Patent Application
20230000926
The present invention relates to the field of clinical medicine, and particularly relates to a new use of a REGEND001 cell autologous deliverable formulation.
Idiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrotic interstitial pneumonia with obscure etiology. IPF has been included in the 2018 National Rare Diseases List, and at present, its incidence is increasing annually in China. IPF tends to occur in middle- and old-aged male population and is manifested as progressively worsening dyspnea, accompanied by restrictive ventilatory dysfunction and gas exchange disorder, eventually leading to hypoxemia and even respiratory failure. The prognosis of IPF is poor, and its lung histology and high-resolution CT (HRCT) of the chest are manifested as a usual interstitial pneumonia (UIP) with diffuse alveolitis and pulmonary interstitial fibrosis as the main pathologic features, and progressive and irreversible lung damage. The lost of alveoli in numbers leads to the decline or even loss of the pulmonary ventilation function, resulting in hypoxia, reduced mobility and even death of patients. As a result, the average survival duration for those diagnosed with IPF is only 2.8 years, the mortality rate is higher than that of most tumors, and thus IPF is called a “tumor-like disease”.
The traditional method for treatment of IPF is mainly administrating anti-inflammatory drugs and anti-fibrotic drugs. Glucocorticoids can suppress the inflammatory response and the immune process. Immunosuppressants (cyclophosphamide, azathioprine, methotrexate, etc.) also have the effect of inhibiting the inflammatory response. Thus, glucocorticoids and immunosuppressants/cytotoxic drugs were used as the basic drugs for the treatment of IPF, but they are not ideally effective in patients with intermediate to advanced fibrosis. The drugs currently approved for IPF treatment in China include Pirfenidone, Nintedanib, etc., which have a delay effect on the decline of pulmonary function of patients. But it is difficult to improve the pulmonary function or reverse the progression of the disease, and the occurrence of fibrosis cannot be really prevented. At present, the fundamental reason for the lack of effective conventional treatment for IPF worldwide, other than whole-lung transplantation, is the lack of effective methods to regenerate and repair the damaged alveolar structures.
The Frank McKeon research group at Harvard University was the first to identify a cell group of bronchial basal cells from the distal bronchi of mice in 2011. In 2018, such group of bronchial basal cells was successfully identified in adults in vivo and isolated and amplified in vitro. This group of cells belongs to the basal cell category and has the potential to differentiate into bronchial and alveolar epithelium.
The present application provides a use of a REGEND001 autologous cell deliverable formulation in preparing a product, wherein the product has a function of improving the pulmonary function in patients with idiopathic pulmonary fibrosis. The product is, for example, a drug or pharmaceutical composition for the treatment of idiopathic pulmonary fibrosis.
The REGEND001 autologous cell deliverable formulation is a finished cell formulation that is prepared by collecting, isolating in vitro, culturing and amplification of autologous bronchial basal cells of patients. A preparation process of the REGEND001 autologous cell deliverable formulation may adopt the methods given in the Examples of the present application or the methods of preparing clinical-grade autologous bronchial basal cells and a deliverable formulation described in Chinese patent application 201910407062.7 (CN111944737A), which is hereby incorporated herein by reference.
The present application provides a use of the REGEND001 autologous cell deliverable formulation in the preparation of a product, wherein the product has a function of improving the pulmonary ventilation function in patients with idiopathic pulmonary fibrosis, and the product is, for example, a drug or pharmaceutical composition for improving the pulmonary ventilation function in patients with idiopathic pulmonary fibrosis.
The present application provides a use of the REGEND001 autologous cell deliverable formulation in the preparation of a product for improving and/or treating the pulmonary ventilatory function in humans.
The present application provides a use of the REGEND001 autologous cell deliverable formulation in the preparation of a product for improving the pulmonary diffusion function in humans.
The present application provides a use of the REGEND001 autologous cell deliverable formulation in the preparation of a product for improving the motor function in humans.
The above REGEND001 autologous cell deliverable formulation is administered to any pulmonary subsegment of the lingual lobe of the left lung, the inferior lobe of the left lung, the middle lobe of the right lung, and the inferior lobe of the right lung.
The REGEND001 autologous cell deliverable formulation is administered at a dose of 0.1-10×106 bronchial basal cells/kg, preferably 1-10×106 cells/kg.
The present application provides a use of the REGEND001 autologous cell deliverable formulation in the treatment of idiopathic pulmonary fibrosis.
In some embodiments, the REGEND001 autologous cell deliverable formulation contains bronchial basal cells suspended in normal saline for injection, and each 14 mL of the REGEND001 autologous cell deliverable formulation contains (4-300)×106 bronchial basal cells, preferably (2-30)×107 bronchial basal cells.
