Classifications

• • 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
  • 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
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
  • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
  • C12Q1/02—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving viable microorganisms
  • C12Q1/18—Testing for antimicrobial activity of a material
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
  • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
  • C12Q1/56—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving blood clotting factors, e.g. involving thrombin, thromboplastin, fibrinogen
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
  • G01N33/86—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving blood coagulating time or factors, or their receptors
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
  • G01N2333/81—Protease inhibitors
  • G01N2333/8107—Endopeptidase (E.C. 3.4.21-99) inhibitors
  • G01N2333/811—Serine protease (E.C. 3.4.21) inhibitors
  • G01N2333/8121—Serpins
  • G01N2333/8128—Antithrombin III
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
  • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
  • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
  • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

• HIV human immunodeficiency virus
• AIDS Acquired Immunodeficiency Syndrome
• HCV Hepatitis C Virus
• HBV Hepatitis B
• a vaccine is available for certain viruses such as HBV, many at-risk people do not receive or have access to the vaccine. Further, some data indicate that the HBV vaccine is not as effective in people already infected with HIV.
• Viral infections once established, are generally incurable.
• anti-viral drugs that can prevent viruses from reproducing and ravaging the body's immune system, i.e., that slow the infection and lengthen the subject's life.
• therapies often only partially effective, and it is unknown how much viral suppression is required to achieve durable virologic, immunologic, and clinical benefits.
• Anti-viral drugs are often highly toxic and can cause serious side effects, including heart damage, kidney failure, and osteoporosis.
• HAART highly active antiretroviral drug therapy
• HAART highly active antiretroviral drug therapy
• HAART highly active antiretroviral drug therapy
• the present invention is based on the surprising finding that ATIII may be activated using saccharides such as heparin directly in situ in a blood product, such as blood, plasma, serum albumin, recombinant plasma, and the like, ad re-administered to a subject.
• a blood product of a subject may be incubated with heparin or other saccharide, dialyzed, and re-administered into the subject.
• a blood product from another source such as a commercial source, may be incubated with heparin or other saccharide, dialyzed, and administered to a subject.
• the blood products so treated contain activated ATIII in an effective dose to treat viral infection.
• This novel treatment eliminates the need for activated ATIII preparation in advance.
• Such treated blood products as a treatment may be useful, for example, in treating patients having viral infections or diseases or conditions that are caused by or contributed to by thrombin activation.
• the methods of treatment provided by the present invention may result in shorter pre-clinical and clinical testing times. Further, these methods of treatment provide an alternative, or supplement, to existing treatment methods of viral infection using purified activated ATIII pharmaceutical preparations.
• FIGURE 1 depicts the HIV-I inhibitory activity in blood treated with LMW heparin
• FIGURE 2 depicts the mechanism of action of activated heparin.
• Pure ATIII from Aventis (human source) and from GTC (recombinant) are inactive.
• Oligosaccharide and ATIII incubation and/or incubation with heat accelerate the interaction of these molecules to form a complex that undergoes a conformational change to produce an active form.
• the articles “a” and “an” are used herein to refer to one or to more than one (i.e., to at least one) of the grammatical object of the article.
• an element means one element or more than one element.
• activating ATIII or “to activate ATIII” refers to treating ATIII under suitable conditions such that the ATIII becomes high molecular weight ATIII and is able to reduce viral load, i.e.”
• administering includes any method of delivery of a pharmaceutical composition or therapeutic agent into a subject's system or to a particular region in or on a subject.
• systemic administration means the administration of a compound, drug or other material other than directly into the central nervous system, such that it enters the patient's system and, thus, is subject to metabolism and other like processes, for example, subcutaneous administration.
• Parenteral administration and “administered parenterally” means modes of administration other than enteral and topical administration, usually by injection, and includes, without limitation, intravenous, intramuscular, intraarterial, intrathecal, intracapsular, intraorbital, intracardiac, intradermal, intraperitoneal, transtracheal, subcutaneous, subcuticular, intra-articular, subcapsular, subarachnoid, intraspinal and intrasternal injection and infusion. [0015] The term “ATIII” refers to antithrombin III.
• blood product refers to any product or substance that is blood or is derived from blood.
• blood products include, but are not limited to, whole blood, plasma, serum, serum albumin preparations, and artificial preparations of the same, such as recombinant plasma.
