US20180339095A1 - Methods of administering nitric oxide to arterial or arterialized blood - Google Patents
Methods of administering nitric oxide to arterial or arterialized blood Download PDFInfo
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- US20180339095A1 US20180339095A1 US16/042,031 US201816042031A US2018339095A1 US 20180339095 A1 US20180339095 A1 US 20180339095A1 US 201816042031 A US201816042031 A US 201816042031A US 2018339095 A1 US2018339095 A1 US 2018339095A1
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- United States
- Prior art keywords
- transfer unit
- oxygen
- blood
- containing gas
- nitric oxide
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Images
Classifications
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- A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes
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- A61M2202/0266—Nitrogen (N)
- A61M2202/0275—Nitric oxide [NO]
Definitions
- Embodiments of the present invention generally relate to the field of methods and devices for therapeutic delivery of nitric oxide (NO) as well as stable pharmaceutical compositions comprising nitric oxide.
- the invention further relates to the use of such methods and devices to treat and protect cells and animals from injury, disease, and premature death.
- NO nitric oxide
- inhaled NO was believed to work exclusively in the lung due to inactivation by hemoglobin (Hb). That is, reaction with oxyhemoglobin to form methemoglobin and nitrate or heme iron nitrosyl hemoblogin (Hb) would cause a loss of vasodilating properties.
- Hb hemoglobin
- SNO-Hb S-nitrosylated-Hb
- the present invention provides methods of administering an NO-containing gas directly to arterial or arterialized blood. These methods may be utilized for a variety of purposes and may be administered to various biological materials, including cells, tissues, organs, organisms, and animals, including humans and other mammals.
- One aspect of the present invention provides a method for administering nitric oxide (NO) to a patient, the method comprising delivering an NO-containing gas directly to arterial or arterialized blood.
- delivery may be via a cardiopulmonary bypass (CPB) circuit, with the NO-containing gas being administered to arterialized blood after blood withdrawn from the patient has passed through the oxygenator of the CPB circuit, prior to infusion of the oxygenated (arterialized) blood into the patient.
- CPB cardiopulmonary bypass
- Another aspect of the present invention provides methods for administering NO to a patient, the method comprising delivering NO-containing gas to arterialized blood in an extracorporeal membrane oxygenation (ECMO) circuit.
- the NO-containing gas may be administered into arterialized blood after blood has been oxygenated and CO.sub.2 has been excreted out of the membrane oxygenator, including at any point after blood withdrawn from the patient has passed through the membrane oxygenator of the ECMO circuit, prior to infusion of the oxygenated (arterialized) blood into the patient.
- ECMO extracorporeal membrane oxygenation
- arterialized blood into which NO-containing gas is delivered may be returned either to the arterial or venous circulation of the patient.
- Another aspect of the invention provides methods for delivery of NO-containing gas directly into arterial blood by injection, catheterization, infusion, or continuous infusion thereof into an arterial blood that is extracorporeal and then reinfusion of that blood into either an artery or vein of a patient.
- administering or contacting is performed by intra-arterial injection or infusion of NO-containing gas.
- the NO-containing gas is administered as a bolus.
- Other embodiments provide that the NO-containing gas is administered continuously or in a pulsatile fashion.
- the delivery concentration of NO in the NO-containing gas is in the range of about 0.1-500 ppm.
- the delivery concentration of NO in the NO-containing gas is in the range of 1-100 ppm.
- the delivery concentration of NO in the NO-containing gas is in the range of 2-20 ppm.
- the delivery concentration of NO in the NO-containing gas is in the range of 5-40 ppm.
- the delivery concentration of NO in the NO-containing gas is in the range of 10-30 ppm.
- the delivery concentration of NO in the NO-containing gas is the containing gas is in the range of 15-25 ppm.
- the delivery concentration of NO in the NO-containing gas is 20 ppm.
- the NO-containing gas for administration may be generated locally (bed-side) for immediate delivery to a patient, for example as a component of an extracorporeal oxygenation apparatus.
- Local generation of NO gas for immediate delivery to a patient may be accomplished by reaction of a nitrite salt, such as sodium nitrite, and a reductant, such as ascorbic acid or maleic acid, in the presence of water, or generation of NO from room air, or other potential means.
- the NO gas so-produced is then delivered or introduced directly into the arterial or arterialized blood of the patient. Suitable devices for such local generation and delivery are known in the art (e.g., US 2007/0190184).
- preformed NO-containing gas is administered from a gas cylinder directly into the arterial or arterialized blood of the patient.
- the NO-containing gas is administered via a device, for example an ECMO device.
- the NO-containing gas may be administered within the oxygenation compartment of the device, wherein the oxygenation compartment contains two components.
- the first component is a first gas exchange membrane (also referred to as a membrane oxygenator) which exchanges oxygen for CO.sub.2 in blood to produce arterialized blood.
- the second component is a second gas exchange membrane which exchanges NO for O.sub.2 in the arterialized blood.
- the first and second components can be either structurally separate components in fluid communication or combined as one structure containing separate reaction areas within the oxygenation compartment. In either case, the second component is down-stream of the first component, as defined by the direction of blood flow in the device.
- NO-containing gas is administered either into the oxygenation compartment after O.sub.2 has been administered into the oxygenation compartment and after CO.sub.2 has been released, or NO is administered downstream of the oxygenation compartment (after blood has left the oxygenator but before it is delivered back into the patient) or both.
- the present invention includes a method of treating or preventing a disease, disorder, or condition that benefits from treatment with NO comprising administering to a patient an amount of NO-containing gas effective to treat such disease, disorder, or condition, wherein the NO-containing gas is administered directly into arterial or arterialized blood.
- the disease, disorder or condition is a respiratory, cardiovascular, pulmonary, or blood disease or disorder, or a tumor, an infection, inflammation, shock, sepsis, or stroke, in a patient.
- the present invention provides a method of preventing or reducing injury to, or enhancing survivability of, a biological material exposed to ischemic, hypoxic, or injured conditions, comprising contacting the biological material with an effective amount NO via administration of an NO-containing gas directly into arterial or arterialized blood.
- a biological material is contacted with the NO-containing gas via administration into arterial or arterialized blood before onset of the disease, disorder or condition that benefits therefrom.
- the biological material is contacted with the NO-containing gas via administration into arterial or arterialized blood during occurrence of the disease, disorder or condition.
- the present invention further provides systems and devices for the administration of NO-containing gas directly into arterial or arterialized blood.
- FIG. 1 illustrates a nitric oxide delivery system that can be used in accordance with one or more embodiments of the invention.
- FIG. 2 illustrates a first embodiment of the oxygenation compartment of an ECMO device.
