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New interview with The Cairns Post
Check out this fantastic new interview with Izzy from the Cairns Post today! In it she talks about Cairns, Sea Shepherd, her agent Sharron Meissner, and – most excitingly of all – her experience on Knight Of Cups. I don't know about you, but I've missed hearing from Isabel, so I really enjoyed reading this!
You can also find it in our Press section now too.
Acting out for the environment
She may be one of Hollywood's hottest rising stars, but Isabel Lucas remains true to her Cairns roots with her environmental passions.
She's just wrapped up filming alongside Christian Bale, Natalie Portman and Cate Blanchett, but Isabel's mind is hardly on Hollywood.
Rather, it's on the Coral Sea, and the Kimberley in northwest Australia, and off the coast of California… in fact, anywhere the environment is under threat.
The experience of filming alongside three Oscar winners and under the guidance of a director she idolises is barely enough to distract the former Cairns schoolgirl from a passion equal to acting.
While her stomping ground is a far cry from her home in Los Angeles, a move that has helped fill her resume with feature films Transformers: Revenge of the Fallen, Immortals, The Pacific and Daybreakers, the plight of the Far North's marine environment remains a priority.
"I feel we are so lucky to experience living in such a beautiful part of the world," Isabel says of Cairns.
"Living by one of the great natural wonders of the world – the Great Barrier Reef – with some of the most unique and attractive sea creatures in the world, it's our responsibility to love it and care for it."
Just three months ago, paparazzo pictures posted on tablood websites show Isabel strolling casually with Christian Bale on the film set of her latest film Knight of Cups.
She plays the role of Caroline, who has an apparent romantic link to the Dark Knight star's character Rick.
Under the instructions of enigmatic director Terrence Malick, Isabel doesn't speak about the storyline – it's reportedly about "a man, temptations, celebrity and excess" – but raves about working with one of the industry's most in‑demand leading men.
"Christian Bale, his generosity and sensitivity…he's an incredible person," Isabel says.
"To describe what he's like as an actor would never do him justice.
"I learnt so much from him, from his fierce truth."
Likewise, her views on Terrence Malick, who also directed The Thin Red Line, are as favourable.
"If I could work with Terrence again one day that would be a dream," Isabel says.
"He wants to capture truth and the realness of raw human emotions, raw human moments, the moments that will always connect us all.
"To see the vulnerability in all of us, the imperfectness in all of us, it's heartening and beautiful."
Now 27, Isabel says it's her active involvement in conservation that keeps her grounded, despite a career that in six years has catapulted her from the Home and Away set in Sydney across the Pacific to Hollywood.
"In the truest sense, I feel being humble is an integral part of being successful," she says.
"It's about finding a balance… being passionate about what you're doing and not having a huge attachment to it."
Her discovery as a screen star is well documented. In 2002, she was spotted by Sydney talent agent Sharron Meissner while wandering the Port Douglas community markets one Sunday.
"I had a really good clear instinct when I met her," she says. "I remember it felt strong. I was interested to talk to her and I could tell she had good intentions."
Within 12 months, she was cast as Tasha in Home and Away, a role that won her the Most Popular New Female Talent TV Week Logie award.
Though she enjoyed drama classes, the then 19-year-old St Monica's College graduate believed at the time her future lay in other vocations.
"I was aware I was quite shy when I was younger," Isabel says. "I loved art and learning about holistic healing and imagined I would have explored further down those pathways had I not met Sharron.
"I liked drama at school and the idea of stories bringing us together in a really powerful way."
The three-year stint in the Aussie soap was only a launching pad.
Director Michael Bay cast her in the Transformers sequel in 2008, alongside Shia LeBouf and Megan Fox, in 2008.
Daybreakers (Ethan Hawke, Willem DeFoe and Sam Neill) followed, then the Steven Spielberg and Tom Hanks produced HBO mini-series The Pacific, some of which was filmed in Far North Queensland.
Then Immortals came along, with screen time next to Mickey Rourke and John Hurt. In Red Dawn (which is about to hit screens), a rework of the 1980s film, she reunites with fellow Aussie Chris Hemsworth.
With a few Australian films squeezed in-between her Hollywood commitments, Isabel has established a presence that has captured the attention of online film sites.
Inevitably, she has been linked to the likes of Jake Gyllenhaal, Jared Leto, Joel Edgerton and Adrian Grenier and Australian musician Angus Stone, who she parted ways with in 2011.
She's hardly fazed about rumours.
"I prefer not to know what's written," Isabel says. "It's usually not really true either. I understand it's one part of the job and it's OK. I just keep my focus on things that feed me positivity."
That outlook also maintains her involvement in conservation, a topic that elicits the most in‑depth response.
Last year, Isabel joined eco-surfer David Rastovich, a close friend, on a month-long sailing and paddling trip down the Californian coast to highlight the plight of cetaceans and dolphins for the TransparentSea campaign.
She's an avid supporter of green groups and her latest focus is on a proposed gas refinery at James Price Point, north of Broome.
In 2007, Japanese police issued an arrest warrant for Isabel when she, along with five celebrities and professional surfers, formed a floating ring of surfboards off the country's coast to protest the slaughter of whales.
While her activism with harder core groups such as Sea Shepherd fuels her reputation as a "hippy chick", she's proud of her efforts.
"I believe 100 per cent in the work they (Sea Shepherd Society) do," Isabel says.
She's happy to continue riding the wave but does have ambitions to work with more film industry heavyweights.
"I'd like to do films that will help me learn what I need to learn at that point in my life."


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The federal workers who handle the certification of new aircraft such as the Boeing 787 made in North Charleston were called back to work this week after being furloughed during the government shutdown.
The Federal Aviation Administration recalled about 800 workers, including about 200 engineers, inspectors and safety staff for the FAA's Aircraft Certification Service and more than 600 airline safety inspectors to the agency's Flight Standards Service.
Boeing South Carolina spokeswoman Candy Eslinger said the recalled workers include those who certify 787s made near Charleston International Airport.
She also said Boeing holds designated authority from the FAA to perform some of its own certification work.
"Boeing Commercial Airplanes is continuing to complete and certify commercial airplanes and make them available for delivery during the government shutdown," Eslinger said. "As the shutdown continues, we are working with our customers to mitigate any potential delivery impacts."
Several planes remained on the flight line for delivery in North Charleston Tuesday.
The shutdown entered its eighth day Tuesday. Thousands of FAA workers remain furloughed as nonessential.
Reach Warren L. Wise at 937-5524 or twitter.com/warrenlancewise.
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subset: commoncrawl


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The X Factor
Exclusive! Project Runway Winner Leanne Marshall on Designing for Paula Abdul: It's Straight Up Awesome
Have you noticed how amazing Paula Abdul's been looking lately? Whether she's on The X Factor or walking a red carpet — she's been looking fab in an assortment of dynamite dresses. The creative star behind her stellar style? Project Runway Season 5 winner Leanne Marshall. We were dying to know the details of dressing an enigma like Paula, and we scored an exclusive straight from the source.
Read on for the glamorous scoop from Leanne:
Whenever Paula's worn your designs, they've always seemed so perfect for her. Was that luck, or did you create the dresses for her specifically?
Leanne Marshall: All of these dresses were made custom for Paula. She chose the pieces that she wanted based on my past collections, and I went to work changing the colors and making tweaks to be sure they were one-of-a-kinds that would really flatter Paula and her beautiful figure.
Do you design more for the body, or for the personality?
LM: It was really a combination of both. Paula has a very petite frame, and she is not afraid to take risks and be fashion forward. Because of her size, she has said that she likes things to always be feminine and lady-like but with an edgy twist, and that is what I love to do.
She sounds like a lot of fun to design for — how does it feel to have her wear your designs? Are they "Paula's dresses" now?
LM: We actually refer to them all here as "Paula Dresses!" After she wore them, she did a lot of tweeting that she had never received more compliments than she did in my dresses. I was honored.
Let's talk about those tweets! Paula's said things to you on Twitter like "You're gonna skyrocket to the top of the fashion world!!" and "You really know how to make a girl feel beautiful inside and out." How great is it to get feedback like that, especially from a huge star like Paula Abdul?
LM: Paula is very affirming. She frequently sends me messages to let me know how everyone loved the dresses, that she has never received more compliments and she even just messages me to let me know she appreciates my talent. I am thrilled to have the privilege of working with her.
How hands-on is Paula when it comes to the whole process? Does she give suggestions? Is it a collaboration, or does she just say "Hey, I need a dress" and you go to town?
LM: Paula has a lot of input, but she also trusts me. She initially found me because she loved my aesthetic. Usually she makes broader requests like the color or the feel, but lately, she has been requesting more specific garments. These relationships develop with time. The more I know Paula and the more she knows me, the greater the things we will create together.
Can you talk a little bit about how that relationship has affected your career?
LM: Paula Abdul is the first iconic celebrity to repeatedly wear my clothing. Not only has she worn it on Live to Dance and The X Factor, she goes out of her way to let people know that she is wearing my designs and feels beautiful in them! How could that not open doors and inform my future?
Now that Paula's opened up that Iconic Celebrity door, who else would you like to dress?
LM: I actually have a little wish list. I think my aesthetic would be a great match for the personalities and styles of Taylor Swift, Kate Winslet, Anne Hathaway, Michelle Williams, Claire Danes — and I could really do some devastatingly awesome things for Lady Gaga.
We don't dare doubt it!
Want more X Factor goodness? "Like" us on Facebook!
Want to see more of Leanne Marshall's work? Check it out at the source: www.leannemarshall.com


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CHATTANOOGA,Tenn. – The Chattanooga Mocs softball team split its first two games of the USF Under Armour Showcase in Clearwater, Fla., Friday afternoon. The Mocs topped Seton Hall 7-1 in the first game but fell 2-0 in the latter game to Utah.
