Abstract:
The present application teaches a coating having a biologically compatible compound conjugated to, or blended with, a polymer, wherein the polymer includes at least one olefin-derived unit and at least one unit derived from a vinyl alcohol, an allyl alcohol, or derivatives thereof.

Description:
CROSS REFERENCE 
     This application is a continuation of application Ser. No. 10/104,769, filed Mar. 20, 2002, now U.S. Pat. No. 7,919,075 which is hereby incorporated by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to the field of medical devices, more particularly, to coatings for devices such as stents. 
     2. Description of the Background 
     In the field of medical technology, there is frequently a necessity to administer drugs locally. To provide an efficacious concentration to the treatment site, systemic administration of medication often produces adverse or toxic side effect for the patient. Local delivery is a preferred method in that smaller total levels of medication are administered in comparison to systemic dosages but are concentrated at a specific site. Thus, local delivery produces fewer side effects and achieves more effective results. 
     One commonly applied technique for local delivery of a drug is through the use of a polymeric matrix. A polymer impregnated with a drug can be formed into particles or can be coated on implantable medical devices such as stents. Subsequent to the implantation of the particle or the device, the drug slowly elutes from the polymer. A variety of well known polymers have suitable biocompatible properties which allow the polymers to serve as suitable hosts for local drug delivery. A selected group of these polymers can also form a film layer or a coating for implantable devices such as stents. One example of a polymer that serves the dual function of being very biocompatible and capable of forming a coating for devices is a copolymer of ethylene and vinyl alcohol, also known as poly(ethylene-co-vinyl alcohol) or EVOH. Poly(ethylene-co-vinyl alcohol) is also known under the trade name EVAL and is distributed commercially by Aldrich Chemical Company of Milwaukee, Wis. EVAL is also manufactured by EVAL Company of America of Lisle, Ill. Other polymers which can be used to coat stents include a copolymer of ethylene and acrylic acid (EAA) and a copolymer of ethylene and glycidyl methacrylate (EGMA). 
     EVAL is a product of hydrolysis and contains ethylene-vinyl acetate copolymers. EVAL may also be a terpolymer and may include up to 5% (molar) units derived from styrene, propylene and other suitable unsaturated monomers. EVAL can be described as being hydrophobic and thus is essentially insensitive to moisture. EAA and EGMA, likewise, are hydrophobic and relatively impermeable to gases. The ethylene fragments of EVAL, EAA and EGMA provide hydrophobicity and barrier properties, while functional fragments of each copolymer (hydroxyl groups, carboxyl groups, and glycidyl groups, respectively) provide at least limited solubility in organic solvents. 
     While EVAL, EAA and EGMA are inert and biocompatible polymers which are quite suitable for use as a drug delivery matrix, and more particularly when used in conjunction with medical devices, some of the properties of these polymers can be improved. In particular, the polymers are prone to protein fouling, which may significantly inhibit the polymers&#39; lifetime in vivo efficacy. 
     There is a need for polymeric carriers suitable for the delivery of drugs, and more particularly for coating medical devices used as a means for drug delivery. Suitable characteristics of the polymeric materials should be significantly impermeable to oxygen, high degree of hydrophobicity and long term biocompatibility with minimum protein fouling effects. 
     SUMMARY 
     The present application generally encompasses a coating having a biologically compatible compound conjugated to, or blended with, a polymer, wherein the polymer includes at least one olefin-derived unit and at least one unit derived from a vinyl alcohol, an allyl alcohol, or derivatives thereof. In some embodiments, the invention includes a coating for a medical device, wherein the coating includes a modified polymer comprising a biologically compatible compound conjugated to a polymer. The modified polymer comprises at least one unit (I)
 
—CH 2 —CH 2 —  (I)
 
and at least one unit (II)
 
                                
wherein, R 1  comprises a component selected from a group consisting of an ester, an ether, an amine, an amide, a urethane, and a combination thereof, and R 2  comprises a component selected from a group consisting of a hydrogen and an alkyl group. In some embodiments, the biologically compatible compound is blended with the polymer.
 
     In some embodiments, the present invention includes a method of fabricating a medical device comprising forming a coating on the device, wherein the coating comprises a modified polymer comprising a biologically compatible compound conjugated to a polymer. The modified polymer comprises at least one unit (I)
 
—CH 2 —CH 2 —  (I)
 
and at least one unit (II)
 
                                
wherein, R 1  comprises a component selected from a group consisting of an ester, an ether, an amine, an amide, a urethane, and a combination thereof, and R 2  comprises a component selected from a group consisting of a hydrogen and an alkyl group. In some embodiments, the forming comprises reacting the polymer with the biologically compatible compound to create the modified polymer, and depositing the modified polymer on the medical device. In some embodiments, the forming comprises depositing the polymer on the medical device to produce a coating, and reacting the coating with a biologically compatible compound to create a modified coating.
 
