WO2007112173A2

WO2007112173A2 - Method for promoting composite tissue regeneration and uses thereof

Info

Publication number: WO2007112173A2
Application number: PCT/US2007/062993
Authority: WO
Inventors: David Weinstein
Original assignee: Gliamed, Inc.
Priority date: 2006-03-24
Filing date: 2007-02-28
Publication date: 2007-10-04
Also published as: US20090093528A1; WO2007112173A3; EP1998767A4; WO2007112173A8; US7795216B2; EP1998767A2

Abstract

The present invention provides a use and method for GM284 to promote the regeneration of a bodily structure comprised of a composite tissue in a subject. Additionally, the present invention provides a use and method for GM284 to promote composite tissue regeneration in a subject. The present invention further provides a use and method for GM284 to promote the regeneration of cells of a composite tissue in a subject. Finally, the present invention provides a use and method for GM284 to treat an injury to a composite tissue in a subject in need of such treatment.

Description

MBTHODS FOR PROMOTING COMPOSITE TISSUE REGENERATION

AND USES THEREOP

RELATED APPlJC All ON

5 \iHH)l ] The present invention claims priority to U.S. Provisional No. 60/743,749 filed on 24 March 2006, which is incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION

1. TECHNICAL FIELD

|0002| This invention relates generally to a .method for promoting the

1C) regeneration of composite tissues, and is particularly related to the use of the GM284 in such, a method,

2. RELATED ART

10003 j Injured tissues are able to heal by regeneration, by repair, or by a combination of these processes. Regeneration results in the re-establishment of 15 the original tissue structure and function. In contrast, tissue repair results in the replacement of the original tissue with a patch of connective tissue, or scat, which is functionally inferior to the original tissue. The response of most mammalian tissues to injury falls within a spectrum bounded by regeneration and repair.

|OΘO4| In mammals and other higher organisms there is a failure of

20 regeneration of composite or complex tissues. Bodily structures comprised of composite tissues, such as a limb or digit, or an appendage, such as an ear or nose, are made of numerous cell types arranged in an organized and iterative structure that is preserved from individual to individual. When composite tissues or bodily structures comprised of composite tissues are injured, regeneration requires the 25 coordinated growth and interactions of numerous cell types within the composite tissues to regenerate a bodily structure that effectively indistinguishable from the original.

|0005] The regeneration of composite tissues and entire body parts are biological capabilities shared by many lower species. For example, the starfish can 5 regenerate entire limbs after amputations and die snail can regenerate its head. In contrast, most vertebrates have no ability to regenerate entire body parts. It is not clear, if die inability of vertebrate composite tissues to regenerate represents a true inability to te-form these tissues following injury, ot if the molecular and cellular mechanisms that control the processes have been re -directed for use in other 10 biological processes. The discover₎?' presented herein, by the inventor argues for the latter.

{0006] The MRL mouse is a spontaneously occurring mutant strain that differs from most mammals in chat it. regenerates composite tissue tol.lowi.ng injury. When a hole is placed through the ear of a wild-type mouse, there is little or no

15 regeneration. In contrast, the placement of a full thickness hole through the ear of the MRL mouse results in complete regeneration of all the cell -types within the ear and the closure of the hole within 30 days (Heber-Katz, E,, The regenerating mouse ear, Semin Ceil Dev Biol \% 415-9 (1999); Clark, L.D., Ckrk, RK. & Heber- Katz, EL, A new murine model for mammalian wound repair and regeneration, CMn

20 Immunol lmmunopathol 88, 35-45 (1998); Heber-Katz, E,, Leferovich, j .M,,

Bedelbaeva, K. & Gourevkch, D. Spailanzani's mouse: a model of restoration and regeneration. Curr Top Microbiol Immunol 2HO, 165-89 (2004)).

|(KH)7| Analysis of the genetic loci that, are involved in this unique biology has demonstrated a complex set. of traits that have been associated with 1 1 25 quantitative trait loci (Hefaer-Katz, EL, et al Regeneration in MRL mice: further

- 2 - genetic loci controlling the ear hole closure trait using MRL, and M.m. Cast.an.eus mice, Wound Repair %rø 12, 384-92 (2004)).

J(K)OS] The regenerative capacity of the MRL mouse is not restricted to the ear. Cryoinfarction of the MRL mouse heart results in the anatomic and functional 5 recover}' of the heart, whereas there is no such regeneration in the wild- type heart. in any mammalian species.

fOΘΘ9] The inventor has previously shown that GM284, a non- imnumosuppressive immunophilin lig&nd, promotes accelerated and extensive regeneration of skin following full -thickness lesions (U.S. Pat. App, No. 10 10/290,657; Publication No. 20040092440) and of peripheral nerves following mechanical transection (U.S. Pat. Λ.pp. No. 10/290,654; Publication No. 20040026681),

l(K}10| The inventor tested the ability of GM284 to promote the regeneration of the composite tissues of the murine ear. The inventor has 15 concluded from his experiments that GM284 activates a cascade of interactions that lock tissues in a state of regeneration. Moreover, the inventor's unexpected discovery suggests that these events are conserved across evolutionary lines, and that GM284 takes advantage of their existence in mammals.

