ORGAN PRESERVING FLUID

Abstract: A novel organ preserving fluid or perfusate to be used in organ transplantation, which comprises sodium lactobionate, sodium dihydrogenphosphate, raffinose, glutathione, allopurinol and nafamostat mesilate, and further contains cyclodextrin in order to present a variation in composition.

Description: The present invention relates to an organ storage solution or perfusate to be used when an organ is extirpated. The drastic improvement of performance record of organ transplantation is attributable to the progress of organ storage solution or perfusate as well as the progress of surgical operations and the advancement of antibiotics and immunosuppressants. In organ transplantation, perfusion of the transplanted organ is essential, but when perfusing the organ which is in an ischemic state, ischemic perfusion trouble is unavoidable. Thus, minimization of the cellular trouble caused in the process of perfusion is a key factor for the success of organ transplantation. Hitherto, UW solution (JP-A-1-246201; a solution composed of potassium lactobionate, potassium dihydrogenphosphate, magnesium sulfate, sodium hydroxide, raffinose, adenosine, glutathione, insulin, bactrim, dexamethasone, allopurinol and hydroxyl ethyl starch) has been used the storage solution, and Ringer's solution or Carolina Rinse solution (a solution composed of sodium chloride, potassium chloride, calcium chloride, sodium lactate, adenosine, allopurinol, desferrioxamine and glutathione) has been used as the perfusate. Further, the modified versions of these solutions featuring incorporation of proteinase inhibitors such as nafamostat mesilate in the compositions have been reported: Shinryo to Shinyaku (Clinic and New Drugs), Vol. 29, No. 1, p194-197, (1992). Of these organ storage solutions and perfusates, UW solution was developed by Belzer et al in 1987 and has phenomenally prolonged the organ preservable period. However, since this solution contains hydroxyl ethyl starch as noted from its composition, the solution is increased in viscosity in use, making it difficult to remove blood from the organ. Also, because of high potassium concentration, this solution gives detrimental effect to the vascular endothelium. This solution is also unsatisfactory in its buffering action. Further, it is costly as it contains insulin. The organ preservable period of Ringer's solution or Carolina Rinse solution is 24 hours at most. This is rather unsatisfactory for a storage solution. The object of the present invention is to provide an organ storage solution or perfusate at a low cost which is designed to safely preserve the organ to be transplanted or to protect the organ from cellular trouble caused in the process of perfusion. The present inventors have tried to incorporate electrolyte, osmotic pressure regulator, proteinase inhibitor, etc., in various combinations in the storage solution or perfusate compositions and, as a result, completed the present invention that can attain the desired end. The organ storage solution and/or perfusate of the present invention comprises sodium lactobionate, sodium dihydrogenphosphate, raffinose, glutathione, allopurinol and nafamostat mesilate. An especially preferred organ storage solution and/or perfusate of the present invention has a composition of 100-120 mM sodium lactobionate, 25-35 mM sodium dihydrogenphosphate, 25-35 mM raffinose, 2-4 mM glutathione, 1-2 mM allopurinol and 0.5-1 mM nafamostat mesilate, an osmotic pressure of 290-350 m0sm/1 and a pH of 7.0-8.0. Further, in the formulation of the present invention, in order to prevent precipitation caused by compositional interaction, it is desirable to add an appropriate amount of cyclodextrin. As cyclodextrin, α-cyclodextrin, β-cyclodextrin or γ-cyclodextrin may be used singly, or a mixture of two or more of said types of cyclodextrin may be used. Thus, the present invention further relates to an organ storage solution and/or perfusate comprising sodium lactobionate, sodium dihydrogenphosphate, raffinose, glutathione, allopurinol, nafamostat mesilate and cyclodextrin, and an especially preferred organ storage solution and/or perfusate of the present invention has a composition of 100-120 mM sodium lactobionate, 25-35 mM sodium dihydrogenphosphate, 25-35 mM raffinose, 2-4 mM glutathione, 1-2 mM allopurinol, 0.5-1 mM nafamostat mesilate, and 3-30 mM cyclodextrin an osmotic pressure of 290-350 m0sm/1 and a pH of 7.0-8.0. The present invention also provides for the use in the preservation of an organ of a solution according to the present invention, as described above, and for a method of preserving an organ comprising storing the organ in a storage solution and/or perfusing it with a perfusate, the storage solution and/or the perfusate being a solution according to the present invention, as described above. Examples of the present invention are shown below, but it is to be understood that the present invention is not limited by these examples. Example 1 41.8 g of sodium lactobionate, 3.00 g of sodium dihydrogenphosphate, 15.13 g of raffinose, 0.92 g