PULMONARY ADMINISTRATION OF DRY POWDER ALPHA 1-ANTITRYPSIN

Abstract: It is a general object of the present invention to provide methods of administering alpha 1-antitrypsin dry powder pulmonarily to a patient. The methods of the present invention generally provide enhanced persistence of alpha 1-antitrypsin in critical tissues of the lower respiratory tract. These methods are generally useful in the treatment of alpha 1-antitrypsin deficiency and the functional derangements of emphysema.

Description: PULMONARY ADMINISTRATION OF DRY POWDER ALPHA 1 -ANTITRYPSIN BACKGROUND OF THE INVENTION Neutrophil elastase is a broad spectrum protease that is known to have access to the tissues of the lung. This protease is generally capable of degrading all major protein components of the alveolar interstitium. The unrestrained action of this protease, with its elastolytic properties can lead to the destruction of lung connective tissue and to the anatomic and functional derangements of pulmonary emphysema. Smith, et al., J. Clin. Invest. 84:1145-1154 (1989). αi-antitrypsin ("αlAT") is a protease inhibitor with inhibitory activity toward neutrophil elastase. A deficiency of αl-antitrypsin in the lower respiratory tract has been found to be central to the pathogenesis of emphysema due to the critical role of αlAT in protecting alveolar structures from neutrophil elastase. αlAT deficiency is a genetic disorder characterized by low plasma and lung levels of the inhibitor and the development of emphysema by the third to fourth decades. In addition to genetic deficiencies in αlAT, it has been found that the lungs of cigarette smokers are burdened with neutrophils. In particular, significantly increased numbers of neutrophils have been found in cell suspensions isolated from bronchoalveolar lavage fluid and from open lung biopsies of both normal and sarcoid cigarette smokers compared with non-smokers. Hunnighake and Crystal, Am. Rev. Respir. Dis. 128:833-838 (1983). Treatment methods for αlAT deficiency, whether genetic or acquired, have primarily focused around 'augmentation therapy, providing an exogenous source of αlAT to patients suffering from such a deficiency. Intravenous administration has been previously employed in this augmentation therapy to provide an exogenous source of αlAT. However, in order to provide effective concentrations of the inhibitor in the tissue where it is needed, e.g. , lung tissue, intravenous methods require administration of large amounts of αlAT, e.g., 4 to 5 grams/week. Further, this intravenous administration generally must be carried out in a hospital setting. Successful results have been reported using aerosol administration of liquid αlAT formulations. Aerosol administration provides local delivery of the inhibitor to the effected tissue of the lower respiratory tract, thereby requiring lower dosages. See, Published European Patent Application No. 0 289 336, Smith et al., J. Clin. Invest. 84:1145-1154 (1989), Hubbard et al. J. Clin. Invest. 84:1349- 1354 (1989), Hubbard, et al. Lung Suppl. 565-578 (1990). Despite the improvements in olAT augmentation therapy, problems still remain. In particular, previously reported liquid aerosol methods provide effective levels of αlAT in the lung tissue for only short periods, e.g., on the order of several hours, thereby requiring often repeated treatments at higher dosage levels, e.g., >200 mg/day. Thus, there is need for a method of administering αlAT to patients which will provide longer term benefits from a single treatment, thereby requiring lower and fewer doses. The present invention meets these and other needs. SUMMARY OF THE INVENTION It is a general object of the present invention to provide methods for pulmonary administration of αlAT dry powder compositions. The methods of the present invention generally provide enhanced persistence of l-antitrypsin in critical tissues of the lower respiratory tract over previously described administration methods. The methods of the invention generally comprise providing the αl-antitrypsin as a dry powder. The dry powder αl-antitrypsin is aerosolized and administered pulmonarily to the patient. The methods of the invention are generally useful in treatment of individuals who suffer from a deficiency of αl-antitrypsin, whether genetic or acquired, and are particularly useful in the treatment of the functional derangements of emphysema. Aerosolization of the dry powder αlAT for pulmonary administration is generally carried out by the use of a dry powder inhalation device, thus, the present invention also provides an apparatus for carrying out the pulmonary administration of αl-antitrypsin dry powders, which device generally includes a housing having a chamber disposed therein, which chamber contains an effective amount of an αl- antitrypsin dry powder composition. The device further includes a gas pressure source fluidly connected to the chamber, for delivering a gas stream to the chamber to aerosolize the dry powder composition. Also included in the device is a delivery system for delivering the aerosolized dry powder composition for inhalation by the patient, fluidly connected to the chamber. BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 shows the concentration of αl-antitrypsin in lymph tissue over time, following dry powder aerosol exposure. Three sheep were tested by different exposure protocols. Figure 2 shows the concentration of αl-antitrypsin