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Title:
Bioartificial lacrimal gland
United States Patent: 7,547,447
Issued: June 16, 2009
Inventors: Yiu; Samuel C.
(Marina del Rey, CA), Mircheff; Austin K. (La Crescenta, CA), Smith;
Ronald E. (Los Angeles, CA), Jacob; Jean (New Orleans, LA), Trousdale; Mel
(Pasadena, CA)
Assignee: Doheny Eye
Institute (Los Angeles, CA), The Board of Supervisors of Louisiana State
University and Agriculture and Mechanical College (New Orleans, LA)
Appl. No.: 10/990,359
Filed: November 15, 2004
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Outsourcing Guide
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Abstract
The present invention provides a
bioartificial lacrimal gland which contains at least one unit that
includes (a) a permeable housing having an interior and an exterior; (b)
an outlet connecting the housing interior to the housing exterior; and (c)
a population of lacrimal epithelial cells within the housing interior.
Description of the
Invention
SUMMARY OF INVENTION
The present invention provides a bioartificial lacrimal gland which contains
at least one unit that includes (a) a permeable housing having an interior
and an exterior; (b) an outlet connecting the housing interior to the
housing exterior; and (c) a population of lacrimal epithelial cells within
the housing interior. In one embodiment, a bioartificial lacrimal gland of
the invention is characterized by directional fluid secretion in which fluid
exits from the housing interior through the outlet. The directional fluid
secretion rate can be, for example, at least 6.5 .mu.l/cm.sup.2/hour.
Further provided herein is a method of treating or reducing the severity of
a disorder resulting from lacrimal gland dysfunction in an individual by
implanting into the individual a bioartificial lacrimal gland that includes
at least one unit containing (a) a permeable housing having an interior and
an exterior; (b) an outlet connecting the housing interior to the housing
exterior; and (c) a population of lacrimal epithelial cells within the
housing interior.
DETAILED DESCRIPTION OF THE INVENTION
The present invention provides a bioartificial lacrimal gland which contains
at least one unit that includes (a) a permeable housing having an interior
and an exterior; (b) an outlet connecting the housing interior to the
housing exterior; and (c) a population of lacrimal epithelial cells within
the housing interior. In one embodiment, a bioartificial lacrimal gland of
the invention is characterized by directional fluid secretion in which fluid
exits from the housing interior through the outlet. The directional fluid
secretion rate can be, for example, at least 6.5 .mu.l/cm.sup.2/hour.
Any of a variety of permeable housings are useful in a bioartificial
lacrimal gland of the invention. In one embodiment, a bioartificial lacrimal
gland of the invention includes a permeable housing which has a concave
interior surface. Such a permeable housing can have, for example, a
substantially cylindrical interior surface or a substantially spherical
interior surface and further can be, for example, substantially tubular.
In one embodiment, the permeable housing included in a bioartificial
lacrimal gland of the invention is a tube. In another embodiment, the
permeable housing is a tube having a first closed end and a second end which
is the outlet connecting the housing interior to the housing exterior. Where
the permeable housing of a bioartificial lacrimal gland is tubular, the tube
can have a lumen, for example, of uniform diameter. In particular
embodiments, the lumen of the tube has a diameter of no more than 2 mm or a
diameter of between 0.1 and 0.5 mm. In further embodiments, the length of
the tube is at most 10 mm or at most 5 mm. A permeable housing useful in the
invention can be, for example, a porous housing having any of a variety of
pore sizes including, without limitation, a pore size of between 0.01 and 10
microns or a pore size of between 0.1 and 5 microns.
Permeable housings useful in the invention can be composed of any of a
variety of biomaterials including, but not limited to, polymeric
biomaterials such as homopolymeric and copolymeric biomaterials;
non-biodegradable biomaterials and biodegradable biomaterials. As
non-limiting examples, a permeable housing useful in the invention can
include a biomaterial such as polysiloxane; polydimethylsiloxane;
polyurethane; polyvinylpyrrolidone; polymethacrylate; polyvinyl alcohol;
polyethylene; polyethylene glycol; poly(glycolic acid); poly(L-lactic acid);
poly(lactic-co-glycolic acid); collagen; cellulose; or a copolymer or
derivative thereof. As further non-limiting examples, a permeable housing
useful in the invention can include at least 90% of one of the following
biomaterials: polysiloxane; polydimethylsiloxane; polyurethane;
polyvinylpyrrolidone; polymethacrylate; polyvinyl alcohol; polyethylene;
polyethylene glycol; poly(glycolic acid); poly(L-lactic acid); poly(lactic-co-glycolic
acid); collagen; cellulose; or a copolymer or derivative thereof.
A bioartificial lacrimal gland of the invention optionally includes a
viscous substratum within the housing interior. In one embodiment, the
viscous substratum is adhered to the interior surface of the permeable
housing. A viscous substratum useful in the invention can be, for example, a
gel such as a hydrogel and further can include, without limitation,
collagen, hydroxymethylcellulose, hyaluronan, or a copolymer or derivative
thereof A viscous substratum useful in the invention also can include, for
example, one or more other extracellular matrix components such as
MATRIGEL.TM.. In one embodiment, the viscous substratum includes MATRIGEL.TM.
at a final concentration of 0.25 to 5 mg/ml. In another embodiment, the
viscous substratum includes MATRIGEL.TM. at a final concentration of 0.25 to
5 mg/ml and further includes fetal bovine serum.
In a bioartificial lacrimal gland of the invention, the lacrimal epithelial
cells can be polarized and, further, can be arrayed in a polarized
monolayer. Such a polarized monolayer of lacrimal epithelial cells
optionally can be adhered to the viscous substratum. Any of a variety of
lacrimal epithelial cells are useful in the bioartificial glands of the
invention including, without limitation, primary cells, established cells,
transfected cells, human cells, primate cells, rabbit cells, and goose
cells. In one embodiment, the population of lacrimal epithelial cells is a
population of human lacrimal epithelial cells. In another embodiment, the
population of lacrimal epithelial cells is a population of rabbit lacrimal
epithelial cells.
A variety of additional components optionally can be included in a
bioartificial gland of the invention. As non-limiting examples, a
bioartificial gland of the invention can include at least one growth factor
or immunosuppressive agent. In particular embodiments, a bioartificial
lacrimal gland of the invention includes HEPATO STIM.RTM. Culture Medium,
epidermal growth factor or nerve growth factor. In another embodiment, a
bioartificial lacrimal gland of the invention includes fetal bovine serum at
a concentration of 10% and epidermal growth factor at a concentration of 5
ng/ml.
A bioartificial lacrimal gland of the invention optionally includes a gate
which is joined to the outlet connecting the housing interior to the housing
exterior. Such a gate can be, for example, responsive to a stimulus. If
desired, a bioartificial lacrimal gland of the invention further can include
an encapsulating membrane which is impermeable to antibodies and immune
cells.
A bioartificial lacrimal gland of the invention can include a single unit or
can include a plurality of units, where each unit contains (a) a permeable
housing having an interior and an exterior; (b) an outlet connecting the
housing interior to the housing exterior; and (c) a population of lacrimal
epithelial cells within the housing interior. In one embodiment, a
bioartificial lacrimal gland of the invention has at least three units. In
another embodiment, a bioartificial lacrimal gland of the invention has at
least five units. In a further embodiment, a bioartificial lacrimal gland of
the invention additionally includes a unit support which holds each of the
plurality of units in a defined configuration. In yet another embodiment, a
bioartificial lacrimal gland of the invention includes a unit support which
holds each of the plurality of units substantially in parallel. Any of the
above bioartificial lacrimal glands of the invention may optionally include
an encapsulating membrane which is impermeable to antibodies and immune
cells.
In a bioartificial lacrimal gland of the invention including a plurality of
units, the permeable housing can be, without limitation, a tube and
additionally can be a tube having a first closed end and a second end which
is the outlet. Furthermore, in a bioartificial lacrimal gland of the
invention including a plurality of tubes having first closed ends and second
ends which are outlets, the gland can further include a common duct which is
joined to each of the outlets. In one embodiment, the common duct further
includes a gate which optionally can be responsive to a stimulus. In another
embodiment, a bioartificial lacrimal gland of the invention includes an
encapsulating membrane which is impermeable to antibodies and immune cells.
As is well known in the art, the cells of a tissue-engineered organ capable
of fluid secretion generally are capable of attaining and maintaining a
polarized monolayer organization (Aframian et al., Tissue Eng. 8(5):871-8.
(2002)). Furthermore, to secrete fluid unidirectionally, secretory cells
generally express an asymmetric distribution of transport proteins which
generate an osmotic gradient to provide a facilitated water permeability
pathway (Baum et al., Ann. NY Acad. Sci. 694:17-23 (1993); Mostov et al.,
Curr. Opin. Cell Biol. 12:483-490 (2000); and Agre et al., J. Biol. Chem.
273:14659-14662 (1998)). The asymmetric distribution of membrane proteins is
due, at least in part, to demarcation of apical and basolateral membrane
domains by tight junctions.
A bioartificial lacrimal gland of the invention can ameliorate, at least in
part, dry eye syndrome and other disorders resulting from lacrimal gland
dysfunction by providing supplemental fluid secretion. In a bioartificial
lacrimal gland of the invention, the lacrimal epithelial cells can be
polarized as in a native gland; such polarized cells are characterized by
apical concentrations of secretory granules, junctional complexes at the
apical-lateral cell surfaces, and basal nuclei and basal lamellae of the
endoplasmic reticulum.
A bioartificial lacrimal gland of the invention can be functionally
characterized by producing a directional fluid secretion rate of, for
example, at least 6.5 .mu.l/cm.sup.2/hour. Furthermore, as non-limiting
examples, a bioartificial lacrimal gland of the invention can be
functionally characterized by producing a directional fluid secretion rate
of, for example, at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 16, 18 or 20 .mu.l/cm.sup.2/hour.
As disclosed further below, the directional fluid secretion rate can be
produced by a bioartificial gland which has a single permeable housing unit
including an outlet and population of lacrimal epithelial cells within the
housing interior, or can accrue from a bioartificial gland which contains a
plurality of such units.
