Source: http://www.google.com/patents/US20050245799?dq=7,496,943
Timestamp: 2017-09-24 11:48:28
Document Index: 226278022

Matched Legal Cases: ['Application No. 10', 'Application No. 10', 'Application No. 10', 'Application No. 10', 'Application No. 10', 'Application No. 10', 'Application No. 10', 'Application No. 10', 'Application No. 09']

Patent US20050245799 - Implantable analyte sensor - Google Patents
Abstract of the Disclosure An implantable analyte sensor including a sensing region for measuring the analyte and a non-sensing region for immobilizing the sensor body in the host. The sensor is implanted in a precisely dimensioned pocket to stabilize the analyte sensor in vivo and enable measurement...http://www.google.com/patents/US20050245799?utm_source=gb-gplus-sharePatent US20050245799 - Implantable analyte sensor
Publication number US20050245799 A1
Application number US 10/838,912
Publication number 10838912, 838912, US 2005/0245799 A1, US 2005/245799 A1, US 20050245799 A1, US 20050245799A1, US 2005245799 A1, US 2005245799A1, US-A1-20050245799, US-A1-2005245799, US2005/0245799A1, US2005/245799A1, US20050245799 A1, US20050245799A1, US2005245799 A1, US2005245799A1
Inventors James Brauker, Mark Tapsak, Mark Shults, Victoria Carr-Brendel, Jack Fisher, William Seare, Paul Neale
US 20050245799 A1
5. An analyte sensor for short-term and long-term immobilization in a host’s soft tissue, the sensor comprising:
17. The method according to claim 16, wherein the short-term immobilization step comprises suturing the sensor to the host’s tissue.
19. The method according to claim 16, wherein the short term immobilization step comprises utilizing at least one of prongs, spines, barbs, wings, and hooks on the sensor to anchor the sensor into the host’s tissue upon implantation.
In a second embodiment, an analyte sensor for short-term and long-term immobilization in a host’s soft tissue is provided, the sensor including: a short-term anchoring mechanism for providing immobilization of the sensor in the soft tissue prior to substantial formation of the foreign body capsule; and a long-term anchoring mechanism for providing immobilization of the sensor in the soft tissue during and after substantial formation of the foreign body capsule.
In an aspect of the third embodiment, the short-term immobilization step includes suturing the sensor to the host’s tissue. In an aspect of the third embodiment, the suturing step includes suturing the sensor such that the sensor is in compression. In an aspect of the third embodiment, the short term immobilization step includes utilizing at least one of prongs, spines, barbs, wings, and hooks on the sensor to anchor the sensor into the host’s tissue upon implantation.
In an aspect of the twelfth embodiment, the first elevated temperature is between about 60ºC and about 100ºC. In an aspect of the twelfth embodiment, the first elevated temperature is about 80ºC.
In an aspect of the twelfth embodiment, the predetermined ramp rate is between about 3ºC per minute and 12ºC per minute. In an aspect of the twelfth embodiment, the predetermined ramp rate is about 7ºC per minute.
In an aspect of the twelfth embodiment, the second elevated temperature is at least about 100ºC.
The term “ROM,” as used herein, is a broad term and is used in its ordinary sense, including, without limitation, read-only memory. The term is inclusive of various types of ROM, including EEPROM, rewritable ROMs, flash memory, or the like.
The term “RAM,” as used herein, is a broad term and is used in its ordinary sense, including, without limitation, random access memory. The term is inclusive of various types of RAM, including dynamic-RAM, static-RAM, non-static RAM, or the like.
The term “physiologically feasible,” as used herein, is a broad term and is used in its ordinary sense, including, without limitation, the physiological parameters obtained from continuous studies of glucose data in humans and/or animals. For example, a maximal sustained rate of change of glucose in humans of about 4 to 5 mg/dL/min and a maximum acceleration of the rate of change of about 0.1 to 0.2 mg/dL/min/min are deemed physiologically feasible limits. Values outside of these limits would be considered non-physiological and likely a result of signal error, for example. As another example, the rate of change of glucose is lowest at the maxima and minima of the daily glucose range, which are the areas of greatest risk in patient treatment, thus a physiologically feasible rate of change can be set at the maxima and minima based on continuous studies of glucose data.
The term “biointerface membrane” as used herein is a broad term and is used in its ordinary sense, including, without limitation, a permeable membrane that functions as a device-tissue interface comprised of two or more domains. In some embodiments, the biointerface membrane is composed of two domains. The first domain supports tissue ingrowth, interferes with barrier cell layer formation, and includes an open cell configuration having cavities and a solid portion. The second domain is resistant to cellular attachment and impermeable to cells (for example, macrophages). The biointerface membrane is made of biostable materials and can be constructed in layers, uniform or non-uniform gradients (i.e., anisotropic), or in a uniform or non-uniform cavity size configuration.
The term “sensing membrane,” as used herein, is a broad term and is used in its ordinary sense, including, without limitation, a permeable or semi-permeable membrane that can be comprised of two or more domains and is typically constructed of materials of a few microns thickness or more, which are permeable to oxygen and may or may not be permeable to glucose. In one example, the sensing membrane comprises an enzyme, for example immobilized glucose oxidase enzyme, which enables an electrochemical reaction to occur to measure a concentration of analyte.
The term “domain” as used herein is a broad term and is used in its ordinary sense, including, without limitation, regions of a membrane that can be layers, uniform or non-uniform gradients (for example, anisotropic) or provided as portions of the membrane. The term is broad enough to include one or more functions one or more (combined) domains, or a plurality of layers or regions that each provide one or more of the functions of each of the various domains.
The term “barrier cell layer” as used herein is a broad term and is used in its ordinary sense, including, without limitation, a cohesive monolayer of cells (for example, macrophages and foreign body giant cells) that substantially block the transport of at least some molecules across the second domain and/or membrane.