in lymph tissue over time, following dry powder aerosol exposure. Two exposures were conducted at time 0 and at 50 hours. Figure 3 shows αlAT levels recovered from sheep pulmonary lymph following multiple administrations by inhalation. Aerosol administrations are marked by arrows. Figure 4 shows mean lymph and plasma concentrations of αlAT in sheep (n=3) following multiple administrations. Administrations are marked by arrows. Figure 5 illustrates a schematic of alveolar structures involved in the movement of αlAT from the alveolar airspace into the plasma. DETAILED DESCRIPTION OF THE INVENTION I. General The present invention generally provides methods and apparatuses for administering αl-antitrypsin to a patient. Typically, such administration is useful in treating patients who suffer from a deficiency of endogenous αl-antitrypsin. By "deficiency of endogenous αlAT" is meant that the endogenous levels of αlAT are insufficient to provide protection against the levels of neutrophil elastase that are present. These deficiencies may be manifested as below normal levels of αlAT or as excessive levels of neutrophil elastase in the targeted tissue. The methods of the present invention generally comprise administering αl-antitrypsin dry powder, pulmonarily to the patient. The administration methods of the present invention generally provide enhanced persistence of αl- antitrypsin within the lung tissue over previously described aerosol administration methods. II. Dry Powder Formulation Aerosol administration of pharmaceutical compositions has been previously reported in treating a number of disorders. For example, respiratory delivery of aerosolized insulin solutions has been described in substantial detail. See, e.g., Laube, et al., J. Am. Med. Assoc. 269:2106-2109 (1993), Elliott et al., Aust. Pediat. J. 23:293-297 (1987) , Wiglet et al., Diabetes 20:552-556 (1971), Corthorpe et al., Phar . Res. 9:764-768 (1992). Pulmonary administration of dry powder medicaments, such as insulin, in a large particle carrier vehicle is described in U.S. Patent No. 5,254,330. A metered dose inhaler for delivering crystalline insulin suspended in a propellant is described in Lee, et al., J. Pharm. Sci. 65:567- 572 (1976). Pulmonary administration of dry powder αlAT may generally be carried out by dry powder administration methods that are known in the art. For example, dry powder administration methods that are particularly suited for the administration and treatment methods of the present invention are described in U.S. Patent Application No. 08/423,515, filed April 14, 1995, and incorporated herein by reference in its entirety for all purposes. αl-antitrypsin ("αlAT") for use in the methods of the present invention may generally be obtained from a variety of sources. For example, both natural and recombinant forms of αlAT are commercially available from, e.g., Cutter Laboratories, Berkeley CA, and Cooper Labs, Mountain View CA, respectively. Alternatively, αlAT may be isolated from human sources, e.g., derived from Cohn fraction IV-I of human plasma, or produced by well known recombinant methods. See, U.S. Patent No. 4,599,311. Preparation of the dry powder αlAT formulations may generally be carried out using a variety of well known methods including lyophilization, spray drying, agglomeration, spray coating, extrusion processes and combinations of these. In preferred embodiments, the dry powder αlAT formulation is prepared using a spray drying/agglomeration process which produces a substantially amorphous powder of homogenous constitution having a particle size that is readily respirable, has a low moisture content and has flow characteristics that allow for ready aerosolization. Methods of preparing spray dried, respirable powder compositions are described in, e.g., U.S. Application Serial No. 08/423,515, filed April 14, 1995, and previously incorporated herein. Typically, in the spray drying process, a homogenous aqueous solution of αlAT, which may or may not include a suitable carrier, is introduced via a nozzle, spinning disk or equivalent device into a hot gas stream to atomize the solution to form fine droplets. Although described as a solution, the aqueous form of the αlAT may be in solution, suspension, slurry or other homogenous liquid form, but is preferably in solution. The solvent in which the αlAT is dissolved, suspended or slurried rapidly evaporates from the droplets producing a fine dry powder having particles primarily from 1 to 5 μm in diameter. Preferably, the particle size of the resulting powder is such that more than about 98% of the mass of the dry powder is in particles having a diameter of about 10 μm or less, with more than about 90% of the mass being in particles having a diameter of less than about 5 μm. Alternatively, about 95% of the mass will have particles of less than about 10 μm with about 80% of the mass being in particles having a diameter of less than or equal to about 5μm. Spray drying may be carried out using conventional, commercially available spray drying equipment such as that which is available from Buchi, Niro, Yamato Chemical Co., Okawara Kakoki Co. and the like, which equipment is generally capable of producing an amorphous powder product. Typically, these machines are capable of operating across a wide range of parameters. For example, a Buchi-190 spray dryer may be utilized to prepare the dry powder compositions by operating