Abstract:
The present invention creates an immunologically protected/enhanced space in viva in a mammal by removing the impact of soluble inhibitors of the mammal&#39;s immune system in a defined space within the body. Placing an antigen source within the defined protected space along with a monocyte-containing blood sample from the mammal being treated and a dendritic cell-inducing factor allows a dendritic-antigen presentation process to proceed to completion. The protected/enhanced space is created by surrounding the protected space with ligands which absorb and/or bind to one or more soluble inhibitors. The implant can be loaded with a patient&#39;s cancer cells to treat cancer.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application claims priority under 35 U.S.C. §119(e) to U.S. Provisional Applications No. 61/156,498, filed on Feb. 28, 2009, and 61/253,077 filed on Oct. 20, 2009, the disclosures of which are incorporated herein by reference in their entireties. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates to medical devices, systems and methods to create an immunologically enhanced or protected space in vivo in a mammal to allow the mammal&#39;s immune system to function properly in the identification and handling of antigens. In particular, the immunologically protected/enhanced space allows the process of antigen presentation by induced dendritic cells to proceed to completion for the purposes of combating infection, inducing anti-tumor vaccination or dampening autoimmunity, in-vivo, by removing the impact of soluble inhibitors of the immune system. 
       BACKGROUND OF THE INVENTION 
       [0003]    Every year, across the world, 12 million individuals get cancer of which about 7.5 million will die. Under current trends, by year 2010 cancer will become one of the leading single causes of death worldwide. 
         [0004]    Current cancer therapies using chemotherapeutic agents and radiation beyond stage 3 cancer are an abject failure. Beyond stage 3 cancer, these strategies often buy the patient only some extra time; but this comes at the heavy cost of extreme suffering and reduction in quality of life for the majority of patients. 
         [0005]    In private, many cancer experts suggest that the most promising approach for the future in treating cancers is through the control of the immune system. Clinically verified cases of spontaneous remission exist, suggesting that the failure of the immune system to generate a proper response is central to the problem of cancer. The body fails to generate a functional vaccine against the cancer allowing the cancer to grow uncontrollably. 
         [0006]    Elevated concentrations of various cytokines, cytokine receptors, and gangliosides (glycosphingolipids), are known to be immunosuppressive and are, as a group, known as soluble inhibitors of the immune system and of immune system function (hereinafter referred to as “soluble inhibitors”). The following non-exhaustive list are known members of the class of soluble inhibitors of the immune system: gangliosides; all known growth factors, most notably TNF-alpha, TGF-beta and variants, PDGF, EGF, IGF and variants, FGF and variants and VEGF; all known inflammatory cytokine receptors most notably the TNF-alpha family—TNF-R1, TNF-R2, CD40L, NGFR, TRAIL and variants, FASL, IL-1R1, IL1R2, IL-2R, IL-3R, IL-5R, IL-6R, IL-7R, GM-CSFR, IL-9R, IL-12R, and erythropoietin receptor. Many patients and most cancer patients have elevated levels of one or more soluble inhibitors which compromise their immune system and inhibit the body from controlling pathogens including bacteria, viruses and cancers. 
         [0007]    U.S. Pat. No. 6,156,305 (&#39;305 patent) which is incorporated herein by reference discloses a method of preventing and treating cancer by implanting cancer cells into mammals with a single chamber implant device. The tumor cells can be the patient&#39;s own tumor cells or processed tumor cells that contain antigens present in the patient&#39;s tumor cells. The boundary of the implant prevents cell to cell contact between the patient&#39;s immune system and the tumor cells but allows sub-cellular materials to pass through the chamber. The &#39;305 patent claims a 60% remission rate in tumor bearing experimental animals. 
       SUMMARY OF THE INVENTION 
       [0008]    Briefly, in accordance with the present invention, a mammal is treated with an implant device to elicit an immune response to an antigen wherein the antigen is presented to the mammal&#39;s immune system in a protected space in vivo. The mammal is provided with an implant device that contains a protective space for antigen presentation to immune cells, such as dendritic cells, wherein the protective space is surrounded by a soluble inhibitor adsorbent. One or more antigens, or cells containing one or more antigens, are placed into the innermost portion of the protective space of the implant device. A monocyte-containing blood sample obtained from the mammal and one or more dendritic cell inducing factors are also placed into the protective space of the implant device to induce formation of activated dendritic cells from the monocytes. The loaded implant device is implanted into the mammal allowing an immune response to proceed within the protective space which is substantially free of soluble inhibitors. After activated dendritic cells are formed, they are allowed to release from the implant and circulate throughout the mammal&#39;s vascular system. The soluble inhibitor adsorbent binds soluble inhibitors and allows antigen presentation to the induced dendritic cells to proceed to completion. The antigen can be any antigen such as bacterial antigens, viral antigens and antigens associated with cancer cells. 
