[0001] This application is a continuation-in-part of co-pending U.S. patent application Ser. No. 09/304,737, filed May 4, 1999 and entitled “Systems and Methods for Treating the Cardia of the Stomach and Adjoining Tissue Regions in the Esophagus.”
[0002] In a general sense, the invention is directed to systems and methods for treating interior tissue regions of the body. More specifically, the invention is directed to systems and methods for treating dysfunctions of organs and tissue in the gastrointestinal tract.
[0003] Disorders of organs or tissue of the gastrointestinal tract can be caused by as neurological factors (such as abnormal nerve impulses) or by physical factors (such as excess tissue volume).
[0004] For example, intestinal motility (i.e., the contraction of intestinal muscles and the propulsion and movement of the lumenal contents) is controlled by nerves and hormones, as well as by electrical activity in the muscular wall of the intestine. There are several disorders that involve abnormal motility and result in abnormal and uncomfortable visceral sensations. These disorders can cause significant discomfort and distress in the absence of gross physical abnormality of the intestine.
[0005] For example, irritable bowel syndrome (IBS) is a common disorder of the intestines. IBS can lead to crampy pain, gassiness, bloating, and changes in bowel habits. Some people with IBS have constipation (difficult or infrequent bowel movements); others have diarrhea (frequent loose stools, often with an urgent need to move the bowels); and some people experience both symptoms intermittently. Sometimes the person with IBS has a crampy urge to move the bowels, but cannot do so. The cause of IBS is not known, and as yet there is no cure. IBS can be characterized as a functional disorder because there is no sign of disease when the intestine is examined. Often IBS is just a mild annoyance, but for some people it can be disabling.
[0006] Dyspepsia is another example. Dyspepsia is literally translated as “bad digestion” and is commonly known as indigestion. Motility-like dyspepsia causes persistent or recurring abdominal pain that is centered in the upper abdomen. People with motilityassociated dyspepsia also may experience bloating, nausea, burping and a feeling of fullness that occurs soon after eating. It is an extremely common symptom complex, affecting as much as one-fourth of the United States adult population.
[0007] There are other disorders affecting the gastrointestinal tract that are characterized by abnormal tissue conditions not associated with neural abnormalities.
[0008] The invention provides systems and methods that treat disorders of the gastrointestinal tract by applying one or more treatment agents to tissue at or near the region where abnormal neurological symptoms and/or abnormal tissue conditions exist. The treatment agent is selected to either disrupt abnormal nerve pathways, e.g., associated with dysmotility and/or discomfort, and/or to alleviate abnormal tissue conditions, e.g., to stiffen tissue in order to alleviate disease.
[0009] One aspect of the invention provides systems and methods that apply a selected treatment agent into contact with tissue at or in a region of the gastrointestinal tract where dysmotility and/or abnormal visceral sensations exist. The application of the treatment agent can provide relief from the pain and symptoms of nerve-related gastrointestinal disorders, such as irritable bowel syndrome or motility-like dyspepsia. Application of the treatment agent may also attenuate the dysmotility and alleviate the dysfunction itself. The systems and methods may be used as either a primary treatment modality, or may be applied before, during, or after some other primary intervention.
[0010] According to this aspect of the invention, the treatment agent includes at least one vanilloid compound. Presence of the vanilloid compound evokes a desired tissue response, which includes at least one of the following, e.g., the interruption of nerve impulses which leads to a reduction of the symptoms that are associated with abnormal nerve impulses, the diminution of pain impulses, the attenuation of the dysmotility, and/or the alleviation the disease state itself. The vanilloid treatment agent may be applied to surface tissue, or, alternatively, it may be injected into subsurface tissue. In one embodiment, the systems and methods can also apply energy to the tissue region to form at least one lesion in conjunction with application of the treatment agent.
[0011] Another aspect of the invention provides systems and methods that apply a selected treatment agent into contact with tissue at or in a region where an abnormal tissue condition exists in order to affect normal functionality.
