Classifications

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  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/56—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic macromolecular compound, e.g. an oligomeric, polymeric or dendrimeric molecule
  • A61K47/59—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic macromolecular compound, e.g. an oligomeric, polymeric or dendrimeric molecule obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyureas or polyurethanes
  • A61K47/60—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic macromolecular compound, e.g. an oligomeric, polymeric or dendrimeric molecule obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyureas or polyurethanes the organic macromolecular compound being a polyoxyalkylene oligomer, polymer or dendrimer, e.g. PEG, PPG, PEO or polyglycerol
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  • A61K49/001—Preparation for luminescence or biological staining
  • A61K49/0013—Luminescence
  • A61K49/0017—Fluorescence in vivo
  • A61K49/005—Fluorescence in vivo characterised by the carrier molecule carrying the fluorescent agent
  • A61K49/0054—Macromolecular compounds, i.e. oligomers, polymers, dendrimers
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  • A61K49/00—Preparations for testing in vivo
  • A61K49/001—Preparation for luminescence or biological staining
  • A61K49/0063—Preparation for luminescence or biological staining characterised by a special physical or galenical form, e.g. emulsions, microspheres
  • A61K49/0069—Preparation for luminescence or biological staining characterised by a special physical or galenical form, e.g. emulsions, microspheres the agent being in a particular physical galenical form
  • A61K49/0089—Particulate, powder, adsorbate, bead, sphere
  • A61K49/0091—Microparticle, microcapsule, microbubble, microsphere, microbead, i.e. having a size or diameter higher or equal to 1 micrometer
  • A61K49/0093—Nanoparticle, nanocapsule, nanobubble, nanosphere, nanobead, i.e. having a size or diameter smaller than 1 micrometer, e.g. polymeric nanoparticle
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• • A—HUMAN NECESSITIES
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  • A61K9/0085—Brain, e.g. brain implants; Spinal cord
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  • A61K9/127—Synthetic bilayered vehicles, e.g. liposomes or liposomes with cholesterol as the only non-phosphatidyl surfactant
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• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• the present application is related to compositions and methods for synthesis and delivery of high-affinity oxygen binding agents to tumors to increase intratumoral partial pressures of oxygen, mitigate the natural selection of tumor cells that demonstrate aggressive molecular behavior and metastatic potential, and potentiate the effects of radiation and chemotherapies.
• the present application is also related to compositions and methods for generation and delivery of vasoactive compounds that induce tumor-specific hemostasis.
• ROS reactive oxygen species
• hypoxia has been recognized as a cause of treatment failure in solid tumors for more than 50 years, efforts to overcome it have generally been unsuccessful. 4, 5* 8 ' 29"35
• a number of strategies have been designed to enhance the radiosensitivity and radiocurability of solid tumors.
• the most well-studied, hypoxia-altering methods have involved the use of electron- affinity radiosensitizers that mimic the actions of 0 2 but are more slowly metabolized.
• the nitroimidazole compounds have been extensively evaluated as adjuncts to XRT in carcinomas of the head, neck, cervix, and lung.
• erythropoietin 5 ' 85-89 allosteric effectors (RSR13), or angiogenesis inhibitors. 90'92 All of these strategies have met with minimal clinical success due to their reliance on hyperbaric oxygen loading, formulation instabilities, release of hemoglobin-bound oxygen that occurs at pC>2 values (20-40 mmHg) that are much higher than those found in hypoxic tumor regions ( ⁇ 3 rnmHg), and/or intravascular regulatory mechanisms that alter blood flow to maintain relatively constant tissue oxygenation levels. 5 ' 8* 83 ' 91
• angiogenesis is required for tumor growth and metastasis require, such process is also an important point in the control of cancer progression.
• some therapies that have been developed to target the molecular underpinnings of tumor-specific angiogenesis include anti- vascular endothelial growth factor (VEGF) therapies and mammalian target of rapamycin (mTOR) inhibitors.
• VEGF vascular endothelial growth factor
• mTOR mammalian target of rapamycin
• Irinotecan As A Radiation Sensitizer For Locally Advanced Pancreatic Cancer,
• Radiotherapy For Patients With Bladder Carcinoma - Hyperbaric Oxygen, Misonidazole, And Accelerated Radiotherapy, Carbogen, And Nicotinamide, CANCER 1999; 86:1322-8.
• Radiotherapy Sensitization Bench To Bedside And Back, CANCER TREATMENT REVIEWS 2007; 33:757-61.
• Ghoroghchian P.P. Lin J.J., Brannan A.K., et al, Quantitative Membrane Loading Of Polymer Vesicles, SOFT MATTER 2006; 2:973-80.
• Ghoroghchian P.P. Frail P.R., Susumu K., et al, Near-Infrared-Emissive Polymersomes: Self-Assembled Soft Matter For In Vivo Optical Imaging, PROC NATL. ACAD. SCI. U.S.A. 2005; 102:2922-7.
• Nanoparticles Into Vesicular Structures A Morphological Study, PHYSICAL CHEMISTRY CHEMICAL PHYSICS 2007; 9:6435-41.
• Escudier B et al., Randomized, Controlled, Double-Blind, Cross-Over Trial Assessing Treatment Preference for Pazopanib Versus Sunitinib in Patients With Metastatic Renal Cell Carcinoma: PISCES Study, JOURNAL OF CLINICAL ONCOLOGY 2014; 32:1 12-8.
• Figlin R.A. et al. Overall survival with sunitinib versus interferon (IFN)-alfa as first- line treatment of metastatic renal cell carcinoma (mRCC), JOURNAL OF CLINICAL ONCOLOGY 2008 (Meeting Abstracts); 26:abstr 5024.
• IFN interferon
• Hylander B.L. et al. Origin of the vasculature supporting growth of primary patient tumor xenografts, JOURNAL OF TRANSLATIONAL MEDICINE 2013; 11:1-14.
• VEGF Vascular Endothelial Growth Factor
• Roberts K.B. et al. Interim Results Of A Randomized Trial Of Mitomycin C As An Adjunct To Radical Radiotherapy In The Treatment Of Locally Advanced Squamous-Cell Carcinoma Of The Cervix, INT. J. CANCER 2000; 90:206-23. 313.
• Robinson M.F. Dupuis N.P., Kusumoto T., Liu F., Menon K., Teicher B. A., Increased Tumor Oxygenation And Radiation Sensitivity In 2 Rat-Tumors By A Hemoglobin-Based, Oxygen-Carrying Preparation, ARTIF. CELLS BLOOD SUBSTIT. IMMOBIL. BlOTECHNOL. 1995; 23:431-8.
• Wood C.G., Figlin R.A., ADAPT An Ongoing international phase 3 randomized trial of autologous dendritic cell Immunotherapy (AGS 003) plus standard treatment in advanced renal cell carcinoma (RCC), BJU INTERNATIONAL 2013; 112:11-2.
• Various embodiments include methods of causing nanoparticle-mediated microvascular embolization (NME) in a tumor that includes delivering a nitric oxide (NO)-affecting agent to a tumor.
• delivering the NO-affecting agent to the tumor includes introducing the NO-affecting agent into systemic circulation, in which the NO-affecting agent does not affect normal activity of NO in systemic circulation and accumulation of the NO- affecting agent within the tumor is based at least in part on enhanced retention and permeability of the tumor micro vasculature.
• the NO-affecting agent is NO-binding molecules encapsulated within carrier particles, and selectively preventing normal activity of NO includes selectively scavenging NO in the tumor microvasculature.
• the carrier particles are selected from the group consisting of nanoparticles and microparticles, and wherein the carrier particles include at least one of phospholipids, synthetic polymers, polypeptides, and polynucleic acids.
• the nanoparticles are polymersomes.
• the NO-binding molecules competitively bind oxygen (O 2 ) and NO
• introducing the NO-affecting agent into systemic circulation includes introducing oxygenated NO-binding molecules into systemic circulation, in which the NO-binding molecules become deoxygenated upon accumulation of the carrier particles in the tumor, thereby enabling the selective scavenging of NO in the tumor microvasculature.
• the accumulation of the NO-affecting agent in the tumor allows diffusion of NO into the carrier particles, in which the selective scavenging of NO is performed at least in part by deoxygenation of the encapsulated NO -binding molecules.
• the NO-affecting agent further includes surface-associated NO-binding molecules, where the selective scavenging of NO is performed at least in part by deoxygenation of the surface-associated NO-binding molecule.
• the NO-binding molecules only release oxygen at tensions less than 10 mmHg.
• NO-binding molecules are selected from one or more of unmodified human myoglobin, unmodified myoglobin from another biological species, and chemically or genetically modified myoglobin from humans or from another biological species.
• the selective prevention of normal NO activity in the tumor vasculature causes vasoconstriction and platelet aggregation in the tumor vasculature.
• the persistent hydrodynamic pressure in the tumor vasculature causes rupture of the platelet aggregation and bleeding into the tumor.
• the bleeding into the tumor causes thrombosis of tumor vasculature and necrosis of tumor tissue.
• surface-associated NO-binding molecules include surface-bound myoglobin.
• delivering the NO-affecting agent to the tumor includes administering the NO-affecting agent in conjunction with at least one of a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI), a mammalian target of rapamycin (mTOR) inhibitor, and radiotherapy.
• VEGFR vascular endothelial growth factor receptor
• TKI tyrosine kinase inhibitor
• mTOR mammalian target of rapamycin
• the NO-affecting agent further includes at least one of a chemotherapy agent and an angiogensis inhibiting agent co- encapsulated with the NO-binding molecules within the carrier particles.
• the NO-affecting agent includes at least one of a NO synthase (NOS) inhibitor and an NO synthase (NOS) inhibitor and angiogensis inhibiting agent.
• NOS NO synthase
• compositions in further embodiments include a nitric oxide (NO)-inhibiting agent, and a carrier vehicle, in which the NO-inhibiting agent is chemically or non-covalently incorporated with the carrier vehicle such that the NO activity is not affected when the carrier vehicle is in systemic circulation, and NO activity is inhibited following extravasation of the carrier vehicle from circulation into a tumor.
• NO activity involves binding of NO, in which the NO binding is enabled only at oxygen tensions of less than 5 mmHg.
• the carrier vehicle is a synthetic polymer vesicle, in which the NO-inhibiting agent is within an aqueous core of the polymer vesicle.
• the carrier vehicle comprises a synthetic polymer vesicle, and the NO-inhibiting agent is within a membranous portion of the polymer vesicle.
• the carrier vehicle is a synthetic polymer vesicle, and the NO-inhibiting agent is attached to the outside surface of the polymer vesicle.
• the carrier vehicle is a uni- or multi-lamellar
• the carrier vehicle includes a plurality of
• biodegradable polymers In other embodiments, the plurality of biodegradable polymers form a nanoparticle. In some embodiments, the nanoparticle is less than 200 nanometers in diameter, and in other embodiments the nanoparticle is less than 100 nanometers in diameter.
• the carrier vehicle co-encapsulates the NO-inhibiting agent with at least one other radiation-sensitizing or chemotherapeutic agent.
• the carrier vehicle is selected from at least one of a micelle, a solid nanoparticle, a polymersome, and a lipsome .
• the carrier vehicle is a nanoparticle, and the composition further includes a plurality of the nanoparticles configured to accumulate at sites of interest via passive diffusion or via a targeting modality comprised of a conjugation of a targeting molecule separate from the nanoparticles.
• the at least some of the plurality of nanoparticles are biodegradable polymer vesicles and at least some of the plurality of polymer vesicles are biocompatible polymer vesicles.
• the biocompatible polymer vesicles include poly(ethylene oxide) or poly(ethylene glycol).
• the biodegradable polymer vesicles include poly(e- caprolactone).
• the biodegradable polymer vesicles include poly(y-methyl ⁇ -caprolactone).
• the biodegradable polymer vesicles include poly(trimethylcarbonate).
• the biodegradable polymer vesicles include at least one block copolymer of poly(ethylene oxide) and poly(e-caprolactone). In other embodiment compositions, the biodegradable polymer vesicles include at least one block copolymer of poly(ethylene oxide) and polyiy-methyl ⁇ -caprolactone). In other embodiment compositions, the biodegradable polymer vesicles include at least one block copolymer of poly(ethylene oxide) and poly(trimethylcarbonate).
• the biodegradable polymer vesicles are either pure or blends of multiblock copolymer, in which the copolymer includes at least one of poly(ethylene oxide) (PEO), poly(lactide) (PLA), poly(glycolide) (PLGA), poly(lactic-co-glycolic acid) (PLGA), poly(e-caprolactone) (PCL), and poly (trimethylene carbonate) (PTMC), poly(lactic acid), poly(methyl ⁇ -caprolactone).
• PEO poly(ethylene oxide)
• PLA poly(lactide)
• PLA poly(glycolide)
• PLA poly(lactic-co-glycolic acid)
• PCL poly(e-caprolactone)
• PTMC poly (trimethylene carbonate)
• FIG. 1 is a graph illustrating the oxygen dissociation curve of hemoglobin.
• FIG. 2 is a graph illustrating the oxygen dissociation curves of hemoglobin and example agents that may be used to manipulate oxygen levels in tissues in accordance with various embodiments.
• FIG. 3 is a graph illustrating the oxygen dissociation curves of hemoglobin and myoglobin.
• FIG. 4A is an illustration of biodegradable polymers that may be a component of a biodegradable cellular oxygen carrier in various embodiments.
• FIG. 4B is an illustration of water-soluble near-infrared fluorophores "0”and water- soluble oxygen-binding proteins "°" that may be used as components of a biodegradable cellular oxygen carrier in various embodiments.
• FIG. 4C is an illustration of the synthesis of nanoscale polymersome-encapsulated myoglobin (PEM) and processing procedures (heat, sonication, and extrusion) used to yield nanoscale PEM in accordance with various embodiments.
• PEM nanoscale polymersome-encapsulated myoglobin
• FIG. 4D is an illustration of an encapsulation schematic of an embodiment polymersome.
• FIG. 4E is a cryogenic transmission electron micrograph and a confocal micrograph of PEM.
• FIG. 5 is a set of photographs illustrating the (A) bright field, (B) oxygen tension in % oxygen, and (C) functional blood vasculature for a window chamber tumor.
• FIG. 6 A is a cryogenic transmission electron micrograph of PEO(2K)-b-PCL(12K)-based polymersomes in de-ionized water (5 mg ml) that illustrates the membrane core thickness of the vesicles as being 22.5 ⁇ 2.3 nanometer.
• FIG. 7A is an in vivo optical image of encapsulated oligo(po hyrin)-based near-infrared (NIR) fluorophores (NIRFs) that illustrates the accumulation of an embodiment carrier in tumors.
• NIR near-infrared fluorophores
• FIG. 7B is a graph of in vivo tumor growth as inhibited by phosphate buffered saline (PBS), doxorubicin (DOX), liposome-encapsualted DOX, and polymersome-encapsualted DOX.
• PBS phosphate buffered saline
• DOX doxorubicin
• DOX liposome-encapsualted DOX
• polymersome-encapsualted DOX polymersome-encapsualted DOX.
• FIG. 8A is a bar chart illustrating the hemoglobin (Hb) encapsulation efficiencies of four polymersome-encapsulated bovine and human Hb formulations after extrusion through 200 nm diameter polycarbonate membranes.
• FIG. 8B is a bar chart illustrating the P50 (mmHg) of red blood cells, hemoglobin and four polymersome-encapsulated hemoglobin formulations after extrusion through 200 nm
• FIG. 9 is a process flow diagram illustrating an embodiment method for the preparation and delivery of a myoglobin-based oxygen carrier (MBOC).
• MBOC myoglobin-based oxygen carrier
• FIG. 10 is a process flow diagram illustrating an embodiment method for preparing a polymersome including at least one biocompatible polymer and at least one biodegradable polymer.
• FIG. 1 1 is a schematic illustration of optimized steps for the generation of PEM.
• FIG. 12 is a set of bar graphs quantifying myoglobin concentrations and weight percentages of myoglobin-to-polymer in PEM suspensions formed by the method of FIG. 1 1.
• FIG. 13A is graph illustrating oxygen saturation of PEM having myoglobin associated both on the surface and in the aqueous cavaties of the polymersomes (i.e. PEM-SE), PEM having myoglobin associated only in the aqueous cavaties of the polymersomes (i.e. PEM-E), and free myoglobin as a function of partial pressure of oxygen.
• FIG. 13B is a graph illustrating the kinetic time course for the dissociation of oxygen from PEM, where all unencapsulated and surface-associated myoglobin had been removed by proteolysis and in which the remaining myoglobin had been reduced to oxymyoglobin in the presence of 1.5 mg/mL of Na 2 S 2 0 4 .
• FIG. 13C is a graph illustrating the kinetic time course for NO-mediated deoxygenation of PEM, where all unencapsulated and surface-associated myoglobin had been removed by proteolysis and in which the remaining myoglobin had been reduced to oxymyoglobin.
• FIG. 14 is a table showing kinetic rate constants for oxygen dissociation (Koff, o2) and NO-mediated deoxygenation (Ko X , NO) for various PEM formulations in comparison to free (unencapsulated) myoglobin (Mb).
• FIG. 15A is a set of in vivo optical images of the biodistribution of NIR-myoglobin, empty polymersomes, and PEM at four time points following intravenous injection.
• FIG. 15B is a graph illustrating tumor accumulations of NIR-myoglobin, empty polymersomes, and PEM as functions of time.
• FIG. 15C is a graph illustrating plasma myoglobin concentrations of NIR-myoglobin, and PEM as functions of time.
• FIG. 16 is a set of images showing PEM treatment of syngeneic orthotopic 4T1 mammary tumors.
• FIG. 17 is a graph illustrating total intratumoral hemoglobin concentration as a function of time for the PEM-treated tumors shown in FIG. 16, as well as for tumors treated with NIR- myoglobin and empty polymersomes.
• FIG. 18A is a set of brightfield images of tumor and surrounding normal tissues over time following treatment with PEM.
• FIG. 18B is a set of images of the tumor FIG. 18A at 24 h after administration of PEM.
• FIG. 19A is a set of images showing hemoglobin saturation (%) in tumors before and at around 4 hours post treatment with PEM and empty polymersomes.
• FIG. 19B is a set of images showing flow velocity ( ⁇ /s) in tumors before and at around 4 hours post treatment with PEM and empty polymersomes.
• FIG. 20 is a set of representative fluorescent images and hematoxylin and eosin images of excised tumors for NIR-myoglobin control and PEM-treated animal.
• FIG. 21 is a table illustrating the results of a serum chemistry panel for PEM-treated animals.
• FIGs. 22A and 22B are sets of hematoxylin and eosin images of excised livers from tumor-mice treated with PEM and empty polymersomes.
• FIG. 22C is a set of images showing allograft RENCA tumors in mice treated with PEM.
• FIG. 22D is a set of images showing allograft RENCA tumors in mice treated with empty polymersomes.
• FIGs. 22E and 22F are sets of representative fluorescent images and hematoxylin and eosin images of excised tumors from mice that were treated with PEM and with empty polymersomes, respectively.
• FIG. 23 A is a table illustrating study parameters for determining safe dosing levels and schedules for PEM.
• FIG. 23B is a table illustrating study parameters for determining minimum effective W
• NME tumor-specific nanoparticle-mediated microvascular embolization
• FIG. 24A is a table illustrating study parameters for determining an optimal PEM dosing schedule and therapeutic combination with a VEGF receptor TKI for inhibiting tumor growth as a first-line therapy for RCC.
