FR2922774A1 - PROCESS FOR PREPARING AN IMPLANTABLE PROSTHESIS FROM A CORE BASE OF POROUS MATERIAL, PROSTHESIS AND USE THEREOF - Google Patents

Abstract

Preparation of implantable prosthesis from a porous material based body (12), comprises application (50) of a reception coating (14) of a bioactive agent comprising a cyclodextrin (derivative) or a complex comprising cyclodextrin and/or cyclodextrin derivatives, a poly(carboxylic) acid and optionally a catalyst, on the body, heating the body at 100-220[deg] C for 1-90 minutes, washing in water, drying and impregnating (46) the body in a solution concentrated with a bioactive agent, where the process comprises a step of laying an additional coating (16) for sealing on the body after drying. An independent claim is included for an implantable prosthesis comprising a tubular body based on porous material, a reception coating of a bioactive agent comprising a cyclodextrin, a cyclodextrin derivative or a complex comprising cyclodextrin and/or cyclodextrin derivatives, a bioactive agent received from the reception coating and an additional seal coating deposited on the body.

Description

The present invention relates to a process for the preparation of an implantable prosthesis from a base body made of porous material, the method for preparing an implantable prosthesis from a porous material base, the prosthesis and the use thereof. process comprising the following successive steps: a) applying to the body a coating for receiving a bioactive agent, the receiving coating comprising: - at least one cyclodextrin and / or at least one derivative of cydodextrin and / or at least one complex inclusion of cyclodextrin and / or cyclodextrin derivatives, - at least one poly (carboxylic acid), and optionally a catalyst; b) heating the body at a temperature between 100 ° C and 220 ° C for a period of 1 to 90 minutes; c) washing the body with water; d) drying the body, then e) optionally, impregnating the body in a concentrated solution of at least one bioactive agent. According to one embodiment, the process for preparing an implantable prosthesis according to the invention comprises the step e) of impregnating the body in a concentrated solution of at least one bioactive agent.

By receiving coating of a bioactive agent is meant a coating capable of receiving at least one bioactive agent, but which does not necessarily receive this bioactive agent. Polyethylene terephthalate vascular tubular prostheses implanted in patients suffering from arterial problems are known.

These prostheses are intended in particular to replace clogged or retracted arteries. In this case, a bypass is performed around the blocked artery using a tubular prosthesis of variable diameter. Such vascular prostheses are also used to prevent aneurysm ruptures. A prosthesis is then introduced into the artery itself, opposite the aneurysm, to prevent the aneurysm from evolving.

Implantation of these prostheses therefore significantly reduces mortality in patients with these arterial problems. However, complications may arise due to the risk of infection per-operative and post-operative respectively before and after implantation of these prostheses. To overcome this problem, the application WO 2006/051227 proposes to bind cyclodextrins on the material constituting an implant intended to be placed in the human body. The implant is then placed in a bath in order to load the cyclodextrins with molecules of active principles for their release into the body after the operation. Such a method is implemented at a laboratory level. However, the implants produced by this method are unsatisfactory for their final implantation in the human body, particularly in terms of sealing, haemocompatibility and more generally, to meet the regulatory constraints related to prostheses. An object of the invention is therefore to obtain a method of preparing an implantable prosthesis that allows to obtain prostheses decreasing the risk of post-operative infection while meeting the implantation constraints in the human body.

To this end, the subject of the invention is a process of the aforementioned type, characterized in that the process comprises, after the drying step, a step of depositing an additional sealing coating on the body. The Applicant has also demonstrated that, unexpectedly, the cyclodextrins bound on the implantable material confer bacteriostatic or even bactericidal activity to said implantable material without even an active ingredient, in particular such as an antibiotic, antimicrobial, antiseptic or antiadhesive, was loaded on the cyclodextrins. The process according to the invention may comprise one or more of the following characteristics, taken separately or in any technically possible combination: the sealing coating is formed based on collagen, gelatin, polyurethane or a polymer likely to seal the body, or their combinations; the step of applying the receiving coating comprises impregnating the body with an aqueous solution comprising: at least one cyclodextrin and / or at least one cydodextrin derivative and / or at least one cyclodextrin inclusion complex and cyclodextrin derivatives, at least one polycarboxylic acid, and optionally a catalyst; it comprises, before the heating step, a step of precooking the body at a temperature of between 40 ° C. and 100 ° C .; it comprises, after the drying step, a step of neutralizing the body to bring it to a neutral pH; the body is formed of a braid, a weave or a knit of at least one polymeric yarn, made in particular on the basis of a polymer chosen from the group consisting of polyethylene terephthalate (PET), polyethylene terephthalate glycol (PETG), polyurethane (PU) polylactic acid, polyglycolic acid and their copolymers, polyvinylidene fluoride (PVDF), polytetrafluoroethylene (PTFE), polyethylene glycol (PEG), polyamide 6, polyamide-6,6, polypropylene, polyethylene and their copolymers, or the combination of these polymers; the receiving coating forms between 5% and 7% of the total mass of the prosthesis; said optional bioactive agent is selected from anticoagulants, anti-thrombogenic agents, anti-mitotic agents, antiproliferation, anti-adhesion, anti-migration agents, cell adhesion promoters, growth factors, antiparasitic molecules, anti- -inflammatory, angiogenic, angiogenesis inhibitors, vitamins, hormones, proteins, antifungals, antimicrobial molecules, antiseptics or antibiotics; and it comprises, before the step of applying the receiving coating and / or after the washing step, a step of embossing the body. - The body is a tubular body, the tubular body provided with said coatings internally defining a sealed conduit for circulation of a liquid. The invention further relates to an implantable prosthesis comprising: a base body made of porous material; a coating for receiving a bioactive agent applied to the body, the coating comprising at least one cyclodextrin and / or at least one cydodextrin derivative and / or at least one cyclodextrin inclusion complex and / or cyclodextrin derivatives - optionally, at least one bioactive agent received in the receiving coating; characterized in that the prosthesis comprises an additional sealing coating deposited on the body.