20 SUMMARY OF THB INVENTION

J(KII l I The inventor demonstrates herein thai treatment with GM284, a nonimmunosupptessivc immunophilin iigand, beginning after a composite tissue in a bodily structure has been injured, results in the regeneration of the lost composite tissue -inά the regeneration of lost cells of the composite tissue. This is the 6f st demonstration ot a pharmacological intervention resulting in the regeneration of a mammalian bodily structure comprised of composite tissues following an injury thereto.

|OΘ12| The present invention is based on the discovery by that GM284,

5 beginning in the hours following a wound to a the ear oi a mouse, and given daily for three weeks, results in the initiation of robust regeneration of the tissue lost by the wounding of t.be ear, as evidenced by .histological changes in the wound margins consistent with the regeneration thereof. This ability of GM284 is valuable and unexpected.

10 100131 Consequently, the present invention provides:

1} a use for GM2S4 to promote the regeneration of a bodily structure comprised of composite tissue in a subject, wherein, the GM284 Is administered to the subject in an amount effective to promote the regeneration, of the bodily structure in the subject;

15 2) a use of GM284 to promote composite tissue regeneration in a subject, wherein the GM284 is administered to the subject in an amount effective to promote regeneration of composite tissue in the subject;

3) a use of GM284 to promote the regeneration of cells of a composite tissue in a subject, wherein the GM284 is administered to the subject in an amount

20 effective to promote the regeneration of cells of the composite tissue in the subject;

4) a use of GM284 to promote the regeneration of cells of a composite tissue, wherein the composite tissue is contacted with an amount, of. GM284 effective to promote the regeneration of cells of the composite tissue;

_ 4 _ 5) a use ot GM284 to treat an injury to a composite tissue in a subject, in need of treatment, wherein the GM284 is ad.mifiist.ered to the subject an amount effective to treat the injury to the composite tissue in the subject;

6) a method tor promoting the regeneration of a bodily structure comprised of 5 composite tissue in a subject, by administering to the subject an amount of

GM284 effective to promote regeneration of the bodily structure in the subject; 7} a method for promoting the regeneration of composite tissue in a subject, by administering to the subject an amount of GM.284 effective to promote 10 regeneration of composite tissue in the subject;

8} a method for promoting the regeneration of cells of a composite tissue in a subject, by administering to the subject an amount of GM284 eftective to promote the regeneration of cells of the composite tissue;

9) a method for promoting the regeneration of cells of a composite tissue, by 15 contacting the composite tissue with an amount of GM284 effective to promote the regeneration of cells of the composite tissue;

10) a method for treating an injury to a composite tissue in a subject in need of treatment, by administering to the subject an amount of GM284 effective to treat the injury to the composite tissue in the subject.

20 |0<)!4] Additional aspects of the present invention will be apparent in view of the description that follows,

BRIEF DESCRIPTION OF THE FIGURES

10015) FIG. 1 is a schematic illustration of the chemical structure of GM284.

£0016] FIG. 2 is a photograph of dorsal aspects of the ears of an ICR

25 laboratory mouse one month after the placement of full-thickness holes into both ears, followed by daily topical administration ot GM284 to the dorsal and ventral aspects of t.be left car and daily topical administration of vehicle to the dorsal and ventral aspects of the right ear.

|OΘ17| FIG. 3 is comprised of four photographs of the dorsal aspects of the

5 twice-punctured ears of a laboratory ICR mouse. The photographs forming a column on the left show the dorsal aspect of the twice --punctured ears of a mouse treated daily with vehicle. The photographs forming a column on the right show the dorsal aspect of the twice-punctured ears of a mouse treated daily with GM284-. The upper row of photographs offers a comparison of the rate of composite tissue 10 regeneration at one week post-iesioning. The lower row of photographs offers a comparison of the rate of composite tissue regeneration at two weeks post- lesiomng.

Ji(NH 8] FIG. 4 shows a bar graph illustrating the relative rates of full- thickness puncture wound closure in GM284-tteated and vehicle-treated mice. In 15 FIG. 4, the ordinate is labeled "area remaining open" in the puncture wound and is scaled in relative units of area; and, the abscissa is labeled "days post-lesion," Taller bars to the left at days 0, 7 and 14 represent vehicle-treated mice and shorter bars to the right at. clays 0, 7 and 14 represent GM284-treated mice.

j(NH9] FIG. 5 [upper portion] shows a low-power photomicrograph on the

20 right taken from tissue indicated by straight lines to the photograph of a wounded ear on the left; and, [lower portion] shows two low-power photomicrographs on the right taken from tissue indicated by straight lines pointing to the photograph of a wounded G M284- treated ear on die let!.. |OΘ20j FIG. 6 is a set of four high-power photomicrographs a., h., c. and d., demons t.rat.i.ng that^" a full complement^" of regenerated tissue-types arc present within a G M284-- treated ear.

|OΘ2I ] FIG. 7 is a set of four photomicrographs of a mouse footpad.

