Patent Application
20230330031
The Sequence Listing associated with this application is provided in XML format and is hereby incorporated by reference into the specification. The name of the XML file containing the Sequence Listing is 15095USDIV.xml. The XML file is 5 KB, was created on Sep. 22, 2022, and is being submitted electronically via the USPTO patent electronic filing system.
Mutations in the coagulation factor VIII gene result in a decreased or defective coagulation factor (fVIII) protein that gives rise to hemophilia A, which is characterized by uncontrolled bleeding. Hemophilia B is similarly associated with a genetic defect in coagulation factor IX (fIX). Treatment of hemophilia A typically entails repeated intravenous infusion of either human plasma-derived or recombinant fVIII product. Significant amounts of patients treated with fVIII replacement products develop neutralizing antibodies that render future treatment ineffective. Thus, there is a need to identify improved therapies.
Voros et al. report nanoconstructs with immobilizing tissue plasminogen activator molecules are capable of dissolving clots. Adv. Funct. Mater. 2015, 25, 1709-1718. Korin et al. report shear-activated nanotherapeutics for drug targeting to obstructed blood vessels. Science. 2012, 337(6101):1453.
Hanafy et al. report the fabrication of homogenous CaCO3 particles in assembling polyelectrolyte capsules. J. Basic Appl. Sci., 4 (2015), 60-70. It also reports that these polyelectrolyte capsules are a template for encapsulation of cargo molecules either by using co-precipitation or by loading cargo molecule after core removal. Poojari et al. report electrostatically mediated layer-by-layer assembled sorafenib nanoparticles. Colloids Surf B Biointerfaces. 2016, 143:131-8.
U.S. Pat. No. 6,391,343 reports fibrinogen-coated particles for therapeutic uses.
References cited herein are not an admission of prior art.
This disclosure relates to microcapsule particles for targeted delivery of drugs. In certain embodiments, the particles comprise polyelectrolyte polymers, e.g., layers of anionic polymers and cationic polymers. In certain embodiments, the particles have a fibrinogen coating. In certain embodiments, the particles contain a polysaccharide core and/or a polysaccharide coating, encapsulating drugs, proteins, clotting agents, coagulation factors, or anticoagulants. In certain embodiments, this disclosure contemplates methods of using particles disclosed herein to prevent or reduce onset of or duration of bleeding. In certain embodiments, this disclosure contemplates methods of using particles disclosed herein to prevent or reduce onset of blood clotting.
In certain embodiments, this disclosure relates to a polymer-protein microcapsule for targeted drug delivery of intravenously administered blood clot regulating drugs. In certain embodiments, the microcapsule comprises of at least four chemical regions comprising: a protein and polymer layer on the exterior of the microcapsule shell, a microcapsule shell comprised of biodegradable polyelectrolyte polymers, a separate polymer layer on the inside of the microcapsule shell, and an aqueous core containing a drug to be delivered. In certain embodiments, the drug to be delivered includes, but are not limited to, human or recombinant forms of Factor VIII, Factor VII, tissue plasminogen activator, or urokinase plasminogen activator.
In certain embodiments, this disclosure relates to particle having core comprising drugs, proteins, clotting agents, coagulation factors, or anticoagulants encapsulated inside a coating comprising: a) a cationic polymer or a polymer comprising cationic monomers; b) an anionic polymer or a polymer comprising anionic monomers; and c) an outer layer exposing fibrinogen or other protein on the outer surface.
In certain embodiments, the anionic polymer or polymer comprising the anionic monomers is under the outer layer. In certain embodiments, the cationic polymer or polymer comprising cationic monomers is poly-L-lysine. In certain embodiments, the anionic polymer or polymer comprising anionic monomers is poly-L-glutamic acid.
In certain embodiments, the particles disclosed herein further comprise a polysaccharide layer such as a dextran layer. In certain embodiments, the cationic polymer and the anionic polymer is over the polysaccharide layer.
In certain embodiments, the disclosure contemplates a particle or microcapsule for delivery of clot regulating drugs towards treating blood-clotting disorders including, but not limited to, hemophilia A, hemophilia B, severe hemorrhage, heart attack, stroke, or thrombosis.
In certain embodiments, this disclosure relates to methods of treating or preventing excessive bleeding comprising administering a particle disclosed herein to a subject in need thereof. In certain embodiments, the subject is diagnosed with hemophilia A or B or the subject is diagnosed with acquired hemophilia or thrombocytopenia.
In certain embodiments, this disclosure relates to methods of producing particle disclosed herein having core comprising a coagulation factor protein encapsulated in a coating comprising: a) mixing carbonate salt such as sodium carbonate and a calcium salt such as calcium chloride under conditions such that a calcium carbonate core is formed; b) mixing the calcium core and a polysaccharide under conditions such that a polysaccharide layer is formed over core to provide a polysaccharide layered core; c) mixing the a polysaccharide layered core with an cationic polymer under conditions such that a polymer layer comprising the cationic polymer is formed providing a cationic polymer coated core; d) mixing the cationic polymer coated core with an anionic polymer under conditions such that an polymer layer comprising the anionic polymer is formed providing a cationic polymer layer and anionic polymer layer coated core; and e) mixing the cationic polymer layer and anionic polymer layer coated core with fibrinogen under conditions such that an outer layer exposing fibrinogen on the outer surface is formed providing a fibrinogen coated particle.
