US010471211B2

United States Patent (10 ) Patent No.: US 10,471,211 B2 Rusch et al. (45 ) Date of Patent: Nov. 12 , 2019

( 54 ) MEDICAL DELIVERY DEVICE WITH A61M 2005/31506 ; A61M 2205/0216 ; LAMINATED STOPPER A61M 2205/0222 ; A61M 2205/0238 ; A61L 31/048 ( 71) Applicant: W.L. Gore & Associates, Inc., Newark , See application file for complete search history. DE (US ) ( 56 ) References Cited ( 72 ) Inventors : Greg Rusch , Newark , DE (US ) ; Robert C. Basham , Forest Hill , MD U.S. PATENT DOCUMENTS (US ) 5,374,473 A 12/1994 Knox et al . 5,708,044 A 1/1998 Branca ( 73 ) Assignee : W. L. Gore & Associates, Inc., 5,792,525 A 8/1998 Fuhr et al. Newark , DE (US ) (Continued ) ( * ) Notice: Subject to any disclaimer, the term of this patent is extended or adjusted under 35 FOREIGN PATENT DOCUMENTS U.S.C. 154 (b ) by 0 days . WO WO2014 / 196057 12/2014 WO WO2015 /016170 2/2015 ( 21) Appl. No.: 15 /404,892 OTHER PUBLICATIONS ( 22 ) Filed : Jan. 12 , 2017 International Search Report PCT/ US2017 /013297 dated May 16 , (65 ) Prior Publication Data 2017 . US 2017/0203043 A1 Jul. 20 , 2017 Primary Examiner Lauren P Farrar Related U.S. Application Data ( 74 ) Attorney , Agent, or Firm — Amy L. Miller (60 ) Provisional application No.62 / 279,553, filed on Jan. ( 57 ) ABSTRACT 15 , 2016 . The present disclosure relates to a medical delivery device that includes a barrel having an inner surface , a plunger rod (51 ) Int. Cl. having a distal end inserted within the barrel , and a stopper A61M 5/315 ( 2006.01) attached to the distal end of the plunger rod and contacting A61L 31/04 (2006.01 ) at least a portion of the inner surface of the barrel . In at least A61M 5/31 ( 2006.01) one embodiment, the inner surface is hydrophilic . The (52 ) U.S. CI. stopper may include an elastomeric body, one or more CPC A61M 5/31505 (2013.01 ) ; A61L 31/048 fluoropolymer layers , and two or more ribs laminated with (2013.01 ) ; A61M 5/31513 ( 2013.01) ; A61M the one or more fluoropolymer layers . In some embodi 2005/3101 ( 2013.01) ; A61M 2005/31506 ments , the contact width between at least one rib having a ( 2013.01) ; A61M 2205/0216 (2013.01 ) ; sealing surface and the portion of the inner surface of the ( Continued ) barrel measured at a compressibility of greater than about (58 ) Field of Classification Search 7.9 % of the stopper is less than about 1.0 mm . CPC A61M 5/31511; A61M 5/31513 ; A61M 5/315 ; A61M 5/31505 ; A61M 2005/3101; 27 Claims, 6 Drawing Sheets

100 -125

150

130 US 10,471,211 B2 Page 2

(52 ) U.S. CI. CPC A61M 2205/0222 (2013.01 ) ; A61M 2205/0238 ( 2013.01 ) (56 ) References Cited U.S. PATENT DOCUMENTS 6,030,694 A 2/2000 Dolan et al . 6,541,589 B1 4/2003 Baillie 7,521,010 B2 4/2009 Kennedy et al. 7,531,611 B2 5/2009 Sabol et al. 8,637,144 B2 1/2014 Ford 8,658,707 B2 2/2014 Xu et al. 8,722,178 B2 5/2014 Ashmead et al. 9,139,669 B2 9/2015 Xu et al . 2011/0137263 A1 6/2011 Ashmead et al. 2012/0251748 A1 * 10/2012 Ashmead A61M 5/31513 428 /34.7 2015/0148751 A1 * 5/2015 Yotsutsuji A61M 5/31513 604/218 2016/0015898 A1 * 1/2016 Jones A61M 5/31513 604/230 2016/0022918 Al 1/2016 Gunzel * cited by examiner U.S. Patent Nov. 12 , 2019 Sheet 1 of 6 US 10,471,211 B2

115 -15 130 20 45 40 60 50 30

35 55 95 85 105 100 25 120

FIG . 1 U.S. Patent Nov. 12 , 2019 Sheet 2 of 6 US 10,471,211 B2

21

140

130 125

FIG . 2

100 125 Itt 150

} 145

130

FIG . 3 U.S. Patent Nov. 12 , 2019 Sheet 3 of 6 US 10,471,211 B2

100 125

150

} 145 ????????

