# Patent

## Title
Co-delivery of stimulatory and inhibitory factors to create temporally stable and spatially restricted zones

## Abstract

The invention provides methods and compositions for local manipulation of regenerative processes via exogenous factor delivery.

## Background
RELATED APPLICATIONS
This application is a national stage application, filed under 35 U.S.C. §371, of International Application No. PCT/US2011/042051, filed Jun. 27, 2011, which claims the benefit of U.S. Provisional Patent Application No. 61/358,499, filed on Jun. 25, 2010, the contents of which are incorporated herein by reference in their entireties.


STATEMENT AS TO FEDERALLY SPONSORED RESEARCH
This invention was made with Government support under National Institutes of Health awards R01HL069957 and R37DE013033. The Government has certain rights in the invention


FIELD OF THE INVENTION
This invention relates generally to the field of drug delivery.
BACKGROUND OF THE INVENTION
Nature frequently utilizes opposing factors to create a stable activator gradient to robustly control pattern formation. Specifically, during developmental processes, tight spatial regulation often results from the combined action of stimulatory and inhibitory factors. In such reaction schemes, the reactions of morphogens and their diffusion through a tissue are adequate in describing morphogenesis and creating sharp boundaries in patterns. However, the diffusion/reaction of stimulatory factors alone results in the formation of shallow gradients that make cellular discrimination of spatial cues difficult. Prior to the invention described herein, the art-recognized strategy for delivering stimulatory factors alone to promote regeneration has ignored this fundamental principle of developmental biology. As such, there has been a long-felt need in the art for the discovery of new approaches to locally manipulate regenerative processes via exogenous factor delivery.
SUMMARY OF THE INVENTION
The invention is based on the surprising discovery that biological processes, e.g., the regeneration of muscle tissue or other tissues, cell differentiation, as well as angiogenesis, can be temporally and spatially (directionally) controlled by simultaneously delivering from a single source/location stimulatory and inhibitory agents that are spatially segregated. For example, the source is a polymeric structure or device, and the agents are segregated from one another by different layers or zones of the structure or device. A method for promoting a morphogenic process is carried out by administering to a subject a composition or device comprising at least one purified morphogen and at least one purified inhibitor or antagonist of the morphogen (e.g., small molecule inhibitor, antibody or fragment thereof that binds to the morphogen or its receptor, or a soluble ligand that binds to the morphogen or its receptor or a second morphogen. In the latter situation in which the antagonist is a second morphogen, the second morphogen promotes a morphogenic process that is different from that driven by the first morphogen. For example, the first morphogen is a differentiation factor that promotes differentiation of cells toward a first tissue type, and the second morphogen is a second differentiation factor that promotes differentiation of cells toward a second tissue type.
The morphogen and the inhibitor remain inside the device and interact there, or they are released from the composition or device and interact, e.g., outside of the composition and device, to promote the morphogenic process over a sustained period of time (e.g., 4 hours, 8 hours, 12 hours, 1 day, 3 days, 7 days, 14 days, 21 days, or 1 month) at a spatially restricted zone at or near a site at which the morphogen and the inhibitor interact in the subject. For example, the morphogen and inhibitor interact within the device or near the device, e.g., about 0.1 cm, about 0.5 cm, about 1 cm, about 2 cm, about 3 cm, about 4 cm, about 5 cm, about 6 cm, about 7 cm, about 8 cm, about 9 cm, or about 10 cm from the site of the device. In some embodiments, the morphogen and the inhibitor are both present in the device and interact within the device to direct proliferation, differentiation, regeneration, or other activities of cells that have been seeded in the device prior to implantation or bodily cells that have entered the device after implantation into an animal. Optionally, the factors (morphogen inhibitor) are released from the device and the morphogen is released at a first rate and the inhibitor is released at a second rate. Exemplary morphogenic processes include angiogenesis, tissue regeneration, organ regeneration, cartilage regeneration, bone regeneration, cell differentiation, or neural regeneration. Suitable morphogens include vascular endothelial growth factor (e.g., VEGFA; GenBank Accession Number: (aa) AAA35789.1 (GI:181971), (na) NM_001171630.1 (GI:284172472), incorporated herein by reference), acidic fibroblast growth factor (aFGF, Genbank Accession Number: (aa) AAB29057.2 (GI:13236891), (na) NM_000800.3 (GI:222144219), incorporated herein by reference), basic fibroblast growth factor (bFGF; GenBank Accession Number: (aa) AAB21432.2 (GI:8250666), (na) A32848.1 (GI:23957592), incorporated herein by reference), placenta growth factor (PIGF or PLGF; GenBank Accession Number: (aa) AAH07789.1 (GI:14043631), (na) NM_002632.4 (GI:56676307), incorporated herein by reference), leptin (Genbank Accession Number: (aa) CBI71013.1 (GI:285310289), (na) NM_000230.2 (GI:169790920), incorporated herein by reference), hematopoietic growth factor (e.g., HGF, Genbank Accession Number: (aa) AAA64297.1 (GI:337938), (na) NM_000601.4 (GI:58533168), incorporated herein by reference), VEGF receptor-1 (VEGFR-1, Genbank Accession Number: (aa) NP_002010.2 (GI:156104876), incorporated herein by reference), VEGFR-2 (Genbank Accession Number: (aa) AAC16450.1 (GI:3132833), (na) EU826563.1 (GI:194318421), incorporated herein by reference), transforming growth factor-β (TGF-β, Genbank Accession Number: (aa) AAA36738.1 (GI:339564), (na) NM_000660.4 (GI:260655621), incorporated herein by reference), bone morphogenetic protein (e.g., BMP-4, Genbank Accession Number: (aa) NP_570912.2 (GI:157276597), (na) NM_001202.3 (GI:157276592), incorporated herein by reference), insulin-like growth factor (IGF-1, Genbank Accession Number: (aa) CAA01954.1 (GI:1247519), (na) NM_001111283.1 (GI:163659898), incorporated herein by reference), fibroblast growth factor-2 (FGF-2), platelet-derived growth factor (PDGF; GenBank Accession Number: (aa) AAA60552.1 (GI:338209), (na) NM_033023.4 (GI:197333759), incorporated herein by reference), epidermal growth factor (EGF, Genbank Accession Number: (aa) AAH93731.1 (GI:62740195), incorporated herein by reference), transforming growth factor-α (TGF-α, Genbank Accession Number: (na) NM_003236.2 (GI:153791671), incorporated herein by reference), nerve growth factor (NGF, Genbank Accession Number: (aa) AAH32517.2 (GI:34192369), (na) NM_002506.2 (GI:70995318), incorporated herein by reference), brain-derived neurotrophic factor (BDNF, Genbank Accession Number: (aa) CAA62632.1 (GI:987872), (na) NM_170731.4 (GI:219842281), incorporated herein by reference), neurotrophin-3 (NT-3, Genbank Accession Number: (aa) NP_001096124.1 (GI:156630995), (na) NM_001102654.1 (GI:156630994), incorporated herein by reference), ciliary neurotrophic factor (CNTF, Genbank Accession Number: (aa) AAB31818.1 (GI:633830), (na) NM_000614.3 (GI:209574322), incorporated herein by reference), and glial cell line-derived neurotrophic factor (GDNF, Genbank Accession Number: (aa) CAG46721.1 (GI:49456801), (na) NM_000514.3 (GI:299473777), incorporated herein by reference). Suitable morphogen inhibitors include anti-VEGF antibody, anti-aFGF antibody, anti-bFGF antibody, anti-PIGF antibody, anti-leptin antibody, anti-HGF antibody, anti-VEGFR-1 antibody, anti-VEGFR-2 antibody, batimastat (BB-94), marimastat (BB-2516), thalidomide, O-(chloroacetylcarbamoyl)-fumagillol (TNP-470), carboxyamidotriazole (CAI), SU5416, anti-TGF-β antibody, anti-BMP antibody, anti-IGF-1 antibody, anti-FGF-2 antibody, anti-PDGF antibody, anti-EGF antibody, anti-TGF-α antibody, and anti-VEGF antibody.
One therapeutic application of the device exemplified herein is angiogenesis (i.e., a physiological process involving the growth and development of new blood vessels from pre-existing vessels) via the administration of vascular endothelial growth factor (VEGF) and anti-VEGF, but the devices are also useful in other drug delivery applications in order to mitigate the negative effects of initial bursts of morphogenic factors (a drawback of some earlier devices). The methods described herein are applicable to any process controlled by morphogen signaling, e.g., regenerative or developmental processes in tissues and organs that require spatial patterning. For example, the methods described herein are applicable to neural regeneration, bone (e.g., tooth) regeneration, and epithelial patterning.
Also provided are methods of temporally and spatially (directionally) controlling regenerative processes by simultaneously delivering from a single source/location agents that act synergistically (e.g., basic fibroblast growth factor (bFGF) and VEGF) rather than antagonistically to create spatial patterns/control.
A method for inducing sustained angiogenesis in a spatially restricted zone is carried out by contacting a tissue with a purified angiogenesis-promoting agent and contacting the tissue with a purified inhibitor of angiogenesis. In one aspect, the inhibitor of angiogenesis is a specific inhibitor of the angiogenesis-promoting agent. In another aspect, the inhibitor of angiogenesis is a general inhibitor of angiogenesis. The agent and the inhibitor interact thereby inducing sustained angiogenesis in a spatially restricted zone at or near a site at which the agent and the inhibitor interact. For example, the interaction is an association and disassociation of an agent and an antibody that specifically binds to that agent. Alternatively, methods for inducing sustained angiogenesis in a spatially restricted zone are carried out by contacting a tissue with angiogenesis-promoting agents that act synergistically, e.g., bFGF and VEGF.
The methods are useful in treating and/or preventing degenerative disorders, diseases or conditions, and for tissue generation, regeneration, or repair. The subject is preferably a mammal in need of such treatment. The mammal can be, e.g., any mammal, e.g., a human, a primate, a mouse, a rat, a dog, a cat, a cow, a horse, or a pig. In a preferred embodiment, the mammal is a human.
Suitable bioactive agents that promote regeneration include growth factors, homing/migration factors, morphogens, differentiation factors, oligonucleotides, hormones, neurotransmitters, neurotransmitter or growth factor receptors, interferons, interleukins, chemokines, cytokines, colony stimulating factors, chemotactic factors, extracellular matrix components, adhesion molecules, and other bioactive compounds. The concentration each agent is manipulated to achieve the desired result.
Therapeutic applications of the methods described herein include tissue generation, regeneration/repair, as well as augmentation of function of a mammalian bodily tissue, and the targeted destruction of undesired tissues (e.g., cancer, undesired adipose depots), as well as the instruction of immune cells. For example, the co-administration of stimulatory and inhibitory agents programs or reprograms resident cells to a desired fate (e.g., immune activation or tissue regeneration). Alternatively, the co-delivery of stimulatory and inhibitory bioactive agents results in muscle regeneration, repair or replacement; liver tissue regeneration, repair or organ transplantation; cartilage replacement, regeneration or repair, bone regeneration, replacement or repair; or neural regeneration. The co-delivery of stimulatory and inhibitory bioactive agents promotes or inhibits differentiation of various stem cell populations (embryonic stem cells differentiated into various cell types) including bone marrow or adipose tissue derived adult stem cells, cardiac stem cells, pancreatic stem cells, endothelial progenitors and outgrowth endothelial cells, mesenchymal stem cells, hematopoietic stem cells, neural stem cells, satellite cells, side population cells. Other cell populations include osteoprogenitors and osteoblasts, chondrocytes, keratinocytes for skin, tenocytes for tendon, intestinal epithelial cells, endothelial cells, smooth muscle cells and fibroblasts for tissue or organ regeneration, repair or replacement and/or for DNA delivery. Preferably, the cells are human; however, the methods described herein are adaptable to other eucaryotic animal cells, e.g., canine, feline, equine, bovine, and porcine as well as prokaryotic cells such as bacterial cells.
In one aspect, the stimulatory and inhibitory agents are delivered with polymeric scaffolds in vivo or in vitro. Exemplary scaffold compositions include polylactic acid, polyglycolic acid, poly(lactic-co-glycolic acid) (PLGA) polymers, alginates and alginate derivatives, gelatin, collagen, fibrin, hyaluronic acid, laminin rich gels, agarose, natural and synthetic polysaccharides, polyamino acids, polypeptides, polyesters, polyanhydrides, polyphosphazines, poly(vinyl alcohols), poly(alkylene oxides), poly(allylamines)(PAM), poly(acrylates), modified styrene polymers, pluronic polyols, polyoxamers, poly(uronic acids), poly(vinylpyrrolidone) and copolymers or graft copolymers of any of the above. One preferred scaffold composition includes an arginine-glycine-aspartate (RGD)-modified alginate. The density and mixture of the bioactive agents and inhibitors is controlled by initial doping levels or concentration gradient of the substance, by embedding the bioactive substances in scaffold material with a known leaching rate, by release as the scaffold material degrades, by diffusion from an area of concentration, by interaction of precursor chemicals diffusing into an area, or by production/excretion of compositions by resident support cells. The physical or chemical structure of the scaffold also regulates the diffusion of bioactive agents.
Alternatively, the stimulatory and inhibitory bioactive agents are administered in drops, injections, or other implantable devices, depending on the precise nature of the formulation and the desired outcome of the administration. The bioactive agents of the invention are administered in any form suitable for drug administration, e.g., dosage forms suitable for topical administration, a solution or suspension for administration as eye drops or washes, ointment, gel, liposomal dispersion, colloidal microparticle suspension, or the like.
The compositions administered according to the present invention optionally also include various other ingredients, including but not limited to surfactants, tonicity agents, buffers, preservatives, co-solvents and viscosity building agents. In carriers that are at least partially aqueous one may employ thickeners, isotonic agents, buffering agents, and preservatives, providing that any such excipients do not interact in an adverse manner with any of the formulation's other components.
The co-delivery of stimulatory and inhibitory bioactive agents may interfere with signal transduction events. Signal transduction events that participate in the process of cell motility are initiated in response to cell growth and/or cell differentiation factors. Thus, the invention optionally provides a bioactive agent that is a growth factor, morphogen, differentiation factor, or chemoattractant. For example, the device includes vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), or fibroblast growth factor 2 (FGF2) or a combination thereof. Other factors include hormones, neurotransmitters, neurotransmitter or growth factor receptors, interferons, interleukins, chemokines, matrix metalloproteinase (MMP)-sensitive substrate, cytokines, and colony stimulating factors. Growth factors used to promote angiogenesis, bone regeneration, neural regeneration, wound healing, and other aspects of tissue regeneration are listed herein and are used alone or in combination to induce colonization or regeneration of bodily tissues.
Immune cells such as T cells, B cells, or dendritic cells (DCs) of an individual are recruited to the site of bioactive agent administration, primed and activated to mount an immune response against an antigen-specific target. Optionally, an antigen corresponding to a target to which an immune response is desired is delivered to the mammal. Cytokines, such as granulocyte macrophage colony stimulating factor (GM-CSF) are suitable to amplify immune activation and/or induce migration of the primed cells to lymph nodes. Other cell specific recruitment compositions are described below. For example, vascular endothelial growth factor (VEGF) is useful to recruit angiogenic cells.