of glutathione and 0.14 g of allopurinol were added and dissolved in approximately 800 ml of distilled water (solution A). Separately from the above, 0.43 g of nafamostat mesilate was added and dissolved in 100 ml of distilled water (solution B). Solution A and solution B were mixed, then distilled water was added to make the total amount of the solution 1,000 ml, and the mixed solution was filtered and sterilized. Example 2 41.8 g of sodium lactobionate, 3.00 g of sodium dihydrogenphosphate, 15.13 g of raffinose, 0.92 g of glutathione, 0.14 g of allopurinol, 3.4 g of β-cyclodextrin and 13 g of γ-cyclodextrin were added and dissolved in 800 ml of distilled water (solution A). Separately from the above, 0.43 g of nafamostat mesilate was added and dissolved in 100 ml of distilled water (solution B). Solution A and solution B were mixed, then distilled water was added to make the total amount of the solution 1,000 ml, and the mixed solution was filtered and sterilized. The stability test conducted on the formulation of Example 1 and the formulation of Example 2 is shown in Test Example 1. The organ transplantation tests carried out with the formulation of Example 1 are shown in Test Example 2 and Test Example 3. Test Example 1 Compositional interaction of the formulations of Examples 1 and 2 are shown in Table 1. The figures indicate persistence (%) of nafamostat mesilate. As is evident from Table 1, in case cyclodextrin was added, precipitation was obviously suppressed and no compositional interaction took place. Compositional interaction test Time (h) 0 3 24 48 72 Formulation of Example 1 Appearance Sedimentation Sedimentation Sedimentation Sedimentation Sedimentation Persistence 100 45.5 20.2 19.7 15.2 Formulation of Example 2 Appearance clear solution clear solution clear solution clear solution clear solution Persistence 100 100 98 68.3 56.4 The test results obtained when rat organs were preserved by using a storage solution (Example 1) of the present invention and a conventional storage solution are shown below. Test Example 2 Male rats with body weight of 150-250 g were used as test animal. 65 mg/kg of streptozocin was intravenously injected to the rats, and those of the rats whose blood-sugar level elevated to and stayed at 300 mg/ml or higher for more than 3 days were used as diabetic rats (recipients). Cuff technique was used as pancreas transplanting technique, and syngeneic pancreas was transplanted to the cervical region. In the test groups, the extirpated pancreas was preserved in UW solution for 48 hours or 72 hours and perfused by using a physiological saline or a storage solution of the present invention, or the extirpated pancreas was preserved in a storage solution of the present invention for 72 hours and perfused with a storage solution of the present invention. The take rate of the transplanted organ is shown in Table 2. Effect of various types of storage solution and perfusate in rat pancreas transplantation Storage Solution Perfusate Take rate of transplanted organ Preserved for 48 hours Preserved for 72 hours UW solution Physiological saline 44% 0% Carolina Rinse solution 63% 0% Storage solution of this invention (Example 1) 100% 56% Storage solution of this invention (Example 1) Storage solution of this invention (Example 1) 100% 80% As is apparent from Table 2, when perfusion was carried out with a storage solution of the present invention, it was possible to preserve the organ for a longer period of time than when perfusion was carried out with a physiological saline or Caroline Rinse solution. Further, the organ could be preserved for the longest period of time when organ storage and perfusion were carried out by using a storage solution of the present invention. Test Example 3 Using male rats with body weight of 150-250 g as test animal and employing Cuff technique as heart transplanting technique, syngeneic heart was transplanted to the cervical region. In the test groups, the extirpated heart was preserved in UW solution for 18 hours and perfused with a physiological saline, Caroline Rinse solution or a storage solution of the present invention, or the extirpated heart was preserved in a storage solution of the present invention for 18 hours and perfused with a storage solution of the present invention. The take rate of the transplanted organ is shown in Table 3. Effect of various types of storage solution and perfusate in rat heart transplantation Storage solution Perfusate Take rate of transplanted organ UW solution Physiological saline 50% Carolina Rinse solution 50% Storage solution of this invention (Example 1) 100% Storage solution of this invention (Example 1) Storage solution of this invention (Example 1) 100% As is apparent from Table 3, when perfusion was carried out with a storage solution of the present invention, the take rate of the transplanted organ was better than when perfusation was conducted with a physiological saline or Carolina Rinse solution. Further, good results were obtained when organ storage and perfusion were carried out with a storage solution of the present invention.