• FIG. 24B is a table illustrating study parameters for determining an optimal PEM dosing schedule and therapeutic combination with an mTOR inhibitor for inhibiting tumor growth as a second-line therapy for RCC.
• FIG. 25 is a table illustrating study parameters for determining an optimal PEM dosing schedule with radiation therapy for inhibiting tumor growth as palliative therapy for RCC.
• subject and “patient” are used interchangeably herein to refer to human patients, whereas the term “subject” may also refer to any animal. It should be understood that in various embodiments, the subject may be a mammal, a non-human animal, a canine and/or a vertebrate.
• monomelic units is used herein to mean a unit of polymer molecule containing the same or similar number of atoms as one of the monomers.
• Monomelic units as used in this specification, may be of a single type (homogeneous) or a variety of types
• polymers are used according to its ordinary meaning of macromolecules comprising connected monomeric molecules.
• amphiphilic substance is used herein to mean a substance containing both polar (water-soluble) and hydrophobic (water-insoluble) groups.
• in vivo delivery is used herein to refer to delivery of a biologic by routes of administration such as topical, transdermal, suppository (rectal, vaginal), pessary (vaginal), intravenous, oral, subcutaneous, intraperitoneal, intrathecal, intramuscular, intracranial, inhalational, oral, and the like.
• an effective amount is used herein to refer to an amount of a compound, material, or composition effective to achieve a particular biological result such as, but not limited to, biological results disclosed, described, or exemplified herein. Such results may include, but are not limited to, the effective reduction of symptoms associated with any of the disease states mentioned herein, as determined by any means suitable in the art.
• membrane is used herein to mean a spatially distinct collection of molecules that defines a two-dimensional surface in three-dimensional space, and thus separates one space from another in at least a local sense.
• pharmaceutically active agent is used herein to refer to any a protein, peptide, sugar, saccharide, nucleoside, inorganic compound, lipid, nucleic acid, small synthetic chemical compound, or organic compound that appreciably alters or affects the biological system to which it is introduced.
• drug delivery is used herein to refer to a method or process of administering a pharmaceutical compound to achieve a therapeutic effect in humans or animals.
• vehicle is used herein to refer to agents with no inherent therapeutic benefit but when combined with an pharmaceutically active agent for the purposes of drug delivery result in modification of the pharmaceutical active agent's properties, including but not limited to its mechanism or mode of in vivo delivery, its concentration, bioavailability, absorption, distribution and elimination for the benefit of improving product efficacy and safety, as well as patient convenience and compliance.
• carrier is used herein to describe a delivery vehicle that is used to incorporate a pharmaceutically active agent for the purposes of drug delivery.
• oxygen-binding agent or "oxygen-binding compound” is used herein to refer to any molecule or macromolecule that binds, stores, and releases oxygen.
• allosteric effector is used herein to refer to a molecule that modulates the rate or amount of oxygen binding to or releasing from of an oxygen carrier.
• high-oxygen affinity agent or "high oxygen affinity compound” is used herein to refer to any molecule or macromolecule that binds and stores oxygen but only releases it at partial pressures of oxygen that are lower than the levels at which natural human hemoglobin normally releases oxygen.
• High-oxygen affinity agents include oxygen-binding compounds.
• High-oxygen affinity agents may include oxygen-binding compounds with a P50 for oxygen then is less than that of human adult or fetal hemoglobins with or without their interactions with natural allosteric modulators, carbon monoxide or strong reducing or oxidizing agents.
• oxygen-binding carrier or "oxygen carrier” is used herein to refer to a carrier comprised of a synthetic or partially synthetic vehicle that incorporates a single or plurality of oxygen-binding agents.
• homopolymer is used herein to refer to a polymer derived from one monomeric species of polymer.
• copolymer is used herein to refer to a polymer derived from two (or more) monomeric species of polymer, as opposed to a homopolymer where only one monomer is used. Since a copolymer consists of at least two types of constituent units (also structural units), copolymers may be classified based on how these units are arranged along the chain.
• block copolymers is used herein to refer to a copolymer that includes two or more homopolymer subunits linked by covalent bonds in which the union of the homopolymer subunits may require an intermediate non-repeating subunit, known as a junction block.
• Block copolymers with two or three distinct blocks are referred to herein as “diblock copolymers” and “triblock copolymers " respectively.
• area strain is used herein to refer to the change in the surface area of a particle under an external force or tension divided by the original surface area of the particle prior to application of said external force or tension (denoted by "A” and expressed as %).
• critical lysis tension or “Tc” is used herein to refer to the tension at which a particle ruptures when subject to an external force as measured by micropipette aspiration and expressed as milliNewtons/meter (mN/m).
• critical areal strain or "Ac” is used herein to refer to the areal strain realized by the oxygen carrier or polymersome at the critical lysis tension.
• loading ratio is used herein to refer to a measurement of a oxygen biding carrier and may be defined as the weight of oxygen binding agent within the oxygen carrier divided by the dry weight of the inert vehicle.
• myoglobin loading capacity is used herein to refer to a measurement of a myoglobin-based oxygen carrier and may be defined as the weight of myoglobin within the oxygen carrier divided by the total weight of carrier.
• myoglobin loading efficiency is used herein to refer to a measurement of a myoglobin-based oxygen carrier and may be defined as the weight of myoglobin that is encapsulated and/or incorporated within a carrier suspension divided by the weight of the original myoglobin in solution prior to encapsulation (expressed as a %).
• a "unit dose" is used herein to refer to a discrete amount of the pharmaceutical composition comprising a predetermined amount of the active ingredient.
• P50 is the partial pressure of oxygen (p02) at which the oxygen-binding compound becomes 50% saturated with oxygen. As the P50 decreases, oxygen affinity increases, and visa verse.
• Normal adult Hemoglobin A has a P50 of 26.5 mm Hg while Fetal Hemoglobin F has a P50 of 20 mm Hg and sickle cell anemia Hemoglobin S has a P50 of 34 mm Hg.
• the various embodiments provide a nanoparticle-based therapeutic carrier to deliver high-oxygen affinity agents (e.g., molecules and proteins such as myoglobin) to tumors in order to increase intratumoral p02, to stunt their aggressive molecular phenotypes, and to increase the efficacy of radiation and chemo-therapies directed against the tumor.
• high-oxygen affinity agents e.g., molecules and proteins such as myoglobin
• radiation treatment may be augmented by increasing the oxygen levels of tumors, in order to generate more oxygen-based free radicals with concomitant radiation therapy, or by delivering another non-0 2 dependent radiation sensitizer to tumor-specific sites.
• Hemoglobin is an oxygen-transporting protein in human red blood cells. Hemoglobin's structure makes it efficient at binding to oxygen, and efficient at unloading the bound oxygen in human tissues/blood stream. Hemoglobin consists of two pairs of globin dimers held together by non-covalent bonds to form a larger four subunit (tetrameric) hemoglobin molecule. The oxygen binding capacity of tetrameric hemoglobin depends on the presence of a non-protein unit called the heme group (i.e., one molecule of hemoglobin can bind with four oxygen molecules).
• FIG. 1 illustrates the oxygen dissociation curve of hemoglobin.
• Cooperative binding of oxygen to hemoglobin gives native hemoglobin a sigmoidal-shaped oxygen dissociation curve and allows oxygen to be bound and released within a narrow physiological range of p0 2 s (from 40-100 mmHg).
• Conventional methods for manipulating the oxygen levels of tumors have attempted to use hemoglobin or agents (proteins, molecules, etc.) having a similar oxygen dissociation curve as native hemoglobin.
• Others have attempted to use agents having oxygen dissociation curves that are shifted to the right of the hemoglobin oxygen dissociation curve (i.e., agents having a lower affinity for oxygen than hemoglobin).
• FIG. 2 illustrates the oxygen dissociation curves of hemoglobin and two other example agents (e.g., Agent A, Agent B) which may be used to manipulate oxygen levels in tumors.
• Agent A e.g., Agent A, Agent B
• Agent B e.g., Agent A, Agent B
• FIG. 2 illustrates that the example agents (Agent A, Agent B) have oxygen dissociation curves that are shifted to the right of the hemoglobin oxygen dissociation curve, which increases the amount of oxygen delivered by the example agents.
• FIG. 3 illustrates the oxygen dissociation curves of hemoglobin and myoglobin, a ubiquitous protein involved in regulating oxygen levels in muscle tissues.
• FIG. 3 shows that the oxygen dissociation curve of myoglobin is a rectangular hyperbola with a very low P50 that lies to the left of the sigmoid-shaped hemoglobin oxygen dissociation curve (i.e., myoglobin has a much higher affinity for oxygen than hemoglobin). That is, in contrast to the example agents (e.g., Agent A, Agent B) discussed above with reference to FIG. 2, myoglobin has an oxygen dissociation curve that is shifted to the left of the hemoglobin oxygen dissociation curve.
• agents e.g., Agent A, Agent B
• compositions and methods for delivering high-oxygen affinity agents e.g., myoglobin, modified hemoglobin, synthetic proteins
• high-oxygen affinity agents e.g., myoglobin, modified hemoglobin, synthetic proteins
• the use of high-oxygen affinity agents ensures that the oxygen is not released from the agents until they are positioned around or within the tumor.
• the oxygen tensions at the center of solid tumors are similar to the oxygen tensions (2 to 3 mmHg) at which oxygen releases from myoglobin.
• the efficacy of radiation treatment may be improved by increasing the oxygen levels of tumors, and conventional methods for manipulating the oxygen levels are reliant upon increasing the systemic level of oxygen.
• existing techniques for delivering oxygen to tumors may involve increasing the amount of blood flow to the tumor, increasing the amount of dissolved oxygen in blood, or increasing the overall blood concentration of hemoglobin.
• compositions of matter and methodology to deliver oxygen to tumor tissues by utilizing agents that have much higher affinity for oxygen than that of natural human hemoglobin and that possess an oxygen dissociation curve similar to that of natural myoglobin. Since the partial pressure of oxygen at the center of a solid tumor is similar to the oxygen tension at which oxygen releases from myoglobin (2 to 3 mmHg), oxygen is not released until the high-oxygen affinity agents are around or within the tumor.
• high-oxygen affinity agents e.g., myoglobin, other synthetic proteins having similar oxygen affinity as myoglobin, etc.
• high-oxygen affinity agents e.g., myoglobin, other synthetic proteins having similar oxygen affinity as myoglobin, etc.
• a large amount of the high-oxygen affinity agents must be injected into the blood stream. Injecting a large amount of such proteins into the bloodstream is dangerous, as the injected agent (e.g., myoglobin) may be nephrotoxic and/or cause hypertensive urgency or emergency (via sequestration of the vasodilator nitric oxide that normally controls blood vessel tone).
• myoglobin such phenomena is commonly observed in people who have heart attacks, run marathons, engage in other strenuous exercises, and/or use various drugs such as cocaine.
• muscles may begin to break down very quickly, thereby releasing a large amount of myoglobin into the blood stream.
• This extra myoglobin may result in the protein getting trapped in the body's filter apparatus (i.e., kidney glomeruli) and or cause a life threatening condition known as rhabdomyolysis.
• a large amount of myoglobin in the blood stream may also increase blood pressure and lead to organ damage.
• myoglobin and other free oxygen-binding proteins sequester nitric oxide (NO) that is a mediator of vascular tone and blood flow.
• NO nitric oxide
• myoglobin floods in the bloodstream it acts to extract nitric oxide from the blood vessel walls, causing the blood vessels to constrict. This may cause an increase in the overall blood pressure and possibly lead to a hypertensive crisis, damaging major organs such as the kidneys, the heart, and the brain.
• injecting an oxygen binding protein, such as myoglobin directly into the blood stream in its free-form is dangerous.
• various embodiments may encapsulate the high- affinity oxygen binding agents in a carrier vehicle (e.g., a nanoparticle shell) that will protect the encapsulated agents from being released into the blood stream or interacting with biological components (e.g. proteins, cells, and the blood vessel walls) while in the blood circulation.
• a carrier vehicle e.g., a nanoparticle shell
• biological components e.g. proteins, cells, and the blood vessel walls
• the various embodiments are not necessarily limited to nanoparticle encapsulation or to any particular carrier vehicle unless expressly recited as such in the claims.
• the inert carrier may be a PEGylated or polymerized version of the high- affinity oxygen-binding agent itself.
• high-affinity oxygen binding agents may be encapsulated in carrier vehicles having characteristics that allow for their accumulation around tumor regions and/or are capable of targeting tumors experiencing low oxygen tension.
• the carrier vehicle may also have characteristics such that oxygen will diffuse from within the vehicle to regions of low oxygen tension (as exist in the center of tumors) while the high-affinity oxygen binding agents remain encapsulated.
• the high-oxygen affinity agents may be delivered to tumors in a manner that allows the delivered agent to release oxygen at the oxygen tension required to increase the efficacy of radiation due to the oxygen partial pressure gradient characteristics of the agent.
• the high-oxygen affinity agents may be encapsulated in a vehicle comprised of biodegradable polymers (e.g., polymersomes, nanoparticles, etc.).
• biodegradable polymers e.g., polymersomes, nanoparticles, etc.
• Encapsulation of the high-oxygen affinity agents e.g., oxygen binding proteins and/or molecules
• biodegradable polymeric vehicles protects the agents from contact with blood and tissues, thereby reducing toxicity while maintaining high internal oxygen concentrations until the vehicles are positioned within hypoxic tumor tissues.
• the agents may be encapsulated such that they are highly concentrated within the aqueous interior of the carrier vehicle.
• the agents may be encapsulated such that the carrier vehicle (e.g., nanoparticle shell) shields the encapsulated proteins from interacting with the blood vessel walls, preventing nitric oxide from being taken up into the nanoparticle and or binding to encapsulated oxygen binding proteins and/or molecules.
• the agents may include proteins and/or molecules that have very high affinity for oxygen (e.g., proteins having a low P50 for oxygen) and/or have oxygen binding proprieties such that oxygen becomes unbound from the proteins and/or molecules only at the lowest oxygen tensions, such as those found in the most hypoxic tumors (i.e., heterogeneous tumors where pockets of tissue have oxygen tensions that are below the P50 of the high-affinity oxygen carrying agent).
• the agents may include proteins and/or molecules for which oxygen is released at an oxygen tension of less than 10 millimeters mercury (mmHg).
• the inert carrier vehicle may be any one or more of a liposome, polymersome, micelle, modified lipoprotein, solid nanoparticle, solid micron-sized particle, lipid or perfluorocarbon emulsion, dendrimer, virus, or virus-like particle.
• the inert carrier vehicle may be a PEGylated or polymerized version of the high- affinity oxygen-binding agent or agents.
• human myoglobin may be encapsulated within nanoparticles, polymer vesicles and/or polymersomes.
• the nanoparticles, polymer vesicles and/or polymersomes may be constructed from one of a number of different biodegradable materials.
• the high-affinity oxygen-binding agents may include myoglobin.
• Myoglobin (Mb) is a cytoplasmic heme protein that plays a well- characterized role in O2 transport and free radical scavenging in skeletal and cardiac muscle (two tissues, notably, with low incidences of malignancy).
• 93 ' 94 Myoglobin's oxygen-related functions are multiple and include at least 3 different activities.
• Myoglobin thus binds 0 2 in aerobic conditions and releases it under hypoxic conditions, 95 as found in tumors.
• myoglobin is capable of buffering intracellular 0 2 by unloading its oxygen as cytoplasmic p0 2 falls to low levels, promoting continuous oxidative phosophorylation.
• myoglobin supplements simple 0 2 delivery by working as a carrier in a process known as facilitated 0 2 diffusion. 97
• Myoglobin has recently been shown to be a modulator of tumor hypoxia.
• 98 ' 9 Myoglobin gene transfer in a mouse xenotransplanted human lung tumor provided a valid model for studying the role of 0 2 and ROS in tumor progression. By enabling oxidative phosphorylation under low p0 2 , myoglobin further prevents baseline ROS formation under hypoxic conditions and mitigates the tumorigenic response.
• 98 These effects were not observed using point-mutated forms of myoglobin unable to bind 0 2 but capable of scavenging free radicals. 98 Together, these data suggest that hypoxia is not just an autosomal phosphate, and others.
• myoglobin has shown to modulate tumor hypoxia, its clinical utility as an 0 2 therapeutic requires overcoming two major obstacles related to its free intravascular infusion: 1) vasoconstriction, hypertension, reduced blood flow, and vascular damage in animals due to entrapment of endothelium-derived nitric oxide (NO); and 2) nephrotoxicity as seen with rhabdomyolysis.
• the limitations of using myoglobin as an oxygen carrier may be overcome by encapsulating myoglobin within an appropriate polymeric vehicle (e.g., polymersome) to improve its tumor-specific delivery and to mitigate its systemic exposure.
• Polymersomes 38 ' 39 are synthetic polymer vesicles that are formed in nanometric dimensions (50 to 300 nm in diameter) and exhibit several favorable properties as cellular oxygen carriers.
• polymersomes belong to the class of bi- and multi-layered vesicles that can be generated through self-assembly and can encapsulate hydrophilic compounds such as hemoglobin (Hb) and myoglobin (Mb) in their aqueous core.
• Hb hemoglobin
• Mb myoglobin
• polymersomes offer several options to be designed from fully biodegradable FDA-approved components and exhibit no in vitro or acute in vivo toxicities.
• Polymersomes exhibit several superior properties over liposomes and other nanoparticle- based delivery vehicles that make them effective myoglobin-based oxygen carriers MBOCs.
• polymersome membranes may be significantly thicker ( ⁇ 9-22 nm) than those of liposomes (3-4 ran), making them 5-50 times mechanically tougher and at least 10 times less permeable to water than liposomes.
• Polymersomes may be readily produced and stored on a large-scale without requiring costly post-manufacturing purification processes.
• formulations have been hypothesized to be comprised of block copolymers that consist of the hydrophilic biocompatible poly(ethylene oxide) (PEO), which is chemically synonymous with PEG, coupled to various hydrophobic aliphatic poly(anhydrides), poly(nucleic acids), poly(esters), poly(ortho esters), polypeptides), poly(phosphazenes) and poly(saccharides), including but not limited by poly(lactide) (PLA), poly(glycolide) (PLGA), poly(lactic-co- glycolic acid) (PLGA), poly(e-caprolactone) (PCL), and poly (trimethylene carbonate) (PTMC).
• PEO hydrophilic biocompatible poly(ethylene oxide)
• Polymersomes comprised of 100% PEGylated surfaces possess improved in vitro chemical stability, augmented in vivo bioavailablity, and prolonged blood circulatory half-lives 42 ' 3
• aliphatic polyesters constituting the polymersomes' membrane portions, are degraded by hydrolysis of their ester linkages in physiological conditions such as in the human body. Because of their biodegradable nature, aliphatic polyesters have received a great deal of attention for use as implantable biomaterials in drug delivery devices, bioresorbable sutures, adhesion barriers, and as scaffolds for injury repair via tissue engineering. 44, 45
• PCL poly(e-caprolactone)
• PCL poly(e-caprolactone)
• its derivatives have several advantageous properties including: 1) high permeability to small drug molecules; 2) maintenance of a neutral pH environment upon degradation; 3) facility in forming blends with other polymers; and 4) suitability for long-term delivery afforded by slow erosion kinetics as compared to PLA, PGA, and PLGA.
• ⁇ -caprolactone or derivatives such as ⁇ -methyl ⁇ -caprolactone
• PEM polymersome- encapsulated myoglobin
• Components of biodegradable polymersomes may include biodegradable polymers, as shown in FIG. 4A, and water-soluble near-infrared fluorophores and water-soluble oxygen binding proteins, as shown in FIG. 4B.
