# Patent

## Title
Implantable device for production of interleukin-1 receptor antagonist

## Abstract

Treatments and devices for generating and using interleukin-1 receptor antagonist (IL-1ra). An implantable device is loaded with adipose tissue and/or white blood cells and inserted into an inflammation site in a patient to produce interleukin-1 receptor antagonist in vivo. The implantable device has an enclosed or substantially enclosed body that defines an internal space. At least a portion of the body comprises a first bioresorbable material and a second bioresorbable material is within the internal space along with one or more voids. The second bioresorbable material includes an activation surface to activate adipose tissue and/or white blood cells loaded into the device to produce IL-1ra.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a 371 U.S. National Stage of International Application No. PCT/US2010/046994, filed Aug. 27, 2010. This application claims the benefit of U.S. Provisional Application No. 61/237,484, filed Aug. 27, 2009. The disclosures of the above applications are incorporated herein by reference.


INTRODUCTION
The present technology relates to implantable devices that produce interleukin-1 receptor antagonist, and implantable devices and methods of using implantable devices for producing interleukin-1 receptor antagonist in vivo.
Interleukin-1 (IL-1) includes a family of cytokines that can stimulate lymphocytes and macrophages, activate phagocytes, increase prostaglandin production, contribute to degeneration of bone joints, increase bone marrow cell proliferation, and are involved in many chronic inflammatory conditions. IL-1 can be generated by macrophages, monocytes, and dendritic cells, and can be part of the inflammatory response against infection.
The mode of action of IL-1 can be mediated by interleukin-1 receptor antagonist protein (IL-1ra; also known as “IRAP”). IL-1ra binds to the same receptor on the cell surface as IL-1, and thus prevents IL-1 from sending a signal to that cell. IL-1ra is secreted from white blood cells, including monocytes, macrophages, neutrophils, polymorphonuclear cells (PMNs), and other cells, and can modulate a variety of IL-1 related immune and inflammatory responses, as described by Arend W P, Malyak M, Guthridge C J, Gabay C (1998) “Interleukin-1 receptor antagonist: role in biology” Annu. Rev. Immunol. 16: 27-55. Production of IL-1ra is stimulated by several substances including adherent immunoglobulin G (IgG), other cytokines, and bacterial or viral components. IL-1ra is an important natural anti-inflammatory protein in arthritis, colitis, and granulomatous pulmonary disease.
IL-1ra can be used in the treatment of rheumatoid arthritis, an autoimmune disease in which IL-1 plays a key role, reducing inflammation and cartilage degradation associated with the disease. For example, KineretTM (anakinra) is a recombinant, non-glycosylated form of IL-1ra (Amgen Manufacturing, Ltd., Thousand Oaks, Calif.). Various recombinant interleukin-1 inhibitors and methods of treatment are described in U.S. Pat. No. 6,599,873, Sommer et al., issued Jul. 29, 2003; U.S. Pat. No. 5,075,222, Hannum et al., issued Dec. 24, 1991; and U.S. Application Publication No. 2005/0197293, Mellis et al., published Sep. 8, 2005 In addition, methods for producing IL-1ra from body fluids, including the use of autologous fluids, are described in U.S. Pat. No. 6,623,472, Reincke et al., issued Sep. 23, 2003; U.S. Pat. No. 6,713,246, Reinecke et al., issued Mar. 30, 2004; and U.S. Pat. No. 6,759,188, Reinecke et al., issued Jul. 6, 2004.
Compositions and methods using IL-1ra are known in the art. For example, IL-1ra has been delivered as part of a composition with hyaluronic acid, as described in U.S. Pat. No. 6,096,728, Collins et al., issued Aug. 1, 2000. However, many such methods and compositions are associated with issues regarding stability and half-life of IL-1ra as well as the amount and rate of IL-1ra provided. Accordingly, improved methods of producing and delivering IL-1ra are desirable and would be useful in treating conditions and pathologies mediated by the interleukin-1 receptor, including the management of inflammation.
SUMMARY
The present technology provides implantable devices and treatment methods using such devices to produce interleukin-1 receptor antagonist for managing one or more sites of inflammation in a human or animal subject. The implantable device produces interleukin-1 receptor antagonist when loaded with white blood cells or adipocytes. The implantable device includes an enclosed or substantially enclosed body defining an internal space where at least a portion of the body comprises a first bioresorbable material. A second bioresorbable material is within the internal space and the second bioresorbable material includes an activation surface. One or more voids are also within the internal space. The white blood cells are part of whole blood, platelet-rich plasma, or are isolated white blood cells. The adipocytes are part of adipose tissue or are isolated adipocytes. The treatment site, such as a site of inflammation, can be associated with arthritis, e.g., osteoarthritis. The IL-1ra produced by the implantable device can be derived from adipose tissue and/or whole blood obtained from the patient receiving the implantable device, thereby providing autologous IL-1ra.



BRIEF DESCRIPTION OF THE DRAWINGS
The present technology will become more fully understood from the detailed description and the accompanying drawings, wherein:
FIG. 1 is a diagrammatic illustration of a method to produce IL-1ra according to an embodiment of the present technology;
FIG. 2 is a perspective view with a cut-away of a first implantable device according to an embodiment of the present technology; and
FIG. 3 is a perspective view of a second implantable device according to an embodiment of the present technology;
FIG. 4 is an illustration of administration of an implantable device to a knee joint according to an embodiment of the present technology.



