Process for Devitalizing Soft-Tissue Engineered Medical Implants and Devitalized Soft-Tissue Medical Implants Produced
The invention provides methodologies and apparatus for producing acellular soft-tissue implants, both in small quantities and in commercializable quantities. Such soft-tissue implants include vascular graft substitutes. An acellular graft is produced by subjecting the tissue sample to an induced pressure mediated flow of an extracting solution, followed by inducing a pressure mediated flow of a treating solution, then washing the treated tissue to produce the acellular graft. The acellular grafts produced are uniform and nonimmunogenic. The inventive method allows for the production of multiple decellularized soft tissue implants, where processing time is significantly less than prior art processes and the number of implants produced per day is increased over prior art processes. In clinical use, the decellularized grafts produced exhibit significantly improved in long-tem durability and function.
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This is a continuation application of U.S. application Ser. No. 10/624,534, filed Jul. 23, 2003, now U.S. Pat. No. 7,338,757, which is a divisional application of U.S. application Ser. No. 09/528,371, filed Mar. 17, 2000, now U.S. Pat. No. 6,734,018, which is a continuation-in-part application of U.S. application Ser. No. 09/327,240, filed Jun. 7, 1999, all of which are herein incorporated by reference in their entireties.
FIELD OF THE INVENTIONThe invention is directed toward methodologies and apparatus for use in the preparation of acellular, i.e. essentially lacking in living cells and/or non-living cells, soft-tissue implants, in small quantities and commercializable quantities. Such soft-tissue implants include vascular graft substitutes. These implants can be derived from tissue engineered soft tissue devices, tissue products derived from animal or human donors that contain or are devoid of cells, and that contain or are devoid of valve structures useful in directing the flow of fluids through tubular vascular devices, and/or combinations of natural tissue products and tissue engineered soft-tissue products. The invention includes methodologies and apparatus for producing uniform, gently processed, decellularized multiple soft tissue implants, where processing time is significantly reduced and the number of implants produced per day is increased. The decellularized grafts produced are significantly improved in long-term durability and function when used in clinical applications.
BACKGROUND OF THE INVENTIONNumerous types of vascular graft substitutes have been produced in the last four decades. These vascular graft substitutes have included large and small diameter vascular, blood, carrying tubular structures, grafts containing valvular structures (vein substitutes, and heart valve substitutes) and lacking valvular structures (artery substitutes). The materials out of which these vascular grafts have been constructed have included man-made polymers, notably Dacron and Teflon in both knitted and woven configurations, and non-man-made polymers, notably tissue engineered blood vessels such as described in U.S. Pat. Nos. 4,539,716; 4,546,500; 4,835,102; and blood vessels derived from animal or human donors such as described in U.S. Pat. Nos. 4,776,853; 5,558,875; 5,855,617; 5,843,181; and 5,843,180.
The prior art processing, methods are prohibitively time consuming, easily requiring numerous days, for example anywhere from eight to twenty-one days total processing time. Such long processing times result in proteolytic degradation of the matrix structures of the processed tissues. Over the past few decades numerous efforts have been made to manage the large surgical use of vascular prostheses in the treatment of vascular dysfunctions/pathologies. While vascular prostheses are available for clinical use, they have met with limited success due to cellular and immunological complications, and the inability to remain patent and function. These problems are especially pronounced for small diameter prostheses, i.e. less than about 6 mm. Efforts have been directed at removing those aspects of allograft and xenograft vascular prostheses that contribute to immunological “rejection” and these efforts have focused primarily on development of various “decellularization” processes, which processes require unduly burdensome incubation times. In addition the prior art methods involve using volumes of processing solutions which do not lend themselves to the production of large numbers of vascular grafts, which ability to “scale-up” is necessary for economic clinical use.
The inventive process produces a cellular grafts including but not limited to ligaments, tendons, menisci, cartilage, skin, pericardium, dura mater, fascia, small and large intestine, placenta, veins, arteries, and heart valves. The process is advantageous over prior art processes in that processing times and conditions have been optimized and reduced, and the economics of production have been dramatically improved, resulting in large numbers of uniform, non-immunogenic grafts being produced. The grafts produced are non-immunogenic, are substantially free from damage to the matrix, and are substantially free from contamination including for example free from infectious agents.
The invention involves the use of an anionic agent, for example sodium dodecylsuifate (SDS), for the treatment of tissues with the dual objective of decellularization and treatment of tissues to restrict recellularization. Further, the invention expands on the process of treating tissue(s) with SDS, describing how the amount(s) of SIDS deposited in the tissue(s) can be further enhanced/reduced to either further inhibit recellularization of the tissue OR enhance recellularization of the tissue. Treatment of tissues with salt solutions prior to treatment with SDS results in different patterns of SDS deposition/precipitation in the tissues than treatment of tissues with SDS followed by treatment of tissues with salt solutions. Treatment of tissues with SDS prior to salt treatment can be expected to result in significant binding of SDS, primarily via hydrophobic interactions, to matrix “proteins” with further deposition of SDS in the tissues as salt precipitated materials by salt precipitation post SDS treatment. Treatment of tissues with salt solutions prior to treatment with SDS solutions can be expected to result in significant precipitation of SDS as a salt precipitated form and less SDS being bound to tissue matrix structure(s) via hydrophobic interactions. It is further understood that the particular salt solution used, either prior to or following SDS treatment, can significantly alter the subsequent solubility of the salt precipitated SDS and thus long-term retention of SDS in the tissues post implantation. The observed salt effects on both perceptibility of SDS and subsequent resolubilization of the salt precipitated form of SDS indicate an activity order of Ca>Mg>Mn>K>Na and calcium salts of dodecylsulfate (CaDS) are less soluble and thus more slowly released from treated tissues than, for example, sodium salts of dodecylsulfate (SDS). The invention is directed at a process for producing acellular soft-tissue implants including vascular grafts, veins, arteries, and heart valves, where processing times and conditions have been optimized to dramatically improve on the economics of production as well as to produce a graft with minimum damage to the matrix structure of the acellular graft. It is a further objective of the present invention to describe how to control the amount(s) of anionic detergents, for example sodium dodecylsulfate (SDS), deposited in the tissue(s) with the objective of enhancing or restricting subsequent recellularization.