• mammal is known in the art, and exemplary mammals include humans, primates, bovines, porcines, canines, felines, and rodents (e.g., mice and rats).
• high molecular weight ATIII means ATIII that has been treated to increase the molecular weight of the molecule relative to wildtype ATIII, e.g. to about 60 Kda to about 240 kDa from 58 kDa.
• a "patient,” “subject” or “host” to be treated by the subject method may mean either a human or non-human animal.
• phrases "pharmaceutically acceptable” refers to those compositions and dosages thereof within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings and animals without excessive toxicity, irritation, allergic response, or other problem or complication, commensurate with a reasonable benefit/risk ratio.
• pharmaceutically-acceptable carrier means a pharmaceutically- acceptable material, composition or vehicle, such as a liquid or solid filler, diluent, excipient, solvent or encapsulating material, involved in carrying or transporting any supplement or composition, or component thereof, from one organ, or portion of the body, to another organ, or portion of the body.
• pharmaceutically acceptable carrier refers to a carrier(s) that is "acceptable” in the sense of being compatible with the other ingredients of a composition and not deleterious to the recipient thereof.
• materials which may serve as pharmaceutically-acceptable carriers include: (1) sugars, such as lactose, glucose and sucrose; (2) starches, such as corn starch and potato starch; (3) cellulose, and its derivatives, such as sodium carboxymethyl cellulose, ethyl cellulose and cellulose acetate; (4) powdered tragacanth; (5) malt; (6) gelatin; (7) talc; (8) excipients, such as cocoa butter and suppository waxes; (9) oils, such as peanut oil, cottonseed oil, safflower oil, sesame oil, olive oil, corn oil and soybean oil; (10) glycols, such as propylene glycol; (11) polyols, such as glycerin, sorbitol, mannitol and polyethylene glycol
• saccharide includes both monosaccharides and polysaccharides.
• a saccharide able to activate ATIII refers to any saccharide able to transform wildtype ATIII into activated and/or high molecular weight ATIII that has the ability to reduce viral load.
• therapeutically effective amount refers to that amount of activated ATIII, drug or other molecule which is sufficient to effect treatment when administered to a subject in need of such treatment. The therapeutically effective amount will vary depending upon the subject and disease condition being treated, the weight and age of the subject, the severity of the disease condition, the manner of administration and the like, which can readily be determined by one of ordinary skill in the art.
• treating is intended to encompass curing as well as ameliorating at least one symptom or the progression of any condition or disease, decreased or prevented. Treatment may be performed either prophylactically, or subsequent to the initiation of a pathologic event.
• viral load refers to the concentration of a virus, such as HIV, in the blood.
• viral load refers to the concentration of a virus, such as HIV, in the blood.
• ATIII Antithrombin III
• ATIII is a glycoprotein present in blood plasma with a well- defined role in blood clotting. Specifically, ATIII is a potent inhibitor of the reactions of the coagulation cascade with an apparent molecular weight of between 54k Da and 65 kDa (Rosenberg and Damus, J. Biol. Chem. 248: 6490-505 (1973); Nordenman et al., Eur. J.
• the primary enzymes it inhibits are factor Xa, factor IXa, and thrombin (factor Ha). It also has inhibitory actions on factor XIIa, factor Xia and the complex of factor Vila and tissue factor but not factor Vila and activated protein C. ATIII also inhibits trypsin, plasmin and kallikrein (Charlotte and Church, Seminars in Hematology 28:3-9 (1995). Its ability to limit coagulation through multiple interactions makes it one of the primary natural anticoagulant proteins.
• ATIII acts as a relatively inefficient inhibitor on its own.
• ATIII can be activated by a simple template mechanism, or by an allosteric conformational change brought about by heparin binding (Skinner et al., J. MoI. Biol. 283: 9-14 (1998);
• compositions comprising high molecular weight antithrombin III (ATIII) in an amount effective to treat a retroviral infection.
• ATIII high molecular weight antithrombin III
• the present invention is based on the surprising finding that ATIII may be activated using saccharides such as heparin directly in situ in a blood product, such as blood, plasma, serum albumin, recombinant plasma, and the like.
• a blood product such as blood, plasma, serum albumin, recombinant plasma, and the like.
• the blood product so treated contains activated or high molecular weight ATIII.
• This novel treatment eliminates the need for advance ATIII preparation, e.g. preparation, purification and formulation into a pharmaceutical composition.
