the present invention describes an implantable material comprising microbial cellulose . the instant implantable material has those properties necessary for in vivo applications , for example , the implantable material of the instant invention can be adapted to a three - dimensional shape and possess low water absorption and desired pliability characteristics . the implantable materials of the instant invention are comprised of microbial cellulose . those methods of preparing microbial cellulose are known to those of ordinary skill and are described , for example , in u . s . pat . nos . 5 , 846 , 213 and 4 , 912 , 049 , which are incorporated herein by reference in their entirety . any cellulose producing organism can be used in producing the raw biosynthetic cellulose material . however , biosynthetic cellulose produced from a static culture of acetobacter xylinum is preferred . the microbial cellulose content of the raw material is dependent on the amount of media supplied to the a . x . bacteria . once the pellicle is harvested , the raw material is physically and chemically processed so as to be a suitable implantable material for medical and surgical uses . for example , the microbial cellulose is first processed and cleaned to remove all non - cellulose material embedded in the cellulose pad and then depyrogenated using chemicals such as sodium hydroxide . after depyrogenation , the cellulose may be cross - linked by irradiation or chemical means if its strength needs to be adjusted . addition of other agents , such as glycerol and polyethylene glycol used to modify the cellulose surface can also be performed in order to control water absorption and pliability which are desirable properties for implantable materials . the material can remain wet , moist , partially dehydrated , or totally dehydrated by air , heat , lyophilization , freeze - drying or supercritical fluid drying . the material may be further processed by compressing to a thin film by applying repeated or sustained force directly to the dried material . preferably , the processed microbial cellulose will be further sterilized for applications as medical implantable articles using standard sterilization methods such as gamma irradiation , e - beam irradiation , ethylene oxide or steam sterilization . in one preferred embodiment , the invention provides a method for preparing an implantable device for medical and surgical applications comprising the steps of providing a microbial cellulose material ; and incorporating said material into an implantable device for medical and surgical applications . once produced , the microbial cellulose may be incorporated or fashioned into medical devices by commonly known methods such as molding , cross - linking , chemical surface reaction , dehydrating and / or drying , cutting or punching . such medical devices include tissue substitutes or scaffolds for repair or reinforcement of damaged soft tissue . for example , the instant microbial cellulose may be used as a scaffold in tissue engineering , substitution and replacement for tissue such as muscle , tendon , ligament or other connective tissue . physical properties of microbial cellulose such as tensile strength , three dimensional structure , suture retention , and conformability may be measured to show its characteristics by commonly utilized techniques such as scanning electron microscopy ( sem ), mechanical testing or other standard physical tests . chemical properties such as degree of crystallinity , active chemical groups and degree of polymerization can also be examined by techniques such as x - ray crystallography . finally , the biocompatibility / safety properties of the implantable microbial cellulose in vitro and in vivo may be assessed . the properties of implantable microbial cellulose may be compared to a wide variety of implantable materials available including polypropylene mesh , ptfe , polymeric hydrogels , collagen , and human or animal derived tissue currently being used in the medical industry . based on the results of these comparisons , including strength , conformability , and adhesion properties , a number of implantable microbial cellulose articles may be tailored for specific applications . the instant microbial cellulose may be use as a substitute or scaffold in tissue engineering , for orthopedic soft tissues such as tendon , ligament , or muscle . in this embodiment , the cellulose acts as a scaffold or trellis on which new tissue forms , orients and matures . in a preferred embodiment , the invention provides a method of tissue reinforcement , comprising an implantable composition comprising microbial cellulose and implanting said composition into a subject in need thereof . for example , the instant invention may be easily prepared as a dry or hydrated pad for direct application on a tissue through which staples , sutures or bone anchors are being added to ensure attachment of the tissue to its supporting structure . often the tissue that is being repaired is friable and sutures or staples alone result in cutting or tearing and re - opening of the wound . in this embodiment the staples and / or sutures pass through both cellulose and tissue , the cellulose acting to reinforce the tissue by creating a stronger backing for attachment . for this application the material must be conformable so as to not cause damage to the tissue by rubbing , sharp edges , etc . in a preferred embodiment , the