at between 5 and 20 ml/min, with an atomizing pressure of 50 to 120 psi, an atomizing air feed rate of 20 to 80 1pm and a drying temperature of from 50 to 200 β C. For the spray drying process, such spraying methods as rotary atomization, pressure atomization and two-fluid atomization can be used. Examples of the devices used in these processes include the Parubisu Mini-Spray GA-32 and "Parubisu Spray Drier DL-41," manufactured by the Yamato Chemical Co., or the CL-8, L-8 FL-12, FL-16 or FL-20 model spray driers manufactured by Okawara Kakoki Co. This equipment can be readily employed for spray drying the compositions described herein, including rotary disk atomizer spray drying methods. The above described dry powders are readily useable in the methods described herein. However, in some aspects, it may be desirable to provide the dry powder formulation in a form that possesses better handling characteristics, e.g., flowability, low caking and the like. Production of aggregate or agglomerate compositions is described in, e.g., U.S. Application Serial No. 08/483,467, filed June 7, 1995, and incorporated herein by reference in its entirety for all purposes. In a particular aspect, the dry powder formulations described herein are provided as aggregates or agglomerates of the above described fine powder compositions. Generally, agglomeration of the above described fine powder compositions is carried out by combining the powder of fine particles with a binding liquid to produce a wetted mass. The wetted mass is then divided into small volumes which are dried to remove the binding liquid and to produce dry powder agglomerate units having a first size distribution. This is typically carried out by well known methods, e.g., extrusion. Extrusion methods typically involve the extrusion of the wetted mass or paste through a screen having holes that are in the range of 40-650 μm and more preferably in the range of from about 150-500 μm. The holes in the screen are typically circular in geometry, thereby producing an elongated cylindrical extrudate. The extrudate is typically dried at a temperature of from about 15°C to about 40°C, depending upon the nature of the material being dried. Typically, forced air convection driers or vacuum driers are used in drying the extrudate. Typically, vacuum dryers will subject the aggregate particles to a pressure of from about 250 to about 650 mm Hg. Binding liquids may include a variety of liquids compatible with the pharmaceutical compositions being prepared, e.g., water, saline, and the like. Additionally, in some aspects, the binding liquid is a nonaqueous solvent, e.g. , fluorocarbon, toluene, xylene, benzene, acetone, hexane, octane, chloroform and methylene chloride. The use of nonaqueous solvents as binding liquids is generally advantageous as carbohydrates and proteins that are generally included in the agglomerate compositions described herein typically have low solubility in these liquids, thereby minimizing the potential for formation of crystalline bridges between the fine powder particles in the agglomerate. Further, most nonaqueous solvents have a low surface tension allowing the larger agglomerate particles to be broken down when needed. Examples of preferred nonaqueous solvents include fluorocarbon liquids such as perfluorodecalin and perfluorooctyl bromide. Fluorocarbon liquids are typically preferred due to their hydrophobic and lipophobic nature that does not dissolve or otherwise interact with proteins or carbohydrates. The high vapor pressure of fluorocarbon liquids is also useful in removing the liquid from the agglomerate particle. These fluorocarbon liquids are also generally biocompatible in most pharmaceutical compositions, and are generally commercially available from a variety of commercial suppliers, e.g., PCR, Inc. (Gainesville, FL) , Sigma Chemical Co. (St Louis, MO) and Aldrich Chemical Co. (Milwaukee, WI) . The amount of binding liquid added to the dry powder composition is generally based on the surface area of the fine particles. For example, where a fluorocarbon binding liquid is used with the fine particles of the initial dry powder compositions, e.g., those having a size range of from 1-5 μm, the liquid is added to the powder in the range of from about 0.5 gram to 5 grams liquid per gram of powder. The dry powder agglomerates produced in this first series of steps are then adjusted to have a second size distribution characterized by a friability index of from about 10 to about 60. When adjusted, the aggregate particles will typically be durable enough to resist breaking apart during normal handling and metering procedures. At the same time, the particles are typically sufficiently friable to allow the aggregates to be broken up when needed, i.e., during administration. Friability indices are generally calculated by placing a small sample, e.g., 0.4 to 0.5 g, of the aggregate composition on a lOOOμm screen. The screen is vibrated at an amplitude of approximately 1 cm and a frequency of approximately 5 Hz for 20 minutes. After 20 minutes, the aggregates remaining on the 1000 μm screen are weighed and this weight is then divided by the beginning weight. The percentage of aggregates that have not broken down through the 1000 μm screen is the friability index. Adjustment of the aggregate particle composition to the second size distribution is generally carried out by sieving the agglomerate