US20140004099A1 - Dodecafluoropentane emulsion as a stroke and ischemia therapy - Google Patents

Dodecafluoropentane emulsion as a stroke and ischemia therapy Download PDF

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US20140004099A1
US20140004099A1 US14/017,975 US201314017975A US2014004099A1 US 20140004099 A1 US20140004099 A1 US 20140004099A1 US 201314017975 A US201314017975 A US 201314017975A US 2014004099 A1 US2014004099 A1 US 2014004099A1
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ddfpe
subject
administered
perfluorocarbon
composition
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William Culp
Robert Skinner
Evan Unger
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BioVentures LLC
Nuvox Pharma LLC
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University of Arkansas
Nuvox Pharma LLC
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Priority to US14/017,975 priority Critical patent/US20140004099A1/en
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Assigned to THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ARKANSAS reassignment THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ARKANSAS ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: CULP, William, SKINNER, ROBERT
Assigned to NUVOX PHARMA, LLC reassignment NUVOX PHARMA, LLC ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: UNGER, EVAN
Priority to US15/614,570 priority patent/US11571467B2/en
Assigned to BIOVENTURES, LLC reassignment BIOVENTURES, LLC ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: BOARD OF TRUSTEES OF THE UNIVERSITY OF ARKANSAS
Priority to US18/078,924 priority patent/US20230190890A1/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/43—Enzymes; Proenzymes; Derivatives thereof
    • A61K38/46—Hydrolases (3)
    • A61K38/48—Hydrolases (3) acting on peptide bonds (3.4)
    • A61K38/482—Serine endopeptidases (3.4.21)
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/10—Dispersions; Emulsions
    • A61K9/107—Emulsions ; Emulsion preconcentrates; Micelles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/02—Halogenated hydrocarbons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K33/00—Medicinal preparations containing inorganic active ingredients
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/43—Enzymes; Proenzymes; Derivatives thereof
    • A61K38/46—Hydrolases (3)
    • A61K38/48—Hydrolases (3) acting on peptide bonds (3.4)
    • A61K38/49—Urokinase; Tissue plasminogen activator
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
    • A61P7/02—Antithrombotic agents; Anticoagulants; Platelet aggregation inhibitors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
    • A61P7/06—Antianaemics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
    • A61P7/08—Plasma substitutes; Perfusion solutions; Dialytics or haemodialytics; Drugs for electrolytic or acid-base disorders, e.g. hypovolemic shock
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

  • the present invention provides methods and combinations for reducing tissue damage in a subject undergoing an ischemic event or at risk of an ischemic event.
  • One aspect of the present invention encompasses a method for reducing the infarct volume in a tissue of a subject undergoing ischemia due to an ischemic event.
  • the method comprises administering an effective amount of a composition comprising a perfluorocarbon emulsion to the subject, wherein the infarct volume is reduced without resolving the ischemic event.
  • Another aspect of the present invention encompasses a method for improving tissue oxygenation in a subject at risk for ischemic tissue damage.
  • the method comprises administering an effective amount of a composition comprising a perfluorocarbon emulsion to the subject prior to a medical procedure that results in the subject being at high risk of ischemic tissue damage.
  • Yet another aspect of the present invention encompasses a method for improving neuroprotection in a subject at risk for ischemic tissue damage.
  • the method comprises administering an effective amount of a composition comprising a perfluorocarbon emulsion to the subject prior to a medical procedure that results in the subject being at high risk of ischemic neural tissue damage.
  • Still another aspect of the present invention encompasses a method for treating hemorrhagic stroke.
  • the method comprises administering an effective amount of a composition comprising a perfluorocarbon emulsion to the subject in need of treatment for hemorrhagic stroke.
  • a further aspect of the present invention encompasses a method for decreasing infarct size due to intracranial brain hemorrhage.
  • the method comprises administering an effective amount of a composition comprising a perfluorocarbon emulsion to the subject in need of treatment for intracranial brain hemorrhage.
  • An alternative aspect of the present invention encompasses a combination.
  • the combination comprises a composition comprising a perfluorocarbon emulsion and a thrombolytic agent.
  • FIG. 1 depicts an image of the set-up used for measuring oxygen absorption.
  • the vials on the left contain one of the PFC emulsions and the vials on the right contain the blank formulation.
  • FIG. 2 depicts the set-up used to measure the volume expansion upon injection at 37° C.
  • FIG. 3 graphically depicts the particle-size distribution of DDFPe for 6 months at 23° C. ⁇ 2° C.
  • the error bars represent one standard deviation of the triplicate measurements.
  • the open diamonds represent measurements of less than 2% of the particle distribution at that time point.
  • FIG. 4 graphically depicts the amount of oxygen absorbed by 5 mL injections of DDFPe (triangles), PFDe (diamonds), PFOBe (squares), and the formulation blank (open circles) at 21° C. (blue) and 37° C. (red) over the course of 60 minutes.
  • FIG. 5 graphically depicts volume increase upon heating 5 mL injections of the 3 PFC emulsions, the blank formulation, and water to 37° C.
  • FIG. 6 depicts images of rabbit angiography.
  • Subselective magnification angiograms of the internal carotid artery demonstrate (A) the Circle of Willis and the MCA and ACA (arrow and arrowhead, respectively) and (B) occlusion of the MCA and ACA following the injection of three embolic spheres.
  • FIG. 7 graphically depicts brain infarction following MCA and ACA embolization.
  • TTC 2,3,5-triphenyltetrazolium chloride
  • FIG. 8 graphically depicts infarct volume at 4 hours vs. DDFPe treatment time. Categorization of treatment times to model various clinical scenarios, pre-treatment, hyperacute, and acute therapy, demonstrates improved outcomes compared to control. Whether DDFPe is used as a pre-treatment (30 minutes before embolization), a hyperacute treatment (0 to 30 minutes), or an acute treatment (1 to 3 hours), stroke volumes are significantly reduced. *P ⁇ 0.021, Dunnett-adjusted comparison of ranks.
  • FIG. 9 depicts images of angiographic anatomy (A) embolization of the middle cerebral artery and the anterior cerebral artery (B), and infarct with hemorrhage in a cross section of a rabbit brain (C).
  • FIG. 10 depicts stroke volumes in ischemic stroke rabbit models receiving DDFPe treatments.
  • DDFPe reduces stroke even when given 60 minutes after permanent arterial occlusion.
  • FIG. 11 depicts stroke volumes in ischemic stroke rabbit models receiving DDFPe treatments up to 3 hours after embolization.
  • FIG. 12 depicts stroke volumes in ischemic stroke rabbit models receiving DDFPe treatments up to 6 hours after embolization. Note, for FIG. 12 , the controls for each time point were as follows:
  • Timepoint Control Value 30 min Control at 4 hrs (leftmost column) 1 hr Control at 4 hrs (leftmost column) 2 hr Control at 4 hrs (leftmost column) 3 hr Control at 4 hrs (leftmost column) 6 hr Control at 7 hrs
  • FIG. 13 depicts stroke volumes in ischemic stroke rabbit models receiving DDFPe treatments 0 to 30 minutes after embolization (hyperacute), and 1 to 3 hours after embolization (acute).
  • FIG. 14 depicts an image of representative brain sections stained with TTC showing infarct areas.
  • A Section from control animal showing the infarct area (large star) of 3.9% (infarct volume as a percent of total brain volume).
  • B Section from animal having a stroke and treated with DDFPe showing the infarcted area (small star) of 0.8%.
  • FIG. 15 graphically depicts DDFP clearance from blood as a function of time in a representative rabbit.
  • the DDFPe dose was 0.6 ml/kg of a 2% w/v emulsified preparation.
  • Blood levels of DDFP were determined using a headspace gas chromatograph-mass spectrometer (Varian TSQ).
  • Half-life in blood for this rabbit was 1.68 min.
  • R value was 0.994
  • the present invention describes methods and combinations that may be used to reduce tissue damage due to an ischemic event in a subject.
  • the methods comprise administering a composition or a combination comprising an oxygen transport substance to the subject.
  • the oxygen transport substance is a composition comprising a perfluorocarbon emulsion.
  • the methods and combinations are effective in reducing infarct volume and providing neuroprotection to subjects undergoing ischemia, or subjects at risk of ischemia due to a medical procedure.