• Such a treatment may be useful, for example, in treating patients having viral disease or diseases or conditions that are caused by or contributed to by thrombin activation.
• the patient's own blood or plasma or serum albumin in combination with heparin may be incubated at moderate conditions (about 37 to about 40°C), (not necessary if the saccharide concentration is much lower than the ATIII equimolar concentration in the treated blood), and the activated blood product injected back into the patient.
• moderate conditions about 37 to about 40°C
• the activated blood product injected back into the patient.
• a method for preparing activated ATIII in situ in a blood product may comprise: (a) adding to a blood product comprising ATIII a saccharide able to activate ATIII in an amount sufficient to activate said ATIII; and (b) incubating the resulting mixture of the blood product and saccharide under conditions sufficient to activate said ATIII.
• the saccharide may be added in a quantity in excess of that quantity of ATIII in the blood product, for example, in an about 0.1 to about 1.0 equimolar amount of the quantity of ATIII in the blood product.
• the conditions sufficient to activate the ATIII are, in certain embodiments about 37°C to about 4O 0 C for about 24 to about 72 hours.
• the temperature is about 37°C to about 38°C, about 38 0 C to about 39°C or about 39 0 C to about 40 0 C.
• the incubation time is about 24 to about 36 hours, about 36 to about 48 hours, about 48 to about 60 hours, or about 60 to about 72 hours.
• the blood product may be any product or substance that is blood or is derived from blood.
• blood products include, but are not limited to, whole blood, plasma, serum, serum albumin preparations, and artificial preparations of the same, such as recombinant plasma.
• the saccharide may be for example, an oligosaccharide, such as any form of heparin, including low molecular weight heparin (about 2 to about 4 kDa), high molecular weight heparin (at least 12 kDa), and standard unfractionated heparin.
• the saccharide is a pentasaccharide.
• the saccharide may be an oligosaccharide treated by a glycosidase or other restriction enzyme.
• the saccharide may be added in an about a 0.1 to about 0.2, about 0.2 to about 0.3, about 0.3 to about 0.4, about 0.4 to about 0.5, about 0.5 to about 0.6, about 0.6 to about 0.7, about 0.7 to about 0.8, about 0.8 to about 0.9, or about 0.9 to about 1.0 equimolar amount of the quantity of ATIII in the blood product.
• Saccharides that may be used in the methods of the present invention include, but are not limited to, monosaccharides, disaccharides, and polysaccharides (including penta-, hepta- and hexa-saccharides), sugar alcohols, and amino sugars.
• Examples of monosaccharides include glucose, fructose, galactose, mannose, arabinose, and inositol.
• Examples of disaccharides include saccharose, lactose, maltose, pectin.
• Examples of sugar alcohols include mannitol, sorbitol, and xylitol.
• Examples of amino sugars include glucosamine, galactosamine, N-acetyl-D-glucosamine and N-acetyl galactosamine, which are the building blocks that can form more complex oligosaccharides, such as aminoglycosides and heparin.
• the oligosaccharides may be low molecular weight (2-4kDa) heparin, high molecular weight (at least 12kDa) heparin, standard unfractionated heparin, pectin, pentasaccharides, and aminoglycosides.
• the oligosaccharide has an affinity for ATIII. Saccharides as used herein can be derivatized with additional small molecules, such as biotin, avidin or streptavidin. Saccharides in certain embodiments may be sulfated oligosaccharides or oligosaccharides identified by glycosidase and other restriction enzyme reactions.
• Blood products in which ATIII has been activated in situ are also within the scope of the present invention.
• Such blood products may be packaged, for example, in sterile i.v. or incubation bags.
• Such methods of treating a disease in a subject in need of treatment may comprise (a) adding to a blood product comprising ATIII a saccharide able to activate ATIII in an amount sufficient to activate said ATIII; (b) incubating the resulting mixture of the blood product and saccharide under conditions sufficient to activate said ATIII; and (c) administering said mixture into said subject to treat a disease.
• Such methods may, in certain embodiments, further comprise purifying said mixture to remove unreacted saccharide prior to the infusing step, e.g. by dialysis.
• the methods of the present invention can be used to human and animal subjects such as cows, horses, dogs, cats, etc.
• the disease is caused by a bacteria or virus.