130 160

FIG . 4

100 125

165

150 -

145

130 FIG . 5 U.S. Patent Nov. 12 , 2019 Sheet 4 of 6 US 10,471,211 B2

100

125

175

180

130

FIG . 6

100

-125

175

180

130

FIG . 7 U.S. Patent Nov. 12 , 2019 Sheet 5 of 6 US 10,471,211 B2

100 170 125

130 190

FIG . 8

100

125

170

175

180

130 195

FIG . 9 U.S. Patent Nov. 12 , 2019 Sheet 6 of 6 US 10,471,211 B2

100

225 ( x ) 220 ( c ) 230 (r ) (c ) 220 205 -230 240 220

210 FIG . 10A

(c % ) = V x 100 100 215 225 (w ). obs ( ) -220 -230

-220 205 240 -230 130 220

240

210 FIG . 10B US 10,471,211 B2 1 2 MEDICAL DELIVERY DEVICE WITH ably low break loose and slide forces ( i.e. , low - friction LAMINATED STOPPER slidability ) but not so much contact that the fluoropolymer film is distorted to create leak paths that decrease air and FIELD liquid impermeability . 5 The present invention relates to a medical delivery device SUMMARY with a laminated stopper , and in particular , to a medical delivery device with a stopper laminated with a fluoropo One embodiment relates to a medical delivery device that lymer film . includes a barrel, a plunger rod having a distal end inserted 10 within the barrel , a stopper attached to the distal end of the BACKGROUND plunger rod and contacting at least a portion of the inner surface of the barrel. The stopper has an elastomeric body, Medical delivery devices such as syringes typically one or more fluoropolymer layers , and two or more ribs include a barrel, a plunger rod reciprocally movable in the laminated with the one or more fluoropolymer layers . A barrel, and a stopper attached to an end of the plunger rod . 15 contact width between at least one of the two or more ribs The stopper to be used for the syringe is typically air, and having a sealing surface and a portion of the inner surface of liquid impermeable while also possessing low - friction slid the barrel measured at a compressibility of greater than ability . Air and liquid impermeability is important for elimi about 7.9 % of the stopper is less than about 1.0 mm . In at nating liquid leakage within the barrel and the introduction least one embodiment, the barrel has a hydrophilic inner of air between an outer face of the stopper and an inner wall 20 surface . Optionally , the hydrophilic inner surface is bare of the barrel when charging or discharging the liquid inside glass ( e.g., free or substantially free of silicone oil ) . the syringe . Low - friction slidability is important for facili In some embodiments, the medical delivery device further tating the charging and discharging of the liquid inside the includes a sliding surface that is less than about 2.0 mm , syringe. In addition to these requirements , a medical which is calculated based on a sum of the contact widths syringe, in particular, must not, adversely affect any phar- 25 between at least one of the two or more ribs having a sealing maceutical composition such as biopharmaceuticals that surface and the portion of the inner surface of the barrel come in contact with the syringe ( e.g. , a pre - filled syringe measured at a compressibility of greater than about 7.9 % . comprising a pharmaceutical composition ). In some embodiments , at least one of: each rib of the two Stoppers for conventional syringes are commonly made or more ribs having a sealing surface includes a radius of of a rubber material such as natural rubber , isoprene rubber 30 curvature at an apex of each respective rib that is less than or styrene -butadiene rubber which may be vulcanized . about 0.22 mm ; and a ratio of a maximum outer diameter of Although this type of conventional stopper, has satisfactory all the ribs having a sealing surface to an inner diameter of air and liquid impermeability , it does not have good low the inner surface of the barrel is nominally greater than about friction slidability . Accordingly , silicone lubricants are typi 1.08 . cally applied to both the outer face of the stopper and the 35 In some embodiments , a maximum outer diameter of the inner wall of the barrel such that the stopper can slide within ribs having a sealing surface is greater than about 5.0 mm , the barrel. However , syringes comprising silicone lubricants an inner diameter of the inner surface of the barrel is cannot be used for pharmaceutical composition and the like nominally between about 4.65 and about 11.85 mm , and a because the silicone lubricant can cause inactivation or ratio of the maximum outer diameter of the ribs having a otherwise impact the efficacy of these pharmaceutical com- 40 sealing surface to an inner diameter of the inner surface of positions. Therefore , in order to maintain the stability of the the barrel is greater than about 1.08 . pharmaceutical composition , stoppers laminated with a fluo In another embodiment, a plunger rod includes a distal ropolymer film have been used . Since the air and liquid end that is insertable into a barrel and a stopper attached to impermeability of stoppers may also have an impact on the the distal end . In one or more embodiment, the barrel has a quality and stability of the pharmaceutical compositions , the 45 hydrophilic inner surface. The stopper is configured to stoppers laminated with a fluoropolymer film are required to contact at least a portion of the inner surface of the barrel. have high levels of air and liquid impermeability . However, The stopper includes an elastomeric body , one or more when stoppers laminated with a fluoropolymer film are used fluoropolymer layers , and two or more ribs laminated with with a glass or resin syringe having a hydrophilic or lubri the one or more fluoropolymer layers . Each rib of the two or cant free inner surface, the stoppers undesirably exhibit 50 more ribs having a sealing surface includes a radius of poorer air and liquid impermeability than conventional, curvature at an apex of each respective rib that is less than non - laminated rubber stoppers. about 0.22 mm , and a ratio of a maximum outer diameter of Another problem associated with some fluoropolymer all the ribs having a sealing surface to an inner diameter of laminates is its ability to maintain air and liquid imperme the inner surface of the barrel is greater than about 1.08 . The ability while also possessing low - friction slidability . For 55 plunger rod may be configured such that when the plunger example , some fluoropolymer laminates function inconsis rod is inserted in the barrel having an inner diameter of an tently and can distort during insertion of the plunger rod into inner surface of the barrel , a contact width between at least the barrel and /or during movement of the plunger rod within one of the two or more ribs having a sealing surface and the the barrel , which can create leak paths for the liquid . portion of the inner surface of the barrel measured at a Additional difficulties with some fluoropolymer laminates 60 compressibility of greater than about 7.9 % of the stopper is include poor airtightness due to a rough outer surface less than about 1.0 mm . especially when manufactured as a skived film . In yet another embodiment, a stopper that is insertable in Accordingly , the need exists for stoppers laminated with a barrel having a hydrophilic inner surface comprises an a fluoropolymer film that are capable of achieving sufficient elastomeric body, one or more fluoropolymer layers , and contact with a hydrophilic or lubricant free inner surface of 65 two or more ribs . The at least one of the two or more ribs are a barrel of a glass or resin syringe to achieve high levels of laminated with the one or more fluoropolymer layers and air and liquid impermeability while also maintaining accept configured to contact at least a portion of the inner surface US 10,471,211 B2 3 4 of the barrel, each rib of the two or more ribs having a surface preferably has a contact, width ( w ) measured at the sealing surface comprises a radius of curvature at an apex of compressibility ( C % ) of less than about 1.0 mm . In some each respective rib that is less than 0.22 mm , and a ratio of embodiments , the contact width at the compressibility is a maximum outer diameter of all the ribs having a sealing between about 0.05 mm and about 1.0 mm , between about surface to an inner diameter of the inner surface of the barrel 5 0.1 and about 0.75 mm , or between about 0.2 and about 0.5 is greater than 1.08 , and wherein the stopper is configured mm . such that when the stopper is inserted in the barrel having an In some embodiments , the stopper also includes, a sliding inner diameter of an inner surface of the barrel, a contact surface ( S ) , which is a sum of the contact widths ( w ) of all width between at least one of the two or more ribs having a the ribs having a sealing surface . The sliding surface may be sealing surface and the portion of the inner surface of the 10 less than about 2.0 mm , or between about 0.05 mm and barrel measured at a compressibility of greater than 7.9 % of about 1.9 mm , between about 0.1 mm and about 1.65 mm , the stopper is less than about 1.0 mm . or between about 0.5 mm and about 1.25 mm . Optionally, at Optionally , the one or more fluoropolymer layers least one rib having a sealing surface has a predefined radius described herein may include a single layer of densified of curvature ( r ) at the apex of the rib of less than about 0.22 expanded polytetrafluoroethylene ( PTFE ), or the one or 15 mm , between about 0.05 and about 0.20 mm , or between more fluoropolymer layers may include a composite fluo about 0.12 and about 0.17 mm . Additionally or alternatively, ropolymer film having a barrier layer and a porous layer , the the ratio of a maximum outer diameter (v ) of at least one rib barrier layer including densified ePTFE , polytetrafluoroeth having a sealing surface to an inner diameter (y ) of the inner ylene (PTFE ), fluorinated ethylene propylene (FEP ), poly surface of the barrel is greater than about 1.08 , between ethylene , polypropylene , polyvinylidene fluoride , polyvinyl- 20 about 1.10 and about 1.25 , or between about 1.13 and about fluoride, perfluoropropylevinylether , a perfluoroalkoxy 1.23 . polymer, and copolymers and combinations thereof. In certain embodiments , the fluoropolymer layer may include a fluoropolymer film , such as a polytetrafluoroeth BRIEF DESCRIPTION OF THE DRAWINGS ylene (PTFE ) or densified expanded polytetrafluoroethylene 25 ( PTFE ) film . Films based on PTFE or ePTFE can provide The present invention will be better understood in view of thin and strong barrier layers to leachables and extractables . the following non - limiting figures, in which : The superior strength of the expanded fluoropolymer struc FIG . 1 illustrates a partial cross sectional side view of a ture allows these materials to form thin barriers, which syringe in accordance with some embodiments ; remain intact during the forming process and installation of FIGS. 2-9 depict cross sectional side views of stoppers in 30 the stopper into the syringe barrel. accordance with some embodiments ; The use of at least partially porous and advantageously FIG . 10A depicts a cross sectional side view of a non fibrilizing materials , such as ePTFE in combination with compressed stopper in accordance with some embodiments ; other materials , provides numerous advantages . In one and aspect , the use of such porous materials may provide a FIG . 10B depicts a cross sectional side view of a com- 35 scaffold that enables thin strong barrier layers to be made pressed stopper in accordance with some embodiments . and improves the bond between the elastomer and the laminate . Laminate compliance is beneficial to maintaining DETAILED DESCRIPTION a seal between the stopper and the barrel. Porous materials also provide for improved compliance of the stopper . I. Introduction 40 Improved compliance may result from reduced film thick ness , flexural compliance , and /or the compressibility of one Persons skilled in the art will readily appreciate that or more layers of the porous material. Accordingly , by various aspects of the present disclosure can be realized by providing a laminate that is at least partially porous to the any number of methods and apparatus configured to perform outside ( e.g. external or outermost surface ) of the stopper, the intended functions. It should also be noted that the 45 the seal between the stopper and syringe barrel may be accompanying drawing figures referred to herein are not improved while the sliding force is minimized . necessarily drawn to scale , but may be exaggerated to The laminate may be of single layer or multiple layer illustrate various aspects of the present disclosure , and in construction . As described herein , layers may be described that regard , the figures should not be construed as limiting . functionally . However , the functional names of the various The present disclosure is directed to a medical delivery 50 layers in the descriptions of embodiments that follow may device ( e.g., a syringe ), a plunger rod and a stopper lami not, describe all of the potential functions of any given layer . nated with a fluoropolymer film . The fluoropolymer lami Accordingly , it will be understood that such functional nate provides a low friction barrier between an elastomeric nomenclature is not intended to be limiting of any layer stopper and a pharmaceutical composition ( e.g. , a drug , property . For example , a laminate layer may have additional medicine or other therapeutic ) in the medical delivery 55 properties and functions such as providing a low friction device , and may inhibit , materials from leaching from the surface , increasing bond strength and the like. Moreover , in elastomeric stopper or from extraction of compounds from multi- layer embodiments , each layer may contribute to the the pharmaceutical composition by the elastomer. Fluoropo reduction of leachable and extractable materials regardless lymer laminates have good biocompatibility , have good of its designation as a barrier layer or otherwise . mechanical integrity , are inert, and are processable . 60 In some embodiments , the stopper has a compressibility II . Syringe ( C % ) that is greater than about 7.9 % , between about 9.5 and about 20.0 % , between about 11.75 and about 18.5 % , FIG . 1 depicts a syringe 10 (optionally a prefilled syringe) between about 14.0 and about 14.5 . In one exemplary in accordance with at least one embodiment. As the skilled embodiment, the compressibility may be about 14.4 % . In 65 artisan will appreciate , although the present invention is addition , the stopper includes at least two ribs laminated described hereafter as it relates to a syringe , other types of with a fluoropolymer layer. At least one rib with a sealing medical delivery devices are contemplated , such as , for US 10,471,211 B2 5 6 example , an auto - injector or cartridge , without departing and one or more laminate layers 130. The elastomeric body from the spirit and scope of the present disclosure . The 125 may include any suitable elastomer, and more particu syringe 10 includes a barrel 15 having opposed distal and larly , rubbers constructed from butyl, bromobutyl, chlorobu proximal ends 20 and 25 and a receiving chamber 30 tyl, silicone , nitrile , styrene butadiene , polychloroprene , positioned between the distal and proximal ends 20 and 25. 5 ethylene propylene diene , fluoroelastomers , thermoplastic The barrel 15 may be formed of a substantially rigid or hard elastomers ( TPE ), and combinations and blends thereof. In material , such as a glass material ( e.g., borosilicate glass ), a some embodiments , the elastomeric body 125 may have an ceramic material, one or more polymeric materials ( e.g. , initial modulus ( small strain ) of between about 2.5 MPa to polypropylene, polyethylene, and copolymers thereof) , a about 5 MPa, or between about 3 MPa to about 4 MPa . In metallicpolymers material (COC ) ,and or acyclic plastic olefin material copolymers ( e.g., cyclic (COP ) olefin , and 10 forone examplenon -limiting , about embodiment 3.5 MPa (, plus the/ minus initial measurementmodulus may andbe , combinations thereof. variability tolerance) . The materials of the one or more In certain embodiments , the barrel 15 is formed of glass laminate layers 130 are chosen , as described in detail herein , ( e.g. , bare glass , without any lubricants thereon ), resin , to provide a low coefficient of friction , compliance , low plastic , metal , or like materials and optionally has a hydro- 15 extractables and leachables , and good barrier properties as philic interior wall characterized by the absence of a lubri they relate to extractables and leachables from the elasto cant such as, but not limited to , silicone or silicone oil. As meric body 125 , as well as good air and liquid imperme used herein , the term “ hydrophilic interior wall” refers to a ability . For example , the one or more laminate layers 130 material ( e.g. , bare glass that is free or substantially free of may include one or more fluoropolymer films, such as, but silicone oil ) that has a contact angle of deionized water on 20 not limited to PTFE or ePTFE films. a flat surface of the material of less than about 90 ° , which FIG . 