  • Methods of the invention also encompass reducing tissue damage from hemorraghic stroke or intracranial hemorrhage.
  • the methods and combinations are effective for pretreating subjects at high risk of an ischemic event.
  • the invention encompasses a method for reducing the infarct volume in a tissue of a subject undergoing ischemia due to an ischemic event.
  • the method comprises administering an effective amount of a composition comprising an oxygen transport substance to the subject, wherein the infarct volume is reduced without resolving the ischemic event.
  • the oxygen transport substance is a composition comprising a perfluorocarbon emulsion.
  • the oxygen transport substance may be administered to the subject before the ischemic event is resolved. Stated another way, the oxygen transport substance may be administered to reduce infarct volume even though normal blood flow, blood pressure, or oxygenation levels in the tissue have not been restored.
  • ischemia may refer to a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue due to inadequate oxygenation. Ischemia may be caused by an “ischemic event.” Generally speaking, an “ischemic event” may be caused by an occluded vessel, hypotension, or hypoxia.
  • Non-limiting examples of an ischemic event may include diseases such as sickle cell anemia and Moyamoya disease, or abnormalities in the circulatory system that may lead to occluded vessels or hemorrhage such as volvulus, or hernia, mechanical compression of an artery such as by a tumor, ventricular tachycardia, extremely low blood pressure as a result of heart attack and congenital heart defects, cardio respiratory arrest, hemorrhage, carbon monoxide poisoning, damaging an artery by trauma, or as atherosclerosis or vasculitides, or vasoconstricting an artery such as cocaine vasoconstriction, iatrogenic ischemic episodes such as cardiac surgery or other surgical interventions, coronary and carotid interventions, embolism (foreign bodies in the circulation) such as amniotic fluid embolism, transient clot or bubbles (gaseous emboli), transient ischemic attack (TIA) inflammation, and hypoperfusion episodes, induced g-forces which restrict the
  • the disease or abnormality may cause ischemia by forming or increasing the risk of formation of blood clots or hemorrhage which may cause a stoppage of blood supply to a part of the body.
  • the ischemia may cause stroke.
  • Ischemia may occur in any organ, tissue or part of the body.
  • mesenteric ischemia may result from inadequate blood supply to the small intestine
  • ischemic colitis may result from inadequate blood supply to the large intestine
  • brain ischemia may result from inadequate blood supply to the brain due to an occluded blood vessel or a hemorrhage leading to hemorrhagic stroke
  • myocardial ischemia may result from inadequate blood supply to the heart
  • coronary ischemia may result from inadequate blood supply to the coronary arteries
  • renal ischemia also called nephric ischemia, may result from inadequate blood supply to one or both kidneys or nephrons
  • limb ischemia may result from inadequate blood supply to a limb
  • anterior ischemic optic neuropathy (AION) may result from inadequate blood supply to the optic nerve.
  • ischemia may be due to a medical procedure.
  • ischemia may be due to a medical procedure that increases the risk of vessel occlusion (e.g. medical procedures that produce emboli or microemboli).
  • medical procedures that may increase the risk of vessel occlusion may include major or minor surgical procedure which may cause hemorrhage or the formation of blood clots leading to ischemia, and chiropractic adjustment.
  • Other examples of medical procedures that may cause ischemia include cardiac surgery such as open heart procedures, coronary artery bypass graft surgery, cardiopulmonary bypass surgery, carotid surgery, cardiac surgery, angioplasty, stenting, device implantation, ablations, and heart valve surgery.
  • Still other examples of medical procedures that may cause ischemia include “open surgery” as well as orthopedic surgery, skeletal surgery, and hip fracture fixation surgery.
  • the invention provides methods for reducing infarct volume in a tissue.
  • the methods of the invention provide for reducing infarct volume in a tissue without increasing incidence of brain hemorrhage.
  • infarct may refer to a lesion caused by tissue damage or death due to ischemia as described in Section I(a)i. above. Methods of measuring infarct volumes are known in the art. For instance, infarct volumes may be measured post-mortem in a tissue or organ by staining the tissue or organ using a live or dead cell stain, followed by measuring the infarcted area in closely spaced sections of the tissue or organ.
  • infarct volume may be measured in a live subject using radiography, computer tomography, magnetic resonance imaging, or other in vivo imaging techniques. Infarct volume may be expressed in volume units, or may be represented as a percentage of the tissue or organ in which it is present.
  • infarct volume may be decreased about 100%, 90%, 80%, 70%, 60%, 50%, 40%, 30%, 20%, or 10% compared to an infarct volume when no oxygen transport substance is administered during a comparable ischemic event.
  • infarct volume may be decreased by about 100, 99, 98, 97, 96, 95, 94, 93, 92, 91, 90, 89, 88, 87, 86, 85, 84, 83, 82, 81, 80, 79, 78, 77, 76, 75, 74, 73, 72, 71, 70, 69, 68, 67, 66, 65, 64, 63, 62, 61, 6, 59, 58, 57, 56, 55, 54, 53, 52, 51, 50, 49, 48, 47, 46, 45, 44, 43, 42, 41, 40, 39, 38, 37, 36, 35, 34, 33, 32, 31, 30, 29, 28, 27, 26, 25, 24, 23, 22, 21, 20, 19,
  • infarct volume may be decreased to about 0, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3.0 or about 3.1% of the tissue when an oxygen transport substance of the disclosure is administered, compared to an infarct volume of about 3.2% or greater when no oxygen transport substance is administered.
  • infarct volume may be decreased to about 0, 0.1, 0.2, 0.3, 0.4, 0.5 or about 0.6% of the tissue when an oxygen transport substance of the disclosure is administered, compared to an infarct volume of about 3.2% or greater when no oxygen transport substance is administered. In yet other embodiments, infarct volume may be decreased to about 0.5, 0.6, 0.7, 0.8, 0.9, 1, or about 1.1% of the tissue when an oxygen transport substance of the disclosure is administered, compared to an infarct volume of about 3.2% or greater when no oxygen transport substance is administered.
  • infarct volume may be decreased to about 1, 1.1, 1.2, 1.3, 1.4, 1.5, or about 1.6% of the tissue when an oxygen transport substance of the disclosure is administered, compared to an infarct volume of about 3.2% or greater when no oxygen transport substance is administered. In other embodiments, infarct volume may be decreased to about 1.5, 1.6, 1.7, 1.8, 1.9, 2, or about 2.1% of the tissue when an oxygen transport substance of the disclosure is administered, compared to an infarct volume of about 3.2% or greater when no oxygen transport substance is administered.
  • infarct volume may be decreased to about 2, 2.1, 2.2, 2.3, 2.4, 2.5, or about 2.6% of the tissue when an oxygen transport substance of the disclosure is administered, compared to an infarct volume of about 3.2% or greater when no oxygen transport substance is administered.
  • infarct volume may be decreased to about 2.5, 2.6, 2.7, 2.8, 2.9, 3.0 or about 3.1% of the tissue when an oxygen transport substance of the disclosure is administered, compared to an infarct volume of about 3.2% or greater when no oxygen transport substance is administered.
  • infarct volume may be decreased to about 0, 0.5, 1, 1.5, 2, 2.5, 3.0 or about 3.1% of the tissue when an oxygen transport substance of the disclosure is administered, compared to an infarct volume of about 3.2% or greater when no oxygen transport substance is administered.
  • Another embodiment of the present invention encompasses a method for improving tissue oxygenation in a subject at risk for ischemic tissue damage.
  • the method comprises administering an effective amount of a composition comprising an oxygen transport substance to the subject prior to a medical procedure that results in the subject being at high risk of ischemic tissue damage.
  • the oxygen transport substance is a composition comprising a perfluorocarbon emulsion.
  • Yet another embodiment of the present invention encompasses a method for improving neuroprotection in a subject at risk for ischemic tissue damage.
  • the method comprises administering an effective amount of a composition comprising an oxygen transport substance to the subject prior to a medical procedure that results in the subject being at high risk of neural ischemic tissue damage.
  • the oxygen transport substance is a composition comprising a perfluorocarbon emulsion.
  • nerveroprotection refers to reduced tissue damage in the nervous system of a subject.
  • the nervous system encompasses both the central nervous system and the peripheral nervous system.