In some embodiments, the REGEND001 autologous cell deliverable formulation is prepared by the following steps:
tissue preparation: getting an ex vivo bronchoscopic brushed-off biopsy tissue from at least one site;
enzyme digestion: digesting the tissue with a tissue digestion solution, and collecting digested cells after terminating the digestion with a stop buffer;
plating and amplification culture: plating a part of the digested cells in a culture flask pre-coated with feeder cells to perform primary culture, collecting the primary cultured cells to perform amplification culture in a culture flask pre-coated with feeder cells, followed by passage culture when the cells grow to cover 50%-90% of the surface area of the culture flask, or when the cells grow to form clones and further form colonies wherein 80% or more of the clones contain 40-100 cells and clones of grade A and grade B are observed in three fields of view among randomly selected five fields of view; wherein the clones of grade A have a regular, round and smooth outline, and clear boundary, and cells are closely arranged in the clones and have uniform sizes; the clones of grade B have a roughly regular outline, and smooth and clear boundary, and most cells are closely arranged in clones and have uniform sizes, yet a small amount of the cells have a slightly larger size and are slightly loose arranged;
cell collecting: when passaged cells grow to cover 85%-95% the surface area of the culture flask, digesting and collecting adherent cells, and washing.
In some embodiments, the tissue digestion solution comprises 99 v % of DMEM/F12, 1-20 ng/mL of DNase, 0.1-4 mg/mL of proteinase type XIV, and 10-200 ng/mL of trypsin; the digesting is performed at a temperature of 37° C. for a duration of 0.5-2 h.
In some embodiments, said primary culture and amplification culture are carried out with a culture medium comprising: 225 mL of DMEM, 225 mL of F12, 20-70 mL of fetal bovine serum (FBS), 0.2-2 mM of L-glutamine, 1-14 ng/mL of insulin, 0.1-1 ng/mL of epidermal growth factor, 5-30 μg/mL of adenine, and 2-20μg/mL of hydrocortisone.
In some embodiments, the stop buffer comprises 90 v % of DMEM and 10 v % of FBS.
In some embodiments, the digested cells and the primary cells are cryopreserved; preferably before the cryopreservation, bacterial detection and mycoplasma detection are carried out; and preferably the cryopreserved cells are rapidly thawed and used to perform the primary culture and/or amplification culture.
According to one aspect of the present application, provided is a method for treating idiopathic pulmonary fibrosis, comprising administering REGEND001 autologous cell deliverable formulation to a subject with idiopathic pulmonary fibrosis, wherein the REGEND001 autologous cell deliverable formulation is a finished cell formulation prepared by collecting, isolating in vitro, and culturing and amplification of autologous bronchial basal cells of patients.
In some embodiments, the method for treating idiopathic pulmonary fibrosis includes delivering the REGEND001 autologous cell deliverable formulation to one or more of 14 pulmonary subsegments from the lingual lobe of the left lung, the inferior lobe of the left lung, the middle lobe of the right lung, and/or the inferior lobe of the right lung. The 14 pulmonary subsegments are the lateral segmental bronchus of the middle lobe of the right lung, the medial segmental bronchus of the middle lobe of the right lung, the apical segmental bronchus of the inferior lobe of the right lung, the medial basal segmental bronchus of the right lung, the anterior basal segmental bronchus of the right lung, the lateral basal segmental bronchus of the right lung, the posterior basal segmental bronchus of the right lung, the superior segmental bronchus of the lingual lobe of the left lung, the inferior segmental bronchus of the lingual lobe of the left lung, the apical segmental bronchus of the inferior lobe of the left lung, the anterior basal segmental bronchus of the left lung, the medial basal segmental bronchus of the left lung, the lateral basal segmental bronchus of the left lung, and the posterior basal segmental bronchus of the left lung, respectively.
In some embodiments, the REGEND001 autologous cell deliverable formulation comprises bronchial basal cells suspended in normal saline for injection, and each 14 mL of the REGEND001 autologous cell deliverable formulation contains (4-300)×106 bronchial basal cells, preferably (2-30)×107 bronchial basal cells.
In some embodiments, the method for treating idiopathic pulmonary fibrosis comprises diluting 14 mL of the REGEND001 autologous cell deliverable formulation into 42 mL with normal saline, and then injecting the diluted solution into one or more of the 14 pulmonary subsegments by using a syringe.
In some embodiments, the subject with idiopathic pulmonary fibrosis has moderate or severe diffusion dysfunction.
In some embodiments, the subject with idiopathic pulmonary fibrosis further suffers from one or more diseases or conditions selected from hypertension, type 2 diabetes, coronary artery disease, Hashimoto's thyroiditis, and pulmonary emphysema.
