Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
  • A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
• • 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
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/18—Growth factors; Growth regulators
• • 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
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/18—Growth factors; Growth regulators
  • A61K38/1833—Hepatocyte growth factor; Scatter factor; Tumor cytotoxic factor II
• • 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
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/22—Hormones
  • A61K38/30—Insulin-like growth factors, i.e. somatomedins, e.g. IGF-1, IGF-2
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
  • A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
  • A61K9/1605—Excipients; Inactive ingredients
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
  • A61K9/50—Microcapsules having a gas, liquid or semi-solid filling; Solid microparticles or pellets surrounded by a distinct coating layer, e.g. coated microspheres, coated drug crystals
  • A61K9/5005—Wall or coating material
  • A61K9/5021—Organic macromolecular compounds
  • A61K9/5031—Organic macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyethylene glycol, poly(lactide-co-glycolide)
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/16—Drugs for disorders of the alimentary tract or the digestive system for liver or gallbladder disorders, e.g. hepatoprotective agents, cholagogues, litholytics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/18—Drugs for disorders of the alimentary tract or the digestive system for pancreatic disorders, e.g. pancreatic enzymes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/10—Drugs for disorders of the urinary system of the bladder
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/12—Drugs for disorders of the urinary system of the kidneys
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/14—Vasoprotectives; Antihaemorrhoidals; Drugs for varicose therapy; Capillary stabilisers

Definitions

• the present disclosure relates to pharmaceutical formulations suitable for targeting particular tissue and/or organ(s) with a formulated active ingredient, for example when administered upstream of the target organ or tissue.
• the disclosure also relates to use of the same in treatment, methods of treatment administering the same and methods of preparing the formulations.
• growth factors and cytokines are employed to stimulate the intrinsic regenerative capacity of solid tissues by activating its resident stem cell population using a device, such as a catheter, for the localized delivery of the active compounds to the target tissue.
• medicines/pharmaceuticals are administered systemically, for example orally, intravenously, by vaccine, intramuscularly or the like. Notable exceptions are stents coated with active ingredients, certain respiratory formulations delivered directly to the lungs, certain radiotherapies which are directed to target areas and certain dermatological, ophthalmological, and otological treatments which are administered topically.
• Figure 1 Shows distribution and characterization of c-kit pos cardiac cells in the adult porcine heart.
• Figure 2 Shows light microscopy images showing various expanded porcine cardiac cells
• Figure 3 Shows H&E staining of GF -treated porcine hearts
• Figure 5 Shows regenerating bands of small, newly formed cells
• FIG. 6 Shows various images of newly formed tissue
• Figure 7 Show an optical microscope image of PLGA particles with IGF-I prepared as per Example 1.
• Figure 8 Show an electron micrograph of PLGA particles with IGF-I prepared as per Example 1.
• Figure 9 Shows sections of porcine heart.
• Figure 10 Shows sections of porcine myocardium after administration of polystyrene microspheres or PLGA and growth factor microspheres.
• Figure 11 Shows sections of porcine heart wherein endogenous cardiac stem cells are highlighted.
• Figure 12 shows histological images of control and damaged quadriceps muscle.
• Figure 13A compares the effect in the number of regenerated cardiac myocytes in pigs post-AMI treated with a combination of two types of microspheres
• Figure 13B shows the left ventricle ejection fraction prior to, immediately after and 4 weeks post-AMI as determined by echocardiography of the pigs treated with different combinations of microspheres
• the present disclosure provides a pharmaceutical formulation for parenteral, especially intra-arterial, administration to a target tissue comprising particles containing an active ingredient and a biodegradable polymer excipient, wherein 30% or more of the particles have a diameter of 25 microns or less and the formulation is substantially free of particles with a diameter greater than 50 microns, such that where the formulation is administered upstream of the target tissue the ability of the active ingredient to pass through the target tissue and pass into systemic circulation is restricted.
• a pharmaceutical formulation for parenteral administration to a cardiac tissue comprising particles containing an active ingredient and a biodegradable excipient, wherein 90% or more of the particles have a diameter of between 10 and 20 microns and the formulation is substantially free of particles with a diameter greater than 50 microns and less than 5 microns, such that where the formulation is administered upstream of the target tissue the ability of the active to pass through the target tissue and pass into systemic circulation is restricted.
• at least 90%, of the particles of the pharmaceutical invention have a diameter that is between 15 and 20 microns.
• a pharmaceutical formulation for parenteral, e.g. intra-arterial, administration to a cardiac tissue comprising particles containing an active ingredient, selected from the group consisting of HGF and IGF-I , and a biodegradable excipient, wherein 90% or more of the particles have a diameter of between 10 and 20 microns and the formulation is substantially free of particles with a diameter greater than 50 microns and less than 5 microns, such that where the formulation is administered upstream of the cardiac tissue the ability of the active to pass through the cardiac tissue and pass into systemic circulation is restricted.
• an active ingredient selected from the group consisting of HGF and IGF-I
• a biodegradable excipient wherein 90% or more of the particles have a diameter of between 10 and 20 microns and the formulation is substantially free of particles with a diameter greater than 50 microns and less than 5 microns
• formulations of the present disclosure when administered in the arterial blood upstream of the target tissue or organ, are carried into the target tissue or organ by the circulation and due to the particle size and distribution lodge, in other words are trapped or caught in the capillaries in the tissue or organ, which are about 5-10 ⁇ rn in diameter. Particles lodging in capillaries and blocking blood flow is not generally desirable but the number of capillaries affected by the formulation of the disclosure is relatively small, particularly as the formulation enables very low therapeutic doses to be employed. Furthermore, the biodegradable excipient melts, dissolves, degrades or in some way disassociates itself from the active and thus ultimately the "blockage" is removed.
• the movement of the particle is restricted/retarded by lodging in capillaries, a reversible process which returns the capillaries back to the natural condition after a short period. Retarding the movement of the particle for a short period allows the active to be maintained in the vicinity of the target for an appropriate amount of time to facilitate local action or absorption of the active into the extravascular space of the tissue.
• the formulation is designed such that most, if not all the active is released from the particle while immobilized in the target tissue vascular bed. Once the active load is released the particle is designed to be degraded and its constituent materials released into the general circulation to be either metabolized or eliminated through the liver and/or kidney.
• the present disclosure provides a pharmaceutical formulation for parenteral administration to a target tissues comprising particles containing an active ingredient and a biodegradable excipient, wherein 30% or more of the particles have a diameter of 25 microns or less and the formulation is substantially free of particles with a diameter greater than 50 microns, such that where the formulation is administered upstream of the target tissue the active is retained in the target tissue or organ for a therapeutically effective period.
• the formulations of the present disclosure allow lower quantities of active ingredients to be employed because the majority of active is retained in the target tissue rather than being taken into the systemic circulation. This seems to increase the therapeutic window of the active. That is to say the dose range over which the ingredient is therapeutically active is increased allowing smaller absolute quantities to be administered. Local administration of a lower dose means that side effects are likely to be minimised.
• Suitable doses are, for example in the range 0.05 ⁇ g/Kg to about lO ⁇ g/Kg, such as O.l ⁇ g/Kg to about 0.5 ⁇ g/Kg, in particular 0.15, 0.2, 0.25, 0.35, 0.4 or 0.45 ⁇ g/Kg.
• Administrating lower doses locally for therapeutic effect is particularly important for potent molecules, for example growth factors, which are known to have potential to stimulate oncogenesis. These potentially harmful side effects limit the utility of such molecules even though in the right circumstance they produce therapeutically beneficial effects.
• the formulations of the present disclosure do not employ microspheres comprising a polystyrene, silica or other non-biodegradable bead with active ingredient attached thereto, because enduring resilient materials i.e. non-biodegradable materials such as polystyrene and silica may cause damage to local capillaries, and may act as foreign bodies and produce local inflammatory reactions. Moreover, such nonbiodegradable beads might eventually gain access to the systemic circulation and may then, for example accumulate in distant tissue such as the lungs and liver, all of which are undesirable. Generally, each particle will comprise active and excipient. It is not intended that the description of the formulation refer to discrete particles of active and separate particles of biodegradable polymer in simple admixture.
• Substantially free of particles over 50 microns as employed supra is intended to refer to formulations that meet the criteria to be administered as a parenteral formulation set down in the US pharmacopeia and/or European pharmacopeia.
• substantially free may include containing less than 5% of said particles, particularly less than 1%, for example less than 0.5%, such as less than 0.1%.
• the at least 50%, at least 60%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 98% such as at least 99% of the particles have a diameter of 25 microns or less.
• the particle size is in the range 6 to 25 microns, such as 10 to 20 microns, particularly 15 or 20 microns, for example at least 50%, at least 60%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 98% such as at least 99% of the particles are the relevant size or within said range.
• at least 95%, at least 98% or at least 99% of the particles of the pharmaceutical composition have a diameter of between 10 and 20 microns.
• at least 95%, at least 98% or at least 99% of the particles of the pharmaceutical composition have a diameter of between 15 and 20 microns.
• the formulation does not contain particles less than 1 micron in diameter.
• the formulation does not contain particles less than 5 microns in diameter.
• At least 30% of the particles with the active are retained in the target tissue after administration, for example at least 40%, at least 50%, at least 60%, at least 70%, such as at least 80% or more of the active particles are retained.
• the active particle is retained in the target tissue or organ for a period in the range 5 minutes to 24 hours, for example 30 minutes to 5 hours, such as 1 , 2, 3 or 4 hours.
• the period that the formulation is retained in the relevant tissue or organ depends primarily on the excipient or the combination of excipients employed.
• the properties required from the excipient in vivo are that:
• biodegradable that is to say it is capable of being processed or metabolised
• a biodegradable polymer excipient suitable for use in the present disclosure is a polymer or co-polymer that does not have a long residency time in vivo, ie would not include entities such a polystyrene, polypropylene, high density polyethene and material with similar properties.
• Biodegradable polymers must be non-toxic and broken down into non-toxic sub-units preferably locally, such that the amount of circulating fragments/debris from the excipient are minimised.
• Suitable excipients can be found in the United States Pharmacopeia (USP) and include inorganic as well organic, natural and man-made polymers. Examples may include polymers such as polylactic acid, polygycolide or a combination of the same namely polylactic co-glycolic acid, polycaprolactone (which has a slower rate of biodegradation than polylactic co-glycolic acid), polyhydroxybutyrate or combinations thereof.
• USP United States Pharmacopeia
• examples may include polymers such as polylactic acid, polygycolide or a combination of the same namely polylactic co-glycolic acid, polycaprolactone (which has a slower rate of biodegradation than polylactic co-glycolic acid), polyhydroxybutyrate or combinations thereof.