A bioartificial lacrimal gland of the invention contains at least one unit
which includes (a) a permeable housing having an interior and an exterior;
(b) an outlet connecting the housing interior to the housing exterior; and
(c) a population of lacrimal epithelial cells within the housing interior.
As used herein, the term "unit" is synonymous with "unit of a bioartificial
lacrimal gland" or "gland unit" and, at a minimum, contains (a) a permeable
housing having an interior and an exterior; (b) an outlet connecting the
housing interior to the housing exterior; and (c) a population of lacrimal
epithelial cells within the housing interior. It is understood that a
bioartificial lacrimal gland of the invention includes, at a minimum, a
single unit and, in some cases, is identical to a unit. In other cases, a
bioartificial lacrimal gland of the invention includes two or more units or
includes a single unit or a plurality of units held by a unit support in a
defined configuration.
As used herein, the term "housing" means any macromolecular structure,
carrier or framework which can be formed so as to have an interior within
which cells can be contained. A housing may be fabricated from any
combination of biological, chemical or other materials which is compatible
with implantation into the human eye. Housings useful in the invention
include, without limitation, those which are essentially impervious to
degradation in the human body as well as those which biodegrade at a variety
of rates. Housings useful in the invention further include, without
limitation, transparent and opaque housings; non-fouling housings; and
housing of varying pliability and tensile strength, including housings with
a pliable structure which can accommodate movement within the eye once
implanted and which do not create pressure having a detrimental effect on
the ocular physiology of the individual receiving the artificial gland.
As used herein, the term "permeable housing" means a structure, either
natural or synthetic or a combination thereof, which acts as a highly
efficient filter in the range of molecular dimensions, allowing passage of
ions, water and other solvents and very small molecules, but almost or
entirely preventing passage of macromolecules such as proteins and colloidal
particles. A permeable housing generally allows the passage of solvents and
small molecules with a diameter of about 8 .ANG.. In one embodiment, a
permeable housing useful in the invention has a microporous structure. In
another embodiment, a permeable housing useful in the invention is a
permeable membrane. One skilled in the art understands that a permeable
housing may be constructed from a porous or non-porous biomaterial or a
combination thereof.
The term "porous housing," as used herein, means a permeable housing which
contains pores. Pores are generally minute cavities in the housing providing
a capillary channel to the surface of the housing and can be, for example,
substantially linear. Where a porous housing useful in the invention is a
porous membrane, such a membrane typically has pores having a diameter of
from 8 .ANG. to 100 .ANG. or more. It is understood that a porous housing
can be constructed so as to allow directional passage of water and other
solvents and small molecules.
Polymers useful in constructing a permeable housing of the invention
include, without limitation, non-biodegradable and biodegradable polymers;
naturally occurring and synthetic polymers and copolymers; porous and
non-porous polymers; linear and branched polymers, homopolymers and
copolymers; modified or derivatized polymers and copolymers; polymers and
copolymers in which the units have different chiralities; and combinations
of two or more of such materials. Polymers and copolymers useful in the
invention further include, yet are not limited to, polysiloxanes such as
polydimethylsiloxane and copolymers thereof; vinyl polymers and copolymers
such as polyvinylpyrrolidone, polymethacrylate and polyvinyl alcohol;
acrylic polymers and copolymers; linear and other polyethers such as
polyethylene glycol (PEG); polyesters such as poly(glycolic acid),
poly(lactic acid) and copolymers of thereof; polypeptides such as collagen;
and polysaccharides such as cellulose.
As non-limiting examples, a permeable housing useful in the invention can
include a biomaterial such as polysiloxane; polydimethylsiloxane;
polyurethane; polyvinylpyrrolidone; polymethacrylate; polyvinyl alcohol;
polyethylene; polyethylene glycol; poly(glycolic acid); poly(L-lactic acid);
poly(lactic-co-glycolic acid); collagen; cellulose; or a copolymer or
derivative thereof. As further non-limiting examples, a permeable housing
useful in the invention can include at least 90% of one of the following
biomaterials: polysiloxane; polydimethylsiloxane; polyurethane;
polyvinylpyrrolidone; polymethacrylate; polyvinyl alcohol; polyethylene;
polyethylene glycol; poly(glycolic acid); poly(L-lactic acid); poly(lactic-co-glycolic
acid); collagen; cellulose; or a copolymer or derivative thereof.
A permeable housing useful in the invention can be fabricated, for example,
from a non-biodegradable biomaterial, which is a biomaterial which does not
change substantially over the period of use, for example, one year or five
years or longer. In one embodiment, a permeable housing useful in the
invention contains a non-biodegradable polymer. In another embodiment, the
non-biodegradable polymeric biomaterial is hydrophobic. Non-biodegradable
polymeric biomaterials useful in the invention include naturally occurring
and synthetic polymeric biomaterials such as, without limitation,
polysiloxane; polyurethane; poly(methylmethacrylate); poly(vinyl chloride);
poly(ethylene-co-vinyl acetate); polyethylene; and copolymers and
derivatives thereof.
As an example, a permeable housing useful in the invention can be fabricated
from a non-biodegradable polymeric biomaterial such as polysiloxane, a
partially inorganic polymer commonly known as silicone and having the
following structure
-- see Original Patent.
In a particular embodiment, a permeable housing useful in the invention
includes the polysiloxane polydimethylsiloxane, also known as PDMS.
Polysiloxanes such as PDMS and silicone elastomers, described below, have
been useful in biomedical applications, for example, in catheters, drug
delivery devices and as tubes which serve as guidance channels for nerve
regrowth (Lundborg et al., J. Neuropath. Exper. Neur. 41:412-422 (1982)).
Polysiloxanes are chemically inert and stable polymers with excellent
biocompatibility, inducing only a limited inflammatory response following
implantation. Polysiloxanes also are characterized by high chain flexibility
and oxygen permeability, and are stable toward hydrolysis. As is known in
the art, the physical characteristics of polysiloxanes can be modified, for
example, by varying the polymer molecular weight, degree of cross-linking or
by chemical modification, for example, introduction of substituents in place
of one or both pendant methyl groups. Polysiloxanes which are cross-linked
and those which are reinforced also can be useful in constructing a
permeable housing; such polysiloxanes include, without limitation,
polysiloxanes reinforced with PET (Dacron) fiber meshes, or polysiloxanes
which include cross-linked dimethylsiloxane polymer or silica or both for
reinforcement. A permeable housing also can be constructed from a
non-biodegradable siloxane copolymer such as, without limitation,
dimethylsiloxane copolymerized with ethylene oxide and methyl methacrylate.
See, for example, Ulman et al., J. of Controlled Release 10:251-260 (1989),
Ulman et al., J. of Controlled Release 10:261-272 (1989), Ulman and Lee, J.
of Controlled Release 10:273-281 (1989).
Polysiloxanes can be prepared by routine methods, for example, hydrolysis of
alkylsilicon or arylsilicon halides and also are commercially available, for
example, from Dow Chemical Corporation. Commercially available polysiloxanes
include, without limitation, SILASTIC.RTM. products such as the SILASTIC.RTM.
MDX4-4210 medical grade elastomer. One skilled in the art understands that
polysiloxane and other housings constructed of non-porous biomaterials can
be permeable or non-permeable, in which case they are generally fabricated
in a manner such that pores are introduced.
In a particular embodiment, a permeable housing useful in the invention is a
non-porous housing such as a silicone hydrogel similar to those used in
extended wear contact lenses. Such silicone hydrogels are well known in the
art as described, for example, in Bambury and Seelye, U.S. Pat. No.
5,610,252, and Griesser et al., WO 96/31792.
A permeable housing useful in the invention also can be constructed from
polyurethane, a non-biodegradable polymer which has been useful in
biomedical applications such as catheters, valves and pacemaker leads.
Polyurethanes can be formed by well known methods, for example, reacting a
bischloroformate with a diamine as follows -- see Original Patent, or by
reacting a diisocyanate with a dihydroxy compound, for example, ethanediol
and hexanediisocyanate, as follows
-- see Original Patent.
Polyurethane copolymers also can be useful in a permeable housing of the
invention; in particular, elastomeric block copolymers containing "hard" and
"soft" segments have been useful in biomedical applications. Such
polyurethane elastomers can be prepared, for example, by a two-step process
in which an aromatic isocyanate-terminated polymer in large excess is
reacted with a polyether or polyester containing terminal hydroxyl groups.
The product of this reaction is chain extended with a diamine to produce a
polymer with urea bonds in addition to urethane linkages. As an example, a
segmented polyurethane elastomer can be prepared as follows
-- see Original Patent.
Diisocyanates useful in preparing polyurethane polymers include, without
limitation, 4,4'-diphenylmethane diisocyanate (MDI) and
4,4'-dicyclohexylmethane diisocyanate. See Hergenrother et al. Biomaterials
14: 449-458 (1993). Chain extenders useful in preparing polyurethane
elastomers include, without limitation, diols and diamines. One skilled in
the art understands that polyurethanes optionally can be surface-modified,
for example, to enhance cell-interaction properties. As a non-limiting
example, a polyurethane can be surface modified to add a RGD-containing or
other cell adhesion peptide as described in Goodman et al, J. Biomed.
Materials Res. 27:683-695 (1993), or Lin et al., J. Biomed. Materials Res.
28:329-342 (1994).
Polyurethane polymers and copolymers useful in the invention include,
without limitation, silicone-urethane copolymers; polycarbonate-urethanes;
segmented polyurethanes; aliphatic non-ether based polyurethanes; aromatic
ether-based polyurethanes; and aliphatic ether-based polyurethanes (Richards
et al., J. Applied Polymer Sci. 34:1967-1975 (1987)). A variety of useful
polyurethanes are commercially available, for example, ANGIOFLEX.RTM. (Abiomed;
Danvers, Mass.); BIONATE.RTM. (Polymer Technology Group; Berkeley, Calif.);
BIOSPAN.RTM. (Polymer Technology Group); CARDIOTHANE.RTM. (Kontron, Inc.;
Everett, Mass.); CHRONOFLEX.RTM. (CardioTech International; Woburn, Mass.);
ELASTHANE.RTM. (Polymer Technology Group); HEMOTHANE.RTM. (Sarns; Ann Arbor,
Mich.); MITRATHANE.RTM. (PolyMedica Corp.; Woburn, Mass.); SURETHANE.RTM.