In certain embodiments, the steps of both c) and d) wherein c) mixing the a polysaccharide layered core with an cationic polymer under conditions such that a polymer layer comprising the cationic polymer is formed providing a cationic polymer coated core and d) mixing the cationic polymer coated core with an anionic polymer under conditions such that an polymer layer comprising the anionic polymer is formed providing a cationic polymer layer and anionic polymer layer coated core, are repeated more than two, three, four, or five times.
In certain embodiments, the methods disclosed herein further comprise the step of exposing the fibrinogen coated particle with a water soluble chelating agent under conditions to remove the calcium ions in the core of the particle, providing a fibrinogen coated particle depleted of the calcium core, and mixing the fibrinogen coated particle depleted of the calcium core with a drug under conditions such that the coagulation factor is absorbed into the core providing a particle having core comprising a coagulation factor protein encapsulated in a coating comprising anionic and cationic polymers.
In certain embodiments, the disclosure contemplates that a drug can be co-encapsulated in the calcium carbonate core by adding it into one of the salt solutions, e.g., before mixing the carbonate salt, e.g., sodium carbonate and calcium salt, e.g., calcium chloride together. In certain embodiments, the drug is then retained in the microcapsule when the calcium carbonate core is removed
In certain embodiment, this disclosure contemplates pharmaceutical compositions comprising particles disclosed herein and pharmaceutically acceptable excipient. In certain embodiments, this disclosure contemplates the production of a medicament comprising particles disclosed herein and uses for methods disclosed herein.
Before the present disclosure is described in greater detail, it is to be understood that this disclosure is not limited to particular embodiments described, and as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present disclosure will be limited only by the appended claims.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs. Although any methods and materials similar or equivalent to those described herein can also be used in the practice or testing of the present disclosure, the preferred methods and materials are now described.
All publications and patents cited in this specification are herein incorporated by reference as if each individual publication or patent were specifically and individually indicated to be incorporated by reference and are incorporated herein by reference to disclose and describe the methods and/or materials in connection with which the publications are cited. The citation of any publication is for its disclosure prior to the filing date and should not be construed as an admission that the present disclosure is not entitled to antedate such publication by virtue of prior disclosure. Further, the dates of publication provided could be different from the actual publication dates that may need to be independently confirmed.
As will be apparent to those of skill in the art upon reading this disclosure, each of the individual embodiments described and illustrated herein has discrete components and features which may be readily separated from or combined with the features of any of the other several embodiments without departing from the scope or spirit of the present disclosure. Any recited method can be carried out in the order of events recited or in any other order that is logically possible.
Embodiments of the present disclosure will employ, unless otherwise indicated, techniques of medicine, organic chemistry, biochemistry, molecular biology, pharmacology, and the like, which are within the skill of the art. Such techniques are explained fully in the literature.
It must be noted that, as used in the specification and the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the context clearly dictates otherwise. In this specification and in the claims that follow, reference will be made to a number of terms that shall be defined to have the following meanings unless a contrary intention is apparent.
Prior to describing the various embodiments, the following definitions are provided and should be used unless otherwise indicated.
“Cationic polymers” refer to macromolecules that are capable of bearing positive charges in solutions at acidic or near neutral pH, which can be either intrinsically present in the polymer backbone and/or in the side chains. Typical cationic polymers possess quaternary amines or primary, secondary, or tertiary functional groups that can be protonated. Examples include natural cationic polymers such as gelatin. Semi-synthetic cationic polymers such as chitosan that has a repeating amino group. The primary amino groups present on a polymer backbone provides reactive sites for a variety of side-group attachments. Other polymers and polysaccharides such as dextrin, cyclodextrin, dextran, and cellulose can be modified to contain amine groups. Other cationic polymers may be synthetic such as polyethylenimine, poly-L-lysine, poly-L-arginine, poly-L-histidine, poly(amidoamine), poly(amino-co-ester)s, poly[2-(N,N-dimethylamino)ethyl methacrylate] and copolymers thereof.
“Anionic polymers” refer to macromolecules that are capable of bearing negative charges in solutions at basic or near neutral pH, which can be intrinsically present in the polymer backbone and/or in the side chains. Typical anionic polymers possess carboxylic acid, sulfate and/or phosphate groups. Examples include polyacrylate, polymethacrylate poly-L-glutamic acid, poly-L-aspartic acid, polyhydroquinone, polydibenzyl phosphate, polyvinyl sulfonate. Also contemplated are copolymers such as acrylic or methacrylic acid that has been crosslinked with a di-functional monomer (e.g., divinylbenzene).