• FIG. 4C illustrates processing procedures involved in the synthesis of nanoscale PEM in various embodiments, which include heat, sonication, and extrusion.
• An embodiment PEM is shown schematically in FIG. 4D, and in cryogenic transmission electron micrograph and confocal micrographs in FIG. 4E.
• Fully biodegradable and bioresorbable polymersomes have previously been demonstrated to be generated via self- assembly upon aqueous hydration of amphiphilic diblock copolymers of PEO-b-PCL 39 .
• PEO-b-PCL copolymers Over 20 PEO-b-PCL copolymers, varying in molecular weights of the component building blocks, have previously been tested for the generation of stable bilayered polymersomes. However, only diblock copolymers of PEO-b-PCL in which the PEO block was 1-5 kDa and 10-20% of the polymer mass by weight have demonstrated a consistent and significant yield of stable mono- dispersed polymersomes, with mean particle diameters of ⁇ 200 nm and membrane thicknesses of 9-22 nm after extrusion through 200-nm diameter pore cut-off membranes.
• PEO-b-PCL polymersomes have subsequently been shown to be capable of loading the anti-neoplastic drug doxorubicin (DOX) using an ammonium sulfate gradient.
• DOX anti-neoplastic drug doxorubicin
• polymersomes were evaluated as a function of pH over 14 days. While the kinetics of release varied under neutral and acidic pH conditions (5.5 and 7.4, at 37 °C), an initial burst release phase (approx. 20% of the initial payload within the first 8 h) was observed at both pH conditions followed by a more controlled, pH-dependent release over the several days. At a pH of 7.4, kinetic release studies suggest that the encapsulated molecules initially escape the polymersome through passive diffusion of the drug across intact poly(e-caprolactone) (PCL) membrane (days 1-4), and subsequently through hydrolytic matrix degradation of PCL (days 5- 14).
• PCL poly(e-caprolactone)
• FIG. 5 illustrates the (A) bright field micrograph of tumor vasculature, (B) distribution of oxygen tensions in the tumor parenchyma (in % oxygen), and (C) overlay of (A) and (B), demonstrating functional oxygen delivery, utilizing an in vivo window chamber tumor model system.
• the tumor is the relatively dark region in panel A in the center-left.
• the oxygen saturation (C) is shown on a color scale whose brightness is modulated by the total 0 2 content (thus well vascularized regions appear bright.)
• the tumor region displays highly heterogeneous oxygen concentration (B), with a central peak in oxygen tension, as well as a peripheral (upper and right) region that is highly hypoxic.
• the composite map shows significant contrast with the surrounding normal tissue due to angiogenesis throughout the tumor, making it appear hazy bright.
• the 02 content (as measured by the partial pressure of oxygen at various points) is heterogeneous throughout the tumor parenchyma but the lowest oxygen-tensions (darkest areas as demarcated by p02 of ⁇ lOmmHg) can be found within the center of the tumor. It is within these low p02 laden areas where tumors tend to up-regulate the HIF-1 signaling cascade, leading to a more aggressive tumorigenic phenotype that is resistant to radiation and chemotherapies and that has a higher tendency to metastasize to other locations.
• increasing the minimum oxygen tensions found within the heterogeneous tumor may be as important as increasing the overall tumor p02 when it comes to a therapeutic goal.
• FIG. 6 A illustrates that only diblock copolymers of poly(ethylene oxide)-block-poly(s- caprolactone) (PEO-b-PCL) in which the PEO block was 1-5 kDa and 10-20% of the polymer mass by weight have demonstrated a consistent and significant yield of stable mono-dispersed polymersomes, with mean particle diameters of ⁇ 200 nm and membrane thicknesses of 9-22 nm after extrusion through 200-nm diameter pore-cutoff membranes.
• PEO-b-PCL polymersomes have subsequently been shown to be capable of loading the anti-neoplastic drug doxorubicin (DOX) using an ammonium sulfate gradient.
• DOX anti-neoplastic drug doxorubicin
• FIG. 6B illustrates the in vitro stability, mechanism of degradation and rate of drug release from DOX-loaded PEO(2kDa)-b-PCL(12kDa) polymersomes evaluated as a function of pH over 14 days.
• FIG. 6B shows that, while the kinetics of release varied under neutral and acidic pH conditions (5.5 and 7.4, at 37 °C), an initial burst release phase (approx. 20% of the initial payload within the first 8 h) was observed at both pH conditions followed by a more controlled, pH-dependent release over the several days.
• these fully-biodegradable polymersomes have a tl/2 half-life of circulation (24-48 h) that is much shorter than their tl/2 half-life of release (2 weeks at pH 7.4).
• polymersomes can be expected to circulate in the blood stream relatively intact and will release their encapsulated contents in an accelerated fashion only when exposed to lower pH
• FIG. 7 A illustrates the accumulation of an embodiment carrier (Polymersomes) in tumors as demonstrated through in vivo optical imaging of oligo(pO hyrin)-based near-infrared (NIR) fluorophores (NIRFs) that are incorporated within the membrane shells of the polymersomes.
• NIR near-infrared
• NIRFs near-infrared fluorophores
• FIG. 7B is a line chart of in vivo tumor growth (depicted as tumor size in log (mm 3 )) as inhibited by phosphate buffered saline (PBS), doxorubicin (DOX), liposome-encapsulated DOX, and polymersome-encapsulated DOX.
• PBS phosphate buffered saline
• DOX doxorubicin
• DOX liposome-encapsulated DOX
• polymersome-encapsulated DOX polymersome-encapsulated DOX.
• This figure illustrates that not only are polymersomes able to accumulate around tumors (as seen in FIG. 7A) but that they do so in sufficient quantities and with preserved intravascular stabilities so as to enable effective release of their encapsulant payload at the tumor site so as to alter tumor biology.
• biodegradable delivery vehicles e.g. polymersomes vs. liposomes vs. free drug
• FIG. 8A illustrates hemoglobin (Hb) encapsulation efficiencies of four polymersome- encapsulated bovine and human Hb formulations after extrusion through 200 nm diameter polycarbonate membranes. Specifically, FIG. 8A illustrates the hemoglobin encapsulation efficiency of PEO-b-PCL-l(1.65 KDa), PEO-b-PCL-2(15 KDa), PEO-b-PLA-l(10 kDa) and PEO-b-PLA-2 (2.45 KDa). As discussed above, the various embodiments provide methodology for generating constructs that have an average radius between 100-125 nm with polydispersity index ⁇ 1.1 and a hemoglobin encapsulation efficiency > 50%.
• FIG. 8B illustrates the Pso (mmHg) of red blood cells, hemoglobin and four
• polymersome-encapsulated hemoglobin formulations (PEO-b-PCL-l(1.65 KDa), PEO-b-PCL- 2(15 KDa), PEO-b-PLA-l(10 kDa) and PEO-b-PLA-2 (2.45 KDa)) extruded through 200 nm diameter polycarbonate membranes.
• the various embodiments provide methodology for generating PEM constructs that have a P50 ⁇ 10 mm mercury and at least an order of magnitude smaller NO binding rate constant than that measured for liposome- encapsulated hemoglobin dispersions (LEHs) at similar hemoglobin loading concentrations.
• polymers are macromolecules comprising chemically conjugated monomeric molecules, wherein the monomeric units being either of a single type
• polymers may be dictated by several factors, including: the total molecular weight, the composition of the polymer (e.g., the relative concentrations of different monomers), the chemical identity of each monomeric unit and its interaction with a solvent, and the architecture of the polymer (whether it is single chain or consists of branched chains).
• PEG polyethylene gylcol
• EG polyethylene gylcol
• the chain lengths of which, when covalently attached to a phospholipid, optimize the circulation life of a liposome is known to be in the approximate range of 34 -114 covalently linked monomers (EG34 to EG114).
• the preferred embodiments comprise hydrophilic copolymers of polyethylene oxide (PEO), a polymer that is related to PEG), and one of several hydrophobic blocks that drive self-assembly of the polymersomes, up to microns in diameter, in water and other aqueous media.
• PEO polyethylene oxide
• PEG polymer that is related to PEG
• hydrophobic blocks that drive self-assembly of the polymersomes, up to microns in diameter, in water and other aqueous media.
• an amphiphilic substance is one containing both polar (water- soluble) and hydrophobic (water-insoluble) groups.
• a potential minimum requisite molecular weight for an amphiphile must exceed that of methanol HOCH3, which is the smallest canonical amphiphile, with one end polar (HO-) and the other end hydrophobic (-CH3).
• HOCH3 methanol HOCH3
• -CH3 hydrophobic
• the oxygen carrier, nanoparticle and/or polymersome does not include polyethylene glycol (PEG) or polyethylene oxide (PEO) as one of its plurality of polymers.
• the oxygen carrier, nanoparticle and/or polymersome include least one hydrophilic polymer that is polyethylene glycol (PEG) or polyethyelene oxide (PEO).
• the PEG or PEO polymer may vary in molecular weight from about 5 kDaltons (kDa) to about 50 kDa in molecular weight.
• the most common lamellae-forming amphiphiles may have a hydrophilic volume fraction between 20 and 50%.
• the hydrophilic volume fraction of the oxygen carriers, nanoparticles and/or polymersomes is up to about 20%.
• the hydrophilic volume fraction of the oxygen carriers, nanoparticles and/or polymersomes is up to about 19%.
• the hydrophilic volume fraction of the oxygen carriers, nanoparticles and/or polymersomes is up to about 18%.
• the hydrophilic volume fraction of the oxygen carriers, nanoparticles and/or polymersomes is up to about 17%.
• the hydrophilic volume fraction of the oxygen carriers, nanoparticles and/or polymersomes is up to about 16%. In some embodiments, the hydrophilic volume fraction of the oxygen carriers, nanoparticles and/or polymersomes is up to about 15%. In some embodiments, the hydrophilic volume fraction of the oxygen carriers, nanoparticles and/or polymersomes is less than 20%. In some embodiments, the hydrophilic volume fraction of the oxygen carriers, nanoparticles and/or polymersomes is from about 1% to about 20%.
• amphiphilic and super-amphiphilic molecules to self-assemble can be largely assessed, without undue experimentation, by suspending the synthetic super-amphiphile in aqueous solution and looking for lamellar and vesicular structures as judged by simple observation under any basic optical microscope, cryogenic transmission electron microscope, or through the scattering of light.
• the effective amount of the composition may be dependent on any number of variables, including without limitation, the species, breed, size, height, weight, age, overall health of the subject, the type of formulation, the mode or manner of administration, the type and/or severity of the particular condition being treated, or the need to modulate the activity of the molecular pathway induced by association of the analog to its receptor.
• the appropriate effective amount can be routinely determined by those of skill in the art using routine optimization techniques and the skilled and informed judgment of the practitioner and other factors evident to those skilled in the art.
• a therapeutically effective dose of the oxygen carriers of the various embodiments may provide partial or complete biological activity as compared to the biological activity of a patient's or subject's physiologically mean, median or minimum tissue oxygenation.
• a therapeutically effective dose of the oxygen carriers of the various embodiments may provide a complete or partial amelioration of symptoms associated with a disease, disorder or ailment for which the subject is being treated.
• the oxygen carriers of the various embodiments may delay the onset or lower the chances that a subject develops one or more symptoms associated with the disease, disorder, or ailment for which the subject is being treated.
• an effective amount is the amount of a compound required to treat or prevent a consequence resulting from low or poor tissue oxygenation.
• the effective amount of active compound(s) used for therapeutic treatment of conditions caused by or contributing to low or poor tissue oxygenation varies depending upon the manner of administration, the age, body weight, and general health of the patient.
• Soluble amphiphiles, proteins, ligands, allosteric effectors, oxygen binding compounds can bind to and/or intercalate within a membrane.
• a membrane must also be semipermeable to solutes, sub-microscopic in its thickness (d), and result from a process of self- assembly or directed assembly.
• the membrane can have fluid or solid properties, depending on temperature and on the chemistry of the amphiphiles from which it is formed. At some temperatures, the membrane can be fluid (having a measurable viscosity), or it can be solid-like, with an elasticity and bending rigidity.
• the membrane can store energy through its mechanical deformation, or it can store electrical energy by maintaining a transmembrane potential. Under some conditions, membranes can adhere to each other and coalesce (fuse).
• myoglobin may be used as the oxygen-binding compound.
• the oxygen-binding compound is protein with oxygen binding properties that are similar to myoglobin.
• the oxygen-binding compound is genetically- or chemically-modified myoglobin or an oxygen binding protein isolated from another species that possesses gaseous binding characteristics that are similar to human myoglobin.
• the oxygen-binding compound is chosen from a protein, small molecule, polypeptide, nucleic acid molecule, a metal-chelator complex or any
• the oxygen-binding compound is a protein. In some embodiments, the oxygen-binding compound is a polypeptide. In some embodiments, the oxygen-binding compound is a polypeptide with a genetically or chemically modified heme group. In some embodiments, the oxygen-binding compound is a small molecule comprising a heme group.
• the oxygen carrier transports an effective amount of oxygen in order to treat a subject or to prevent a subject from suffering from a disease or disorder in which their blood does not carry or release sufficient levels of oxygen to tissues.
• the oxygen carrier comprises an effective amount of oxygen in order to treat or prevent the spread of cancer in a subject in need thereof.
• the oxygen carrier comprises an effective amount of oxygen in order to promote wound healing in a subject in need thereof.
• the allosteric effector is 2,3-Bisphosphoglycerate or an isomer derived there from. Allosteric effectors such as 2,3-Bisphosphoglycerate may increase the offload of oxygen from the oxygen carrier or polymersome of the various embodiments to a tissue or cell that is deoxygenated within a subject.
• critical lysis tension is the tension at which a particle ruptures when subject to an external force, as measured by micropipette aspiration and expressed as milliNewtons/meter (mN/m).
• the change in critical lysis tension of an oxygen carrier or polymersome may be measured before and after loading of the oxygen carrier, nanoparticle and/or polymersome with myoglobin, another oxygen-binding compound, or a mixture of one or more oxygen-binding compounds.
• the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension of no more than 20%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension of no more than 19%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension of no more than 18%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension of no more than 17%. In various embodiments, the oxygen carriers, nanoparticles and/or
• polymersomes have a change of critical lysis tension of no more than 16%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension of no more than 15%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension of no more than 14%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension of no more than 13%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension of no more than 12%.
• the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension of no more than 11%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension of no more than 10%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension from about 5% to about 10%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes may have a change of critical lysis tension from about 10% to about 15%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension from about 15% to about 20%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a change of critical lysis tension from about 1% to about 5%.
• critical areal strain is the areal strain realized by the oxygen carriers, nanoparticles and/or polymersomes at the critical lysis tension.
• the oxygen carriers, nanoparticles and/or polymersomes have a critical areal strain from about 20% to about 50%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a critical areal strain from about 20% to about 25%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a critical areal strain from about 25% to about 30%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a critical areal strain from about 30% to about 35%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a critical areal strain from about 35% to about 40%.
• the oxygen carriers, nanoparticles and/or polymersomes have a critical areal strain from about 40% to about 45%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a critical areal strain from about 45% to about 50%.
• a "myoglobin loading capacity" is a measurement of a myglobin- based oxygen carrier and is defined as the weight of myoglobin within the oxygen carrier divided by the total weight of carrier.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading capacity of greater than about 5.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading capacity of greater than 10.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading capacity of greater than 15.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading capacity of greater than 20.
• polymersomes have a myoglobin loading capacity of greater than 25.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading capacity of greater than 26.
• polymersomes have a myoglobin loading capacity of greater than 27.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading capacity of greater than 28.
• polymersomes have a myoglobin loading capacity of greater than 29.
• oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading capacity of greater than 30.
• a "myoglobin loading efficiency" is a fundamental measurement of a myoglobin-based oxygen carrier and is defined as the weight of myoglobin that is encapsulated and/or incorporated within a carrier suspension divided by the weight of the original myoglobin in solution prior to encapsulation (expressed as a %).
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 10%.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 11%.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 12%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 13%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 14%. In various embodiments, the oxygen carriers,
• nanoparticles and or polymersomes have a myoglobin loading efficiency of greater than about 15%.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 16%.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 17%.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 18%.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 19%.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 20%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 21%. In various embodiments, the oxygen carriers,
• nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 22%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 23%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 24%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 25%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 26%.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 27%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 28%. In various embodiments, the oxygen carriers,
• nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 29%.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency of greater than about 30%.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency from about 10% to about 35%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency from about 15% to about 35%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency from about 18% to about 35%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency from about 20% to about 35%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency from about 22% to about 35%.
• the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency from about 24% to about 35%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency from about 26% to about 35%. In various embodiments, the oxygen carriers, nanoparticles and or polymersomes have a myoglobin loading efficiency from about 28% to about 35%. In various embodiments, the oxygen carriers, nanoparticles and/or polymersomes have a myoglobin loading efficiency from about 30% to about 35%.
• the subject may be a mammal. In various embodiments, the subject may be a non-human animal. In various embodiments, the subject may be a canine. In various embodiments, the subject may be a vertebrate.
• the various embodiments include compositions and methods for making, storing and administering oxygen carriers comprising of an oxygen-binding compound encapsulated in a nanoparticle such as a polymersome.
• the oxygen-binding compound may be comprised of myoglobin.
• the oxygen-binding compound may be comprised of human or animal hemoglobin.
• the oxygen-binding compound may be comprised of a genetically- or chemically-altered form of human or animal hemoglobin.
• the oxygen-binding compound may be derived from a peptide, protein, or nucleic acid that possess oxygen affinities (P50, cooperativity coefficient n) similar to that of human myoglobin.
• the oxygen-binding compound may be derived from a small molecule or metal-chelator complex that possess oxygen affinities (P50, cooperativity coefficient n) similar to that of human myoglobin.
• the oxygen-binding compound may be derived from a nucleic acid or polysaccharide that possess oxygen affinities (P50, cooperativity coefficient n) similar to that of human myoglobin.
• the oxygen carriers, nanoparticle and or polymersomes may be comprised of a mixture of oxygen-binding compounds.
• the various embodiments include compositions and methods for making, storing and administering oxygen carriers comprising of an oxygen-binding compound encapsulated in a vehicle such as a polymersome.
• the oxygen carriers may comprise myoglobin.
• the oxygen carriers may comprise a genetically- or chemically-altered form of human or animal hemoglobin.
• the oxygen carriers, nanoparticle and/or polymersomes may comprise a mixture of oxygen-binding compounds.
• Some embodiments may further include compositions and methods for developing polymersome-encapsulated myoglobin (PEM) as oxygen carriers.
• the PEM may include polymersomes comprising of poly(ethylene oxide)-block-poly(s-caprolactone) (PEO-b-PCL) and related diblock copolymers of poly(ethylene oxide)-block-poly(y-methyl ⁇ - caprolactone) (PEO-b-PMCL).
• PEO may provide the polymersomes improved in vitro chemical stability, augmented in vivo bioavailability and prolonged blood circulation half-lives.
• biodegradable polymersome-encapsulated myoglobin (PEM) dispersions may be comprised of diblock copolymers of PEO-b-PCL with a PEO block size of ⁇ 1.5-2kDa and with a block fraction of -10-20% by weight.
• the biodegradable polymersome- encapsulated myoglobin (PEM) dispersions may be comprised of diblock copolymers of PEO-b- PCL with a PCL block size of ⁇ 8kDa-23kDa and with a block weight fraction of about ⁇ 50 to 85 percent.
