1. Field of the Invention
The invention generally relates to methods and compositions for the controlled and sustained release of peroxides (e.g., hydrogen peroxide, calcium peroxide, zinc peroxide, sodium peroxide, magnesium peroxide, etc.) or oxygen for use in biological, industrial, and other applications. The invention includes methods and compositions for the generation of oxygen from various peroxides in, for example, aqueous and non-aqueous environments including without limitation biological tissues in humans and animals; soil, lake and other environments; in tanks and reservoirs for industrial or medical applications, etc.
2. Background of the Invention
The leading cause of preventable death due to traumatic injury on the battlefield is hemorrhage.1, 2 Hemorrhage is the second leading cause of death in civilian trauma.3 Hemorrhagic shock leads to either immediate or delayed death by reducing oxygen delivery to vital organs to levels below those needed to sustain oxidative metabolism. When this occurs over a long enough period of time, the result is the production of massive oxygen debt or tissue ischemia.4 Obviously, the treatment of such injuries must utilize approaches which combine hemorrhage control (when possible) with restoration of adequate oxygen delivery to avoid accumulation of oxygen debt levels that are associated with immediate or delayed death.4, 5 Even when bleeding is controlled, restoration of oxygen delivery above critical threshold levels to maintain survival is challenging.
There is a need for improved mechanisms for providing oxygen to tissues and organs of humans and animals over an extended period of time. Sustained delivery of oxygen can also be a benefit to many non-medical applications. Similarly, there is a need for improved mechanisms for providing peroxides, including without limitation hydrogen peroxide and inorganic peroxides, over an extended period of time for both biological and industrial applications.
In an exemplary embodiment, a peroxide or oxygen producing composition is provided which includes a nanoparticulate peroxide slurried with a hydrophobic fluid. The hydrophobic liquid, which can be for example perfluorinated compounds such as perfluorodeclin as well as a wide variety of other compounds protect the nanoparticulate peroxide from water until desired. The nanoparticulate peroxide is preferably present in crystalline form, but can also be non-crystalline, and is preferably on the order of nanometers in diameter, however, given application, the particulate can have median diameters that are sub-micron (10−12 to 10−6 being preferred), millimeter, or even larger sizes. Upon exposure to water or other aqueous fluid which may diffuse or otherwise pass through the hydrophobic liquid to contact the nanoparticulate peroxide, hydrogen peroxide or oxygen is produced which can then be delivered to a desired environment (a wound, a polluted soil, a tank requiring sterilization, etc.). In the case of delivering hydrogen peroxide, the environment itself may include enzymes (catalase and others) which cause generation of oxygen from the hydrogen peroxide. The nanoparticulate peroxide might be freeze dried hydrogen peroxide, an inorganic peroxide (calcium peroxide, sodium peroxide, magnesium peroxide, etc.), or a peroxide adduct (compounds which include hydrogen peroxide molecules, e.g., sodium carbonate perhydrate (Na2CO3.1.5H2O2), urea hydrogen peroxide ((NH2)2CO.H2O2) (UHP), histidine hydrogen peroxide, adenine hydrogen peroxide, and alkaline peroxyhydrates (for example, sodium orthophosphorate).
In another exemplary embodiment, the peroxide or oxygen producing composition may be encapsulated in a membrane or coating which retains the composition and protects it from exposure to water or aqueous fluid until used. The membrane or coating preferably will selectively allow water (e.g., from the environment in which the composition is to be used) to pass through (from the environment into encapsulated or coated composition), and will allow hydrogen peroxide or oxygen (which are similarly sized to water and have other similar characteristics) that is generated upon contact of the peroxide or oxygen producing composition with water to pass through (e.g., the oxygen or hydrogen peroxide (or inorganic peroxides (e.g. sodium, lithium, calcium, zinc, or magnesium peroxides)) will be directed out through the membrane or coating into the environment). However, the membrane or coating will retain the peroxide or oxygen producing composition. The membrane or coating might include catalysts such as iron and copper species, or enzymes such as catalase embedded therein or otherwise associated therewith such that if hydrogen peroxide is generated by contact of the peroxide or oxygen producing composition with water, the hydrogen peroxide will be converted or otherwise decomposed to oxygen upon traversal of the membrane or coating. In an alternative exemplary embodiment, the peroxide or oxygen producing composition will be interlaced into gauze (e.g., a bandage application) or other suitable carrier, where the carrier is preferably hydrophobic so as to allow the peroxide or oxygen producing composition which itself preferably includes a hydrophobic component (e.g., a hydrophobic liquid) co-mingle and associate with the carrier. The rate of delivery of the peroxide or oxygen may be controlled, without limitation, by the choice of hydrophobic liquid, the ratio of hydrophobic liquid to nanoparticulate peroxide (when the peroxide or oxygen producing composition is a slurry of the same), the characteristics of the membrane or coating which encases the peroxide or oxygen producing composition, or the characteristics of the carrier.
Whole body oxygen delivery can be described by the following equation:
DO2=CO×CaO2
where DO2 stands for oxygen delivery or the volume of oxygen delivered to the systemic vascular bed per minute. It is the product of cardiac output (CO) in liters/minute, and arterial oxygen content (CaO2) cc/dl. CaO2 can be further defined by the equation:
CaO2=Hb×1.36×SaO2+(PaO2×0.003).
In this equation, Hb is hemoglobin in gm/dl, SaO2 is the percent saturation of hemoglobin by oxygen, and PaO2 is the partial pressure of oxygen in arterial plasma in mmHg. The factor 1.36 is the estimate of the mean volume of oxygen (ml) that can be bound by 1 gm of normal hemoglobin when it is fully saturated (SaO2=1.0). The factor 0.003 is the solubility coefficient of oxygen in human plasma. Thus for an average human with a hemoglobin level of 15 gm/dl and with a PaO2 of 100 mmHg (and thus an SaO2 of approximately 1.0), an arterial oxygen content of 20.3 ml/dl of oxygen:
CaO2=15 gm/dl×1.36×1.0 +(100×0.003)=20.3 cc/dl.
As the equation demonstrates, the amount of oxygen dissolved in plasma does not normally make a significant contribution to CaO2. This is due to the low solubility of oxygen in plasma. DO2 for an individual with a cardiac output of 5 l/min and CaO2 of 20 cc/dl would be 1000 cc/min.