“Polysaccharides” refer to polymers having a sugar backbone. Examples of polysaccharides include dextrans, dextrins, chitosan, pullulans, and celluloses. Dextrans refer to polysaccharides with molecular weights that are typically greater than 1,000 Dalton and have a linear backbone of repeating alpha-linked D-glucopyranosyl, such as isomaltose units. Dextrans are typically produced in bacteria. The molecular weight and spatial arrangement of dextrans depends on the microbial producing strains and cultivation conditions. There are three classes of dextran differentiated by the structural features.
As used herein, the term “biodegradable” refers to a material that when transplanted into an area of a subject, e.g., human, will be degraded my biological mechanism such that the material will not persist in the area for over a long period of time, e.g., material will be removed by the body after a couple days or a week or month(s). In certain embodiments, this disclosure contemplates that the biodegradable material will not be found at the transplanted location after one day, two days, a week, a month, six months, or a year.
As used herein, “subject” refers to any animal, preferably a human patient, livestock, or domestic pet.
As used herein, the terms “prevent” and “preventing” include the prevention of the recurrence, spread or onset. It is not intended that the present disclosure be limited to complete prevention. In some embodiments, the onset is delayed, or the severity is reduced.
As used herein, the terms “treat” and “treating” are not limited to the case where the subject (e.g. patient) is cured and the disease is eradicated. Rather, embodiments of the present disclosure also contemplate treatment that merely reduces symptoms, and/or delays disease progression.
Blood clot regulating drugs are administered topically for hemorrhage or intravenously for either clot promoting or clot busting treatments. Topical administration has a low risk of side effects but is ineffective in treating hemorrhage from severe trauma or non-compressible injuries. Intravenous delivery, while more effective, is done systemically, which increases the risk of side effects. These side effects include hemorrhage from clot busting drugs or heart attack and stroke from clot promoting drugs. Furthermore, patients suffering from bleeding disorders such as hemophilia A may form inhibitors to the drug, which significantly decreases the drug's efficacy.
There exists a substantial need for targeted delivery systems of clot regulating drugs administered intravenously, so as the patient is only exposed to the drug strictly at the site wherein clot regulation is needed, thereby avoiding side effects and inhibitor interactions. However, current targeted delivery technologies that have been developed are inappropriate for treating critical conditions in restrained periods. They either require external resources (magnets or lasers) to target or deliver the drug, or if they have biochemical targeting and delivery mechanisms, taking several days or even weeks to fully deliver their drug payload. A targeted delivery technology for clot regulating drugs would leverage existing biochemical and biomechanical pathways within the body to target and deliver the full dose of the drug without external equipment and within a short time frame. It is an object of the instant disclosure to address these needs.
Certain embodiments disclosed herein provides for therapeutics that are delivered systemically and become active or released at sites in blood vessels that require blood clot regulation. This is based upon using micron size capsules as vehicles that will target specific cells/tissues by interaction with naturally occurring pathways in the blood clotting mechanism such as the contractile force of platelets and their adhesion to fibrinogen.
This disclosure relates to a drug delivery approach to treat unregulated blood clotting in cases where severe blood loss and/or unwanted clotting occurs. This includes disorders such as, deep vein thrombosis, pulmonary thrombosis, Factor V Leiden Mutation, PT gene mutation, Protein C and S deficiency, Hemorrhagic Stroke, Severe Bleeding, Hemophilia A/B, von Willebrands disease.
Fibrinogen is a glycoprotein in vertebrates that helps in the formation of blood clots. Fibrinogen is a soluble, large, and complex glycoprotein, 340 kDa in size, which is converted by thrombin into fibrin during blood clot formation. During normal blood coagulation, a coagulation cascade activates the zymogen prothrombin by converting it into the serine protease thrombin. Thrombin then converts the soluble fibrinogen into insoluble fibrin strands. These strands are then cross-linked by factor XIII to form a blood clot. Factor XIIa stabilizes fibrin further by incorporation of the fibrinolysis inhibitors alpha-2-antiplasmin and TAFI (thrombin activatable fibrinolysis inhibitor, procarboxypeptidase B), and binding to several adhesive proteins of various cells.
By displaying fibrinogen on the exterior of the drug delivery vehicles, the drug-loaded vehicles will integrate into the fibrin network of the forming clot. The mechanical force of the contracting clot caused by activated platelets will rupture the vehicle and will thereby deliver the drug solely to the site of the clot.
In certain embodiments, this disclosure relates to a polymer-protein microcapsule for targeted drug delivery of intravenously administered blood clot regulating drugs. In certain embodiments, the microcapsule comprises of at least four chemical regions comprising: a protein and polymer layer on the exterior of the microcapsule shell, a microcapsule shell comprised of biodegradable polyelectrolyte polymers, a separate polymer layer on the inside of the microcapsule shell, and an aqueous core containing a drug to be delivered. In certain embodiments, the drug to be delivered includes, but are not limited to, human or recombinant forms of Factor VIII, Factor VII, tissue plasminogen activator, or urokinase plasminogen activator.