  • Still another embodiment of the present invention encompasses a method for treating hemorrhagic stroke.
  • the method comprises administering an effective amount of a composition comprising an oxygen transport substance to the subject in need of treatment for hemorrhagic stroke.
  • the oxygen transport substance is a composition comprising a perfluorocarbon emulsion.
  • a further aspect of the present invention encompasses a method for decreasing infarct size due to intracranial brain hemorrhage.
  • the method comprises administering an effective amount of a composition comprising an oxygen transport substance to the subject in need of treatment for intracranial brain hemorrhage.
  • the oxygen transport substance is a composition comprising a perfluorocarbon emulsion.
  • the methods of the present disclosure comprise administering an oxygen transport substance to a subject.
  • a subject in need of an oxygen transport substance may be a rodent, a human, a livestock animal, a companion animal, a laboratory animal, or a zoological animal.
  • the subject in need of an oxygen transport substance may be a lab animal.
  • a lab animal include a rabbit, a mouse, a guinea pig, a hamster, or a rat.
  • the subject in need of an oxygen transport substance may be a rodent, e.g. a mouse, a rat, a guinea pig, etc.
  • the subject in need of an oxygen transport substance may be a livestock animal.
  • suitable livestock animals may include pigs, cows, horses, goats, sheep, llamas and alpacas.
  • the subject in need of an oxygen transport substance may be a companion animal.
  • companion animals may include pets such as dogs, cats, rabbits, and birds.
  • the subject in need of an oxygen transport substance may be a zoological animal.
  • a “zoological animal” refers to an animal that may be found in a zoo. Such animals may include non-human primates, large cats, wolves, and bears.
  • the subject in need of an oxygen transport substance may be a human.
  • the subject may be undergoing ischemia.
  • the subject may be undergoing ischemia caused by an occluded vessel, hypoxia, or hypotension.
  • the subject may be undergoing ischemia due to stroke.
  • the subject may be at high risk for developing an ischemic event. It will be appreciated by those skilled in the art that a subject may be at high risk for an ischemic event as a result of controllable or uncontrollable risk factors.
  • controllable risk factors may include high blood pressure, atrial fibrillation, high cholesterol, diabetes, atherosclerosis, circulation problems, tobacco use and smoking, alcohol use, physical inactivity, and obesity.
  • uncontrollable risk factors may include age, gender, race, family history, previous stroke or TIA, fibromuscular dysplasia, and patent foramen ovale (PFO or Hole in the Heart).
  • the subject may be undergoing a medical procedure that increases the risk of an ischemic event.
  • medical procedures that may increase the risk of vessel occlusion may include major or minor surgical or catheter based procedure or interventional which may cause hemorrhage or the formation of blood clots leading to ischemia, and chiropractic adjustment.
  • the subject may be in need of treatment for a hemorrhagic stroke.
  • the invention comprises a method for reducing the infarct volume in a tissue of a subject undergoing ischemia caused by an occluded vessel, the method comprising administering an effective amount of a dodecafluoropentane emulsion to the subject, wherein the dodecafluoropentane emulsion improves the oxygenation of the tissue such that the infarct volume is reduced without resolving the occlusion.
  • the invention comprises a method for reducing vessel occlusion during a medical procedure that increases the risk for vessel occlusion, the method comprising administering an effective amount of a dodecafluoropentane emulsion to a subject at before the medical procedure is performed.
  • additional doses of a dodecafluoropentane emulsion may be administered during and/or after the medical procedure is performed.
  • the invention comprises a method for reducing infarct volume in a tissue of a subject at high risk for developing an occluded blood vessel, the method comprising administering an effective amount of a dodecafluoropentane emulsion to the subject prior to onset of symptoms of an occluded blood vessel.
  • the method may further comprise resolving the occlusion.
  • the invention comprises a method for treating hemorrhagic stroke, the method comprising administering an effective amount of a dodecafluoropentane emulsion to a subject in need of treatment for a hemorrhagic stroke.
  • the subject is chosen from a rodent, a research animal, a companion animal, an agricultural animal, and a human.
  • the dodecafluoropentane emulsion is administered at least once in a time ranging from immediately after the onset of symptoms of an occluded blood vessel to 24 hours after the onset of symptoms of an occluded blood vessel.
  • the dodecafluoropentane emulsion is administered to the subject intravenously.
  • a solution of about 1% to about 5% w/v of the dodecafluoropentane emulsion is administered to the subject in an amount of about 0.2 mL to about 1 mL per kilogram of the subject.
  • a solution of about 2% w/v of the dodecafluoropentane emulsion is administered to the subject in an amount of about 0.01 mL per kilogram to about 1 ml per kilogram of the subject.
  • the dodecafluoropentane emulsion improves the oxygenation to the tissue such that the infarct volume is reduced without increasing incidence of brain hemorrhage.
  • the dodecafluoropentane emulsion is administered in combination with an anticoagulant.
  • the dodecafluoropentane emulsion is administered in combination with a thrombolytic drug selected from the group consisting of tissue plasminogen activators, antistreptase, streptokinase, urokinase, and combinations thereof.
  • a thrombolytic drug selected from the group consisting of tissue plasminogen activators, antistreptase, streptokinase, urokinase, and combinations thereof.
  • the dodecafluoropentane emulsion is administered in combination with surgical techniques selected from the group consisting of cardiac surgery, open surgery, orthopedic surgery, and skeletal surgery, angioplasty, stenting, device implantation, and ablations and combinations thereof.
  • the subject is undergoing ischemia due to stroke.
  • the methods of the present disclosure comprise administering an oxygen transport substance to a subject.
  • the oxygen transport substance may be blood, a blood product, or a synthetically produced oxygen transport substance.
  • the oxygen transport substance may be a synthetically produced oxygen transport substance.
  • Synthetically produced oxygen transport substances are known in the art and may include hemoglobin-based oxygen carriers and perfluorochemicals.
  • the synthetically produced oxygen transport substance may be hemoglobin-based oxygen carriers.
  • hemoglobin-based oxygen carriers may be hemoglobin, polymerized hemoglobin, conjugated hemoglobin, crosslinked hemoglobin, phospholipid-encapsulated hemoglobin, recombinant hemoglobin, hemoglobin-based oxygen carriers complexed with superoxide dismutase and catalase, and hemoglobin derivatives.
  • the synthetically produced oxygen transport substance may be perfluorochemicals (PFCs).
  • PFCs may be liquid perfluorochemicals that dissolve oxygen.
  • Non-limiting examples of liquid PFCs that dissolve oxygen and may be used as an oxygen transport substance include perfluorooctyl bromide, perfluorooctyl dibromide, bromofluorocarbons, perfluoroethers, Fluosol DATM, F-44E, 1,2-bisperfluorobutyl-ethylene, F-4-methyl octahydroquinolidizine, 9 to 12 carbon perfluoro amines, perfluorodecalin, perfluoroindane, perfluorotrimethyl bicyclo[3,3,1]onane, perfluoromethyl adamante, and perfluorodimethyl adamantane.
  • PFCs may also be a gas used to deliver oxygen in the body of a subject. Particularly useful is a PFC gas that has been formulated into microbubbles. Microbubbles comprising PFCs are known in the art and are disclosed in, for example, U.S. Pat. Nos. 5,393,524, 5,409,688, 5,558,854, 5,558,855, 5,595,723, and 5,558,853, all of which are incorporated herein by reference.
  • Non-limiting examples of PFC gases that may be formulated into microbubbles include dodecafluoropentane (DDFPe), sulfur hexafluoride, pentane, hexafluoropropylene, octafluoropropane, hexafluoroethane, octafluoro-2-butyne, hexafluorobuta-1,3-diene, isoprene, octafluorocyclobutane, decafluorobutane, cis-2-pentene, dimethyl sulfide, ethylarsine, bromochlorofluoromethane, trans-2-pentene, 2-chloropropane, hexafluorodisulfide, ethylmercaptan, diethylether, ethylvinylether, valylene, trisfluoroarsine, furfuyl bromide, c
  • the preferred fluorocarbons useful as an oxygen therapeutic have a boiling point between about room temperature and at about or near physiological temperature. In one embodiment, the fluorocarbon has a boiling point of below about 100° C.
  • the preferred fluorocarbon is perfluoropentane with perfluoroisopentane being particularly preferred.