- FIG. 3 illustrates an alternative embodiment of the oxygenation compartment of an ECMO device.
- FIG. 4 illustrates a further alternative embodiment of the oxygenation compartment and NO delivery system of an ECMO device.
- arterialized blood refers to venous blood which has been converted to arterial blood by absorption of oxygen and excretion of CO.sub.2 Such conversion may be accomplished in vivo (e.g., by absorption of oxygen in the lungs) or ex vivo (e.g., by extracorporeal oxygenation).
- arterial blood refers to oxygenated blood in the arterial circulation of the body.
- biological material refers to any living biological material, including cells, tissues, organs, and/or organisms. It is contemplated that the methods of the present invention may be practiced on a part of an organism (such as in cells, in tissue, and/or in one or more organs), or on the whole organism.
- in vivo biological material refers to biological material that is in vivo, i.e., still within or attached to an organism.
- “Therapeutically effective amount” refers to that amount of NO gas that, when administered via arterial or arterialized blood to a subject, preferably a human, is sufficient to effect treatment as defined herein.
- the amount of a compound of the invention which constitutes a “therapeutically effective amount” will vary depending on the compound, the condition and its severity, and the manner of administration, but can be determined routinely by one of ordinary skill in the art having regard to his own knowledge and to this disclosure.
- Treating” or “treatment” as used herein covers the treatment of the disease or condition of interest in a subject, preferably a human, having the disease or condition of interest, and includes: (i) preventing the disease or condition from occurring in the subject, (ii) inhibiting the disease or condition, i.e., arresting its progression; (iii) relieving the disease or condition, i.e., causing regression of the disease or condition; or (iv) relieving the symptoms resulting from the disease or condition.
- the terms “disease,” “disorder,” and “condition” may be used interchangeably.
- Delivery concentration refers to the concentration of NO gas in a composition of NO-containing gas for medical use which is delivered to arterial or arterialized blood.
- compositions for medical use may further comprise an inert diluent gas. It is to be understood that the delivery concentration will be diluted upon contact with blood, where it is mixed and distributed to the target biological material.
- One aspect of the current invention relates to a method of delivering nitric oxide (NO) to a patient comprising administering NO-containing gas directly into arterial or arterialized blood, the administered gas having a delivery concentration of 0.01 to 10 ppm NO.
- the delivery concentration is in the range of 10 to 40 ppm.
- the delivery concentration is in the range of 40 to 100 ppm. In other embodiments, the delivery concentration is greater than 100 ppm.
- the NO-containing gas is administered continuously, for example by continuous infusion.
- the NO-containing gas is delivered as a bolus rather than via a continuous administration method.
- a “bolus” refers to a single administration delivered over a short period of time, for example by injection from a syringe. Multiple bolus administrations may be given to the subject, each separated by a period of time.
- the NO-containing gas is delivered in a pulse as opposed to continuous administration.
- a “pulse” refers to multiple short administrations within a time period.
- a device can monitor the arterial or arterialized blood and administer the NO-containing gas at any delivery rate or concentration as necessary to provide sufficient results. Administration can automatically or manually adjust or otherwise change the flow, concentration or amount of NO during the course of delivery.
- the present invention includes improved methods of systemically treating diseases and disorders with nitric oxide, which comprise administering nitric oxide gas directly into arterial or arterialized blood. Further, the present invention provides improved methods of enhancing cell survival, inducing stasis, or protecting cells or tissue from injury due to hypoxia or ischemia, which comprise administering NO-containing gas directly to arterial or arterialized blood. The invention further includes methods and devices for the preparation and administration of NO-containing gas to a subject via arterial or arterialized blood.
- NO gas directly to oxygenated blood (e.g., after blood passes through an extracorporeal oxygenation system) or directly through an arterial catheter or intra-arterial injection will maximize the formation of SNO-Hb and thus maximize the systemic effects.
- methods, compositions, and devices of the present invention are used to systemically treat or prevent any of a variety of diseases and disorders that benefit from treatment with nitric oxide.
- the methods of the present invention may be used to modulate biological pathways regulated or affected by nitric oxide.
- Nitric oxide mediates blood pressure (causing vasodilation), learning and memory, immune responses and inflammatory responses.
- diseases, disorders or conditions potentially treatable by systemic administration of NO gas directly into arterial or arterialized blood according to the invention include respiratory, cardiovascular, pulmonary, and blood diseases, disorders or conditions, as well as hypoxemia, tumors, infections, inflammation, shock, sepsis and stroke.
- respiratory distress syndrome, asthma, bronchospastic disease, myocardial infarction, hemorrhage, sickle cell disease, platelet aggregation and major surgery may be treatable according to the methods of the invention.
- Further specific examples include pulmonary hypertension and hypoxemia following cardiopulmonary bypass, mitral valve replacement, heart or lung transplantation, and pulmonary embolism.
- Systemic administration of nitric oxide gas into arterial or arterialized blood may be useful in suppressing, killing, and inhibiting pathogenic cells, such as tumor cells, cancer cells, or microorganisms, including but not limited to pathogenic bacteria, pathogenic mycobacteria, pathogenic parasites, and pathogenic fungi.
- pathogenic cells such as tumor cells, cancer cells, or microorganisms, including but not limited to pathogenic bacteria, pathogenic mycobacteria, pathogenic parasites, and pathogenic fungi.
- microorganisms include those associated with a respiratory infection within the respiratory tract.
- Systemic administration of nitric oxide gas into arterial or arterialized blood may enhance the survivability of biological materials, including, e.g., organs and tissues, that are subjected to ischemic or hypoxic conditions.
- biological materials including, e.g., organs and tissues, that are subjected to ischemic or hypoxic conditions.
- the present invention provides methods of preventing or reducing damage to biological materials, including, e.g., including cell, organ or tissue injuries resulting from ischemia or hypoxia. It is understood that a whole biological material or only a portion thereof, e.g., a particular organ, may be subjected to ischemic or hypoxic conditions.
- the ischemic or hypoxic conditions may be the result of an injury or disease suffered by an organism.
- diseases that can induce ischemia or hypoxia include, but are not limited to, traumatic injury or surgery, respiratory or cardiac arrest, tumors, heart diseases, and neurological diseases.
- specific injuries that can result in ischemic or hypoxic conditions include, but are not limited to, external insults, such as burns, cutting wounds, amputations, gunshot wounds, or surgical trauma.
- injuries can also include internal insults, such as stroke or heart attack, which result in the acute reduction in circulation.
- Other injuries include reductions in circulation due to non-invasive stress, such as exposure to cold or radiation, or a planned reduction in circulation, e.g., during heart surgery.
