Abstract:
This invention is in the area of medical devices, in particular in the area of medical devices for drug delivery, more in particular for controlled release of drugs to the eye. Delivery of drugs to the anterior side of the eye is routinely done with eye drops, but this method results in low bioavailability and low patient compliance. Devices that address these problems have been described for the delivery of drugs to the eye. One of such devices, called the OphthaCoil, consists of a thin metallic wire, which is coiled and carries a drug-loaded adherent hydrogel coating on its surface. Surprisingly it has now been found that the drug loading capacity can be dramatically increased by filling the lumen of the coil with micro-particles such as microspheres that contain the drug of choice.

Description:
This application is the U.S. national phase of International Application No. PCT/EP2006/006355 filed 30 Jun. 2006 which designated the U.S. and claims priority to European Patent Application Nos. 05076580.9 filed 11 Jul. 2005 and 05077210.2 filed 27 Sep. 2005, the entire contents of each of which are hereby incorporated by reference. 
     BACKGROUND  
     This invention is in the area of medical devices, in particular in the area of medical devices for drug delivery, more in particular for controlled release of drugs to the eye. 
     Delivery of drugs to the anterior side of the eye is routinely done with eye drops, but this method results in low bioavailability and low patient compliance. Devices that address these problems have been described for the delivery of drugs to the eye. One of such devices, called the OphthaCoil, consists of a thin metallic wire, which is coiled and carries a drug-loaded adherent hydrogel coating on its surface. The drug is then released in a more or less controlled fashion in vitro as well as in vivo (Pijls et al., Eur. J. Pharm. Biopharm. 59, 283 (2005)). 
     By using this device, anti-microbial drug levels in the tear fluid of dogs could well be maintained above the MIC-values of relevant bacteria after 16 hours, using pradofloxacin, a very potent anti-microbial drug. The devices were well tolerated, but may be lost when left in the eye overnight. 
     The drug loading capacity of the OphthaCoil, however, becomes the limiting factor when less potent drugs are to be delivered to the eye. Several strategies have been suggested to solve this problem. First, it was suggested to fill the coil with a hydrogel. When polymerizing a hydrogel in the lumen itself, it appeared that the coil lost its flexibility. The loss of flexibility is detrimental for the patient, since the device is no longer tolerated when rigid. The solution was found in that a number of straight wires, made of the same material as the wires constituting the coil, was inserted into the coil. The straight wires were coated with the same coating as the coil and so increased the drug load of the assembled device. The coils thereby lost some of their flexibility by that process. 
     Therefore, it remains desirable to increase the drug loading capacity of such coiled devices while maintaining or improving the flexibility. 
     SUMMARY  
     Surprisingly it has now been found that the drug loading capacity can be dramatically increased by introducing micro-particles such as micro-spheres or microbeads that contain the drug of choice into the lumen of the coil. A coil or coiled wire as used herein defines a wound structure with a distal and proximal end and a lumen inside the windings of the wire. The invention therefore relates to a coiled wire with a distal and proximal end and defining a lumen inside the windings of the wire wherein said lumen contains micro-particles comprising an active component such as a drug. 
     Advantageously, the coiled wire according to the invention comprises a hydrophilic coating. 
     When pHEMA (poly-(2-hydroxyethyl)methacrylate) micro-particles loaded with fluorescein sodium salt as a model for a drug were introduced into the lumen of an OphthaCoil device, a controlled release pattern of the dye could be demonstrated. It was found that the dye was quickly released from the hydrophilic coating on the outside of the coil, whereas the dye in the micro-particles was released more slowly. In this way the release of a drug may be influenced and dosed more reliably in comparison to the prior art technology. The invention therefore also relates to a coiled wire comprising micro-particles that consist of a hydrophilic polymer, such as pHEMA and/or NVP. 
     Preferably, the micro-particles for use in the invention are micro-spheres and/or made of a polymer, preferably a biodegradable polymer, even more preferably a porous polymer wherein the drugs are contained inside the micro-particle. 
     Moreover, the invention also relates to the use of a coiled wire according to the invention for controlled drug release. 
     Even more surprisingly, the coils filled with micro-particles had an exceptionally good flexibility, far better than the devices filled with straight wires. They were as flexible as the unfilled coils. 
     It is important to control the diameter of the micro-particles. The particles should not be too small in order to prevent leakage of complete particles into the eye through the windings of the coil. They should also be small enough to be filled into the lumen when in the dry state. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1 . Experimental set up of the drug and dye release experiments 
         FIG. 2A . Release curve of a fluorescein loaded coil 
         FIG. 2B . Release curve of fluorescein from loaded microspheres in an unloaded coil 
         FIG. 2C . Release curve of fluorescein from loaded microspheres in a loaded coil 
         FIG. 3 . Release of fluorescein from two different types of microspheres in the lumen of the coil 
         FIG. 4 . The set up of the three-point bending test 
         FIG. 5 . The results of the three-point bending test, showing the average values obtained for the three different coils (n=8) 
     