    
    
     DETAILED DESCRIPTION 
     The present invention provides for a modification of polymers to be used for the local delivery of therapeutic substances or drugs. The polymers can also be used as coatings for implantable medical devices such as stents. The polymers can be referred to herein as “modified polymers,” “polymers to be modified,” or “polymers subject to modification.” 
     The polymers can be characterized by the presence of a polyolefin backbone, pendant on which are alkyl, hydroxyl, and/or carboxyl groups. EVAL is one example of a polymer that can be modified according to this invention. Other examples of polymers that can be modified include a copolymer of ethylene and acrylic acid (EAA) and a copolymer of ethylene and glycidyl methacrylate (EGMA). EVAL, EAA, and EGMA have relatively high oxygen-barrier properties and are resistant to water vapor; however, the polymers&#39; long-term biocompatibility is somewhat limited due to protein fouling effects. Modification of the polymers by covalent conjugation to biologically active materials will enhance the polymers&#39; in vivo behavior, thus providing better long-term results. 
     EVAL, EAA and EGMA can be modified by biologically active compounds, hereinafter also referred to as “modifiers” or “modifying compounds.” Modification can be accomplished by covalent conjugation of the polymer to one or more modifiers. The functional groups of the polymers, such as the hydroxyl groups in EVAL, the carboxyl groups in EAA, and the glycidyl groups in EGMA, can be used as the target sites for the conjugation. The modification of the polymer can be conducted directly on the stent or the polymer can be modified first, and the modified product can then applied to the stent. 
     In one embodiment, the modifiers include poly(ethylene glycol) (PEG) and PEG&#39;s functionalized derivatives. More particularly, representative examples include PEG, PEG-isocyanate, PEG-epoxide, and amino-terminated PEG. In accordance with another embodiment of the invention, the modifier can be an intracellular enzyme, for example, oxidoreductases containing seven-coordinate complexes of manganese, which is also known as superoxide dismutase mimics (SODm). In yet another embodiment, the modifier can include diazenium diolate type nitric oxide donors. In yet another embodiment, the modifier can include hyaluronic acids. In yet another embodiment of the invention, the modifying compound(s) can be conjugated to proteins or polysaccharides followed by cold-blending of the conjugates with the matrix polymer such as EVAL. 
     A therapeutic substance or a drug can be incorporated in the modified polymer. The therapeutic substance can include any compound that exerts a therapeutic or prophylactic effect for the patient. The substance can be for inhibiting the migration and/or proliferation of smooth muscle cells or for the treatment of restenosis and can include small molecule drugs, peptides, proteins, oligonucleotides, or DNA. Examples of the drugs include antiproliferative substances such as actinomycin D, or derivatives and analogs thereof. Synonyms of actinomycin D include dactinomycin, actinomycin IV, actinomycin I 1 , actinomycin X 1 , and actinomycin C 1 . The substance can also fall under the genus of antineoplastic, anti-inflammatory, antiplatelet, anticoagulant, antifibrin, antithrombin, antimitotic, antibiotic, antiallergic and antioxidant substances. Examples of such antineoplastics and/or antimitotics include paclitaxel, docetaxel, methotrexate, azathioprine, vincristine, vinblastine, fluorouracil, doxorubicin hydrochloride, and mitomycin. Examples of such antiplatelets, anticoagulants, antifibrin, and antithrombins include sodium heparin, low molecular weight heparins, heparinoids, hirudin, argatroban, forskolin, vapiprost, prostacyclin and prostacyclin analogues, dextran, D-phe-pro-arg-chloromethylketone (synthetic antithrombin), dipyridamole, glycoprotein IIb/IIIa platelet membrane receptor antagonist antibody, recombinant hirudin, and thrombin. Examples of such cytostatic or antiproliferative agents include angiopeptin, angiotensin converting enzyme inhibitors such as captopril, cilazapril or lisinopril, calcium channel blockers (such as