It should be noted that the figures set forth herein are intended to exemplify the general characteristics of materials and methods among those of the present technology, for the purpose of the description of certain embodiments. These figures may not precisely reflect the characteristics of any given embodiment, and are not necessarily intended to define or limit specific embodiments within the scope of this technology.
DETAILED DESCRIPTION
The description of the following technology is merely exemplary in nature of the subject matter, manufacture and use of one or more inventions, and is not intended to limit the scope, application, or uses of any specific invention claimed in this application or in such other applications as may be filed claiming priority to this application, or patents issuing therefrom. The following definitions and non-limiting guidelines must be considered in reviewing the description of the technology set forth herein.
The headings (such as “Introduction” and “Summary”) and sub-headings used herein are intended only for general organization of topics within the present disclosure, and are not intended to limit the disclosure of the technology or any aspect thereof. In particular, subject matter disclosed in the “Introduction” may include novel technology and may not constitute a recitation of prior art. Subject matter disclosed in the “Summary” is not an exhaustive or complete disclosure of the entire scope of the technology or any embodiments thereof. Classification or discussion of a material within a section of this specification as having a particular utility is made for convenience, and no inference should be drawn that the material must necessarily or solely function in accordance with its classification herein when it is used in any given composition.
The citation of references herein does not constitute an admission that those references are prior art or have any relevance to the patentability of the technology disclosed herein. All references cited in the “Detailed Description” section of this specification are hereby incorporated by reference in their entirety.
The description and specific examples, while indicating embodiments of the technology, are intended for purposes of illustration only and are not intended to limit the scope of the technology. Moreover, recitation of multiple embodiments having stated features is not intended to exclude other embodiments having additional features, or other embodiments incorporating different combinations of the stated features. Specific examples are provided for illustrative purposes of how to make and use the apparatus and systems of this technology and, unless explicitly stated otherwise, are not intended to be a representation that given embodiments of this technology have, or have not, been made or tested.
As referred to herein, all compositional percentages are by weight of the total composition, unless otherwise specified. As used herein, the word “include,” and its variants, is intended to be non-limiting, such that recitation of items in a list is not to the exclusion of other like items that may also be useful in the materials, compositions, devices, and methods of this technology. Similarly, the terms “can” and “may” and their variants are intended to be non-limiting, such that recitation that an embodiment can or may comprise certain elements or features does not exclude other embodiments of the present technology that do not contain those elements or features.
“A” and “an” as used herein indicate “at least one” of the item is present; a plurality of such items may be present, when possible. “About” when applied to values indicates that the calculation or the measurement allows some slight imprecision in the value (with some approach to exactness in the value; approximately or reasonably close to the value; nearly). If, for some reason, the imprecision provided by “about” is not otherwise understood in the art with this ordinary meaning, then “about” as used herein indicates at least variations that may arise from ordinary methods of measuring or using such parameters. In addition, disclosure of ranges includes disclosure of all distinct values and further divided ranges within the entire range.
The present technology relates to interleukin-1 receptor antagonist (IL-1ra), including methods of generating IL-1ra, compositions comprising IL-1ra produced by such methods, methods of using IL-1ra, treatment methods comprising IL-1ra, and devices for the generation, isolation, and administration of IL-1ra.
Implantable devices for producing interleukin-1 receptor antagonist when loaded with white blood cells or adipocytes can include the following aspects. In some embodiments, the implantable device comprises an enclosed or substantially enclosed body defining an internal space where at least a portion of the body includes a first bioresorbable material. Within the internal space of the body are a second bioresorbable material and one or more voids. The second bioresorbable material includes an activation surface to stimulate production of IL-1ra by cells placed within the device.
Without limiting the mechanism, utility, or function of the present technology, the activation surface of the second bioresorbable material appears to serve as an activator of IL-1ra production by adipocytes and white blood cells. In some respects, contact of the adipocytes and/or white blood cells with the activation surface of the second bioresorbable material appears to stimulate IL-1ra production and secretion by these cells. There also appears to be a correlation between the amount of IL-1ra produced and the concentration of white blood cells, where adipose tissue can include white blood cells. Thus, the present technology uses adipose tissue and disaggregated adipose tissue to obtain adipocytes, where white blood cells can be present in both the adipose tissue and the adipocytes obtained from adipose tissue. White blood cells can also be obtained from bone marrow.
The present implantable devices can further comprise the following aspects. One or more voids within the internal space may include white blood cells and/or adipocytes. For example, the white blood cells may be present in a medium selected from the group consisting of whole blood and/or platelet rich plasma. The adipocytes may be part of isolated adipose tissue; where, for example, the adipose tissue may include other cell types. Following loading and activation of the cells, the implantable device may produce from about 30,000 pg/mL to about 110,000 pg/mL of interleukin-1 receptor antagonist over an activation period of from about 30 seconds to about 24 hours.