    
    
     DETAILED DESCRIPTION  
     Examples 
     Example 1 
     Preparation of the OphthaCoil Device 
     The OphthaCoil is a device for the controlled delivery of drugs to the anterior side of the eye. The device consists of a drug-loaded adherent hydrogel (Slipskin®) on a thin metallic wire, which is coiled (Hanssen et al., J. Biomed. Mater. Res (Appl. Biomater.) 48, 820 (1999)), as described in U.S. Pat. No. 6,086,547. The metallic wire had a diameter of 76 μm and was first coated with the primer polyethersulfone (PES). Then the wire was coated with a solution of Slipskin® with a drug dissolved. This resulted in a diameter of ±85 μm for wire and coating. Finally the coated wire was coiled around a core wire of 432 μm and cut into pieces of 15 mm in length. The ends of the coil were closed with a polymeric cap and the device was gas-sterilized before use. 
     Several release studies have been done with the OphthaCoil. In vitro release studies of the dye fluorescein, and the antibiotics chloramphenicol and pradofloxacin, show that a dye or drug can be released for over 48 hours, and show that the drugs are still active when released from the coating. In vivo study with a device loaded with the pupil widening agent atropine shows that mydriasis can be obtained and in vivo studies with dogs show that the device is well tolerated in the canine eye and that pradofloxacin can be detected at a concentration well above the MIC-value in the tear fluid for at least 16 hours (Pijls et al., Biomed. Mater. Eng. 14(4), 383 (2004); Pijls et al., Eur. J. Pharm. Biopharm. 59(2), 283 (2005)). 
     This invention is concerned with increasing the capacity of the device by filling the lumen of the coil with drug-loaded microparticles, such as pHEMA-microspheres. pHEMA is used for its high water uptake and it is a well-known material in opthalmology (Karlgard et al., Int. J. Pharm. 257, 141 (2003); Gulsen et al., Invest. Opthalmol. Vis. Sci. 45, 2342 (2004)). The result of filling the lumen with drug-loaded microspheres is a device with two release systems: fast release of a drug from the coating of the coiled wire and slow release of the microspheres inside the lumen of the device. Most importantly, filling the lumen with microspheres does not compromise the coil&#39;s flexibility. Moreover, the device can also be loaded with different drugs. 
     Example 2 
     Preparation of the Microspheres 
     Chemicals were purchased from Acros Organics, Belgium, unless stated otherwise. Two types of microspheres are exemplified herein; pHEMA microspheres and pHEMA/NVP microspheres. 
     The pHEMA-microspheres were prepared by the suspension polymerization of the monomer HEMA in an aqueous medium containing 17% w/w sodium chloride and 0.672% w/w magnesium hydroxide. The suspension stabilizer magnesium hydroxide was prepared in situ by precipitation from magnesium chloride using sodium hydroxide. The dispersed phase contained the monomer HEMA (96.8% w/w), the cross-linker tetra-ethyleneglycol-dimethacrylate (tetra-EGDM) (3% w/w) (Fluka Chemie, the Netherlands) and the initiator 2,2′-azobis(2-methylpropionitrile) (AlBN) (0.2% w/w) (Jayakrishnan et al., J. Biomed. Mater. Res. 24, 913 (1990); Jayakrishnan et al., Polymer 31, 1339 (1990)). 
     The reaction, based on the description of Jayakrishnan, was carried out as follows. A 250 mL round-bottomed flask fitted with a stirrer of half-moon type was charged with a solution containing the calculated quantity of sodium chloride and magnesium chloride in 70 mL of water. The flask was heated to 70° C. in a thermostatic oil bath and the required amount of sodium hydroxide was added in 15 mL of water with stirring to precipitate the magnesium hydroxide. The temperature was raised to 80° C. and the monomer with cross-linker and initiator (total weight of 36 g) was introduced drop wise into the flask. The suspension was stirred at 150 rpm for 4 h. 
     After the reaction, the magnesium hydroxide was dissolved by adding dilute hydrochloric acid (Merck, Germany). The beads were washed several times with distilled water. Then they were dried under vacuum in an oven at 35° C. and sieved into different fractions using standard test sieves (Retsch, Germany). 
     With monomers such as HEMA that are highly water soluble, dispersion of the monomer into droplets has to be carried out in concentrated salt solutions in which the distribution coefficient of the monomer is very low. By varying the stabilizer concentration and stirring speed the size of the beads can be varied (Jayakrishnan et al., J. Biomed. Mater. Res. 24, 913 (1990)). 
     The pHEMA/NVP spheres were prepared via the same method, as described above. Here the dispersed phase consisted not only of the monomer HEMA, but it consisted of 70/30% w/w HEMA/NVP. The addition of NVP to the microspheres resulted in more hydrophilic microspheres. The suspension polymerization was carried out as described above. The yield of both reactions was 75% for the pHEMA spheres and 95% for the pHEMA/NVP spheres. The distribution of the different beads into sizes is given in table 1. 
     