  • Microbubbles comprising PFCs capable of transporting oxygen in the blood are smaller than red blood cells, and can flow through partially obstructed vessels to deliver large amounts of oxygen to oxygen-starved tissues or organs.
  • Methods of formulating microbubbles comprising PFCs are known in the art, and are disclosed in, for example, U.S. Pat. Nos. 5,393,524, and 5,558,855, each of which are incorporated herein by reference.
  • microbubbles comprising PFC gas are prepared by a phase-shift technology whereby an emulsion of liquid PFC droplets is prepared in a cool environment, and then when infused or injected into the body of an individual, the droplets become vaporized gas microbubbles comprising a PFC gas.
  • an emulsion may refer to a colloidal dispersion of one immiscible liquid dispersed in another liquid in the form of droplets, whose diameter, in general, exceeds approximately 100 nm and which is typically optically opaque, unless the dispersed and continuous phases are refractive index matched.
  • an emulsion of the invention comprises the dispersed PFC droplets and an amphiphilic material in a continuous phase.
  • the continuous phase of the colloidal dispersion of the present invention may be an aqueous medium.
  • aqueous medium may refer to a water-containing liquid which may contain pharmaceutically acceptable additives such as acidifying agents, alkalizing agents, antimicrobial preservatives, antioxidants, buffering agents, chelating agents, complexing agents, solubilizing agents, humectants, solvents, suspending and/or viscosity-increasing agents, tonicity agents, wetting agents or other biocompatible materials.
  • the amphiphilic material may be a biocompatible protein, a fluorine-containing surfactant, polyoxypropylenepolyoxyethylene glycol nonionic block copolymers, and synthetic surfactants.
  • the composition of the invention may comprise a surfactant.
  • surfactants that may be used in the composition of the invention may include various commercial anionic, cationic, and nonionic surfactants, including Tweens, Spans, Tritons, and the like, phospholipids, cholesterol, PLURONIC F-68®, HAMPOSYL L30® (W.R.
  • Emulsions of fluorocarbons may be prepared, in some embodiments, using fluorosurfactants such as fluorinated phospholipids.
  • the surfactant is PEG-Telomer-B.
  • the composition comprises DDFPe with PEG-Telomer-B.
  • Phospholipids are also useful for preparing emulsions and may comprise one or more different phospholipids and also fatty acids. Chain length in phospholipids may vary from about 12 to about 20 carbon atoms in length.
  • the alkyl groups may be saturated or unsaturated. Preferably if phospholipids are employed, two or more lipids are employed.
  • dipalmitoylphosphatidylcholine can be mixed with dipalmitoylphosphatidylethanolamine-PEG (DPPE-PEG).
  • the pegylated lipid is usually mixed between 1 and 10 mole percent with the non-PEG'ylated lipid.
  • the PEG chain may vary from about 1,000 to 10,000 MW but more preferably is from 2,000 to 5,000 MW.
  • Cholesterol and derivatives of cholesterol such as cholesterol-acetate may be included in the emulsion.
  • the emulsion may contain a cationic (dipalmitoylphosphatidylethylcholine) or anionic lipid (e.g. dipalmitoylphosphatidic acid) or a glycosylated lipid.
  • the lipids or surfactants are mixed with the fluorocarbon and homogenized to prepare an emulsion.
  • One or more viscosity modifying agents may also be included in the emulsion.
  • the emulsion may also comprise various additives to assist in stabilizing the dispersed phase or in rendering the formulation biocompatible.
  • Acceptable additives include acidifying agents, alkalizing agents, antimicrobial preservatives, antioxidants, buffering agents, chelating agents, suspending and/or viscosity-increasing agents, including triodobenzene derivative, such as iohexyl or iopamidol, tonicity agents, acacia, agar, alginic acid, aluminum mono-stearate, bentonite, magma, carbomer 934P, carboxymethylcellulose, calcium and sodium and sodium 12, carrageenan, cellulose, dextrin, gelatin, guar gum, hydroxyethyl cellulose, hydroxypropyl methylcellulose, magnesium aluminum silicate, methylcellulose, pectin, polyethylene oxide, polyvinyl alcohol, povidone, propylene glycol alginate, silicon dioxide, sodium alginate, tragacanth,
  • the oxygen transport substance may be an emulsion of about 0.1% to about 8% w/v dodecafluoropentane. In other embodiments, the oxygen transport substance may be an emulsion of about 0.1% to about 1.5% w/v dodecafluoropentane. In yet other embodiments, the oxygen transport substance may be an emulsion of about 0.5% to about 2.5% w/v dodecafluoropentane. In additional embodiments, the oxygen transport substance may be an emulsion of about 1% to about 3% w/v dodecafluoropentane. In preferred embodiments, the oxygen transport substance may be an emulsion of about 1% to about 5% w/v dodecafluoropentane.
  • the emulsions may be formed by comminuting a suspension of the dispersed phase in the continuous phase by the application of mechanical, manual, or acoustic energy.
  • Comminuting comprises the process of forming a colloidal dispersion by mixing the liquid dispersed and continuous phases together and then causing a decrease in size of the particles of the dispersed phase from large particles to the size required, using mechanical energy generated by mixing manually, mechanically, or by the action of ultrasound. Appropriate mixing can be achieved in a Microfluidic's Model 110 Microfluidizer apparatus, as described in U.S. Pat. No. 4,533,254, incorporated herein by reference.
  • the microbubbles are stabilized to last in the bloodstream for a time ranging from a few minutes to several hours.
  • the size of the microbubbles formed can be controlled by the manufacturing process to be sufficiently small so as not to obstruct the systemic or pulmonary capillaries and to pass through or around vessels occluded to flow of larger red blood cells.
  • the oxygen transport substance may be microbubbles comprising DDFPe, formulated as an emulsion of about 250 nanometer droplets.
  • An oxygen transport substance of the disclosure may be administered to a subject by parenteral administration such as via intravenous injection, intra-arterial, intramuscular, intraperitoneal, intraventricular, epidural, intracranial injection, and infusion techniques.
  • the oxygen transport substance may be administered to a subject by intra-arterial injection.
  • the oxygen transport substance may be administered to a subject by intramuscular injection.
  • the oxygen transport substance may be administered to a subject via intraperitoneal injection.
  • the oxygen transport substance may be administered to a subject by intraventricular injection.
  • the oxygen transport substance may be administered to a subject by intracranial injection.
  • the oxygen transport substance may be administered to a subject by epidural injection.
  • the oxygen transport substance may be administered to a subject intravenously.
  • the oxygen transport substance may be administered in a bolus. In other embodiments, the oxygen transport substance may be administered continuously. In yet other embodiments, the oxygen transport substance may be administered in a combination of a bolus and continuously. Non-limiting examples of continuous administration may include infusion.
  • the oxygen transport substance may be administered to a subject once, or multiple times. In some preferred embodiments, the oxygen transport substance may be administered once. In other preferred embodiments, the oxygen transport substance may be administered multiple times. For instance, the oxygen transport substance may be administered 2, 3, 4, 5, 6, 7, 8, 9, 10, 20 or more times. In some embodiments, the oxygen transport substance may be administered 2, 3, 4, 5, 6, 7, 8, 9, or 10 times. In other embodiments, the oxygen transport substance may be administered 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 or more times. In preferred embodiments, the oxygen transport substance may be administered 2, 3, 4, 5, or 6 times.
  • an initial bolus or slow IV push loading dose may be administered generally ranging from about 0.01 to about 0.6 cc per kg body weight with 2% w/vol DDFPe. More preferably the loading dose is from about 0.05 to about 0.3 cc per kg. Thereafter the material is infused IV for between about 1 hour and up to 24 hours and even longer depending upon the subject's condition. For sustained infusion the material is generally infused at rates from about 0.01 to about 0.3 cc per kg and more preferably from about 0.025 to about 0.1 cc per kg per hour.
  • the oxygen transport substance When administered multiple times, the oxygen transport substance may be administered at regular intervals or at intervals that may vary during the treatment of a subject. In some embodiments, the oxygen transport substance may be administered multiple times at intervals that may vary during the treatment of a subject. In preferred embodiments, the oxygen transport substance may be administered multiple times at regular intervals. In some alternatives of the preferred embodiments, the oxygen transport substance may be administered at intervals of about 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, or more minutes. In other alternatives of the preferred embodiments, the oxygen transport substance may be administered at intervals of about 10, 20, 30, 40, 50, 60, 70, 80, 90, 100 or more minutes.