• Polyurethanes polysaccharides, proteins and polyaminoacids, carbohydrates, kitosane, heparin, polyhyaluronic acid, etc may also be suitable
• the excipient is generally in the form of a particle, an approximate sphere (microsphere) to which the active can be attached or with which the active is associated or incorporated within.
• Liposomes are not biodegradable polymer excipients within the meaning of the present disclosure. Liposomes are vesicles of a phospholipid bilayer generally comprising cholesterol. For diseases such as myocardical infarction induced by arterio sclerosis cholesterol levels are monitored as one of the risk factors for the disease and thus it may be advisable to avoid administering cholesterol containing formulations to such patients. In addition patients with liver cirrhosis may have increased difficulty metabolising lipids and dietary fats, therefore administration of liposomes to such patients may not be advisable.
• the biodegradable excipient is not a hydrogel (a continuous phase of a corresponding colloidal dispersed phase).
• both the rate of "release” of the active and the rate of “dissolution” of the particle can be altered by altering the excipient or/and the method of binding the active to the excipient, so for example employing polycaprolactone would provide a particle which takes longer to dissolve or disintegrate than a corresponding particle employing polylactic co-glycolic acid. If the active is embedded within the excipient it will be released more slowly than if it is on the surface of the particle. If on the surface and bound by electrostatic charge it will be released faster than if covalently bound.
• the excipient comprises polylactic co-glycolic acid.
• substantially all the particles for example 80, 85, 90, 95, 96, 97, 98, 99 or 100% of the particles comprise polylactic co-glycolic acid.
• polylactic co-glycolic acid is in the ratio 75:25 respectively.
• excipient comprises two or more distinct polymers, the term polymer includes co-polymers.
• the excipient may include an acrylate polymer, for example a methacrylate polymer.
• the particle comprises alginate.
• the excipient comprises a biodegradable form of polyurethane.
• the excipient is in the form of a microsphere.
• the disclosure employs a polyvinyl alcohol microsphere formulation.
• the microspheres are not albumin.
• the active(s) employed are encapsulated within a biodegradable coating for example selected from the Eudragit range.
• one or more active molecules are embedded within the particle.
• the active compounds to perform, as described in the present disclosure they need to be administered into the circulation as a microparticle which because of its size, morphology and composition will travel with the blood flow to reach its target tissue.
• the particle should release its active load in a controllable manner. To accomplish this goal, once unloaded, the particle should be degraded and its constituents either metabolized or delivered into the systemic circulation to be eliminated by the normal excretion systems of the body.
• microparticles should fulfill the following characteristics:
• the microparticles should be of uniform size and morphology in order to insure that they reach and become lodged at the designed level of the circulatory system. Uniformity of size and shape is better controlled when the particles are spherical.
• the microspheres of this disclosure should have a diameter >6 microns, and preferably of ⁇ 15 microns. Particles in the range of 20 microns in diameter or larger lodge into pre-capillary arterioles or arterioles and block the blood flow to several capillaries at once. Therefore, they might create microscopic infarctions. Thus for the delivery of regenerative therapies the most suitable diameter of the microspheres is in the range of 15 microns. In addition, however, particles having diameters of 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 16, 17, 18, 19, 20, 21, 22, 23, 24 and 25 are contemplated for use according to the present invention.
• the time required to release the active compound once they have reached their target could range from minutes to days and even weeks, depending on the type of microsphere and the therapeutic goal.
• the microspheres should be made with a biodegradable and non-toxic compound.
• the stability of the particle and its degradation time will depend on the composition and type of the microsphere. It might be designed to deliver its load before it starts degrading; alternatively it might be designed so that the delivery of its load occurs as the particle disintegrates.
• the nature of the polymer used as excipient, its size, lability of the bonds between the monomers and degree of cross-linking, if any, will affect the rate of release of the active as well as the stability and degradability of the particle.
• the microspheres should be stable enough in solution for them not to substantially break or degrade during their administration into the circulation and the time required for them to reach the target vascular bed.
• each particle will carry a single type of active compound.
• a mixture of microparticles each loaded with a single type of compound, may be administered. This design simplifies the production of the therapeutic compounds and offers greater therapeutic flexibility, thereby allowing individualized medicaments to be prepared rapidly to meet the patient's individual specific needs.
• a particle(s) employed has/have only one type of active molecule bound to it/them. In one embodiment a particle(s) employed has a mixture, such as two, three or four active molecules bound to it.
• the active compound might be loaded onto the particle at the time of its formation and, for example be dispersed throughout the particle.
• the active compound may be encapsulated inside the particle where the excipient forms the shell of the microsphere.
• active(s) are bound to a particle(s) by covalent bonds, for example a polypeptide or protein is bonded to a microsphere through cross-linking by treatment with an aldehyde such as formaldehyde or glutaldehyde, for example by emulsifying the microsphere (or ingredient of the microspheres) in the presence of the active(s), a suitable aldehyde and homogenizing the mixture under conditions suitable for forming particles of the required size.
• the active may be bonded to a carboxylate group located on the excipient microsphere.
• the active(s) are bound to a particle(s) by electrostatic forces (charge).
• the active(s) are bound to a particle(s) through a polyelectrolyte such as, for example comprising sodium, potassium, magnesium and or calcium ions with chloride counter ions in aqueous solution.
• the active(s) are bound to a particle(s) between layers of polyelectrolytes.
• the active compound may be loaded on the surface of the particle either by charge (electrostatic forces) or covalently bound.
• the active(s) is/are bound to the particle by electrostatic charge.
• the active(s) is/are bound to the particle by polyelectolytes, for example by means of a polyelectrolyte shell covering the particle onto which the active attaches by charge.
• the active compound may form a single layer on the surface of the particle or might be deposited in multiple layers either contiguous or separated by polyelectrolyte layers.
• the active compound may be bound to the particle by means of "linkers" which on one hand bind to the excipient matrix and on the other to the active compound. These bonds might be either electrostatic or covalent.
• microparticles may for example be stabilized by lyophilization. Microparticle may also be stable when frozen.
• the excipient is degraded rapidly in the range of minutes to hours, or over a longer period such as weeks to months.
• the formulation is such that once in the circulation one or more actives is/are rapidly released for example in period in the range of 1 to 30 minutes to about 1 to 12 hours.
• the disclosure relates to a mixed population of particles that is to say, particles with different rates of "dissolution", which may be used to provide a formulation with controlled or pulsed release.
• formulations of the disclosure can comprise particles with different release kinetics and degradation rates.
• the active is released over a period of 1 to 24 hours. In one embodiment the active is released over a period of 1 day to 7 days.
• all the formulation of the disclosure is metabolized within 7 days of administration.
• the active(s) is/are released very slowly, over a period weeks to months, for example 1 week to 1, 2, or 3 months.
• the population of particles is well characterized and for example has the same characteristics. That is to say the physical and/or chemical properties of each particle fall with a narrow defined range.
• the size of the microspheres is monodispersed.
• the particles of the formulation have mean particle size with a small standard deviation, for example at least 68% of particles have a size +/- 1 micron of the mean, such as 99% of particles have a particle size +/- 1 micron of the mean (eg 15 +/- 1 microns).
• compositions wherein the particles have at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 96%, at least 97%, or at least 98% of particles within +/- 1 micron of the mean are contemplated by the present invention.
• the formulation comprises a population of particles characterized in that the populations contains at least two distinct types of particle, for example the distinct particles may have different actives, coatings, particle size or a combination of the same.
• the disclosure relates to a mixed population of particles comprising particles of active in admixture with particles of one or more further distinct actives.
• the particle size and distribution of the formulation influences the in v/vo profile of the formulation including how the formulation in distributed in the tissue. It seems that is insufficient to simply have a mean particle size within the range 10 to 20 microns because this allows some particles to have a much larger particle size and also a much smaller particle size. This variation can cause problems in vivo because, for example the small particles are not retained with the relevant tissue and the larger particles can damage the tissue.
• the amount of active :excipient employed may be in the ratio 1%:99% w/w,
• the microsphere employed has a half life of about 16 hours.
• the formulation is lyophilized.
• the formulation is frozen.
• the particles of the disclosure are not magnetic to an appreciable extent.
• the active ingredient may be any medicine or pharmaceutical that may be administered in the form of a particle according to the disclosure.
• 15 x 10 6 particles are administered, such as 14 x lO 6 , 13 x lO 6 , 12 x lO 6 , 11 x 10 6 , 10 x 10 6 , 9 x 10 6 , 8 x 10 6 , 7 x 10 6 , 6 x 10 6 , 5 x 10 6 , 4 x 10 6 , 3 x 10 6 , 2 x 10 6 or 1 x 10 6 particles are administered.
• a particle as employed herein may comprise, for example micronized drug, semisolid or hydrated entities such as proteins or biologically derived actives formulated as discrete particles provided the particle maintains its structure for a sufficient period to perform the required function.
• the disclosure also extends to particles with a liquid core provided that the external integrity of the particle is such that is can perform its function in vivo. The disclosure does not extend to particles with a gas core.
• Microspheres may be fabricated by emulsifying a polymer solution, followed by evaporation of solvent. In other instances monomers are emulsified followed by thermal or UV polymerization. Alternatively, a polymer melt is emulsified and successively cooled to solidify the droplets. A size reduction of the emulsion can be obtained by homogenizing or sonicating the bulk. The microspheres can be collected by filtering and/or centrifuging the reaction mixture.
• Biodegradable microspheres and microcapsules of biopolymers for the controlled release and targeted delivery of different pharmaceutical compounds and therapeutic macromolecules have been long known in a number of forms, particularly those of relatively large diameters as described in the present disclosure (see D. D. Lewis “Biodegradable polymers and drug delivery systems” M. Chasin and R. Langer, editors (Marcel Dekker, New York, 1990); J.P. McGee et al, J. Control. Release 34:77, 1995).
• Microspheres and microcapsules are routinely produced by mechanical-physical methods such as spraying constituent monomers into microdroplets of the size followed by either a drying or polymerization step. Such microparticles can also be formed through emulsification followed by removal of the emulsifying solvent (B. Miksa et al.,
• This process may require that all the components of the microparticle be combined into a single mixture (the focused compound) from which are generated the microdroplets that will form the microparticles.
• the mixture requires emulsifying to ensure a homogeneous composition is obtained before the microparticles are formed.
• particles may be prepared, for example by aspirating a solution of active into microspheres in a convection current, from a nozzle with a net electric charge toward a plate or entity with a counter charge, in an anode/cathode type arrangement.