SUMMARY OF THE INVENTIONThe inventive process is a process for preparing biological material(s) for implantation into a mammalian cardiovascular system, musculoskeletal system, or soft tissue system. The process removes cellular membranes, nucleic acids, lipids, and cytoplasmic components and produces an implant having an extracellular matrix including as major components collagens, elastins, proteoglycans, and mucopolysaccharides.
The process provides for the production of commercializable quantities of acellular soft tissue grafts for implantation into mammalian systems by removing the cellular populations, cellular remnants, nucleic acids, and small molecular weight proteins, lipids, and polysaccharides forming an acellular nonsoluble matrix having is major components collagens, elastins, hyaluronins, and proteoglycans. The acellular tissue produced can be implanted into a mammalian system, or recellularized in vitro and subsequently implanted into a mammalian system.
An embodiment of the process includes the following steps:
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- isolating from a suitable donor a desired tissue sample of the biological material;
- extracting the tissue with mildly alkaline hypotonic buffered solution of an endonuclease such as Benzonase® (a registered product of Merck KGaA, Darmstadt, Germany) and a nonionic detergent formulation such as Allowash Solution™ (a registered trademark product of LifeNet, Virginia Beach, Va.);
- optionally treating the tissue with a hypertonic buffered salt solution; extracting and treating the tissue with a mildly alkaline hypotonic buffered solution of sodium dodecylsulfate, optionally with 0.1 to 0.5 M sodium chloride rendering the solution hypertonic;
- optionally treating the tissue with a hypertonic buffered salt solution;
- washing the tissue with ultrapure water followed by a water solution of chlorine dioxide; and
- storage in a sealed container in isotonic saline, chlorine dioxide or 70% isopropanol.
The invention provides a process for preparing an acellular soft tissue graft for implantation into a mammalian system, including extracting a soft tissue sample with an extracting solution including one or more nonionic detergents and one or more endonucleases, to produce extracted tissue; treating the extracted tissue with a treating solution including one or more anionic detergents, to produce a treated tissue; washing the treated tissue with a decontaminating solution including one or more decontaminating agents to produce the acellular soft tissue graft; and storing the acellular soft tissue graft in a storage solution comprising one or more decontaminating agents.
The invention further provides a process for preparing commercializable quantities of acellular soft tissue grafts for implantation, into mammalian systems, including obtaining tissue samples from an acceptable donor; extracting the tissue samples with an extracting solution including one or more nonionic detergents and one or more endonucleases, to produce extracted tissue; treating the extracted tissue with a treating solution including one or more anionic detergents, to produce a treated tissue; washing the treated tissue with a decontaminating solution including one or more decontaminating agents to produce the acellular soft tissue graft; and storing the acellular soft tissue graft in a storage solution including one or more decontaminating agents.
The invention also provides a process for preparing an acellular soft tissue graft for implantation into a mammalian system, including inducing a pressure mediated flow of an extracting solution including one or more nonionic detergents and one or more endonucleases, through soft tissue, to produce extracted tissue; inducing a pressure mediated flow of a treating solution including one or more anionic detergents, through the extracted tissue, to produce a treated tissue; inducing a pressure mediated flow of a decontaminating solution including one or more decontaminating agents through the treated tissue, to produce the acellular soft tissue graft; and storing the acellular soft tissue graft in a storage solution including one or more decontaminating agents.
The invention provides a process where the extracting solution is recirculated through the soft tissue graft.
The invention further provides a process where the treating solution is recirculated through the soft tissue graft.
The invention also provides a process where the decontaminating solution is recirculated through the soft tissue graft.
The invention provides a process for producing an acellular tissue graft and includes the use of calcium salts which use results in the acellular tissue graft containing a significantly more insoluble form of salt precipitated anionic detergent, which results in retarded recellularization of the acellular tissue graft in vivo or in vitro.
The below definitions serve to provide a clear and consistent understanding of the specification and claims, including the scope to be given such terms.
Allowash™ Solution.By the term “Allowash™ solution” is intended those compositions disclosed in U.S. Pat. No. 5,556,379 incorporated herein by reference. Examples of suitable Allowash™ compositions include: A cleaning composition containing about 0.06 wt polyoxyethylene-4-lauryl ether; about 0.02 wt % poly(ethylene glycol)-p-nonyl-phenyl-ether; about 0.02 wt % octylphenol-ethyleneoxide and endotoxin free deionized/distilled water.
Decontaminating Agent.By the term “decontaminating agent” is intended one or more agents which remove or inactivate/destroy any infectious material potentially present in a biological tissue sample, for example, such agents include but are not limited to one or more of the following: an antibacterial agent; an antiviral agent; an antimycotic agent; an alcohol for example, methyl, ethyl, propyl, isopropyl, butyl, and/or t-butyl; trisodium phosphate; a preservative such as chlorine dioxide, isopropanol, METHYLPARABIN® (Croda, Inc.), antimicrobials, antifungal agents, sodium hydroxide; hydrogen peroxide; a detergent, and ultrapure water, where the decontaminating agent or agents do not chemically alter the matrix components of the soft tissue grafts.
Essentially Free From.By the term “Essentially Free From” is intended for the purposes of the present invention, a soft tissue graft where the material removed (for example, cellular elements and infectious materials) from the soft tissue graft is not detectable using detection means known in the art at the time of filing of this application.
Normal Tissue.By the term “normal tissue” is intended for the purposes of the present invention, a particular soft tissue, for example a vein, artery, heart valve, ligament, tendon, fascia, dura mater, pericardium or skin, present in a living animal, including for example a human, a pig, and/or cow. Tensile properties of a particular decellularized soft tissue graft approximate, that is, are not statistically significantly different from, the tensile properties of that tissue in a living animal. Cellular components of soft tissue graft biomaterials represent the major immunogenic component of such grafts post implantation.
Acellular Soft Tissue GraftBy the term “acellular tissue graft” is intended for the purposes of the present invention, soft tissue including but not limited to veins, arteries, heart valves, ligaments, tendons, fascia, dura matter, pericardium, and skin, from any mammalian source, including but not limited to, a human source, porcine source, and a bovine source, where the acellular graft produced is allogenic or xenogenic to the mammalian recipient.
The invention provides a process for removing these cellular components from the tissue without resultant damage to the matrix and/or tissue structure. Preferably, the tissue thickness does not exceed about 8 mm, more preferably does not exceed about 6 mm, and most preferably does not exceed about 4 mm, such that the time intervals described herein are sufficient for the process solutions to penetrate the tissue and solubilize the cellular components, allowing for the extraction of extractable materials. Processing times can be altered to accommodate thicker tissues. A quantity of endonuclease is used for a given volume of tissue, such that the quantity is sufficient to digest the DNA within that volume of tissue.