The term “cellular attachment,” as used herein is a broad term and is used in its ordinary sense, including, without limitation, adhesion of cells and/or mechanical attachment of cell processes to a material at the molecular level, and/or attachment of cells and/or cell processes to micro- (or macro-) porous material surfaces. One example of a material used in the prior art that allows cellular attachment due to porous surfaces is the BIOPORE™ cell culture support marketed by Millipore (Bedford, MA) (see Brauker ‘330, supra).
The phrase “distal to” as used herein is a broad term and is used in its ordinary sense, including, without limitation, the spatial relationship between various elements in comparison to a particular point of reference. For example, some embodiments of a device include a biointerface membrane having a cell disruptive domain and a cell impermeable domain. If the sensor is deemed to be the point of reference and the cell disruptive domain is positioned farther from the sensor, then that domain is distal to the sensor.
The term “proximal to” as used herein is a broad term and is used in its ordinary sense, including, without limitation, the spatial relationship between various elements in comparison to a particular point of reference. For example, some embodiments of a device include a biointerface membrane having a cell disruptive domain and a cell impermeable domain. If the sensor is deemed to be the point of reference and the cell impermeable domain is positioned nearer to the sensor, then that domain is proximal to the sensor.
The term “cell processes” as used herein is a broad term and is used in its ordinary sense, including, without limitation, pseudopodia of a cell.
The term “solid portions” as used herein is a broad term and is used in its ordinary sense, including, without limitation, a solid material having a mechanical structure that demarcates the cavities, voids, or other non-solid portions.
The term “substantial” as used herein is a broad term and is used in its ordinary sense, including, without limitation, a sufficient amount that provides a desired function. For example, in the micro-architecture of the preferred embodiments, a substantial number of cavities have a size that allows a substantial number of inflammatory cells to enter therein, which may include an amount greater than 50 percent, an amount greater than 60 percent, an amount greater than 70 percent, an amount greater than 80 percent, and an amount greater than 90 percent of cavities within a preferred nominal pore size range.
The term “co-continuous” as used herein is a broad term and is used in its ordinary sense, including, without limitation, a solid portion wherein an unbroken curved line in three dimensions exists between any two points of the solid portion.
The term “biostable” as used herein is a broad term and is used in its ordinary sense, including, without limitation, materials that are relatively resistant to degradation by processes that are encountered in vivo.
The term “analyte” as used herein is a broad term and is used in its ordinary sense, including, without limitation, to refer to a substance or chemical constituent in a biological fluid (for example, blood, interstitial fluid, cerebral spinal fluid, lymph fluid or urine) that can be analyzed. Analytes can include naturally occurring substances, artificial substances, metabolites, and/or reaction products. In some embodiments, the analyte for measurement by the sensing regions, devices, and methods is glucose. However, other analytes are contemplated as well, including but not limited to acarboxyprothrombin; acylcarnitine; adenine phosphoribosyl transferase; adenosine deaminase; albumin; alpha-fetoprotein; amino acid profiles (arginine (Krebs cycle), histidine/urocanic acid, homocysteine, phenylalanine/tyrosine, tryptophan); andrenostenedione; antipyrine; arabinitol enantiomers; arginase; benzoylecgonine (cocaine); biotinidase; biopterin; c-reactive protein; carnitine; carnosinase; CD4; ceruloplasmin; chenodeoxycholic acid; chloroquine; cholesterol; cholinesterase; conjugated 1-ß hydroxy-cholic acid; cortisol; creatine kinase; creatine kinase MM isoenzyme; cyclosporin A; d-penicillamine; de-ethylchloroquine; dehydroepiandrosterone sulfate; DNA (acetylator polymorphism, alcohol dehydrogenase, alpha 1-antitrypsin, cystic fibrosis, Duchenne/Becker muscular dystrophy, glucose-6-phosphate dehydrogenase, hemoglobinopathies, A,S,C,E, D-Punjab, beta-thalassemia, hepatitis B virus, HCMV, HIV-1, HTLV-1, Leber hereditary optic neuropathy, MCAD, RNA, PKU, Plasmodium vivax, sexual differentiation, 21-deoxycortisol); desbutylhalofantrine; dihydropteridine reductase; diptheria/tetanus antitoxin; erythrocyte arginase; erythrocyte protoporphyrin; esterase D; fatty acids/acylglycines; free ß-human chorionic gonadotropin; free erythrocyte porphyrin; free thyroxine (FT4); free tri-iodothyronine (FT3); fumarylacetoacetase; galactose/gal-1-phosphate; galactose-1-phosphate uridyltransferase; gentamicin; glucose-6-phosphate dehydrogenase; glutathione; glutathione perioxidase; glycocholic acid; glycosylated hemoglobin; halofantrine; hemoglobin variants; hexosaminidase A; human erythrocyte carbonic anhydrase I ; 17 alpha-hydroxyprogesterone; hypoxanthine phosphoribosyl transferase; immunoreactive trypsin; lactate; lead; lipoproteins ((a), B/A-1, ß); lysozyme; mefloquine; netilmicin; phenobarbitone; phenytoin; phytanic/pristanic acid; progesterone; prolactin; prolidase; purine nucleoside phosphorylase; quinine; reverse tri-iodothyronine (rT3); selenium; serum pancreatic lipase; sissomicin; somatomedin C; specific antibodies (adenovirus, anti-nuclear antibody, anti-zeta antibody, arbovirus, Aujeszky’s disease virus, dengue virus, Dracunculus medinensis, Echinococcus granulosus, Entamoeba histolytica, enterovirus, Giardia duodenalisa, Helicobacter pylori, hepatitis B virus, herpes virus, HIV-1, IgE (atopic disease), influenza virus, Leishmania donovani, leptospira, measles/mumps/rubella, Mycobacterium leprae, Mycoplasma pneumoniae, Myoglobin, Onchocerca volvulus, parainfluenza virus, Plasmodium falciparum, poliovirus, Pseudomonas aeruginosa, respiratory syncytial virus, rickettsia (scrub typhus), Schistosoma mansoni, Toxoplasma gondii, Trepenoma pallidium, Trypanosoma cruzi/rangeli, vesicular stomatis virus, Wuchereria bancrofti, yellow fever virus); specific antigens (hepatitis B virus, HIV-1); succinylacetone; sulfadoxine; theophylline; thyrotropin (TSH); thyroxine (T4); thyroxine-binding globulin; trace elements; transferrin; UDP-galactose-4-epimerase; urea; uroporphyrinogen I synthase; vitamin A; white blood cells; and zinc protoporphyrin. Salts, sugar, protein, fat, vitamins and hormones naturally occurring in blood or interstitial fluids can also constitute analytes in certain embodiments. The analyte can be naturally present in the biological fluid, for example, a metabolic product, a hormone, an antigen, an antibody, and the like. Alternatively, the analyte can be introduced into the body, for example, a contrast agent for imaging, a radioisotope, a chemical agent, a fluorocarbon-based synthetic blood, or a drug or pharmaceutical composition, including but not limited to insulin; ethanol; cannabis (marijuana, tetrahydrocannabinol, hashish); inhalants (nitrous oxide, amyl nitrite, butyl nitrite, chlorohydrocarbons, hydrocarbons); cocaine (crack cocaine); stimulants (amphetamines, methamphetamines, Ritalin, Cylert, Preludin, Didrex, PreState, Voranil, Sandrex, Plegine); depressants (barbituates, methaqualone, tranquilizers such as Valium, Librium, Miltown, Serax, Equanil, Tranxene); hallucinogens (phencyclidine, lysergic acid, mescaline, peyote, psilocybin); narcotics (heroin, codeine, morphine, opium, meperidine, Percocet, Percodan, Tussionex, Fentanyl, Darvon, Talwin, Lomotil); designer drugs (analogs of fentanyl, meperidine, amphetamines, methamphetamines, and phencyclidine, for example, Ecstasy); anabolic steroids; and nicotine. The metabolic products of drugs and pharmaceutical compositions are also contemplated analytes. Analytes such as neurochemicals and other chemicals generated within the body can also be analyzed, such as, for example, ascorbic acid, uric acid, dopamine, noradrenaline, 3-methoxytyramine (3MT), 3,4-dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), 5-hydroxytryptamine (5HT), and 5-hydroxyindoleacetic acid (FHIAA).
The terms “operably connected” and “operably linked” as used herein are broad terms and are used in their ordinary sense, including, without limitation, one or more components being linked to another component(s) in a manner that allows transmission of signals between the components. For example, one or more electrodes can be used to detect the amount of analyte in a sample and convert that information into a signal; the signal can then be transmitted to a circuit. In this case, the electrode is “operably linked” to the electronic circuitry.
The phrase “continuous (or continual) analyte sensing” as used herein is a broad term and is used in its ordinary sense, including, without limitation, the period in which monitoring of analyte concentration is continuously, continually, and or intermittently (regularly or irregularly) performed, for example, about every 5 to 10 minutes.
The term “sensing region” as used herein is a broad term and is used in its ordinary sense, including, without limitation, the region of a monitoring device responsible for the detection of a particular analyte. The sensing region generally comprises a non-conductive body, a working electrode (anode), a reference electrode and a counter electrode (cathode) passing through and secured within the body forming an electrochemically reactive surface at one location on the body and an electronic connective means at another location on the body, and a multi-region membrane affixed to the body and covering the electrochemically reactive surface. The counter electrode has a greater electrochemically reactive surface area than the working electrode. During general operation of the sensor a biological sample (for example, blood or interstitial fluid) or a portion thereof contacts (directly or after passage through one or more membranes or domains) an enzyme (for example, glucose oxidase); the reaction of the biological sample (or portion thereof) results in the formation of reaction products that allow a determination of the analyte (for example, glucose) level in the biological sample. In some embodiments, the multi-region membrane further comprises an enzyme domain (for example, and enzyme layer), and an electrolyte phase (i.e., a free-flowing liquid phase comprising an electrolyte-containing fluid described further below).
The term “electrochemically reactive surface” as used herein is a broad term and is used in its ordinary sense, including, without limitation, the surface of an electrode where an electrochemical reaction takes place. In the case of the working electrode, the hydrogen peroxide produced by the enzyme catalyzed reaction of the analyte being detected reacts creating a measurable electric current (for example, detection of glucose analyte utilizing glucose oxidase produces H2O2 peroxide as a by product, H2O2 reacts with the surface of the working electrode producing two protons (2H+), two electrons (2e-) and one molecule of oxygen (O2) which produces the electronic current being detected). In the case of the counter electrode, a reducible species, for example, O2 is reduced at the electrode surface in order to balance the current being generated by the working electrode.
The term “oxygen antenna domain” as used herein is a broad term and is used in its ordinary sense, including, without limitation, a domain composed of a material that has higher oxygen solubility than aqueous media so that it concentrates oxygen from the biological fluid surrounding the biointerface membrane. The domain can then act as an oxygen reservoir during times of minimal oxygen need and has the capacity to provide on demand a higher oxygen gradient to facilitate oxygen transport across the membrane. This enhances function in the enzyme reaction domain and at the counter electrode surface when glucose conversion to hydrogen peroxide in the enzyme domain consumes oxygen from the surrounding domains. Thus, this ability of the oxygen antenna domain to apply a higher flux of oxygen to critical domains when needed improves overall sensor function.
The term “casting” as used herein is a broad term and is used in its ordinary sense, including, without limitation, a process where a fluid material is applied to a surface or surfaces and allowed to cure. The term is broad enough to encompass a variety of coating techniques, for example, using a draw-down machine, dip coating, or the like.