Particles disclosed herein show activity and effect in a clot-like in vitro system using static fibrin networks with a high concentration of activated platelets. Only platelets located in the fibrin network ruptured and released the drug. Drug delivery from capsules occurs only in specific clot-like structures and is controlled by contractive mechanical action of activated platelets
In certain embodiments, this disclosure relates to a particle having core comprising a drug, protein, or coagulation factor encapsulated in a coating comprising: a) a cationic polymer or a polymer comprising cationic monomers; b) an anionic polymer or a polymer comprising anionic monomers; and c) an outer layer exposing fibrinogen on the outer surface.
In certain embodiments, the anionic polymer or polymer comprising the anionic monomers is under the outer layer. In certain embodiments, the coagulation factor is fVIII. In certain embodiments, the cationic polymer or polymer comprising cationic monomers is poly-L-lysine. In certain embodiments, the anionic polymer or polymer comprising anionic monomers is poly-L-glutamic acid.
In certain embodiments, the particles disclosed herein further comprise a polysaccharide layer such as a dextran layer. In certain embodiments, the cationic polymer and the anionic polymer is over the polysaccharide layer.
In certain embodiments, this disclosure relates to a polymer-protein microcapsule for intravenous targeted drug delivery of the encapsulated drug. An illustrated embodiment is shown in
As illustrated in
The layer 14 functions as a barrier between the core 12 and the element 16 so that there are limited chemical or electrostatic interactions between the drug retained in the core 12 and the polymers of element 16.
The polymer layer 14 is surrounded by the element 16 of the microcapsule, which comprises several layers of polyelectrolyte polymers. The polyelectrolyte polymers are repetitively layered around layer 14 with alternating charge. The element 16 of the microcapsule comprises a minimum of 4 polyelectrolyte polymer layers, which may either be cross-linked through chemical means or held together through electrostatic interactions. The polyelectrolyte polymers may be, but are not limited to, poly-L-lysine, poly-L-glutamic acid, poly-L-arginine, poly malic acid, or dextran sulfate of various sizes.
The layer 18 of the microcapsule surrounds element 16 and functions as the exterior of the microcapsule. The layer 18 is comprised of the protein, fibrinogen, and a negatively charged polyelectrolyte in various concentration ratios. The polyelectrolyte used in layer 18 may or may not be used in element 16. The components of layer 18, that is to say the protein and negative polyelectrolyte polymer, may or may not be chemically cross-linked together. Furthermore, the components of layer 18 may or may not be chemically cross-linked to the components of element 16. The protein's biochemical activity of layer 18 is retained, such that platelets can adhere to the microcapsule exterior by binding to the protein after intravenous administration.
In
The mechanical properties of element 16 are such that the microcapsule structure will withstand forces experienced during fabrication, storage, and handling. However, the mechanical properties of element 16 are weak enough such that the microcapsule will rupture open upon contraction of platelets on the microcapsule.
The advantages of the present invention include, but are not limited to, targeted delivery and burst release of the encapsulated drug. The protein of layer 18 imparts the advantage of targeted delivery by allowing platelets to adhere to the microcapsule exterior. The adhered platelets allow the microcapsule to be directed and adhered to areas requiring blood clot regulation (target sites for the drug carried in core 12 within the microcapsule). The microcapsule is further adhered to target sites by the fibrinogen protein of layer 18, which polymerizes into the target site's fibrin network. Once the microcapsule is adhered to the target site, physical contraction of nearby platelets provides sufficient mechanical force to rupture the microcapsule shell (element 16) and release the encapsulated drug from core 12. Burst release of the drug occurs because layer 14 physically shields the drug from the electrostatic charge of element 16, allowing full exposure of the drug to the target site.
In certain embodiments, particles and microcapsules disclosed herein encapsulate a drug that can be a coagulation factor. The blood clotting system is a proteolytic cascade. Blood clotting factors are present in the plasma as a zymogen, in other words in an inactive form, which on activation undergoes proteolytic cleavage to release the active factor form the precursor molecule. The ultimate goal is to produce thrombin. Thrombin converts fibrinogen into fibrin strands. These strands are then cross-linked by factor XIII to form a blood clot.
Fibrinogen, or Factor I, has an approximate molecular weight of 340 kDa. The purification of human plasma fibrinogen by chromatography is described. See Kuyas et al., Thromb Haemost. 1990, 63(3):439-44, and Dempfle et al. Thromb Res. 1987, 46(1):19-27.