• viruses that may be treated using the methods of activating ATIII in situ or with the blood products of the invention include Hepatitis A Virus (HAV) infection, Hepatitis B Virus (HBV) infection, Hepatitis C Virus (HCV) infection, Human Immunodeficiency Virus (HIV) infection, corona virus infection, cytomegalovirus infection (CMV) and severe acute respiratory syndrome (SARS).
• the virus is a retrovirus, such as HIV.
• the disease may be a disease or condition that is caused by or contributed to by thrombin activation.
• Thrombin activation related diseases in a patient include sepsis, trauma, acute respiratory distress syndrome, thrombosis, stroke, and restenosis.
• the methods may also be used to treat patients at risk of a thrombin related pathological disease such as reocclusion and restenosis in percutaneous transluminal coronary angioplasty; thrombosis associated with surgery, ischemia/reperfusion injury; and coagulation abnormalities in cancer or surgical patients.
• the treated blood product administered in the methods may serve an anti ⁇ coagulant in the treatment of, for example, congenital antithrombin III deficiency which leads to an increased risk of venous and arterial thrombosis, or acquired antithrombin III deficiency which results in disseminated intravascular coagulation, microangiopathic hemolytic anemias due to endothelial damage (i.e. hemolytic-uremic syndrome) and veno- occlusive disease (VOD).
• the methods and blood products may also be used to treat semi- chronic diseases like arterial thrombus and deep vein thrombosis.
• the methods of treating may further comprise administering other pharmaceutical compositions, such as an anti-viral drug, to said subject.
• an anti-viral drug may be administered concurrently with the blood product.
• an anti-viral drug may be administered subsequent to administering the mixture.
• anti-viral drug may be administered both concurrently and subsequently with the blood product.
• An anti-viral drug may be added to the mixture, or administered as a separate composition.
• anti-viral drugs include reverse transcriptase inhibitors such as zidovudine, zalcitabine, didanosine, stavudine, lamivudine, abacavir, tenofovir, nevirapine, efavirenz, delavirdine; protease inhibitors such as saquinavir, ritonavir, indinavir, nelfinavir, amprenavir, lopinavir, and other agents such as adenine arabinoside, adenine arabinoside 5 '-monophosphate, acyclovir, ganciclovir, famciclovir, lamivudine, clevudine, afedovir dipivoxil, entecavir, IFN-a-2b, IFN-a-2a, lymphoblastoid IFN, consensus-IFN, IFN-b, IFN-g, pegylated IFN
• HAART Highly Active Antiretroviral Therapy
• HAART combines two or more anti-viral medications in a daily regimen, also known as a "cocktail.”
• Cocktails of anti-viral drugs are well-known to those of skill in the art.
• effective known anti-HIV cocktails include, but are not limited to, combinations such as AZT, 3TC and efavirenz; nevirapine, stavudine and lamivudine; emtricitabine and tenofovir disoproxil fumarate; indinavir, zidovudine and lamivudine (3TC); and zidovudine and 3TC.
• An effective anti-HCV cocktail is ribavrin and interferon.
• the combined use of blood products of the present invention and other anti-virals may reduce the required dosage for any individual component because the onset and duration of effect of the different components may be complimentary.
• the different active agents may be delivered together or separately, and simultaneously or at different times within the day.
• compositions that may be administered either concurrently, subsequently, or both concurrently and subsequently include ATIII and interferon or interferon derived drugs.
• the blood product may be supplemented with additional ATIII prior to adding the oligosaccharide to activate it.
• anticoagulants may be used alone or in combination with saccharides such as heparin or a pentasaccharide to treat the blood products of the invention prior to their use in a treatment method in order to improve their efficacy.
• high molecular weight ATIII pharmaceutical compositions as described in Pending U.S. Patent Application 10/436,872 may be used to supplement the method of treatment, e.g.
• the blood products of the present invention may be administered directly to a subject or may be formulated in a conventional manner using one or more physiologically acceptable carriers or excipients.
• the compounds of the invention can be formulated for a variety of loads of administration, including systemic and topical or localized administration. Techniques and formulations generally may be found in Remmington's Pharmaceutical Sciences, Meade Publishing Co., Easton, PA.
• injection is preferred, including intramuscular, intravenous, intraperitoneal, and subcutaneous.
• the blood product may be formulated for parenteral administration by injection, e.g., by bolus injection or continuous infusion.
• the blood products of the invention can be formulated in liquid solutions, preferably in physiologically compatible buffers such as Hank's solution or Ringer's solution.
• physiologically compatible buffers such as Hank's solution or Ringer's solution.