The term “water vapor permeable” as used herein is a broad term and is used in its ordinary sense, including, without limitation, characterized by permitting water vapor to permeate therethrough.
The following abbreviations apply herein: Eq and Eqs (equivalents); mEq (milliequivalents); M (molar); mM (millimolar) μM (micromolar); N (Normal); mol (moles); mmol (millimoles); μmol (micromoles); nmol (nanomoles); g (grams); mg (milligrams); μg (micrograms); Kg (kilograms); L (liters); mL (milliliters); dL (deciliters); μL (microliters); cm (centimeters); mm (millimeters); μm (micrometers); nm (nanometers); h and hr (hours); min. (minutes); s and sec. (seconds); and °C (degrees Centigrade).
Fig. 1A is a perspective view of a system of the preferred embodiments, including a continuous analyte sensor 12 implanted within a human 10 and a receiver 14 for processing and displaying sensor data. The system of the preferred embodiments provides improved convenience and accuracy because of its discrete design that enables acceptance into a host’s tissue with minimum invasive trauma, while providing reliable wireless transmissions through the physiological environment, and thereby increases overall patient comfort, confidence, safety, and convenience.
A potentiostat (Fig. 3C) is employed to monitor the electrochemical reaction at the electroactive surface(s). The potentiostat applies a constant potential to the working and reference electrodes to determine a current value. The current that is produced at the working electrode (and flows through the circuitry to the counter electrode) is substantially proportional to the amount of H2O2 that diffuses to the working electrode. Accordingly, a raw signal can be produced that is representative of the concentration of glucose in the user’s body, and therefore can be utilized to estimate a meaningful glucose value.
Fig. 2 is a block diagram that illustrates the electronics 22 associated with the implantable glucose sensor 12 in one embodiment. In this embodiment, a potentiostat 24 is shown, which is operably connected to an electrode system (such as described above) to obtain a current value, and includes a resistor (not shown) that translates the current into voltage. An A/D converter 26 digitizes the analog signal into “counts” for processing. Accordingly, the resulting raw data stream in counts is directly related to the current measured by the potentiostat 24.
A microprocessor module 28 includes the central control unit that houses ROM 30 and RAM 32 and controls the processing of the sensor electronics 22. It is noted that certain alternative embodiments can utilize a computer system other than a microprocessor to process data as described herein. In some alternative embodiments, an application-specific integrated circuit (ASIC) can be used for some or all the sensor’s central processing as is appreciated by one skilled in the art. The ROM 30 provides semi-permanent storage of data, for example, storing data such as sensor identifier (ID) and programming to process data streams (for example, programming for data smoothing and/or replacement of signal artifacts such as described in copending U.S. Patent Application No. 10/648,849 and entitled, “SYSTEMS AND METHODS FOR REPLACING SIGNAL ARTIFACTS IN A GLUCOSE SENSOR DATA STREAM,” filed August 22, 2003, which is incorporated herein by reference in its entirety). The RAM 32 can be used for the system’s cache memory, for example for temporarily storing recent sensor data. In some alternative embodiments, memory storage components comparable to ROM 30 and RAM 32 may be used instead of or in addition to the preferred hardware, such as dynamic-RAM, static-RAM, non-static RAM, EEPROM, rewritable ROMs, flash memory, or the like.
It is noted that the preferred embodiments advantageously encapsulate the electronics in a water vapor permeable material, such as described in more detail with reference to Figs. 4 to 5, below. It has been observed, however, that a change of the electrical properties of the water permeable sensor body contributes to a changing dielectric loading of the RF, causing shifting of the carrier frequency that may prohibit a receiver (for example, listening in a particular frequency range) from receiving the data transmissions. Although conventional PLL’s are designed to run a standard calibration to compensate for dielectric loading changes over time, it has been seen that certain situations occur in an implantable water vapor permeable sensor, wherein the water penetration rate increases more quickly than can be compensated for in a standard calibration cycle. Accordingly, the preferred embodiments are programmed to monitor the PLL to determine when the carrier frequency has shifted outside of the predetermined range and to run a re-calibration cycle upon an indication of “off-frequency.” While not wishing to be bound by theory, it is believed that re-calibrating the PLL responsive to detection of off-frequency reduces or eliminates missing data transmissions that result from a shifting carrier frequency in an implantable water vapor permeable sensor.
Figs. 3A and 3B are top (Fig. 3A) and side cross-sectional (Fig. 3B) views of the electronic subassembly 46 associated with the sensor 12 in one exemplary embodiment, which includes the hardware and software that provides for the functionality of sensor electronics as described above. Particularly, Figs. 3A and 3B illustrate the electronics subassembly 46 prior to encapsulation in a moldable plastic material.
The electronics subassembly 46 generally includes hardware and software designed to support the functions described above; additionally, the electronics subassembly of the preferred embodiments is configured to accommodate certain preferred design parameters described herein, which facilitate analyte sensor immobilization within the subcutaneous pocket. Immobilization of the sensor within the host tissue is advantageous because motion (for example, acute and/or chronic movement of the sensor in the host tissue) has been found to produce acute and/or chronic inflammation, which has been shown to result in poor short-term and/or long-term sensor performance. For example, during an experiment wherein larger, bulkier versions of the analyte sensor were implanted in humans for an average of 44 days +/- 14 days [See Garg, S.; Schwartz, S.; Edelman, S. “Improved Glucose Excursions Using an Implantable Real-Time Continuous Glucose Sensor in Adults with Type I Diabetes.” Diabetes Care 2004, 27, 734-738], it was discovered that movement of the sensor resulted in thicker foreign body capsule formation, which correlated with decreased sensor performance. While not wishing to be bound by theory, it is believed that size optimization (for example, miniaturization) of the analyte sensor enables more discrete and secure implantation, and is believed to reduce macro-motion of the sensor induced by the patient and micro-motion caused by movement of the sensor within the subcutaneous pocket, and thereby improve sensor performance.