nifedipine), colchicine, fibroblast growth factor (FGF) antagonists, fish oil (ω-3-fatty acid), histamine antagonists, lovastatin (an inhibitor of HMG-CoA reductase, a cholesterol lowering drug), monoclonal antibodies (such as those specific for Platelet-Derived Growth Factor (PDGF) receptors), nitroprusside, phosphodiesterase inhibitors, prostaglandin inhibitors, suramin, serotonin blockers, steroids, thioprotease inhibitors, triazolopyrimidine (a PDGF antagonist), and nitric oxide. An example of an antiallergic agent is permirolast potassium. Other therapeutic substances or agents which may be appropriate include alpha-interferon, genetically engineered epithelial cells, rapamycin, rapamycin derivatives and analogs, and dexamethasone. 
     The coating of the present invention can be used in conjunction with a balloon-expandable or self-expandable stent. The application of the coating is not limited to stents and the coating can also be used with a variety of other medical devices. Examples of other implantable medical device include stent-grafts, grafts (e.g., aortic grafts), artificial heart valves, cerebrospinal fluid shunts, pacemaker electrodes, axius coronary shunts and endocardial leads (e.g., FINELINE and ENDOTAK, available from Guidant Corporation). The underlying structure of the device can be of virtually any design. 
     The device can be made of a metallic material or an alloy such as, but not limited to, cobalt-chromium alloys (e.g., ELGILOY), stainless steel (316L), “MP35N,” “MP20N,” ELASTINITE (Nitinol), tantalum, tantalum-based alloys, nickel-titanium alloy, platinum, platinum-based alloys such as, e.g., platinum-iridium alloy, iridium, gold, magnesium, titanium, titanium-based alloys, zirconium-based alloys, or combinations thereof. Devices made from bioabsorbable or biostable polymers can also be used with the embodiments of the present invention. “MP35N” and “MP20N” are trade names for alloys of cobalt, nickel chromium and molybdenum, available from Standard Press Steel Co. of Jenkintown, Pa. “MP35N” consists of 35% cobalt, 35% nickel, 20% chromium, and 10% molybdenum. “MP20N” consists of 50% cobalt, 20% nickel, 20% chromium, and 10% molybdenum. 
     The following examples illustrate various embodiments for the modified polymers. 
     1. Modification of EVAL 
     In one embodiment of the invention, EVAL (—[CH 2 —CH 2 ] m —[CH 2 —CH(OH)] n —) manufactured by EVALCA Corp., Lisle, Ill., has an m:n ratio of 44:56. Those having ordinary skill in the art will understand that EVAL with higher or lower ethylene content can be modified by the same methods as those discussed below. In accordance with some of the embodiments of this invention, EVAL is modified as shown in the following examples. 
     Example 1 
     Modifier: poly(ethylene glycol) 
     Poly((ethylene glycol) (PEG) is a highly biologically compatible product. Due to the presence of hydroxyl groups, PEG is capable of entering reactions of condensation with EVAL. The reaction may need to be catalyzed by a suitable acidic or basic catalyst. PEG can be in an oligomeric or polymeric form and can have a molecular weight within a range of between about 500 and about 30,000 Daltons. The conditions under which this reaction is conducted can be determined by one having ordinary skill in the art. EVAL can be firmly bonded to the biologically compatible PEG. Thus, EVAL is modified by PEG and the modified EVAL can have an enhanced long-term biocompatibility. 
     Example 2 
     Modifier: poly(ethylene glycol)-isocyanate 
     Poly(ethylene glycol)-isocyanate (hereinafter, PEG-ISO) is a PEG based product having the isocyanate fragments —N═C═O. An example of a PEG-ISO suitable as a modifier for EVAL is a methoxylated PEG-ISO. The PEG-ISO has a general formula CH 3 —[O—CH 2 —CH 2 ] p —N═C═O. This modifier, manufactured by Shearwater Corp. of Huntsville, Ala., has a molecular weight of about 5,000 which corresponds to the value of the integer “p” of about 112. Due to the presence of the isocyanate groups, PEG-ISO is chemically very active and readily reacts with EVAL in solution. The —N═C═O group of PEG-ISO, having strong electron accepting properties, reacts with the nucleophilic hydroxyl group of EVAL, as illustrated by reaction scheme (I): 
     