This approach is exemplified herein in the context of angiogenesis via the administration of VEGF and anti-VEGF, but is also useful in other drug delivery applications in order to mitigate the negative effects of initial bursts, as well as regenerative processes in general. The in vivo and in vitro methods described herein promote regeneration of a tissue or organ immediately adjacent to the bioactive agents, or at some distant site. Alternatively, the methods described herein promote destruction of a tissue (locally or at a distant site). The methods are also useful for disease prevention, e.g., to promote cell-based maintenance of tissue structure and function and to stop or retard disease progression or age-related tissue changes.
The invention provides in vivo and in vitro methods for inducing angiogenesis by contacting a tissue with an agent that promotes angiogenesis (i.e., growth and development of new blood vessels from pre-existing vessels), and contacting the tissue with an inhibitor of angiogenesis. In one aspect, the inhibitor of angiogenesis is a specific inhibitor of the agent that promotes angiogenesis. Alternatively, the inhibitor of angiogenesis is a general inhibitor of angiogenesis. In one aspect, the agent and agent inhibitor are administered in a 1:1 ratio. In other aspects, the agent/agent inhibitor are administered in a 1:2; 1:5; 1:10; 1:100; 1:1,000; or 1,000:1, 100:1, 10:1, 5:1, or 2:1 ratio. Preferably, the agent and the inhibitor are administered simultaneously. In one aspect, the agent and the inhibitor are incorporated in or on a device comprising a scaffold composition. The agent and the inhibitor are spatially segregated in or on the scaffold composition. Alternatively, the agent and inhibitor are injected directly into the tissue, e.g., an artery. The simultaneous delivery of agents and agent inhibitors maintains the temporal stability of the active agent concentration profile. Preferably, the angiogenesis methods described herein result in heterogeneous distribution of blood vessels.
Suitable agents for the promotion of angiogenesis include vascular endothelial growth factor (VEGF), acidic fibroblast growth factor (aFGF), basic fibroblast growth factor (bFGF), placenta growth factor (PIGF), leptin, hematopoietic growth factor (HGF), VEGF receptor-1 (VEGFR-1), and VEGFR-2. Suitable inhibitors of angiogenesis include anti-VEGF antibody, anti-aFGF antibody, anti-bFGF antibody, anti-PIGF antibody, anti-leptin antibody, anti-HGF antibody, anti-VEGFR-1 antibody, and anti-VEGFR-2 antibody. Suitable agents for the promotion of angiogenesis include fibroblast growth factor-2 (FGF-2), matrix metalloproteinase-9 (MMP-9), interleukin-8 (IL-8), and IL-6. Suitable angiogenic inhibitors include endostatin, tumstatin, and pigment epithelium-derived factor (PEDF). Small molecule inhibitors of angiogenesis include batimastat (BB-94) and marimastat (BB-2516), metalloproteinase inhibitors; thalidomide, a hypnosedative agent; O-(chloroacetylcarbamoyl)-fumagillol (TNP-470), a fumagillin analog; carboxyamidotriazole (CAI), a calcium channel blocker; and SU5416, a tyrosine kinase inhibitor (TKI). Preferably, the agent for promotion of angiogenesis is VEGF and the inhibitor is anti-VEGF antibody. In one aspect, the agent and the inhibitor are encapsulated.
Angiogenesis is induced in a subject in need thereof at a site in need of angiogenesis, e.g., ischemic tissue, a narrowed or occluded vascular conduit, or an injured vascular tissue. The narrowed or occluded vascular conduit is a narrowed or occluded artery, narrowed or occluded vein, or a narrowed or occluded synthetic graft. Angiogenesis is induced in a mammalian subject. Preferably, the subject is a human.
Regeneration can be temporally and spatially (directionally) controlled by simultaneously delivering from a single source/location stimulatory and inhibitory agents that are spatially segregated. Specifically, the invention also provides a method of inducing regeneration in a spatially restricted zone by contacting a target site with an agent that promotes regeneration and contacting a target site with an inhibitor of regeneration. In one aspect, the inhibitor of regeneration is a specific inhibitor of the agent that promotes regeneration. In another aspect, the inhibitor of regeneration is a general inhibitor of regeneration. Preferably, the agent and the inhibitor are administered simultaneously. Optionally, the agent and the inhibitor are incorporated in or on a device comprising a scaffold composition. The agent and the inhibitor are spatially segregated in or on the scaffold composition. Alternatively, the agent and inhibitor are injected directly into the tissue, e.g., an artery. The simultaneous delivery of agents and agent inhibitors maintains the temporal stability of the active agent concentration profile. Also provided are methods of temporally and spatially (directionally) controlling regenerative processes by simultaneously delivering from a single source/location agents that act synergistically rather than antagonistically to create spatial patterns/control.
As described herein, the invention provides for in vivo and in vitro temporal and spatial control of regenerative processes, e.g., tissue regeneration, organ regeneration, cartilage regeneration, bone regeneration, or neural regeneration. The inhibitor of regeneration is a specific inhibitor of the agent that promotes regeneration. Alternatively, the inhibitor of regeneration is a general inhibitor of regeneration. In one aspect, the regeneration is bone regeneration, and the agent that promotes bone regeneration is transforming growth factor-β (TGF-β), bone morphogenetic protein (BMP), insulin-like growth factor (IGF-1), fibroblast growth factor-2 (FGF-2), or platelet-derived growth factor (PDGF). Suitable inhibitors of bone regeneration include anti-TGF-β antibody, anti-BMP antibody, anti-IGF-1 antibody, anti-FGF-2 antibody, and anti-PDGF antibody. Other suitable inhibitors of bone regeneration include noggin, follistatin, chordin, sclerostin, differential screening-selected gene aberrative in neuroblastoma (DAN), protein related to DAN and cerberus (PRDC), follistatin-related protein (FSRP), and Dante. In another aspect, the regeneration is tissue regeneration, and the agent that promotes tissue regeneration is epidermal growth factor (EGF), platelet-derived growth factor (PDGF), transforming growth factor-α (TGF-α) or VEGF, and the inhibitor of tissue regeneration is anti-EGF antibody, anti-PDGF antibody, anti-TGF-α antibody, or anti-VEGF antibody, respectively. In yet another aspect, the regeneration is neural regeneration of the peripheral or central nervous system, and the agent that promotes neural regeneration is nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), ciliary neurotrophic factor (CNTF), or glial cell line-derived neurotrophic factor (GDNF). Optionally, the regeneration is induced in a mammal. Preferably, the mammal is a human.
The invention provides for methods for inducing cell differentiation/specialization in a spatially restricted zone by contacting a cell with a promoter of differentiation and an inhibitor of differentiation. The agent and the inhibitor interact, thereby inducing cell differentiation in a spatially restricted zone at or near a site at which the agent and the inhibitor interact. Optionally, the agent and the inhibitor are administered simultaneously. In one aspect, the agent and the inhibitor are incorporated in or on a device comprising a scaffold composition. The agent and the inhibitor are spatially segregated in or on said scaffold composition. The simultaneous delivery of agents and agent inhibitors maintains the temporal stability of the active agent concentration profile. Suitable combinations of agents to promote differentiation of stem cells into bone cells or tooth cells include BMP4 and anti-BMP4. Suitable combinations of agents to promote differentiation of stem cells into dentin include TGF-β1 and latency associated peptide (LAP).
Also provided are methods for selectively destroying tissue in a spatially restricted zone comprising contacting a target site with an agent that promotes tissue destruction and an inhibitor of tissue destruction. The agent and the inhibitor interact thereby selectively destroying tissue in a spatially restricted zone at or near a site at which the agent and the inhibitor interact. For example, a device that contains a small molecule, e.g., like SC68896 (small molecule proteosome inhibitor) that up regulates expression of cell death receptors such as tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) receptor such as cell death receptors 4 (DR4) and 5 (DR5) and the ligand, TNFα, sensitizes local tumor cells to apoptotic signals (Clin Cancer Res 2009; 15(21):6609-18, hereby incorporated by reference). In this example, the scaffold device contains a primary molecule (SC68896) that leads to up regulation of cell death receptors of infiltrating tumor cells, and a tissue destruction molecule (TNFα) which subsequently induces tumor cell death of those primed tumor cells. Thus, method for selectively destroying tissue in a spatially restricted zone is carried out by contacting a target site a device containing an agent that promotes tissue destruction and an inhibitor of the tissue destruction agent or a tissue destruction primer (e.g., SC68896, described above). The agent and the inhibitor or primer contact a cell inside the device at or near target site (e.g., a tumor) leading to selective destruction of cell, e.g., a tumor cell) in a spatially restricted zone at or near a site at which the agent and the inhibitor interact. Such a device is also useful to treat cancers of the circulatory system such as leukemias. Circulating cells enter the device and are primed and subsequently encounter an apoptosis signal (TNFα) leading to destruction of the cancer cell.
Also within the invention is a polymeric device that comprises at least 2 spatially distinct zones. The first zone comprises a purified morphogen, and a second zone comprises an antagonist of the morphogen and/or a second morphogen. The device optionally contains 3, 4, 5 or more morphogens in spatially divided or distinct areas or zones, e.g., the device includes, 2, 3, 4, 5, or more layers. Optionally, one or more of the layers is a buffer zone/layer. A buffer layer contains an a non-morphogenic compound or is empty, i.e., is defined by the area or zone of the polymeric device but has not been loaded with an morphogen or inhibitor/antagonist. The zones are stacked or in a core/shell configuration. The distinct zones are contiguous in the geometry of the scaffold device.
In some examples, the composition or device comprises at least two purified morphogens and at least two purified morphogen inhibitors, e.g., TGF-β1 and BMP4, and their respective inhibitors anti-TGF-β1 antibody and an anti-BMP4 antibody. In another example, the purified morphogen comprises Latent TGF-B1 and the purified inhibitor of said morphogen comprises a small molecule inhibitor SB431542.
The device optionally further comprises purified cells or purified populations of cells. For example, the device is administered to the patient pre-seeded with cells or empty, i.e., cell-free. In the latter case, cells of the patient populate the device after implantation into or onto the body of the subject. For cell differentiation devices, exemplary cells include mesenchymal stem cells, embryonic stem cells, or induced pluripotent stem cells. The devices are particularly useful to promote a morphogenic process that comprises differentiation of cells into at least two different tissue types, e.g., to generate or regenerate a site of two juxtaposed tissues. Examples include tooth regeneration, lung regeneration, liver regeneration, kidney regeneration, cardiac valve regeneration, joint regeneration, or pancreas regeneration.
The a variation of the above-described strategy of delivering stimulatory agents and antagonist or inhibitor agents includes a method for promoting a morphogenic process that includes the steps of administering to a subject a first device comprising a purified morphogen at a first anatomical site and a second device comprising an antagonist of the morphogen at a second anatomical site. In this example, the first device and second (or additional) device(s) are non-contiguous. The factor-loaded devices are implanted or injected (e.g., in the case of a gel) at different physical locations in the body. The area between the first and second implantation or injection sites defines a zone of interaction between the morphogen and antagonist and the morphogenic process occurs in the zone of interaction.
As described herein, the term “controlled release” refers to an agent-containing formulation or fraction thereof in which release of the agent is not immediate, i.e., with a “controlled release” formulation, administration does not result in immediate release of the agent into an absorption pool. The term is used interchangeably with “nonimmediate release” as defined in Remington: The Science and Practice of Pharmacy, Nineteenth Ed. (Easton, Pa.: Mack Publishing Company, 1995). In general, the term “controlled release” as used herein refers to “sustained release” rather than to “delayed release” formulations. The term “sustained release” (synonymous with “extended release”) is used in its conventional sense to refer to a formulation that provides for gradual release of an agent over an extended period of time.
All polynucleotides and polypeptides of the invention are purified and/or isolated. Purified defines a degree of sterility that is safe for administration to a human subject, e.g., lacking infectious or toxic agents. Specifically, as used herein, an “isolated” or “purified” nucleic acid molecule, polynucleotide, polypeptide, or protein, is substantially free of other cellular material, or culture medium when produced by recombinant techniques, or chemical precursors or other chemicals when chemically synthesized. Purified compounds are at least 60% by weight (dry weight) the compound of interest. Preferably, the preparation is at least 75%, more preferably at least 90%, and most preferably at least 99%, by weight the compound of interest. Purity is measured by any appropriate standard method, for example, by column chromatography, polyacrylamide gel electrophoresis, or HPLC analysis.
By the terms “effective amount” and “therapeutically effective amount” of a formulation or formulation component is meant a nontoxic but sufficient amount of the formulation or component to provide the desired effect.
Other features and advantages of the invention will be apparent from the following description of the preferred embodiments thereof, and from the claims. Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, suitable methods and materials are described below. All publications, patent applications, patents, Genbank/NCBI accession numbers, and other references mentioned herein are incorporated by reference in their entirety. In the case of conflict, the present specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a series of photomicrographs showing in vitro endothelial cell sprouting in response to anti-vascular endothelial growth factor (VEGF) and VEGF. FIG. 1a shows representative images of cell-seeded dextran beads embedded in fibrin gel under different media conditions. Cells were stained with DAPI. A sprout was defined as a multi-cellular extension with >1 connected ECs that were attached to the micro-carrier (see arrows). FIG. 1b shows the results of quantification of the number of sprouts per bead at different conditions. Values represent means and error bars represent standard deviations (n=4).
FIG. 2 is a line graph demonstrating the in vitro cumulative release kinetics of anti-VEGF antibody and VEGF from scaffolds. Initial mass of proteins incorporated were 4 μg of VEGF and 20 μg of anti-VEGF. Values represent mean and error bars represent standard deviations (n=5).
FIG. 3 is a series of schematic diagrams and graphs that illustrate results from computational simulation of an AVA implanted scaffold, i.e., tri-layered scaffolds with a VEGF-containing layer sandwiched by two anti-VEGF-containing layers. FIG. 3a shows orientation of implanted scaffold in a mouse that underwent ischemic hindlimb surgery. The axes definitions are such that x is perpendicular to the severed femoral artery and vein, y is parallel to the femoral artery and vein, and positive z points away from the underlying muscle. Note that the x-y plane lies tangential to the interface between the scaffold and the underlying muscle, and that the coordinate (0,0,2.1 mm) is located at the center of the scaffold. FIG. 3 also shows the simulation results of the concentration profiles of (b) total VEGF, (c) free VEGF, and (d) free anti-VEGF over time at y=0 and z=−0.5 mm. FIG. 3e shows cross-sectional plots of concentration profiles of total anti-VEGF (blue solid) and free anti-VEGF (green dashed) at 3, 7, 14, and 21 days. FIG. 3f illustrates cross-sectional plots of concentration profiles of total VEGF (blue solid) and free VEGF (green dashed) at 3, 7, 14, and 21 days. FIG. 3g demonstrates the peaks of total VEGF and free VEGF over time, while FIG. 3h shows angiogenic promotion region (APR) at 1, 7, and 14 days, where the angiogenic promotion signal is defined as




  
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Finally, FIG. 3i shows angiogenic promotion region without the delivery of anti-VEGF.