According to one embodiment, the implantable prosthesis according to the invention comprises at least one bioactive agent received in the receiving coating. The invention further relates to the use of at least one cyclodextrin and / or at least one cydodextrin derivative and / or at least one inclusion complex of cyclodextrin and / or cyclodextrin derivatives, for the manufacture of a bacteriostatic medical device. According to variants, - the use defined above is for the manufacture of a bactericidal medical device, - the medical device is intended to come into contact with blood plasma or any other liquid or biological tissue, - the medical device is implantable at least partially in the body of a patient; - the device is an implantable prosthesis which comprises: - a base body made of porous material; a coating for receiving a bioactive agent applied to the body, the coating comprising said at least one cyclodextrin and / or at least one derivative of cydodextrin and / or at least one inclusion complex of cyclodextrin and / or derivatives of cyclodextrin, - optionally, at least one bioactive agent received in the receiving coating the prosthesis comprising an additional coating of sealing deposited on the body. According to one embodiment, the prosthesis comprises: a base body made of porous material; a coating for receiving a bioactive agent applied to the body, the coating comprising said at least one cyclodextrin and / or at least one derivative of cydodextrin and / or at least one inclusion complex of cyclodextrin and / or derivatives of cyclodextrin, - optionally, at least one bioactive agent received in the receiving coating; the prosthesis comprising an additional coating of sealing deposited on the body. Without wishing to be bound by a mechanism of action, the cyclodextrin and / or cyclodextrin and / or cyclodextrin derivative and / or cyclodextrin derivative would act at least by reducing the ability of bacteria to adhere to the medical device. and, consequently, the development of bacteria. Cyclodextrins therefore confer bacteriostatic or even bactericidal properties on the medical device. This bacteriostatic or bactericidal effect conferred by cyclodextrins manifests itself in particular when the medical device has been in contact with blood plasma, for example for 24 hours. Thus, the cyclodextrin and / or cydodextrin derivative and / or cyclodextrin inclusion complex and / or cyclodextrin derivatives may be preferentially used to manufacture a medical device that is intended to come into contact with blood plasma or any other liquid or biological tissue, for example a device that is implantable at least partially in the body of a patient, said medical device exerting its bacteriostatic or bactericidal properties when it is brought into contact with the blood plasma or any other liquid or biological tissue, in particular when partially implanted in the patient's body.

By bacteriostatic is meant here the ability of a material to inhibit, prevent, prevent the multiplication of bacterial populations.

A bacteriostatic effect can be mediated or not by the death of bacteria.

By bactericidal is meant here the ability of a material to reduce or destroy bacterial populations, usually killing bacteria.

The prosthesis according to the invention may comprise one or more of the following characteristics, taken in isolation or in any technically possible combination:

the body has a chemical structure which comprises a hydroxyl function and / or an amine function, said structure being covalently bonded to at least one cyclodextrin molecule or to a cyclodextrin compound polymer of the receiving coating whose structure comprises the repetition of the pattern of general formula:

- [SB] -X - [- CO- [Ac] -CO-O- [CD] -O-] n- (COOH) xy SB representing the chemical structure of the body consisting of a polymer material of natural origin or artificial, X being either an oxygen atom or an NH group, x> 3, and 2 <y <(x-1) and (xy)> 1,

x being the number of carboxyl functions carried by the poly (carboxylic acid) before reaction, y represents the number of carboxyl functional groups of the poly (carboxylic acid) esterified or amidified during the reaction,

- (x-y) is the number of carboxyl functional groups of the poly (carboxylic acid) which are not esterified or amidified after reaction,