       
                 
         
             
             
         
      
     
     The conditions under which reaction scheme (I) is conducted can be determined by one having ordinary skill in the art. As a result, EVAL is firmly bonded to the biologically compatible PEG-ISO to form the urethane product of reaction scheme (I). Thus, EVAL, modified by PEG-ISO, can have an enhanced long-term biocompatibility. 
     Example 3 
     Modifier: poly(ethylene glycol)-epoxide 
     Poly(ethylene glycol)-epoxide (hereinafter, PEG-EPO) is a PEG-based product having epoxy fragments. An example of a PEG-EPO suitable as a modifier for EVAL is a methoxylated PEG-EPO, such as methoxy-PEG-glycidyl ether and has the following general formula 
                                
The PEG-EPO has a molecular weight of about 5,000, which corresponds to the value of the integer “p” of about 112, and is manufactured by Shearwater Corp. of Huntsville, Ala.
 
     Epoxy groups in PEG-EPO are reactive, and PEG-EPO easily reacts with EVAL in solution. The epoxy group of PEG-EPO can react with the nucleophilic hydroxyl group of EVAL, via the nucleophilic substitution reaction S N 2. Normally, the proton of the hydroxyl group attacks the less substituted α-carbon atom of the epoxy group. The β-carbon is less accessible due to the steric hindrances. As a result of the proton attack on the α-carbon atom, the ring opens, and the modified EVAL is formed according to a reaction that can be shown as reaction scheme (II): 
     
       
                 
         
             
             
         
      
     
     Reaction scheme (II) is carried out more effectively in the presence of electron acceptors, because the electron acceptors facilitate electrophilic polarization of the C—O bond of the epoxy ring, thus making the subsequent attack by the proton of the hydroxyl group of EVAL easier. Accordingly, modification of EVAL with PEG-EPO is facilitated in the presence of electrophilic ring-opening catalysts, for instance, aprotonic acids such as amine-boron trifluoride products or tertiary amines. The use of any ring-opening catalyst is optional. The conditions under which this reaction is conducted can be determined by one having ordinary skill in the art. 
     Example 4 
     Modifier: Hyaluronic Acid 
     Hyaluronic acid is a linear polysaccharide composed of disaccharide units of N-acetylglucosamine and D-glucoronic acid. In hyaluronic acid, uronic acid and the aminosugar are linked by alternating β-1,4 and β-1,3 glucosidic bonds. Hyaluronic acid has hydroxymethyl groups and secondary amino groups. EVAL can be modified by these groups. In order to facilitate the condensation reaction of either the hydroxymethyl groups or the secondary amino groups of hyaluronic acid with the hydroxyl groups of EVAL, an appropriate catalyst may be needed. Alternatively, the modification of EVAL by hyaluronic acid can be carried in the presence of 1-ethyl-3(3-dimethylaminopropyl)carbodiimide, also known as carbodiimide or EDC, having the formula CH 3 —CH 2 —N═C═N—CH 2 —CH 2 —CH 2 —N(CH 3 ) 2 . EDC is manufactured by Pierce Corp., Rockford, Ill. Instead of EDC, 1,3-dicyclohexylcarbodiimide (DCC) having the formula 
                                
can be used. As a result, EVAL is firmly bonded to the biologically compatible hyaluronic acid for enhanced long-term biocompatibility.
 