- methods of the present invention include systemically administering NO-containing gas directly into arterial or arterialized blood prior to development of a disease, disorder or condition treatable with NO gas, e.g., prior to an ischemic or hypoxic injury or disease insult.
- a disease, disorder or condition treatable with NO gas e.g., prior to an ischemic or hypoxic injury or disease insult.
- situations include, but are not limited to, major surgery where blood loss may occur spontaneously or as a result of a procedure, cardiopulmonary bypass in which oxygenation of the blood may be compromised or in which vascular delivery of blood may be reduced (as in the setting of coronary artery bypass graft (CABG) surgery), or in the treatment of organ donors prior to removal of donor organs for transport and transplantation into a recipient.
- CABG coronary artery bypass graft
- Other examples include, but are not limited to, medical conditions in which a risk of injury or disease progression is inherent (e.g., in the context of unstable angina, following angioplasty, bleeding aneurysms, hemorrhagic strokes, following major trauma or blood loss).
- methods of the present invention include systemically administering NO-containing gas directly into arterial or arterialized blood after development or onset of a disease, disorder or condition treatable with NO, e.g., after an ischemic or hypoxic injury or disease insult, or after onset any of the diseases, disorders or conditions discussed above.
- NO-containing gas may be administered to a patient suffering from the disease, disorder or condition upon recognition or diagnosis of the disease, disorder or condition.
- inflammatory-related diseases or disorders may be treated by administration of NO-containing gas directly into arterial or arterialized blood.
- Inflammatory-related diseases or disorders which may be treatable by the methods of the present invention include, e.g., multiple sclerosis, arthritis, rheumatoid arthritis, systemic lupus erythematosus, graft versus host disease, diabetes, psoriasis, progressive systemic sclerosis, scleroderma, acute coronary syndrome, Crohn's Disease, endometriosis, glomerulonephritis, myasthenia gravis, idiopathic pulmonary fibrosis, asthma, acute respiratory distress syndrome (ARDS), vasculitis, and inflammatory autoimmune myositis.
- ARDS acute respiratory distress syndrome
- the methods of the invention comprise administration of NO-containing gas directly into arterialized blood in an extracorporeal oxygenation system.
- the extracorporeal oxygenation system may be, for example, an extracorporeal membrane oxygenation system or a CPB circuit.
- the NO-containing gas is administered into the blood at any point in the system which is after oxygenation of the withdrawn blood.
- An example of CPB system 20 according to the invention is illustrated in FIG. 1 .
- Venous blood is withdrawn from the patient through venous cannula 20 , which may be inserted in the right atrium, vena cava or femoral vein. Withdrawn venous blood is collected in reservoir 11 and circulated into oxygenator 13 by pump 12 , where it is oxygenated and typically cooled by heat exchanger 14 to slow the body's basal metabolism during bypass surgery.
- the oxygenated blood is generally filtered through filter 15 prior to return to the body via arterial cannula 16 , which may be inserted in the ascending aorta or the femoral artery.
- NO-containing gas may be introduced into the CBP circuit via NO delivery device 18 which is and in fluid communication with NO generating device/NO reservoir 17 and with CBP system 20 downstream of oxygenator 13 .
- NO-containing gas may be introduced into the CBP circuit at any point after oxygenator 13 for return to the arterial circulation. In the CBP circuit illustrated in FIG. 1 , this includes introduction between oxygenator 13 and filter 15 (as shown) or between filter 15 and arterial cannula 16 (not shown). Alternatively, NO-containing gas may be introduced into the CBP circuit in oxygenator 13 , provided blood is oxygenated prior to contact with the NO-containing gas within oxygenator 13 .
- the invention provides extracorporeal oxygenation systems which comprise a component for introduction of NO-containing gas into oxygenated (arterialized) blood prior to infusion into the body of a patient.
- a component for introduction of NO-containing gas into oxygenated (arterialized) blood prior to infusion into the body of a patient Such structure of such apparati are generally as described above, with the addition of a device for introduction of NO-containing gas into the portion of the circuit which contains arterialized blood.
- the device for introduction of NO-containing gas into oxygenated blood prior to infusion may comprise a container, gas cylinder or receptacle for holding or locally generating the NO-containing gas, referred to as an “NO generator/receptacle”.
- the device for introduction of the NO-containing gas into the arterialized blood will typically include a pump, injector or metering device to facilitate delivery of the NO-containing gas into the oxygenated blood of the extracorporeal circuit for return to the patient, referred to as an “NO delivery device”.
- Extracorporeal oxygenation systems are simplified CBP circuits which provide cardiac and respiratory support oxygen to patients.
- venous blood is withdrawn from the patient, oxygenated outside of the body, and returned either via the arterial system or the venous system.
- a typical extracorporeal oxygenation system uses a membrane oxygenator and is referred to as an extracorporeal membrane oxygenation (ECMO) system.
- the system comprises a venous cannula typically placed in the right common femoral vein for extraction and an arterial cannula placed either into the right femoral artery (veno-arterial ECMO) or the right internal jugular vein (veno-venous ECMO) for infusion.
- ECMO extracorporeal membrane oxygenation
- the NO-containing gas is introduced into the withdrawn blood at any point between the oxygenator and the venous or arterial infusion cannula.
- NO-containing gas may be introduced into the withdrawn blood in the oxygenator, provided blood is oxygenated prior to contact with the NO-containing gas within the oxygenator.
- the NO-containing gas is administered via a device, for example an ECMO device.
- the NO-containing gas may be administered within the oxygenation compartment of the device, wherein the oxygenation compartment contains two components.
- the first component is a first gas exchange membrane (also referred to as a membrane oxygenator) which exchanges oxygen for CO.sub.2 in blood to produce arterialized blood.
- the second component is a second gas exchange membrane which exchanges NO for O.sub.2 in the arterialized blood.
- the first and second components can be either structurally separate components in fluid communication or combined as one structure containing separate reaction areas within the oxygenation compartment. In either case, the second component is down-stream of the first component, as defined by the direction of blood flow in the device.
- NO-containing gas is administered either into the oxygenation compartment after O.sub.2 has been administered into the oxygenation compartment and after CO.sub.2 has been released, or NO is administered downstream of the oxygenation compartment (after blood has left the oxygenator but before it is delivered back into the patient) or both.
- FIG. 2 illustrates oxygenation compartment 113 of an ECMO device, wherein oxygenation of blood and delivery of NO both occur within gas transfer unit 121 .
- blood enters oxygenation compartment 113 through inlet 127 , flows into chamber 123 , and exits oxygenation compartment 113 through outlet 126 .