Factor X is the first molecule of the common pathway and is activated by a complex of molecules containing activated factor IX (FIXa), factor VIII, calcium, and phospholipids, which are on the platelet surface. Factor VIII is activated by thrombin, and it facilitates the activation of factor X by FIXa. Factor VIII (fVIII) contains multiple domains (A1-A2-B-ap-A3-C1-C2) and circulates in blood in an inactivated form bound to von Willebrand factor (VWF). The C2 domain is involved with fVIII binding to VWF. Thrombin cleaves fVIII causing dissociation with VWF ultimately leading to fibrin formation through factor IX (fIX).
Congenital hemophilia A is associated with genetic mutations in the fVIII gene and results in impaired clotting due to lower than normal levels of circulating fVIII. Hemophilia B is similarly associated with genetic mutations in the fIX gene.
A treatment option for a patient diagnosed with hemophilia A is the exogenous administration of recombinant fVIII sometimes referred to as fVIII replacement therapy. In some patients, this therapy can lead to the development of antibodies that bind to the administered fVIII protein. Subsequently, the fVIII-antibody bound conjugates, typically referred to as inhibitors, interfere with or retard the ability of fVIII to cause blood clotting. Inhibitory autoantibodies also sometimes occur spontaneously in a subject that is not genetically at risk of having hemophilia, termed acquired hemophilia. Inhibitory antibodies assays are typically performed prior to exogenous fVIII treatment in order to determine whether the anti-coagulant therapy will be effective.
A “Bethesda assay” has historically been used to quantitate the inhibitory strength the concentration of factor VIII binding antibodies. In the assay, serial dilutions of plasma from a patient, e.g., prior to having surgery, are prepared and each dilution is mixed with an equal volume of normal plasma as a source of fVIII. After incubating for a couple hours, the activities of factor VIII in each of the diluted mixtures are measured. Having antibody inhibitor concentrations that prevent factor VIII clotting activity after multiple repeated dilutions indicates a heightened risk of uncontrolled bleeding. Patients with inhibitor titers after about ten dilutions are felt to be unlikely to respond to exogenous fVIII infusions to stop bleeding. A Bethesda titer is defined as the reciprocal of the dilution that results in 50% inhibition of FVIII activity present in normal human plasma. A Bethesda titer greater than 10 is considered the threshold of response to FVIII replacement therapy. Thus, in certain embodiments, this disclosure contemplates that a subject to receive administrations of pharmaceutical compositions comprising particles disclosed herein is diagnosed with a Bethesda titer of greater than 5, 6, 7, 8, 9, or 10.
In blood plasma, Factor VIII is usually complexed with another plasma protein, von Willebrand factor (vWF), which is present in plasma in a large molar excess to Factor VIII and is believed to protect Factor VIII from premature degradation. Another circulating plasma protein, albumin, may also play a role in stabilizing Factor VIII in vivo. Factor VIII preparations use of albumin and/or vWF to stabilize Factor VIII during the manufacturing process and during storage. In certain embodiments, this disclosure contemplates particles comprising Factor VIII in the core in combination with albumin and/or vWF.
FVIII is a large glycoprotein containing the domain structure A1-A2-B-activation peptide (ap)-A3-C1-C2. Gitschier et al., Nature, 1984, 312, 326-330. Factor VIII domain boundaries refer to the human fVIII amino acid sequence numbering as follows; residues 1-19 (Signal Sequence), 20-391 (A1), 392-759 (A2), 760-1667 (B), 1668-1708 (ap), 1709-2038 (A3), 2039-2191 (C1) and 2192-2351 (C2). Gitschier et al., Nature, 1984,312, 326-330. (SEQ ID NO: 1):
Before cell secretion, fVIII is cleaved at the B/ap-A3 domain junction into A1-A2-B (heavy chain) and ap-A3-C1-C2 (light chain) subunits. fVIII circulates in the plasma as an inactive heavy chain/light chain heterodimeric procofactor that is non-covalently bound to von Willebrand factor. Proteolytic activation of fVIII by thrombin results from cleavages at Arg-372 between the A1 and A2 domains, Arg-740 between the A2 and B domains, and Arg-1689 between the ap and A3 domains. During this process, the covalent linkage between the A1 and A2 domains is lost, and the B domain and 41-residue ap are released, producing a heterotrimeric, A1/A2/A3-C1-C2 subunit structure. See Doering et al. J Biol Chem. 2004, 279(8):6546-52. A number of functional B-domain-deleted recombinant factor VIII proteins containing a linker with recognition sequence for PACE/furin processing sequence, RHQR (SEQ ID NO: 2), substituted for the B-domain are known. See Sandberg et al. Thromb Haemost. 2001, 85(1):93-100 and Brown et al., Mol Ther Methods Clin Dev. 2014, 1:14036.
In certain embodiments, this disclosure contemplates methods of using particles disclosed herein to prevent or reduce onset of or duration of bleeding. In certain embodiments, this disclosure contemplates methods of using particles disclosed herein to prevent or reduce onset of blood clotting. In certain embodiments, the disclosure contemplates a particle or microcapsule for delivery of clot regulating drugs towards treating or preventing blood-clotting disorders including, but not limited to, hemophilia A, hemophilia B, severe hemorrhage, heart attack, stroke, or thrombosis.