Reference is now made to the electrode system 54 of the preferred embodiments, including the working electrode (anode) 54a, the reference electrode 54b, and the counter electrode (cathode) 54c, such as shown in Figs. 3A and 3C. Although alternative electrode configurations and measurement techniques may be used with the preferred embodiments, the following description is focused on the preferred three-electrode system, which is described above in the Overview section.
The working electrode 54a and counter-electrode 54c of a glucose oxidase-based glucose sensor 12 require oxygen in different capacities. Within the enzyme layer above the working electrode 54a, oxygen is required for the production of H2O2 from glucose. The H2O2 produced from the glucose oxidase reaction further reacts at the surface of the working electrode 54a and produces two electrons. The products of this reaction are two protons (2H+), two electrons (2e-), and one oxygen molecule (O2) (See Fraser, D.M. “An Introduction to In Vivo Biosensing: Progress and problems.” In “Biosensors and the Body,” D.M. Fraser, ed., 1997, pp. 1-56 John P. Wiley and Sons, New York). In theory, the oxygen concentration near the working electrode 54a, which is consumed during the glucose oxidase reaction, is replenished by the second reaction at the working electrode 54a; therefore, the net consumption of oxygen is zero. In practice, however, not all of the H2O2 produced by the enzyme diffuses to the working electrode surface nor does all of the oxygen produced at the electrode diffuse to the enzyme domain.
Fig. 3E is a bottom view of the PCB 48 only, showing the side of the PCB 48 that faces the antenna board 50 in one embodiment. Notably, the RF module 38 is provided on the PCB 48 and includes VCO circuitry, for example, an inductor 62 that provides a magnetic field suitable for RF telemetry. It is further noted that in some preferred embodiments, the sensor body is substantially formed from a water vapor permeable material, such as described in more detail with reference to Figs. 4 and 5, below. Unfortunately, if water vapor penetrates through the sensor body to a location that is within the magnetic field produced by the inductor 62, distortion of the electro-magnetic field effects may create shifts in the carrier frequency. Generally speaking, when the VCO is unable to provide a stable carrier frequency, the RF transmissions are unlikely or unable to successfully reach their designated receiver (for example, the receiver 14), which has been tuned to the specified carrier frequency. Therefore it is advantageous to reduce or prevent water vapor from entering and distorting the magnetic field created by the inductor in order to maintain a stable dielectric constant within a fixed distance from sensitive RF electronic components.
In the preferred embodiments, a substantial portion of the electronics 46 is coated with a conformal coating 66. This conformal coating preferably has a water permeability rate that is less than the water permeability rate of the sensor body and enables sufficient spacing for the electro-magnetic field as described in more detail above with reference to Figs. 3F and 3G; additionally the coating protects the PCB 48 and any coated portion of the electronics subassembly 46 from damage during the molding process (Figs. 4 and 5) and from water permeation that may imbibe through the molded water vapor permeable sensor body over the lifetime of the sensor in vivo.
In one preferred embodiment, one or more conformal Parylene coatings are applied prior to encapsulation in the sensor body. Parylene is known to have a slow water vapor permeability rate and is suitable for biomedical applications. The Parylene coating process exposes product to the gas-phase monomer at low pressure. Through vacuum deposition, Parylene condenses on the object’s surface in a polycrystalline fashion, providing a coating that is truly conformal and pinhole free. Compared to liquid processes, the effects of gravity and surface tension are negligible so there is no bridging, thin-out, pinholes, puddling, run-off or sagging; additionally, the process takes place at room temperature so there is no thermal or mechanical stress on the product. Parylene is physically stable and chemically inert within its usable temperature range. Parylene provides excellent protection from water vapor, corrosive vapors, and solvents, for example. In alternative embodiments, other conformal coatings (for example, HumiSeal®, Woodside, New York), spray coatings, or the like, may be used for the less- or minimally-water vapor penetrable layer, which protect the PCB 48 and electronics subassembly 46 from damage during the molding process (Figs. 4 and 5) and from water penetration through the molded water vapor permeable sensor body in vivo.
In one embodiment, the body of the sensor is preferably formed from a plastic material molded around the sensor electronics, however in alternative embodiments, the body may be formed from a variety of materials, including metals, ceramics, plastics, resins, or composites thereof.
Fig. 6A is a perspective view of an analyte sensor in one embodiment, including a thin substantially oval geometry, a curved sensing region, and an overall curved surface on which the sensing region is located, thereby causing contractile forces from the foreign body capsule to press downward on the sensing region. Fig. 6B is an end view of the analyte sensor of Fig. 6A showing the contractile forces that would be caused by a foreign body capsule. Fig. 6C is a side view of the analyte sensor of Fig. 6A.
Sensing Membrane
In preferred embodiments, the sensing membrane is constructed of two or more domains and is disposed adjacent to the electroactive surfaces of the sensing region 16. The sensing membrane provides functional domains that enable measurement of the analyte at the electroactive surfaces. For example, the sensing membrane includes an enzyme, which catalyzes the reaction of the analyte being measured with a co-reactant (for example, glucose and oxygen) in order to produce a species that in turn generates a current value at the working electrode, such as described in more detail above in the Overview section. The sensing membrane can be formed from one or more distinct layers and can comprise the same or different materials.