         [0009]    In a broad aspect, the present invention creates an immunologically protected/enhanced space in vivo in a mammal by removing the impact of soluble inhibitors of the mammal&#39;s immune system in a defined space within the body. Placing an antigen source within the defined protected space along with a monocyte-containing blood sample from the mammal being treated and a dendritic cell inducing factor allows a dendritic-antigen presentation process to proceed to completion. The protected/enhanced space is created by surrounding the protected space with ligands that absorb and/or bind to one or more soluble inhibitors. 
         [0010]    In one embodiment, the medical implant device of the present invention contains (a) a biocompatible outer case; (h) an immunologically protected/enhanced inner space that contains (i) one or more antigens, (ii) one or more dendritic cell inducing factors, (iii) a monocyte containing blood sample, such as a buffy coat sample, from a mammal who is the intended recipient of the medical implant device, and (iv) an adsorbent that binds soluble immune inhibitors to a mammalian immune system; and (c) a plug that allows the activated dendritic cells formed in the immunologically protected/enhanced inner space to be released into the mammal&#39;s vascular system after the dendritic cell-antigen presentation process proceeded sufficiently to form activated dendritic cells within the immunologically protected inner space. 
         [0011]    The configuration of the soluble inhibitor adsorbent defines the immunologically protected inner space. The size of the implant is not critical to the practice of the present invention and the implant can be from several centimeters in length that can be implanted using a minor surgical incision to a miniaturized pellet that can be inserted with, for example, a 12 or 16 gauge needle and syringe. 
         [0012]    Alternatively, the medical implant device for mammals contains a biocompatible outer case that allows flow of blood/plasma into the implant device when implanted into a mammal and an immunologically protected inner space that contains (i) one or more antigens, (ii) a leukocyte attractant, and (iii) an adsorbent of soluble immune inhibitors to a mammalian immune system whereby a dendritic cell antigen presentation process is able to proceed sufficiently to form mature activated dendritic cells. 
         [0013]    In another aspect, the present invention relates to a medical implant device used to treat cancer in a mammal wherein the implant contains (a) a porous outer biocompatible case, (b) a peripheral region within the biocompatible case that contains ligands that bind to soluble inhibitors of a mammalian immune system and (c) an inner region that contains cancer cell antigens, one or more dendritic cell inducing factors and a leukocyte (buffy coat sample) sample from the mammal to the treated for cancer. The inner region is defined by the configuration of the soluble inhibitor ligands in the peripheral region and provides a protected space in vivo that allows antigen presentation to dendritic cells formed in the inner region from the monocytes contained in the buffy coat sample. A biodegradable plug allows the activated dendritic cells of the inner region to be released into the mammal&#39;s vascular system. The biodegradable plug can be designed to degrade over any amount of time such as between about 3 and about 20 days and preferably between about 5 and 7 days. The peripheral region and the inner region are separated by a membrane that is porous to sub-cellular components such as antigenic proteins, inactivated viruses, cytokines, cytokine receptors and the like. 
         [0014]    In a further aspect of the present invention, a subcutaneous implant is provided to facilitate the induction of a natural cancer vaccine. It does so by taking an approach never tried before. The device creates an idealized immunologic space in which the natural process of creating a vaccine is protected from the cancer compromised/impacted immune system of the patient. The patient&#39;s own blood cells or a fraction thereof are harvested and placed within the implant of the present invention. Another chamber within the device is loaded with cancer cells, preferably harvested from the patient&#39;s cancer/tumor, and other substances that will show the cancer to the immune system. A trivial surgical procedure places the implant subcutaneously, to use the patient&#39;s own body as an incubator. Alternatively, the implants can be miniaturized into pellet form and injected with a needle and syringe. Within the implant, the vaccine process runs its course. At a pre-determined time, the implant yields a precious cargo of immune cells to the body, and a vaccine against the cancer, is released from the implant. The released immune cells travel to the nearest lymph nodes, where the vaccine will be amplified and propagated throughout the body as antigen presenting cells to T-cells and B-cells. 