• the PEM dispersions may be comprised of diblock
• PEO-b-PCL and PEO-b-PMCL polymersomes may be preferred cellular myoglobin-based oxygen carriers (MBOCs) and possess all the requisite properties for effective oxygen delivery, including tunable oxygen-binding capacities, uniform and
• a supramolecular self-assembly approach may be used to prepare mono-disperse unilamellar polymersomes (50-300 nm diameter) that incorporate high quantum yield oligo(porphyrin)-based near-infrared (NI ) fluorophores (NIRFs) within their bilayer membranes 124 ' 130 ' 164"167 .
• NIRFs near-infrared fluorophores
• Tumor-specific accumulation may further be enhanced by modifying polymersome surfaces through chemical conjugation to targeting ligands, such as small molecules, peptides, proteins (e.g. antibodies), and nucleic acids.
• targeting ligands such as small molecules, peptides, proteins (e.g. antibodies), and nucleic acids.
• Some embodiments include an operating methodology to synthesize PEM dispersions that consistently meet the following standard characteristics: (i) average radius between 100-200 nm with polydispersity index ⁇ 1.1 (ii) Mb encapsulation efficiency > 50 mol%; (iii) weight ratio of encapsulated Mb:polymer > 2; (iv) solution metMb level ⁇ 5%; (v) suspension viscosity between 3-4 cP; (vi) P50 between 2-3 mm Hg; and, (vii) at least an order of magnitude smaller NO binding rate constant as that measured for free Mb at similar weight per volume of distribution; (viii) final suspension concentration of between 80 to 180 mg Mb/mL solution; and (ix) excellent stability under different storage and flow conditions as determined by intact morphology, change in average particle diameter ⁇ 5 nm and unaltered Mb concentration (change ⁇ 0.5 g/dL) and unchanged metMb level (change ⁇ 2%).
• PEMs may differ in their combination of particle size, deformability and concentration. Each of these parameters may independently affect the amount of Mb per particle, particle stability, and the numbers of particles that will accumulate at the tumor site. PEMs may be formed that are either 100 nm or 200 nm in mean particle diameter.
• Polymersomes like other nanoparticles that are smaller than 250 nm in diameter may accrue in solid tumors due to the EPR effect 11 114 ' 164 Although polymersomes with 200 nm mean particular diameter may deliver more Mb per particle, those that are ⁇ 100 nm in diameter may exhibit longer blood circulation half-lives (before eventual clearance by the RES) )102 ' 1 H ' 114, 136 ' 1 72 and may demonstrate enhanced tumor accumulation by traversing plasma channel 8173 (small W
• An embodiment PEM may be constructed from either PEO-b-PCL, poly(ethylene oxide)- block-polyfr-methyl ⁇ -caprolactone) (PEO-b-PMCL), and/or poly(ethylene oxide)-block- poly(trimethylcarbonate) (PEO-b-PTMC) diblock copolymers in order to determine the ultimate balance of particle stability versus deformability that may maximize in vivo tumor delivery.
• PEO-b-PMCL poly(ethylene oxide)-block-polyfr-methyl ⁇ -caprolactone)
• PEO-b-PTMC poly(ethylene oxide)-block- poly(trimethylcarbonate)
• PEO-b-PCL may yield ultra-stable, solid vesicle membranes while PEO-b-PMCL and PEO-b-TMC may generate more deformable polymersomes, a characteristic that may aid in PEM passage through tortuous tumor blood vessels.
• the various embodiments may include a polymersomes nanoparticle, or other oxygen carriers with varying sizes.
• the polymersome or oxygen carrier includes a roughly spherical shape and has a diameter of about 50 nm to about 1 ⁇ .
• the polymersome or oxygen carrier has a diameter of about 50 nm to about 250 nm.
• the polymersome or oxygen carrier has a diameter of about 100 nm to about 200 nm.
• the polymersome or oxygen carrier has a diameter of about 200 nm to about 300 nm.
• the polymersome or oxygen carrier has a diameter of about 300 nm to about 400 nm.
• the polymersome or oxygen carrier has a diameter of about 400 nm to about 500 nm. In various embodiments, the polymersome or oxygen carrier has a diameter of about 500 nm to about 600 nm. In various embodiments, the polymersome or oxygen carrier has a diameter of about 600 nm to about 700 nm. In various embodiments, the polymersome or oxygen carrier has a diameter of about 700 nm to about 800 nm. In various embodiments, the polymersome or oxygen carrier has a diameter of about 800 nm to about 900 nm. In various embodiments, the polymersome or oxygen carrier has a diameter of about 900 nm to about 1 ⁇ .
• the oxygen carrier consists of a nanoparticle that has a diameter of about 5 nm to about 100 nm. In various embodiments, the oxygen carrier has a diameter of about 5 nm to about 10 nm. In various embodiments, the oxygen carrier has a diameter of about 10 nm to about 50 nm. In various embodiments, the oxygen carrier has a diameter of about 50 nm to about 100 nm. In various embodiments, the oxygen carrier has a diameter of about 100 nm to about 300 nm. In various embodiments, the oxygen carrier has a diameter of about 300 nm to about 500 nm. In various embodiments, the oxygen carrier has a diameter of about 500 nm to about 1 ⁇ .
• the oxygen carriers, nanoparticle and/or polymersomes may include varying membrane thicknesses.
• the thickness of the membrane may depend upon the molecular weight of the polymers and the types of polymers used in the preparation of the oxygen carriers or polymersomes.
• the membrane may be a single, double, triple, quadruple, or more layers of polymers.
• the oxygen carriers, nanoparticle and/or polymersomes have a polymer membrane thickness from about 5 nm to about 35 nm.
• polymersomes have a membrane thickness from about 5 nm to about 10 nm. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes have a membrane thickness from about 10 nm to about 15 nm. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes have a membrane thickness from about 15 nm to about 20 nm. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes have a membrane thickness from about 20 nm to about 25 nm. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes have a membrane thickness from about 25 nm to about 30 nm.
• the oxygen carriers, nanoparticle and/or polymersomes have a membrane thickness from about 30 nm to about 35 nm. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes have a polymer membrane that is no more than about 5 nm in thickness. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes have a polymer membrane that is no more than about 10 nm in thickness. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes have a polymer membrane that is no more than about 15 nm in thickness. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes have has a polymer membrane that is no more than about 20 nm in thickness.
• the oxygen carriers, nanoparticle and/or polymersomes have a polymer membrane that is no more than about 25 nm in thickness. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes have a polymer membrane that is no more than about 30 nm in thickness. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes have a polymer membrane that is no more than about 35 nm in thickness.
• FIG. 9 illustrates a method 900 for MBOC preparation and delivery.
• the myoglobin-based oxygen carrier (MBOC) is self-assembled in aqueous solution.
• the myoglobin-based oxygen carrier is stabilized via chemical modification.
• step 906 the resultant construct is lypholized.
• step 908 the resultant construct is stored via dry-phase storage.
• step 910 point-of-care solution rehydration.
• step 912 biodegradable MBOCs that retain their original myoglobin are delivered in vivo.
• polymersome- encapsulated Mb may be prepared and generated via such an MBOC preparation method.
• the treatment may be administered by, for example, administering the MBOC and/or high-oxygen affinity agent to the patient and administering ionizing radiation to the tumor.
• FIG. 10 illustrates a method 1000 for preparing a polymersome comprising at least one biocompatible polymer and at least one biodegradable polymer.
• an organic solution having a plurality of polymers may be prepared.
• the organic solution comprising the plurality of polymers may be exposed to a plastic, polytetrafluoroethylene (i.e., TeflonTM) (herein "PTFE"), or glass surface.
• PTFE polytetrafluoroethylene
• the organic solution may be dehydrated on the plastic, PTFE, or glass surface to create a film of polymers.
• the film of polymers may be rehydrated in an aqueous solution.
• the polymers may be cross-linked in the aqueous solution via chemical modification.
• Polymersomes of the various embodiment PEM may comprise copolymers that are synthesized to include polymerizable groups within either their hydrophilic or hydrophobic blocks.
• the polymerizable biodegradable polymers may be utilized to form polymersomes that co-incorporate Mb and a water-soluble initiator in their aqueous interiors, or alternatively, by compartmentalizing Mb in their aqueous cavities and a water-insoluble initiator in their hydrophobic membranes.
• the various embodiments may further include a method for preparing a polymersome comprising at least one biocompatible polymer and at least one biodegradable polymer comprising: (a) preparing an organic solution comprising a plurality of polymers and exposing the organic solution comprising the plurality of polymers to a plastic, polytetrafluoroethylene (PTFE) (a.k.a. Teflon ® ), or glass surface; (b) dehydrating the organic solution on the plastic, Teflon ® , or glass surface to create a film of polymers; and (c) rehydrating the film of polymers in an aqueous solution; (d) cross-linking the polymers in the aqueous solution via chemical modification.
• PTFE polytetrafluoroethylene
• compositions of the various embodiments may be made by direct hydration methods as described in O'Neil, et al. confrontLangmuir 2009, 25(16), 9025-9029, the entire contents of which are hereby incorporated by reference. Briefly, polymersomes of the various embodiments may be made and encapsulated using the following method: To prepare formulations, 20 total mgs of polymer may be weighed into a 1.5mL centrifuge tube, heated at 95 °C for 20 min, and mixed.
• the polymersomes may be formed via dilution with PBS (10, 20, 70, 890 ⁇ , of PBS with mixing after each addition) and finally add 10 ⁇ . of the protein solution after the formation of the polymersomes. In this way, the
• encapsulation efficiency and loading may be calculated by subtraction. All samples may be prepared in triplicate. Encapsulation efficiencies may be quantified from standard curves generated from the fluorescently labeled crosslinked to the polymers of choice under
• polymersome preparation may involve large-scale fractionation of vesicular particles.
• a total of 1.25 g of diblock copolymer may be hydrated with 25mL of 1 OmM phosphate buffer (PB) at pH 7.3.
• PB OmM phosphate buffer
• the aqueous polymer mixture may be sonicated (Branson Sonifier 450, VWR Scientific,West Chester, PA) for 8-10 h at room temperature to yield the stock copolymer solution.
• the stock copolymer solution may be then mixed with 25mL of purified Mb (250-300 g/L) to yield a copolymer concentration of 12.5 mg/mL in the Mb copolymer mixture.
• Empty polymersomes may be prepared by diluting the stock copolymer solution in PB, instead of purified Mb solution, to yield a copolymer concentration of 12.5 mg/mL.
• the Mb-copolymer/copolymer mixture may be extruded 20 times through either 100 run or 200 nm diameter polycarbonate membranes (Avanti).
• the Mb-copolymer/copolymer mixture may be extruded through a 0.2 ⁇ HF membrane (Spectrum Laboratories Inc., Collinso Dominguez, CA).
• extruded PEM dispersions may be dialyzed overnight using 300 kDa molecular weight cutoff (MWCO) dialysis bags (Spectrum Laboratories Inc., Collinso Dominguez, CA) in PB at 4 °C at a 1 : 1000 Volume/Volume ration (v/v)(extruded PEM/PB) ratio to remove unencapsulated Mb from the vesicular dispersion.
• MWCO molecular weight cutoff
• An Eclipse asymmetric flow field-flow fractionator (Wyatt Technology Corp., Santa Barbara,CA) coupled in series to an 18 angle Dawn Heleos multi-angle static light scattering photometer (Wyatt Technology Corp., Santa Barbara, CA) may be used to measure the size distribution of empty polymersomes and PEM particles.
• the light scattering photometer is equipped with a 30 mW GaAs laser operating at a laser wavelength of 658 nm. Light scattering spectra may be analyzed using the ASTRA software package (Wyatt
• the elution buffer consisted of 10 mM PB at pH 7.3.
• Mb Encapsulation in PEM To measure the amount of Mb that was encapsulated inside PEM particles, dialyzed PEM dispersions were first lysed using 0.5% v/v Triton XI 00 (Sigma- Aldrich, St. Louis, MO) in PB. Lysed PEM samples may be centrifuged at 14,000 rpm for 15 min, and the supernatant collected for analysis. The concentration of encapsulated Mb obtained after lysing the PEM particles (mg/mL) may be measured using the Bradford method via the Coomassie Plus protein assay kit (Pierce Biotechnology, Rockford, IL).
• stabilized PEM dispersions may be generated via formation of covalent bonds between chains of the copolymers forming the polymersome membranes.
• These stabilized PEM constructs may be further dried via well-established lyophilization protocols without disrupting the formed polymersome structure or losing the encapsulated Mb.
• the polymersomes are administered in the aqueous solution. If lyophilized, in various embodiments, the polymersomes are reconstituted in an appropriate aqueous solution and administered to a subject.
• Lyophilized biodegradable PEM may be stored in a dessicator (free of O2) at 4 °C for varying periods of time without polymer or Mb degradation as the dried suspensions are free of aqueous free radicals, protons, etc.
• the polymersomes may be rehydrated at point-of-care prior to delivery.
• polymerizable units may be chemically linked to either the hydrophilic or hydrophobic ends of the copolymer after synthesis.
• One or more crosslinks between multiblock copolymer chains may be formed between the polymerizable units and the hydrophilic or hydrophobic polymers of the various embodiments.
• cross-links may be suitably formed by introducing a composition having multiple polymerizable groups to the chains of multiblock copolymer, although in various cases, the multiblock copolymer itself includes multiple polymerizable groups.
• the multiple polymerizable groups are chosen from acrylates, methacrylates, acrylamides, methacrylamides, vinyls, vinyl sulfone units or a combination thereof.
• nanoparticle and/or polymersomes comprise the polymerizable groups from about 0 weight (wt) % to about 5 wt % of the total weight of the composition.
• the oxygen carriers, nanoparticle and/or polymersomes comprise the polymerizable groups from about 5 wt % to about 10 wt % of the total weight of the composition.
• the oxygen carriers, nanoparticle and/or polymersomes comprise the polymerizable groups from about 10 wt % to about 20 wt % of the total weight of the composition.
• the oxygen carriers, nanoparticle and/or polymersomes comprise the polymerizable groups from about 20 wt % to about 30 wt % of the total weight of the composition. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes comprise the polymerizable groups from about 30 wt % to about 40 wt % of the total weight of the composition. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes comprise the polymerizable groups from about 40 wt % to about 50 wt % of the total weight of the composition.
• the oxygen carriers, nanoparticle and/or polymersomes comprise the polymerizable groups from about 50 wt % to about 60 wt% of the total weight of the composition. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes comprise the polymerizable groups from about 60 wt % to about 70 wt % of the total weight of the composition. In various embodiments, the oxygen carriers or the polymersomes comprise the polymerizable groups from about 70 wt % up to about 80 wt % of the total weight of the composition.
• the oxygen carriers, nanoparticle and/or polymersomes comprise the polymerizable groups from about 80 wt % up to about 90 wt % of the total weight of the composition. In various embodiments, the oxygen carriers, nanoparticle and/or polymersomes comprise the polymerizable groups from about 90 wt % up to about 95 wt % of the total weight of the composition.
• the oxygen carriers, nanoparticle and/or polymersomes comprise the polymerizable groups from about 95 wt % up to about 100 wt % of the total weight of the composition.Cross-linking between chains of a membrane is achieved via activation of the polymerization reaction by an initiator and results in enhancing the rigidity of the polymersome composition.
• the polymerizable group may be conjugated to copolymer's hydrophilic block consisting of either poly(ethylene oxide), poly(ethylene glycol), poly(acrylic acid), and the like.
• the polymerizable group may be conjugated to the copolymer's hydrophobic block consisting of either poly(e-caprolactone), poly(y-methyl ⁇ -caprolactone), poly(trimethylcarbonate), poly(menthide), poly(lactide), poly(glycolide), poly(methylglycolide), poly(dimethylsiloxane), poly(isobutylene), poly(styrene), poly(ethylene), poly(propylene oxide), etc.
• the initiator may be a molecule that generates/reacts to heat, light, pH, solution ionic strength, osmolality, pressures, etc. In various embodiments, the initiator may be photoreactive and cross-links the polymers of the oxygen carrier or polymersome via exposure to ultraviolet light.
• compositions of the various embodiments may be prepared without the use of organic solvents.
• the compositions of the various embodiments may include polymersomes comprising poly(ethylene oxide)-block-poly(8-caprolactone), poly(ethylene oxide)-block-poly(y- methyl ⁇ -caprolactone) and/or ), and or poly(ethylene oxide)-block-poly(trimethylcarbonate) copolymers that have been modified with an acrylate moiety at the hydrophobic block terminus.
• the oxygen carriers, nanoparticle and/or polymersomes may comprise cross-linked polymers formed between the hydrophobic block terminus and a diacrylate using a UV initiator, such as 2,2-dimethoxy-2-phenylacetophenone (DMPA).
• DMPA 2,2-dimethoxy-2-phenylacetophenone
• Mb occupies the internal aqueous compartment of the carrier.
• composition of the various embodiments may also comprise polymersomes, nanoparticles or oxygen carriers that have increased degradative half-lives.
• Circulation times of oxygen carrier and polymersomes may be generally limited to hours (or up to one day) because of either rapid clearance by the mononuclear phagocytic system (MPS) of the liver and spleen, or by excretion.
• MPS mononuclear phagocytic system
• Clinical studies have shown that circulation times of spherical carriers may be generally extended threefold in humans over rats.
• oxygen carriers and polymersomes with long circulating lifetime may increase the drug exposure to cancer cells, low oxygenated tissues, or healing wounds, and thereby increase the time-integrated dose, commonly referred to in drug delivery as "the area under the curve.”
• the enhanced permeation and retention effect that allows small solutes and micelles to permeate the leaky blood vessels of a rapidly expanding tumor might also allow oxygen carriers and polymersomes to transport into the tumor stroma. Persistent circulation of the oxygen carriers and polymersomes has many practical applications because these vehicles can increase exposure of drugs to cancer cells, low or poor oxygenated tissues, or healing wounds.
• compositions of the various embodiments may comprise polymersomes
• nanoparticles or oxygen carriers that have increased circulatory half-lives.
• the compositions have a certain percent mass composition of polymer designed to have a circulatory half-life from about 12 hours to about 36 hours, and a degradative half-life from about 38 to about 60 hours.
• the compositions have a certain percent mass composition of polymer designed to have circulatory half-life about 12 hours less than the degradative half-life of the oxygen-carrier or polymersome. This delay in degradation may vary depending upon the route of administration and/or the targeted micro-compartment, the size of the oxygen-carrier or polymesome or subcellular microenvironment where the polymersome or oxygen carrier deploys its contents for treatment or prevention of the disease states or disorders disclosed herein.
• the compositions comprising polymersomes, nanoparticles or oxygen carriers have circulatory half-life about 11 hours less than the degradative half-life of the oxygen-carrier or polymersome.
• the compositions comprising polymersomes, nanoparticles or oxygen carriers have circulatory half-life about 10 hours less than the degradative half-life of the oxygen-carrier or polymersome. In various embodiments, the compositions comprising polymersomes, nanoparticles or oxygen carriers have circulatory half-life about 9 hours less than the degradative half-life of the oxygen-carrier or polymersome. In various embodiments, the compositions comprising polymersomes, nanoparticles or oxygen carriers have circulatory half-life about 8 hours less than the degradative half-life of the oxygen- carrier or polymersome.