FIG. 4 is a series of photomicrographs and a bar graph illustrating blood vessel densities within layered scaffolds 4 weeks post-implantation (n=5). FIG. 4a shows representative images of CD31 stained sections of various types of scaffolds implanted in ischemic hindlimbs. ‘B only’=blank scaffolds; ‘V only’=scaffolds delivering only VEGF. ‘BVB’=tri-layered scaffolds with a VEGF-containing layer sandwiched by two blank layers; ‘AVA’=tri-layered scaffolds with a VEGF-containing layer sandwiched by two anti-VEGF-containing layers. Scale bar represents 200 μm. FIG. 4b demonstrates the quantification of vessel densities within each layer of implanted scaffolds (*p≦0.05, **p≦0.01, ***p≦0.001). Values represent mean and error bars represent standard deviations (n=5).
FIG. 5 is a series of photomicrographs and a bar graph illustrating blood vessel densities within muscle tissue sections (n=5) directly underneath the corresponding scaffold layer. FIG. 5a demonstrates representative images of CD31 stained muscle sections directly underneath the layers of various types of implanted scaffolds. Scale bar represents 200 μm. FIG. 5b shows the quantification of vessel densities within the underlying muscles (*p≦0.05, **p≦0.01, ***p≦0.001). Values represent mean and error bars represent standard deviations (n=5).
FIG. 6 is a line graph demonstrating the quantitative analyses of hindlimb perfusion using laser Doppler perfusion image (LDPI) in mice (n=5). Blood flow was expressed as ischemic limb/untreated limb perfusion in mice. ‘B’=blank scaffolds; ‘V’=scaffolds delivering only VEGF. ‘BVB’=tri-layered scaffolds with a VEGF-containing layer sandwiched by two blank layers; ‘AVA’=tri-layered scaffolds. Implantations of scaffolds containing VEGF (V, AVA, BVB) all resulted in enhanced perfusion in the ischemic limb compared to the implantation of blank scaffolds (B).
FIG. 7 is a series of line graphs illustrating the robustness of angiogenic promotion signal against minimum free VEGF threshold for angiogenic promotion. APR is shown at 1, 7, 14, and 21 days and the widths of the APR are plotted over time.
FIG. 8 is a series of line graphs showing the robustness of angiogenic promotion signal against initial anti-VEGF dosage. APR is shown at 1, 7, 14, and 21 days and the widths of the APR are plotted over time.
FIG. 9 is a series of line graphs demonstrating the robustness of angiogenic promotion signal against degradation rate of anti-VEGF. APR is shown at 1, 7, 14, and 21 days and the widths of the APR are plotted over time.
FIG. 10 is a series of photographs depicting various views of dual dye-incorporated layered polylactic acid and polyglycolic acid (PLGA) scaffolds demonstrating the distinct spatial compartments.
FIG. 11 is a scanning electron micrograph (SEM) image of a layered PLGA scaffold demonstrating the macroporous architecture.
FIG. 12 is an SEM image demonstrating cell seeding in a PGA scaffold.
FIG. 13 is a photograph illustrating microcomputed tomography showing pore distribution in a PLGA scaffold.
FIG. 14 is a series of photomicrographs showing multilayered scaffolds seeded with either TGF-β reporter or BMP4 reporter in the absence of growth factors (upper panels) or in the presence of growth factors in media (lower panels). Luciferase activity was measured after 24 hours, and demonstrated a generalized induction of cell reporters.
FIG. 15 is a schematic diagram of the Bone-Dentin layered scaffold design with distinct compartments containing growth factors and neutralizing antibodies.
FIG. 16 is a series of photomicrographs and line graphs. The top row shows a multilayered scaffold seeded with the TGF-β reporter cell line. (MLEC p3TP Luc) illustrating spatially localized luciferase activity. The quantification of luciferase activity demonstrates a left spatial bias of luciferase activity representing the localized TGF-β inducing the reporter locally (top row). The middle row shows a multilayered scaffold seeded with the BMP4 reporter cell line (C2C12 BRE Luc) illustrating spatially localized luciferase activity. The quantification of luciferase activity demonstrates right spatial bias of luciferase activity representing the localized BMP-4 inducing the reporter locally (middle row). The bottom row shows a multilayered scaffold seeded with both the TGF-β reporter line (MLEC p3TP Luc) and the BMP4 reporter (C2C12 BRE Luc) illustrating two distinct zones of localized luciferase activity. The quantification of luciferase activity demonstrates the dual spatial zones of luciferase activity representing the localized TGF-B and BMP4 induction of the reporter cell lines locally (bottom row).
FIG. 17A is a photograph of an immunoblot for phospho-Smad2 to evaluate TGF-β responsiveness of D1 (MSCs) demonstrating a dose-dependent activation.
FIG. 17B is a photomicrograph showing immunostaining for phosphor-Smad2/3 to evaluate TGF-B responsiveness of D1 (MSCs) demonstrating nuclear localization of activated Smads following stimulation.
FIG. 17C is a photograph of an immunoblot for phospho-Smad1/5/8 to evaluate BMP4 responsiveness of D1 (MSCs) demonstrating a dose-dependent activation.
FIG. 17D is a photograph of a scaffold seeded with D1s for 21 days with twice weekly media changes. The scaffold was subsequently divided into three distinct zones for spatial analyses and lysed in RIPA, sonicated for 45 sec thrice and spun at 14000 rpm at 4° C. for 20 min to collect total protein.
FIG. 17E is a photograph of an immunoblot of the protein extracted from the scaffold. Total protein was extracted and immunoassayzed for Dentin and Bone matrix markers illustrating spatially distinct differentiation into dentin and bone differentiation D1s.
FIG. 18 is a photograph showing spatially restricted luciferase activity of TGF-β reporter cell line in another iteration of the scaffold design where a latent growth factor (TGF-β1) is encapsulated in either the core (left) or outer shell (right) and the small molecule inhibitor against TGF-β1 Receptor (SB431542) in the corresponding zone.
FIG. 19 is a series of diagrams showing normal joint histology and a scaffold system for joint implants.
FIG. 20 is a series of schematics demonstrating endochondral and intramembranous ossification and a scaffold system for spinal implants.
FIG. 21A is a bar graph showing the release of rhTGF-β1 measured with an ELISA over time in PBS at 37° C. from PLGA microspheres that were foamed into macro-porous scaffolds.
FIG. 21B is a line graph showing the calculated cumulative release of rhTGF-β1 from PLGA macro-porous scaffolds.
FIG. 21C is a line graph showing the half life estimation of rhTGF-β1 in culture dishes due to uptake and degradation determined by ELISA.
FIG. 21D is a line graph showing the half life estimation of rhBMP4 in culture dishes due to uptake and degradation determined with an ELISA.
FIG. 21E is a series of formulas used to model release and uptake kinetics of growth factors and antibodies in COMSOL. The key assumptions used here were: (i) Complete/free mixing in media and 90% mixing within scaffolds; (ii) Antibody and protein-antibody degradation were assumed to be equal; (iii) the protein-antibody lifetime was considered infinite (no dissociation).
FIG. 21F depicts the release kinetics of a growth factor using COMSOL as modeled in FIG. 21E.
FIG. 22A is a bar chart showing the effect of cell density of the TGF-β reporter line (MLEC p3TP Luc) luciferase activity and demonstrates the ability to be induced in a dose dependent manner.
FIG. 22B is a bar chart showing the effect of cell density of BMP4 reporter (C2C12 BRE Luc) luciferase activity and demonstrates the ability to be induced in a dose dependent manner.
FIG. 22C is a bar chart showing the effect of varying TGF-β1 concentration on the TGF-β reporter line (MLEC p3TP Luc) luciferase activity and demonstrates a linear dose dependence.
FIG. 22D is a bar chart showing the effect of varying BMP4 concentration on the BMP4 reporter (C2C12 BRE Luc) luciferase activity and demonstrates a linear dose dependence.
FIG. 22E is a schematic showing an experimental scheme to show the precise kinetics of growth factor exposure on luciferase activity in the reporter lines. Following seeding and serum starvation (reduces background), a specific inhibitor is added to create a uniform inhibitory field. Subsequently, for given amounts of time, the inhibitor is washed off, the growth factor (either TGF-β1 or BMP4) is added for specified time, and washed off followed by re-addition of the inhibitor. At 24 hours, cells are lysed and assayed for luciferase activity.
FIG. 22F is a line graph showing luciferase activity and demonstrates the sufficiency of 5-15 min TGF-β1 exposure for maximal induction.
FIG. 22G is a line graph showing luciferase activity demonstrating the sufficiency of 5-15 min BMP4 exposure for maximal induction.
FIG. 23 is a series of photograph demonstrating immunoblotting on MSC (D1), pre-odontoblasts (MDPC-23) and osteoblasts (7F2) with TGF-β1, BMP4 and both together to evaluate their influence on canonical signaling pathways (A) for TGF-β (Phospho Smad2 & 3) and BMP (Phospho Smad1/5/8) as well as bone and teeth transcription factors (B) and extracellular matrix deposition (C).



DETAILED DESCRIPTION
Regenerative medical technologies are devices and methods that repair or replace diseased or defective tissues or organs. Tissue engineering is the application of the principles and methods of engineering and the life sciences to the development of biological substitutes to restore, maintain or improve function of bodily structures and tissues, or to selectively promote the destruction of undesired tissues. It involves the development of methods to build biological substitutes as supplements or alternatives to whole organ or tissue transplantation, or the development of strategies to manipulate tissues in vivo. The methods of the invention are useful to generate functional biological structure de novo or to regenerate organs in situ, as well as to restore or supplement tissue function.
Nature frequently utilizes opposing factors to create a stable activator gradient to robustly control pattern formation. Specifically, during developmental processes, tight spatial regulation often results from the combined action of stimulatory and inhibitory factors (Barrio et al., 1999 Bull Math Biol 61, 483-505; Faissner, A., and Steindler, D. 1995 Glia 13, 233-254; Maini, P. K. 1989 J Math Biol 27, 507-522). Diffusion/reaction of stimulatory factors alone results in formation of shallow gradients that make cellular discrimination of spatial cues difficult. By contrast, it has long been appreciated that sharp cut-offs can result from Turing's reaction diffusion mechanism, where an inhibitor and activator act together to form distinct patterns (Turing, A. M. 1952 Philosophical Transactions of the Royal Society of London Series B-Biological Sciences 237, 37-72; Turing, A. M. 1990 The chemical basis of morphogenesis. 1953, Bull Math Biol 52, 153-197; discussion 119-152; Harrison, L. G. 1987 J Theor Biol 125, 369-384). In such reaction schemes, the reactions of morphogens and their diffusion through a tissue are adequate in describing morphogenesis and creating sharp boundaries in patterns. Prior to the invention described herein, the art-recognized strategy for delivering stimulatory factors alone to promote regeneration has ignored this fundamental principle of developmental biology.
Angiogenesis is a physiological process involving the growth and development of new blood vessels from pre-existing vessels. Prior to the invention described herein, much of the effort in therapeutic angiogenesis has been focused on the delivery of growth factors to restore blood perfusion; however, current delivery techniques often lead to supraphysiologic growth factor concentrations and undirected vessel growth. Such over-stimulation can result in improperly organized vascular networks and other pathological effects which reduce perfusion. As such, there has been a long-felt need in the art for the discovery of new approaches to achieve temporally stable and spatially restricted angiogenesis to allow for the creation of heterogeneous and functional vasculature. Described herein are studies that employ a biomimicry approach, by delivery of both angiogenic and anti-angiogenic factors from spatially restricted zones of a synthetic polymer to achieve temporally stable and spatially restricted angiogenic zones in vivo. However, the invention is not limited to angiogenesis and can also be applied to other drug delivery applications in order to mitigate the negative effects of initial bursts.
The invention is based on the discovery that the simultaneous release of two spatially separated agents leads to a spatially sharp angiogenic region that is sustained over 4 weeks. Further, the contradictory action of the two agents leads to a stable level of pro-angiogenic stimulation in this region, in spite of significant variations in the individual release rates over time. The resulting spatially restrictive and temporally sustained profiles of active signaling allow the creation of a spatially heterogeneous and functional vasculature.
Bioactive Agents
Bioactive compositions are purified naturally-occurring, synthetically produced, or recombinant compounds, e.g., polypeptides, nucleic acids, small molecules, or other agents. The compositions described herein are purified. Purified compounds are at least 60% by weight (dry weight) the compound of interest. Preferably, the preparation is at least 75%, more preferably at least 90%, and most preferably at least 99%, by weight the compound of interest. Purity is measured by any appropriate standard method, for example, by column chromatography, polyacrylamide gel electrophoresis, or HPLC analysis.
The bioactive composition alters a function, e.g., level of differentiation, state of activation, motility, or gene expression, of a cell. Optionally, bioactive agents that influence growth, development, movement, and other cellular functions are introduced into or onto scaffold structures. Such substances include BMP, bone morphogenetic protein; ECM, extracellular matrix proteins or fragments thereof; EGF, epidermal growth factor; FGF-2, fibroblast growth factor 2; NGF, nerve growth factor; PDGF, platelet-derived growth factor; PIGF, placental growth factor; TGF, transforming growth factor, and VEGF, vascular endothelial growth factor. Cell-cell adhesion molecules (cadherins, integrins, ALCAM, NCAM, proteases) are optionally added to the scaffold composition.
Exemplary growth factors and ligands are provided in the tables below.
Growth Factors Used for Angiogenesis