In some embodiments, the sensing membrane 88 includes an enzyme, for example, glucose oxidase, and covers the electrolyte phase. In one embodiment, the sensing membrane 88 generally includes a resistance domain 90 most distal from the electrochemically reactive surfaces, an enzyme domain 92 less distal from the electrochemically reactive surfaces than the resistance domain, and an electrolyte domain 96 adjacent to the electrochemically reactive surfaces. However, it is understood that a sensing membrane modified for other devices, for example, by including fewer or additional domains, is within the scope of the preferred embodiments. Co-pending U.S. Patent Appl. No. 09/916,711, entitled, “SENSOR HEAD FOR USE WITH IMPLANTABLE DEVICES” and U.S. Patent Appl. No. 10/153,356 entitled, “TECHNIQUES TO IMPROVE POLYURETHANE MEMBRANES FOR IMPLANTABLE GLUCOSE SENSORS,” which are incorporated herein by reference in their entirety, describe membranes that can be used in the preferred embodiments. It is noted that in some embodiments, the sensing membrane 88 may additionally include an interference domain 94 that limits some interfering species; such as described in the above-cited co-pending patent application. Co-pending U.S. Patent Application 10/695,636, entitled, “SILICONE COMPOSITION FOR BIOCOMPATIBLE MEMBRANE” also describes membranes that may be used for the sensing membrane of the preferred embodiments, and is incorporated herein by reference in its entirety.
In some alternative embodiments, a lower ratio of oxygen-to-glucose may be sufficient to provide excess oxygen by using an oxygen antenna domain (for example, a silicone or fluorocarbon based material or domain) to enhance the supply/transport of oxygen to the enzyme domain. In other words, if more oxygen is supplied to the enzyme, then more glucose may also be supplied to the enzyme without creating an oxygen rate-limiting excess. In some alternative embodiments, the resistance domain is formed from a silicone composition, such as described in copending U.S. Application No. 10/685,636 filed October 28, 2003 and entitled, “SILICONE COMPOSITION FOR BIOCOMPATIBLE MEMBRANE,” which is incorporated herein by reference in its entirety.
The preferred embodiments additionally provide a method for preparing the resistance domain, which provides a homogeneous and uniform structure. The homogeneous, uniform structure is advantageous in order to ensure that glucose traversing through the resistance domain adequately reaches the electroactive surfaces of the electrode system, which is described in more detail with reference to co-pending U.S. Patent Appl. No. 09/916,711 filed July 27, 2001, entitled “SENSOR HEAD FOR USE WITH IMPLANTABLE DEVICE,” and U.S. Patent Appl. No. 10/153,356, entitled, “TECHNIQUES TO IMPROVE POLYURETHANE MEMBRANES FOR IMPLANTABLE GLUCOSE SENSORS,” both of which are incorporated herein by reference in their entirety.
The blend is heated substantially above room temperature in order to mix the hydrophilic and hydrophobic components with each other and the solvent. In one embodiment, the composition of the blend of the hydrophilic polymer and the hydrophobic polymer is heated to a temperature of at least about 70ºC for a predetermined time period (for example, at least about 24 hours, preferably at least about 44 hours) to ensure the first and second polymers are substantially intermixed. One skilled in the art appreciates that the level of heating is dependent upon the relative miscibility of the polymer components and may be adjusted accordingly.
The preferred embodiments cure the coated film formed on the liner 98 to dry at an elevated temperature. Additionally, the temperature is ramped up during the curing process. In one embodiment, the coated film is placed in an oven wherein the temperature is ramped at a preferred ramp rate of within the range of 3ºC/minute and 12ºC/minute, more preferably 7ºC per minute from a first elevated temperature to a second elevated temperature. Preferably, the first elevated temperature is between about 60ºC and 100ºC, more preferably about 80ºC. Preferably, the second elevated temperature is at least about 100ºC. The elevated temperature serves to drive the solvent from the coating as quickly as possible. Ramping of the temperature serves to provide more uniformity and fewer defects in the hydrophobic and hydrophilic domain structures as they cure. While not wishing to be bound by theory, it is believed that elevating the temperature prior to coating and ramping up the temperature during curing inhibits the hydrophilic and hydrophobic portions of the membrane from segregating and forming large undesired structures. Membranes prepared in this way have been shown to provide accurate sensor operation at temperatures from about 30ºC to about 45ºC for a period of time exceeding about 30 days to exceeding about 6 months.
In one experiment, a plurality of resistance membranes (n=5) were prepared as described above, including heating at about 80ºC for greater than 24 hours prior to curing. In this experiment, each of the membranes was cured in an oven where the temperature was ramped at a rate of about 3ºC/min., 5ºC/min., or 7ºC/min. All of the membranes provided sufficient glucose permeability when tested (about 1.24 nA/mg/dL to 2.5 nA/mg/dL). It was noted that the rate of permeability of glucose (namely, the sensitivity) through the membrane decreased as a function of temperature ramp rate. Namely, the glucose permeability of a membrane decreased as the ramp rate used to cure that membrane increased, with a correlation (R2) of 0.58. While not wishing to be bound by theory it is believed that the glucose permeability can be optimized for a variety of design requirements by altering the ramp rate at which the resistance membrane is cured.
In one embodiment, a “sufficiently diluted interference solution” includes a ratio of about 5 wt.% polymer to about 95 wt.% solvent. However, a ratio of about 1 to 10 wt.% polymer to about 90 to 99 wt.% solvent may be used. Additionally, due to the volatility of solvents used for in the interference solution (for example, solvents with a boiling point slightly greater than room temperature (about 5 to 15ºC)), a sufficiently fast casting speed is advantageous to avoid invariabilities (for example, film thickness inhomogeneities) due to evaporation during casting. In one embodiment, the liquid film is drawn down at a speed of about 8 to about 15 inches/second, and preferably about 11.5 inches/second. While not wishing to be bound by theory, optimization of the solvent dilution and draw down speed limits solvent evaporation and viscosity buildup, which enables a very thin but constant interference domain. Variability in the interference domain has been discovered by the inventors to be a significant contributor in the variability of sensor function.
In one embodiment, the electrolyte domain 96 includes a flexible, water-swellable, substantially solid hydrogel film having a “dry film” thickness of from about 5 microns to about 15 microns, more preferably from about 3, 3.5, 4, 4.5, 5, or 5.5 to about 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, or 12 microns. “Dry film” thickness refers to the thickness of a cured film cast from a coating formulation onto the surface of the membrane by standard coating techniques.