  • the oxygen transport substance may be administered at intervals of about 80, 90, 100 or more minutes. In other alternatives of the preferred embodiments, the oxygen transport substance may be administered at intervals of about 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100 or more minutes. In exemplary embodiments, the oxygen transport substance may be administered at intervals of about 90 minutes.
  • the oxygen transport substance may be administered to a subject undergoing ischemia, prior to development of ischemia, or administered prior to development of ischemia and continued throughout an ischemic episode.
  • administration of the oxygen transport substance to a subject may be administered prior to development of ischemia when the subject is undergoing a medical procedure that increases the risk of ischemia due to vessel occlusion, or when the subject is at high risk for developing an occluded blood vessel as described in Section I(b) above.
  • the oxygen transport substance may be administered to a subject undergoing ischemia.
  • the oxygen transport substance may be administered to a subject prior to development of ischemia.
  • the oxygen transport substance may be administered to the subject prior to development of ischemia and continued throughout an ischemic episode. In preferred embodiments, the oxygen transport substance may be administered to a subject before a medical procedure that increases the risk of vessel occlusion is performed. In other preferred embodiments, the oxygen transport substance may be administered to a subject at high risk for developing an occluded blood vessel prior to onset of symptoms of an occluded blood vessel.
  • the oxygen transport substance may be administered about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110 minutes or more prior to development of ischemia.
  • the oxygen transport substance may be administered about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 minutes prior to development of ischemia. In another embodiment, the oxygen transport substance may be administered about 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 minutes prior to development of ischemia. In yet another embodiment, the oxygen transport substance may be administered about 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40 minutes prior to development of ischemia. In another embodiment, the oxygen transport substance may be administered about 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 minutes prior to development of ischemia.
  • the oxygen transport substance may be administered about 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60 minutes prior to development of ischemia. In yet another embodiment, the oxygen transport substance may be administered about 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70 minutes prior to development of ischemia. In another embodiment, the oxygen transport substance may be administered about 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80 minutes prior to development of ischemia.
  • the oxygen transport substance may be administered about 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90 minutes prior to development of ischemia.
  • the oxygen transport substance may be administered about 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100 minutes prior to development of ischemia.
  • the oxygen transport substance may be administered about 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110 minutes or more prior to development of ischemia. In a preferred embodiment, the oxygen transport substance may be administered about 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 minutes prior to development of ischemia.
  • the oxygen transport substance may be administered about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65 minutes, or 1, 2, 3, 4, 5, or 6 hours or more after the onset of ischemia.
  • the oxygen transport substance may be administered about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 minutes after the onset of ischemia.
  • the oxygen transport substance may be administered about 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 minutes after the onset of ischemia. In yet another embodiment, the oxygen transport substance may be administered about 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40 minutes after the onset of ischemia. In another embodiment, the oxygen transport substance may be administered about 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 minutes after the onset of ischemia. In yet another embodiment, the oxygen transport substance may be administered about 1, 2, 3, 4, 5, or 6 hours or more after the onset of ischemia.
  • the oxygen transport substance may be administered about 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, or 65 minutes after the onset of ischemia.
  • the oxygen transport substance may be administered about 1, 2, 3, 4, 5, or 6 hours or more after the onset of ischemia.
  • the oxygen transport substance may be administered less than about 1 hour after the onset of ischemia.
  • the oxygen transport substance may be administered about 1, 2, or 3 hours after the onset of ischemia.
  • the oxygen transport substance may be administered to the subject in an amount of about 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, or about 1.1 mL per kilogram of the subject. In other embodiments, the oxygen transport substance may be administered to the subject in an amount of about 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.1, 0.11, 0.12, 0.13, 0.14, 0.15, 0.16, 0.17, 0.18, 0.19, or about 0.2 mL per kilogram of the subject.
  • the oxygen transport substance may be administered to the subject in an amount of about 0.11, 0.12, 0.13, 0.14, 0.15, 0.16, 0.17, 0.18, 0.19, 0.2, 0.21, 0.22, 0.23, 0.24, 0.25, 0.26, 0.27, 0.28, 0.29, or about 0.3 mL per kilogram of the subject.
  • the oxygen transport substance may be administered to the subject in an amount of about 0.21, 0.22, 0.23, 0.24, 0.25, 0.26, 0.27, 0.28, 0.29, 0.3, 0.31, 0.32, 0.33, 0.34, 0.35, 0.36, 0.37, 0.38, 0.39, or about 0.4 mL per kilogram of the subject.
  • the oxygen transport substance may be administered to the subject in an amount of about 0.31, 0.32, 0.33, 0.34, 0.35, 0.36, 0.37, 0.38, 0.39, 0.4, 0.41, 0.42, 0.43, 0.44, 0.45, 0.46, 0.47, 0.48, 0.49, or about 0.5 mL per kilogram of the subject.
  • the oxygen transport substance may be administered to the subject in an amount of about 0.41, 0.42, 0.43, 0.44, 0.45, 0.46, 0.47, 0.48, 0.49, 0.5, 0.51, 0.42, 0.53, 0.54, 0.55, 0.56, 0.57, 0.58, 0.59, or about 0.6 mL per kilogram of the subject.
  • the oxygen transport substance may be administered to the subject in an amount of about 0.001, 0.005, 0.01, 0.015, 0.02, 0.025, 0.03, 0.035, 0.04, 0.045, 0.05, 0.055, 0.06, 0.065, 0.07, 0.075, 0.08, 0.085, 0.09, or about 0.1 mL per kilogram of the subject.
  • the oxygen transport substance may be administered to the subject in an amount of about 0.6 mL per kilogram of the subject.
  • the oxygen transport substance may be administered to the subject in an amount of about 0.3 mL per kilogram of the subject.
  • the oxygen transport substance may be administered to the subject in an amount of about 0.1 mL per kilogram of the subject.
  • the oxygen transport substance of the invention may be administered in combination with other treatments for ischemia or treatments that may increase oxygenation of tissue.
  • treatments for ischemia or treatments that may increase oxygenation of tissue may include oxygen inhalation, administration of blood, thrombolytics or anticoagulants, and reducing the temperature of the tissue.
  • an administration of an oxygen transport substance of the invention may be used to reduce infarct volume while a secondary treatment is used to resolve the occlusion.
  • a composition of the invention may be used to reduce infarct volume during ischemia even though the occlusion is not resolved.
  • a composition of the invention is administered to protect tissue, and then treatments to resolve the occlusion may be administered.
  • the oxygen transport substance of the invention may be administered in combination with blood. In other embodiments, the oxygen transport substance of the invention may be administered in combination with oxygen inhalation. In yet other embodiments, the oxygen transport substance of the invention may be administered in combination with one or more anticoagulant.
  • Non-limiting examples of anticoagulants may include vitamin K antagonists such as acenocoumarol, coumatetralyl, dicoumarol, ethyl biscoumacetate, phenprocoumon, warfarin, clorindione, diphenadione, phenindione, antiplatelet compounds such as abciximab, eptifibatide, tirofiban, clopidogrel, prasugrel, ticlopidine, cangrelor, elinogrel, ticagrelor, beraprost, prostacyclin, iloprost, treprostinil, acetylsalicylic acid (aspirin), aloxiprin, carbasalate calcium, indobufen, triflusal, dipyridamole, picotamide, terutroban, cilostazol, dipyridamole, triflusal, cloricromen, ditazole, inhibitors of factor X
  • the oxygen transport substance of the invention may be administered in combination with one or more thrombolytic.
  • thrombolytics may include plasminogen activators (tPA; alteplase, reteplase, tenecteplase), antistreptase, Urokinase, Saruplase, streptokinase, anistreplase, monteplase, ancrod, fibrinolysin, and brinase.
  • the oxygen transport substance of the invention may be administered in combination with an anticoagulant or thrombolytic selected from the group consisting of tissue plasminogen activators, antistreptase, streptokinase, urokinase, and combinations thereof.
  • the oxygen transport substance of the invention may be administered in combination with tPA.