Chattanooga 7 – Seton Hall 1
Junior Taylor Deason (Clarksville,Tenn.) tossed a one-run gem in the Mocs' first game of the day against Seton Hall. Winning 7-1 over the Pirates, Deason's sixth win of the season came on just five hits and three strikeouts. The only run of the game came on a solo homerun in the fifth inning off the right-hander.
On the offensive side of the ball, UTC posted nine hits. The Mocs – Sam Taylor (Chickamauga, Ga.), Anyssa Robles (Lawrenceville, Ga.) and Sarah Beth Roberts (Mt. Juliet, Tenn.) – each tallied two hits in the offensive explosion.
Chattanooga got on the board first in the top of the first inning on a hit and an error. Alyssa Taylor (Orange, Calif.) walked with one out and Robles singled to put runners at first and second. Sophomore Criket Blanco (Maryville,Tenn.) walked to load the bases and Roberts put the ball in play to put the runners on the move. Roberts reached on the fielder's choice and a fielding error by the Pirates' catcher allowed Taylor to score on the play, putting UTC up 1-0.
The Mocs added on three more runs in the top of the second on four hits. Junior Marina Wilkerson (Hogansville,Ga.) led off the inning with her first hit of the season and stole second base. Senior Kaiti Dutton (Tulsa, Okla.) followed up with a single of her own and Wilkerson advanced to third. Sam Taylor drove in the innings first run on a single to center, scoring Wilkerson, and Alyssa Taylor was hit by a pitch to load the bases again. With two outs, Roberts singled through the right side to drive both Taylors around to score, moving to score to 4-0.
Seton Hall claimed its only run of the game in the fifth as Destaso homered to centerfield to lead off the inning, but Deason mowed through the rest of the Pirates' lineup with a groundout and a double play.
Chattanooga added on its final three runs in the sixth inning on a bases-clearing double. Wilkerson walked and Sam Taylor singled up the middle to put runners on the corners. Alyssa Taylor walked and Robles slammed a fly ball to center, missing a homerun by just about a foot, sending the ball off the fence to score all three runners.
Chattanooga 0 – Utah 2
The Mocs did not fare as well, however, against Utah in the second game of the evening. Chattanooga was out-hit 8-2 and out-scored 2-0.
Despite the loss, sophomore Katie Henderson (Hixson, Tenn.) pitched a tough game, allowing just one earned run over six innings of work. The right-hander fanned three batters and walked just one, forcing seven gounders eight fly outs.
The story of the night was Utah starter Kayce Nieto who was nearly untouchable. The hurler tossed seven innings of two-hit softball, facing only the minimum amount of Chattanooga batters through 5.2 innings.
Robles and senior Tyler Templet (Woodstock, Ga.) were the lone Chattanooga hitters to find hits in the game. Dutton was the only other Moc to reach base, finding her way to first on an error.
Utah scored its only runs of the game in the first and second innings, scoring on a single to right from shortstop Anissa Urtez. The second run came courtesy of a Chattanooga throwing error after Hannah Flippen singled to right with two runners on.
Chattanooga's weekend continues Saturday at 11:15 a.m. as the Mocs take on Central Michigan. After its game with the Chippewas, UTC goes up against Fordham for the second time this season. Both games are available via live stats and live audio. Both services are free through GoMocs.com.


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I use the techniques of the acting profession and apply them to business settings. My many years of banking, consulting and high level performance art experience allows me to assess complex situations and help discover solutions.
Gold profile
I use the techniques of the acting profession and apply them to business settings. My many years of banking, consulting and high level performance art experience allows me to assess complex situations and help discover solutions.
The Double Eagle Process and Access Communications have a uniquely effective approach to dealing with difficult business and personal issues.
Our collective years of business experience combined with our professional performance art techniques enable us to motivate, train and educate individuals from the factory floor to the executive boardroom.
We use professional actors to present customized, on-site training in areas such as communication skills, cold calling, sales, conflict resolution, creative problem solving, diversity, sexual harassment, team building and caregiving.
Woodside, NY 11377
This business address is private; the map is showing an approximate location.
A. My most common programs we provide are sales training, career counseling, executive coaching, fiscal management, diversity, sexual harassment, team building and project finance.
A. Be realistic, open minded, willing to make changes and understand that success takes time and hard work to achieve. There are no short cuts. It is also important to know that I may not have the answers but I ask the right questions.
A. The key to my trade is listening skills. So many of my competitors take this approach, they tell the client what they need and give it to them. The secret sauce exists in clearing your mind to be able to virtually step in the client's situation.
A. My buyers need the desire to achieve their goals and be willing to look deep within themselves to find their individual strengths.
A. I am personally and professionally, an individual of the highest integrity. My creative solutions and practical advice are influenced by past experiences in business, banking, the magic and the not-for profit communities. This enables me to be provide creative consulting services in areas of business development, finance and coaching.
A. I take great interest in listening to my client's history and challenges. This helps me present solutions that are focused and tailored to the uniqueness of every scenario.
A. How do I get more business? You cant expect much progress in earning more business in just one quarter or even in a year or two. Thats why many businesses give up on it. The bad news is its hard to do. The good news is its hard to do, because once you build it, its a competitive advantage that cant be copied. If it were easy everyone would be doing it.
A. One of my first clients, a friend for many years, was sharing frustrations about the document a marketing consultant he hired sent him. My client was angry because the document took a long time to receive and ultimately was a dissertation on the obvious. Things he knew he needed to do but didn't know how to go about executing. Apparently, the consultant didn't know how either. Within weeks we had formulated an action plan and were making great progress.
A. I wish customers knew how difficult it is to quantify the value of the services I provide. Often the results of my involvement are in the way the individual conducts themselves, and their business, which happens slowly, over time. For example, we know that the earth is constantly moving, however we don't necessarily feel it, but we know it is. My clients know they are moving, in the right direction.
A. I decided to get into this line of work after I achieved many successes helping individuals, business owners and not for profit organizations reach their goals. I wanted to recreate the sense of accomplishment and satisfaction of seeing a project to completion as an independent adviser.
A. My pricing system is project specific. The client would contact me, discuss the scope and budget of the project, we arrange a meeting and then I present a proposal that outlines the scope of services and associated cost.
Write a review


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KaTom wins "Small Business of the Year"
The Morristown Area Chamber of Commerce's 9th annual Small Business Awards luncheon was held yesterday.... and Patricia walked away with the title of "2011 Small Business of the Year."
"It is certainly amazing to be a part of a community that supports company growth and recognizes small businesses. KaTom is blessed to have community and chamber support and this accomplishment could not have been achieved without the help of many people." - Patricia Bible, KaTom CEO and President
Nominations were open to any business that is a member of the chamber that is considered to be a "small business".
Other Morristown small business winners include:
- The Chocolate Ladies, 2011 retail-based award
- Megan's Corner Catering and More, 2011 service-based business award
- Crossroads Integrated Health Services, 2011 healthcare-based business
- All Celebrity Travel, 2011 hospitality/leisure-based award
- Bullard Group Insurance, 2011 horizon award (given to a business less than five years old that demonstrates tremendous potential)
KaTom is thrilled and honored to be considered the business of the year and would like to thank our employees and customers who have helped the company grow to where it is today!


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Nike Kids' Air Range Golf Shoes
Product Information:
The Nike® Junior Range Golf Shoe will take any young golfer's game to the next level. The full-length Phylon midsole features the revolutionary Nike® Air heel unit for superior breathability and comfort. A Flywire cage provides added support, and the integrated traction system ensures maximum balance throughout the swing.
- Integrated traction for solid footing and proper balance throughout swing
- Full-length Phylon midsole
- Nike® Air heel unit for improved comfort and breathability
- Flywire cage provides added support
- Mesh and TPU upper
- Rubber outsole
- Die-cut sockliner for snug fit
- Nike
Country of Origin: VietnamWeb ID: 18053146
Customer Reviews:
Rated 4.7 out of 5�by 3 reviewers.
Rated 5 out of 5�by Jacqcarlton My 8 year old loves them! Great fit, great style! The color disguises dirt!! February 23, 2013
Rated 4 out of 5�by enmac2016 Good shoes I really liked the look of these shoes and how comfortable they were, but as soon as I got on the course in the morning, there was morning dew, and these shoes happen to not be very waterproof. My feet were soaked by the end of the first hole. Otherwise, great shoes! December 17, 2013
Rated 5 out of 5�by trugeisha great shoe for junior golfer true to size, exact color as in picture. my son loves his new golf shoe, very comfortable and breathable. April 7, 2014
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Shoreline Editing Services
Shoreline Productions is a small company with one edit suite, and that allows us to keep our rates low and our level of personal attention high. We treat every project that comes through our doors as if it were our own. Hopefully, we've already shot some of the video that we'll be editing, so the production process has already begun before we've made the first cut.
And because we do so much work on the road, we also have two Mac-based location editing systems. These can be set up in hotels or convention centers, with tape decks and monitors (SD or HD), so that we can produce finished videos on-site for meetings and events. We've traveled all over the country, and internationally, with these systems, and our clients and audiences are always wowed by the sophistication of the programs we can produce so far from the studio.


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SANTA BARBARA, Calif. ---
The Cal State Northridge women's soccer team (6-4-5, 3-1-1 Big West) defeated UC Santa Barbara 1-0 Sunday afternoon at Harder Stadium in a Big West Conference match. Freshman Taylor Hobson scored her first career goal in the 84th minute as the Matadors defeated the host Gauchos in Santa Barbara for the first time since 1999.
Coming off a grueling 2-2 draw at Cal Poly, the Matadors were locked into a physical affair with the Gauchos through 80+ minutes of action. It was then that senior Chloe McDaniel collected a loose ball at midfield and proceeded to make a long run into the UCSB 18-yard area.
From there, McDaniel slid a pass to Hobson, who buried a low shot into the netting for her first career goal. McDaniel added her her first assist of the season and Hobson became the sixth different CSUN player to record a game-winning goal in the 2012 season.
In net, senior Cynthia Jacoborecorded five saves to post her sixth shutout of the season. She now has 28 career wins, 22 career shutouts and a 0.64 goals-against-average and a .895 save percentage in her senior season.