Abbre-



Growth factor
viation
Relevant activities







Vascular
VEGF
Migration, proliferation and survival of ECs


endothelial


growth factor


Basic fibroblast
bFGF-2
Migration, proliferation and survival of ECs


growth factor

and many other cell types


Platelet-derived
PDGF
Promotes the maturation of blood vessels by


growth factor

the recruitment of smooth muscle cells


Angiopoietin-1
Ang-1
Strengthens EC-smooth muscle cell interaction


Angiopoietin-2
Ang-2
Weakens EC-smooth muscle cell interaction


Placental
PIGF
Stimulates angiogenesis


growth factor


Transforming
TGF
Stabilizes new blood vessels by promoting


growth factor

matrix deposition









For example, VEGF and PDGF is a suitable combination of agents to promote sustained angiogenesis in a spatially restricted zone (Chen et al., 2006 Pharmaceutical Research, 24(2): 258-264; incorporated herein by reference).
Anti-Angiogenic and Anti-Vascular Agents
Drugs Currently in Clinical Trials and their Effects on Vascular Endothelial Cells













Type of Agent
Target Cells
Molecular Targets
Description















Antiangiogenic Agents










RhuMabVEGEF
ECs
VEGF-A
Monoclonal antibody to VEGF


(bevacizumab)*


VEGF-Trap
ECs
VEGFps
Composite fusion protein of





VEGFR-1 and -2 with Fc fragment





of IgG


BAY 43-9006
ECs, tumor cells
VEGFR
Small molecule receptor TKI




Rafkinase c-kit


SU11248 (sunitinib)*
ECs, pericytes
VEGFRs,
Small-molecule receptor TKI




PDGFR-β, CSF-




1R


ZO6474 (vandetanb)
ECs, tumor cells
VEGFR-2,
Small-molecule receptor TKI




EGFR


PTK787/ZK 222584
ECs
VEGFRs,
Small-molecule receptor TKI


(vatalarib)

PDFGR


AZD2171 (codiranib)
ECs, tumor cells
VEGFR-2,
Small-molecule multikinase inhibitor




PDGFRs


GW786034 (pezopanib)
ECs pericytes
VEGFR,
Small-molecule multikinase inhibitor




PDGFRs, c-kit


AG013736
ECs, pericytes
VEGFR, EGFR,
Small-molecule multikinase inhibitor




Erb82, c-src, c-




abi, c-tnos, Flt-1


AMG706
ECs
VEGFRs,
Small-molecule multikinase inhibitor




PDGFR, c- kit


BMS-582664 (brivanti)
ECs
VEGFRs,
Small-molecule multikinase inhibitor




bFGFRs


PI-88
ECs
VEGF, bFGFs
Small molecule inhibiting haparanase



Inflammatory

activity and herperin-binding growth



cells

factors


M200 (volociximab)
ECs, ECM
Integrins αvβ1
Monoclonal antibody to α5β1





integrin


CNTO 95
ECs, ECM
Integins αv
Monoclonal antibody to αv integrin


EMD 121974
ECs, ECM
Integrins αvβ3,
Synthetic peptide RGDMV


(cilengitide)

αvβ5


ATN-161
ECs, ECM
Integrin αvβ1
Synthetic peptide/Ac—PHSCN—NH(2)


ADH-1 (extherin)
ECs, tumor cells
N-cadherin
Synthetic peptide sequence





recognizing cadherin (affects cell





adhesion)


ABT-510
ECs
CD36 receptor
Synthetic peptidr/thrombospondin-1





nanlog







Antivasular Agents


Ligand-Directed Agents










Fusion proteins of the
ECs, ECM
Extra domain B
Antibody fragment-directed IL-2


antibody, L19, with IL 2

of fibronectin


(L19-IL2)


Radiolabeled antibody
ECs, ECM
Extra-domain B
Antibody fragment-directed radioiscope


fragments from the L19

of fibronectin


(1311-L19)


Radiolabeled
ECs
Prostate-specific
Antibody-directed radioiscope


monoclonal antibody,

membrane


J591 (111In-J591)

antigen


CNGRC peptide-TNFα
ECs
CD13, Integrin
Peptide-directed TNF


conjugate (NGR-TNF)







Vascular-Disrupting Agents










Combretastatin A4
ECs
Unknown
Small-molecule microtubule-


phosphate


depolymerization agent


dimethylxanthenone
ECs
Unknown
Small-molecule cytokine-inducing


acetic acid


agent





*Approved by the US Food and drug Administration.






Growth Factors Used for Bone Regeneration













Abbre-



Growth factor
viation
Relevant activities







Transforming growth
TGF-β
Proliferation and differentiation of


factor-β

bone-forming cells


Bone morphogenetic
BMP
Differentiation of bone-forming cells


protein


Insulin-like
IGF-1
Stimulates proliferation of osteoblasts


growth factor

and the synthesis of bone matrix


Fibroblast growth
FGF-2
Proliferation of osteoblasts


factor-2


Platelet-derived
PDGF
Proliferation of osteoblasts


growth factor









Growth Factors Used for Wound Healing













Abbre-



Growth Factor
viation
Relevant activities







Platelet-derived
PDGF
Active in all stages of healing


growth factor

process


Epidermal growth
EGF
Mitogenic for keratinocytes


factor


Transforming growth
TGF-β
Promotes keratinocyte migration,


factor-β

ECM synthesis and remodeling, and




differentiation of epithelial cells


Fibroblast growth
FGF
General stimulant for wound healing


factor









Growth Factors Used for Tissue-Engineering
















Moleular

Representative




weight

supplier of rH


Growth factor
Abbreviation
(kDa)
Relevant activities
growth factor



















Epidermal growth
EGF
6.2
Proliferation of epithelial,
PeproTech Inc.


factor


mesenchymal, and fibroblast cells
(Rocky Hill, NJ,






USA)


Platelet-derived
PDGF-AA
28.5
Proliferation and chemoattractant
PeproTech Inc.


growth factor
PDGF-AB
25.5
agent for smooth muscle cells;



PDGF-BB
24.3
extracellular matrix synthesis and





deposition


Transforming
TFG-α
5.5
Migration and proliferation of
PeproTech Inc.


growth factor-α


keratinocytes; extracellular matrix





synthesis and deposition


Transforming
TGF-β
25.0
Proliferation and differentiation of
PeproTech Inc.


growth factor-β


bone forming cells; chemoattractant





for fibroblasts


Bone
BMP-2
26.0
Differentiation and migration of
Cell Sciences Inc.


morphogenetic
BMP-7
31.5
bone forming cells
(Norwood, MA,


protein



USA)


Basic fibroblast
bFGF/FGF-2
17.2
Proliferation of fibroblasts and
PeproTech Inc.


growth factor


initiation of angiogenesis


Vascular
VEGF165
38.2
Migration, proliferation, and
PeproTech Inc.


endothelial growth


survival of endothelial cells


factor





rH, recombinant human






Factors Used in Epithelial Patterning







TABLE 1







Regulation of epithelial growth, differentiation and apoptosis












Responding



Soluble factors
Cells expressed
cells
Possible role





HGF and MSP
Fibroblasts
Epithelia
+ Proliferation





+ Transformation





+ Morphogenic


IGF-1, IGF-2
Fibroblast
Epithelia
− Apoptosis




(breast)
+ Proliferation


EGF and TGF-α
Epithelia and
Epithelia
+ Proliferation



fibroblasts

+ Morphogenic


TGF-β1, TGF-β2,
Epithelia and
Epithelia and
− Proliferation


TGF-β3
fibroblasts
fibroblasts
+/− Apoptosis





+ Morphogenic


FGF7/KGF
Fibroblast
Epithelia
+ Proliferation





+ Morphogenic


IL6, LIF, and
Fibroblast
Epithelia
+ Proliferation


oncostatin M

(colonic)
+ Transformation


FGF2
Fibroblast
Epithelia
+ Proliferation





+ Transformation


FGF10
Fibroblast
Epithelia
+ Proliferation


NGF
Fibroblast
Epithelia
+ Transformation


Stromal cell-
Fibroblast
Epithelia
+ Proliferation


derived factor

(glioblastoma)
+ Transformation


1α (CXCL12)


Wnt1, Wnt3
Fibroblast
Epithelia
+ Proliferation





+ Transformation


MMP-1, MMP-7
Fibroblast
ECM and growth-
+/− Proliferation




factor activation
+/− Apoptosis




in the stroma
+ Morphogenic




affect epithelia





IL6, interleukin 6; LIF, leukaemia inhibitory factor; NGF, nerve growth factor.






Neurotrophic factors are a family of proteins that are responsible for the growth and survival of developing neurons and the maintenance of mature neurons. Neurotrophic factors promote the initial growth and development of neurons in the central nervous system (CNS) and peripheral nervous system (PNS). Most neurotrophic factors belong to one of three families: (1) neurotrophins, (2) glial cell-line derived neurotrophic factor family ligands (GFLs), and (3) neuropoietic cytokines. Exemplary neurotrophic factors are provided in the table below.
Neurotrophic Factors











Neural response promoted
Neurotrophic factors







Motor neuron survival
BDNF, NT-3, NT-4/5, CNTF, GDNF


Motor neuron outgrowth
BDNF, NT-3, NT-4/5, CNTF, GDNF


Sensory neuron survival
NGF, NT-4/5, GDNF


Sensory neuron outgrowth
NGF, BDNF, NT-3


Spinal card regeneration
NGF, NT-3, CNTF, FGFs


Peripheral nerve regeneration
NGF, NT-3, NT-4/5, CNTF, GDNF, FGFs


Sensory nerve growth across
NGF, NT-3, GDNF, FGFs


the PNS-CNS transition zone





Abbreviations: Brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), neurotrophin-4/5 (NT-4/5), ciliary neurotrophic factor (CNTF), glial cell line-derived growth factor (GDNF), nerve growth factor (NGF), acidic and basic fibroblast growth factors (FGFs).






The invention also provides factors that are involved in the patterning of the peripheral and central nervous system, e.g., sonic hedgehog and anti-sonic hedgehog antibody. Other suitable factors involved in the patterning of the peripheral and central nervous system are provided in the table below.
Major Neurotrophic Factors Derived from Glial Cells














ASTROCYTE
MICROGLIA




















Neurotrophin





NGF
+
+



BDNF
+
+



NT-3
+
+



NT-4/5
+
+



Cytokine



IL-1
+
+



IL-2
+
(?)



IL-3

+



IL-6
+
+



CNTF
+



TGF-β
+
+



GDNF
+
+



Neurturin
+



Persephin
+



TNF-α
+
+



Growth factor



bFGF
+
+



IGF-I, -II
+
+



HGF

+



Protease, Protease inhibitor



Plasminogen (plasmin)

+



GDN
+



α-2M
+



Calcium binding protein



S-100 β
+



Annexin V
+
+







Abbreviations: NGF, nerve growth factor; BDNF, brain-derived neurotrophic factor; NT-3, neurotrophin-3; IL, interleukin; CNTF, ciliary neurotrophic factor; TGF, transforming growth factor; GDNF, glial cell line-derived neurotrophic factor; TNF, tumor necrosis factor; bFGF, basic fibroblast growth factor; IGF, insulin-like growth factor; HGF, hepatocyte growth factor; GDN, glia-derived neurite promoting factor; α-2M, α 2-macroglobulin.






Molecules that can modulate the signaling pathways of growth factors, such as Notch activators (e.g., jagged, DH, and serrate) and Notch inhibitors (e.g., anti-jagged, anti-DII, and N-[(3,5-Difluorophenyl)acetyl]-L-alanyl-2-phenyl]glycine-1,1-dimethylethyl ester (DAPT)) can also be used to augment or diminish the angiogenesis process. Notch is a cell-surface receptor that regulates cell fate decisions throughout development and under selected conditions in adult tissues. Notch signaling results in widely variable outcomes depending on the cells and signaling molecules involved. However, it is generally known that binding of Notch ligands of the Delta and Jagged families results in the proteolytic cleavage of Notch. The Notch protein is first cleaved in the extracellular domain and then subsequently cleaved in the transmembrane domain. The second cleavage event is mediated by γ-secretase. Notch cleavage allows the intracellular domain of the receptor (the Notch IntraCellular Domain, NICD) to translocate to the nucleus where it regulates transcription. Thus, γ-secretase is a Notch activator.
Notch signaling is involved in angiogenesis and vascular remodeling. Moreover, Notch signaling regulates endothelial cell proliferation and migration events necessary to form new blood vessels during angiogenesis in normal tissues as well as malignant tumors. Methods of the present invention are drawn towards inducing angiogenesis in normal tissues, not malignant tissues. Furthermore, it is of great importance to avoid inducing a malignant-state within a stable or benign tumor by introducing pro-angiogenic factors in the absence of factors to limit Notch activation. In one embodiment of the present invention, pro-angiogenic factors are released from compositions, scaffolds, or devices, either simultaneously or sequentially, with notch-inhibitors, e.g., inhibitors of gamma-secretase (γ-secretase), to prevent stimulation of angiogenesis within neoplastic tissue.
Compositions, scaffolds, and devices of the present invention comprise all inhibitors of Notch activation to be released simultaneously or sequentially with pro-angiogenic factors. Inhibitors of Notch activity encompassed by the present invention block binding of one or more ligands to the Notch receptor. Alternatively, or in addition, inhibitors of Notch activity present intracellular signal transduction from the Notch receptor or cleavage of the Notch receptor polypeptide. Notch inhibitors of the present invention comprise endogenous or exogenous small molecules, compounds, single- or double-stranded RNA polynucleotides, single- or double-stranded DNA polynucleotides, polypeptides, antibodies, intrabodies, natural or synthetic ligands, genetically-engineered ligands, and genetically-manipulated γ-secretase proteins or fragments thereof. Exemplary inhibitors of Notch activation include, but are not limited to, monoclonal antibodies to Notch ligands and receptors, RNA interference, antisense Notch, receptor and mastermind-like 1 (MAML1) decoys, beta and gamma-secretase inhibitors (GSI). Exemplary regulators of Notch activity are shown in the table below.
Regulators of Notch/LIN-12/GLP-1 Activity














Direct interaction




with Notch/


Regulator
Protein type
LIN-12/GLP-1







Positive




regulators


DSL Ligands
Cell-surface protein
Yes


Su(H): LAG-1:
DNA-binding protein,
Yes


XSu(H)1: GBF1/
transcription factor


RBP-Jκ/KBF2


E(spl): ESR1:
bHLH transcription factors
No


HES1: HES5


Groucho
WD40 motif transcription factor
No


Deltex
SH3-binding domain, zinc finger,
Yes



cytoplasmic protein


SEL-12:
Multiple-spanning transmembrane
?