• particles employed have a net electric charge, for example a positive charge or negative charge. This may, for example assist the particle's movement being retarded in the target tissue or organ.
• This net charge may be balanced in the formulation for administration by counter ion spheres (for example without active) of a small dimension, for example less than 5 micron, which are not retained within the target tissue after administration.
• the active ingredient is a biological molecule or derived therefrom, for example a protein such as an antibody or a growth factor, a cytokine or combination of entities.
• formulations of the disclosure are, particularly useful for targeting/activating resident stems cells found in the relevant tissue.
• the disclosure is used to activate the resident stems, progenitors and/or precursors of a particular tissue or organ to stimulate regeneration of said tissue or organ.
• the disclosure relates to localized administration of ligands for the receptors expressed by the stem cells present in the post-natal tissue for initiation of regeneration of the same.
• the ligand may, for example be a growth hormone as described herein.
• the ligands are administered to activate the receptors present on the most undifferentiated stem cells present in each target tissue. These cells express the so-called “multipotency genes", such as Oct 4, Sox2, Nanog, etc. and they have a potent regenerative capacity (hereafter known as Oct4-expressing stem cells).
• the ligand is administered to the heart to minimize and/or regenerate tissue damage for example caused by myocardial infraction.
• MI myocardial infarction
• the survival post-MI depends in large measure on the size of the infarct (% of muscle mass lost) due to the ischemic event.
• the loss affects ⁇ 40-45% of the left ventricular mass it produces an irreversible cardiogenic shock which is uniformly lethal (Page et al., 1971. N. Engl. J. Med. 285; 133).
• This segmental myocardial loss produces a reorganization of the reminder myocardium with increased cell death by apoptosis, hypertrophy of the surviving myocytes, increased fibrosis of the tissue and dilation of the ventricular chamber (Pfeffer, M.A. & Braunwald, E., 1990.
• VEGF vascular endothelial growth factor
• the goal of the therapeutic approaches to the acute MI is to restore the blood flow the damaged muscle as soon as possible to prevent further muscle loss.
• reperfusion therapies include the use of thrombolytic agents, balloon angioplasty or bypass surgery. In the USA in 1998 >500,000 angioplasties and a similar number of surgical bypasses were performed. These therapies often are successful in restoring blood flow to the ischemic muscle, but none are able to replace a single muscle cell already lost at the time of the intervention. If this loss has been substantial, the long term consequence is an inability to generate the required cardiac output which will inexorably evolve to terminal heart failure.
• the formulations of the present disclosure allow the administration of the therapeutically active molecules to be administered in a form where the tissue or organ such as the heart can be targeted specifically to regenerate tissue, for example damaged by obstruction of an artery, by stimulating stem cells already present in the tissue to regenerate.
• stem cell is used here to identify a cell that has the properties of self- renewal (generate more cells like itself), is clonogenic (can be expanded starting from a single cell) and it is pluripotent; that is it can produce a progeny which will differentiate into different cell types, often present in the tissue where they reside. That is, the cells originated from a stem cell will acquire particular cellular specializations characteristic of the tissue or organ from which the stem cell originated or into which it is transplanted (Stem Cells: A Primer. 2000. National Institutes of Health USA).
• pluripotent refers to cells which are capable of differentiating into a number of different cell types.
• the term “tretrapotent” refers to a cell that although it might not be totipotent (capable of generating a whole individual), it is capable to generate four different cell types; e.g. cardiomyocytes, vascular endothelial and smooth muscle cells and connective tissue fibroblasts.
• progenitor cell refers to a descendant of a stem cell which has already committed to a particular differentiation pathway and, therefore, has a more restricted differentiation potential than the stem cell.
• the progenitor cell has a great capacity of amplification and, although it does not yet express markers of differentiation, it has the capacity to create a progeny that is more differentiated than itself.
• the term may refer to an undifferentiated cell or to a cell that has differentiated to an extent short of its final differentiation. This cell is capable of proliferation and giving rise to more progenitor cells, therefore having the ability to generate a large number of mother cells that can in turn give rise to differentiated or differentiable daughter cells.
• progenitor cell refers to a generalized mother cell whose descendants (progeny) specialize, often in different directions, e.g., by acquiring completely individual characters, as occurs in progressive diversification of embryonic cells and tissues.
• a progenitor cell is more differentiated than a true stem cell because it has already restricted somewhat the multipotency of the stem cell from which it originated.
• stem cell refers to stem cells, progenitor cells and/or precursor cells.
• Cellular differentiation is a complex process typically occurring through many cell divisions.
• a differentiated cell may derive from a multipotent cell which itself is derived from a multipotent cell, and so on. While each of these multipotent cells may be considered stem cells, the range of cell types each can give rise to may vary considerably.
• Some differentiated cells also have the capacity to give rise to cells of greater developmental potential. Such capacity may be natural or may be induced artificially upon treatment with various factors as has been recently demonstrated with the iESCs (induced embryonic stem cells) (Takahashi et al., 2007.CeIl 131 :1-12).
• a "precursor cell” is a descendant of the progenitor cell which has gone further down the differentiation pathway and has become committed to differentiate into a single cell type even though it might not yet express any of the identifiable markers for this cell type.
• the precursor cell is usually the one undergoing the last round of amplification before the appearance of the identifiable differentiated pheno type.
• Stem cells are present in the inner cell mass of the blastocyst, the genital ridges of the early embryo, the placenta and in the majority of tissues of the adult animals, including the human.
• the stem cells isolated from adult tissues are a mixture of true stem cells, progenitors and precursors together with cells at the earliest stage of their final differentiation.
• Adult stem cells have now been identified in practically all tissues originated from each of the three embryonic cell layers (endoderm, mesoderm and ectoderm), ranging from the bone marrow, central and peripheral nervous system, all connective tissues, skin, gut, liver, heart, inner ear, etc.
• This property refers to the fact that when certain stem cells are placed within a tissue different from the one they originated from, they can adapt to this new environment and differentiate into the cell types characteristic of the host tissue instead of the donor tissue. Although the extent and nature of this plasticity for many cell types still remains controversial (Wagers & Weissman, 2004.CeIl 116:636-648; Balsam et al., 2004 Nature 428, 668-673; Murray et al, 2004. Nature 428, 664-668; Chien, 2004. Nature 428, 607-608), it has spawned countless preclinical protocols and clinical trials.
• the cells are injected directly into the myocardium, it requires either a thoracotomy or the use of complex and time consuming instrumentation (Noga-type systems) in order to identify the target area.
• This technique requires specialized operators and it is only available in specialized medical centers.
• the intramyocardial injections either by transendocardial (Noga) or transepicardial (surgical) route still delivers ⁇ 50% of the cells to the tissue.
• the disclosure provides a method for the regeneration of solid tissues in living mammals, including humans, which include the local delivery of ligands for the receptors expressed by the stem cells present in the post-natal tissue to be regenerated. These are cells that when stimulated physiologically or pharmacologically multiply in situ and differentiate into the parenchymal cells characteristics of the tissue or organ that harbors them.
• New cardiomyocyte formation has been detected in both the normal heart and in pathological conditions such as MI and cardiac failure (Beltrami, A. P. et al., 2001. New Engl. J. Med. 344:1750; Urbanek, K. et al, 2003. Proc. Netl. Acad. Sci. USA. 100: 10440; Nadal-Ginard, B. et al., 2003. J. Clin. Invest. 111:1457; Nadal-Ginard, B. et al., 2003. Circ. Res. 92:139).
• these new myocytes are significantly more abundant at the border zone of MIs where they are an order of magnitude more abundant than in the myocardium of age matched healthy individuals.
• the communication between the resident stem cells and their environment, at least in the myocardium, is regulated by a feed-back loop between the cardiomyocytes, that sense the changes in wall stress produced by increased physiological or pathological demands in cardiac output, and the stem cells responsible to produce an increase in muscle mass through the generation of new contractile cells and microcirculation to nurture them.
• the myocytes have a stereotypical response to stress independently of whether it is physiological or pathological (Ellison et al., 2007. J. Biol. Chem. 282: 11397-11409).
• This response consists in rapidly activating expression and secretion of a large battery of growth factors and cytokines such as HGF (hepatocyte growth factor), IGF-I (insulin-like growth factor 1), PDGF- ⁇ (platelet-derived growth factor ⁇ ), a family of FGFs (fibroblast growth factor), SDF-I (stromal cell-derived factor 1), VEGF (vascular endothelial growth factor), erythropoietin (EPO), epidermal growth factor (EGF), activin A and TGF ⁇ (transforming growth factor ⁇ ), WINT3A and neurogeulin among others.
• HGF hepatocyte growth factor
• IGF-I insulin-like growth factor 1
• PDGF- ⁇ platelet-derived growth factor ⁇
• FGFs fibroblast growth factor
• SDF-I stromal cell-derived factor 1
• VEGF vascular endothelial growth factor
• EPO epidermal growth factor
• EGF epidermal growth factor
• This secretory response in addition to stimulate the hypertrophy of the myocytes themselves through an auto/paracrine loop, also triggers the activation of CSCs in their vicinity because these cells express receptors for these myocyte-secreted factors and respond to them.
• This response activates genetic pathways downstream of the receptor that are responsible for cell survival, multiplication and differentiation.
• the activation of these receptors also activate a feed-back loop in the CSCs themselves which stimulates the production of the respective ligand by the CSCs, thus putting in place a self-sustained response which, in response to a single stimulus, can remain active for several weeks or until the increased mass produced has restored the myocardial wall stress to normal levels.
• the CSCs respond to a paracrine stimulus with an auto/paracrine response which allows the maintenance of a sustained response to a short lived stimulation.
• normal cardiac cellular homeostasis is maintained through a continuous feed-back between myocytes and CSCs to produce and maintain the appropriate contractile muscle mass required to generated the needed blood cardiac output.
• the myocytes which are unable to divide, depend on the CSCs to maintain or increase their cell number and the capillary density to guaranty their oxygen and nutrient supply.
• the CSCs on the other hand, depend and respond to the biochemical cues produced by their surrounding myocytes to regulate their resting vs activated state.
• the myocardium of mammals including the human, as well as most other tissues, contain a small population of very undifferentiated cells that have many similarities to the embryonic stem cells (ESCs) which have been known for a long time to be multipotent; that is, a single cell is capable, when placed in the proper environment, to generate a whole organism identical to the one from which it originated.
• ESCs embryonic stem cells
• the main characteristic of these cells is their expression of a battery of so-called “multipotency genes” such as Oct4, Sox2, Nanog, etc (see US provisional application serial number 61/127,067 ) that confer multipotency to these cells, so that, independently of their tissue of origin they seem capable to give rise to most, if not all cell types of the body.