In the first half the Matadors played to a scoreless draw, the ninth time this season that CSUN has played to a 0-0 result after the opening 45 minutes. Chloe McDaniel, Stephanie Galarze and Jessa Yukihiro each had quality chances for Northridge but could not solve the UCSB defense.
In all, the teams combined for 26 shots and 24 fouls. One player from each team saw the yellow card.
The three points Sunday coupled with the point at Cal Poly marks the first time in program history that the squad was able to get four points on this roadtrip. The team also improved to 18-13 in 1-0 contests since the start of the 2009 season.
Next week, CSUN plays its final two home matches of the season. On Oct. 19, the Pacific Tigers come to Matador Soccer Field for a 7 p.m. contest. Two days later, Northridge hosts UC Davis on Senior Day for a 1 p.m. affair. Prior to the start of that match, the Matadors will honor their nine senior student-athletes on the team.


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BURNABY — It was last Oct. 30 in Toronto, opening night in the NBA, and there was former UBC Thunderbirds player Jama Mahlalela, doing his best to convince himself that he was about to spend his first night as an … Continue reading
University of Toronto RSS
Hart Hanson's road to TV's Backstrom led him down the corporate rabbit-hole
Home-grown writer-producer Hart Hanson was back at his former stomping grounds at the University of B.C. this week to talk to writing students there about a TV career that most recently had him running the Fox mystery series Bones. He … Continue reading
Naomi Lakritz: Attacks on David Gilmour are a symptom of a sick culture of trolls
You know what the most shocking thing is in the whole story about University of Toronto instructor David Gilmour's refusal to teach women authors to students in his literature classes? It's not the omission of those authors; it's the vitriol … Continue reading
Husband, coach, mentor, player, DAD: Ken Olynyk's basketball life defined by family ties
It was really nothing more than an early pit stop along a coaching road that has stretched an entire generation and touched on parts of five decades. But even back in late 1970's, in the infancy of his career as … Continue reading
Langley's Ellenwood, Kelowna's Turner post decisive wins at BCHS multi-event championships
ABBOTSFORD — Georgia Ellenwood and Rostam Turner left no doubt Saturday afternoon in Abbotsford, winning their respective multi-event championships as the first weekend of the B.C. high school track and field championships wrapped up at Rotary Stadium. Langley Secondary's Ellenwood … Continue reading
In loo of
Finally — fresh Coco in the post. Coco is a lifer. He and I did time together in a seedy west coast prison that, until recently, was the most crowded porta-potty in Canada. When most folks think of a prison … Continue reading


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This is some of the mini mochi I got at Imagiknit today.
This is a hat I knit yesterday, and decided to give it a Maine-flavored name. Let me know when y'all are sick of them, and I'll start knitting underwear (if that model is available).
I'm knitting gloves, and after each finger the pattern says to "rejoin" the yarn. I assume this means to start over with a tail and weave that in when I get around to it.
So I got the bright idea a couple of months ago to try and do a colorwork project, after 4 failures, I think this one is finally going to have a good result.
I'm looking for some advice from the more experienced--in knitting that is...
Hey guys I know I've asked you all to look at my blog before, but I think I've made some big improvements...so if you like to cook...or just eat...check it out.
I was tossing another skein of mohair lace yarn to Evan for a shawl he was doing for a friend...
This is my newest penannular brooch from www.ThorThorsHammer.com
It is a full 3" in diameter (quite large for a penannular brooch) and perfect for me and my ClapotiSaurus Rex!
During the Midwest Men's Knitting Retreat, I had the opportunity to meet Stephen West and see his very cool Herbivore that he was wearing.


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Intraocular devices which are capable of sustained release of a cell proliferation modulating agent, together with methods for their preparation and use, are provided. The proliferation modulating agent is associated either covalently or non-covalently with the material from which the intraocular device is prepared, generally a biologically inert polymer which is physiologically compatible with ocular tissue. The intraocular devices are implanted in the tissue, and the drug is released from the intraocular device such that the drug is substantially retained within the implant region. The device may be used to inhibit cellular proliferation around the implant. The device can be provided as a sterile kit, preferably in a form suitable for immediate use.
1. An occular implant comprising:
a biologically inert polymer having at least one proliferation inhibiting agent associated therewith by a labile interaction selected from the group consisting of: a hydrophobic interaction and a hydrophilic interaction, such that upon implantation into the eye said proliferation inhibiting agent is gradually released from the implant in a localized region of the eye to thereby inhibit proliferation of target cells in the localized region of the eye.
2. An occular implant comprising:
a biologically inert polymer having at least one proliferation inhibiting agent associated therewith by a labile covalent bond selected from the group consisting of: a hydrazone bond and a semicarbazone bond, such that upon implantation into the eye said proliferation inhibiting agent is gradually released from the implant in a localized region of the eye to thereby inhibit proliferation of target cells in the localized region of the eye.
3. The implant according to claim 1, wherein the polymer is selected from the group consisting of polyamides, polypeptides, polyesters, polycarbonates, polyurethanes, polyacetals, polysaccharides, and polyolefins.
4. The implant according to claim 1, wherein the polymer is selected from the group consisting of silicone rubber, polyurethane rubber, polyethylene, polyvinyl chloride, poly(hydroxyethyl methacrylate), poly(methyl methacrylate), poly(ethyleneterephthalate), polypropylene, polystryene, poly(tetrafluoroethylene), polyglycolic acid, cellulose, ethylcellulose, methycellulose, dextran, carboxymethylcellulose, hyaluronic acid, nylon, and collagen.
5. The implant according to claim 1, wherein the polymer is a polysaccharide selected from the group consisting of: carboxymethylcellulose, hyaluronic acid, and heparin.
6. The implant according to claim 1, wherein the proliferation inhibiting agent is selected from the group consisting of: doxirubicin, daunomycin, and 5-fluorouracil.
7. The implant according to claim 1, wherein said inhibiting agent is a toxin.
8. The implant according to claim 7, wherein said toxin is ricin.
9. The implant according to claim 1, wherein said implant is a membrane.
10. The implant according to claim 1, wherein said implant is selected from the group consisting of an intraocular lens, drainage shunt, a prosthesis, and a lens capsular loop.
11. The implant according to claim 1, wherein said polymer is selected from the group consisting of silicon, polymetthylmethacrylate, and nylon.
12. The implant according to claim 1, wherein the polymer is nylon and said proliferation inhibiting agent is daunomycin.
13. A method for killing residual lens epithelial cells after cataract surgery, said method comprising placing an implant according to claim 1 into an eye during or after said cataract surgery, to thereby kill residual lens epithelial cells.
14. A method for preventing formation of scar tissue in an eye, said method comprising placing an implant according to claim 1 into a fistula, whereby scar formation is prevented.
15. A method for preparing an intraocular device, said method comprising: contacting a biologically inert polymer with a proliferation inhibiting agent, such that a labile interaction selected from the group consisting of: hydrazone bond, a semicarbazone bond, a hydrophobic interaction, and a hydrophilic interaction between said polymer and said proliferation inhibiting agent results.
This Application is a continuation of U.S. Ser. No. 08/483,795, filed on Jun. 7, 1995, now issued as U.S. Pat. No. 5,618,553, which is a continuation-in-part of U.S. Ser. No. 08,329,366, filed on Oct. 26, 1994, now abandoned.
This invention relates to methods and compositions featuring polymer implants associated with cell proliferation modulating agents. The invention provides for the modulation of cell proliferation and/or wound healing at sites immediately adjacent to the implant and for the inhibition of cell adhesion to the implant itself.
The inappropriate proliferation of cells in an organism may lead to a variety of disease states. The particular symptoms will vary depending oil the type of proliferative cell and on the location of the cell. These disease states may range from cancerous malignancies when the cell is a cancer cell, to scarring when the cell type is a normal fibroblast, or to a skin disease when the proliferating cell is an epithelial or dermal cell forming a part of the integument or skin.
Proliferation of cells in various tissues of the eye can lead to impaired vision. One such example of impaired vision results from a proliferation of lens epithelial cells which remain associated with the lens capsule following cataract surgery. Specifically, extracapsular cataract extraction for the removal of cataracts frequently is accompanied by an undesired proliferation of lens epithelial cells, resulting in posterior lens capsule opacification. Virtually all pediatric patients and approximately 50% of adult patients undergoing extracapsular cataract extraction develop an opaque secondary cataract within three to five years of surgery.
Various cytotoxic agents are reported to inhibit secondary cataract formation or posterior lens capsule opacification. For example, cytotoxic agents such as 5-fluorouracil, methotrexate, colchicine, and daunomycin have been instilled into the anterior chamber of the eye to kill residual lens epithelial cells for prevention of posterior lens capsule opacification. These drugs have been delivered, e.g., by injection or with the aid of various drug delivery techniques that provide for diffusion of the drug within the eye.
A second example of vision-threatening cellular proliferation occurs following glaucoma surgery. Glaucoma encompasses a heterogeneous group of eye diseases characterized by a classical triad of symptoms: elevated intraocular pressure (IOP), optic nerve damage and progressive visual field loss. The increase in IOP is due to a decrease in the outflow of aqueous humor, the fluid in the anterior segment of the eye that is responsible for maintaining pressure balance for the entire eye. Current medical therapy for glaucoma involves the administration of one or more ocular agents, including beta-blockers (e.g., timolol), miotics (e.g., pilocarpine), adrenergic agonists (e.g., epinephrine) and carbonic anhydrase inhibitors (e.g., acetazolamide). While most glaucoma patients initially respond to drug therapy, many become refractory over time. For those individuals, maintenance of normal IOP requires surgical intervention.