The preferred embodiments provide a biointerface membrane disposed more distal to the electroactive surface than the sensing membrane. Preferably, the biointerface membrane 106 supports tissue ingrowth, serves to interfere with the formation of a barrier cell layer, and protects the sensitive regions of the device from host inflammatory response. In some embodiments, the biointerface membrane is composed of one or more domains.
It is noted that a contraction of the FBC around the device as a whole produces downward forces on the device, such as shown in Figs. 6B and 6C, which can be helpful in reducing motion artifacts such as described with reference to copending U.S. Patent Application 10/646,333 entitled “OPTIMIZED SENSOR GEOMETRY FOR AN IMPLANTABLE GLUCOSE SENSOR,” which is incorporated herein in its entirety by reference. However, the architecture of the first domain described herein, including the interconnected cavities and solid portion, are advantageous because the contractile forces caused by the downward tissue contracture that can otherwise cause cells to flatten against the device and occlude the transport of analytes, is instead translated to, disrupted by, and/or counteracted by the forces 128 that contract around the solid portions 112 (for example, throughout the interconnected cavities 114) away from the device. That is, the architecture of the solid portions 112 and cavities 114 of the cell disruptive domain cause contractile forces 128 to disperse away from the interface between the cell disruptive domain 108 and cell impermeable domain 110. Without the organized contracture of fibrous tissue toward the tissue-device interface typically found in a FBC, macrophages and foreign body giant cells substantially do not form a monolayer of cohesive cells (i.e., barrier cell layer) and therefore the transport of molecules across the second domain and/or membrane is substantially not blocked (indicated by free transport of analytes 126 through the domains in Fig. 8A).
Co-pending U.S. Patent Application 09/916,386, entitled, “MEMBRANE FOR USE WITH IMPLANTABLE DEVICES,” U.S. Patent Application 10/647,065, entitled, “POROUS MEMBRANES FOR USE WITH IMPLANTABLE DEVICES,” and U.S. Provisional Patent Application 60/544,722, entitled “BIOINTERFACE WITH INTEGRATED MACRO- AND MICRO-ARCHITECTURES,” describe biointerface membranes that may be used in conjunction with the preferred embodiments, and are incorporated herein by reference in their entirety.
Fig. 9A is an exploded perspective view of the analyte sensor prior to membrane attachment. Fig. 9B is a perspective view of the analyte sensor after membrane attachment. In preferred embodiments, the membrane 130 is attached to the sensing region 16 of the sensor 12 via a mechanical fastener 132, which in the illustrated embodiment of Figs. 9A and 9B is a clip 132a.
Long- and Short-term Anchoring
The final step in the assembly of the implantable sensor includes attaching the outermost layers, which serve as the device-tissue interface and may play a critical role in device stabilization in vivo. The preferred embodiments may be designed with short- and/or long-term anchoring systems and methods in order to ensure stabilization of the device in vivo. As discussed above and in more detail below, stabilization of the device in the subcutaneous tissue is believed to impact the performance of the sensor short- and long-term. In one preferred embodiment, the sensor comprises a short-term anchoring component configured to anchor the sensor to the tissue and thereby minimize motion-related damage at the device-tissue interface, which is believed to cause local inflammation and poor wound healing during the initial tissue ingrowth phase. Additionally, the preferred embodiments comprise a long-term anchoring component on the sensor to ensure long-term stabilization of the sensor in the subcutaneous pocket. Although both long- and short-term anchoring are preferred, some embodiments may utilize only one or the other, for example, when the sensor is sufficiently miniaturized such that the sensor body substantially “floats” within the subcutaneous space, or when a precise pocket forming or implantation technique is utilized, at least one of short- and long-term anchoring may not be required for sufficient sensor performance.
In the illustrated embodiment, the long-term anchoring component 136 is an anchoring material. The term “anchoring material,” as used herein, is a broad term and is used in its ordinary sense, including, without limitation, biocompatible material or surface that is non-smooth, and particularly comprises an architecture that supports tissue ingrowth in order to facilitate anchoring of the material into bodily tissue in vivo. Some examples of anchoring materials include polyester, velours, polypropylene cloth, expanded polytetrafluoroethylene, and porous silicone, for example. However, anchoring material may be built into the sensor body, for example, by texturizing the non-sensing region 18 of the analyte sensor 12. In one embodiment, the entire surface of the sensor is covered with an anchoring material to provide for strong attachment to the tissues. In another embodiment, only the sensing side of the sensor incorporates anchoring material, with the other sides of the sensor lacking fibers or porous anchoring structures and instead presenting a very smooth, non-reactive biomaterial surface to prevent attachment to tissue and to support the formation of a thicker capsule.
Implantation @$ndash; Sizing Tool
The preferred embodiments employ implantation techniques that exploit the knowledge gained by the inventors in experimentation with implantation techniques. In one study, nineteen glucose sensors were implanted in humans, wherein the sensors were designed with a cylindrical configuration with the sensing region on one end thereof. It was observed that of the nineteen patients participating in the study, acceptable efficacy was observed for only about half. The study is described in more detail with reference to co-pending U.S. Provisional Patent Application 60/460,825. In summary, surgical methods employed in the clinical study entailed making a 1-inch incision, then forming a pocket lateral to the incision by blunt dissection. After placement of the device, a suture was placed by pulling the connective tissue together at the end of the device proximal to the incision. During the first several weeks after implantation of the sensor in the human test subjects, photographs were taken of the wound site and the position of the device was determined tactilely. It was observed that eighteen of the nineteen sensors migrated in a retrograde fashion from the placement site towards the incision site. Thirteen of these devices moved a significant distance, namely, a distance of 1 cm or more (device movement of 0.5 cm or less is not considered to be significant, based on the resolution of the test measurements utilized). While not wishing to be bound by theory, it is believed that the sutures did not hold in the softer, fatty subcutaneous tissues as healing began and wound contracture formed. This permitted the devices to move into the virtual space remaining after the formation of the pocket, and in some cases even permitted the device to migrate into the space immediately under the incision.