In some embodiments, the REGEND001 autologous cell deliverable formulation is administered at a dose of 0.1-10×106 bronchial basal cells/kg, preferably 1-10×106 bronchial basal cells/kg.
The technical solutions of the present application have the advantages as follows: a bronchial basal cell product, namely the REGEND001 autologous cell deliverable formulation, is developed in the present application. In an early exploratory clinical study, the REGEND001 autologous cell deliverable formulation is autologously delivered into patients with idiopathic pulmonary fibrosis via local administration through airway, which shows the effects of repairing lung damage and improving the pulmonary ventilation function.
In order to more clearly illustrate the specific embodiments of the present application or the technical solutions in the prior art, the accompanying drawings required for use in the description of the specific embodiments or the prior art will be briefly described below. It will be apparent that the accompanying drawings in the following description are some embodiments of the present application, and that other drawings may be obtained from these drawings without any creative effort for a person of ordinary skill in the art.
The DLCO predicted values in the following examples are calculated from an equation of predicted values recommended by the European Thoracic Society (ECSC). For Chinese, the predicted values are obtained by adding a correction factor for correction on the basis of the ECSC equation. The predicted values are usually correlated with the height (H), weight (W), and age (A) of the patients. A formula for calculating a predicted value of the pulmonary function in adults in East China is:
DLCO=0.3894×H−0.1244×A−0.0790×W−25.3405.
The reference standard for the 6-minute walk test in the following examples is described as follows:
according to the detailed guidelines for the 6-minute walk test published by the American Thoracic Society (ATS) in 2002, the 6-minute walk test is an exercise test of the functional status in patients with moderate or severe cardiopulmonary diseases and is primarily applicable to measure the response of patients with moderate to severe cardiac or pulmonary diseases to medical interventions, primarily to assess the patient's exercise capacity. There is no final conclusion on which way (an absolute value, a percentage, or a change/predicted value %) to express the change in the 6-minute walk distance has the greatest clinical significance, and the guideline recommend the use of the absolute value.
St. George's Respiratory Questionnaire (SGRQ) reference standard is described as follows:
the St. George Respiratory Questionnaire (SGRQ) is one of the most widely used specific scales for measuring health impairment and quality of life in adult patients with respiratory diseases, and is a standardized patient self-administered questionnaire scored by weighting based on questions in symptoms (frequency and severity of symptoms), activity (capability of causing shortness of breath or restriction of movement caused by shortness of breath), and impact on daily activities (impairment of social competence and psychological disorder due to airway disease). The higher the score, the worse the quality of life (reference: Jones P W, Quirk F H, Baveystock C M. The St George's Respiratory Questionnaire. Respir Med. 1991 September; 85 Suppl B:25-31; discussion 33-7). The SGRQ is currently adopted by more and more respiratory diseases to assess the quality of life of patients. This evaluation index was also used in the clinical trial of Nintedanib, a chemical drug approved in 2017 for the treatment of IPF. There are currently no fixed criteria, it is mainly being used to compare patients themselves before and after treatment.
This example provides a process for preparing clinical-grade autologous bronchial basal cells, specifically including the following steps:
ex vivo bronchoscopic brushed-off biopsy tissues were prepared, and in this example, tissues from two different sites of the bronchus were selected. Selecting tissues from two or more sites is to ensure the success rate of separation.
A tissue digestion solution and a stop buffer were prepared. The tissue digestion solution comprised 99 v % of DMEM/F12, 1-20 ng/mL of DNase, 0.1-4 mg/mL of protease type XIV, and 10-200 ng/mL of trypsin. The stop buffer comprised 90 v % of DMEM and 10 v % of FBS.
The brushed-off biopsy tissues were digested with the tissue digestion solution. The digestion was terminated with the stop buffer, and digested cells were collected. The cells after enzyme digestion were subjected to bacterial detection and mycoplasma detection, and then part of the digested cells were cryopreserved.
A culture medium was prepared, wherein the culture medium comprised 225 mL of DMEM, 225 mL of F12, 20-70 mL of FBS, 0.2-2 mM of L-glutamine, 1-14 ng/mL of insulin, 0.1-1 ng/mL of epidermal growth factor, 5-30 μg/mL of adenine, and 2-20 μg/mL of hydrocortisone.
Irradiation-inactivated feeder cells were plated in T25 cell culture flasks and cultured in a cell incubator (37° C., 5% CO2) for 1-2 days, wherein the cells should have a density that the cells covered 50-70% of the bottom surface of the culture flask after 1-2 days.
