OA16231A - A method for the preparation of a heat stable oxygen carrier-containing pharmaceutical composition. - Google Patents

A method for the preparation of a heat stable oxygen carrier-containing pharmaceutical composition. Download PDF

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OA16231A
OA16231A OA1201200185 OA16231A OA 16231 A OA16231 A OA 16231A OA 1201200185 OA1201200185 OA 1201200185 OA 16231 A OA16231 A OA 16231A
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hemoglobin
cross
heat stable
red blood
pharmaceutical composition
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OA1201200185
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Wong Bing Lou
Kwok Sui Yi
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Abstract

A highly purified and heat stable cross-linked nonpolymeric tetrameric hemoglobin suitable for use in mammals without causing renal injury and vasoconstriction is provided. A high temperature and short time (HTST) heat processing step is performed to remove undesired dimeric form of hemoglobin, uncross-linked tetrameric hemoglobin, and plasma protein impurities effectively. Addition of N-acetyl cysteine after heat treatment and optionally before heat treatment maintains a low level of met-hemoglobin. The heat stable cross-linked tetrameric hemoglobin can improve and prolong oxygenation in normal and hypoxic tissue. In another aspect, the product is used in the treatment of various types of cancer such as leukemia, colorectal cancer, lung cancer, breast cancer, liver cancer, nasopharyngeal carcinoma and esophageal cancer. The inventive tetrameric hemoglobin can also be used to prevent tumor metastasis and recurrence following surgical tumor excision. Further the inventive tetrameric hemoglobin can be administered to patients prior to chemotherapy and radiation treatment.

Description

A METHOD FOR THE PREPARATION OF A HEAT STABLE OXYGEN CARRIERCONTAINING PHARMACEUTICAL COMPOSITION
Cross-Refercncc to Related Applications:
This application daims priority from U.S. Application Nos. 12/821,214, 12/957,430, and 13/013,850 the dîsclosures of which are incorporated by reference.
Copyright Notice/Permission
A portion of the disclosure of this patent document contains material which is subject to copyright protection. The copyright owner has no objection to the facsimiie reproduction by anyone of the patent document or the patent disclosure as it appears in the Patent and Trademark Office patent file or records, but otherwise reserves al! copyright rights whatsoever. The following notice applies to the processes, experiments, and data as described below and in the drawings attached hereto: Copyright © 2010, Billion King International Limited, Ail Rights Reserved.
Technical Field [0001] The présent invention relates to a method for the préparation of a heat stable oxygencarrier-containing pharmaceutical composition and the composition made by the process. The présent invention also relates to the use of the heat stable oxygen carrier-containing pharmaceutical composition for cancer treatment, oxygen-deprivatîon disorders and organ préservation for humans and other animais.
Background of Invention [0002] Hemoglobin plays an important rôle in most vertebrates for gaseous exchange between the vascular System and tissue. It is responsible for carrying oxygen from the respiratory System to the body cells via blood circulation and also carrying the metabolic waste product carbon dioxide away from body cells to the respiratory System, where the carbon dîoxide is exhaled. Since hemoglobin has this oxygen transport feature, it can be used as a potent oxygen supplier if it can be stabilized ex vivo and used in vivo. V [0003] Naturally-occurring hemoglobin is a tetramer which is generaliy stable when présent within red blood cells. However, when naturally-occurring hemoglobin is removed from red blood cells, it becomes unstable in plasma and splits into two α-β dimers. Each of these dimers is approximately 32 kDa in molecular weight. These dimers may cause substantial rénal injury when filtered through the kidneys and excreted. The breakdown of the tetramer linkage also negatively impacts the sustainability of the functional hemoglobin in circulation.
[0004] In order to solve the problem, récent developments in hemoglobin processing hâve incorporated various cross-linking techniques to create intramolecular bonds within the tetramer as well as intermolecular bonds between the tetramers to form polymeric hemoglobin. The prior art teaches that polymeric hemoglobin is the preferred form in order to increase circulatory halflife of the hemoglobin. However, as determined by the présent inventors, polymeric hemoglobin more readily converts to met-hemoglobin in blood circulation. Met-hemoglobin cannot bînd oxygen and therefore cannot oxygenate tissue. Therefore, the cross-linking taught by the prior art that causes the formation of polymeric hemoglobin is a problem. There is a need in the art for a technique that permits intramolecular crosslinking to create stable tetramers without the simultaneous formation of polymeric hemoglobin.
[0005] Further problems with the prior art attempts to stabilize hemoglobin include production of tetrameric hemoglobin that includes an unacceptably htgh percentage of dimer units; the presence of dimers makes the hemoglobin composition unsatisfactory for administration to mammals. The dimeric form of the hemoglobin can cause severe rénal injury in a mammalian body; this rénal injury can be severe enough to cause death. Therefore, there is a need in the art to create stable tetrameric hemoglobin with undetectable dimeric form in the final product.
[0006] Another problem with prior art hemoglobin products is a sudden increase in blood pressure following administration. In the past, vasoconstriction events hâve been recorded from older génération of hemoglobin based oxygen carriers. For instance, the Hemopure® product (Biopure Co., USA) resulted in higher mean arterial pressure (124 ±9 mmHg) or 30% higher when compared to the baseline (96± 10 mmHg) as disclosed by Katz et al., 2010. Prior attempts to solve this problem hâve relied on sulfhydryl reagents to react with hemoglobin sulfhydryl groups, aliegedly to prevent endothelium-derived relaxing factor from binding to the sulfhydryl groups. However, the use of sulfhydryl treatment adds processing steps, resulting in added cost and impurities which must be later removed from the hemoglobin composition. Thus there is a need in the art for a process to préparé hemoglobin which will not cause vasoconstriction and high blood pressure when applied to a mammal.
[0007] Further problems with prior art attempts to create stable hemoglobin include the presence of protein impurities such as immunoglobîn G that can cause allergie effects in mammals. Therefore, there is a need in the art for a process which can produce stable letrameric hemoglobin without protein impurities.
[0008] In addition to the above problems, there is a need in the art for a stabilized tetramerîc hemoglobin that is dimer free, phosphoiipid free and capable of production on an industrial scaie.
Summary of Invention [0009] The présent invention provides a method for processing a nonpoiymeric, heat stable purified cross-linked tetrameric hemoglobin suitable for use in mammals without causing severe rénal injury, vascular detrimental effects and severe adverse events including death. The présent invention removes the dimeric form of hemoglobin, uncross-lînked tetrameric hemoglobin, phospholipids and protein impurities. Additionally, the présent invention uses (l) an instant cytolysis apparatus for précisé and controlled hypotonie lysis, (2) a flowthrough column chromatography, (3) a high température short tîme (HTST) apparatus for heat processing the hemoglobin solution in the purification process to remove the undesirable non-stabilized dimers of hemoglobin and to remove the protein impurities, for example immunoglobin-G, so that rénal injury, vascular detrimental effects and other toxicîty reactions can be avoided, and (4) an airtight infusion bag packaging to avoid oxygen intrusion into the product.
[0010] The method includes a starting material of mammalian whole blood including at least red blood cells and plasma. Red blood cells are separated from the plasma in the mammalian whole blood followed by filtering to obtain a filtered red blood cell fraction. The filtered red blood cell fraction is washed to remove plasma protein impurities. The washed red blood cells are disrupted by a controlled hypotonie lysis for a tîme sufficient to lyse red blood cells without lysing white blood cells in an instant cytolysis apparatus at a flow rate of 50-1000 liters/hr. Filtration is performed to remove at least a portion of the waste retentate from the lysate. A first hemoglobin solution is extracted from the lysate.
[0011] A first ultrafiltration process is performed using an ultrafiltration filter configured to remove impurities having a higher molecular weight than tetrameric hemoglobin and to further remove any viruses and residual waste retentate from the first hemoglobin solution to obtain a second hemoglobin solution. Flowthrough column chromatography is performed on the second 5 hemoglobin solution to remove protein impurities, dimeric hemoglobin and phospholipids to form a phospholipid-free hemoglobin solution. A second ultrafiltration process is performed on the phospholipid-free hemoglobin solution using a filter configured to remove impurities resulting in a concentrated purified phospholipid-free hemoglobin solution.
[0012] At least the a-a subunits of the purified hemoglobin are cross-linked by bis-3,510 dibromosalicyl fumarate to form heat stable cross-linked hemoglobin without the formation of polymeric hemoglobin such that the molecular weight of the résultant nonpolymeric cross-linked tetrameric hemoglobin is 60 - 70 kDa. The expression “nonpolymeric” as used herein, refers to tetrameric hemoglobin that is not intermolecularly cross-linked with other hemoglobin molécules or any other non-hemoglobin molécules such as PEG. A suitable physiological buffer such as 15 phosphate buffered saline (PBS), lactated Ringer's solution, acetated Ringer's solution, or Tris buffer is exchanged for the cross-linked tetrameric hemoglobin. Any residual chemicals are removed using tangential-flow filtration.
[0013] Following this procedure, the cross-linked hemoglobin is heat-treated to remove any residual non-cross-linked tetrameric hemoglobin and any non-stabilized hemoglobin, for 20 example the dimeric form of hemoglobin, and any other protein impurities. Prior to the heat treatment N-acetyl cysteine is optionally added at a concentration of approximately 0.2% to the cross-linked tetrameric hemoglobin to prevent formation of met-hemoglobin. Immediately following heat treatment and cooling, N-acetyl cysteine is added at a concentration of approximately 0.2 % to 0.4% to further prevent formation of met-hemoglobin. The heat 25 treatment is preferably a high température short time treatment conducted at approximately 70°C to 95°C for 30 seconds to 3 hours with subséquent cooling to 25° C. Any précipitâtes formed during the heat treatment are removed by centrifugation or a filtration apparatus to form a clear solution thereafter.