The invention recognizes that the mechanical strength of soft tissue graft biomaterials resides in the matrix structure of the graft. The matrix structure of these biomaterials include collagens, elastins, mucopolysaccharides and proteoglycan components. The removal of cellular components from the graft does not compromise the mechanical strength of the graft. The invention further recognizes that vascular and nonvascular soft tissue grafts do not need to be readily repopulated by recipient cells, post implantation, to function long-term. The absence of an early and rapid repopulation event(s) results in a graft having adequate mechanical strength similar to the mechanical strength associated with that particular normal tissue. This is because the subsequent remodeling of a graft is associated with weakening of the mechanical strength of the graft. That treatment of the graft with a strongly anionic detergent, such as sodium dodecylsulfate, leaves a strongly anionic charge distribution to the graft. This, in turn, restricts recellularization of the graft post implantation. Further, differences in anionic detergent binding to basement membrane components of the graft allows early re-endothelialization of vascular graft(s). That slow leaching of the anionic detergent from the graft allows slow long-term repopulation and slow long-term remodeling of the transplanted soft tissue graft consistent with a durability and graft life, to be measured in terms of decades. Although the description of the invention is directed primarily at processing vascular graft materials, it should be appreciated that this invention is not restricted to processing of vascular graft materials and can also be directed to processing non-vascular soft tissue grafts. Such tissue grafts include, but are not limited to, tissues such as tendons, fascia, ligaments, pericardium, intestine, skin, dura, and cartilage. Such soft tissue can be processed by one of ordinary skill in the art to which the present invention pertains by simple manipulation of the inventive processing times, without undue experimentation.
Tissue is processed according to the invention by surgically removing normal healthy tissues (for example, veins, arteries, heart valves) from animals or humans. The removed tissue is then transported to a processing facility were the tissue is cleaned of extraneous matter and quickly submersed in the first processing (extracting) solution which includes hypotonic buffered solutions containing an endonuclease, for example Benzonas®, and nonionic detergent(s) including for example Allowash Solution™, TritonX-100, and/or Tweet 20, and MgCl2 Other suitable nonionic detergents can be readily selected and employed by one of ordinary skill in the art to which the present invention pertains, without undue experimentation. Procurement and transport of tissue is preferably carried out sterilely and is held in a sterile container on wet ice in a solution iso-osmolar to the cellular population of the tissue being procured and transported. Furthermore, antibiotics may be added to the procurement and transport solution. The invention includes the use of one or more decontaminating agents including for example one or more antibiotics, anti-fungal agents or anti-mycotic agents. Other such agents can be added during processing if so desired to maintain sterility of the procured tissues.
According to an aspect of the invention, a process for preparing biological material for implantation into a mammalian cardiovascular system, musculoskeletal system, or soft tissue system, or for recellularization in vitro, is provided and includes removing cellular membranes, nucleic acids, lipids, and cytoplasmic components, and forms an extracellular matrix including collagens, elastins, proteoglycans, and mucopolysaccharides, the process includes, isolating from a suitable donor a desired tissue sample of the biological material; extracting the tissue with mildly alkaline hypotonic buffered solution of an endonuclease (including for example Benzonase® (a registered product of Merck KGaA, Darmstadt, Germany)) and a nonionic detergent formulation (including for example Allowash Solution™ (a product of LifeNet, Virginia Beach, Va.)); treating the tissue with a mildly alkaline hypotonic buffered solution of an anionic detergent (including for example sodium dodecylsulfate); washing the tissue with water followed by a water or isotonic saline solution of chlorine dioxide or alcohol wash; and storage in a sealed container in water (for example, ultrapure water) or a dilute isotonic solution which may contain low concentrations of chlorine dioxide or 70% isopropanol.
The cellular components of soft tissue graft biomaterials represent the major immunogenic component of such grafts post implantation and the invention provides for the removal of these cellular components without resultant damage to the matrix structure in which the cells resided. Preferably, the soft tissue sample thickness does not exceed about 4 mm such that the time intervals described herein are sufficient for the solutions to penetrate and affect the necessary solubilization and extraction of extractable materials. The concentration of endonuclease utilized is based on calculations designed at achieving a sufficient quantity of endonuclease within a given volume of tissue which is sufficient to digest the DNA within that volume of tissue and is not arbitrarily chosen based on volume of processing solution. The inventive process maintains the mechanical strength of the soft tissue graft biomaterials because the process does not detrimentally affect the matrix structure of the graft. The matrix structure of these biomaterials include collagen, elastin, mucopolysaccharide and proteoglycan components.
The inventive process provides for the modulation of recellularization of the acellular soft tissue graft by adjusting the amount of bound and/or precipitated anionic detergent left in the acellular soft tissue graft produced.
This invention provides for the production of vascular and tendenous grafts, which are not repopulated by recipient cells, post implantation. The inventors discovered that these grafts do not need to be repopulated to function long-term. That absence of repopulation events reduce the possibility that subsequent remodeling of the graft will occur along with the weakening of mechanical strength of the graft which would be associated with remodeling. That treatment of the graft with a strongly anionic detergent, such as sodium dodecylsulfate, will leave a strongly anionic charge distribution, to the graft that will restrict recellularization of the graft post implantation and that differences in SDS binding to the basement membrane components will allow reendothelialization of the vascular graft(s).
The inventors further discovered that the introduction of high salt concentrations in the tissues prior to or following treatment/extraction with an anionic detergent such as SDS results in the precipitation of greater quantities of this anionic detergent within the tissues and that this greater quantity of anionic detergent significantly restricts recellularization of the acellular tissue graft, than treatment of the tissue sample with an anionic detergent without the use of high salt concentrations in that tissue.
The invention provides a process that uses 0.001% to 0.024% anionic detergent, for example, SDS in the treatment phase which causes deposition of SDS in the tissues without the potentially harmful effects of using SDS in the treatment phase and can be used preferentially with or without introduction of high salt concentrations in the tissue when recellularization of that tissue is desired. Although the description of this invention is directed primarily at processing vascular graft materials, it should be appreciated that this invention can also be directed to processing non vascular soft tissue grafts such as tendons, fascia, ligaments, pericardium, skin, dura, and cartilage by simple manipulation of processing times and parameters, such manipulation can be readily determined and employed by one of ordinary skill in the art, without undue experimentation.