Further aspects of the implantable devices include features relating to the enclosed or substantially enclosed body. For example, at least a portion of the body may comprise a self-healing material. Such self-healing materials include polysiloxane-organic hybrid copolymers, for example including components such as oligopeptides of alanine or glycine and polydimethylsiloxane (PDMS), which may further include side-grafted polypeptides or oligopeptides; self-healing polymers based on the bioresorbable materials described herein, such as poly-lactic acid; and hydrogels. The self-healing material allows use of a syringe, for example, to inject a volume of white blood cells and/or adipocytes into the one or more voids within the internal space. The body may also be substantially cylindrically shaped. For example, the enclosed or substantially enclosed body can be tubular with the internal space comprising the lumen. One end of the body may be open to expose the one or more voids within the internal space. In some cases, the one or more voids are operable to wick liquid into the one or more voids within the internal space and at least one of the one or more voids may be a longitudinal channel substantially traversing the length of the body. Such wicking by the void(s) may draw liquid and cells into the void via capillary action where the liquid and cells contact the activation surface of the second bioresorbable material within the internal space of the body.
The second bioresorbable material can include the following aspects. In some cases, the second bioresorbable material comprises a plurality of beads within the internal space of the body. The second bioresorbable material may be porous where the pores provide the activation surface. For example, the pores may be a few nanometers in average diameter and may be up to several hundred nanometers. In some cases, the activation surface of the second bioresorbable material may comprise immunoglobulin G. The second bioresorbable material may also comprise a texture, for example, where the surface has features ranging from the nanometer scale to features ranging from about 10 nanometers to several hundred nanometers in each of length, width, and height. The activation surface of the second bioresorbable material may comprise a surface to volume ratio of about 150,000 m−1 to about 300,000 m−1; e.g., spherical beads from about 20 microns to about 10 microns. The second bioresorbable material may also provide an activation surface comprising a surface area of about 50 m2/g to about 1,000 m2/g for the second bioresorbable material.
The first bioresorbable and second bioresorbable materials are biodegradable and are eroded or broken down by the patient's body following implantation. For example, the backbone of a bioresorbable polymer can be hydrolytically unstable; i.e., the polymer is unstable in a water based environment. As a result, bioresorption may occur in two stages. First, water penetrates the material, attacking the chemical bonds and converting long polymer chains into shorter water-soluble fragments. This can result in a reduction in molecular weight without the loss of physical properties, as the polymer can still be held together by the crystalline regions and/or crosslinking between chains, for example. Water can continue to penetrate the material over time and lead to metabolization of the fragments and bulk erosion. Second, surface erosion of the material occurs when the rate at which the water penetrating the device is slower than the rate of conversion of the polymer into water soluble materials. Degradation rate of the bioresorbable material may be therefore tailored according to the desired persistence of the implantable device, where choice of material and physical parameters, such as thickness, influence the rate of bioresorption.
Bioresorbable materials include synthetic polymers, natural polymers, polysaccharides, and combinations thereof. In some cases, the first and second bioresorbable materials comprise the same material and in other cases the first and second bioresorbable materials comprise different materials. Suitable synthetic polymers include polymers and copolymers of glycolic acid, L-lactic acid, D-lactic acid, urethane urea, trimethylene carbonate, dioxanone, ε-caprolactone, hydroxybutyrate, orthoesters, orthocarbonates, aminocarbonates, anhydrides of at least one of sebacid acid, p-(carboxyphenoxy)propane, and p-(carboxyphenoxy)hexane, trimethylene carbonate, and combinations thereof. Suitable natural polymers include elastin, silk, fibrin, fibrinogen, collagen, gelatin, and combinations thereof. And suitable polysaccharides include hyaluronic acid, chitin, chitosan, alginate, carboxymethylcellulose, and combinations thereof. Other bioresorbable materials include those known in the biomedical arts including, for example, those used for bioresorbable sutures, dental devices, orthopedic fixation devices, tissue engineering scaffolds, and biodegradable vascular stents.
In some embodiments, the second bioresorbable material comprises a dry or dessicated material that is operable to absorb liquid. For example, the second bioresorbable material may be dehydrated gelatin beads that draw liquid from a volume of adipose tissue, adipocytes, whole blood, PRP, and/or white blood cells that are loaded into one or more voids of the implantable device. In this way, bulk solution or liquid, such as water, buffers, or blood, is drawn into the dry second bioresorbable material, thereby increasing the concentration and density of tissue and/or cells which are not absorbed into the dry material. The increased concentration and density can consequently provide for more contact between the tissue and/or cells and the activation surface of the second bioresorbable material.
The bioresorbable materials of the implantable device may also be porous or permeable so that IL-1ra produced therein may diffuse out of the body through the first bioresorbable material, for example. What is more, the permeability may allow other signaling molecules to diffuse out of the body as well as allowing such molecules to diffuse into the device from the surrounding implantation site. In some cases, the body may be sufficiently porous to allow cells to migrate into or out of the implantable device. As the first bioresorbable material degrades, for example, pores may form and/or existing pores may increase in size such that the rate of diffusion and/or cell migration increases over time. Eventually the second bioresorbable material within the internal space of the body begins to degrade and erode. At some point thereafter, the entire implantable device may be resorbed.
Referring now to FIG. 1, a flowchart 100 diagrammatically illustrates use of the present implantable device and production of IL-1ra for treating a site in a patient. Adipose tissue can be obtained from a patient as shown at step 110. This adipose tissue may be directly placed within the implantable device as per step 160, or may be processed to isolate adipocytes as shown in step 120. Whole blood can also be obtained from the patient as shown at step 130. The whole blood can be processed into platelet-rich plasma (PRP), as shown in step 140. For example, whole blood can be centrifuged to isolate PRP comprising white blood cells and platelets, which are located in the buffy coat layer following sedimentation. The whole blood can also be processed to isolate white blood cells, as per step 150.