• the blood products may be formulated in solid form and redissolved or suspended immediately prior to use. Lyophilized forms of the blood products are also included.
• Formulations for injection may be presented in unit dosage form, e.g., in ampoules or in multi-dose containers, with an added preservative.
• the formulations may take such forms as suspensions, solutions or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilizing and/or dispersing agents.
• the active ingredient may be in powder form for constitution with a suitable vehicle, e.g., sterile pyrogen-free water, before use.
• a suitable vehicle e.g., sterile pyrogen-free water
• any of the subject formulations may be administered in any suitable dose, such as, for example, in a single dose or in divided doses.
• Dosages for the blood products of the present invention, alone or together with any other compound of the present invention, or in combination with any compound deemed useful for the particular disorder, disease or condition sought to be treated may be readily determined by techniques known to those of skill in the art, based on the present description, and as taught herein.
• the present invention provides mixtures of more than one subject compound, as well as other therapeutic agents.
• ATIII has been shown to be well-tolerated when administered at a dose of ⁇ 100U/kg/day (Warren et al, JAMA 286: 1869-78 (2001)) and has an overall elimination half-life with 18.6 h was demonstrated (Ilias et al. Intensive Care Medicine 26: 7104-7115 (2000)). While the dose is appropriately determined depending on symptom, body weight, sex, animal species and the like, it is generally 1-1,000 units/kg body weight/day, preferably 10-500 units/kg body weight/day of ATIII (as contained in the treated blood products of the invention) for a human adult, which is administered in one to several doses a day. In the case of intravenous administration, for example, the dose is preferably 10-100 units/kg body weight/day.
• the precise time of administration and amount of any particular product or compound that will yield the most effective treatment in a given patient will depend upon the activity, pharmacokinetics, and bioavailability of a particular compound, physiological condition of the patient (including age, sex, disease type and stage, general physical condition, responsiveness to a given dosage and type of medication), route of administration, and the like.
• the guidelines presented herein may be used to optimize the treatment, e.g., determining the optimum time and/or amount of administration, which will require no more than routine experimentation consisting of monitoring the subject and adjusting the dosage and/or timing.
• the administration regimen may also be dependent on the relative amount of ATIII in the blood product, for example, when the blood product is the patient's blood..
• the health of the patient may be monitored by measuring one or more relevant indices at predetermined times during a 24-hour period. Treatment, including supplement, amounts, times of administration and formulation, may be optimized according to the results of such monitoring.
• the patient may be periodically reevaluated to determine the extent of improvement by measuring the same parameters, the first such reevaluation typically occurring at the end of four weeks from the onset of therapy, and subsequent reevaluations occurring every four to eight weeks during therapy and then every three months thereafter. Therapy may continue for several months or even years, with a minimum of one month being a typical length of therapy for humans. Adjustments to the amount(s) of agent administered and possibly to the time of administration may be made based on these reevaluations.
• the blood products may be administered in the HAART rest interval.
• Treatment may be initiated with smaller dosages which are less than the optimum dose of the product or compound. Thereafter, the dosage may be increased by small increments until the optimum therapeutic effect is attained. [0058] 4. Kits
• kits comprising compositions of the present invention, and optionally instructions for their use.
• kits for the practice of certain of the treatment methods of the invention may comprise a saccharide able to activate ATIII and instructions for use.
• Still other kits for the practice of certain of the treatment methods of the invention may comprise blood products in which ATIII has been activated in situ.
• the present invention provides kits for the methods of preparing activated ATIII in situ in a blood product.
• such kits may comprising an oligosaccharide able to activate ATIII and instructions for use.
• Kit components may be packaged for either manual or partially or wholly automated practice of the foregoing methods.
• kits contemplates a kit including compositions of the present invention, and optionally instructions for their use.
• a kit may further comprise controls, reagents, buffers, and/or instructions for use.
• Such kits may have a variety of uses, including, for example, imaging, diagnosis, therapy, and other applications.
• Standard, unfractionated heparin for human use (1 ,000-10,000 units, or about 2 to about 40 mg) was added to 500 mL samples of commercially available human plasma (containing an average of about 120 to about 150 mg of ATIII) in a sterile incubation bag.
• the amount of heparin added to the bag depends on the viral load of the patient and the treatment regimen desired.
• the resulting mixture was incubated at room temperature, 37 0 C or 40 0 C, for 24-72 hours. Gentle mixing was applied as necessary during the incubation period.