(COOH) xy 1 [Ac] representing the molecular chain of a poly (carboxylic acid) of formula (COOH) x 1 [Ac] of which at least two carboxyl functions (-000H) have undergone an esterification or undergone respectively an esterification and an amidation and which carries at least one carboxyl function which has not undergone esterification or amidation reaction; [CD] representing the molecular structure of cyclodextrins chosen preferentially from: α-cyclodextrin, β-cyclodextrin, γ-cyclodextrin and mixtures thereof; their derivatives which are preferably chosen from aminated, methylated, hydroxypropylated, sulphobutylated, carboxymethylated or carboxylic derivatives, and mixtures thereof, said bioactive agent being at least one therapeutic molecule forming a complex with the cyclodextrin molecules and / or cyclodextrin derivatives ; the receiving coating is formed by a crosslinked polymer of at least one cyclodextrin and / or at least one cyclodextrin derivative and / or at least one inclusion complex of cyclodextrin or cyclodextrin derivatives and whose structure comprises repetition of a unit of general formula: - [CD] -O-CO- [Ac] -CO-O-] n-1 (COOH) xy with x> 3, and 2 <y <_ (x-1 ) and (xy)> 1, x being the number of carboxyl functions carried by the poly (carboxylic acid) before reaction, y being the number of carboxyl functions of the poly (carboxylic acid) esterified in the reaction, - (xy) being the number of carboxyl functional groups of the non-esterified poly (carboxylic acid) after reaction (COOH) xy 1 [Ac] representing the molecular chain of a poly (carboxylic acid) of formula: (COOH) x 1 [Ac] of which at least two carboxyl functions (-COOH) have undergone esterification and which carries at least one carboxyl function which has not undergone esterification reaction cation; [CD] representing the molecular structure of the cyclodextrins chosen preferentially from: α-cyclodextrin, 8-cyclodextrin, γ-cyclodextrin and mixtures thereof; their derivatives which are preferably chosen from aminated, methylated, hydroxypropylated, sulphobutylated, carboxymethylated or carboxylic derivatives, and mixtures thereof, said bioactive agent being a therapeutic molecule forming a complex with the cyclodextrin molecules and / or cyclodextrin derivatives; the porous material is formed of a braid, a weave or a knit of at least one polymeric yarn, in particular made from a polymer chosen from the group consisting of polyethylene terephthalate (PET ), polyethylene terephthalate glycol (PETG), polyurethane (PU), polylactic acid, polyglycolic acid and their copolymers, polyvinylidene fluoride (PVDF), polytetrafluoroethylene (PTFE), polyethylene glycol (PEG), polyamide-6, polyamide-6,6, polypropylene, polyethylene and their copolymers, or the combination of these polymers; the receiving coating forms between 5% and 7% of the total mass of the prosthesis; the possible bioactive agent is chosen from anticoagulants, antithrombogenic agents, anti-mitotic agents, anti-proliferation, anti-adhesion, anti-migration agents, cell adhesion promoters, growth factors, antiparasitic, anti- -inflammatories, antifungals, antimicrobial molecules, antiseptics and antibiotics; - the body is embossed; and the sealing liner is formed based on collagen, gelatin, polyurethane or a polymer capable of sealing the body, or their combinations. - The body is a tubular body, the tubular body provided with said coatings internally defining a sealed conduit for circulation of a liquid. The invention will be better understood on reading the description which follows, given solely by way of example, and with reference to the appended drawings, in which: FIG. 1 is a side perspective view of a first tubular prosthesis according to the invention; - Figure 2 is a schematic view of the first steps of a method of manufacturing a tubular prosthesis according to the invention; Figure 3 is a view similar to Figure 2 of the steps of the manufacturing method subsequent to the steps shown in Figure 2; and - Figure 4 is a view similar to Figure 1 of a second prosthesis according to the invention. The invention applies in particular to prostheses, stents or stents having a straight or bifurcated tubular body. A first prosthesis 10 according to the invention is shown in FIG. 1. As illustrated by this Figure, this prosthesis comprises a tubular body 12 embossed externally having a coating 14 for receiving a bioactive agent and a coating 16 for sealing the prosthesis. The tubular body 12 comprises a substantially cylindrical tubular wall 18 of X-X 'axis having an inner surface 20 delimiting a blood circulation duct 22 and an outer surface 24 intended to be applied at least partially against a human tissue. The tubular wall 18 is made from interlaced polymer strands, in the form of a braid, a weave, or a knit. The or each polymeric yarn is made of a polymer selected from the group consisting of polyethylene terephthalate (PET), polyethylene terephthalate glycol (PETG), polyurethane (PU) polylactic acid, polyglycolic acid and their copolymers, polyvinylidene fluoride (PVDF), polytetrafluoroethylene (PTFE), polyethylene glycol (PEG), polyamide-6, polyamide-6,6, polypropylene, polyethylene and their copolymers, or the combination of these polymers. The or each polymer wire delimits through the wall 18 a plurality of pores extending between the inner surface 20 and the outer surface 24.

The tubular wall 18 is therefore porous in the absence of coatings 14, 16. In the example shown in Figure 1, the wall 18 is embossed or lined. It thus has a plurality of annular ribs 26 projecting outwards. The coatings 14, 16 are applied to the wires constituting the wall 18 and in the pores delimited between these wires, along the inner surface 20 and the outer surface 24. The coatings 14, 16 cooperate to seal substantially all the pores, so that the tubular body 12 provided with the coatings 14, 16, internally delimits a sealed conduit 22 for circulating the X-axis blood X '.