Surgical techniques for the correction of glaucoma include various types of glaucoma filtering surgery (GFS), during which a drainage channel is created for aqueous humor outflow from the anterior chamber in order to lower IOP. The most successful GFS is that which uses the creation of a filtering bleb or drainage fistula, which is an elevation of the conjunctiva at the surgical site, to decrease IOP. Numerous techniques may be employed to maintain the patency of the bleb or fistula, including the use of biocompatible plastic tubes or valves, yet scarring over of the drainage channel frequently causes blockage of the bleb or fistula and a concomitant increase in IOP. Recent clinical studies have demonstrated that introduction of agents which inhibit the wound healing process can in some instances improve the success rate of GFS. These agents typically are administered by non-specific means such as application by sponge to the drainage filter tissue during the surgical procedure or by repeated, painful injections into the conjunctiva after the operation.
Drug delivery techniques which have been reported both for prevention of secondary cataracts and for GFS rely to a greater or lesser extent upon diffusion of the administered drug to the target cell site. However, the continuous movement of the aqueous fluid through the anterior chamber of the eye can alter the effective concentration of the drug at the target cell site. Thus, these delivery techniques create undesirable side effects due to the inherent activity of the modulating agent on cells other than target cells combined with the lack of specific localization to the target site, resulting in a lower effective dose at that site. For example, the non-specific delivery of potent antiproliferative agents such as mitomycin C and 5-fluorouracil often has resulted in inadequate wound healing, leakage of the aqueous humor, hypotony or very low pressure leading to further complications.
It therefore would be of interest for treatment regimens which involve a surgical procedure and for which a successful outcome depends on the modification of cell proliferation, for example, inhibition of growth of lens epithelial cells in cataract surgery and fibroblasts in glaucoma filtering surgery, to identify methods and compositions for the delivery of agents capable of modulating cell proliferation and modulating wound healing responses in a site specific manner.
Relevant Literature
Heyrman, et al. (1989), J. Cataract Refract. Surg., 5:169, describes studies of drug uptake and release by polymethylmethacrylate (PMMA) and hydrogel intraocular lenses. European Patent Application 0 443 809 A2 describes an intraocular lens (IOL) coated with a hydrophilic material and including a pharmacologically active agent. U.S. Pat. No. 4,918,165 describes an antibody-cytotoxin conjugate covalently linked to an IOL. U.S. Pat. No. 4,170,043 describes an IOL coated with a biocompatible, water-soluble film. U.S. Pat. No. 4,240,163 describes an IOL coated with a medicament.
Biodegradable microcapsules for use in the eye are disclosed in Wong (U.S. Pat. No. 4,853,224). A bioerodible polymer disc containing an aqueous mixture of mitomycin is disclosed by is disclosed by Charles et al. (1991), Ophthalmology 25 98(4):503. A biodegradable ocular implant for delivery of therapeutic agents is described by U.S. Pat. No. 4,863,457, by Lee et al. (1988), Invest. Opth. & Visual Science 29(11):1692 and by Lee et al. (1987) Ophthalmology 94:1523. Kay et al. (1986) Ophthalmic Surgery 17(12):796 describe a collagen sponge containing 5-fluorouracil for ocular use. A wafer having a diffusion limiting membrane and containing colchicine is described by Legler, et al. (1993), J. Cataract Refract. Surg. 19:462. See also Hartmann, (1990) Ophtalmologie, 4:102.
The following references also may be relevant to the subject invention: Xu, et al. (1993), Ophthal. Surgery, 24(6):382-388; Tahery and Lee (1989), J. of Ocular. Pharm., 5(2):155-179; Palmer (1991) Ophthalmology, 98:317-321; K. Mosbach (Editor ed. 1976), Methods in Enzymology, Vol. 24 Immobilized Enzymes; S. Wong (1991) Chemistry of Protein Conjugation and Crosslinking CRC; G. Pietersz (1990), G. Bioconjugate Chem. 1:89; W. J. Power, et al. (1994), J. Cat. Refract. Surg. 19:440; M. Weller, et al. (1988), International Ophthalmology 12:127; M. Bruce Shields, Textbook of Glaucoma (3rd ed. 1992), Ch. 34 and 36; and H. Alkock and F. W. Lampe (ed. 1981), Contemporary Polymer Chemistry.
The following are general articles: Maeda, et al. (1992) Bioconj. Chem. 3:351-362; Takakura and Hasida (1995) Crit. Rev. Oncol. Hematol. 18:207-231.
The present invention provides methods and compositions for modulating the proliferation of target cells, for example in the eye. The composition is a polymer implant with which a cell growth modulating agent is associated. The association can be a covalent labile bond or non-covalent reversible association. Upon release from the polymer, the modulating agent remains substantially within a localized tissue region, so that it affects primarily target cells in the localized region. The invention also provides for an intraocular device comprising a biologically inert polymer associated with a modulating agent, and methods for preparing the intraocular device. The methods and compositions find use, for example, in the prevention of secondary cataract, in enhancing the success of glaucoma filtering surgery, and in the enhancement of biocompatibility of tissue implants by use of an antiproliferative agent as the cell proliferation-modulating agent to modulate growth of cells migrating into an implant site.
FIG. 1 shows a schematic representation of one embodiment of the invention wherein a tissue of interest is contacted with an implant composed of a polymer and a cell proliferation-modulating agent. In this embodiment, daunomycin (15) is associated with the polymer nylon which has been fabricated as a loop (10) to produce a daunomycin coated loop (5). The daunomycin coated loop (5) is inserted into the lens capsule (30) of the lens (35) following cataract surgery, thus placing the drug in close proximity to the lens epithelial cells (25) which line the inner surface of the capsule (30).
FIG. 2 shows a schematic representation of another embodiment of the invention wherein the cell proliferation-modulating agent daunomycin (15) is associated with a nylon membrane (100) to produce an implant form (105). The nylon-daunomycin implant (105) is contacted with tissue posterior to the conjunctiva (115) in the surgically created fistula (120) following filtration surgery. Implantation at this site places the cytotoxic agent in close proximity to proliferating fibroblasts which in the absence of treatment can cause scarring over of the surgically created drainage channel (120).
The present invention provides methods and compositions for modulating cell proliferation and wound healing in a tissue of interest. In the methods, a tissue of interest is contacted with a composition which includes a cell proliferation-modulating and/or wound healing agent and a biologically inert polymer implant. The selected modulating agent is associated reversibly with the polymer implant so as to provide for localized delivery of the agent following implantation of the device into the tissue. By "polymer implant" is meant a polymer in a physical form suitable for placement within the body by surgical or other means. The actual physical shape of the polymer implant will be determined by the intended use. The polymer implant can be prepared by immersing the implant into a solution of a modulating agent, whereby the agent is adsorbed to the polymer by hydrophobic/hydrophilic action and/or by chemical linkage. In use, the polymer implant and associated agent are introduced into the tissue during or following surgery. For GFS, the implant is laid on top of the sclerostomy site (if partial thickness) in the subconjunctival space. For prevention of secondary cataracts, the implant is inserted into the lens capsule. The modulating agent is continuously released from the implant polymer at a concentration and rate sufficient to modify cell proliferation and/or wound healing of the target cells in the immediate vicinity of the implant and so have minimal or no effect on cells away from the implant site. The target cells include lens epithelial cells, in the case of secondary cataracts, and fibroblasts and leukocytes, in the case of GFS or any other application in which scarring is to be minimized.
The localized region of modulation will be determined by the release characteristics of the polymer and the concentration of the modulating agent, and can readily be optimized using the experimental techniques described herein. For example, for use in secondary cataract prevention, the implant will reside within the remaining lens capsule, and the modulating agent will be substantially localized to the equatorial region. Localization may be further facilitated when, during normal healing, cells surround and attach to and/or encase the implant. Generally, the localized region will be within 10 mm of the implant, more preferably 7 mm, most preferably 5 mm or less. The modulating activity of the implant will be maximally exerted upon any cell coming into actual contact with the implant. Such contact inhibition is particularly desirable for GFS.
The compositions and methods of the subject invention offer several advantages over currently available methods for modulating cell proliferation and/or wound healing. For example, as a result of binding of the modulating agent to a polymer implant, the modulating agent remains localized in the wound site, creating a high local concentration of the agent and minimizing or eliminating diffusion or systemic delivery to other areas. Even if there is some diffusion away to other areas, the concentration of the antiproliferative agent generally will be insufficient to effect cells in those other areas. In contrast, currently available methods of applying antiproliferative agents without localization can result in complications such as poor control of the proliferation and/or healing and wound leaks and negative effects on cells away from the implant site. Other advantages of the subject invention include control of the dosage of the modulating agent and prevention of unwanted effects on essential cells in the tissue of interest, since localization of the drug to the tissue site prevents migration to other areas of sensitive cells, especially normal cells, and instead sequesters the growth-modulating agent in the region of invading cells. It also is unnecessary to prepare separate formulations for each tissue of interest as the localization of the drug is accomplished by the implant. The resulting effect can, as appropriate, range from complete elimination of an undesirable cell type to inhibition of cell proliferation at the implant site, or could be used to stimulate growth, for example, of a poorly healing wound, such as in a diabetic or a burn patient.
The compositions include a biocompatible polymer implant with which a modulating agent is associated. By "modulating agent" is meant any compound that alters the growth or development of cells, including both cell-proliferation-modulating, agents and agents that affect wound healing. Examples include antimetabolites and cytotoxins which kill cells, antimitotics that further inhibit growth or proliferation of cells, growth factors which stimulate cell division, differentiation, etc., or compounds which alter the wound healing process, e.g. by selectively inhibiting or stimulating a population of cells associated with wound healing, such as fibroblasts.
When the intended application is an inhibition of cell proliferation and/or prevention of wound healing, specific proliferation-modulating agents can include daunomycin, daunorubicin, doxorubicin, mitomycin C, 5-fluorouracil, cytosine arabinoside, colchicine, cytochalasin B, bleomycin, vincristine, vinblastine, methotrexate or the like. Also of interest are toxic agents which may be derived from microorganism or plant sources. Examples include naturally occurring toxins such as ricin, abrin, diphtheria toxin, and the like. When the desired result is enhanced cell proliferation or wound healing, the proliferation-modulating agent can be a growth-promoting agent such as fibroblast growth factor, epidermal growth factor, transforming growth factor B, and platelet-derived growth factor and/or the like.