At least one of the products of steps 110, 120, 130, 140, and 150 is then placed into one or more voids within the internal space of an implantable device, as per step 160. In some embodiments, two, three, four, or all five products are placed into the void(s); i.e., adipose tissue, adipocytes, whole blood, PRP, and/or white blood cells. In some embodiments, only adipose tissue is used and in other embodiments only PRP is used. One or more of these products may also be used in preparation of the other products. For example, whole blood may be used to resuspend cell pellets of isolated adipocytes and white blood cells. The adipose tissue in 110 and the whole blood in 130 may also be obtained from the patient receiving the implantable device in 170. In this way, the implantable device produces autologous IL-1ra.
As shown at step 160 of FIG. 1, once the implantable device is loaded with adipose tissue, adipocytes, whole blood, PRP, and/or white blood cells, the product(s) contact the activation surface of the second bioresorbable material. In some embodiments, contact can be for a time from about 30 seconds to about 72 hours and may be carried out at a temperature from about 20° C. to about 41° C. For example, the incubation may be from about one minute to about 48 hours, from about 5 minutes to about 12 hours, or from about 10 minutes to about 6 hours. In some embodiments, the implantable device may be incubated at about 37° C. during these time intervals. In other embodiments, the incubation may occur at ambient conditions, e.g., at a temperature of about 20-25° C. In some embodiments, the loaded implantable device is not incubated, but is instead inserted at the site of inflammation in the patient immediately after loading or within only a few minutes after loading.
Without limiting the mechanism, utility or function of the present technology, the activation surface of the second bioresorbable material serves as an activator of IL-1ra production by the adipose tissue, adipocytes, whole blood, PRP, and/or white blood cells. As described, the second bioresorbable material may also be a dry or dessicated material that absorbs liquid in addition to providing an activation surface to stimulate production of IL-1ra. In such cases, the second bioresorbable material not only activates production of IL-1ra, but also absorbs liquid from the volume of adipose tissue, adipocytes, whole blood, PRP, and/or white blood cells, thereby concentrating the tissue and/or cells relative to the activation surface.
Whole blood, platelet-rich plasma, and white blood cells may be obtained or isolated using methods known in the biomedical arts. For example, various devices may be used to generate platelet-rich plasma that includes a platelet concentration up to about 8-fold higher than whole blood and a white blood cell concentration up to about 5-fold higher than whole blood. The platelet rich plasma may comprise from about 80% to about 90% of the white blood cells present in the whole blood. Commercially available devices include the GPS® II Platelet Concentrate System, from Biomet Biologics, LLC (Warsaw, Ind., USA) and GPS® III Platelet Separation System, from Biomet Biologics, LLC (Warsaw, Ind., USA). Additional devices that may be used to isolate platelet-rich plasma at step 120 are also described, for example, in U.S. Pat. No. 6,398,972, Blasetti et al., issued Jun. 4, 2002; U.S. Pat. No. 6,649,072, Brandt et al., issued Nov. 18, 2003; U.S. Pat. No. 6,790,371, Dolocek, issued Sep. 14, 2004; U.S. Pat. No. 7,011,852, Sukavaneshvar et al., issued Mar. 14, 2006; U.S. Application Publication No. 2004/0251217, Leach et al., published Dec. 16, 2004 (incorporated by reference herein); U.S. Application Publication No. 2005/0109716, Leach et al., published May 26, 2005 (incorporated by reference herein); U.S. Application Publication No. 2005/0196874, Dorian et al., published Sep. 8, 2005 (incorporated by reference herein); and U.S. Application Publication No. 2006/0175242, Dorian et al., published Aug. 10, 2006 (incorporated by reference herein).
Other methods may be used to isolate platelet-rich plasma. For example, whole blood can be centrifuged without using a buoy system, whole blood may be centrifuged in multiple stages, continuous-flow centrifugation can be used, and filtration can also be used. In addition, a blood component including platelet-rich plasma can be produced by separating plasma from red blood cells using a slow speed centrifugation step to prevent pelleting of the platelets. In other embodiments, the buffy coat fraction formed from centrifuged blood can be separated from remaining plasma and resuspended to form platelet-rich plasma.
In addition to the GPS® Platelet Concentrate and Separation Systems, a variety of other commercially available devices may be used to isolate platelet-rich plasma at step 120, including the MagellanTM Autologous Platelet Separator System, commercially available from Medtronic, Inc. (Minneapolis, Minn., USA); SmartPRePTM, commercially available from Harvest Technologies Corporation (Plymouth, Mass., USA); DePuy (Warsaw, Ind., USA); the AutoloGelTM Process, commercially available from Cytomedix, Inc. (Rockville, Md., USA); the GenesisCS System, commercially available from EmCyte Corporation (Fort Myers, Fla., USA); and the PCCS System, commercially available from Biomet 3i, Inc. (Palm Beach Gardens, Fla., USA).
Blood drawn from the patient may be mixed with an anticoagulant. Suitable anticoagulants include heparin, citrate phosphate dextrose (CPD), ethylenediaminetetraacetic acid (EDTA), anticoagulant citrate dextrose solution (ACD), and mixtures thereof. The anticoagulant may be placed in the syringe used for drawing blood from the subject, or may be mixed with the blood after it is drawn.
White blood cells may also be prepared using other methods known in the art. For example, white blood cells may be prepared from whole blood by lysing red blood cells or by centrifugation of whole blood utilizing a density gradient where the white blood cells sediment to the bottom of a centrifuge tube. An example of density centrifugation includes the Ficoll-PaqueTM Plus (GE Healthcare Bio-Sciences, Piscataway, N.J., USA). In some cases, a density gradient may be used to further separate mononuclear and polymorphonuclear cells. White blood cells may also be prepared from whole blood using filtration; an example includes the AcelereTM MNC Harvest System (Pall Life Sciences, Ann Arbor, Mich., USA). White blood cells can also be obtained from bone marrow.