         [0015]    Of particular interest in practicing the present invention, human patients are treated with the present medical implant device to treat cancer. The patient is provided with an implant device that contains a protective space for antigen presentation to the patient&#39;s immune cells, such as dendritic cells, wherein the protective space is surrounded by a soluble inhibitor adsorbent. The protective space is formed by providing ligands which bind or adsorb soluble inhibitors of the patient&#39;s immune system preferably positioned around the periphery of the implant device. A sample of the patient&#39;s cancer cells is placed into the innermost portion of the protective space of the implant device in a chamber that is porous to sub-cellular components but impervious to cells. A monocyte-containing fraction of the patient&#39;s blood such as a buffy coat sample or a leukocyte fraction obtained from the patient and one or more dendritic cell inducing factors are also placed into the protective space but outside the cancer cell-containing chamber to induce formation of activated dendritic cells. Additionally, leukocyte attractants can also be included in the protective space. The loaded implant device is implanted into the patient allowing an immune response to proceed within the protective space, which is substantially free of soluble inhibitors that are bound to the ligands. The immune response includes the presentation of cancer antigens to the activated dendritic cells. After activated dendritic cells are formed and allowed to react with the cancer antigens they are allowed to release from the implant and circulate throughout the mammal&#39;s vascular system by the degradation of a biodegradable plug that seals that portion of the medical implant device that contains the monocyte-containing fraction (e.g. buffy coat). The soluble inhibitor adsorbent allows antigen (from the sample cancer cells) presentation to the induced dendritic cells to proceed to completion. After about 9 days or more the implant device is removed and can be replaced with another one. This can be done several times. 
         [0016]    In a broad aspect, the present invention creates an immunologically protected/enhanced space in vivo in a mammal by removing the impact of soluble inhibitors of the mammal&#39;s immune system in a defined space within the body. Placing an antigen source within the defined protected space along with a leukocyte sample (e.g. buffy coat) from the mammal being treated and one or more dendritic cell inducing factors allows a dendritic-antigen presentation process to proceed to completion in the substantial absence of soluble inhibitors. The protected/enhanced space is created by surrounding the protected space with ligands which absorb and/or bind to one or more soluble inhibitors. 
         [0017]    In one embodiment of the present invention, the implant device is made up of three concentric biocompatible hollow fiber membranes, approximately 5 cm long with an outside diameter of about 5-20 millimeters and which can be implanted with a small incision. In another embodiment the implant device comprises injectable pellets having a diameter of from about 0.5 mm to about 2 mm and a length of from about 3-10 mm or more and which can be implanted with a needle and syringe. The injectable pellets can also be made with a configuration of 3 concentric hollow fiber membranes. 
         [0018]    The exact size and shape of the implant device is not critical to the practice of the present invention. The outermost portion of the device can be packed with beads that absorb particular chemical messengers that interfere with the immune system, i.e. soluble inhibitors, and defines the protective space within the device. The middle portion or protective space can contain (a) the patient&#39;s own immune cells, e.g., buffy coat, (b) dendritic cell growth factors and (c) cancer cells or cancer markers (antigens) wherein the cancer cells or antigens are contained within a separate compartment that is impervious to cells but which is pervious to sub-cellular components. A timed, biodegradable plug degrades over a period of days, eventually breaking down fully, and letting the activated immune cells in the protective space escape into the patient&#39;s vascular system to deliver the vaccine into the patient&#39;s blood stream. 
         [0019]    The various medical implant devices and associated methods of the present invention create an immunologically protected/enhanced space in vivo by removing the impact of soluble inhibitors of the immune system. The process of antigen presentation by induced dendritic cells proceeds to completion in the immunologically protected/enhanced space for the purposes of combating infection, inducing anti-tumor vaccination or dampening autoimmunity, in-vivo. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0020]      FIG. 1  shows a medical implant device that is implanted into a mammal with a small surgical incision. 
           [0021]      FIG. 2  shows a medical implant device pellet that is implanted into a mammal with a needle and syringe. 
           [0022]      FIG. 3  is a cross-sectional view of a medical implant device of the present invention configured as three concentric hollow fiber membranes. 
           [0023]      FIG. 4  is a cross sectional view of a medical implant device of the present invention configured as two concentric hollow fiber membranes. 
           [0024]      FIG. 5  is a cross sectional view of a medical implant device of the present invention configured as two cross sectional hollow fiber membranes wherein ligands of soluble inhibitors and dendritic cell growth factors are covalently bound to the hollow fiber membranes. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0025]    In practicing the present invention, a mammal is treated with an implant device to elicit an immune response to an antigen wherein the antigen is presented to the mammal&#39;s immune system in a protected space in vivo. The mammal can be any mammal but humans, non-human primates, dogs, cats, horses, zoo animals, prized breeding bulls and any other commercially valuable agricultural animals are preferred. Any description herein relating to humans is equally applicable to other mammals. 
         [0026]    The following definitions apply to the practice of the present invention: 
         [0027]    The term “leukocyte fraction” or “leukocyte-containing fraction” refers to any fraction of a mammal&#39;s blood that contains white blood cells including monocytes. A buffy coat is a leukocyte fraction. 
         [0028]    The term “buffy coat” means” the fraction of an anticoagulated blood sample after density gradient centrifugation that contains most of the white blood cells and platelets. 
