# Patent

## Title
Polycationic peptide coatings and methods of making the same

## Abstract

Polycationic peptide coatings for implantable medical devices and methods of making the same are described. The methods include applying an emulsion on the device, the emulsion including a polymer and a polycationic peptide. Other methods include incorporation of the polycationic peptide in microspheres and liposomes.

## Background
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates to the field of implantable medical devices, such as stents. More particularly, this invention is directed to coatings for devices, the coatings including peptides such as polymers and/or oligomers of L-arginine.
2. Description of the Background
In the field of medical technology, there is frequently a necessity to administer a therapeutic substance locally. To provide an efficacious concentration to the treatment site, systemic administration of medication often produces adverse or toxic side effect for the patient. Local delivery is a preferred method in that smaller total levels of medication are administered in comparison to systemic dosages, but are concentrated at a specific site. Thus, local delivery produces fewer side effects and achieves more effective results. For the treatment of vascular occlusions, such as restenosis, stents are being modified to administer therapeutic substances locally. One method of medicating a stent is with the use of a polymer coating impregnated with a therapeutic substance. The coating allows for the sustained release of the substance at the treatment site. L-arginine, or polypeptide oligomeric derivatives or analogs thereof, for example, those containing 5 to 20 amino acid units are one example of a therapeutic substance that can be used in conjunction with a stent.
L-arginine is a known precursor of endothelium derived nitric oxide (NO). NO is synthesized from L-arginine, or its polymeric and/or oligomeric derivatives, by the enzyme NO synthase oxygenase, a homodimeric flavo-hemoprotein that catalyzes the 5-electron oxidation of L-arginine to produce NO and L-citrulline. Among other therapeutic properties, NO regulates vascular tone, inhibits platelet aggregation, and inhibits vascular smooth muscle proliferation. These therapeutic properties are believed to contribute to the reduction or elimination of neo-intimal hyperplasia in vascular injury models.
U.S. Pat. No. 5,861,168 to Cooke et al. teaches that NO activity is reduced after vascular injury. Cooke et al. also teach that administering L-arginine as the NO precursor helps to restore vascular NO activity in patients with endothelial vasodilator dysfunction due to restenosis. It has been also taught that oligomeric peptides comprising 6 to 15 units of L- or D-arginine can be effective transfectors of cells (see, Mitchell, et al., J. Peptide Res., vol. 56, p. 318 (2000)) and, using a rabbit vein-graft model, it has been demonstrated that oligomers of L- or D-arginine can inhibit vascular smooth cell proliferation by efficiently transfecting cells. See, Uemura, et al., Circulation, vol. 102, p. 2629 (2000). Using the rabbit model, it has also been shown that intramural administration of L-arginine inhibits lesion formation in a hypercholesterolemic balloon injury. See, Schwarzacher et al. Circulation, vol. 95, p. 1863 (1997).
Accordingly, it is desirable to incorporate L-arginine, or its polymers and/or oligomers into a stent coating. The present application describes the methods that can be used to achieve this goal.
SUMMARY
A method of coating an implantable medical device is provided. The method comprises applying an emulsion of a polymer and a polycationic peptide on the device to form a coating for the device. The device can be, for example, is a stent. The polycationic peptide can be poly(L-arginine), poly(D-arginine), poly(D,L-arginine), a racemic mixture of poly(L-arginine) and poly(D-arginine), poly(L-lysine), poly(D-lysine), poly(δ-guanidino-α-aminobutyric acid), or mixtures thereof.
The polymer can be, for example, an acrylic polymer, a vinyl polymer, a polyurethane, or a combination thereof. Representative examples of the acrylic polymer include poly(butyl methacrylate) and poly(methyl methacrylate). Representative examples of the vinyl polymer include poly(ethylene-co-vinyl alcohol) and poly(vinyl acetate). In one embodiment, the emulsion can include first surfactant. This first surfactant can have hydrophilic-lipophilic balance between about 3 and about 6. The emulsion can additionally include a second surfactant having has a hydrophilic-lipophilic balance exceeding the value of 10.
A method for incorporating a polycationic peptide into a coating for an implantable medical device, e.g., a stent, is provided comprising fabricating microspheres containing the polycationic peptide; dispersing the microspheres in a polymer solution; and applying the solution onto the device. The fabrication of the microspheres can include emulsification of an aqueous solution of the polycationic peptide in an organic solvent medium. The organic solvent medium can be, for example, cyclooctane, cyclohexane, cycloheptane, para-xylene, dimethylformamide, dimethylsulfoxide, chloroform, methylene oxide, dimethylacetamide, and mixtures thereof.
A method for incorporating a polycationic peptide into a coating for an implantable medical device is provided, comprising: fabricating liposomes containing the polycationic peptide; dispersing the liposomes in a polymer solution; and applying the solution onto the device. The fabrication of the liposomes car include suspending a lipid in an aqueous medium solution in the presence of the polycationic peptide. The lipid can be phosphatidyl choline.
A medical device, such as a stent is also disclosed comprising a coating, the coating including a polymer phase and a polycationic peptide phase separate and distinguishable from the polymer phase.