• multipotency genes such as Oct4, Sox2, Nanog, etc (see US provisional application serial number 61/127,067 ) that confer multipotency to these cells, so that, independently of their tissue of origin they seem capable to give rise to most, if not all cell types of the body.
• Oct4-expressing cells isolated from the adult heart are capable to give raise to skeletal muscle, neurons, heart, liver, etc. Their regenerative capacity seems more robust and broader than that of the tissue-specific stem cells.
• Oct4-expressing cells are the origin of most, if not all, the tissue-specific stem cells of every organ and that their stimulation is the main source of the regenerative capacity of every individual tissue. Therefore, the stimulation of these cells is a primary target for the therapeutic approaches described herein.
• the growth factors and cytokines produced by the stressed myocytes and to which the CSCs respond could be as or more effective than cell transplantation to trigger a regenerative response.
• a combination of insulin-like growth factor 1 and hepatocyte growth factor may be particularly effective.
• resident stems cell are activated, for example to stimulate regeneration of the tissue, to increase muscle density and/or cell function of target cells. If the target cells are cardiac muscle then the increased function would, for example be greater/increase contractile function.
• the increased function may be increased capacity to generate EPO.
• the increased function may be increased capacity to generate insulin. It seems that formulations of the disclosure are able to stimulate/activate stems cells resident in "mature tissue” thereby obviating the need to administer "stem-cell” therapy to the patient as the resident stems are stimulated to undergo mitosis and grow.
• Stimulating resident stems cells is distinct from angiogenesis.
• Angiogenesis is the process of stimulating growth of capillaries (which may be in tissue or tumors) (see Husnain, K.H. et al. 2004. J. MoI. Med. 82:539; Folkman, J., and D'Amore, PA. 1996. Cell 87:1153).
• formulations of the present disclosure employing appropriate ligands are administered a stem cells resident in the tissue, such as pluripotent cells, progenitor cells and/or a precursor cells are activated to generate new/additional tissue cells such as muscle cells.
• VEGF vascular endothelial growth factor
• These therapies neither attempt nor accomplish the regeneration of the parenchymal cells that perform the characteristic function of the tissue or organ; e.g. contractile cardiomyocytes in the heart, hepatocytes in the liver, insulin-producing ⁇ cells in the pancreas, etc.
• these therapies have had modest effects and none of them has become part of standard medical practice.
• all the regenerative therapies designed to replace the functional cells of the tissue or organ have until now been based in the transplantation of cells believed to be able to take on the characteristics of the missing cells in the target tissue. These approaches are still in clinical trials.
• a main drawback for all the regenerative approaches used has been to deliver the regenerative agent to the damaged tissue and limit their spread throughout the rest of the body. This is a serious problem even when the regenerative agents are administered through the coronary arterial tree of the tissue to the treated. In the cases of myocardial cell therapy by coronary administration, only a very small fraction of the cells administered is retained in the heart, while the majority (>95%) rapidly enters the systemic circulation and it is distributed throughout the body. This also occurs when the regenerative agents are directly injected into the myocardium either trans-epicardially or trans-endocardially, as has been repeatedly demonstrated with the administration of a cell suspension.
• the trans-epicardial administration requires exposing the heart through a thoracotomy
• the trans-endocardial administration requires a sophisticated, time consuming and expensive procedure to map the endocardium to identify the regions suitable for injection (a Noga-type instrument), a procedure available in a very limited number of centers and the participation of an expert manipulator.
• a Noga-type instrument a procedure available in a very limited number of centers and the participation of an expert manipulator.
• at best 50% of the administered compound is retained in the damaged are while the remainder is spread either throughout the thoracic cavity or through the systemic circulation.
• the formulations of the disclosure may be used in combination with the delivery of stems cells to a target tissue or organ and increase the number that are retained locally in comparison to other delivery mechanisms.
• this disclosure describes a novel method to regenerate the parenchymal cells (that is, the functional, "noble" cells) of a tissue or organ that is based neither on cell transplantation nor on the growth stimulation of the surviving endothelial cells in order to improve the blood supply to the tissue or organ of interest.
• the methods described here are based in the stimulation in situ, that is, within the tissue, of the resident stem cells of such tissue by means of local delivery of specific growth factors and/or cytokines which are able to stimulate their activation, replication and differentiation to generate the parenchymal cells lost as well as the microvasculature needed for their growth, survival and function.
• the regenerative agents that stimulate the stem cells are very active and might stimulate the growth and translocation of a variety of cells they interact with, among them latent neoplastic cells, the potential clinical application of many of these factors will require the administration of the smallest therapeutic doses in a very localized manner in order to, as much as possible, limit exposure to the cells that are to be regenerated.
• the more localized the administration the lower the doses required and lower the risk of undesired side effect due to stimulation of by-stander cells in the same or other organs.
• the disclosure describes a new approach for the use of therapeutic doses of different growth factors administered and delivered locally, instead of systemically or tissue -wide, to produce the regeneration of specific areas of a solid tissue.
• the formulation of the disclosure is capable, among others applications, to regenerate the heart muscle and its microvasculature after a myocardial infarction and/or in chronic cardiac failure.
• the formulation is administered at the border of the damaged tissue, for example at the border or an ischemic zone.
• Suitable ligands for stems cells include growth factors such as those listed in Table 1
• HGF hepatocyte growth factor
• IGF insulin-like growth factor
• PDGF Pulse-tkrrvcd growth factor
• PDGF- ⁇ PDGF- ⁇
• FGF fibroblast growth factor
• FGF-I aFGF
• FGF-2 bFGF
• FGF-4 FGF
• EGF epidermal growth factor
• VEGF vascular endothelial growth factor
• EPO erythropoietin
• TGF ⁇ transforming growth factor
• G-CSF Gramulocytc-colony stimulating factor
• GM-CSF Granulocyte -macrophage colony stimulating factor
• Bone morphogenetic proteins BMPs, BMP -2, BMP-4
• Neurotrophic for example NGF (Nerve growth factor), neuroregulin, BDNF (brain- derived neurotrophic factor), NT-3 (ncurotrophin-3), NT -4 (neurotrophin-4) and (neurotrophin-1), which is structurally unrelated to NGF, BDNF, NT-3 and NT -4
• GDF-8 Myostatin
• GDF9 (Growth differentiation faclor-9).
• the growth factor(s) employed is human.
• the growth factor employed is selected from HGF, IGF (such as IGF-I and/or IGF -2) and FGF, in particular HGF and IGF-I . These factors appear to be particularly effective in stimulating resident stem cells.
• Combinations of growth factors may also be employed and, for example may be selected from the above-identified list, such as HGF and IGF-I and optionally VEGF.
• the formulation for regenerating/activating stems cells does not consist of VEGF as the only active but for example may comprise a combination of actives include VEGF.
• the formulation is suitable for localized delivery of VEGF as angiogenesis factor.
• the growth factor formulation is employed in combination with an angiogenesis factor, for example administered concomitantly or sequentially by the same route or a different route.
• the formulation comprises a cytokine, for example selected from IL-I , IL-2, IL-6, IL-IO, IL-17, IL-18 and/or interferon.
• a cytokine for example selected from IL-I , IL-2, IL-6, IL-IO, IL-17, IL-18 and/or interferon.
• the formulation comprises combinations of actives, for example a growth factor and a cytokine.
• each active may, for example be the same dose employed when the active is administered alone.
• the components employed in the formulations and/or methods of the disclosure, especially biological type actives may be derived from natural origin.
• a biological type active employed is prepared by recombinant DNA technology.
• the active or actives administered may be peptide fragments of a biological molecule, with the desired therapeutic effect.
• the molecules employed are mutants of a biological molecule (for example a ligand of a receptor) with the desired therapeutic effect having the same, higher or lower affinity for the corresponding biological molecule.
• a biological molecule for example a ligand of a receptor
• the substance(s)/active employed is an aptomer (a small RNA molecule that binds to a receptor instead of the natural ligand).
• the substance/active employed is an antibody that recognizes and binds to a target receptor, and in particular has a suitable specificity and/or avidity for the same.
• the antibody has the required activity to upregulate the receptor or down regulates the receptor thereby either producing activation or blocking of the same, as appropriate.
• the active is a diaquine, which is an artificial antibody molecule that recognizes and binds to two of the receptors of interest resulting in either the activation or blocking of one and/or the other.
• the substance/active employed is a small molecule with a molecular weight ⁇ 5,000 Daltons.
• one or more actives employed may be of synthetic origin.
• the formulation disclosed herein to target the desired organ or tissue should be administered upstream of the organ or tissue. That is to say should be introduced into the circulation such that the flow of blood carries the formulation into the desired tissue/organ.
• the formulation can be introduced upstream of an organ such as the heart employing a suitable device such as a catheter. Other major organs can be reached in this way. Similarly whilst is it rare it is also possible to use catheters to gain access to the liver. In other instances the formulation may be introduced by strategic intra-arterial injection or by retrograde venous injection and/or cannular before the target tissue.
• the formulation may also be administered by infusion or a pump driven delivery device such as a syringe pump, for example of the type employed in the administration of heparin or morphine or contrast agents during catheterization.
• a suitable flow rate may for example be 0.5mL/min.
• the formulation might also be administered through the so-called perfusion catheters that allow slowing down the rate of blood flow downstream from the site of the injection with an intra-arterial balloon, while maintaining perfusion of the tissue through a second lumen of the catheter.
• the formulation is administered into an artery upstream of the target tissue or organ.
• a catheter is used to deliver the formulation of the disclosure into the artery supplying the target tissue or organ.
• the formulation may be delivered exclusively (primarily or substantially) to the segmental artery that supplies the area of the tissue or organ.
• the catheter employed is a balloon catheter.
• the catheter carries a filter mesh at its distal end with a pore size sufficiently small to prevent or hinder the release of microparticle aggregates > 50, 25 or 20 ⁇ m, as required.
• the target cells are the cardiac stem cells resident in the postnatal heart.
• the regeneration obtained includes together or separately the regeneration of cardiomyocytes and vascular structures composed of capillaries (endothelial cells) and/or arterioles (endothelium and vascular smooth muscle cells).
• the regeneration is induced at any time after a myocardial infarction (MI) be it acute or chronic, for example 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11 up to 24 hours after an acute infarction.
• MI myocardial infarction
• the regeneration is induced in an individual with ischemic heart disease, with or without a myocardial infarction. In one embodiment the regeneration is induced in the hearts of individuals that have developed cardiac failure (CF) either acute or chronic.
• CF cardiac failure
• the regeneration is induced in individuals with ischemic, infectious, degenerative or idiopathic cardiomyopathy.