DETAILED DFiSCRIFFK)N OF THFi INVENTION

J0Θ22J The inventor has discovered thai: a nonimmunosuppressive lϊgand, termed GM284, that is known to enhance axonal regeneration and induce liyperrnyeliπation following mechanical transection of peripheral nerves, promotes 10 the regeneration of composite tissue,

|CHΪ23] The structure of GM284 is depicted in FIG. 1. U.S. Pat. No.

6,809,107, entitled, "Neurotrophic pyrrolidines and piperidmes, and related compositions and methods," issued to Kanojia, et al, o.n October 26, 2004, and assigned to Ortho-McNeil Pharmaceutical, Inc. ("Ortho Patent '107"), which is 15 herein incorporated bv reference, discloses the composition and structure of

GM284. GM284 may be prepared in accordance with method described in Ortho Patent '1.0?. GM284 may be also administered for the uses and by the methods disclosed herein as a pro-drug.

|0024j It is believed that GM284 will be effective as a drug to treat injuries

20 to composite tissue, as well as many types of disorders associated with diseases of composite tissue,

J0Θ25J Tn the course of his experiments, the inventor discovered that injured composite tissue of the ears of mice treated topically with GM284 appeared dramatically different from those ot vehicle-treated animals. The inventor's

_ 7 _ analysis demonstrates that the injured composite tissue ot the ears of mice treated with GM284 healed by regeneration, as opposed to failing to heal and as opposed to scarification, when compared with controls.

[0026] Accordingly, the present, invention provides a method for promoting

5 composite tissue regeneration in a subject in need of such regeneration. As demonstrated herein, the GM284 has the ability to promote healing of a bodily structure comprised of composite tissue by promoting regeneration of the composite tissue from the margins of a wound that has excised composite tissue.

[0027] The amount of GM284 effective to promote healing of injured

10 composite tissue in a subject in need thereof will vary depending upon the particular factors of each case, including the location and size of the injury to the composite tissue , the severity of the injury, the length of time to treatment, and the method of administration. ^'This amount .may he readily determined by the skilled artisan, based upon known procedures, including clinical trials, and methods 15 disclosed herein.

[0028] A used herein, the term:

■ "composite, tissue" refers to a combination of tissues, which, in the exemplary 20 ease of a limb, includes a "composite" of skin, muscles, bones, joints, nerves, blood vessels and connective tissue; and in the exemplary case of an ear includes a "composite" of skin, cartilage, nerves, blood vessels and hair follicles;

- S - * "bodily structure" refers to an aspect, part, portion or division of a mammalian body, such as, for example, a limb, a digit, an appendage, a feature, an organ, or an organ system rhat includes composite tissue;

^■ "promoting regeneration of composite tissue" means augmenting, 5 improving, increasing, or inducing partial or full growth or tegrowt.h of composite tissue in a region of a bodily part that includes injured composite tissue;

* "growth" or "regrowth" refers to an increase in mass, volume, and/or thickness of composite tissue, and includes an increase in the proliferation

10 of cell types of which the composite tissue is comprised.

J0029J Regeneration or enhanced regeneration of composite tissue in a region of a bodily part that includes injured composite tissue may be promoted, for example, by enhancing the regeneration of cell types of which the injured composite tissue is comprised. In a subject, the regeneration of composite tissue is 15 promoted in the bodily part that includes the injured composite tissue; and, thus, contributes to the promotion of healing of the injured composite tissue in the subject.

J0Θ30J The injury to the composite tissue may be the result of trauma, ischemia or any affliction (e.g., disease, injury, surgery) that eventuates in an injuty 20 to the composite tissue, such as, for example, and without limitation, laceration, avulsion, abrasion, amputation, crash, inflammation, infection, degeneration, degradation, dystrophy, destruction or atrophy.

[0031 J The subject may be any animal, but is preferably a mammal (e.g., humans, domestic animals, and commercial animals). Mote preferably, the subject 25 is a human.

_ 9 - |OΘ32| In the method of the present invention, GM284 is administered to a subject in an amount effective to promote regeneration of injured composite tissue in the subject.

|OΘ33] As used herein, the phrase "promote regeneration of injured

5 composite tissue" means effective to ameliorate or moderate the tectonic impairment, functional impairment, clinical impairment, clinical appearance or clinical symptoms associated with an injury to composite tissue. 1'Or example, in an injury to composite tissue, the associated tectonic impairment, functional impairment, clinical impairment, clinical appearance or clinical symptoms may be 10 ameliorated or moderated by inducing of accelerating t.hε regeneration of ceil types comprising the injured composite tissue,

J0O34] In the present invention, the effective amount of GM284 is between about 1 μg/kg and about 100 μg/kg or between about: I pM and about 1.00 pM.

|(KI35j The method of the present invention may be used to promote

15 regeneration of composite tissue in a subject that includes the step of administering GM2S4 to the subject. The GM.284 is administered to the subject in an amount effective to promote regeneration of the injured composite tissue in the subject, as defined above, Tn the present invention, the effective amount of GM284 is between about 1 Jig/kg and about 100 μg/kg or between about. 1 pM and about 20 100 pM.