(Cardiac Control; Palm Coast, Fla.); and TECOFLEX.RTM. (Thermedics; Woburn,
Mass.).
A permeable housing useful in the invention also can be constructed from a
non-biodegradable vinyl polymer. Vinyl polymers useful in the invention
include, but are not limited to, polyvinylpyrrolidone (PVP);
polymethacrylate; poly(methyl methacrylate) (pMMA); polyvinyl alcohol (PVA);
polyvinyl chloride (PVC); and poly[acrylonitrile-co-(vinyl chloride)]. For
example, the vinyl polymer poly(methyl methacrylate) is a biocompatible
material previously used in intraocular lenses. Poly(methyl methacrylate),
which has the following structure -- see Original Patent, can be routinely
prepared using free radical polymerization. Polyvinyl chloride, which has
good dimensional stability and chemical resistance, has been used, for
example, in medical tubing, catheter tubes and plasmapheresis membranes.
Poly[acrylonitrile-co-(vinyl chloride)], which has the structure
-- see Original Patent.
A permeable housing useful in the invention also can be constructed from a
copolymer of ethylene and vinyl acetate. Such copolymers, known as
polyethylene-co-vinyl acetates or EVAcs, have exceptional biocompatibility
and have been widely used in implanted and topical devices including, for
example, implantation into rabbit corneas and in OCUSERT.RTM. devices (Alzal
Mountain View, Calif.) used for drug delivery to the surface of the eye in
glaucoma treatment (Langer and Folkman, Nature 263:797-800 (1976) and Brown
et al., J. Pharm. Res. 72:1181-1185 (1983)). Polyethylene-co-vinyl acetates
useful in the invention include those which have been washed to remove low
molecular weight oligomers and impurities. As a non-limiting example, a
poly(ethylene-co-vinyl acetate) copolymer useful in the invention can have
40% vinyl acetate and the general structure
-- see Original Patent.
Poly(ethylene-co-vinyl acetate) copolymers can be routinely synthesized, for
example, by free radical polymerization from ethylene and vinyl acetate and
also are commercially available, for example, from Dupont Corporation, which
produces ELVAX.RTM. products such as ELVAX.RTM.-40, a copolymer containing
about 40% vinyl acetate and having a low degree of crystallinity (5-20%).
See, for example, Hsu and Langer, J. Biomed. Materials Res. 19:445-460
(1985). A permeable housing useful in the invention also can be fabricated
from polyethylene-co-vinyl acetate and one or more proteins by, for example,
solvent evaporation or compression molding (Siegel and Langer,
Pharmaceutical Research 2-10 (1984)). Briefly, in solvent evaporation,
extensively washed polyethylene-co-vinyl acetate is dissolved in methylene
chloride; the one or more proteins are lyophilized, ground and sieved to the
desired particle size range, and suspended in the polymer solution. After
the suspension is poured into a chilled mold and allowed to solidify, the
housing is removed from the mold, dried at atmospheric pressure at
-4.degree. C. for 48 hours, and then dried under vacuum at 20.degree. C. for
48 hours.
A non-biodegradable permeable housing useful in the invention also can be
constructed from polyethylene, a biocompatible polymer which is inexpensive
to produce and easy to process. Polyethylene is well known in the art and
has been used in biomedical applications, for example, in catheters (Dumitriu
and Dumitriu-Medvichi, Polymeric Biomaterials, pp. 3-97, New York: Marcel
Dekker, (1994)) and as a guidance channel for nerve regrowth (Madison et
al., Exper. Neurol. 95:378-390 (1987)).
Biodegradable polymers and other biodegradable materials also can be useful
in constructing a permeable housing useful in a bioartificial lacrimal gland
of the invention. Biodegradable polymers are those in which the molecular
weight of the polymer decreases over time; when the constituent polymeric
molecules become sufficiently small, they dissolve, thereby eroding the
permeable housing. It is understood that biodegradable polymers may degrade
slowly or relatively quickly; as non-limiting examples, a biodegradable
polymer or other biomaterial used to construct a permeable housing can have
a rate of degradation in the human body of about several weeks to about
several years (Kim and Mooney, Trends Biotech. 16:224-230 (1998)). One
skilled in the art understands that a biodegradable permeable housing can be
advantageous in that immunotolerance to the implanted lacrimal epithelial
cells can be induced following degradation of the housing. Biodegradable
polymers are well known in the art as described, for example, in Saltzman,
Drug Delivery: Engineering Principles for Drug Therapy New York: Oxford
University Press, 2001; and Chasin and Langer (Eds.), Biodegradable Polymers
as Drug Delivery Systems New York: Marcel Dekker, 1990.
A biodegradable permeable housing useful in the invention can be
constructed, for example, from a polyether such as polyethylene glycol
(PEG), which has the following structure
-- see Original Patent.
Although low molecular weight PEG (less than 1000 Da) is a liquid at room
temperature, higher molecular weight preparations of polyethylene glycol are
solids. Furthermore, for use in constructing a permeable housing useful in
the invention, a water soluble polymer such as polyethylene glycol also can
be crosslinked by chemical or physical means into a solid material or can be
prepared in the form of a copolymer. In addition, synthetic RGD-containing
or other cell adhesion peptides optionally can be immobilized on a
polyethylene glycol permeable housing in order to enhance cell adhesion
properties (see, for example, Drumheller et al., Biotech. Bioengin.
43:772-780 (1994), and Drumheller and Hubbell, Anal. Biochem. 222:380-388
(1994)). Polyethylene glycol is well known in the art for its use in
biomedical applications as described, for example, in Harris (Ed.),
Poly(Ethylene Glycol) Chemistry: Biotechnical and Biomedical Applications
New York: Plenum Press, 1992.
A permeable housing useful in the invention also can be fabricated, for
example, from a biodegradable polymer such as poly(glycolic acid), poly(L-lactic
acid) or poly(lactic-co-glycolic acid). Poly(glycolic acid) and poly(L-lactic
acid), which have the following structures -- see Original Patent, and
copolymers thereof, are well known in the art as described, for example, in
DeLuca et al., Polymeric Delivery Systems: Properties and Applications
Washington, D.C.: American Chemical Society, pp. 53-79 (1993), and Chasin
and Langer (Eds.), Biodegradable Polymers as Drug Delivery Systems New York:
Marcel Dekker, pp. 1-42 (1990). Poly(glycolic acid) is a widely used
synthetic absorbable suture with predictable absorption; outstanding tensile
strength; in vivo inertness; excellent handling properties; and high
porosity which permits diffusion of nutrients and allows subsequent
neovascularization of the developing tissue when used in tissue engineering.
Furthermore, poly(glycolic acid) is suitable for preparing permeable
housings of varying geometry and provides a surface suitable for cell
adherence (Mooney et al., Biomaterials 17:115-124 (1996)).
Poly(L-lactic acid), a slowly biodegradable polymer, also can be useful in
preparing a permeable housing useful in the invention. Poly(L-lactic acid)
is known in the art as a material suitable for tissue engineering as
described, for example, in Aframian et al., Tissue Engineering 6:209-216
(2000). As compared to poly(glycolic acid), poly(L-lactic acid) degrades
more slowly and has greater resistance to compressional forces. Advanced
polymer processing technology can furnish, for example, fibers and sheets of
poly(L-lactic acid) with high tensile strength and high transparency (see,
for example, Tsuji et al., Curr. Interv. Cardiol. Rep. 3:10-17 (2001);
Langer and Vicanti, Science 260: 920-926 (1993); and Aframian et al., supra,
2000).
Copolymers of lactic and glycolic acid also can be useful in fabricating a
permeable housing useful in a bioartificial lacrimal gland of the invention.
Such biodegradable polymers, for example, 50/50 and 85/15 copolymers of
lactic acid and glycolic acid, are well known in the art of tissue
engineering (Aframian et al., supra, 2000). These porous, biodegradable
copolymers can be prepared by well-known methods including, without
limitation, the gas foaming polymer processing approach described in
Sheridan et al., J. Controlled Release 64:91-102 (2000).
The biodegradable polymer collagen, which has been used in preparation of a
variety of ophthalmic devices and drug delivery platforms, also can be
useful in fabricating a permeable housing for use in a bioartificial
lacrimal gland of the invention. Collagens are abundant proteins which in
nature are secreted into the extracellular space by chondrocytes,
fibroblasts and other cell types. Collagens useful in the invention include,
without limitation, collagens type I, type II, type III and type IV.
Collagens are structurally characterized as an alpha-helical chain formed by
three polypeptides of about 1000 amino acids which are specific to each type
of collagen. Collagen types I, II and III generally organize into larger
fibrils of about 10 to 300 nm in diameter which are stabilized by
crosslinking between lysine residues. Unlike the fibrillar collagens,
collagen type IV forms a mesh-like lattice that in nature constitutes a
major part of the mature basal lamina.
A permeable housing useful in the invention also can include a naturally
occurring, biodegradable polymer such as a polysaccharide. As an example,
the polysaccharide cellulose, and derivatives thereof, have previously been
useful as dialysis membranes. In one embodiment, a permeable housing useful
in the invention is fabricated from cellulose, which is a polymer of glucose
residues connected by .beta.-(1,4) linkages
-- see Original Patent.
