Abstract:
Systems and methods that treat disorders of the gastrointestinal tract by applying one or more treatment agents to tissue at or near the region where abnormal neurological symptoms or abnormal tissue conditions exist. The treatment agent is selected to either disrupt the abnormal nerve pathways and/or to alleviate the abnormal tissue conditions. The treatment agent can include at least one cytokine and/or at least one vanilloid compound to evoke a desired tissue response. The systems and methods can be used a primary treatment modality, or as a neoadjuvent or adjuvant treatment modality.

Description:
RELATED APPLICATIONS 
     This application is a divisional of U.S. patent application Ser. No. 10/912,268, filed Aug. 5, 2004 (now U.S. Pat. No. 7,293,563), which is divisional of U.S. patent application Ser. No. 09/994,375, filed Nov. 26, 2001 (now U.S. Pat. No. 6,790,207, which is a continuation-in-part of U.S. patent application Ser. No. 09/304,737, filed May 4, 1999, now U.S. Pat. No. 6,464,697, and a continuation-in-part of U.S. patent application Ser. No. 09/090,794, filed Jun. 4, 1998 and entitled “Method for Treating a Sphincter” (now abandoned). 
    
    
     FIELD OF THE INVENTION 
     In a general sense, the invention is directed to systems and methods for treating interior tissue regions of the body. More specifically, the invention is directed to systems and methods for treating dysfunctions of organs and tissue in the gastrointestinal tract. 
     BACKGROUND OF THE INVENTION 
     Disorders of organs or tissue of the gastrointestinal tract can be caused by as neurological factors (such as abnormal nerve impulses) or by physical factors (such as excess tissue volume). 
     For example, intestinal motility (i.e., the contraction of intestinal muscles and the propulsion and movement of the lumenal contents) is controlled by nerves and hormones, as well as by electrical activity in the muscular wall of the intestine. There are several disorders that involve abnormal motility and result in abnormal and uncomfortable visceral sensations. These disorders can cause significant discomfort and distress in the absence of gross physical abnormality of the intestine. 
     For example, irritable bowel syndrome (IBS) is a common disorder of the intestines. IBS can lead to crampy pain, gassiness, bloating, and changes in bowel habits. Some people with IBS have constipation (difficult or infrequent bowel movements) others have diarrhea (frequent loose stools, often with an urgent need to move the bowels); and some people experience both symptoms intermittently. Sometimes the person with IBS has a crampy urge to move the bowels, but cannot do so. The cause of IBS is not known, and as yet there is no cure. IBS can be characterized as a functional disorder because there is no sign of disease when the intestine is examined, often IBS is just a mild annoyance, but for some people it can be disabling. 
     Dyspepsia is another example. Dyspepsia is literally translated as ‘bad digestion” and is commonly known as indigestion. Motility-like dyspepsia causes persistent or recurring abdominal pain that is centered in the upper abdomen. People with motility associated dyspepsia also may experience bloating, nausea, burping and a feeling of fullness that occurs soon after eating. It is an extremely common symptom complex, affecting as much as one-fourth of the United States adult population. 
     There are other disorders affecting the gastrointestinal tract that are characterized by abnormal tissue conditions not associated with neural abnormalities. 
     SUMMARY OF THE INVENTION 
     One aspect of the invention provides a method of treating tissue within a body. The method comprises selecting at least one treatment agent comprising at least one of a vanilloid compound and a cytokine compound. The method provides a source of the treatment agent. The method includes deploying an endoscope to a targeted tissue region. The endoscope has an interior lumen. The method includes visualizing the targeted tissue region with the endoscope and deploying through the interior lumen of the endoscope a catheter carrying on its distal end a tissue-piercing element adjacent to the targeted tissue region visualized by the endoscope. The method includes coupling the catheter to the source of the treatment agent, and applying through the tissue-piercing element the treatment agent into contact with the targeted tissue region visualized by the endoscope. 
     In one embodiment, the method injects the treatment agent into subsurface tissue in the targeted tissue region. 
     In one embodiment, the method includes providing a guide wire to facilitate deployment of the endoscope and/or catheter. 