Claims: An organ storage solution and/or perfusate comprising sodium lactobionate, sodium dihydrogenphosphate, raffinose, glutathione, allopurinol and nafamostat mesilate. An organ storage solution and/or perfusate according to claim 1, having a composition of 100-120 mM sodium lactobionate, 25-35 mM sodium dihydrogenphosphate, 25-35 mM raffinose, 2-4 mM glutathione, 1-2 mM allopurinol and 0.5-1 mM nafamostat mesilate and has an osmotic pressure of 290-350 mOsm/1 and a pH of 7.0-8.0. An organ storage solution and/or perfusate comprising sodium lactobionate, sodium dihydrogenphosphate, raffinose, glutathione, allopurinol, nafamostat mesilate and cyclodextrin. An organ storage solution and/or perfusate according to claim 3, having a composition of 100-120 mM sodium lactobionate, 25-35 mM sodium dihydrogenphosphate, 25-35 mM raffinose, 2-4 mM glutathione, 1-2 mM allopurinol, 0.5-1 mM nafamostat mesilate and 3-30 mM cyclodextrin and has an osmotic pressure of 290-350 mOsm/1 and a pH of 7.0-8.0. Use of a solution comprising sodium lactobionate, sodium dihydrogenphosphate, raffinose, glutathione, allopurinol and nafamostat mesilate in the preservation of an organ. Use according to claim 5 of a solution having a composition of 100-120 mM sodium lactobionate, 25-35 mM sodium dihydrogenphosphate, 25-35 mM raffinose, 2-4 mM glutathione, 1-2 mM allopurinol and 0.5-1 mM nafamostat mesilate and having an osmotic pressure of 290-350 mOsm/l and a pH of 7.0-8.0. Use of a solution comprising sodium lactobionate, sodium dihydrogenphosphate, raffinose, glutathione, allopurinol, nafamostat mesilate and cyclodextrin in the preservation of an organ. Use according to claim 7 of a solution having a composition of 100-120 mM sodium lactobionate, 25-35 mM sodium dihydrogenphosphate, 25-35 mM raffinose, 2-4 mM glutathione, 1-2 mM allopurinol, 0.5-1 mM nafamostat mesilate and 3-30 mM cyclodextrin and having an osmotic pressure of 290-350 mOsm/l and a pH of 7.0-8.0. A method of preserving an organ comprising storing the organ in a storage solution and/or perfusing it with a perfusate, the method being characterised in that the storage solution and/or the perfusate is a solution comprising sodium lactobionate, sodium dihydrogenphosphate, raffinose, glutathione, allopurinol and nafamostat mesilate and advantageously cyclodextrin. A method according to claim 9 wherein the storage solution and/or the perfusate is a solution having a composition of 100-120 mM sodium lactobionate, 25-35 mM sodium dihydrogenphosphate, 25-35 mM raffinose, 2-4 mM glutathione, 1-2 mM allopurinol and 0.5-1 mM nafamostat mesilate, and advantageously 3-30 mM cyclodextrin, and having an osmotic pressure of 290-350 mOsm/l and a pH of 7.0-8.0.

Inventors: DOHI KIYOHIKO, IWATA MASANORI, URUSHIHARA TAKASHI, DOHI, KIYOHIKO, IWATA, MASANORI, URUSHIHARA, TAKASHI, URUSHIHARA, TAKASHI, OKUNO MANSHON 503
Applicants: TORII PHARMACEUTICAL CO LTD, TORII PHARMACEUTICAL CO., LTD.
Application year: 1993
Main classification: A01N1
IPC codes: A01N1