Some of the digested cells were taken, and the cells derived from respective site were resuspended and plated into one T25 culture flask pre-coated with feeder cells, 200 ng/mL of gentamicin was added, and the cells were cultured at 37° C. with a CO2 concentration of 4%-8%. The culture medium was replaced every other day. The cells were collected and passaged when the cells grew to form clones, wherein 80% or more of the clones contained 40-100 cells and clones of grade A and grade B were observed in three fields of view among randomly selected five fields of view.
The clones can be classified as grades A, B, and C depending on the morphology. The clones of grade A have a regular, round and smooth outline, and clear boundary, and cells are closely arranged in clones and have uniform sizes. The clones of grade B have a roughly regular outline, smooth and clear boundary, and most cells are closely arranged in clones and have uniform sizes, yet a small amount of the cells have a slightly larger size and are slightly loose arranged. The clones of grade C have an irregular outline, and unclear boundary, and the cells are loosely arranged in clones and have large sizes.
First passage was carried out as follows: the cell culture supernatant was removed, and the cells were washed once with 1×DPBS, and digested with 2 mL of recombinant trypsin at 37° C. for 5-10 min. After most of the cells became round and bright, adherent cells were detached by pipetting up and down and prepared into a single-cell suspension. The digestion was terminated with an equal volume of DMEM medium, and the cell suspension was collected, and centrifuged at 1200 rpm for 5 min. Supernatant was removed, and the cells were resuspended in the culture medium. Finally the re-suspended cells were plated onto one T75 cell culture flask pre-coated with feeder cells at a density of 5-10×103 cells/cm2. The culture medium was replaced every other day.
2nd passage was carried out when the first passaged cells grew to cover 50%-90% of the bottom surface area of the culture flask. The culture supernatant was removed, and the cells were washed once with 1×DPBS, and digested with 5 mL of recombinant trypsin at 37° C. for 5-10 min. Adherent cells were detached by pipetting up and down and prepared into a single-cell suspension after most of the cells became round and bright. The digestion was terminated with an equal volume of DMEM medium, and the resulting cell suspension was collected and centrifuged at 1200 rpm for 5 min. Supernatant was removed, and the cells are re-suspended in the culture medium. The re-suspended cells were plated onto three T75 cell culture flasks pre-coated with feeder cells at a density of 5-10×103 cells/cm2, and the culture medium was replaced every other day.
3rd passage was carried out when the second passaged cells grew to cover 50%-90% of the bottom surface area of the culture flasks. For cells in each flask, the culture supernatant was removed, and the cells were washed once with 1×DPBS, and digested with 5 mL of recombinant trypsin at 37° C. for 5-10 min. After most of the cells became round and bright, adherent cells were detached by pipetting up and down and prepared into a single-cell suspension. The digestion was terminated with an equal volume of DMEM medium. Cell suspension was collected and centrifuged at 1200 rpm for 5 min. Supernatant was removed, and the cells were resuspended in the culture medium. 2 mL of cell culture supernatant and 3-16×105 cells were taken to carry out tests, wherein bacterial detection and mycoplasma detection gave negative results, gentamicin residual result was less than 5.4 ppb, HOPX positive percentage in biological potency test was ≥30%, cell identification test confirmed cells were KRT5 positive, and cell purity analysis showed KRT5 cell percentage was ≥90%. Meanwhile, the re-suspended cells were plated onto ten T75 cell culture flasks pre-coated with feeder cells at a density of 5-10×103 cells/cm2, and the culture medium was replaced every other day.
The fourth passage was performed when the third passaged cells grew to cover 50%-90% of the bottom surface area of the culture flask. For cells in each flask, the culture supernatant was removed, and the cells were washed once with 1×DPBS, and digested with 5 mL of recombinant trypsin at 37° C. for 5-10 min.
After most of the cells became round and bright, adherent cells were detached by pipetting up and down and prepared into a single-cell suspension. The digestion was terminated with an equal volume of DMEM medium. The cell suspension was collected, and centrifuged at 1200 rpm for 5 min. Supernatant was removed, and the cells were resuspended in the culture medium. 1-10×105 cells were taken for biological potency test, wherein the HOPX positive percentage was ≥30%. Meanwhile, the resuspended cells were plated on 30 T75 cell culture flasks pre-coated with feeder cells at a density of 5-10×103 cells/cm2, and the culture medium was replaced every other day.
The feeder cells were removed when the fourth passaged cells grew to cover 50%-90% of the bottom surface area of the culture flask. The operation was performed as follows: the culture supernatant in each culture flask was removed, and each culture flask was washed once with 1×DPBS, 5 mL of recombinant trypsin was added, and the culture flask was placed at 37° C. for 1-2 min. The feeder cells were detached by pipetting up and down, and each flask was washed again with 1×DPBS, and 5 mL of recombinant trypsin was added for digestion. After most of the cells became round and bright, adherent cells were detached by pipetting up and down and prepared into a single-cell suspension. The digestion was terminated with an equal volume of DMEM medium. The cell suspension was collected, and centrifuged at 1200 rpm for 5 min. The supernatant was removed, and the cells were resuspended in the culture medium. 5-10×105 cells were taken for cell purity analysis, wherein the result showed the proportion of KRT5 cells was ≥90%. Finally, all cells were plated in 30 T75 cell culture flasks for culture.