Oxygen consumption (VO2) is the amount of oxygen that is normally consumed by tissues and averages 250 cc/min for an adult. Since oxygen transport averages 1000 cc/min, about 750 cc/min returns to the right heart in venous blood each minute. This 750 cc/min of oxygen is still carried in 5 liters or 50 dl of blood each minute. Each 1 dl therefore carries 15 cc/dl (750 cc/min divided by 50 dl/min). Thus the average V02 is 5 volume %.
The above discussion illustrates the challenges in restoring and maintaining tissue oxygenation in the setting of hemorrhagic shock, even when hemorrhage is controlled. Because hemoglobin is the major carrier of oxygen, simple restoration of circulating volume will, in and of itself, be insufficient to overcome reductions in CaO2 since current intravenous fluids cannot carry oxygen any better than plasma. This problem is compounded if victims have respiratory insufficiency and cannot be provided supplemental oxygen. While these latter issues are more readily resolved in the civilian trauma setting, their recognition and correction in the combat setting can be impossible since the provision of supplemental oxygen and the routine performance of endotracheal intubation or other forms of respiratory support is severely limited. Thus hypoxemia can be a major contributing factor to critical reductions in DO2.
Acute soft tissue wounds and burns require sufficient oxygen delivery to maintain cellular viability and to prevent superinfection. Oxygen delivery to wounds and burns is many times insufficient due to circulatory compromise from causes ranging from anemia, tissue edema, and vascular destruction. The timing and type of fluid resuscitation after incurring burns can influence the transition of partial thickness bums to full thickness burns.7 Therefore, metabolic support prior to definitive treatment can be tissue sparing.
Various strategies have been proposed and many studied as a means to improve short-term survival in the setting of traumatic shock. These have focused on providing low volume plasma expanders such has hypertonic saline and hetastarch as a means of increasing cardiac output and keeping tissue vascular beds open.8, 9 While this is helpful and tissue oxygen delivery will be improved to some extent, it cannot routinely compensate for major reductions in CaO2 for the reasons above. Additional strategies have involved the creation of hemoglobin and nonhemoglobin based oxygen carriers (HBOC and NHBOC). While promising both HBOC's and NHBOC's have their limitations. For HBOC's, the major concern is the amount needed to raise hemoglobin to significant levels as well as storage and product source (bovine, etc).10 Even if provided in sufficient levels, hypoxemia due to various causes (inability to manage the airway, inability to provide supplemental oxygen, etc) would limit its potential ability to restore tissue oxygen delivery.
The major NHBOC strategies involve the use of perfluorocarbons (PFC's).10-12 PFC's are composed entirely of carbon and fluorine. They are biologically and pharmacologically inert. PFC's have the unique ability to dissolve and carry significant quantities of gases. In terms of oxygen, PFC's have the ability to carry between 5-18 volume % (250 cc or greater of oxygen). This amount of oxygen is capable of meeting the metabolic demands of an adult human. Animal studies have demonstrated the ability of animals to survive complete exchanges of blood for PFC. However, in order for PFC's to carry large quantities of oxygen, the inspired concentration of oxygen must be very high. This would limit them in situations such as the battlefield where supplemental oxygen would not be readily available or in which the lungs were damaged and alveolar diffusion of oxygen is limited.
A recent iteration on the use of PFCs for oxygen delivery has been noted with the dodecafluoropentane (DDFP) emulsions.13, 14 This PFC undergoes a phase transition from liquid to gas at 37° C. (body temperature). The transition in blood leads to the development of microbubbles. These microbubbles are capable of carrying enormous amounts of gas including oxygen. Preliminary studies have demonstrated that it might be possible for as little 2-5 cc of DDFP to carry enough oxygen to meet the metabolic demands of the body. Issues with this approach include the unknown life-span of the bubbles as well as preventing phase transition prior to administration. Proper airway management and threshold levels of alveolar diffusion of oxygen would still be required, potentially limiting their value in the ultraearly stages of casualty treatment.
Neither current HBOC nor NHBOC products may impact on initial burn or wound treatments to prevent ischemia or transition to states beyond repair in the initial stages of casualty care.
In summary, there is still a technological gap in restoring and/or preventing tissue ischemia in the setting of traumatic shock and traumatic wounds, especially in austere environments such as exist on the battlefield. A need continues to exist in developing novel therapeutic approaches that enhance tissue oxygen delivery especially in the first critical hours after injury.
A standard, off-the-drugstore-shelf, 3% solution of H2O2 contains 30 mg H2O2/ml of solution, which is equivalent to 0.88 moles/l solution since the molecular weight of H2O2 is 34.0. Given that one mole of O2 and two moles of H2O are produced when two moles of H2O2 are exposed to the enzyme catalase, 2H2O2→2H2O+O2, 0.44 moles of O2, or equivalently, 11.2 liters of O2, are generated from one liter of this off-the-shelf H2O2 solution. The estimate of the volume of O2 is made with the Ideal Gas Law (V=nRT/P, where n is the number of moles, R is the gas constant, T is the temperature in K, and P is the pressure in atm.) The normal body temperature is assumed to be 37° C. at one atm for this calculation. The consumption rate of this H2O2 solution is only 22 ml/min to meet the oxygen requirement of a resting 70 kg male, which is approximately 250 ml/min (˜3.6 ml/kg/min).
This large production (sometimes hyperbaric amounts) of oxygen from small amounts of H2O2 is attractive for medicinal uses. In fact, this relationship has been studied for medical purposes dating for the early and mid-1900s in animals and humans.15-21 Remarkable reports exist of H2O2 being used to resuscitate animals in cardiac standstill due to hypoxemia and coronary artery occlusion.21 It has also been used in an attempt to oxygenate patients with severe hypoxemia secondary to influenza.22 While reports were encouraging, these studies do not contain detailed experimental design information and proper controls. It appears that the ability to raise tissue oxygenation levels is less impressive when H2O2 is delivered intravenously as opposed to intra-arterially. This probably has to do with the rapid conversion of H2O2 in the blood to oxygen, which is then off-gassed via normal ventilation.
Most reports, however, ignore the dangers of intravascular administration. It is likely that many unreported deaths have occurred due to its use. When H2O2 is given directly in quantities needed to raise tissue oxygenation, hyperbaric amounts of oxygen are produced. Given the low solubility of oxygen in plasma (0.3 cc/dl blood), the rapid increase in plasma oxygen levels will exceed the ability of the plasma to dissolve it particularly if hemoglobin is already fully saturated with oxygen. The result will be that the oxygen produced by H2O2 will come out of solution forming bubbles. These bubbles will coalesce and be capable of blocking both large vessels as well as the microvasculature. In essence a form of decompression illness will occur. Thus instead of providing oxygen to tissues, ischemia is produced in tissue beds by blockage of blood flow.