[0014] The dimer-free, phospholipid-free, protein impurities-free, heat stable, nonpolymeric cross-linked tetrameric hemoglobin is then added to a pharmaceutically acceptable carrier.
[0015] Thereafter, the heat stable, cross-linked tetrameric hemoglobin is formulated and packaged in a custom-made and air-tight polyethylene, ethylene-vinyl-acetate, ethylene-vinyl alcohol (PE, EVA, EVOH) infusion bag. The packaging prevents oxygen contamination which results in the formation of inactive met-hemoglobin.
[0016] The heat stable cross-linked tetrameric hemoglobin produced by the above method is used for the treatment of various cancers such as leukemia, colorectal cancer, lung cancer, breast cancer, liver cancer, nasopharyngeal cancer and esophageal cancer. The mechanism for destroying cancer cells is to improve oxygénation of tumors in a hypoxie condition, thereby enhancing the sensitivity towards radiation and chemotherapeutic agents. The heat stable crosslinked tetrameric hemoglobin is also used for préservation of organ tîssue during transplant or for préservation of the heart in situations where there is a lack of oxygen supply in vivo, such as in an oxygen-deprived heart.
Brief Description of the Drawings [0017] FIG. I depicts the amino acid sequence alignaient of different hemoglobins.
[0018] FIG. 2 is a flow-chart depîcting an overview of the process of the présent invention.
[0019] FIG. 3 schematically depicts an instant cytolysîs apparatus used in the process of the présent invention.
[0020] FIG. 4 depicts high performance liquid chromatography analysis for (a) non-heat treated cross-linked tetrameric hemoglobin, and (b) heat stable cross-linked tetrameric hemoglobin which has undergone a heat treatment at 90°C for 45 seconds to 2 minutes or 80°C for 30 minutes.
[0021] FIG. 5 depicts electrospray ionization mass spectrometry (ESI-MS) analysis for the heat stable cross-linked tetrameric hemoglobin.
[0022] FIG. 6 shows a circular dichroism spectroscopy analysis for (a) purified hemoglobin solution and (b) heat stable cross-linked tetrameric hemoglobin.
[0023] FIG. 7 shows an improvement of oxygénation in normal tissue. Injection of 0.2g/kg heat stable cross-linked tetrameric hemoglobin solution results in a significant increase in (A) plasma hemoglobin concentration and (B) oxygen delivery to muscle. A significant increase in oxygénation is observed for a longer period of time compared with the plasma hemoglobin level.
[0024] FIG. 8 shows an improvement of oxygénation in hypoxie tumor tissue. Injection of 0.2g/kg heat stable cross-linked tetrameric hemoglobin solution results in a significant increase in oxygen delivery to the head and neck squamous cell carcinoma (HNSCC) xenograft.
[0025] FIG. 9 shows partial tumor shrinkage in rodent models of (A) nasopharyngeal carcinoma (NPC) and (B) liver tumor.
[0026] FIG. 10 demonstrates the mean arterial pressure changes in a rat mode) of severe hémorrhagie shock after the treatment with the heat stable cross-linked tetrameric hemoglobin.
[0027] FIG. Il is an elution profile for flowthrough column chromatography; the hemoglobin solution is in the flowthrough fraction.
[0028] FIG. 12 schematically depicts a flowthrough CM column chromatography system with ultrafiltration for an industrial scale operation.
[0029] FIG. 13 is a schematic depiction of an apparatus used for HTST heat treatment processing step.
[0030] FIG. 14 demonstrates the température profile in the HTST processing apparatus and the time taken to remove unstabilized tetramer (dimer) in the system at 85°C and 90°C of the présent invention.
[0031] FIG. 15 demonstrates the rate of met-hemoglobin formation in the system at 85°C and 90°C in the HTST processing apparatus of FIG. 13.
[0032] FIG. 16 is a schematic depiction of an infusion bag for the heat stable cross-linked tetrameric hemoglobin of the présent invention.
[0033] FIG. 17 shows a schematic drawing summarizing the surgical and hemoglobin product administration procedures during liver resection.
[0034] FIG. 18 shows représentative examples of intra-hepatic liver cancer récurrence and metastasis and distant lung metastasîs induced in the rats of the IR injury group after hepatectomy and ischemia/reperfusion procedures and its protection using the inventive heat stable cross-linked tetrameric hemoglobin.
[0035] FIG. 19 shows the histological examination in experimental and control groups at four weeks after liver resection and IR injury procedures. v\T
Detailed Description of Invention [0036] Hemoglobin is an iron-containing oxygen-transport protein in red blood cells of the blood of mammals and other animais. Hemoglobin exhibits characteristics of both the tertiary and quatemary structures of proteins. Most of the amino acids in hemoglobin form alpha helices connected by short non-helical segments. Hydrogen bonds stabilize the helical sections inside the hemoglobin causing attractions within the molécule thereto folding each polypeptide chain into a spécifie shape. A hemoglobin molécule is assembled from four globular protein subunits. Each subunit is composed of a polypeptide chain arranged into a set of a-hélix structural segments connected in a “myoglobin fold” arrangement with an embedded heme group.
[0037] The heme group consîsts of an iron atom held in a heterocyclic ring, known as a porphyrin. The iron atom binds equally to ail four nitrogen atoms in the center of the ring which lie in one plane. Oxygen is then able to bind to the iron center perpendicular to the plane of the porphyrin ring. Thus a single hemoglobin molécule has the capacity to combine with four molécules of oxygen.
[0038] In adult humans, the most common type of hemoglobin is a tetramer called hemoglobin A consisting of two a and two β non-covalently bound subunits designated as α2β2, each made of 141 and 146 amino acid residues respectively. The size and structure of a and β subunits are very similar to each other. Each subunit has a molecular weight of about 16 kDa for a total molecular weight of the tetramer of about 65 kDa. The four polypeptide chains are bound to each other by sait bridges, hydrogen bonds and hydrophobie interaction. The structure of bovine hemoglobin is similar to human hemoglobin (90.14% identity in a chain; 84.35% identity in β chain). The différence is the two sulfhydryl groups in the bovine hemoglobin posîtioned at β Cys 93, while the sulfhydryls in human hemoglobin are at posîtioned at a Cys 104, β Cys 93 and β Cys 112 respectively. FIG. 1 shows the amino acid sequences alignment of bovine, human, canine, porcine and equine hemoglobin, respectively labeled B, H, C, P, and E. The unlike amino acids from various sources are shaded. FIG. 1 indîcates that human hemoglobin shares high simîlarity with bovine, canine, porcine and equine when comparing their amino acid sequences.
[0039] In naturally-occurring hemoglobin inside the red blood cells, the association of an a chain with its corresponding β chain is very strong and does not disassociate under physiological conditions. However, the association of one αβ dimer with another αβ dimer is fairly weak outside red blood cells. The bond has a tendency to split into two αβ dimers each approximately 32 kDa. These undesired dimers are small enough to be filtered by the kidneys and be excreted, with the resuit being potential rénal injury and substantially decreased intravascular rétention time.
[0040] Therefore, it is necessary to stabilize any hemoglobin that is used outside of red blood cells both for efficacy and safety. The process for producing the stabilized hemoglobin is outlined below; an overview of the process of the présent invention is présented in the flow chart ofFIG.2.
[0041] Initially, a whole blood source is selected as a source of hemoglobin from red blood cells. Mammalian whole blood is selected including, but not limited to, human, bovine, porcine, equine, and canine whole blood. The red blood cells are separated from the plasma, filtered, and washed to remove plasma protein impurities.
[0042] In order to release the hemoglobin from the red blood cells, the cell membrane is lysed. Although various techniques can be used to lyse red blood cells, the présent invention uses lysis under hypotonie conditions in a manner which can be precisely contre lied at volumes suitable for industrial-scale production. To this end, an instant cytolysis apparatus as seen in FIG. 3 is used to lyse the red blood cells. Hypotonie lysis créâtes a solution of lysate including hemoglobin and a waste retentate. To enable industrial-scale production, the lysis is carefully controlled such that only red blood cells are lysed without lysing white blood cells or other cells. In one embodiment, the size of the instant cytolysis apparatus is selected such that the red blood cells traverse the apparatus in 2 to 30 seconds or otherwîse a time sufficient to lyse the red blood cells and preferably, 30 seconds. The instant cytolysis apparatus includes a static mixer. Deionizcd and distîlled water is used as a hypotonie solution. Of course it is understood that the use of other hypotonie solutions having different saline concentrations would resuit in different time péri ods for red blood cell lysis. Because the controlled lysis procedure lyses the red blood cells only, not white blood cells or cellular matter, it minimîzes the release of toxic proteins, phospholipids or DNA from white blood cells and other cellular matter. A hypertonie solution is added immediately after 30 seconds, that is, after the red blood-cell containing solution has traversed the static mixer portion of the instant cytolysis apparatus. The résultant hemoglobin has a higher purity and lower levels of contaminants such as undesired DNA and phospholipids than hemoglobin resulted from using other lysis techniques. Undesired nucleic acids from white blood celle and phospholipids impurities are not detected in the hemoglobin solution by polymerase chain reaction (détection limit = 64 pg) and high performance liquid chromatography (HPLC, détection limit = l pg/ml) method respectîvely.
[0043] Two ultrafiltration processes are performed: one which removes impurities having molecular weights greater than hemoglobin before flowthrough column chromatography, and another which removes impurities having molecular weights less than hemoglobin after flowthrough column chromatography. The latter ultrafiltration process concentrâtes the hemoglobin. In some embodiments, a 100 kDa filter is used for the first ultrafiltration, while a 30 kDa filter is used for the second ultrafiltration.