The coating 14 for receiving a bioactive agent comprises at least one cyclodextrin and / or a cyclodextrin derivative and / or an inclusion complex of cyclodextrin and / or cyclodextrin derivative. It further comprises a polycarboxylic acid and a catalyst. The coating 14 is bonded to the tubular wall 18 in at least one of the two bonding modes described below. In a first mode of bonding, the tubular wall 18 has a chemical structure which comprises a hydroxyl function and / or an amine function, said structure being covalently bonded to at least one cyclodextrin molecule or to a cyclodextrin polymer composed of the coating receiving structure whose structure comprises the repetition of the unit of general formula: - [SB] -X - [- CO- [Ac] -CO-O- [CD] -O-] n- 1 (COOH) xy SB representing the chemical structure of the tubular body made of a polymer material of natural or artificial origin, X being either an oxygen atom or an NH group, x> 3, and 2 <y <(x-1) and (xy)> 1, - x being the number of carboxyl functions carried by the poly (carboxylic acid) before reaction, - y represents the number of carboxyl functions of the poly (carboxylic acid) esterified or amidified during the reaction, - (xy) is the number of carboxyl functions of the poly (carboxylic acid) which are not esterified or amidified after reaction, (COOH) xy 1 [Ac] representing the molecular chain of a poly (carboxylic acid) of formula (COOH) x 1 [Ac] of which at least two carboxyl functions (-COOH) have undergone esterification or undergone respectively esterification and amidification and which carries at least one carboxyl function which has not undergone an esterification or amidation reaction; [CD] representing the molecular structure of the cyclodextrins chosen preferentially from: α-cyclodextrin, (3-cyclodextrin, γ-cyclodextrin and mixtures thereof, in which case the coating is obtained by forming an anhydride of the poly (carboxylic acid) which reacts with the material constituting the tubular wall 18 by forming an amide or ester type covalent bond between this material and the poly (carboxylic acid) Then, in the simplest case, a second anhydride of the poly (carboxylic acid) already bound to the material is formed, which reacts with a cyclodextrin molecule or a cyclodextrin molecule anchored to an ester bond with the cyclodextrin or cyclodextrin derivative molecule. second binding mode, the receiving coating is formed by a crosslinked polymer of at least one cyclodextrin and / or at least one cyclodextrin derivative and / or at least one cyclodex inclusion complex trine or cyclodextrin derivatives and whose structure comprises the repetition of a unit of general formula: - [CD] -O-CO- [Ac] -CO-O-] n-1 (COOH) xy with x> 3 and 2 <y 5 (x-1) and (xy) 1, where x is the number of carboxyl functions carried by the poly (carboxylic acid) before reaction, where y is the number of carboxyl functions of the acid. poly (carboxylic acid) esterified during the reaction, - (xy) being the number of carboxyl functional groups of the poly (carboxylic acid) non-esterified after reaction (COOH) xy 1 [Ac] representing the molecular chain of a poly acid ( carboxylic acid) of formula: (COOH) x 1 [Ac] of which at least two carboxyl functions (-COOH) have undergone an esterification and which carries at least one carboxyl function which has not undergone an esterification reaction; [CD] representing the molecular structure of the cyclodextrins chosen preferentially from: α-cyclodextrin, [3-cyclodextrin, γ-cyclodextrin and mixtures thereof. In this second mode, the binding of the or each cyclodextrin and / or cyclodextrin derivatives is carried out by forming a crosslinked polymer obtained by the exclusive reaction between the cyclodextrin molecules and / or cyclodextrin derivatives and at least a poly (carboxylic acid). The cross-linked polymer thus formed forms a film or a deposit on the surface of the wires of the tubular wall 18 or is recorded inside its porous structure and remains permanently fixed thereto. Alternatively, the two modes of connection coexist on the son constituting the wall 18.

In this example, the sealing coating 16 is formed by a coating of collagen deposited on the son forming the tubular wall 18, in the pores delimited between the son, and on the receiving coating 14. The collagen forms a film clogging the interstices between the inner surface 20 and the outer surface 24 to form the sealed conduit 22 within the tubular body 12.

Alternatively, the sealing coating 16 is made of gelatin, polyurethane or any other polymer capable of sealing the tubular body 12, or their mixture. The optional bioactive agent is received in the hollow molecular structure constituted by each cyclodextrin. It is selected from anticoagulants, anti-thrombogenic agents, anti-mitotic agents, anti-proliferation, anti-adhesion, anti-migration agents, cell adhesion promoters, growth factors, antiparasitic molecules, anti-inflammatory agents. , angiogenics, angiogenesis inhibitors, vitamins, hormones, proteins, antifungals, antimicrobial molecules, antiseptics or antibiotics. The process for preparing the prosthesis 10 according to the invention will now be described with reference to FIGS. 2 and 3.

This method comprises a step 40 of shaping the tubular body 12, a step 42 of applying the receiving coating 14, a step 43 of neutralization, an application step 44 of the sealing coating 16, then, optionally a step 46 of loading the bioactive agent on the prosthesis 10.