       
         
               
             
               
               
               
               
               
             
               
               
               
               
               
             
               
               
               
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 Size distribution of the microspheres 
               
             
          
           
               
                   
                 pHEMA 
                   
                 pHEMA/NVP 
                   
               
             
          
           
               
                   
                 size (μm) 
                 % w/w 
                 size (μm) 
                 % w/w 
               
               
                   
                   
               
             
          
           
               
                   
                 &lt;200 
                 19.6% 
                 &lt;200 
                 0.5% 
               
               
                   
                 200-300 
                 28.4% 
                 200-300 
                 15.2% 
               
               
                   
                 300-425 
                 36.2% 
                 300-425 
                 34.8% 
               
               
                   
                  425-1000 
                 15.6% 
                 425-600 
                 46.7% 
               
               
                   
                 &gt;1000  
                 0.2% 
                 &gt;600 
                 2.7% 
               
               
                   
                   
               
             
          
         
       
     
     Example 3 
     Swelling and Drug Loading of Microparticles 
     The lumen of the OphthaCoil as prepared in Example 1 was appr. 450 μm in diameter, so in the following experiments the fraction of beads of 300-425 μm was used. To determine the diameters of the different beads, dry or swollen, a light microscope (Nikon Eclipse 800) and a program for image processing and analysis (ImageJ, version 1.32j) were used. First the diameters of dry microspheres (n=50) were measured. Then the spheres were put in Simulated Lacrimal Fluid (SLF) (Paulsson et al., J. Pharm. Sci. 90(9) 1216 (2001)). The diameters of the swollen microspheres were measured after 4 h and finally the total volume swelling was calculated by the formula:
 
Vol. Swelling= r   wet   3   /r   dry   3 ×100%, with  r =radius of the sphere.
 
     Also the swelling of the microspheres in time was investigated. To do this, a dry microsphere was put under the microscope. Several drops of SLF were put onto the microsphere and photos are taken at different time points between 0 and 45 minutes. The radius of the microsphere can then be measured in time. 
     The average diameters of the dry microspheres (n≧300) and the swelling times are given in Table 2. Also the volume swelling is given in the table. 
     
       
         
               
             
               
               
               
               
             
               
               
               
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 2 
               
             
             
               
                   
               
               
                 Average size and swelling of the different microspheres 
               
             
          
           
               
                   
                   
                 pHEMA 
                 pHEMA/NVP 
               
               
                   
                   
               
             
          
           
               
                   
                 Average size diameter 
                 195 
                 μm 
                 300 
                 μm 
               
               
                   
                 Swelling time 
                 20 
                 minutes 
                 10 
                 minutes 
               
             
          
           
               
                   
                 Diameter swelling 
                 13.5%   
                 15% 
               
               
                   
                 Volume swelling 
                 50% 
                 52% 
               
               
                   
                   
               
             
          
         
       
     
     In the following experiments the dye fluorescein sodium salt is used to load the microspheres. The dye serves as a model compound of a drug. The microspheres were put in a vial with a concentrated solution of fluorescein sodium salt (75 mM) for 24 hours. The excess of the solution was removed from the vial and the spheres were lyophilized. The dry spheres contained the dye, as could be inferred from their orange color. Then the coils could be filled with dye-loaded microspheres through a tiny funnel. 
     Example 4 
     Release Characteristics of Dye-Loaded Microspheres 
     The release of fluorescein sodium salt from the device was measured in three different experiments in fourfold for both types of microspheres. In the different experiments the drug loading of the coils was different. This is explained in table 3. 
     
       
         
               
             
               
               
               
             
           
               
                 TABLE 3 
               
             
             
               
                   
               
               
                 Types of drug loading of the device. 
               
