Cross Reference to Related Applications

This application claims the benefit under 35 U.S.C. § 119(e) of U.S. Provisional Application Serial No. 62/482,003 filed on April 5, 2017, the entire disclosure of which incorporated herein by reference.

Background

Cold slurries used in medical applications typically comprise a partially frozen saline solution. Cold slurries are used in surgical applications to induce therapeutic hypothermia and slow organ and tissue metabolic rates thereby protecting a patient's organs during a surgical procedure. Cold slurries can also be injected into a patient for selective or non-selective cryotherapy and/or cryolipolysis.

Approaches to preparing and delivering a cold slurry to fat tissue through a cannula or needle are reported in International Application No. PCT/US2015/047292; U.S. Patent Application Publication No. 2013/0190744; and U.S. Provisional Application No. 62/416484, which are incorporated by reference herein in their entirety. An injectable cold slurry typically can have particle sizes ranging from 0.1 millimeters to 1.5 millimeters. The particles are generally globular in shape giving the cold slurry high fluidity. This allows the slurry to flow easily through a small diameter needle. In contrast, an ice slush consisting of dendritic crystals is difficult to inject without clogging.

A traditional approach to making an injectable cold slurry is to mix a saline solution with ice, crush it, and condition it prior to injection. The resulting cold slurry is then transferred to a syringe for injection. There are many challenges with this approach, including maintaining temperature, shape, and size of the cold slurry particles. As the slurry warms, the particles lose the desired shape and size. The problem of melting cold slurry is further exacerbated when a large amount of cold slurry needs to be delivered to many different areas. By the time the last injection of cold slurry is made, the cold slurry is markedly different than when first injected. Refreezing the cold slurry is not an option because doing so causes dendritic crystals to form that may clog the syringe needle. Summary

The present invention provides methods and devices for making a cold slurry at a point of delivery. A point of delivery device delivers cold slurry components to a location at or near a target tissue. The components are combined to form the cold slurry at or near the point of delivery. This approach to generating a cold slurry at the point-of-delivery allows the characteristics of the cold slurry, such as temperature, particle shape and particle size, to be maintained and controlled

Point of delivery generation also allows cold slurry to be made on demand and on a continuous basis. This is particularly useful for treatment over an extended period of time during which melting can occur. The point of care, just-in-time slurry delivery of the invention delivers fresh cold slurry over an entire course of treatment obviating concerns over melting and slurry decomposition. The invention can also greatly reduce the cost and time associated with making cold slurry in batches.

One aspect of the invention comprises methods of making a cold slurry at or near a target tissue. Preferred methods include delivering components needed to make a cold slurry.

A first component can be water or a water mixture, such as water and glycerol. Cold slurry is formed at or near the target tissue as a result of interaction between the components. The delivery of components for making a cold slurry; and the formation of a cold slurry can occur continuously so that there is steady supply of fresh cold slurry at or near the target tissue.

Preferred ingredients for forming a cold slurry include liquid water and solid water. A surfactant, such as glycerol, can be added as well to enhance the fluidity of the cold slurry. Liquid water and the solid water are mixed to form a cold slurry at or near the target tissue. The solid water can be broken into particles that are mixed with the liquid water to form the slurry. Solid water (i.e., ice) can also be formed from another supply of liquid water that is subsequently frozen within the device.

The cold slurry can also be made at or near the target tissue from the nucleation of supercooled water with ice pellets (seeds). In this case the supercooled water is purified liquid water that has been "undercooled" below the freezing point of water. The supercooled water remains in liquid form due, in part, to its purity. When the supercooled water interacts with the ice pellets, it crystallizes and forms the cold slurry.

Methods of the invention are carried out using a point of delivery generation device. An exemplary device includes a first cannula for delivering a first component and a second cannula for delivering a second component to a target tissue. The first and second cannulas can be arranged side -by- side such that their respective outlets are more or less aligned to facilitate cold slurry formation. In some examples, the first and second cannulas each have a size and shape suitable for inserting through the subject's skin.

Cold slurry can also be made at or near a target tissue using a balloon. In a preferred embodiment, the balloon comprises an outer balloon and an inner balloon. The inner balloon is filled with liquid water supplied through, for example, a first delivery cannula. A space between the inner balloon and the outer balloon is filled with a cooling fluid or gas supplied through a second delivery cannula. This causes a cold slurry to form inside the inner balloon. The inner balloon can optionally be punctured (e.g. , by a puncturing needle on the device) to release the cold slurry at or near the target tissue. In this example of the point of delivery generation device, the first delivery cannula and the second delivery cannula are arranged coaxially. The invention may also include a temperature sensor to measure the temperature of the cold slurry made at or near the target tissue. Other factors and aspects of the invention are provided in the following detailed description thereof.

Brief Description of Drawings

FIG. 1 is a diagram of an approach to generating a cold slurry inside a patient's body.