• compositions comprising polymersomes, nanoparticles or oxygen carriers have circulatory half-life about 7 hours less than the degradative half-life of the oxygen-carrier or polymersome. In various embodiments, the compositions comprising polymersomes, nanoparticles or oxygen carriers have circulatory half-life about 6 hours less than the degradative half-life of the oxygen-carrier or polymersome. In various embodiments, the compositions comprising polymersomes, nanoparticles or oxygen carriers have circulatory half-life about 5 hours less than the degradative half-life of the oxygen-carrier or polymersome. In various embodiments, the compositions comprising polymersomes,
• nanoparticles or oxygen carriers have circulatory half-life about 4 hours less than the degradative half-life of the oxygen-carrier or polymersome.
• the compositions comprising polymersomes, nanoparticles or oxygen carriers have circulatory half-life about 3 hours less than the degradative half-life of the oxygen-carrier or polymersome.
• the compositions comprising polymersomes, nanoparticles or oxygen carriers have circulatory half-life about 2 hours less than the degradative half-life of the oxygen-carrier or polymersome.
• nanoparticles or oxygen carriers have circulatory half-life about 1 hours less than the degradative half-life of the oxygen-carrier or polymersome. In various embodiments, the compositions comprising polymersomes, nanoparticles or oxygen carriers have circulatory half-life about 14 hours less than the degradative half-life of the oxygen-carrier or polymersome. In various embodiments, the compositions comprising polymersomes, nanoparticles or oxygen carriers have circulatory half-life from about 1 hour to about 20 hours less than the degradative half-life of the oxygen-carrier or polymersome.
• compositions comprising polymersomes, nanoparticles or oxygen carriers have a certain percent mass composition of polymer designed to have a circulatory half-life of about 36 hours, and a degradative half-life greater than about 48 hours. In various embodiments, the compositions comprising
• polymersomes, nanoparticles or oxygen carriers have a certain percent mass composition of polymer designed to have a circulatory half-life from about 24 hours to about 36 hours, and a degradative half-life from about 38 to about 60 hours.
• the compositions comprising polymersomes, nanoparticles or oxygen carriers have a certain percent mass composition of polymer designed to have a circulatory half-life from about 28 hours to about 36 hours, and a degradative half-life from about 38 to about 60 hours.
• the compositions comprising polymersomes, nanoparticles or oxygen carriers have a certain percent mass composition of polymer designed to have a circulatory half-life from about 30 hours to about 36 hours, and a degradative half-life from about 38 to about 60 hours. In various embodiments, the compositions comprising polymersomes, nanoparticles or oxygen carriers have a certain percent mass composition of polymer designed to have a circulatory half-life of no more than 36 hours, and a degradative half-life from about 38 to about 60 hours.
• the degradation half-life is 6 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is between 6 hours and 24 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is more than 24 hours greater than the circulatory half-life. In various embodiments, the degradation half- life is about 6 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 7 hours greater than the circulatory half-life. In various
• the degradation half-life is about 8 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 9 hours greater than the circulatory half- life. In various embodiments, the degradation half-life is about 10 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 11 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 12 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 13 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 14 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 15 hours greater than the circulatory half-life.
• the degradation half-life is about 16 hours greater than the circulatory half- life. In various embodiments, the degradation half-life is about 17 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 18 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 19 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 20 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 21 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 22 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 23 hours greater than the circulatory half-life.
• the degradation half-life is about 24 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 36 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 48 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 60 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is about 72 hours greater than the circulatory half-life. In various embodiments, the degradation half-life is more than 96 hours greater than the circulatory half-life.
• in vivo delivery is achieved by intravenous, inhalational, transmucosal (e.g. buccal) or transcutaneous routes of administration.
• Dosages for a given host may be determined using conventional considerations, e.g., by customary comparison of the differential activities of the subject preparations and a known appropriate, conventional pharmacological protocol.
• different final concentrations of PEMs may be used in order to test the effects of Mb dose on improving oxygenation and mitigating tumor hypoxia.
• 100 uL injections of PEMs that contain either 90 or 180 mg Mb/mL may result in 450 or 900 mg/kg injection doses of Mb, respectively, assuming a 20 g mouse.
• These doses correspond to the total hemoglobin injection dose found in 0.5 and 1 unit of whole blood, assuming 15 g dL blood concentrations, 450 mL blood/unit, and a 70 kg human. While larger PEM doses may likely enhance Mb tumor delivery, increased amounts of free Mb (released during PEM degradation) may also result in local NO uptake, decreased microperfusion, and ineffective oxygenation.
• the associated polymer concentrations and subject injection doses may range between 2.5-18 mg/mL and 12.5-90 mg kg, assuming a final weight ratio of encapsulated Mb:polymer ranging between 10-35, both of which fall well within the range of previous animal studies that demonstrated no subacute or acute in vivo toxicities from various polymersome compositions. , l l ⁇ I22 ⁇ 164 ' ,68 ⁇ I7,
• the pharmaceutical composition of the various embodiments may be an oxygen carrier that possess different "loading ratios" of oxygen binding agents to inert vehicle.
• the pharmaceutical composition comprises ⁇ 5 mg oxygen binding agent/mg inert vehicle.
• the pharmaceutical composition comprises from about 5 to about 40 mg oxygen binding agent mg inert vehicle.
• the pharmaceutical composition comprises from about 5 to about 40 mg oxygen binding agent mg inert vehicle.
• the pharmaceutical composition comprises from about 10 to about 40 mg oxygen binding agent/mg polymer inert vehicle. In various embodiments, the pharmaceutical composition comprises from about 20 to about 40 mg oxygen binding agent mg inert vehicle. In various embodiments, the pharmaceutical composition comprises from about 30 to about 40 mg oxygen binding agent /mg inert vehicle. In various embodiments, the pharmaceutical composition comprises from about 35 to about 40 mg oxygen binding agent/mg inert vehicle. In various embodiments, the
• composition comprises from about 25 to about 40 mg oxygen binding agent/mg inert vehicle. In various embodiments, the pharmaceutical composition comprises from about 25 to about 35 mg oxygen binding agent/mg inert vehicle. In various embodiments, the
• pharmaceutical composition comprises from about 25 to about 30 mg oxygen binding agent/mg inert vehicle. In various embodiments, the pharmaceutical composition comprises from about 20 to about 25 mg oxygen binding agent/mg inert vehicle. In various embodiments, the
• composition comprises from about 10 to about 15 mg oxygen binding agent/mg inert vehicle.
• the pharmaceutical composition comprises from about 5 to about 35 mg Mb/mg polymer. In various embodiments, the pharmaceutical composition comprises from about 10 to about 35 mg Mb/mg polymer. In various embodiments, the pharmaceutical composition comprises from about 20 to about 35 mg Mb/mg polymer. In various embodiments, the pharmaceutical composition comprises from about 30 to about 35 mg Mb/mg polymer. In various embodiments, the pharmaceutical composition comprises from about 25 to about 35 mg Mb/mg polymer. In various embodiments, the pharmaceutical composition comprises from about 25 to about 30 mg Mb/mg polymer. In various embodiments, the pharmaceutical composition comprises from about 20 to about 25 mg Mb/mg polymer.
• the pharmaceutical composition comprise from about 10 to about 15 mg Mb/mg polymer. In various embodiments, the pharmaceutical composition comprise from about 5 to about 10 mg Mb/mg polymer. In various embodiments the Mb dosages may be replaced by the same weight of Mb.
• the pharmaceutical composition is a liquid formulation, wherein the dosage may be from about 1 unit of compositions to about 50 units of oxygen-carrier suspension, wherein a unit of suspension comprises from about 40 g of Mb to about 85 g of Mb.
• the high-oxygen affinity agent/compound has a P50 for oxygen that is less than 25 mmHg. In an embodiment, the high-oxygen affinity agent/compound has a P50 for oxygen that is less than 20 mmHg. In an embodiment, the high-oxygen affinity agent/compound has a P50 for oxygen that is less than 15 mmHg. In an embodiment, the high-oxygen affinity agent/compound has a P50 for oxygen that is less than 10 mmHg. In an embodiment, the high- oxygen affinity agent/compound has a P50 for oxygen that is less than 5 mmHg.
• a unit of a liquid formulation comprising the pharmaceutical composition comprises about 41 grams of Mb. In various embodiments, a unit of a liquid formulation comprising the pharmaceutical composition comprises about 45 grams of Mb. In various embodiments, a unit of a liquid formulation comprising the pharmaceutical composition comprises about 50 grams of Mb. In various embodiments, a unit of a liquid formulation comprising the pharmaceutical composition comprises about 55 grams of Mb: In various embodiments, a unit of a liquid formulation comprising the pharmaceutical composition comprises about 60 grams of Mb. In various embodiments, a unit of a liquid formulation comprising the pharmaceutical composition comprises about 65 grams of Mb. In various embodiments, a unit of a liquid formulation comprising the pharmaceutical composition comprises about 70 grams of Mg.
• a unit of a liquid formulation comprising the pharmaceutical composition comprises about 75 grams of Mb. In various embodiments, a unit of a liquid formulation comprising the pharmaceutical composition comprises about 80 grams of Mb. In various embodiments, a unit of a liquid formulation comprising the pharmaceutical composition comprises about 85 grams of Mb.
• a pharmaceutical composition may comprise a dose of an oxygen-binding protein that is suspended within a solution and administered in units, where a unit is equal to 81 grams of oxygen-binding protein. If a subject undergoes surgery or experiences blood loss, the pharmaceutical composition may be administered to the subject according to the following dosing regimen, where blood is replaced with units of liquid formulation: In various embodiments, the pharmaceutical composition comprises from about 40 g of oxygen binding protein/unit of solution administered to about 81 g of oxygen binding protein/unit of solution administered.
• the pharmaceutical composition comprises a dose from about 40 g of Mb/unit of solution administered to about 80 g of Mb/unit of solution administered. In various embodiments, the pharmaceutical composition comprises a dose from about 50 g of Mb/unit of solution administered to about 80 g of Mb/unit of solution administered. In various embodiments, the pharmaceutical composition comprises a dose from about 60 g of Mb/unit of solution administered to about 80 g of Mb/unit of solution administered. In various
• the pharmaceutical composition comprises a dose from about 70 g of Mb/unit of solution administered to about 80 g of Mb/unit of solution administered.
• the pharmaceutical composition comprises a dose from about 60 g of Mb/unit of solution administered to about 70 g of Mb/unit of solution administered.
• the dose of the pharmaceutical composition of the various embodiments may also be measured in grams of polymersome administered per kg of a subject.
• the total dose administered comprises from about 12.5 mg of polymer to about 90 mg of polymer per kg of a subject. In various embodiments, the total dose administered comprises from about 15 mg of polymer to about 90 mg of polymer per kg of a subject. In various embodiments, the total dose administered comprises from about 25 mg of polymer to about 90 mg of polymer per kg of a subject. In various embodiments, the total dose administered comprises from about 35 mg of polymer to about 90 mg of polymer per kg of a subject. In various embodiments, the total dose administered comprises from about 45 mg of polymer to about 90 mg of polymer per kg of a subject.
• the total dose administered comprises from about 55 mg of polymer to about 90 mg of polymer per kg of a subject. In various embodiments, the total dose administered comprises from about 65 mg of polymer to about 90 mg of polymer per kg of a subject. In various embodiments, the total dose administered comprises from about 75 mg of polymer to about 90 mg of polymer per kg of a subject. In various embodiments, the total dose administered comprises from about 80 mg of polymer to about 90 mg of polymer per kg of a subject. In various embodiments, the total dose administered comprises from about 85 mg of polymer to about 90 mg of polymer per kg of a subject.
• the pharmaceutical composition is a liquid formation that comprises an allosteric effector such as 2,3-Bisphosphoglycerate, wherein the formulation comprises from about 1 to about 100 mmol/L of formulation. In various embodiments, the formulation comprises from about 1 to about 100 mmol of a isomer of 2,3-Bisphosphoglycerate per L of formulation. In various embodiments, the formulation comprises from about 1 to about 10 mmol of a isomer of 2,3Bisphosphoglycerate per L of formulation. In various embodiments, the formulation comprises about 5 mmol of 2,3-Bisphosphoglycerate or isomer derived thereof per L of formulation. In various embodiments, the formulation comprises about 2.25 mmol of 2,3-Bisphosphoglycerate or isomer derived thereof per Unit (450 mL) of formulation.
• an allosteric effector such as 2,3-Bisphosphoglycerate
• the pharmaceutical compositions may be prepared, packaged, or sold in the form of a sterile, injectable, aqueous or oily suspension or solution.
• This suspension or solution may be formulated according to the known art, and may comprise, in addition to the active ingredient, additional ingredients such as the dispersing agents, wetting agents, or suspending agents described herein.
• Such sterile injectable formulations may be prepared using a non-toxic parenterally acceptable diluent or solvent, such as water or 1,3 butane diol, for example.
• Other acceptable diluents and solvents include, but are not limited to, Ringer's solution, isotonic sodium chloride solution, and fixed oils such as synthetic mono or di-glycerides.
• Other parentally-administrable formulations which are useful include those which comprise the active ingredient in microcrystalline form, in a liposomal preparation, or as a component of
• compositions for sustained release or implantation may comprise pharmaceutically acceptable polymeric or hydrophobic materials such as an emulsion, an ion exchange resin, a sparingly soluble polymer, or a sparingly soluble salt.
• pharmaceutically acceptable polymeric or hydrophobic materials such as an emulsion, an ion exchange resin, a sparingly soluble polymer, or a sparingly soluble salt.
• the formulations described herein, are also useful for pulmonary delivery and the treatment of such cancers of the respiratory system or lung, are also useful for intranasal delivery of a pharmaceutical
• composition of the various embodiments is a coarse powder comprising the active ingredient and having an average particle from about 0.2 to 500 micrometers, administered by rapid inhalation through the nasal passage from a container of the powder held close to the nares.
• the various embodiment pharmaceutical compositions may be administered to deliver a dose of from about 0.1 g kg day to about 100 g/kg/day, where the gram measurement is equal to the total weight of Mb and polymer in the pharmaceutical composition.
• the dosage is from about 0.1 to 1 g/kg/day.
• the dosage is from about 0.5 g/kg/day to about 1.0 g/kg/day.
• the dosage is from about 1.0 g/kg/day to about 1.5 g/kg/day.
• the dosage is from about 1.5 g kg/day to about 2.0 g/kg/day.
• the dosage is from about 2.5 g/kg/day to about 3.0 g/kg/day.
• the dosage is 1.0, 2.0, 5.0, 10, 15, 20, 25, 30, 35, 40, 45, or 50 g/kg/day, where the gram measurement is equal to the total weight of Mb and polymer in the
• administration of a dose may result in a therapeutically effective concentration of the drug, protein, active agent, etc., between 1 ⁇ and 10 ⁇ in a diseased or cancer-affected tissue, or tumor of a mammal when analyzed in vivo.
• a pharmaceutical composition can comprise, in addition, a pharmaceutically acceptable adjuvant filler or the like.
• Suitable pharmaceutically acceptable carriers are well known in the art. Examples of typical carriers include saline, buffered saline and other salts, lipids, and surfactants.
• the oxygen carrier or polymersome may also be lyophilized and administered in the forms of a powder.
• the preparations can be sterilized and if desired mixed with auxiliary agents, e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, and the like that do not deleteriously react with the oxygen carrier or polymersome discussed herein. They also can be combined where desired with other biologically active agents, e.g., antisense DNA or mRNA.
• auxiliary agents e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, and the like that do not deleteriously react with the oxygen carrier or polymersome discussed herein.
• auxiliary agents e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, and the like that do not deleteriously react with the
• a pharmaceutical composition of the various embodiments may be prepared, packaged, or sold in bulk, as a single unit dose, or as a plurality of single unit doses.
• the amount of the active ingredient is generally equal to the dosage of the active ingredient which would be administered to a subject, or a convenient fraction of such a dosage, such as, for example, one- half or one-third of such a dosage, as would be known in the art.
• the relative amounts of the active ingredient, the pharmaceutically acceptable carrier, and any additional ingredients in a pharmaceutical composition of the various embodiments may vary, depending upon the identity, size, and condition of the subject treated and further depending upon the route by which the composition is to be administered.
• the composition may comprise from about 0.1% to about 100% (w/w) active ingredient.
• compositions and methods described herein may be useful for preventing or treating cancer or any blood disorder including but not necessarily limited to anemia, wherein a blood disorder causes low or poor oxygenation of tissues in a subject.
• composition and methods described herein may be used in treatment of cancer in conjunction with radiation therapy.
• compositions and methods described herein can be useful for preventing the dissemination or improving the chemotherapy and/or radiation therapy of cancers including leukemias, lymphomas, meningiomas, mixed tumors of salivary glands, adenomas, carcinomas, adenocarcinomas, sarcomas, dysgerminomas, retinoblastomas, Wilms' tumors, neuroblastomas, melanomas, and mesotheliomas; as represented by a number of types of cancers, including but not limited to breast cancer, sarcomas and other neoplasms, bladder cancer, colon cancer, lung cancer, pancreatic cancer, gastric cancer, cervical cancer, ovarian cancer, brain cancers, various leukemias and lymphomas.
• cancers including leukemias, lymphomas, meningiomas, mixed tumors of salivary glands, adenomas, carcinomas, adenocarcinomas, sarcomas, dysgerminomas, retino
• the various embodiments may also encompass a method of treatment, according to which a therapeutically effective amount of the drug, protein, active agent, etc., or a vector comprising same according to the various embodiments may be administered to a patient requiring such treatment.
• the various embodiments should not be construed as being limited solely to these examples, as other cancer-associated diseases which are at present unknown, once known, may also be treatable using the methods of the various embodiments.
• chemotherapeutic agent means any chemical agent or drug used in chemotherapy treatment, which selectively affects tumor cells, including but not limited to, such agents as adriamycin, actinomycin D, camptothecin, colchicine, taxol, cisplatinum, vincristine, vinblastine, and methotrexate. Other such agents are well known in the art.
• the various embodiments may include methods for stimulating wound healing in a subject in need thereof comprising administering the oxygen carrier or polymersome of the various embodiments to a subject in need thereof. Some embodiments may include methods for treating or preventing diseases, illnesses or conditions in mammals. In various embodiments, the compositions of the various embodiments may be used for canine anemia. In various embodiments
• compositions of the various embodiments may be useful to treat or prevent symptoms associated with iron deficiency.
• Some embodiments may provide methods for treating a blood disorder or low oxygenation of tissues in patients susceptible to, symptomatic of, or at elevated risk for developing hypertension.
• kits comprising any of the aforementioned compositions or pharmaceutical compositions comprising an oxygen carrier or a polymersome, wherein the oxygen carrier or a polymersome comprises at least one biocompatible polymer and at least one biodegradable polymer.
• the formulation may be supplied as part of a kit.
• the kit may comprise the pharmaceutical composition comprising an oxygen carrier or a polymersome.
• the kit may comprise a lyophilized oxygen carrier or polymersome with an aqueous rehydration mixture.
• the oxygen carrier or polymersome may be in one container while the rehydration mixture is in a second container.
• the rehydration mixture may be supplied in dry form, to which water may be added to form a rehydration solution prior to administration by mouth, venous puncture, injection, or any other mode of delivery.
• the kit may further comprise a vehicle for administration of the composition such as tubing, a catheter, syringe, needle, and/or combination of any of the foregoing.
• nanoparticles may be used to increase intratumoral p0 2 in order to increase the efficacy of radiation and chemotherapies as discussed above, in some embodiments various nanoparticle formulations may be designed for tumor reduction through alternative mechanisms.
• a particular of such alternative mechanisms is a unique process of "nanoparticle-mediated microvascular embolization" (NME).