Initially, in step 40 shaping, a tubular body 12 braided, woven or knitted based on polymeric yarns is provided. This tubular body 12 initially has an outer surface 24 and a smooth inner surface and a porous tubular wall 18. An embossing of the tubular wall 18 constituting the body is then performed to form the ribs 26. The coating application step 42 comprises the impregnation 50 in a solution 52 of precursor mixture of each body 12 shaped, the padding 54 of each body 12 impregnated with precursor mixture, pre-cooking 56, cooking 58 and washing and drying 60 of each body 12. Precursor mixture 52 is formed by an aqueous solution comprising: at least one cyclodextrin and / or at least one cydodextrin derivative and / or at least one cyclodextrin inclusion complex and / or cyclodextrin derivatives, at least one polycarboxylic acid, and optionally a catalyst. The cyclodextrin is preferably chosen from α-cyclodextrin, β-cyclodextrin and γ-cyclodextrin, and mixtures thereof, which derivatives are preferably chosen from the amino, methylated, hydroxypropylated, sulphobutylated, carboxymethylated or carboxylic derivatives of these cyclodextrins. and their mixtures. The carboxylic acid is chosen from saturated and unsaturated aromatic saturated and unsaturated cyclic saturated acyclic poly (carboxylic) acids, hydroxypoly (carboxylic) acids, preferably citric acid, polyacrylic acid and poly (methacrylic acid). , 1,2,3,4-butanetetracarboxylic acid, maleic acid, citraconic acid, itaconic acid, 1,2,3-propanetricarboxylic acid, trans-aconitic acid, all-cis-1,2,3,4-cydopentanetetracarboxylic acid, melititic acid, oxydisuccinic acid, thiodisuccinic acid or anhydrides derived from the above-named acids.

The catalyst is chosen from dihydrogen phosphates, hydrogen phosphates, phosphates, hypophosphites, alkali metal phosphites, alkali metal salts of polyphosphoric acids, carbonates, bicarbonates, acetates, borates and alkali metal hydroxides. aliphatic amines and ammonia, and preferably from sodium hydrogen phosphate, sodium dihydrogen phosphate and sodium phypophosphite. Preferably, the mixture consists of poly (carboxylic acid), catalyst and cyclodextrin in the following proportions by weight: poly (carboxylic acid): between 2 and 4, catalyst: 1, cyclodextrin: between 2 and 5 The padding 54 is made by passing the tubular bodies 12 impregnated with precursor mixture between two rollers 62, and by enclosing the tubular body 12 between the rollers 62.

Precooking 56 is preferably carried out in an oven 64 heated to a temperature between 40 ° C and 100 ° C for a period of time between 1 minutes and 30 minutes. The surfaces 20 and 24 of the body 12 are then substantially dry.

The heating step is carried out in the oven 64 at a temperature between 100 ° C and 220 ° C for a period of 1 to 90 minutes. The retention rate of the receiving coating 14 thus formed is between 5% and 7% relative to the total mass of the prosthesis 10 after drying. This rate preserves the physical and mechanical properties of the prosthesis 10, such as flexibility, piquability and flexibility. In the neutralization step 43, each tubular body 12 is immersed in an aqueous solution of alkali carbonate, for example sodium carbonate.

The concentration of this solution is between 1 gll and 5 g / l. The immersion time of each tubular body 12 in the neutralization solution is for example between 1 minutes and 60 minutes. Then, a water-soxhlet wash 72 is performed over three cycles, followed by complete drying of the prostheses 10 provided only with the receiving coating 14. The pH of the inner surface and the outer surface is then substantially equal to 7. The step 44 of applying the collagen coating comprises the immersion 74 of the tubular body 12 in an aqueous solution of collagen 76. The collagen is example chosen from type IV collagens derived from a calfskin. The concentration of collagen in the solution is between 2% and 4% by weight. The retention rate of collagen on the body 12 is for example between 20% and 30% by weight of the total mass of the body 12 provided with the coatings 14, 16 forming the prosthesis 10 after drying.

Collagen is for example provided based on an aqueous solution at acidic pH supplied by the French company SYMATHESE. In the collagen solution, glycerol is added to improve flexibility, and water is added to bring the collagen solution to neutral pH, i.e., at about pH 7. Drying 78 the prosthesis 10 is then performed. Then, the prosthesis 10 is sterilized with ionizing radiation j3.

When it is implemented, the step 46 of loading the active ingredient on the prosthesis 10 is for example performed by the surgeon just before the operation. For this purpose, the prosthesis 10 is immersed in a bath 80 containing the bioactive agent. This bioactive agent is selected from anticoagulants, anti-thrombogenic agents, anti-mitotic agents, anti-proliferation, anti-adhesion, anti-migration agents, cell adhesion promoters, growth factors, antiparasitic molecules, anti- -Inflammatory, angiogenic, angiogenesis inhibitors, vitamins, hormones, proteins, antifungals, antimicrobial molecules, antiseptics or antibiotics. The method which has just been described thus makes it possible to obtain prostheses which can advantageously be loaded with a bioactive agent which will be released over time in the body after its implantation in the human body.

The cooperation between a coating 14 for receiving the active ingredient and a sealing coating 16 makes it possible to obtain prostheses which have a very satisfactory seal with a view to their implantation in the human body. Local cooperation between the coatings 14, 16 decreases the amount of collagen used while ensuring a good seal, which limits the risks associated with the presence of collagen of animal origin. Surprisingly, the presence of the sealing coating 16 does not affect the ability of the receiving coating 14 to load into bioactive agent, nor its ability to diffuse this agent once implanted into the human body. The amounts of the receiving coating 14 and the sealing coating 16 deposited on the tubular body 12 have been optimized to ensure good physical and mechanical properties (flexibility, piquability, impermeability, flexibility, etc.). In addition, the neutralization of the inner surface 20 and the outer surface 24 of the prosthesis 10 provides hemocompatibility of the wall 18 coated coatings 14, 16 for the subsequent implantation of the prosthesis in the human body and the circulation of blood within the prosthesis. The presence of embossings on the prosthesis 10 further improves the grip of the receiving liner 14 on the inner surface 20 and on the outer surface 24 of the prosthesis 14, which decreases the concentration of the precursor mixture solutions 52 and avoids the problems of plication. A second prosthesis 100 according to the invention is shown in FIG. 4. Unlike the prosthesis 10, it has a single helical groove 110.