The polymer is biologically inert and physiologically compatible with tissues, e.g., the eye. The polymer also desirably in and of itself does not induce an inflammatory response. The polymer also preferably is capable of associating reversibly with a sufficient amount of the selected modulating agent, and of releasing that agent in a suitable manner to satisfy the intended objective, e.g., inhibition of wound healing. The preferred characteristics of the polymer include capacity for interacting in a reversible manner with the cytotoxic agent, whereby the cytotoxic agent is released slowly into the eye. The polymer is capable of absorbing the cytotoxic agent either covalently or non-covalently. Examples of association include by way of electrostatic charge, hydrophobic or hydrophilic interactions, or covalently.
Various molecules which have the desired characteristics can be used to prepare the general class of polymers such as polyamides, polypeptides, polyesters, polycarbonates, polyurethanes, polyacetals, polysaccharides, and polyolefins may be used for preparing the polymer implant. Specific examples of such polymers include, but are not limited to, silicone rubber, polyurethane rubber, polyethylene, polyvinyl chloride, poly(hydroxyethyl methacrylate), poly(methyl methacrylate), poly(ethylene terephthalate), polypropylene, polystyrene, poly(tetrafluoroethylene), polyglycolic acid, cellulose, ethylcellulose, methycellulose, dextran, carboxymethylcellulose, hyaluronic acid, nylon and collagen. Additionally the implant may be a polymer and/or salts thereof and/or homologues, analogues, derivatives, complexes, fragments as well as copolymers, composites or blends of the above.
Of particular interest are biologically inert polymer implants with which the modulating agent is associated covalently or noncovalently in an amount sufficient to provide the desired amount of modulation of cell proliferation following release of the modulating agent after insertion of the implant. One such example is a nylon polymer implant to which is adsorbed an amount of daunomycin sufficient to inhibit cell proliferation and/or wound healing. The nylon polymer to which the cell modulating agent is bound can be in the form of a membrane, or alternatively, the polymer can be in the form of a powder, which can be prepared as a wafer or other implant form by various techniques, i.e., pressure mold. Various fillers/binders and coatings could be used. Essentially the binder would dissolve in aqueous solution allowing the dispersion of the particles. In tissue this would provide a more amorphous distribution than an intact implant. The biological properties of many other suitable polymers are known to the art. The ability to reversibly associate a modulating agent with the polymer is readily determined by one skilled in the art for any polymer having otherwise desired biological properties using methods known to those skilled in the art.
It is desirable for the modulating agents to be bound reversibly to the polymer implant or via a labile bond so as to be only locally diffusible about the region in contact with that implant, thereby increasing the local concentration of the modulating agent, while reducing side effects to cells away from the implant site and frequency of administration. The rate of release of the growth-modulating agent from the polymer may vary depending on the particular use. Generally, the rate is about 25 to 50% of the initial amount released in the first 24 hours, and 5-10% per 24 hour period, thereafter.
The polymer implant can be prepared in a number of ways. For example, the modulating agent can be associated with the implant by immersing it in a solution of the modulating agent, whereby the agent becomes reversibly associated with the polymer. The modulating agent also may be reversibly bound to the implant by other coating techniques known to those skilled in the art, such as spraying the implant or flowing the modulating agent about the implant. Two systems are of particular interest. The first system uses a cytotoxic agent (daunomycin, doxorubicin, etc.) absorbed onto the polymer, i.e., nylon. In aqueous solutions daunomycin is released from the nylon slowly. In the second system a covalent bond is formed between reactive groups present on the polymer and the modulating agent. Examples of such a bonds are imine derivatives of the C13 carbonyl groups of doxorubicin and daunomycin, such as hydrazones and semicarbazones. These types of bonds have been described in Yamamoto, et al., J. Medicinal Chem. (1972) 15:872-875 and Morrison and Boyd (1966) Organic Chemistry (2d Ed.)(Allyn and Baeen, Inc., Boston, p. 640).
For covalent coupling of an anti-proliferative agent to the polymer, reactive sites such as --OH, --COOH, --SH, or --NH2 can be present on the polymer, or can be introduced by procedures known to those skilled in the art. See, for example, Mosbach, Methods of Enzymology and Wong, Chemistry of Protein Conjugation and Crosslinking. Of particular interest are covalent bonds which are labile, i.e., they can be cleaved enzymatically or by acidic or reducing conditions. Numerous methods for coupling drugs to the above reactive sites are known to those skilled in the art. See, for example, Pietersz, Bioconjugate Chemistry (1990) 1:89. Where the polymer is nylon, for example, functional carboxyl and amino groups can be introduced by controlled hydrolysis using 3 M HCI. The carboxyl group can be activated with 1-ethyl-3-[3-dimethylaminopropyl)-carbodiimide (EDC) for reaction with adipic dihydrazide to provide hydrazide substituted nylon.
Modified nylons can also be produced as described by Morris, et al. Biochem J. (1975) 147:593 through an initial O-alkylation of the polymer with triethyloxonium tetrafluoroborate. The resulting imidate salt of nylon then can be allowed to react under nonaqueous conditions with a bi-acid hydrazide, such as adipic acid dihydrazide, to give hydrazide substituted nylon.
Where the polymer is polymethyl methacrylate (PMMA) for example, carboxyl groups can be introduced by treatment with an oxygen plasma discharge, followed by acrylic acid granting to yield PMMA with available carboxyl groups. See, for example, Inn-Kyu Kang, et al. (1993). Activation of the carboxyl group using EDC and reaction with adipic acid dihydrazide provides hydrazide substituted PMMA.
Where the polymer is a polysaccharide such as carboxmethylcellulose, hyaluronic acid, heparin or the like or a protein with naturally available carboxyl groups, the carboxyl groups may be derivatized directly by using EDC and adipic acid dihydradize or hydrazine in a similar manner to give hydrazide substituted polysaccharide or protein respectively. See, for example, Herwitz, et al. (1980) J.
Applied Biochem, 2:25-[?]; Pouyani and Piestwich (1994) [Journal?] 5:339-347; Larson, et al. (1989) Biomaterials 10:511-516.
The biocompatibility of the implants can be increased, for example, by attachment of PEG. Methods for preparing activated PEG are well known. See, for example, Bergstrom et al., (1992), J. Biomed. Mat. Research 26:779-790. Methods for preparing polymers with functional groups capable of reacting with these activated PEG molecules are well known. Examples of improved biocompatibility of implant materials with PEG have been published. Such a modification also allows for use of polymers which would be otherwise suitable for use in preparing an implant, but which are not biocompatible, or have poor biocompatibility. Other means of improving the biocompatibility of implants include the use of heparin (see, for example, Behar-Cohen et al. (1995) Investigative Ophthalmology Visual Science 36:5802 which discloses heparin coated IOLs).
The polymer implant can be provided in a variety of forms. The polymer can be cast, molded or fabricated into any form suitable for the particular application. It may be a stand-alone device such as IOL, or the implant can be in a form that can be used in conjunction with another device. For use in the prevention of secondary cataract, for example, the form of the implant can be a substantially circular ("O") ring or loop capable of fitting into the lens capsule in conjunction with an IOL. The O ring or loop has approximately the diameter of the lens and is placed in the eye so as to go around the inner periphery of the capsule. After the device is in place, an IOL is then inserted. Alternatively, for GFS, the implant can be in the form of a thin membrane or sponge. A thin polymeric membrane also can be used to encapsulate a polymeric or other implant, when it is desirable that scarring in the region of implant be minimized.
The implant is fabricated as desired, sterilized by any acceptable means, for example, autoclave (steam) sterilization, irradiation, ethylene oxide gas, etc. It is then aseptically immersed into a sterile solution of cell proliferation modulating agent to allow for association. Following association, the implant is rinsed with water to remove unbound agent, dried and packaged. Alternatively, nylon powder (particles) can be sterilized as above, added to solution of daunomycin for example, rinsed with water to remove unbound drug, and dried. The nylon powder with associated daunomycin is then mixed with appropriate formulation agents (such as hydroxypropyl methyl cellulose (HPMC), sucrose, etc.) as binders and formed into tablets, wafers, etc. When placed into tissue, the binder dissolves leaving the nylon-daunomycin particles trapped in the tissue. The drug is slowly released from the particles.
The load capacity of the polymer for the modulating agent is determined in part by the surface area of the implant and in the case of covalent bonds, by the number of available reactive groups. Accordingly, implants with maximized surface areas, for example porous or woven implants, may be preferred. The implant also may be formed so as to provide a physical gate to cell encroachment, e.g., a lip, ridge, or grid, that is designed to increase physical contact of the target cells with the implant. For example, in GFS the implant can be a membrane which can be implanted in the fistula. The membrane implant generally is designed to allow free passage of aqueous fluid from the filtration site, and generally is of a size to cover the scleral surgery site. An approximate diameter of 1 cm, and a thickness of 1-5 mm, is typical for a membrane implant. The membrane can be placed directly over the scleral surgery site, under the conjunctiva, and hence help support the fistula bleb created during GFS. The implant also can be cut to the shape of and be placed in the scleral bed in the case of a partial thickness surgery.
In use, the polymer implant and associated agent are introduced into the tissue during or following surgery. As an example, for GFS, the polymer implant is placed at the surgical site as follows. The conjunctiva is carefully dissected anteriorly to the limbus. Excessive tenons tissue overlying the sclera are excised. A limbal groove is made and extended anteriorly, into the corneal stroma. Before the anterior chamber is entered, a paracentesis is made through peripheral clear cornea away from the filtering site. Then the anterior chamber is entered through the filtering site and a small (1�3-mm) block of scleral tissue and trabecular meshwork is excised. The edges of the sclerectomy are cauterized to control hemostasis. Then a peripheral iridectomy is performed. The cylindrical polymer is inserted into the sclerostomy site before closure.