• the target cells are the stem cells resident in the endocrine pancreas (stem cells of the islands of Langerhans).
• the regeneration is induced in an individual with diabetes.
• the target cells are the neural stem cells of the central nervous system (CNS).
• CNS central nervous system
• the target stem cells are the neural stem cells of the spinal cord.
• the regeneration is induced in an individual with a spinal cord lesion.
• the target cells are the stem cells of the substantia nigra of the brain, for example in an individual with Parkinson's disease.
• the regeneration is induced in an individual with a cerebral vascular accident (stroke).
• the ligands employed in formulations of the disclosure are able to cross the blood brain barrier to treat strokes and the like.
• the blood brain barrier becomes impaired and chemical entities can more readily pass through the barrier.
• the target cells are the liver stem cells and for example the regeneration is induced in an individual with liver damage such as cirrhosis.
• the target stem cells are the stem cells of the lung(s) and for example the regeneration is induced in a patient with lung damage, for example emphysema.
• the target cells are the stem cells of the skeletal muscle and for example the regeneration is induced in an individual with a particular skeletal muscle deficit, such as osteoporosis or pagets disease.
• the target cells are the stem cells of the epithelium.
• the target stem cells are the stem cell of the kidneys.
• Target cells refers to the cells that are to be stimulated and which have the potential to provide the desired regeneration.
• the formulation of the disclosure provides optimized parameters and materials to ensure accurate and/or reproducible dosing of the relevant active to the target tissue or organ.
• the formulations of the disclosure may be employed to treat solid tumors, by allowing local delivery of the antineoplastic to the tumor tissue, for example by intra-tumor injection.
• Actives suitable for the treatment of tumors include etoposide, cyclophosphamide, genistein, cisplatin, andriamycin, vindesine, mitoguazone, fiuorouracil and paclitaxil.
• the formulation is not for the treatment of cancer.
• the invention is not administration directly into a tumor or tissue.
• the methods according to the disclosure may employ combinations of actives administered separately, for example concomitantly or sequentially, or formulated as one (one -pot) formulation.
• Formulations of the disclosure may be administered as liquid solutions/suspension, for example in an isotonic carrier, for example as a buffered solution such as phosphate buffer, saline or glucose solution.
• an isotonic carrier for example as a buffered solution such as phosphate buffer, saline or glucose solution.
• Formulations of the disclosure may optionally comprise one or more further excipients.
• the excipients should be suitable for administration to humans and/or animals.
• the formulation comprises albumin in solution, which may for example stabilize the small quantities of active in the formulations, for example from 1% to 20% w/vol of albumin, such as human serum album, may be sufficient to achieve the required stabilization.
• the disclosure also extends to use of as a formulation as defined herein for treatment, particularly for the treatment of myocardial infarction; ischemic heart disease; cardiac failure; ischemic, infectious, degenerative or idiopathic cardiomyopathy, sclerosis, cirrhosis, emphysema, diabetes and the like.
• the disclosure relates to a formulation as described herein for use in treatment, particularly for treatment of an illness described above.
• the disclosure also extends to methods of treatment comprising administering a therapeutically effective amount of a formulation described herein to a patient in need thereof, particularly for the treatment of a disease described above.
• the disclosure also extends to use of a ligand, for example as described herein, for stimulating a resident stem cell in vivo to activate the cell.
• the disclosure also includes uses of a suitable growth factor for the manufacture of a medicament for stimulate resident stem cells in vivo.
• the hearts were analyzed at different time points after myocardial infarction, ranging from a few days to 1 month.
• the results showed a dramatic increase in the number of activated stem and progenitor cells in the ischemic area and its borders of pigs treated with human IGF-I and HGF. Notable regeneration of the muscle was seen in the ischemic area, which also contained newly formed arterioles and vessels. The regenerative response seemed to be proportional to the doses of growth factors administered. From these preliminary data, therapeutic in situ activation of CSCs can produce extensive new myocardial tissue formation and significantly improve left ventricular function in animal hearts that are similar in size and anatomy to human hearts.
• Cardiac small cells were incubated with anti- human CDl 17(c-kit) Ab (Miltentyi Biotechnology) and sorted by fluorescence-activated cell sorting (FACS; MoFIo (Dako Cytomation) cell sorter) or magnetic activated micro- immunobeads (MACS). Propidium iodide (PI; 2 ⁇ g/mL) was added before FACS to exclude dead cells.
• c-kit pos porcine cardiac cells were analysed for hematopoietic, mesenchymal and endothelial cell markers using a FacsCalibur flow cytometer (Becton Dickinson, BD).
• Antibodies used were anti-porcine CD45 (Serotec, Clon: MCA1447), anti-human CD34 (BD, clon 8G12), anti-human CD90, (BD, Clon:5E10, pig cross-reactivity) and anti- human CD 166 (BD, Clon: 3A6, pig cross-reactivity), anti-human CD 105 (Caltag Laboratories, Clon: SN6, pig cross-reactivity) and anti-human CD 133 (Miltenyi Biotec, clon AC 133, pig cross-reactivity).
• Anti-human antibodies specific to PECAM, E- cadherin, CDl Ib, CD13, CD14, CD29, CD31, CD33, CD36, CD38, CD44, CD49, CD62, CD71, CD73, CD106, were purchased from BD Biosciences. Respective isotype controls (Pharmingen) were used as negative controls for all FACS procedures. Data were analysed using the CellQuest software.
• c-kit pos Cardiac Cell Culture, Cloning, and Differentiation Potential c-kit pos cells were plated for 7-10 days at 2 x 10 cells/ml in Dulbecco's MEM/Ham's F12 (DMEM/F12) modified medium containing 10% FBS, bFGF (10ng/ml), insulin-transferrin-selenite (ITS), and EPO (2.5U).
• DEM/F12 Dulbecco's MEM/Ham's F12
• ITS insulin-transferrin-selenite
• EPO EPO
• mCSFM modified cardiosphere formation media
• 1 1 ratio of DMEM/F12, bFGF (10 ng/ml), EGF (20 ng/ml), ITS, 2- ⁇ -mercapethanol (O.lmM) and Neural Basal Media supplemented with B27 and N2 supplements (Gibco), for the generation of cardiospheres.
• mCSFM modified cardiosphere formation media
• bFGF 10 ng/ml
• EGF 20 ng/ml
• ITS 2- ⁇ -mercapethanol
• O.lmM 2- ⁇ -mercapethanol
• Gabco Neural Basal Media supplemented with B27 and N2 supplements
• the clonogenicity of the ckit pos cells was determined by counting the number of clones generated in each 96-well plate and expressed as a percentage. A total of 10 plates per cardiac region were analyzed. Clonogenic cells and cardiospheres were transferred to a specific cardiogenic differentiation medium (modified from 42) for myocyte, vascular smooth muscle and endothelial cell specification.
• the cell migration assay was carried out using a modified Boyden chamber, according manufacturer's instructions (Chemicon). 200 ng/ml HGF or 200 ng/ml IGF-I were placed in the lower chamber of a 24 well plate for 24 hours. For proliferation assay, 2.5 x 10 pCSCs were plated in 24 x 35mm dishes and were serum starved for 36hrs in 0% serum DMEM/F 12 base medium. 6 dishes acted as baseline control and were supplemented with BrdU (lug/ml) before being fixed and stained 1 hour later.
• Cells were cultured on glass chamber slides (BD Falcon) for 2 days, fixed with 4% PFA for 20 min, and then stained. For intracellular staining, cells were permeabilized using 0.1% Triton X- 100. Cells were incubated with the primary antibody overnight at 4 0 C, washed three times and then incubated with a FITC- or Texas Red-conjugated secondary antibody for 1 hr at 37 0 C. Then cells were washed three times, and nuclei were counterstained with DAPI. Fluorescence was visualized and images acquired with confocal microscopy (Zeiss LSM510).
• the following antibodies were used for cell staining: Oct3/4, Nanog, IsI-I , c-kit, FIk-I , and Nkx2.5 (R&D Systems); Bmi-1 , c-met and IGF-Ir (Santa Cruz Biotechnology), telomerase (Abeam). Cardiospheres were stained for c-kit after 24 hours of culture in a glass chamber slide. After 4-6 days in culture to allow outgrowth and differentiation of cells from sphere, they were stained with antibodies against smooth muscle actin, ⁇ -sarcomeric actin (Sigma) and von Willebrand factor (DAKO). All secondary antibodies were purchased from Jackson Immunoresearch.
• Immunoblots to detect the IGF-I (IGF-IR) and HGF (c-met) receptors were carried out as previously described (Ellison et al. 2007. J. Biol. Chem. 282: 11397) using protein lysates obtained from c-kit pos pCSCs subjected to serum starvation medium for 24 hours followed by supplementation with 200ng/ml IGF-I or 200ng/ml HGF for 10- 20 minutes.
• the following antibodies were used at dilutions suggested by the manufacturers: rabbit polyclonal Abs IGF-IR, phosphor-IGFIR, Akt, phosphor- Akt,c-met (Cell Signalling), phosphor-c-met (Abeam), FAK, and phosphor-FAK (Upstate).
• Myocyte diameter was measured across the nucleus in H&E sections (3 slides per animal) of the peri-infarct region from levels C and D, on a light microscope (Nikon ElOOOM) using Lucia G software. A total of 200 myocytes per section were analyzed for each pig.
• connective tissue mainly collagen
• connective tissue mainly collagen
• Semi-quantitative evaluation of the amount of myocardial connective tissue was carried out using Lucia G image analysis at x40 magnification. Percent collagen (percent area of positive staining) was determined in the entire infarct zone. A total of 3 slides were assessed per animal for each level, and an average obtained.
• c-kit pos CSCs were identified as lineage-negative (Lin ne ⁇ ), by staining negative for markers of haematopoietic, neural, and skeletal muscle lineages (21).
• the number of c- kit pos (lin neg ) cells and cardiomyocytes was counted for a total of 5 sections at x63 magnification. The area of each cross section was then measured, and the number of CSCs and cardiomyocytes per unit area was determined. The data for the atria were pooled, due to few differences found between the number of c-kit pos CSCs in the left and right atria. The number of CSCs was expressed per 10 6 myocytes.
• cycling cells were identified by BrdU (Roche) and Ki67 (Vector labs) staining. Progenitor cells stained positive for c-kit and the transcription factors, Nkx2.5 (R&D Systems), Ets-1 and GATA6 (Santa Cruz Biotechnology). Newly formed myocytes were identified with antibodies against BrdU, Ki67 and ⁇ -sarcomeric actin (Sigma), cardiac troponin I (Santa Cruz Biotechnology) or slow (cardiac) myosin heavy chain (Sigma). Newly formed vascular structures were detected by staining for BrdU and ⁇ -smooth muscle actin (mouse monoclonal, Sigma) or vWF (rabbit polyconal, Dako).