PS1: PS2
proteins


EMB-5
Large acidic nuclear protein
Yes


Negative


regulators


Hairless
Acidic nuclear protein
No


Dishevelled
PDZ domain-containing
Yes



cytoplasmic protein


Numb
PTB domain-containing
Yes



membrane-associated protein


SEL-1
Intracellular vesicle protein
?









The release profiles of bioactive agents and agent inhibitors is controlled by both factor diffusion and polymer degradation, the dose of the factor loaded in the system, and the composition of the polymer. Similarly, the range of action (tissue distribution) and duration of action, or spatiotemporal gradients of the released factors are regulated by these variables. The diffusion and degradation of the factors in the tissue of interest is optionally regulated by chemically modifying the factors (e.g., PEGylating growth factors).
Carrier systems for tissue regeneration are described in the table below.
Polymeric Carriers Used to Deliver Various Growth Factors and the Type of Tissues Regenerated












Growth factor
Carrier
Tissue regenerated







EGF
Gelatin
Dermis



PET suture
Tendon



PVA sponge
Dermis


PDGF
Chitosan-PLLA scaffold
Craniofacial bone



CMC gel
Dermis



Fibrin
Ligament



Porous HA
Long Bone


TGF-β
Alginate
Cartilage



PLA
Long Bone



CaP-titanium mesh
Craniofacial bone



Polyoxamer; PEO gel
Dermis


rhBMP-2
Collagen sponge
Long bone




Craniofacial bone



HA-TCP granules
Spinal bone



HA-collagen
Long bone



PLA-DX-PEG
Ectopic and hip bone


rHBMP-7
HA
Spinal bone



Collagen-CMC
Spinal bone



Porous HA
Craniofacial bone


bFGF
Chitosan
Dermis



Heparin-alginate
Blood vessels



EVAc microspheres
Blood vessels



Fibrin matrices
Blood vessels


VEGF
PLG scaffold
Blood vessels



PLG scaffold
Blood vessels



PLG microspheres
Blood vessels



Fibrin mesh
Blood vessels





Abbreviations: PET, poly (ethylene terepthalate); PVA, polyvinyl alcohol; PLLA, poly(L-lactic acid); CMC, carboxymethylcellulose; HA, hydroxyapatite; PLA, poly(D,L-lactic acid); CaP, calcium phosphate; PEO, poly (ethylene oxide); TCP, tricalcium phosphate; PEG, poly(ethylene glycol); -DX-, -p-dioxanone-; EVAc, ethylene vinyl acetate; PLG, poly (lactide-co-glycolide).






The bioactive agents and agent inhibitors are added to the scaffold compositions using known methods including surface absorption, physical immobilization, e.g., using a phase change to entrap the substance in the scaffold material. For example, a growth factor is mixed with the scaffold composition while it is in an aqueous or liquid phage, and after a change in environmental conditions (e.g., pH, temperature, ion concentration), the liquid gels or solidifies thereby entrapping the bioactive substance. Alternatively, covalent coupling, e.g., using alkylating or acylating agents, is used to provide a stable, longterm presentation of a bioactive substance on the scaffold in a defined conformation. Exemplary reagents for covalent coupling of such substances are provided in the table below.
Methods to Covalently Couple Peptides/Proteins to Polymers












Functional

Reacting groups


Group of
Coupling reagents and
on proteins/


Polymer
cross-linker
peptides







—OH
Cyanogen bromide (CNBr)
—NH2



Cyanuric chloride



4-(4,6-Dimethoxy-1,3,5-



triazin-2-yl)-4-methyl-



morpholinium chloride (DMT-MM)


—NH2
Diisocyanate compounds
—NH2



Diisothoncyanate compounds
—OH



Glutaraldehyde



Succinic anhydride


—NH2
Nitrous Acid
—NH2



Hydrazine + nitrous acid
—SH




—Ph—OH


—NH2
Carbodiimide compounds
—COOH



(e.g., EDC, DCC)[a]



DMT-MM


—COOH
Thionyl chloride
—NH2



N-hydroxysuccinimide



N-hydroxysulfosuccinimide + EDC


—SH
Disulfide compound
—SH





[a]EDC: 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride; DCC: dicyclohexylcarbodiimide