In the inventive process, normal healthy vessels (veins, arteries, heart valves, tendons, ligaments, fascia, pericardium, intestine, urethra, etc.) are surgically removed from animals or humans, transported to the processing facility where they are cleaned of extraneous matter and immediately submersed in an extracting solution which contains a hypotonic buffered solution containing one or more endonucleases including for example, Benzonase, and one or more nonionic detergents including for example, Allowash Solution, Triton X-1100, and Tween 20. In that most such vessels are procured at sites distant from the processing facility and that such vessels may ultimately either be cryopreserved or made acellular, procurement and transport will normally be in a sterile container on wet ice in a solution isoosmolar to the cellular population of the tissue being procured and transported. Furthermore, antibiotics are preferably added to the procurement and transport solution. One or more decontaminating agents, including for example, one or more antibiotics, can be optionally employed in any step of the inventive process, to maintain sterility of the procured tissues.
For alt other soft tissue grafts, the tissue is placed into the deformable processing device such that the smaller portion is directed towards the inlet port and the larger (bulkier) end of the tissue is directed towards the outlet port. Preferably the thickness of other soft tissue gratis does not exceed about 8 mm, more preferable does not exceed 5 mm, and most preferably the thickness does not exceed about 2-3 mm. If the thickness of the tissue graft exceeds about 5 mm, incubation and processing times need to be appropriately extended. Such incubation and processing times can be readily selected and employed by one of ordinary skill in the art to which the present invention pertains based on the thickness of the tissue being processed, the type of tissue being processed, and the volume of tissue being processed, without undue experimentation. Prior to closing the processing vessel, a portion of the first processing (extracting) solution is gently added to the processing vessel. The processing vessel is then turned such that the inlet port is down and the outlet port is up and the vessel is attached to its support racking system for example, via clamps. Sterile disposable tubing is attached to the inlet port and to pump tubing in a peristaltic pump. Further, sterile disposable tubing is attached to the inflow side of the peristaltic pump and to the solution reservoir which will contain all remaining first processing (extracting) solution. Finally, sterile disposable tubing is attached between the top (outlet) port of the processing vessel and the solution reservoir. Sterile, in-line, filters can optionally be added at appropriate positions in the fluid flow to safeguard sterility during processing. The first processing (extracting) solution is pumped into through and out of the processing vessel such that flow of fluids occurs in close proximity to the surfaces of the soft tissue grafts into the processing vessel to affect constant solution change in the processing vessel and out through the outlet port to a solution reservoir. By processing the soft tissue graft in this orientation, the bulkier portions of the soft tissue graft will receive the greatest flow of fluids across the surfaces facilitating equal access of the processing solutions to the tissue being processed. Processing of the soft tissue graft with the first processing (extracting) solution is preferably performed at a temperature of from about 4° C. to about 37° C., for a period of time preferably of from about one hour to about 24 hours (overnight as necessary to accommodate processing scheduling of processing staff). The endonuclease (Benzonase) is optimally active between pH 6 and 10, and from 0° C. to above 42° C. (Merck literature describing product) when provided with 1-2 mM Mg+2. Following processing with the first processing (extracting) solution, the first processing (extracting) solution is optionally be replaced with water, for example sterile ultrapure water, to preclude a possible precipitation reaction between the nonionic detergents in the first processing (extracting) solution and the anionic detergent in the second processing solution, or the first processing (extracting) solution can be replaced with an alkaline hypotonic solution containing for example, preferably about 1% by weight of a detergent, for example, preferably sodium dodecylsulfate (SDS) (second processing (treating) solution). Under the optional processing procedure, only sufficient water need be circulated through the processing vessel to affect one volume change of solution in the processing vessel. The second processing (treating) solution is circulated through and/or around the tissue at a temperature of preferably form room temperature to about 37° C., to avoid precipitation of the detergent, for example SDS, at reduced temperatures, for a time period of preferably not shorter than 3 hours. Following processing with the second processing (treating) solution, water for example ultrapure sterile water, is circulated through and/or around the tissue and processing vessel such that the available volume of washing solution approximates a 1000-fold dilution of the SDS present in the second processing (treating) solution. The SDS will exit from the tissues to a given amount of SDS/mg tissue wet weight (protein concentration) provided the washing time preferably exceeds 1 hour, more preferably exceeds 2 hours and most preferably exceeds 3 hours, at a flow rate sufficient to affect a volume change in the processing vessel about every 30-40 minutes, suitable flow rates including for example of from about 30 mls/min. to about 70 mls/min., more preferably from about 40 mls/min to about 60 mls/min., and most preferably about 50 mls/min. Following washing, the soft tissue graft may be removed from the processing vessel and transferred into storage solution containing for example, buffered isotonic saline, 70% isopropanol, or 0.001% to 0.005% chlorine dioxide in sterile ultrapure water/isotonic saline, and packaged in a volume of storage solution sufficient to cover the tissue preventing dehydration. Alternatively, the storage solutions can be pumped into the processing vessel until the ultrapure water wash solution has been adequately exchanged and the whole processing vessel sealed, sterilized for example using gamma-irradiation, and used as the storage container for distribution. Storage of processed soft tissue grafts should be in a solution which covers the graft and which is contained in a container that will prevent evaporation and fluid loss or concentration of solutes. The solution can be isotonic saline, isotonic saline or ultrapure water containing a preservative such as chlorine dioxide, isopropanol, METHYLPARABIN® (Croda, Inc.), antibiotics, antimicrobials, antimycotic agents, antifungal agents, or ultrapure water, or similar bacteriostatic or bacteriocidal agent which do not chemically alter the matrix components of the soft tissue grafts. Suitable storage solutions are well known to of ordinary skill in the art to which the present invention applies, and such solutions can be readily selected and employed by those of ordinary skill in the art to which the present invention applies without undue experimentation. The storage containers with solution and soft tissue grafts can be terminally sterilized, for example using gamma irradiation at doses up to 2.5 Mrads.
The following examples illustrate processing of soft tissue grafts according to the invention.