FIG. 2 is a view of a generating end of a point of delivery generation device for forming a cold slurry from liquid water and solid water.

FIG. 3A is a view of a generating end of another point of delivery generation device for forming a cold slurry from liquid water and solid water.

FIG. 3B is a sectional view of the generating end of FIG. 3A. FIG. 4 is a view of a generating end of a point of delivery generation device for forming solid water from a first supply of liquid water and then forming a cold slurry from the solid water and a second supply of liquid water and .

FIG. 5 is a view of a generating end of a point of delivery generation device for forming a cold slurry from supercooled water and ice pellets.

FIGS. 6 A and 6B are views of a generating end of a point of delivery generation device for forming a cold slurry inside a balloon.

FIG. 7 is a view of a point of delivery generation device for generating and replenishing cold slurry.

FIG. 8 is a view of a point of delivery generation device having multiple working channels.

Detailed Description

Methods and devices of the invention comprise elements for point-of-care delivery of cold slurry to a tissue or organ. The invention obviates the need to pre-mix slurry prior to delivery, thus ensuring that fresh slurry (i.e., uncrystallized and at appropriate phase and temperature) is delivered for the duration of treatment and uniformly to all treatment areas. In a preferred embodiment, slurry is made in situ at a point of delivery in a patient. Components (reactants) used to generate the slurry are provided under conditions that result in the formation of a slurry at an appropriate temperature and of an appropriate consistency for a desired treatment protocol. In a highly-preferred embodiment, methods of the invention are provided subcutaneously to adipose tissue in order to cause reduction of the adipose tissue. Methods and devices of the invention can also be applied to cause reduction of visceral fat, or to reduce pain.

FIG. 1 shows an example of a point of delivery generation device 100 for making a cold slurry inside a patient's body. The device 100 includes an application cannula 105 having a shape and size configured to be inserted through a patient's skin. The device 100 is fluidly coupled to a supply 110 providing components for making a cold slurry. At the distal of the application cannula 105, there is a generating end 115 for forming a cold slurry from the components. The point of delivery generation device 100 is used by inserting the application cannula 105 through the patient's skin and advancing the generating end 115 to a location at or near a target tissue or treatment site 120 (shown in phantom line). The target tissue 120 can, for example be subcutaneous adipose tissue. The cold slurry ingredients, such as liquid water, solid water, and glycerol, are pumped or otherwise conveyed, separately, from the supply 110, through the application cannula 105, and out the generating end 115. At the generating end 115, the components interact with each other and form the cold slurry 125 at or near the target tissue 120.

The cooling effect of the cold slurry 125 is localized to the target tissue 120 and possibly surrounding tissue, such as adjacent tissue 130. In this way, discomfort caused by the cold treatment is limited. The cold slurry is sterile and biocompatible; and, as such, the cold slurry 125 can be advantageously left in the body (e.g. no removal of the slurry is necessary after cooling has been effected).

FIG. 2 shows an example of the generating end 115 for making cold slurry from mixing liquid water and solid water. The application cannula 105 houses a first delivery cannula 205 for supplying liquid water 210 (or a liquid mix of water and glycerol) and a second delivery cannula 215 for supplying solid water (ice) 220. The distal end of the first delivery cannula 205 is open and forms a first outlet 230 for the liquid water 210 to exit. The distal end of the second delivery cannula 215 is open and forms a second outlet 235 for the solid water 220 to exit. The outlets 230, 235 are arranged so that the liquid water 210 and the solid water 220 mix together as they exit to form a cold slurry.

FIG. 3 A shows an example of the generating end 115 for making cold slurry from mixing liquid water and solid water. This example is similar to the one described above with reference to FIG. 2 with the addition of a grinder 240 located in front of the second outlet 235. The arrangement of the grinder 240 with respect to the second outlet 235 is better seen in the cross-sectional view of FIG. 3B. As the solid water 220 emerges from the second delivery cannula 215, the grinder 240 breaks the solid water 220 into particles 245. The liquid water 210 exiting from the first delivery cannula 205 mixes with the particles 245 to form a cold slurry. In another example (not shown), a vibrator can break solid water into particles to make cold slurry at the point of delivery. FIG. 4 shows another example of the generating end 115 for making a cold slurry from mixing liquid water and solid water. The application cannula 105 houses a first delivery cannula 305 for providing a first supply of liquid water 310 (or mix of water and glycerol) and a second delivery cannula 315 for providing a second supply of liquid water 320. As shown, the application cannula 105 further includes a gas line 325 for spraying a cooling gas 330 and freezing the second supply of water 320 into solid water 335.

The distal end of the first delivery cannula 305 is open forming a first outlet 340 for the first supply of liquid water 310 to exit. The distal end of the second delivery cannula 315 is open forming a second outlet 345 for the solid water 335 to exit. In front of the second outlet 345, there is a grinder (or vibrator) 350 to break the solid water 335 into particles as it emerges from the second delivery cannula 315. The outlets 340, 345 are arranged so that the first supply of liquid water 310 and the particles of solid water mix together to form a cold slurry.