A permeable housing useful in
the invention also can be prepared using a biodegradable synthetic polymer
such as a poly(anhydride), poly(orthoester) or another synthetic polymer
having functional groups available for covalent modification (Peppas and
Langer, Science 263:1715-1720 (1994)). Amino-acid-based polymers also can be
useful for fabrication of a permeable housing including, without limitation,
artificial collagen-like, silk-like and elastin-like proteins expressed in
bacteria (James and Kohn, MRS Bull. 21:22-26 (1996)); such amino-acid-based
polymers can advantageously interact with cells. Chemically synthesized
pseudo-poly(amino acid)s, such as tyrosine-derived polycarbonates or
polyarylates, also can be useful in fabricating a porous housing useful in
the invention (James and Kohn, supra, 1996). One skilled in the art
understands that a porous housing composed of a biomaterial with a
hydrophobic surface can promote cell adhesion through a hydrophobic
interaction with the lacrimal epithelial cell membrane. Biomaterials with a
hydrophobic surface include, but are not limited to, plastics and other
polymers to which hydrophobic groups have been linked, for example,
polystyrene, polyethylene and polyvinyl. One skilled in the art understands
that these and a variety of other well known naturally occurring and
synthetic non-biodegradable and biodegradable biomaterials can be useful in
constructing a permeable housing useful in the invention. See, for example,
Lewandrwoski et al. (Eds.), Scientific and Clinical Applications New York:
M. Dekker (2002); Saltzman, Tissue Engineering: Engineering Principles for
the Design of Replacement Organs and Tissues New York: Oxford University
Press (2004); Palsson and Sangeeta, Tissue Engineering New Jersey: Pearson
Prentice Hall (2004); and Guilak et al., Functional Tissue Engineering New
York: Springer (2003).
A permeable housing useful in the invention can have any of a variety of
shapes and sizes, which typically are chosen to promote, for example, the
native in situ cytoskeletal organization, tight junction formation,
polarization or monolayer formation of the population of lacrimal epithelial
cells within the housing interior. In particular embodiments, the permeable
housing has a concave interior surface such as a substantially cylindrical
interior surface or a substantially spherical interior surface. In a further
embodiment, the permeable housing is substantially tubular; such a permeable
housing can be a tube such as a tube having a first closed end and a second
end which is the outlet connecting the housing interior to the housing
exterior. Where the permeable housing of a bioartificial lacrimal gland is
tubular, the tube can have a lumen, for example, of uniform diameter. In
particular embodiments, the lumen of the tube has a diameter of no more than
2 mm or a diameter of between 0.1 and 0.5 mm. In further embodiments, the
length of the tube is at most 10 mm or at most 5 mm. As discussed further
below, a permeable housing useful in the invention can be a porous housing
having any of a variety of pore sizes including, without limitation, a pore
size of between 0.01 and 10 microns or a pore size of between 0.1 and 5
microns.
As used herein in reference to a permeable housing, the term "substantially
tubular" means a hollow body having a concave interior surface and an axial
length which is significantly longer than either the width or depth of the
permeable housing. As non-limiting examples, the axial length can be at
least two, three, four, five, six, seven, eight, nine, ten, eleven, twelve,
thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty,
thirty, forty or fifty times the greater of the width or depth of the
permeable housing. Where the permeable housing is cylindrical, the axial
length can be, without limitation, at least two, three, four, five, six,
seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen,
sixteen, seventeen, eighteen, nineteen, twenty, thirty, forty or fifty times
the diameter of the cylinder. It is understood that, while a substantially
tubular permeable housing has a concave interior surface, the exterior of a
substantially tubular permeable housing may have a variety of shapes and
will not necessarily be convex.
The lumen of a substantially tubular permeable housing can be, for example,
symmetrical or non-symmetrical and further can be, without limitation,
cylindrical, elliptical or oblong. It is understood that the lumen of a
substantially tubular permeable housing can have a regular or irregular
diameter such as, without limitation, a fixed diameter, a diameter which
periodically increases and decreases, or a tapering diameter which is
narrower at one end than the other. In one embodiment, a substantially
tubular permeable housing has a first closed end and a second end which is
an outlet connecting the housing interior to the housing exterior. The
outlet can be, for example, narrower, wider or roughly the same dimension as
the closed end of the substantially tubular permeable housing. In another
embodiment, the substantially tubular permeable housing is a tube. As used
herein, the term "tube" means a hollow body with parallel sides and a
concave interior surface. A tube can have, for example, a circular or
elliptical cross section and can be, without limitation, a cylinder. As used
herein, the term "cylinder" means a uniform hollow body with parallel sides
and a circular cross-section.
A permeable housing useful in a bioartificial lacrimal gland of the
invention can be constructed with any of a variety of dimensions. In
general, a permeable housing useful in the invention has an axial length of
at most 20 mm and an inner diameter of at most 3 mm. Such a permeable
housing can have, for example, an axial length of at most 20 mm, 18 mm, 15
mm; 14 mm; 13 mm; 12 mm; 11 mm; 10 mm; 9 mm; 8 mm; 7 mm; 6 mm; 5 mm; 4 mm; 3
mm; 2 mm or 1 mm. As non-limiting examples, a permeable housing useful in
the invention can have, for example, an axial length of from 1 mm to 15 mm;
1 mm to 12 mm; 1 mm to 10 mm; 1 mm to 8 mm; 1 mm to 6 mm; 1 mm to 5 mm; 1 mm
to 4 mm; 1 mm to 3 mm; 3 mm to 15 mm; 3 mm to 12 mm; 3 mm to 10 mm; 3 mm to
8 mm; 3 mm to 6 mm; 3 mm to 5 mm; 4 mm to 15 mm; 4 mm to 12 mm; 4 mm to 10
mm; 4 mm to 8 mm; 4 mm to 6 mm; 5 mm to 15 mm; 5 mm to 12 mm; 5 mm to 10 mm;
5 mm to 8 mm; 5 mm to 6 mm; 6 mm to 15 mm; 6 mm to 12 mm; 6 mm to 10 mm; or
6 mm to 8 mm.
A permeable housing useful in the invention also can have, for example, an
inner diameter of at most 3.00 mm; 2.75 mm; 2.50 mm; 2.25 mm; 2.00 mm; 1.90
mm; 1.80 mm; 1.70 mm; 1.60 mm; 1.50 mm; 1.40 mm; 1.30 mm; 1.20 mm; 1.10 mm;
1.00 mm; 0.95 mm; 0.90 mm; 0.85 mm; 0.80 mm; 0.75 mm; 0.70 mm; 0.65 mm; 0.60
mm; 0.55 mm; 0.50 mm; 0.45 mm; 0.40 mm; 0.35 mm; 0.30 mm; 0.25 mm; 0.20 mm;
0.15 mm; 0.10 mm or 0.05 mm. A permeable housing useful in the invention
also can have, for example, an inner diameter of at least 0.05 mm; 0.10 mm;
0.15 mm; 0.20 mm; 0.25 mm; 0.30 mm; 0.35 mm; 0.40 mm; 0.45 mm; 0.50 mm; 0.55
mm; 0.60 mm; 0.65 mm; 0.70 mm; 0.75 mm; 0.80 mm; 0.85 mm; 0.90 mm; 0.95 mm;
1.00 mm; 1.10 mm; 1.20 mm; 1.30 mm; 1.40 mm; 1.50 mm; 1.60 mm; 1.70 mm; 1.80
mm; 1.90 mm; 2.00 mm; 2.25 mm; 2.50 mm; 2.75 mm; or 3.00 mm. As non-limiting
examples, a permeable housing useful in the invention can have, for example,
an inner diameter of from 0.05 mm to 2 mm; 0.05 mm to 1.5 mm; 0.05 mm to
1.25 mm; 0.05 mm to 1.0 mm; 0.05 mm to 0.90 mm; 0.05 mm to 0.8 mm; 0.05 mm
to 0.7 mm; 0.05 mm to 0.6 mm; 0.05 mm to 0.5 mm; 0.05 mm to 0.4 mm; 0.05 mm
to 0.3 mm; 0.05 mm to 0.2 mm; 0.1 mm to 2 mm; 0.1 mm to 1.5 mm; 0.1 mm to
1.25 mm; 0.1 mm to 1.0 mm; 0.1 mm to 0.90 mm; 0.1 mm to 0.8 mm; 0.1 mm to
0.7 mm; 0.1 mm to 0.6 mm; 0.1 mm to 0.5 mm; 0.1 mm to 0.4 mm; 0.1 mm to 0.3
mm; 0.1 mm to 0.2 mm; 0.2 mm to 2 mm; 0.2 mm to 1.5 mm; 0.2 mm to 1.25 mm;
0.2 mm to 1.0 mm; 0.2 mm to 0.90 mm; 0.2 mm to 0.8 mm; 0.2 mm to 0.7 mm; 0.2
mm to 0.6 mm; 0.2 mm to 0.5 mm; 0.2 mm to 0.4 mm; 0.2 mm to 0.3 mm; 0.3 mm
to 2 mm; 0.3 mm to 1.5 mm; 0.3 mm to 1.25 mm; 0.3 mm to 1.0 mm; 0.3 mm to
0.90 mm; 0.3 mm to 0.8 mm; 0.3 mm to 0.7 mm; 0.3 mm to 0.6 mm; 0.3 mm to 0.5
mm; 0.3 mm to 0.4 mm; 0.4 mm to 2 mm; 0.4 mm to 1.5 mm; 0.4 mm to 1.25 mm;
0.4 mm to 1.0 mm; 0.4 mm to 0.90 mm; 0.4 mm to 0.8 mm; 0.4 mm to 0.7 mm; 0.4
mm to 0.6 mm; 0.4 mm to 0.5 mm; 0.5 mm to 2 mm; 0.5 mm to 1.5 mm; 0.5 mm to
1.25 mm; 0.5 mm to 1.0 mm; 0.5 mm to 0.90 mm; 0.5 mm to 0.8 mm; 0.5 mm to
0.7 mm; or 0.5 mm to 0.6 mm.