• NME nanoparticle-mediated microvascular embolization
• nanoparticles may be used to selectively deliver vasoactive substances to tumors for cutting off blood supply in a manner that is not reliant upon the expression of molecular angiogenic targets.
• TACE transcatheter arterial chemoembolization
• HCC hepatocellular carcinoma
• HCC liver-dominant metastases from other primary malignancies. While such techniques typically induce direct tumor necrosis in more than half of patients, the infusion agents that are used may distribute only amongst branching vessels in the tumor and be excluded from the collateral microvascular circulation. Therefore, TACE is highly effective for temporary, palliative and localized treatment but cannot be administered
• TACE may also be associated with a self-limiting post-embolization syndrome (pain, fever, and malaise), chemical hepatitis, and a leukemoid reaction due to necrosis and release of cytokines from hepatocytes and embolized tumor cells.
• conventional agents for tumor embolization are typically polymeric microparticles embedded with chemotherapies. Such agents are not amenable to systemic administration because their sizes and toxic payloads promote severe damage to the vascular beds of vital organs (e.g. liver, heart, lungs, kidneys, etc).
• the vasoactivity of HBOCs is generally attributed at least in part to infiltration of modified iron-containing hemoglobin into the endothelium of blood vessels, resulting in the consumption of nitric oxide (NO).
• the treatment techniques of the various embodiments may involve encapsulating molecules that are capable of binding nitric oxide ("NO-binding molecules"), such as myoglobin, within the aqueous cavities of nanoparticles, for example, polymersomes.
• NO-binding molecules such as myoglobin
• Such encapsulated NO-binding molecules may be the same as or different from those that also have a high affinity for binding oxygen and that are discussed above with respect to tumor oxygenation (e.g., PEM).
• NO-binding molecules may be referred to herein as "NO-inhibiting" or “NO-affecting" molecules.
• NO-binding molecules may also bind 0 2 , and therefore the term "NO-binding" molecule may be used herein to refer to an NO- and O-binding molecule.
• encapsulated NO-binding molecules may mediate a tumor through NME effects by local vasoactivity that ensues only after accumulation of the
• EPR enhanced permeability and retention
• the EPR effect is a property describing the tendency of molecules to accumulate in tumor tissue more than they would in normal tissue, which may be based on the creation of abnormal vessels in the rapid angiogenesis stimulated by active tumor growth.
• Such abnormal vasculature may be dysfunctional, and may be referred to herein as "leaky” vasculature.
• tumor tissues usually lack effective lymphatic drainage, which together with leaky vasculature may lead to abnormal molecular and fluid transport, i.e., the EPR effect.
• the result of NME may be eventual microvascular occlusion and tumor necrosis, but without any systemic vasoactivity.
• the nanoparticles of the various embodiments may have particular utility for the treatment of the most highly vascular tumors, including renal cell carcinoma (RCC), Hepatocellular carcinoma (HCC), glioblastoma multiforme (GBM), and multiple myeloma (MM).
• RCC renal cell carcinoma
• HCC Hepatocellular carcinoma
• GBM glioblastoma multiforme
• MM multiple myeloma
• the introduction of nanoparticles containing myoglobin or another NO-binding molecule into the systemic circulation may selectively induce NME in tumors by selectively delaying the binding of NO until the particles have extravasated via the EPR effect or become lodged within the tumor microvaculature.
• NO-binding molecules such as a myoglobin
• nanoparticles such as polymersomes.
• additional imaging agents and/or therapeutic molecules may also be encapsulated within the nanoparticles, such as to promote a complementary activity against the tumor.
• the NO-binding molecule may be delivered to tumors via passive accumulation and/or active targeting by nanoparticles. Upon delivery, the NO-binding molecule may induce NME in the tumor tissue.
• the NME may be based on a number of specific characteristics, properties, and adjustments to previously investigated polymersome encapsulation formulations and other HBOCs.
• NO sequestration by the encapsulated NO-binding molecule may be significantly delayed in time and/or amount, thereby allowing tumor tissue specificity.
• Such delay may be based on physical and/or chemical properties of the NO-binding molecule (i.e., binding affinity for NO and/or other molecules, etc.) and of the nanoparticles (i.e., size, type, membrane, etc.).
• Various non-limiting theories of these properties affecting NO sequestration time are discussed below.
• the NME effect may be due to the interaction of nanoparticles with NO.
• the molecules encapsulated in nanoparticles may be oxygen carriers that competitively bind both oxygen and NO (e.g., myoglobin). These encapsulated molecules may be preloaded with oxygen, and therefore unable to bind NO until oxygen is released.
• oxygen carriers may also have particularly high affinities for oxygen binding, providing an additional barrier to NO sequestration while in systemic circulation since NO binding only occurs after deoxygenation. In some embodiments, such deoxygenation may only occur once the encapsulated oxygen carriers are able to accumulate in tumor tissue.
• the encapsulated oxygen carrier may be PEM.
• myoglobin has a high affinity (low P 5 o) for oxygen, which enables it to bind and retain oxygen to a much greater extent than hemoglobin found in natural red blood cells within the circulation.
• the specific molecular site (i.e. the iron prophyrin) to which NO binds on myoglobin is occupied by oxygen under physiologic conditions. In such physiologic conditions, which are seen while the nanoparticle is in the systemic circulation, encapsulated myoglobin is therefore unable to bind significant amounts of NO.
• the tumor specific NME effect may also be due to sequestration of the NO- binding molecule from the environment due to incorporating within or upon nanoparticles.
• the nanoparticles that encapsulate oxygen carriers are polymersomes
• their synthetic polymer membranes may be significantly thicker than those of other natural vesicles, such as liposomes. Such thick membranes may provide an additional barrier against diffusions of polar gas molecules, including NO, into the aqueous cavities of polymersomes until reaching the hypoxic tumor.
• other agents may be co- encapsulated within the nanoparticle in order to provide complementary activity against a tumor. Examples of such additional agents may include, without limitation, additional chemotherapy agents or biologic agents that inhibit angiogenesis (i.e. the process of molecular signals generated by the tumor that prompt the growth of new blood vessels), thereby enhancing the NME effects.
• molecules can be attached to the surface of nanoparticles that incorporate the NO-binding molecules, which may allow for targeting to particular organs or uptake by specific cells.
• the nanoparticles are polymersomes.
• the surface molecules may be surface-bound myoglobin, which may be used in addition to or instead of the encapsulated myoglobin.
• nanoparticles may accumulate in tumors due to the EPR effect, discussed above. While nanoparticles in circulation may be unable to penetrate through tight endothelial junctions of normal blood vessels, they may selectively extravasate in tumor tissues as a result of the leaky vasculature, in which they may become trapped and accumulate, which may be helped by the lack of effective lymphatic drainage.
• oxygen bound to the encapsulated NO-binding molecules that are accumulated in tumor tissue may then dissociate and diffuse out of the nanoparticles.
• oxygen dissociation from the nanoparticles may occur when the partial pressure of oxygen in the tumor falls below the equilibrium binding pressure (i.e., partial pressure of oxygen required for 50% saturation) of the encapsulated NO-binding molecule.
• the equilibrium binding pressure in various embodiments is based on the properties/composition of the specific NO-binding molecule.
• the deoxygenation of the encapsulated NO-binding molecule may then enable it to bind NO that has passively diffused into the nanoparticles, which may the result in vasoconstriction due to depletion of NO from vascular endothelium. Downstream results of such vasoconstriction due to endothelial NO depletion may include damage to the tumor microvasculature, followed by platelet adhesion, activation, and aggregation resulting in clot formation (i.e., thrombosis).
• clotting in the tumor microvasculature may lead to local hemostasis (i.e.,
• the newly formed clot may rupture and cause bleeding into the body of the tumor (i.e., hemorrhage). Subsequent to the hemorrhage, complete thrombosis of the tumor capillary bed may progress to stop all blood flow to the tumor, including further delivery of red blood cells. In this manner, the NME effect may lead to necrosis of tumor cells.
• NO-binding molecules may include compounds that inhibit NO production (e.g. NO synthase (NOS) inhibitors), compounds that scavenge NO radicals, and commercially-available NO- binding reagents.
• NOS NO synthase
• NO is produced enzymatically by three different NOSs: Neuronal NOS (nNOS) and endothelial NOS (eNOS) are constitutive enzymes important for homeostatic processes, such as neurotransmission and vascular tone, respectively, and inducible NOS (iNOS), which is normally not expressed, but rather is synthesized de novo in response to inflammation.
• nNOS Neuronal NOS
• eNOS endothelial NOS
• iNOS inducible NOS
• nanoparticles may be created that encapsulate nNOS inhibitors, eNOS inhibitors, and or iNOS inhibitors.
• NOS enzymes make NO from L-arginine
• competitive L- arginine analogues may prevent the NOS enzymes from producing NO, and may also be encapsulated in some embodiment nanoparticles.
• encapsulated analogues may include, but are not limited to, NG-monomethyl-L-arginine (L-NMMA), ⁇ -nitro-L-arginine (L-NNA), and NG-Nitroarginine methyl ester (L-NAME).
• NO-scavenging compounds may be encapsulated and used in the various embodiment nanoparticle formulations.
• Such compounds may include, but are not limited to, nitronyl nitroxides (e.g., carboxy-PTIO), dithiocarbamate derivatives, a chemically modified human- derived hemoglobin conjugate pyridoxalated hemoglobin polyoxyethylene (PHP), etc.
• Additional NO-scavenging compounds that are specific for NO radicals may be developed in the future for use in the various embodiments.
• NO-binding reagents may be encapsulated in
• nanoparticles for use in the various embodiment nanoparticle formulations.
• Such reagents may be those that have shown to induce some degree of NO sequestration for other
• NO-binding reagents may include small molecule NO- inhibitors and low molecular weight nitric oxide metabolite compounds developed by Medinox, Inc. for treatment of septic shock, type-2 diabetes, arthritis and other inflammatory diseases, and sickle cell anemia.
• Medinox, Inc. for treatment of septic shock, type-2 diabetes, arthritis and other inflammatory diseases, and sickle cell anemia.
• nanoparticle formulations other than polymersomes may be used instead of or in addition to polymersomes to encapsulate the NO-binding or NO-affecting, molecules.
• a variety of commercially available acellular HBOCs may be used in addition, or as alternatives, to developing the encapsulated NO-binding molecules.
• HBOCs may be, without limitation, polymerized hemoglobin products (e.g., PolyHemeTM by Northfield Laboratories Inc., USA, HemopureTM and OxyglobinTM by Biopure, Inc., USA), conjugated hemoglobin products (e.g., HemospanTM by Sangart Inc., USA), which may have larger overall particles based on the surface modification with inert polymers (e.g., polyethylene glycol (PEG, with a molecular weight greater than 5 kDa)), and/or cross-linked hemoglobin products (e.g., HemoAssistTM by Baxter, OptraTM by Somatogen, etc.).
• inert polymers e.g., polyethylene glycol (PEG, with a molecular weight greater than 5 kDa)
• cross-linked hemoglobin products e.g., HemoAssistTM by Baxter, OptraTM by Somatogen, etc.
• iron in HBOCs may
• microparticles and/or nanoparticles that encapsulate oxygen carriers/NO-binding or NO-affecting molecules may be modified by surface
• CD47 which mediates mononuclear phagocytic system (MPS) (primarily the liver and spleen) via engagement of the CD 172 a receptor, may be conjugated onto nanoparticle surfaces.
• MPS mononuclear phagocytic system
• nanoparticles that may be used to encapsulate an NO-inhibiting NO-affecting molecule instead of the nanoparticle formulations discussed above may include, without limitation, Abraxane® (i.e., a nanoparticle-albumin bound paclitaxel), Doxil® (i.e., doxorubicin encapsulated by liposomes), and or various other nanoparticles that have been developed specifically for cancer therapy.
• Abraxane® i.e., a nanoparticle-albumin bound paclitaxel
• Doxil® i.e., doxorubicin encapsulated by liposomes
• nanoparticles that have been developed specifically for cancer therapy.
• the use of the encapsulated NO-inhibiting/NO-effecting molecules (e.g., PEM) to cause NME may be especially effective for highly vascularized tumors, such as RCC, HCC, GBM, and MM, all of which are cancers with unsatisfactory treatment options.
• PEM may be effective with many or all solid tumors, including vascular tumors with poor treatment options, such as ovarian cancer, non-small cell lung cancer, breast cancer and colon cancer.
• the use of encapsulated NO-affecting molecules to cause NME may use the PEM constructs that are described above with respect to tumor oxygenation to augment radiation and/or chemotherapy.
• Deregulation of angiogenesis is a key pathophysiologic factor in the development of highly vascularized tumors, such as RCC tumors.
• RCC renal cancer
• conventional or clear cell RCC is the most common histological subtype of kidney cancer and is characterized by somatic loss, secondary to mutation or silencing by methylation, of the von Hippel-Lindau (VHL) tumor suppressor gene.
• VHL von Hippel-Lindau
• HEF hypoxia inducible factor
• VEGFR vascular endothelial growth factor receptor
• VEGFR tyrosine kinase inhibitors have emerged as front-line treatments for RCC, such as sunitinib, pazopanib, and sorafenib.
• RCC sunitinib
• mTOR mammalian target of rapamycin
• temsirolimus and everolimus have demonstrated benefits in increasing progression free survival after the development of VEGFR TKI-resistant disease. No combination therapies have resulted in further improvements and have only vastly increased side effects.
• the efficacy and safety of PEM as a novel therapeutic modality for highly vascular tumors may be demonstrated by showing therapeutic use as a single agent in murine models of RCC, and developing optimal dose levels and dosing schedules. Then, the efficacy and safety of PEM in synergistic combination with VEGFR-directed therapies (first-line therapy), and/or in cases of VEGFR TKI-resistant disease (second-line therapy) may be shown. PEM may also have utility as a novel palliative treatment with and without radiation therapy (XRT), improving outcomes (or in lieu) of palliative nephrectomy. Thus, effective combinations of PEM with established anti-angiogenesis therapies and/or XRT may be shown in various embodiments using murine models of RCC.
• PEM may be used in synergistic combinations with a variety of different cancers, agent classes and agent names below.
• embodiment nanoparticles may also be used to co-incorporate multiple agents within a single nanoparticle.
• embodiment PEM constructs may be loaded with any two or more of NO binding molecules and molecules that affect NO (e.g., NOS inhibitors, VEGFR TKIs, and mTOR inhibitors), thereby producing maximal anti-angiogenesis activity and inhibition of tumor growth.
• NOS inhibitors e.g., NOS inhibitors, VEGFR TKIs, and mTOR inhibitors
• PEM-induced NME is likely synergistic with anti-angiogenesis therapies (e.g. VEGFR TKIs or mTOR inhibitors) and may demonstrate similar efficacy in treatment naive, heavily treated and poor risk patient populations.
• PEO-b-PCL Poly(ethyleneoxide)-block-poly(s-caprolactone) possessing a PEO block size of ⁇ 1.5- 4 kDa and with a PEO block fraction of -10-20% by weight are utilized to form biodegradable PEM dispersions.
• PEM constructs Poly(ethylene oxide)-block-poly(v-methyl ⁇ -caprolactone) (PEO-b-PMCL) and Polyethylene oxide)-block-poly(trimethylcarbonate) (PEO-b-PTMC) copolymers of varying molecular weight, hydrophobic-to-hydrophilic block fraction, and resulting polymersome membrane-core thickness are further incorporated to generate PEM constructs that are not only slowly biodegradable but also uniquely deformable, enabling passage through compromised capillary beds, via infra.
• PMCL as a derivative of PCL, is a similarly fully bioresorbable polymer that degrades via non-enzymatic cleavage of its ester linkages.
• Polymersomes composed from PEO-b-PTMC and/or PEO-b-PMCL are spontaneously formed at lower temperatures, in greater yields, and possess more deformable and viscoelastic membranes as compared to those composed from PEO-b-PCL. They also similarly degrade much more slowly than vesicles formed from PEO-b-PGA, PEO-b-PLA, or PEO-b-PLGA.
• PEO-b- PCL and PEO-b-PMCL-derived PEM dispersions demonstrate larger Mb-encapsulation efficiencies, smaller average particle diameters, and lower levels of met-myoglobin generation as compared to biodegradable cellular MBOCs claimed in the literature.
• Purified human Mb may be purchased from Sigma- Aldrich® to be used as starting materials.
• PEO-b-PCL, PEO-b-PMCL, and PEO-b-PTMC copolymers with PEO molecular weight ranging from lkDa-4kDa have previously been shown to give a stable and high yield of polymersomes .
• the PEO may have a molecular weight of 2kDa and the PMCL may have a molecular weight of 9.4kDa.
• PEM dispersions will be formed by using three different methodologies: 1) "thin-film rehydration", which involves the deposition of an organic solution of dissolved polymer on a Teflon film, drying of the film under vacuum oven overnight to remove all organic solvent, immersion of the dry thin-film of polymer in an aqueous solution of purified Mb and subsequent high-frequency sonication with heat, and, finally, extruding through a series of different pore- size membranes in order to yield the desired nanometric PEM dispersion; 2) "direct
• PEO-b-PMCL and PEO-b-PTMC polymersomes will be formed by direct or thin-film direct hydration at room temperature (under ambient p0 2 ) and expectedly enable a higher yield of PEMs with greater Mb encapsulation efficiency.
• NIR- emissive PEM constructs may be generated via co-incorporation of oligo(po h rin)-based NIRFs with dried polymer (at a mol ratio of 1 :40), 166 prior to exposure to the aqueous Mb solution. Unencapsulated Mb are separated from all PEM dispersions using dialysis, ultrafiltration, and/or size exclusion chromatography.
• each Mb/polymer formulation are characterized for particle size distribution using dynamic light scattering (DLS).
• DLS dynamic light scattering
• PEM structure and morphology are directly visualized using cryogenic transmission electron microscopy (cryo-TEM).
• the viscosity of the various PEM dispersions are measured using a microviscometer.
• Mb encapsulation% two independent methods are used. In the first method, PEM dispersions are initially lysed with a detergent (e.g. triton X-100) and the UV absorbance of the resulting lysate is measured to determine the mass of Mb and subsequent Mb encapsulation% of the original PEM composition.
• a detergent e.g. triton X-100
• Nitric oxide (NO) binding profiles of various PEO-b-PCL and PEO-bPMCL-based PEM dispersions are further determined.
• Acellular MBOCs can be expected to induce vasoconstriction, hypertension, reduced blood flow, and vascular damage in animals due to their entrapment of endothelium-derived NO.
• Mb-encapsulated in nanoparticles such as polymersomes, liposomes, micelles, etc, however, is not been expected to be similarly "vasoactive"; analogous to those of natural RBCs, liposome and polymersome membranes should effectively retard NO binding through effective Mb sequestration from the surrounding vascular environment.
• micropipet aspiration of Mb-encapsulating polymersomes follows analogous procedures to those described in previous references. Briefly, micropipets made of borosilicate glass tubing (Friedrich and Dimmock, Milville, NJ) are prepared using a needle/pipette puller (model 730, David opf Instruments, Tujunga, CA) and microforged using a glass bead to give the tip a smooth and flat edge. The inner diameters of the micropipets range from 1 um to 6 urn and are measured using computer imaging software. The pipettes are used to pick up the Mb-loaded and unloaded polymersomes and apply tension to their membranes. Micropipets are filled with PBS solution and connected to an aspiration station mounted on the side of a Zeiss inverted
• micromanipulators model WR-6, Narishige, Tokyo, Japan
• MellesGriot millimanipulators course x,y,z control
• Suction pressure is applied via a syringe connected to the manometer.