Even now, sporadic reports of death after oral ingestion of H2O2 exist.23 These deaths are caused by the development of large oxygen gas emboli which occur as the result of large oxygen production in the lumen of the intestines. This rapid gas production breaches various vascular plexi in the intestines which leads to introduction of gas into the systemic circulation. Thus the use of H2O2 in its native form is too dangerous to contemplate its use in humans due to the uncontrolled release of oxygen. It use in hemorrhagic shock would represent an even more dangerous proposition given the concurrent loss of hemoglobin which acts as the native carrier of oxygen.
In an attempt to control the release of oxygen from the reaction of H2O2 with catalase in the blood, the use of urea-hydrogen peroxide (UHP) has been suggested.24 UHP is a 1:1 adduct of urea and H2O2 and is very stable, decomposing at a temperature of 75-85° C. It is 32% H2O2 by weight with a density of 1.4 g/cc. One gram of UHP (32% H2O2 by weight and equal to 1 cc), will produce 114 cc oxygen. In this setting, the urea adduct is cleaved from the H2O2. The H2O2 is then free to react with catalase to produce oxygen and water.
UHP has been used to treat hypoxemic rabbits with some success.24 However, only enough UHP was used to raise arterial PO2 levels by 10 mmHg. Although this is a small amount, the use of UHP did allow for a rise in arterial PO2 when given intravenously likely due to the delayed conversion of H2O2 into oxygen by the required cleavage of urea from the H2O2. However, other attempts to use UHP in amounts that would supply the oxygen consumption needs of a rabbit failed. When used in amounts necessary to do this, animals died of gas emboli. Even when used in conjunction with PFCs the amount of oxygen produced over short time periods overwhelmed the ability of the PFC to dissolve the oxygen. Use of either straight H2O2 or UHP in wounds would also result in conversion to O2 at rates so rapid as to require amounts of agents too large and application times too often to be practical.
Thus, even though UHP provides a stable source of releasable oxygen in solid form with some delay in the conversion process, it is not sufficient by itself to act as the sole entity for controlled release and delivery of oxygen in amounts required to meet the metabolic needs of the body as a whole or the needs to wounds.
Many other medical and non-medical uses for the safe, controlled and sustained delivery of oxygen also exist. For example, various disinfecting, cleaning, soil cleanup, and whitening agents could benefit from advances in such technology.
Gibbons et al. (U.S. Pat. No. 7,160,553) provides matrices/dressings for oxygen delivery to tissues. However, the matrices/dressing are useful only for localized delivery of oxygen directly to tissues, e.g. directly to a wound. Gibbons also does not disclose a prolonged controlled delivery method.
Montgomery (U.S. Pat. No. 7,189,385) describes tooth whitening compositions that comprise a peroxide source. However, the compositions described by Montgomery are for external application only, and are not suitable for sustained, controlled internal oxygen delivery.
The prior art has thus-far failed to supply a viable solution to the long-standing problem to how to safely deliver large amounts of oxygen to aqueous and nonaqueous environments in a safe, controlled and sustained manner. The present invention provides compositions and methods to safely release oxygen in an aqueous or nonaqueous environment, such as in a patient's body or in non-biological applications, in a sustained, controlled manner.
The prior art also does not provide a mechanism for delivering peroxides to aqueous and non-aqueous environments over a sustained period.
According to an embodiment of the invention, a peroxide or oxygen producing composition which is encapsulated or coated with a selectively permeable material may be used to sustainably provide peroxides (e.g., hydrogen peroxide or inorganic peroxides) over an extended period of time. The peroxide or oxygen producing composition preferably includes a nanoparticulate peroxide slurried with a hydrophobic fluid. In some applications, the membrane or coating may not be present, as the hydrophobic fluid serves to keep water or other aqueous fluid from interacting with the peroxide until desired (i.e., diffusion of water into contact therewith). Also, in some applications, the peroxide or oxygen producing composition might simply include a peroxide adduct which is encased by the encapsulating material or coating. The peroxide or oxygen producing composition can be simply be placed where sustained delivery of peroxides (hydrogen peroxide or inorganic peroxides) or oxygen is desired (e.g., in a wound (e.g., use on a bandage or in a lotion or emulsion or other formulation applied thereto), in soil, in a tank (e.g., for sterilization, etc.). Upon exposure to water or other aqueous fluid which may diffuse or otherwise pass through the hydrophobic liquid (when employed) and or the encapsulating material or coating to contact the peroxide or oxygen producing moiety, hydrogen peroxide, inorganic peroxides or oxygen is produced which can then be delivered to the desired environment. The rate of delivery can be varied in a number of ways including choice of the hydrophobic liquid, varying the ratio of the hydrophobic liquid to nanoparticulate peroxide, choice of the material for encapsulation or coating, or choice of substrate which the composition is associated with. In medical treatments, the patient might be given a bolus dose of perfluorocarbon or like compounds to reduce the chance of embolism or of catalase or other enzymes to supplement the generation of oxygen from hydrogen peroxide, or of oxygen scavengers to prevent oxidative damage, etc. In some applications where the peroxide or oxygen producing composition produces hydrogen peroxide, the encapsulating or coating material may have iron catalysts, catalase or other enzyme catalysts embedded therein or associated therewith to convert hydrogen peroxide to oxygen as the hydrogen peroxide traverses the membrane or coating.
a and 1b show embodiments of the invention where a peroxide or oxygen producing composition 10, which can optionally include a selectively permeable membrane or coating material 20 so as to form a complex 50 is positioned in an environment of interest 40. The environment 40, which may be aqueous or non-aqueous. Water or other aqueous fluid, which may come from the environment itself (exudate from a wound, water in the soil, etc.) or be supplied from an external source (not shown) is permitted to selectively pass through the permeable membrane or coating material 20 of the complex 50 and to come into contact with the peroxide or oxygen producing composition 10. In some embodiments, interaction of the peroxide or oxygen producing composition 10 with water, hydrogen peroxide is produced and hydrogen peroxide is permitted to pass through the material 20 or otherwise be delivered to the environment 40. In the environment 40, enzymes (e.g., catalase) or other catalysts (e.g., iron) which are naturally present or which are supplied by an external source (e.g., supplying a patient (human or animal) with additional catalase to that which is already present naturally) could be used to convert the hydrogen peroxide to oxygen. Furthermore, the membrane or coating material 20 might be constructed to include catalysts such as catalase or iron embedded therein or otherwise associated with the surface such that hydrogen peroxide which is generated by the peroxide or oxygen producing composition may be converted to oxygen as it traverses or otherwise passes through the material 20. In other embodiments of the invention, the hydrogen peroxide itself may be desired (e.g., for disinfecting a wound or industrial surface or soil sample), and the environment 40 would not necessarily include catalysts for generating oxygen from hydrogen peroxide. In still other embodiments, the peroxide or oxygen producing composition 10 will produce oxygen directly (e.g., calcium or magnesium peroxide).