In particular embodiments, a permeable housing useful in the invention has
an axial length of from 3 mm to 12 mm and an inner diameter of from 0.05 to
0.6 mm, 0.1 to 0.5 mm, 0.2 to 0.4 mm, 0.25 to 0.35 mm or about 0.3 mm. In
further embodiments, a permeable housing useful in the invention has an
axial length of from 3 mm to 10 mm and an inner diameter of from 0.05 to 0.6
mm, 0.1 to 0.5 mm, 0.2 to 0.4 mm, 0.25 to 0.35 mm or about 0.3 mm. In
additional embodiments, a porous housing useful in the invention has an
axial length of from 3 mm to 8 mm and an inner diameter of from 0.05 to 0.6
mm, 0.1 to 0.5 mm, 0.2 to 0.4 mm, 0.25 to 0.35 mm or about 0.3 mm. In still
further embodiments, a permeable housing useful in the invention has an
axial length of from 4 mm to 6 mm and an inner diameter of from 0.05 to 0.6
mm, 0.1 to 0.5 mm, 0.2 to 0.4 mm, 0.25 to 0.35 mm or about 0.3 mm.
A permeable housing useful in the invention also can have any of a variety
of thicknesses from about 0.01 mm to 1 mm, for example, from 0.01 mm to 0.5
mm or from 0.05 mm to 0.5 mm. As non-limiting examples, the thickness of the
permeable housing can be at most 0.1 mm; 0.2 mm; 0.3 mm; 0.4 mm; 0.5 mm; 0.6
mm; 0.7 mm; 0.8 mm; 0.9 mm or 1.0 mm. As further non-limiting examples, the
thickness of the permeable housing can be at least 0.01 mm; 0.025 mm; 0.050
mm; 0.075 mm; 0.1 mm; 0.2 mm; 0.3 mm; 0.4 mm; or 0.5 mm. It is understood
that the dimensions of a permeable housing can be varied by the skilled
person and that permeable housings of these and other dimensions can be
useful in the bioartificial glands of the invention.
In selecting the size and shape of a permeable housing, it is understood
that one skilled in the art will take into consideration the ocular anatomy
of the individual into whom the bioartificial lacrimal gland is being
implanted including, for example, the curvature of the individual's eye and
the etiology of the lacrimal gland dysfunction. One skilled in the art
further will take into consideration the extent of lacrimal gland
dysfunction including the extent of residual lacrimal gland function, if
any.
In one embodiment, a permeable housing useful in the invention is a porous
housing. In another embodiment, a permeable housing useful in the invention
is a porous membrane. As used herein, the term "membrane" means a thin,
pliable sheet of material. In general, a porous membrane has a thickness of
at most 0.25 mm, for example, from 0.03 to 0.2 mm or from 0.03 to 0.1 mm
and, further, typically has an effective water permeation rate of at least
0.18.times.10.sup.-6 cm.sup.2/second. Porous membranes useful in the
invention can have, for example, a pliability similar to that of a soft
contact lense and include, without limitation, those made of synthetic
materials such as synthetic polymers; film membranes such as silicone film
membranes; and symmetric and asymmetric porous membranes. Thus, porous
membranes useful in the invention include, without limitation, asymmetric
membranes, which possess a thin layer for size selectivity and a thicker,
more porous layer for mechanical strength, and further include asymmetric
membranes like ones used in separation processes such as dialysis.
As non-limiting examples, membrane polymers which have been used in
hemodialysis and hollow fiber bioreactors can be useful in fabricating a
permeable housing which is a porous membrane; such membrane polymers
include, but are not limited to, cellulose and derivatives thereof such as
cellulose diacetate, cellulose triacetate and diethylaminoethyl-substituted
cellulose; polyrnethylmethacrylate; poly(acrylonitrile-co-vinyl chloride);
polyacrylonitrile-methacrylate copolymer; polyacrylonitrile-methallyl
sulfonate copolymer; and polysulfone (see, for example, Pastan and Bailey,
New Engl. J. Med. 338: 1428-1437 (1998)). Porous membranes useful in the
invention further include silicone hydrogels and other membranes of a
biphasic nature. In particular, a porous membrane useful in the invention
can be a biphasic silicone hydrogel such as, without limitation, a
perfluoroalkylether macromer with two polymerizable groups; a polysiloxane-containing
perfluoroalkylether; a polymerizable perfluoroalkylether siloxane macromer
or a polymerizable perfluoroalkylether macromer.
A bioartificial lacrimal gland of the invention also includes an outlet
connecting the housing interior to the housing exterior. As used herein, the
term "outlet" means an opening in the permeable housing through which water
and solutes can pass but which does not permit release of lacrimal
epithelial cells from the housing interior. It is understood that an outlet
can have a variety of positions on the permeable housing. For example, where
the permeable housing is a tube or other substantially tubular structure,
the outlet can be positioned anywhere along the length of the tube or at one
end of the tube and that the outlet is significantly longer than the pores
of a porous housing.
A variety of lacrimal epithelial cell populations can be useful in a
bioartificial lacrimal gland of the invention. As described above, the
lacrimal epithelial cells can be polarized and, further, can be arrayed in a
polarized monolayer. Such a polarized monolayer of lacrimal epithelial cells
optionally can be adhered to a viscous substratum. Any of a variety of
lacrimal epithelial cells are useful in the bioartificial lacrimal glands of
the invention including, without limitation, primary cells, established
cells, transfected cells, and cells from a variety of species. In one
embodiment, the population of lacrimal epithelial cells is a population of
human lacrimal epithelial cells. In another embodiment, the population of
lacrimal epithelial cells is a population of rabbit lacrimal epithelial
cells.
Cell populations useful in the invention include those in which the cell
population within the housing interior is at least 80% pure lacrimal
epithelial cells. In another embodiment, the cell population within the
housing interior is at least 90% pure lacrimal epithelial cells. In still
another embodiment, the cell population within the housing interior is at
least 95% pure lacrimal epithelial cells. In further embodiments, the cell
population within the housing interior is at least 96%, 97%, 98% or 99% pure
lacrimal epithelial cells.
Lacrimal epithelial cells useful in the invention include, without
limitation, naturally occurring and genetically engineered cells, and
further encompass primary cells including primary cells which have been
expanded in culture; lacrimal epithelial cells from established cell lines;
immortalized; transfected and infected cells; and live and attenuated cells.
Lacrimal epithelial cells useful in the invention can be immortalized
primary patient cells or immortalized primary cells from a close relative of
the patient. Immortalized lacrimal gland cell lines also are useful in the
invention and encompass immortalized rabbit cell lines such as those
described in Nguyen et al., In Vitro Cell Dev. Biol. Anim. 35:198-204
(1999), and Saarloos et al., Curr. Eye Res. 19:439-449 (1999). Lacrimal
epithelial cells also can be prepared, for example, by differentiating stem
cells in vitro or in vivo. Lacrimal epithelial cells useful in the invention
include, but are not limited to, mammalian cells such as human cells; cells
from higher order mammals such as primates, dogs and cats; rabbit cells and
goose cells. One skilled in the art understands that these and other species
of lacrimal epithelial cells can be useful in a bioartificial lacrimal gland
to be implanted into a human patient. Such lacrimal epithelial cells can be
characterized, for example, by containing enzymes similar to those generally
found in human lacrimal epithelial cells.
Lacrimal epithelial cells useful in the invention further include those
which express an exogenous nucleic acid molecule. As is well known in the
art, primary or immortalized lacrimal epithelial cells can be transfected or
infected, for example, and thereby express an exogenous nucleic acid
molecule. Methods for gene delivery into lacrimal epithelial cells include,
without limitation, the use of adenoviral or vaccinia viral vectors such as
Ad5CMV or VSC9 as described, for example, in Vanaken et al., J. Steroid
Biochem. Mol. Biol. 78:319-328 (2001), and Banin et al., Invest. Ophthalmol.
Vis. Sci. 44:1529-1533 (2003). Exogenous nucleic acid molecules which can be
expressed in lacrimal epithelial cells for use in a bioartificial gland of
the invention include, without limitation, receptors; integrins; growth
factors such as epidermal growth factor; pro-angiogenic agents such as
fibroblast growth factor (FGF) or vascular endothelial growth factor (VEGF);
extracellular matrix molecules; and transport proteins including, but not
limited to, those described in Baum et al., supra, 1993.
In the methods of the invention for treating or reducing the severity of a
disorder of lacrimal gland dysfunction, the lacrimal epithelial cells can be
autologous, allogeneic or xenogeneic with respect to the individual into
whom the bioartificial lacrimal gland is implanted. Autologous lacrimal
epithelial cells are those derived from the same individual into whom the
bioartificial gland is implanted. Allogenic lacrimal epithelial cells are
those derived from a genetically different individual of the same species as
the individual into whom the bioartificial gland is implanted, and xenogenic
lacrimal epithelial cells are those derived from an individual of a
different species as the individual into whom the bioartificial gland is
implanted. For treatment of humans, allogeneic cells may be derived, for
example, from a family member or a non-family member and can be HLA matched
cells or unmatched cells. By HLA matched cells, it is meant that one or more
of the major histocompatibility complex (MHC) molecules on the lacrimal
epithelial cells included in the bioartificial gland is the same as one or
more of the MHC molecules on the cells of the individual into whom the
bioartificial gland is implanted. Such HLA matched allogeneic cells include,
yet are not limited to, HLA-A2 matched cells. One skilled in the art
understands that unmatched allogenic lacrimal epithelial cells can be
rendered immunocompatible, for example, by genetic engineering to alter cell
surface expression of one or more antigens. Matched or unmatched allogeneic
cells also can be used in conjunction with an immunosuppressive agent as
described further below.
A bioartificial lacrimal gland of the invention optionally includes a
viscous substratum within the housing interior. The term "viscous
substratum," as used herein, means a viscous organic or inorganic material
which promotes the growth, attachment, polarization or tight junction
formation of lacrimal epithelial cells. A viscous substratum can promote,
for example, formation of a monolayer of polarized lacrimal epithelial
cells. In one embodiment, the viscous substratum is adhered to the interior
surface of the permeable housing. In another embodiment, the bioartificial
lacrimal gland is constructed such that the viscous substratum adheres to
the interior surface of the permeable housing, and the polarized monolayer
of lacrimal epithelial cells adheres to the viscous substratum.