• the density of capillaries in the infarct region was evaluated by staining with an antibody against vWF (DAKO).
• the 2 0 Ab used was a donkey anti -rabbit, conjugated with HRP (Santa Cruz). Endogenous peroxidase in the section was blocked with 3% hydrogen peroxide in PBS for 15 minutes at room temperature.
• the chromogen 3, 3- diaminobenzidine (DAB) (Sigma) was used to visualize the blood vessels. The slides were counterstained with hematoxylin for identification of nuclei.
• the number of capillaries (defined as 1 or 2 endothelial cells spanning the vWF-positive vessel circumference) was determined by counting 10 fields/section in the infarct zone in levels C and D at x 40 magnification. A total of 3 slides/animal were assessed. The number of capillaries was expressed per 0.2mm .
• HSA human serum albumin
• IGF-I insulin-like growth factor 1
• HGF hepatocyte growth factor
• the lipid phase consisted of: 5% PLGA in EtOAc (ethyl acetate)
• the aqueous phase consisted of: 5% HSA, 0.1% growth factor, 0.45% NaCL, 0.25% Tween 20 in H2O.
• the mixture of the two phases was sonicated for 30 min.
• the microdroplets are produced in a bath of 2 % polyvinyl alcohol (PVA, Fluka
• the aqueous phase consisted of 20% HSA, 0.4% IGF-I; 0.2 NaCl; 0.1 Tween 20; 0.15 Span 60.
• the organic phase consisted of 5.5% PLGA in EtOAc (ethyl acetate).
• microparticles were obtained by simple flow focusing using the conditions described in Example #1.
• the size of the particles, as determined by SEM was of 14.36 ⁇ m with a SD of 0.91 and an efficiency of encapsulation of 82.4 with an entrapment of 13.1%.
• Protein determinations complemented by quantitative ELISAs documented that each 1 x 10 6 microspheres carried 3 ⁇ g of IGF-I and 348 ⁇ g of HSA.
• Biological in vitro assays of the IGF-I contained in the microspheres tested by their capacity to bind and activate the IGF- 1 receptor of live cells show that after one round of liophylization and resuspension the encapsulated IGF-I maintained 82% of the original biological activity. Therefore, each one million of microspheres had a biological activity equivalent of 2.5 ⁇ g of the native IGF-I .
• SCF Stem Cell Factor
• ligand for the c-kit receptor produced particles containing 2.3 ⁇ g SCF per 1 x 10 microspheres with an activity 76% of the original solution as determined through activation of the c-kit receptor.
• Protanal LF 10/60 Protanal LF10/60LS at a ratio 0.7% :.3% gave the optimal results.
• the optimal distance for nebulization was found to be 10 cm.
• the optimal concentration of HAS in the mix was 14% and IGF-I 0.3%.
• the nebulizer is placed at 10 cm of a solution of 3% CaCl 2 in a shaking bath, collected by centrifugation after 30 min and washed to remove the CaCl 2 .
• the size distribution of the particles is determined by flow cytometry and SEM.
• the encapsulation of hrHGF-1 was determined by ELISA as described in Example #2.
• the size of the particles, as determined by SEM was of 15.87 ⁇ m with a SD of
• This protocol can be adapted to be used with different types of polymers such as Poly ether-polyester segmented block copolymers of polybutylene terephthalate (PBT) and polyethylene oxide (PEO) Poly Active® using the FF nebulizer as well as other spraying methods.
• PBT polybutylene terephthalate
• PEO polyethylene oxide
• Alginate is an adequate polymer for the production of monodisperse microspheres with an approximate diameter of 15 ⁇ m and to encapsulate large amounts of proteins.
• the protocols used can be modified to increase the ratio of IGF-I to HSA up to 60:40 which increases the load of active compound by more than two orders of magnitude. From the results obtained, the range of sizes around the peak of 15 ⁇ m is narrower when using PLGA than with the combination of alginates tested here. Given the large number of different alginate preparations it is likely that the homogeneity of the microparticles found here could be significantly improved.
• microspheres where the active compound is located on the surface of the particle it is possible to produce the microspheres shown above using a polyelectrolyte instead of PLGA of charge of opposite sign to the active to be bound.
• polyelectrolytes are gum Arabic, pectins, proteins, nucleic acids, polysaccharides, hyaluronic acid, heparin, carboxymethylcellulose, chitosan, alginic acid and a multitude of synthetic polymers.
• the polyelectrolyte has a charge of opposite sign to the active compound, it is possible to attach it to the microparticle by absorption from a solution of the active.
• Microspheres of 15 ⁇ g in diameter are optimal for capillary entrapment after intracoronary administration without spillover to the systemic circulation.
• telazol lOOmg, I.M.
• An intravenous catheter was placed in a peripheral ear vein.
• the animals were moved to the surgery room, placed onto a support board, and secured to the surgical table with limb bindings. Animals were maintained anesthesized with isoflurane (2.5% in O 2 ) and their EKG monitored continuously throughout the procedure.
• GE STENOSCOP GE Medical Systems USA
• the left main coronary artery was intubated with a 6F guiding catheter JR 3.5 of 40 cm in length specially designed for the protocol (Cordynamic- Iberhospitex S. A.
• a baseline coronary angiography was performed.
• a coronary guide catheter of 2 mm diameter was advanced over a guide wire (Hi-Torque Balance Middle-Weight 0,014") to the origin of the left coronary artery.
• LAD left anterior coronary artery
• Another catheter was placed into the coronary sinus to collect cardiac venous blood samples during the procedure.
• a peripheral, coronary venous and arterial blood sample was collected.
• Lidocaine of 1- 3mg/kg was administered intravenously.
• Pre-operative medication was administered as 75mg clopidrogel (Plavix) and 250mg aspirin one day before surgical procedure.
• Postoperative medication consisted of 75mg clopidrogel (Plavix) and 125mg aspirin daily until the sacrifice.
• a mixture of fluorescent polystyrene microspheres of diameters 2 ⁇ m, 4 ⁇ m, 6 ⁇ m, 10 ⁇ m; 12 ⁇ m and 15 ⁇ m, each labeled with a different dye purchased from Invitrogen and from Polysciences Inc., Cat # F8830, F8858; F8824; Polybead Black dyed microsphere 6.0 ⁇ m, Megabead NIST 12.0 ⁇ m and F8842
• This suspension was administered at the origin of the left coronary artery of three pigs through the angiography catheter by a Harvard pump at a rate of 1 mL/min. After administration of each mL (1 million microspheres) the injection was suspended for 3 min. during which time a coronary sinus blood sample was taken. Immediately after obtaining the blood samples, blood smear slides were prepared to check for the presence of fluorescent microparticles. After the complete administration of the 20 mL microsphere suspension coronary sinus blood samples were collected for an additional 3 hours at every 30 min intervals. At the conclusion of the experiment the animals were sacrificed and the heart excised, fixed and samples were taken for sectioning followed by histological and fluorescent microscopy examination.
• the microspheres of different sizes were administered in equal numbers their ratios in the coronary sinus venous flow and in the myocardium should be mirror images of each other. Those particles that go through the capillary bed should have a high concentration in the coronary sinus blood and low in the myocardium at the end of the experiment. The reverse should be true for the particles that do not pass through the capillary bed. As shown below, only sizes ⁇ 10 ⁇ m are eff ⁇ cienly retained in the myocardium but even microspheres of 10 and 12 ⁇ m leak through to a meaningful extent since between 19 and 8 % , respectively of these microspheres passed into the systemic circulation. On the other hand, > 1% of the 15 ⁇ m particles passed through the capillary bed and reached to coronary sinus.
• the minimum size of microspheres that insures > 99% retention in the tissue of interest is 15 ⁇ m in diameter. Because it is important to use the minimum effective size in order to minimize the production of micro foci of ischemia by obstructing precapillary arterioles, this diameter size is the optimal for the local delivery of substances to a particular tissue through its capillary bed.
• This suspension was administered through the angiography catheter by a Harvard pump at a rate of 1 mL/min at the origin of the main left coronary artery. After administration of each mL (1 million microspheres) the injection was suspended for 3 min. during which time a complete EKG and a coronary sinus blood sample was taken. Immediately after obtaining the blood samples, blood smear slides were prepared to check for the presence of fluorescent microparticles.
• TIMI Coronary blood flow
• animal #1 In animal #1 the first EKG alterations were detected after the administration of 16 mL of the suspension (16 million microspheres). In the second animal EKG alterations did not appear until after the administration of 18 mL (18 million microspheres). In both animals, the coronary blood flow was TIMI 3 (normal) at the end of the procedure. Animal #1 was sacrificed 24 hours after termination of the infusion. A complete EKG and blood samples were collected before sacrifice. The heart was processed for macroscopic and microscopic examination.
• the enzyme measurements show that animal #1 developed a small myocardial infarction as shown by the increased level of cardiac specific troponin T (TnT) in blood (values higher than 0.01 ng/ml are abnormal), while the values of animal #2 are normal and suggest that this animal developed only transient ischemia during the administration of the particles and recovered without any permanent myocardial damage. This interpretation was confirmed by the pathology as shown below. The macroscopic section of the heart of animal #1 shows micro foci of necrosis (pale areas) while the section of animal #2 is normal. This conclusion was confirmed by the histopathology (data not shown).
• the microsphere suspension was composed of 4x10 PLGA microspheres loaded with a total of 2 ⁇ g of human recombinant insulin-like growth factor 1 (IGF-I); 4xlO 6 PLGA microspheres loaded with a total of l ⁇ g of human recombinant hepatocyte growth factor (HGF). These two types of microspheres were also loaded with a fluorescent green dye in order to make easier their visualization in the blood and in the histological sections.
• IGF-I insulin-like growth factor 1
• HGF hepatocyte growth factor
• the suspension contained 2x10 polystyrene fluorescent in the orange range from Invitrogen.
• the Invitrogen spheres were included to serve as control for the stability and distribution of the PLGA microspheres.
• the suspension in 10 mL of physiological PBS, was administered to the instrumented pigs as described above.
• the administration of the suspension to the two animals was uneventful and there were no electrocardiographic signs of ischemia.
• the capillary blood flow was normal during and after the procedure (TIMI 3).
• One animal (pig #3) was sacrificed 30 min after the procedure and the other (pig #4) at 24 hours after the procedure. Both hearts were processed for macroscopic and microscopic analyses.