• PBS solutions that has osmolalities of 310-320 mOsm in order to make the polymersomes flaccid (internal vesicle solution was typically 290-300 mOsm sucrose).
• the osmolalities of the solutions are measured using an osmometer. Since sucrose and PBS have different densities and refractive indices, the polymersomes settle in solution and are readily visible under phase contrast or DIC optics.
• Acrylate-modified diblock copolymers e.g. an acryl modified PEO-b-PCL-based polymer deemed PEO-b-PCL-acryl
• PEO-b-PCL-acryl is found to have a number average molecular weight of 14 kDa (12 and 2 kDa for the PCL and PEO blocks, respectively). These are determined by calibrating the NMR peaks to the terminal methoxy group on the PEO at approximately 3.4 ppm.
• the polydispersity of the polymer is ⁇ 1.5. Acrylation of the OH terminus of the PCL block does not lead to a significant change in the polymer size or distribution following the second purification. The acrylation efficiency has been found to be 99%.
• PEM dispersions comprised of acryl-modified polymers (e.g. PEO-b-PCL- acryl-based PEM dispersions).
• pure human Mb may be purchased from Sigma- Aldrich®.
• PEO(2k)-b-PCL(12k)-acryl polymer and 2,2- dimethoxy-2-phenylacetophenone (DMPA) are dried on roughened Teflon® via dissolution in methylene chloride at a molar ratio of 1:1, deposition on Teflon®, and evaporation of the organic solvent. Varying the amount of acryl-modified polymer (e.g.
• PEO(2k)-b-PCL(12k)-acryl polymer from 5 mg - 20 mg per sample), as well as the initial aqueous Mb concentrations used in polymersome formation (from 100 mg ml to 300 mg/ml), PEM dispersions that
• PEM dispersions are formed by using three well-established methodologies: 1) thin-film rehydration, 2) direct hydration, and 3) thin-film direct hydration (see Example I). Each of these methods produces a high yield of stable polymersomes that can be effectively controlled through membrane extrusion to yield unilamellar, mono-dispersed suspensions of PEMs that vary from 100 nm - 1 ⁇ in diameter in average size.
• oligo(porphyrin)-based NIRFs with dried polymer (at a mol ratio of 1:40), 165 prior to exposure to the aqueous Mb solution.
• Unencapsulated Mb is separated from all PEM dispersions using dialysis, ultra-filtration, or size exclusion chromatography.
• acryl-modified polymersomes comprising the membranes of the PEM dispersions (e.g. PEO-b-PCL-acryl) can be crosslinked via UV light exposure that induces a radical polymerization of the acryl groups via activation of the photoinitator DMPA incorporated in the polymersome membranes.
• This approach does not hinder hydrolysis of the biodegradable block (e.g. the PCL chain of PEO-b-PCL-acryl) and yields degraded monomers (e.g. oligo- caprolactone units), PEO, and kinetic chains of poly(acrylic acid) as the degradation products.
• Mb is protected from photo-induced degradation of metMb formation by co-ecapsulation of NAC or methylene blue with Mb within the polymersomess' aqueous core.
• Polymerization of the vescicles' membranes proceeds by exposure of the DMPA-incorporated acryl-modified polymers (e.g. PEO-b-PCL-acryl) that compose thePEM dispersions using UV light generated from an OmniCure Series 1000 spot-curing lamp with a collimating lens (Exfo, Ontario, Canada; 365 nm, 55 mW/cm2) for 10-30 m .Lyophilization and Dry-phase Storage:
• Lyophilization proceeds by freeze-drying the acryl-modified PEM dispersions (e.g. PEO- b-PCL acryl PEM) after UV light exposure by placement in liquid nitrogen until bubbling ceases.
• the frozen PEM dispersions are then placed on a benchtop lyophilizer (FreeZone 4.5 L Benchtop Freeze Dry System, Labconco, Kansas City, MO; Model 77500) for 24 h until samples are dry.
• the dry, collapsed PEM dispersions are then stored in a dessicator under argon gas and placed at 4 °C.
• the dried acry-modified PEM dispersions are taken out of the dessicator and placed in a vial. The same original volume of aqueous solution is added back to the samples to hydrate the vesicles. Polymersome rehydration is further augmented by gentle vortexing for 10 minutes to achieve full vesicle resuspension. Intact polymersomes are verified by DLS, which shows minimal vesicle aggregation and no destruction into micelles. Mb retention is verified by running the PEM dispersion over an aqueous size-exclusion column and taking aliquots of the running bands for UV-vis analysis.
• polymersome surfaces are modified with various biological ligands to impart specific multi-avidity biological adhesion. Similar methodology may are adopted to generate molecularly-and cellular-targeted polymersome-encapsulated PEM dispersions that are able to promote, amongst other things, wound healing and improved efficacy of radiation therapy to hypoxia tissues.
• Biological ligands are conjugated to these nanoparticles via a carbodiimide- poly-vinyl sulfone-mediated aqueous phase reactions.
• the degree of polymersome-surface coverage with ligand is systematically varied (from 1% to > 10% of the total surface area of the polymersomes) by using ligands of different concentrations and PEM dispersions that are synthesized from mixtures containing different ratios of functionalized to unfunctionalized polymers. After verifying peptide conjugation to polymersome surfaces, the kinetic binding of the resultant PEM formulations to recombinant molecular targets/receptors are characterized via surface plasmon resonance
• Ligand conjugation to carboxyl-terminated PEO groups on the polymersome surface is carried in an aqueous reaction mediated by l-ethyl-3- (3-dimethylaminopropyl) carbodiimide (EDC) and Nhydroxysuccinimide (NHS).
• EDC l-ethyl-3- (3-dimethylaminopropyl) carbodiimide
• NHS Nhydroxysuccinimide
• the extent of ligand conjugation is determined using a micro-BCA assay.
• the resultant targeted PEM dispersions are extensively imaged by cryogenic transmission electron microscopy (cryo-TEM) to verify their stability after ligand conjugation. Their size distributions are again measured by DLS. The degree of ligand conjugation is verified using flow cytometry.
• ligand conjugation chemistries can also be employed.
• organic phase reactions where the diblock polymer is chemically functionalized and conjugated with select ligands (small molecules, peptides that have organic-phase solubility) prior to forming PEM dispersions are possible; this organic coupling methods ensures that the PEO terminus is conjugated with ligand before it is exposed to aqueous solution where it might lose many of its modified surface reactive groups via competing hydrolysis.
• PEM dispersions composed of PEO-b-PCL copolymers that vary with respect to PEO and PCL block sizes are created. This approach controls the kinetics of ligand conjugation to polymersome surfaces as well as the degree of ligand surface coverage for a given PEM formulation. It is possible for targeted PEM
• PEM dispersions formed from PEO-b-PCL, PEO-b-PMCL, PEO-b-PTMC and/or acryl- modified versions of these polymers are tested for their abilities to alter in vivo tumor oxygenation upon tail-vein injection into xenotransplanted-tumor bearing mice.
• the co-dependent effects of particle size, deformability and concentration on effective Mb delivery, and resultant tumor oxygenation, are also deconstructed.
• a hyperspectral optical imaging system that can spatially deconstruct real-time kinetic 0 2 transport is used to assess the efficacy of a given PEM construct to alter mean and minimum tumor oxygen tensions ( ⁇ 2).
• 151 ' 15 ' 156 ' 158 While mean p0 2 s have been previously studied and are readily measured by other techniques, the spatially-distributed minimum tumor p0 2 s are perhaps the most responsible for driving tumorigenesis and providing the cancer stem cell niche that helps tumors evade effective treatment.
• 151 ' 154 ' 155 ' 189 A hyperspectral optical imaging system enables the spatial mapping of kinetic p0 2 s, in real-time, and is used to visualize and quantify the degree of PEM-modulation of low tumor p0 2 areas.
• mild localized tumor heating increases vessel pore sizes in solid tumors for up to several hours, aiding in nanoparticle extravasation.
• hyperspectral imaging is used to evaluate the effects of the various PEM constructs on modifying tumor p0 2 . Temperatures are adjusted between 34 - 42 °C. t90 ' 191 Hyperspectral imaging of Mb absorption is used to quantify Mb 02 saturation, 158 while ratiometric evaluation of boron nanoparticle fluorescence and phosphorescence is used to quantify absolute tumor p0 2 . 153 HIF-1 activity is also evaluated by measuring GFP emission. This enables quantification of both vascular and tissue oxygenation, as well as the presence of the tumor hypoxic phenotype, independently and concurrently.
• Example V As discussed above, various embodiment nanoparticles that exhibit high concentrations of biologically active oxygen carriers may accumulate into tumors when injected into the circulation of an animal model of human breast cancer. Within the tumors of these animals, the nanoparticles may result in widespread shutdown of vascular flow, hemorrhage, and necrosis, of the cancer cells but with no obvious toxic side effects to normal tissue.
• Anesthesia may be performed using isofluorane (1.5-2.5% via nose cone) for imaging. Ketamine/xylazine (100/10 mg/kg, i.p.) may be used for surgical procedures. Animals may be monitored for proper depth of anesthesia by toe pinch response and respiratory rate. They may also be maintained for proper body temperature using a circulating water heating pad.
• Moisturizing ointment may be placed on their eyes.
• PEM and empty polymersomes may be prepared under sterile good laboratory practice (GLP) conditions in 0.9% NaCl USP.
• GLP sterile good laboratory practice
• the viscosity, pH and osmolality of each injectate may be measured and verified to be within standard physiologic range for blood (e.g. 4-5 kPa, pH 7.4, 290 mOsm).
• IV slow intravenous
• a butterfly needle may be preferentially used, but an intravenous cannula may be taped in place in a superficial vein (short term), or surgically placed some time prior to use (longer term or multiple injections, e.g. for weekly application of three cycles).
• Initial infusion may be attempted in volumes of 10 ml/kg and at a rate of 1 ml/kg/min; but these may be increased, pending exact PEM concentrations.
• a maximum volume of 20 mL/kg, infused as at 5 mL/kg min, may be set in order to avoid significant distress or development of pulmonary lesions.
• the vein may be raised by gentle pressure above the joint and the vessel is punctured using the smallest gauge needle that enables sufficiently rapid blood withdrawal without hemolysis (e.g. 25-27 gauge for mice).
• a simple stab leads to a drop of blood forming immediately at the puncture site and a
• microhematocrit tube may be used to collect a standard volume. After blood has been collected, pressure over the site may be sufficient to stop further bleeding. Removal of the scab may enable serial sampling. For blood draws that occur no more frequently than a weekly basis, the maximum volume removed per draw may be set at 10% of the circulatory volume (0.2 mL in mouse). For blood draws that occur no more frequently than every 3 weeks, the maximum volume removed per draw may be set at 20% of the circulatory volume (0.4 mL in mouse). For terminal blood draws at sacrifice, cardiac puncture may be employed under general anesthesia.
• the kinetic parameters and end points that may be evaluated include clinical signs (hourly for the first 6h, then every 12 hours for 3 days, and weekly thereafter), body weights and changes (2-3 times per week), food consumption (2-3 times per week), abbreviated functional observational battery (2-3 times per week), ophthalmologic assessments (2- 3 times per week), serologic profiles (hematology, coagulation, clinical chemistry, and urinalysis performed (weekly), toxicokinetic parameters (hourly for the first 6h, then every 12 hours for 3 days, and weekly thereafter), gross necropsy findings (upon sacrifice after completion of the third cycle), organ weights (upon sacrifice), and histopathologic examinations (upon sacrifice).
• Animals may be anesthetized with 100/10 mg/kg ketamine/ xylazine. Exidine solution may be used to disinfect the animal's skin and washed off with 70% ethanol. In a sterile field, the animal's dorsal skin may be sutured to a metal c-frame, and a titanium metal frame may then surgically inserted and sutured in place. A 12 mm circular section of the skin may be excised. Approximately 10,000 RCC cells, suspended in 20 microliters of phosphate buffered saline (PBS) may then be injected into the now visible back-side of the underlying skin. A cover glass window may next be inserted and held in place with a spring loaded metal ring. The c-frame may subsequently be removed and the animal may be allowed to recover from anesthesia.
• PBS phosphate buffered saline
• Temperature may be maintained throughout the procedure using a heated wax pad.
• Buprenorphine may be injected subcutaneously immediately post-surgery, and then at 8-12 hours post-surgery, as needed for pain alleviation.
• Imaging NME [0269] Imaging NME:
• An animal with an active scavenging system may be anaesthetized using isofluorane (1.5- 2.5% via nose cone), and positioned on the imaging stage.
• a Bacitracin Neomycin/Polymyxin B (BNP) suspension may be topically applied, and hemoglobin saturation and green fluorescent protein (GFP) (HIF-1) fluorescence may be imaged up to 30 minutes to establish baseline oxygenation levels.
• the imaging may be performed using a fluorescence microscope (e.g., a Zeiss).
• a 42-degree Celsius hyperthermia treatment may be imposed for 1 hour, after which the animal may be tail-vein injected with a PE suspension (e.g., 100 sL). Imaging may be continued for 1 hour, and follow up imaging sessions may be carried out at 24 and 48 hours post treatment, with a second PEM dose delivered at 24 hours.
• the total imaging and treatment time for each time point may be less than 2 hours.
• Sunitinib malate salt (a VEGFR T I) may be purchased (e.g., from LC Laboratories (Japan), 99% USP).
• Oral formulation may be prepared by four-fold concentrations (e.g. 3.2 mg for a 20 g mouse) in a Cremephor EL/ethanol (50:50) solution. This stock of four-fold concentration may be prepared fresh daily.
• Final dosing solutions may be generated on the day of use by dilution to normal concentration with endotoxin free distilled water and mixed by vortexing immediately prior to dosing at 40 mg/kg daily (0.8 mg for a 20 g mouse) by oral administration.
• 786-0 cells that have been engineered to constitutively express luciferase may be utilized to generate orthotopically xenografted RCC tumor-bearing animals. Luciferase imaging may be used to monitor tumor size and to track metastases. Tumor luciferase intensity and body weights may be recorded two to three times a week starting with the first day of treatment. Tumor volume may be determined via a preliminary calibration curve to relate total radiance from luciferase to tumor volume, in which animals may be imaged and then sacrificed to measured tumor volume directly.
• Orthotopically xenografted RCC tumor-bearing animals may be generated and subject to daily treatment with.PO Sunitinib (40 mg kg per day), which may be initiated when tumors reach 100 mm 3 and continued until they grow to 1.5 times their initial size. Further therapeutic administration with PEM with and/or without temsirolimus, or with control nanoparticles, may then take place.
• Sunitinib 40 mg kg per day
• mice injected with PEM versus controls i.e. polymersomes alone or myoglobin alone
• the minimal effective dose (MED) of PEM necessary to induce NME of RCC may also be identified.
• its maximum dose for safe administration may be set as either the STD10 (the severely toxic dose in 10% of animals) or the MTD75 (the maximum tolerated dose that results in less than 15-20% weight loss in 75% of animals), if no dose limiting toxicities (DLTs) are discovered.
• PEM constructs may be developed that have a myoglobin encapsulation efficiency of greater than 50%, a weight ratio of encapsulated myoglobin to polymer of greater than 5 wt%, a solution metmyoglobin level that was less than 5% of the total myoglobin, a suspension viscosity between 3-4 cP, a P50 similar to free myoglobin, and an order of magnitude smaller NO binding rate constant as that measured for free myoglobin.
• PEM constructs may be developed using biocompatible poly(ethyleneoxide)-block-poly(butadiene) (PEO-b-PBD) copolymers.
• PEM constructs may be developed using any of a number of biodegradable copolymers. Encapsulation of the myoglobin may be accomplished using methods including thin film rehydration, thin film direct rehydration, electroporation, and direct rehydration.
• FIGs. 11 and 12 illustrate steps for generation and measurement of PEM formulations according to some embodiments.
• 10 mg of reduced myoglobin solution (150 mg mL metmyoglobin (metMb) in 10 mM PBS at pH 7.4) may be added, and reduced by addition of 1 wt% sodium dithionite.
• the mixture may be agitated and sonicated for 0.5 hr at RT, and the polymer suspension may be further diluted by addition of titrated aliquots (10, 20, 50, and finally 100 nl) of the reduced Mb solution with thorough sonication after each dilution step.
• the sample may be subjected to further dialysis against sterile PBS buffer at 4°C, and characterization of the resultant PEM formulations by dynamic light scattering (DLS) to determine size.
• the sample may be subjected to cryogenic transmission electron microscopy (cryo-TEM) to verify morphology.
• Cryo-TEM cryogenic transmission electron microscopy
• the sample may further be subjected to UV-vis spectrometry to calculate final concentrations of Mb and weight percentages of Mb to polymer (wt% Mb/polymer) in the final PEM constructs.
• ICP-OES inductively Coupled Plasma Optical Emission Spectroscopy
• Particle sizes may be tuned between 100 and 200 nm in diameter through selection of polymer composition and molecular weight.
• myoglobin may be encapsulated within the aqueous cavities and bound to the surfaces of polymersomes.
• surface-associated myoglobin may be removed by proteolysis using pronase (i.e., a mixture of various proteinases isolated from Streptomyces griseus that digests proteins into individual amino acids). Since pronase cannot cross the polymersome bilayer membrane, it may be used to digest all surface-associated myoglobin while leaving encapsulated Mb unaffected. In brief, pronase solution may be added to PEM samples to obtain a final 4 wt% enzyme concentration.
• pronase i.e., a mixture of various proteinases isolated from Streptomyces griseus that digests proteins into individual amino acids. Since pronase cannot cross the polymersome bilayer membrane, it may be used to digest all surface-associated myoglobin while leaving encapsulated Mb unaffected.
• pronase solution may be added to PEM samples to obtain
• the solution may be further mixed for at least 2 hr at RT, centrifuged, and dialyzed to remove enzyme.
• Retained Mb in PEM suspensions was subsequently quantified and found to be between 3 wt% (by UV-Vis) and 5 wt% Mb/polymer (by ICP-OES).
• Direct hydration may also be utilized to obtain small PEM compositions (i.e., around 100-150 nm in diameter) generated from biodegradable PEO-b-poly(caprolactone) (PEO-b-PCL) and PEO-b-poly(PCL/trimethylene carbonate) (PEO-b-PTMC) copolymers.
• PEO-b-PCL biodegradable PEO-b-poly(caprolactone)
• PEO-b-PTMC PEO-b-poly(PCL/trimethylene carbonate)
• myoglobin/polymer as well as myoglobin encapsulation efficiencies may be similar in both biocompatible and biodegradable PEM formulations.
• Iron in myoglobin is oxidized to Fe 3+ when exposed to atmospheric conditions.
• various agents may be used for chemical reduction of met-myoglobin in order to enable O2/NO binding, such as sodium dithionite (Na 2 S 2 0.i).
• Na 2 S 2 0.i sodium dithionite
• Using reduced myoglobin may result in more efficient generation and higher yields of PEM than are achievable by utilizing met-myoglobin.
• met-myoglobin may be reduced to oxymyoglobin (with 1 wt% Na 2 S 2 0 4 ) prior to PEM generation, most PEM may be reoxided to met-myoglobin after long-term storage. Therefore, PEM may be re-reduced back to oxymyoglobin prior to immediate infusion.
• such re-reduction may be performed by a process consisting of sonication in dilute quantities of Na 2 S 2 04 followed by dialysis, in which effects of sonication power and time may be examined and optimized. To avoid further oxidation, reduced PEM may be used immediately for animal studies.