         [0029]    As used herein the terms “cancer” and “tumor” refer to malignancies including solid tumors, metastatic tumor cells and non-solid cancers of the blood, marrow, and lymphatic systems. “Cancer” and “tumor” shall include: carcinomas (cancers derived from epithelial cells), sarcomas (derived from mesenchymal tissues) lymphomas (solid tumors of lymphoid tissues) and leukemias (marrow or blood borne tumors of lymphocytes or other hematopoietic cells). Specific cancers include bladder cancers, breast cancers, melanomas, lung cancers, renal cancers, endometrial cancers, colon and rectal cancers, brain cancers, thyroid cancers, pancreatic cancers, prostate cancers, non-Hodgkin lymphomas, non-melanoma skin cancers (including basal cell and squamous cell cancers) and leukemias. 
         [0030]    The mammal is provided with an implant device that contains a protective space for antigen presentation to immune cells, such as dendritic cells, wherein the protective space is surrounded by a soluble inhibitor adsorbent. One or more antigens, or cells containing one or more antigens, are placed into the innermost portion or chamber of the protective space of the implant device. This innermost chamber contains the antigens or antigenic cells within the innermost portion of the protective space and prevents cellular contact with other cells in the protective space and release of cells into the host mammal. However, the walls of the chamber are pervious to sub-cellular components contained within the protective space. A monocyte-containing blood sample, such as a buffy coat sample, obtained from the mammal to be treated and one or more dendritic cell inducing factors are also placed into the protective space of the implant device to induce formation of mature dendritic cells. The antigens within the protective space are presented to the maturing dendritic cells. The loaded implant device is implanted into the mammal allowing an immune response to proceed within the protective space, which is substantially free of the soluble inhibitors that are adsorbed by the specific ligands contained in the soluble inhibitor adsorbent which surrounds the protective space. After activated dendritic cells are formed in the protective space they are allowed to release from the implant and circulate throughout the mammal&#39;s vascular system. The soluble inhibitor adsorbent allows antigen presentation to the induced, maturing dendritic cells to proceed to completion. The antigen can be any antigen such as bacterial antigens, viral antigens and antigens associated with cancer cells or autoimmune disease. The antigens can be any source of antigens including but not limited to recombinant antigenic determinants, inactivated viruses, inactivated virus particles, bacterial cells, and cancer cells. While the exact amount of antigen is not critical to the practice of the present invention usually at least about 0.05 mcg of antigen is employed and preferably 0.1 mcg or more cancer cells are added to the inner most portion of the implant device. 
         [0031]    The implant device of the present invention can be made with biocompatible polymers, biopolymers or composite material porous membranes employing manufacturing procedures well known to one of ordinary skill in the art. Polymer membranes having a pore size of from about 0.6 to about 60 μm or more are advantageous. Preferably, the inner membranes (described below) have a pore size less than about 1 μm and the outer membrane (described below) less than about 5 μm. The outermost membrane should promote vascularization around the outside of the implant and membranes having a pore size of about 60 μm are preferred for the purpose of promoting vascularization. All of the membranes should allow sub-cellular components to move freely through the membrane. Suitable polymer membranes include mixed esters of cellulose having a nominal pore size ranging from 1.2 to 8.0 μm; cellulose acetate having a nominal pore size ranging from 0.8 to 8.0 μm; and PTFE/polyester having a nominal pore size ranging from 1.0 to 15 μm. See U.S. Pat. No. 5,964,804, which is incorporated herein by reference. 
         [0032]    The biodegradable plug used to release the activated dendritic cells into the patient&#39;s circulation according to the present invention may be made of any biodegradable, biocompatible polymer. Biodegradable polymers that are biocompatible are well known to one of ordinary skill in the art. Preferred polymers are selected from the group consisting of a polylactide, polyglycolide, poly(dioxanone), poly(trimethylene carbonate copolymers, poly (ε-caprolactone) homopolymers and copolymers, polyorthoesters, polyphosphazenes, copolymers of polylactide and polyglycolide, copolymers of lactide and lactone, polysaccharides, polyanhydrides, polystyrenes, polyalkylcyanoacrylates, polyamides, poly(methylmethacrylate), polyurethanes, copolymers of methacrylic acid and acrylic acid, copolymers of hydroxyethylmethacrylate and methylmethacrylate, polyaminoacids and polypeptides. Preferred biodegradable, biocompatible polymers for use as the biodegradable plug include polymers from all major suppliers, e.g. PURASORB® of Purac Biomaterials, RESOMER® of Boehringer Ingelheim as well as those supplied by Lakeshore and Lactel/Durect. 