invention provides a method for repair of the rotator cuff and other shoulder related tears using the cellulose material . a method or process for fabricating such implantable materials will be cited in the examples accordingly . the material can be used for reinforcing tissue in and around the shoulder . the microbial cellulose described can be processed using the methods described above to create a sheet with multi - directional strength that can be used as a surgical device for rotator cuff repair . this may include both open and arthroscopic repair and include suture or staple reinforcement . the instant invention also contemplates an implantable composition comprising microbial cellulose and a medically useful agent . any number of medically useful agents for tissue repair can be used in the invention by adding the substances to an implantable composition comprising the microbial cellulose carrier , either at any steps in the manufacturing process or directly to the final composition . a medically useful agent is one having therapeutic , healing , curative , restorative , or medicinal properties . such medically useful agents include collagen and insoluble collagen derivatives , hydroxyapatite and soluble solids and / or liquids dissolved therein . also included are amino acids , peptides , vitamins , co - factors for protein synthesis ; hormones ; endocrine tissue or tissue fragments ; synthesizers ; enzymes such as collagenase , peptidases , oxidases ; cell scaffolds with parenchymal cells ; angiogenic drugs and polymeric carriers containing such drugs ; collagen lattices ; biocompatible surface active agents , antigenic agents ; cytoskeletal agents ; cartilage fragments , living cells such as chondrocytes , bone marrow cells , mesenchymal stem cells , natural extracts , tissue transplants , bioadhesives , transforming growth factor ( tgf - beta ) and associated family proteins ( bone morphogenetic protein ( bmp ), growth and differentiation factors ( gdf ) etc . ), fibroblast growth factor ( fgf ), insulin - like growth factor ( igf - 1 ) and other growth factors ; growth hormones such as somatotropin ; bone digesters ; antitumor agents ; fibronectin ; cellular attractants and attachment agents ; immuno - suppressants ; permeation enhancers ; and peptides , such as growth releasing factor , p - 15 and the like . the drug can be in its free base or acid form , or in the form of salts , esters , or any other pharmacologically acceptable derivatives , enantomerically pure forms , tautomers or as components of molecular complexes . the amount of drug to be incorporated in the composition varies depending on the particular drug , the desired therapeutic effect , and the time span for which the device is to provide therapy . generally , for purposes of the invention , the amount of drug in the system can vary from about 0 . 0001 % to as much as 60 %. the active agent may be used to reduce inflammation , increase cell attachment , recruit cells , and / or cause differentiation of the cells to repair the damaged tissue . the implantable microbial cellulose may also act to delivery bone forming agents needed to intimately secure the soft tissues to the bone , where needed . in addition , implantable materials using microbial cellulose may be applied in a number of other useful areas , including , but not limited to other soft tissue substitutes or scaffolds . other objects , features and advantages of the present invention will become apparent from the following examples . it should be understood , however , that the detailed description and the specific examples , while indicating preferred embodiments of the invention , are given by way of illustration only , since various changes and modifications within the spirit and scope of the invention will become apparent to those skilled in the art from this detailed description . the invention , thus generally described , will be understood more readily by reference to the following examples , which are provided by way of illustration and are not intended to be limiting of the present invention . to prepare the microbial cellulose of the invention , acetobacter xylinum microorganisms were cultured in a bioreactor containing a liquid nutrient medium at 30 degrees celsius at an initial ph of 3 - 6 . the medium was based on sucrose or other carbohydrates . the bioreactor was composed of a plastic box fitted with an airtight cover . dimensions of the bioreactor measured 3 . 5 in × 3 . 5 in . an aeration port was made in the bioreactor that allowed the proper oxygen tension to be achieved . the fermentation process under static conditions was allowed to progress for a period of about 10 - 14 days , during which the bacteria in the culture medium produced an intact cellulose pellicle . once the media was expended , the fermentation was stopped and the pellicle removed from the bioreactor . this material was termed ‘ 250 ’. the excess medium contained in the pellicle was removed by mechanical compression prior to chemical cleaning and subsequent processing of the pellicle . the cellulose pellicle was subjected to a series of chemical wash steps to convert the raw cellulose film into a medical grade and non - pyrogenic implantable material . processing started with an 8 % sodium hydroxide solution at 70 - 75 degrees celsius for 1 hour , followed by a rinse in deionized water and then a soak in 0 . 