• Oxygen equilibrium binding curves of PEM and free Mb dispersions may be measured using a HemoxTM Analyzer at physiological temperature (37°C). In brief, samples may be allowed to saturate to a p0 2 of 147 mm Hg using compressed air and then deoxygenated using a compressed nitrogen stream. UV-Vis absorbance measurements of oxygenated and
• deoxygenated samples may be recorded as a function of p02 via dual wavelength spectroscopy.
• Oxygen-PEM myoglobin equilibrium curves may be fit to a four-parameter (Ao , A ⁇ , P 50 , n) Hill model: Abs -AbSp ⁇
• the p02 represents the partial pressure of 02
• P50 represents the partial pressure of 02 where PEM/Mb is 50% saturated with oxygen.
• 'n' represents the cooperativity coefficient of PEM/Mb.
• the P50 for PEM before (PEM-SE) and after proteolysis (PEM-E) were found to be 7.9 and 17.1 mm Hg, respectively, which were both significantly higher than the P50 for free Mb ( ⁇ 2 mm Hg).
• PEM-SE PEM having myoglobin associated only in the aqueous c avaties of the polymersomes
• PEM-E PEM having myoglobin associated only in the aqueous c avaties of the polymersomes
• free myoglobin as a function of partial pressure of oxygen.
• the lower 0 2 affinity (higher P50) of PEM than free myoglobin may be attributed to the shielding effect of the polymersome membrane, which was further found to delay the kinetics of 0 2 binding to PEM.
• kinetic measurements of binding/release for various gaseous ligands (0 2 and NO) to PEM and free myoglobin may be performed using an Applied
• Photophysics SX-20 microvolume stopped-flow spectrophotometer Example measurements of kinetic curves were fit to a first order exponential e quation to regress the pseudo rate constants, whi c h were found t 0 be first order in t he case of NO and zero-order for 0 2 dissociation. By measuring kinetic time courses at different NO concentrations, the apparent first order rate cons t ants were plotted against NO concentrations, and the slope of the fitted line yielded the second order rate constant for NO deoxygenation.
• 13B shows 0 2 dissociation time courses of PEM, where all unencapsulated and surface-associated myoglobin had been removed by proteolysis and in which the remaining myoglobin had been reduced to oxymyoglobin in the presence of 1.5 mg mL of Na 2 S 2 0 4 .
• FIG. 14 is a table showing kinetic rate constants for oxygen dissociation (K off , 02) and NO-mediated deoxygenation ( ⁇ ⁇ , ⁇ ) for various PEM formulations in comparison to free (unencapsulated) myoglobin (Mb).
• FIG. 13C shows the kinetic time course for NO-mediated deoxygenation of PEM in which all unencapsulated and surface-associated myoglobin had been removed by proteolysis and in which the remaining myoglobin had been reduced to oxymyoglobin.
• the absorbance from the deoxygenation reaction was observed at 437.5 nm in 0.1 M phosphate buffered saline (PBS), pH 7.4 at 20°C.
• the NO deoxygenation time courses of PEM were acquired based on absorbance changes at 420 nm and 20°C following rapid mixing of oxygenated PEM (7.5 ⁇ heme) and appropriate dilutions of the NO stock solution.
• the oxygen dissociation constants (koff, 02) as well as NO deoxygenation constants (ko X ,No) of PEM-SE and PEM-E may be significantly lower than those of free myoglobin. Such differences may be due to the shielding effect of the thick polymersome membrane, which may effectively serve as a barrier between PEM and gaseous ligands in the environment, thereby delaying 0 2 dissociation, NO deoxygenation, and the equilibrium binding of these gasses to PEM.
• the shielding effect is also consistent with observed differences in kinetic and equilibrium binding of gaseous ligands in polymersomes that have both surface associated and encapsulated myoglobin (PEM-SE) as compared to PEM formulations that have been treated with pronase to remove non-specifically bound surface myoglobin (PEM-E).
• PEM-SE surface associated and encapsulated myoglobin
• PEM-SE may display higher koff, 02 than PEM-E.
• PEM may display an 0 2 affinity that is higher than RBC-bound hemoglobin and lower than free myoglobin. Examples of kinetic rate constants for oxygen dissociation (Koff, 02) and NO-mediated deoxygenation (Ko X> NO) for various PEM formulations in comparison to free (unencapsulated) myoglobin (Mb), are shown in the table of FIG. 14.
• negative controls may be prepared using near-infrared (NIR) - myoglobin.
• NIR near-infrared
• a near-infrared fluorophore (IRDye800cw NHS) may be covalently attached to the lysines on horse skeletal myoglobin to form the control NIR-myoglobin.
• tail veins may be catheterized using 30G needles and heparinized saline, empty polymersomes (a first control), NIR-myoglobin (a second control), and PEM suspensions may be administered via invtravensous (IV) injection. Following injection, the catheters may be flushed with heparinized saline to ensure accurate dosage.
• mice were sacrificed at 24 h (for biodistribution/pharmacokinetic studies) or at 6-9 days (for histology and toxicology assessment following tumor efficacy studies).
• EF-5 was used to stain for hypoxia and Hoechst solution for perfusion. Tumors were collected at sacrifice. Immunofluorescence (IF) was carried out to image EF-5 and Hoechst distribution throughout the tumors. The same tumor sections were also stained with hematoxylin and eosin (H&E) for immunohistologic (IHC) analysis. Blood was collected via cardiac puncture at sacrifice; plasma was isolated and stored at -80 °C for later analyses.
• FIG. 15 A shows the biodistribution, tumor accumulation, and pharmacokinetics of NIR- Mb, empty polymersomes, and PEM at points following TV injection.
• Empty polymersomes and PEM constructs had a fluorescent NIR-dye PZns) incorporated to enable in vivo optical imaging of particle biodistribution, as well as pharmacokinetic determinations of plasma concentrations via quantification of fluorescence signals, which were subsequently compared to initial fluorescence values and correlated to Mb concentrations determined by ICP-OES prior to administration.
• FIG. 15B shows such plasma concentrations of empty polymersomes, PEM, and NIR-myoglobin as a function of time
• FIG. 15C shows the correlated myogblobin concentrations as a function of time. As illustrated by FIGs. 15A-15C, uptake and
• NIR-Mb pharmacokinetics of PEM appeared to be similar to that of empty polymersomes, which demonstrated a rapid distribution phase, a slower clearance phase, and an overall plasma half-life of approximately 15 h.
• NIR-Mb exhibited an extremely rapid plasma clearance (via the kidneys and into the bladder), as expected from the known biodistribution and clearance of free Mb.
• Dorsal skin flap window chambers were used to image the tumor microenvironment as described previously. To carry out window chamber studies, Balb/c mice were shaved and Nair was applied prior to surgery. During surgery, 1-1.5 x 105 4T1 cells were injected into the fascia. 7-9 days following surgery, tumors were visible within the windows. Mice were then treated via tail vein catheter with 150 - 200 ⁇ of 50 mg/mL polymer suspensions, corresponding to empty polymersomes or PEMs. Mice were anesthetized with isofluorane via nose cone and the windows were secured to the microscope stage. Imaging was carried out prior to and during injection of the treatments, and at various time points over the course of the experiment until 48 h.
• FIG. 18A shows a typical mouse tumor during treatment with PEM and empty polymersomes. Vascular occlusions become apparent within one hour following PEM administration, and more severe over time. By the 4 h time point, darkening of the tumor region becomes pronounced and continues to increase in severity for up to 48 h.
• FIG. 18B shows a brightfield image (left) and a near-infrared (NIR)-fluorescence image of using PZn 3 (right) of the tumor shown in FIG. 18 A at 24 hours after administration of PEM, where the NIR fluorescence corresponds to the localization of PEM within the tumor
• FIGs. 19A and 19B show hemoglobin saturation and blood flow velocity maps for a representative tumor, respectively. Each of these maps show the representative tumor before and after treatment with PEM and empty polymersomes (control). PEM treatment results in a substantial reduction in oxygenated hemoglobin saturation following treatment, as well as a marked decrease in blood flow, which becomes more pronounced in severity over time. These results are not seen with empty polymersome treatments.
• FIG. 20 illustrates representative immunohistochemistry (IHC) and Hematoxylin and Eosin (H&E) images of excised tumors for a NIR-myoglobin control and PEM treated animal.
• IHC immunohistochemistry
• H&E Hematoxylin and Eosin
• the liver is the major organ of polymersome PEM accumulation, and thus the histology of livers may be performed to determine any corresponding microvascular damage to normal tissues.
• each treatment suspension may be mixed with a 2 S 2 04 to regenerate oxy-myoglobin prior to infusion. Animals were both directly injected with this solution mixture (of PEM and a 2 S 2 04) as well as with dialyzed PEM suspensions (where Na 2 S 2 0 4 had been removed) to determine any potentiating effects.
• Livers from orthotopic 4Tl-xenografted mice treated with PEMs and empty polymersomes (control) were also excised upon sacrifice (6-9d post-treatment, 14-17d post-tumor injection) for H&E staining and microscopy.
• Each treatment suspension was also mixed with a 2 S 2 04 to regenerate oxy-myoglobin prior to infusion.
• FIGs. 22A and 22B are 20x magnification and 40x magnification H&E images, respectively, of excised livers from tumor-mice treated with PEM and empty
• PEM may be particularly effective as a first-line therapy for the most highly vascularized tumors.
• An example target may be, clear cell RCC (CC-RCC), which is chemotherapy resistant but responsive to cancer therapeutics that inhibit angiogenesis.
• CC-RCC clear cell RCC
• a mouse model of RCC may be used to test the effectiveness of PEM in promoting the selective NME of RCC tumors and inhibiting their growth.
• ectopic and orthoptopic xenografts of human RCC tumor cells and/or allografts of mouse RCC tumor cells in immunocompromised mice may be used to generate mouse models of RCC.
• PEM is able to induce tumor-specific NME after a single administration at 10-15 mg/kg Mb (corresponding to 200-300 mg/kg polymer).
• optimal dose levels that achieve maximal effect with minimal toxicity may be determined.
• FIG. 22C shows mouse RCC tumors approximately prior to treatment with PEM, and approximately 28 hours after treatment.
• the change in color from their initial light (as seen in the surrounding normal tissue) to a dark color may correspond to an accumulation of RBC-bound hemoglobin (Hb) as assessed by optical spectroscopy (from Zenascope, by Zenalux, Inc.).
• FIG. 22D shows mouse RCC tumors approximately prior to, and approximately 28 hours following, treatment with empty polymersomes. Any color changes observed in the tumors in FIG. 22D are significantly lower than those in FIG. 22C. Without wishing to be bound to a particular theory, these results may show that PEM-induced NME occurs in mouse tumors other than mammary tumors, such as in RCC tumors.
• FIGs. 22E and 22F illustrate representative IHC and H&E images of excised tumors from mouse models of RCC treated with PEM and with empty polymersomes, respectively.
• PEM treated animals there are vastly enhanced areas of necrosis shown in FIG. 22E, which comprise the majority of the tumor sections. Such areas are not similarly shown in FIG. 22F for empty polymersome treatment.
• Gram scale preparations of PEM may be generated under GLP conditions, and dose escalation studies may be conducted to determine its therapeutic window as a single agent
• the table in FIG. 23 A provides parameters for studies to determine any DLTs and the table in FIG. 23B provides parameters for studies to determine the MED of PEM to promote NME of RCC.
• the highest dose of PEM for safe administration may be set as the STD10 (the severely toxic dose in 10% of animals) or the MTD75 (the maximum tolerated dose that results in less than 15- 20% weight loss in 75% of animals), if no DLTs are discovered.
• Biodegradable PEM Dispersions may be formed using purified human myoglobin and diblock copolymers of PEO(2k)-b-PCL(12k) and PEO(2k)-b-PMCL(9.4k). PEM formation may be performed by a modified direct rehydration protocol as discussed above. For in vivo optical imaging studies, NIR-emissive PEM constructs may be generated via co-incorporation of PZ3 ⁇ 4 fluorophores as also discussed above.
• particle sizes may be determined by dynamic light scattering (DLS) and viscosity may be measured using a microviscometer, oxygen and NO binding as well as the concentrations of myoglobin, final wt% of myoglobin/polymer, and wt% of met-myoglobin may be determined, following established methodology.
• DLS dynamic light scattering
• concentrations of myoglobin, final wt% of myoglobin/polymer, and wt% of met-myoglobin may be determined, following established methodology.
• In situ changes in met-myoglobin level, NO uptake, and myoglobin release from biodegradable PEM formulations may be tested under various solution conditions (e.g. temperature, pH, ⁇ 2 , and pNO) and at various time points, to verify product stability.
• kinetic parameters and end points may be evaluated: clinical signs (hourly for the first 24 h, then every 12 h for 3 days, and weekly thereafter), body weights and changes (2-3 times per week), food consumption (2-3 times per week), abbreviated functional observational battery (2-3 times/ week),
• ophthalmologic assessments (2-3 times per week), serologic profiles (hematology, coagulation, clinical chemistry, and urinalysis (performed weekly), toxicokinetic parameters (hourly blood draws for the first 24 h, then every 12 h for 3 days, and weekly thereafter, gross necropsy findings (upon sacrifice after completion of third cycle of treatment), organ weights (upon sacrifice), and histopathologic examinations (upon sacrifice).
• a human RCC cell line, 786-0 (VHL ⁇ ) may be obtained from American type culture collection (ATCC), maintained and propagated in RPMI 1640 media (GIBCO), and
• mice may be implanted subcutaneously with 1 mm tumor fragments of 786-0 cells for the ectopic RCC xenograft models.
• male athymic NCr nu/nu mice may be implanted with similar tumor fragment volumes by making an incision in the renal capsule and placing the donor fragment underneath the capsule sheath.
• Window chambers may be surgically implanted in ectopically xenografted RCC tumor- bearing animals.
• PEM suspensions may be prepared as discussed above, and injected via the tail vein when tumors reach 4-6 mm in diameter.
• Hyperspectral imaging of hemoglobin absorption may be used to quantify hemoglobin oxygen saturation, and HIF-1 activity may be evaluated by measuring GFP emission.
• PEM may prove to be a more uniformly effective first-line therapy of RCC.
• PEM may be administered in different dosing levels and schedules, with and without the VEGFR TKI sunitinib, to determine the therapeutic combination that achieves maximal activity against treatment-naive RCC.
• the preclinical efficacy of PEM may be established if any treatment achieves a duration of tumor growth inhibition that is greater than 1.5 times that of sunitinib alone, and no associated DLTs are observed.
• FIG. 24 A provides parameters for a study to develop a single combination of PEM dose level, schedule, and treatment (i.e. either as a single agent or with sunitinib) in a first-line therapy that results in maximal tumor growth inhibition, and no severe toxicities to treated animals.
• 786-0 cells that have been engineered to constitutively express luciferase may be utilized to generate orthotopically xenografted RCC tumor-bearing animals. Luciferase imaging may subsequently be used to monitor tumor size and to track metastases. Luciferase intensity and body weights may be recorded two to three times a week, starting with the first day of treatment. A preliminary calibration curve may be generated to relate total tumor radiance to tumor volume, which may be directly measured at the time of sacrifice. Treatments may be initiated when tumors reach 100 mm 3 and treatment efficacy may be measured as a percent tumor growth inhibition (TGI) relative to control groups. TGI may be calculated by the Equation 2 below:
• TGI (1 - T/C) x 100 (Eq. 2), where T and C represent the mean tumor mass on the last day of therapy in treated (T) and control (C) groups, respectively.
• the general health of animals may be monitored daily until tumors sizes have increased by 5 times, tumors reach a volume of 500 mm 3 , or signs of significant animal distress are observed (e.g., greater than 15% loss in body mass). Toxicity parameters may be determined for all combinations of PEM and sunitinib. At the end of treatment, all tumors may be removed and surface photomicrographs taken.
• the tumors may then be fixed in 10% formalin and embedded in paraffin for IHC analyses, as below. Data are assumed to be normal upon transformation, and a t-test may be used to test for statistical significance. Assuming a standard deviation of 50% of the control mean, a minimum of 10 animals per group may be needed to ensure a greater than 80% power of detecting a TGI of more than 50%. Multiple comparisons may be corrected for by false discovery rate.
• Inhibition of tumor angiogenesis may be assessed by measuring levels of CD31 and aSMA, cell proliferation by Ki-67 staining, the extent of tumor apoptosis by terminal
• the preclinical efficacy and safety of PEM, as a first line therapy, as a single agent or in combination with the VEGFR TKI sunitinib, may be established if any treatment achieves a duration of TGI that is greater than 1.5 times that of Sunitinib alone, and no DLTs are observed.
• the efficacy of PEM as second-Line therapy may be determined.
• PEM may be administered in different dosing levels and schedules, with and without the mTOR-inhibitor temsirolimus, to determine the most effective therapeutic combination against VGFR TKI-resistant RCC.
• FIG. 24B provides parameters for a study to determine the therapeutic effects of different dose levels and dosing schedules when PEM is administered as a second-line therapy, both as a single agent and in combination with temsirolimus.
• orthotopically xenografted RCC tumor-bearing animals may be generated and subject to treatment with sunitinib (40 mg orally administered per day), which may be initiated when tumors reach 100 mm 3 and continued until they grow to 1.5 times their initial size. At this point, they may be randomized for second-line therapy and monitored, as discussed above.
• the preclinical efficacy and safety of PEM, as a single agent or combination with the mTOR inhibitor temsirolimus may be established if any treatment achieves a duration of TGI that is greater than 1.5 times that of temsirolimus alone, and no DLTs are observed.
• the benefits in combining PEM with XRT as palliative treatment for RCC may be determined.
• PEM may be administered after XRT in order to evaluate its ability to prolonging local control of RCC.
• FIG. 25 provides parameters for a study to determine a single PEM dose level and schedule in a palliative treatment that results in maximal tumor growth inhibition, and a decreased number of new metastases as measured over weekly intervals for one month.
• Orthotopically xenografted RCC tumors-bearing animals may be established, as discussed above, and treated daily with a fractionated dose of 3Gy x5 to the renal bed (via PXi X-Rad 225Cx, orthovoltage image-guided irradiator). Following PEM administration, tumor growth may be assessed at weekly intervals for 1 month, and the number of metastases may be determined at sacrifice. The benefit of combining PEM and XRT may be established if administration results in more than 50% TGI; and, there is a 25% reduction in the number of metastases as compared with animals that undergo XRT alone, by one month after treatment.
• PEM scale-up may also be achieved via a tangential flow filtration apparatus, following established techniques. For animal studies, if the MTD75 is not established within the first five initial dose levels, two additional PEM dose levels may be selected (e.g. 200 and 500 mg kg myoglobin). In addition to 786-0 cells, A498, 769-P, Caki-1, Caki-2, SW839, ACHN, G401 and/or SK-NEP-1 cell lines (all available from ATCC) may be used to generate mouse models of RCC. Further, NOD/SCID mice may be utilized to generate tumor xenografts, if tumors in NCr nu/nu mice fail to grow or respond effectively.
• the transgenic model of cancer of the kidney (i.e., the "TRACK” mouse), which expresses a constitutively active HIF-la in kidney proximal tubule cells, may alternatively be employed.
• Different dosages of temsirolimus and/or, alternatively, everolimus may be examined if animals experience excess toxicities with temsirolimus treatment after sunitinib, as assessed for positive control (temsirolimus only) animals.
• alternative doses e.g. 30 Gy
• modes of XRT i.e. SBRT
• SBRT modes of XRT

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