J0Θ36J The method of the present invention comprises contacting composite tissue with GM284. The composite tissue may be damaged or healthy/ undamaged. The composite tissue may comprise a region of composite tissue that includes an injury. The GM2S4 is contacted with composite tissue in an 25 amount effective to promote regeneration of at least wo of the cell-types of which

- 10 - 5 J0Θ37J The method ot the present invention may be used to promote regeneration of at least two of the cell- types of which the composite tissue is comprised in vitro, or in vivo in a subject. For example, GM2S4 may be contacted in vitro with facial tissue (e.g., a biopsy or plug of facial tissue removed from a subject) by introducing GM284 rø the facial tissue using conventional procedures. 10 Alternatively, GM284 may be contacted in vivo with composite tissue in a subject by administering GM284 to the subject.

J0038] It is also within the confines of the present invention that GM284 may be introduced to composite tissue in vitro, using conventional procedures, to promote regeneration of cells- types of the composite tissue in vitro. Thereafter, 15 the composite tissue may be introduced into a subject to provide cells-types of the composite tissue in vivo. In such an ex vivo approach, the composite tissue is preferably removed from the subject, subjected to introduction of GM284, and then reintroduced into the subject. The composite tissue cell- type regeneration promotes healing of an injured composite tissue in the subject.

20 10039] Accordingly, the present invention provides a method for treating an injured composite tissue in a subject in need of treatment, comprising contacting the composite tissue in the subject with GM284 (e.g., by administering GM284 to the subject), thereby treating the injured composite tissue. Injured composite tissue that may be treated by methods disclosed herein include disorders

25 characterized by injury of composite tissue cells. The GM284 is contacted with

- I l - composite tissue in a subject (e.g., administered to a subject), tor the purpose of treating an. injured composite tissue, in. an amount effective to promote regeneration of at least two cell - types of which the composite tissue is comprised.

|OΘ4β] According to the method of the present: invention, GM284 may be

5 ad.rainist.ered to a human or anima.1 subject, by known, procedures, including, without limitation, oral administration, parenteral administration (e.g., epifascial, intracapsular, intracutaneous, intradermal, intramuscular, infraorbital, intraperitoneal, intraspinal, intrasternal, intrathecal, intravascular, intravenous, parenchymatous, or subcutaneous administration), sublingual administration, 10 topical administration, transdermal administration, and administration through an osmotic mini-pump. Preferably, GM284 is administered topically.

J0041] For oral administration, the formulation of the GM284 may be presented as capsules, tablets, powders, granules, or as a suspension. The formulation may have conventional additives, such as lactose, mannitol,

15 cornstarch, or potato starch, ^".[^'he formulation also may be presented with binders, such as crystalline cellulose, cellulose derivatives, acacia, cornstarch, or gelatins. Additionally, the formulation may be presented with disintegrators, such as cornstarch, potato starch, or sodium carboxymethylcellulose. The formulation also may be presented with dibasic calcium phosphate anhydrous or sodium starch

20 glycolate. Finally, the formulation may be presented with lubricants, such as talc or magnesium stearate.

{01)42] For parenteral administration (i.e., administration by injection through a route other than the alimentary canal), the GM.284 may be combined with a sterile aqueous solution that is preferably isotonic with the blood of the 25 subject. Such a formulation may be prepared by dissolving a solid active ingredient

. 1 i _ in water containing physiologically-compatible substances, such as sodium chloride, glycine, and die like, and having a buffered p.H compatible with physiological conditions, so as to produce an aqueous solution, then rendering said solution sterile. The formulations may be presented in unit or multi-dose 5 containers, such as sealed ampoules or vials. The formulation may be delivered by any mode of injection, including, without limitation, epi fascial, intracapsular, intracranial, intracutaneous, intramuscular, intraorbital, intraperitoneal, intraspinal, mtrastemal, intrathecal, intravascular, intravenous, parenchymatous, of subcutaneous,

10 1011431 ^^oi: transdermal administration, the GM284 may be combined with skin penetration enhancers, such as propylene glycol, polyethylene, glycol, isopropanol, ethanol, oleic acid, N-methylpyrrolidone, dimethyl sulfoxide, and the like, which increase the permeability of the skin to the GM284, and permit the GM284 to penetrate through the skin and into the bloodstream, ^"[^'he

15 ligaml/ enhancer compositions also may be further combined with a polymeric substance, such as ethylceilulose, hydroxy-propyl cellulose, ethylene/vinylacetate, polyvinyl pyrrolidone, and the like, to provide the composition in gel form, which may be dissolved in solvent, such as met.hy.ienc chloride, evaporated to the desired viscosity, and then applied to backing material to provide a patch. GM284 may be

20 administered transdermal!}- at the site of an injury to the subject where trauma has occurred, or where the injury is localized Alternatively, GM284 may be administered transdermal!}¹ at. a site other than the affected area, in order to achieve systemic admini strati on.

jOΘ44| For topical administration, the GM284 may be combined with

25 additional materials that are known for use in skin-care products, or which are otherwise suitable for topical application. Such optional materials include, but are

- 13 - not limited to, disbursing agents, masking agents, preservatives, processing agents, and additives having specific pliysicochcmical properties, such as polymeric fiiπi formers and the like.

|OΘ45| GM284 may also be released or delivered from an osmotic mini-

5 pump or other rime-release device, ^'The release rate from an elementary osmotic mini- pump may be modulated with a microporoυs, fast-- response gel disposed in the release orifice. An osmotic mini-pump would be useful for controlling release, ot targeting delivery, of the GM284.