The inner surface 20 thus forms a first sealingly insulated surface of the second surface formed by the outer surface 24, when the body 12 is provided with the coatings 14, 16. In another variant, the body 12 is formed by an assembly of nonwoven polymer fibers, bonded together for example by an adhesive.

In another variant, the prosthesis is a vascular patch comprising a body 12 which is not tubular. The body 12 is then substantially planar and has a nominal wall thickness of less than 0.6 mm and a transverse suture resistance greater than or equal to 15 N. The body 12 thus delimits a substantially flat upper surface and a substantially flat bottom surface. Another advantage of the invention lies in the nature of the coating capable of receiving the bioactive agent, said coating comprising a cyclodextrin and / or a cyclodextrin derivative and / or a complex of inclusion of cyclodextrin. Indeed, the Applicant has demonstrated that a prosthesis as defined above comprising a coating based on cyclodextrin and / or cyclodextrin derivative and / or cyclodextrin inclusion complex, has a bacteriostatic activity without however this coating has been impregnated with a bioactive agent. This bacteriostatic activity specific to the cyclodextrin, or its derivatives or inclusion complexes, was demonstrated in a bacterial adhesion assay performed against a control consisting of a prosthesis devoid of coating based on cyclodextrin and / or derivative cyclodextrin and / or cyclodextrin inclusion complex. The demonstration of these properties is detailed in the example below, in which the prostheses have been placed in contact with blood plasma. These results demonstrate the more general interest of using at least one cyclodextrin and / or cyclodextrin derivative and / or cyclodextrin inclusion complex for the manufacture of a bacteriostatic or even bactericidal medical device, this device being in particular a prosthesis or an implantable biomaterial. Such a device is for example a vascular prosthesis or a vascular patch, a suture, a dialysis catheter, an infusion catheter, artificial nutrition catheter, an implantable catheter chamber, a heart valve, a coronary stent, a bare peripheral stent or covered, a thoracic endoprosthesis, a drain, a dental implant, a wall reinforcement (hernia / incisional hernia), a transcutaneous implant, a guided tissue regeneration membrane, a guided bone regeneration membrane, an intrasucular delivery device, a lattice and network for tissue engineering, a micro and macroporous bone substitute, a dressing for medical and veterinary use. Example: Demonstration of a bacteriostatic activity specific to cyclodextrin coating and / or cyclodextrin derivative and / or cyclodextrin inclusion complex. The impact of the cyclodextrin coating on the bacterial adhesion capacity on a tubular prosthesis according to the invention was evaluated. For this, a bacterial adhesion test was carried out on two types of vascular prostheses: a cycloD PMC vascular prosthesis, consisting of a tubular body made of woven or knitted polyester, coated with collagen (15% w / w) and HpBCyclodextrins (hydroxypropyl-13-cyclode) trines, 15% plp); - A vascular prosthesis PMC, consisting of a tubular body made of woven or knitted polyester, coated with collagen (30% plp). Discs 1 cm in diameter were prepared from vascular prostheses cycloD PMC or PMC. Four disks of each of the cycloD PMC and PMC prostheses were separately immersed in 12 ml of plasma at 37 ° C for 24 hours with shaking. Then, all of the disks were rinsed in DPBS buffer (Dulbecco's phosphate buffered saline). Two disks per prosthesis were then immersed for 1 hour in a bacterial suspension (104 CFU / ml) of Staphyloccocus aureus (ATCC 6538) or Pseudomonas aerugenosa (ATCC 9027), then rinsed with DPBS buffer (two disks per prosthesis sample). for each bacterial strain). The bacteria were then harvested from the disks according to the following protocol: ultrasonic vibrations at a frequency of 47 KHz 6 ° read for five minutes at room temperature (+ 15-25 ° C); - mechanical agitation at 800 shakes / minute for 20 minutes at room temperature (+ 15-25 ° C); - Vortex stirring for 30 seconds at room temperature (+ 15-25 ° C). The extracts were then diluted from 10-1 to 10-3 and filtered through 0.45 micron filtration units. The harvested membranes were incubated on plates of Tryptone soy agar at a temperature between 30 and 35 ° C under aerobic conditions for 24 hours.

The number of colonies was determined visually. The results obtained are shown in Table 1 below. Table 1: number of microorganisms harvested for disks incubated before 24 hours in plasma: PMC CycloD PMC CFU / membrane UFC disks CFU / membrane CFU / disk 1a '102 1o3 10' 10-2 10-3 Staphyloccocus ND ND 224 7.5.105 287 36 1 9,6,103 aureus Pseudomonas ND ND 372 1,2,106 370 37 3 1,2,10 'aeruginosa ND: not determined After a 24 hour incubation in plasma, PMC prostheses were covered with a white felt-like layer which was withdrawn.

After 24 hours of plasma immersion, a greater bacterial adhesion of 2 log was observed for PMC vascular prostheses compared to CycloD PMC prostheses, thus demonstrating that the cyclodextrin coating reduces the adhesiveness of bacteria.