As shown in
The peroxide or oxygen producing composition 10, in a preferred embodiment, includes a nanoparticulate peroxide slurried with a hydrophobic fluid. The slurry can be produced by, for example, ball milling a perfluorocarbon (PFC) such as perfluorodeclin with a peroxide adduct such as UHP. The ball milling process can be performed in the presence of a supercritical fluid such as supercritical carbon dioxide so as to enhance the formation of a fluidized powder of the PFC and the peroxide adduct. In a preferred embodiment the UHP is present in crystalline form with the PFC. Ball milling produces nanoparticles of the UHP/PFC composition 10, and assures a close association of the UHP and PFC. The PFC is present in the form of a hydrophobic liquid and will slow down or otherwise impede water from being exposed to the UHP until the composition is placed, for example, in an aqueous environment such as in a wound where water passes through or otherwise displaces the hydrophobic liquid and comes into contact with the UHP crystals, for example. Other procedures and materials can be used to make nanoparticulate peroxide slurried with a hydrophobic fluid. For example, non-PFC hydrophobic liquids could be used; other peroxide adducts, freeze dried hydrogen peroxide, or inorganic peroxides could be used; and high pressure mixing systems could be used.
By “hydrophobic liquid”, we mean a fluid that will dissolve less than 1% by weight of water if exposed to liquid water or saturated water vapor at room temperature. Examples of suitable hydrophobic fluids include but are not limited to chlorocarbons, (methylene chloride, chloroform, carbon tetrachloride, etc.), hydrofluorocarbons (dihdrodecaflouropentane(VentrelFX)), hydrochlorofluorocarbons (e.g., HCFC 141b and HCFC 123), olefinic waxes and oils, microcrystalline waxes, silicone oils, waxes and gels, perfluorocarbons (e.g. perfluorodecalin, perfluorooctyl bromide); hydrocarbons (e.g. pentane, hexane, etc.); long chain (e.g. greater than about 600) polyethylene glycols (PEGs); ethyl acetate; various oils such as cod liver oil; glyceryl triacetate; water solubility enhancers (e.g. urea, salts, perfluorocarbon ketones, etc.); blood substitutes such as perfluoro-t-butyl cyclohexane and perfluorooctyl bromide; hydrophobic solvents (see, e.g., Flick Industrial Solvents Handbook, 3rd ed., Noyes Data Corporation, Park Ridge, N.J.); etc. Solubility enhancers can also be included including without limitation 1-perfluorohexyl-3-octanone, 1-perflourooctylactanone, 1-(4-perfluorobutylphenyl)-1-hexanone, 1-hexyl-4-perfluorobenzene, and perfluoroethyl phenyl ketone. In some applications, a hydrophobic material that is not a liquid (e.g. a gel or solid) might be used in place of the hydrophobic liquid. Examples of such hydrophobic materials include but are not limited to polymers such as olefinic, styryl, and vinyl polymers, polyamides, polyesters, polyurethanes, polycarbamates, poly ether ether ketones, silicon polymers, polysilanes, fluoropolymers, olefinic and polyethelyene waxes, animal fats, gels made by dissolving polymers in hydrophobic solvents (e.g., PS in toluene, PC in MeCl2).
When the peroxide or oxygen producing composition 10 takes the form of a nanoparticulate peroxide slurried with a hydrophobic liquid or material, the choice of hydrophobic liquid can vary widely, with PFCs being only one example. The nanoparticulate peroxide is preferably present in crystalline form, but can also be non-crystalline, and is preferably on the order of nanometers in diameter, however, given application, the particulate can have median diameters that are sub-micron (10−12 to 10−6 being preferred), millimeter, or even larger sizes.
The peroxide or oxygen producing composition 10 might be interlaced into gauze or other cellulose containing materials or otherwise be associated with a carrier having a hydrophobic surface or region. For example, a bandage or wound care device may have the peroxide or oxygen producing composition 10 associated with cellulose polymers or hydrophobic surfaces or regions such that when the bandage or wound care device is applied to or inserted into a wound, it can supply, for example, hydrogen peroxide, inorganic peroxides or oxygen directly to the wound.
The peroxide adducts produce hydrogen peroxide; however, calcium or sodium carbonates or peroxides will produce oxygen directly on contact with water. In a number of embodiments of the invention the peroxide or oxygen producing composition 10 is a peroxide adduct. UHP is particularly attractive since the urea produced is physiologically compatible with the body. However, in some embodiments, freeze dried hydrogen peroxide or inorganic peroxides might be used. In most medical applications, it will be desirable to select an oxygen producing or hydrogen peroxide producing compound for use as or with the peroxide or oxygen producing composition 10.
The rate of hydrogen peroxide, inorganic peroxide or oxygen generation can be controlled by the selection of the hydrophobic liquid or by the controlling the ratio of the hydrophobic liquid to peroxide adduct. However, the rate can also be controlled by using a encapsulating or coating material 20. The membrane or coating material 20 preferably will selectively allow water (e.g., from the environment in which the composition is to be used) to pass through (from the environment into encapsulated or coated composition), and will allow hydrogen peroxide or oxygen (which are similarly sized to water and have other similar characteristics) that is generated upon contact of the peroxide or oxygen producing composition with water to pass through (e.g., the oxygen or hydrogen peroxide (or inorganic peroxide) will be directed out through the membrane or coating material 20 into the environment 40). However, the membrane or coating material 20 will retain the peroxide or oxygen producing compound separate from the environment 40 a length of time desired (e.g., until the material 20 biodegrades). In some applications, the rate of delivery will produce a flux of approximately 1-5×10−6 moles peroxide/square centimeter.