1 also shows a material 135 provided in the receiving indicates high wettability . chamber 30 of barrel 15 (e.g. , a prefilled syringe ). For The distal end 20 of barrel 15 includes an elongated tip 35 purposes of illustration but not of limi ition , the material extending through and communicating with the receiving 135 is herein identified as a predetermined dose of a phar chamber 30. In some embodiments , a cap 40 is disposed at 25 maceutical composition 135 ; however , it should be under the distal end 20 of the barrel 15. The cap 40 includes a stood that the material 135 could be any type of liquid or proximal end 45 mated to the distal end 20 or to the material capable of being expelled from a syringe , or the elongated tip 35 and a closed distal end 50. Thus, the cap 40 material 135 may be all together absent from the receiving inhibits or prevents ambient air from communicating with chamber ( e.g., an unfilled syringe ) . the receiving chamber 30 through the elongated tip 35. 30 Optionally , a piercing element 55 is also disposed at the III. Laminate Layers distal end 20 of the barrel 15. The piercing element 55 includes a proximal end 60 mated to the distal end 20 or In some embodin its , the one or more , laminate layers the elongated tip 35 and a distal end 65. It is within the 130 may include a single layer of a fluoropolymer . FIG . 2 purview of the present disclosure that the piercing element 35 depicts a stopper 100 that includes an elastomeric body 125 55 may include a sharply pointed needle cannulae , or a and a single layer of fluoropolymer or barrier layer 140 . blunt- ended cannulae , such as those employed with “ needle Examples of elastomers that can be used to form the less” systems. For purposes of illustration , the piercing elastomeric body 125 include any elastomer suitable for the element 55 depicted and described herein is formed as a application , most notably rubbers constructed from butyl, sharply pointed , elongate needle cannula 55 including the 40 bromobutyl, chlorobutyl, silicone , nitrile , styrene butadiene , proximal end 60, a sharply pointed distal end 85 and a lumen polychloroprene , ethylene propylene diene, fluoraelasto 70 extending between the proximal end 60 and the distal end mers , thermoplastic elastomers ( TPE ), thermoplastic vulca 65. Proximal end 60 of needle cannula 55 may be rigidly nizates ( TPV ), and materials sold under the trade name mounted to the elongated tip 35 of the barrel 15 . VITON® , and combinations and blends thereof. Exemplary In some embodiments , the cap 40 is mounted over needle 45 elastomeric materials include , but are not limited to , butyl cannula 55 and is releasably engaged to the elongated tip 35 rubber, bromobutyl rubber, chlorobutyl rubber, silicone , of the barrel 15. The cap 40 may be formed from a rigid nitrile , styrene butadiene, polychloroprene, ethylene propyl material such as plastic , or can be formed from a flexible ene diene, fluoroelastomers and combinations thereof. material such as rubber, or from like materials or combina Examples of fluoropolymers that can be used to form the tions known to the skilled artisan . The cap 40 may be 50 fluoropolymer or barrier layer 140 include any fluoropoly configured for closing the lumen 70 of the needle cannula 55 mer suitable for the application , most notably a densified in fluid communication with a pharmaceutical composition , expanded fluoropolymer, polytetrafluoroethylene (PTFE ), and / or to otherwise protectively seal , engage or surround densified ePTFE , fluorinated propylene (FEP ) , polyethyl sharply pointed distal end 65 of needle cannula 55 and ene, polypropylene, polyvinylidene fluoride, polyvinylfluo isolate same from the ambient environment. Thus , the cap 40 55 ride, perfluoropropylevinylether , perfluoroalkoxy polymers , prevents ambient air from communicating with the receiving tetrafluoroethylene (TFE ) , and copolymers and combina chamber 30 through needle cannula 55 . tions thereof. The barrier film may also include a composite The proximal end 25 of barrel 15 may include a flange 80 fluoropolymer film having a barrier layer and a porous layer. to be used as a finger stopper for pressing and pulling a The porous layer , for example , maybe formed of ePTFE or plunger rod 85 reciprocally in the barrel 15. The plunger rod 60 other porous expanded and fibril zing fluoropolymers ( for 85 has opposed distal and proximal ends 90 and 95 with a example , ePTFE as taught in U.S. Pat . No. 6,541,589 ) . The stopper 100 attached to the distal end 90. Stopper 100 ePTFE layers may be filled with an organic or inorganic includes opposed proximal and distal ends 105 and 110 and material to provide color , lubricity , or other function . a side surface 115 extending therebetween . The side surface In a some embodiments, the fluoropolymer or barrier 115 of stopper 100 may include two or more ribs 120 such 65 layer 140 may include a densified expanded fluoropolymer , as one or more circumferentially extending annular ribs. The preferably a densified expanded polytetrafluoroethylene stopper 100 is preferably formed ofan elastomeric body 125 ( PTFE ) . A densified ePTFE film may be prepared in the US 10,471,211 B2 7 8 manner described in U.S. Pat. No. 7,521,010 to Kennedy , et 145 , the porous layer 150 , and the elastomeric body 125 . al ., U.S. Pat. No. 6,030,694 to Dolan et al. , U.S. Pat. No. Specifically , FIG . 4 shows a region of partial penetration 160 5,792,525 to Fuhr et al. , or U.S. Pat . No. 5,374,473 to Knox of the elastomer material of the elastomeric body 125 into et al. Expanded copolymers of PTFE , such as are described the porous layer 150. Penetration of the elastomer material in U.S. Pat . No. 5,708,044 to Branca , U.S. Pat. No. 6,541, 5 of the elastomeric body 125 into the porous layer 150 may 589 to Baillie , U.S. Pat . No. 7,531,611 to Sabol et al ., U.S. improve the bond between the elastomeric body 125 and the Pat. No. 8,637,144 to Ford , and U.S. Pat. No. 9,139,669 to one or more laminate layers 130 . Xu et al . may be utilized if they are densified . In accordance with other aspects , the material of the The barrier film may also include an expanded polymeric barrier layer 145 may at least partially penetrate the porous material including a functional tetrafluoroethylerie ( TFE ) 10 layer 150. FIG . 5 illustrates a cross - section of a stopper copolymer material having a microstructure characterized depicting the barrier layer 145 , the porous layer 150, and the by nodes interconnected by fibrils , where the functional TFE elastomeric body 125. Specifically , FIG . 5 shows a region of copolymer material includes a functional copolymer of TFE partial penetration 165 of the material of the barrier layer and PSVE (perfluorosuifonyl vinyl ether ) , or TFE with 145 into the porous layer 150. Penetration of the material of another suitable functional monomer, such as, but not lim- 15 the barrier layer 145 into the porous layer 150 may improve ited to , vinylidene fluoride (VDF ) , vinyl acetate , or vinyl the bond between the barrier layer 145 and the porous layer alcohol. The functional TFE copolymer material may be 150. The region of partial penetration 165 may also provide prepared , for example , according to the methods described support for the barrier layer 145 to impart strength , tough in U.S. Pat . No. 9,139,669 to Xu et al. or U.S. Pat. No. ness , compliance and stability , which may be beneficial in 8,658,707 to Xu et al. 20 both the forming process and in the application . The densified ePTFE film may be combined with an In another embodiment, as shown in FIG . 6 , the one or elastomer to construct the stopper 100. In this embodiment, more laminate layers 130 may comprise a composite fluo the densified ePTFE film is thermoformed to make a pre ropolymer film having a densified expanded fluoropolymer form . Thermoforming is done at process temperatures suf layer 170 , a barrier melt fluoropolymer layer 175 , and a ficiently above the nodal melt temperature to ensure melt 25 porous layer 180. The densified expanded fluoropolymer forming while preserving barrier and strength properties . layer 170 can may include or be formed of a densified The high strength of the resulting expanded film allows for ePTFE . The barrier melt fluoropolymer layer 175 may forming extremely thin films. The films can be made with include a fluoropolymer such as a densified expanded fluo thicknesses ranging from about 0.5 micron to about 20 ropolymer, PTFE , PTFE , densified ePTFE , or fluorinated microns . In some embodiments , the films have a thickness 30 propylene (FEIN ), polyethylene , polypropylene , polyvi that is less than about 30 microns. The film can optionally be nylidene fluoride , polyvinylfluoride, perfluoropropyleviny pre- treated or post- treated with chemical etching , plasma lether , perfluoroalkoxy polymers , and copolymers and com treating, corona , roughening , or the like to improve bonding binations thereof. The porous layer 150 may include or be to the elastomeric body 125. The thermoformed , densified formed of ePTFE or other porous expanded and fibrilizing ePTFE preform can be combined with the elastomeric body 35 fluoropolymers . The one or more laminate layers 130 having 125 by injection molding , compression molding , priming the densified expanded fluoropolymer layer 170 , the barrier and post laminating around an elastomer perform , or by melt fluoropolymer layer 175 and the porous layer 180 may other suitable methods known to those of skill in the art . be constructed by coating or otherwise depositing the fluo In another embodiment , as shown in FIG . 3 , the one or ropolymer onto the porous layer to create the composite more laminate layers 130 may include a composite fluo- 40 fluoropolymer film . The densified ePTFE film , fluoropoly ropolymer film having a barrier layer 145 and a porous layer mer , and porous layer may be thermoformed to make a 150. The barrier layer 145 can include a fluoropolymer such preform , and may be combined with the elastomeric body as a densified expanded fluoropolymer , PTFE, ePTFE , den 125 by injection molding, compression molding , priming sified ePTFE, FEP, polyethylene, polypropylene, polyvi and post laminating around an elastomer perform , or other nylidene fluoride, polyvinylfluoride , perfluoropropyleviny- 45 suitable methods known to the skilled artisan . lether, perfluoroalkoxy polymers , TFE , and copolymers and In accordance with some aspects , the elastomer material combinations thereof. The porous layer 150 may include of the elastomeric body 125 may at least partially penetrate ePTFE ( for example , ePTFE as taught in U.S. Pat. No. the porous layer 180. FIG . 7 shows a cross- section of a 6,541,589 to Bailie ) or other porous expanded and fibrilizing stopper depicting a densified expanded fluoropolymer layer fluoropolymers . The one or more laminate layers 130 having 50 170 , a barrier melt fluoropolymer layer 175 , and a porous the barrier layer 145 and the porous layer 150 may be layer 180. Specifically , FIG . 7 shows a region of partial constructed by coating or otherwise depositing the fluoropo penetration 185 of the elastomer material of the elastomeric lymer onto the porous layer to create the composite fluo body 125 into the porous layer 180. Penetration of the ropolymer film . One such example of this would be to elastomer material of the elastomeric body 125 into the deposit granular or powdered fluoropolymers such as pow- 55 porous layer 180 may improve the bond between the elas dered PTFE onto a porous ePTFE surface in a coating tomeric body 125 and the one or more laminate layers 130 . process. The ePTFE support should be constructed to be In accordance with other aspects , the material of the thermally stable enough to allow heat treatment of the barrier melt fluoropolymer layer 175 may at least partially deposited fluoropolymer for the creation of a barrier or for penetrate the porous layer 180. FIG . 8 shows a cross - section bonding of the deposited layer to the porous ePTFE support. 60 of a stopper according to an embodiment depicting densified The ePTFE layer may be filled with an organic or inorganic expanded fluoropolymer layer 170 , a barrier melt fluoropo material to provide color, lubricity, or other functional lymer layer 175 and a porous layer 180. Specifically , FIG . 8 attributes . shows a region of partial penetration 190 of the material of In accordance with some aspects of the present invention , the barrier melt fluoropolymer layer 175 into the porous the elastomer material of the elastomeric body 125 may at 65 layer 180. Penetration of the material of the barrier melt least partially penetrate the porous layer 150. FIG . 4 illus fluoropolymer layer 175 into the porous layer 180 may trates a cross- section of a stopper depicting the barrier layer improve the bond between the barrier melt fluoropolymer US 10,471,211 B2 9 10 layer 175 and the porous layer 180. The region of partial 10A and 10B as being the furthest towards the proximal end penetration 190 may also provide support for the barrier 210 of the body 205 has a compressibility of about 7.9 % or melt fluoropolymer layer 175 to impart strength , toughness, less, and thus is referred to as having a non - sealing surface . compliance and stability , which is beneficial in both the As the skilled artisan will appreciate , although the present forming process and in use . 5 invention is described hereafter as it relates to rib arrange In accordance with some aspects , the material of the ment shown in FIGS . 10A and 10B , other types of rib barrier melt fluoropolymer layer 175 may at least partially arrangements are contemplated , such as, for example having penetrate the densified expanded fluoropolymer layer 170 . three ribs with sealing surfaces , without departing from the FIG . 9 shows a cross- section of a stopper depicting a spirit and scope of the present disclosure. densified expanded fluoropolymer layer 170 , a barrier melt 10 Each rib 220 having a sealing surface includes at least one fluoropolymer layer 175 , and a porous layer 180. Specifi a predefined outer diameter ( x ) measured from an apex of cally , FIG . 9 shows a region of partial penetration 195 of the the respective rib with the stopper 100 in a non -compressed material of the barrier melt fluoropolymer layer 175 into the state ( see, e.g., FIG . 10A ), a curvature ( c ) having a pre densified expanded fluoropolymer layer 170. Penetration of defined radius of curvature ( r ) at the apex of the respective the material of the barrier melt fluoropolymer layer 175 into 15 rib that is measured with the stopper 100 in a non -com the densified expanded fluoropolymer layer 170 may pressed state ( see , e.g. , FIG . 10A ), and a contact width ( w ) improve the bond between the barrier melt fluoropolymer between each respective rib and an inner surface 240 of the layer 175 and the densified expanded fluoropolymer layer barrel measured at a compressibility (C % ) of the stopper 170. The region of partial penetration 195 may also provide 100 in a compressed state ( see, e.g., FIG . 10B ) . In some support for the barrier melt fluoropolymer layer 175 to 20 embodiments, at least one of the predefined outer diameter impart strength , toughness, compliance and stability , which ( x ) of at least one rib 220 having a sealing surface is greater is beneficial in both the forming process and in use . than about 5.0 mm , between about 5.0 mm and about 14.0 The stopper 100 may include various degrees of penetra mm , or between about 5.5 mm and about 10 mm . In some tion of either the elastomer material or the barrier polymer embodiments , the predefined outer diameter ( x ) may be , for into the porous material or the densified expanded fluoropo- 25 example , about 7.42 mm or about 5.5 mm . The predefined lymer layer as shown in FIGS . 