     Example 5 
     Modifier: Protein and/or Polysaccharide Products 
     As a first step, a biologically active agent is conjugated to a protein or a polysaccharide, or to a combination of the protein and the polysaccharide. Albumin (also known as albumen or the egg white protein) can be used as the protein, and heparin, heparin derivatives, including the derivatives containing hydrophobic counter-ions, hyaluronic acid or chitosan can be used as polysaccharides. PEG is one example of the biologically active agent to be conjugated to the protein or polysaccharide, or to a combination of the protein and the polysaccharide. Other biologically active agents that can be used include superoxide dismutase-mimetics (SOD-mimetics or SODm) and diazenium diolate type nitric oxide donors. 
     Superoxide dismutase-mimetics are oxidoreductase-based complexes that contain cations of copper, iron, or manganese. SOD-mimetics are major intracellular enzymes that protect the cell against oxygen toxicity by dismutating the radical oxygen superoxide, .O 2 , to oxygen and hydrogen peroxide. 
     Manganese-based SODm, manganese(II)dichloro-aminoethylthiolated pentaazatetracyclohexacosatriene (SOD-40470) manufactured by Metaphore Pharmaceuticals, Inc., St. Louis, Mo. is one example of a SODm that can be used to conjugate to the protein or polysaccharide. Those having ordinary skill in the art can also select other types of SODm. Due to the presence of the primary amino ligands, SOD-40470 is chemically quite active and can be easily conjugated to the protein or the polysaccharide, or to a combination of the protein and the polysaccharide. 
     Diazenium diolate type nitric oxide donors are products of nitric oxide (NO) with nucleophilic amines. Diazenium diolates also known as NONOates are highly biologically compatible and possess valuable medicinal properties. In slightly acidic medium they spontaneously release NO which has excellent therapeutic properties. One example of a diazenium diolate that can be used to conjugate to the protein or polysaccharide is spermine diazenium diolate (SDD). 
     An aliphatic NONOate, SDD, or 1,3-propanediamine, N-{4-[1-(3-aminopropyl)-2-hydroxy-2-nitrosohydrazino]butyl}-diazen-1-ium-1,2-diolate has the formula NH 2 —CH 2 ) 3 —N[N + (O)—(N—OH)]—(CH 2 ) 4 —NH—(CH 2 ) 3 —NH 2  and is manufactured by Molecular Probes, Inc., Eugene, Oreg. Alternatively, other diazenium diolate-type NO donors can be used. One example of a suitable alternative diazenium diolate-type NO donor can be 1-{N-methyl-N-[6-(N-methylammonio)hexyl]amino}diazen-1-ium-1,2-diolate having the formula CH 3 —N + H 2 —CH 2 ) 6 —N(CH 3 )—N + (O − )═N—O −  (MAHMA-NO). Another example of a suitable alternative NONOate can be Z-1-[N-(2-aminoethyl)-N-(2-ammonioethyl)amino]diazen-1-ium-1,2-diolate having the formula O − —N + [N(CH 2 —CH 2 —NH 2 )CH 2 —CH 2 —N + H 3 ]═N—O −  (DETA-NO). MAHMA-NO and DETA-NO can be obtained from Cayman Chemical Co., Ann Arbor, Mich. 
     Due to the presence of amino groups, both SDD, MAHMA-NO and DETA-NO are easily conjugated to the above-mentioned proteins and/or polysaccharides, or to a combination thereof. The conditions under which the reaction of conjugation of PEG, SODm or diazenium diolates to the protein or polysaccharide, or a combination thereof, is conducted can be determined by those having ordinary skill in the art. 
     As a second step, the product of conjugation of PEG, SODm or diazenium diolates to the protein or polysaccharide, or a combination thereof, is cold-blended with EVAL. As a result, EVAL is modified with a product having high biocompatibility. 
     2. Polymer Subject to Modification is an EVAL Derivative. 
     EVAL can be preliminarily derivatized by tosylation (treatment with tosyl chloride), or alternatively by tresylation (by reacting with tresyl chloride). Tosyl chloride is a derivative of toluene, p-toluene sulfonyl chloride having the formula CH 3 —C 6 H 4 —SO 2 Cl (TsCl). The process of EVAL derivatization can be conducted directly on the stent. The following process of tosylation can be used. 
     A 2% (mass) solution of EVAL in dimethylacetamide (DMAC) can be sprayed on the stent and dried for 10 minutes at 80° C., and then again for 1 hour at 140° C. A 3% (mass) of TsCl in dry xylene can be prepared and the coated EVAL stent can be shaken for 1 minute with 1.4 ml of the TsCl solution. 0.25 ml of 33% (mass) of pyridine in dry xylene can be added, followed by shaking for 4 hours in a desiccator. The stent can be then rinsed with acetone and twice with 1 mM solution of HCl to remove the excess TsCl. As a result, EVAL can be tosylated according to reaction scheme (III) and the tosyl group is attached to the EVAL backbone via a hydroxy group to yield the toluenesulfoester: 
     
       
                 
         
             
             
         
      
     
     Alternatively, tresyl chloride (2,2,2-trifluoroethanesulphonyl chloride) can be used to derivatrize EVAL according to reaction scheme (IV), and the tresyl group is attached to the EVAL backbone via hydroxy group: 
     
       
                 
         
             
             
         
      
     
     Example 6 
     Modifier: poly(ethylene glycol)-amine Product 
     Poly(ethylene glycol)-amine product (hereinafter, PEG-NH 2 ) is a PEG-based product having amino groups NH 2 . An example of a PEG-NH 2  that can be used as a modifier for the tosylated or tresylated EVAL is a methoxylated PEG-NH 2  product having a general formula CH 3 —[O—CH 2 —CH 2 ] p —O—CH 2 —CH 2 —NH 2 . This product, manufactured by Shearwater Corp., Huntsville, Alab., has a molecular weight of about 5,000 which corresponds to the value of the integer “p” of about 113. 
     Due to the presence of the amino groups, PEG-NH 2  is chemically active and is readily alkylated with the tosylated or tresylated EVAL in solution. Typically, compared with the hydroxyl group of EVAL, the amino group of PEG-NH 2  is more reactive with alkylating agents such as tosylated or tresylated agents. 
     In addition, since toluenesulfonic acid is known to be a very strong acid, on par with sulfuric or hydrochloric acids, its anion, CH 3 —C 6 H 4 —SO 3   − , is an excellent leaving group in the nucleophilic substitution alkylation reaction of a primary amine; it is much better than the hydroxyl group of an underivatized EVAL. Accordingly, the tosylated EVAL obtained as described above, readily reacts with PEG-NH 2  as schematically shown by the alkylation reaction scheme (V): 
     