Example 1Saphenous vein tissues (two) from each leg of an acceptable human donor were carefully dissected under sterile conditions to remove all visible fat deposits and the side vessels were tied off using nonresorbable suture materials such that the ties did not occur in close proximity to the long run of the vessel. Sutures can restrict the decellularization process and the tissues under the sutures were removed following decellularization. For long vein grafts (40-60 cm) (
Saphenous vein tissues (two) from each leg of an acceptable human donor were carefully dissected under sterile conditions to remove all visible fat deposits and side vessels were tied off using nonresorbable suture materials such that the ties did not occur in close proximity to the long run of the vessel. Sutures can restrict the decellularization process and the tissues under the sutures were removed following decellularization. For these long vein grafts (33 and 28 cm) (
Internal mammary artery tissues (two) from an acceptable human donor were carefully dissected under sterile conditions to remove all visible fat deposits and side vessels were tied off using nonresorbable suture materials such that the ties did not occur in close proximity to the long run of the vessel. Sutures can restrict the decellularization process and the tissues under the sutures were removed following decellularization. For short artery grafts (11 and 8 cm) (
Aortic and pulmonary tissues (one each) from a heart of an acceptable human donor were carefully dissected under sterile conditions to remove all visible fat deposits and cardiac muscle tissue (leaving only a small but visible band of cardiac muscle tissue around the proximal end of the conduit. The valves were then removed from the dissecting solution (ultrapure water containing 50 mM Tris-HCl (pH 7.2), 5 mM EDTA, and one or more antibiotics) transferred to the deformable (plastic) processing vessel (
Following processing with the second processing solution, ultrapure sterile water was circulated through the tissue and processing vessel such that the available volume of washing solution approximated a 1000-fold dilution of the SDS present in the second processing solution with a flow rate of 1 ml/min. for 1.5 hours. Following washing in this final processing step, the heart valve(s) was (were) removed from the processing vessel and transferred into storage solution of 0.05% chlorine dioxide in sterile ultrapure water and packaged in a volume of this solution sufficient to cover the tissue.
Example 5Saphenous vein tissues (two) from each leg of an acceptable human donor were carefully dissected under sterile conditions to remove all visible fat deposits and side vessels were tied off using nonresorbable suture materials such that the ties did not occur in close proximity to the long run of the vessel. Sutures can restrict the decellularization process and the tissues under the sutures were removed following decellularization. For long vein grafts (40-60 cm) (
Saphenous vein tissues (two) from each leg of an acceptable human donor were carefully dissected under sterile conditions to remove all visible fat deposits and side vessels tied off using nonresorbable suture materials such that the ties did not occur in close proximity to the long run of the vessel. Sutures can restrict the decellularization process and the tissues under the sutures will be removed following decellularization. For long vein grafts (40-60 cm) (
Saphenous vein tissues (two) from each leg of an acceptable human donor were carefully dissected under sterile conditions to remove all visible fat deposits and side vessels tied off using nonresorbable suture materials such that the ties did not occur in close proximity to the long run of the vessel. Sutures can restrict the decellularization process and the tissues under the sutures will be removed following decellularization. For these long vein grafts (33 and 28 cm) (
Internal mammary artery tissues (two) from an acceptable human donor were carefully dissected under sterile conditions to remove all visible fat deposits and side vessels tied off using nonresorbable suture materials such that the ties did not occur in close proximity to the long run of the vessel. Sutures can restrict the decellularization process and the tissues under the sutures will be removed following decellularization. For short artery grafts (11 and 8 cm) (
Aortic and pulmonary tissues (one each) from a heart of an acceptable human donor were carefully dissected under sterile conditions to remove all visible fat deposits and cardiac muscle tissue (leaving only a small but visible band of cardiac muscle tissue around the proximal end of the conduit. At this point, the valves were removed from the dissecting solution (ultrapure water and antibiotic solution for cardiovascular tissue procurement and transport) and transferred to the deformable (plastic) processing vessel(s). Prior to closing the processing vessel, a portion of the First Processing Solution was gently added to the processing vessel and the side access port closed using the clamping mechanism illustrated in
While the invention has been described in connection with specific embodiments thereof, it will be understood that it is capable of further modifications and this application is intended to cover any variations, uses, or adaptations of the invention following, in general, the principles of the invention and including such departures from the present disclosure as come hypotonic buffered within known or customary practice within the an to which the invention pertains and as may be applied to the essential features hereinbefore set forth as follows in the scope of the appended claims. Any references including patents cited herein are incorporated herein in their entirety.1.
Claims
1. A process for preparing an acellular soft tissue graft for implantation into a mammalian system, comprising:
- extracting a soft tissue sample with an extracting solution comprising one or more nonionic detergents and one or more endonucleases, to produce extracted tissue;
- treating said extracted tissue with a treating solution comprising one or more anionic detergents, to produce a treated tissue;
- washing said treated tissue with a decontaminating solution comprising one or more decontaminating agents to produce said acellular soft tissue graft; and
- storing said acellular soft tissue graft in a storage solution comprising one or more decontaminating agents.
2. A process for preparing commercializable quantities of acellular soft tissue grafts for implantation into mammalian systems, comprising:
- obtaining tissue samples from an acceptable donor; extracting said tissue samples with an extracting solution comprising one or more nonionic detergents and one or more endonucleases, to produce extracted tissue;
- treating said extracted tissue with a treating solution comprising one or more anionic detergents, to produce a treated tissue;
- washing said treated tissue with a decontaminating solution comprising one or more decontaminating agents; to produce said acellular soft tissue graft; and
- storing said acellular soft tissue graft in a storage solution comprising one or more decontaminating agents.
3. A process for preparing an acellular soft tissue graft for implantation into a mammalian system, comprising:
- inducing a pressure mediated flow of an extracting solution comprising one or more nonionic detergents and one or more endonucleases, through soft tissue, to produce extracted tissue;
- inducing a pressure mediated flow of a treating solution comprising one or more anionic detergents, through said extracted tissue, to produce a treated tissue;
- inducing a pressure mediated flow of a decontaminating solution comprising one or more decontaminating agents through said treated tissue; to produce said acellular soft tissue graft; and
- storing said acellular soft tissue graft in a storage solution comprising one or more decontaminating agents.
4. The process of claim 3, wherein said extracting solution is recirculated through said soft tissue graft.
5. The process of claim 3, wherein said treating solution is recirculated through said soft tissue graft.
6. The process of claim 3, wherein said decontaminating solution is recirculated through soft tissue graft.
7. The process of any one of claim 1, 2 or 3, said one or more decontaminating agents comprise one or more antimicrobial agents.