[0012] According to this aspect of the invention, the treatment agent includes at least one sub-type of a cytokine. Presence of the cytokine evokes a desired tissue response, which can include, e.g., an initiation of a localized healing process including influx of white blood cells and fibroblasts, followed by deposition of collagen, and subsequent tissue compliance reduction and tightening. These effects will result in a reduction of tissue volume. The cytokine treatment agent may be applied to surface tissue, or, alternatively, it may be injected into subsurface tissue, including the submucosa.
[0013] Features and advantages of the inventions are set forth in the following Description and Drawings, as well as in the appended Claims.
[0014]
[0015]
[0016]
[0017]
[0018] The invention may be embodied in several forms without departing from its spirit or essential characteristics. The scope of the invention is defined in the appended claims, rather than in the specific description preceding them. All embodiments that fall within the meaning and range of equivalency of the claims are therefore intended to be embraced by the claims.
[0019] This Specification discloses various systems and methods for treating dysfunctions of organs or tissue in the gastrointestinal tract. Still, it should be appreciated that the disclosed systems and methods are applicable for use in treating other dysfunctions elsewhere in the body, e.g., for treating sphincter barrier dysfunctions in the lower gastrointestinal tract or in the upper gastrointestinal tract. The systems and methods that embody features of the invention are adaptable for use with catheter-based systems and surgical techniques, as well as systems and surgical techniques that are not necessarily catheter-based.
[0020] I. System Overview
[0021] A tissue treatment system
[0022] A. The Tissue Treatment Device
[0023] The tissue treatment device
[0024] The tissue treatment device
[0025] The tissue treatment device
[0026] Alternatively, the tissue treatment device
[0027] B. The Delivery Device
[0028] The configuration of the delivery apparatus
[0029] If the treatment site can be directly visualized the delivery apparatus
[0030] If the treatment site can not be directly visualized or is otherwise not as readily accessible, the delivery apparatus
[0031] C. The Tissue Treatment Agent
[0032] The treatment agent
[0033] In the illustrated embodiment, the group consists essentially of two candidate agents: (1) Vanilloid Compounds, and (2) Cytokine Sub-Types.
[0034] 1. Vanilloid Compounds
[0035] The treatment agent
[0036] The specific neuron for capsaicin is deemed “VR
[0037] Exposure to vanilloid compounds variably reduces the responsiveness of the neuron to stimuli. In many cases, the neuron may actually degenerate either temporarily or permanently, thus impairing transmission of pain signals or other special sensory signals.
[0038] The term “vanilloid compound” as used herein means a compound or a mixture of compounds having a biologically active vanillyl group. Vanilloid compounds include both naturally occurring vanilloids, synthetic vanilloids, pharmaceutically acceptable salts of the vanilloid compound (whether natural or synthetic) as well as pharmaceutically acceptable derivatives and/or analogues thereof (whether natural or synthetic). Examples of natural vanilloid compounds include both the crude extracts and the purified extracts of active vanilloid compounds from: capsicum, cayenne pepper, black pepper, paprika, cinnamon, clove, mace, mustard, ginger, turmeric, papaya seed and the cactus-like plant
[0039] Synthetic vanilloid compounds such as synthetic capsaicin are disclosed in WO 96/40079, which is incorporated herein by reference. The vanilloid compound family includes: Capsaicin; Dihydrocapsaicin: Nordihydrocapsaicin; Homocapsaicin: Homodihydrocapsaicin. Alternatively, resiniferotoxin (RTX) is derived from the euphorbia cactus and is considered a capsaicin-like compound. This substance also activates the VR
[0040] Other examples of vanilloid compounds include capsaicin ((E)-(N)-[(4-hydroxy-3-methoxyphenyl)-methyl]-8-me thyl-6-nonenamide); eugenol (2-methoxy-4-(2-propenyl)phenol); zingerone (4-(4-hydroxy-3-methoxyphenyl)-2-butanone); curcumin (1,7-bis(4-hydroxy-3-methoxyphenyl)-1,6-heptadiene-3,5-dione ); piperine (1-[5-(1,3-benzodioxol-5-yl)-1-oxo-2,4-pentadienyl] piperidine); resiniferatoxin(6,7-deepoxy-6,7-didehydro-5-deoxy-21-depheny l-21-(phenylmethyl)-20-(4-hydroxy-3-thoxybenzeneacetate)) or pharmaceutically effective salts, analogues, derivatives or equivalents thereof.