Adipose tissue refers to any fat tissue, either white or brown adipose tissue, which may be derived from subcutaneous, omental/visceral, mammary, gonadal, or other adipose tissue sites. In some embodiments, adipose tissue is derived from human subcutaneous fat isolated by suction assisted lipectomy or liposuction. Adipocytes may be isolated and/or freed from the adipose tissue and/or tissue portions using any suitable method, including methods known in the art such as mechanical and breakdown centrifugation. Adipocytes can also be isolated using enzymatic digestion. For example, adipocytes can be isolated from lipoaspirate, treated by sonication and/or enzymatic digestion, and enriched by centrifugation. Adipocytes isolated from adipose tissue may be washed and pelleted.
Methods for isolating adipose tissue and adipocytes can include the following aspects. Adipose tissue can be collected by suction-assisted tumescent liposuction inside a specialized collection container attached to suction hoses and to a liposuction cannula. The collection container can have a gauze-type grid filter that allows the tumescent fluid to pass through and retains the solid adipose tissue. After collecting the adipose tissue, the collection container is removed from the suction device and reattached to a centrifugation device. The filter unit may further contain a filter having approximately a 100 micrometer pore size. Once the collection container containing the adipose tissue is attached to the centrifugation device, the tissue is sonicated. After sonication, the entire apparatus is inserted into a centrifuge bucket and centrifuged at about 300×g for about 5 minutes. After centrifugation, the collection container together with the filter unit is detached and can be discarded. The pellet containing the adipocytes can be resuspended using one or more biocompatible solutions, such as autologous plasma, plasma concentrate, and platelet rich plasma.
Adipose tissue may also be treated with digestive enzymes and with chelating agents that weaken the connections between neighboring cells, making it possible to disperse the tissue into a suspension of individual cells, including adipocytes, without appreciable cell breakage. Following disaggregation, the adipocytes may be isolated from the suspension of cells and disaggregated tissue. For example, isolation of adipocytes may be performed by obtaining subcutaneous adipose tissue from lipoaspiration/liposuction procedures and digesting the tissue in collagenase type I solution (Worthington Biochemical Corp., Lakewood, N.J.) under gentle agitation for about 1 hour at 37° C. The dissociated cells may be filtered with 500 μm and 250 μm Nitex filters. The fraction is centrifuged at about 300×g for about 5 minutes. The supernatant is discarded and the cell pellet is resuspended in a compatible liquid solution, such as a blood-derived solution.
In some embodiments, adipocytes are prepared as follows. Adipose tissue is minced into small pieces (about 1 cm3) and digested in 2 mg/mL type I collagenase (Worthington Biochemical Corp., Lakewood, N.J.) under intermittent mechanical agitation in a water bath at 37° C. for about 180 minutes. Digestion can be neutralized by the addition of medium or a blood-derived solution. The dissociated cells may be filtered with 500 μm and/or 250 μm Nitex filters. The cell suspension is centrifuged (300×g for 7 minutes at 25° C.) followed by removal of the supernatant from the cell pellet. The pellet is then resuspended in a compatible solution to provide a liquid volume comprising adipocytes.
Various methods and devices for isolating and/or fractionating adipose tissue include those as described by U.S. Pat. Nos. 7,374,678 and 7,179,391 to Leach et al. and U.S. Pub. Nos. 2009/0014391, 2008/0283474, and 2007/0208321 to Leach et al. A device, such as the GPSTM Platelet Concentrate System (Biomet, Warsaw, Ind.), may be used to isolate adipocytes. These methods may include obtaining adipocytes by performing lipoaspiration on the patient to obtain adipose tissue, enzymatically digesting the adipose tissue, and separating and/or washing the adipocytes using these devices.
Referring again to FIG. 1, once the implantable device is loaded in step 160, the activation surface of the second bioresorbable material activates the generation of IL-1ra by the adipose tissue, adipocytes, whole blood, PRP, and/or white blood cells. The implantable device is then inserted at a site of inflammation in a patient, as shown at step 170, such as a site of osteoarthritis.
The implantable device may be inserted in step 170 to provide IL-1ra at or near a site of inflammation in a human or animal subject (i.e., a patient). The patient receiving the IL-1ra-rich solution may be the same patient from whom the adipose tissue and/or whole blood are derived in steps 110 and 130. In this case, the method provides an autologous preparation of IL-1ra. Administration of the implantable device may be performed using various means, such as by injection of the implantable device using a syringe, cannulated device, surgical application, or application concomitant with another surgical procedure. It should be understood, however, that step 170 may comprise any biomedically acceptable process or procedure by which the implantable device is inserted, implanted, injected, or otherwise administered in or in proximity to a site in order to mediate effects related to stimulation of the interleukin-1 receptor, such as inflammation and inflammation due to osteoarthritis. For example, for treating inflammation caused by arthritis, an implantable device for producing autologous IL-1ra may be administered to the patient via a cannulated device. Implantation may be at or into the synovial space of an inflamed joint, or otherwise at or near the joint.
The present implantable devices may be sterilized by prior to loading with adipose tissue, adipocytes, whole blood, PRP, and/or white blood cells. For example, chemical sterilization or irradiation may be used to sterilize the implantable device and the device may be loaded using biomedically accepted sterile technique. In addition, an antibiotic may be included in the implantable device or added to one or more of the adipose tissue, whole blood, and products thereof loaded into the device; e.g., adipose tissue, adipocytes, whole blood, PRP, and/or white blood cells.
The present technology provides an implantable device capable of producing IL-1ra in vivo following implantation, including autologous IL-1ra, which reduces and/or substantially eliminates immunological issues that may arise when using non-autologous material or recombinant material. In addition, since the IL-1ra is produced by the patient's cells, natural post-translational modifications, such as glycosylation, are already present. This is not the case with most recombinant proteins since they are produced in prokaryotic hosts.