[0(146] It is within the confines of the present invention that a formulation

10 containing GM.284 may be further associated with a pharmaceutically acceptable carrier, thereby comprising a pharmaceutical composition. Accordingly, the present invention further provides a pharmaceutical composition, comprising GM284 and a pharmaceutically acceptable carrier. The pharmaceutically acceptable carrier must be "acceptable" in the sense of being compatible with the 15 other ingredients of the composition, and not deleterious to the recipient thereof. Examples of acceptable pharmaceutical carriers include carboxymethylccllulosc, crystalline cellulose, glycerin, gum arabic, lactose, magnesium stearate, methyl cellulose, powders, saline, sodium alginate, sucrose, starch, talc, and water, among others. Formulations of the pharmaceutical composition may be conveniently 20 presented in unit dosage.

[0047] The formulations of the present invention may be prepared by methods well known in the pharmaceutical arts. For example, GM284 may be brought into association with a carrier or diluent, as a suspension or solution. Optionally, one or more accessory ingredients (e.g., buffers, flavoring agents, 25 surface active agents, and the like) also may be added. The choice of carrier will

- 14 - depend upon the route of administration. The pharmaceutical composition would be useful for administering the GM284 of the present invention to a subject to promote regeneration of an injured composite tissue. The GM2S4 is provided in an amount that is effective to promote regeneration of the injured composite tissue 5 i.n a subject to whom the pharmaceutical composition is administered. That amount may be readilv determined bv the skilled artisan, as described above.

f(Kϊ48| The present invention also provides a method for promoting regeneration of composite tissue in a subject. As described above, regeneration of composite tissue in a subject may be promoted by enhancing proliferation of cells 10 of the composite tissue in the subject. Accordingly, in one embodiment of the invention, the regeneration of composite tissue is promoted at the site of an injury to a composite tissue in the subject, and, thus, contributes to the promotion of healing of the composite tissue in the subject,

J0Θ49) The present invention is described the following example, which is

15 set forth to aid in the understanding of the invention, and should not be construed to limit, in any way the scope of the invention as defined in the claims which follow thereafter,

EXAMPLE

Experimental Methods

20 JOOSOj All mice used herein were retired ICR breeders. The animals were anesthetized with an intraperitoneal injection of 200 μl of 5% Tribtomoet.hanol (Avertm®), When anesthesia was attained, the ears were cleaned with alcohol and [either one or] two holes about 3 mm in diameter were punched into the ear using a standard ear punch intended for use in permanently identifying animals. The ear

25 was chosen as the animal structure to be wounded because it is comprised of a

- 15 - composite tissue including cells of the epidermis and dermis, chondrocytes, hair follicle cells, and cells of t.be vasculature system.

I (H)S J 3 The wounded animals were returned to their cages and treatment with GM284 was begun within 2 hours of the surgery,

5 JO052] Fl G, 1 shows a schematic illustration of the chemical structure of

GM284-. GM284 was diluted to a final concentration of 10nM in diluent ("vehicle") of a 30% MeOH/ 70% polypropylene glycol solution, As diluted, 5μl of GM284 was applied topically once daily to both the ventral side and dorsal side of an ipsikteral twice-punctured ear of each mouse. The contralateral twice- 10 punctured ear of each mouse received a topical application of 5 μl ot vehicle to both the ventral side and dorsal side. These mice formed a first group,

f(KI53j In a second group, treatment was applied unilaterally using 5 μl. of

GM284 applied topically once daily to both the ventral side and dorsal side of an ipsilateral twice- punctured ear of each mouse. The contralateral twice- punctured 15 ear of each mouse received no treatment,

|(KΪ54] In a third group, treatment was applied unilaterally using 5 μl of vehicle applied topically once dailv to both the ventral side and dorsal side of an ipsilateral twice-punctuted ear of each mouse. The contralateral twice-punctured ear of each mouse received no treatment.

20 J0Θ5S] All groups of animals were maintained under standard conditions.

|CHΪ56] In order to monitor the progress of composite tissue regeneration or a failure thereof, the animals were anesthetized and photographed to compare the size ot their lesions on the 7^lfl and 14^r" post-lesion days.