  • tPA may be administered after administration of the oxygen transport substance of the invention, followed by a second dose of the oxygen transport substance as described in the examples.
  • a composition of the invention may be combined with lowering the temperature of the tissue suffering the ischemic event.
  • the tissue temperature is lowered to no less than 29° C.
  • the tissue temperature may be lowered to about 30, 31, 32, 33, 34, 35, or 36° C.
  • the present disclosure provides a combination comprising a dodecafluoropentane emulsion and a thrombolytic.
  • the doedecafluoropentane emulsion and the thrombolytic are as described in Section (I) above.
  • the combination comprises a thrombolytic selected from the group consisting of tissue plasminogen activators, antistreptase, streptokinase, urokinase, and combinations thereof.
  • the combination comprises a dodecafluoropentane emulsion and tPA.
  • the effective amount of tPA may be determined using methods commonly known in the art.
  • Stroke is a serious and widespread condition that can result in neural damage. Such damage is known to be caused in part by a reduction in the opportunity for local brain cells to exchange oxygen and carbon dioxide.
  • Current approved treatments for stroke, such as aspirin are designed to limit the process of thrombus formation but are not designed to restore tissue viability.
  • Agents such as tissue plasminogen activator (tPA) can currently only be utilized for a 4.5 hour window of time following onset of stroke due to an increased incidence of intra-cranial hemorrhage when administered later [8,9]. It would be interesting and quite beneficial if an agent could be used to extend the window of time for tissue viability so either thrombus dissolving or recanalization life-saving treatment paradigms can be used beyond the current limit.
  • tPA tissue plasminogen activator
  • DDFP dodecafluoropentane
  • perfluoropentane also known as perfluoropentane
  • This emulsion was proven by Lundgren et al. [11] to carry out respiratory gas transport and maintain tissue viability as well as normal physiological processes in severely anemic rats.
  • Koch et al. [5] have shown that by facilitating the oxygenation of anaerobic tumor cells the formulation can render those cells aerobic, thus making them vulnerable to radiation.
  • the in vitro experiments detailed herein suggest physical characteristics and a gas transport mechanism that indicate how this 2% w/v DDFP emulsion (DDFPe) may function to help maintain tissue oxygen perfusion.
  • the data may also offer insight into how the formulation might be useful as a cellular protectant during stroke or heart attack.
  • these submicronsized particles (5-10 ⁇ smaller than red blood cells) may be able to perfuse beyond vascular occlusions, when blood cells are unable, and provide vital oxygen.
  • Hemoglobin is the sole natural transporter of oxygen in the body.
  • fluorocarbons are known to dissolve gases more efficiently than other fluids or packed red blood cells [12].
  • fluorocarbon emulsions under investigation for gas transport.
  • These other products in development contain relatively large, non-volatile perfluorocarbons (PFCs) such as perfluorodecalin (PFD) and perfluorooctylbromide (P FOB) [13], both having boiling points of 142° C.-144° C. They are formulated in high concentration (20% to 60% w/v) in order to provide adequate oxygen [14-16].
  • PFCs non-volatile perfluorocarbons
  • PFD perfluorodecalin
  • P FOB perfluorooctylbromide
  • DDFP DDFP has a 2-minute half-life in the blood and is 99% cleared through the lungs in 2 hours after intravenous administration [23]. Although this short half-life may appear to be a disadvantage, animal studies suggest that a low dose of DDFPe, around 0.7 cc per kg, administered one time as an IV infusion, may be sufficient for resuscitation of severely anemic animals [6,11].
  • DDFP has an advantage in solubilizing gases over many other PFCs due to its short linear chain length [1,17] and low boiling point [6,21]. This more efficient oxygen absorption may be attributed to the fact that DDFP has the highest ratio of primary CF 3 groups relative to secondary CF 2 groups compared to longer chain perfluorocarbons (PFD and P FOB). The CF 3 groups, being strongly electronegative, are largely responsible for the attraction of gases [24].
  • liquid DDFP can dissolve more respiratory gases than other linear liquid PFCs.
  • oxygen-carrying capacity is the fact that DDFP expands from the liquid to the gaseous state [7,25,26] at biological temperatures and as a result transfers gases based on local pressure gradients. It is believed that the gaseous state of DDFP can absorb, deliver, and exchange much more oxygen not only in comparison to its own liquid state but also in comparison to the liquid states of other larger PFCs [21,27].
  • the goal of this example is to compare the ability of 2% w/v DDFPe with equivalent emulsions of PFD and PFOB for their abilities to pick up oxygen, thus simulating a scenario where oxygen would be available to be carried and delivered to a hypoxic environment. Furthermore, the physical stability of DDFPe is addressed.
  • Vials were vortexed for 5 seconds and 10 ⁇ L aliquots of the liquid formulation were removed by syringe, injected into 3 mL cuvettes containing 2 mL of a phosphate buffered saline diluent (of known viscosity), and chilled in an ice bath. The cuvettes were covered and gently inverted 3 times. The temperature of the sample was then measured and each sample was analyzed using a Malvern Zetasizer HS100 at the temperature and viscosity settings determined. The 9 selected vials were each sampled once, unless an error message was given by the Malvern, in which case sampling was repeated until a passing test was achieved. Only the DDFPe particle size was monitored over a 6-month time period.
  • a Symphony SB21 pH meter and a Symphony 850 pH probe were used to determine the pH of the final formulation. Analysis of the hydrogen ion concentration was performed in triplicate. The meter was calibrated with pH standards at 4.0 and 7.0 and then, in order to confirm intra-batch uniformity, 1 vial was selected from the beginning, middle, and end of each batch for measurement.
  • the in vitro set-up to measure oxygen uptake by the formulations, shown in FIG. 1 was adapted from Lundgren et al. [11]. Three hundred mL beakers with stir bars were filled with 250 mL of deionized water and placed in temperature-controlled water baths. The water baths were set on top of stirring hotplates. The probes of portable oxygen meters were submerged into the beakers and dissolved oxygen readings were allowed to stabilize. Once stabilization was established, the water surfaces were first covered with Styro-foam® disks and then sealed in Parafilm® to eliminate any headspace and prevent further gas exchange with the atmosphere.
  • a needle and syringe were used to inject 5 mL of formulation through the parafilm and into the 250 mL volume of water (1:50, v:v).
  • the injection hole was resealed each time with adhesive tape.
  • Dissolved oxygen readings were recorded at 30-second intervals on a computer using custom-designed communications port data logger software [28] for 1 hour after each injection. This procedure was carried out in triplicate for the DDFPe, PFDe, PFOBe, and the blank formulation at both temperatures of 20° C. and 37° C.
  • DDFP is expected to volatilize at 37° C.
  • the volume expansion of each formulation upon injection was tested using a manometer apparatus shown in FIG. 2 .
  • 5 mL volumes of the DDFPe, PFDe, PFOBe, the blank formulation, and deionized water were injected into 250 mL of stirred DI water while the temperature of the stoppered 250 mL Erlenmeyer flask containing the 250 mL of DI water was maintained at 37° C.
  • a 25 mL burette was inserted through the stopper and its tip submerged into the water such that any volume increase would be forced up into the burette and then could be measured.
  • the initial average particle diameters were determined to be 215 ⁇ 56 nm, 103 ⁇ 8 nm and 155 ⁇ 6 nm for DDFPe, PFDe and PFOBe, respectively.
  • FIG. 3 shows that the DDFPe particle size remains stable at a diameter below 400 nm for 6 months at room temperature (23° C. ⁇ 2° C.). Note that the open diamonds represent less than 2% of the particles in the sample and these bimodal distributions were only observed for the first 2 months.
  • the pH values of DDFPe, PFDe and PFOBe were found to be 5.5, 6.1 and 5.7, respectively.
  • FIG. 4 shows the oxygen uptake data for all of the samples and controls tested.
  • the PFDe and PFOBe formulations were determined to absorb no more oxygen than the blank formulation at both test temperatures of 21° C. and 37° C.
  • DDFPe absorbed significantly more oxygen than the PFDe, the PFOBe, and the blank formulation at both temperatures.
  • One is the fact that the DDFPe contains approximately twice the molar amount of perfluorocarbon vs. PFC wt amount and the other is the higher ratio of trifluoromethyl groups present per unit volume compared to the other formulations.