The implantable device can produce IL-1ra within minutes of loading with adipose tissue, adipocytes, whole blood, PRP, and/or white blood cells and can continue to produce to IL-1ra for up to 24 hours or more. For example, the implantable device can produce about 34,000 pg/mL to about 108,000 pg/mL of IL-1ra. It is understood, however, the concentrations present in any given solution may vary depending on the initial levels of components present in the adipose tissue, adipocytes, and/or source of white blood cells used in the present methods, and that increases in concentration are relative to those initial levels. In general, IL-1ra is produced at concentrations of at least about 10,000 pg/mL, at least about 25,000 pg/mL, or at least about 30,000 pg/mL, and can be up to 108,000 pg/mL or more. As the first bioresorbable material of the body of the implantable device begins to erode following implantation, the IL-1ra produced therein will contact the area at the implantation site at or near the site of inflammation. The first bioresorbable material may be porous and/or permeable to allow IL-1ra to begin diffusing out from the device even before the bioresorbable materials begin to degrade.
The implantable device for producing IL-1ra may be used to mediate effects of IL-1 and attenuate signaling via the interleukin-1 receptor. The IL-1ra produced from the implantable device may be used to block the biologic activity of naturally occurring IL-1, including inflammation and cartilage degradation associated with arthritis, by competitively inhibiting the binding of IL-1 to the interleukin-1 type receptor, which is expressed in many tissues and organs. For example, bone resorption and tissue damage such as cartilage degradation as a result of loss of proteoglycans due to IL-1 may be treated by administration of the IL-1ra-rich solution. In patients with arthritis, endogenous IL-1ra may not be present in effective concentrations in synovium and synovial fluid to counteract IL-1 concentrations in these patients, and hence the implantable device for producing IL-1ra may be inserted to treat these conditions and these sites. Size of the device, administration and implantation methods, and frequency of treatment may be modified based on established medical practices to achieve effective treatment. The present technology also includes methods of treating one or more sites of inflammation in a patient by using one or more implantable devices at an inflammation site or using one or more devices at multiple inflammation sites.
As one example, the implantable device for producing IL-1ra is inserted into a patient's knee joint using a cannulated device. The device produces IL-1ra in vivo that diffuses outward from the device to contact the immediate space around one or more of the patient's femur, tibia, fibula, patella, and cartilage. It should be understood, however, that the implantation site may be in any joint of a human or animal patient, including shoulders, elbows, wrists, ankles, hips, and the spinal column. In addition, the present methods and devices may be used to treat inflammation in sites within other tissues, such as muscle and tendon.
The present technology can include aspects of U.S. Provisional Application No. 61/031,803 filed Feb. 27, 2008, U.S. Provisional Application No. 61/116,940 filed Nov. 21, 2008, and U.S. Provisional Application No. 61/155,048 filed Feb. 24, 2009 and includes aspects of PCT/US2009/035541 filed Feb. 27, 2009.
The following specific examples are provided for illustrative purposes of how to make and use the compositions and methods of this technology and, unless explicitly stated otherwise, are not intended to be a representation that given embodiments of this technology have, or have not, been made or tested
Example 1
With reference to FIG. 2, an embodiment of an implantable device 200 is shown for producing interleukin-1 receptor antagonist in vivo when loaded with white blood cells or adipose tissue. The implantable device 200 includes an enclosed tubular body including a lumen where the tubular body comprises a first bioresorbable material 210. A second bioresorbable material 220 is within the lumen of the tubular body, as shown in the cut-out portion. The second bioresorbable material 220 comprises a plurality of gelatin beads from about 10 microns to about 20 microns in diameter. One end of the tubular body comprises a self-healing surface 230 that can be pierced with one or more needles for loading adipose tissue, adipocytes, whole blood, PRP, and/or white blood cells into the lumen of the device 200. The self-healing surface 230 is operable to substantially seal the puncture hole once loading is complete and the needle(s) is withdrawn. In this way, the beads of the second bioresorbable material 220 and the loaded adipose tissue, adipocytes, whole blood, PRP, and/or white blood cells do not leak out of the device 200.
Example 2
With reference to FIG. 3, an embodiment of an implantable device 300 is shown for producing interleukin-1 receptor antagonist in vivo when loaded with white blood cells or adipose tissue. The implantable device 300 has a tubular body comprising a first bioresorbable material 310. The tubular body includes a lumen and at least one open end exposing a porous second bioresorbable material 320 within the lumen. The porous second bioresorbable material is capable of activating adipose tissue, adipocytes, whole blood, platelet rich plasma, and/or white blood cells to produce IL-1ra. The lumen includes one or more voids intermixed with the porous second bioresorbable material 320 where the void(s) are operable to wick liquid into the lumen.
The open end of the implantable device 300 is contacted with a solution including adipose tissue, adipocytes, whole blood, platelet rich plasma, and/or white blood cells so that the solution is wicked into the void(s) within the lumen to load the device.
Example 3
With reference to FIG. 4, an embodiment of a treatment 400 using the present technology includes delivering an embodiment of the present implantable device 410 using a cannulated device 420. A movable element (not shown) is disposed within a portion of the cannulated device 420 and the implantable device 410 is originally disposed within a portion of the cannula device 420. The movable element is operable to expel the implantable device 410 from the cannulated device 420 into position at or near a site of inflammation, as shown. The implantable device 410 is loaded with white blood cells or adipocytes and produces interleukin-1 receptor antagonist in vivo at the implantation site. As shown in FIG. 4, the implantation site is proximate to the end of the patient's femur near the knee joint.
The examples and other embodiments described herein are exemplary and not intended to be limiting in describing the full scope of compositions and methods of this technology. Equivalent changes, modifications and variations of specific embodiments, materials, compositions and methods may be made within the scope of the present technology, with substantially similar results.