A viscous substratum useful in the invention generally has a tensile
strength which is significantly lower than the tensile strength of the
permeable housing in which it resides. The term tensile strength is well
known in the art and means the resistance of a material to a force such as a
longitudinal force tending to tear it apart, measured as the maximum tension
the material can withstand without tearing. In one embodiment, a viscous
substratum useful in the invention has a tensile strength which is at most
50% of the tensile strength of the permeable housing in which it resides. In
further embodiments, a viscous substratum useful in the invention has a
tensile strength which is at most 45%, 40%, 35%, 30%, 25%, 20%, 15% or 10%
of the tensile strength of permeable housing in which it resides. One
skilled in the art understands that tensile strength can be varied by the
skilled artisan and is a property which generally depends upon the component
biomaterial or biomaterials of the permeable housing or viscous substratum
as well as the extent of cross-linking and extent and type of modification,
if any, of the housing and substratum.
A viscous substratum useful in the invention can be a gel such as a hydrogel.
As used herein, the term "gel" is synonymous with "colloidal gel" and means
a mixture with properties between those of a solution and fine suspension
which is in a more solid form than a sol. The term "hydrogel," as used
herein, means a colloidal gel in which water is the dispersion medium.
A viscous substratum useful in the invention can be a simple or complex
material and further can be porous or non-porous. Viscous substrata useful
in the invention include, without limitation, those containing one or more
naturally occurring or synthetic components such as, without limitation, a
peptide, protein, polysaccharide or other polymeric component. As
non-limiting examples, a viscous substratum useful in the invention can
include a protein such as an extracellular matrix component, gelatin or
poly-lysine. As further non-limiting examples, a viscous substratum useful
in the invention can include collagen, hydroxymethylcellulose, hyaluronan,
or a copolymer or derivative thereof As additional non-limiting examples, a
viscous substratum useful in the invention can include a polysaccharide such
as, without limitation, cellulose; starch; glycogen; chitosane; or animated
sepharose. One skilled in the art understands that these and other viscous
substrata including, without limitation, those which function to provide a
porous layer for adherence of lacrimal epithelial cells and those which
function to promote the growth or polarization of lacrimal epithelial cells,
can be useful in the bioartificial lacrimal glands of the invention.
Extracellular matrix components which can be included in a viscous
substratum of the invention encompass, without limitation, MATRIGEL.TM.;
vitrogen; fibronectin; laminin; and collagens such as collagen type I or
collagen type IV. In one embodiment, a viscous substratum useful in the
invention includes MATRIGEL.TM., which is a well known solubilized
preparation made from basement membranes isolated from the EHS mouse sarcoma
line, a tumor cell line rich in extracellular matrix molecules. MATRIGEL.TM.
includes substantial amounts of laminin, collagen IV, heparan-sulfate
proteoglycans, entactin and nidogen (Kleinman et al., Biochem. 21:6188-6193
(1982)) and contains transforming growth factor (TGF-.beta.), basic
fibroblast growth factor-2 (FGF-2), tissue plasminogen activator (TPA) and
other growth factors. When included in a viscous substratum, MATRIGEL.TM.
typically is present at a final concentration of about 0.01 mg/ml to 100
mg/ml, for example, 0.1 mg/ml to 20 mg/ml, 0.1 mg/ml to 10 mg/ml, 0.1 mg/ml
to 5 mg/ml, 0.1 mg/ml to 2.5 mg/ml, 0.1 mg/ml to 1.0 mg/ml, 0.25 mg/ml to 10
mg/ml, 0.25 mg/ml to 5 mg/ml, 0.25 mg/ml to 2.5 mg/ml or 0.25 mg/ml to 1.0
mg/ml. In a particular embodiment, a bioartificial gland of the invention
includes a viscous substratum in which MATRIGEL.TM. is present at a final
concentration of 0.25 to 5 mg/ml. In a further embodiment, a bioartificial
gland of the invention includes a viscous substratum containing fetal bovine
serum in addition to MATRIGEL.TM. at a final concentration of 0.25 to 5
mg/ml. Techniques for applying MATRIGEL.TM. to a permeable housing during
construction of a bioartificial lacrimal gland of the invention are
described herein below.
A bioartificial lacrimal gland of the invention includes at least one unit
which contains (a) a permeable housing having an interior and an exterior;
(b) an outlet connecting the housing interior to the housing exterior; and
(c) a population of lacrimal epithelial cells within the housing interior.
In particular embodiments, a bioartificial lacrimal gland of the invention
includes a plurality of such units, for example, at least three units or at
least five units. In further embodiments, a bioartificial lacrimal gland of
the invention additionally includes a unit support which holds each of the
plurality of units in a defined configuration, for example, a unit support
which holds each of the plurality of units substantially in parallel. Any of
the above bioartificial lacrimal glands of the invention including a
plurality of units may optionally include an encapsulating membrane which is
impermeable to antibodies and immune cells.
In a bioartificial lacrimal gland of the invention including a plurality of
units, the permeable housing can be, without limitation, a tube, and
additionally can be a tube having a first closed end and a second end which
is the outlet connecting the housing interior to the housing exterior.
Furthermore, in a bioartificial lacrimal gland of the invention including a
plurality of tubes having first closed ends and second ends which are
outlets, the gland may optionally include a common duct which is joined to
each of the outlets. In one embodiment, the common duct further includes a
gate which is optionally responsive to a stimulus. In another embodiment, a
bioartificial lacrimal gland of the invention includes an encapsulating
membrane which is impermeable to antibodies and immune cells. As a
non-limiting example, a bioartificial lacrimal gland containing three units
based on a porous tubular housing is shown in FIG. 2
(see Original Patent).
A bioartificial lacrimal gland having a plurality of units can be
advantageous as compared to a bioartificial gland having a single unit since
the gland with a plurality of units can produce a greater directional fluid
secretion rate while maintaining a limited radius of curvature of the
concave interior surface and a limited axial length of the individual units.
As non-limiting examples, a bioartificial lacrimal gland including a
plurality of units can have at least two, three, four, five, six, seven,
eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen,
seventeen, eighteen, nineteen, twenty, thirty, forty, fifty, sixty, seventy,
eighty, ninety, 100, 200, or more units, which units can be identical or
non-identical. One skilled in the art understands that the number of units
will be selected taking in account the ocular anatomy of the individual into
whom the gland is being implanted; the severity of lacrimal gland
dysfunction including the extent of residual lacrimal gland function, if
any; and the desired fluid-secretion rate.
The optional unit support can have, for example, a top side, which faces
away from the eye and a bottom side, which is in direct or indirect contact
with the globe of the eye. In a bioartificial lacrimal gland of the
invention, it is the top side of the unit support which typically directly
or indirectly holds the plurality of units in a defined configuration.
Furthermore, in a bioartificial lacrimal gland of the invention, the bottom
of the unit support typically is shaped to fit the contour of the globe such
that the unit support arches over the globe.
The size and dimensions of a bioartificial lacrimal gland including the
plurality of units and the unit support, if any, can vary. In general, a
bioartificial lacrimal gland of the invention has a length of at most 30 mm;
a width of at most 30 mm and a depth of at most 5 mm. As non-limiting
examples, a bioartificial lacrimal gland of the invention, including any
number of units and optionally a unit support can have, without limitation,
a length of from 1 mm to 20 mm, a width of from 1 mm to 20 mm and a depth of
from 0.5 to 5 mm, or a length of from 1 mm to 10 mm, a width of from 1 mm to
10 mm; and a depth of from 0.5 to 5 mm. One skilled in the art understands
that these are illustrative dimensions which can be varied by one skilled in
the art of ophthalmology.
A bioartificial lacrimal gland of the invention can be made by routine
methods. The bioartificial gland can include an integrally formed permeable
housing or a housing constructed from two or more components or surface
treatments. The permeable housing can be manufactured as a unitary or
multi-component structure in a variety of ways as will be appreciated by
those of skill in the art. In one embodiment, the permeable housing includes
at least two components connected together. For example, where the unit
gland includes an attachment surface on the exterior surface of the
permeable housing to aid in tissue ingrowth, an outer sleeve of porous
material such as expanded polytetrafluoroethylene (PTFE) or other tissue
ingrowth material can be attached by bonding the two components together
using, without limitation, solvent bonding, thermal bonding, adhesives or
other means well known in the art.
A variety of well known techniques are suitable for preparing a permeable
housing from a polymeric or non-polymeric biomaterial. Such techniques
include, yet are not limited to, gas foaming polymer processing methods;
solvent evaporation methods; phase separation methods; interfacial methods;
extrusion methods; molding methods including injection molding methods; heat
press methods and the like. See U.S. Pat. Nos. 5,164,188 and 5,660,847 and
Scott and Roff (Eds.), Handbook of Common Polymers Section 64; CRC Press;
Cleveland, Ohio (1971). As a non-limiting example, a poly(glycolic acid);
poly(lactic acid); or poly(lactic-co-glycolic acid) polymer can be
fabricated into the desired shape of porous permeable housing using a well
known technique such as molding, extrusion or solvent casting (Kim and
Mooney, supra, 1998). As further non-limiting examples, a permeable housing
can fabricated using injection molding, which is well known in the art as
described, for example, in U.S. Pat. Nos. 3,432,592; 4,801,460; 4,806,377;
5,004,601; 5,082,655; and 6,331,313, or can be fabricated using gas foaming
polymer processing with CO.sub.2 and biomaterials such as, without
limitation, amorphous copolymers of lactide and glycolide without organic
solvents or high temperatures essentially as described in Sheridan et al.,
supra, 2000. As described further below, a pro-angiogenic agent or other
component can be incorporated into the permeable housing during the
fabrication process, for example, for subsequent controlled release
(Sheridan et al., supra, 2000).
As a non-limiting example, a tubular permeable housing with a viscous
substratum including MATRIGEL.TM. can be prepared essentially as follows.
MATRIGEL.TM., which is soluble at 4.degree. but forms a gel at 37.degree.,
can be thawed overnight on ice in a refrigerator and, immediately before
use, diluted into cold HEPATO STIM.RTM. Culture Medium (HSM) containing 10%
fetal bovine serum (FBS; Omega Scientific, Inc.; Tarzana, Calif.) and 5 ng/ml
epidermal growth factor (EGF). The final working concentration of
MATRIGEL.TM. for use in applying the viscous substratum to the tubular
permeable housing is approximately 1 mg/ml. The solution of MATRIGEL.TM. can
be applied, for example, into a doubly open-ended tubular permeable housing
essentially as follows. The doubly open-ended permeable housing is perfused
at 4.degree. with a solution of diluted MATRIGEL.TM. in HEPATO STIM.RTM.