These results indicate that implantable tubular prostheses which comprise (i) a tubular body 12 of base of porous material, (ii) a coating 14 comprising at least one cyclodextrin and / or at least one derivative of cydodextrin and / or at least one complex of inclusion of cyclodextrin and / or cyclodextrin derivatives, and (iii) additional sealing coating 16, per se constitute bacteriostatic or even bactericidal tubular implantable prostheses. Trials are in progress to demonstrate a bactericidal effect related to cyclodextrin coating. Such prostheses are therefore particularly advantageous since they make it possible to reduce the risks of post-operative infection even in the absence of impregnation of the cyclodextrin coating with an antibiotic or non-stick bioactive agent, for example.

Claims (25)

A method for preparing a prosthesis (10) implantable from a porous material body (12), the method comprising the following successive steps: a) applying (50) to the body (12) of a coating (14) for receiving a bioactive agent, the receiving coating (14) comprising: - at least one cyclodextrin and / or at least one cydodextrin derivative and / or at least one cyclodextrin inclusion complex and / or cyclodextrin derivatives, at least one poly (carboxylic acid), and optionally a catalyst; b) heating (58) the body (12) at a temperature between 100 ° C and 220 ° C for a period of 1 to 90 minutes; c) washing (60) with water of the body (12); d) drying (60) the body (12), then e) optionally, impregnating (46) the body (12) in a concentrated solution of at least one bioactive agent; characterized in that the method comprises, after the drying step, a step (44) of depositing an additional coating (16) of sealing on the body (12). 2. Method according to claim 1, characterized in that the sealing coating (16) is formed based on collagen, gelatin, polyurethane or a polymer capable of sealing the body (12), or their combinations. 3. Method according to one of claims 1 or 2, characterized in that the step (50) of application of the receiving coating (14) comprises the impregnation of the body with an aqueous solution (52) comprising: - at minus one cyclodextrin and / or at least one cydodextrin derivative and / or at least one cyclodextrin inclusion complex and / or cyclodextrin derivatives, at least one polycarboxylic acid, and optionally a catalyst. 4. Method according to any one of claims 1 to 3, characterized in that it comprises, before the heating step (58), a step (56) of precooking (12) of the body at a temperature between 40. ° C and 100 ° C. 5. Method according to any one of the preceding claims, characterized in that it comprises, after the drying step (60), a step (43) of neutralization of the body (12) to bring it to a neutral pH . 6. Method according to any one of the preceding claims, characterized in that the body (12) is formed of an assembly, a braid, a weave or a knit of at least one polymeric thread, made in particular based on a polymer selected from the group consisting of polyethylene terephthalate (PET), polyethylene terephthalate glycol (PETG), polyurethane (PU) polylactic acid, polyglycolic acid and their copolymers, the polyvinylidene fluoride (PVDF), polytetrafluoroethylene (PTFE), polyethylene glycol (PEG), polyamide-6, polyamide-6,6, polypropylene, polyethylene and their copolymers, or the combination of these polymers. 7. Method according to any one of the preceding claims, characterized in that the receiving coating (14) forms between 5% and 7% of the total mass of the prosthesis (10). 8. Method according to any one of the preceding claims characterized in that it comprises the step e) of impregnating (46) the body (12) in a concentrated solution of at least one bioactive agent. 9. Method according to claim 8, characterized in that said bioactive agent is selected from anticoagulants, antithrombogenic agents, anti-mitotic agents, anti-proliferation, antiadhesion, antimigration agents, cell adhesion promoters, growth factors, antiparasitic molecules, anti-inflammatories, angiogenics, angiogenesis inhibitors, vitamins, hormones, proteins, antifungals, antimicrobial molecules, antiseptics or antibiotics. 10. Method according to any one of the preceding claims, characterized in that it comprises, before the step (50) of application receiving coating (14) and / or after the washing step, a step (40). ) embossing the body (12). 11. Method according to any one of the preceding claims, characterized in that the body (12) is a tubular body, the tubular body (12) provided with said coverings (14, 16) internally defining a duct (22) sealed circulation of a liquid. 12. Implantable prosthesis (10) comprising: a base body (12) of porous material; a coating (14) for receiving a bioactive agent applied to the body (12), the coating comprising at least one cyclodextrin and / or at least one cydodextrin derivative and / or at least one cyclodextrin inclusion complex and and / or cyclodextrin derivatives, optionally, at least one bioactive agent received in the receiving coating (14); characterized in that the prosthesis (10) comprises an additional sealing coating (16) deposited on the body (12). 