When the cells in the cell culture flasks grew to cover 85%-95% of the surface area of the culture flask, each culture flask was washed once with 1×DPBS, 5 mL of recombinant trypsin was added, and the culture flasks were placed at 37° C. for 5-15 min. After most of the cells became round and bright, adherent cells were gently detached by pipetting up and down with a 1 mL pipette and prepared into a single-cell suspension, and the digestion was terminated with an equal volume of DMEM medium. The cell suspension was collected, and then the bottom surface of the culture flask was rinsed with 5 mL of DMEM medium, and all the cell suspensions were collected. The collected cell suspensions were centrifuged at 1200 rpm for 5 min, the supernatant was removed, and the cells were washed for three times with normal saline for injection. Each washing step was performed as follows: 40 mL of 1×DPBS was used to resuspend the cell pellet, cells were centrifuged at 1200 rpm for 5 min, and the supernatant was removed. Then the cells were resuspended with 16 mL of normal saline for injection to prepare into a finished formulation, i.e., the REGEND001 autologous cell deliverable formulation.
This example provides a process for the preparation of clinical-grade autologous bronchial basal cells, specifically including the following steps:
ex vivo bronchoscopic brushed-off biopsy tissues were prepared, and in this example, tissues from two different sites of the bronchus were selected. Selecting tissues from two or more sites is to ensure the success rate of separation.
A tissue digestion solution and a stop buffer were prepared. The tissue digestion solution comprised 99 v % of DMEM/F12, 1-20 ng/mL of DNase, 0.1-4 mg/mL of protease type XIV, and 10-200 ng/mL of trypsin. The stop buffer comprised 90 v % of DMEM and 10 v % of FBS.
The brushed-off biopsy tissues were digested with the tissue digestion solution. The digestion was terminated with the stop buffer, and digested cells were collected. The cells after enzyme digestion were subjected to bacterial detection and mycoplasma detection, and then part of the digested cells were cryopreserved.
A culture medium was prepared, wherein the culture medium comprised 225 mL of DMEM, 225 mL of F12, 20-70 mL of FBS, 0.2-2 mM of L-glutamine, 1-14 ng/mL of insulin, 0.1-1 ng/mL of epidermal growth factor, 5-30 μg/mL of adenine, and 2-20 μg/mL of hydrocortisone.
Irradiation-inactivated feeder cells in T25 cell culture flasks and cultured in a cell incubator (37° C., 5% CO2) for 1-2 days, wherein the cells should have a density that the cells covered 50-70% of the bottom surface of the culture flask after 1-2 days.
Some of the digested cells were taken, and the cells derived from respective site were resuspended and plated into one T25 culture flask pre-coated with feeder cells, 200 ng/mL of gentamicin was added, and the cells were culture at 37° C. with a CO2 concentration of 4%-8%. The culture medium was replaced every other day. The cells were collected and cyropreserved when the cells grew to form clones wherein 80% or more of the clones contained 40-100 cells and clones of grade A and grade B were observed in three fields of view among randomly selected five fields of view.
The clones can be classified as grades A, B, and C depending on the morphology. The clones of grade A have a regular, round and smooth outline, clear boundary, and are closely arranged and have uniform sizes. The clones of grade B have a roughly regular outline, smooth and clear boundary, and most cells in clones are closely arranged and have uniform sizes, yet a small amount of the cells have a slightly larger size and are slightly loose arranged. The clones of grade C have irregular outlines and unclear boundary, and the cells in the clones are loosely arranged and have large sizes.
After the arrangement of the product preparation was confirmed, the cryopreserved cells were taken out (one tube for each site), and were quickly thawed in a 37° C. water bath. All the liquids were collected in a 15 mL tube, into which 2 mL of recovery solution pre-warmed at 37° C. was added dropwise, and the tube was centrifuged at 1200 rpm for 5 min. Supernatant was removed, and the cells were resuspended in the culture medium, and then cultured in T25 cell culture flasks pre-coated with feeder cells.