In certain embodiments, the disclosure relates to methods of inducing blood clotting comprising administering an effective amount of a particle as disclosed herein to a subject in need thereof. In certain embodiments, the subject is diagnosed with hemophilia A or B or acquired hemophilia and/or unlikely to respond to exogenous fVIII infusions.
In certain embodiments, the methods are provided to increase the speed or strength of blood clot formation. In certain embodiments, this disclosure contemplates methods of using particles disclosed herein to prevent or reduce onset of or duration of bleeding.
In certain embodiments, the methods include controlling and/or preventing bleeding episodes in adults and children (0-16 years) with hemophilia A. In certain embodiments, the methods include perioperative management, e.g., administration prior to surgery or anesthesia, in adults and children (0-16 years) with hemophilia A.
In certain embodiments, the methods include routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adults and children (0-16 years) with hemophilia A. For prevention of bleeding episodes, doses between 20 to 40 International Units of Factor VIII per kg body weight every other day (3 to 4 times weekly) may be utilized. Alternatively, an every third day dosing regimen targeted to maintain FVIII trough levels ≥1% may be employed. In certain embodiments, the methods contemplate a subject under the age of 6, is administered doses of 25 to 50 IU of Factor VIII per kg body weight 3 to 4 times weekly.
In certain embodiments, this disclosure contemplates therapeutic methods comprising the step of administering (e.g., to inject or infuse) fibrinogen coated particles disclosed herein intravenously for the purpose of decreasing bleeding time in thrombocytopenic subject. Thrombocytopenic subjects lack a sufficient concentration of platelets that are essential cellular elements responsible for hemostasis. In a thrombocytopenic animal, the number of platelets is not sufficient to form a plug quickly. As a result, it takes a much longer time for bleeding to stop. It is anticipated that in patients about to undergo surgery with major blood loss, or in trauma patients such as soldiers wounded in the battlefield, even though they have a “normal” platelet count, an augmentation of the number of particles will decrease blood loss and lead to shortened surgical time. Subjects at risk of thrombocytopenic include those with aplastic anemia, cancer in the bone marrow, such as leukemia, cirrhosis (liver scarring), folate deficiency, myelodysplastic syndrome, and a vitamin B12 deficiency.
In certain embodiments, the methods are provided to prevent, decrease the speed, reduce or weaken blood clot formation. In certain embodiments, the disclosure relates to methods of preventing blood clotting comprising administering an effective amount of a particle disclosed herein carrying or encapsulating or comprising immobilizing tissue plasminogen activator molecules (tPA) and/or other anti-clotting agent on the interior of the particle, e.g., warfarin (coumadin), acenocoumarol, phenprocoumon, atromentin, phenindione, a heparin, heparin tetrasaccharide, pentosan polysulfate, phosphomannopentanose sulfate, factor IIa (dabigatran) and factor Xa (rivaroxaban, apixaban and edoxaban), to a subject in need thereof.
In certain embodiment, this disclosure contemplates pharmaceutical compositions comprising particles disclosed herein and pharmaceutically acceptable excipient. In certain embodiments, this disclosure contemplates the production of a medicament comprising particles disclosed herein and uses for methods disclosed herein.
Pharmaceutical compositions typically comprise an effective amount of particles and a suitable pharmaceutical acceptable carrier. The preparations can be prepared in a manner known per se, which usually involves mixing the particles according to the disclosure with the one or more pharmaceutically acceptable carriers, and, if desired, in combination with other pharmaceutical active compounds, when necessary under aseptic conditions. Reference is made to U.S. Pat. Nos. 6,372,778, 6,369,086, 6,369,087 and 6,372,733 and the further references mentioned above, as well as to the standard handbooks, such as the latest edition of Remington's Pharmaceutical Sciences.
In certain embodiments, the disclosure relates to pharmaceutical compositions comprising particles disclosed herein and a pharmaceutically acceptable excipient. In certain embodiments, the composition is a pill or in a capsule or the composition is an aqueous buffer, e.g., a pH between 6 and 8. In certain embodiments, the pharmaceutically acceptable excipient is selected from a filler, glidant, binder, disintegrant, lubricant, and saccharide. Optionally, the pharmaceutical composition further comprises a second clotting agent such as aminocaproic acid (ε-aminocaproic acid), tranexamic acid, fibrinogen, and vitamin K.
Compositions suitable for parenteral injection may comprise physiologically acceptable sterile aqueous or nonaqueous solutions, dispersions, suspensions or emulsions, and sterile powders for reconstitution into sterile injectable solutions or dispersions. Examples of suitable aqueous and nonaqueous carriers, diluents solvents or vehicles include water, ethanol, polyols (propylene glycol, polyethylene glycol, glycerol, and the like), suitable mixtures thereof, vegetable (such as olive oil, sesame oil and viscoleo) and injectable organic esters such as ethyl oleate.