         [0033]    Factors that accelerate the degradation time of the polymer include such things as having a more hydrophilic backbone, having more hydrophilic end groups, having more hydrolytic groups in the backbone, having less crystallinity, having more porosity and modification of the mechanical or physical attributes of the polymer plug such as the thickness of the plug. One of ordinary skill in the art can take these considerations into account to optimize the degradation time of the polymer plug without undue experimentation. 
         [0034]    In a preferred embodiment of the present invention a biodegradable plug forms the end of the medical implant device adjacent to the portion of the device where the activated immune cells are formed. The degradation of the plug allows the activated immune cells to be released into the patient&#39;s circulatory system ultimately ending up in the lymph nodes. For example, the biodegradable plug will form the end of the inner chamber  32  shown in  FIG. 3 , the outer chamber/compartment  42  shown in  FIG. 4  and the outer chamber/compartment  52  shown in  FIG. 5 . The biodegradable plug is attached to the end of the medical implant device employing standard manufacturing techniques. The chambers containing the patient&#39;s monocyte blood fraction, e.g., huffy coat, are loaded by injecting the buffy coat through the biodegradable plug into the chamber. 
         [0035]    The innermost chamber of the medical implant device that contains the antigens (e.g. cancer cells) preferably contains a diaphragm through which the antigens are injected into the antigen-containing chamber. When cells are employed as the antigen source the cells are injected into this chamber and contained therein. The diaphragm prevents escape of the cells into the patient&#39;s circulatory system. For example the diaphragm will form the end of the innermost chamber  31  shown in  FIG. 3 , inner antigen chamber/compartment  41  shown in  FIG. 4  and the inner antigen chamber/compartment  51  shown in  FIG. 5 . The diaphragm is attached to the end of the medical implant device employing standard manufacturing techniques. The chambers containing the antigen, e.g. cancer cells, are loaded by injecting the antigen/cells through the diaphragm and into the chamber. 
         [0036]    A preferred configuration of the present medical implant device has three concentric hollow fiber membranes having (a) antigens contained in the innermost hollow fiber space, (b) the patient&#39;s monocytes and one or more dendritic cell growth factors in the middle hollow fiber space, and (c) a soluble inhibitor adsorbent in the outermost hollow fiber space. The soluble inhibitor adsorbent can be a matrix comprised of beads that contain ligands that bind soluble inhibitors of the patient&#39;s immune system thereby providing the protective space within the medical implant device that allows the antigen(s) of the patient&#39;s cancer cells to fully react with the patient&#39;s immune system, e.g., activate dendritic cells. Monocytes are typically provided with a leukocyte fraction or buffy coat sample obtained from the mammal to be treated. 
         [0037]    Antigens that are present in the present implant can be any antigens to which an appropriate immune response by the patient is desired. Antigens include bacterial antigens, viral antigens, tumor antigens and any antigens present in cancer cells. Antigens can be recombinant antigenic domains, purified antigenic proteins or cells that contain/express antigens. When the present implant device is used to treat cancer the antigens can be autologous cancer cells or allogenic cancer cells having antigens in common with the patient&#39;s cancer. Allogenic cancer cells can be surgically removed from another patient or can be taken from an in vitro cancer cell line. Preferably, the antigens used in the present medical implant device are autologous cancer cells harvested from the treated patient&#39;s own tumor using well known surgical techniques. 
         [0038]    The antigens are placed in an inner compartment (antigen compartment) of the implant device wherein the compartment wall is porous to sub-cellular components but impervious to cells. It is important that bacteria and cancer cells are contained within the inner compartment and not released into the blood stream of the mammal being treated. Bacteria cells or cancer cells are harvested and placed into the inner antigen compartment, which is then sealed to prevent release of the cells into the mammal&#39;s blood stream. Alternatively, the present implant device is made having a diaphragm that allows antigens, preferably cancer cells, to be injected directly into the inner, antigen-containing compartment. 
         [0039]    In a preferred embodiment, cancer cells are harvested from a cancer patient by a surgical procedure or a needle biopsy and, placed into the inner antigen compartment which is then sealed, or injected directly into the inner antigen compartment through a diaphragm. 
         [0040]    Optionally, abrasive materials can be added to the inner antigen compartment when the inner antigen compartment contains cells. The abrasive materials will control overgrowth of cells in the inner antigen compartment when implanted into a mammal. The abrasive materials mechanically disrupt cell wall membranes and will control overgrowth of bacterial or cancer cells contained within the inner antigen compartment while the implant is implanted within a mammals&#39; body. The abrasive material can be abrasive heads or abrasive fibers. Abrasive heads can be coated with abrasive inorganic compounds. Suitable abrasive fibers include silicon fiber whiskers and ceramic whiskers. 