8. The process of any one of claim 1, 2, or 3, said extracting solution having an alkaline pH.
9. The process any one of claim 1, 2, or 3, said extracting solution further comprises one or more organic or inorganic buffers, wherein an alkaline pH is maintained, and an osmolality of the extracting solution which is hypotonic to the cells in said soft tissue is maintained.
10. The process of any one of claim 1, 2, or 3, wherein said nonionic detergent comprise one or more detergents selected from the group consisting of: polyoxyethylene alcohol, polyoxyethylene isoalcohol, polyoxyethylene p-t-octyl phenol, polyoxyethylene nonylphenol, polyoxyethylene esters of fatty acids, and polyoxyethylene sorbitol esters.
11. The process of any one of claim 1, 2, or 3, said treating solution comprises one or more buffers selected from the group consisting of: an organic buffer and an inorganic buffer, wherein an alkaline pH is maintained, and an osmolality of the treating solution which is hypotonic to the cells in said soft tissue is maintained.
12. The process of any one of claims 1, 2, or 3, said one or more anionic detergents are selected from the group consisting of: sodium dodecylsulphate, sodium dodecylsulphonate, sodium dodecyl-N-sarcosinate, and sodium suramin.
13. The process of anyone of claim 1, 2, or 3, said decontaminating solution comprises ultrapure, endotoxin-free, water solutions of antimicrobial agents, wherein said antimicrobial agents are non-reactive towards said one or more anionic detergents.
14. The process of any one of claim 1, 2, or 3, said storage solution comprises ultrapure, endotoxin-free, water.
15. The process of claim 14, wherein said storage solution further comprises one or more antimicrobial agents.
16. The process of claim 15, wherein said one or more antimicrobial agents comprise one or more members selected from the group consisting of: chlorine dioxide, ethanol, isopropanol, methanol, glycerol, and methylparaben.
17. The process of claim 16, wherein said chlorine dioxide or said methylparaben are present in said storage solution at a concentration in the range of from 0.001% to 0.1% (v:v).
18. The process of claim 16, wherein said ethanol, isopropanol, methanol, or glycerol are present in said storage solution at a concentration in the range of from 60% to 90% (v:v).
19. The process of claim 12, wherein said one or more anionic detergents are present in said treating solution at a concentration in the range of from 0.001% to 10% (w:v).
20. The process of claim 19, wherein said one or more anionic detergents are present in said treating solution at a concentration in the range of from about 0.08% to about 0.35% (w:v).
21. The process of any one of claim 1, 2, or 3, said one or more endonucleases comprise one or more broad spectrum endonucleases capable of degrading both deoxyribonucleic acids and ribonucleic acids.
22. The process of claim 21, wherein said one or more broad-spectrum endonucleases comprise one or more recombinant endonucleases.
23. The process of claim 22, wherein said one or more recombinant endonucleases comprise Benzonase®
24. The process of claim 21, said one or more endonucleases are present in said extracting solution at a concentration sufficient to degrade nucleic acids present in said tissue sample.
25. The process of claim 24, wherein said one or more endonucleases are present in said extracting solution at a concentration of from about 30 IU/mil tissue to about 70 IU/ml tissue.
26. The process of claim 25, wherein said one or more endonucleases are present in said first washing solution at a concentration of about 50 IU/ml tissue.
27. The process of any one of claim 1, 2, or 3, said one or more nonionic detergents enhance activity of said one or more endonucleases.
28. The process of claim 3, said step of inducing a pressure mediated flow of extracting solution is carried out at a flow rate sufficient to carry away solutes which become dissolved in said extracting solution.
29. The process of claim 28, wherein said flow rate for said extracting solution is from about 5 mls/minute to about 220 mls/minute.
30. The process of claim 29, wherein said flow rate for said extracting solution is from about 40 mls/minute to about 90 mls/minute.
31. The process of claim 3, wherein said flow rate for said treating solution is from about 5 mls/minute to about 225 mls/minute.
32. The process of claim 31, wherein said flow rate for said treating solution is from about 40 mls/minute to about 70 mls/minute.
33. The process of anyone of claim 1, 2, or 3, said treated tissue is washed with a volume of said decontaminating solution sufficient to cause an approximate 1:1000 dilution of a concentration of said treating solution.
34. The process of any one of claim 1 or 2, wherein said step of extracting is carried out for a period of time of from about 6 hours to about 24 hours.
35. The process of claim 34, wherein said step of extracting is carried out for a period of time of from about 12 hours to about 16 hours.
36. The process of any one of claim 1 or 2, wherein said step of extracting is carried out at a temperature of from about 4° C. to about 42° C.
37. The process of claim 36, wherein said step of extracting is carried out at a temperature of from about 20° C. to about 27° C.
38. The process of anyone of claim 1 or 2, wherein said step of treating is carried out for a period of time of from about 3 hours to about 12 hours.
39. The process of claim 38, wherein said step of treating is carried out for a period of time of from about 3 hours to about 6 hours.
40. The process of any one of claim 1 or 2, wherein said step of treating is carried out at a temperature of from about 20° C. to about 42° C.
41. The process of claim 40, wherein said step of treating, is carried out at a temperature of from about 20° C. to about 27° C.
42. The process of any one of claim 1, 2, or 3, wherein said one or mare nonionic detergents are present in said extracting solution at a concentration of from about 0.1% (w:v) to about 10% (w:v).
43. The process of claim 42, wherein said one or more nonionic detergents are present in said extracting solution at a concentration of from about 0.5% (w:v) to about 2% (w:v).
44. The process of claim 12, wherein said one or more anionic detergents are present in said treating solution at a concentration of from about 0.001% (w:v) to about 10% (w:v).
45. The process of claim 44, wherein said one or more anionic detergents are present in said treating solution at a concentration of from about 0.1% (w:v) to about 0.5% (w:v).
46. A decellularized soft tissue graft which is substantially non-immunogenic.
47. A decellularized soft tissue graft having tensile properties which approximate tensile properties of normal tissue, following the decellularization process.
48. The decellularized soft tissue graft of any one of claim 46 or 47, comprising a vein, an artery, or a heart valve.
49. The decellularized soft tissue graft of anyone of claim 46 or 47, comprising a ligament or a tendon.
50. The decellularized soft tissue graft of any one of claim 46 or 47, comprising fascia, dura mater, pericardium or skin.
51. The decellularized soft tissue graft of claim 46, wherein said soft tissue graft remains acellular post implantation.