     Features and advantages of the inventions are set forth in the following Description and Drawings, as well as in the appended Claims. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIGS. 1A and 1B  are schematic views of a system for treating tissue that includes a treatment device with a tissue piercing member that embodies features of the invention,  FIG. 1A  showing the treatment device deployed in a tissue region and  FIG. 1B  showing the treatment device piercing the tissue region to inject a treatment agent; 
         FIGS. 2A and 2B  are schematic views of a system for treating tissue that includes a treatment device with multiple tissue piercing members that embodies features of the invention,  FIG. 2A  showing the treatment device deployed in a tissue region and  FIG. 2B  showing the treatment device piercing the tissue region to inject a treatment agent; 
         FIG. 3  is an embodiment of a tissue treatment device that takes the form of a syringe and a needle for injecting a treatment agent into a tissue region that can be visualized from outside the body; and 
         FIG. 4  is an embodiment of a tissue treatment device for injecting a treatment agent into a tissue region that cannot be visualized from outside the body. 
     
    
    
     The invention may be embodied in several forms without departing from its spirit or essential characteristics. The scope of the invention is defined in the appended claims, rather than in the specific description preceding them. All embodiments that fall within the meaning and range of equivalency of the claims are therefore intended to be embraced by the claims. 
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     This Specification discloses various systems and methods for treating dysfunctions of organs or tissue in the gastrointestinal tract. Still, it should be appreciated that the disclosed systems and methods are applicable for use in treating other dysfunctions elsewhere in the body, e.g., for treating sphincter barrier dysfunctions in the lower gastrointestinal tract or in the upper gastrointestinal tract. The systems and methods that embody features of the invention are adaptable for use with catheter-based systems and surgical techniques, as well as systems and surgical Techniques that are not necessarily catheter-based. 
     I. System Overview 
     A tissue treatment system  10  that embodies features of the invention is shown in  FIGS. 1A and 1B . The tissue treatment system  10  includes a tissue treatment device  12  and an apparatus  14  to deliver the tissue treatment device  12  to a tissue region  16  targeted for treatment. The treatment system  10  also includes a source  18  of a treatment agent  20 . 
     A. The Tissue Treatment Device 
     The tissue treatment device  12  serves to apply the treatment agent  20  to the targeted tissue region  16  to obtain a desired therapeutic effect. The therapeutic effect can comprise either alteration of nerve impulse pathways in the region  16  or a physical alteration of tissue characteristics in the region  16 . 
     The tissue treatment device  12  includes one or more agent delivery ports  22 . The one or more delivery ports  22  can apply the treatment agent  20  to surface tissue in the region  16 . Desirably (as  FIG. 1A  shows), the port  20  is located at the end of a tissue piercing member  24 . In this arrangement, the treatment agent  20  may be injected into subsurface tissue. 
     The tissue treatment device  12  can include single or multiple ports  22  located single or multiple tissue piercing members  24  to inject the treatment agent  20 . As  FIGS. 1A and 1B  show, a single tissue piercing member  24  (with a single port  22 ) may be used. Alternatively, as  FIGS. 2A and 2B  show, the treatment device  24  can carry multiple tissue piercing members  24 , each with a port  22 . Desirably, the multiple tissue piercing members  24  are arranged in a spaced-apart array, to apply the treatment agent  20  in a prescribed pattern at the targeted site. 
     Alternatively, the tissue treatment device  12  may employ air powered, needle-less injection technology. 
     B. The Delivery Device 
     The configuration of the delivery apparatus  14  for the device  12  can also vary, depending upon the accessibility of the treatment site and the particular treatment objectives desired. 
     If the treatment site can be directly visualized the delivery apparatus  14 , the source  18 , and the treatment device  12  can comprise a syringe  100  and a needle  102 , as  FIG. 3  shows. 
     If the treatment site can not be directly visualized or is otherwise not as readily accessible, the delivery apparatus  14  can comprise an endoscope  106  having an interior lumen  104  passed down the esophagus through the mouth, as  FIG. 4  shows. In this arrangement, the treatment device  12  is desirably carried on the distal end of a catheter tube  108  for passage through the endoscope lumen  104  to the targeted site. A guidewire may be used, if desired, to further facilitate deployment of the endoscope and treatment device to the targeted site. 