         [0041]    In a preferred embodiment, dendritic cell inducing factors are present in the present medical device within the protective space. These factors can be present in any form that reacts with the patient&#39;s monocytes to form dendritic cells. The dendritic cell inducing factors can be bound to polymer beads or imbued into porous polymer beads where they can diffuse into the protective space. The beads can be any commercially available chromatographic column bead such as Pierce Ultra Link beads. The size of the heads is not critical to the practice of the present invention and are typically 50-100 μm in diameter. Suitable beads include a highly cross linked his-acrylamide/azolactone copolymer head. Preferably, the dendritic cell inducing factors are covalently bound to the polymer membranes present in the medical device employing standard manufacturing procedures well known to one of ordinary skill in the art. Dendritic cell inducing factors that are bound/imbued to the heads or bound to a membrane include IL-4, GM-CSF, IL-10, IL-13, the IL-17 family of cytokines and the IL-18 family of cytokines. The dendritic cell inducing factors are placed into the protective space of the present implant device with the buffy coat or leukocyte fraction that contains monocytes or bound to an appropriate membrane that is in contact with the monocytes present in the device. 
         [0042]    Soluble inhibitors of the immune system are well known and include gangliosides; all known growth factors, most notably TNF-alpha, TGF-beta and variants, PDGF, EGF, IGF and variants, FGF and variants and VEGF; all known inflammatory cytokine receptors, most notably the TNF-alpha family—TNF-R1, TNF-R2, CD40L, NGFR, TRAIL and variants, FASL, IL-1R1, IL1R2, IL-2R, IL-3R, IL-5R, IL-6R, IL-7R, GM-CSFR, IL-9R, IL-12R, and erythropoietin receptor. Ligands which that to one or more of the soluble inhibitors are bound to a solid support and configured in the present implant to define the protective space within the implant. The ligands of the soluble inhibitors are bound to polymer beads such as those used to deliver the dendritic cell-inducing factors described herein. Preferably, the ligands are covalently hound to the polymer membranes present in the medical device employing standard manufacturing procedures well known to one of ordinary skill in the art. The membrane in which the ligands are bound should be a membrane outside the inner most membrane that contains the antigens. Preferred ligands include those that bind to TGF-beta, TNF-R1 and TNF-R2. 
         [0043]    The implant can be inserted into any subcutaneous tissue in the body. Suitable locations include the inner aspect of an arm, the lateral midline area of the chest below the arm pit, a side region of the abdomen and the inner aspect of the thigh. It is preferred to place the implant as far away as possible from the site of the primary tumor and any metastatic lesion. The implant insertion can conveniently be done as a minor surgical procedure in an outpatient facility. After the biodegradable plug has degraded the implant is then removed. Additional implants can be administered in different body locations as deemed necessary by a healthcare practitioner. As one implant is removed a new implant can be administered. Alternatively, additional implants can be spaced out at one or two week intervals. In another embodiment, two or more implants can be implanted at the same time. The patient&#39;s cancer is monitored using standard diagnostic/monitoring techniques such as blood testing to determine cancer marker levels, X-rays and scans. 
         [0044]    The medical implant device of the present invention can be administered to a patient at any time but it is preferred to administer the implant when the patient&#39;s immune system is not in a compromised condition such as during and shortly after the administration of chemotherapy or radiation treatments. Once the patient&#39;s white blood cell count is within normal ranges, then the present implant is preferably administered. Other lifestyle choices to bolster the patient&#39;s immune system are of benefit. These lifestyle choices include plenty of sleep, moderate exercise, an insulin lowering diet, consumption of EPA and DHA as well as other omega-3 fatty acids such as those found in cold water ocean fish (salmon, tuna, sardines, mackerel, etc), a reduction in omega-6 fatty acids, elimination of trans-fats from the diet, restricted ingestion of alpha linolenic acid and the like. Immune enhancing supplements, such as Vit C, co-enzyme Q-10 and Vit D, can also be taken. 
         [0045]    In a preferred embodiment of the present invention, the loaded implant is placed into the patient by inserting it into a small incision made at a desirable location or by injecting implant pellets with a needle and syringe. The implant is preferably left in the patient&#39;s body until at least after the biodegradable plug has degraded and supplied the activated immune cells into the patient&#39;s vascular system. Another implant can then be implanted and repeated as many times as desired depending on the patient&#39;s response. 