53. The decellularized soft tissue graft of claim. 47, wherein, said soft tissue graft remains acellular for at least 6 months post implantation.
54. The decellularized soft tissue graft of claim 48, wherein said soft tissue graft reendothelializes on a luminal surface 3 to 6 months post implantation.
55. A non-immunogenic, acellular soft tissue graft produced by the process as claimed in any one of claim>1, 2, or 3.
56. A process for preparing, an acellular soft tissue graft, said process comprising:
- extracting one or more soft tissue samples with a hypotonic buffered extracting solution comprising one or more nonionic detergents and one or more endonucleases to produce extracted tissue;
- optionally treating said extracted tissue with a treating solution comprising a hypertonic salt solution to produce an optionally treated tissue;
- treating said extracted tissue or said optionally treated tissue, with a first processing solution comprising one or more anionic detergents to produce a first processed tissue, wherein said first processing treating solution optionally comprises a hypertonic salt solution;
- second optionally treating said first processed tissue with a second treating solution comprising a hypertonic salt solution to produce an optionally second treated tissue;
- washing said first processed tissue or said optionally second treated tissue, in one or more washing solutions, said washing solutions comprising water and optionally one or more antimicrobial agents, to produce washed tissue; and
- storing said washed tissue in a storage solution comprising one or more decontaminating agents and water.
57. The process of claim 56, said extracting solution comprises one or more organic or inorganic buffers, wherein said buffers maintain said extracting solution at an alkaline pH and maintain a hypotonic osmolality of said extracting solution which is hypotonic to cells in said one or more soft tissue samples.
58. The process of claim 57, said extracting solution comprises one or more nonionic detergents selected from the group consisting of: polyoxyethylene alcohol (Brij series, Lubrol W, AL series), polyoxyethylene isoalcohol (Sterox Al, AP series, Emulphogen BC series, Renex 30 series), polyoxyethylene p-t-octyl phenol (Triton X series, Igepal CA series Nonidet P 40) polyoxyethylene nonylphenol (Triton N series, Igepal CO series, Surfonic N series), polyoxyethylene esters of fatty acids (Sterox CO series, Myrj series, Span series), and polyoxyethylene sorbitol esters (Tween series, Ernasol series).
59. The process of claim 58, said extracting solution further comprises one or more endonuclease.
60. The process of claim 56, said first processing, solution comprises one or more organic or inorganic buffers, wherein said buffers maintain said extracting solution at an alkaline pH and maintain a hypertonic osmolality of said extracting solution which is hypertonic to cells in said one or more soft tissue samples.
61. The process of claim 60, said first processing solution comprises one or more anionic detergents selected from the group consisting of sodium dodecylsulphate, sodium dodecylsulphonate, sodium dodecyl-N-sarcosinate, sodium laurylsulfate and sodium suramin.
62. The process of claim 56, said hypertonic sail solution comprises water solutions comprising one or more members selected from the group consisting of a monovalent salt, a divalent salt, and an antimicrobial agent, wherein said hypertonic salt solution is reactive with said one or more anionic detergents.
63. The process of claim 56, said storage solution comprises ultrapure, endotoxin-free, water.
64. The process of claim 56, said one or more decontaminating agents comprise one or more antimicrobial agents.
65. The process of claim 64, said one or more antimicrobial agents selected from the group consisting of: chlorine dioxide, ethanol, isopropanol, methanol, glycerol, and methylparaben.
66. The process of claim 65, wherein a concentration of chlorine dioxide or methylparaben is in a range of from 0.001% to 0.1% (v:v).
67. The process of claim 65, wherein a concentration of ethanol, isopropanol, methanol, or glycerol is in a range of from 60% to 90% (v:v).
68. The process of claim 61, wherein a concentration of said one or more anionic detergents are in a range of from 0.001% to 10% (w:v).
69. The process of claim 68, said concentration of anionic detergent is 0.24% (w:v), and said second processing solution further comprising 0.5M sodium chloride.
70. The process of any one of claim 56 or 59, said endonuclease is a broad spectrum endonuclease which degrades deoxyribonucleic acids (DNA) and ribonucleic acids (RNA).
71. The process of claim 70, said broad-spectrum endonuclease is a recombinant endonuclease.
72. The process of claim 70, said recombinant endonuclease is Benzonase.
73. The process of claim 70, wherein a concentration of said broad-spectrum endonuclease is sufficient to degrade deoxyribonucleic acids and said ribonucleic acids present in said soft tissue sample having a volume in an allotted time.
74. The process of claim 73, said concentration of said broad-spectrum endonuclease is from about 20 IV to about 400 IV per ml volume of tissue.
75. The process of claim 70, wherein an activity of said broad-spectrum endonuclease is enhanced by said one or more nonionic detergents.
76. The process of claim 56, said extracting comprises subjecting said soft tissue sample to a pressure mediated flow of said extracting solution.
77. The process of claim 56, said optionally treating comprises subjecting said extracted tissue to a pressure mediated flow of said treating solution.
78. The process of claim 56, said treating comprises subjecting said extracted tissue or said optionally treated tissue to a pressure mediated flow of said first processing solution.
79. The process of claim 56, said second optionally treating comprises subjecting said first processed tissue to a pressure mediated flow of said second treating solution.
80. The process of claim 56, said washing comprises subjecting said second optionally treated tissue or said first processed tissue to a pressure mediated flow of said one or more washing solutions.
81. The process of claim 76, wherein a flow rate of said extracting solution is sufficient to remove any solutes dissolved in said extracting solution.
82. The process of claim 81, said flow rate of said extracting solution is from about 5 mls/minute to about 100 mls/minute.
83. The process of claim 82, said flow rate of said extracting solution is from about 30 mls/minute to about 60 mls/minute.
84. The process of claim 77, wherein a flow rate of said first processing solution is from about 5 mls/minute to about 100 mls/minute.
85. The process of claim 84, said flow rates of said first processing solution is from about 30 mls/minute to about 60 miss/minute.
86. The process of claim 62, said hypertonic salt solution comprises one or more members selected from the group consisting of: sodium chloride, potassium chloride, lithium chloride, calcium chloride, sodium phosphate, calcium hydroxide, potassium sulfate, lithium sulfate, calcium phosphate, potassium phosphate, lithium phosphate, ammonium chloride, magnesium chloride, and calcium sulfate.