• CK creatine kinase
• MB the MB isoform of creatine kinase which is cardiac specific
• TrT Cardiac troponin T, which is the most specific and sensitive marker for myocardial damage.
• PRE INJ CS blood sample taken from the coronary sinus at the start of the procedure
• PRE INJ systemic blood sample taken at the start of the procedure
• POST POST
• CS blood sample taken from the coronary sinus at the end of the procedure
• POST blood sample from systemic circulation taken at the end of the procedure
• POST 14H systemic blood sample taken at 14 hours after the procedure
• POST 24H systemic blood sample taken 24 hours after the procedure before sacrificing the animal.
• the combination of IGF-I and HGF administered through the coronary arteries was very effective in stimulating the activation of the resident cardiac stem cells.
• this preliminary assay we monitored the activation of the stem cells in the region were the microspheres were delivered and compared it to a region of the left ventricle not irrigated by the left coronary artery. As can be seen in the images in Figure
• Porcine c-kit pos Cardiac Stem and Progenitor Cells are Multipotent and Phenotypically Similar to Those of Other Animal Species Histological sections of myocardium from 3 England pigs weighing 24 ⁇ 3 kg were examined by confocal microscopy for the presence of cells positive for the common stem cell marker, c-kit, the receptor for stem cell factor (SCF), known to be expressed by the majority of CSCs.
• SCF stem cell factor
• c-kit pos Small cells positive for c-kit (c-kit pos ) were distributed throughout the atrial and ventricular myocardium ( Figure 1 A-B) with a higher density in the atria (no difference between left and right atria, data not shown) and the ventricular apex, compared to other cardiac regions ( Figure 1C).
• This distribution pattern matches the anatomical location of the c-kit pos CSCs in the hearts of other animal species, including humans. Accordingly, the density of c-kit pos cells in the pig heart is similar to human and rodent myocardium: 1 cell per -1,000 myocytes or -50,000 c-kit pos cells per gram of tissue.
• c-kit pos cells constituted 10 ⁇ 3%, 3 ⁇ 2% and 7 ⁇ 3% of the starting myocyte-depleted cardiac cell population from the atria, ventricle, and apex, respectively ( Figure ID).
• the c-kit pos cells were separated using MACS technology (21) which yielded a highly enriched cell preparation constituted by >90% of c-kit pos cells ( Figure IE). FACS analysis showed that the c-kit pos enriched cardiac cells were negative for the pan leukocyte marker CD45 and the endothelial/hematopoietic progenitor marker CD34 ( Figure IE).
• c-kit pos porcine cardiac cells expressed CD90, (a common non-specific mesenchymal marker) and CD 166 (adhesion molecule) (Figure IE). Only a small fraction was positive for the markers of hematopoietic/endothelial progenitors, CD 105 and C D 133 (Suppl Figure 1). c-kit pos cardiac cells were negative when analyzed for a panel of CD markers specific for other hematopoietic, mesenchymal and endothelial cell lineages, including CD13, CD14, CD31, CD38, CD44, CD33 .
• porcine c-kit-sorted cardiac cells are c-kit pos , CD90 pos , CD166 pos , CD105 low , CD133 low and CD45 neg , CD34 neg , CD31 neg , CD44 neg .
• c-kit pos porcine cardiac cells were analyzed for markers of sternness and cardiac-lineage commitment using immunocytochemistry. Cells showed positivity for c- kit (90 ⁇ 8%), FIk-I (86 ⁇ 9%), Oct3/4 (62 ⁇ 11%), Nanog (46 ⁇ 5%), telomerase (81 ⁇ 10%), Bmi-1 (70 ⁇ 14%), Nkx2.5 (52 ⁇ 8%), IsI-I (8 ⁇ 6%) ( Figure 2Di. Because the clones originated from single cells, the wide expression of the multipotency genes in their progeny suggested that the level of expression of these genes in the parental cell population is very high.
• c-kit pos cells Unfortunately, the primary population of c-kit pos cells is a mixture of CSCs, progenitors and precursors and we do yet have markers specific for the 'real' CSCs. Therefore, it is only possible to infer the phenotype of these cells through the analysis of their descendants.
• porcine c-kit pos cardiac stem cells (hereafter identified as pCSCs) have a pattern of gene expression and a phenotype consistent with c-kit pos CSCs isolated from other species (Ellison et al., 2007. J. Biol. Chem. 282: 11397). Porcine CSCs Express Intact IGF-I, HGF and SCF Signaling Pathways that Modulate Their Activation
• pCSCs express IGF-I and c-met receptors in vivo and in vitro ( Figure 2F).
• pCSCs When grown in culture, freshly isolated pCSCs respond to the stimulation by hrIGF-1 , hrHGF and hrSCF with cell proliferation ( Figure 2G) and migration ( Figure 2H).
• Figure 21 Upon ligand binding, specific downstream effector pathways were activated in pCSCs ( Figure 21). Similar results were obtained with cells from the expanded single cell clones (data not shown). Therefore, pCSCs have functionally coupled GF receptor systems that can be exploited in vivo to test myocardial regeneration protocols.
• Pigs were given 125UI/kg of heparin before the infarction was induced and then heparin infusion (10UI/kg/h) during the infarction procedure.
• the LAD coronary artery was occluded by balloon inflation (2.5mm diameter) for 75 mins.
• pigs were continuously infused throughout the procedure with Amiodarona (Trangorex) (5mg/kg/h) beginning 15 minutes before the infarction.
• Amiodarona Trangorex
• Lidocaine 1 - 3mg/kg was administered intravenously.
• Pre-operative medication was administered as 75mg clopidrogel (Plavix) and 250mg aspirin one day before surgical procedure.
• Postoperative medication consisted of 75mg clopidrogel (Plavix) and 125mg aspirin daily until the sacrifice.
• Human recombinant IGF-I and HGF (Peprotech) were administered in differential doses (ranging from 2 ⁇ g to 8 ⁇ g of IGF-I and from 0.5 ⁇ g to 2 ⁇ g of HGF) to 17 pigs through a perfusion balloon catheter advanced immediately distal to the origin of the first septal artery 30 minutes after coronary reperfusion.
• the GFs were administered in 15 ml of PBS at a rate of 2.5 ml per minute with a 2 min reperfusion after every 5 ml administration.
• Saline alone was injected in another 9 pigs with MI (saline -placebo control group; CTRL) using the same protocol.
• Five (2 in the CTRL group and 3 in the GF groups) of the 26 animals died during acute myocardial infarction (AMI) (acute mortality of -30%). Subsequently, 3 animals died in the postoperative period: one animal on day 1 (CTRL group), one animal on day 13 (CTRL group) and one animal on day 14 (GF group). Of the remaining 18 pigs completing the study protocol, 13 were in the GF- treated groups and 5 in the CTRL group.
• AMI acute myocardial infarction
• IGF-1/HGF Human recombinant IGF-I and HGF (hereafter abbreviated as IGF-1/HGF or
• GFs were administered in differential doses to pigs by intracoronary injection 30 minutes after acute myocardial infarction. Additional pigs were injected with identical volume of saline alone, constituting the control group (CTRL).
• the infarct size, as determined by planimetry, as a percent of the coronal circumferential area was not different between the GF-treated and CTRL group (28 ⁇ 5%, 26 ⁇ 7%, 29 ⁇ 5% in GF-Ix, -2x and -4x, respectively, vs. 27 ⁇ 4% in CTRL).
• c-kit pos cells expressed the transcription factors Nkx-2.5, Ets-1 or Gata ⁇ indicative of their differentiation toward the main cardiac lineages, i.e. myocyte, endothelial and smooth muscle cells (Figure 4F-I). Quantitative analysis revealed that the number of c-kit pos Nkx2.5 pos cells (committed myocyte/vascular precursors), significantly increased in the infarct and border regions in GF-treated pig hearts in a GF-dose dependent manner (Figure 4G), reaching levels which were > 10-fold higher than in CTRL hearts. IGF-1/HGF Treatment Produces Robust Myocardial Regeneration after Acute Myocardial Infarction
• Echocardiographic imaging showed that left ventricular ejection fraction (LVEF) was significantly depressed in CTRL and GF -treated pigs following coronary occlusion (Figure 6G). However, 28 days after AMI, LVEF worsened slightly in CTRL, while it was significantly preserved/ improved by the GF -treatment, when compared to CTRL ( Figure 6G). In order to gain further insight in regional cardiac function, tissue Doppler echocardiography was employed to measure antero-septal radial strain that was significantly improved in GF -treated pigs, compared to CTRL ( Figure 6H-I). Cardiac function preservation/improvement correlated with increasing GF dose ( Figure 6).
• LVEF left ventricular ejection fraction
• Example #5 >99% of the 15 ⁇ m diameter microspheres are trapped into the capillary network of the target tissue, and specifically the myocardium. These data, however, do not address the issue of whether when the active molecule is unloaded is retained within the tissue or whether it leaches out into the capillary circulation and the venous return.
• 5 x 10 6 microspheres loaded with a total of 50 ⁇ g of rhIGF-1 were administered intracoronary at the origin of the left anterior descending artery following the same administration protocol outlined in Examples #5-7. The main different was that a catheter was left into the coronary sinus throught the jugular vein.
• Example 12 Intra-arterial local administration of IGF-1/HGF to damaged skeletal muscle induced the activation of the muscle stem cells and stimulates regeneration.
• the local administration of IGF-1/HGF encapsulated in PLGA microspheres of 15 ⁇ m in diameter was very effective in stimulation the regeneration of muscle tissue in the treated leg but not in the contralateral one as compared with the ischemic but placebo treated controls.
• the local administration of growth factors to damaged tissue others than the myocardium has a stimulatory effecto in the regenerative reaction of the damaged tissue which is localized to the area downstream from the site of administration of the microspheres, as is expected for a delivery system that targets the capillary network of the damaged tissue/organ.
• IGF-1/HGF/SCF Intracoronary injection of IGF-1/HGF/SCF has a more potent effect in the activation of the CSCs and preserving ventricular function than IGF-1/HFG alone.
• the regeneration produced by the three factors protocols is significantly better in both the level of regeneration as well as in the maturation of the regenerated myocytes that by the combination of IGF-1/HGF.
• the cellular and histological, and functional parameters as shown in the Table ???. which confirms the synergy among the factors employed and documents the suitability of the described invention to produce multiple variants of the therapeutic compound to modify the regenerative reaction. It is reasonable to extrapolate from these data that in addition to the addition or subtraction of particles with particular factors, other variations might involve changing the dose of a particular factor or set of factors, the profile of release/unloading for a particular factor, the degree of loading, etc.