25 % hydrogen peroxide at 70 - 75 degrees celsius for 1 hour . the resulting films were tested for pyrogens and mechanical properties . the amount of cellular debris left in the cellulose pad after processing is measured by validated limulus amoebocyte lysate ( lal ) testing as outlined by the u . s . food and drug administration ( fda ) in 21 cfr10 . 90 . the instant cleaning process outlined above provided a nonpyrogenic cellulose pad (≦ 0 . 50 eu / ml ). the steps of the lal test are defined by the test kit manufacturer and can simply be followed to yield the pyrogen level in the cellulose film . once cleaned , the pellicles were mechanically pressed to reduce the water content . the materials were then soaked in 100 % methanol for approximately 1 hour . the methanol water mixture was decanted and the samples soaked again in 100 % methanol overnight . the methanol was changed at approximately 16 hours and again at 24 hours . following the methanol exchange , the pellicle was repressed to reduce the methanol . pellicles were then placed into a pressure vessel separated by polypropylene mesh and underwent supercritical carbon dioxide drying at 2000 psi and 40 degrees celsius until the methanol was removed and the material dry . the resulting dry pad is cut to shape , packaged in single or dual foil pouches and sterilized by gamma irradiation at 25 - 35 kgy . material was prepared the same as in example 1 , however additional media was added at the start and the pellicle was allowed to grow 14 - 17 days . the resulting pellicle was termed ‘ 360 ’. the cleaning , whitening , drying , packaging and sterilization were identical to example 1 . material was prepared the same as in example 1 , however additional media was added at the start and the pellicle was allowed to grow 21 - 25 days . the resulting pellicle was termed ‘ 440 ’. the cleaning , whitening , drying , packaging and sterilization were identical to example 1 . material was initially cleaned , whitened , and dried as in example 2 . it was further processed by subjecting it to mechanical pressure to create a thinner version termed ‘ 360p ’. for this example the material was hammered with a plastic mallet to compress the cellulose into a thin wafer . this was then packaged and sterilized as in example 1 . material was initially cleaned , whitened , and dried as in example 3 . it was further processed by subjecting it to mechanical pressure to create a thin version termed ‘ 440p ’. for this example the material was hammered with a plastic mallet to compress the cellulose into a thin wafer . this was then packaged and sterilized as in example 1 . materials were processed as in examples 1 - 3 . the mechanical properties of these implantable microbial cellulose forms were analyzed using a united tensile tester ( model sstm - 2kn ), including tensile strength , elongation , and suture retention . for each lot , samples for both tensile and suture ( 1 cm × 4 cm ) were tested . samples were prepared by soaking them in deionized water for 30 - 35 minutes prior to testing . tensile tests were performed by placing the samples between two grips such that a 25 mm gap was tested . a 1n preload was applied and the test performed at 300 mm / minute until failure . both tensile load and elongation at failure were recorded . the suture testing was performed by threading a single 2 . 0 prolene suture through one end of the test sample . the sample was placed in the grips at one end and the suture placed in the grips at the other such that a gap length of 60 mm was achieved . a 1n preload was applied and the test performed at 300 mm / minute until failure . young &# 39 ; s modulus was calculated from the tensile test results and sample measurements . table 1 and fig1 demonstrate the increased tensile strength , young &# 39 ; s modulus and suture retention strength with increasing cellulose content . a decrease in elongation percent suggests that the material becomes stiffer with increasing cellulose . materials were processed as in examples 2 - 5 . the mechanical properties of these implantable microbial cellulose forms were performed using a united tensile tester ( model sstm - 2kn ). testing included tensile strength , elongation , suture retention and fabric stiffness . for each lot , samples for both tensile and suture ( 1 cm × 4 cm ) and samples for stiffness ( 4 cm × 5 cm ) were tested . samples were prepared by soaking them in deionized water for 30 - 35 minutes prior to testing . tensile tests were performed by placing the samples between two grips such that a 25 mm gap was tested . a in preload was applied and the test performed at 300 mm / minute until failure . both tensile load and elongation at failure were recorded . the suture testing was performed by threading a single 2 . 0 prolene suture through one end of the test sample . the sample was placed in the grips at one end and the suture placed in the grips at the other , such that a 60 mm gap length was produced . a 1n preload was applied and the test performed at 300 mm / minute until failure . stiffness testing was performed by placing a 4 cm × 5 cm piece of test material onto a fabric stiffness testing rig . a 1 . 2 cm diameter flat based probe was then lowered to the sample and the peak force needed to push the test material through a 2 . 