         [0046]      FIG. 1  is a drawing illustrating one embodiment of the medical implant device of the present invention  12 . Line  17  represents an axis through the middle of the medical implant device. Three concentric hollow fibers approximately 50 millimeters long are loaded as follows: Innermost hollow fiber  13  is filled with tumor cells or tumor antigen in plasma (or other vehicle) and is sealed at the end  14  so that no tumor cells can escape from the innermost hollow fiber. The middle (second innermost section) hollow fiber  15  is filled with a mixture of cells from the patient&#39;s blood commonly referred to as the “buffy coat,” which comprises macrophages, T-cells, B-cells, and other leukocytes. The middle hollow fiber also contains 20-100 micron beads imbued with dendritic cell inducing factors including one or more of the following: IL-4, GM-CSF, IL-10, IL-13 and TNF-alpha with or without members of the IL-17 or IL-18 families of cytokines. The middle hollow fiber is also equipped with a biodegradable polymer plug (not shown) which allows activated immune cells to be released from the middle hollow fiber into the patient&#39;s vascular system when the plug degrades in 5-7 or more days. The outer (outermost section) hollow fiber  16  is packed with 20-100 micron beads saturated with bound ligand for the purposes of adsorbing and acting as a concentration sink for soluble inhibitors of the immune system. The outer hollow fiber is sealed to prevent escape of beads into the patient&#39;s vascular system. 
         [0047]    The described medical device implant, which has an outside diameter of about 5 mm, is implanted into a patient with a minor surgical incision and forcefully shields the antigen presentation process from soluble inhibitors of the immune system, facilitating an immune response overcoming inhibitor-induced anergy. The immune response is also triggered by the presence of highly localized concentrations of dendritic cell inducing cytokines and T-cell activation factors while simultaneously exposing the leukocyte fraction to the antigens of interest diffusing from the center hollow fiber. 
         [0048]      FIG. 2  is a drawing illustrating another embodiment of the medical device of the present invention as an injectable pellet implant  22 . Line  27  represents an axis through the middle of the medical implant device. Three concentric hollow fibers approximately 5 millimeters long are loaded as follows: Innermost hollow fiber  23  is filled with tumor cells or tumor antigen in plasma (or other vehicle) and is scaled at the end  24  so that no tumor cells can escape from the innermost hollow fiber. The middle hollow fiber  25  is filled with a mixture of cells from the patient&#39;s blood commonly referred to as the “buffy coat,” which comprises monocytes, macrophages, T-cells, B-cells, and other leukocytes. The middle hollow fiber also contains 20-100 micron beads (not shown) imbued with dendritic cell inducing factors including one or more of the following: IL-4, GM-CSF, IL-10, IL-13 and TNF-alpha with or without members of the IL-17 or IL-18 families of cytokines. The middle hollow fiber is also equipped with a biodegradable polymer plug (not shown) which allows activated immune cells to be released from the middle hollow fiber into the patient&#39;s vascular system when the plug degrades in 5-9 or more days. The outer hollow fiber  26  is packed with 20-100 micron beads saturated with bound ligand for the purposes of adsorbing and acting as a concentration sink for soluble inhibitors of the immune system. The outer hollow fiber is sealed to prevent escape of beads into the patient&#39;s vascular system. The described medical device implant, having an outside diameter of about 1-2 mm, is implanted into a patient with a needle and syringe (12-16 gauge needles) and forcefully shields the antigen presentation process from soluble inhibitors of the immune system, facilitating an immune response overcoming inhibitor-induced anergy. The immune response is also triggered by the presence of highly localized concentrations of dendritic cell inducing cytokines and T-cell activation factors while simultaneously exposing the leukocyte fraction to the antigens of interest diffusing from the center hollow fiber. 
         [0049]      FIG. 3  is a drawing that shows a cross-sectional view of an implant of the present invention  30  used to treat cancer and is made of 3 concentric hollow fiber membranes  34 ,  35  and  36 . The innermost hollow fiber membrane  36  defines the innermost chamber  31  which contains cancer cells (not shown) from the patient to be treated. Hollow fiber membrane  36  is impervious to cells but pervious to sub-cellular components such as antigens, cytokines, cytokine receptors, and the like. Hollow fiber membrane  36  is sealed at both ends to prevent cancer cells (not shown) from being released into the patient&#39;s vascular system. The middle hollow fiber membrane  35  defines the middle chamber  32  which contains a buffy coat sample (not shown) from the patient to be treated along with one or more dendritic cell-inducing factors (not shown). Hollow fiber membrane  35  is impervious to cells but pervious to sub-cellular components such as antigens, cytokines, cytokine receptors, and the like. Hollow fiber membrane  35  is sealed at one end and on the other end is sealed with a biodegradable polymer plug (not shown) which will degrade over time and allow the patient&#39;s immune cells and other sub-cellular components contained therein to be released into the patient&#39;s vascular system. The outermost hollow fiber membrane  34  defines the outermost chamber  33  which contains a matrix having ligands that bind to soluble inhibitors of the immune system (not shown). Such ligands are typically bound to inert polymer beads. Hollow fiber membrane  34  is impervious to cells but pervious to sub-cellular components such as antigens, cytokines, cytokine receptors, and the like and also promotes vascularization and inhibits encapsulation by the patient&#39;s immune system. Hollow fiber membrane  34  is sealed at both ends (not shown) to prevent the soluble inhibitor matrix from being released into the patient&#39;s vascular system. Soluble inhibitors which circulate throughout the cancer patient&#39;s vascular system can enter the medical implant device but are adsorbed onto the ligands contained in the outermost portion  33  of the implant device  30  which provides the protected space in the middle portion  32  and innermost portion  31  of medical implant device  30 . 
