected to sterilization in a solution containing peracetic acid, alcohol, propylene glycol, and water and soaked and agitated at 65RPM under vacuum for a minimum of 4 hours, up to a maximum of 8 hours. The dermis undergoes a rinse series followed with agitation at 65RPM under vacuum; two 5-minute rinses, followed by two 10- minute rinses, followed by two 15-minute rinses for a total of 6 rinses. After the last rinse, the residual test is performed on the rinsate to ensure that the peracetic acid has been adequately removed.

Other tissue such as fascia, cartilage, pericardium, tendons and ligaments is soaked in antibiotic soak for 1.5 to 24 hours and rinsed with sterile phosphate buffered saline. If desired the other tissue can also be soaked in IM NaCl for 1.5 to 48 hours, rinsed with sterile water a plurality of times, then soaked in 0.1% Triton X-IOQ for 4 to 48 hrs and rinsed with sterile water until a minimal residual amount of detergent is reached. The tissue is soaked in peracetic acid in vacuum for 4 hours and rinsed with sterile water from 6 to 9 times until a minimum residual amount of acid is tested.

The sterilized tissue is cut to finished size. The fascia and dermis can be perforated with holes about 1.2mm in diameter spaced from each other 2 to 3 mm. The tissue is dipped in 70% ethanol and 30% water and packaged.

Example 1 : Treatment of Fascia

A desired frozen soft tissue sample is isolated from a suitable donor and then thawed.

The thawed tissue is processed and decellularized and is inspected for visual defects and trimmed.

The trimmed tissue sample is sterilized while soaking the tissue in an antibiotic soak for 1.5 to 24 hours and is rinsed with phosphate buffered saline. If desired at the time of sterilization one or more of the following protease inhibitors may be added; Aminoethylbenzenesulfonyl fluoride HCL (Serine Proteases), Aprotinin (broad spectrum, serine proteases), Protease Inhibitor E-64 (Cysteine Proteases), Leupeptin, Hemisulfate Cysteine Proteases and trypsin-like proteases, Pepstatin A (Aspartic Proteases) and Marmistat (MMP2). If desired a solution with pH of 8.0 can be added which will inhibit lysozomal enzymes

The processed soft tissue is placed into a stainless steel container which is filled with an antibiotic solution. The antibiotic solution is a packet of pre-measured antibiotics; Primaxin 0.2168 g / Ppπ_m, Amphotericin B 0.0297 g / P_amph, Gentamicin 0.0369 g / P_gent, respectively, with a tolerance of ± 2.5%, and Phosphate Buffered Saline. It should be noted that one of the antibiotics is light sensitive and must be protected from light source. The container or a plurality of containers is placed on a incubator orbital shaker. The purpose of the incubator orbital shaker is to agitate the tissue in the antibiotic solution. The incubator orbital shaker is set at 120 rpm and the temperature reading on the incubator shaker is kept in a range between 35⁰C to 39⁰C. The tissue is soaked and agitated on the incubator shaker for a rninimum of 1.5 hours and a maximum of 24 hours in the antibiotic solution.

When rinsing, the tissue is transferred to a 1000ml polypropylene or Nalgene container. In a graduated beaker 2 packets of phosphate buffered saline are added into 2000ml of USP purified water and stirred until dissolved. Each polypropylene or Nalgene container containing tissue is filled with the phosphate buffer saline solution and the cap tightened. The tissue is agitated for a minimum of 5 minutes (to a maximum of 20 minutes) and the phosphate buffered saline solution is then emptied out of the container. The rinse steps are repeated; (2^nd rinse rninimum 5 minute, maximum 20 minutes phosphate buffered saline rinse). A final additional distilled water rinse is then completed. Once the cycle is complete the containers are removed from the orbital shaker. The solution is emptied and the processed tissue is placed on sterile wipes. The soft tissue is now ready to be measured for finishing cutting, perforating and packaging.

The treated fascia tissue is cut to size and may be frozen or lyophilized. If desired, the tissue may be perforated with the perforations 10 spaced 2-3mm apart and each perforation preferably having a diameter of about 1.2mm. A view of the finished cut tissue is seen in figure 4

The fascia tissue is immersed in 70% ethanol and 30% water and packaged in a sealed container.

Example 2 : Treatment of Dermis

Frozen donor tissue is then thawed and then rinsed to maintain moisture. The thawed tissue is processed and decellularized. If desired at the time of decellularization one or more of the following protease inhibitors may be added; Aminoethylbenzenesulfonyl fluoride HCL (serine proteases) (25-100 μm, Aprotinin (broad spectrum, serine proteases) (7.5-30μm),

Protease Inhibitor E-64 (cysteine proteases) (0.05-.0.20μm), Leupeptin, Hemisulfate (cysteine

proteases) (0.05-.0.20μm), EDTA, Disodium (0.025-.0.10μm), and trypsin-like proteases,

Pepstatin A (Aspartic Proteases). Marmistat (MMP2). The thawed tissue is processed and decellularized and is inspected for visual defects and trimmed.