Prevention of the action of microorganisms may be controlled by addition of any of various antibacterial and antifungal agents, example, parabens, chlorobutanol, phenol, sorbic acid, and the like. It may also be desirable to include isotonic agents, for example sugars, sodium chloride, and the like. Prolonged absorption of the injectable pharmaceutical form can be brought about by the use of agents delaying absorption, for example, aluminum monostearate and gelatin.
Solid dosage forms for oral administration include capsules, tablets, pills, powders and granules. In such solid dosage forms, the particles may be admixed with at least one inert customary excipient (or carrier) such as sodium citrate or dicalcium phosphate or: (a) fillers or extenders, as for example, starches, lactose, sucrose, glucose, mannitol and silicic acid, (b) binders, as for example, carboxymethylcellulose, alginates, gelatin, polyvinylpyrrolidone, sucrose, and acacia, (c) humectants, as for example, glycerol (d) disintegrating agents, as for example, agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain complex silicates, and sodium carbonate, (e) solution retarders, as for example paraffin, (f) absorption accelerators, as for example, quaternary ammonium compounds, (g) wetting agents, as for example cetyl alcohol, and glycerol monostearate, (h) adsorbents, as for example, kaolin and bentonite, and (i) lubricants, as for example, talc, calcium stearate, magnesium stearate, solid polyethylene glycols, sodium lauryl sulfate, or mixtures thereof. In the case of capsules, tablets, and pills, the dosage forms may also comprise buffering agents.
Liquid dosage forms for oral administration include pharmaceutically acceptable emulsions, solutions, suspensions, syrups, and elixirs. In addition to the particles, the liquid dosage forms may contain inert diluents commonly used in the art, such as water or other solvents, solubilizing agents and emulsifiers, for example, ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3-butylene glycol, dimethylformamide, oils, in particular, cottonseed oil, groundnut oil, corn germ oil, olive oil, Viscoleo™, castor oil and sesame oil, glycerol, tetrahydrofurfuryl alcohol, polyethylene glycols and fatty acid esters of sorbitan or mixtures of these substances, and the like.
In certain embodiments, production processes are contemplated which two components, d particles disclosed herein and a pharmaceutical carrier, are provided already in a combined dry form ready to be reconstituted together. In other embodiments, it is contemplated that particles disclosed herein and a pharmaceutical carrier are admixed to provide a pharmaceutical composition.
Providing a pharmaceutic composition is possible in a one-step process, simply by adding a suitable pharmaceutically acceptable diluent to the composition in a container. In certain embodiments, the container is preferably a syringe for administering the reconstituted pharmaceutical composition after contact with the diluent. In certain embodiments, the coated particles can be filled into a syringe, and the syringe can then be closed with the stopper. A diluent is used in an amount to achieve the desired end-concentration. The pharmaceutical composition may contain other useful component, such as ions, buffers, excipients, stabilizers, etc.
A “dry” pharmaceutical composition typically has only a residual content of moisture, which may approximately correspond to the moisture content of comparable commercial products, for example, has about 12% moisture as a dry product. Usually, the dry pharmaceutical composition according to the present invention has a residual moisture content preferably below 10% moisture, more preferred below 5% moisture, especially below 1% moisture. The pharmaceutical composition can also have lower moisture content, e.g., 0.1% or even below. In certain embodiments, the pharmaceutical composition is provided in dry in order to prevent degradation and enable storage stability.
A container can be any container suitable for housing (and storing) pharmaceutically compositions such as syringes, vials, tubes, etc. The pharmaceutical composition may then preferably be applied via specific needles of the syringe or via suitable catheters. A typical diluent comprises water for injection, and NaCl (preferably 50 to 150 mM, especially 110 mM), CaCl2) (preferably 10 to 80 mM, especially 40 mM), human albumin (preferably up to 2% w/w, especially 0.5% w/w), sodium acetate (preferably 0 to 50 mM, especially 20 mM) and mannitol (preferably up to 10% w/w, especially 2% w/w). Preferably, the diluent can also include a buffer or buffer system so as to buffer the pH of the reconstituted dry composition, preferably at a pH of 6.2 to 7.5, especially at pH of 6.9 to 7.1.
In certain embodiments, the diluent is provided in a separate container. This can preferably be a syringe. The diluent in the syringe can then easily be applied to the container for reconstitution of the dry compositions. If the container is also a syringe, both syringes can be finished together in a pack. It is therefore preferred to provide the dry compositions in a syringe, which is finished with a diluent syringe with a pharmaceutically acceptable diluent for reconstituting, said dry and stable composition.