DETAILED DESCRIPTION
L-arginine, also known as 2-amino-5-guanidinovaleric acid, is an amino acid having a formula NH═C(NH2—NH—CH2—CH2—CH2—CH(NH2)—COOH. Polymers and/or oligomers of L-arginine that can be used are hereinafter referred to as “PArg” which comprise a plurality of repeating monomeric amino acid units connected with peptide bonds. PArg has a general formula H[NH—CHX—CO]p—OH, where “p” can be within a range of 5 and 1,000, typically, within a range of between 6 and 20. For example, a heptamer (designated R7), having p=7, can be used. In the formula of PArg “X” is 1-guanidinopropyl radical having the structure —CH2—CH2—CH2—NH—C(NH2)═NH. The terms “polymers and/or oligomers of L-arginine,” “poly-L-arginine,” and “PArg” are intended to include L-arginine in both its polymeric and oligomeric form.
In addition to PArg, other polycationic peptides can be incorporated into the stent coatings. Examples of alternative polycationic peptides include racemic mixtures of poly(L-arginine), poly(D-arginine), racemic mixtures of poly(D-arginine), poly(L-lysine), poly(D-lysine), and poly(δ-guanidino-α-aminobutyric acid). Those having ordinary skill in the art may choose to use other appropriate peptides if desired.
Coating Stents with Polypeptide-Containing Emulsions
In accordance with one embodiment, an emulsion containing a polymer and a polypeptide, for example, R7 is prepared. To make the emulsion, R7 can be dissolved in water to form the aqueous phase (solution I). The concentration of R7 in solution I can be between about 5 and 15 mass %. A polymer is then dissolved in a suitable organic solvent, such as dimethylformamide, dimethylsulfoxide, chloroform, methylene chloride, or dimethylacetamide, to form the organic phase (solution II). The concentration of the polymer in solution II can be between about 1 and 15 mass %.
One example of the polymer that can be used for making the organic phase is poly(ethylene-co-vinyl alcohol), the copolymer of ethylene and vinyl alcohol also known under the trade name EVAL and distributed commercially by Aldrich Chemical Company of Milwaukee, Wis. EVAL is also manufactured by EVAL Company of America of Lisle, Ill. EVAL has the general formula —[CH2—CH2]m—[CH2—CH(OH)]n—. EVAL is a product of hydrolysis of ethylene-vinyl acetate copolymers. Those having ordinary skill in the art of polymer chemistry will understand that EVAL may also be a terpolymer and may include up to 5% (molar) of units derived from styrene, propylene and other suitable unsaturated monomers.
Other polymers can be used in lieu of or in addition to EVAL to for preparation of solution II. Examples of such polymers include other vinyl polymers such as poly(vinyl acetate) (PVA), acrylic polymers such as poly(butyl methacrylate) (PBMA) or poly(methyl methacrylate) (PMMA), polyurethanes, and combinations thereof.
The organic phase can also optionally include a surfactant or a mixture of surfactants. The surfactant or the mixture of surfactants can have a hydrophilic-lipophilic balance (HLB) within a range of between about 3 and about 6. Examples of suitable surfactants having HLB between 3 and 6 include SPAN 80 (sorbitan oleate), SPAN 60 (sorbitan monostearates), ARLACEL 83 (sorbitan sesquioleate), TX-4 (polyoxyethylene alkylphenol ether), MOA-3 (polyoxyethylene aliphatic alcohol ether), polyoxamers such as poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) block-copolymer, egg lechitin, BRIJ 93 (polyoxyethylene oleyl ether), IGEPAL CO-210 (polyoxyethylene nonyl phenyl ether), propylene glycol monostearate, propylene glycol monolaurate, glycerol monolaurate and mixtures thereof.
Surfactants having high HLB (>10) can be also blended with low HLB surfactants described above. Example of suitable high HLB surfactants include TWEEN 20 and TWEEN 21 (polyoxyethylene sorbitan monolaurates), TWEEN 80 (polyoxyethylene sorbitan monooleate), TWEEN 85 (polyoxyethylene sorbitan trioleate), BRIJ 76 and BRIJ 78 (polyoxyethylene stearyl ethers). TWEEN, SPAN, BRIJ, ARLACEL and IGEPAL are trade names of the surfactants. TWEEN, SPAN, BRIJ and ARLACEL are available from ICI Americas, Inc. of Bridgewater, N.J. IGEPAL is available from Rhone-Poulenc, Inc. of Cranbury, N.J.