       
                 
         
             
             
         
      
     
     The conditions under which this reaction are conducted can be determined by those having ordinary skill in the art. The reaction of tresylated EVAL and PEG-NH 2  is similar to reaction scheme (V). As a result, EVAL is firmly bonded to the biologically compatible PEG-NH 2  to form the secondary amine product of reaction (V). 
     Example 7 
     Modifier: SOD-Mimetic 
     SOD-mimetics are highly biocompatible and can be used for modifying tosylated or tresylated EVAL. In particular, SOD-40470 can be used as a modifying agent with the tosylated or tresylated EVAL. Due to the presence of the primary amino ligands, SOD-40470 is chemically active and is readily alkylated with the tosylated or tresylated EVAL in solution. Alternatively, other SOD-mimetics can be used so long as they have amino groups. The mechanism of the tosylation or tresylation is via a reaction of alkylation of the amino group of SODm and is similar to reaction scheme (V) discussed above. The conditions under which this reaction is conducted will be determined by those having ordinary skill in the art. As a result, EVAL is firmly bonded to the biologically compatible amino ligand-containing SODm to form the secondary amine product. 
     Example 8 
     Modifier: Spermine Diazenium Diolate 
     Tosylated or tresylated EVAL can be modified by binding to a NONOate. Spermine diazenium diolate, SDD, can be used as a modifying agent for the tosylated or tresylated EVAL. Due to the presence of two primary and one secondary amino groups, SDD is easily alkylated with the tosylated or tresylated EVAL in solution. The mechanism of such tosylation or tresylation includes alkylation of the amino group of SDD and is similar to reaction scheme (V) discussed above. Alternatively, other diazenium diolate-type NO donors can be used, so long as they have amino groups, for example, MAHMA-NO or DETA-NO. The mechanism of binding of the tosylated or tresylated EVAL to MAHMA-NO or DETA-NO is the same as the mechanism of binding to SDD. 
     The conditions under which the tosylated or tresylated EVAL is bound to SDD, or the alternative diazenium diolate-type NO donors, can be determined by those having ordinary skill in the art. As a result, EVAL is firmly bonded to the biologically compatible diazenium diolate-type NO donors to form the secondary amine product. Since the modified product will be able to release NO having valuable medicinal properties, the stent coating will acquire additional therapeutical properties. 
     3. The Polymer Subject to Modification is a Copolymer of Ethylene with Acrylic Acid (EAA) 
     EAA has the general formula —[CH 2 —CH 2 ] m —[CH 2 —CH(COOH)] n —. In one embodiment of this invention, 25% (by mass) aqueous, ammonia-neutralized dispersion of EAA manufactured by Michelman, Inc., Cincinnati, Ohio is used. In some of the embodiments of this invention, EAA is modified as illustrated in the following examples. 
     Example 9 
     Modifier: PEG-NH 2    
     Due to the presence of the amino groups, PEG-NH 2  is chemically active and readily acylated with the carboxyl groups of EAA. Accordingly, EAA readily reacts with PEG-NH 2 . The reaction is carried out in the presence of EDC. EAA reacts with EDC and forms an O-acylisourea, an amine-reactive intermediate. This intermediate is unstable in an aqueous environment and immediately reacts with PEG-NH 2  utilizing PEG-NH 2 &#39;s amino groups. 
     The path of the reaction is via a nucleophilic attack of the carbon of the carboxyl group of EAA by the electron-rich nitrogen of the amino group of PEG-NH 2 , followed by the formation of the peptide bond —NH—CO—. Water is the by-product. The process is schematically shown by the acylation reaction scheme (VI): 
     
       
                 
         
             
             
         
      
     