[0044] Flowthrough column chromatography is used to remove protein impurities in the purified hemoglobin solution such as immunoglobin-G, albumin and carbonic anhydrase. In some embodiments, column chromatography is carried out by using one or a combination of commercially available ion exchange columns such as a DEAE column, CM column, hydroxyapatite column, etc. The pH for column chromatography is typically from 6 to 8.5. In one embodiment, a flowthrough CM column chromatography step is used to remove protein impurities at pH 8.0. Enzyme-linked immunosorbent assay (ELISA) is performed to detcct the protein impurities and phospholipids remaîning in the sample after elution from the column chromatography. This unique flowthrough column chromatography séparation enables a continuous séparation scheme for industrial-scale production. The ELISA resuit shows that the amount of these impurities are substantially low in the eluted hemoglobin (immunoglobin-G:
44.3 ngrinl; albumin: 20.37 ng/ml; carbonic anhydrase: 81.2 pg/ml). The protein impurities removal results using different kinds of column with different pH values are shown in Table l
below.
[0045] Table 1
Column (pH condition) Removal percentage (%) Carbonic anhydrase Albumin Immunoglobin-G
DEAE (at pH 7.5) — 68 29.8
DEAE (at pH 7.8) 60 50.9
CM (at pH 6.2) — 32 21.8
CM (at pH 8.0) 5.6 53.2 66.4
Hydroxyapatite (at pH 7.5) 4.5 23.5 22.8
[0046] Following the column chromatographie process, the hemoglobin is subjected to crosslinking by bis-3, 5-dibromosalicyl fumarate (DBSF). In order to prevent formation of polymeric hemoglobin, the reaction is carefully controlled in a deoxygenated environment (preferably less than 0.1 ppm dissolved oxygen level) with a molar ratio of hemoglobin to DBSF between 1:2.5 to 1:4.0 for a period of time from 3 to 16 hours at ambient température (15-25°C), preferably at a pH of around 8-9, such that the résultant cross-lînked hemoglobin is tetrameric hemoglobin having a molecular weight of 60-70 kDa, demonstrating that polymeric hemoglobin is not présent. The yield of the DBSF reaction is high, > 99% and the dimer concentration in the final product is low. Optionally, the présent process does not require sulfhydryl treatment reagents such as iodoacetamide to react with the hemoglobin before cross-linking as used in various prior art processes.
[0047] At this point phosphate buffered saline (PB S), a physiological buffer, is exchanged for the cross-linking solution and any residual chemicals are removed by tangential flow filtration.
[0048] Following the process of cross-linking of the hemoglobin by DBSF under a deoxygenated condition, the présent invention provides a heat processing step for the cross-linked tetrameric hemoglobin solution in a deoxygenated environment. Prior to heat treatment, N-acetyl cysteine is optionally added to prevent formation of met-hemoglobin (inactive hemoglobin). After the heat processing step, the solution is cooled and N-acetyl cysteine is immediately added to maintain a low level of met-hemoglobin. If N-acetyl cysteine is added before and after heat treatment, the amount added before heat treatment is approximately 0.2%, while the amount
added after heat treatment is approximately 0.2 to 0.4%. However, if N-acetyl cysteine is added only after heat treatment, then the amount added is 0.4%.
[0049] In some embodiments, the cross-Iinked tetrameric hemoglobin solution is heated in a deoxygenated environment (less than O.l ppm dissolved oxygen level) under a range of températures from 50°C to 95°C for durations from 0.5 minutes to 10 hours. In some embodiments, the cross-lînked tetrameric hemoglobin solution is heated under a range of températures from 70°C to 95°C and for durations from 30 seconds to 3 hours. In some preferred embodiments, the cross-Iinked tetrameric hemoglobin solution is heated under 80°C for 30 minutes. And yet in other preferred embodiments, the linked hemoglobin solution is heated to 90°C for 30 seconds to 3 minutes, then rapîdly cooled down to approximately 25° C in approximately 15 to 30 seconds, and the N-acetyl cysteine is added as set forth above. A very low amount of met-hemoglobin results, for example, less than 3%. Without the use of N-acetyl cysteine, the amount of met-hemoglobin formed is approximately 16%, an unacceptably high percentage for pharmaceutical applications.
[0050] High performance liquid chromatography (HPLC), electrospray ionization mass spectrometry (ESI-MS), circular dichroism (CD) spectroscopy and Hemox Analyzer for p50 measurement are used thereafter to analyze and characterize the heat stable cross-Iinked tetrameric hemoglobin. For a bovine blood source originated hemoglobin, FIG. 4 shows that the dimeric form of hemoglobin is undetectable in a HPLC system (détection limit: 2.6 pg/ml or 0.043%) for hemoglobin which has undergone a heat treatment at 90°C for 45 seconds to 2 minutes or 80°C for 30 minutes. The cross-Iinked nonpolymeric tetrameric hemoglobin is found as heat stable at 80 or 90 °C for a period of time. The heat process (High Température Short Time, HTST) step is a powerful step to dénaturé the naturel unreacted tetrameric form and dimeric form of hemoglobin.
[0051] To analyze the outcome of this HTST step, a HPLC analytical method is used to detect the amount of dimer after this heat process step. The mobile phase for HPLC analysis contains magnésium chloride (0.75M) which can separate dimer (non-stabilîzed tetramer) and heat stable cross-lînked tetrameric hemoglobin. For promoting hemoglobin dissociation into dimers, magnésium chloride is approximately 30 times more effective than sodium chloride at the same ionic strength. The heat processing step also acts as a dénaturation step to dramatically remove those unwanted protein impurities in the cross-Iinked tetrameric hemoglobin (undetectable in
immunoglobin-G; undetectable in albumin; 99.99% decrease in carbonic anhydrase). Enzymelinked immunosorbent assay (ELISA) is performed to detect the protein impurities în the sample. Thus the purified, heat stable cross-linked tetrameric hemoglobin solution has an undetectable level of dimer (below détection limit: 0.043%), and immunoglobin-G, and a very low amount of 5 albumin (0.02 pg/ml) and carbonic anhydrase (0.014 pg/ml). Table 2 shows the experimental results regarding the protein impurities and dimer removal by the HT ST heat processing step. This HTST heat step enables the sélective séparation of heat stable cross-linked tetramer from unstable tetramer and dimer.
[0052] Table 2
Sample condition Protein impurities (By ELISA) By HPLC p50 37°C (mmHg)
Immunoglobin- G (gg/ml) Albumin (pg/ml) Carbonic anhydrase (gg/ml) Tetramer (%) Dimer (%)
No heat treatment 0.36 0.57 355.41 90.1 5.4 38
80°C for 10min Not détectable 0.33 0.032 92.7 3.4 No data
80°C for 15min Not détectable 0.14 0.022 93.3 2.9 No data
80°C for 30min Not détectable 0.03 0.014 96.6 Not détectable 32
No heat treatment 0.29 0.52 261.80 91.8 5.3 38
90°C for 1.0min Not détectable 0.21 >0.063 93.4 2.0 29
90°C for 1.5min Not détectable 0.04 0.022 94.9 0.6 31
90°C for 2.0min Not détectable 0.02 0.016 96.1 Not détectable 31
at
[0053] Following the heat processing step for the cross-linked hemoglobin under a deoxygenated condition, the heat stable cross-linked tetrameric hemoglobin is ready for pharmaceutical formulation and packaging. The présent invention describes an air-tight packaging step of the heat stable cross-linked tetrameric hemoglobin solution in a deoxygenated environment. Heat stable cross-linked tetrameric hemoglobin in the présent invention is stable under deoxygenated condition for more than two years.
[0054] In this invention, the oxygen carrier-containing pharmaceutical composition is primarily intended for intravenous injection application. Traditionally, prior products use conventional PVC blood bag or Stcricon blood bag which has high oxygen permeabilîty which will eventually shorten the life span of the product since it tums into inactive met-henioglobîn rapidly (within a few days) under oxygenated conditions.
[0055] The packaging used in the présent invention results in the heat stable cross-linked tetrameric hemoglobin being stable for more than two years. A multi-layer package of EVA/EVOH material is used to minimize the gas permeabilîty and to avoid the formation of inactive met-hemoglobin. A 100 ml infusion bag designed for use with the purified and heat stable cross-linked tetrameric hemoglobin of the présent invention is made from a five layers
EVA/EVOH lamînated material with a thickness of 0.4 mm that has an oxygen permeabilîty of 0.006-0.132 cm3 per 100 square inches per 24 hours per atmosphère at room température. This material is a Class VI plastic (as defined in USP<88>), which meets the in-vivo Biological Reactivity Tests and the Physico-Chemîcal Test and is suitable for fabricating an infusion bag for intravenous injection purpose. This primary bag is particularly useful to protect the heat stable cross-linked tetrameric hemoglobin solution from long term oxygen exposure that cause its instability and eventually affects its therapeutic properties.
[0056] For secondary protection of blood products, it has been known to use aluminum overwrap to protect against potential air Ieakage and to maintain the product in a deoxygenated state. However, there is a potential of pin holes in the aluminum overwrap that compromise its air tightness and make the product unstable. Therefore the présent invention uses as secondary packaging an aluminum overwrap pouch which prevents oxygénation and also prevents light exposure. The composition of the overwrap pouch includes 0.012mm of polyethylene terephthalate (PET), 0.007mm of aluminum (Al), 0.015mm of nylon (NY) and 0.1mm of polyethylene (PE). The overwrap film has a thickness of 0.14mm and an oxygen transmission
rate of 0.006 cm3 per 100 square inches per 24 hours per atmosphère at room température. This secondary packaging lengthens the stability time for the hemoglobin, extending the product shelf-life.