Solution I is added to solution II and the mixture is sonicated or homogenized to make the water-in-oil emulsion. “Sonication” is defined as agitation by high-frequency sound waves applied to the mixture. The conditions under which the sonication or homogenization is carried out can be determined by one having ordinary skill in the art. The ratio between solution I and solution II can be between about 1:9 and about 1:1 by volume. The R7-containing emulsion can then be applied to a stent by any conventional technique, for example, by spraying or dipping, to form the reservoir matrix of the stent coating. The amount of R7 in this layer can be between about 10 and 200 micrograms.
Optionally, a therapeutic agent or a drug can be incorporated into the coating, for example by dispersing or dissolving the drug in solution I or II prior to mixing the solutions. The agent could be for inhibiting the activity of vascular smooth muscle cells. It can be directed at inhibiting abnormal or inappropriate migration and/or proliferation of smooth muscle cells to inhibit restenosis. The active agent can include any substance capable of exerting a therapeutic or prophylactic effect in the practice of the present invention. The drug may include small molecule drugs, peptides, proteins, oligonucleotides, or double-stranded DNA. The active agent can also be conjugated to R7 either by covalent attachment or by ionic interaction.
Examples of the drugs include antiproliferative substances such as actinomycin D, or derivatives and analogs thereof. Synonyms of actinomycin D include dactinomycin, actinomycin IV, actinomycin I1, actinomycin X1, and actinomycin C1. The active agent can also fall under the genus of antineoplastic, anti-inflammatory, antiplatelet, anticoagulant, antifibrin, antithrombin, antimitotic, antibiotic, antiallergic and antioxidant substances. Examples of such antineoplastics and/or antimitotics include paclitaxel, docetaxel, methotrexate, azathioprine, vincristine, vinblastine, fluorouracil, doxorubicin hydrochloride, and mitomycin. Examples of such antiplatelets, anticoagulants, antifibrin, and antithrombins include sodium heparin, low molecular weight heparins, heparinoids, hirudin, argatroban, forskolin, vapiprost, prostacyclin and prostacyclin analogues, dextran, D-phe-pro-arg-chloromethylketone (synthetic antithrombin), dipyridamole, glycoprotein IIb/IIIa platelet membrane receptor antagonist antibody, recombinant hirudin, and thrombin. Examples of such cytostatic or antiproliferative agents include angiopeptin, angiotensin converting enzyme inhibitors such as captopril, cilazapril or lisinopril, calcium channel blockers (such as nifedipine), colchicine, fibroblast growth factor (FGF) antagonists, fish oil (ω-3-fatty acid), histamine antagonists, lovastatin (an inhibitor of HMG-CoA reductase, a cholesterol lowering drug), monoclonal antibodies (such as those specific for Platelet-Derived Growth Factor (PDGF) receptors), nitroprusside, phosphodiesterase inhibitors, prostaglandin inhibitors, suramin, serotonin blockers, steroids, thioprotease inhibitors, triazolopyrirnidine (a PDGF antagonist), and nitric oxide. An example of an antiallergic agent is permirolast potassium. Other therapeutic substances or agents which may be appropriate include alpha-interferon, genetically engineered epithelial cells, rapamycin and dexamethasone.
Prior to the application of the reservoir layer, a polymer primer layer can be formed on the bare stent. The polymers for the optional primer layer can be the same polymers that are used to make the reservoir layer.