Once all blood and lipids are removed from the skin, the water is changed with clean sterile water. Impurities are removed from each piece of skin with a scalpel (epidermal side up during this process). Place each skin piece with the epidermal side up on the cutting board or flat surface, check the skin for damage (holes and initial tearing) and for distinctive features (mole, warts, tattoos) and cut these impurities off using a scalpel.

Each piece is checked for hairs and the hairs are removed with forceps after which the skin is rinsed with water. The skin is positioned with the dermis side up (epidermis down) on the cutting board and rectangular skin pieces are cut by removing the rough edges of each piece with one or more uninterrupted cuts using a scalpel and ruler. An incision is cut into the left hand corner of each piece of skin indicating the epidermal side of the skin. A visual inspection is performed to make sure the tissue has a uniform thickness throughout the piece and regions with a visibly low or non-uniform thickness are removed. A thickness measurement is then performed using a thickness gauge. An incision is cut into the upper left comer of each piece of skin so that the epidermal side of the skin is facing the processor to ensure that tissue has a uniform thickness. The skin is decellularized in a sterile tissue culture bottle filled with IL of IM NaCl. The bottle is sealed in a self-seal pouch and then placed the bottle on its flat side on the shaker with a set speed of 65rpm's. The bottle(s) is checked after 12 hours to see if the epidermal layers have sloughed off. After the first 12 hour check, the bottle is checked every 2 hours until all epidermal layers have been sloughed. The bottles are removed from the shaker and the NaCl is emptied from the bottle(s). The skin is removed from the bottle and placed on the cutting board with the epidermal side up. The epidermal layers are peeled off with forceps and discarded leaving only the dermal layer (dermis). The bottles are rinsed with sterile water and the peeled skin pieces (dermis) are placed back into the bottle. The bottles are then filled with enough sterile water to submerge the tissue while the bottle is lying flat and the bottle is placed on the shaker which has a preset speed of 65rpm's. The shaker is set to run for 15 minutes. After running 15 minutes, the bottle(s) are removed and the water is changed with clean sterile water. This rinse is repeated one more time for a total of two times. The bottle(s),are removed from the shaker, emptied and filled with IL of 0.1% Triton X-100. The bottle containing the dermis is seated in a self-seal pouch and placed on the shaker set to the speed to 65 rpm's and allowed to shake for 24 to 48 hours. The shaker is stopped after 24 hours or a later time period, the dermis is removed from the bottles and place submerged in a container with sterile water to rinse off the Triton X-100. The tissue is again rinsed with a sterile water for 15 minutes at 65 rpm's for irrigation to rinse off the Triton X- 100. The rinse is repeated 5 more times for a total of 6 times. After rinsing a residual detergent test is performed to make sure that the detergent has been removed from the tissue.

The dermis is placed on a screen sterilized in peracetic acid for at least 4 hours in a canister. The dermis can be soaked in peracetic acid for 4 to 8 hours .The canister stays on the shaker during the soak with the shaker set at 65 rpm's. The dermis is initially rinsed in sterile water on the shaker at 65 rpm=s for 5 minutes and then rinsed 5 more times; 2^nd rinse for 5 minutes, 3^rd and 4^th rinse for 10 minutes and 5^th and 6^th rinse for 15 minutes. After the 6th rinse, a test is performed for the presence of the peracetic acid.

The strips of dermis are taken out of the canister using forceps and placed into a stainless steel basin. The basin is filled with water for irrigation and the residual detergent is rinsed from the surface of the skin. A wipe is placed on the top of a cutting board and moistened with sterile water. The skin is taken from the basin and laid on the cutting board epidermal side down (smooth side up) and measured.

If the dermis is to be lyophilized the skin is placed in a double Tyvek® pouch and the tissue placed in a freezer at -70° on the lyophilization staging shelf until the lyophilization is available.

After the 6^th rinse or upon later removal from the lyophilization , the dermis tissue is cut to size and perforated with the perforations 10 spaced 2-3 mm apart as shown in figure 4 with each perforation preferably having a diameter of about 1.2mm.

The tissue may be lyophilized or is immersed in 70% ethanol and 30% water and packaged for storage in sterile foil.

The dipped tissue is laid fiat on screens and placed in double Tyvek® pouches for lyophilization and 1 each Tyvek® pouch is sealed. The package is stored flat in the freezer to prevent the tissue from becoming wrinkled or deformed.

The principles, preferred embodiments and modes of operation of the present invention have been described in the foregoing specification. However, the invention should not be construed as limited to the particular embodiments which have been described above. Instead, the embodiments described here should be regarded as illustrative rather than restrictive. Variations and changes may be made by others without departing from the scope of the present invention as defined by the following claims:

Claims

What is claimed is:

1. A method for the treatment of soft tissue to prepare the same for implantation into a human comprising the steps of:

(a) thawing frozen donor tissue and decellularizing the donor tissue;

(b) inspecting the donor tissue for defects

(c) trirnming the donor tissue for processing

(d) sterilizing the trimmed donor tissue with a soak in peracetic acid in a vacuum,

(e) rinsing the material contained in the soak from the tissue;

(f) cutting the treated tissue to a specific size;

(g) immersing the cut tissue in ethanol; and

(h) packaging the ethanol soaked tissue in a sealed package.