When the thawed cells grew to cover 50%-90% of the surface area of the cell culture flask, first passage was performed as follows: the cell culture supernatant was removed, and the cells were washed once with 1×DPBS, and digested with 2 mL of recombinant trypsin at 37° C. for 5-10 min. After most of the cells became round and bright, adherent cells were detached by pipetting up and down and prepared into a single-cell suspension. The digestion was terminated with an equal volume of DMEM medium, and the cell suspension was collected, centrifuged at 1200 rpm for 5 min. Supernatant was removed, and the cells were resuspended in the culture medium. Finally the resuspended cells were plated onto one T75 cell culture flask pre-coated with feeder cells at a density of 5-10×103 cells/cm2. The culture medium was replaced every other day.
2nd passage was carried out when the first passaged cells grew to cover 50%-90% of the bottom surface area of the culture flask. The culture supernatant was removed, and the cells were washed once with 1×DPBS, and digested with 5 mL of recombinant trypsin at 37° C. for 5-10 min. Adherent cells were detached by pipetting up and down and prepared into a single-cell suspension after most of the cells became round and bright. The digestion was terminated with an equal volume of DMEM medium, and the resulting cell suspension was collected and centrifuged at 1200 rpm for 5 min. Supernatant was removed, and the cells are re-suspended in the culture medium. 2 mL of cell culture supernatant and 3-16×105 cells were taken to carry out tests, wherein bacterial detection and mycoplasma detection of gave negative results, HOPX positive percentage in biological potency test was ≥30%, cell identification test confirmed cells were KRT5 positive, and cell purity analysis showed KRT5 cell percentage was ≥90%. Meanwhile the re-suspended cells were plated onto three T75 cell culture flasks pre-coated with feeder cells at a density of 5-10×103 cells/cm2, and the culture medium was replaced every other day.
When the second passaged cells grew to cover 50%-90% of the bottom surface area of the culture flask, 3rd passage was performed as follows: for cells in each flask, the culture supernatant was removed, and the cells were washed once with 1×DPBS, and digested with 5 mL of recombinant trypsin at 37° C. for 5-10 min. After most of the cells became round and bright, adherent cells were detached by pipetting up and down and prepared into a single-cell suspension. The digestion was terminated with an equal volume of DMEM medium. The cell suspension was collected and centrifuged at 1200 rpm for 5 min. Supernatant was removed, and the cells were resuspended in the culture medium. The re-suspended cells were plated onto ten T75 cell culture flasks pre-coated with feeder cells at a density of 5-10×103 cells/cm2, and the culture medium was replaced every other day.
When the 3rd passaged cells grew to cover 50%-90% of the bottom surface area of the culture flask, the fourth passage was performed as follows: for cells in each flask, the culture supernatant was removed, and the cells were washed once with 1×DPBS, and digested with 5 mL of recombinant trypsin at 37° C. for 5-10 min. After most of the cells became round and bright, adherent cells were detached by pipetting up and down and prepared into a single-cell suspension. The digestion was terminated with an equal volume of DMEM medium. The cell suspension was collected, and centrifuged at 1200 rpm for 5 min. Supernatant was removed and the cells were resuspended in the culture medium. 1-10×105 cells were taken for biological potency test, wherein the HOPX positive percentage was ≥30%. Meanwhile, the resuspended cells were plated onto 30 T75 cell culture flasks pre-coated with feeder cells at a density of 5-10×103 cells/cm2, and the culture medium was replaced every other day.
The feeder cells were removed when the fourth passaged cells grew to cover 50%-90% of the bottom surface area of the culture flask. The operation was performed as follows: the culture supernatant in each culture flask was removed, and each culture flask was washed once with 1×DPBS, 5 mL of recombinant trypsin was added, and the culture flask was placed at 37° C. for 1-2 min. The feeder layer cells were detached by pipetting up and down, washed again with 1×DPBS, and digested with 5 mL of recombinant trypsin. After most of the cells became round and bright, adherent cells were detached by pipetting up and down and prepared into a single-cell suspension. The digestion was terminated with an equal volume of DMEM medium. The cell suspension was collected, and centrifuged at 1200 rpm for 5 min. Supernatant was removed, and the cells were resuspended in the culture medium. 5-10×105 cells were taken for cell purity analysis, and the result showed the proportion of KRT5 cells was >90%. Finally, all cells were plated in 30 T75 cell culture flasks for culture.
When the cells in the cell culture flasks grew to cover 85%-95% of the surface area of the culture flask, each culture flask was washed once with 1×DPBS, 5 mL of recombinant trypsin was added, and the culture flasks were placed at 37° C. for 5-15 min. After most of the cells became round and bright, adherent cells were gently detached by pipetting up and down with a 1 mL pipette and prepared into a single-cell suspension, and the digestion was terminated with an equal volume of DMEM medium. The cell suspension was collected, and then the bottom surface of the culture flask was rinsed with 5 mL of DMEM medium, and all the cell suspensions were collected. The cell suspensions were centrifuged at 1200 rpm for 5 min, the supernatant was removed, and the cells were washed for three times with normal saline for injection. Each washing step was performed as follows: 40 mL of 1×DPBS was used to resuspend the cell pellet, cells were centrifuged at 1200 rpm for 5 min, and the supernatant was removed. Then the cells were resuspended with 16 mL of normal saline for injection to prepare into a finished formulation, i.e., the REGEND001 autologous cell deliverable formulation.