Following insertion of the implant, the cell proliferation-modulating or wound healing agent is continuously released from the implant polymer at a concentration and for a time sufficient to modify cell proliferation or wound healing in the immediate vicinity of the implant. The implant may exhibit a slow, steady-state release of the modulating agent such that the agent remains substantially within the region of the implant. Alternatively, the implant may exhibit a multi-phase release in which the polymer delivers an initial "burst" of short duration followed by sustained release of lower concentrations. Such a release profile also advantageously minimizes the amount of modulating agent delivered to non-target regions while advantageously exposing the target cells in the localized region to an initial exposure that rapidly initiates the desired modulation. The load bound to the support depends on the surface area of the support and the concentration of the cell modulating solution and the time. Using high concentrations, a higher amount of weakly associated drug may come as a burst. The amounts can be varied and the release modified by how extensively the implant is washed prior to use. The implant also advantageously retains sufficient concentrations of the desired modulating agent to effectively exert contact modulation upon any target cell physically contacting the implant, for at least several days following placement of the implant.
Thus, both concentration and the release rate of the growth-modulating agent can affect the time elapsed before the effect on target cells is achieved. Generally, the effect on cell proliferation of the cell-modulating agent associated with the implant polymer is realized within 24 to 48 hours after target cells come in contact with the cell-modulating agent, depending upon the concentration of the agent used. The effect may be expected to last as long as 3-5 days or longer, depending upon the release characteristics of the polymer and the potency of the modulating agent.
The effectiveness of the implant with associated cell modulating agent for its intended use can be determined in a variety of ways. Many types of cells can be used to test the complex, preferably cells similar to the cell type in the tissue of interest. For example, when the intended use of the implant is in human ocular tissue, it is preferable that human scleral fibroblast cells obtained from surgical specimens or fresh eye bank tissues be used. When the intended use is a veterinary one, it is preferable that the cells be from the intended recipient host species. For example, when the desired effect is inhibition of cell proliferation, particularly proliferation of cells which migrate into an ocular wound, the implant can be tested an in vitro cell culture assay in which mammalian cells are added to culture wells containing the polymer implants. An in vivo model of the intended condition for treatment, such as glaucoma or secondary cataract development can be used. As an example of an in vitro assay for determining the ability of the conjugate to inhibit or stimulate cell proliferation in vitro. Alternatively, growth can be evaluated by functional determination such as the effect of the test agent on protein synthesis. For example, the stimulation of collagen formation can be monitored in vitro using the incorporation of 1-[2,3-3 H]-proline into collagenase susceptible protein. (Peterkofsky, B., et al., (1982) Immunochemistry of the Extracellular Matrix Vol. II, ed. Furthmayr, H. CRC Boca Raton, Fla. pp. 19-42.)
In one particular use of the polymer implant, the tissue(s) of interest are the sclera and conjunctiva of the eye, and the intended application of the invention is to enhance the success of glaucoma filtering surgery. In glaucoma filtering surgery, a drainage fistula or channel is surgically created to increase aqueous humor outflow as a means of lowering IOP. The intended application of the polymer implant in glaucoma filtering surgery is to control or down-regulate the healing of the surgical wound such that it heals, but in the process does not create excessive scar tissue to block the filtering channel or bleb that has been made. Since many of the cells in the tissue abutting the wound site are amitotic (non-dividing), the antimitotic agents would have little or no effect on these cells, thus conferring additional selectivity to the use of the implant.
A sufficient amount of the modulating agent on the polymer implant is introduced into the surgical wound site to achieve the desired effect of enhanced healing or inhibition of healing following surgery. An effective concentration is defined as the dose which inhibits cell proliferation using an in vitro assay such as that described above by at least 70%, preferably more than 80%, and most preferably by more than 95% when compared to control plates, i.e., those to which polymer implant alone is added, or as the dose that stimulates cell proliferation by at least 50%, preferably more than 100%, and most preferably by more than 200% when compared to control plates. An effective dose of the conjugates for inhibiting wound healing in GFS generally is in the range of 10-500 μg, more preferably 10-200 μg, still more preferably 10-100 μg.
In another use of the invention, the tissue(s) and cells of interest are the lens capsule and any associated residual lens epithelial cells following cataract surgery. The invention is used to prevent growth of the residual lens epithelial cells on the lens capsule after removal of a primary cataract. The primary cataract can be of any type, including senile, juvenile and radiation-induced. The polymer implant may inhibit proliferation of, or preferably kill, lens epithelial cells which can grow across the optic axis of the posterior lens capsule following removal of the primary cataract. For evaluation of the efficacy of the invention for use in the prevention of secondary cataract following primary extracapsular cataract surgery, an art accepted in vitro model can be used. Cataract surgery is performed in a host animal such as a rabbit according to methods described by Ulrich, et al., ((1993) J. Cat. Refract Surg. 19:462). Following surgery, a polymer implant is inserted into the capsular bag. The implant is crafted in the form of an open loop or ring whose diameter approximates the lens equatorial diameter. Both ends of the loop are placed inside the bag using techniques common for placement of intraocular lens haptics. Various concentrations of the cell proliferation-modulating agent are absorbed to the implant. Following surgery, eyes are observed to determine the effect of the implant on lens epithelial cells proliferating on the posterior capsule surface. At selected times following surgery, animals are humanely sacrificed and the eyes are submitted for histological evaluation to assess the degree of lens epithelial cell proliferation.
The development of secondary cataract in humans can take from a few months to several years. Clinically, secondary cataract is determined by slit lamp microscopy presenting as the appearance of lens epithelial cells growing on the posterior lens capsule (posterior capsule opacification). This opacification, especially if centrally located, can result in decreased visual acuity. Treatment of posterior capsule opacification is conventionally performed by YAG laser capsulotomy which removes the opacified capsule and restores a clear line of vision resulting in improved visual acuity. The invention described herein would, when implanted at the time of primary cataract surgery, allow for the release of therapeutic concentrations of agents cytotoxic for lens epithelial cells. These agents would destroy the cells and hence prevent their proliferation. Thus, slit lamp microscopy can be used to determine that posterior capsule opacification has not occurred. Alternatively, since posterior capsule opacification can lead to a loss of visual acuity, the maintenance of visual acuity at post-cataract surgery levels or a decreased incidence of YAG capsulotomies can be used to determine the efficacy of the implant.
The subject compositions can be provided as kits for use in one or more operations. Kits may include a separate polymer implant and growth-modulating agent. The agent may be a concentrate, including lyophilized compositions, and may be provided in vials which may include one or more dosages. Conveniently, single dosages may be provided in sterilized containers. Alternatively, the kits may include a composition prepared for direct use. Generally, the growth-modulating agent is combined with the solid support by assembly of the various components in a sterile environment and the assembly is maintained in an aseptic environment until use. The compositions are preferably stored dried or lyophilized in a sterile container. Excipients may be used to promote stability under these conditions. Generally if the drug is currently stable under these conditions, it should be stable under the same conditions when associated to an implant. The implant should be kept dry until it is ready for implantation.
The following examples are offered by way of illustration and not by way of limitation.
______________________________________Example 1 Cytotoxic Activity of Ricin Associated with PolystyreneExample 2 Release Characteristics of Ricin Associated with Polystyrene Culture WellsExample 3 Binding and Release Characteristics of 125 I-Ricin and Various PolymersExample 4 Cell Proliferation on Daunomycin Associated Nylon MembraneExample 5 Cytotoxic Activity of Daunomycin Associated with Different PolymersExample 6 Quantitation of Daunomycin Binding to Different Types of PolymersExample 7 Binding and Release Characteristics of Daunomycin with Nylon MembranesExample 8 Nylon-Daunomycin Implant for the Prevention of Secondary Cataracts in a Rabbit ModelExample 9 Nylon-Daunomycin Implant for Control of Scar Formation After Filtering Surgery in Beagles With GlaucomaExample 10 Covalent Coupling of Daunomycin to Polymer Implant Via a Hydrazone LinkageExample 11 Binding and Release of Daunomycin from Nylon PowderExample 12 Covalent Coupling of Daunomycin to Carboxymethylcellulose via a Hydrazone Linkage.Example 13 In Vitro Evaluation of Cell Growth Modulating Properties of ImplantsExample 14 Evaluation of Implant for Enhancement of Cell Proliferation During Wound Healing______________________________________
Ricin (Sigma Chemical Company) was diluted in phosphate buffered saline (PBS) to prepare a dilution series of 20, 2.0, 0.2, 0.02 and 0.002 ug protein/ml. Ricin dilutions were added to duplicate wells (0.5 ml/well) of a 24 well polystyrene culture plate (Corning). PBS was added to two additional wells as controls. Following incubation for 1 hour at 37� C. and overnight at 4� C. the plates were washed three times with PBS to remove all unbound ricin. ME 180 cells (ATCC No. HTB 33) suspended in 1.0 ml M199 (Gibco) containing 10% fetal bovine serum were added to the wells to give 1.0�104 cells/well and incubated at 37� C. for eight days. Following incubation the culture media was aspirated from the wells and cell monolayers stained by the addition of 0.5 ml crystal violet solution (5% in 70% methanol) to each well. Following incubation for five minutes the plates were washed with water to remove excess stain and allowed to air dry. Plates were then inspected with an inverted microscope and the degree of cell growth (percent confluence) was estimated. Results are shown in Table 1, below.
TABLE 1______________________________________Cell Proliferation in PolystyreneCulture Wells Pretreated with RicinPretreatment Concentration (μg/ml)1 Percent Cell Confluence2______________________________________20 02.0 00.2 <250.02 50-750.002 25-50PBS Control 50-75______________________________________ 1 Concentration of ricin in PBS added to culture wells. 2 Percent confluence was estimated by visual inspection of the stained monolayer using an inverted microscope. Zero percent confluence indicates that no cells were observed growing in these wells. One hundred percent confluence would indicate that the well was completely covered with a monolayer of cells.