• the present invention allows for the formulation of an almost infinity number of specific combination of therapeutic compounds starting from a limited set of building blocks in which each factor can be used at different doses, different patterns of release and combined with an unlimited of other factors. This allows in a single administration to target a particular tissue with different combinations of therapeutic agents each of which might act at a different time, on a different cell target, and require a different effective dose. These possibilities are particularly advantageous for tissues of difficult access which can not be accessed repeatedly, such as the myocardium and most of the internal organs.
• A-B Representative confocal images of c-kit positive (c-kit pos ; white) cells in the right atria (A) and left ventricle (B) of the normal pig heart. Cardiomyocytes stained in red (shown in grey in the figures) by ⁇ -sarcomeric actin ( ⁇ -sarc act) and nuclei stained with DAPI in blue.
• C c-kit pos cells are distributed throughout the atrial and ventricular myocardium with a higher density in the atria and the apex, compared to Right and left ventricle (RV, LV). *p ⁇ 0.05 vs RV and LV.
• Figure 2 c-kit pos porcine cardiac cells express sternness markers, have stem cell properties of clonogenicity, self-renewal, cardiosphere-forming and multipotency, and express intact signaling IGF-1/HGF systems modulating their activation.
• A A light microscopy image showing expanded c-kit pos porcine cardiac cells at the 4 th passage.
• B A light microscopy image of a clone, after single c-kit pos porcine cardiac cells were deposited into wells of terasaki plates to generate single cell clones.
• C The clonogenicity of c-kit pos porcine cardiac cells was similar across cardiac chambers, and compared to mouse and rodent CSCs.
• D- E Sirius red staining identified fibrotic tissue (grey staining) and muscle (yellow staining) in cross sections of the infarct zone, in GF-treated (D) and saline -treated CTRL (E) pig hearts.
• F GF-treated (IGF-1/HGF) pig hearts had a decreased percentage area fraction of fibrosis in the infarct zone, compared to saline-treated CTRL pigs. *p ⁇ 0.05 vs. CTRL. fp ⁇ 0.05 vs. IGF-1/HGF Ix.
• FIG. 1 Staining for activated caspase-3 (brown; arrowheads) revealed apoptotic myocytes in the peri-infarct/border zone of the CTRL pig heart after AMI.
• H IGF-I and HGF injection resulted in decreased numbers of apoptotic myocytes, in the peri-infarct/border zone, compared to saline -treated CTRL. *p ⁇ 0.05, vs. CTRL, fp ⁇ 0.05 vs. IGF-1/HGF Ix, $p ⁇ 0.05 vs. IGF-1/HGF 2x.
• A-B The majority of porcine ckit pos CSCs (white) express Igf-1 (A, grey) and c- met (B, grey) receptors in vivo. DAPI stains the nuclei in blue.
• C A cluster of ckit pos CSCs (white) in the area of infarct of a GF-4x treated pig heart.
• D The number of c- kit pos CSCs significantly increased in the border but more in the infarcted region of GF- treated pigs, compared to saline-treated CTRL. *p ⁇ 0.05, vs. CTRL, fp ⁇ 0.05 vs. IGF- 1/HGF Ix, Jp ⁇ 0.05 vs.
• IGF-1/HGF 2x IGF-1/HGF 2x.
• E Many c-kit pos CSCs (white) in the GF-treated pig hearts were positive for BrdU (grey), indicative of their newly formed status.
• F c- kit pos CSCs (white) expressed the cardiac transcription factor, Nkx2.5 (grey), representing cardiac progenitor cells. Nuclei were stained with DAPI (blue).
• G The number of c- kit pos Nkx2.5 pos cardiac progenitor cells increased in the infarct and border zones in GF- treated pig hearts, *p ⁇ 0.05, vs. CTRL, fp ⁇ 0.05 vs. IGF-1/HGF Ix, Jp ⁇ 0.05 vs. IGF- 1/HGF 2x.
• H-I Some c-kit pos CSCs (white) expressed the transcription factors, GAT A6 (H; grey) and Ets-1 (I; grey), indicative of smooth muscle and endothelial cell differentiation, respectively.
• A-B Regenerating bands of small, newly formed BrdU pos (white) myocytes (grey; ⁇ -sarcomeric actin, ⁇ -Sarc Act) in the infarct regions of GF-Ix (A) and GF -4x (B) treated pig hearts. Note the increased size of the regenerating band after 4x the amount of GF administration. Also the myocytes are more dense, compact and structured as myocardium after 4x the amount of GF administration. (C) Within these regenerating bands in the infarct zone were small Ki67 pos (white) proliferating myocytes (grey; ⁇ -Sarc Act).
• D-E Newly formed small BrdU pos (white nuclei) myocytes (grey; ⁇ -Sarc Act cytoplasm) in the border zone after GF-Ix (D) and GF-4x (E) doses.
• F Small Ki67 pos (white) myocytes (grey; ⁇ -Sarc Act) were also present in the border zone after GF- injection.
• G-H The fraction of small BrdU pos and Ki67 pos myocytes significantly increased in the border but more in the infarct region after GF injection. *p ⁇ 0.05, vs. CTRL, fp ⁇ 0.05 vs. IGF-1/HGF Ix, $p ⁇ 0.05 vs. IGF-1/HGF 2x.
• I A small Ki67 pos mitotic myocyte in the infarct zone of a GF-4x treated pig heart.
• FIG. 6 Growth factor administration increased the generation of new vascular structures and improved cardiac function in the infarcted pig heart.
• A Newly formed arterial structures (BrdU, white; ⁇ -smooth muscle actin, SMA, white; Myosin Heavy Chain, MHC, grey; DAPI, blue) were evident in the infarcted region of GF-treated pig hearts.
• B-C Newly formed capillaries were also evident in the infarcted regions after IGF-I and HGF injection (BrdU, white; vWF, grey; DAPI, dark grey).
• G-H GF- treated hearts showed improved left ventricular (LV) ejection fraction (G) and radial strain (H), compared to saline-treated CTRL.
• I Representative Tissue Doppler radial strain tracing from CTRL (a-c) and GF-4x (d-f) treated pigs.
• AMI coronary occlusion
• IGF-1/HGF injection produced a wide variety of beneficial effects on cardiac remodeling and autologous cell regeneration that were proportional to the dose of GF administered.
• Figure 7 shows Optical microscope image of the PLGA particles containing IGF- 1 obtained with the recipe described above
• Figure 8 shows an electron micrograph of the same batch of particles shown in the figure above.
• Figure 9 shows sections of the hearts of pig #1 (left image) and pig #2 (right image).
• the anterior wall of the left ventricle, irrigated by the left coronary artery, of pig #1 shows a number of micro infarcts (paler areas), while the myocardium of pig #2 is normal as shown by the uniform coloration.
• Figure 1OA Sections of the myocardium of pig #3, sacrificed 30 min after the administration of a mixture of polystyrene (red beads-shown in the figure as grey, larger diameter, smooth circles) and PLGA+growth factors (green beads-shown in the figure as white, smaller diamter and more irregular shape) beads.
• red beads-shown in the figure as grey, larger diameter, smooth circles a mixture of polystyrene (red beads-shown in the figure as grey, larger diameter, smooth circles) and PLGA+growth factors (green beads-shown in the figure as white, smaller diamter and more irregular shape) beads.
• the apparence difference in size between the red and green particles is due to the higher fluorescence of the red
• Figures 1OB and 1OC show sections of the myocardium of pig #4, sacrificed 24hours after the administration of a mixture of polystyrene (red- shown in figures as grey, larger diameter, smooth circles) and PLGA+growth factors (green -shown in the figure as white, smaller diamter and more irregular shape) beads.
• the ratio of green to red beads is significantlo lower in this animal because of the degradation of the PLGA microparticles In the four panel of the left only red beads are detected, while in those of the right the ratio is closer to 1:1.
• FIG 11 shows Microscopic sections of two areas of pig #4. Myocytes are in grey. Nuclei in darker gry. The endogenous cardiac stem cells (CSCs) are identified by an arrow head (upper) and an arrow (lower). Their membrane is labeled in paler green. On the upper figure, the nuclei are clean because the cells are quiescent. On the lower figure all the CSCs have pale grey stain in the nuclei that identifies the protein Ki-67 a marker of cells that have entered the cell cycle.
• CSCs cardiac stem cells
• Panel A Histological image of the left muscle (control) five days after producing the lesion on the right muscle. No treatment was administered to this leg.
• Panel B Histological section of a right quadriceps five days after producing the damage with no treatment (damaged control). The arrowheads point to two of the several extensive areas of cell necrosis where a concentration of nuclei appear to initiate a regenerative reaction.
• Panel C Right biopsy of right quadriceps 3 days after the lesion treated with a mixture of microspheres loaded with IGF-I and microspheres loaded with HGF with a total administered equivalent of 16 ⁇ g IGF-I and 4 ⁇ g HGF.
• Panel D Biopsy of the same muscle shown in Panel C two days later (5 days after the lesion).
• the smaller sized dark fibers are regenerated fibers labeled with an antibody against embryonic myosin heavy chain, a marker or regenerated fibers.
• the image in this panel is the equivalent to the one in Panel B. The striking difference between the two images shows the effectiveness of the therapy.
• Figure 13 Enhanced myocardial regenerative capacity of the combination of IGF- 1/HGF/SCF administered intracoronary encapsulated in PLGA microspheres of 15 ⁇ m in diameter
• the bar graph of Fig 13A compares the effect in the number of regenerated cardiac myocytes in pigs post- AMI treated with a combination of two types of microspheres, white bars (one loaded with IGF-I and the other with HGF) with the animals treated with a combination of three types of microspheres (hrIGF-1, hrHGF, and hrSCF), black bars. It is obvious that at the three different concentrations used the combination of 3 types of microspheres each loaded with a different factor is superior to the combination of only two.
• CTRL control animals treated with placebo; White bars:
• IGF-I and 2 ⁇ g of HGF Black bars: Same amounts of IGF-I and HGF as for the animals represented by the white bars plus microspheres loaded with SCF equivalent to 2 , 4 and 8 ⁇ g of biologically active hrSCF
• Fig. 13B shows the left ventricle ejection fraction prior to, immediately after and 4 weeks post- AMI as determined by echocardiography of the pigs treated with different combinations of microspheres.
• Baseline LV ejection fraction just prior the AMI;
• AMI LV ejection fraction after AMI;
• Post-AMI LV ejection fraction 4 weeks after AMI and local GF treatment.
• Embodiments of the disclosure are hereby described as comprising integers.
• the disclosure also extends to separate embodiments consisting of or consisting essentially of said integers.

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