4 , 5 , and 7-9, and as described radius of curvature ( r ) of at least one rib 220 having a sealing in U.S. Pat. No. 8,722,178 to Ashmead , et al ., U.S. Patent surface is less than about 0.22 mm , between about 0.05 mm Publication No. 2012/0251748 to Ashmead , et al. , and U.S. and about 0.20 mm , or between about 0.12 mm and about Patent Publication No, 2016/0022918 to Ashmead , et al. It 0.17 mm . The contact width ( w ) of, at least one rib 220 is to be appreciated that there are many variations of the 30 having a sealing surface measured at the compressibility ( C processes described herein that could be utilized for forming % ) is less than about 1.0 mm . In some embodiments , the the stopper 100 without departing from the scope and /or contact width at the compressibility is between about 0.05 spirit the invention . Some of these variations may include , mm and about 1.0 mm , between about 0.1 and about 0.75 but are not limited to , forming any of the fluoropolymers mm , or between about 0.2 and about 0.5 mm . A sliding used in the stopper 100 of the present invention with an 35 surface ( S ) of the stopper 100 includes a sum of the contact expanded fluoropolymer film based on PTFE , modified widths (w ) of all the ribs having a sealing surface that is less PTFE , and PTFE and TFE copolymers such as , for example , than 2.0 mm . The sliding surface may be less than about 2.0 the resins as described in U.S. Pat . No. 6,541,589 to Bailie mm , or between about 0.05 mm and about 1.9 mm , between and U.S. Pat. No. 8,637,144 to Ford . about 0.1 mm and about 1.65 mm , or between about 0.5 mm 40 and about 1.25 mm . IV . Stopper Structure As the skilled artisan will appreciate , the ribs 220 can be structured in any number of configurations, and FIGS. 10A In some embodiments , the stopper 100 is configured to and 10B are provided for purposes of illustration only , and achieve container closure integrity with high levels of air are not intended to limit the present disclosure. For example , and liquid impermeability while also maintaining acceptably 45 in certain embodiments , all of the ribs 220 having a sealing low break loose and slide forces . FIGS . 10A and 10B show surface may have a same predefined outer diameter ( x ) . In such a stopper 100 that includes a body 205 having opposed other embodiments , each rib 220 having a sealing surface proximal and distal ends 210 and 215 and two or more ribs may have its own predefined outer diameter ( x ). For 220. A head portion 225 is formed integrally with the distal example , a distal or leading rib may have a predefined outer end 215 of the body 205. One or more annular grooves 230 50 diameter ( 1x ) and a proximal or trailing rib may have a is formed in an outer surface of the body 205 , thus forming predefined outer diameter (2x ) that is between about 75 % and connecting the two or more ribs 220. At least one of the and about 99.9 % of the predefined outer diameter ( 1x ) . two or more ribs 220 is laminated with the one or more The compressibility ( C % ) is defined in relation to a laminate layers 130. A cavity 240 may extend from the maximum outer diameter (v ) of the ribs 220 having a sealing proximal end of 210 of the body 205 towards the distal end 55 surface of the stopper 100 in a non - compressed state and the 215. The distal end 90 of the plunger rod 85 may be inserted inner diameter (y ) of the inner surface 240 of the barrel as and fixed inside the cavity 240 of the stopper. follows : C % = (( v -y )/ v )x100 . For example , understanding The two or more ribs 220 can be classified based on that each of the ribs 220 having a sealing surface may have whether they have a sealing surface or a non -sealing surface . its own predefined outer diameter (x ), and thus its own As used herein , the term “ sealing surface ” refers to a rib 60 compression , compressibility ( C % ) of the stopper 100 is having a compressibility of greater than about 7.9 % , and the defined in relation to the largest outer diameter (x ) ( i.e., the term “ non - sealing surface ” refers to a rib having a com maximum outer diameter ( v )) out of all of the ribs 220 pressibility of about 7.9 % or less. For example , the two ribs having a sealing surface of the stopper 100 in a non shown in FIGS. 10A and 10B as being the furthest towards compressed state . In some embodiments , the maximum the distal end 215 of the body 205 have a compressibility of 65 outer diameter (V ) of the ribs 220 having a sealing surface is greater than about 7.9 % , and thus are referred to as having greater than about 5.0 mm , between about 5.0 mm and about a sealing surface . In contrast, the one rib shown in FIGS . 14.0 mm , or between about 5.5 mm and about 10 mm . In US 10,471,211 B2 11 12 some embodiments , the sealing surface may be , for predefined radius of curvature ( r ) of at least one rib having example , about 7.42 mm or about 5.5 mm ; the inner diam a sealing surface is at less than about 0.22 mm , or between eter ( y ) may be between about 2.5 mm and about 30.0 mm , about 0.05 and about 0.20 mm , or between about 0.12 and between about 4.5 mm and about 20.0 mm , or between about about 0.17 mm , and the ratio of themaximum outer diameter 5.5 mm and about 11.5 mm . In some embodiment , the inner 5 (v ) of at least one rib having a sealing surface to the inner diameter may be , for example , about 6.35 mm or nominally diameter ( y ) of the inner surface of the barrel is greater than ( a tolerance of +/- 0.1 on the 4.65 side and a tolerance about 1.08 , between about 1.10 and about 1.25 , or between of +/- 0.2 on the 11.85 ) between about 4.65 mm and about about 1.13 and about 1.23 , the fluoropolymer laminate of the 11.85 mm ; and the compressibility ( C % ) of the stopper may stoppers do not distort under the compressibility ( C % ), be greater than about 7.9 % , between about 9.5 % and about 10 which is necessary to achieve an adequate seal pressure 20.0 % , or between about 11.75 % and about 18.5 % . In some while allowing for acceptably low break loose and slide embodiments , the compressibility may be , for example , forces . about 14.4 % . In some embodiments , a ratio of the maximum Additionally , it has been surprisingly and unexpectedly outer diameter ( v ) of the ribs 220 having a sealing surface to found that using the aforementioned one or more laminate the inner diameter ( y ) of the inner surface 240 of the barrel 15 layers allows for improved geometry with respect to afore may be greater than , for example , about 1.08 , or between mentioned properties of the two or more ribs without about 1.10 and about 1.25 , or between about 1.13 and about causing leak paths. Accordingly , the aforementioned aspects 1.23 . of the present invention allow for the construction of stop In some embodiments , the stopper 100 may be configured pers laminated with a fluoropolymer film that achieve suf based on the aforementioned composition of the one or more 20 ficient contact with the inner surface of the barrel of a glass laminate layers 130 and properties of the two or more ribs or resin syringe (hydrophilic and /or lubricant free ) to 220 to have a predetermined slide force and predetermined achieve high levels of air and liquid impermeability while seal pressure . In , some embodiments , the predetermined also maintaining acceptably low break loose and slide forces slide force is a peak extrusion force of less than about 20 N low - friction slidability ) but not so much contact that the at speeds of 50-250 mm /min using a syringe filled with 25 fluoropolymer film surface is distorted to create leak paths water. In some embodiments , the predetermined seal pres that decrease the air and liquid impermeability . sure is , a seal pressure adequate to achieve , a helium leak In another aspect , the medical delivery device , plunger rate of less than 6x10-6 secs . rod , and stopper described herein may be used in combina Referring to FIGS. 10A and 10B , it was found that the seal tion different therapeutic compounds such as , for example , pressure of a stopper laminated with a fluoropolymer film 30 drugs and biologics , including but not limited to , antibodies , that is in contact with a hydrophilic or lubricant free inner antisense, RNA interference , gene therapy, primary and surface of a barrel depends particularly upon compressibility embryonic stem cells , vaccines , and combinations thereof. (C % ), and the break loose ( e.g., the amo of force For instance, the embodiments described herein may be required to begin moving the stopper from a stationary utilized in combination with any or all of the following : position within the barrel) and slide forces (e.g. , the amount 35 Cell therapy using cells that are derived primarily from of force required to move the stopper parallel along the inner endoderm such as Exocrine secretory epithelial cells and surface of the barrel ) particularly depend upon the contact Hormone -secreting cells ; ectoderm such as Keratinizing width ( w ) or sliding surface (S ) . Additionally , it was found epithelial cells , Wet stratified barrier epithelial cells , Sensory that distortion of the fluoropolymer film (both the portion of transducer cells , Autonomic neuron cells , Sense organ and the fluoropolymer film contacting the inner surface of the 40 peripheral neuron supporting cells , Central nervous system barrel and the portion of the fluoropolymer film not con neurons and glial cells , Lens cells ; mesoderm such , as tacting the inner surface of the barrel ) of the stopper that is Metabolism and storage cells , Barrier function cells ( lung , in contact with a hydrophilic or lubricant free inner surface gut, exocrine glands, and urogenital tract) , Extracellular of a barrel depends particularly upon the dimensions of the matrix cells , Contractile cells , Blood and immune system two or more ribs. Some of the conventional stoppers lami- 45 cells , Germ cells , Nurse cell , Interstitial cells or a combi nated with a fluoropolymer film when compressed enough to nation thereof. Additionally cells that are genetically , chemi achieve a desired seal pressure have unacceptable break cally or physically altered or modified are considered to be loose and slide forces due to excessive contact area or in the scope of the invention . sliding surface between the stopper and the inner surface of Examples of Exocrine secretory epithelial cells include , barrel. Moreover , some conventional laminates tends to 50 but are not limited to , Salivary gland mucous cell, Salivary distort during movement of the plunger rod within the barrel gland number 1 , Von Ebner's gland cell in tongue, Mam during charging or discharging due to the structure of the mary gland cell, Lacrimal gland cell, Ceruminous gland cell one or more annular grooves and the two or more ribs . in ear , Eccrine sweat gland dark cell , Eccrine sweat gland However , it has been surprisingly and unexpectedly found clear cell, Apocrine sweat gland cell , Gland of Moll cell in that when the contact width ( w ) of at least one rib with a 55 eyelid , Sebaceous gland cell, Bowman's gland cell in nose , sealing surface measured at a compressibility ( C % ) of Brunner's gland cell in duodenum , Seminal vesicle cell, greater than 7.9 % is less than about 1.0 mm , or between Prostate gland cell , Bulbourethral gland cell, Bartholinis about 0.05 mm and about 1.0 mm , between about 0.1 and gland cell, Gland of Littre cell, Uterus endometrium cell , about 0.75 mm , or between about 0.2 mm and about 0.5 mm Isolated goblet cell of respiratory and digestive tracts , Stom and a sliding surface ( S ) of the stopper 100 that includes a 60 ach lining mucous cell, Gastric gland zymogenic cell, Gas sum of the contact widths ( w ) of all the ribs having a sealing tric gland oxyntic cell, Pancreatic acinar cell , Paneth cell of surface is less than about 2.0 mm , or between about 0.05 mm small intestine , Type II pneumocyte of lung , Clara cell of and about 1.9 mm , between about 0.1 mm and about 1.65 lung; Hormone - secreting cells including but not limited to : mm , or between about 0.5 and about 1.25 mm , the stoppers Anterior pituitary cells, Intermediate pituitary cell , Magno of the present disclosure achieve a desired seal pressure with 65 cellular neurosecretory cells , Gut and respiratory tract cells , acceptable break loose and slide forces. Moreover , it has Thyroid gland cells , Parathyroid gland cells , Adrenal gland been surprisingly and unexpectedly found that when the cells , Leydig cell of testes secreting testosterone , Theca US 10,471,211 B2 13 14 interns cell of ovarian follicle secreting estrogen , Corpus Monocyte , Connective tissue macrophage , Epidermal luteum cell of ruptured ovarian follicle secreting progester Langerhans cell, Osteoclast, Dendritic cell, Microglial cell , one , Juxtaglomerular cell , Macula dense cell of kidney , Neutrophil granulocyte , Eosinophil granulocyte , Basophil Peripolar cell of kidney, Mesangial cell of kidney , Pancreatic granulocyte , Hybridoma cell , Mast cell, Helper T cell , islets ; Keratinizing epithelial cells including but not limited 5 Suppressor T cell, Cytotoxic T cell , Natural Killer T cell, B to : Epidermal keratinocyte , Epidermal basal cell, Keratino cell , Natural killer cell , Reticulocyte , Stem cells and com cyte of fingernails and toenails , Nail bed basal cell, Medul mitted progenitors for the blood and immune system ; Germ lary hair shaft cell , Cortical hair shaft cell, Cuticular hair cells including but not limited to : Oogonium /Oocyte , Sper shaft cell , Cuticular hair root sheath cell , Hair root sheath matid , Spermatocyte , Spermatogonium cell, Spermatozoon ; cell of Huxley's layer, Hair root sheath cell of Henle's layer , 10 Nurse cell including but not limited to : Ovarian follicle cell , External hair root sheath cell , Haft matrix cell ; Wet stratified Sertoli cell, Thymus epithelial cell ; Interstitial cells includ barrier epithelial cells including but not limited to : Surface ing but not limited to : Interstitial kidney cells and a com epithelial cell of stratified squamous epithelium and basal bination thereof. cell of epithelia of cornea, tongue , oral cavity , esophagus, Examples of antibodies, antisense , RNA interference , or anal canal, distal urethra and vagina , Urinary epithelium 15 gene therapy made to protein targets or gene( s ) of: Ataxia cell; Sensory transducer cells including but not limited to : Telangiectasia Mutated , Tumor Protein p53 , Checkpoint Auditory inner hair cell of organ of Corti , Auditory outer kinase 2 , breast cancer susceptibility protein , Double - strand hair cell of organ of Corti, Basal cell of olfactory epithelium , break repair protein , DNA repair protein RAD50 Nibrin , Cold - sensitive primary sensory neurons, Heat- sensitive pri p53 -binding protein , Mediator of DNA damage checkpoint mary sensory neurons , Merkel cell of epidermis , Olfactory 20 protein , HA histone family member X , Microcephalin , receptor neuron , Pain - sensitive primary sensory neurons , C - terminal - binding protein 1 , Structural maintenance of Photoreceptor cells of retina in eye : Proprioceptive primary chromosomes protein 1A ; Esterases ; Phosphatases ; sensory neurons, Touch - sensitive primary sensory neurons , Examples of Ion channels include but are not limited to : Type I carotid body cell, Type II carotid body cell , Type I ligand - gated ion channels , voltage- gated ion channels ; hair cell of vestibular system of ear, Type II hair cell of 25 Examples of growth factors include but are not limited to : vestibular system of ear , Type I taste bud cell; Autonomic nerve growth factor (NGF ) , vascular endothelial growth neuron cells including but not limited to : Cholinergic neural factor (VEGF ) , platelet -derived growth factor (PDGF ) , cell, Adrenergic neural cell , Peptidergic neural cell ; Sense C - fos - induced growth factor (FIGF ) , platelet - activating fac organ and peripheral neuron supporting cells including but tor ( PAF ) , transforming growth factor beta ( TGF - B ) , b , one not limited to : Inner pillar cell of organ of Corti, Outer pillar 30 morphogenetic proteins (BMPs ) , Activin , inhibin , fibroblast cell of organ of Corti, Inner phalangeal cell of organ of Corti , growth factors (FGFs ), granulocyte - colony stimulating fac Outer phalangeal cell of organ of Corti, Border cell of organ tor (G - CSF ), granulocyte -macrophage colony stimulating , of Corti, Hensen cell of organ of Corti, Vestibular apparatus factor (GM -CSF ), glial cell line -derived neurotrophic factor supporting cell , Taste bud supporting cell , Olfactory epithe (GDNF ) , growth differentiation factor- 9 (GDF9 ), epidermal lium supporting cell, Schwann cell, Satellite glial cell, 35 growth factor ( EGF ) , transforming growth factor- a ( TGF Enteric glial cell ; Central nervous system neurons and glial a ), growth factor (KGF ), migration - stimulating factor cells including but not limited to : Astrocyte , Neuron cells , (MSF ) , hepatocyte growth factor- like protein (HGFLP ) , Oligodendrocyte , Spindle neuron ; Lens cells including but hepatocyte growth factor (HGF ) , hepatoma- derived growth not limited to : Anterior lens epithelial cell, Crystallin -con factor (HDGF ) , Insulin - like growth factors ; Examples of G taining lens fiber cell ; Metabolism and storage cells includ- 40 Protein Coupled Receptors (GPCR ) include but are not lim ing but not limited to : Adipocytes : Liver lipocyte ; Barrier ited to : Adenosine receptor family , Adrenergic receptor function cells including but not limited to : Kidney parietal family , Angiotensin H receptor, Apelin receptor, Vasopressin cell , Kidney glomerulus podocyte , Kidney proximal tubule receptor family , Brain - specific angiogenesis inhibitor fam brush border cell, Loop of Henle thin segment cell , Kidney ily, Bradykinin receptor family, Bombesin receptor family, distaltubule cell, Kidney collecting duct cell, Principal cells , 45 Complement component 3a receptor 1 , Complement com Intercalated cells , Type I pneumocyte , Pancreatic duct cell, ponent 5a receptor 1 , Calcitonin receptor family , Calcitonin Nonstriated duct cell, Principal cell, Intercalated cell, Duct receptor- like family, Calcium -sensing receptor , Cholecysto cell, Intestinal brush border cell, Exocrine gland striated kinin A receptor ( CCK1) , Cholecystokinin B receptor duct cell , Gall bladder epithelial cell , Ductulus efferens (CCK2 ) , Chemokine ( C - C motif ) receptor family , Sphin nonciliated cell, Epididymal principal cell, Epididymal basal 50 gosine 1 - phosphate receptor family , Succinic receptor , Cho cell; Extracellular matrix cells including but not limited to : linergic receptor family. Chemokine -like receptor family, Ameloblast epithelial cell , Planum semilunatum epithelial Cannabinoid receptor family , Corticotropin releasing hor cell of vestibular system of ear, Organ of Corti interdental mone receptor family , prostaglandin D2 receptor , epithelial cell , Loose connective tissue fibroblasts , Corneal Chemokine C - X3 - C receptor family , Chernokine ( C - X - C fibroblasts , Tendon fibroblasts, Bone marrow reticular tissue 55 motif ) receptor family , Burkitt lymphoma receptor, fibroblasts , Other nonepithelial fibroblasts , Pericyte , Chemokine ( C - X - C motif ) receptor family , Cysteinyl leu Nucleus pulposus cell of intervertebral disc , Cemento kotriene receptor 2 (CYSLT2 ), chemokine receptor (FY ) , blasticementocyte , Odontoblastiodontocyte , Hyaline carti Dopamine receptor family , G protein -coupled receptor 183 lage chondrocyte , Fibrocartilage chondrocyte , Elastic carti (GPR183 ) , Lysophosphatidic acid receptor family , Endothe lage chondrocyte , Osteoblastiosteocyte , Osteoprogenitor 60 lin receptor family , Coagulation factor (thrombin ) receptor cell, Hyalocyte of vitreous body of eye, Stellate cell of family , Free fatty acid receptor family , Formylpepticle perilymphatic space of ear, Hepatic stellate cell , Pancreatic receptor family , Follicle stimulating hormone receptor stelle cell; Contractile cells including but not limited to : (FSHR ), gamma- aminobutyric acid (GABA ) B receptor, Skeletal muscle cell, Satellite cell, Heart muscle cells , Galanin receptor family , Glucagon receptor, Growth hor Smooth muscle cell, Myoepithelial cell of iris, Myoepithe - 65 mone releasing hormone receptor (GHRH ) , Ghrelin receptor lial cell of exocrine glands; Blood and immune system cells (ghrelin ), Growth hormone secretagogue receptor 1b including but not limited to : Erythrocyte, Megakaryocyte , (GHSR1b ), Gastric inhibitory polypeptide receptor (GIP ) , US 10,471,211 B2 15 16 Glucagon -like peptide receptor family, Gonadotropin - re gen -activated protein kinase kinase kinase family aurora leasing hormone receptor (GnRH ) , pyroglutamylated kinase A ( AURKA ), aurora kinase B (AURKB ) , aurora RFamide peptide receptor ( QRFPR ) , G protein - coupled bile kinase C (AURKC ) , AXL receptor tyrosine kinase (AXL ) , acid receptor 1 (GPBA ) , Hydroxycarboxylic acid receptor BMP 2 inducible kinase (BIKE ), B lymphoid tyrosine kinase family , Lysophosphatidic acid receptor 4 (LPA4 ) Lysophos- 5 (BLIP ) , bone morphogenetic protein receptor family , BMX phatidic acid receptor 5 (GPR92 ) , G protein -coupled recep non -receptor tyrosine kinase (BMX ), v - raf murine sarcoma tor 79 pseudogene (GPR79 ) , Hydroxycarboxylic acid recep viral oncogene homolog B1 (BRAF ) , protein tyrosine kinase tor 1 (HCA1 ) , G -protein coupled receptor (C5L2 , FFA4 , 6 (BRK ) , BR serine/ threonine kinase family , Bruton agam FFA4, FFA4 , GPER , GPR1 , GPR101 , GPR107, GPR119, maglobulinemia tyrosine kinase (BTK ) , calcium / calrnodu GPR12 , GPR123, GPR132 , GPR135 , GPR139, GPR141, 10 lin - dependent protein kinase family , cyclin - dependent GPR142 , GPR143 , GPR146 , GPR148 , GPR149 , GPR15 , kinase family , cyclin -dependent kinase -like family , CHK1 GPR150 , GPR151 , GPR152 , GPR157 , GPR161, GPR162 , checkpoint homolog ( S. pombe ) (CHEK1 ) , CHK2 check SPRIT GPR171 , GPR173 , GPR176 , GPR18 , GPR182 , point homolog ( S. pombe ) ( CHEK2) , Insulin receptor, iso GPR20 , GPR22 , GPR25 , GPR26 , GPR27 , GPR3, GPR31 , form A (INSR ), Insulin receptor, isoform B ( INSR ) , rho GPR32 , GPR35, GPR37L1, GPR39 , GPR4, GPR45, 15 interacting serine/ threonine kinase (CIT ) , v - kit Hardy GPR50 , GPR52 , GPR55 , GPR6 , GPR61, GPR65 , GPR75 , Zuckerman 4 feline sarcoma viral oncogene homolog (KIT ) , GPR78 , GPR83 , GPR84 , GPR85 , GPR88 , GPR97 , CDC -Like Kinase family - Hepatocyte growth factor recep TM7SF1 ), Metabotropic glutamate receptor family , Gastrin tor (MET ), Proto -oncogene tyrosine -protein kinase receptor, releasing peptide receptor ( 882 ) , Orexin receptor family , colony - stimulating factor family receptor , c - src , tyrosine Histamine receptor family , 5 -hydroxytryptamine receptor 20 kinase (CSK ), casein kinase family , megakaryocyte -associ family, KISS1- derived peptide receptor (kisspeptin ), Leu ated tyrosine kinase (CTK ) , death - associated protein kinase cine -rich repeat - containing G protein -coupled receptor fam family , doublecortin - like kinase family , discoidin domain ily , horiogonadotropin receptor (LH ) , Leukotriene 84 recep receptor tyrosine kinase , dystrophia myotonica -protein tor (BLT1 ) , Adenylate Cyclase Activating Polypeptide 1 kinase (DMPK ), dual- specificity tyrosine-( Y ) -phosphoiya Receptor 1 (mPAC1 ) , Motilin receptor, Melanocortin recep- 25 tion regulated kinase family, epidermal growth factor recep tor family , Melanin concentrating hormone receptor 1 tor family , eukaryotic translation initiation factor 2 - alpha ( TVICHI) , Neuropeptide Y1 receptor (Yl ) , Neuropeptide kinase 1 ( EIF2AK1) , EPH receptor family, Ephrin type - A Y2 receptor (NPY2R ), Opioid receptor family, Oxytocin receptor family , Ephrin type- B receptor family, V - erb - b2 receptor (OT ) , P2Y Purinoceptor 12 (mP2Y12 ) , P2Y Puri erythroblastic leukemia viral oncogene homolog family , noceptor 6 (P2Y6 ), Pancreatic polypeptide receptor family , 30 mitogen - activated protein kinase family , endoplasmic Platelet- activating factor receptor family , Prostaglandin E reticulum to nucleus signaling 1 ( ERN1 ) , PTK2 protein receptor family , Prostanoid IP1 receptor ( IP1) , MAS - related tyrosine kinase 2 (FAK ) , fer ( fps/ fes related ) tyrosine kinase GPR , member family , Rhodopsin (Rhodopsin ), Relaxin (FER ), feline sarcoma oncogene ( FES ), Fibroblast growth family peptide receptor family , Somatostatin receptor fam factor receptor family , Gardner- Rasheed feline sarcoma ily , Tachykinin receptor family , Melatonin receptor family, 35 viral (v - fgr ) oncogene homolog ( FGR ), fms- related tyrosine Urotensin receptor family , Vasoactive intestinal peptide kinase family . Fms- related tyrosine kinase family , fyn - re receptor 1 (mVPAC1 ) , Neuromedin B Receptor (BB1 ) , lated kinase (FRK ), FYN oncogene related to SRC , cyan G Neuromedin U receptor 1 (NMU1 ) , Neuropeptides B / W associated kinase (GAK ), eukaryotic translation initiation receptor family , Neuropeptide FF receptor 1 (NPFF1 ) , neu factor 2 alpha kinase , Growth hormone receptor . G protein ropeptide S receptor 1 (NPS receptor ), Neuropeptide Y 40 coupled receptor kinase 1 (GRK1 ) , G protein - coupled recep receptor family , Neurotensin receptor 1 (NTS1 ) , Opsin 5 tor kinase family , glycogen synthase kinase family , germ (OPN5 ) , Opioid receptor- like receptor (NOP ), Oxoeico cell associated 2 (haspin ) (HASPIN ) , Hemopoietic cell sanoid (OXE ) receptor 1 (OXE ), Oxoglutarate ( alpha - keto kinase (HCK ), homeodomain interacting protein kinase glutarate ) receptor 1 (OXGR1 ) , Purinergic receptor family , family , mitogen - activated protein kinase kinase kinase Pyrimidinergic receptor family, Prolactin releasing hormone 45 kinase family , hormonally up - regulated Neu - associated receptor (PRRP ), Prokineticin receptor family , Platelet acti kinase (HUNK ) , intestinal cell (MAK - like ) kinase ( ICK ) , vating receptor (PAF ), Prostaglandin F receptor family , Insulin - like growth factor 1 receptor ( IGF1R ) , conserved Prostaglandin 12 ( prostacyclin ) receptor family , Parathyroid helix - loop -helix ubiquitous kinase ( IKK - alpha ), inhibitor of hormone receptor family , muscarinic 4 ( rM4) , Prostanoid kappa light polypeptide gene enhancer in B -cells kinase beta DP2 receptor ( rGPR44 ), Prokineticin receptor family , 50 family , insulin receptor ( INSR ), insulin receptor -related Relaxin family peptide receptor family , Secretin receptor receptor ( INSRR ), interleukin - 1 receptor- associated kinase ( secretin ), Smoothened , Frizzled class receptor (Smooth family , IL2 - inducible T -cell kinase (ITK ), Janus kinase ened ) , trace amine associated receptor family , Tachykinin family , Kinase Insert Domain Receptor, v - kit Hardy -Zuck family , Thromboxane A2 receptor ( TP ) , Thyrotropin releas erman 4 feline sarcoma viral oncogene homolog , lympho ing hormone receptor (TRH1 ) , Thyroid Stimulating Hor- 55 cyte -specific protein tyrosine kinase (LCK ) , LIM domain mone Receptor ( TSH ) ; Examples of Protein kinases include kinase family, serine/ threonine kinase family leucine- rich but are not limited to : AP2 associated kinase , Homo sapiens repeat kinase family , v - yes- 1 Yamaguchi sarcoma viral ABL proto -oncogene 1 -non -receptor tyrosine - protein kinase related oncogene homolog ( LYN ) , male germ cell- associ family , c -abl oncogene 1 receptor tyrosine kinase family , ated kinase (MAK ) MAP /microtubule affinity - regulating V - abl Abelson murine leukemia viral oncogene homolog 2 , 60 kinase family , microtubule associated serine/ threonine activin A receptor family , chaperone — ABC1 activity of bel kinase family , maternal embryonic leucine zipper kinase , complex homolog ( S. pombe ) ( ADCK3) , aarF domain con c -mer proto -oncogene tyrosine kinase (MERTK ) ,met proto taining kinase 4 (ADCK4 ), V - akt murine thymoma viral oncogene (hepatocyte growth factor receptor ), MAP kinase oncogene homolog family , anaplastic lymphoma receptor interacting serine/ threonine kinase family , myosin light tyrosine kinase family , protein kinase A family , protein 65 chain kinase family , mixed lineage kinase domain - like pro kinase B family , ankyrin repeat and kinase domain contain tein isoform , CDC42 binding protein kinase family , serine / ing 1 ( ANKK1) , NUAK family — SNF1- like kinase , mito threonine kinase family, macrophage stimulating 1 receptor US 10,471,211 B2 17 18 ( c -met - related tyrosine kinase ) (MST1R ), mechanistic target Proliferator Activated Receptor alpha (PPARA ), Peroxisome of rapamycin ( serine /threonine kinase ) (MTOR ), muscle Proliferator Activated Receptor gamma (PPARG ), Peroxi skeletal- receptor tyrosine kinase (MUSK ) , myosin light some Proliferator Activated Receptor delta ( PPARD ), Pro chain kinase family , NIMA (never in mitosis gene a )-related gesterone receptor a ( PGR ) , Progesterone receptor ß (PGR ) , kinase family , serine / threonine - protein kinase NIM1 5 Retinoic acid receptor - alpha (RARA ) , Retinoic acid recep (NIM1 ) , nemo - like kinase (NLK ), oxidative - stress respon tor- beta (RARB ), Retinoid X receptor - alpha (RXRA ) , Ret sive 1 ( OSR1) , p21 protein (Cdc42 /Rac ) -activated kinase inoid X receptor- gamma (RXRG ) , Thyroid hormone recep family , PAS domain containing serine/ threonine kinase , tor- alpha ( THRA ) , Thyroid hormone receptor- beta ( THRB ) , Platelet -derived growth factor receptor family , 3 -phospho Retinoic acid - related orphan receptor, Liver X receptor, inositide dependent protein kinase - 1 (PDPK1 ) , Calcium- 10 Farnesold X receptor , Vitamin D receptor, Pregnane X dependent protein kinase 1 , phosphorylase kinase gamma receptor, Constitutive androstane receptor , Hepatocyte family , Phosphatidylinositol 4,5 -bisphosphate 3 -kinase , nuclear factor 4 , Oestrogen receptor , Oestrogen - related phosphoinositide- 3 - kinase family , phosphatidylinositol receptor , Glucocortioic receptor , Nerve growth factor - in 4 -kinase family, phosphoinositide kinase, FYVE finger con duced -B , Germ cell nuclear factor; Examples of Epigenetic taining, Pim - 1 oncogene (PIM1 ) , pim - 2 oncogene (PIM2 ) , 15 targets include but are not limited to : ATPase family AAA pim - 3 oncogene (PIM3 ) , phosphatidylinositol- 4 - phosphate domain - containing protein 2 (ATAD2A ) , ATPase family 5 -kinase family , phosphatidylinositol- 5 -phosphate 4 -kinase AAA domain containing 28 (ATAD2B ), ATPase family family protein kinase , membrane associated tyrosine/ threo AAA domain containing - 2B ( ATAD2B ), bromodomain nine ( PKMYT1 ), protein kinase N family , polo - like kinase adjacent to zinc finger domain - 1A (BAZIA ), bromodo family , protein kinase C family , protein kinase D family , 20 main adjacent to zinc finger domain — 1B (BAZ1B ), bro CGMP -dependent protein kinase family , eukaryotic transla modomain adjacent to zinc finger domain -2A (BAZ2A ) , tion initiation factor 2 - alpha kinase 2 ( PRKR ), X - linked bromodomain adjacent to zinc finger domain 2A (BAZ2A ), protein kinase (PRKX ), Prolactin receptor (PRLR ), PRP4 bromodomain adjacent to zinc finger domain -2B (BAZ2B ), pre -mRNA processing factor 4 homolog B (yeast ) (PRP4 ) , bromodomain - containing protein 1 (BRD1 ) , Bromodomain PTK2B protein tyrosine kinase 2 beta (PTK2B ), SIK family 25 containing protein 2-1st bromodomain ( BRD2 ) , Bromodo kinase 3 ( QSK ) , V -raf - 1 murine leukemia viral oncogene main containing protein 2—1st & 2nd bromodomains homolog 1 (RAF1 ) , Neurotrophic tyrosine kinase receptor (BRD2 ) , bromodomain -containing protein 2 isoform type family , receptor ( TNFRSF ) -interacting serine -threo 1 - bromodomain 2 (BRD2 ( 2 )) , bromodomain -containing nine kinase family , dual serine /threonine and tyrosine pro protein 3 -bromodomain 1 (BRD3 ( 1) ) , Bromodomain - con tein kinase (RIPK5 ) , Rho - associated , coiled - coil containing 30 tain ng protein 3—1st bromodomain (BRD3 ) , Bromodo protein kinase family , C - ros oncogene 1 , receptor tyrosine main - containing protein 3—1st & 2nd bromodomains kinase (ROS1 ) , ribosomal protein S6 kinase family , SH3 (BRD3 ) bromodomain - containing protein 3 -bromodomain 2 binding domain kinase 1 (SBK1 ) , serum /glucocorticoid ( BRD3( 2 ) ) , Bromodomain containing protein 4-1st bro regulated kinase family , Putative uncharacterized serine / modomain (BRD4 ), bromodomain -containing protein 4 iso threonine -protein kinase (Sugen kinase 110 ) (SgK110 ), salt- 35 form long bromodomains 1 and 2 (BRD4 ( 1-2) ), bromodo inducible kinase family , SNF related kinase (SHIRK ), src main - containing protein 4 isoform long -bromodomain 2 related kinase SFRS protein kinase family , Spleen tyrosine (BRD4 ( 2 ) ) , bromodomain -containing protein 4 isoform kinase (SYK ), TAO kinase family . TANK -binding kinase 1 short (BRD4 ( full -length - short - iso .) ), Bromodomain con ( TBK1) , tec protein tyrosine kinase ( TEC ) , testis -specific taining protein 7 (BRD7 ) , bromodomain containing 8 -bro kinase 1 ( TESK1 ), transforming growth factor , beta receptor 40 modomain 1 (BRD8 (1 )) , bromodomain containing 8- bro family , tyrosine kinase with immunoglobulin - like and EGF modomain 2 (BRD8 (2 ) ), bromodomain -containing protein 9 like domains 1 (TIE1 ) , TEK tyrosine kinase, endothelial isoform 1 (BRD9 ) , Bromodomain containing testis - spe ( TIE2) , Angiopoietin - 1 receptor ( Tie2 ) , tousled - like kinase cific — 1st bromodomain (BRDT ) , Bromodomain containing family , TRAF2 and ICK interacting kinase ( TNIK ) , non testis - specific — 1st & 2nd bromodomains ( BRDT) , bro receptor tyrosine kinase family , TNNI3 interacting kinase 45 modomain testis -specific protein isoform b bromodomain 2 ( TNNI3K ) , transient receptor potential cation channel , tes ( BRDT ( 2 )) , bromodomain and PHD finger containing — 1 tis -specific serine kinase family , TTK protein kinase ( TTK ), (BRPF1 ) , bromodomain and PHD finger containing - 3 TXK tyrosine kinase ( TXK ) , Tyrosine kinase 2 ( TYK2) , (BRPF3 ), bromodomain and PHD finger containing - 3 TYRO3 protein tyrosine kinase ( TYRO3 ), unc -51 - like (BRPF3 ) , Bromodomain and WD repeat - containing 3-2nd kinase family , phosphatidylinositol 3 -kinase , vaccinia 50 bromodomain ( BRWD3( 2 ) ) , Cat eye syndrome critical related kinase 2 (VRK2 ) , WEE1 homolog family , WNK region protein 2 (CECR2 ) , CREB binding protein lysine deficient protein kinase family , v -yes - 1 Yamaguchi (CREBBP ), E1A binding protein , p300 ( EP300 ) , EP300 sarcoma viral oncogene homolog 1 ( YES ) , sterile alpha ( EP300 ) , nucleosome- remodeling factor subunit BPTF iso motif and leucine zipper containing kinase AZK (ZAK ), form 1 (FALZ ) , Nucleosome- remodeling factor subunit BPT zeta - chain ( TCR ) associated protein kinase 70 kDa 55 (FALZ ) , Euchromatic histone - lysine N -methyltransferase 2 (ZAP70 ); Examples of nuclear hormone receptors include (EHMT2 ), Histone Acetyltransferase KAT2A (GCN5L2 ) , but are not limited to : Androgen receptor ( AR ), Estrogen Euchromatic histone - lysine N -methyltransferase 1 related receptor alpha (ESRRA ) , Estrogen receptor 1 ( EHMT1) , Histone- lysine N -methyltransferase (MLL ) , ( ESR1) , Nuclear receptor subfamily 1 group H -member 4 Polybromo 1—1st bromodomain (PB1 ( 1 ) ) , Polybromo (NR1H4 ), Nuclear receptor subfamily 3 group ?. mem- 60 1-2nd bromodomain (PE31 (2 )) , polybromo 1 -bromodomain ber 1 (glucocorticoid receptor) (NR3C1 ) , Nuclear receptor 2 (PBRM1 ( 2 ) ) , polybromo 1 -bromodomain 5 (PBRM1 ( 5 )) , subfamily 1 - group H — member 3 (Liver X receptor a ) Histone acetyltransferase KAT2B (PCAF ) , PH - interacting (NR1H3 ) , Nuclear receptor subfamily 1— group H mem protein - 1st bromodomain (PHIP ( 1 ) ) , PH - interacting pro ber 2 (Liver X receptor B ) (NR1H2 ), Nuclear receptor tein -2nd bromodomain (PHIP ( 2 )) , Protein kinase C -binding subfamily 1 - group H - member 2 (Liver X receptor B ) 65 protein 1 (PRKCBP1 ) , Protein arginine N -methyltransferase (NR1H2 ) , Nuclear receptor subfamily 3 — group C -mem 3 (PRMT3 ) , SWI/ SNF related matrix associated actin ber 2 (Mineralcorticoid receptor ) (NR3C2 ), Peroxisome dependent regulator of chromatin — subfamily a — member 2 US 10,471,211 B2 19 20 ( SMARCA2 ) , SWI/ SNF related — matrix associated actin Theragyn , Theraloc, Tysabri, Vectibix , Verluma, Xolair, dependent regulator of chromatin subfamily a member 4 Yervoy, Zenapax , and Zevalin or combinations thereof. (SMARCA4 ), Nuclear body protein — SP110 (SP110 ), Examples of known Monoclonal antibodies include but Nuclear body protein SP140 (SP140 ), Transcription ini are not limited to : 3F8 , 8H9, Abagovomab , Abciximab , tiation factor TFIID subunit 1 ( TAF1( 1-2 )) , TAF1 RNA 5 Abituzumab , Abrilumab , Actoxumab , Adalirnumab , Adeca polymerase II — TATA box binding protein ( TBP )-associated turnumab , Aducanumab , Afasevikumab , Afelimomab , Afu factor — 250 kDa — bromodomain 2 ( TAF1 (2 ) ), Transcrip tuzumab , Alacizumab pegol, ALD518 , ALD403 , Alemtu tion initiation factor TFIID subunit 1 - like 1st bromodo zumab , Alirocumab , Altumomab pentetate , Amatuximab , main ( TAF1L ( 1 ) ) , Transcription initiation factor TFIID sub AMG 334 , Anatumomab mafenatox , Anetumab ravtansine , unit 1 - like — 2nd bromodomain ( TAF1L ( 2 )) , tripartite motif 10 Anifrolumab , Anrukinzumab , Apolizumab , Arcitumomab , containing 24 ( TRIM24 (Bromo . ) ), tripartite motif contain Ascrinvacumab , Aselizumab , Atezolizumab , Atinumab , ing 24 ( TRIM24 (PHD - Bromo. ) ) , E3 ubiquitin - protein ligase Atlizumab , Atorolimumab , Avelumab , Bapineuzumab , TRIM33 ( TRIM33 ) , tripartite motif containing 33 ( TRIM33 Basiliximab , Bavituximab , Bectumomab , Begelomab , Belit ( PHD - Bromo . ) ), WD repeat 9-1st bromodomain (WDR9 numab , Benralizumab , Bertilimumab , Besilesomab , Beva ( 1 ) ) , WD repeat 9—2nd bromodomain (WDR9 ( 2 ) ) ; mem- 15 cizumab , Beziotoxiimab , Biciromab , Birnagrumab , Birneki brane transport proteins including but not limited to ATP zumab , Bivatuzumab mertansine , Bleselumab , binding cassette (ABC ) superfamily , solute carrier (SLC ) Blinatumomab , Biontuvettnab , Blosozumab , Bococizumab , superfamily , multidrug resistance protein 1 (P - glycopro Brazikumab , Brentuximab vedotin , Briakinumab , tein ), organic anion transporter 1 , and protein such as Brodalumab , Brolucizumab , Broritictuzumab , Burosumab , EAAT3 , EAAC1, EAATI, GLUTI , GLUT2 , GLUTS , 20 Cabiralizumab , Canakinumab , Cantuzumab mertansine , GLUT10 , rBAT, AE1 , NBC1, KNBC , CHED2, BTR1, Cantuzumab ravtansine , Caplacizumab , Capromab pen NABC1, CDPD , SGLT1 , SGLT2 , NIS , CHT1 , NET, DAT, detide, Carlumab , Carotuximab , Catumaxomab , CBR96 GLYT2 , CRTR , BOAT1 , SIT1 , XT3 , y + LAT1, BAT1 , doxorubicin immunoconjugate , Cedelizumab , Cergutu NHERF1, NHE6 , ASBT, DMT1, DCT1, NRAMP2 , zumab amunaleukin , Certolizumab pegol, Cetuximab , NKCC2 , NCC , KCC3 , NACT , MCT1, MCT8 , MCT12 , 25 Citatuzumab bogatox , Cixutumumab , Clazakizurriab , Cle SLD , VGLUT3 , THTR1, THTR2 , PIT2 , GLVR2, OCTN2, noliximab , Clivatuzumab tetraxetan , Codrituzumab , Coltux URAT1, NCKX1, NCKX5 , CIC , PiC , ANT1, ORNT1, imab ravtansine , Conatumumab , Concizumab , CR6261, AGC1, ARALAR , Citrin , STLN2, aralar2 , TPC , MUP1, Crenezumab , Crotedumab , Dacetuzumab , Daclizumab , MCPHA , CACT, GC1, PHC , DTD , CLD , DRA , PDS , Dalotuzumab , Dapirolizumab pegol, Daratumumab , Dectre Prestin , TAT1, FATP4 , ENT3 , ZnT2 , ZnT10 , AT1, NPT2A , 30 kumab , Derncizumab , Denintuzumab mafodotin , Deno NPT2B , HHRH , CST, CDG2F , UGAT, UGTL , UGALT , sumab , Depatuxizumab mafodotin , Derlotuximab biotin , UGTI , UGT2 , FUCTI , CDG2C , NST, PAT2 , G6PT1 , Detumomab , Dinutuxiinab , Diridavumab , Dornagrozumab , X4 , ZIP4 , LIV4 , ZIP13 , LZT- Hs9 , FPN1,MTP1 , IREGI, Dorlirnomab aritax , Drozitumab , Duligotumab , Dupilumab , RHAG , AIM1 PCFT , FLVCR1 FLVCR2 , RFT1 , RFT2 , Durvalumab , Dusigitumab , Ecronieximab , Eculizumab RFT3, OATP1B1, OATP1B3, OATP2A1 ; structural proteins 35 Edobacomab , Edrecolomab , Efalizumab Efungumab , Elde including but not limited to tubulin , heat shock protein , lumab, Elgemtumab, Elotuzumab , Elsilimomab , Emactu Microtubule - stabilizing proteins , Oncoprotein 18 , stathmin , zumab , Emibetuzumab , Ernicizumab , Enavatuzumab , kinesin - 8 and kinesin - 14 family , Kip3 , Kif18A ; proteases Enfortumab vedotin , Enlimomab pegol, Enoblituzumab , including but not limited ADAM (a disintegrin and metal Enokizumab , Enoticumab , Ensituximab , Epitumomab citux loprotease ) family ; Other molecule targets in signal trans- 40 etan , Epratuzumab , Erenumab , Erlizumab , Ertumaxomab , ductions include but are not limited to : Cell , division cycle Etaracizumab , Etrolizumab , Evinacumab , Evolocumab , 25 homolog A (CDC25A ) , forkhead box 03 ( forkhead box Exbivirumab , Fanolesomab , Faralimoniab , Farletuzumab , 03 ), nuclear factor ofkappa light polypeptide gene enhancer Fasinumab , FBTA05 , Felvizumab , Fezakinumab , Fibatu in B - cells inhibitor, alpha (NFKBIA ) , nuclear factor ( eryth zumab , Ficlatuzumab , Figitumumab , Flanvotumab , Fleti roid -derived 2 ) -like 2 (NFE2L2 ) , Natriuretic peptide recep- 45 kumab , Fontolizumab , Foralumab , Foravirumab , Fresolim tor A ( NPR1) , Tumor necrosis factor receptor superfamily , umab , Fulranumab , Futuximab , Galcanezumab , Galiximab , member 11a ( TNFRSF11A ) , V -rel reticuloendotheliosis viral Ganitumab , Gantenerumab , Gavilirnomab , Gemtuzumab oncogene homolog A (avian ) (RELA ), Sterol regulatory ozogamicin , Gevokiztimab , Girentuximab , Giernbatur element binding transcription factor 2 (SREBF2 ) , CREB numab vedotin , Golimumab , Gomiliximab , Guselkumab , regulated transcription coactivator 1 (CRTC1 ), CREB regu- 50 lbalizumab , Ibritumomab tiuxetan , Icrucumab , Iciaruci lated transcription coactivator 2 (CRTC2 ) , X -box binding zumab , Igovomab , IMAB362, Imalumab , Imciromab , Img protein 1 (XBP1 ) , Catenin ( cadherin -associated protein ) , atuzumab , Inclacumab , Indatuximab ravtansine , Indusat beta 1 (CTNNB1 ), and combinations thereof. umab vedotin , Inebilizumab , Infliximab , Inolimomab , Examples of known biologics include but are not limited Inotuzumab ozogamicin , Intetumumab , Iratumumab , Isatux to : Abbosynagis , Abegrin , Actemra , AFP -Cide , Antova, 55 imab , Itolizumab , Ixekizumab , Kelixirrab , Labetuzumab , Arzerra , Aurexis , Avastin , Benlysta , Bexxar , Blontress , Lambrolizumab , Lampalizumab , Lanadelumab , Landogro Bosatria , Carripath , CEA - Cde, CEA - Scan , Cirnzia , zumab , Laprituximab emtansine, LBR - 101/ PF0442g7429 , Cyramza, Ektomab , Erbitux , FibriScint, Gazyva , Herceptin , Lebrikizumab , Lernalesomab , Lendalizumab , Lenzilumab , hPAM4 - Cide, HumaSPECT, HuMax -CD4 , HuMax - EGFr, Lerdelimumab , Lexatumumab , Libivirumab , Lifastuzumab Humira , HuZAF , Hybri -ceaker , Ilaris , Indimacis -125 , Kad- 60 vedotin , Ligelizumab , Lilotomab satetraxetan , Lintuzumab , cyla , Lemtrada, LeukArrest , LeukoScan , Lucentis , Lympho Liniumab , Lodelcizumab , Lokivetmab , Lorvotuzumab mer murt , LymphoScan , LymphoStat -B , MabThera , Mycograb , tansine, Lucatumumab , Lulizumab pegoi, Lumretuzumab , Mylotarg , Myosoint, NeutroSpec , Numax , Nuvion , Omni LY2951742 , Mapatumumab , Margetuximab , Maslimomab , targ , Opdivo , Orthoclone OKT3 , OvaRex , Panorex , Prolia ; Matuzumab , Mavnlimumab , Mepolizumab , Metelimumab , Prostascint, Raptiva , Remicade , Removab , Rencarex , Reo- 65 Milatuzumab , Minretumomab , Mirvetuximab soravtansine, Pro , Rexomun , Rituxan , RoActemra , Scintimun , Sirriponi, Miturnomab , Mogamulizumab , Monalizumab , hilorolir Simulect, Soliris , Stelara , Synagis , Tactress, Theracim , numab , Motavizumab , Moxeturnomab pasudotox , Mur US 10,471,211 B2 21 22 omonab CD3, Nacolomab tafenatox , Namilumab , Naptu vaccine, Typhoid vaccine, Pneumococcal conjugate vaccine, momab estafenatox, Naratuximab emtansine , Narnatumab , Pneumococcal polysaccharide vaccine, Cholera vaccine , Natalizumab , Navicixizumab , Navivumab , Nebacumab , Caries vaccine, Ehrlichiosis vaccine , Leprosy vaccine , Lyme Necitumumab , Nemolizumab , Nerelimomata , Nesvacumab , disease vaccine , Staphylococcus aureus vaccine , Streptococ Nirnotuzumab , Nivolumab , Nofetumomab merpentan , Obit- 5 cus pyogenes vaccine, Syphilis vaccine , Tularemia vaccine, toxaximab , Obinutuzumab , Ocaratuzumab , Oorelizumab , Yersinia pestis vaccine ; Examples of parasitic diseases Odulimomab , Ofatumumab , Olaratumab , Olokizumab , include but are not limited to ; Malaria vaccine , Schistoso Omalizumab , Onartuzumab , Ontuxtzumab , Opicinumab , miasis vaccine, Chagas disease vaccine, Hookworm vac Oportuzumab monatox , Oregovomab , Orticumab , Otelixi cine , Onchocerciasis river blindness vaccine for humans , zumab , Otiertuzunlab , Oxelumab , Ozartezumab , Ozorali- 10 Trypanosomiasis vaccine , Visceral leishmaniasis vaccine ; zumab , Pagibaximab , Palivizumab , Pamrevlumab , Panitu Examples of non - infectious diseases include but are not mumab , Pankomab , Panobacumab , Parsatuzumab , limited to : Alzheimer's disease amyloid protein vaccine , Pascolizumab , Pasotuxizumab , Pateclizumab , Patritumab , Breast cancer vaccine, Ovarian cancer vaccine , Prostate Pembrolizumab , Pemturnomab , Perakizumab , Pertuzumab , cancer vaccine, Talimogene laherparepvec ( T - VEC ) ; also Pexelizumab , Pidilizumab, Pinatuzumab vedotin , Pintu- 15 vaccines including but not limited to the following trade momab , Placulumab , Plozalizumab , Pogalizumab , names : ACAM2000 , ActHIB , Adacel, Afluria , AFLURIA Polatuzumab vedotin , Ponezumab , Prezalizumab , Prilix QUADRIVALENT, Agriflu , BCG Vaccine , BEXSERO , imab , Pritaxaximab , Pritumumab , PRO 140 ; Quilizumab , Biothrax , Boostrix , Cervarix , Comvax , DAPTACEL , Racoturnomab , Radretumab , Rafivirumab , Ralpancizumab , DECAVAC , Engerix - B , FLUAD , Fluarix , Fluarix Quadri Ramucirumab , Ranibizumab , Raxibacumab , Refanezumab , 20 valent, Flublok , Flucelvax, Flucelvax Quadrivalent, FluLa Regavirumab , Reslizumab , Ritotumumab , Rinucumab , val , FluMist , FluMist Quadrivalent, Fluvirin , Fluzone Qua Risankizumab , Rituximab , Rivabazumab pegol, Robatu drivalent , Fluzone, Fluzone High - Dose and Fluzone mumab , Roledumab , Romosozumab , Rontalizumab , Roval Intradermal, Gardasil, Gardasil 9 , Havrix , Hiberix , Imovax , pituzumab tesirine, Rovelizumab , Ruplizumab , Sacitu Infanrix , IPOL , Ixiaro , JE - Vax , KINRIX , Menactra , IVlen zumab govitecan , Sarnalizumab , Sapelizumab , Sarilumab , 25 Hibrix , Menomune - A / C /Y / W - 135, Merweo , M - M - R II , Satumomab pendeticle , Secukinumab , Seribantumab , M - M - Vax , Pediarix , PedvaxHIB , Pentacel, Pneumovax 23 , Setoxaximab , Sevirumab , SGN -CD18A , SGN - CD33A , Poliovax , Prevnar, Prevnar 13, ProQuad , Quadracel, Qua Sibrotuzumab , Sifalirnumab , Sittuximab , Sirntuzumab , Sip drivalent, RabAvert, Recombivax HB , ROTARIX , RotaTeq , tizumab ; Sirukumab , Sofituzumab veslotin , Solanezumab , TENIVAC , TICE BCG , Tripedia , TRUMENBA , Twinrix , Solitomab , Sonepcizumab, Sontuzumab , Stamulumab , Sule- 30 TYPHIM VI, VAQTA , Varivax, Vaxchora , Vivotif , YF - Vax , somab , Suvizumab , Tabalumab , Tacatuzumab tetraxetan , Zostavax , and combinations thereof. Tadocizumab , Talizumab , Tamtuvetmab , Tanezumab , Tapli Examples of injectable drugs include but are not limited tumomab paptox , Tarextumab , Tefibazumab , Telimomab to : Ablavar (Gadofosveset Trisodium Injection ), Abarelix aritox , Tenaturnomab , Teneliximab , Teplizumab , Teprotu Depot, Abobotulinum toxin A Injection (Dysport ), ABT- 263, mumab , Tesdolumab , Tetulomab , Tezepelumab , TGN1412 , 35 ABT -869 , ABX - EFG , Accretropin (Somatropin Injection ), Ticilimumab , Tigatuzumab , Tildrakizumab , Timolumab , Acetadote (Acetylcysteine Injection ), Acetazoiamide Injec Tisotumab vedotin , TNX -650 , Tocilizumab , Toralizumab , tion ( Acetazolamide Injection ), Acetylcysteine Injection Tosatoxumab , Tositumomab , Tovetumab , Tralokinumab , ( Acetadote ), Actemra ( Tocilizumab Injection ), Acthrel (Cor Trastuzumab , Trastuzumab erntansine, TRBS07 , Tregali ticorelin Ovine Triflutate for Injection ), Actummune, Acti zumab , Tremelimumab , Trevogrumab , Tucotuzurriab cel- 40 vase, Acyclovir for Injection (Zovirax Injection ) , [0137 ] , moleukin , Tuvirumab , Ublituximab , Ulocuplumab , Ure Adacel, Adalimumab , Adenoscan (Adenosine Injection ), lumab , Urtoxazumab , Ustekinumab , Utomilumab , Adenosine Injection ( Adenoscan ) , Adrenaclick , AdreView Vadastuximab talirine , Vandortuzumab vedotin , Vantic ( Iobenguane 1123 Injection for Intravenous Use ) , Afluria , tumab , Vanucizumab , Vapaliximab , Varlilumab , Vateli Ak -Fluor (Fluorescein Injection ), Aldurazyme (Laronidase ) , zumab , Vedolizumab , Veltuzumab , Vepalimomab , Vesen- 45 Alglucerase Injection (Ceredase ), Alkeran Injection (Mel cumab , Visilizurriab , Vobarilizumab , Volociximab , phalan Hel Injection ), Allopurinol Sodium for Injection Vorsetuzumab mafodotin , Votumumab , Xentuzumab , Zalu ( Aloprim ) , Aloprim (Allopurinol Sodium for Injection ), tumumab , Zanolimumab , Zatuximab , Ziralirnumab , and Alprostadil, Alsuma (Sumatriptan Injection ), ALTU 238 , Zolimomab aritox or combinations thereof. Amino Acid Injections , Aminosyn , Apidra , Apremilast , Examples of vaccines developed for viral diseases include 50 Alprostadil Dual Chamber System for Injection ( Caverject but are not limited to : Hepatitis A vaccine , Hepatitis B Impulse ), AMG 009, AMG 076 , AMG 102 , AMG 108 , AMG vaccine , Hepatitis E vaccine, HPV vaccine, Influenza vac 114 , AMG 162, AMG 220 , AMG 221 , AMG 222 , AMG 223 , cine, Japanese encephalitis vaccine , MMR vaccine , MMRV AMG 317 , AMG 379 , AMG 386 , AMG 403 , AMG 477 , vaccine , Polio vaccine, Rabies vaccine , Rotavirus vaccine , AMG 479 , AMG 517 , AMG 531 , AMG 557 , AMG 623 , Varicella vaccine, Shingles vaccine , Smallpox vaccine , Yel- 55 AMG 655 , AMG 706 , AMG 714 , AMG 745 , AMG 785 , low Fever vaccine , Adenovirus vaccine, Coxsackie B virus AMG 811 , AMG 827 , AMG 837 , AMG 853 , AMG 951 , vaccine, Cytomegalovirus vaccine , Dengue vaccine for Amiodarone HC1 Injection (Amiodarone HCl Injection ), humans, Eastern Equine encephalitis virus vaccine for Amobarbital Sodium Injection ( Amytal Sodium ), Amytal humans, Ebola vaccine , Enterovirus 71 vaccine , Epstein Sodium (Amobarbital Sodium Injection ), Anakinra, Anti Barr vaccine, Hepatitis C vaccine , HIV vaccine , HTLV - 1 60 Abeta , Anti - Beta7 , Anti- Bta20 , Anti -CD4 , Anti - CD20 , Anti T- lymphotropic leukemia vaccine for humans , Marburg CD40 , Anti - IFNalpha, Anti- IL13, Anti- OX40L , Anti -ox virus disease vaccine, Norovirus vaccine, Respiratory syn LDS , Anti -NGF , Anti- NRP1 , Arixtra , Amphadase cytial virus vaccine for humans, Severe acute respiratory (Hyaluronidase Inj) , Ammonul (Sodium Phenylacetate and syndrome (SARS ) vaccine , West Nile virus vaccine for Sodium Benzoate Injection ), Anaprox , Anzemet Injection humans; Examples of bacterial diseases include but are not 65 ( Dolasetron Mesylate Injection ) , Apidra ( Insulin Glulisine limited to : Anthrax vaccines, OPT vaccine, Q fever vaccine , [rDNA origin ] Inj) , Apomab , Aranesp (darbepoetin alfa ) , Hib vaccine, Tuberculosis (BCG ) vaccine , Meningococcal Argatroban ( Argatroban