• the incubated mixture may be infused into a patient with or without further purification to remove unreacted heparin. In these procedures, the heparin dosage is very low compared to the level of ATIII in the plasma so that free heparin in the resultant mixture is avoided, thus decreasing the risk for bleeding.
• Example 2 Preparation Procedures for In vitro Blood ATIII Activation Using Standard, Unfractionated Heparin
• Standard, unfractionated heparin for human use (1 ,000-20,000 units, or about 2 to about 40 mg) was added to 1,000 mL samples of blood drawn from HIV or HCV patients (containing an average of about 70 to about 150 mg of ATIII) in a sterile incubation bag.
• the resulting mixture was incubated at room temperature, 37 0 C or 4O 0 C, for 24-72 hours. Gentle mixing was applied as necessary during the incubation period.
• the incubated mixture may be infused into a patient with or without further purification to remove unreacted heparin. In these procedures, the heparin dosage is very low compared to the level of ATIII in the plasma so that free heparin in the resultant mixture is avoided, thus decreasing the risk for bleeding.
• Example 3 Preparation Procedures for In vitro Plasma ATIII Activation Using Low Molecular Weight Heparin
• LMW Low molecular weight
• heparin for human use 1,000-10,000 units, or about 2 to about 20 mg was added to 500 niL samples of commercially available human plasma (containing an average of about 70 to about 150 mg of ATIII) in a sterile incubation bag.
• the resulting mixture was incubated at room temperature, 37°C or 40 0 C, for 24-72 hours. Gentle mixing was applied as necessary during the incubation period.
• the incubated mixture may be infused into a patient with or without further purification to remove unreacted heparin.
• LMW Low molecular weight
• heparin for human use 1,000-20,000 units, or about 2 to 20 mg was added to 1,000 mL samples of blood drawn from HIV or HCV patients (containing an average of about 70 to 150 mg of ATIII) in a sterile incubation bag.
• the resulting mixture was incubated at room temperature, 37°C or 40 0 C, for 24-72 hours. Gentle mixing was applied as necessary during the incubation period.
• the incubated mixture may be infused into a patient with or without further purification to remove unreacted heparin. In these procedures, the heparin dosage is very low compared to the level of ATIII in the plasma so that free heparin in the resultant mixture is avoided, thus decreasing the risk for bleeding.
• Example 5 Activation of ATIII in the Blood or Blood Plasma Using Heparin, Heparin Derivatives, or other Oligosaccharides Able to Activate ATIII
• ATIII may also be activated in the blood or blood plasma using the protocols described in Examples 1-4 above using a 0.1 to 1.0 equimolar amount of any heparin- derived pentasaccharide or other oligosaccharide able to activate ATIII. Examples of such are provided in the Detailed Description above.
• Example 6 Estimation of Protein Bound Heparin and Free Heparin in Modified Forms [0073] To estimate the free heparin and protein-bound heparin, both UV and refractive index (RI) integrations were used as follows.
• the total RI integration may be expressed as follows:
• RItotal RIprotein + Rlhepa ⁇ n
• Free heparin (F h e pa ⁇ n ) is calculated according to:
• Example 7 Assay for Inhibition of HIV-I Replication
• X4 HTLV-IIIB (hereinafter X4 HIV; Chang et al, NATURE, 363: 466-9 (1993)), a prototypical T-tropic strain of HIV (American Type Tissue Collection, Monassass, VA, USA; ATCC No. CRL-8543), was used to assess the effect of the ATIII activation protocols on T-tropic HIV infection.
• the quantity of virus in a specified suspension volume e.g. 0.1 ml
• n number of cell culture microplate wells, or tubes, is termed the Tissue Culture Infectious Dose 50 [TCID 5 0].
• TdD 50 is used as an alternative to determining virus titer by plaqueing (which gives values as PFUs or plaque-forming units).
• Human T lymphoblastoid cells H9 cells expressing the human leukocyte antigen proteins (HLA) B6, Bw62, and Cw3 were acutely infected with X4 HIV at a MOI of 1 x 10 "2 TCID 50 per milliliter.
• the infected H9 cells were resuspended to 5 x 10 5 cells/ml in R20 cell culture medium. Two milliliters of this suspension was pipetted into each well of a 24-well microtiter plate. These cells were then cultured in the presence or absence of samples having activated ATIII for up to 12 days.

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