     Example 10 
     Modifier: SOD-Mimetic 
     SOD-40470 can be used as a modifying agent of EAA. Due to the presence of the primary amino ligands, SOD-40470 is chemically active and readily couples with EAA. As in the case of modification with PEG-NH 2 , the reaction is carried out in the presence of EDC. The mechanism of the reaction is via acylation of the amino group of SOD-40470 and is similar to reaction scheme (VI). Other SOD-mimetics can be used so long as they have amino groups. EAA can be firmly bonded to the biologically compatible amino ligand-containing SOD-40470 to form the peptide-type product. 
     Example 11 
     Modifier: Spermine Diazenium Diolate 
     SDD can be used as a modifying agent for EAA. Due to the presence of the amino groups, SDD is chemically active and readily couples with EAA. As in the case of modification with PEG-NH 2  and SOD-40470, the reaction is carried out in the presence of EDC. The mechanism of the reaction is via acylation of the amino group of SDD and is similar to reaction scheme (VI). Other diazenium diolate-type NO donors can be used, so long as they have amino groups, for example, MAHMA-NO or DETA-NO. The mechanism of the coupling of EAA to MAHMA-NO or to DETA-NO is the same as the mechanism of coupling EAA to SDD. The conditions under which the reaction of binding EAA to SDD or the alternative diazenium diolate-type NO donors is conducted can be determined by those having ordinary skill in the art. As a result, EAA is firmly bonded to the biologically compatible diazenium diolate-type NO donors to form the peptide-type product. The modified product will be able to release NO. 
     4. Polymer Subject to Modification is a Copolymer of Ethylene with Glycidyl Methacrylate (EGMA) 
     EGMA has the general formula 
                                
wherein m and n are integers.
 
     A brand of EGMA having about 80% (by mass) of the units derived from ethylene can be used for modification. EGMA is an aliphatic epoxy oligomer with relatively high contents of epoxy functionality. Due to the presence of the epoxy groups, EGMA is chemically reactive and can be modified via these epoxy groups, particularly, by reacting EGMA with substances containing amino-, carboxyl-, and/or hydroxyl groups. In accordance with some of the embodiments of this invention, EGMA is modified as shown in the following examples. 
     Example 12 
     Modifier: PEG-NH 2    
     As mentioned above, PEG-NH 2  is chemically active and its amino group easily reacts with the epoxy group of EGMA. The path of the reaction is via the S N 2 nucleophilic attack of the epoxy group of EGMA by the electron-rich nitrogen of the amino group of PEG-NH 2 . As a result, the oxirane ring of EGMA opens and a hydroxyl group forms. The process is schematically shown by reaction scheme (VII): 
     
       
                 
         
             
             
         
      
     