[0057] The hemoglobin of the présent invention is analyzed by various techniques, including ESI-MS. ESI-MS enables the analysis of very large molécules. It is an ionization technique that analyzes the high molecular weight compound by ionizing the protein, and thon separating the îonized protein based on mass/charge ratio. Therefore, the molecular weight and the protein interactions can be determined accurately. In FIG. 5, ESI-MS analysis resuit indicates that the size of heat stable cross-linked tetrameric hemoglobin is 65 kDa (nonpolymeric hemoglobin tetramers). The far UV CD spectra from 190 to 240 nm reveal the secondary structures of globin portion of the hemoglobin. In FIG. 6, the consistency of the spectra of purified hemoglobin solution and heat stable cross-linked tetrameric hemoglobin reveals that the hemoglobin chains are properly folded even after the heat treatment at 90°C. The CD resuit shows that heat stable cross-linked tetrameric hemoglobin has around 42 % of alpha-helix, 38 % of beta-sheet, 2.5 % of beta-tum and 16 % of random coil. It further confîrms that the cross-linked tetrameric hemoglobin is heat stable.
[0058] The process in this invention is applicable to large scale industrial production of the heat stable cross-linked tetrameric hemoglobin. In addition, the heat stable cross-linked tetrameric hemoglobin in combination with a pharmaceutical carrier (e.g. water, physiological buffer, in capsule form) is suitable for mammalian use.
[0059] The présent invention further discloses the uses of the oxygen carrier-containing pharmaceutical composition in improving tissue oxygénation, in cancer treatment, in the treatment of oxygen-deprivation disorders such as hémorrhagie shock, and in heart préservation under a low oxygen content environment (e.g. heart transplant). The dosage is selected to hâve a concentration range of approximately O.2-l.3g/kg with an infusion rate of less than 10 ml/hour/kg body weight.
[0060] For uses in cancer treatment, the oxygen carrier-containing pharmaceutical composition of the présent invention serves as a tissue oxygénation agent to improve the oxygénation in tumor tissues, lhereby enhancing chemosensitivity and radiation sensitivity.
[0061] In addition, the ability of the heat stable cross-linked tetrameric hemoglobin to improve oxygénation in normal tissues (FIG. 7) and in extremely hypoxie tumors (FIG. 8), human nasopharyngeal carcinoma (using CNE2 cell line) is demonstrated in this invention. The représentative oxygen profile along the tissue track of a human CNE2 xenograft is showed in FIG. 8. Oxygen partial pressure (pO2) within the tumor mass is directly monitored by a fibreoptic oxygen sensor (Oxford Optronix Limited) coupled with a micro-positioning System (DTI Limited). After intravenous injection of 0.2g/kg of the heat stable cross-lînked tetrameric hemoglobin, the médian pO? value rises from baseline to about two-fold of relative mean oxygen partial pressure within 15 minutes and extends to 6 hours. Further, the oxygen level on average still maintains a level of 25% to 30% above the baseline value 24 to 48 hours post infusion. No commercial products or existing technologies show as hîgh an efïïcacy when compared to the oxygen carrier-contaînmg pharmaceutical composition prepared in this invention.
[0062] For tumor tissue oxygénation, a représentative oxygen profile of a human head and neck squamous cell carcinoma (HNSCC) xenograft (FaDu) is shown in FIG. 8. After intravenous injection of 0.2g/kg of the heat stable cross-linked tetrameric hemoglobin, a significant increase în the mean pCL of more than 6.5-fold and 5-fold is observed at 3 and 6 hours, respectively (FIG. 8)· [0063] For applications in cancer treatment, the oxygen carrier-containing pharmaceutical composition of the présent invention serves as a tissue oxygénation agent to improve the oxygénation in tumor tissues, thereby enhancing chemo- and radiation sensitivity. In conjunction with X-ray irradiation and the heat stable cross-linked tetrameric hemoglobin, tumor growth is delayed. In FIG. 9A, the représentative curves show signîficant tumor shrinkage in rodent models of nasopharyngeal carcinoma. Nude mice bearing CNE2 xenografts are treated with X-ray alone (2Gy) or in combination with the heat stable cross-linked tetrameric hemoglobin (2Gy+Hb). l.2g/kg of the heat stable cross-linked tetrameric hemoglobin is înjected intravenously into the mouse approxîmately 3 to 6 hours before X-ray irradiation and results in a partial shrinkage of nasopharyngeal carcinoma xenograft.
[0064] In one embodiment, signîficant liver tumor shrinkage is observed after injecting the composition, in conjunction with a chemotherapeutic agent. In FIG. 9B, the représentative chart shows signîficant tumor shrinkage in a rat orthotopic liver cancer model. Buffalo rats bearing a liver tumor orthograft (CRL1601 cell line) are treated with 3mg/kg cisplatin alone, or in combination with 0.4g/kg of the heat stable cross-linked tetrameric hemoglobin (Cisplatin+Hb).
Administration of the heat stable cross-linked tetrameric hemoglobin before cisplatin injection results in a partial shrinkage of the liver tumor.
[0065] For the use in the treatment of oxygen-deprivation disorders and for heart préservation, the oxygen carrier-containing pharmaceutical composition of the présent invention serves as a blood subslitute providing oxygen to a target organ.
[0066] The mean arterial pressure changes in a rat model of severe hémorrhagie shock after treatment with 0.5g/kg of the heat stable cross-linked tetrameric hemoglobin are shown in FIG. 10. In a rat model of severe hémorrhagie shock, the mean arterial pressure is retumed back to a safe and stable level and maintained at or about the baseline after treatment with the heat stable cross-linked tetrameric hemoglobin. Following treatment with the heat stable cross-linked tetrameric hemoglobin, the time required for the mean arterial pressure to retum to normal is even shorter than administrating autologous rat’s blood which serves as a positive control. The results indicate that a vasoconstriction event does not occur after the transfusion of the heat stable cross-linked tetrameric hemoglobin.
Examples [0067] The following examples are provided by way of describing spécifie embodiments of this invention without intending to limit the scope of this invention in any way.
[0068] Example 1 [0069] Process Overview [0070] A schematic flow diagram of the process of the présent invention is illustrated in FIG. 2. Bovine whole blood is collected into an enclosed stérile container/bag containing 3.8% (w/v) trisodium citrate solution as anti-coagulant. Blood is then immediately mixed well with tri-sodium citrate solution to inhibit blood clotting. Red blood cells (RBC) are isolated and collected from plasma and other smailer blood cells by an apheresis mechanism. A “cell washer” is used for this procedure with gamma sterilized disposabie centrifuge bowl. RBC are washed with an equal volume of 0.9% (w/v sodium chloride) saline.
[0071] Washed RBC are lysed to release hemoglobin content by manipulating hypotonie shock to the RBC cell membrane. A specîalized instant cytolysis apparatus for RBC lysis device depicted in FIG. 3 is used for this purpose. Following RBC lysis, hemoglobin molécules are isolated from other proteins by tangentîal-flow ultrafdtration using a 100 kDa membrane. Hemoglobin in the filtrate is collected for flowthrough column chromatography and further concentrated to !2-l4g/dL by a 30 kDa membrane. Column chromatography is carried out to remove the protein impurities.
[0072] The concentrated hemoglobin solution is first reacted with DBSF to form heat stable cross-linked tetrameric hemoglobin molécules under a deoxy genat ed condition. A heat treatment step is then performed under deoxygenated conditions at 90°C for 30 seconds to three minutes before final formulation and packaging.
[0073] Example 2 [0074] Time & Controlled Hypotonie lysis and filtration [0075] Bovine whole blood is freshly collected and transported under a cool condition (2 to l0°C). The red blood cells are separated from the plasma via a cell washer and subsequently with a 0.65 pm filtration. After washîng the red blood cells (RBC) filtrate with 0.9% saline, the filtrate îs disrupted by hypotonie lysis. The hypotonie lysis is performed by using the instant cytolysis apparatus depicted in FIG. 3. The instant cytolysis apparatus includes a static mixer to assist in cell lysis. A RBC suspension with controlled hemoglobin concentration (!2-l4g/dL) is mixed with 4 volumes of purified water to généra te a hypotonie shock to RBC cell membranes. The period of hypotonie shock is controlled to avoid unwanted lysis of white blood cells and platelets. The hypotonie solution passes through the static mixer portion of the instant cytolysis apparatus for 2 to 30 seconds or otherwise a time sufficient to lyse the red blood cells and preferably, 30 seconds. The shock îs terminated after 30 seconds by mixing the lysate with 1/10 volume of hypertonie buffer as it exits the static mixer. The hypertonie solution used is 0.1M phosphate buffer, 7.4% NaCl, pH 7.4. The instant cytolysis apparatus of FIG. 3 can process at 50 to 1000 liters of lysate per hour and, preferably at least 300 liters per hour in a continuons manner.
[0076] Following the RBC lysis, the lysate of red blood cells is filtered by a 0.22 pm filter to obtaîn a hemoglobin solution. Nucleic acids from white blood cells and phospholipids impurities are not detected in the hemoglobin solution by polymerase chain reaction (détection limit = 64 pg) and HPLC (détection limit = 1 pg/ml) method respectively. A first 100 kDa ultrafiltration is performed to remove impurities having a higher molecular weight than hemoglobin. A flowthrough column chromatography is followed to further purify the hemoglobin solution, A second 30 kDa ultrafiltration is then performed to remove impurities having a lower molecular weight than hemoglobin and for concentration.