Additionally, it is believed that certain behavioral issues lead to incomplete healing. Complicating factors included “fiddling” behaviors (namely, feeling and moving the sensor under the skin), and the like. These complicating factors were present to some extent in all of the patients, but were less frequent in patients with working sensors. Thus, the inventors attribute at least some sensor performance issue to patient-related movement.
Taken together, the inventors identified likely contributing factors to these performance issues, including: the location of the sensing region in this experiment on the end of the device may have led to problems with healing if the sensor moves in such a way that even a small gap is produced at the end of the sensor; the high profile of the cylindrical geometry is believed to have caused the sensor to have a high profile, which makes it easier to bump the sensor and can lead to the patient touching and feeling the sensor (“fiddling”); and the sensing region can be disrupted easily if pressure is placed on the opposite end of the device because the sensor may act as a lever, for example, and rotational energy can be applied to the sensor, which can also cause disruption of the sensor-tissue interface.
Implantation @$ndash; Technique
The implantable analyte sensor of the preferred embodiments may be implanted in variety of locations, including: subcutaneous, intramuscular, intraperotoneal, intrafascial, axillary region, soft tissue of a body, or the like. Although the preferred embodiments illustrate implantation within the subcutaneous space of the abdominal region, the systems and methods described herein are limited neither to abdominal nor to subcutaneous implantation. One skilled in the art appreciates that these systems and methods may be implemented and/or modified for other implantation sites and may be dependent upon the type, configuration, and dimensions of the analyte sensor.
It may be noted that other factors of the preferred embodiments aid in immobilizing the sensor within the host, for example the sensor geometry, such as described in more detail with reference to Fig. 6. Additionally, the inventors have designed the sensor with a “low profile” to reduce the possibility of “fiddling” behavior that was seen in the above-described experiment. “Low profile” is loosely defined as an overall configuration, including dimensions, shape, and aspect ratio, that is deliberately inconspicuous when implanted.
Taken together, the preferred sensor substantially does not protrude through the host’s skin (which may be somewhat dependent upon the host’s body fat) and is less amenable to accidental bumping or movement, and less available for patient “fiddling.” It is a thin, oblong shape, not cylindrical, so rotational forces are not as likely to affect the sensor-tissue interface. With the sensing region oriented down towards the fascia, and nearer to the center of the sensor, downward pressure on either end is not transferred as shear force to the sensing region.
Methods and devices that are suitable for use in conjunction with aspects of the preferred embodiments are disclosed in copending U.S. Patent Application No. 10/789,359 filed February 26, 2004 and entitled, “INTEGRATED DELIVERY DEVICE FOR CONTINUOUS GLUCOSE SENSOR”; U.S. Application No. 10/685,636 filed October 28, 2003 and entitled, “SILICONE COMPOSITION FOR BIOCOMPATIBLE MEMBRANE”; U.S. Application No. 10/648,849 filed August 22, 2003 and entitled, “SYSTEMS AND METHODS FOR REPLACING SIGNAL ARTIFACTS IN A GLUCOSE SENSOR DATA STREAM”; U.S. Application No. 10/646,333 filed August 22, 2003 entitled, “OPTIMIZED SENSOR GEOMETRY FOR AN IMPLANTABLE GLUCOSE SENSOR”; U.S. Application No. 10/647,065 filed August 22, 2003 entitled, “POROUS MEMBRANES FOR USE WITH IMPLANTABLE DEVICES”; U.S. Application No. 10/633,367 filed August 1, 2003 entitled, “SYSTEM AND METHODS FOR PROCESSING ANALYTE SENSOR DATA”; U.S. Application No. 09/916,386 filed July 27, 2001 and entitled “MEMBRANE FOR USE WITH IMPLANTABLE DEVICES”; U.S. Appl. No. 09/916,711 filed July 27, 2001 and entitled “SENSOR HEAD FOR USE WITH IMPLANTABLE DEVICE”; U.S. Appl. No. 09/447,227 filed November 22, 1999 and entitled “DEVICE AND METHOD FOR DETERMINING ANALYTE LEVELS”; U.S. Appl. No. 10/153,356 filed May 22, 2002 and entitled “TECHNIQUES TO IMPROVE POLYURETHANE MEMBRANES FOR IMPLANTABLE GLUCOSE SENSORS”; U.S. Appl. No. 09/489,588 filed January 21, 2000 and entitled “DEVICE AND METHOD FOR DETERMINING ANALYTE LEVELS”; U.S. Appl. No. 09/636,369 filed August 11, 2000 and entitled “SYSTEMS AND METHODS FOR REMOTE MONITORING AND MODULATION OF MEDICAL DEVICES”; and U.S. Appl. No. 09/916,858 filed July 27, 2001 and entitled “DEVICE AND METHOD FOR DETERMINING ANALYTE LEVELS,” as well as issued patents including U.S. 6,001,067 issued December 14, 1999 and entitled “DEVICE AND METHOD FOR DETERMINING ANALYTE LEVELS”; U.S. 4,994,167 issued February 19, 1991 and entitled “BIOLOGICAL FLUID MEASURING DEVICE”; and U.S. 4,757,022 filed July 12, 1988 and entitled “BIOLOGICAL FLUID MEASURING DEVICE.” The foregoing patent applications and patents are incorporated herein by reference in their entireties.
U.S. Classification 600/347, 600/309
International Classification A61B5/05, A61B5/00
Cooperative Classification A61B5/6882, A61B5/14532, A61B5/14865, A61B5/0031
European Classification A61B5/145G, A61B5/1486B, A61B5/68D3D
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