Self-regulating device for modulating inflammation
A bioreactor is provided which contains cells capable of producing cytokine inhibitors in response to cytokines, in a manner regulated by the local or systemic milieu of an individual patient and predicted by mechanistic computational simulations. The bioreactor transfers the cytokine inhibitors to a patient in need of control of the inflammation process as part of a disease or condition in the patient, such as sepsis, trauma, traumatic brain injury, or wound healing. Related methods also are provided.
1. A method of inhibiting tumor necrosis factor-alpha (TNF-α) comprising, providing blood of a patient to an extracorporeal bioreactor, wherein the extracorporeal bioreactor comprises: a compartment comprising cells and a selectively permeable membrane in contact with the cells that does not permit passage of the cells and which permits passage of TNF-α in the blood of the patient, wherein the cells comprise a chimeric gene comprising a response element operably linked to a sequence encoding a soluble TNF-α receptor (sTNFR), in which the response element causes expression of the sTNFR when the cells are contacted with the TNF-α in the blood of the patient; contacting the blood with the selectively permeable membrane, such that the TNF-α in the blood passes through the selectively permeable membrane and sTNFR produced by the cells passes into the blood; and returning the blood to the patient, thereby inhibiting TNF-α.
2. The method of claim 1 , in which the cells are selected by use of a computer model of an inflammatory response characteristic of a disease or condition in the patient.
3. The method of claim 1 , in which the patient is a TBI patient.
4. The method of claim 1 , in which the compartment comprising the cells comprises a plurality of selectively permeable hollow fibers passing through the compartment in which the plurality of hollow fibers are fluidly connected to a plasma or blood circulation system in which blood or plasma from the patient is circulated through the hollow fibers and into the patient.
5. The method of claim 1 , in which the compartment comprising the cells has at least one wall that is the selectively permeable membrane, in which the selectively permeable membrane is placed in contact with a wound on the patient or a bodily fluid in situ in the patient.
6. The method of claim 5 , in which the compartment comprising the cells comprises a plurality of selectively permeable hollow fibers passing through the compartment through which one or both of a gas and a fluid comprising nutrients for the cells is passed.
7. The method of claim 1 , in which the cells are hepatic cells.
8. A method of inhibiting interleukin-1 (IL-1), transforming growth factor-beta1 (TGF-β1), interleukin-6 (IL-6), and/or tumor necrosis factor-alpha (TNF-α), comprising, providing blood of a patient to an extracorporeal bioreactor, wherein the extracorporeal bioreactor comprises: a compartment comprising cells and a selectively permeable membrane in contact with the cells that does not permit passage of the cells and which permits passage of IL-1, TGF-β1, IL-6, and/or TNF-α in the blood of the patient, wherein the cells comprise at least one chimeric gene comprising a response element operably linked to a sequence encoding one of: an IL-1 receptor antagonist (IL-1ra); TGF-β1 latency-associated peptide (LAP); a soluble IL-6 receptor (sIL-6R); and a soluble TNF-α receptor (sTNFR); in which the response element causes expression of the IL-1ra, LAP, sIL-6R, and/or sTNFR when the cells are contacted with the IL-1, TGF-β1, IL-6, and/or TNF-α, respectively, in the blood of the patient; contacting the blood with the selectively permeable membrane, such that the IL-1, TGF-β1, IL-6, and/or INF-α in the blood passes through the selectively permeable membrane and IL-1ra, LAP, sIL6-R, and/or sTNFR, respectively, produced by the cells passes into the blood; and returning the blood to the patient, thereby inhibiting IL-1, TGF-β1, IL-6, and/or TNF-α.
9. The method of claim 8 , comprising determining levels of one or more of interleukin-1 (IL-1), transforming growth factor-beta1 (TGF-β1), interleukin 6 (IL-6), and/or tumor necrosis factor-alpha (TNF-α) in the patient, modeling inflammation associated with sepsis using the one or more levels in the patient, and determining a level of IL-1, TGF-β1, IL-6, and/or TNF-α to be controlled in the patient to determine a chimeric gene construct to place in the bioreactor based on an outcome of the modeling.
10. The method of claim 8 , wherein the patient is a TBI patient.
11. The method of claim 10 , comprising determining levels of one or more of interleukin-1 (IL-1), transforming growth factor-beta1 (TGF-β1), interleukin 6 (IL-6), and/or tumor necrosis factor-alpha (TNF-α) in the patient, modeling inflammation associated with TBI using the one or more levels in the patient, and determining a level of IL-1, TGF-β1, IL-6, and/or TNF-α to be controlled in the patient to determine a chimeric gene construct to place in the bioreactor based on an outcome of the modeling.
12. The method of claim 8 , in which one or both of a soluble TNF-α receptor (sTNFR) and a soluble IL-6 receptor (sIL-6R) are produced by the cells.
13. The method of claim 8 , in which the chimeric gene expresses an inhibitor selected from the group consisting of soluble TNF-α receptor, IL-1 receptor antagonist (IL-1ra), and TGF-β1 LAP (latency-associated peptide).
14. The method of claim 8 , in which the cells comprise one or more genes that express one or both of a soluble TNF-α receptor (sTNFR) and an IL-1 receptor antagonist (IL-1ra).
15. The method of claim 8 , in which the compartment comprising the cells comprises a plurality of selectively permeable hollow fibers passing through the compartment in which the plurality of hollow fibers are fluidly connected to a plasma or blood circulation system in which blood or plasma from the patient is circulated through the hollow fibers and into the patient.
16. The method of claim 8 , in which the compartment comprising the cells has at least one wall that is the selectively permeable membrane, in which the selectively permeable membrane is placed in contact with a wound on the patient or a bodily fluid in situ in the patient.
17. The method of claim 8 , in which the cells are hepatic cells.