[0077] Example 3 [0078] Viral clearance study on stroma-free hemoglobin solution [0079] In order to demonstrate the safety of the product from this invention, the virus removal abilities of (l) 0.65 μτη diafiltration step and (2) 100 kDa ultrafiltration step are demonstrated by virus validation study, This is done by the deliberate spiking of a down-scaled version of these 10 two processcs with different model viruses (encephalomyocarditis virus, pseudorabies virus, bovine viral diarrhea virus and bovine parvovirus). In this study, four types of viruses (see Table 3) are used. These viruses vary in their biophysical and structural features and they display a variation in résistance to physical and chemical agents or treatments.
[0080] Table 3
Target Virus Model Virus Taxonomy Genome Structure Size [nm] Stability*
Hepatitis C virus (HCV) Bovine viral diarrhea virus (BVDV) Flaviviridae ssRNA enveloped 40-60 low
- Encephalomyocarditis virus (EMCV) Picomavirus ssRNA non- enveloped 25-30 medium
Parvovirus B19 Bovine parvovirus (BPV) Parvoviridae ssDNA non- enveloped 18-26 very high
Hepatitis B virus (HBV) Pseudorabies virus (PRV) Herpesviridae dsDNA enveloped 120- 200 Low to medium
[0081] The validation scheme is briefly shown in the following Table 4.
[0082] Table 4
Diafîltration Ultrafiltration
Cell Washing Virus spiking I
1 Virus spiking 1 l Ultrafiltration
♦ Diafîltration 1
I Virus tests
Virus tests
[0083] The summary of the log réduction results of the 4 viruses in (1) 0.65 pm diafîltration and (2) 100 kDa ultrafiltration is shown in the following Table 5. Ail four viruses, BVDV, BPV,
EMCV and PRV, are effectively removed by 0.65 pm diafîltration and 100 kDa ultrafiltration.
[0084] Table 5
Viruses BVDV BPV EMCV PRV
Run 1 2 1 2 1 2 1 2
0.65pm Diafîltration 2.69 3.20 3.73 3.53 3.25 >3.90 2.67 2.63
lOOkDa Ultrafiltration >4.68 >4.38 5.87 5.92 3.60 3.43 >6.05 3.27
Cumulative maximum >7.88 9.65 >7.50 >8.72
Cumulative minimum >7.07 9.40 6.68 5.90
Annotation:
> no residual infectivîty determined [0085] Example 4 [0086] Flowthrough column chromatography [0087] A CM column (commercially available from GE healthcare) is used to further remove any protein impurities. The starting buffer is 20mM sodium acetate (pH 8.0), and the elution buffer is 20mM sodium acetate, 2M NaCI (pH 8.0). After the équilibration of the CM column with starting buffer, the protein sample is loaded into the column. The unbound protein impurities are washed with at least 5 column volume of starting buffer. The elution is performed using 25% elution buffer (0-0.5M NaCI) in 8 column volume. The elution profile is shown in FIG. Il; the hemoglobin solution is in the flowthrough fraction. The purity of the flowthrough fraction is analyzed by ELIS A. The results are indicated in the following Table 6.
[0088] Table 6
Protein impurities
Immunoglobin-G Carbonic anhydrase Albumin
Beforc CM column 1320 ng/ml 860.3 pg/ml 435.2 ng/ml
Flowthrough (containing hemoglobin) 44.3 ng/ml 81.2 pg/ml 20.4 ng/ml
[0089] As the hemoglobin solution is in the flowthrough from the CM column chromatography at pH 8 (not in the eluate), it is a good approach for continuous industrial scale operation. The first ultrafiltration set-up is connected directly to the flowthrough CM column chromatography system, and the flowthrough tubing can be connected to the second ultrafiltration set-up for industrial scale operation. The schematic industrial process configuration is shown in FIG. 12.
[0090] Example 5 [0091] Préparation of heat stable cross-linked tetrameric hemoglobin [0092] (5a) Cross-linking reaction with DBSF [0093] The cross-linking reaction is carried out in a deoxygenated condition. DBSF is added to the hemoglobin solution to form cross-linked tetrameric hemoglobin without formation of polymeric hemoglobin. DBSF stabilization procedure stabilizes the tetrameric form of hemoglobin (65 kDa) and prevents dissociation into dimers (32 kDa) which are excreted through the kidneys. In this embodiment, a molar ratio of hemoglobin to DBSF of 1:2.5 is used and the
pH is 8.6. This process is carried out for a period of 3-16 hours at ambient température (15-25°C) in an inert atmosphère of nitrogen to prevent oxidation of the hemoglobin to form ferrie methemoglobin which is physiologically inactive (dissolved oxygen level maintained at less than O.l ppm). The completeness of DBSF reaction is monitored by measuring the residual DBSF using HPLC. The yield of the DBSF reaction is high, > 99%.
[0094] (5b) HTST heat process step [0095] A High Température Short Time (HTST) processing apparat us is shown in FIG 13. A heatîng process using the HTST processing apparatus is performed on the cross-linked tetrameric hemoglobin. In this example, the condition for heat treatment is 90°C for 30 seconds to 3 minutes, and preferably 45 to 60 seconds although other conditions can be selected as dîscussed above and the apparatus modified accordingly. A solution containing cross-lînked hemoglobin optionally with 0.2% of N-acetyl cysteine added thereto is pumped into a HTST processing apparatus (first section of the HTST heat exchanger is pre-heated and maintained at 90°C) at a flow rate of l.O liter per minute, the résidence time of the first section of the apparatus is between 45 to 60 seconds, then the solution is passed through at the same flow rate into another section of the heat exchanger that is maintained at 25°C. The time required for cooling is between 15 to 30 seconds. After cooling down to 25°C, N-acetyl cysteine is îmmediately added at a concentration of 0.2% to 0.4%, preferably at 0.4%. This chemical addition after the HTST heating process is very important to maintain met-hemoglobin (inactive hemoglobin) at a low level. The set-up of the processing apparatus is easily controlled for industrial operation. A température profile with dimer content îs shown in FIG. 14. If the hemoglobin is not cross-linked, it is not heat stable and forms a precipitate after the heat step, The precipitate is then removed by a centrifugation or a filtration apparatus to form a clear solution thereafter.
[0096] During the HTST heating process at 90°C, met-hemoglobin (inactive hemoglobin) is increased (shown in FIG. 15). After immédiate addition of N-acetyl cysteine, a low level of methemoglobin, approximately less than 3%, can be maintained.
[0097] The following Table 7 shows that protein impurities such as immunoglobin-G, albumin, carbonic anhydrase and undesirable non-stabilized tetramer or dimers are removed after the heat treatment step, The amount of immunoglobin-G, albumin and carbonic anhydrase are measured using an ELISA method, while the amount of dimer is determined by an HPLC method. The
purity of heat stable cross-linked tetrameric hemoglobin is extremely high after the HTST heating processing step, in the range of 98.0 to 99.9%. The p50 value, oxygen partial pressure (at which the hemoglobin solution is half (50%) saturated) measured by a Hemox Analyzer, is maintained at around 30 to 40 mmHg throughout the HTST heating processing step and therefore, the heat treated cross-linked tetrameric hemoglobin is stable at 90°C.
[0098] Table 7
Sample condition Protein impurities (by ELISA) By HPLC p50 at 37°C (mmHg)
Immunoglobîn- Albumin G (pg/ml) (pg/ml) Carbonic anhydrase (gg/ml) Tetramer (%) Dimer (%)
No heat treatment 0.29 0.52 261.80 91.8 5.3 38
90°C for 2min Not 0.02 détectable 0.016 96.1 Not détectable 31
Removal (%) 100.0 96.15 99.99 100.0
[0099] Example 6 [00100] Packaging [00101] Because the product of the présent invention is stable under deoxygenated conditions, the packaging for the product is important to minimize gas permeability. For intravenous application, a custom designed, 100 ml infusion bag is made from a five-layer EVA/EVOH laminated material with a thickness of 0.4 mm that has an oxygen permeability of 0.006 to 0.132 cm3 per 100 square inches per 24 hours per atmosphère at room température. This spécifie material is a Class VI plastic (as defined in USP<88>), which meets the in-vivo biological reactivity tests and the physico-chemical test and are suitable for fabricating containers for intravenous injection purpose (note that other forms of packaging can be made from this material as well depending upon the desired application). A secondary packaging aluminum overwrap pouch is also applied to the primary packaging infusion bag that provides an additionaî barrier, mînimizing light exposure and oxygen diffusion. The layers of the pouch comprise: 0.012mm of Polyethylene terephthalate (PET), 0.007mm of Aluminum (Al), 0.015mm
of Nylon (NY) and O.lmm of Polyethylene (PE). The overwrap film has a thîckness of 0.14mm and oxygen transmission rate of 0.006 cm3 per 100 square inches per 24 hours per atmosphère at room température. A schematic dcpiction of the infusion bag is depîcted in FIG. 16. The overall oxygen permeability for each infusion bag according to the présent invention is 0.0025 cm3 per 24 hours per atmosphère at room température.