- 16 - |OΘ57j At the completion of the experiments, all ot the animals were sacrificed with an overdose of Aveπin®. All of die ears were harvested and immersion fixed, in 4% paraformaldehyde in phosphate buffered saline (PBS) overnight at 4"C, followed by cryoprotection in 30% sucrose and sectioning -at 10 5 micra through the lesion sites. The sections were stained with H&E and viewed with an Olympus BX60 light microscope,

|(KΪ58| In the first, group of animals, GM2S4 was applied topically once per day unilaterally to an ipsilateral ear of following the placement of two holes in each ear. The contralateral ear was treated with vehicle.

10 10059) FIG. 2 is a photograph of dorsal aspects of the ears of an 1^"CR laboratory mouse one month after the placement of full-thickness holes into both ears, followed by daily topical administration of GM284 to the dorsal and ventral aspects of the left ear and daily topical administration of vehicle to the dorsal and ventral aspects of the right ear,

15 {0(160] As shown in FIG. 2, the holes in the left ear responded to treatment with GM284 by closing. In contrast, the holes in the contralateral right ear, treated with the vehicle only, remain open, suggesting that the actions of GM284 are local, mediated by the interactions of the drug with the local environment, FlG. 2 shows that GM284 induces regeneration of composite tissues through local actions.

20 |00(>l| FIG. 3 is comprised of four photographs of the dorsal aspects of the twice -punctured ears of a laboratory ΪCR mouse. The photographs forming a column on the left show the dorsal aspect oi: the twice-punctured ears of a mouse treated daily with vehicle. The photographs forming a column on the right show the dorsal aspect ot the twice-punctured ears of a mouse treated daily with GM284.

25 The upper row of photographs offers a comparison of the rate of composite tissue

- 17 - wound regeneration at one week post-lesioning, The lower row of photographs offers a comparison of the rate of composite tissue wound regeneration at two wee ks pos t-lesioning,

[0062] FIG. 3 demonstrates that as early as one week following lesioning, the

5 GM284-treated composite tissue of the right ear showed significant, regeneration, whereas the vehicle -treated composite tissue of the left ear showed virtually no signs of regeneration (compare the upper row of photographs in FIG. 3), MG, 3 further demonstrates that at two weeks following lesioning, the GM284 -treated composite tissue of the right ear showed near complete regeneration, whereas the 10 vehicle- treated composite tissue of the left ear continued to show virtually no signs of regeneration (compare the lower row of photographs in FIG. 3).

J0063] Quantitation of the extent of tissue regeneration (at one week] revealed that the GM284-treated composite tissue of the right ear regenerated to an extent that left about 2/3 of the area of the original wound open, whereas the 15 vehicle-treated ears remain unchanged. As shown in FIG. 3, the lesions are 95% closed by the 14^rti day of treatment, while no significant regeneration is seen in the control animals. Treatment with GM284 rapidly induced composite tissue regeneration

(0064] Inspection revealed that holes in the vehicle-treated mouse ears did

20 not close under baseline conditions. Rather the edge of the untreated wound takes on die appearance of scat tissue.

[0065] FIG. 4 shows a bar graph illustrating the relative rates of full- thickness puncture wound closure in GM284-tteated and vehicle-treated mice. In FIG. 4, the ordinare is labeled "area remaining open" in the puncture wound and is 25 scaled in relative units of area; and, the abscissa is labeled "days post-lesion."

- 18 - Taller bars to the left at days 0, 7 and 14 represent vehicle-treated mice and shorter bars to die right, at. days 0, 7 and 1 4 represent. GM284-t.reatcd mice. FIG. 4 demonstrates that at 14 days post- lesion the area of wounding in GM284 - treated mice has all but closed; whereas, the area of wounding in vehicle-treated mice has 5 decreased in substantially,

f(H⁾66] FϊG. 5 [upper portion] shows a low -power photomicrograph on the right taken from tissue indicated by straight, lines pointing to the photograph of a wounded ear on the left; and, power portion] shows two low-power photomicrographs on the right taken from tissue indicated by straight lines

10 pointing to the photograph of a wounded GM284-treated ear on the left. The area in the curly bracket in the upper left micrograph shows the area of scar formation in the vehicle treated ear, which is absent in the drug-treated tissue. The thin arrows point to the band of chondrocytes that run down the middle of the ear, which have regenerated up to the distal-most, end of the treated ear, and the

15 thick arrowheads show newly generated blood vessels in the distal, regenerated ear.

|O(I67] Histological analysis of the G M284- treated composite tissue- demonstrates a remarkable degree of regeneration of the complex components of the ear. Low-power micrographs, such as those shown in FlG. 5 [lower portion], reveal that both of the leading edges of the G M284- treated ear are visible, as they 20 have regenerated sufficiently that both are visible in the same microscopic field. In contrast, in FJG. 5 [upper portion], only one side of the vehicle -treated tissue can be seen in the micrograph at the same magnification due to a failure to regenerate.

|0i)68j liven, at the low-power microscopy of FIG . 5, a scar is visible at the distal end of the vehicle-treated tissue [upper portion, bracketed area on right J₁ 25 which is filled with amorphic, fih-rotic material By contrast, the distal aspects of

- 19 - the G M 284- treated composite tissue is well-tormed, with clearly identifiable tissues within the growing car. The regenerated tissues include a band of chondrocytes growing in the middle of the ear, intact dermis and epidermis, and blood vessels that grow up to the distal end of the ear bud.