1) The Process was Carried Out by the Following Specific Steps:
(1) sites where the formulation is delivered back are 14 pulmonary subsegments (segmental bronchi) of the lingual lobe of the left lung, the inferior lobe of the left lung, the middle lobe of the right lung, and the inferior lobe of the right lung, specifically the lateral segmental bronchus of the middle lobe of the right lung, the medial segmental bronchus of the middle lobe of the right lung, the apical segmental bronchus of the inferior lobe of the right lung, the medial basal segmental bronchus of the right lung, the anterior basal segmental bronchus of the right lung, the lateral basal segmental bronchus of the right lung, the posterior basal segmental bronchus of the right lung, the superior segmental bronchus of the lingual lobe of the left lung, the inferior segmental bronchus of the lingual lobe of the left lung, the apical segmental bronchus of the inferior lobe of the left lung, the anterior basal segmental bronchus of the left lung, the medial basal segmental bronchus of the left lung, the lateral basal segmental bronchus of the left lung, and the posterior basal segmental bronchus of the left lung. No formulation is delivered to all of bronchial segments of the superior lobe of the left lung and the superior lobe of the right lung.
(2) 14 mL of the 16 mL REGEND001 autologous cell deliverable formulation prepared in Example 1 or 2 (it was tested that the 14 mL REGEND001 autologous cell deliverable formulation contained (4-300)×106 bronchial basal cells, preferably (2-30)×107 bronchial basal cells) was taken, and diluted to 42 mL with normal saline. The diluted REGEND001 autologous cell deliverable formulation was transferred to a syringe, which was connected to a catheter in a bronchoscopic operating channel, and injected into each pulmonary subsegment via a bronchofiberscope, with 3 mL formulation injected into each pulmonary segment entrance (a pulmonary subsegment); specifically, 3 mL of the REGEND001 autologous cell deliverable formulation was injected into each pulmonary segment with the syringe, followed by injecting 5 mL of air, which was used to push the REGEND001 autologous cell deliverable formulation into the distal pulmonary subsegment.
(3) It would take about 1.5 hours to establish tight adhesion between the cells and the inflammatory and wounded areas of the lungs, and after completion of transplantation, the subjects were required to lie in horizontal position for about two hours.
(4) Fasting for food and water was required within 2 hours after treatment, the subjects shall avoid coughing as much as possible, and codeine can be given orally if necessary.
2) Treatment Course
The REGEND001 autologous cell deliverable formulation was proposed to be used once, the treatment was divided into two parts, wherein the first part was the collection, isolation and culture of bronchial basal cells (i.e. Example 1 or 2), the second part was once transplantation and delivery of the REGEND001 autologous cell deliverable formulation (the delivery was done only once during the whole course of treatment). The treatment course would take totally 4-8 weeks from the collection and isolation of bronchial basal cells to the formulation administration, followed by a 24-week follow-up observation period in which subjects needed to go to the hospital to receive corresponding tests, including safety and efficacy tests.
Safety tests included blood routine examination, urine routine examination, blood biochemistry, electrocardiogram and lung tumor marker detection.
Efficacy tests included pulmonary function tests (including the actual measured value of diffusing capacity of carbon monoxide (DLCO), the actual measured value/the predicted value of diffusing capacity of carbon monoxide (DLCO %), forced vital capacity FVC), six-minute walk test, and St. George's Respiratory Questionnaire (SGRQ).
3) The Following is Pulmonary Function Data of Four Patients With IPF Before and After Treatment.
According to the guidelines in the diagnosis of idiopathic pulmonary fibrosis (IPF) issued jointly by the four international respiratory societies, the American Thoracic Society (ATS), the European Respiratory Society (ERS), the Japanese Respiratory Society (JRS) and the Latin American Thoracic Association (ALAT), in the American Journal of Respiratory Critical Care in September, 2018 (references: 1. Raghu G, et al. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med Published Online: September 2018; 2. Raghu G, et al. ATS/ERS/JRS/ALAT Committee on Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management. Am J Respir Crit Care Med Published Online: March 2011): IPF is a specific form of chronic progressive fibrotic interstitial pneumonia with unknown causes, which is confined to the lungs. The diagnostic criteria are: 1. exclusion of other interstitial lung diseases (ILD) (e.g., ILD associated with home or occupational environmental exposure, ILD associated with connective tissue disease, ILD associated with drug toxicity); 2. HRCT is manifested as UIP; 3. Patients with lung tissue specimens can be diagnosed by combining HRCT and histological features. (Where one of the above items 2 and 3 can be satisfied). Patients with idiopathic pulmonary fibrosis have an impaired pulmonary ventilation function (pulmonary diffusion function) and the actual measured value/the predicted value of DLCO (DLCO %) is less than 80%. (Clinical pulmonary diffusion function classification: normal: 80%≤DLCO/predicted (DLCO %); mild: 60%≤DLCO/predicted (DLCO %)<80%; moderate: 40%≤DLCO/predicted (DLCO %)<60%; severe: DLCO/predicted (DLCO %)<40%).