Thus, this example demonstrates that a modulating agent such as ricin associates with a polymer such as polystyrene and inhibits the growth of cells that contact the coated polymer or are in the vicinity of the polymer implant.
Ricin (Sigma Chemical Company) was diluted in phosphate buffered saline (PBS) to prepare a dilution series of 10, 5.0, 2.5, 1.25 and 0.62, 0.31 and 0.15 μg protein/ml. Ricin dilutions were added to wells (0.5 ml/well) of a 24 well polystyrene culture plate (Corning). PBS was added to additional wells as a control. Following incubation for 1 hour at 37� C. and overnight at 4� C. the plates were washed five times with PBS to remove all unbound ricin. Following washing, 1.0 ml PBS was added to each well and the plate was incubated at 4� C. for 24 hours. Supernatants from individual wells were collected and titrated in a MTT cytotoxicity assay using ME 180 cells. The amount of ricin released into PBS was determined by comparing the cytotoxicity to that obtained with known amounts of ricin. Results are shown in Table 2, below.
TABLE 2______________________________________Binding and Release of Ricin fromPolystyrene Cell Culture WellsConcentration of Amount of RicinRicin Added (μg/ml) Released (ng)1______________________________________10.0 26.25.0 12.22.5 8.31.25 4.60.62 4.20.31 2.30.15 0.84______________________________________ 1 Amount of ricin released from polystyrene following 24 hours incubation in PBS.
Thus, this example demonstrates that the polymer slowly releases the bound modulating agent.
Ricin was labeled with 125I and diluted to a concentration of 10 ug/ml with a specific activity of 5.8�104 cpm/ug protein. Polymer balls (1/4 inch diameter) were purchased from Polysciences and sterilized by autoclaving. Polymer balls were added to the solution of ricin and incubated at 37� C. for one hour and 4� C. overnight. Following incubation unbound ricin was removed by washing the balls with PBS. Individual balls were added to tubes and the amount of associated radioactivity determined by counting in an LKB compugamma counter. Individual balls were also placed in individual wells of a 24 well culture dish containing 1 ml of M199 containing 10% FBS and 4.5�104 ME 180 cells. Plates were incubated at 37� C. for five days. Following incubation the individual balls were removed from the wells, rinsed and counted for radioactivity. Aliquots of culture media was collected and counted. The remaining media was then aspirated and the wells stained and inspected as described above.
Nylon membrane discs (Biodyne A, 7.5 mm in diameter, Pall Biosupport) were cut from sheet membrane using a hole punch and autoclaved. The discs were then incubated in a solution of daunomycin (200 ug/ml in PBS) for two hours at room temperature. Discs were visibly red due to the absorbed daunomycin. The discs were rinsed in PBS and placed in M199 and incubated for an additional 2 and 3/4 hours. The discs were finally rinsed and blotted to remove excess liquid. The discs were then placed in the bottom of a 24 well culture plate and ten microliters of ME 180 cells suspended in M199 containing 10% FBS was placed in the center of the disc. Plates were incubated at 37� C. for one hour to allow for cell
TABLE 3______________________________________Ricin Associated with Polymer Balls4 Pre-Incubation1 Post-Incubation2 PercentPolymer (ng/ball) (ng/ball) Confluence3______________________________________Polystyrene 0.677 0.397 0Poly-propylene 1.004 0.598 0Acrylic 0.192 0.143 0Polyamide 0.161 0.081 0______________________________________ 1 Ricin associated with polymer balls (nanograms/ball) following rinsing and prior to being added to cell culture wells. 2 Ricin associated with polymer balls (nanograms/ball) after 5 days of culture in wells 3 Relative estimation of viable cells attached to cell culture well. Zero indicates no cells. 4 Controls (balls with no ricin) had percent confluence of 3+.
adhesion and then washed to remove unbound cells. M199 containing 10% FBS was added and the plates incubated at 37� C. for 48 hours. To determine the extent of cell proliferation 1uCi 3 H-thymidine was added to each well and the plates incubated for an additional 24 hours. The discs were then rinsed in ice cold 10% trichloroacetic acid, rinsed in water and placed in scintillation fluor for counting. Results are presented in Table 4, below.
Polymer balls (1/4 inch diameter) were obtained from Polysciences. Individual balls (sterilized by autoclaving) and were placed in a solution of daunomycin diluted to 0.5 mg/ml in PBS and incubated overnight at room temperature. The balls were then rinsed extensively with PBS to remove unbound daunomycin. Individual balls were then placed in wells of a 24 well culture plate (Costar). Additionally a polymethmethylacrylate (PMMA) intraocular lenses (IOL)
TABLE 4______________________________________Cell Proliferation on DaunomycinAssociated Nylon MembranesDaunomycin used for Daunomycin in 3 H-ThymidineMembrane Treatment1 Culture Media2 Incorporation (cpm3)______________________________________- - 1627 � 689- + 62 � 57+ - 29 � 4______________________________________ 1 Nylon membrane discs were incubated in a solution of daunomycin in PBS and washed to remove unbound daunomycin. Control membranes were treated with PBS. 2 Following addition of cells control wells received an aliquot of daunomycin in solution sufficient to inhibit cell proliferation. 3 Incorporation of 3 Hthymidine into DNA was used to monitor cell proliferation. Data represent the mean and standard deviation of triplicate values.
was treated in a similar manner. A single cell suspension of ME180 cells was prepared by trypsinization of a confluent monolayer and resuspended in M199 containing 10% FBS. One milliliter of cell suspension (1.4�104 cells/ml) was added to each well of the culture plate. The plate was incubated at 37� C. until control wells (no balls) reached confluence. At this time the media was aspirated and cell monolayers were stained with crystal violet as described above. The degree of cell growth was determined by visually inspecting the wells for stained cells using an inverted microscope. No cells were observed in any of the wells which contained the daunomycin treated polymer balls or the daunomycin treated IOL. In contrast, wells not containing polymer balls or LOLS had a confluent monolayer of growing cells. This example demonstrates that a polymeric IOL may advantageously be treated with a modulating agent to prevent undesired cell growth on or around the IOL.
Polymer balls (1/4 inch diameter) were incubated in a solution of daunomycin as described above. Following incubation and rinsing to remove unbound daunomycin individual balls were placed in one milliliter of methanol to extract bound drug. The absorbance of the methanol extracts was read at 476 nm. Using the extinction coefficient of 173 at 1 cm for a 1% solution of daunomycin and the surface area of the balls the capacity of the polymers was determined. Results are shown below in Table 5, below.
TABLE 5______________________________________Capacity of Different Polymersfor Binding DaunomycinPolymer Daunomycin bound (μg/cm2)______________________________________Polyamide ball (nylon) 1.26Polypropylene ball 0.50Polystyrene ball 0.71Acrylic ball 0.28______________________________________ This example demonstrates that a variety of polymers will bind daunomycin with nylon demonstrating superior binding capabilities.
Nylon membrane (Biodyne from Pall) discs, diameter 7.0 mm, were cut from sheet membrane using a punch and autoclaved. The discs were then incubated in a solution of daunomycin (Sigma), 50 μg/ml in PBS, for three hours at room temperature. Discs were visibly red in color from the absorbed daunomycin. The discs were thoroughly rinsed with PBS to remove unbound daunomycin. Four discs were added to tubes containing one ml of methanol to extract the bound daunomycin. Daunomycin concentration was determined by measuring the absorbance of the methanol solution at 476 nanometers and an extinction coefficient of 173 for a 1% solution. Eight discs were added to tubes containing one ml of PBS and incubated for 24 hours at room temperature. Following incubation the PBS from tubes containing four of the discs was removed. These discs were extracted with methanol to determine the amount of drug bound to the discs as described above. Incubation of the other four discs was continued for an additional 72 hours (total of 96 hours in PBS). Following incubation the PBS was removed and the discs extracted with methanol to determine the amount of drug bound. Results are shown in Table 6, below.
TABLE 6______________________________________Release of Daunomycin fromNylon Membrane Over Time Nylon Associated Daunomycin (μg/disc)______________________________________Initial membrane 16.5Following 24 hour PBS Extraction 10.3Following 96 hour PBS Extraction 6.5______________________________________ 1 Total daunomycin (ug) associated per nylon membrane disc. Daunomycin was obtained by extracting from membrane with methanol. Concentration determined by absorbance at 476 nm using 173 (1 cm) as the extinction coefficient for a 1% solution of daunomycin.
Secondary cataract typically develops in rabbits within a few weeks following cataract surgery as indicated by proliferation of residual lens epithelial cells on the posterior lens capsule. The effect of a nylon loop-daunomycin implant on the proliferation of lens epithelial cells following cataract surgery is evaluated in vivo in a rabbit model.
Cataract surgery is performed according to methods described by Ulrich, et al., ((1993) J. Cat. Refract. Surg. 19:462). Female New Zealand white rabbits are randomly assigned to two treatment groups of six animals per group. Both groups receive lens extraction surgery with phacoemulsification in one eye. The surgical procedure simulates the method used on humans to remove primary cataracts. Animals in group 1 will receive untreated nylon loops. Animals in group 2 receive nylon loops to which one of the test concentrations of the cell proliferation-modulating agents is absorbed. Loops are placed inside the lens capsule following removal of lens material by phacoemulsification.
All of the rabbits will receive one week of standard post-surgical care involving anti-inflammatory (topical steroid and antibiotic (topical gentamicin) treatment. Eyes are then observed to determine the effect of the implant on lens epithelial cells proliferating on the posterior capsule surface. At selected times (three and six months), animals are sacrificed and their eyes are submitted for histological evaluation to assess the degree of lens epithelial proliferation.
By implanting the subject intraocular nylon-daunomycin implant into the anterior chamber, remnant lens epithelial cells can be inhibited from proliferating, thus preventing secondary cataracts. The use of an intraocular implant provides a superior means for delivery of cytotoxic drug by allowing for release of drug over time and protection of the drug from degradative processes in the eye. The subject methods and device thus provide a simple procedure for preventing secondary cataracts.