- Chamber 123 is in contact with gas permeable membrane 124 of gas transfer unit 121 .
- Oxygen source 125 is also in fluid communication with gas transfer unit 121 through inlet 131 .
- oxygen introduced into gas transfer unit 121 from oxygen source 125 diffuses through gas permeable membrane 124 into the blood, exchanging oxygen for CO.sub.2.
- gas transfer unit 121 downstream of inlet 131 is in fluid communication with NO delivery device 118 , through inlet 132 .
- NO delivery device 118 is in fluid communication with NO generator/reservoir 117 to deliver NO to gas transfer unit 121 .
- NO introduced into gas transfer unit 121 through inlet 132 diffuses through gas permeable membrane 124 into the oxygenated blood, exchanging NO for oxygen.
- remaining oxygen and NO may be removed from gas transfer unit 121 to venting device 122 via outlet 133 in fluid communication with gas transfer unit 121 .
- FIG. 3 illustrates oxygenation compartment 113 of an ECMO device, wherein oxygenation of blood and delivery of NO occur within structurally separate components 221 and 229 of oxygenation compartment 213 .
- blood enters oxygenation compartment 213 through inlet 227 , flows into chamber 223 , and exits oxygenation compartment 213 through outlet 226 .
- Chamber 223 is in contact with oxygen permeable membrane 224 of oxygen transfer unit 221 .
- Oxygen source 225 is also in fluid communication with oxygen transfer unit 221 through inlet 231 .
- oxygen introduced into oxygen transfer unit 221 from oxygen source 225 diffuses through oxygen permeable membrane 224 into the blood, exchanging oxygen for CO.sub.2.
- remaining oxygen may be removed from oxygen transfer unit 221 to oxygen venting device 222 via outlet 233 in fluid communication with oxygen transfer unit 221 .
- the downstream portion of chamber 223 is in contact with NO permeable membrane 230 of NO transfer unit 229 .
- NO delivery device 218 is also influid communication with NO transfer unit 229 through inlet 232 .
- NO delivery device 218 is in fluid communication with NO generator/reservoir 217 to deliver NO to NO chamber 229 .
- As oxygenated blood flows to the downstream portion of chamber 223 it comes into contact with NO permeable membrane 230 of NO transfer unit 229 , and NO introduced into NO transfer unit 229 through inlet 232 diffuses into the oxygenated blood, exchanging NO for oxygen.
- remaining NO may be removed from NO transfer unit 229 to NO venting device 228 via outlet 234 in fluid communication with NO transfer unit 229 .
- FIG. 4 illustrates oxygenation compartment 313 of an ECMO device, wherein oxygenation of blood occurs within oxygenation compartment 313 and delivery of NO to the blood occurs downstream of and outside oxygenation compartment 313 .
- blood enters oxygenation compartment 313 through inlet 327 , flows into chamber 323 , and exits oxygenation compartment 313 through outlet 326 .
- Chamber 323 is in contact with oxygen permeable membrane 324 of oxygen transfer unit 321 within oxygenation compartment 313 .
- Oxygen source 325 is also in fluid communication with oxygen transfer unit 321 through inlet 331 .
- oxygen introduced into oxygen transfer unit 321 from oxygen source 325 diffuses through oxygen permeable membrane 324 into the blood, exchanging oxygen for CO.sub.2.
- remaining oxygen may be removed from oxygen transfer unit 321 to oxygen venting device 322 via outlet 333 in fluid communication with oxygen transfer unit 321 .
- the downstream portion of chamber 323 is in contact with NO permeable membrane 330 of NO transfer unit 329 , which is outside oxygenation compartment 313 .
- NO delivery device 318 is also influid communication with NO transfer unit 329 through inlet 332 .
- NO delivery device 318 is in fluid communication with NO generator/reservoir 317 to deliver NO to NO chamber 329 .
- NO permeable membrane 330 of NO transfer unit 329 As oxygenated blood exits oxygenation compartment 313 and flows to the downstream portion of chamber 323 , it comes into contact with NO permeable membrane 330 of NO transfer unit 329 , and NO introduced into chamber 329 through inlet 332 diffuses into the oxygenated blood, exchanging NO for oxygen. After delivery of NO to the blood, remaining NO may be removed from NO transfer unit 329 to NO venting device 328 via outlet 334 in fluid communication with NO transfer unit 329 .
- the NO-containing gas may be administered in the oxygenator after the blood has been partially oxygenated or fully oxygenated and may be administered separately from the addition of the oxygen.
- the NO-containing gas is typically administered after O.sub.2 administration and CO.sub.2 release.
- methods of the present invention include delivery of NO-containing gas directly into arterial blood by injection, catheterization, infusion, or continuous infusion into an artery, for example, a central or peripheral artery (e.g., the aorta, femoral, brachial, radial, ulnar, dorsalis pedis, etc.).
- a central or peripheral artery e.g., the aorta, femoral, brachial, radial, ulnar, dorsalis pedis, etc.
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Abstract
Description
- This application is a continuation of U.S. application Ser. No. 14/402,786, filed Nov. 21, 2014 which is a U.S. National Phase entry of International Application No. PCT/US2013/043232, filed May, 30, 2013, which claims priority to U.S. Provisional Application No. 61/653,499, filed May 31, 2012, and to U.S. Provisional Application No. 61/787,865, filed Mar. 15, 2013.
- Embodiments of the present invention generally relate to the field of methods and devices for therapeutic delivery of nitric oxide (NO) as well as stable pharmaceutical compositions comprising nitric oxide. The invention further relates to the use of such methods and devices to treat and protect cells and animals from injury, disease, and premature death.
- The action of nitric oxide (NO) is considered regulatory in maintaining normal physiological homeostasis in humans and animals, i.e., host-defense, vascular tone, neurotransmission, bronchodilatation and inhibition of platelet function (see Giustarini et al., Clinica Chimica Acta (2003) 330:85-98). NO mediates blood pressure, learning and memory, immune responses, and inflammatory responses (see Thippeswamy et al., Histol. Histopathol. (2006) 21:445-458). In addition, the actions of NO have been observed in pathological conditions such as acute respiratory distress syndrome, hypertension, pulmonary hypertension, arthritis, arteriosclerosis, cancer, diabetes, some neurodegenerative diseases and stroke (see Giustarini et al., Clinica Chimica Acta (2003) 330:85-98).