The coated stent can be optionally freeze-dried to remove the residual solvent and/or moisture. The process of freeze-drying can be carried out using techniques and equipment known to those having ordinary skill in the art. Also, the R7-coated stent can be over-coated with a diffusion limited hydrophobic polymer topcoat if desired. The use of the topcoat is optional. The polymers used for fabrication of the topcoat can include poly(vinylidene fluoride), PBMA, PMMA, or combinations thereof.
Coating Stents with Polymer Compositions Containing Microspheres or Liposomes
In accordance with other embodiments, microspheres or liposomes containing a polypeptide, for example R7, can be dispersed in a polymer composition. The polymer composition, containing the microspheres incorporating R7, is then applied to the stent.
In accordance with one embodiment, an encapsulating polymer is dissolved in a suitable organic solvent such as methylene chloride, cyclooctane, cyclohexane, cycloheptane, para-xylene, dimethylformamide, dimethylsulfoxide, chloroform, dimethylacetamide, or mixtures thereof. The encapsulating polymers can include EVAL, other vinyl polymers such as poly(vinyl acetate) (PVA), acrylic polymers such as poly(butyl methacrylate) (PBMA) or poly(methyl methacrylate) (PMMA), polyurethanes, poly(L-lactide), poly(D,L-lactide), poly(glycolide), poly(caprolactone), polyanhydrides, polydiaxanone, polyorthoesters, polyamino acids, poly(trimethylene carbonate), and combinations thereof. The R7 is then added to the polymer solution either as an aqueous solution containing an emulsifying agent such as poly(vinyl alcohol), or as a solid dispersion, and stirred, homogenized or sonicated to create a primary emulsion of R7 in the polymer phase. Surfactants such as poly(vinyl alcohol), albumin (either bovine or human serum), gelatin, lipophilic emulsifiers such as PLURONIC or TETRONIC, or a combination thereof can be optionally added to stabilize the primary emulsion. PLURONIC is a trade name of poly(ethylene oxide-co-propylene oxide). TETRONIC is a trade name of a family of non-ionic tetrafunctional block-copolymer surfactants. PLURONIC and TETRONIC are available from BASF Corp. of Parsippany, N.J.
The primary emulsion is stirred with an aqueous solution containing an emulsifying agent such as poly(vinyl alcohol) to create a secondary emulsion of protein containing polymer in the aqueous phase. The secondary emulsion is stirred in excess water, optionally under vacuum to remove the organic solvent and harden the microspheres. The hardened microspheres are collected by filtration or centrifugation and lyophilized.
According to another technique, a primary emulsion of R7 in an aqueous phase is formed as in the first technique described above. This emulsion is then stirred with a non-solvent for the polymer, such as silicone oil to extract the organic solvent and form embryonic microspheres of polymer with trapped R7. The non-solvent is then removed by the addition of a volatile second non-solvent such as heptane, and the microspheres harden. The hardened microspheres are collected by filtration or centrifugation and lyophilized.
According to yet another technique, the R7, formulated as lyophilized powder is suspended in a polymer phase consisting of polymer dissolved in a volatile organic solvent such as methylene chloride. The suspension is then spray dried to produce polymer microparticles with entrapped R7.
According to yet another technique, the R7, formulated as a powder is suspended in a polymer phase consisting of polymer dissolved in a volatile organic solvent such as methylene chloride. The suspension is sprayed into a container containing frozen ethanol overlaid with liquid nitrogen. The system is then warmed to about −70° C. to liquefy the ethanol and extract the organic solvent from the microspheres. The hardened microspheres are collected by filtration or centrifugation and lyophilized.