  • FIG. 5 shows the differences in volume expansion of all the samples and controls when introduced into a 37° C. semi-sealed flask.
  • a 2% w/v DDFP emulsion was prepared and tested against equivalent emulsion concentrations of PFD and PFOB for oxygen absorption ability.
  • the final DDFPe has a pH of 5.5, appears milky white, and the initial particle size is 215 ⁇ 56 nm.
  • the ability of DDFP to expand at physiological temperature appears to provide it with a substantial advantage over PFD and PFOB to deliver a higher payload of oxygen.
  • DDFP offers a strong advantage over PFD and PFOB in that a much smaller dose of PFC can be administered to achieve the desired result. This is not only less invasive for the patient but also for the environment, as it has been clearly documented that PFCs exit the body through the lungs.
  • the data herein support the contentions of Burkard and Van Liew [21] as well as Lundgren et al. [6,11] in that DDFP should be able to provide enhanced oxygen delivery over other PFCs due to its expansion from a liquid to a gas at physiological temperature.
  • Another oxygen transport substance may have therapeutic potential: because of the highly electrophilic fluorine content and lack of intermolecular attractive forces inherent to PFCs, PFC emulsions have the ability to physically dissolve, transport, and deliver significant quantities of oxygen and other electron-rich respiratory gases (8, 9). Sophisticated techniques allow the production of stable PFC emulsions with exceptionally small particles. Such a small-scale droplet allows passage beyond many vascular occlusions that block 8 ⁇ m red blood cells, and allows perfusion into even the smallest areas of microcirculation and tissues that would not otherwise be oxygenated by an occluded arterial supply.
  • Dodecafluoropentane (DDFP) emulsion is a stable emulsion of 250-nm droplets that, on in vitro administration at 37° C., undergoes expansion into the gaseous state (10 and Example 1). This expansion is unique to DDFP among PFCs.
  • DDFP has a boiling point of approximately 29° C.; thus, at 37° C., large intermolecular “pockets” open up in the DDFPe droplets, such that high concentrations of respiratory gases can be rapidly drawn within.
  • the DDFP droplets eventually expand to form microbubbles.
  • DDFPe when DDFPe is injected intravenously, it does not expand to true bubble form (Example 1).
  • the intravenous emulsion therapy in a rabbit model of acute ischemic stroke is caused by permanent angiographic occlusions of branches of the internal carotid artery (ICA).
  • ICA internal carotid artery
  • MCA middle cerebral artery
  • ACA anterior cerebral artery
  • Treatments were initiated according to group schedules by using an ear vein catheter access (Instyle-W; Becton Dickinson, Sandy, Utah). Four or 7 hours after embolization, rabbits were euthanized with 1.5 mL of intravenous pentobarbital (Euthasol; Virbac, Fort Worth, Tex.).
  • DDFPe 2% weight/volume DDFP, 0.6 mL/kg; NuvOx Pharma, Arlington, Ariz.
  • ICH intracranial hemorrhage
  • Treatment with DDFPe was combined into three important groups for analysis: pretreatment 30 minutes before embolization, hyperacute treatment less than 1 hour after symptom onset, and acute therapy 1-3 hours after onset.
  • infarct volumes were not normally distributed, ranks of infarct volume percentages were analyzed with the PROC GLM (ie, Kruskal-Wallis equivalent) function of SAS software (SAS, Cary, N.C.). Dunnett-adjusted P values were used in comparing each DDFPe group versus controls. Comparisons of 4- and 7-hour control groups, and of treatment groups within the acute and hyperacute treatment subgroups, were made by using the “exact” procedures in the software package StatXact (Cytel, Cambridge, Mass.). The incidence of hemorrhage within or outside the stroke area was compared by using the ⁇ 2 test and Fisher exact test.
  • PROC GLM Kruskal-Wallis equivalent
  • Pre-treat represents DDFPe administration starting 30 minutes before embolization.
  • P-values compare each treatment time to untreated controls DDFPe Mean ⁇ P-value treatment Standard P-value (Dunnett- start time N Error, % Median, % (unadjusted) adjusted)
  • Control 7 3.57 ⁇ 1.41 3.20 — —
  • Pre-treat 7 0.64 ⁇ 0.37 0.30 0.008 0.04
  • Immediate 8 0.5 ⁇ 0.35 0.20 0.010 0.05 30-min 5 0.70 ⁇ 0.32 0.40 0.083 0.32 1-hour 7 1.03 ⁇ 0.59 0.30 0.012 0.06 2-hours 5 0.72 ⁇ 0.50 0.40 0.028 0.12 3-hours 6 0.48 ⁇ 0.28 0.25 0.008 0.04
  • the control rabbits at 7 hours had a numerically greater overall hemorrhage rate compared with 4-hour control animals, but not to a significant level (83% vs 29%; P 0.10).
  • the incidence of hemorrhage within stroke trended downward with treatment with DDFPe at 1 hour and every 90 minutes until euthanasia at 7 hours (P 0.06) compared with control.
  • Blood has a limited capacity to deliver oxygen, in large part requiring red blood cells to transit capillaries. With decreased blood flow or occlusion, this limitation becomes critical, causing infarction with nearly immediate cell death in some areas and ischemic damage without immediate cell death in others. This threatened area is the penumbra. In many strokes, an ischemic penumbra of potentially viable brain tissue might be saved if oxygen could be delivered there.
  • DDFPe as a gas at body temperature transports many times more oxygen per weight volume than liquid PFCs ( FIG. 4 ).
  • the intravenous dose of DDFPe is less than 1% of that of other PFC-based agents.
  • the nanosized droplets and bubbles pass-like TPA-through spaces smaller than red blood cells and transport oxygen to ischemic areas blocked from whole blood flow.
  • Other PFC agents require larger doses and are retained within the body on a long-term basis.
  • intravenous DDFPe as a single smaller dose is well tolerated, and is rapidly cleared by exhalation without significant residual or side effects (12).
  • rats and pigs larger doses act for as long as 2 hours (19).
  • DDFPe When given intravenously, DDFPe may “pause the clock” on the treatment window for several hours, acting as a bridge to further acute stroke therapies, which might be delayed far beyond current therapeutic time windows.
  • the present rabbit study shows clear benefit in decreased stroke volume compared with untreated controls, not only when DDFPe is given before occlusion or in the hyperacute time period (ie, from 0 to 30 min), but also with delays of 1-3 hours.
  • prestroke administration could model preventive therapy in high-risk procedures and 0-30-minute therapy could model iatrogenic ischemic episodes, the latter groups model the usual stroke therapy, which is more delayed (20).
  • ICH intracranial hemorrhage
  • clinical applications might also include pretreatment of high-risk cardiac and carotid surgeries or neurovascular or cardiac interventions, providing a few hours of improved tissue oxygenation during iatrogenic ischemic episodes.
  • Many strokes, cognitive deficits, or myocardial infarctions caused by transient clot, bubbles, or hypoxia might be completely avoided.
  • Gaseous emboli and hypoperfusion episodes associated with surgery and vascular or cardiac interventions are transient phenomena and may require no additional therapy after DDFPe treatment. As human single-dose experience appears safe, this testing could quickly progress.
  • DDFPe In addition to the need to fully investigate the time course of effectiveness of DDFPe, another limitation of the present study is the lack of therapeutic dosage testing. These studies used established dose levels for sonographic imaging, and optimization of therapeutic dose levels in rabbits and humans is required. Although considerable benefit was demonstrated at the chosen dosage and time points, further studies that compare other artificial oxygen carriers and fully characterize the treatment effects are needed. Moreover, the use of DDFPe must be examined in a thromboembolic stroke model as a combination treatment with intravenous TPA thrombolysis, intraarterial interventions, or sonothrombolysis with microbubbles and ultrasound (US). Here, safety and synergistic or additive effects will be appraised. If continued preclinical research overcomes these limitations, human feasibility testing in acute stroke can rapidly advance.
  • Intravenous DDFPe protects brain tissue from ischemia, possibly by decreasing the degree of hypoxia. It decreases infarct volumes in stroke, and the effect can be sustained for several hours with repeated doses. Safety in humans has been demonstrated. Further animal studies and rapid development as a therapeutic oxygen delivery agent during times of stroke, blood loss, ischemia, and hypoxia, and in some preventive situations such as high-risk procedures, are warranted.