2. The method as claimed in claim 1 wherein said soft tissue is fascia.

3. The method as claimed in claim 1 wherein said soft tissue is dermis.

4. The method as claimed in claim 1 wherein said soft tissue is at least one tendon.

5. The method as claimed in claim 1 wherein said soft tissue is at least one ligament.

6. The method as claimed in claim 1 wherein said soft tissue is muscle.

7. The method as claimed in claim 1 wherein said soft tissue is pericardium.

8. The method as claimed in claim 1 wherein said soft tissue is a human valve.

9. The method as claimed in claim 1 wherein said soft tissue is a human vein.

10. The method as claimed in claim 1 wherein the soft tissue is dermis and after step (f), the cut tissue is perforated with a plurality of spaced apertures.

11. The method as claimed in claim 1 wherein after step (a), decellularizing adding one or more of a group of the protease inhibitors consisting of one or more of the following protease inhibitors may be added; Aminoethylbenzenesulfonyl fluoride HCL (Serine Proteases), Aprotinin (broad spectrum, serine proteases), Protease Inhibitor E-64 (Cysteine Proteases), Leupeptin, Hemisulfate Cysteine Proteases and trypsin-like proteases, Pepstatin A (Aspartic Proteases). Marmistat (MMP2).

12. A method for the treatment of soft fascia tissue to prepare the same for implantation into a human comprising the steps of:

(a) thawing frozen donor fascia tissue;

(b) inspecting the donor tissue for defects;

(c) trirnming the donor tissue for processing;

(d) soaking the trimmed donor tissue in a compound antibiotic mixture from 1.5 to 24 hours;

(e) rinsing the antibiotic mixture from the tissue with sterile water;

(f) cutting the treated tissue to a specific size;

(g) perforating the cut tissue with a plurality of spaced apertures; (h) immersing the perforated cut tissue in ethanol; and

(i) packaging the ethanol soaked perforated tissue in a sealed package.

13. The method as claimed in claim 12 wherein said antibiotic mixture comprises Primaxin 0.2168 g / P_prim, Amphotericin B 0.0297 g / Pamph and Gentamicin.

14. The method as claimed in claim 12 wherein said antibiotic mixture is taken from a group of antibiotics consisting of one or more of Primaxin , Amphotericin, and Gentamicin.

15. The method as claimed in claim 12 wherein after step (c) Irirnming, there is an additional step of adding one or more of a group of the following protease inhibitors consisting of Aminoethylbenzenesulfonyl fluoride HCL (Serine Proteases), Aprotinin (broad spectrum, serine proteases), Protease Inhibitor E-64 (Cysteine Proteases), Leupeptin, Hemisulfate Cysteine Proteases and trypsin-like proteases, Pepstatin A (Aspartic Proteases) and Marmistat

(MMP2).

16. The method as claimed in claim 12 wherein after step (d), there is an additional step of soaking the donor tissue with phosphate buffered saline.

17. A method for the treatment of soft skin tissue to prepare the same for implantation into a human comprising the steps of:

(a) thawing the frozen donor tissue

(b) inspecting the donor tissue for defects

(c) trimming the donor tissue for processing

(d) removing the epidermal layer from the skin leaving the dermis;

(e) soaking the remaining skin in IM NaCl from 1.5 to 48 hours;

(f) rinse the NaCl soaked skin with sterile water a plurality of times to remove the NaCL;

(g) soak the treated skin in 0.1 % Triton X- 100 detergent from 1.5 to 48 hours;

(h) rinse the Triton X-100 detergent soaked skin with sterile water to remove the detergent to an acceptable level;

(i) sterilize the skin in a sterilization solution for 4 to 8 hours; (j) rinse the skin with sterile water a plurality of times to reduce the acid content to a predetermined residual level; (k) cutting the treated tissue to a specific size; (1) perforating the cut tissue with a plurality of spaced apertures; (m) immersing the perforated cut tissue in ethanol; and

(n) packaging the ethanol soaked perforated tissue in a sealed package.

18. The method as claimed in claim 17 wherein after step (d), the step of adding one or more of a group of the following protease inhibitors consisting of Aminoethylbenzenesulfonyl fluoride HCL (Serine Proteases), Aprotinin (broad spectrum, serine proteases), Protease Inhibitor E-64 (Cysteine Proteases), Leupeptin, Hemisulfate Cysteine Proteases and trypsin-like proteases, Pepstatin A (Aspartic Proteases) and Marmistat (MMP2).

19. The method as claimed in claim 17 wherein the sterilization solution of step (e) comprises propylene glycol, ethanol 95% sterile water and peracetic acid 35%.

20. A method for the treatment of cartilage to prepare the same for implantation into a human comprising the steps of:

(a). thawing frozen cartilage tissue;

(b) soaking the donor tissue in a compound antibiotic mixture from 1.5 to 24 hours;

(c ) rinsing the antibiotic mixture from the tissue with phosphate buffered saline;

(d) lyophilizing the treated tissue to achieve a residential moisture level between 0.1% to 8.0%; and

(e) milling the cartilage pieces to sizes less than lmm.