- Traditionally, inhaled NO (iNO) was believed to work exclusively in the lung due to inactivation by hemoglobin (Hb). That is, reaction with oxyhemoglobin to form methemoglobin and nitrate or heme iron nitrosyl hemoblogin (Hb) would cause a loss of vasodilating properties. However it has been found that a stable derivative is formed by a reaction resulting in nitrosylation of a conserved cysteine residue of the .beta. subunit of Hb: S-nitrosylated-Hb (SNO-Hb). This reaction is favored in the presence of oxyhaemoglobin whereas binding of NO to the heme iron is favored in the deoxygenated state. See B. C. Creagh-Brown, et al. (2009) Critical Care 13:212. In the past, remote or non-pulmonary effects of exogenously administered iNO were thought to be undesirable; however, it has recently been found that the stable derivative SNO-Hb retains vasodilatory properties and therefore could be beneficial for circulating targets.
- There is clearly a need in the art for improved nitric oxide delivery, particularly systemic delivery that enables delivery of NO, via the circulatory system, to target tissues and organs outside of the pulmonary system.
- The present invention provides methods of administering an NO-containing gas directly to arterial or arterialized blood. These methods may be utilized for a variety of purposes and may be administered to various biological materials, including cells, tissues, organs, organisms, and animals, including humans and other mammals.
- One aspect of the present invention provides a method for administering nitric oxide (NO) to a patient, the method comprising delivering an NO-containing gas directly to arterial or arterialized blood. In a specific embodiment delivery may be via a cardiopulmonary bypass (CPB) circuit, with the NO-containing gas being administered to arterialized blood after blood withdrawn from the patient has passed through the oxygenator of the CPB circuit, prior to infusion of the oxygenated (arterialized) blood into the patient.
- Another aspect of the present invention provides methods for administering NO to a patient, the method comprising delivering NO-containing gas to arterialized blood in an extracorporeal membrane oxygenation (ECMO) circuit. The NO-containing gas may be administered into arterialized blood after blood has been oxygenated and CO.sub.2 has been excreted out of the membrane oxygenator, including at any point after blood withdrawn from the patient has passed through the membrane oxygenator of the ECMO circuit, prior to infusion of the oxygenated (arterialized) blood into the patient. In ECMO, arterialized blood into which NO-containing gas is delivered may be returned either to the arterial or venous circulation of the patient.
- Another aspect of the invention provides methods for delivery of NO-containing gas directly into arterial blood by injection, catheterization, infusion, or continuous infusion thereof into an arterial blood that is extracorporeal and then reinfusion of that blood into either an artery or vein of a patient. In particular embodiments of methods of the present invention, administering or contacting is performed by intra-arterial injection or infusion of NO-containing gas.
- In certain embodiments, the NO-containing gas is administered as a bolus. Other embodiments provide that the NO-containing gas is administered continuously or in a pulsatile fashion.
- In certain embodiments, the delivery concentration of NO in the NO-containing gas is in the range of about 0.1-500 ppm.
- In some embodiments, the delivery concentration of NO in the NO-containing gas is in the range of 1-100 ppm.
- In a particular embodiment, the delivery concentration of NO in the NO-containing gas is in the range of 2-20 ppm.
- In a particular embodiment, the delivery concentration of NO in the NO-containing gas is in the range of 5-40 ppm.
- In a particular embodiment, the delivery concentration of NO in the NO-containing gas is in the range of 10-30 ppm.
- In a particular embodiment, the delivery concentration of NO in the NO-containing gas is the containing gas is in the range of 15-25 ppm.
- In a particular embodiment, the delivery concentration of NO in the NO-containing gas is 20 ppm.
- In certain embodiments, the NO-containing gas for administration may be generated locally (bed-side) for immediate delivery to a patient, for example as a component of an extracorporeal oxygenation apparatus. Local generation of NO gas for immediate delivery to a patient may be accomplished by reaction of a nitrite salt, such as sodium nitrite, and a reductant, such as ascorbic acid or maleic acid, in the presence of water, or generation of NO from room air, or other potential means. The NO gas so-produced is then delivered or introduced directly into the arterial or arterialized blood of the patient. Suitable devices for such local generation and delivery are known in the art (e.g., US 2007/0190184). In an alternative embodiment, preformed NO-containing gas is administered from a gas cylinder directly into the arterial or arterialized blood of the patient.
- In a particular embodiment, the NO-containing gas is administered via a device, for example an ECMO device. The NO-containing gas may be administered within the oxygenation compartment of the device, wherein the oxygenation compartment contains two components. The first component is a first gas exchange membrane (also referred to as a membrane oxygenator) which exchanges oxygen for CO.sub.2 in blood to produce arterialized blood. The second component is a second gas exchange membrane which exchanges NO for O.sub.2 in the arterialized blood. The first and second components can be either structurally separate components in fluid communication or combined as one structure containing separate reaction areas within the oxygenation compartment. In either case, the second component is down-stream of the first component, as defined by the direction of blood flow in the device. Thus, NO-containing gas is administered either into the oxygenation compartment after O.sub.2 has been administered into the oxygenation compartment and after CO.sub.2 has been released, or NO is administered downstream of the oxygenation compartment (after blood has left the oxygenator but before it is delivered back into the patient) or both.
- In a related embodiment, the present invention includes a method of treating or preventing a disease, disorder, or condition that benefits from treatment with NO comprising administering to a patient an amount of NO-containing gas effective to treat such disease, disorder, or condition, wherein the NO-containing gas is administered directly into arterial or arterialized blood. In particular embodiments, the disease, disorder or condition is a respiratory, cardiovascular, pulmonary, or blood disease or disorder, or a tumor, an infection, inflammation, shock, sepsis, or stroke, in a patient.
- In a further embodiment, the present invention provides a method of preventing or reducing injury to, or enhancing survivability of, a biological material exposed to ischemic, hypoxic, or injured conditions, comprising contacting the biological material with an effective amount NO via administration of an NO-containing gas directly into arterial or arterialized blood.
- In one embodiment, a biological material is contacted with the NO-containing gas via administration into arterial or arterialized blood before onset of the disease, disorder or condition that benefits therefrom. In another embodiment, the biological material is contacted with the NO-containing gas via administration into arterial or arterialized blood during occurrence of the disease, disorder or condition.
- The present invention further provides systems and devices for the administration of NO-containing gas directly into arterial or arterialized blood.
-
FIG. 1 illustrates a nitric oxide delivery system that can be used in accordance with one or more embodiments of the invention. -
FIG. 2 illustrates a first embodiment of the oxygenation compartment of an ECMO device. -
FIG. 3 illustrates an alternative embodiment of the oxygenation compartment of an ECMO device. -
FIG. 4 illustrates a further alternative embodiment of the oxygenation compartment and NO delivery system of an ECMO device. - As used in the specification and appended claims, unless specified to the contrary, the following terms have the meaning indicated:
- The term “arterialized blood” refers to venous blood which has been converted to arterial blood by absorption of oxygen and excretion of CO.sub.2 Such conversion may be accomplished in vivo (e.g., by absorption of oxygen in the lungs) or ex vivo (e.g., by extracorporeal oxygenation).