13. Prosthesis (10) according to claim 12, characterized in that the body (12) has a chemical structure which comprises a hydroxyl function and / or an amine function, said structure being covalently bound to at least one cyclodextrin molecule or a cyclodextrin polymer of the receiving coating, the structure of which comprises the repetition of the unit of the general formula: - [SB] -X - [- CO- [Ac] -CO-O- [CD] -O-] n - 1 (COOH) xy SB representing the chemical structure of the body consisting of a polymer material of natural or artificial origin, X being either an oxygen atom or a group NH, x> 3, and 2 <y <(x -1) and (xy)> 1, - x being the number of carboxyl functions carried by the poly (carboxylic acid) before reaction, - y represents the number of carboxyl functions of the poly (carboxylic acid) esterified or amidified during of the reaction, - (xy) is the number of carboxyl functions of the unesterified polycarboxylic acid or amidated after reaction, (COOH) xy 1 [Ac] representing the molecular chain of a poly (carboxylic acid) of formula (COOH) x 1 [Ac] of which at least two carboxyl functions (-COOH) have undergone esterification or undergoing esterification and amidification, respectively, and which carries at least one carboxyl function which has not undergone esterification or amidation reaction; [CD] representing the molecular structure of the cyclodextrins chosen preferentially from: α-cyclodextrin, R-cyclodextrin, γ-cyclodextrin and mixtures thereof; their derivatives which are preferably chosen from aminated, methylated, hydroxypropylated, sulphobutylated, carboxymethylated or carboxylic derivatives, and mixtures thereof, said bioactive agent being at least one therapeutic molecule forming a complex with the cyclodextrin molecules and / or cyclodextrin derivatives . 14. Prosthesis (10) according to one of claims 12 or 13, characterized in that the receiving coating (14) is formed by a crosslinked polymer of at least one cyclodextrin and / or at least one cyclodextrin derivative and / or at least one inclusion complex of cyclodextrin or cyclodextrin derivatives and whose structure comprises the repetition of a unit of general formula: - [CD] -O-CO- [Ac] -CO-O -] n-1 (COOH) xy with x> 3, and 2 <y <_ (x-1) and (xy)> 1, - x being the number of carboxyl functions carried by the poly (carboxylic) acid before reaction, where y represents the number of carboxyl functions of the poly (carboxylic acid) esterified during the reaction, - (xy) being the number of carboxyl functions of the poly (carboxylic acid) non esterified after reaction (COOH) xy 1 [Ac] representing the molecular chain of a poly (carboxylic acid) of formula: (COOH) x 1 [Ac] of which at least two carboxyl functions (-COOH) have undergone esterification and which carries at least one carboxyl function which has not undergone an esterification reaction; [CD] representing the molecular structure of the cyclodextrins chosen preferentially from: α-cyclodextrin, R-cyclodextrin, ycyclodextrin and mixtures thereof; their derivatives which are preferably chosen from aminated, methylated, hydroxypropylated, sulphobutylated, carboxymethylated or carboxylic derivatives, and mixtures thereof, said bioactive agent being a therapeutic molecule forming a complex with the cyclodextrin molecules and / or cyclodextrin derivatives. 15. Prosthesis (10) according to any one of claims 12 to 14, characterized in that the porous material is formed of an assembly, a braid, a weave, or a knit of at least a polymeric yarn, especially made from a polymer selected from the group consisting of polyethylene terephthalate (PET), polyethylene terephthalate glycol (PETG), polyurethane (PU) polylactic acid, polyglycolic acid and their copolymers, polyvinylidene fluoride (PVDF), polytetrafluoroethylene (PTFE), polyethylene glycol (PEG), polyamide-6, polyamide-6,6, polypropylene, polyethylene and their copolymers, or the combination of these polymers. 16. Prosthesis (10) according to any one of claims 12 to 15, characterized in that the receiving coating (14) forms between 5% and 7% of the total mass of the prosthesis (10). 17. Prosthesis (10) according to any one of claims 12 to 16, characterized in that it comprises at least one bioactive agent received in the receiving coating (14). 18. Prosthesis (10) according to any one of claims 12 to 17, characterized in that the bioactive agent is selected from anticoagulants, anti-thrombogenic agents, anti-mitotic agents, antiproliferation, anti-adhesion agents, antimigration, cell adhesion promoters, growth factors, antiparasitic, anti-inflammatory, antifungal, antimicrobial, antiseptic and antibiotic molecules. 19. Prosthesis (10) according to any one of claims 12 to 18, characterized in that the sealing coating (16) is formed from collagen, gelatin, polyurethane or a polymer capable of sealing the body (12), or their combinations. 20. Prosthesis (10) according to any one of claims 12 to 19, characterized in that the body (12) is a tubular body, the tubular body (12) provided with said coverings (14, 16) internally defining a sealed conduit (22) circulation of a liquid. 21. Use of at least one cyclodextrin and / or at least one cydodextrin derivative and / or at least one inclusion complex of cyclodextrin and / or cyclodextrin derivatives, for the manufacture of a bacteriostatic medical device (10) . 22. Use according to claim 21 for the manufacture of a bactericidal medical device (10). 23. Use according to one of claims 21 or 22, characterized in that the medical device (10) is intended to come into contact with blood plasma or any other liquid or biological tissue. 24. Use according to any one of claims 21 to 23, characterized in that the medical device (10) is at least partially implantable in the body of a patient. 25. Use according to claim 21 or 24, wherein the device (10) is an implantable prosthesis which comprises: - a body (12) of base of porous material; a coating (14) for receiving a bioactive agent applied to the body (12), the coating comprising said at least one cyclodextrin and / or at least one cydodextrin derivative and / or at least one cyclodextrin inclusion complex and and / or cyclodextrin derivatives, - optionally, at least one bioactive agent received in the receiving coating (14); the prosthesis (10) comprising an additional sealing coating (16) deposited on the body (12).