WO2005112885A2 - Oligonucleotide-containing microspheres, their use for the manufacture of a medicament for treating diabetes type 1 - Google Patents

Oligonucleotide-containing microspheres, their use for the manufacture of a medicament for treating diabetes type 1 Download PDF

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WO2005112885A2
WO2005112885A2 PCT/US2005/016689 US2005016689W WO2005112885A2 WO 2005112885 A2 WO2005112885 A2 WO 2005112885A2 US 2005016689 W US2005016689 W US 2005016689W WO 2005112885 A2 WO2005112885 A2 WO 2005112885A2
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microspheres
oligonucleotides
pancreas
accordance
beta cells
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French (fr)
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WO2005112885A3 (en
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Terrence L. Scott
Debra Lafreniere
Nick Giannoukakis
Vered Bisker-Leib
Larry R. Brown
Jennifer Machen
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Baxter Healthcare SA
Baxter International Inc
Childrens Hospital of Philadelphia CHOP
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Baxter Healthcare SA
Baxter International Inc
Childrens Hospital of Philadelphia CHOP
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Priority to EP05749674.7A priority Critical patent/EP1758558B1/en
Priority to AU2005244851A priority patent/AU2005244851B2/en
Priority to JP2007513370A priority patent/JP2007537288A/ja
Priority to DK05749674.7T priority patent/DK1758558T3/da
Priority to MXPA06012989A priority patent/MXPA06012989A/es
Priority to CA2566199A priority patent/CA2566199C/en
Priority to ES05749674.7T priority patent/ES2442115T3/es
Publication of WO2005112885A2 publication Critical patent/WO2005112885A2/en
Publication of WO2005112885A3 publication Critical patent/WO2005112885A3/en
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    • C12N15/00Mutation or genetic engineering; DNA or RNA concerning genetic engineering, vectors, e.g. plasmids, or their isolation, preparation or purification; Use of hosts therefor
    • C12N15/09Recombinant DNA-technology
    • C12N15/11DNA or RNA fragments; Modified forms thereof; Non-coding nucleic acids having a biological activity
    • C12N15/113Non-coding nucleic acids modulating the expression of genes, e.g. antisense oligonucleotides; Antisense DNA or RNA; Triplex- forming oligonucleotides; Catalytic nucleic acids, e.g. ribozymes; Nucleic acids used in co-suppression or gene silencing
    • C12N15/1138Non-coding nucleic acids modulating the expression of genes, e.g. antisense oligonucleotides; Antisense DNA or RNA; Triplex- forming oligonucleotides; Catalytic nucleic acids, e.g. ribozymes; Nucleic acids used in co-suppression or gene silencing against receptors or cell surface proteins
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/0012Galenical forms characterised by the site of application
    • A61K9/0019Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/14Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/16Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
    • A61K9/1605Excipients; Inactive ingredients
    • A61K9/1629Organic macromolecular compounds
    • A61K9/1635Organic macromolecular compounds obtained by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyvinyl pyrrolidone, poly(meth)acrylates
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/14Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/16Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
    • A61K9/1605Excipients; Inactive ingredients
    • A61K9/1629Organic macromolecular compounds
    • A61K9/1641Organic macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyethylene glycol, poloxamers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/14Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/16Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
    • A61K9/1605Excipients; Inactive ingredients
    • A61K9/1629Organic macromolecular compounds
    • A61K9/1658Proteins, e.g. albumin, gelatin
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/14Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
    • A61K9/19Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles lyophilised, i.e. freeze-dried, solutions or dispersions
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/18Drugs for disorders of the alimentary tract or the digestive system for pancreatic disorders, e.g. pancreatic enzymes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00Drugs for disorders of the metabolism
    • A61P3/08Drugs for disorders of the metabolism for glucose homeostasis
    • A61P3/10Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00Drugs for immunological or allergic disorders
    • A61P37/02Immunomodulators
    • A61P37/06Immunosuppressants, e.g. drugs for graft rejection
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    • C12N15/09Recombinant DNA-technology
    • C12N15/11DNA or RNA fragments; Modified forms thereof; Non-coding nucleic acids having a biological activity
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    • C12N2310/00Structure or type of the nucleic acid
    • C12N2310/30Chemical structure
    • C12N2310/31Chemical structure of the backbone
    • C12N2310/315Phosphorothioates
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    • C12N2320/00Applications; Uses
    • C12N2320/30Special therapeutic applications
    • C12N2320/32Special delivery means, e.g. tissue-specific