Culture Medium and subsequently briefly perfused with media that does not
contain MATRIGEL.TM.. The unstirred fluid layer adjacent to the interior
surface of the tubular permeable housing contains the MATRIGEL.TM. solution.
Upon transfer of the tubular permeable housing to a 37.degree. water bath,
MATRIGEL.TM. lines the interior wall of tubular housing while the lumen of
the permeable housing remains patent. One skilled in the art can vary, for
example, the MATRIGEL.TM. concentration, length of the tubular permeable
housing, and perfusion rate in order to obtain a viscous substratum which is
suitably uniform. If desired, one skilled in the art can readily section the
tubular housing for evaluation of the thickness and uniformity of the
viscous substratum by microscopy.
A population of lacrimal epithelial cells can subsequently be applied into
the interior of the MATRIGEL.TM.-lined tubular permeable housing essentially
as follows. In particular, a suspension of lacrimal epithelial cells is
perfused through permeable housing; such a cell population can be, for
example, suspended in HEPATO STIM.RTM. Culture Medium (HSM) and perfused at
37.degree. C. or, for example, suspended in dilute MATRIGEL.TM. and perfused
at 4.degree. C., then warmed to 37.degree. C. One skilled in the art can
routinely vary parameters such as the cell concentration, perfusion rate and
MATRIGEL.TM. concentration, if any, as well as the length of the tubular
housing and the lumen diameter to achieve the desired characteristics such
as lacrimal cell polarization, monolayer formation and tight junction
formation. The concentration of cells which is perfused generally is in the
range of 1.times.10.sup.6 cells/ml to 5.times.10.sup.7 cells/ml, and can be,
for example, in the range of 5.times.10.sup.6 cells/ml to 1.times.10.sup.7
cells/ml or 2.times.10.sup.7 cells/ml to 4.times.10.sup.7 cells/ml Perfusion
rates typically are in the range of 0.1 ml/minute to 5 ml/minute, and can
be, for example, in the range of 0.1 ml/minute to 3 ml/minute or 0.5
ml/minute to 5 ml/minute. When included in the cell suspension, MATRIGEL.TM.
generally is provided at a concentration of from 0.3 mg/ml to 5 mg/ml, for
example, from 1 mg/ml to 3 mg/ml, or from 0.5 mg/ml to 2 mg/ml.
Further provided herein is a method of treating or reducing the severity of
a disorder resulting from lacrimal gland dysfunction in an individual by
implanting into the individual a bioartificial lacrimal gland which includes
at least one unit containing (a) a permeable housing having an interior and
an exterior; (b) an outlet connecting the housing interior to the housing
exterior; and (c) a population of lacrimal epithelial cells within the
housing interior.
The methods of the invention can be useful for treating or reducing the
severity of any of a variety of disorders resulting from lacrimal gland
dysfunction including disorders of any etiology. One skilled in the art
understands that disorders to be treated by a method of the invention may
result from a reduction in either the quality or quantity of fluid which
forms the tear film of the ocular surface and may be, for example, disorders
of partial or complete lacrimal gland hypofunction or disorders in which the
tear ducts are blocked. Disorders of lacrimal gland dysfunction which can be
treated or reduced in severity according to a method of the invention
encompass, but are not limited to, Stevens-Johnson syndrome; chemical and
thermal eye injuries; ocular cicatricial pemphigoid; Sjogren's syndrome;
rheumatoid arthritis; lupus; and dry eye syndrome of a variety of
etiologies.
In one embodiment, a method of the invention is used to treat dry eye
syndrome (keratoconjunctivitis), which is an inflammation of the cornea and
conjunctiva due to the normal aging of the tear glands or to one of a number
of specific pathologies. See, for example, Tsubota, Adv. Exp. Med. Biol. 506
(Part A): 3-16 (2002); Schaumberg et al., Adv. Exp. Med. Biol. 506 (Part B):
989-998 (2002); and Johnson and Murphy, Prog. Retin. Eye Res. 23(4):449-474
(2004). Dry eye syndrome generally is characterized by hyperemia of the
conjunctiva, lacrimal deficiency, thickening of the corneal epithelium,
itching and burning of the eye and, often, reduced visual acuity. In dry eye
syndrome, the decline in the quality or quantity of fluid that forms the
tear film of the ocular surface results in constant discomfort from eye
irritation which is typically experienced as a sandy or gritty sensation. In
the early stages of the disorder, the symptoms of dry eye may be
intermittent, but generally become more persistent as dry eye continues.
When untreated, dry eye syndrome can lead to scarring or ulceration of the
cornea, infection and possible vision loss.
Dry eye syndrome results from any of a variety of etiologies. The
approximately 10 million Americans afflicted with dry eye syndrome include
those with normal aging of the tear glands as well as nearly 75% of
individuals over the age of 65. Dry eye syndrome is most common in women who
are pregnant or postmenopausal; individuals suffering from allergies or
wearing contact lenses; and in patients with Sjogren's syndrome.
A bioartificial lacrimal gland of the invention can be implanted into any of
several anatomical regions of the eye including, without limitation,
substantially upon the outer surface of the eye or episclerally, for
example, over an avascular region. As a non-limiting example, a
bioartificial lacrimal gland of the invention can be implanted substantially
upon the outer surface of the eye and anchored in the sclera. In one
embodiment, a bioartificial lacrimal gland of the invention is implanted in
the conjunctiva, which is the mucous membrane lining the anterior surface of
the eyeball and the posterior surface of the eyelids. In another embodiment,
a bioartificial lacrimal gland of the invention is implanted in the supero-temporal
conjunctiva and optionally anchored in the sclera. In a further embodiment,
a bioartificial lacrimal gland of the invention is implanted into the supero-temporal
conjunctiva and optionally anchored into one or more orbital bones. In still
another embodiment, a bioartificial lacrimal gland which is implanted into
the supero-temporal conjunctiva and anchored into the sclera or orbital
bones includes a common duct that egresses at the conjunctival surface of
the eye.
One skilled in the art understands that a bioartificial gland of the
invention can be positioned, for example, close to the native lacrimal gland
such that the one or more outlets, or a common duct if present, is localized
relatively close to the tear film. In one embodiment, the one or more
outlets, or a common duct if present, exits underneath the upper eyelid. If
desired, fluid can be directed from one or more outlets or a common duct of
the bioartificial gland to the conjunctival surface by forming holes or
tunnels through layers of the sclera or other tissue, directing the fluid
outflow to the conjunctival surface. Such holes can be formed by surgical
procedures well known in the art or through application of a permeability
enhancing agent such as ethanol, oleic acid, isopropyl myristate or the
like.
A variety of techniques suitable for ocular implantation are well known in
the art and include, without limitation, surgical means, injection and
trocar. As an example, a bioartificial lacrimal gland of the invention can
be implanted, for example, using an implanter as described, for example, in
U.S. Pat. Nos. 3,921,632 or 4,451,254. The mobility of a bioartificial
lacrimal gland of the invention can optionally be reduced or prevented by
anchoring, which can be performed by any of a variety of routine techniques
including, but not limited to, suturing or cellular ingrowth into an
anchoring orbital bone or artificial plate.
One skilled in the art understands that a bioartificial lacrimal gland of
the invention optionally can include one or more additional components. Such
components can have a biological activity which promotes, without
limitation, immunosuppression; vascularization; cell growth; cell adhesion;
stability or resistance to movement; or tissue ingrowth into the implanted
bioartificial lacrimal gland. Such components include, yet are not limited
to, naturally and non-naturally occurring biological, chemical and
pharmaceutical agents such as immunosuppressive agents; pro-angiogenic
agents; soluble growth factors and inhibitors; cell adhesion peptides;
endothelial cells; and feeder cells. Such components can be included within
any portion of the bioartificial lacrimal gland including, without
limitation, the housing interior; interior surface of the permeable housing;
within the viscous substratum; incorporated within the permeable housing
itself; adhered to or associated with the external surface of the permeable
housing or unit support; or otherwise included within or stably associated
with the bioartificial lacrimal gland. As one example, biodegradable
supports which promote vascularization following implantation have been
described for use in tissue engineering (Mooney et al., Cell Transplant.
3:203-210 (1994)). As another non-limiting example, a component which
promotes resistance of the bioartificial gland to movement or which promotes
tissue ingrowth, or both, can be adhered to the external surface of the
permeable housing or unit support or otherwise attached to the exterior of
the permeable housing or unit support, or indirectly attached to a portion
of the bioartificial lacrimal gland.
In one embodiment, a bioartificial lacrimal gland of the invention includes
an immunosuppressive agent. Such an immunosuppressive agent can be useful,
for example, when a bioartificial lacrimal gland is implanted into a patient
with an elevated risk of immunological rejection or who exhibits one or more
symptoms consistent with immunological rejection, or in conjunction with a
bioartificial lacrimal gland which is not encapsulated by a membrane, or as
a precautionary measure especially where unmatched allogeneic or xenogeneic
lacrimal epithelial cells are used. As described further below, one skilled
in the art understands that immunosuppressive agents useful in the invention
include those which are incorporated within a bioartificial lacrimal gland
as well as those administered systemically or locally at the same or a
different site as the site of gland implantation.
A variety of immunosuppressive agents can be useful in the bioartificial
lacrimal glands and methods of the invention. Such immunosuppressive agents
encompass, without limitation, steroids such corticosteroids, prednisolone
acetate, cyclosporin and tacrolimus (FK506); and therapeutic monoclonal
antibodies such as anti-T lymphocyte, anti-CD4+, anti-ICAM-1 and anti-IL-2
antibodies. Such immunosuppressive agents further include, yet are not
limited to, cyclophosphamide, azathioprine, prednisone, methylprednisone,
prostaglandins and other steroids.