[0041] The treatment agent
[0042] The vanilloid-containing treatment agent can be applied through the port
[0043] The treatment agent
[0044] The vanilloid-containing treatment agent
[0045] In dyspepsia and irritable bowel syndrome, the use of a vanilloid-containing treatment agent can serve to diminish the pain impulses or could attenuate the dysmotility and alleviate the disease state.
[0046] An example of vanilloid materials that can be used is produced by Afferon and is called RTX, which has been instilled into the lumen of the urinary bladder for the treatment of urge incontinence. There are also several topical, over-the-counter capsaicin products for topical analgesic applications.
[0047] 2. Cytokine Sub-Types
[0048] The treatment agent
[0049] The term “cytokine subtype” as used herein means any polypeptide that affects the functions of other cells, and is a molecule which modulates interactions between cells in the immune or inflammatory response. A cytokine subtype includes, but is not limited to monokines and lymphokines regardless of which cells produce them. For instance, a monokine is generally referred to as being produced and secreted by a mononuclear cell, such as a macrophage and/or monocyte but many other cells produce monokines, such as natural killer cells, fibroblasts, basophils, neutrophils, endothelial cells, brain astrocytes, bone marrow stromal cells, epideral keratinocytes, and B-lymphocytes. Lymphokines are generally referred to as being produced by lymphocyte cells. Examples of cytokine subtypes include, but are not limited to, interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF alpha) and tumor necrosis factor beta (TNF beta).
[0050] Other cytokine subtypes include TGF-β (transforming growth factor β); PDGF (platelet derived growth factor); b-FGF (basic fibroblast growth factor): IGF-1 (insulin-like growth factor 1); EGF (epidermal growth factor); and VEGF. Some of these cytokines are available commercially, could be produced commercially, or can be extracted from a persons harvested platelets (platelet releasates). The effects of a given cytokine upon tissue physiology can include one or more of the following: smooth muscle and fibroblast mitogenic effects (induces division and growth of cells); stimulation of the release of cytokines from other cells; chemoattractant (bringing new healing cells into local region); decrease of collagen enzyme activity allowing collagen to build up; inflammation; and angiogenesis (development of new blood vessels).
[0051] The treatment agent
[0052] The cytokine-containing treatment agent
[0053] The cytokine-containing agent
[0054] The application of a single cytokine or mixture thereof, as primary, neoadjuvant, or adjuvant therapy for abnormal tissue conditions (e.g., excess tissue volume) could have the various mechanical and therapeutic effects. With or without an inciting wound event (such as RF), cytokines can serve to initiate the process of healing within the local region. This process includes, but is not limited to, influx of white blood cells and macrophages, stimulation of fibroblast and smooth muscle division and collagen secretion, new blood vessel growth, wound contraction and tightening, maturation of the new or existing collagen framework, and reduced tissue compliance. These tissue effects could improve the compliance and reduce the tissue volume.
[0055] Examples of cytokine materials that can be used include commercially available Regranex, which is recombinant human PDGF-BB. This material has been applied as a gel for promoting the healing of diabetic foot ulcers. Platelet granules contain many of the cytokines listed above, and the cytokines can be extracted with a fairly simple technique (platelet releasates). Platelets (harvested as a pooled platelet product or from autologous donation) provide a source of cytokines for extraction. TGF-β and PDGF are considered to be the most important substances for the purpose of initiating the wound healing process.
[0056] Various features of the invention are set forth in the following claims.