87. The process of claim 56, said extracting is carried out for a time period of from about 6 hours to about 24 hours.
88. The process of claim 87, said extracting is carried out for a time period of from about 12 hours to about 16 hours.
89. The process of claim 56, said extracting is carried out at a temperature of from about 4° C. to about 42° C.
90. The process of claim 89, said extracting is carried out at a temperature of from about 20° C. to about 27° C.
91. The process of claim 56, said optionally treating is carried out for a time period of from about 3 hours to about 24 hours.
92. The process of claim 91, said optionally treating is carried out for a time period of from about 3 hours to about 6 hours.
93. The process of claim 31, said optionally treating is carried out for a time period of at least about 3 hours.
94. The process of claim 56, said optionally treating is carried out at a temperature of from about 20° C. to about 42° C.
95. The process of claim 94, said optionally treating is carried out at a temperature of from about 20° C. to about 27° C.
96. The process of claim 58, said nonionic detergents are at a concentration of from about 0.001% (w:v) to about 10% (w:v).
97. The process of claim 96, said nonionic detergents are at a concentration of from about 0.1% (w:v) to about 2% (w:v).
98. The process of claim 61, said anionic detergents are at a concentration of from about 0.001% (w:v) to about 4% (w:v).
99. The process of claim 98, said anionic detergents are at a concentration of from about 0.1% (w:v) to about 2% (w:v).
100. The process of claim 86, said hypertonic salt solution is at a concentration of from about 0.00001 M to about 2.0 M.
101. The process of claim 100, said hypertonic salt solution is at a concentration of from about 0.0002 M to about 0.08 M.
102. The process of claim 86, said monovalent salt and said divalent salt comprise one or more calcium salts selected from the group consisting of: calcium chloride, calcium hydroxide, magnesium chloride, lithium chloride potassium chloride, and sodium chloride.
103. An acellular tissue graft, comprising a soft tissue sample substantially free from cellular elements produced by the process as claimed in claim 102, wherein recellularization of said acellular tissue graft in vivo or in vitro, is retarded.
104. An acellular tissue graft, comprising: a soft tissue sample substantially free from cellular elements, and calcium ion precipitated anionic detergent.
105. An acellular tissue graft, comprising a soft tissue sample substantially free from cellular elements and calcium ion precipitated anionic detergent, produced by the process as claimed in claim 102, wherein recellularization of said acellular tissue graft in vivo or in vitro, is retarded.
106. The acellular tissue graft of any one of claim 104 or 105, said calcium ion precipitated anionic detergent is present in an amount of at least 1.0 μmole/mg wet weight of tissue.
107. The acellular tissue graft of claim 106, said calcium ion precipitated anionic detergent is present in an amount of from about 0.1 wt % to about 10.0 wt %.
108. An acellular tissue graft of claim 56, said anionic detergent is SDS and is present at a concentration of about 0.001 wt %, where in said acellular tissue graft contains comparable levels of SDS as when concentrations of about 1.0 wt % of a different anionic detergent is used.
109. A process for pre paring an acellular soft tissue graft, said process comprising:
- extracting one or more soft tissue samples with a hypotonic buffered extracting solution at an alkaline pH, comprising one or more nonionic detergents and one or more endonucleases to produce extracted tissue;
- treating said extracted tissue with a treating solution comprising a hypertonic salt solution to produce a treated tissue;
- treating said treated tissue, with a first processing solution comprising one or more anionic detergents in a hypertonic salt solution to produce a first processed tissue;
- second treating said first processed tissue with a second treating solution comprising a hypertonic salt solution to produce a second treated tissue;
- washing said second treated tissue, in one or more washing solutions, said washing solutions comprising water and optionally comprising one or more antimicrobial agents, to produce washed tissue; and
- storing said washed tissue in a storage solution comprising one or more decontaminating agents and water.
110. An acellular tissue graft, comprising: a soft tissue sample substantially free from cellular elements produced by the process as claimed in any of claim 56 or 109, wherein said acellular tissue graft retains dimensions approximate to said soft tissue sample prior to processing.
111. The acellular tissue graft of claim 110, wherein said extracting solution comprises 0.24 wt % sodium dodecylsulfate in 0.5 M sodium chloride.
112. An acellular tissue graft, comprising: a soft tissue sample substantially free from cellular elements produced by the process as claimed in any of claim 56 or 108, wherein said acellular tissue graft retains tensile properties approximate (0 tensile properties of said soft (issue sample prior to processing.
113. The acellular tissue graft of claim 112, said soft tissue sample is a heart valve, and wherein said acellular heart valve leaflets maintain normal coaptation.
114. The acellular tissue graft of claim 110, wherein tissue retaining lower amounts of SDS and/or CaDS, recellularizes more quickly in vivo and/or in vitro than tissues retaining higher amounts of SDS and/or CaDS.
115. An acellular tissue graft, comprising a soft tissue sample substantially free from cellular elements, and precipitated anionic detergent present in an amount effective to enhance recellularization of said acellular tissue in vivo or in vitro.
116. An acellular tissue graft, comprising a soft tissue sample substantially free from cellular elements, and precipitated anionic detergent present in an amount effective to enhance recellularization of said acellular tissue in vivo or in vitro, produced by the process as claimed in claim 102, wherein recellularization of said acellular tissue in vivo or in vitro is enhanced.
117. The acellular tissue graft of any one of claim 115 or 116, said precipitated anionic detergent is present at a concentration of no more than 20 wt %.
118. The acellular tissue graft of claim 117, said precipitated anionic detergent is present at a concentration of from about 0.2 wt % to about 2.0 wt %.
119. A method for modulating recellularization of an acellular soft tissue graft upon implantation of said acellular soft tissue graft in a mammalian system, comprising:
- precipitating an amount of anionic detergent in a tissue sample, said amount precipitated is effective to enhance or retard recellularization of said acellular soft tissue graft.
120. An acellular soft tissue graft, comprising: a soft tissue sample essentially free from cellular elements and precipitated anionic detergent, produced by the process as claimed in claim 119.
Type: Application
Filed: Oct 31, 2013
Publication Date: Mar 6, 2014
Applicant: LifeNet Health (Virginia Beach, VA)
Inventors: Lloyd Wolfinbarger, JR. (Norfolk, VA), Peny Lange (Virginia Beach, VA), Alyce Linthurst-Jones (Virginia Beach, VA), Eric Moore (Virginia Beach, VA), Barry Naif (Courtland, VA)
Application Number: 14/068,308
International Classification: A61L 27/36 (20060101);