Beagle dogs are naturally susceptible to glaucoma and are well accepted as a model for human glaucoma. King, et al. (1991), Am. J. Vet. Res. 52:2067-2070. Two groups of six beagles each with glaucoma, as characterized by an IOP of greater than 30 mm Hg in one or both eyes receive glaucoma filtering surgery in one glaucomatous eye; one group receives nylon membrane-daunomycin implant and the other group is treated with nylon filter control. Beagles will be given a preoperative eye examination with a Zeiss slit lamp biomicroscope. Preoperative IOP will be obtained from the average of three measurements by pneumototometry, using an Applanation Pneumatograph (BioRad), after the installation of one drop of 0.5% proparacaine HCI to each eye. The dog is placed under general anesthesia, a lid speculum placed, a limbal-based conjunctival portame is made approximately 8 mm posterior to the limbus and sharp and blunt dissection performed until the cornea scleral limbus is well visualized. A triangular partial thickness scleral flap is then developed based at the limbus to approximately 50% scleral depth, and then an entry wound into the anterior chamber is made with a sharp 15 degree razor knife. A 1 mm�3 mm sclerostomy is then performed to excise the tissue under the partial thickness flap. A peripheral iridectomy is performed with Vannus scissors and curved jewelers' forceps. The sclera flap is sutured in place with 10-0 nylon suture. A nylon membrane coated with daunomycin is then laid between the sclera and conjunctiva. The conjunctiva is closed with a running absorbable suture.
The animals are then given a combination antibiotic/steroid ointment applied to each eye, are kept warm, and observed every hour for eight hours and then every four hours the following day. Daily observations continue thereafter with the instillation of the antibiotic steroid ointment for approximately 21 days. Examinations including a routine ophthalmic examination for bleb patency, toxicity and complications, slit lamp biomicroscopy and pneumotonometry, are performed daily for the first five days after surgery, then every third day through week six, and then weekly through week twelve. Observations, including variations in IOP, are subjected to standard statistical analysis to look for maintenance of lowered IOP.
Nylon membrane discs (Biodyne C, pore size 1.2 micron, 7 mm diameter, Pall Biosupport) having free carboxyl groups were immersed in 30 ml of adipic acid dihydrazide (100 mg/mL in water). One-ethyl-3-3-[dimethylamino-propyl]carbodiimide (EDC) was added to the solution to a final concentration of 3.0 mg/ml and the membrane discs were incubated for 90 minutes at room temperature. The pH was maintained at 4.75 by the dropwise addition of 1.0 M HCI. Following incubation, the membrane was washed extensively with water and added to a solution of daunomycin (3.0 ml, 2.0 mg/ml) in 0.2 M sodium acetate buffer pH 4.5 and incubated for 48 hours at room temperature. Following incubation, the membrane discs were rinsed with PBS to remove unassociated daunomycin. The membrane discs were placed in 100% methanol (1 ml/disc) for 2 hours to remove noncovalently bound daunomycin. A total of 37.2 μg/disc was removed by this procedure. The discs were placed in a 1:1 solution of methanol and 0.2 M sodium acetate buffer pH 4.5 (1 ml/disc) and incubated at room temperature to extract daunomycin bound to nylon via the hydrazone linkage. After 24 hours, the discs were removed and the extraction buffer saved. The discs were placed in 1 ml of fresh extraction buffer. The amount of daunomycin released into the extraction buffer was determined spectrophometrically. This process was repeated at 48 and 96 hours. In the first 24 hours 37.4 μg/cm2 was released. At 48 hours an additional 12.15 μg/cm2 was released. At 96 hours an additional 8.6 μg/cm2 was released. A total of 58.2 μg/disc was extracted. Following the above incubations, the discs were slightly red, indicating that some daunomycin was still associated with the nylon. Control membranes that did not receive the hydrazide treatment also bound daunomycin. Substantially all of the daunomycin was removed from these discs during the initial methanol extraction.
Nylon 6 pellets (Polysciences Inc., 3 g) were suspended in 100 ml of %100 methanol containing 20% CaCl2. Following extended incubation (four days) with stirring at room temperature, the nylon solution was added dropwise with stirring into a large excess (2 liters) of water at room temperature. The powder thus obtained was separated on a suction filter and washed successively with water and absolute ethanol and dried under vacuum.
Nylon powder (15.5 mg) was weighed out and ground in a mortar. The powder was added to a 0.5 ml solution of daunomycin (2.2 mg/ml) in PBS and incubated overnight at room temperature. Following incubation, the powder was washed twice with PBS by centrifugation to remove unbound daunomycin. The daunomycin associated powder was resuspended in 1.0 ml of methanol and incubated overnight at room temperature. Following incubation, the methanol was recovered and the powder extracted two more times. The concentration of daunomycin in the extraction solutions was determined spectrophotometrically. The total daunomycin extracted per mg of nylon powder was 51.9 μg.
Carboxymethylcellulose (Sigma Chemical Company) low viscosity, 100 mg, was dissolved in water to give a final concentration of 4.0 mg/ml. The pH was adjusted to 4.75 with HCI. Adipic acid dihydrazide (1.75 g) was added to the solution with stirring at room temperature. EDC was added (200 mg) to the solution and the pH was maintained at 4.7 by the dropwise addition of HCI. Following 60 minutes of incubation an additional 200 mg of EDC was added followed by 60 minutes of incubation. The solution was dialyzed against H2 O for 72 hours at room temperature followed by dialysis against 0.1 M sodium acetate buffer pH 4.5 for 24 hours. Following dialysis the derivatized CMC was stored at 4� C. The final volume was 30 ml.
Derivatized CMC (CMC-Hz) 5 ml containing approximately 3.3 mg/ml was mixed with 1 mg of daunomycin in 0.1 ml H2 O and incubated at 4� C. for 48 hours. The extent of daunomycin association with DMD-Hz was determined by determining the absorbance at 473 nm. One ml aliquots of the CMC-daunomycin complex were precipitated by the addition of 14 ml cold absolute ethanol followed by centrifugation and the precipitate dried. The dried pellet was hydrated by the addition of 1 ml PBS followed by incubation at room temperature. After 3 hours the pellet had swelled and had the appearance and consistency of a gel.
The extent of hydrazide derivatization can be controlled by adjusting the amount of EDC used during the reaction. Following incubation free daunomycin can be removed by dialysis of the polymer-drug mixture against phosphate buffered saline. The extent of daunomycin association with CMC-Hz is determined by measuring the absorbance at 473 nm.
The release rate of daunomycin from the carboxymethylcellulose as a function of pH can be determined by incubation of individual pellets in aliquots of dilute aqueous (0.1M) buffers at pH 4.5, 5.0 and 7.4 containing 10% acetone. Incubation in each buffer is carried out at 37� C. At each time period the amount of free daunomycin in solution is determined by measuring the absorbance (476 ml) of daunomycin remaining in solution following precipitation of polymer associated daunomycin with absolute ethanol.
Polymer implants coated with agents that modulate cell proliferation can be evaluated in vitro. Cell culture wells are loaded with one ml M199 medium containing 10% FBS. The implant polymer coated with cell proliferative agent is added to the wells. Culture wells are then seeded with cells from the tissue of interest, for example, scleral or conjunctival-derived fibroblasts or lens epithelial cells, and incubated for a sufficient time with the growth-modulating composition to observe the desired effect. Growth is determined for each plate by any method known to those skilled in the art, such as trypan blue dye exclusion, tritiated thymidine incorporation and the like. Cell growth also can be determined by direct microscopic visualization of cells, either stained or unstained. Alternatively cell growth can be determined using the vital dye MTT (3-(4,5-dimethylthiazol-2y)-2,5-diphenyl tetrazolium bromide. This dye is converted to a blue formazan product by living cells, but not dead cells (Mosman, J. Immunol. Methods (1983) 65:55). The blue product is then solubilized with sodium dodecyl sulfate/HCl and quantitated on an ELISA reader at 590 nm. The IC50 value is determined by the concentration of agent that causes killing of 50% of the cells compared to the untreated control wells.
The polymer implant with associated cell proliferation modulating agent can be evaluated in any of a number of art accepted wound healing models. Especially relevant in this instance are models which incorporate surgical wounds. The polymer implant, coated with cell proliferation modulating agent, for example, transforming growth factor type beta (TGF type beta), is placed subconjunctivally in rabbit eyes. New Zealand white rabbits are placed under general anesthesia and a lid speculum is placed in the eye. A limbal based conjunctival flap is created by incision of the conjunctiva and blunt dissection forward to the limbus. Care is taken not to cut the episclera. The implant is placed under the flap and the conjunctiva is closed with 9-0 vicryl suture in a running-looking fashion.
Animals are sacrificed on days 3, 5 and 7 following implantation. The eyes are enucleated and fixed in neutral buffered formalin. Paraffin sections of tissue containing the implant are prepared, followed by staining with hematoxylin and eosin to observe the degree of fibrovascular proliferation at the implant site. Staining of sections with Massons trichrome is performed to observe newly formed collagen fibers at the implant site. The degree of fibrovascular proliferation and the amount of newly formed collagen in and around the implant is substantially greater in tissue receiving implants coated with TGF type beta as compared to implants with no agent or tissue not receiving an implant.
The above examples demonstrate that growth modulating agents such as ricin and daunomycin reversibly associate with polymers such as polystyrene, polypropylene, acrylic, polyamide, and nylon. Alternatively, a labile covalent band can be used to link the growth modulating agent to the polymer. The modulating agent is then released by the polymer. The association and release can be readily determined using the above experimental methods. The polymer can be crafted into an implant form suitable for the desired application and implanted into an animal. The method can be applied for example to prevent secondary cataracts or to maintain patency of a filtering bleb in GFS.
All publications and patent applications mentioned in this specification are indicative of the level of skill of those skilled in the art to which this invention pertains. All publications and patent applications are herein incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.
The invention now having been fully described, it will be apparent to one of ordinary skill in the art that many changes and modifications can be made thereto without departing from the spirit or scope of the appended claims.
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