Male, 66 years old, height 172 cm, weight 83 kg, suffering from recurrent cough and sputum with shortness of breath for 2 years, clinically diagnosed as idiopathic pulmonary fibrosis, with moderate diffusion dysfunction. Meanwhile suffered from hypertension for 7 years and type 2 diabetes for 7 years. The patient was treated with the REGEND001 autologous cell deliverable formulation prepared in Example 1 at a dose of 1.13×106 bronchial basal cells/kg.
Pulmonary ventilation function (DLCO) before/predicted (DLCO %) (i.e., actual measured value/predicted value %) was 50.0% at a baseline, and was 60.7% at 12 weeks after transplantation treatment, indicating an improvement of 21.4% compared to baseline; and was 61.5% at 24 weeks after treatment, indicating an improvement of 23.0% compared to baseline. The diffusion function is improved significantly after treatment (see Table 1 and
Pulmonary ventilation function, actual measured value of DLCO (mL·kPa−1/s) was 4.40 at the baseline, 5.29 at 12 weeks after treatment, and 5.37 at 24 weeks after treatment. The diffusion function is improved significantly after treatment (see
The result of 6-minute walk test was 330 m at the baseline, and 523 m at 12 weeks after treatment (193 m or 58.48% increase than the baseline). The motor function status is improved significantly.
St. George's Respiratory Questionnaire (SGRQ) was 17.39 at the baseline, 9.57 at 12 weeks after treatment (7.82 or 44.97% decrease than the baseline). The treatment on quality of life is improved significantly.
Male, 64 years old, height 172 cm, weight 86 kg, suffering from recurrent cough and sputum, clinically diagnosed as idiopathic pulmonary fibrosis with severe diffusion dysfunction for 4 years of disease duration. Meanwhile suffered from coronary heart disease for 4 years and hypertension for 4 years. The patient was treated with the REGEND001 autologous cell deliverable formulation prepared in Example 2 at a dose of 0.71×106 bronchial basal cells/kg.
Pulmonary ventilation function DLCO before/predicted (DLCO %) (i.e., actual measured value/predicted value %) was 23.1% at a baseline, and was 26% at 4 weeks after treatment, and 28% at 12 weeks after treatment, indicating a significant improvement in diffusion function compared to baseline (see Table 1 and
The pulmonary ventilation function, actual measured value of DLCO (mL·kPa−1/s) was 2.04 at the baseline, 2.25 at 4 weeks after treatment, and 2.34 at 12 weeks after treatment, indicating significant improvement in diffusion function than the baseline (see
There was no abnormal or abnormally increased change in urine routine examination and blood biochemistry before and after treatment.
Female, 60 years old, height 156 cm, weight 55 kg, suffering from recurrent cough and sputum for more than 8 years, clinically diagnosed as idiopathic pulmonary fibrosis, which was severe with undetectable diffusion function. Meanwhile suffered from Hashimoto's thyroiditis. The patient was treated with the REGEND001 autologous cell deliverable formulation prepared in Example 2 at a dose of 3.84×106 bronchial basal cells/kg.
DLCO before/predicted (DLCO %) (i.e. actual measured value/predicted value %) was not detected at baseline, and this value was 23.2% at 4 weeks after treatment, and 31% at 12 weeks after treatment, indicating significant improvement in diffusion function (see Table 1 and
The DLCO actual measured value (mL·kPa−1/s) was not measured at baseline, was 1.64 at 4 weeks after treatment and 2.19 at 12 weeks after treatment, indicating a significant improvement in diffusion function (see
It is apparent that the foregoing examples are merely examples for clear description and are not intended to limit the embodiments. For a person of ordinary skill in the art, variations or changes in other different forms can be made based on the above description. It is not necessary or possible to be exhaustive of all embodiments here. The obvious variations or changes derived therefrom still fall within the protection scope of the present application.
| Number | Date | Country | Kind |
|---|---|---|---|
| 202010682604.4 | Jul 2020 | CN | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/CN2021/106176 | 7/14/2021 | WO |