5 cm ( od ), 2 cm id diameter hole with a 45 - degree beveled edge was recorded . the physical characteristics of implantable microbial cellulose can be seen in fig3 and 4 that show an sem image of the implantable microbial cellulose materials . note the interconnected fibers in fig3 and the laminar structure in fig4 . biocompatibility testing and implantation studies were conducted to assess the implantable microbial cellulose safety profile . a battery of in vitro and animal biocompatibility tests including cytotoxicity , sensitization , intracutaneous irritation , systemic toxicity and genotoxicity have been conducted on microbial cellulose , with the results indicating that the material is biocompatible . muscle implantation studies in rabbits up to 24 weeks have been performed and the histological and gross necropsy results showed no significant tissue reaction , minimal cellular interaction , and very low adhesion to tissue . table 3 lists the tests and the results . the implantable microbial cellulose materials prepared in examples 1 - 3 were compared with existing medical devices used for shoulder repair . the suture retention properties of collagen - based products ( both human - and animal - derived ) and ptfe materials were compared to the implantable microbial cellulose . these were tested in the following in vitro model . chicken achilles tendons were harvested from fresh legs and stored in isotonic saline before use . these specimens were approximately 5 cm long , 1 cm wide and 2 mm thick . test specimens were individually prepared and tested on an instron mini 44 machine . the test fixture consisted of a 3 - mm thick aluminum ‘ l ’ shaped plate with three 0 . 5 mm holes ( hole edges polished to prevent suture damage ) spaced 2 . 5 mm in a row on both the side and top the top holes were used for pull - off testing and the side holes for shear testing . no . 2 mersilene ™ suture was introduced from the back of the plate and through the tendon and graft ( when present ) and returned through the tendon maintaining either a 2 . 5 mm or 5 mm suture gap and tied on the back of the plate with a square knot . the plate was held by one grip of the instron and the free end of the tendon passed through a small eye bolt held by the other grip and constrained with a hemostat . tension was applied at 1 . 0 cm / min until failure . failure load and mechanism of failure were determined . tendon with no graft and suture gaps of 2 . 5 mm and 5 mm served as controls . test materials included ptfe - teflon fabric ( gore - text soft tissue patch ), human derived cross - linked collagen ( graftjacket ™), bovine pericardium ( peri - guard ), and implantable cellulose material of examples 1 and 2 . test units were one centimeter square patches with 5 - mm suture spacing . twelve specimens were run for each test material and graft material . the two lowest failure load values were discarded ( due to loosening of knot or tendon clamp ) and the remaining ten averaged to determine failure strength . averages were compared by unpaired student &# 39 ; s t - tests . results of the tests are given in table 4 . the failure loads occurred when the repairs first began to displace and these loads gradually decreased as the suture / graft passes through the tendon . the implantable microbial cellulose and bovine pericardium grafts were significantly ( p & lt ; 0 . 05 ) stronger than the non - augmented suture for both tests . all non - augmented specimens failed by the suture slicing along the tendon ( tear - out ). only the human collagen graft failed in a similar manner . the other grafts failed by various amounts of cut - out and tear - out with the bovine pericardium failing mainly by tear - out . however in all of the cut - out failures , the suture did not cut through any of the grafts but pulled them into and usually through the tendon . the graft / suture subsequently sliced along the tendon . these cut - out failures generally resulted in higher strengths . as is apparent from the preceding description and examples , the present invention is directed to a class of implantable materials using microbial cellulose that can be used for medical applications and medical devices to repair and replace injured orthopedic soft tissue . the products maybe constructed in variety of forms ( e . g . film , pad , hydrated , dry ) and with varying physical and chemical properties . additionally , the materials can be used in combination with other biomaterials such as collagen , proteins , and other bioactive agents to enhance its efficacy for a particular application . many other variations and details of construction , composition and configuration will be apparent to those skilled in the art and such variations are contemplated within the scope of the present invention . material was initially cleaned , whitened , and dried as in example 3 . it was further processed by subjecting it to perforation by placing it in a tissue 1 / 1 mesher . this made macroscopic holes in the material while maintaining strength in one dimension .
this invention relates to polysaccharide materials and more particularly to microbial cellulose having suitable implantation properties for repair or replacement of soft tissue . the invention also relates to the use of the implantable microbial cellulose as scaffolds for tendon and ligament repair , tissue closure reinforcement , buttresses for reinforcement of the soft tissue , adhesion barriers , articular cartilage repair , pericardial patches , bone graft substitutes , and as carrier vehicles for drug or other active agent delivery for repair or regeneration of tissue .