## Claims

1. A method for treating a site of inflammation in a patient, the method comprising:
providing an implantable device having an outer body comprising a first bioresorbable material and defining an internal space, the internal space having a second bioresorbable material, comprising gelatin, carboxymethylcellulose, or a combination thereof, and one or more voids disposed therein;
injecting a liquid volume comprising adipose tissue, adipocytes, whole blood, platelet-rich plasma, white blood cells, or a combination thereof, into the one or more voids of the implantable device;
implanting the implantable device at or proximate to the site of inflammation in the patient; and
activating a plurality of cells in the liquid volume to generate interleukin-1 receptor antagonist (IL-1ra), including causing the liquid volume to contact the gelatin, carboxymethylcellulose, or a combination thereof, to activate the plurality of cells to generate IL-1ra.

2. A method for treating a site of inflammation in a patient, comprising:
loading one or more voids of an implantable device with a liquid volume comprising adipose tissue, adipocytes, whole blood, platelet-rich plasma, white blood cells, or a combination thereof;
inserting a cannulated device into the site of inflammation in the patient, including positioning the implantable device within a cannula of the cannulated device;
moving a movable element of the cannulated device to expel the implantable device from the cannula, thereby implanting the implantable device at or proximate to the site of inflammation in the patient; and
activating a plurality of cells within the liquid volume to generate interleukin-1 receptor antagonist (IL-1ra), wherein the implantable device comprises:
an enclosed or substantially enclosed body defining an internal space, wherein at least a portion of the body comprises a first bioresorbable material;

a second bioresorbable material within the internal space, the second bioresorbable material comprising gelatin, carboxymethylcellulose, or a combination thereof defining an activation surface to activate the plurality of cells to generate IL-1ra when the plurality of cells contact the activation surface; and
one or more voids within the internal space.

3. A method for treating a site of inflammation in a patient, comprising:
injecting into one or more voids of a lumen of an implantable device a liquid volume comprising adipose tissue, adipocytes, whole blood, platelet-rich plasma, white blood cells, or a combination thereof;
activating a plurality of cells within the liquid volume to generate interleukin-1 receptor antagonist, including causing the plurality of cells to contact an activation surface of the implantable device; and
implanting the implantable device at or proximate to the site of inflammation in the patient; wherein the implantable device comprises:
an enclosed tubular body including a lumen, the tubular body comprising a first bioresorbable material, wherein at least one end of the tubular body comprises a self-healing surface;

a porous second bioresorbable material within the lumen and exposed by piercing the self-healing surface, the second bioresorbable material comprising gelatin, carboxymethylcellulose, or a combination thereof to activate the plurality of cells to generate IL-1ra.

4. The method according to claim 1, wherein the white blood cells are present in whole blood, platelet-rich plasma, or a combination thereof.

5. The method according to claim 1, wherein the adipocytes are present in adipose tissue.

6. The method according to claim 1, wherein at least a portion of the body further comprises a self-healing material.

7. The method according to claim 1, wherein the activating occurs within 30 second of contact of the liquid volume with the second bioresorbable material.