Liposomes are aqueous compartments pouches which are typically made of phospholipids. Liposomes can be fabricated according to standard techniques known to those having ordinary skill in the art. One way of forming of the liposome can be by suspending a suitable lipid, such as phosphatidyl choline in an aqueous medium followed by sonication of the mixture. An alternative way of preparing the lipid vesicles can be by rapidly mixing a solution of the lipid in an ethanol-water blend, for example, by injecting the lipid through a needle into a agitated ethanol-water solution. Besides phospholipids, other amphophilic substances can be used, for example, shingomyelin or lipids containing polymerized portions of poly(ethylene glycol). Liposomes having a diameter of about 500 Angstroms can be fabricated.
To trap R7 inside the liposomes, the liposomes can be formed in the presence of R7. For example, in the process of forming the liposomes described above, the aqueous or ethanol-water medium can contain R7. R7 can be dissolved in the medium. For example, if 500 Angstrom vesicles are formed in an approximately decimolar solution of R7 (i.e., the concentration of R7 in the medium is about 0.1 moles per liter), about 2,000 molecules of R7 can be trapped in the inner compartment of each liposome. Following the formation of the R7-filled lipid vesicles, the vesicles can be separated from the surrounding solution and purified, for example, by dialysis or gel-filtration chromatography. Other suitable methods of separation can be employed as is understood by one having ordinary skill in the art.
The R7-containing microspheres or liposomes can then be dispersed in a solution of an appropriate polymer to form a polymer-microsphere or polymer-liposome suspension. The mass ratio between the liposome and the polymer in the suspension can be within a range of between about 1:5 and 1:2. Examples of polymers that can be used, include, but are not limited to, EVAL, other vinyl polymers such as PVA, acrylic polymers such PBMA or PMMA, polyurethanes, and combinations thereof.
The coatings and methods of the present invention have been described in conjunction with a stent. The stent can be used in any part of the vascular system, including neurological, carotid, coronary, renal, aortic, iliac, femoral or any other peripheral vascular sites. The stent can be balloon-expandable or self-expandable. There are no limitations on the size of the stent, its length, diameter, strut thickness or pattern. The use of the coating is, however, not limited to stents and the coating can also be used with a variety of other medical devices. Examples of the implantable medical device, that can be used in conjunction with the embodiments of this invention include stent-grafts, grafts (e.g., aortic grafts), artificial heart valves, cerebrospinal fluid shunts, pacemaker electrodes, axius coronary shunts and endocardial leads (e.g., FINELINE and ENDOTAK, available from Guidant Corporation). The underlying structure of the device can be of virtually any design. The device can be made of a metallic material or an alloy such as, but not limited to, cobalt-chromium alloys (e.g., ELGILOY), stainless steel (316L), “MP35N,” “MP20N,” ELASTINITE (Nitinol), tantalum, tantalum-based alloys, nickel-titanium alloy, platinum, platinum-based alloys such as, e.g., platinum-iridium alloy, iridium, gold, magnesium, titanium, titanium-based alloys, zirconium-based alloys, or combinations thereof. Devices made from bioabsorbable or biostable polymers can also be used with the embodiments of the present invention. “MP35N” and “MP20N” are trade names for alloys of cobalt, nickel, chromium and molybdenum available from Standard Press Steel Co. of Jenkintown, Pa. “MP35N” consists of 35% cobalt, 35% nickel, 20% chromium, and 10% molybdenum. “MP20N” consists of 50% cobalt, 20% nickel, 20% chromium, and 10% molybdenum.
While particular embodiments of the present invention have been shown and described, it will be obvious to those skilled in the art that changes and modifications can be made without departing from this invention in its broader aspects. Therefore, the appended claims are to encompass within their scope all such changes and modifications as fall within the true spirit and scope of this invention.