             
          
           
               
                 Experiment 
                 Coil 
                 Lumen 
               
               
                   
               
               
                 A 
                 Drug-loaded coating 
                 No microspheres 
               
               
                 B 
                 Not loaded coating 
                 Drug-loaded microspheres 
               
               
                 C 
                 Drug-loaded coating 
                 Drug-loaded microspheres 
               
               
                   
               
             
          
         
       
     
     The experimental set up is shown in  FIG. 1 . Simulated lacrimal fluid was pumped through a tube, with an inner diameter of 1 mm. The flow was set on 0.1 mL/min. A coil was placed on the end of the tube and fractions of appr. 150 μL were collected in Eppendorf vials at different time points. The concentration of fluorescein sodium in these fractions was measured with a spectrofluorimeter, using a 96-wells plate and a calibration curve. 
     The curves of the release experiments based on pHEMA microspheres are given in  FIG. 2 . It may be concluded that the capacity of the OphthaCoil can be increased by filling the lumen of the coil with drug-loaded microspheres. The dye fluorescein sodium salt was released for over 5 hours from the device. 
     To compare both types of microspheres, the release of experiment B (no drug-loaded coating, only drug-loaded microspheres) is given in  FIG. 3 . The total release of fluorescein sodium was determined by calculating the area under the curve (AUC). The results are given in Table 4. When the composition of the microspheres was changed from pHEMA to HEMA/NVP in 70/30% w/w, the drug-loading capacity was more than doubled to 70 μg. 
     
       
         
               
             
               
               
               
             
           
               
                 TABLE 4 
               
             
             
               
                   
               
               
                 The amounts of fluorescein sodium released 
               
               
                 from the different microspheres 
               
             
          
           
               
                   
                 Type of microspheres 
                 Total amount FI-Na released 
               
               
                   
                   
               
               
                   
                 pHEMA 
                 33 μg (n = 4) 
               
               
                   
                 pHEMA/NVP 
                 70 μg (n = 4) 
               
               
                   
                   
               
             
          
         
       
     
     Example 5 
     Flexibility of the OphthaCoil Device 
     The following experiment demonstrates that it is possible to fill the lumen with microspheres without adversely affecting the flexibility. This is demonstrated against  2  controls wherein coated filaments are introduced into the lumen or wherein the lumen is left empty. The experiments are performed in the dry and the hydrated state. 
     The coil&#39;s flexibility, after introducing wires or microspheres in the lumen, was measured with a three-point bending test. The coil was placed onto two clamps with a space of 10 mm. Then the coil was bent in the middle and the displacement was set on 2.5 mm. The force necessary to bend the coil was measured. The set-up is shown in  FIG. 4 . The coils were filled in several ways to compare the flexibility. Table 5 shows the different coils used in this experiment. 
     
       
         
               
             
               
               
             
           
               
                 TABLE 5 
               
             
             
               
                   
               
               
                 The different coils used for the flexibility experiment 
               
             
          
           
               
                 Coil 
                 Lumen 
               
               
                   
               
               
                 1 
                 empty lumen 
               
               
                 2 
                 three coated metallic wires 
               
               
                 3 
                 pHEMA microspheres 
               
               
                   
               
             
          
         
       
     
     In the eye, the coil is placed in the conjunctival sac. Here the tear fluid will hydrate the coil. To imitate a natural environment, all three measurements were done in the dry and the hydrated state. For hydration, the coils were placed in water for one hour and the bending test was repeated with hydrated coils. All measurements (n=4) were done at room temperature. 
     
       
         
               
             
               
               
               
             
               
               
               
               
               
             
               
               
               
               
               
             
           
               
                 TABLE 6 
               
             
             
               
                   
               
               
                 Average value of the spring-constants for 
               
               
                 the different types of coils (n = 4) 
               
             
          
           
               
                   
                 Dry state 
                 Wet state 
               
             
          
           
               
                   
                 Constant 
                 St. dev. 
                 Constant 
                 St. dev. 
               
               
                   
                 (mN/mm) 
                 (n = 4) 
                 (mN/mm) 
                 (n = 4) 
               
               
                   
                   
               
             
          
           
               
                 Empty coils 
                 0.79 
                 0.09 
                 0.87 
                 0.06 
               
               
                 Coils with MS 
                 1.60 
                 0.32 
                 1.69 
                 0.25 
               
               
                 Coils with wires 
                 36.22 
                 1.68 
                 35.02 
                 0.96 
               
               
                   
               
             
          
         
       
     
       FIG. 5  shows the average values of the measurements, and Table 6 shows the spring constants of the different coils as well as their standard deviations. In the figure, the force is plotted against the displacement. The figure shows that the coil with coated wires inside the lumen has a much higher bending stiffness than the other two coils. The coil with microspheres in the lumen has a doubled bending stiffness than the empty coil. There are no significant differences between dry and wet coils. 
     This experiment has demonstrated that the lumen of the OphthaCoil can be filled with microspheres, without compromising the coil&#39;s flexibility. This in contrast with filaments in the lumen of the coil, which do affect the flexibility negatively.