8. The method according to claim 1, wherein the body comprises at least one end that is open to expose the one or more voids within the internal space.

9. The method according to claim 1, wherein the second bioresorbable material comprises a plurality of beads.

10. The method according to claim 1, wherein the second bioresorbable material is porous, wherein the pores provide the activation surface.

11. The method according to claim 1, wherein the second bioresorbable material further comprises immunoglobulin G.

12. The method according to claim 1, wherein the first and second bioresorbable materials independently comprise a synthetic polymer, a natural polymer, a polysaccharide, or a combination thereof.

13. The method according to claim 10, wherein the pores are from about 1 nanometer to about 10 nanometers in average diameter.

14. The method according to claim 1, wherein the activation surface of the second bioresorbable material comprises a surface to volume ratio of about 150,000 m−1 to about 300,000 m−1.

15. The method according to claim 1, wherein at least one of the one or more voids is a longitudinal channel traversing the entire length of the body.

16. The method according to claim 1, wherein injecting the liquid volume includes wicking the liquid volume into the one or more voids.

17. The method according to claim 1, wherein activating further includes allowing the second bioresorbable material to absorb a portion of the liquid volume.

18. The method according to claim 1, wherein the second bioresorbable material comprises a dry or a desiccated bioresorbable material configured to absorb at least a portion of the liquid volume.

19. The method according to claim 1, wherein activating further includes allowing the second bioresorbable material to absorb at least a portion of the liquid volume to cause the plurality of cells to become concentrated within the one or more voids so as to contact the activation surface.

20. A method for treating a site of inflammation in a subject, comprising:
providing or receiving an implantable device comprising a shell at least partially formed of a first bioresorbable material and defining a lumen, a second bioresorbable material comprising gelatin, carboxymethylcellulose, or a combination thereof, disposed within the lumen to activate adipocytes, white blood cells, or both to generate interluken-1 receptor antagonist (IL-1ra);
injecting a liquid volume into at least one void within the lumen, the liquid volume comprising a plurality of cells including adipocytes, white blood cells, or a combination thereof;
activating the plurality of cells to generate IL-1ra, including causing the plurality of cells to contact the gelatin, carboxymethylcellulose, or a combination thereof; and
implanting the implantable device at or proximate to the site of inflammation in the subject.

21. The method of claim 20, wherein the step of implanting the implantable device in the subject occurs within 10 minutes or less after injecting the liquid volume.

22. The method of claim 20, wherein the step of activating occurs at temperature between 20° C. and 25° C.

23. The method of claim 20, wherein the at least one void comprises a plurality of voids, and wherein injecting includes allowing the liquid volume to wick through the plurality of voids.

24. The method of claim 20, wherein the second bioresorbable material comprises a plurality of pores, and wherein activating occurs within the plurality of pores.

25. The method of claim 20, wherein activating the plurality of cells further includes allowing the second bioresorbable material to absorb a portion of the liquid volume such that the density or the concentration of the plurality of cells is increased in the at least one void.

26. The method of claim 20, wherein allowing the liquid volume to wick from the at least one void into other ones of the plurality of voids includes causing a density or a concentration of the plurality of cells to increase in the plurality of voids.

27. The method of claim 20, wherein allowing the liquid volume to wick from the at least one void into other ones of the plurality of voids includes causing the liquid to be drawn toward or into the second bioresorbable material.

28. A method for treating a site of inflammation in a subject, the method comprising:
providing or receiving an implantable device comprising shell defining a lumen, the shell at least partially formed of a self-healing first bioresorbable material, a second bioresorbable material disposed within the lumen, the second bioresorbable material including gelatin, carboxymethylcellulose, or a combination thereof, to activate adipocytes, white blood cells, or a combination thereof to generate interluken-1 receptor antagonist;
injecting a liquid volume into at least one void formed by the lumen, the second bioresorbable material, or both, the liquid volume comprising a plurality of adipocytes, white blood cells, or a combination thereof, including piercing the self-healing first bioresorbable material;
activating the plurality of adipocytes, white blood cells, or the combination thereof to generate IL-1ra, including allowing the second bioresorbable material to absorb at least a portion of the liquid volume; and
implanting the implantable device at or proximate to the site of inflammation in the subject.

29. The method of claim 28, further comprising healing the self-healing first bioresorbable material after piercing the self-healing first bioresorbable material.

30. The method of claim 29, wherein the self-healing first bioresorbable material comprises a polysiloxane-organic hybrid copolymer.

31. The method of claim 30, wherein the polysilioxane organic hybrid copolymer includes a polypeptide or an oligopeptide of alanine or glycine.

32. The method of claim 29, wherein the self-healing first bioresorbable material comprises a hydrogel.

33. The method of claim 28, wherein the at least one void includes a longitudinal channel traversing the entire length of the shell, the longitudinal channel in fluid communication with the second bioresorbable material.

34. The method of claim 28, wherein the activating occurs at a temperature between 20° C. and 25° C.

35. The method of claim 28, wherein the activating occurs within 10 minutes or less after injecting the liquid volume.

36. The method of claim 28, wherein activating further includes causing the density or the concentration of the plurality of cells to be increased in the lumen.

37. The method of claim 36, wherein the density or the concentration of the plurality of cells is increased by allowing the second bioresorbable material to absorb a liquid portion of the liquid volume.