## Claims

1. A method of coating an implantable medical device, comprising applying an emulsion of a polymer and a polycationic peptide on the device to form a coating for the device.

2. The method of claim 1, wherein the device is a stent.

3. The method of claim 1, wherein the polycationic peptide includes poly(L-arginine), poly(D-arginine), poly(D,L-arginine), a mixture of poly(L-arginine) and poly(D-arginine), poly(L-lysine), poly(D-lysine), poly(δ-guanidino-α-aminobutyric acid), or mixtures thereof.

4. The method of claim 1, wherein the polymer comprises an acrylic polymer, a vinyl polymer, a polyurethane, or a combination thereof.

5. The method of claim 4, wherein the acrylic polymer is selected from a group consisting of poly(butyl methacrylate) and poly(methyl methacrylate).

6. The method of claim 4, wherein the vinyl polymer is selected from a group consisting of poly(ethylene-co-vinyl alcohol) and poly(vinyl acetate).

7. The method of claim 1, wherein the emulsion further comprises a first surfactant.

8. The method of claim 7, wherein the first surfactant has a hydrophilic-lipophilic balance between about 3 and about 6.

9. The method of claim 8, wherein the emulsion additionally comprises a second surfactant having has a hydrophilic-lipophilic balance exceeding the value of 10.

10. The method of claim 1, wherein the emulsion is a water-in-oil emulsion.

11. A coating for an implantable medical device, the coating fabricated by the method of claim 1.

12. A method for incorporating a polycationic peptide into a coating for an implantable medical device, the method comprising:
(a) fabricating microspheres containing the polycationic peptide;
(b) dispersing the microspheres in a polymer solution; and
(c) applying the solution onto the device.

13. The method of claim 12, wherein the medical device is a stent.

14. The method of claim 12, wherein the polycationic peptide includes poly(L-arginine), poly(D-arginine), poly(D,L-arginine), a mixture of poly(L-arginine) and poly(D-arginine), poly(L-lysine), poly(D-lysine), poly(δ-guanidino-α-aminobutyric acid), or mixtures thereof.

15. The method of claim 12, wherein the fabrication of the microspheres includes emulsification of an aqueous solution of the polycationic peptide in an organic solvent medium.

16. The method of claim 15, wherein the organic solvent is selected from a group consisting of cyclooctane, cyclohexane, cycloheptane, para-xylene, dimethylformamide, dimethylsulfoxide, chloroform, methylene oxide, dimethylacetamide, and mixtures thereof.

17. The method of claim 12, wherein a polymer in the polymer solution is selected from the group consisting of poly(ethylene-co-vinyl alcohol), poly(vinyl acetate), poly(butyl methacrylate), poly(methyl methacrylate), poly(urethane), poly(L-lactide), poly(D,L-lactide), poly(glycolide), poly(caprolactone), polyanhydrides, polydiaxanone, polyorthoesters, polyamino acids, poly(trimethylene carbonate), and combinations thereof.

18. A coating for an implantable medical device, the coating fabricated by the method of claim 12.

19. A method for incorporating a polycationic peptide into a coating for an implantable medical device, the method comprising:
(a) fabricating liposomes containing the polycationic peptide;
(b) dispersing the liposomes in a polymer solution; and
(c) applying the solution onto the device.

20. The method of claim 19, wherein the medical device is a stent.

21. The method of claim 19, wherein the polycationic peptide includes poly(L-arginine), poly(D-arginine), poly(D,L-arginine) a mixture of poly(L-arginine) and poly(D-arginine), poly(L-lysine), poly(D-lysine), poly(δ-guanidino-α-aminobutyric acid), or a mixture thereof.

22. The method of claim 19, wherein the fabrication of the liposomes includes suspending a lipid in an aqueous medium solution in the presence of the polycationic peptide.

23. The method of claim 22, wherein the lipid is phosphatidylcholine.

24. The method of claim 22, further comprising isolation and purification of the liposomes.

25. The method of claim 24, wherein the isolation and purification is achieved by dialysis or gel-filtration chromatography.

26. The method of claim 19, wherein a polymer in the polymer solution is selected from the group consisting of poly(ethylene-co-vinyl alcohol), poly(vinyl acetate), poly(butyl methacrylate), poly(methyl methacrylate), and poly(urethane).

27. A coating for an implantable medical device, the coating fabricated by the method of claim 19.