     C. The Tissue Treatment Agent 
     The treatment agent  20  is selected from a group of candidate agents based upon the physiologic effect or effects that are desired. One or more candidate agents may be applied, either as a primary treatment modality, a neoadjuvent treatment modality, or an adjuvent treatment modality. 
     In the illustrated embodiment, the group consists essentially of two candidate agents: (1) Vanilloid Compounds, and (2) Cytokine Sub-Types. 
     1. Vanilloid Compounds 
     The treatment agent  20  can comprise a vanilloid compound. Vanilloid compounds have a unique capacity to bind to a membrane receptor in sensory neurons. Capsaicin is one of many vanilloid compounds. Capsaicin is a powerful basic compound which is derived from chili peppers. 
     The specific neuron for capsaicin is deemed “VR1”. This receptor is expressed only on small unmyelinated C-fibers (nerves typically involved in special visceral sensation and pain). 
     Exposure to vanilloid compounds variably reduces the responsiveness of the neuron to stimuli. In many cases, the neuron may actually degenerate either temporarily or permanently, thus impairing transmission of pain signals or other special sensory signals. 
     The term “vanilloid compound” as used herein means a compound or a mixture of compounds having a biologically active vanillyl group. vanilloid compounds include both naturally occurring vanilloids, synthetic vanilloids, pharmaceutically acceptable salts of the vanilloid compound (whether natural or synthetic) as well as pharmaceutically acceptable derivatives and/or analogues thereof (whether natural or synthetic). Examples of natural vanilloid compounds include both the crude extracts and the purified extracts of active vanilloid compounds from: capsicum, cayenne pepper, black pepper, paprika, cinnamon, clove, mace, mustard, ginger, turmeric, papaya seed and the cactus-like plant  Euphorbia resinifera.    
     Synthetic vanilloid compounds such as synthetic capsaicin are disclosed in WO 96/40079, which is incorporated herein by reference. The vanilloid compound family includes: Capsaicin; Dihydrocapsaicin: Nordihydrocapsaicin; Homocapsaicin: Homodihydrocapsaicin. Alternatively, resiniferotoxin (RTX) is derived from the  euphorbia  cactus and is considered a capsaicin-like compound. This substance also activates the VR1 receptor and attenuates or eliminates afferent nerve function, although it may not illicit the rapid heat sensation that other vanilloids produce. 
     Other examples of vanilloid compounds include capsaicin ((E)-(N)-[(4-hydroxy-3-methoxyphenyl)-methyl]-8-methyl-6-nonenamide); eugenol (2-methoxy-4-(2-propenyl)phenol); zingerone (4-(4-hydroxy-3-methoxyphenyl)-2-butanone); curcumin (1,7-bis(4-hydroxy-3-methoxyphenyl)-1,6-heptadiene-3,5-dione); piperine (1-[5-(1,3-benzodioxol-5-yl)-1-oxo-2,4-pentadienyl]piperidine); resiniferatoxin(6,7-deepoxy-6,7-didehydro-5-deoxy-21-dephenyl-2l-(phenylmethyl)-20-(4-hydroxy-3-thoxybenzeneacetate)) or pharmaceutically effective salts, analogues, derivatives or equivalents thereof. 
     The treatment agent  20  can include capsaicin, another vanilloid compound, RTX, or combination thereof, alone or in combination with other substances (which will be generically called a vanilloid-containing treatment agent  20 ). 
     The vanilloid-containing treatment agent can be applied through the port  22  or ports  22  to the mucosal lining or extrinsically to the outside of an organ. The vanilloid-containing treatment agent can also be injected into the targeted tissue region or organ wall. 
     The treatment agent  20  can be a solution, a gel, a powder, a pellet, or other form. The treatment agent may be released immediately, or, be a sustained release product such as a slow released implant, slow release gel, coated pellet, microsphere, or other form. 
     The vanilloid-containing treatment agent  20  may be applied or injected as primary therapy, or, as a neoadjuvant or adjuvant procedure. For example, RF energy may be used to incite a wound, followed by application of the vanilloid-containing treatment agent to facilitate exuberant wound healing. 