  • MCA middle cerebral artery
  • ACA anterior cerebral artery
  • Treatments were initiated according to group schedules using an ear vein catheter. Four hours following embolization, rabbits were euthanized with IV 1.5-mL of pentobarbital.
  • the simple IV dose of DDFPe is less than 1/100 th of other PFC based agents.
  • the nano-sized droplets and bubbles pass, like tPA, through spaces smaller than red blood cells and transport oxygen to ischemic areas blocked from whole blood flow.
  • Other PFC agents require larger doses and are retained within the body long-term.
  • IV DDFPe is well tolerated, acts for about 2 hours, and is cleared by exhalation within hours.
  • clinical applications might also include pretreatment of high-risk cardiac and carotid surgeries or neurovascular or cardiac interventions providing a few hours of improved tissue oxygenation during iatrogenic ischemic episodes.
  • Many strokes or myocardial infarctions caused by transient clot, bubbles, or hypoxia might be completely avoided.
  • Both gaseous emboli and hypoperfusion episodes are transient phenomena and may require no additional therapy after DDFPe treatment.
  • Surgical procedures, angiographic treatments with DDFPe, measurement of infarctions and infarct volumes were as described in Example 2 above. Rabbits were randomly assigned to 6 groups: 1) control, no therapy; 2) immediate DDFPe; 3) DDFPe at 30 minutes; 4) DDFPe at 1 hr, 5) DDFPe at 2 hrs, and 6) DDFPe at 3 hrs.
  • Surgical procedures, angiographic treatments with DDFPe, measurement of infarctions and infarct volumes were as described in Example 2 above. Rabbits were randomly assigned to 8 groups: 1) control, no therapy; 2) control, pretreated with DDFPe 7 hours before embolization, 3) immediate DDFPe; 4) DDFPe at 30 minutes; 5) DDFPe at 1 hr, 6) DDFPe at 2 hrs, 7) DDFPe at 3 hrs, and 8) DDFPe at 6 hrs.
  • Surgical procedures, angiographic treatments with DDFPe, measurement of infarctions and infarct volumes were as described in Example 2 above. Rabbits were randomly assigned to 3 groups: 1) control, no therapy (7 rabbits); 2) a hyperacute treatment with DDFPe at 0 to 30 minutes after embolization, and 3) an acute treatment with DDFPe at 1 to 3 hours after embolization.
  • Stroke is the fourth most common cause of death in the USA [1] and ischemic stroke affects 795,000 patients annually, costing $73.7 billion [2]. Few patients receive therapy and current best therapy improves outcomes to the point of independent lives in only 40% of those [3].
  • the treatment of ischemic stroke is currently focused on prompt revascularization and restoration of oxygenated blood flow. Due to time constraints and diagnostic requirements, therapy reaches fewer than 4% of patients and increases the urgency for the development of new therapies [2].
  • a neuroprotectant that extends the time window until safe thrombolytic or intra-arterial interventional therapy can be applied would have a profound impact, but no neuroprotectant has yet progressed successfully from animal models into human clinical therapy [4-6].
  • An effective oxygen transport substance may have therapeutic potential in diverse situations involving blood loss, hypoxia, and ischemic stroke, but this approach using other drugs including various liquid perfluorocarbons and other techniques has not yet proven clinically applicable.
  • Dodecafluoropentane is a perfluorocarbon (PFC) with a pentane base.
  • PFC perfluorocarbon
  • DDFPe perfluorocarbon
  • DDFPe emulsion of nanodroplets, 250 to 300 nm in size when below 29° C.
  • DDFP has a boiling point of 29° C.
  • the particle size expands only slightly allowing facilitation of respiratory gas dissolution.
  • This mechanism transports high levels of oxygen and other gasses, much higher than other liquid phase PFCs with much higher boiling points [7].
  • the exceptionally small particle size may allow oxygen delivery into tissues unreachable by erythrocytes.
  • New Zealand White rabbits received cerebral angiography from a femoral artery approach. Embolic spheres (700-900 ⁇ m) were injected into the internal carotid artery occluding the middle cerebral and/or anterior cerebral arteries. Animals with other occlusions, 10% of cases, were discarded. In all treated groups, intravenous DDFPe (NuvOx Pharma, LLC, Arlington, Ariz.) dosing over 1-2 min with a 2% w/v emulsion began at 1 h post-embolization via a cannula placed in an ear vein and was repeated every 90 min until sacrifice.
  • DDFPe NuvOx Pharma, LLC, Arlington, Ariz.
  • mice were sacrificed at either 7 or 24 h post-embolization.
  • the brain was harvested, immediately chilled in saline, and then sliced coronally at 4.0-mm intervals.
  • Brain sections were placed in 1% 2,3,5-triphenyltetrazolium chloride (Sigma-Aldrich; St. Louis, Mo.) for 45 min at 37° C., fixed in 10% formalin, and digitally photographed ( FIG. 14 ). Brain size and areas of infarction were measured using digital analysis (NIH ImageJ) by a technician blinded to treatment groups. Infarct volume was calculated as a percent of total brain volume.
  • infarct volumes were not normally distributed, ranks of infarct volume were analyzed with PROC GLM of SAS software (Kruskal-Wallis equivalent). Blood levels of DDFP were analyzed for exponential curve fit and exponential decay time constant using KaleidaGraph software v4.01 (2005). Values are given as mean ⁇ standard error.
  • % IV Mean percent infarct volumes decreased greatly for all DDFPe-treated groups compared with controls (Table 3, FIG. 14 ).
  • the % IVs for the DDFPe groups were significantly different from the control group at p values less than 0.009, but were not different from each other.
  • the average % IV for the 0.1, 0.3, and 0.6 ml/kg dose groups was 18.8% of the untreated control group.
  • DDFPe can be damaged by uncontrolled fluctuations in storage conditions (i.e., hot/cold cycles) prior to use. This appears to enlarge droplet size. Use of this damaged form may have lead to pulmonary edema and severe toxicity in rabbits (unpublished data). The drug must be maintained at moderate room temperatures in storage but need not be refrigerated.
  • a mean half-life value of 1.45 ⁇ 0.17 min for DDFP in blood after a single 0.6 ml/kg dose agrees with a previous study in humans in which blood data showed a short half-life of 2.2 ⁇ 1.2 min [18].
  • the higher blood clearance rate of 78.5 ⁇ 24.9 ml/min/kg in rabbits compared to 30.1 to 48.6-ml/min/kg in humans may in part be due to the higher heart and respiratory rates and faster circulation time in rabbits.
  • 99% of DDFP in a single dose was recovered from expired air within 2 h [18].
  • Intravenous DDFPe protects brain from ischemic injury and significantly decreases infarct volumes in ischemic stroke. Although DDFPe has a short half-life in blood, 1.45 ⁇ 0.17 min, the effect of DDFPe is much longer, >90 min, which suggests the possibility of two or more compartments in the model.
  • Dodecafluoropentane Emulsion Decreases Infarct Volume and Neurological Deficit in a Rat Ischemic Stroke Model
  • DDFPe Dodecafluoropentane emulsion
  • Intravenous DDFPe will reduce the percent brain infarct volume and neurological deficit in treatment animals compared to controls.

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EP3334421A4 (fr) * 2015-08-14 2019-04-10 Nuvox Pharma, LLC Ajustement de taille de particule dans des nano-émulsions d'hydrocarbure fluoré
WO2020092815A1 (fr) * 2018-11-01 2020-05-07 Memorial Sloan Kettering Cancer Center Ciblage de tumeur intra-artériel amélioré pour un diagnostic et/ou un traitement
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WO2021216402A1 (fr) * 2020-04-20 2021-10-28 Nuvox Pharma Llc Procédés et compositions pour le traitement d'infections virales et de détresse respiratoire
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WO2018213657A1 (fr) * 2017-05-19 2018-11-22 University Of Cincinnati Dispositif à ultrasons intravasculaire et procédés pour éviter ou traiter une lésion de reperfusion
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WO2020092815A1 (fr) * 2018-11-01 2020-05-07 Memorial Sloan Kettering Cancer Center Ciblage de tumeur intra-artériel amélioré pour un diagnostic et/ou un traitement
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