By “selectively permeable membrane” or “selectively permeable barrier” we mean that the material 20 is of a nature that allows certain molecules to pass through it by passive diffusion, while excluding others, and/or that allows the passage of different molecules at different rates. The rate of passage is dependent on the pressure, concentration and temperature of the molecules that are traversing the barrier. Such barriers are also referred to as “partially permeable” or “differentially permeable”. According to the present invention, the peroxide adduct itself should not cross the barrier in most applications. Examples of materials that are suitable for use as selectively permeable membranes/barriers include but are not limited to: poly(lactic-co-glycolic acid) (PLGA) blends (e.g. pure polyglycolic acid (PGA), pure polylactic acid (PLA), and blends in the range of about 1:100 PGA to PLA or 1:100 PLA to PGA, or various blends with ratios in between e.g. about 10:90, 20:80, 30:70, 40:60 or 50:50, the composition being known to affect crystallinity and solubility and the transport rate of water and thus of H2O2; polyanhydrides; polysaccharides; polyamide esters; polyvinyl esters; polybutyric acid; poly(R)-3-hydroxybutyrate, poly(ε-caprolactones); etc. Preferably, and particularly when the invention is used to treat patients (humans or animals), the membrane/barrier material is non-toxic and biodegradable. Exemplary biodegradable polymers for use in human and animal patients include without limitation poly(α-hydroxy esters) including poly(glycolic acid) polymers, poly(lactic acid) polymers, poly(lactic-co-glycolic acid) co-polymers, poly(ε-caprolactone) polymers, poly(ortho esters), polyanhydrides, poly(3-hydroxybutyrate) copolymers, polyphosphazenes, fumarate based polymers including poly(propylene fumarate), poly(propylene funarate co-ethylene glycol), and oligo(poly(ethylene glycol) fumarate), polydioxanones and polyoxalates, poly(amino acids), and pseudopoly(amino acids).
In some applications of the invention, the peroxide or oxygen producing composition 10 is simply a peroxide adduct, straight hydrogen peroxide (e.g., in freeze dried form), or an inorganic peroxide (as opposed to a peroxide adduct slurried together with a hydrophobic liquid), and the peroxide adduct is coated with the selectively permeable material 20.
The present invention provides compositions and methods to safely generate or release oxygen or peroxides (hydrogen peroxides or inorganic peroxides) in aqueous and nonaqueous environments in a sustained, controlled manner. In the case of oxygen release, the source of the O2 can be H2O2 which is subsequently catalyzed by exposure to iron or catalase or other enzymes to produce oxygen; a peroxide adduct; an inorganic peroxide, peroxide which directly decomposes to form oxygen, etc. The oxygen or peroxide producing compounds can be peroxide adducts such as UHP, carbamide peroxide, histidine hydrogen peroxide, adenine hydrogen peroxide, sodium percarbonate, and alkaline peroxyhdrates; inorganic peroxides such as sodium, lithium, calcium, zinc or magnesium peroxides; straight or freeze dried hydrogen peroxide. The environment 40 (i.e., the “use environment” or “aqueous environment”) can vary widely and can serve as a source of water for reaction with the H2O2, inorganic peroxides, or a peroxide adduct and as a recipient of the H2O2 or inorganic peroxides that are generated by the reaction of water (or other (e.g., non-aqueous) fluid) with the peroxide or oxygen generating composition 10. As noted above, the environment 40 may contain the enzyme catalase or other enyzmes, either naturally (e.g. when the environment is a within a patient) or through the addition of catalase or other enzymes or a source of catalase or other enzymes (e.g. when the invention is practiced outside the context of the direct treatment of patients, or when it is necessary or beneficial to augment a patient's normal supply of catalase). In some embodiments, this external environment does not contain catalase, but serves as a reservoir to hold the H2O2 that is generated. The H2O2 may then be transferred to another location at which catalase, or other agents which can liberate O2, are present and O2 is formed. These may include such catalysts as ferric chloride, cupric chloride, etc. By “catalase” we mean the well-known catalase enzyme found in living organisms. Catalase catalyzes the decomposition of hydrogen peroxide to water and oxygen. This enzyme has one of the highest turnover rates for all enzymes; one molecule of catalase can convert millions of molecules of hydrogen peroxide to water and oxygen per second. The enzyme is a tetramer of four polypeptide chains, each over 500 amino acids long. It contains four porphyrin heme (iron) groups which allow the enzyme to react with the hydrogen peroxide. The optimum pH for catalase is approximately neutral (pH 7.0), while the optimum temperature varies by species. In the practice of the present invention, preparations of the enzyme, as are known in the art, may be utilized. Alternatively, in some embodiments, the use of a source of catalase, (e.g. a vector that encodes the enzyme, or an organism that is genetically engineered to overproduce the enzyme) may be appropriate. Furthermore, in some application agents other than catalase which are capable of liberating O2 may be included or added to the environment 40 However, as discussed above, it should be understood that rather than using catalase or other enzymes, the membrane itself could be fabricated to include iron or copper catalysts, and that the peroxide would be converted to oxygen as it traversed the membrane. Furthermore, it should be understood that in some applications release of hydrogen peroxide or inorganic peroxides alone is the objective (not generation of oxygen). For example, the peroxides can serve as cleaning and disinfecting agents in industrial and soil applications. In these cases, enzymes are not required. Also, it will be understood that, if oxygen generation is desired, this can be achieved by decomposition of peroxides as opposed to requiring enzymes.
The arrangement and form of the peroxide or oxygen generating composition 10 can take a wide variety of forms depending on the application. For example, the peroxide or oxygen producing composition 10 and surrounding material 20 (if any) may be prepared roughly in the shape of spheres of any useful size or amorphous particles of any useful size. They may be formed into various shapes such as discs, blocks, filaments, layers, cylinders (e.g. hollow tubes or solid cylinders), or molded to fit other useful and specific shapes, e.g. the interior of a particular container, or as a paste or gel for versatile application. Further, they may be “hard” or “brittle”, or they may be flexible or pliable in nature. An example of a means to produce various forms and properties would be the use of electrospinning to produce H2O2 or oxygen producing embedded nanofilaments for topical applications. In addition, electrospraying can be used to coat materials on the peroxide or oxygen producing composition 10.