Bioactive agents and agent inhibitors are capable of inducing migration of the transplanted cells and their progeny out of the polymer matrix. Other preferred bioactive substances are capable of maintaining cell viability, promoting cell proliferation or preventing premature terminal differentiation of transplanted cells. Such bioactive substances are used alone or in combination to achieve the desired result.
Bioactive substances suitable for use in the present invention include, but are not limited to: growth factors, hormones, neurotransmitters, neurotransmitter or growth factor receptors, interferons, interleukins, chemokines, cytokines, colony stimulating factors, chemotactic factors, MMP-sensitive substrate, extracellular matrix components; such as growth hormone, parathyroid hormone (PTH), bone morphogenetic protein (BMP), transforming growth factor-β (TGF-β), TGF-β1, TGF-β2, fibroblast growth factor (FGF), granulocyte/macrophage colony stimulating factor (GMCSF), epidermal growth factor (EGF), platelet derived growth factor (PDGF), insulin-like growth factor (IGF), scatter factor/hepatocyte growth factor (HGF), fibrin, collagen, fibronectin, vitronectin, hyaluronic acid, an RGD-containing peptide or polypeptide, an angiopoietin and vascular endothelial cell growth factor (VEGF). Splice variants of any of the above mentioned proteins, and small molecule agonists or antagonists thereof that may be used advantageously to alter the local balance of pro and anti-migration and differentiation signals are also contemplated herein.
Examples of small molecule inhibitors of angiogenesis include batimastat (BB-94) and marimastat (BB-2516), metalloproteinase inhibitors; thalidomide, a hypnosedative agent; O-(chloroacetylcarbamoyl)-fumagillol (TNP-470), a fumagillin analog; carboxyamidotriazole (CAI), a calcium channel blocker; and SU5416, a tyrosine kinase inhibitor (TKI) (Hamby and Showalter 1999, Pharmacol Ther, 82 (2-3): 169-193, incorporated herein by reference). Other suitable receptor tyrosine kinase inhibitors include 4-anilinoquinazolines and related analogs and pyrido[2,3-d]pyrimidines.
Examples of cytokines as mentioned above include, but are not limited to IL-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-10, IL-12, IL-15, IL-18, granulocyte-macrophage colony stimulating factor (GM-CSF), granulocyte colony stimulating factor (G-CSF), interferon-γ (γ-IFN), IFN-γ, tumor necrosis factor (TNF), TGF-β, FLT-3 ligand, and CD40 ligand.
Suitable bioactive agents useful in accordance with the invention also include but are not limited to DNA molecules, RNA molecules, antisense nucleic acids, ribozymes, plasmids, expression vectors, marker proteins, transcription or elongation factors, cell cycle control proteins, kinases, phosphatases, DNA repair proteins, oncogenes, tumor suppressors, angiogenic proteins, anti-angiogenic proteins, cell surface receptors, accessory signaling molecules, transport proteins, enzymes, anti-bacterial agents, anti-viral agents, antigens, immunogens, apoptosis-inducing agents, anti-apoptosis agents, and cytotoxins.
Clinical Applications
The bioactive agents and agent inhibitors are useful for generation or regeneration of a number of different organs and tissue types such as musculoskeletal tissue. In the latter case, environmental cues work in concert with transcription factors to activate satellite cells, induce them to proliferate and eventually differentiate into mature muscle fibers. Numerous trophic factors play a role as initiators of satellite cell activation. Of these candidate trophic factors, both hepatocyte growth factor (HGF) and members of the fibroblast growth factor (FGF) family have been demonstrated to have a physiological role in skeletal muscle regeneration. Both types of factors initiate satellite cell activation, stimulate satellite cells to enter the cell cycle in vivo and are potent mitogens for satellite cells. In addition, the receptor for HGF, c-met, is expressed in both quiescent and activated satellite cells, and FGF-2 is present in the basement membrane surrounding developing myotubes. Both HGF and FGF2 are heparin binding proteins which depend on heparin sulfate proteoglycans (HSPG) to facilitate receptor activation. While HSPG's are ubiquitous on the surface of the cells of mammals, a specific family of HSPG's called Syndecans are involved in FGF2 signaling. In addition, Syndecan 3 and 4 are expressed on both quiescent and activated satellite cells indicating that HGF and FGF2 play important physiological roles in regulating satellite cell activation.
For cell differentiation device, cells such as stem cells are seeded into the factor-loaded polymer scaffold ex vivo and then implanted or injected into the body. Such devices are implanted at or near a target site for tissue generation or regeneration such as regenerating a tooth or a joint, e.g., an articulating joint such as a knee, elbow, shoulder, or vertebra. The zone of interaction or zone of influence in this case is in the scaffold device itself.
In a second scenario, a device that is pre-loaded with factors (e.g., morphogens, differentiation factors, and/or antagonists) but not seeded with cells (i.e., empty or cell-free) is administered to the patient. In this case, host cells of the patient enter the scaffold device after administration and differentiate in the device (in the zone of interaction or zone of influence). In each case, the device is characterized by a promoting zone and an inhibiting zone (initially), i.e., at least 2 zones. In the case of a device with multiple different factors, additional zones are present. For example, the device includes 2-5 different layers or zones. As the factors diffuse or move within the device, zones of interaction develop.
In a third scenario, the zone of influence or interaction occurs not only in the device but also outside of the device, thereby defining a sphere of influence outside of the device in surrounding tissue. An example of such a scenario is an angiogenesis-promoting device.
Clinical devices range in size from approximately microliter range volumes, e.g., 10, 25, 50 μl, to cubic millimeters to cubic centimeters (1, 2, 3, 5, 10 cm3). The devices are implanted or injected directly into a site to be treated or bracketing or surrounding a treatment site.
Multi-factor polymer devices are constructed or fabricated in layers. Each device contains a plurality of factors, each of which is located in a contiguous but spatially distinct layer of the device. For example, a first layer of polymer device is made and loaded with a first active agent (e.g., morphogen), then a second layer of polymer device is made and loaded with a second active agent (e.g., second morphogen or inhibitor or antagonist thereof) and so on until the multi-layered device is completed. As described above, the process is stacked or the layers are built concentrically, e.g., starting with a first layer of polymer device loaded with a first active agent (e.g., morphogen) as the core, followed by a second layer of polymer device loaded with a second active agent (e.g., second morphogen or inhibitor or antagonist thereof) as the shell and so on adding shells until the multi-layered core-shell device is completed. Cell-seeding takes place after scaffold device fabrication (which includes factor-loading). Cells are added to the device dropwise (i.e., adding drops of a cell suspension onto a device) or by bathing the device in a cell suspension. For example, the cell suspension comprises 105-107 cells/ml.
In the case of noncontiguous factor delivery, a first device is fabricated to contain a first active agent (e.g., a morphogen) and a second device is fabricated to contain a second active agent (e.g., a second morphogen or antagonist/inhibitor). The first and second devices are not physically contiguous, i.e., they are injected or implanted at different anatomical locations in the body and the zone of influence is located between them. The distance between the 2 sites is about 0.1 cm, about 0.5 cm, about 1 cm, about 2 cm, about 3 cm, about 4 cm, about 5 cm, about 6 cm, about 7 cm, about 8 cm, about 9 cm, or about 10 cm.
Angiogenesis and VEGF
Prior to the invention described herein, current approaches to therapeutically intervene in the various regenerative process have been limited by significant drawbacks, as described in detail below. Described herein are strategies leading to the creation of organized and functional networks of blood vessels that have a significant utility in the treatment of ischemic diseases and the engineering of high dimensional tissues (Richardson et al., 2001Nat Biotechnol 19, 1029-1034; Melero-Martin et al., 2008 Circulation Research 103, 194-202; Bonauer et al., 2009 Science 324, 1710-1713; Jain, R. K. 2003 Nature Medicine 9, 685-693). Numerous molecular players are involved in different mechanisms of vascular growth (Carmeliet, P. 2000 Nat Med 6, 389-395; Folkman, J. 2006 Annu Rev Med 57, 1-18). In particular, vascular endothelial growth factor (VEGF) plays a prominent role in activating endothelial cells to form new vessels (Yancopoulos et al., 2000 Nature 407, 242-248). To date, much of the effort in therapeutic angiogenesis has been focused on the delivery of VEGF to restore blood perfusion (Takeshita et al., 1994 J Clin Invest 93, 662-670; Henry et al., 2003 Circulation 107, 1359-1365; Rajagopalan et al., 2003 Circulation 108, 1933-1938). However, formation of truly functional vasculature will likely require control over the location and magnitude of the angiogenic region, as undirected vessel growth can result in pathological effects (Dor et al., 2003 Trends in Cell Biology 13, 131-136). Moreover, improperly organized vascular networks resulting from this over-stimulation can reduce perfusion (Noguera-Troise et al., 2006 Nature 444, 1032-1037; Thurston et al., 2007 Nature Reviews Cancer 7, 327-331). This may be particularly problematic with angiogenic delivery approaches currently utilized, as systemic delivery leads to supraphysiologic concentrations, while polymeric sustained delivery systems frequently demonstrate an early burst release that leads to over-saturated local VEGF concentration in situ (Silva, E. A., and Mooney, D. J. 2007 Journal of Thrombosis and Haemostasis 5, 590-598). Importantly, while clearly documented with VEGF delivery, this issue permeates all current approaches to locally manipulate regenerative processes via exogenous factor delivery.
Described herein are results that demonstrate that clear demarcation of stimulatory zones for regeneration is achieved via appropriate co-delivery of stimulatory and inhibitory factors. Specifically, the results are presented in the context of VEGF-driven angiogenesis, using delivery of both recombinant human VEGF and an angiogenic inhibitor, anti-VEGF antibody (anti-VEGF) (Ferrara, N., and Kerbel, R. S. 2005 Nature 438, 967-974; Ferrara et al., Nat Rev Drug Discov 3, 391-400). A biodegradable polymer scaffold system is utilized to allow local and sustained release of the two factors. As described herein, the ability of this approach to spatially regulate angiogenesis was examined in a model of hindlimb ischemia (Sun et al., 2005 Pharm Res 22, 1110-1116), due to its relevance to clinical situations requiring revascularization interventions. The results from the studies presented herein demonstrate spatial control of regenerative processes by simultaneously delivering spatially segregated promoting and inhibitory agents with polymeric scaffolds. More specifically, the simultaneous, but spatially distinct, delivery of anti-VEGF and VEGF reduced the initial burst concentration of active VEGF and maintained the temporal stability of the active VEGF concentration profile. Furthermore, the spatial separation of the encapsulated pro- and anti-angiogenic agents resulted in a spatially sharp and restricted angiogenic region, leading to a heterogeneous distribution of vessels in the scaffolds and in underlying muscles.
The in vitro sprouting assay described herein confirmed that the anti-VEGF was functional and inhibited angiogenesis in a dose-dependent manner. These findings were consistent with a previously reported ND50 of four to fifteen times the mass of VEGF (Wang et al., 2004 Angiogenesis 7, 335-345; Ishihara, K. et al., 2002 International Immunopharmacology 2, 499-509; Conn et al., 1990 Proc Natl Acad Sci USA 87, 1323-1327; Cullen, V. C. 2000 General Pharmacology—the Vascular System 35, 149-157). The release profiles of VEGF and its antibody showed that the two agents were released in a sustained manner, albeit with initial bursts as observed in other studies utilizing poly(lactic-co-glycolic acid) (PLGA) (Cohen et al., 1991 Pharm Res 8, 713-720; Sheridan, et al., 2000 J Control Release 64, 91-102; Kawashima et al., 1999 J Control Release 62, 279-287; Jain, R. A. 2000 Biomaterials 21, 2475-2490).
As described in detail below, by simultaneously delivering anti-VEGF with VEGF in AVA scaffolds, the overly high concentration of VEGF that typically results from the initial burst release was mitigated. Computational simulations accounting for release, diffusion, degradation, and binding dynamics of VEGF and anti-VEGF showed that excessive VEGF was bound by anti-VEGF in this situation. The remaining free VEGF is the only active angiogenic agent delivered. Since release profiles of VEGF and anti-VEGF both exhibit initial bursts, the resulting concentration profile peak of free VEGF in the beginning was drastically reduced. Thus, the results presented herein describe that a temporally stable concentration profile of an active angiogenic agent is achieved with a delivery device that has an inherent initial burst release. This methodology is applicable to other drug delivery applications in order to mitigate the negative effects of initial bursts.
Aside from a reduction in the concentration of the free activator, VEGF, the initial spatial separation of the inhibitor and activator lead to a spatially sharp and restricted angiogenic region. This methodology mimics developmental processes in nature that use opposing factors as a method of control. Reaction-diffusion mechanisms involving an inhibitor and an activator manifest in murine interfollicular patterns, angelfish skin patterns, and avian feather size and spacing (Sick et al., 2006 Science 314, 1447-1450; Kondo, S., and Asai, R. 1995 Nature 376, 765-768; Jiang et al., 1999 Development 126, 4997-5009).
The polymer system described in the present application is also robust against fluctuations in angiogenic VEGF threshold and initial encapsulated mass. Similarly, natural processes employ mechanisms to enhance the robustness of morphogen gradients against fluctuations in gene dosage or environmental conditions (Eldar et al., 2004 Current Opinion in Genetics & Development 14, 435-439). These mechanisms include self-enhanced degradation (Eldar et al., 2003 Developmental Cell 5, 635-646), complexes with restricted diffusion (Eldar et al., 2002 Nature 419, 304-308, feedback (von Dassow et al., 2000 Nature 406, 188-192), or their combination.
Many researchers have proposed the delivery of multiple agents with different release methodologies in order to address complex biological events (Richardson et al., 2001 Nat Biotechnol 19, 1029-1034; Carmeliet et al., 2000 Nature 407, 249-257; Kisak et al., 2004 Curr Med Chem 11, 199-219; Almarza et al., 2006 Arch Oral Biol 51, 215-221; Moioli et al., 2007 Adv Drug Deliv Rev 59, 308-324; Richards Grayson et al., 2003) Nat Mater 2, 767-772; Burdick, J. A. et al., 2006 Biomaterials 27, 452-459). However, described herein is a study to achieve spatial restriction and temporal stability of an active concentration profile of a drug by simultaneously delivering a direct inhibitor.
Example 1: Effect of VEGF and Anti-VEGF on Angiogenesis
The relation between VEGF and anti-VEGF concentrations on angiogenesis was first evaluated using a common in vitro sprouting assay, in order to quantitatively determine the appropriate doses of the two factors for subsequent in vivo studies.
Cell Culture and In Vitro Sprouting Assay
Briefly, dermal human vascular endothelial cells (HMVECs) were purchased from Lonza (CC-2543) and cultured to confluence at 37° C. and 5% CO2 in microvascular endothelial cell growth medium-2 (EGM-2MV) (Lonza) containing all supplements. Angiogenic activity of endothelial cells was assessed using a modification of a widely used in vitro sprouting assay (Nehls, V., and Drenckhahn, D. 1995 Microvasc Res 50, 311-322). Briefly, dextran beads microcarriers (Cytodex 3) with a dry weight of 50 mg were swollen in PBS and autoclaved. The microcarriers were washed in EGM-2MV medium and seeded with 3×106 HMVECs in a spinner flask. The microcarriers were stirred for 2 minutes out of 30 minutes for 3 hours at 37° C. incubation. After 4 hours, the beads and cells mixture were continuously stirred and incubated for an additional 20 hours. The cell-coated beads were then seeded in fibrin gel in a 24-well-plate. The composition of the fibrin gel in each well was 0.682 mg fibrinogen (Sigma, T3879), 11.4 μg aprotinin (Sigma, A4529), 0.455 U thrombin (Sigma, T6884) in 393 μL of phosphate buffered saline (PBS) and 57 μL of EGM2-MV. Gels were incubated at 37° C. for 30 minutes and media of experimental conditions were placed on top of the gel. Experimental media were prepared by adding appropriate concentrations of VEGF and anti-VEGF to EGM-2MV without the growth factor supplements, but with the addition of 10 ng/mL hepatocyte growth factor (HGF) for all conditions. Media were changed every 24 hours and the cells were allowed to sprout from beads into surrounding gel over 4 days. After 4 days, the gels were rinsed with PBS and fixed with 4% paraformaldehyde prior to imaging. Subsequent to fixing, samples were stained with 4′,6-diamidino-2-phenylindole (DAPI) and visualized at 10× objective magnification with an Olympus IX2 microscope. Sprouts were identified as continuous multi-cellular structures extended from the microcarrier beads with a minimum of two cells in the structure.
VEGF induced angiogenic sprouting, an analog to the initial stage of angiogenesis, whereas anti-VEGF reduced the angiogenic effects of VEGF (FIG. 1), as expected. The dose-dependent effects of anti-VEGF at a constant VEGF of 50 ng/mL were analyzed, and an anti-VEGF concentration 50-fold greater than that of VEGF effectively eliminated the angiogenic effects of VEGF (FIG. 1b).
Scaffold Fabrication and Quantification of Protein Release Kinetics
To allow local and sustained delivery of VEGF and anti-VEGF, the proteins were incorporated into poly(lactide-co-glycolide) scaffolds that have been commonly utilized in the past for delivery of single stimulatory factors (Sun et al., 2005 Pharm Res 22, 1110-1116; Peters et al., 2002 J Biomed Mater Res 60, 668-678; Chen, R. R., and Mooney, D. J. 2003 Pharm Res 20, 1103-1112). However, in this situation, three-layer PLG scaffolds were fabricated, and the different proteins were localized into the distinct layers.
An exemplary scaffold device is produced as follows. A 85:15, 120 kD copolymer of D,L-lactide and glycolide (PLG) (Alkermes, Cambridge, Mass.) was used in a gas-foaming process to form macroporous PLG matrix scaffolds (Harris et al., 1998 Journal of Biomedical Materials Research 42, 396-402). All scaffolds were cylinders 4.2 mm in diameter and 3 mm in thickness. PLG microspheres (diameter=5-100 μm), prepared by standard double emulsion (Cohen et al., Pharm Res 8, 713-720), were mixed with lyophilized proteins, sodium chloride, and 5% alginate by mass. The mixture was compressed into discs and equilibrated with high-pressure carbon dioxide. When the pressure was released, PLG particles expanded into spaces between salt particles and fused, entrapping the lyophilized proteins and salt. Salt particles were removed by leaching with a 100 mM CaCl2 solution to generate porous scaffolds. The VEGF-A isoform VEGF (165) (Biological Resources Branch of the National Cancer Institute, Bethesda, Md., USA) was used throughout these studies. Four types of scaffolds were fabricated: i) blank scaffolds without protein incorporation (B), ii) scaffolds with 4 μg of VEGF (V), iii) 3-layered scaffolds with a 1 mm central layer containing 4 μg of VEGF and two surrounding 1-mm layers without protein incorporation (BVB for Blank-VEGF-Blank), and iv) 3-layered scaffolds with a 1 mm central layer containing 4 μg of VEGF and two surrounding 1-mm layers each incorporating 20 μg of anti-VEGF (R&D Systems AB-293-NA).
The release kinetics of anti-VEGF antibody (anti-VEGF) and VEGF from each layer of the scaffold were determined using 0.11 μCi 125I-labeled anti-mouse IgG (Perkin Elmer, DEX159100UC) and 0.11 μCi 125I-labeled human VEGF (Perkin Elmer, NEX328005UC), respectively, as tracers. The tracers were entrapped in scaffolds using an identical process with the remaining bulk quantities consisting of unlabeled anti-VEGF and unlabeled VEGF, respectively. The total radioactivity of each scaffold layer (n=5) was measured with a WIZARD Automatic Gamma Counter (Perkin Elmer) prior to incubation at 37° C. in 2 mL of PBS. At specific measurement time points, release solutions were measured using the Gamma counter and the scaffolds were placed in fresh release solutions. The cumulative protein release from the scaffolds at each time point was normalized as a percentage of total protein incorporated.
Protein which was incorporated into each layer of the scaffold remained confined to that layer, as demonstrated previously (Chen et al., 2007 Pharm Res 24, 258-264). Radiolabeled tracers were used to model the release of the two proteins from the scaffolds and there was a sustained release of the proteins over several weeks (FIG. 2). Approximately 60% and 75%, respectively, of VEGF and anti-VEGF were released in the first 3 days. Notice that the initial burst release for anti-VEGF was greater than that of VEGF. Over the next 11 days, the release rates varied between 0.5% to 3% per day, and from day 14 to 31, only 1-2% of the proteins were released.
Example 2: Mathematical Model of Protein Distribution
In order to design appropriate encapsulated doses of VEGF and anti-VEGF to create spatially defined angiogenic regions, mass transport PDEs of the proteins in the scaffolds and the underlying tissues were simulated.
Briefly, a computational model was generated to depict the concentration profiles of free VEGF anti-VEGF, and VEGF complexed with anti-VEGF. This model accounted for diffusion, release from scaffolds, binding kinetics, and protein degradation. The governing equations of the VEGF and anti-VEGF concentrations inside the scaffold and underlying muscle were:



  
    
      
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See, Chen et al., 2007 Pharm Res 24, 258-264; Helm et al., 2005 Proceedings of the National Academy of Sciences of the United States of America 102, 15779-15784; Brouwers et al., 2006 J Biomech 39, 2774-2782; Clauss, M. A., and Jain, R. K. 1990 Cancer Res 50, 3487-3492; Pluen 2001 Proceedings of the National Academy of Sciences of the United States of America 98, 4628-4633; Crank, J. 1975 The mathematics of diffusion, 2d ed., Clarendon Press, Oxford, Eng; Vieira, P., and Rajewsky, K. 1988 Eur J Immunol 18, 313-316; Vieira, P., and Rajewsky, K. 1986 Eur J Immunol 16, 871-874; and Bakri, et al., 2007 Ophthalmology 114, 855-859.
In the model, the VEGF-anti-VEGF-body complex is assumed to have no degradation. VEGF and anti-VEGF are modeled to only degrade when not bound together. This should have a negligent impact on the overall dynamics of the system due to the small magnitude of degradation rates compared to koff. The release function inside each layer of the scaffolds was determined by the initially incorporated amount of protein multiplied by the instantaneous release curve, which was a piecewise cubic interpolation from the empirically measured radio-labeled protein release kinetics. Effective diffusion coefficients and degradation rates were assumed to be time-invariant and spatially uniform. Since the effective diffusion coefficients were experimentally measured, they were assumed to incorporate binding kinetics to the extracellular matrix (ECM) proteins as well as uptake by cells. The system geometry, equation system, and initial conditions were constructed in COMSOL Multiphysics using the 3D coefficient form PDE model. The time dependent system was solved with the GMRES linear system solver and the output was exported and analyzed in Matlab.
Parameters for the models were obtained from empirical release kinetics and diffusion and degradation coefficients from literature. For example, by setting an initial amount of 4 μg VEGF in the central layer of the scaffold and 20 μg anti-VEGF in each of the surrounding layers (FIG. 3a), the concentration profiles of total VEGF free VEGF (not bound to anti-VEGF), and free anti-VEGF over time at a tissue cross section 0.5 mm into the underlying muscle were simulated (FIGS. 3b-d). These simulations showed a sharp peak for the total VEGF concentration (free VEGF+VEGF bound to antibody) centered at the central layer and two anti-VEGF peaks on the two sides. However, the diffusion of anti-VEGF into the central layer caused most of the total VEGF to become antibody bound in the central layer, creating significantly reduced peaks of free VEGF compared to total VEGF (FIG. 3e). Strikingly, the binding of free VEGF by antibody had a dramatic smoothing effect on the concentration of free VEGF as a function of time. By contrast, the total VEGF concentration started extremely high and then rapidly dropped, due to the changing release rate over time and its simultaneous degradation. These effects were largely dose-independent (FIGS. 8-9), although the absolute value of the quasi-steady-state free VEGF concentration was strongly influenced by the VEGF and anti-VEGF doses. From previous in vitro VEGF dosage studies of endothelial sprouting (Chen et al., 2007 FASEB J 21, 3896-3903) and in vivo measurement of tissue VEGF concentrations (Silva, E. A., and Mooney, D. J. 2007 Journal of Thrombosis and Haemostasis 5, 590-598), the minimum effective VEGF concentration in vivo to induce angiogenesis is  ̃5 ng/mL. Utilization of the 4 μg doses led to free VEGF concentrations that were still above this threshold for a 4 week timeframe. As a comparison of the profile stability, the standard deviations of the daily peak for total VEGF and free VEGF over 28 days were computed: 558 ng/mL for total VEGF and 132 ng/mL for free VEGF. Most of the fluctuations came from the spike in concentrations on day 2 (FIG. 3g). The concentration peak of active VEGF on day 2 was reduced by 72% by the binding activity of anti-VEGF.
To determine the spatial control over angiogenesis with this approach, the level of angiogenic promotion was expressed as a binary event, defined as angiogenic promotion