- The term “arterial blood” refers to oxygenated blood in the arterial circulation of the body.
- The term “biological material” refers to any living biological material, including cells, tissues, organs, and/or organisms. It is contemplated that the methods of the present invention may be practiced on a part of an organism (such as in cells, in tissue, and/or in one or more organs), or on the whole organism. The term “in vivo biological material” refers to biological material that is in vivo, i.e., still within or attached to an organism.
- “Therapeutically effective amount” refers to that amount of NO gas that, when administered via arterial or arterialized blood to a subject, preferably a human, is sufficient to effect treatment as defined herein. The amount of a compound of the invention which constitutes a “therapeutically effective amount” will vary depending on the compound, the condition and its severity, and the manner of administration, but can be determined routinely by one of ordinary skill in the art having regard to his own knowledge and to this disclosure.
- “Treating” or “treatment” as used herein covers the treatment of the disease or condition of interest in a subject, preferably a human, having the disease or condition of interest, and includes: (i) preventing the disease or condition from occurring in the subject, (ii) inhibiting the disease or condition, i.e., arresting its progression; (iii) relieving the disease or condition, i.e., causing regression of the disease or condition; or (iv) relieving the symptoms resulting from the disease or condition. As used herein, the terms “disease,” “disorder,” and “condition” may be used interchangeably.
- “Delivery concentration” refers to the concentration of NO gas in a composition of NO-containing gas for medical use which is delivered to arterial or arterialized blood. In addition to NO gas, such compositions for medical use may further comprise an inert diluent gas. It is to be understood that the delivery concentration will be diluted upon contact with blood, where it is mixed and distributed to the target biological material.
- Prior to the present invention, NO was thought to react with oxyhemoglobin to form methemoglobin and nitrate or heme iron nitrosyl Hb, and thereby lose all vasodilating properties. However, it has been found that a stable derivate that retains vasodilatory properties is formed by a reaction resulting in nitrosylation of a conserved cysteine residue of the 13 subunit of Hb: S-nitrosylated-Hb (SNO-Hb). This reaction is favored in the presence of oxyhemoglobin whereas the prior reaction is favored in the deoxygenated state. Thus the present invention provides methods that maximize the formation of SNOHb, thereby maximizing the systemic effects of NO.
- One aspect of the current invention relates to a method of delivering nitric oxide (NO) to a patient comprising administering NO-containing gas directly into arterial or arterialized blood, the administered gas having a delivery concentration of 0.01 to 10 ppm NO. In certain embodiments, the delivery concentration is in the range of 10 to 40 ppm. According to one or more embodiments, the delivery concentration is in the range of 40 to 100 ppm. In other embodiments, the delivery concentration is greater than 100 ppm.
- In one embodiment, the NO-containing gas is administered continuously, for example by continuous infusion.
- In another embodiment, the NO-containing gas is delivered as a bolus rather than via a continuous administration method. A “bolus” refers to a single administration delivered over a short period of time, for example by injection from a syringe. Multiple bolus administrations may be given to the subject, each separated by a period of time.
- In another embodiment, the NO-containing gas is delivered in a pulse as opposed to continuous administration. A “pulse” refers to multiple short administrations within a time period.
- In an additional embodiment, a device can monitor the arterial or arterialized blood and administer the NO-containing gas at any delivery rate or concentration as necessary to provide sufficient results. Administration can automatically or manually adjust or otherwise change the flow, concentration or amount of NO during the course of delivery.
- The present invention includes improved methods of systemically treating diseases and disorders with nitric oxide, which comprise administering nitric oxide gas directly into arterial or arterialized blood. Further, the present invention provides improved methods of enhancing cell survival, inducing stasis, or protecting cells or tissue from injury due to hypoxia or ischemia, which comprise administering NO-containing gas directly to arterial or arterialized blood. The invention further includes methods and devices for the preparation and administration of NO-containing gas to a subject via arterial or arterialized blood. Without wishing to be bound by any particular theory, it may be that administration of NO gas directly to oxygenated blood (e.g., after blood passes through an extracorporeal oxygenation system) or directly through an arterial catheter or intra-arterial injection will maximize the formation of SNO-Hb and thus maximize the systemic effects.
- In certain embodiments, methods, compositions, and devices of the present invention are used to systemically treat or prevent any of a variety of diseases and disorders that benefit from treatment with nitric oxide. In particular embodiments, the methods of the present invention may be used to modulate biological pathways regulated or affected by nitric oxide.
- Nitric oxide mediates blood pressure (causing vasodilation), learning and memory, immune responses and inflammatory responses. Accordingly, diseases, disorders or conditions potentially treatable by systemic administration of NO gas directly into arterial or arterialized blood according to the invention include respiratory, cardiovascular, pulmonary, and blood diseases, disorders or conditions, as well as hypoxemia, tumors, infections, inflammation, shock, sepsis and stroke. In specific examples, respiratory distress syndrome, asthma, bronchospastic disease, myocardial infarction, hemorrhage, sickle cell disease, platelet aggregation and major surgery may be treatable according to the methods of the invention. Further specific examples include pulmonary hypertension and hypoxemia following cardiopulmonary bypass, mitral valve replacement, heart or lung transplantation, and pulmonary embolism.
- Systemic administration of nitric oxide gas into arterial or arterialized blood may be useful in suppressing, killing, and inhibiting pathogenic cells, such as tumor cells, cancer cells, or microorganisms, including but not limited to pathogenic bacteria, pathogenic mycobacteria, pathogenic parasites, and pathogenic fungi. Examples of microorganisms include those associated with a respiratory infection within the respiratory tract.
- Systemic administration of nitric oxide gas into arterial or arterialized blood may enhance the survivability of biological materials, including, e.g., organs and tissues, that are subjected to ischemic or hypoxic conditions. In related embodiments, the present invention provides methods of preventing or reducing damage to biological materials, including, e.g., including cell, organ or tissue injuries resulting from ischemia or hypoxia. It is understood that a whole biological material or only a portion thereof, e.g., a particular organ, may be subjected to ischemic or hypoxic conditions.