     Reaction scheme (VII) may then continue and, depending on the amounts of EGMA and PEG-NH 2 , the second proton of the amino group of the product can attack the second molecule of EGMA by the same nucleophilic mechanism. As a result, a cross-linked oligomer may form. The conditions under which reaction (VII) is conducted can be determined by those having ordinary skill in the art. Irrespective of whether the reaction stops at a stage shown by reaction (VII) or continues through the formation of the cross-linked tri-dimensional oligomeric network, EGMA is firmly bonded to the biologically compatible PEG-NH 2 . 
     Example 13 
     Modifier: SOD-Mimetic 
     SOD-40470 can be used as a modifying agent of EGMA. Due to the presence of the primary amino ligands, SOD-40470 is chemically active and readily couples with EGMA. The mechanism of the reaction is via nucleophilic bonding of the amino group of SOD-40470 to the oxirane group of EGMA and is similar to the reaction (VII) discussed above. Alternatively, other SOD-mimetics can be used so long as they have amino groups. EGMA can be firmly bonded to the biologically compatible amino ligand-containing SOD-40470 to form a linear or cross-linked oligomer, depending on the conditions of the reaction of modification. 
     Example 14 
     Modifier: Spermine Diazenium Diolate 
     SDD can be used as a modifying agent of EGMA. Due to the presence of the amino groups, SDD is chemically active and readily couples with EGMA according to the mechanism similar to reaction scheme (VII). Other diazenium diolate-type NO donors can be used, so long as they have amino groups, for example, MAHMA-NO or DETA-NO. The mechanism of coupling of EAA to MAHMA-NO or DETA-NO is the same as the mechanism of coupling to SDD. The conditions under which the reaction of binding EGMA to SDD, or the alternative diazenium diolate-type NO donors, is conducted can be determined by those having ordinary skill in the art. EGMA can be firmly bonded to the biologically compatible diazenium diolate-type NO donors. 
     Example 15 
     Modifier: Hydroxyl-Terminated Methoxy-PEG 
     Hydroxyl-terminated methoxy-PEG is a PEG-based product having hydroxyl groups. An example of a hydroxyl-terminated methoxy-PEG suitable as a modifier for EGMA is a monomethyl ether of PEG, a methoxylated PEG product having a general formula CH 3 O—[CH 2 —CH 2 —O] p —CH 2 —CH 2 —OH, known as a low-diol mPEG. The product is manufactured by Shearwater Corp., Huntsville, Ala., and, like PEG-ISO or PEG-EPO, has a molecular weight of about 5,000 which corresponds to “p” being an integer of about 112. The low-diol mPEG is a strong nucleophilic agent and bonds with EGMA via a nucleophilic substitution reaction of its nucleophilic hydroxyl group with the oxirane ring of EGMA. The mechanism of that reaction is similar to the mechanism illustrated schematically by reaction (II). 
     Naturally, modification of EGMA by the low diol mPEG is carried out more effectively in the presence of the electron acceptors, which facilitate the nucleophilic attack of the epoxy group of EGMA by the proton of the hydroxyl group of the low diol MPEG. Accordingly, modification of EGMA with the low diol mPEG is facilitated in the presence of ring-opening catalysts that include either amines or electrophilic agents which can be, for example, aprotonic acids such as amine-boron trifluoride products. The use of any ring-opening catalysts is optional. 
     The conditions under which this reaction is conducted can be determined by those having ordinary skill in the art. As a result, EGMA is firmly bonded to the biologically compatible low diol mPEG to form the product similar to the product of reaction (II). 
     Example 16 
     Modifier: Carboxyl-Terminated Methoxy-PEG 
     Carboxyl-terminated methoxy-PEG is a PEG-based product having carboxyl groups. An example of a carboxyl-terminated methoxy-PEG suitable as a modifier for EGMA is methoxy-PEG propionic acid, a methoxylated PEG-based product having a general formula CH 3 O—[CH 2 —CH 2 —O] p —CH 2 —CH 2 COOH, known as PA-PEG. The product, manufactured by Shearwater Corp., Huntsville, Ala., has a molecular weight of about 5,000 which corresponds to the value of the integer “p” of about 111. 
     Like low diol mPEG, PA-PEG is a strong nucleophilic agent which can react with the epoxy group of EGMA. The mechanism of this reaction is similar to the mechanism illustrated schematically by reaction (II), except a proton of carboxyl group carries out the nucleophilic attack instead of the alcohol proton illustrated by the reaction (II). EGMA can be firmly bonded to the biologically compatible PA-PEG to form a product similar to the product of the reaction (II). 
     Modification of the EVAL, tosylated or tresylated EVAL, EAA and EGMA discussed in Examples 1-16 can be recapitulated as shown in Table 1. 
     
       
         
               
               
               
             
               
               
               
             
           
               
                 TABLE 1 
               
               
                   
               
               
                 Example 
                 The modified polymer 
                 The modifying agent 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 1 
                 EVAL 
                 PEG 
               
               
                 2 
                 EVAL 
                 PEG-ISO 
               
               
                 3 
                 EVAL 
                 PEG-EPO 
               
               
                 4 
                 EVAL 
                 Hyaluronic acid 
               
               
                 5 
                 EVAL 
                 PEG or SODm or diazenium 
               
               
                   
                   
                 diolate + albumin or 
               
               
                   
                   
                 heparin or chitosan 
               
               
                 6 
                 Tosylated or tresylated EVAL 
                 PEG-NH 2   
               
               
                 7 
                 Tosylated or tresylated EVAL 
                 SODm 
               
               
                 8 
                 Tosylated or tresylated EVAL 
                 SDD 
               
               
                 9 
                 EAA 
                 PEG-NH 2   
               
               
                 10 
                 EAA 
                 SODm 
               
               
                 11 
                 EAA 
                 SDD 
               
               
                 12 
                 EGMA 
                 PEG-NH 2   
               
               
                 13 
                 EGMA 
                 SODm 
               
               
                 14 
                 EGMA 
                 SDD 
               
               
                 15 
                 EGMA 
                 Low diol mPEG 
               
               
                 16 
                 EGMA 
                 PA-PEG 
               
               
                   
               
             
          
         
       
     
     While particular embodiments of the present invention have been shown and described, it will be obvious to those skilled in the art that changes and modifications can be made without departing from this invention in its broader aspects. Therefore, the appended claims are to encompass within their scope all such changes and modifications as fall within the true spirit and scope of this invention.