[00102] Example 7 [00103] Improvement of oxygénation [00104] (7a) Improvement of oxygénation in normal tissue [00105] Some studies for the normal tissue oxygénation by heat stable cross-linked tetrameric hemoglobin are carried out (shown in FIG. 7). A comparative pharmacokinctic and pharmacodynamie study is conducted in buffalo rats. Male inbred buffalo rats are individually administered with 0.2g/kg heat stable cross-linked tetrameric hemoglobin solution or ringer’s acetate buffer (control group), through the penîle vein of the rats by bolus injection. The concentration-time profile of plasma hemoglobin is determined by Hemocue™ photometer at 1, 6, 24, 48 hours and compared with the baseline reading. The methods are based on photometric measurement of hemoglobin where the concentration of hemoglobin is direelly read out as g/dL. Oxygen partial pressure (pO2) is directly measured by the Oxylab™ tissue oxygénation and température monitor (Oxford Optronix Limited) in hind leg muscle of buffalo rats. Rats are anesthetized by intra-peritoneal injection of 30-50mg/kg pentobarbitone solution followed by insertion of oxygen sensor into the muscle. Ail pO2 readings are recorded by Datatrax2 data acquisition System (World Précision Instrument) in a real-time marrner. Results demonstrate that after an intravenous injection of 0.2g/kg of the heat stable cross-linked tetrameric hemoglobin, the mean pO2 value rises from baseline to about two-fold of the relative mean oxygen partial pressure within 15 minutes and extends to 6 hours. Further, the oxygen levei on average is stîll maîntained at 25% to 30% above the baseline value 24 to 48 hours post injection (FIG. 7B).
[00106] (7b) Significant improvement of oxygénation in extremely hypoxie tumor area [00107] Improvement of oxygénation in an extremely hypoxie tumor area is evaluated by a human head and neck squamous cell carcinoma (HNSCC) xenograft modei. A hypopharyngeal squamous cell carcinoma (FaDu cell line) is obtained from the Am encan Type Culture Collection. Approximately 1 x 106 cancer cells are injected subcutaneously into four to six week-old inbred BALB/c AnN-nu (nude) mice. When the tumor xenograft reaches a diameter of 8-10 mm, oxygen partial pressure (pO2) within the tumor mass is directly monitored by the Oxylab™ tissue oxygénation and température monitor (Oxford Optronix Limited). Ail pO2 readings are recorded by the Datatrax2 data acquisition System (World Précision Instrument) in a real-time manner. When the pO? reading is stabilized, 0.2g/kg heat stable cross-linked tetrameric hemoglobin solution is injected întravenously through the tail vein of the mice and the tissue oxygénation is measured. Results demonstrate that after intravenous injection of 0.2g/kg of the said heat stable cross-linked tetrameric hemoglobin, a significant increase in the mean pO2 of more than 6.5-fold and 5-fold is observed in 3 and 6 hours, respectively (FIG. 8).
[00108] Example 8 [00109] Cancer treatment studies: A significant tumor shrinkage in Nasopharyngeal Carcinoma [OOllO] A significant tumor shrinkage is observed after administration of heat stable cross-linked tetrameric hemoglobin solution in combination with X-ray irradiation (FIG. 9A). A human nasopharyngeal carcinoma xenograft model is employed. Approximately l x 106 cancer cells (CNE2 ccll line) are injected subcutaneously into four to six week-old inbred BALB/c AnN-nu (nude) mice. When the tumor xenograft reaches a diameter of 8-10 mm, lumor-bearing mice are randomized into three groups as follows:
[00111] Group I : Ringcr’s acetate buffer (Ctrl) [00112] Group 2: Rïnger’s acetate buffer + X-ray irradiation (2Gy) [00113] Group 3: Heat stable cross-linked tetrameric hemoglobin + X-ray irradiation (2Gy+Hb) [00H4] Nude mice bearing CNE2 xenografts are irradiated with X-irradiation alone (Group 2) or in combination with heat stable cross-linked tetrameric hemoglobin (Group 3). For X-ray irradiation (Groups 2 and 3), mice are anesthetized by an intra-peritoneal injection of 50mg/kg pentobarbitone solution. 2 Grays of X-ray is delivered to the xenograft of tumorbearing mice by a linear accelerator System (Varian Medical Systems). For Group 3, 1.2g/kg heat stable cross-linked tetrameric hemoglobin is injected întravenously through the tail vein into the mouse before X-ray treatment. Tumor dimensions and body weights are recorded every
altemate day starting with the first day of treatment. Tumor weights are calculated using the équation 1/2LW2, where L and W reprcsent the length and width of the tumor mass, measured by a digital caliper (Mitutoyo Co, Tokyo, Japan) at each measurement. Group l is the nontreatment control group. Results (shown in FIG. 9) demonstrate that significant shrinkage of the CNE2 xenograft is observed in mice treated with the heat stable cross-linked tetrameric hemoglobin solution in conjunction with X-irradiation (Group 3, FIG. 9A).
[00115] Example 9
[00116] Cancer treatment studies: a significant shrinkage in liver tumor
[00117] In addition, significant tumor shrinkage is observed after administration of heat
stable cross-linked tetrameric hemoglobin solution in combination with cisplatin (FIG. 9B). A rat orthotopic liver cancer model is employed. Approximately 2 x ÎO6 rat liver tumor cells labeled with luciferase gene (CRL160l-Luc) are injected into the left lobe of the liver in a buffalo rat. Tumor growth is monitored by a Xenogen in vivo imaging System. Two to three weeks after injection, the tumor tissue is harvested, dissected into small pièces and orthotopîcally implanted into the left liver lobe of a second group of rats. Rats bearing liver tumor are randomized into three groups as follows:
[00118] Group 1: Ringer’s acetate buffer (Control)
[00119] Group 2: Ringer’s acetate buffer + cisplatin (Cisplatin)
[00120] Group 3: Heat stable cross-linked tetrameric hemoglobin^- cisplatin (Cisplatin+Hb)
[00121] Rats implanted with liver tumor tissue are treated with 3mg/kg of cisplatin alone
(Group 2) or in conjunction with heat stable cross-linked tetrameric hemoglobin (Group 3). For groups 2 and 3, rats are anesthetized by an intra-peritoneal injection of 30-50 mg/kg pentobarbitone solution and cisplatin are administered via the left portai veîn. For Group 3, 0.4g/kg heat stable cross-linked tetrameric hemoglobin is injected intravenously through the penile vein of the rat before cisplatin treatment. Group 1 is the non-treatment control group. Importantly, a sîgnificant shrinkage of liver tumor is observed 3 weeks after treatment (FIG. 9B).
[00122] Example 10
[00123] Treatment of Acute Severe Hémorrhagie Shock in Rats Tk/
[00124] Heat stable cross-linked tetrameric hemoglobin is also used as a resuscitation agent în a model of Acute Severe Hémorrhagie Shock in rats. 50 Sprague-Dawley rats are randomly divided into 3 groups according to resuscitation agents, 16 to 18 rats in each group. [00125] Group 1: Lactate Ringer’s solution (Négative Control, 16 rats) [00126] Group 2: Animal autologous blood (Positive Control, 16 rats) [00127] Group 3: Heat stable cross-linked tetrameric hemoglobin treatment group (0.5 g
Hb /kg of body weight, 18 rats) [00128] Acute severe hémorrhagie shock is established by withdrawing 50% of animal whole blood, which is estimated as 7.4% of body weight. After hémorrhagie shock is established for 10 minutes, Lactate Ringer’s solution, animal autologous blood, or 0.5 g Hb/kg of heat stable cross-linked tetrameric hemoglobin are infused into the animais. The infusion rate of heat stable cross-linked tetrameric hemoglobin is set at 5 ml/h, thereafter, ail experimental animais are observed for 24 hours. A panel of parameters is observed and analyzed during study period including survival, hemodynamics, myocardial mechanics, cardiac output, cardiac fonction, blood gas, tissue oxygen delivery & consumption, tissue perfusion & oxygen tension (liver, kidney and brain), liver & rénal fonction, hemorheology (blood viscosity), and mitochondrial respiratory control rate (liver, kidney and brain). Above ail, survival is the primary end point. After 24 hours of observation, the heat stable cross-linked tetrameric hemoglobin treatment group has a much higher survival rate compared with the Lactate Ringer’s solution or négative control group and the autologous blood group (shown in the following Table 8).
[00129] Table 8
Groups Survival no. after 24-hour 24-hour survival rate (%)
Négative control 3 in 16 rats 18.8
Rat’s Autologous Blood 10 in 16 rats 62.5
0.5 g Hb/kg 13 in 18 rats 72.0
*Hb= heat stable cross-linked tetrameric hemoglobin [00130] and Metastasis
le 11: Method of Preventing Post-operative Liver Tumor Récurrence [00131] Surgical résection of liver tumors is a frontline treatment of liver cancer. However, post-operative récurrence and metastasis of cancer remains a major attribute of unfavorable prognosis in these patients. For instance, previous studies reported that hepatic resection is associated with a 5-year survival rate of 50% but also a 70% récurrence rate. Follow-up studies on hepatocellular carcinoma (HCC) patients also reveal that extrahepatic métastasés from primary HCC were detected in approximately 15% of HCC patients with the lungs being the most frequent site of extrahepatic métastasés. It has been suggested that surgical stress, especially ischemia/reperfusion (IR) injury introduced durîng liver surgery is a major cause of tumor progression. Conventionally, hepatic vascular control is commonly used by surgeons to prevent massive hemorrhage during hepatectomy. For example, inflow occlusion by clamping of the portai triad (Pringle maneuver) has been used to minimize blood loss and reduce the requirement of perioperatïve transfusions. A recent Japanese study shows that 25% surgeons apply a Pringle maneuver on a routine basis. However, Pringle maneuver induces various degrees of ischémie injury in the remuant liver and is associated with cancer récurrence and metastasis.
[00132] Association of IR injury and tumor progression is also supported by previous animal studies. Firstly, the effect of IR injury and hepatic resection on liver cancer récurrence and metastasis was demonstrated in a recent study with an orthotopic liver cancer model. Hepatic IR injury and hepatectomy resulted in prominent récurrence and metastasis of liver tumors. Similar results were obtained in a colorectal liver metastasis mouse model where introduction of IR injury accelerates the outgrowth of colorectal liver metastasis.