Definitions

  • the present invention generally relates to microsphere delivery of AS-oligonucleotides in order to induce dendritic cell tolerance, particularly in the non-obese- diabetic (NOD) mouse model. More particularly, the invention relates to drug delivery technology by way of microspheres that are fabricated using totally aqueous conditions, which microspheres incorporate antisense (AS) oligonucleotides. These microspheres are used for an antisense approach to prevent an autoimmune diabetes condition in NOD mice in vivo and in situ .
  • AS antisense
  • Microparticles, microspheres, and microcapsules are solid or semi-solid particles having a diameter of less than one millimeter, more preferably less than 100 microns, which can be formed of a variety of materials, including synthetic polymers, proteins, and polysaccharides . Microspheres have been used in many different applications, primarily separations, diagnostics, and drug delivery.
  • microspheres A number of different techniques can be used to make these microspheres from synthetic polymers, natural polymers, proteins and polysaccharides, including phase separation, solvent evaporation, emulsification, and spray drying. Generally the polymers form the supporting structure of these microspheres, and the drug of interest is incorporated into the polymer structure.
  • Exemplary polymers used for the formation of microspheres include homopolymers and copolymers of lactic acid and glycolic acid (PLGA) as described in U.S. Pat. No. 5,213,812 to Ruiz, U.S. Pat. No. 5,417,986 to Reid et al., U.S. Pat. No. 4,530,840 to Tice et al . , U.S. Pat. No.
  • Spherical beads or particles have been commercially available as a tool for biochemists for many years.
  • antibodies conjugated to beads create relatively large particles specific for particular ligands.
  • the large antibody-coated particles are routinely used to crosslink receptors on the surface of a cell for cellular activation, are bound to a solid phase for immunoaffinity purification, and may be used to deliver a therapeutic agent that is slowly released over time, using tissue or tumor-specific antibodies conjugated to the particles to target the agent to the desired site.
  • tissue or tumor-specific antibodies conjugated to the particles to target the agent to the desired site.
  • Microparticles produced by these known methods have a wide particle size distribution, often lack uniformity, and fail to exhibit long term release kinetics when the concentration of active ingredients is high. Furthermore, the polymers used in these known methods are dissolved in organic solvents in order to form the microparticles. They must therefore be produced in special facilities designed to handle organic solvents. These organic solvents could denature proteins or peptides contained in the microparticles. Residual organic solvents could be toxic when administered to humans or animals .
  • microparticles prepared using polylactic glycolic acid (PLGA) are large and have a tendency to aggregate.
  • a size selection step, resulting in product loss, is necessary to remove particles too large for injection.
  • PLGA particles that are of a suitable size for injection must be administered through a large gauge needle to accommodate the large particle size, often causing discomfort for the patient.
  • microparticles are activated to release their contents in aqueous media and therefore must be lyophilized to prevent premature release.
  • particles such as those prepared using the PLGA system exhibit release kinetics based on both erosion and diffusion. In this type of system, an initial burst or rapid release of drug is observed. This burst effect can result in unwanted side effects in patients to whom the particles have been administered.
  • Microparticles prepared using lipids to encapsulate target drugs are known. For example, lipids arranged in bilayer membranes surrounding multiple aqueous compartments to form particles may be used to encapsulate water soluble drugs for subsequent delivery as described in U.S. Pat. No. 5,422,120 to Sinil Kim.
  • Liposomes are spherical particles composed of a single or multiple phospholipid and cholesterol bilayers. Liposomes are 30 microns or greater in size and may carry a variety of water-soluble or lipid-soluble drugs. Liposome technology has been hindered by problems including purity of lipid components, possible toxicity, vesicle heterogeneity and stability, excessive uptake and manufacturing or shelf-life difficulties.
  • An objective for the medical community is the delivery of nucleic acids to the cells in an animal for diabetes treatment.
  • nucleic acids can be delivered to cells in culture ( in vi tro) relatively efficiently, but nucleases result in a high rate of nucleic acid degradation when nucleic acid is delivered to animals ( in vivo) .
  • nucleic acid delivery vehicle In addition to protecting nucleic acid from nuclease digestion, a nucleic acid delivery vehicle must exhibit low toxicity, must be efficiently taken up by cells and have a well-defined, readily manufactured formulation. As shown in clinical trials, viral vectors for delivery can result in a severely adverse, even fatal, immune response in vivo . In addition, this method has the potential to have mutagenic effects in vivo. Delivery by enclosing nucleic acid in lipid complexes of different formulations (such as liposomes or cationic lipid complexes) has been generally ineffective in vivo and can have toxic effects. Complexes of nucleic acids with various polymers or with peptides have shown inconsistent results and the toxicity of these formulations has not yet been resolved.