- The ischemic or hypoxic conditions may be the result of an injury or disease suffered by an organism. Examples of specific diseases that can induce ischemia or hypoxia include, but are not limited to, traumatic injury or surgery, respiratory or cardiac arrest, tumors, heart diseases, and neurological diseases. Examples of specific injuries that can result in ischemic or hypoxic conditions include, but are not limited to, external insults, such as burns, cutting wounds, amputations, gunshot wounds, or surgical trauma. In addition, injuries can also include internal insults, such as stroke or heart attack, which result in the acute reduction in circulation. Other injuries include reductions in circulation due to non-invasive stress, such as exposure to cold or radiation, or a planned reduction in circulation, e.g., during heart surgery.
- In certain embodiments, methods of the present invention include systemically administering NO-containing gas directly into arterial or arterialized blood prior to development of a disease, disorder or condition treatable with NO gas, e.g., prior to an ischemic or hypoxic injury or disease insult. Examples of such situations include, but are not limited to, major surgery where blood loss may occur spontaneously or as a result of a procedure, cardiopulmonary bypass in which oxygenation of the blood may be compromised or in which vascular delivery of blood may be reduced (as in the setting of coronary artery bypass graft (CABG) surgery), or in the treatment of organ donors prior to removal of donor organs for transport and transplantation into a recipient. Other examples include, but are not limited to, medical conditions in which a risk of injury or disease progression is inherent (e.g., in the context of unstable angina, following angioplasty, bleeding aneurysms, hemorrhagic strokes, following major trauma or blood loss).
- In certain embodiments, methods of the present invention include systemically administering NO-containing gas directly into arterial or arterialized blood after development or onset of a disease, disorder or condition treatable with NO, e.g., after an ischemic or hypoxic injury or disease insult, or after onset any of the diseases, disorders or conditions discussed above. In a particular aspect of such embodiments, NO-containing gas may be administered to a patient suffering from the disease, disorder or condition upon recognition or diagnosis of the disease, disorder or condition.
- In certain embodiments, inflammatory-related diseases or disorders may be treated by administration of NO-containing gas directly into arterial or arterialized blood. Inflammatory-related diseases or disorders which may be treatable by the methods of the present invention include, e.g., multiple sclerosis, arthritis, rheumatoid arthritis, systemic lupus erythematosus, graft versus host disease, diabetes, psoriasis, progressive systemic sclerosis, scleroderma, acute coronary syndrome, Crohn's Disease, endometriosis, glomerulonephritis, myasthenia gravis, idiopathic pulmonary fibrosis, asthma, acute respiratory distress syndrome (ARDS), vasculitis, and inflammatory autoimmune myositis.
- In a specific embodiment, the methods of the invention comprise administration of NO-containing gas directly into arterialized blood in an extracorporeal oxygenation system. The extracorporeal oxygenation system may be, for example, an extracorporeal membrane oxygenation system or a CPB circuit. In such methods the NO-containing gas is administered into the blood at any point in the system which is after oxygenation of the withdrawn blood. An example of
CPB system 20 according to the invention is illustrated inFIG. 1 . - Venous blood is withdrawn from the patient through
venous cannula 20, which may be inserted in the right atrium, vena cava or femoral vein. Withdrawn venous blood is collected inreservoir 11 and circulated intooxygenator 13 bypump 12, where it is oxygenated and typically cooled byheat exchanger 14 to slow the body's basal metabolism during bypass surgery. The oxygenated blood is generally filtered throughfilter 15 prior to return to the body viaarterial cannula 16, which may be inserted in the ascending aorta or the femoral artery. NO-containing gas may be introduced into the CBP circuit via NOdelivery device 18 which is and in fluid communication with NO generating device/NOreservoir 17 and withCBP system 20 downstream ofoxygenator 13. NO-containing gas may be introduced into the CBP circuit at any point afteroxygenator 13 for return to the arterial circulation. In the CBP circuit illustrated inFIG. 1 , this includes introduction betweenoxygenator 13 and filter 15 (as shown) or betweenfilter 15 and arterial cannula 16 (not shown). Alternatively, NO-containing gas may be introduced into the CBP circuit inoxygenator 13, provided blood is oxygenated prior to contact with the NO-containing gas withinoxygenator 13. - In a further aspect, the invention provides extracorporeal oxygenation systems which comprise a component for introduction of NO-containing gas into oxygenated (arterialized) blood prior to infusion into the body of a patient. Such structure of such apparati are generally as described above, with the addition of a device for introduction of NO-containing gas into the portion of the circuit which contains arterialized blood. The device for introduction of NO-containing gas into oxygenated blood prior to infusion may comprise a container, gas cylinder or receptacle for holding or locally generating the NO-containing gas, referred to as an “NO generator/receptacle”. The device for introduction of the NO-containing gas into the arterialized blood will typically include a pump, injector or metering device to facilitate delivery of the NO-containing gas into the oxygenated blood of the extracorporeal circuit for return to the patient, referred to as an “NO delivery device”.
- Extracorporeal oxygenation systems are simplified CBP circuits which provide cardiac and respiratory support oxygen to patients. In these systems venous blood is withdrawn from the patient, oxygenated outside of the body, and returned either via the arterial system or the venous system. A typical extracorporeal oxygenation system uses a membrane oxygenator and is referred to as an extracorporeal membrane oxygenation (ECMO) system. The system comprises a venous cannula typically placed in the right common femoral vein for extraction and an arterial cannula placed either into the right femoral artery (veno-arterial ECMO) or the right internal jugular vein (veno-venous ECMO) for infusion. In the methods of the invention, to obtain direct administration of NO-containing gas into arterialized blood, the NO-containing gas is introduced into the withdrawn blood at any point between the oxygenator and the venous or arterial infusion cannula. Alternatively, NO-containing gas may be introduced into the withdrawn blood in the oxygenator, provided blood is oxygenated prior to contact with the NO-containing gas within the oxygenator.
- In a particular embodiment, the NO-containing gas is administered via a device, for example an ECMO device. The NO-containing gas may be administered within the oxygenation compartment of the device, wherein the oxygenation compartment contains two components. The first component is a first gas exchange membrane (also referred to as a membrane oxygenator) which exchanges oxygen for CO.sub.2 in blood to produce arterialized blood. The second component is a second gas exchange membrane which exchanges NO for O.sub.2 in the arterialized blood. The first and second components can be either structurally separate components in fluid communication or combined as one structure containing separate reaction areas within the oxygenation compartment. In either case, the second component is down-stream of the first component, as defined by the direction of blood flow in the device. Thus, NO-containing gas is administered either into the oxygenation compartment after O.sub.2 has been administered into the oxygenation compartment and after CO.sub.2 has been released, or NO is administered downstream of the oxygenation compartment (after blood has left the oxygenator but before it is delivered back into the patient) or both.