[00133] Previously, sevcral protective strategies hâve been sludied for use to reduce IR injury during resection. For example, the application of a short period of ischemia before prolonged clamping, known as ischémie preconditioning (IP), was suggested to trigger hepatocellular defense mechanisms and has been used to reduce IR injury during liver resection. Others apply intermittent clamping (IC) procedures which allows cycles of inflow occlusion followed by reperfusion. Both methods were suggested to be effective in protecting against postoperative liver injury in non-cirrhotic patients undergoing major liver surgery. However, in a tumor setting, animal studies also show that IP failed to protect the liver against accelerated tumor growth induced by IR injury. In addition, some groups attempt to use anti-oxidants such as α-tocopherol and ascorbic acid to protect the liver from IR injury, thereby preventing liver
metastasis. However, both anti-oxidants faîled to restrict intrahepatic tumor growth stîmulated by IR.
[00134] Mechanistically, different lines of evidence suggest hypoxia is assocîated with tumor récurrence and metastasis for a number of reasons: (l) studies show that hypoxie tumor is more résistant to radiation- and a chemo- therapy, tumor cells that survive the treatment are prone to recur; clinical evidence also suggests that patients with more hypoxie tumor areas hâve higher rates of métastasés; (2) under hypoxie condition, cancer cells become more aggressive through the activation of hypoxia inducible factor-1 (HIF-1) pathway. This in tum triggers complementary responses involving pro-angiogenic factor vascular endothélial growth factor (VEGF) and receptors such as c-Met and CXCR4, which enhanced cell motility and homing to spécifie, distant organs; (3) recent studies also demonstrated that circulating cancer cells (CTCs) become more aggressive under hypoxie condition. Circulating tumor cells detected in the peripheral blood of cancer patients was shown to be an index of disease aggression in patients with distant metastasis, while hypoxia enabled those cells a more aggressive phenotype and diminished apoptotic potential. In particular, cancer stem cell population, which is more radiorésistant were enriched under reduced oxygen level in brain tumor.
[00135] Therefore, in view of the above observations and studies, the nonpolymeric crosslinked tetrameric hemoglobin of the présent invention is used to prevent post-operative Iiver tumor récurrence and metastasis following hepatic resection. A rat orthotopic liver cancer model is established. Hepatoceilular carcinoma cell line (McA-RH7777 cells) is used to establish the orthotopic liver cancer model in Buffalo rats (Male, 3OO-35Og). FIG. 17 shows a schematic drawing summarizing the surgical and hemoglobin product administration procedures. McARH7777 cells (3x105/100 μΙ) are injected into the hepatic capsule of buffalo rat to induce solid tumor growth. Two weeks later (when the tumor volume reaches about 10* 10mm), tumor tissue is collected and eut into 1-2 mm3 cubes and implanted into the left liver lobes of a new group of buffalo rats. Two weeks after orthotopic liver tumor implantation, the rats undergo liver resection (left lobe bearing liver tumor) and partial hepatic IR injury (30 minutes of ischemia on right lobe).
[00136] Two groups of rats with implanted tumor tissue are used for comparison of tumor récurrence and métastasés. In group 1, rats are aneslhetized with pentobarbital and administered intravenously with 0.2g/kg of the nonpolymeric heat stable cross-linked tetrameric hemoglobin
of the présent invention 1 hour before ischemia. Ischemia is întroduced in the right lobe of the Iiver by clamping of right branches of hepatic portai vein and hepatic artery with a bulldog clamp. Subsequently, ligation is performed in the left liver lobe followed by resection of the left liver lobe bearing the liver tumor. At 30 minutes after ischemia, an additional 0.2g/kg of the heat stable cross-linked tetrameric hemoglobin is injected through the inferior vena cava followed by reperfusion. In group 2, ringer’s acetate buffer is injected as a vehicle control with the same procedure. Ail rats are sacrificed 4 weeks after the hepatectomy procedures.
[00137] To examine tumor growth and metastasis, the liver and lungs of Buffalo rats are sampled at 4 weeks after Ischemia/reperfüsion and hepatectomy procedures for morphological examination. Tissue is harvested, parafilm-embedded and sectioned followed by Hematoxylin and Eosin (H&E) staining. Local recurrence/metastasis (intrahepatic) and distant metastasis (lungs) are confirmed by histological examination. Table 9 summarizes the observations.
[00138] Table 9: Comparîson of tumor récurrence / metastasis at four weeks after liver resection and IR injury in a rat orthotopic liver cancer model.
Control (n=6) Treatment (n=5)
Intrahepatic 4 (66.7%) 2 (40%)
metastasi s/recurrence
Lung metastasis 4 (66.7%) 2 (40%)
[00139] To examine the protectîve effects of nonpolymeric heat stable cross-linked tetrameric hemoglobin on liver tumor récurrence and metastasis, ail rats are sacrificed 4 weeks after the hepatectomy and 1R procedures. Lungs and liver tissues are harvested; hepatic tumor recurrence/metastasis and distant metastasis in the lungs are compared in both groups. Results show that the hemoglobin treatment decreases occurrence of récurrence and metastasis in both organs.
[00140] FIG. 18 shows représentative examples of intra-hepatic liver cancer récurrence and metastasis and distant lung metastasis induced in the rats of the IR injury group after hepatectomy and ischemia/reperfüsion procedures and its protection using the inventive heat stable cross-linked tetrameric hemoglobin. In FIG. 18A, extensive intrahepatic liver cancer recurrence/metastasis is observed in the IR injury group. Distant lung metastasis is also occurred
in the same rat (indicated by a solid arrow). In FIG. 18B, intrahepatic liver cancer recurrence/metastasis is observed in another case in the IR injury group (indicated by a dotted arrow). Extensive lung metastasis is observed in the same case (indicated by solid arrows). In contrast, FIG. 18C shows a représentative exampie of protection from intrahepatic liver cancer recurrence/metastasis and distant lung metastasis in the inventive heat stable cross-linked tetrameric hemoglobin treated rat.
[00141 ] FIG. 19 shows the histological examination in both groups at four weeks after liver resection and IR injury procedures. Histological examination (H&E staining) of liver and lung tissues in both the IR injury and hemoglobin treatment groups is performed to conflrm the identity of the tumor nodules. Représentative fields showing intrahepatic recurrence/metastasis in the hemoglobin treatment (T3) and IR injury groups (Tl and T2) are shown. Histological examination showing a normal liver architecture in the treatment group is inchided for comparison (NI). In addition, distant metastasis in the lungs is found in the same rat in IR injury group (M). Lung tissue without metastasis is shown in the treatment group (N2) for comparison. [00142] As a resuit of the investigation, it is concluded that treatment with the nonpolymeric heat stable cross-linked tetrameric hemoglobin of the présent invention has a preventative effect on both the récurrence of hepatic tumors and on metastasis in other organs.
[00143] While the foregoing invention has been described with respect to various embodiments, such embodiments are not limiting. Numerous variations and modifications would be understood by those of ordinary skill in the art. Such variations and modifications are considered to be included within the scope of the following claims. Z
3 AVR 2012'

Claims (10)

  1. What is claimed:
    l. A method for the préparation of a highly purified and heat stable oxygen carrier-containing pharmaceutical composition, the oxygen carrier-containing pharmaceutical composition including hemoglobin, the hemoglobin consisting essentially of nonpolymeric cross-Iinked tetrameric hemoglobin, the method comprising:
    a) providing mammaiian whole blood including at least red blood cells and plasma;
    b) separating the red blood cells from the plasma in the mammaiian whole blood;
    c) filtering the red blood cells that were separated from the plasma to obtain a filtered red blood cell fraction;
    d) washing the filtered red blood cell fraction to remove plasma protein impurities, resulting in washed red blood cells;
    e) dîsrupting the washed red blood cells by a précisé and controlled hypotonie lysis for 2 to 30 seconds or a time otherwise sufficient to lyse the red blood cells in an instant cytolysis apparatus to create a solution comprising a lysate of disrupted red blood cells at a flow rate of 5O-lOOOL/hr;
    f) performing filtration to remove at least a portion of the waste retentate from the lysate;
    g) extracting a first hemoglobin solution from the lysate;
    h) performing a first ultrafiltration process, using an ultrafiltration filter configured to remove impurities having a higher molecular weight than hemoglobin to further remove any viruses and residual waste retentate from the first hemoglobin solution to obtain a second hemoglobin solution;
    i) performing flowthrough column chromatography on the purified hemoglobin solution to remove protein impurities;
    j) performing a second ultrafiltration process using an ultrafiltration filter configured to remove impurities and to concentrate the purified hemoglobin solution;
    k) cross-linking at least α-α subunits of the hemoglobin by bis-3,5-dibromosalicyl fùmarate to form cross-lînked hemoglobin in a deoxygenated environment wherein the crosslînked hemoglobin is nonpolymeric cross-Iinked tetrameric hemoglobin;
    l) exchangîng a suitable physiological buffer for the cross-Iinked tetrameric hemoglobin;
    m) removing any residual chemicals by tangential flow filtration; 4
    n) heat treating the cross-linked hemoglobin in a deoxygenated environment to dénaturé and precipitate any residual non-reacted hemoglobin, non-stabilized hemoglobin (dimer) and any other protein impurities such that the resulting heat stable cross-linked tetrameric hemoglobin has an undetectable concentration of dimer and consists essentially of nonpolymeric cross-linked tetrameric hemoglobin;
    o) adding N-acetyl cysteine immediately following heat treating the cross-linked tetrameric hemoglobin to maintain a Iow level of met-hemoglobin;
    p) removing precipitate by a centrifugation or a filtration apparatus to form a clear solution; and
    q) adding the purified and heat stable cross-linked tetrameric hemoglobin to a phanmaceutically acceptable carrier.