An attachment surface also can be useful in a bioartificial lacrimal gland
of the invention. Such an attachment surface can be included, for example,
on the external surface of the permeable housing or unit support in order to
promote tissue ingrowth, thereby stabilizing and maintaining the
bioartificial lacrimal gland at a fixed location following implantation. The
composition and spacing of the one or more attachment surfaces generally
promote cellular ingrowth and provide resistance to both proximal and distal
axial migration of the bioartificial gland. As non-limiting examples, where
the permeable housing is a tube having a first closed end and a second end
which is the outlet connecting the housing interior to the housing exterior,
an attachment surface that promotes tissue ingrowth can be positioned
proximally of the closed end, throughout the length of the tube,
concentrically around the tube, or can cover essentially the entire external
surface of the tube. In one embodiment, the attachment surface is a porous
surface which promotes cellular ingrowth; the porosity of the cell ingrowth
surface can be, for example, in the range of 0.2 .mu.m to 100 .mu.m or
greater, for example, in the range of 0.2 .mu.m to 50 .mu.m or in the range
of 0.2 .mu.m to 20 .mu.m. Suitable materials which promote tissue ingrowth
include, yet are not limited to, polytetrafluoroethylene (PTFE);
polyethylene terephthalate; polyester; polyurethane; silicone; dacron; and
polypropylene knit. In one embodiment, a bioartificial lacrimal gland of the
invention includes PTFE with a 0.22 .mu.m pore size, allowing shallow
ingrowth into the bioartificial gland and preventing axial migration of the
gland along tissue planes.
A pro-angiogenic agent also can be optionally included in a bioartificial
lacrimal gland of the invention. Pro-angiogenic agents are well known in the
art as described, for example, in Folkman and Klagsbrun, Science,
235:442-447 (1987), and include, without limitation, agents which act
predominantly or solely upon endothelial cells such as vascular endothelial
growth factors (VEGFs). Pro-angiogenic agents useful in a bioartificial
lacrimal gland of the invention include naturally occurring and synthetic
angiogenic growth factors and cytokines that induce or promote the growth of
new blood vessels by stimulating endothelial cell growth or migration and
encompass, without limitation, isoforms of vascular endothelial growth
factor (VEGF) such as VEGF-A, including VEGF.sub.121 and VEGF.sub.165, and
various forms of fibroblast growth factor including, but not limited to,
FGF-1 and FGF-2.
VEGF-A, also known as vascular permeability factor (VPF), as well as VEGF-B,
VEGF-C and VEGF-D, can be useful in a bioartificial lacrimal gland of the
invention. Exemplary pro-angiogenic agents useful in a bioartificial
lacrimal gland of the invention include, without limitation, the recombinant
165 kDa isoform of VEGF, designated rhVEGF, developed by Genentech; a
nucleic acid molecule encoding the 121 amino acid isoform of VEGF (BIOBYPASS.TM.;
GenVec/Parke Davis); and nucleic acids encoding VEGF-B, VEGF-C and VEGF-D.
See, for example, Miller and Abrams, Gen. Engin. News 18:1 (1998).
Pro-angiogenic agents useful in a bioartificial lacrimal gland of the
invention further include, without limitation, members of the fibroblast
growth factor family such as FGF-1 (acidic), FGF-2 (basic), FGF-4 and FGF-5
(Slavin et al., Cell Biol. Int. 19:431-444 (1995); and Folkman and Shing, J.
Biol. Chem. 267:10931-10934 (1992)). A fibroblast growth factor useful in
the invention can be, without limitation, FIBLAST.RTM. (trafermin), a
recombinant form of FGF-2 being developed by Scios, Inc. (Mountain View,
Calif.) and Wyeth Ayerst Laboratories (Radnor, Pa.); or GENERX.TM., an
adenoviral gene therapy vector encoding FGF-4 developed by Collateral
Therapeutics (San Diego, Calif.) and Schering A G (Miller and Abrams, supra,
1998). Pro-angiogenic agents useful in the invention further include, yet
are not limited to, angiopoietin-1, an angiogenic factor that signals
through the endothelial cell-specific Tie2 receptor tyrosine kinase (Davis
et al., Cell 87:1161-1169 (1996); and Suri et al., Cell 87:1171-1180
(1996)). One skilled in the art understands that these and other pro-angiogenic
agents, which can be delivered as protein or nucleic acid therapeutics, can
be useful in the bioartificial lacrimal glands and methods of the invention.
A variety of additional components, including those with biological
activity, also can be optionally included in a bioartificial lacrimal gland
of the invention. As one non-limiting example, endothelial cells can be
included in the gland to engineer a vascular network. See, for example,
Holder et al., Tissue Engineering 3:149-160 (1997). As another non-limiting
example, a soluble growth factor such as epidermal growth factor (EGF) or
nerve growth factor (NGF) can be included in a bioartificial lacrimal gland
of the invention. The use of growth factors in tissue engineering is well
known in the art as described, for example, in Mooney et al., Biotech.
Bioeng. 50:442-449 (1996). As a further non-limiting example, cell adhesion,
which is generally dependent on the presence of specific cell-surface
receptors such as integrins, can be enhanced by inclusion of a cell-adhesion
promoting agent such as a cell adhesion peptide as described, for example,
in Hubbell, Biotech. 13:565-576 (1995).
The methods of the invention optionally include separate systemic or local
administration of an immunosuppressive agent, pro-angiogenic agent or other
therapeutic agent or component with biological activity. Useful routes of
systemic or local administration encompass, without limitation, oral
administration; intravenous injection; intraperitoneal injection;
intramuscular injection; subcutaneous injection; transdermal diffusion or
electrophoresis; topical eye-drops or ointments; periocular or intraocular
injection including subconjunctival injection; extended release delivery
devices including locally implanted extended release devices; and
intraocular or periocular implants including bioerodible and reservoir-based
implants which are separate from the bioartificial lacrimal gland.
Furthermore, where the immunosuppressive agent, pro-angiogenic agent or
other therapeutic agent or component with biological activity is a nucleic
acid molecule, one of various methods known in the art of gene therapy can
be utilized. Such methods include, but are not limited to, ballistic gun
delivery, adenoviral transformation, lentiviral transformation,
cytomegaloviral transformation, microinjection and electroporation as
described further below.
As non-limiting examples, a corticosteroid immunosuppressive agent can be
incorporated within a bioartificial lacrimal gland of the invention or
administered topically, periocularly, systemically, or as a slow-release
formulation, or using multiple routes of administration. As one example,
prednisolone acetate can be administered topically as a 1% preparation.
Topical prednisolone acetate can be applied hourly for mild reactions
combined with intravenous methylprednisolone pulse therapy (3 to 5 mg/kg IV
push) and followed by five days of oral prednisone (1 mg/kg/day) for severe
reactions. A single dose of intravenous methylprednisolone (500 mg) can be
substituted, if desired, for daily oral prednisone (60 to 80 mg) when
combined with topical therapy. One skilled in the art understands that these
and other corticosteroid immunosuppressive agents can be useful in the
methods of the invention.
The immunosuppressive agent cyclosporin also can be useful in the methods of
the invention and can be administered, for example, systemically for a
period of months or years or administered topically, for example, as a 2%
cyclosporin formulation. Therapeutic monoclonal antibodies also can be
useful in the methods of the invention; for example, anti-T lymphocyte or
other immunosuppressive monoclonal antibodies can be administered
intracamerally. It is understood that these and other immunosuppressive
agents can be administered to the individual receiving a bioartificial
lacrimal gland of the invention. It is further understood that separate
administration of an immunosuppressive agent can be prior to, during, or
subsequent to implantation of the bioartificial lacrimal gland, and that an
immunosuppressive agent can be administered once or repeatedly as needed.
Immunosuppressive agents, pro-angiogenic agents and other nucleic acid
therapeutics can be administered by established gene transfer techniques
including ballistic gun delivery (see, for example, Tanelian et al.,
BioTechniques 23:484-488 (1997)). In this method, 0.2-0.5 mg gold particles
are coated with plasmid DNA, which is then delivered into the cornea using a
ballistic gun. The depth of delivery of the plasmid DNA is a function of the
pressure of the gun, thus facilitating delivery of plasmid DNA to a desired
depth. A lentivirus also can be used to administer an immunosuppressive
agent, pro-angiogenic agent or other nucleic acid therapeutic agent in a
method of the invention, for example, essentially as described in Wang et
al., Gene Therapy 7:196-200 (2000). Corneal endothelial cells, epithelial
cells and stromal keratocytes in human cornea can be exposed to a lentivirus
that includes the desired nucleic acid molecule for transduction in vitro or
in situ. An adenovirus also can be used to administer an immunosuppressive
agent, pro-angiogenic agent or other nucleic acid therapeutic to the eye in
vivo using procedures which are well known in the art. (See, for example,
U.S. Pat. No. 5,827,702).
Microinjection and electric pulse also can be useful for administering an
immunosuppressive agent, pro-angiogenic agent or other nucleic acid
therapeutic to an individual receiving a bioartificial lacrimal gland.
Microinjection and electric pulse can be used, for example, to introduce
cytomegalovirus, or a plasmid expression vector, into cornea essentially as
described in Sakamoto et al., Hum. Gene Ther. 10:2551-2557 (1999), or Oshima
et al., Gene Therapy 5:1347-1354 (1998). Injection of virus or plasmid into
the anterior chamber at the limbus, followed by electric pulses, results in
transduction of corneal endothelial cells. One skilled in the art
understands that these and other established gene therapy techniques can be
useful in the methods of the invention.
Claim 1 of 60 Claims
1. A bioartificial lacrimal gland,
comprising at least one unit, said unit comprising (a) a permeable housing
having an interior and an exterior; (b) an outlet connecting the housing
interior to the housing exterior; (c) a population of lacrimal epithelial
cells within the housing interior, wherein said gland is characterized by
directional fluid secretion in which fluid exits from said housing
interior to said housing exterior through said outlet; and (d) a gate
joined to said outlet. ____________________________________________
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