FIG. 5 shows an example of the generating end 115 for making cold slurry from crystalizing supercooled water. The application cannula 105 houses a first delivery cannula 405 for supplying supercooled water 410. Water normally freezes at 273.15 K (0 °C or 32 °F), but it can be "supercooled" at standard pressure down to its crystal homogeneous nucleation at almost 224.8 K (-48.3 °C/-55 °F). The supercooling process requires that water be pure and free of nucleation sites. This can be done by processes like reverse osmosis or chemical demineralization. Rapidly cooling water at a rate on the order of 10 ^A 6 K/s avoids crystal nucleation and water becomes a glass, i.e., an amorphous (noncrystalline) solid.

The application cannula 105 further houses a second delivery cannula 415 for supplying ice pellets 420, which serves as nucleation sites for the crystallization process. The distal end of the first delivery cannula 405 is open and forms a first outlet 430 for the supercooled water 410 to exit. The distal end of the second delivery cannula 415 is open and forms a second outlet 435 for the ice pellets 420 to exit. The outlets 430, 435 are arranged so that the supercooled water 410 interacts with the ice pellets 420 causing it to crystalize and form a cold slurry.

FIG. 6A shows another example of the point of delivery generation device. The device includes an application cannula 605 that is open at its distal end defining an outlet 610. A generating end 615 includes an outer balloon 620 disposed around the outlet 610. The application cannula 605 is in fluid communication with the interior volume of the outer balloon 620. The application cannula 605 includes a fluid delivery cannula 625. The application cannula 605 and the fluid delivery cannula 625 share a common longitudinal axis and can be said to be coaxial aligned.

The fluid delivery cannula 625 is open at its distal end defining a fluid outlet 630. The generating end 615 further includes an inner balloon 635 disposed around the fluid outlet 630. The fluid delivery cannula 625 is in fluid communication with an interior volume of the inner balloon 635, which is labeled 640 in the figure. The inner balloon 635 is located inside the outer balloon 620. As shown, the inner balloon 635 occupies a portion of the interior volume of the outer balloon 620 leaving a space or gap 645 between an outer wall of the inner balloon 635 (which is labeled 650 in the figure) and an inner wall of the outer balloon 620 (which is labeled 655 in the figure).

To generate a cold slurry at the point of delivery, the application cannula 605 is inserted through a patient's skin and the generating end 615 is advanced to a location at or near a target tissue in much the same manner as described above with reference to FIG. 1. In this example, the outer balloon 620 and the inner balloon 635 are inserted into the patient's body in their uninflated state. The inner balloon 635 is then filled or inflated with a cool fluid, such as mix of cold water and cold glycerol that is supplied through the fluid delivery cannula 625.

Once the inner balloon 635 is filled with the cool fluid, the outer balloon 620 is filled with a cooling gas or fluid, such as liquid nitrogen. The cooling gas fills the gap 645 between the inner balloon 635 and the outer balloon 620. This causes the cool fluid in the inner balloon 635 to partial freeze and form a cold slurry 660, as shown in FIG. 6B. (For clarity the outer balloon 620 is not shown in FIG. 6B.) The slurry-filled inner balloon 635 can then be used to cool a target tissue. Alternatively, the inner balloon 635 can be ruptured by a retractable puncture needle 665 that extends beyond the application cannula 605 when extended as shown. Rupturing the inner balloon 635 releases the cold slurry 600 at or near the target tissue.

FIG. 7 shows another example of the point of delivery generation delivery device for generating and replenishing cold slurry. This example is similar to the one described above with reference to FIG. 6 with the addition of a fluid return cannula 670. (For clarity the outer balloon 620 is not shown in FIG. 7.) The fluid return cannula 670 is housed within the application cannula 605 together with the fluid delivery cannula 625, as shown. The fluid return cannula 670 removes cold slurry from the inner balloon 635 that is no longer at the desired temperature. Replenishing the "old" cold slurry with "fresh" cold slurry in this manner can accommodate for the eventually melting of cold slurry. This approach is particular useful for a treatment that requires a long period of cooling.

FIG. 8 shows an example point of delivery generation device having multiple cannulas or "working channels" to control the functions described above with reference to FIGS. 6 A, 6B, and 7. The device includes an application cannula 705. The application cannula 705 houses a gas delivery cannula 710, a fluid delivery cannula 715, and a fluid return cannula 720, to continuously generate and replenish cold slurry, as described above with reference to FIGS. 6 A and 7. The application cannula 705 can also include a retractable puncture needle 725 to rupture a balloon filled with cold slurry, as described above with reference to FIG. 6B. The application cannula 705 can further have a cold slurry temperature monitor 730 for measuring the temperature of the cold slurry.