  • Nucleic acids also have been encapsulated in polymer matrices for delivery, but in these cases the particles have a wide size range and the effectiveness for therapeutic applications has not yet been demonstrated. [00012] Therefore, there is a need for addressing nucleic acids delivery issues, and there is an on-going need for development of microspheres and to new methods for making microspheres. Details regarding microspheres are found in US Patents No. 6,458,387 to Scott et al., No. 6,268,053, No. 6,090,925, No. 5,981,719 and No. 5,599,719 to Woiszwillo et al . , and No. 5,578,709 to Woiszwillo. These and all references identified herein are incorporated by reference hereinto.
  • DNA to be delivered to dendritic cells is delivered as microspheres. It is believed that such a delivery approach prevents access of the nucleases to the nucleic acids within the microsphere.
  • Microsphere delivery of AS-oligonucleotides is carried out in order to induce dendritic cell tolerance, particularly in the NOD mouse model.
  • the microspheres are fabricated using aqueous conditions, which microspheres incorporate antisense (AS) oligonucleotides. These microspheres are used to inhibit gene expression and to prevent an autoimmune diabetes condition in NOD mice in vivo and in si tu .
  • three AS- oligonucleotides targeted to the CD40, CD80 and CD86 primary transcripts are synthesized, and an aqueous solution of the oligonucleotide mixture is prepared and combined with a polymer solution. After processing, microspheres containing the oligonucleotides are provided, and these are delivered to the NOD mice.
  • FIG. 1 is a schematic illustration of the role of dendritic cells in the autoimmune destruction of pancreatic insulin-producing beta-cells in Type 1 diabetes;
  • Fig. 2 is a diagram of the Beta-Galactosidase gene- containing plasmid vector;
  • FIG. 3 shows photomicrographs providing evidence for transfection of NIH 3T3 fibroblast cells with the plasmid DNA microspheres
  • FIG. 4 is a photomicrograph of agarose electrophoresis gel of naked plasmid DNA and of two plasmid DNA microsphere formulations according to the invention, each after exposure to DNAase;
  • Fig. 5 is a bar graph of Beta-Galactosidase activity in four different plasmid DNA applications.
  • Fig. 6 is a scanning electron migrograph of microspheres of AS-oligonucleotides and poly-L-lysine polycation;
  • Fig. 7 is a scanning electron micrograph of microspheres of AS-oligonucleotides and poly-L-ornithine polycation;
  • Fig. 8 is a plot summarizing diabetes incidence in three groups of NOD mice treated with the microspheres and according to other procedures for delivery of the three primary transcripts.
  • the preferred embodiment prevents autoimmune insulin-dependent diabetes by formulating and injecting antisense (AS) -oligonucleotide microspheres described herein targeting the primary transcripts of CD40, CD80 and CD86.
  • AS antisense
  • oligonucleotides are designed to induce immune tolerance in an attempt to prevent destruction of the insulin producing beta cells in the NOD mouse model.
  • Fig. 1 This illustrates how Type 1 diabetes is manifested by the autoimmune destruction of the pancreatic insulin-producing beta cells in the NOD mouse, as well as in humans.
  • humans At the time of clinical onset, humans have 10-20% residual beta cell mass. Sparing of this residual mass can result in remaining insulin levels which are adequate to regulate glucose levels.
  • the microparticles of the invention are provided to interfere with the autoimmune destruction of the beta cells which is illustrated in Fig. 1.
  • dendritic cells can be activated to be potent antigen presenting cells found in all tissues and which are highly concentrated under the skin. These antigen presenting dendritic cells function as triggers of the immune response through the activation of T-cells, particularly in lymph nodes.
  • FIG. 2 is a drawing of a plasmid vector containing the Beta-galactosidase gene that can be used to transfect NIH 3T3 fibroblast cells.
  • Fig. 3 In vitro evidence for the transfection of NIH 3T3 fibroblast cells with the plasmid DNA microspheres is shown in Fig. 3 by the cells which stain blue in color in response to the addition of the Beta-Galactosidase x-gal (5- bromo-4-chloro-3-indolyl-beta-galactopyranoside) substrate.
  • Fig. 4 illustrates the ability of microspheres to protect DNA in solution.
  • Plasmid samples 1, 2 and 3 naked plasmid DNA was exposed to DNAse, with the smears indicating plasmid DNA degradation at I each of the three levels of DNAase application.
  • Particle 1 and Particle 2 samples plasmid DNA microsphere formulations were exposed to DNAase. The lack of smearing indicates the microsphere formulations show shielding of the plasmid DNA from degradation.
  • Fig. 5 reports on Beta-Galactosidase activity in four different plasmid DNA applications.
  • the naked plasmid DNA application showed very low levels. Somewhat greater levels are indicated for plasmid DNA cationic lipid complex application using lipofecta ine, a commercial cationic lipid, as the delivery vehicle. Substantially greater activity is shown for two pDNA microspheres, with Microspheres 1 corresponding to Particle 1 of Fig. 4, and Microspheres 2 corresponding to Particle 2 of Fig. 4.