5 j^"OΘ69j FIG. 6 is a set of tour high-power photomicrographs a., b., c. and d., demonstrating that a full complement of regenerated tissue- types are present within a GM284-treated ear. Micrographs a, and c, are control, vehicle treated tissue; micrographs b. and d. are GM284 treated tissue. The triangular arrowheads point to newly formed blood vessels; asterisk marks sebaceous glands present in 10 the newly regenerated tissue.

|0070j In FlG. 6:

a) photomicrograph a, shows the scar- containing stump of the vehicle treated ear;

b) photomicrograph b. shows regenerated cartilage that, has grown to the very 15 distal end of a GM2S4-treated ear. Adjacent to the new cartilage there are numerous small blood vessels that have regenerated as well j triangular arrow-heads], which are not seen in the distal-most region of the vehicle- treated tissue;

c) photomicrograph c. shows a band of chondrocytes that runs through the 20 middle of an undamaged region of a vehicle-treated ear; and,

ά) photomicrograph d. shows the regeneration of sebaceous glands [asterisks] in a GM284- treated ear.

Taken together, these data demonstrate that, treatment with GM2S4 results in the full regeneration of the composite tissues of the ear.

- 20 - |OΘ?i ] FIG. 7 is a set of four photomicrographs of a mouse footpad.

Micrographs a. and b. arc low power (4X) images; micrographs c. and d. arc higher power images (20X). In FIG. 7, image a. is microphotograph of a histological section of an intact mouse foot pad that^" has received a daily application ot GM284. 5 Image a, shows that, the daily application of GM284 to the intact mouse footpad does not result in any readily identified, alterations in the histological appearance of the tissues.

f 0072 i .In FIG. 7, image b. is a rmcrophofograph of a histological section of a mouse footpad in which a small incision has been made in the footpad prior to 10 daily application of GM2S4. Image b. shows that the wounded tissue to which

GM284 has been applied responds by generating numerous well formed sebaceous glands.

|(HJ73] These findings are significant in that the moose foot, pad, much like the palm of the human hand, is glabrous, and, as such, it is normally without these

15 structures, lliese finding are also consistent with observations that treatment with GM284 induces structures that are thought to be the normal repository of skin stem cells (Ghazizadeh, S. & Taichman, L.B., Multiple classes of stem cells in cutaneous epithelium: a lineage analysis of adult mouse skin, Hmbβ / 20, 1215-22 (2001); Ferraris, C, Bernard, B. A. & Dhouailly, D., Adult epidermal keratinocytes

20 are endowed with pilosebaceous forming abilities, ϊntj Dev Biol 41, 491 -8 (1997)).

|OΘ74j The foregoing unexpected results demonstrate that topical application of GM0284 results in the regeneration of the mouse ear, a composite structure that comprises cartilage, blood vessels and skin, with a full compliment of intradermal structures.

- 21 - |0θ?5] The foregoing unexpected results expand the therapeutic potential of

GM284 beyond the inventor's previous showing (^"hat^" treatment^" of damaged tissues with GM284 results in anatomical regeneration as well as restoration of physiological function, including the regeneration of skin (dermis, epidermis and 5 intradermal structures), LLS. Publication No. 20040092440, the regeneration of cardiac myocytes following ischemia, U.S. App, No, 11 /670964, and the regeneration of sensory and motor nerves U.S. Publication No. 20040026681.

|0076| Importantly, there are no observed anatomical, histological or functional effects of GM284 on normal, undamaged tissue, suggesting that GM284 10 exerts its regenerative effects preferentially - - only on damaged tissue - - and to the exclusion of scarring.

J0O77] The foregoing unexpected results are in contradistinction to the scarring and disfigurement chat, ensues when, the ear is untreated or vehicle-treated,

J0Θ78J While regeneration often phenocopies some aspects of development,

15 the two biological processes differ in significant ways. These differences are especially apparent in the regeneration of composite tissue, ϊn the case of the ear, the tissue develops en tota from an anlage of the ear bud first seen at day 1 1.5 of mouse embryonic development (Kaufman, M.H., The Adas ofAlouse Development, xvi, 512 (Academic Press, .London; San Diego, 1992)), with each tissue type 20 entering in stereotyped manner.

J0079] In contrast, the wounded composite tissue created at the margins of the boles punched in die mouse ears that are the subject of this disclosure, which regenerates to closure under the influence of GM284, does so in an environment that, is very different, from, the H 11.5 ear bud. The regeneration of the wounded 25 composite tissues requires that each of the cell -types in the affected area respond both by proliferating and by interacting with the other cell-types to repopulate the excised tissues in. a highly organized manner.

JΘ08Θ] One hypothesis for this capability is that the needed cell-types are recruited from distal reserves to repopulate damaged regions. Another hypothesis 5 is that. GM284 acts locally to alter the proliferative and cell-fate choices of proximal cell- types to repopulate damaged regions. The inventor's finding that GM284 acts locally is consistent with the later hypothesis. It is likely that. GM284 acts to accelerate cell-cell interactions that mediate regeneration.