     In dyspepsia and irritable bowel syndrome, the use of a vanilloid-containing treatment agent can serve to diminish the pain impulses or could attenuate the dysmotility and alleviate the disease state. 
     An example of vanilloid materials that can be used is produced by Afferon and is called RTX, which has been instilled into the lumen of the urinary bladder for the treatment of urge incontinence. There are also several topical, over-the-counter capsaicin products for topical analgesic applications. 
     2. Cytokine Sub-Types 
     The treatment agent  20  can include one or more subtypes of cytokines. A cytokine, in the natural state within the body, is a protein produced and released by a biological cell that has an effect on the local environment surrounding the cell. Cytokines are involved in many cellular processes, such as wound healing. The mechanism of action would depend on the specific cytokine utilized. 
     The term “cytokine subtype” as used herein means any polypeptide that affects the functions of other cells, and is a molecule which modulates interactions between cells in the immune or inflammatory response. A cytokine subtype includes, but is not limited to monokines and lymphokines regardless of which cells produce them. For instance, a monokine is generally referred to as being produced and secreted by a mononuclear cell, such as a macrophage and/or monocyte but many other cells produce monokines, such as natural killer cells, fibroblasts, basophils, neutrophils, endothelial cells, brain astrocytes, bone marrow stromal cells, epideral keratinocytes, and B-lymphocytes. Lymphokines are generally referred to as being produced by lymphocyte cells. Examples of cytokine subtypes include, but are not limited to, interleukin-1. (IL-1), tumor necrosis factor-alpha (TNF alpha) and tumor necrosis factor beta (TNF beta). 
     Other cytokine subtypes include TGF-β(transforming growth factor β); PDGF (platelet derived growth factor) b-FGF (basic fibroblast growth factor): IGF-1 (insulin-like growth factor 1); EGF (epidermal growth factor); and VEGF. Some of these cytokines are available commercially, could be produced commercially, or can be extracted from a persons harvested platelets (platelet releasates). The effects of a given cytokine upon tissue physiology can include one or more of the following: smooth muscle and fibroblast mitogenic effects (induces division and growth of cells); stimulation of the release of cytokines from other cells; chemoattractant (bringing new healing cells into local region); decrease of collagen enzyme activity allowing collagen to build up; inflammation; and angiogenesis (development of new blood vessels). 
     The treatment agent  20  can include a cytokine sub-type or combination of cytokine sub-types, alone or in combination with other substances. The cytokine-containing treatment agent can be applied by the port or ports  22  to the tissue or organ wall, or injected into the tissue or organ wall. 
     The cytokine-containing treatment agent  20  can be a solution, a gel, a powder, a pellet, or other form. The treatment agent may be released immediately, or, be a sustained release product such as a slow released implant, slow release gel, coated pellet, microsphere, or other form. 
     The cytokine-containing agent  20  may be applied or injected as primary therapy, or, as a neoadjuvant or adjuvant procedure. For example, radio frequency (RF) energy may be used to induce the wound healing process, followed by cytokine application to facilitate more exuberant wound healing. 
     The application of a single cytokine or mixture thereof, as primary, neoadjuvant, or adjuvant therapy for abnormal tissue conditions (e.g., excess tissue volume) could have the various mechanical and therapeutic effects. With or without an inciting wound event (such as RF), cytokines can serve to initiate the process of healing within the local region. This process includes, but is not limited to, influx of white blood cells and macrophages, stimulation of fibroblast and smooth muscle division and collagen secretion, new blood vessel growth, wound contraction and tightening, maturation of the new or existing collagen framework, and reduced tissue compliance. These tissue effects could improve the compliance and reduce the tissue volume. 
     Examples of cytokine materials that can be used include commercially available Regranex, which is recombinant human PDGF-BB. This material has been applied as a gel for promoting the healing of diabetic foot ulcers. Platelet granules contain many of the cytokines listed above, and the cytokines can be extracted with a fairly simple technique (platelet releasates). Platelets (harvested as a pooled platelet product or from autologous donation) provide a source of cytokines for extraction. TGF-β and PDGF are considered to be the most important substances for the purpose of initiating the wound healing process. 
     Various features of the invention are set forth in the following claims.