  • microspheres that are used for autoimmune treatment of diabetes in mice
  • three AS- oligonucleotides are dissolved in aqueous solution and combined with water soluble polymer (s) and a polycation.
  • the solution typically is incubated at about 60-70°C, cooled to about 23°C, and the excess polymer is removed.
  • Microspheres are formed which are believed to contain the three AS- oligonucleotides having the following sequences, ' wherein an asterisk indicates thioation: Seq ID 1: CD 40-AS: 5'C*AC* AG*C C*GA* GG*C* AA*A GA*C* AC*C A*T*G C*AG* GG*C* A-3'
  • Seq ID 2 CD80-AS: 5'-G*GG* AA*A G*CC* AG*G A*AT* CT*A G*AG* CC*A A*TG G*A-3'
  • the nucleic acids typically comprise between about 30 and about 100 weight percent of the microspheres and have an average particle size of not greater than about 50 microns.
  • they are prepared as follows.
  • An aqueous solution of the oligonucleotide mixture is prepared by combining aliquots from three oligonucleotide solutions, each solution containing one of these three types.
  • a solution containing the three types of oligonucleotides is prepared.
  • the solutions preferably contain about 10 mg/ l oligonucleotide. These are combined with aliquots of a 10 mg/ml stock solution of polycation solution at volumetric ratios of polycation: oligonucleotide of from about 1:1 to about 4:1.
  • Microspheres according to the invention are a viable non-viral delivery tool for plasmid DNA and antisense oligonucleotides and other nucleic acids. They allow for in vitro delivery of Beta-Galactosidase plasmid DNA in 3T3 fibroblast cells. The microspheres protect plasmid DNA from nuclease activity.
  • Beta-Galactosidase activity are expressed following transfection with the microsphere formulations.
  • Microspheres containing the antisense oligonucleotides of interest down-regulate surface cell antigens CD40, CD80 and CD86, known to be critical in the activation of the autoimmune reaction that results in destruction of insulin-producing beta cells of the pancreas. This can be accomplished by subcutaneous injection to dendritic cells located under the skin. NOD mice studies demonstrate effective prevention of the autoimmune destruction of beta cells.
  • the DNA and oligonucleotide microspheres are effective transfection vehicles in vitro and in vivo.
  • Dendritic cells appear to take up the oligonucleotide microspheres and suppress the expression of surface cell antigens CD40, CD80 and CD86.
  • the anitsense oligonucleotide microspheres effectively prevent diabetes development in the NOD mouse.
  • EXAMPLE 1 Three AS-oligonucleotides targeted to the CD40, CD80 and CD86 primary transcripts were synthesized by the DNA synthesis facility at University of Pittsburgh (Pittsburgh, PA) .
  • the AS-oligonucleotides sequences are:
  • Seq ID 2 CD80-AS: 5' ⁇ G*GG* AA*A G*CC* AG*G A*AT* CT*A G*AG* CC*A A*TG G*A-3'
  • aqueous solution of the oligonucleotide mixture was prepared by combining aliquots of three oligonucleotide solutions, each of which contained one type of oligonucleotide, to form a 10 [mg/ml] solution of the three types of oligonucleotides.
  • 10 [mg/ml] poly-L-lysine-HBr in diH20 (poly-L-lysine-HBr up to 50,000 by Bachem, King of Prussia, PA) was prepared.
  • Poly-L-lysine* HBr was added to the oligonucleotides solution at a volumetric ratio of 1:1. The mixture was vortexed gently.
  • the polymer solution was added in a 2:1 volumetric ratio as follows: 750 ⁇ l of AS-oligonucleotides, 0.75 ml of poly-L- lysine-HBr, 3.0 ml of PEG/PVP, and a total volume of 4.50 ml. [00038]
  • the batch was incubated for 30 minutes at 70°C and then cooled to 23°C.
  • Fig. 6 presents a scanning electron micrograph (SEM) of the 1:1 poly-L-lysine: oligonucleotide ratio material.
  • aqueous solution of the oligonucleotide mixture was prepared by combining aliquots of the three oligonucleotide solutions, each of which contained one type of oligonucleotide, to form a 10 [mg/ml] solution of the three types of oligonucleotides.
  • a solution of oligonucleotide mixture was prepared. 5 [mg/ml] poly-L- ornithine-HBr in diH20 (poly-L-ornithine- HBr 11,900 (vis) by Sigma) was prepared. Poly-L-ornithine* HBr was added to the oligonucleotides solution. The mixtures were vortexed gently.
  • Dendritic cells with low levels of CD40, CD80 and CD86 are known to promote suppressive immune cell networks in vivo . These cascades can result in T-cell hyporesponsiveness to beta cells in vivo.
  • dendritic cells were propagated ex vivo from bone marrow progenitors of NOD mice. Combinations of the three AS-oligonucleotides targeting the primary transcripts of CD40, CD80 and CD86 were added to the cells in tissue culture. After incubation, the AS- oligonucleotide transfected dendritic cells were injected into syngenetic recipients of 5 to 8 weeks of age (not yet diabetic) . This is a known ex-vivo delivery approach. [00044] In parallel, AS-oligonucleotide microspheres were injected directly into other NOD mice of the same age. A single injection was carried out on each thus-treated mouse. Another group of these NOD mice was not treated and served as a control.
  • Fig. 8 shows that the control, untreated NOD mice all developed diabetes by age 23 weeks.
  • AS-ODN DC AS-ODN DC
  • 71% remained "Diabetes Free" at 43 weeks .