{0081 j GM284 has no functional or histological effects on undamaged

10 tissues supports our hypothesis that GM284 acts preferentially on damaged composite tissues to drive them into a regenerative rather that forming scar tissue.

|CMI82] GM2S4 promotes composite tissue regeneration to contribute to the reformation of intact composite tissues that is substantially indistinguishable in appearance and function from normal, undamaged tissue.

15 {(1(183] While the foregoing invention has been described in some detail for purposes of clarity and understanding, it will be appreciated by one skilled in the art, from a reading of the disclosure that various changes in form and detail can be made without departing from the true scope of the invention in the appended claims.

- 23 -

Claims

1 What Is claimed is:

2

3 1. A method for promoting the regeneration of a bodily structure

4 comprised of composite tissues in a subject, comprising the step of administering

5 to the subject, an amount, of GM284 effective to promote the regeneration of the

6 bodily structure in the subject.

7

8 2. The method of Claim 1, wherein the regeneration of the bodily

9 structure is promoted in the subject by promoting composite tissue regeneration. 10

1 1 3. The method of Claim 2, wherein the regeneration of the bodily

12 structure in the subject is promoted by regenerating cells of the composite tissue. 13

14 4. The method of Claim 1, wherein the subject is a mammal.

15

16 5. The method of Claim 4, wherein the mammal is a human.

17

18 6. The method of Claim 1, wherein the amount, of GM284 is between

19 about 1 fig/kg and about 100 μg/kg, inclusive of the indicated dosage en.dpo.ints. 20

21 7. The method of Claim 1, wherein the amount of GM284- is between

22 about 1 nig/ kg and 5 mg/kg, inclusive of the indicated dosage enclpoints. 23

24 8. The method of Claim 1, wherein the amount of GM284 is between

25 about 1 pM and about 100 pM, inclusive of the indicated dosage endpoints.

26

- 24 - 1 9. The method of Claim 1 , wherein the GM284 Is administered to the

2 subject by oral administration, parenteral administration, sublingual admirxist.rat.ion,

3 topical administration, transdermal administration, or osmotic pump. 4

5 10. A method for promoting composite tissue regeneration in a subject,

6 comprising the step of administering to the subject an amount of GM284 effective

7 to promote composite tissue regeneration in the subject. 8

9 1 1 . The method of Claim 10, wherein the. composite tissue regeneration

10 in the subject is promoted by promoting regeneration of ceils of the composite

11 tissue in the subject, 12

13 12. The method of Claim 11, wherein the composite tissue regeneration

14 is promoted in the region of an injury to a composite tissue in the subject. 15

16 13. The method of Claim 10, wherein the subject is a mammal.

17

18 14. The method of Claim 13, wherein die mammal is a human.

19

20 15. The method of Claim 12, wherein the amount of GM284 is between

21 about 1 fig/ kg and about 100 μg/kg, inclusive of the indicated dosage endpoints. 22

23 16. The method of Claim 12, wherein the amount of GM284 is between

24 about. 1 mg/kg and about 5 μg/kg, inclusive of the indicated dosage endpoints. 25

- 25 - 1 17. The method of Claim 12, wherein the amount of GM284 is between

2 about 1 pM and about 100 pM, inclusive of die indicated dosage eπdpoints. 3

4 18. The method of CI.ai.rn 12, wherein the GM284 is administered to the

5 subject by oral administration, parenteral administration, sublingual administration,

6 topical administration, transdermal administration, or osmotic pump. 7

8 19. A method for promoting the regeneration of cells of a composite

9 tissue, comprising contacting the composite tissue with an amount of GM284 10 effective to promote the regeneration of cells of the composite tissue.

11

12 20. The method of Claim 19, wherein the contacting is effected in vitro,

13

14 21 , The method of Claim 19, wherein the contacting is effected in vivo

15 in a subject. 16

17 22. Hie method of Claim 21, wherein the regeneration of cells of the

18 composite tissue promotes healing of a wound in the composite tissue in the

19 subject. 20

21 23. The method of Claim 19, wherein the contacting is effected in vivo

22 in a subject by administering GM284 to the subject. 23

24 24. The method of Claim 23, wherein the GM284 is administered to the

25 subject by oral administration, parenteral administration, sublingual administration,

26 topical administration, transdermal administration, or osmotic pump.

- 26 - 1

2 25. The method of Claim 21 , wherein the subject is a mammal.

3

4 26. Hie method of Claim 25, wherein the mammal is a human.

5

6 27, The method of Claim 26, wherein the human has an Injury to the

7 composite tissue. 8

9 30. The method of Claim 24, wherein the amount of the GM284 is

10 between about. 1 pM and about K)OpM, inclusive of the indicated dosage endpoints 11

12 31. A method for treating an injury to a composite tissue in a subject in

13 need of treatment, comprising administering to the subject an amount of GM284

14 effective to treat die injury to the composite tissue in the subject. 15

16 17 18

- 27 -