  
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S(x,y,z)=1 indicated that angiogenesis was promoted at said coordinate and local S=0 indicated that angiogenesis was inhibited. Plots of S vs. x (FIG. 3f) demonstrated that angiogenic promotion was restricted with this system in the approximate 1 mm central region, which was defined as the angiogenesis-promoting region (APR). This spatial restriction was maintained for 3 weeks, demonstrating a highly stable environment, although the APR first broadened then contracted slowly. In the first 19 days, the APR width expanded gradually from 0.84 mm to 1.2 mm, although there is a brief drop to 0.48 mm on day 4. From day 20 to day 28, the APR contracted from 1.2 mm to 0.72 mm. In this computational model, 5 ng/mL was chosen as the minimum threshold for angiogenic promotion, consistent with other groups (Wang et al., 2004 Angiogenesis 7, 335-345; Ozawa et al., 2004 J Clin Invest 113, 516-527). The choice of this parameter did not affect the temporal stability of the free-VEGF concentration profiles, though the width of the APR deviated by ±25% with the minimum threshold ranging from 2 ng/mL to 10 ng/mL (FIG. 7). Thus, both temporal stability and spatial restriction of active VEGF were robust to the minimum biologically active threshold. The results of this modeling suggest that highly stable, in terms of both time and space, regions of pro-angiogenic activity could be readily created by appropriate dosing of VEGF and anti-VEGF. The maintenance of the APR is also robust against changes in the amount of anti-VEGF and VEGF encapsulated initially. When the initial encapsulated mass of anti-VEGF was varied from 80% to 110% of the base level, the width of the APR deviates for less than 25% (FIG. 7b). Similarly, the width of the APR deviated for less than 25% when the degradation rate of anti-VEGF was varied from 80% to 130% (FIG. 7c).
Example 3: Spatially Regulated Angiogenesis In Vivo
To test the ability of this system to provide spatial control over angiogenesis, scaffolds were subsequently implanted into the ischemic hindlimbs of SCID mice.
Mouse Model of Hindlimb Ischemia
Scaffolds were implanted in 6-week-old SCID mice (Taconic, Hudson, N.Y.) that had undergone unilateral ligation of hindlimb blood vessels to create a severe model of hindlimb ischemia (Sun et al., 2005 Pharm Res 22, 1110-1116). The SCID model was chosen because it offered a stable loss of perfusion over weeks and the angiogenic effects from inflammation were reduced. Briefly, animals were anesthetized by IP injection of a 7:1 mixture of ketamine and xylazine. The targeted hindlimb was shaved and sterilized with ethanol prior to making an incision through the dermis. Ligation sites were made on the external iliac artery and vein, and on the femoral artery and vein using 5-0 Ethilon (Ethicon, Somerville, N.J.). The vessels were severed between the ligation sites. A scaffold was implanted such that its rotational axis was perpendicular to the direction of the severed vessels, with the round edge sitting on top of the muscle. This orientation effectively made each layer parallel to the original femoral artery and vein.
Analysis of Vascularization
Scaffolds and the surrounding muscles from the ischemic hindlimbs were retrieved after 4 weeks, fixed in Z-fix (Anatech, Battle Creek, Mich.) overnight and changed into 70% ethanol (EtOH) for storage prior to histologic processing. Samples were embedded in paraffin and sectioned onto slides. Sections were immunostained with a monoclonal antibody raised against mouse CD31 (diluted 1:250) (Pharmingen, San Diego, Calif.) with the Tyramide Signal Amplification (TSA) Biotin System (Perkin Elmer Life Sciences, Boston, Mass.). Briefly, deparaffinized sections were rehydrated, blocked for endogenous peroxidase activity and non-specific interactions, and incubated overnight at 4° C. with the primary CD31 antibody. Sections were then incubated with a biotinylated anti-rat IgG (Vector Laboratories, Burlingame, Calif.), followed by application of a tertiary TSA strepavidin antibody and a TSA biotinyl tyramide amplification. This was followed by reapplication of the tertiary antibody. The samples were stained using DAB+ substrate chromogen (DAKO, Carpinteria, Calif.) and counterstained with hematoxylin.
Sections from each sample were visualized at 10× and 20× objective magnifications with a Nikon light microscope (Indianapolis, Ind.) connected to a SPOT digital image capture system (Diagnostic Instruments, Sterling Heights, Mich.). Images were taken of entire sections at 10× objective magnification and merged into a complete image of the section using Photoshop Elements (Adobe Systems, San Jose, Calif.). Blood vessel densities (BVD), marked by CD31, were manually determined in the entire scaffold and underlying muscle tissues as previously described (Richardson et al., 2001 Nat Biotechnol 19, 1029-1034; Sun et al., 2005 Pharm Res 22, 1110-1116).
Measurements of the blood perfusion in the ischemic and normal limb of the anesthetized animals (n=5) were performed using Laser Doppler Perfusion Imaging (LDPI; Perimed, AB, Stockholm, Sweden). To minimize variability due to ambient light, temperature, and individual heart rate, perfusion in the ischemic hindlimb was normalized by the perfusion in the normal hindlimb of the same animal.
Both the new vasculature that formed within the infiltrated scaffold and the vasculature in the muscle underneath the scaffold were analyzed, four types of scaffolds were examined: 1) blank scaffolds containing no proteins (B), 2) scaffolds containing 4 μg of VEGF in total distributed homogenously (V), 3) three-layered scaffolds with 4 μg VEGF contained in the central layer and 20 μg anti-VEGF contained in each of the side layers (AVA), and 4) three-layered scaffolds with 4 μg VEGF in the central layer and side layers containing no proteins (BVB). The aforementioned computational model suggested that implanted AVA scaffolds would result in a distinct region that promoted angiogenesis and that this region would be maintained in the first two weeks. This spatially restricted signal was expected to lead to spatially heterogeneous blood vessel densities. At the experimental end point (4 weeks), mice were sacrificed and blood vessel densities of the cell-infiltrated scaffolds and underlying muscles were quantified. Delivery of VEGF in all scaffold types (V, BVB, and AVA) resulted in an approximate twofold increase in blood vessel density in the scaffolds (FIGS. 4a and b). Furthermore, layers ‘B’ in BVB showed a similar level of increase (FIG. 4b), indicating that the region of angiogenesis-promotion was not restricted to the central layer. In contrast, layers ‘A’ in the AVA scaffolds showed a reduction of blood vessel density, to a similar value as the blank condition (FIG. 4b). Similarly, analysis of the underlying muscle showed that increased blood vessel densities were generated in the muscles underneath a polymer initially encapsulated VEGF, and AVA scaffolds effectively restricted this increase to the muscle directly underneath the central layer (FIG. 5). Finally, laser Doppler perfusion imaging (LDPI) was performed in order to assess the effects on functional perfusion by local restriction of angiogenesis (FIG. 6). In all groups, perfusion decreased immediately subsequent to induction of ischemia. However, implantation of all three types of scaffolds containing VEGF led to significant recovery of perfusion, well above the control (no VEGF delivery), and spatially restricting angiogenesis did not compromise the ability of VEGF delivery to improve regional perfusion.
The capillary densities achieved in VEGF-containing layers were comparable to previous studies with protracted release of VEGF (Sun et al., 2005 Pharm Res 22, 1110-1116; Chen Pharm Res 24, 258-264). Despite the reduction in total active VEGF delivered in the AVA scaffolds, the resulting vessel densities and perfusion in the scaffold and in the underlying muscles were not statistically different than those of the scaffolds delivering VEGF only. The free VEGF concentration in the V and BVB scaffolds likely is an over-saturating dose, or the excessive VEGF created non-productive vasculature in these conditions (Noguera-Troise et al., 2006 Nature 444, 1032-1037; Thurston et al., 2007 Nature Reviews Cancer 7, 327-331; Ridgway et al., 2006 Nature 444, 1083-1087). Another possibility is that the lowered microenvironmental VEGF concentration in the AVA condition resulted in more structurally effective blood vessels in the central layer that compensated for the reduced blood vessel densities in the two side layers.
Example 4: Multi-Modal Scaffold Design to Create Spatiotemporal Morphogens Fields for Precision Tissue Engineering
The methods and compositions are also useful to release distinct factors from various compartments (with a complementary inhibitory factor released from another compartment) to promote stem cell differentiation down different pathways in distinct spatial locations. These methods mimic naturally-occurring tissue development such as embryonic development.
Embryonic development involves a concerted, precise interplay of morphogens and inhibitors that provide spatial and temporal cues to drive tissue differentiation and organismal patterning. A major premise of such development is that all the cells within the given developmental field are homogenous and pluripotent in terms of their lineage and are capable of being programmed into multiple distinct lineages that represents stable, functional tissue fates.
Control release methodology utilizes polymer based systems that are capable of precisely controlling temporal kinetics and spatial regulation of biomolecules ranging from peptides, proteins, nucleic acids and small molecules. One can spatially segregate a single induction signal, or even multiple factors by placing them in distinct compartments in a delivery system (Chen R R, Silva E A, Yuen W W, Mooney D J. Spatio-temporal VEGF and PDGF delivery patterns blood vessel formation and maturation. Pharmaceutical Research. 2007 February; 24(2):258-64). Spatially segregating the release of an inductive and an inhibitory molecule (VEGF and an a neutralizing antibody to VEGF) can lead to sharp boundaries defining the region in which a process is promoted (Yuen W W, Du N R, Chan C H, Silva E A, Mooney D J. Mimicking nature by codelivery of stimulant and inhibitor to create temporally stable and spatially restricted angiogenic zones. Proc Natl Acad Sci USA. 2010 Oct. 19; 107(42):17933-8).
Improvements over existing systems described herein include: (1) use of macroporous polymer systems that mediate spatial reorganization and morpho-differentiation; (2) use of multiple morphogens and inhibitory molecules to precisely define induction fields; and (3) use of latent complexes that allow precise temporal onset of actions by photoactivation.
Spatially Distinct Morphogens Fields (Multilayered Design)
Using the PLGA microsphere system release of morphogens cues was demonstrated. For example, two growth factors, TGFB-β1 and BMP4, are in two layered zones while their neutralizing antibodies are released from opposite compartments a well as within the middle neutral zone to restrict their field of action.
A mixture of two distinct colored dyes, red and blue, were mixed with PLGA microspheres which were processed into layers thus, demonstrating distinct spatial compartments (FIG. 10). The shape and dimensions of the scaffolds described herein are useful for various applications including joint replacement, spinal defects, etc. The dimensions of each scaffold is defined by individual applications and configured (total size, ratio of tissue induction zones and interfaces and respective ratios) using material synthesis processes including 3D printing (Tables 2 and 3 of Arany P R & Mooney D J Oral Diseases (2011) 17, 241-251, incorporated herein by reference). Inter-pore continuity was assessed using Scanning Electron Microscopy (FIG. 11) and microcomputed tomography to validate a contiguous cell environment to allow cells to uniformly distribute throughout the system (FIG. 12). Validation of this system was performed using two separate biological approaches namely, reporter cells lines to visualize and confirm morphogen fields and stem cells for differentiation.
Representative Polymeric Systems
Most cells in the body require adhesion to the extracellular matrix for survival and function. As host cells are recruited in the programming approaches, the materials provide specific adhesion cues analogous to ECM to direct cell organization and regulate gene expression. Scaffolding materials are modeled on connective tissue and basement membrane components that support epithelial stratification, maturation and function. A wide range of natural polymers (e.g., collagens, fibrin, matrigel, alginate, chitosan, hyaluronate, silk, and polyhydroxyalkanoates) are used to mimic the ECM niche. These materials provide requisite physical support and allow natural tissue patterning and morpho-differentiation and this has been specifically demonstrated in regenerating pulp tissue (Bohl et al., 1998 J Biomater Sci, 9: 749-764; El-Backly et al., 2008 Aust Endod J, 34: 52-67). However, there are concerns of mechanical integrity, immune rejection and batch-to-batch variations. Another major limitation with these naturally derived polymeric systems is that complex cell-matrix interactions are not easily definable, making some of the biological responses unpredictable.
A variety of synthetic polymeric systems address the limitations of naturally derived materials, including controlled manufacturing at large scales and providing a precisely tailored cellular niche. Suitable synthetic polymer systems include poly(lactic) acid (PLA), poly(glycolic) acid (PGA), poly(lactic-co-glycolic) acid (PLGA), poly(ethylene glycol)-diacrylates (PEG-DA), poly(ε-caprolactone) (PCL), poly(ethylene glycol) terephtalate (PEGT), poly (butylene) terepthalate (PBT), polyphospho-esters (PPEs), polyphosphazenes (PPAs), polyanhydrides (PAs), polyortho-esters (POEs), and poly(propylene fumarate)-diacrylates (PPF-DA; Arany P R & Mooney D J Oral Diseases (2011) 17, 241-251).
Design Principles for Programmable Material Design
Polymeric materials with suitably designed chemistry not only define the cell-matrix interaction, but also aid in directing cellular responses by acting as depots to develop spatially restricted morphogen fields. Suitable design principles for programmable material design include the following. Biocompatible materials allow for minimal inflammatory and immune rejection, while controlled pore architecture allows for control over cell trafficking, morpho-differentiation, spatial organization, and host integration. Materials that encapsulate or bind soluble signaling molecules offer the advantage of spatiotemporal controlled delivery, while cell adhesive materials allow for cell attachment and promotion of interface-dependent cellular behavior. Materials with controlled biodegradation allow replacement by host tissue and avoid chronic host responses, while dynamic materials are responsive to local environment and/or external stimuli. Finally, gelable, injectable, or micro/nanoparticle materials allow for ease of delivery and minimal trauma.
Material Processing Techniques
Many techniques are routinely used to fabricate polymeric systems in a variety of geometries and architecture with precise control over pore size, shape and connectivity (Sohier et al., 2008 Expert Opin Drug Deliv, 5: 543-566). Spatially precise fabrication techniques have more recently been developed to provide better control of pore scaffold architecture, internal and external pore connectivity (Sohier et al., 2008 Expert Opin Drug Deliv, 5: 543-566). The conventional and newer techniques often involve the use of heat and solvents that can result in denaturation and loss of incorporated protein activity. One approach to overcome this limitation is by the use of two phase systems in which the polymeric fabrication step is decoupled from the biological incorporation step. Two common techniques used are addition of microspheres encapsulating proteins to a preformed scaffold or adsorption of the protein onto the polymer scaffold post-fabrication. In addition, processing techniques that utilize non-harmful solvents (such as CO2, H2O) allow biologically active molecules to be incorporated without diminishing their activity. Material processing techniques that allow for conventional architectures/geometry include fiber extrusion and electrospinning, heat bonding, gas foaming, phase separation, freeze drying, and particulate leaching. Material processing techniques that allow for more precise architectural control include fused diffusion molding, 3D fiber deposition, solid free form techniques, 3D printing, selective laser sintering, surface selective laser sintering, laser abalation, and stereolithiography.
Growth Factor Specific Reporter Cell Lines
Reporter cell lines demonstrate increased luciferase activity when exposed to specified growth factors. These cells were uniformly seeded within a regular PLGA scaffold (no layer, no incorporated growth factors) that demonstrates minimal luciferase activity when no growth factors are present (FIG. 14, top rows) or uniform activation throughout the scaffold when growth factor was added to the media allowing it to diffuse freely (FIG. 14, bottom rows).
Following testing with a 3 layered system that demonstrated a few design deficiencies, we developed a five layered scaffold system (FIG. 15) that had additional outer buffer zones that neutralize media diffused growth factors as well as fluorescent nanoparticles incorporated zone that enabled scaffold orientation due to the free floating nature of scaffolds in media during cell culture.
The reporter cell lines were seeded in these 5 layered systems and imaged for luciferase activity after 24 hours to confirm development of spatially distinct morphogens fields. The TGF-β reporter demonstrated activation of luciferase only in the defined left zone while BMP reporter line demonstrated the opposite orientation (FIG. 16). Seeding both cell lines in this system effectively demonstrated the ability to activate distinct growth factor signaling pathways in a spatially regulated manner.
The data demonstrated peak luciferase expression reflecting the spatially distinct morphogens fields that are developed by the 5 layered system and induced specific reporter activity in cell lines.
Directed Differentiation of Mesenchymal Stem Cells into Distinct Tissue Lineages
To test the ability of the created morphogens fields with the scaffold system, the scaffolds were seeded with D1s, a Mesenchymal Stem Cell (MSC) cell line, which has been shown to be multipotent and can give rise to various differentiated tissue such as bone, fat, cartilage when provided with the appropriate cues. (Harnessing traction-mediated manipulation of the cell-matrix interface to control stem-cell fate. Huebsch N, Arany P R, Mao A S, Shvartsman D, Ali O A, Bencherif S A, Rivera-Feliciano J, Mooney D J. Nat. Mater. 2010 June; 9 (6):518-26.). Differentiation to dentin and bone was evaluated.
Experiments were carried out with the following morphogens: TGF-β1 to drive dentin differentiation and BMP4 to drive bone differentiation. The scaffold devices were fabricated, loaded with morphogens (in this case, differentiation factors), and then seeded with stem cells, e.g., mesendymal stem cells, embryonic stem cells or induced pluripotent stem cells (iPS)). The loaded, seeded devices were cultured for 21 days with no additional factors present in the media. All factors came from within the scaffold from the point of seeding. Immunoblots were carried out to assess activation of the downstream Smad signaling pathways following treatment of D1s with these morphogens. Robust activation was demonstrated, e.g., by phosphorylation of cytoplasmic intermediates in a dose dependent manner (FIGS. 17A and B).
To test the ability of the created morphogens field to direct mesendymal stem cell (MSC) differentiation, D1s were seeded into the scaffold systems. The cells were housed in the scaffolds for 21 days, changing the media twice weekly. Then the scaffold was divided into distinct zones as shown in FIG. 17C. Total protein was extracted and assessed by immunoblotting (FIG. 17D).
The results demonstrated the ability of the scaffold system to differentiate MSCs into specific lineages expressing matrix markers for bone (Bone Sialoprotein BSP) and Dentin (Dentin Matrix Protein-1) in a tightly regulated manner.
Spatial and Temporal Control System (Core-Shell Design)
Another system involves a similar spatial segregation into a central ‘core’ and an outer ‘shell’ compartment that has a latent growth factor complex, Latent TGF-β1 (LTGF-β1), and a commercially available small molecule inhibitor (SB) that blocks its effects contained in them. Activation of the LTGF-β1 using specific parameters of laser irradiation (U.S. Ser. No. 61/449,249, incorporated herein by reference) permitted temporal control the onset of morphogen action. The utility of this system was demonstrated using the same reporter line described above. The data demonstrated the spatial and temporally regulated morphogens fields were generated to direct biological behavior (FIG. 18).
In the two variants of this system, the results demonstrated activation of the TGF-β1 pathway in a spatially defined manner indicating that the compositions and methods promote morpho-differentiation of tissue. For example, the scaffold systems promote differentiation of stem cells to a desired tissue type. In one example, a single cue and its corresponding inhibitor are used in the scaffold, but more complex systems with multiple cues that can be temporally controlled are manufactured and used in a similar manner. Such polymer-based scaffold systems use a biologically-inspired design and have been shown to provide distinct spatial and temporal cues to program cells, direct tissue organization and remodeling and ultimately define biological function.
Clinical Applications
Applications of the compositions and methods include: (1) Precision Engineering of Tissues and Organs that contain interfaces between distinct tissue types (e.g., engineering of joints, teeth, and spinal implants), and (2) in situ models to analyze biological mechanisms.
Precision Engineering Organs
With advance in tissue engineering approaches, it is now relatively simple to direct a single tissue differentiation to enable replacement or regeneration of diseased/destroyed tissue. The present system provides a powerful tool in defining two or more distinct tissue lineages from a homogenous population of cells, either recruited from host or externally provided along with the scaffold system. For example, current scaffold systems are able to either recruit or differentiate transplanted cells into bone or cartilage based on the delivery system. But prior to the invention, the production of specialized tissues constituting the joint are made of two juxtaposed specialized connective tissue was not achievable with conventional scaffold systems. The improved scaffold systems described herein recruit and differentiate host cells into two distinct lineages to regenerate the complex joint architecture and promote restoration of function (FIG. 19).
Another key application of this system is to drive cartilage and bone differentiation in vertebral defects as spinal implant systems. The differentiated cartilage, better than any synthetic inert material, provides the necessary mechanoelastic behavior that bone implants alone cannot provide effectively that is a key functional determinant of the clinical success in these applications (FIG. 20).
Many other such applications involving two differentiated tissue that need to be engineered juxtaposed to each other could benefit from this system design. Some examples are teeth (enamel and dentin, dentin and cementum, cementum and periodontal ligament), lung (respiratory epithelium and endothelium), liver (hepatocytes and sinus endothelium), kidney (glomerular filtration apparatus), cardiac valves (endocardium and myocardium), pancreas (β islets and a cells), among others. Suitable target tissues and corresponding morphogens for use in the scaffolds of the invention are provided in the table below. Exemplary inhibitors of the morphogens described herein include antibodies and small molecule inhibitors.