         [0050]      FIG. 4  is a drawing that shows a cross-sectional view of an implant of the present invention  40  used to treat cancer and is made of 2 concentric hollow fiber membranes  43  and  44 . The innermost hollow fiber membrane  43  defines an inner antigen chamber or compartment  41  which contains cancer cells (not shown) from the patient to be treated. Hollow fiber membrane  43  is impervious to cells but pervious to sub-cellular components such as antigens, cytokines, cytokine receptors, and the like. Hollow fiber membrane  43  is sealed at both ends to prevent cancer cells (not shown) from being released into the patient&#39;s vascular system. The outer hollow fiber membrane  44  defines the outer chamber or compartment  42  which contains a buffy coat sample (not shown) from the patient to the treated along with (a) one or more dendritic cell inducing factors (not shown) and (b) one of more soluble inhibitor ligands (not shown). The outer hollow fiber membrane  44  is impervious to cells but pervious to sub-cellular components such as antigens, cytokines, cytokine receptors, and the like. Hollow fiber membrane  44  is sealed at one end and on the other end is sealed with a biodegradable polymer plug (not shown) which will degrade over time and allow the patient&#39;s immune cells and other sub-cellular components contained therein to be released into the patient&#39;s vascular system. Hollow fiber membrane  44  also promotes vascularization and inhibits encapsulation by the patient&#39;s immune system. Soluble inhibitors which circulate throughout the cancer patient&#39;s vascular system can enter the medical implant device but are adsorbed onto the ligands contained in the outer chamber or compartment  42  of the implant device  40  which provides a protected space in both the inner chamber or compartment  41  and the outer chamber  42  of medical implant device  40 . 
         [0051]    The ligands of soluble inhibitors and the dendritic cell inducing factors can be bound to polymer beads as described herein or they can be covalently bound to the hollow fiber membranes  43  and  44  as shown in  FIG. 5 . 
         [0052]      FIG. 5  is a drawing that shows a cross-sectional view of an implant of the present invention  50  used to treat cancer and is made of 2 concentric hollow fiber membranes  53  and  54 . The innermost hollow fiber membrane  53  defines an inner antigen chamber or compartment  51  which contains cancer cells (not shown) from the patient to be treated. The outer hollow fiber membrane  54  defines the outer chamber or compartment  52  which contains a leukocyte-containing blood sample, such as a buffy coat sample, (not shown) from the patient to be treated. The outer hollow fiber membrane  54  is impervious to cells but pervious to sub-cellular components such as antigens, cytokines, cytokine receptors, and the like. Hollow fiber membrane  54  is sealed at one end and on the other end is sealed with a biodegradable polymer plug (not shown) which will degrade over time and allow the patient&#39;s immune cells and other sub-cellular components contained in compartment  52  to be released into the patient&#39;s vascular system. Hollow fiber membrane  54  also promotes vascularization and inhibits encapsulation by the patient&#39;s immune system. Hollow fiber membrane  53  is impervious to cells but pervious to sub-cellular components such as antigens, cytokines, cytokine receptors, and the like. Ligands of soluble inhibitors of the immune system  56  (shown as “Y”) are covalently bound to the hollow fiber membrane  54  and dendritic cell growth factors  55  (shown as “T”) are covalently bound to hollow fiber membrane  53  employing standard manufacturing techniques well know to one of ordinary skill in the art. In an alternative embodiment the ligands of soluble inhibitors may be attached to the inner hollow fiber membrane  53  and the dendritic cell growth factors may be attached to the outermost hollow fiber membrane  54 . In a further embodiment, both the soluble inhibitor ligands and dendritic cell growth factors can be attached to both hollow fiber membranes  53  and  54 . Hollow fiber membrane  43  is sealed at both ends to prevent cancer cells (not shown) from being released into the patient&#39;s vascular system. 
         [0053]    Reference throughout this specification to “one embodiment,” “an embodiment,” or similar language means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of the present invention. Thus, appearances of the phrases “in one embodiment,” “in an embodiment,” and similar language throughout this specification may, but do not necessarily, all refer to the same embodiment. 
         [0054]    The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.