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PCT/US2005/016689 2004-05-12 2005-05-12 Oligonucleotide-containing microspheres, their use for the manufacture of a medicament for treating diabetes type 1 Ceased WO2005112885A2 (en)

Priority Applications (7)

Application Number Priority Date Filing Date Title
EP05749674.7A EP1758558B1 (en) 2004-05-12 2005-05-12 Oligonucleotide-containing microspheres, their use for the manufacture of a medicament for treating diabetes type 1
AU2005244851A AU2005244851B2 (en) 2004-05-12 2005-05-12 Oligonucleotide-containing microspheres, their use for the manufacture of a medicament for treating diabetes type 1
JP2007513370A JP2007537288A (ja) 2004-05-12 2005-05-12 オリゴヌクレオチド含有マイクロスフェア、1型糖尿病を処置する医薬の製造のための、その使用
DK05749674.7T DK1758558T3 (da) 2004-05-12 2005-05-12 Oligonukleotidholdige mikrokugler samt deres anvendelse til fremstilling af et medikament til behandling af diabetes type 1
MXPA06012989A MXPA06012989A (es) 2004-05-12 2005-05-12 Microesferas de acidos nucleicos, produccion y suministro de las mismas.
CA2566199A CA2566199C (en) 2004-05-12 2005-05-12 Delivery of as-oligonucleotide microspheres to induce dendritic cell tolerance for the treatment of autoimmune type 1 diabetes
ES05749674.7T ES2442115T3 (es) 2004-05-12 2005-05-12 Microesferas que contienen oligonucleótidos, su utilización para la preparación de un medicamento para el tratamiento de la diabetes tipo 1

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US57027304P 2004-05-12 2004-05-12
US60/570,273 2004-05-12
US62548304P 2004-11-05 2004-11-05
US60/625,483 2004-11-05

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JP5457414B2 (ja) 2014-04-02
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US7884085B2 (en) 2011-02-08
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PT1758558E (pt) 2013-12-05
US20100260855A1 (en) 2010-10-14
MXPA06012989A (es) 2007-06-12
US9115357B2 (en) 2015-08-25
EP1758558B1 (en) 2013-10-16
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