Organ
Juxtaposed Tissue
Induction Ligand/Molecule







Teeth
Enamel
Ectodysplasin



Dentin
TGFβ1



Cementum
Periostin



Periodontal ligament
BMP12 & 13


Lung
respiratory epithelium
FOXM-1



Endothelium
VEGF


Liver
Hepatocytes
FGF & HGF



sinus endothelium
VEGF


cardiac valves
Endocardium
TGF-β2



Myocardium
VEGF, bFGF


Pancreas
β islets
Glucagon like Peptide1, NGF



Endotheloium
VEGF


Joints
Bone
BMP2, 4 or 7



Cartilage
TGF-β3









In Situ Models to Analyze Biological Mechanisms

A significant limitation of current experimental approaches in the laboratory are either they are too simplistic cell culture and limited 3D culture systems or involve in vivo animal studies that are extremely complex, multi-parametric systems. The described scaffold systems are useful as research tools. The scaffolds are used to build multi-tissue types and even critical functional organ systems on the bench allowing analyses of these intricate tissue interactions in vitro. Tissues constructed in this manner are used to analyze these systems as well as allow key perturbations to gain mechanistic insights into the biology of the tissues or organs. This provide a powerful tool to perform clinically relevant translational studies including disease modeling and therapeutic interventions.
Other Embodiments
While the invention has been described in conjunction with the detailed description thereof, the foregoing description is intended to illustrate and not limit the scope of the invention, which is defined by the scope of the appended claims. Other aspects, advantages, and modifications are within the scope of the following claims.
The patent and scientific literature referred to herein establishes the knowledge that is available to those with skill in the art. All United States patents and published or unpublished United States patent applications cited herein are incorporated by reference. All published foreign patents and patent applications cited herein are hereby incorporated by reference. Genbank and NCBI submissions indicated by accession number cited herein are hereby incorporated by reference. All other published references, documents, manuscripts and scientific literature cited herein are hereby incorporated by reference.
While this invention has been particularly shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims.

## Claims

1. A method for promoting cartilage regeneration, comprising:
contacting a target site of a subject with a device comprising a polymeric scaffold comprising a first and a second spatially distinct restricted zones, wherein the first zone comprises a purified morphogen that promotes cartilage regeneration, and wherein the second zone comprises a purified inhibitor of the morphogen;
wherein the morphogen and the inhibitor are released from the device into the target site;
wherein the morphogen promotes cartilage regeneration over a sustained period of time at a spatially restricted first region of the target site contacted by the first zone, thereby creating a field of action; and
wherein the inhibitor inhibits the activity of the morphogen at a spatially restricted second region of the target site contacted by the second zone, thereby creating a boundary between the first region and the second region of the target site defining where cartilage regeneration is promoted.

2. The method of claim 1, wherein said morphogen is released at a first rate and said inhibitor is released at a second rate.

3. The method of claim 1, wherein the morphogen that promotes cartilage regeneration is a transforming growth factor-β (TGF-β).

4. The method of claim 3, wherein the TGF-β is selected from the group consisting of TGF-β1, TGF-β2, TGF-β3, and Latent TGF-β1 (LTGF-β1).

5. The method of claim 3, wherein the inhibitor is an anti-TGF-β antibody.

6. The method of claim 5, wherein the anti-TGF-β antibody is an anti-TGF-β1 antibody.

7. The method of claim 3, wherein the inhibitor is the small molecule inhibitor SB431542.

8. The method of claim 1, wherein the purified morphogen that promotes cartilage regeneration is Latent TGF-β1 and the purified inhibitor is the small molecule inhibitor SB431542.

9. The method of claim 1, wherein the morphogen is encapsulated within a microsphere.

10. The method of claim 1, wherein the inhibitor is encapsulated within a microsphere.

11. The method of claim 1, wherein the morphogen and the inhibitor are released from the device by diffusion.

12. The method of claim 1, wherein the polymeric scaffold comprises poly(lactic-co-glycolic) acid (PLGA).

13. The method of claim 1, wherein said device further comprises cells.

14. The method of claim 13, wherein said cells comprise mesenchymal stem cells, embryonic stem cells, or induced pluripotent stem cells.

15. The method of claim 1, wherein said device further comprises:
a) a second purified morphogen, wherein the second purified morphogen promotes bone regeneration, and wherein the second purified morphogen is present in a spatially distinct restricted zone from the purified morphogen that promotes cartilage regeneration; and
b) a second purified inhibitor, wherein the second purified inhibitor inhibits the activity of the second purified morphogen, and wherein the second purified inhibitor is present in a spatially distinct restricted zone from the second purified morphogen.

16. The method of claim 15, wherein the second purified morphogen is a bone morphogenetic protein (BMP).

17. The method of claim 16, wherein the bone morphogenetic protein is BMP4.

18. The method of claim 16, wherein the second purified inhibitor is an anti-BMP antibody.

19. The method of claim 18, wherein the anti-BMP antibody is an anti-BMP4 antibody.

20. The method of claim 1, wherein said method is performed in vivo.

21. A method of inducing cartilage regeneration in a spatially restricted region of a target site, comprising:
contacting the target site with a device comprising a polymeric scaffold comprising a first and a second spatially distinct restricted zones, wherein the first zone comprises a purified morphogen that promotes cartilage regeneration, and wherein the second zone comprises a purified inhibitor of the morphogen;
wherein the morphogen and the inhibitor are released from the device into the target site;
wherein the morphogen promotes cartilage regeneration at a spatially restricted first region of the target site contacted by the first zone, thereby creating a field of action; and
wherein the inhibitor inhibits the activity of the morphogen at a spatially restricted second region of the target site contacted by the second zone, thereby creating a boundary between the first region and the second region of the target site defining where cartilage regeneration is promoted, and inducing cartilage regeneration in a spatially restricted region of the target site.

22. The method of claim 21, wherein the morphogen that promotes cartilage regeneration is a transforming growth factor-β (TGF-β).

23. The method of claim 22, wherein the transforming growth factor-β is selected from the group consisting of TGF-β1, TGF-β2, TGF-β3, and Latent TGF-β1 (LTGF-β1).

24. The method of claim 22, wherein the inhibitor is an anti-TGF-β antibody.

25. The method of claim 24, wherein the anti-TGF-β antibody is an anti-TGF-β1 antibody.

26. The method of claim 22, wherein the inhibitor is the small molecule inhibitor SB431542.

27. The method of claim 21, wherein the morphogen is encapsulated within a microsphere.

28. The method of claim 21, wherein the inhibitor is encapsulated within a microsphere.

29. The method of claim 21, wherein the morphogen and the inhibitor are released from the device by diffusion.

30. The method of claim 21, wherein the polymeric scaffold comprises PLGA.

31. The method of claim 21, wherein said device further comprises cells.

32. The method of claim 31, wherein said cells comprise mesenchymal stem cells, embryonic stem cells, or induced pluripotent stem cells.

33. The method of claim 21, wherein the device further comprises:
a) a second purified morphogen, wherein said second purified morphogen promotes bone regeneration, and wherein the second purified morphogen is present in a spatially distinct restricted zone from the purified morphogen that promotes cartilage regeneration; and
b) a second purified inhibitor, wherein said second purified inhibitor inhibits the activity of the second purified morphogen, and wherein the second purified inhibitor is present in a spatially distinct restricted zone from the second purified morphogen.

34. The method of claim 33, wherein the second purified morphogen is a bone morphogenetic protein (BMP).

35. The method of claim 34, wherein the bone morphogenetic protein is BMP4.

36. The method of claim 34, wherein the second purified inhibitor is an anti-BMP antibody.

37. The method of claim 36, wherein the anti-BMP antibody is an anti-BMP4 antibody.

38. The method of claim 21, wherein said method is performed in vivo.