In certain embodiments, this disclosure contemplates a kit comprising a pharmaceutical composition disclosed herein and a container with a suitable diluent. Further components of the kit may be instructions for use, administration means, such as syringes, catheters, brushes, etc. (if the compositions are not already provided in the administration means) or other components necessary for use in medical (surgical) practice, such as substitute needles or catheters, extra vials or further wound cover means. In certain embodiments, the kit comprises a syringe housing the dry and stable hemostatic composition and a syringe containing the diluent (or provided to take up the diluent from another diluent container).
The production of microcapsules is illustrated in
To make the microcapsules, 2 mg/mL solutions of poly-1-lysine (PLL) and poly-1-glutamic acid (PLG) were made with 0.5 M NaCl, pH 6.25. Polyelectrolyte layers were deposited onto the cores with alternating charge in a layer-by-layer fashion. In brief, a 2% w/v solution of cores was dispersed in the PLL solution for 10 minutes. The cores were then pelleted at 200 g for 5 minutes and washed 3 times with 0.5 M NaCl pH 6.25 before the next layer was deposited. To deposit the fibrinogen on the surface of the microcapsule, a 1:1 solution of human fibrinogen and PLG was used for deposition of the last polyelectrolyte layer. When the desired number of layers was deposited, the cores were dispersed in a 0.2 M EDTA solution at pH 6.25 for 30 minutes to remove the calcium carbonate. The microcapsules were then washed and pelleted several times with 5 mM IVIES pH 6.25. Microcapsules were then stored at 4° C. until use.
To load FVIII into the microcapsules, the appropriate concentration of FVIII was incubated with the microcapsules at a particle density of 1 million/mL for 1 hour in pH 6.25 MES buffer. The microcapsules were then washed and pelleted several times to remove any unloaded FVIII.
Zeta potential of cores during PEM synthesis was measured with a Malvern Zetasizer Nano Series™ (Malvern, UK). Samples were diluted with DI water at a 1:9 ratio. Each sample was measured 3 times at 20 runs for each measurement. See
Experiments measuring the diffusive release of FVIII-RBITC out of capsules were conducted in PPP at 37° C. and under 40 rpm agitation. At appropriate time points, capsules were pelleted, and an aliquot of the supernatant was removed to measure diffusive release of FVIII-RBITC. A PPP aliquot of the same volume was added back to the capsule solution to preserve sample volume. Fluorescence intensity of the supernatant was measured and compared to a standard curve to calculate concentration of released FVIII-RBITC in the supernatant.
Static fibrin clot experiments were fabricated by mixing fibrinogen, 1 U/mL thrombin, 10 mM calcium, washed platelets stained with Cell Mask Deep Red, and microcapsules on a glass slides treated with Sigmacote™. Clots were formed at 37° C. and 60% humidity and imaged via confocal laser scanning microscopy using a Zeiss LSM 710 NLO system (Thornwood, NY).
Data for clotting studies are shown in
WB was perfused at 5 μL/min for 10 minutes followed by PPP at 5 μL/min for 30 minutes. Both WB and PPP were recalcified to 5 mM and contained 2 mM Mg, CD41a-APC (platelet specific antibody), 59D8-AF488 (fibrin specific antibody), and experiment condition (PBS, systemic FVIII, or FVIII in microcapsules). For experiments mimicking hemophilia with inhibitory antibodies, MAb 2-76 was added to both WB and PPP. Samples were kept at the same total volume. They also contained the same WB or PPP volumes.
The collagen patch was monitored over time via confocal laser scanning microscopy using a Zeiss LSM 700 System™ (Thornwood, NY). Videos were constructed by taking images every 10 seconds. Tile scans were taken of the entire patch after the experiment ended and used to measure fluorescence intensity of fibrin, platelets, and FVIII on the patch via Image J.
For well plate clots citrated whole blood was mixed with MAb 2-76 for 30 minutes followed by addition of 5 mM Ca, 2 mM Mg, and 12 pM TF. Advate™ or microcapsules loaded with Advate™ were added at the appropriate concentration. Samples (50 uL) were loaded into wells and washed with PBS to remove soluble blood products at appropriate time points until the wash solution was clear. Samples were considered clotted when the clot covered the bottom of well and remained unchanged between time points.
This application is a continuation of U.S. application Ser. No. 17/934,813 filed Sep. 23, 2022, which is a division of U.S. application Ser. No. 16/074,643 filed Aug. 1, 2018 that granted as U.S. Pat. No. 11,464,748 on Oct. 11, 2022, which is the National Stage of International Application No. PCT/US2017/015872 filed Jan. 31, 2017, which claims the benefit of U.S. Provisional Application No. 62/289,642 filed Feb. 1, 2016. The entirety of each of these applications is hereby incorporated by reference for all purposes.
This invention was made with government support under HL121264 awarded by the National Institutes of Health and W81XWH-13-1-0495 awarded by the Department of Defense. The government has certain rights in the invention.
| Number | Date | Country | |
|---|---|---|---|
| 62289642 | Feb 2016 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 16074643 | Aug 2018 | US |
| Child | 17934813 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 17934813 | Sep 2022 | US |
| Child | 18343932 | US |