While
In another embodiment, a solid peroxide or oxygen generating composition can be dispersed in a hydrophobic fluid, where the mixture of the peroxide or oxygen generating composition and the hydrophobic fluid are isolated from the use environment, (e.g. an aqueous environment) by a selectively permeable barrier. This embodiment of the invention is illustrated schematically in
While
Those of skill in the art will recognize that this embodiment of the invention is not confined to the particular arrangement shown in
The oxygen generating system described herein can be used for the medical treatment of patients. It can be particularly useful for supplying oxygen to oxygen starved tissues within a patient in need thereof. The blood or plasma of the patient can be the “aqueous environment” discussed above, and can supply native catalase to convert hydrogen peroxide to oxygen. Also, the blood or plasma can be supplemented with additional catalase or other enzymes, as well as oxygen scavengers to assist in controlling the rate of oxygen generation in the patient and to prevent oxidative damage. Preferably, the peroxide or oxygen generating composition provided to the patient is in particulate form and administration may be accomplished by any of a variety of known methods, including but not limited to by injection, addition to blood or plasma being supplied to a patient, incorporation in a device or material which will contact blood or a tissue, aerosolization, ingestion, interperitoneal, intracolonic administration, administration in situ to for example explanted organs for preservation, etc. In this embodiment, the particles are preferably stored in a non-aqueous environment, e.g. “dry” such as under vacuum or with a desiccant, and are reconstituted in an administrable (e.g. liquid, emulsion, gel or solid) form prior to administration. Alternatively, the particles may be stored in a liquid material with very low or no water content (e.g. an oil or other hydrophobic liquid) and either administered directly, or further reconstituted prior to administration.
For such medical uses, such particles may be provided as an emulsion in a non-aqueous physiologically acceptable carrier such as those listed above. Of particular interest are carriers that offer the advantage of decreasing the possibility of O2 emboli formation. Carriers such as PFCs have the ability to increase the dissolution of nonpolar gases such as O2 (and N2) by a factor of 20-100 fold over human plasma. As such, PFCs are known to be useful as a means of treating decompression illness, and as blood substitutes. Another suitable carrier is dodecafluoropentene. Dodecafluoropentene is capable of creating microbubbles, which may provide additional compartments within plasma to carry intravascular O2 generated by the methods of the invention. Using the methods of the invention, an increase in the O2 carrying capacity of the blood or plasma in the amount of at least about 1 volume percent, and preferably at least about 2 volume percent, more preferably about 3 volume percent, most preferably about 4 or even 5 volume percent or more, may be achieved. Other materials such as Crocentin which enhance diffusion through the rearrangement of water molecules may also be helpful as adjuncts.
As discussed above, although mammalian bodies contain a large amount of circulating catalase, or other agents capable of liberating O2 medical use embodiments of the invention may also include the co-administration of additional catalase to further increase the O2 generating capacity for the patient. In addition, other substances may be co-administered with the H2O2 generating material, examples of which include but are not limited to additional carriers (e.g. PFCs, blood substitutes, etc.) and antioxidants and/or free radical scavengers. Such substances may be administered in admixture with the H2O2 generating material (taking care to prevent excessive exposure of the H2O2 generating material to water during administration). Alternatively, such substances may be administered separately, sequentially (one after the other), or concomitant with administration of H2O2 generating material (e.g. at roughly the same time but not in the same solution or emulsion, e.g. via two intravenous lines). Delivery may be, for example: intraarterial (e.g. via catheter injection) either systemically or to isolated organ systems; intraperitoneally (e.g. via delivery to the peritoneal cavity); intrathoracic, intramediastinal, intracardiac, intrapulmonary (e.g. via injection through an intratracheal tube or via an aerosol, with or without PFCs); gastrointestinally (e.g. to stomach, intestines or colon); topically (e.g. to wounds or during surgery); intraosseously, intracystically (e.g. bladder), intracranially, intracardiac, or intranasally. The delivery of H2O2 generating material via non-vascular routes may be considered as a means to increase the delivery of oxygen to tissues via nonpulmonary means.
In some applications, various catalysts may be embedded into the delivery systems themselves, or molecules such as iron may be used to cause peroxides to breakdown and release oxygen.
These strategies may be useful in a wide variety of medical settings, and may be of particular use in the treatment of trauma and acute injury as a “stop-gap” measure until conventional means of providing O2 (e.g., inhaled O2) are available. Such scenarios include but are not limited to combat, accidents and other situations where profound shock might occur, particularly at locations remote from conventional O2 sources. Alternatively, many other uses are also contemplated such as for treatment of asthma, pulmonary edema, acute lung injury, or airway obstruction where inhalation of O2 is not immediately possible; or in states of extremely low blood flow such as cardiac arrest (global) or myocardial infarction, stroke, intestinal ischemia (regional) in which a large increase in oxygen content might overcome the decrease in blood flow to critical organs. Complex shock states such as sepsis (which is believed to due to a state of microvascular shunting) or states of severe tissue edema (such as burns) may also benefit by increased levels of dissolved oxygen as provided herein to overcome decreases in blood flow. Treatment of toxicologic emergencies in which oxygenation is impaired (e.g. carbon monoxide or cyanide poisoning) may also benefit from such treatment.
In terms of wound care, using the methods of the present invention, it would be possible to provide normobaric and hyperbaric oxygen externally to wounds using, for example, a special sleeve or container placed over the wound followed by addition of H2O2 generating material, and optionally with catalase and other catalysts and other agents or substances as described herein. This could be particularly useful in the treatment of burn victims. Wound dressings might be prepared with a hydrogen peroxide or inorganic peroxide producing material which releases peroxides slowly into a wound for use in disinfecting the wound.
Delivery of peroxides or oxygen via these methods could provide effective therapy for certain local or systemic infections by providing direct antimicrobial activity or indirectly via enhancement of the body's own immune response. The methods may also allow for development of strategies that produce whole body or regional organ preconditioning as well as allowing for the induction of significant vasodilation/hypotension to increase blood flow and thus oxygen delivery to organ systems.
Additionally, it is envisioned that certain devices could be made to take advantage of the large amounts of oxygen produced by the reaction of H2O2 with catalase or other catalysts. This includes creation of special containers to store harvested organs prior to transplant. In essence, a hyperbaric oxygen environment can be created in which the need for external oxygen tanks or other complex circulating equipment would not be required. H2O2 and other components could be added to the system to keep a hyperbaric oxygen environment present. Such a system may be able to preserve and enhance the transplantable lifetime of harvested organs. These may take the form shown in
In addition, the use of the methods of the invention need not be for dire medical emergencies. Currently, the administration of oxygen is being suggested to combat the effects of aging. Thus, small amounts of O2 can be conveniently and safely provided to those who wish to obtain such benefits, either internally via inhalation, or by external application in washes or creams, etc.