-
FIG. 2 illustratesoxygenation compartment 113 of an ECMO device, wherein oxygenation of blood and delivery of NO both occur withingas transfer unit 121. In this embodiment, blood entersoxygenation compartment 113 throughinlet 127, flows intochamber 123, and exitsoxygenation compartment 113 throughoutlet 126.Chamber 123 is in contact with gaspermeable membrane 124 ofgas transfer unit 121.Oxygen source 125 is also in fluid communication withgas transfer unit 121 throughinlet 131. As blood enters the upstream portion ofchamber 123, oxygen introduced intogas transfer unit 121 fromoxygen source 125 diffuses through gaspermeable membrane 124 into the blood, exchanging oxygen for CO.sub.2. The portion ofgas transfer unit 121 downstream ofinlet 131 is in fluid communication with NOdelivery device 118, throughinlet 132. NOdelivery device 118 is in fluid communication with NO generator/reservoir 117 to deliver NO togas transfer unit 121. As the oxygenated blood inchamber 123 comes into contact with gaspermeable membrane 124 downstream ofinlet 131, NO introduced intogas transfer unit 121 throughinlet 132 diffuses through gaspermeable membrane 124 into the oxygenated blood, exchanging NO for oxygen. After delivery of oxygen and NO to the blood, remaining oxygen and NO may be removed fromgas transfer unit 121 to ventingdevice 122 viaoutlet 133 in fluid communication withgas transfer unit 121. -
FIG. 3 illustratesoxygenation compartment 113 of an ECMO device, wherein oxygenation of blood and delivery of NO occur within structurallyseparate components oxygenation compartment 213. In this embodiment, blood entersoxygenation compartment 213 throughinlet 227, flows intochamber 223, and exitsoxygenation compartment 213 throughoutlet 226.Chamber 223 is in contact with oxygenpermeable membrane 224 ofoxygen transfer unit 221.Oxygen source 225 is also in fluid communication withoxygen transfer unit 221 throughinlet 231. As blood enters the upstream portion ofchamber 223, oxygen introduced intooxygen transfer unit 221 fromoxygen source 225 diffuses through oxygenpermeable membrane 224 into the blood, exchanging oxygen for CO.sub.2. Downstream ofinlet 231, remaining oxygen may be removed fromoxygen transfer unit 221 tooxygen venting device 222 viaoutlet 233 in fluid communication withoxygen transfer unit 221. The downstream portion ofchamber 223 is in contact with NOpermeable membrane 230 of NOtransfer unit 229. NOdelivery device 218 is also influid communication with NOtransfer unit 229 throughinlet 232. NOdelivery device 218 is in fluid communication with NO generator/reservoir 217 to deliver NO to NOchamber 229. As oxygenated blood flows to the downstream portion ofchamber 223, it comes into contact with NOpermeable membrane 230 of NOtransfer unit 229, and NO introduced into NOtransfer unit 229 throughinlet 232 diffuses into the oxygenated blood, exchanging NO for oxygen. After delivery of NO to the blood, remaining NO may be removed from NOtransfer unit 229 to NOventing device 228 viaoutlet 234 in fluid communication with NOtransfer unit 229. -
FIG. 4 illustratesoxygenation compartment 313 of an ECMO device, wherein oxygenation of blood occurs withinoxygenation compartment 313 and delivery of NO to the blood occurs downstream of andoutside oxygenation compartment 313. In this embodiment, blood entersoxygenation compartment 313 throughinlet 327, flows intochamber 323, and exitsoxygenation compartment 313 throughoutlet 326.Chamber 323 is in contact with oxygenpermeable membrane 324 ofoxygen transfer unit 321 withinoxygenation compartment 313.Oxygen source 325 is also in fluid communication withoxygen transfer unit 321 throughinlet 331. As blood enters the upstream portion ofchamber 323, oxygen introduced intooxygen transfer unit 321 fromoxygen source 325 diffuses through oxygenpermeable membrane 324 into the blood, exchanging oxygen for CO.sub.2. Downstream ofinlet 331, remaining oxygen may be removed fromoxygen transfer unit 321 tooxygen venting device 322 viaoutlet 333 in fluid communication withoxygen transfer unit 321. The downstream portion ofchamber 323 is in contact with NOpermeable membrane 330 of NOtransfer unit 329, which is outsideoxygenation compartment 313. NOdelivery device 318 is also influid communication with NOtransfer unit 329 throughinlet 332. NOdelivery device 318 is in fluid communication with NO generator/reservoir 317 to deliver NO to NOchamber 329. As oxygenated blood exitsoxygenation compartment 313 and flows to the downstream portion ofchamber 323, it comes into contact with NOpermeable membrane 330 of NOtransfer unit 329, and NO introduced intochamber 329 throughinlet 332 diffuses into the oxygenated blood, exchanging NO for oxygen. After delivery of NO to the blood, remaining NO may be removed from NOtransfer unit 329 to NOventing device 328 viaoutlet 334 in fluid communication with NOtransfer unit 329. - The NO-containing gas may be administered in the oxygenator after the blood has been partially oxygenated or fully oxygenated and may be administered separately from the addition of the oxygen. The NO-containing gas is typically administered after O.sub.2 administration and CO.sub.2 release.
- In various embodiments, methods of the present invention include delivery of NO-containing gas directly into arterial blood by injection, catheterization, infusion, or continuous infusion into an artery, for example, a central or peripheral artery (e.g., the aorta, femoral, brachial, radial, ulnar, dorsalis pedis, etc.).
- Reference throughout this specification to “one embodiment,” “certain embodiments,” “one or more embodiments” or “an embodiment” means that a particular feature, structure, material, or characteristic described in connection with the embodiment is included in at least one embodiment of the invention. Thus, the appearances of the phrases such as “in one or more embodiments,” “in certain embodiments,” “in one embodiment” or “in an embodiment” in various places throughout this specification are not necessarily referring to the same embodiment of the invention. Furthermore, the particular features, structures, materials, or characteristics may be combined in any suitable manner in one or more embodiments.
- Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It will be apparent to those skilled in the art that various modifications and variations can be made to the method and apparatus of the present invention without departing from the spirit and scope of the invention. Thus, it is intended that the present invention include modifications and variations that are within the scope of the appended claims and their equivalents.
Claims (20)
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CA3036361A1 (en) * | 2016-09-10 | 2018-03-15 | Vero Biotech LLC | System and method for portable nitric oxide delivery |
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US20080160107A1 (en) * | 2002-09-10 | 2008-07-03 | Nitric Biotherapeutics, Inc. | Use of nitric oxide gas to treat blood and blood products |
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US8790715B2 (en) * | 2006-02-16 | 2014-07-29 | Ino Therapeutics Llc | Method and apparatus for generating nitric oxide for medical use |
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