Injection ) , Arginine Hydrochloride US 10,471,211 B2 23 24 Injection (R -Gene 10 , Aristocort, Aristospan , Arsenic Tri vera 104 mg/ ml , Depo -Provera 150 mg/ ml , Depo - Testoster oxide Injection ( Trisenox ) , Articane HCl and Epinephrine one , Dexrazoxane for Injection , Intravenous Infusion Only Injection (Septocaine ), Arzerra (Ofatumumab Injection ), ( Totect) , Dextrose /Electrolytes , Dextrose and Sodium Chlo Asclera (Polidocanol Injection ) , Ataluren , Ataluren - DMD , ride Inj (Dextrose 5 % in 0.9 % Sodium Chloride ), Dextrose , Atenolol Inj (Tenormin I.V. Injection ), Atracurium Besylate 5 Diazepam Injection ( Diazepam Injection , Digoxin Injection Injection (Atracurium Besylate Injection ) , Avastin , Azactam (Lanoxin Injection ), Dilaudid -HP (Hydromorphone Hydro Injection (Aztreonam Injection ), Azithromycin ( Zithromax chloride Injection ), Dimercarprol Injection (Bal in Oil Injection ) , Aztreonam Injection (Azactam Injection ) , Ampules ), Diphenhydramine Injection (Benadryl injection ), Baclofen Injection (Lioresal Intrathecal) , Bacteriostatic Dipyridamole Injection (Dipyridamole Injection ), DMOAD , Water (Bacteriostatic Water for Injection ), Baclofen Injec- 10 Docetaxel for Injection ( Taxotere) , Dolasetron Mesylate tion (Lioresal Intrathecal ) , Bal in Oil Ampules (Dimercar Injection (Anzemet Injection ), Doribax (Doripenem for prol Injection ), BayHepB , Bay Tet , Benadryl, Bendamustine Injection ), Doripenem for Injection (Doribax ), Doxercalcif Hydrochloride Injection ( Treanda ), Benztropine Mesylate erol Injection (Hectorol Injection ), Doxil ( Doxorubicin Hel Injection (Cogentin ), Betamethasone Injectable Suspension Liposome Injection ) , Doxorubicin Hot Liposome Injection (Celestone Soluspan ), Bexxar, Bicillin C - R 900/300 (Peni- 15 (Doxil ) , Duraclon (Clonidine Injection ), Duramorph (Mor cillin G Benzathine and Penicillin G Procaine Injection ) , phine Injection ), Dysport (Abobotulinum toxin A Injection ), Blenoxane (Bleomycin Sulfate Injection ) , Bleomycin Sul Ecallantide Injection (Kalbitor ) , EC -Naprosyn (naproxen ) , fate Injection ( Blenoxane ) , Boniva Injection ( Ibandronate Edetate Calcium Disodium Injection (Calcium Disodium Sodium Injection ), Botox Cosmetic (OnabotulinumtoxinA Versenate ), Edex ( Alprostadil for Injection ), Erigerix , Edro for Injection ), BR3- FC , Bravelle (Urofollitropin Injection ), 20 phonium Injection (Enlon ) , Eliglustat Tartate , Eloxatin Bretylium (Bretylium Tosylate Injection ), Brevital Sodium (Oxaliplatin Injection ) , Emend Injection (Fosaprepitant ( Methohexital Sodium for Injection ) , Brethine , Briobacept , Dimegiumine Injection ) , Enalaprilat Injection (Enalaprilat BTT- 1023, Bupivacaine HCI, Byetta , Ca -DTPA (Pentetate Injection ), Enlon ( Edrophonium Injection ), Enoxaparin Calcium Trisodium Inj) , Cabazitaxel Injection (Jevtana ) , Sodium Injection ( Lovenox ), Eovist (Gadoxetate Disodium Caffeine Alkaloid ( Caffeine and Sodium Benzoate Injec- 25 Injection ), Eribrel ( etanercept) , Enoxaparin , Epicel, Epi tion ), Calcijex Injection (Calcitrol ) , Calcitrol (Calcijex nepherine, Epipen , Epipen Jr., Epratuzumab , Erbitux , Injection ) , Calcium Chloride (Calcium Chloride Injection Ertapenem Injection ( Invanz ), Erythropoieten , Essential 10 % ) , Calcium Disodium Versenate ( Edetate Calcium Diso Amino Acid Injection (Nephramine ), Estradiol Cypionate , dium Injection ), Campath ( Altemtuzumab ) , Camptosar Estradiol Valerate , Etanercept, Exenatide Injection ( Byetta ) , Injection ( Irinotecan Hydrochloride ), Canakinumab Injec- 30 Evlotra , Fabrazyme (Adalsidase beta ), Famotidine Injection , tion ( Ilaris ) , Capastat Sulfate (Capreomycin for injection ), FDG ( Fludeoxyglucose F 18 Injection ), Feraheme (Feru Capreomycin for Injection (Capastat Sulfate ), Cardiolite moxytol Injection ) , Feridex I.V. (Ferumoxides Injectable (Prep kit for Technetium Tc99 Sestamibi for injection ), Solution ) , Fertinex , Ferumoxides Injectable Solution (Feri Carticel , Cathflo , Cefazolin and Dextrose for Injection (Ce dex I.V.) , Ferurnoxytol Injection ( Feraheme) , Flagyl Injec fazolin . Injection ), Cefepime Hydrochloride, Cefotaxime, 35 tion (Metronidazole Injection ), Fluarix , Fludara (Fludara Ceftriaxone , Cerezyme , Carnitor Injection , Caverject , Cele bine Phosphate ) , Fludeoxyglucose F 18 Injection ( FOG ) , stone Soluspan , Celsior , Cerebyx (Fosphenytoin Sodium Fluorescein Injection ( Ak -Fluor ) , Follistim AQ Cartridge Injection ) , Ceredase ( Alglucerase Injection ), Ceretec ( Tech ( Follitropin Beta Injection ) , Follitropin Alfa Injection (Go netium Tc99m Exametazine Injection ), Certolizumab , nal- f RFF ) , Follitropin Beta Injection (Follistim AQ Car CF - 101, Chloramphenicol Sodium Succinate ( Chloram- 40 tridge ) , Folotyn (Pralatrexate Solution for Intravenous Injec phenicol Sodium Succinate Injection ) , Chloramphenicol tion ) , Fondaparinux , Forteo ( Teriparatide ( rDNA origin ) Sodium Succinate Injection (Chloramphenicol Sodium Suc Injection ), Fostarnatinib , Fosaprepitant Dimeglumine Injec cinate ), Cholestagel (Colesevelam HCL) , Choriogonadotro tion (Emend Injection ) , Foscarnet Sodium Injection pin Aifa Injection (Ovidrel ) , Cimzia , Cisplatin (Cisplatin (Foscavir ) , Foscavir (Foscarnet Sodium Injection ), Fosphe Injection ) , Clolar (Clofarabine Injection ), Clomiphine Cit- 45 nytoin Sodium Injection (Cerebyx ), Fospropofol Disodium rate , Clonidine Injection ( Duraclon ) , Cogentin (Benztropine Injection (Lusedra ), Fragmin , Fuzeon ( enfuvirtide ) ,GA101 , Mesylate Injection ) , Colistimethate Injection (Coly -Mycin Gadobenate Dimeglumine Injection (Multihance ), Gadofos M ), Coly -Mycin M ( Colistimethate Injection ) , Compath , veset Trisodium Injection ( Ablavar) , Gadoteridol Injection Conivaptan Hel Injection ( Vaprisol) , Conjugated Estrogens Solution (ProHance ), Gadoversetamide Injection (Opti for Injection (Premarin Injection ), Copaxone , Corticorelin 50 MARK ) , Gadoxetate Disodium Injection ( Eovist ), Ganirelix Ovine Triflutate for Injection ( Acthrel) , Corvert ( Ibutilide (Ganirelix Acetate Injection ) , Gardasil, GC1008 , GDFD , Fumarate Injection ), Cubicin (Daptomycin Injection ), Gemtuzumab Ozogamicin for Injection (Mylotarg ), Geno CF - 101 , Cyanokit (Hydroxocobalamin for Injection ), Cyt tropin , Gentamicin Injection , GENZ - 112638 , Golimumab arabine Liposome Injection (DepoCyt ) , Cyanocobalamin , Injection (Simponi Injection ), Gonal- f RFF ( Follitropin Alfa Cytovene (ganciclovir ), D.H.E. 45, Dacetuzumab, Dacogen 55 injection ), Granisetron Hydrochloride (Kytril Injection ) , (Decitabine Injection ), Dalteparin , Dantrium IV (Dantrolene Gentamicin Sulfate , Glatiramer Acetate , Glucagen , Gluca Sodium for Injection ), Dantrolene Sodium for Injection gon , HAEI , Haldol (Haloperidol Injection ), Havrix , Hec ( Dantrium IV ) , Daptomycin Injection (Cubicin ) , Darbepoi torol injection (Doxercalciferol Injection ), Hedgehog Path etin Alfa , DDAVP injection (Desmopressin Acetate Injec way Inhibitor, Heparin , Herceptin , hG - CSF , Humalog , tion ) , Decavax, Decitabine Injection (Dacogen ), Dehydrated 60 Human Growth Hormone, Humatrope, HuMax , Humegon , Alcohol (Dehydrated Alcohol Injection ) , Denosumab injec Humira , Humulin , Ibandronate Sodium Injection (Boniva tion (Prolia ), Delatestryl , Delestrogen , Delteparin Sodium , Injection ), Ibuprofen Lysine Injection (NeoProfen ), Ibutilide Depacon ( Vaiproate Sodium Injection ), Depo Medrol Fumarate Injection (Corvert ), Idamycin PFS ( idarubicin (Methylprednisolone Acetate Injectable Suspension ) , Depo Hydrochloride Injection ), Idarubicin Hydrochloride Injec Cyt (Cytarabine Liposome Injection ), DepoDur (Morphine 65 tion ( Idamycin PFS ) , Rads (Canakinumab Injection ) , Imi Sulfate XR Liposome Injection ), Desmopressin Acetate penem and Cilastatin for Injection (Primaxin Imitrex , Inco injection (DDAVP Injection ), Depo - Estradiol, Depo -Pro botulinum toxin A for Injection (Xeomin ) , Increlex US 10,471,211 B2 25 26 (Mecasermin [ rDNA origin ] Injection ), Indocin IV ( Indo GAA , Neo Tect ( Technetium Tc 99m Depreotide Injection ), methacin Inj) , Indomethacin Inj ( Indocin IV ), Infanrix , Nephramine (Essential Amino Acid Injection ), Neulasta Innohep , Insulin , Insulin Aspart [rDNA origin ] Inj (Novo (pegfilgrastim ), Neupogen (Filgrastim ), Novolin , Novolog , Log) , Insulin Glargine [rDNA origin ] Injection (Lantus ), NeoRecormon , Neutrexin ( Trimetrexate Glucuronate MD , Insulin Glulisine [ rDNA origin ] Inj ( Apidra ), Interferon 5 NPH ( N ) , Nexterone ( Amiodarone HCl Injection ) , Norditro alfa - 2b , Recombinant for Injection ( Intron A ) , Intron A pin (Somatropin Injection ), Normal Saline (Sodium Chlo ( Interferon alfa -2b , Recombinant for Injection ) , Invanz ( Er ride Injection ) , Novantrone (Mitoxantrone for Injection tapenem Injection ), Invega Sustenna (Paliperidone Palmi Concentrate ), Novolin 70/30 Innolet (70 % NPH , Human tate Extended -Release Injectable Suspension ) , Invirase ( sa Insulin Isophane Suspension and 30 % Regular , Human quinavir mesylate ), Iobenguane 1123 Injection for 10 Insulin Injection ), NovoLog ( Insulin Aspart [ rDNA origin ] Intravenous Use (AdreView ) , lopromide Injection (Ultra Inj ) , Nplate ( romiplostim ) , Nutropin (Somatropin (rDNA vist ) , Ioversol Injection (Optiray injection ), Iplex (Mecaser origin ) for Inj) , Nutropin AQ , Nutropin Depot ( Somatropin min Rinfabate [ rDNA origin ] Injection ) , Iprivask , Irinotecan ( rDNA origin ) for trip , Octreotide Acetate Injection (San Hydrochloride (Camptosar Injection ), Iron Sucrose Injec dostatin LAR ), Ocrelizumab , Ofatumumab Injection tion (Venofer ), Istodax (Romidepsin for Injection ), Itracon- 15 ( Arzerra ), Olanzapine Extended Release Injectable Suspen azole Injection (Sporanox Injection ), Jevtana (Cabazitaxel sion (Zyprexa Relprew ), Orrmitarg, Omnitrope ( Somatropin Injection ), Jonexa, Kaibitor (Ecallantide Injection ), KCL in [ rDNA origin ] Injection ), Ondansetron Hydrochloride Injec D5NS (Potassium Chloride in 5 % Dextrose and Sodium tion (Zofran Injection ) , OptiMARK (Gadoversetamide Chloride Injection ) , KCL in D5W , KCL in NS, Kenalog 10 Injection ), Optiray Injection ( loversol Injection ), Orencia , Injection ( Triamcinolone Acetonide Injectable Suspension ), 20 Osmitrol Injection in Aviva (Mannitol Injection in Aviva Kepivance (Palifermin ) , Keppra Injection (Levetiracetam ), Plastic Vessel 250 ), Osmitrol Injection in Viaflex (Mannitol Keratinocyte , KFG , Kinase Inhibitor , Kineret (Anakinra ), Injection in Viaflex Plastic Vessel 250 ), Osteoprotegrin , Kinlytic (Urokinase Injection ) , Kinrix , Kionopin ( clonaze Ovidrel (Choriogonadotropin Alfa Injection ), Oxacillin pam ), Kytril Injection (Granisetron Hydrochloride) , Iacos (Oxacillin for Injection ), Oxaliplatin Injection (Eloxatin ), amide Tablet and Injection (Vimpat ) , Lactated Ringer's , 25 Oxytocin Injection (Pitocin ) , Paliperidone Palmitate Lanoxin Injection (Digoxin Injection ), Lansoprazole for Extended -Release Injectable Suspension ( Invega Susterma) , Injection (Prevacid Lantus, Leucovorin Calcium (Leuco Pamidronate Disodium Injection ( Pamidronate Disodium vorin Calcium Injection ) , Lente ( L ) , Leptin , Levemir , Leu Injection ), Panitumumab Injection for Intravenous Use kine Sargramostim , Leuprolide Acetate , Levothyroxine , (Vectibix ) , Papaverine Hydrochloride Injection (Papaverine Levetiracetam (Keppra Injection ), Lovenox , Levocarnitine 30 Injection ), Papaverine Injection (Papaverine Hydrochloride Injection (Carnitor Injection ) , Lexiscan (Regadenoson Injection ) , Parathyroid Hormone, Paricalcitol Injection Tip Injection ), Lioresal Intrathecal (Baclofen Injection ), Lira top Vial (Zemplar Injection ), PARP Inhibitor, Pediarix , glutide [ rDNA ] Injection (Victoza ), Lovenox ( Enoxaparin PEGIntron , Peginterferon , Pegfilgrastim , Penicillin G Ber Sodium Injection ), Lucentis (Ranibizumab Injection ) ,Lumi izathine and Penicillin G Procaine , Pentetate Calcium Tri zyme, Lupron (Leuprolide Acetate Injection ), Lusedra (Fos- 35 sodium Inj (Ca - DTPA ) , Pentetate Zinc Trisodium Injection propofol Disodium Injection ) , Maci, Magnesium Sulfate (Zn -DTPA ) , Pepcid Injection (Famotidine Injection ) , Per (Magnesium Sulfate Injection ) ,Mannitol Injection (Manni gonal, Pertuzumab , Phentolamine Mesylate (Phentolamine tol IV ) , Marcaine (Bupivacaine Hydrochloride and Epineph Mesylate for Injection ), Physostigmine Salicylate ( Phys rine Injection ) , Maxipime (Cefepime Hydrochloride for ostigmine Salicylate ( injection )) , Physostigmine Salicylate Injection ) , MDP Multidose Kit of Technetium Injection 40 ( injection ) (Physostigmine Salicylate ) , Piperacillin and ( Technetium Tc99m Medronate Injection ), Mecasermin Tazobactam Injection ( Zosyn ), Pitocin (Oxytocin Injection ) , [ rDNA origin ] Injection ( Increlex ), Mecasermin Rinfabate Plasma- Lyte 148 (Multiple Electrolytes Inj ), Plasma - Lyte 56 [ rDNA origin ] Injection (Iplex ), Melphalan Hel Injection and Dextrose (Multiple Electrolytes and Dextrose Injection ( Alkeran Injection ) , Methotrexate , Menactra , Menopur in Viaflex , Plastic Vessel 250 ), PlasmaLyte , Plerixafor Injec (Menotropins injection ), Menotropins for Injection (Re- 45 tion (Mozobil ) , Polidocanol Injection (Aselera ), Potassium pronex ) , Methohexital Sodium for injection (Brevital Chloride, Pralatrexate Solution for Intravenous Injection Sodium ), Methyldopate Hydrochloride Injection , Solution (Folotyn ), Pramlintide Acetate Injection (Symlin ), Premarin (Methyldopate Hel) , Methylene Blue (Methylene Blue Injection ( Conjugated Estrogens for Injection ), Prep kit for Injection ) , Methylprednisolone Acetate Injectable Suspen Technetium Tc99 Sestamibi for Injection (Cardiolite ) , Pre sion (Depo Medrol) , MetMab , Metoclopramide Injection 50 vacid I.V. (Lansoprazole for Injection ), Primaxin I.V. ( Imi ( Reglan Injection ), Metrodin (Urofollitropin for Injection ), penem and Cilastatin for Injection ) , Prochyrnal, Procrit , Metronidazole Injection (Flagyl Injection ) , Miacalcin , Progesterone, ProHance (Gadoteridol Injection Solution ), Midazolam (Midazolam Injection ) , Mimpara (Cinacalet ) , Prolix (Denosumab Injection ), Promethazine HC1 Injection Minocin Injection (Minocycline Inj) , Minocycline Inj (Mi (Promethazine Hydrochloride Injection ) , Propranolol nocin Injection ), Mipomersen , Mitoxantrone for Injection 55 Hydrochloride Injection (Propranolol Hydrochloride Injec Concentrate (Novantrone ) , Morphine Injection (Du tion ), Quinidine Gluconate Injection (Quinidine Injection ), ramorph ), Morphine Sulfate XR Liposome Injection ( Depo Quinidine Injection ( Quinidine Gluconate Injection ), Dur) , Morrhuate Sodium (Morrhuate Sodium Injection ) , R -Gene 10 (Arginine Hydrochloride Injection ), Ranibi Motesanib , Mozobil (Plerixafor Injection ) , Multihance (Ga zumab Injection (Lucentis ), Ranitidine Hydrochloride Injec dobenate Dimegiumine injection ), Multiple Electrolytes and 60 tion (Zantac Injection ), Raptiva, Reclast ( Zoledronic Acid Dextrose Injection , Multiple Electrolytes injection , Mylo Injection ), Recombivarix HB , Regadenoson Injection targ (Gemtuzumab Ozogarnicin for Injection ), Myozyme (Lexiscan ), Reglan Injection (Metoclopramide Injection ), ( Alglucosidase alfa ), Nafcillin Injection (Nafcillin Sodium ), Remicade , Renegel, Renvela (Sevelamer Carbonate ) , Nafcillin Sodium (Nafcillin Injection ) , Naltrexone XR Inj Repronex (Menotropins for Injection ), Retrovir IV (Zido ( Vivitrol) , Naprosyn (naproxen ) , Neo Profen ( Ibuprofen 65 vudine Injection ) , rhApo2L / TRAIL , Ringers and 5 % Dex Lysine Injection ) , Nandrol Decanoate , Neostigmine Meth trose Injection (Ringers in Dextrose ), Ringers Injection ylsulfate (Neostigmine Methylsulfate Injection ), NEO (Ringers Injection ), Rituxan , Rituximab , Rocephin (ceftri US 10,471,211 B2 27 28 axone ), Rocuronium Bromide Injection ( Zemuron ), Rof Bromide Injection ), Zenapax (daclizumab ), Zevalin , Zido eron - A ( interferon alfa - 2a ) , Romazicon ( flumazenil) , vudine Injection (Retrovir IV ), Zithromax Injection Romidepsin for Injection ( Istodax ), wizen (Somatropin (Azithromycin ), Zn -DTPA (Pentetate Zinc Trisodium Injec Injection ) , Sandostatin LAR ( Octreotide Acetate Injection ) , tion ) , Zofran Injection (Ondansetron Hydrochloride Injec Sclerostin Ab , Sensipar ( cinacalcet ), Sensorcaine (Bupiva- 5 tion ), Zingo, Zoledronic Acid for Inj (Zometa ), Zoledronic caine NCI Injections ), Septocaine ( Articane HCl and Epi Acid Injection (Reclast ) , Zometa (Zoledronic Acid for Inj) , nephrine Injection ), Serostim LQ ( Somatropin ( rDNA ori Zosyn (Piperacillin and Tazobactam Injection ) , Zyprexa gin ) Injection ), Simponi Injection (Golimumab Injection ), Relprevv (Olanzapine Extended Release Injectable Suspen Sodium Acetate (Sodium Acetate Injection ), Sodium Bicar sion ) and a combination thereof. bonate (Sodium Bicarbonate 5 % Injection ), Sodium Lactate 10 (Sodium Lactate Injection in AVIVA ) , Sodium Phenylac Test Methods etate and Sodium Benzoate Injection ( Ammonul) , Somatro pin ( rDNA origin ) for Inj (Nutropin ), Sporanox Injection It should be understood that although certain methods and ( Itraconazole Injection ), Stelara Injection (Ustekinumab ) , equipment are described below , other methods or equipment Stemen , Sufenta (Sufentanil Citrate Injection ), Sufentanil 15 determined suitable by one of ordinary skill in the art may Citrate Injection (Sufenta ) , Sumavel , Sumatriptan Injection be alternatively utilized . ( Alsuma) , Symlin , Symlin Pen , Systemic Hedgehog Antago Helium Leak nist , Synvisc - One (Hylan G - F 20 Single Intra - articular To evaluate the seal of the plunger to the barrel the leak Injection ), Tarceva, Taxotere (Docetaxel for Injection ) , rate of helium from the internals of an assembled syringe Technetium Tc 99m , Telavancin for Injection ( Vibativ ), 20 system to the external environment was performed . This was Temsirolimus Injection ( Torisel ), Tenormin I.V. Injection accomplished by placing a stopper into a dry bare glass (Atenolol Inj) , Teriparatide (rDNA origin ) Injection (For barrel (no lubricant present) and restraining the plunger rod teo ), Testosterone Cypionate , Testosterone Enanthate , Tes to prevent movement of the stopper during testing . The tosterone Propionate , Tev - Tropin (Somatropin , rDNA Ori internal volume of the assembled syringe was evacuated gin , for Injection ), tgAAC94 , Thallous Chloride , 25 through the needle by use of a vacuum and replaced with a Theophylline, Thiotepa ( Thiotepa Injection ), Thyroglobulin helium atmosphere pressurized to approximately 1 prig . The ( Anti - Thymocyte Globulin (Rabbit ), Thyrogen ( Thyrotropin space around the syringe was monitored by use of a Gas Alfa for Injection ), Ticarcillin Disodium and Clavulanate chromatography /mass spectrometry (GC /MS ) tuned for Potassium Galaxy ( Timentin Injection ), Tigan Injection helium (LACO's Titan TestTM Helium Leak Tester , Salt Lake ( Trimethobenzamide Hydrochloride Injectable ), Timentin 30 City , Utah ) . The area around the syringe was evacuated, and Injection ( Ticarcillin Disodium and Clavulanate Potassium analyzed for Helium concentration to determine a helium Galaxy ) , TNKase, Tobramycin Injection ( Tobramycin Injec leak rate at 1 minute after helium differential pressure of tion ), Tocilizumab Injection ( Actemra ), Torisel ( Temsimli approximately 15.7 psid was established . mus Injection ), Totect (Dexrazoxane for Injection , Intrave Slide Force nous Infusion Only ) , Trastuzumab - DM1, Travasol (Amino 35 Slide force was measured by filling syringe with 0.96 ml Acids ( Injection )) , Treanda (Bendamustine Hydrochloride of Water For Injection (WFI ) and inserting stopper using a Injection ), Trelstar ( Triptorelin Pamoate for Injectable Sus vent tube stopper insertion machine . The syringe used was pension ) , Triamcinolone Acetonide, Triamcinolone Diac a staked needle design with a 29 gauge 1/2 inch needle . An etate , Triamcinolone Hexacetonide Injectable Suspension appropriate plunger rod to match the stopper Aij was fitted (Aristospan Injection 20 mg) , Triesence ( Triamcinolone 40 into the assembled syringe system without moving or dis Acetonide Injectable Suspension ) , Trimethobenzamide turbing the stopper . The system was placed into a holder on Hydrochloride Injectable ( Tigan Injection ), Trimetrexate a force displacement analyzer and the cross head moved at Glucuronate Inj (Neutrexin ), Triptorelin Pamoate for Inject a rate of 25 mm /minute until contact was made between the able Suspension ( Trelstar ) , Twinject , Trivaris ( Triamcino crosshead and the plunger rod proximal end . The test speed lone Acetonide Injectable Suspension ), Trisenox ( Arsenic 45 of 250 mm /minute was established , after which force dis Trioxide Injection ) , Twinrix , Typhoid Vi, Ultravist ( Iopro placement data was obtained . The maximum force obtained mide Injection ), Urofollitropin for Injection (Metrodin ), was recorded . The force displacement instrument used was Urokinase Injection (Kinlytic ), Ustekinumab ( Stelara Injec a TA XT Plus Texture Analyzer with a TA 270N syringe test tion ), Ultralente ( U ) , Valium (diazepam ), Valproate Sodium fixture (Hamilton , Mass. ) . Injection (Depacori ), Valtropin (Somatropin Injection ) , Van- 50 Contact Width comycin Hydrochloride ( Vancomycin Hydrochloride Injec The contact width of the plunger interface with a glass tion ) , Vancomycin Hydrochloride Injection (Vancomycin barrel was measured under 30x magnification averaging 3 Hydrochloride ), Vaprisol ( Conivaptan Hel Injection ), measurements on each rib using a Keyence digital microm VAQTA , Vasovist (Gadofosveset Trisodium Injection for eter VHX -5000 ( Itasca , Ill .) . Intravenous Use ), Vectibix (Panitumumab Injection for 55 Barrel ID Intravenous Use ) , Venofer (Iron Sucrose Injection ), Verte The internal diameter of the syringe barrel was measured porfin (Visudyne ), Vibativ ( Telavancin for Injection ), Vic by use of a digital three point internal micrometer (Mitutoyo toza (Liraglutide [rDNA ] Injection ), Vimpat ( Iacosamicle series 468 , Aurora, Ill. ) . Tablet and Injection ) , Vinblastine Sulfate (Vinblastine Sul Stopper Rib Diameter and Rib Radius fate Injection ), Vincasar PFS (Vincristine Sulfate Injection ) , 60 The rib diameter and rib radius of the stopper was Victoza , Vincristine Sulfate (Vincristine Sulfate Injection ), measured using an optical measurement system (Keyence Visudyne ( Verteporfin Inj) , Vitamin 8-12 , Vivitrol (Naltrex IM 6225 , Itasca , Ill. ) . one XR Inj) , Voluven (Hydroxyethyl Starch in Sodium Chloride Injection ), Xeloda, Xenical (orlistat ), Xeomin (In EXAMPLES cobotulinum toxin A for Injection ), Xolair , Zantac Injection 65 (Ranitidine Hydrochloride Injection ), Zemplar Injection A series of stoppers was fabricated as described in U.S. (Paricalcitol Injection Fliptop Vial) , Zemuron (Rocuronium Pat . No. 8,722,178 to Ashmead , et at using a halobutyl with US 10,471,211 B2 29 30 an initial modulus of 3.5 MPa . The stoppers were sized for What is claimed is : use with a 1 ml long bare glass (not siliconized or otherwise 1. A medical delivery device comprising : treated ) syringe barrel with a nominal inside diameter of a barrel having an inner surface ; a plunger rod having a distal end inserted within the 6.35 mm . The stoppers differed in number , shape and size of barrel ; the ribs intended to form the seal against the interior of the 5 a stopper attached to the distal end of the plunger rod and syringe barrel. After processing was completed , the stopper contacting at least a portion of the inner surface of the was measured using non -contact measuring equipment. The barrel, the stopper comprising an elastomeric body, one average results for each design are reported in Table 1. The or more fluoropolymer layers , and two or more ribs stoppers were washed using warm purified water with a having a sealing surface and being positioned on the small amount of detergent, then rinsed and dried to remove 10 one or more fluoropolymer layers ; any residual contamination from fabrication . The stoppers wherein a contact width between at least one of said two were inserted into bare glass barrels and tested as described or more ribs and a portion of the inner surface of the herein . The results are reported in Table 2. Rib 1 is the distal barrel measured at a compressibility of greater than about 7.9 % of the stopper is less than about 1.0 mm . end rib and subsequent ribs count up towards the proximal 15 2. The medical delivery device of claim 1 , wherein said end . inner surface is a hydrophilic inner surface . Example 1 and Example 2 in Tables and 2 are stoppers 3. The medical delivery device of claim 1, wherein said which meet the intent, of this disclosure. inner surface is free or substantially free of lubricants . Comparative Example 3 in Tables 1 and 2 is an example 4. The medical delivery device of claim 1 , wherein said of a stopper which has good slide force but is insufficient in 20 two or more ribs are laminated with said one or more diameter to achieve the required seal and is therefore insuf fluoropolymer layers. ficient . 5. The medical delivery device of claim 1 , wherein said Comparative Example 4 in Tables 1 and 2 is an example stopper further comprises a sliding surface that is less than of a stopper which achieves the required seal but has about 2.0 mm . excessive slide force due to a larger than desired contact 25 6. The medical delivery device of claim 1 , wherein the between the stopper and the barrel and is therefore insuffi inner surface is bare glass . cient. 7. The medical delivery device of claim 1 , wherein each rib of said two or more ribs has a sealing surface that In the Tables, OD represents outer diameter and ID comprises a radius of curvature at an apex of each respective represents inner diameter . 30 rib that is less than about 0.22 mm . 8. The medical delivery device of claim 7 , wherein a ratio TABLE 1 of a maximum outer diameter of all said ribs having a Rib 4 sealing surface to an inner diameter of the inner surface of OD Rib 1 OD Rib 2 OD Rib 3 OD / rad , the barrel is greater than about 1.08 . rib 1 radius rib 2 radius rib 3 radius Rib 5 35 9. The medical delivery device of claim 7 , wherein a Sample ( mm ) (mm ) (mm ) (mm ) (mm ) (mm ) OD / rad maximum outer diameter of said ribs having a sealing Example 1 7.42 0.12 7.41 0.13 6.73 0.26 surface is greater than about 5.0 mm , an inner diameter of Example 2 7.42 0.15 7.41 0.16 7.40 0.16 the inner surface of the barrel is between about 4.65 mm and Comparative 6.62 0.90 6.62 0.89 6.62 0.89 Example 3 about 11.85 mm , and a ratio of the maximum outer diameter Comparative 7.35 0.07 7.27 0.14 7.21 0.16 7.20 / 0.173, 40 of said ribs having a sealing surface to an inner diameter of Example 4 7.23 / 0.21 the inner surface of the barrel is greater than about 1.08 . 10. The medical delivery device of claim 1 , wherein the one or more fluoropolymer layers comprise a single layer of TABLE 2 densified expanded polytetrafluoroethylene . 45 11. The medical delivery device of claim 10, wherein each Total Maxi rib of said two or more ribs comprises a radius of curvature Contact mum at an apex of each respective rib of less than about 0.22 mm . width extrusion Com Contact (ribs He (break 12. The medical delivery device of claim 11, wherein a Barrel pression width with leak loose ) ratio of a maximum outer diameter of all said ribs having a ID (Rib 1 ) rib 1 C > rate force 50 sealing surface to an inner diameter of the inner surface of Sample (mm ) - ( % ) (mm ) 7.9 % ) (sccs ) ( N )) the barrel is greater than about 1.08 . Example 1 6.35 14.42 0.37 0.73 8.27-8 9.8 13. The medical delivery device of claim 11 , wherein a Example 2 6.35 14.47 0.56 1.62 4.7-8 12.5 maximum outer diameter of the ribs having a sealing surface Comparative 6.35 4.06 0.52 N / A 1.5-5 5.2 is greater than about 5.0 mm , an inner diameter of the inner example 3 55 surface of the barrel is between about 4.65 mm and about Comparative 6.35 13.61 0.40 1.94 7.7-8 21.8 11.85 mm , and a ratio of the maximum outer diameter of example 4 said ribs having a sealing surface to an inner diameter of the inner surface of the barrel is greater than about 1.08 . The invention of this application has been described 14. The medical delivery device of claim 1 , wherein the above both generically and with regard to specific embodi- 60 one or more fluoropolymer layers comprise a composite ments . It will be apparent to those skilled in the art that fluoropolymer film having a barrier layer and a porous layer , various modifications and variations can be made in the the barrier layer comprising at least one member selected embodiments without departing from the scope of the dis from densified ePTFE , PTFE , fluorinated ethylene propyl closure . Thus, it is intended that the embodiments cover the ene, polyethylene, polypropylene, polyvinylidene fluoride, modifications and variations of this invention provided they 65 polyvinylfluoride , perfluoropropylevinylether , or a perfluo come within the scope of the appended claims and their roalkoxy polymer and copolymers and combinations equivalents. thereof. US 10,471,211 B2 31 32 15. The medical delivery device of claim 14 ,wherein each 22. The plunger rod of claim 18 , wherein the one or more rib of the said two or more ribs comprises a radius of fluoropolymer layers comprise a single layer of densified curvature at an apex of curvature of each respective rib that expanded polytetrafluoroethylene . 23. The plunger rod of claim 18 , wherein the one or more is less than about 0.22 mm . 5 fluoropolymer layers comprise a composite fluoropolymer 16. The medical delivery device of claim 15 , wherein a film having a barrier layer and a porous layer, the barrier ratio of a maximum outer diameter of all said ribs having a layer comprising at least one member selected from densi sealing surface to an inner diameter of the inner surface of fied ePTFE , PTFE , fluorinated ethylene propylene , polyeth the barrel is greater than about 1.08 . ylene, polypropylene , polyvinylidene fluoride, polyvinyl 17. The medical delivery device of claim 15 , wherein a fluoride, perfluoropropylevinylether, perfluoroalkoxy maximum outer diameter of the ribs having a sealing surface 10 polymers and copolymers and combinations thereof. is greater than about 5.0 mm , an inner diameter of the inner 24. A stopper insertable in a barrel having an inner surface of the barrel is between about 4.65 mm and about surface, the stopper comprising : an elastomeric body; 11.85 mm , and a ratio of the maximum outer diameter of one or more fluoropolymer layers ; and said ribs having a sealing surface to an inner diameter of the 15 two or more ribs, inner surface of the barrel is greater than about 1.08 . wherein at least one of the two or more ribs is positioned 18. A plunger rod comprising : on the one or more fluoropolymer layers and is con a distal end that is insertable in a barrel having an inner figured to contact at least a portion of the inner surface surface ; and of the barrel; and a stopper attached to the distal end and configured to 20 wherein each rib of said two or more ribs comprises a contact at least a portion of the inner surface of the radius ofcurvature at an apex of each respective rib that barrel, the stopper comprising an elastomeric body, one is less than about 0.22 mm , a ratio of a maximum outer or more fluoropolymer layers , and two or more ribs diameter of all said ribs to an inner diameter of the positioned on the one or more fluoropolymer layers , inner surface of the barrel is greater than about 1.08 , wherein each rib of said two or more ribs having a sealing 25 and surface comprises a radius of curvature at an apex of wherein the stopper is configured such that when the each respective rib that is less than about 0.22 mm , a stopper is inserted in the barrel , a contact width ratio of a maximum outer diameter of all said ribs between at least one of said two or more ribs and the having a sealing surface to an inner diameter of the portion of the inner surface of the barrelmeasured at a inner surface of the barrel is greater than about 1.08 , 30 and compressibility of greater than 7.9 % of the stopper is less than about 1.0 mm . wherein the plunger rod is configured such that when the 25. The stopper of claim 24 , wherein said two or more ribs plunger rod is inserted in the barrel having an inner are laminated with said one or more fluoropolymer layers . diameter of an inner surface of the barrel , a contact 26. The stopper of claim 24 , wherein the one or more width between at least one of said two or more ribs 35 fluoropolymer layers comprises a single layer of densified having a sealing surface and the portion of the inner expanded polytetrafluoroethylene. surface of the barrel measured at a compressibility of 27. The stopper of claim 24 , wherein the one or more greater than 7.9 % of the stopper is less than about 1.0 fluoropolymer layers comprise a composite fluoropolymer mm . film having a barrier layer and a porous layer, the barrier 19. The plunger rod of claim 18 , wherein said inner 40 surface is a hydrophilic inner surface . layer comprising at least one member selected from densi 20. The plunger rod of claim 18 , wherein said inner fied ePTFE , PTFE , fluorinated ethylene propylene ( FEP ) , surface is free or substantially free of lubricants . polyethylene, polypropylene, polyvinylidene fluoride , poly 21. The plunger rod of claim 18 , wherein said two or more vinylfluoride, perfluoropropylevinylether, perfluoroalkoxy ribs are laminated with said one or more fluoropolymer polymers and copolymers and blends thereof. layers.