  2. 2. The method for the préparation of a highly purified and heat stable oxygen carriercontaining pharmaceutical composition according to claim l wherein the heat treating is a high température short time process conducted at approximately 70°C to 95°C for 30 seconds to 3 hours followed immediately by cooling and the N-acetyl cysteine in an amount of 0.2 to 0.4% is added immediately following the cooling.
  3. 3. The method for the préparation of a highly purified and heat stable oxygen carriercontaining pharmaceutical composition according to claim 1 wherein the whole blood is human, bovine, porcine, canine or equine whole blood.
  4. 4. The method for the préparation of a highly purified and heat stable oxygen carriercontaining pharmaceutical composition according to claim 1 wherein said column chromatography comprises one or more cation-exchange columns or anion-exchange columns.
  5. 5. The method for the préparation of a highly purified and heat stable oxygen carriercontaining pharmaceutical composition according to claim 4 wherein the chromatography column is one or more DEAE column, CM column and/or hydroxyapatite column. J
  6. 6. The method for the préparation of a highly purified and heat stable oxygen carriercontainîng pharmaceutical composition according to claim l wherein the pharmaceutically acceptable carrier is a physiological buffer or water.
  7. 7. A highly purified and heat stable oxygen carrier-containing pharmaceutical composition comprising hemoglobin, the hemoglobin consisting essentially of nonpolymeric cross-linked tetrameric hemoglobin formed by the process of claim 1.
  8. 8. A method for the préparation of a highly purified and heat stable oxygen carrier-containing pharmaceutical composition, the oxygen carrier-containing pharmaceutical composition including hemoglobin, the hemoglobin consisting essentially of nonpolymeric cross-linked tetrameric hemoglobin, the method comprising:
    a) providing mammalian whole blood including at least red blood cells and plasma;
    b) séparaiing the red blood cells from the plasma in the mammalian whole blood;
    c) filtering the red blood cells that were separated from the plasma to oblaîn a filtered red blood cell fraction;
    d) washing the filtered red blood cell fraction to remove plasma protein impurities, resulting in washed red blood cells;
    e) disrupting the washed red blood cells by a précisé and controlled hypotonie lysis for 2 to 30 seconds or a time otherwise sufficient to lyse the red blood cells in an instant cytolysis apparatus to create a solution comprising a lysate of disrupted red blood cells at a flow rate of 50-1000L/hr;
    f) performing filtration to remove at least a portion of the waste retentate from the lysate;
    g) extracting a first hemoglobin solution from the lysate;
    h) performing a first ultrafiltration process, using an ultrafiltration filter configured to remove impurities having a higher molecular weight than hemoglobin to further remove any viruses and resîdual waste retentate from the first hemoglobin solution to obtain a second hemoglobin solution;
    i) performing flowthrough column chromatography on the purified hemoglobin solution to remove protein impurities;
    j) performing a second ultrafiltration process using an ultrafiltration filter configured to remove impurities and to concentrate the purified hemoglobin solution;
    k) cross-linking at least a-a subunits of the hemoglobin by bis-3,5-dibromosalicyl fumarate to form cross-linked hemoglobin in a deoxygenated environment wherein the hemoglobin is nonpolymeric cross-linked tetrameric hemoglobin;
    l) exchangîng a suitable physiological buffer for the cross-linked tetrameric hemoglobin;
    m) removing any residual chemicals by tangential flow filtration;
    n) heat treating the cross-linked hemoglobin at a température of approximately 90° C to 95° C to dénaturé and precipîtate any residual non-reacted hemoglobin, non-stabilized hemoglobin (dimer) and any other protein impurities such that the resulting heat stable crosslinked tetrameric hemoglobin has an undetectable concentration of dimer and consists essentially of nonpolymeric cross-linked tetrameric hemoglobin and immediately cooling to approximately 25° C;
    o) adding N-acetyl cysteine immediately following heat treating the cross-linked tetrameric hemoglobin to maintain a low level of met-hemoglobin;
    p) removing precipîtate by a centrifugation or a filtration apparatus to form a clear solution; and
    q) adding the purified and heat stable cross-linked tetrameric hemoglobin to a pharmaceutically acceptable carrier.
  9. 9. The method for the préparation of a hîghly purified and heat stable oxygen carriercontaînîng pharmaceutical composition according to claim 8 wherein the heat treating is performed in a deoxygenated environment.
    10. The method for the préparation of a highly purified and heat stable oxygen carriercontaining pharmaceutical composition according to claim 8 wherein the heat treating is conducted for 30 seconds to 3 minutes followed immediately by cooling and the N-acetyl cysteine in an amount of 0.2 to 0.4% îs added immediately following the cooling.
    11. The method for the préparation of a highly purified and heat stable oxygen carriercontaining pharmaceutical composition according to claim 8 wherein the whole blood is human, bovine, porcine, canine or equine whole blood.
    5
    12. The method for the préparation of a highly purified and heat stable oxygen carriercontaining pharmaceutical composition according to claim 8 wherein said column chromatography comprises one or more catîon-ex change columns or anion-exchange columns.
    13. The method for the préparation of a highly purified and heat stable oxygen carrier10 containing pharmaceutical composition according to claim 12 wherein the chromatography column is one or more DEAE column, CM column and/or hydroxyapatîte column.
    14 A highly purified and heat stable oxygen carrier-containing pharmaceutical composition comprising hemoglobin, the hemoglobin consisting essentîally of nonpolymeric cross-linked 15 tetrameric hemoglobin formed by the process of claim 8.
    15. A method for the préparation of a highly purified and heat stable oxygen carrier-containing pharmaceutical composition, the oxygen carrier-containing pharmaceutical composition including hemoglobin, the hemoglobin consisting essentîally of nonpolymeric cross-linked 20 tetrameric hemoglobin, the method comprising:
    a) providing mammalian whole blood including at least red blood cells and plasma;
    b) separating the red blood cells from the plasma in the mammalian whole blood;
    c) filtering the red blood cells that were separated from the plasma to obtain a filtered red blood cell fraction;
    25 d) washing the filtered red blood cell fraction to remove plasma protein impurities, resulting in washed red blood cells;
    e) disrupting the washed red blood cells by a précisé and controlled hypotonie lysis for 2 to 30 seconds or a time otherwise sufficient to lyse the red blood cells in an instant cytolysis apparatus to create a solution comprising a lysate of disrupted red blood cells at a flow rate of
    50-1000L/hr;
    f) performîng filtration to remove at least a portion of the waste retentate from the lysate;
    g) extracting a first hemoglobin solution from the lysate;
    h) performing a first ultrafiltration process, using an ultrafiltration filter configured to remove impuniies having a higher molecular weight than hemoglobin to further remove any viruses and residual waste retentate from the first hemoglobin solution to obtain a second hemoglobin solution;
    i) performing flowthrough column chromatography on the purified hemoglobin solution to remove protein impurities;
    j) performing a second ultrafiltration process using an ultrafiltration filter configured to remove impurities and to concentrate the purified hemoglobin solution;
    k) cross-linking at least α-α subunits of the hemoglobin by bis-3,5-dibromosalicyl fumarate to form cross-linked hemoglobin in a deoxygenated environment wherein the crosslinked hemoglobin is nonpolymeric cross-linked tetrameric hemoglobin;
    l) exchanging a suitable physiological buffer for the cross-linked tetrameric hemoglobin;
    m) removing any residual chemicals by tangential flow filtration;
    n) adding N-acetyl cysteine to the cross-linked tetrameric hemoglobin and heat treating the cross-linked hemoglobin at a température of approximately 70° C to 95° C in a deoxygenated environment to dénaturé and precipitate any residual non-reacted hemoglobin, non-stabîlized hemoglobin (dimer) and any other protein impurities such that the resulting heat stable crosslinked tetrameric hemoglobin has an undetectable concentration of dimer and consists essentially of nonpolymeric cross-linked tetrameric hemoglobin;
    o) adding N-acetyl cysteine immediatcly following heat treating the cross-linked tetrameric hemoglobin to maintain a low level of met-hemoglobin;
    p) removing precipitate by a centrifugation or a filtration apparatus to form a clear solution; and
    q) adding the purified and heat stable cross-linked tetrameric hemoglobin to a pharmaceutically acceptable carrier.
    16. The method for the préparation of a highly purified and heat stable oxygen carrier- containing pharmaceutical composition according to claim 15 wherein the heat treating is conducted for 30 seconds to 3 hours followed immcdiately by cooling to 25° C and the N-acetyl cysteine in an amount of approximately 0.2 to 0.4% is added immediately following the cooling.
    17. The method for the préparation of a highly purified and heat stable oxygen carriercontaining pharmaceutical composition according to claim 15 wherein addition of N-acetyl cysteine prior to heat treating is in an amount of approximately 0.2%.
    18. The method for the préparation of a highly purified and heat stable oxygen carriercontaining pharmaceutical composition according to claim 15 wherein the whole blood is human, bovine, porcine, canine or equine whole blood.
  10. 10 19. A highly purified and heat stable oxygen carrier-containing pharmaceutical composition comprising hemoglobin, the hemoglobin consîsting essentially of nonpolymeric cross-linked tetrameric hemoglobin formed by the process of claim 15.
    SAGHTSarl
OA1201200185 2010-06-23 2011-04-15 A method for the preparation of a heat stable oxygen carrier-containing pharmaceutical composition. OA16231A (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US12/821214 2010-06-23
US12/957430 2010-12-01
US13/013850 2011-01-26

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Publication Number Publication Date
OA16231A true OA16231A (en) 2015-04-10

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