Other methods of delivery may also be conceived, including but not limited to an external apparatus for continuous intravenous delivery in which solutions containing the maximum amount of atmospheric oxygen could be delivered based on the atmospheric pressure surrounding the patient. Thus at 1 atmosphere (760 torr), an intravenous solution of oxygen at 760 torr could be delivered by having as part of the apparatus, a means to off-gas hyperbaric amounts of oxygen prior to its entrance into the patient.
Several of the methods described above could be envisioned as useful adjunctive treatments for cancerous tumors which are known to become more sensitive to radiation therapy when exposed to higher oxygen levels. For example, a complex containing peroxide adduct or other peroxide or oxygen producing compound and/or a selectively permeable membrane can be placed in close proximity to a tumor or other tissue to oxygenate the tumor or tissue. In addition, the combination of H2O2 and PFC's (or other carriers) may also be useful as ultrasonic contrast agents.
The methods and compositions of the invention may also be used to produce medical grade oxygen for environments where delivery and storage of oxygen containing vessels is problematic, for example, in field hospitals or other field settings. Such a strategy would also provide other advantages, such as the simultaneous ability to purify water sources for consumption. For example, particles containing a peroxide adduct, or peroxide nanoparticles slurried together with a hydrophobic liquid or other material, and/or a selectively permeable membrane can be added to water during purification. Many other uses of the O2 generating systems described herein are also possible.
As discussed above, the systems should also be considered as H2O2 generating systems, and the generation of H2O2 may be the primary goal. In these application, catalase and/or agents to release O2 are avoided until desired at a later time. Examples of uses of the systems described herein, in addition to those listed above, include but are not limited to: use for delivery of hydrogen peroxide to a wound as a disinfectant; use in whitening systems, e.g. for tooth whitening or as a whitening agent in cleaning products; generation of O2 at sites such as in aquariums or in soil (e.g. an additive to potting soil, lawns, etc.); production of a deodorizing effect, e.g. at sites on or within fabric and/or clothing inserts, in cat litter, or in products designed for application to the body; for the purpose of generating “bubbles” in a liquid for any reason; etc.).
In one exemplary application, the peroxide releasing devices (i.e., devices which use the peroxide or oxygen generating compositions described herein) can be incorporated with ferrous oxide (rust) and citric acid into recycled paper in the form of, for example, pellets. These pellets may be added to soil containing organic contaminants (e.g., gasoline, solvents, etc.). Water in the soil causes release of the peroxide to the aqueous soil environment where the peroxide is decomposed by the catalytic action of the iron and acid to create hydroxyl radicals. Hydroxyl radicals are well known oxidants for organic materials and the chemistry employed is often referred to as Fenton's chemistry. Fenton's Reagent is a combination of hydrogen peroxide with catalytic amounts of iron II or III or copper II (another catalyst which might be used in the practice of this invention), and an acid to create a pH in the range of 3-5. Hence, the present invention will generate a Fenton's reagent in situ so as to eliminate organic soil contaminants.
Production of the O2 generating systems described herein requires that the characteristics of the various components and their interactions with each other be taken into account, as well as the particular use of the system. For systems that are used in vivo, preferably all components will be either non-toxic or used at a level at which they are non- (or only mildly) toxic, so as to avoid causing further injury to the patient. Chief among the considerations is the determination of suitable levels or rates of O2 production, as modulated by the porosity of the selectively permeable barrier. The barrier must be sufficiently porous such that sufficient water will diffuse in and make contact with the hydrogen peroxide, inorganic peroxides, or peroxide adducts to generate a worth-while amount of O2, but must exclude water sufficiently to prevent a burst or bursts of O2 generation.
Various additives may be included in the material to supplement or modulate its properties. For example, solubility enhancers, oxygen scavengers, stabilizers, clarifiers, buffers, antimicrobials (e.g., parabens and benzalkonium chloride), coloring agents, etc. may be included. Furthermore, the microencapsulation technique may be modified to allow for the production of capsules which also serve to act as volume expanders by increasing the tonicity or oncocity of the injection. This may be done by decorating the capsules with certain moieties such as starches or with the use of dendrimers attached to the capsule which can carry these moieties. Inclusion of volume expanding substances within the interior of the microcapsules which are released over time might be considered. The end result is that in addition to increasing the circulating volume of oxygen, the materials also serve to expand the circulating volume of fluids within the cardiovascular systems. This leads to increases in tissue blood flow and hence oxygen delivery. Furthermore, anti-inflammatory and/or antioxidant agents might be incorporated into the delivery system either separately or as a part of the microcapsule. Dendrimers for example could be used which are highly anionic as a potential means to decrease microvascular inflammation.
The following examples serve to illustrate various non-limiting embodiments of the invention.
To investigate rationally the impact of the myriad of variables and focus the experimental scope of this project, we developed a transport model for the delivery process. The model allows us to simulate the oxygen delivery rate for any combination of geometric and mass loading variables and thereby design and plan the construction of a hydrogen peroxide delivery system to produce the desired amounts of oxygen. The rates of diffusion of water into the microcapsules, the rate of generation of hydrogen peroxide from the reaction of water with urea hydrogen peroxide (UHP) particles, and the diffusion of hydrogen peroxide out the microcapsules were computed using the following equations. Shrinking core kinetics were assumed for the UHP-water reaction and the UHP particles were assumed to be spherical for ease of computation. Other values for the transport coefficients, reaction rate constants, microcapsule compositions, and different particle geometries are easily incorporated. The model equations are given in dimensionless form. The model provides an efficient means to identify workable combinations of geometric and mass loading variables as targets for the experimental studies and considerably reduces the complexity of the search for a practical delivery system. Example calculations strongly support the feasibility of our approach. The model results demonstrate that readily achievable combinations of UHP size, microcapsule size, and shell thickness can be combined to produce an efficacious way to deliver hydrogen peroxide to the blood at the sustained rates needed to keep a person alive for 1 to 2 hours. These results would be applicable to other H2O2 adducts coated with hydrophobic materials and/or permeable membranes.
The model used to simulate the hydrogen peroxide delivery process is as follows:
Rate of Hydrogen Peroxide Delivery into the Blood Stream
Np=the total number of UHP particles in a microcapsule
where M° is the initial moles of UHP in a microcapsule
MW=molecular weight of UHP (94.07 g/mol)
krxn=rate constant for the UHP-water reaction (400 cm−2 sec−1)
VPG=volume of the perfluorocarbon carrier
Cw plasma=concentration of water in blood plasma (˜0.055 mol/cm3)
Cpw=concentration of water in the PLGA shell
Cpx=concentration of hydrogen peroxide in the PLGA shell
Cpgw=concentration of water in the perfluorocarbon carrier
Cpgx=concentration of hydrogen peroxide in the perfluorocarbon carrier
M=mols of hydrogen peroxide delivered from a microcapsule to the blood
Ro=outside radius of the microsphere
Ri=inside radius of the microsphere
D=diffusion coefficient of water or H2O2 in the PLGA shell
Ro UHP=initial radius of the UHP particles inside the microcapsule
Vpx=volume fraction of the UHP particles inside the microcapsule
kw=partition coefficient for H2O between the PLGA shell and blood
(0.011 moles water/cm3 polymer)/(moles water/cm3 in the blood)
kwg=partition coefficient for H2O between the PLGA shell and the UHP carrier
kxg=partition coefficient for H2O2 between the PLGA shell and the UHP carrier
(kwg=kxg and kwg=10kw was assumed for the simulations shown in
Each of the elements of the proposed delivery system has been chosen after careful consideration of the oxygen delivery requirements, of the constraints imposed by human biocompatibility, of the influence of reaction kinetics, thermodynamics, and molecular transport parameters on the production and delivery of hydrogen peroxide, of the commercial availability of the various materials required, and of the feasibility of synthesizing the microcapsules. Despite what combination is chosen, the concomitant use of a perfluorocarbon carrier is indicated in order to ensure that the amount of oxygen produced by H2O2 delivery does not overwhelm the plasma's ability to keep the oxygen that is produced in solution (it being understood that there is a different between the internal PFC used in the oxygen or peroxide generating composition and the external PFC carrier).
PFCs are known to be able to dissolve between 5-18 vol % of oxygen. The curves in
Many different oxygen delivery profiles may be realized by mixing different sizes of microcapsules coated with different thicknesses of membrane materials having different rate-influencing transport properties. Consider the oxygen delivery rates shown by Curves B and E in
Practically, it is quite difficult to make perfectly uniform UHP particles used in the simulation by grinding or ball milling UHP powder. Ball milling produces a distribution of sizes and the separation of ground particles by size is an imperfect art. However, it is not important that we segregate uniformly sized UHP particles in different microcapsules. If each microcapsule contains a blend of different size particles, the release behavior will be the same as for our hypothetical blend of microspheres containing segregated UHP sizes so long as the overall particle size weight fractions are reasonably the same between the two types of mixtures. The imperfect separation of particle sizes in commercial processes notwithstanding, the production of nanometer-size particle distributions is both practical and commnonplace. High energy ball milling can be carried out at very low temperatures (e.g., a −10° C. glycol solution might be used to keep the material cool during grinding). For example, 20 g of UHP, 100 ml perfluorodecalin and 170 g or zirconium oxide spheres (p=5.68 g/ml) may be introduced into a 150 ml milling chamber under liquid full conditions where the chamber is rotated for 3-4 hours. As an alternative to ball milling, sonication, for example, high wattage sonication, might be used to produce nanoparticles
Based on a human cardiac output of 5 L/min of blood containing an arterial O2 concentration of 8630 μmol O2/L vs. a venous concentration of 5874 μmol O2/L, the metabolic rate of oxygen consumption is 0.5 g O2/min. The injection of 176 g of UHP is required to generate 0.5 g O2/min for 60 minutes. If the UHP is dispersed at 60 vol % in the perfluorocarbon carrier, 5 μm diameter microcapsules carrying a total of 176 g of UHP will occupy 237 cm3. Emergency treatment with these microcapsules would require the injection of about 500-700 cc of a 45 wt % microcapsule suspension. A 45 wt % loading corresponds to about 35 vol % in the injection mixture. According to Einstein's classical equation for the viscosity of slurries of uniform spherical particles, the viscosity of a 35 vol % suspension of 5 μm diameter spheres in the water/PEG (or perfluorocarbon) mixture will be 5-6 cp. This is less than the viscosity of packed red cells which is approximately 10 cp. Thus, delivery of sufficient O2 for a one-hour traumatic shock treatment is feasible. Additional volume strategies exists which may allow significant reduction in required injection volumes.
A diffusion cell was constructed in order to measure the release rate of hydrogen peroxide from UHP and its diffusion across a selectively permeable membrane. A side view of the cell is provided in
The amount of hydrogen peroxide in the top half of the cell was monitored colorimetrically by testing samples that were periodically removed from the water-rich phase in the top half of the cell. The testing was carried out using the Ferric Thiocyanate Method (see, D. F. Boltz and J. A. Howell, eds., Colorimetric Determination of Nonmetals, 2nd ed., Vol. 8, p. 304 (1978). The ferric thiocyanate method consists of ammonium thiocyanate and ferrous iron in acid solution. Hydrogen peroxide oxidizes ferrous iron to the ferric state, resulting in the formation of a red thiocyanate complex. The absorbance of the red solution obtained is measured using a colorimeter and the quantity of hydrogen peroxide required to give the absorbance can be computed.
As explained, according to this test, an increase in color intensity over time correlates with an increase in peroxide concentration in the water. The results are presented in
Worth noting is that the PLGA membrane used in these preliminary experiments did not swell or rupture and the PFC and urea did not diffuse through the membrane.
The microcapsule contains tiny particles of urea hydrogen peroxide (UHP) suspended in a biocompatible, anhydrous carrier solvent, such as perfluorodecalin. The consistency of the suspension is that of a paste. Micron-sized droplets of this paste are created in a non-solvent for the perfluorodecalin and then encapsulated with a nanometer-thick shell of biodegradable poly(lactide-coglycolide) (PLGA) copolymer. This is illustrated in
Although UHP will also react slowly with PEG, the molecular weight of PEG prevents the molecule from diffusing across the PLGA barrier at rates high enough to be problematic for long-term storage. When needed for trauma treatment, the microcapsule/injection carrier suspension is mixed with a biocompatible carrier such as PFC and injected into the blood stream.
The sequence of events described next results in the generation of oxygen in the blood. The diagram in
As shown by example in
While the invention has been described in terms of its preferred embodiments, those skilled in the art will recognize that the invention can be practiced with modification within the spirit and scope of the appended claims. Accordingly, the present invention should not be limited to the embodiments as described above, but should further include all modifications and equivalents thereof within the spirit and scope of the description provided herein.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US07/68910 | 5/14/2007 | WO | 00 | 3/9/2009 |
Number | Date | Country | |
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60800041 | May 2006 | US |