composition through a series of screens or sieves having a desired screen size range. For example, where a size range distribution of from about 150-500 μm is desired, the aggregated particles are placed on a set of stacked screens. The top screen will have a passage of approximately 500 μm, whereas the bottom screen will have a passage of 150 μm. The aggregate particles are placed on the top screen and sieved, i.e., by vibration and/or tapping. All particles exceeding the 500 μm size limit are retained on the top screen from which they may be discarded or subjected to reprocessing. Particles smaller than 500 μm will pass to the bottom screen where particles exceeding 150 μm will be retained. Those particles that pass the second screen are collected, i.e., in a pan below the second screen, from which they may be discarded or reprocessed. Typically, the second size distribution will have a mean particle size between about 50 μm and about 600 μm, preferably between about 150 μm to about 500 μm, and most preferably between about 200 μm and 500 μm. The agglomerates are typically formed/selected whereby greater than 90% of the agglomerate composition falls within a size range that is ± 250 μm, and preferably within a range of ± 150 and more preferably within about ± 100 μm. The dry powder agglomerates may also be spheronized, i.e., given a spherical geometry, by well know methods, e.g., rolling methods, such as those commonly used in pan coating operations. This typically involves rolling the particles in a container to result in a spherical particle being produced. Agglomerate compositions may also be prepared in fluid bed drying apparatuses. Typically, this involves first fluidizing the dry powder composition in a stream of hot air. The binding liquid is then sprayed into the fluidized powder through a nozzle. The wetting of individual particles allows for the agglomeration of other particles thereto. The concurrent drying of the hot air stream prevents formation of agglomerates having low friability. Fluid bed dryers are also commercially available from, e.g., Glatt Air Techniques, Inc. Dry powder compositions may also be prepared using other drying processes such as agglomeration processes, extrusion, spray coating and lyophilization and jet milling processes. Lyophilization/jet milling processes for preparation of dry powder polypeptide formulations are described in, e.g., Published PCT Application No. WO 91/16038. In preferred aspects, the dry powder αlAT compositions for use in the methods described herein will be substantially pure. By substantially pure, is meant that within the dry powder formulation, αlAT will make up the predominant component on a weight/weight basis. Typically for example, the dry powder formulation will be greater than about 30% αlAT by weight. In preferred aspects, the dry powder formulation will be greater than about 70% αlAT by weight, more preferably greater than about 80% αlAT by weight. In still more preferred aspects, the dry powder formulation will be greater than about 90% αlAT by weight with dry powder formulations of greater than about 95% αlAT and greater than about 99% being most preferred. Calculation of weight percent of αlAT may be carried out by any of a variety of well known methods, e.g., immunosorbent assays, activity based assays, and the like. Where the dry powder composition contains elements other than αlAT, the remaining fraction of the composition may generally comprise one or more of a number of other elements. For example, the dry powder composition may contain products of the spray drying process, i.e., inactive αlAT species, or other macromolecular components remaining from the preparation of the αlAT. In particularly preferred aspects, however, pure or nearly pure αlAT is used to formulate the dry powder compositions. In particular, αlAT compositions that are greater than 90% and more preferably greater than 95% pure, are used to formulate the dry powder compositions. In addition to the above described additional elements, a variety of adjuncts may be added to the dry powder formulation, either during the spray drying process or after the spray drying process by addition of a dry component via dry powder blending methods. For example, in some aspects, it may be desirable to combine the αlAT with one or more pharmaceutical carriers or excipients which are suitable for respiratory and pulmonary administration. Such carriers may serve as bulking agents, e.g. , when it is desirable to reduce the concentration of the αlAT delivered to the patient in a single dose, or may serve to enhance the efficacy of the formulation, either as a stabilizing agent for the dry powder composition, a dispersing agent to enhance the handling properties of the formulation, an adjuvant that enhances the activity of the αlAT within the tissue of the lung, e.g. , buffering agents and the like. Examples of suitable pharmaceutically acceptable excipients or bulking agents include carbohydrates, polypeptides, amino acids or combinations thereof. Suitable carbohydrates include, e.g., monosaccharides such as galactose, D-mannose, sorbose and the like, disaccharides, such as lactose, trehalose and the like, cyclodextrins, such as 2-hydroxypropyl-/3-cyclodextrin, and polysaccharides, such as raffinose, maltodextrins, dextrans and the like, alditols, such as mannitol, xylitol and the like. Preferred carbohydrates include lactose, trehalose, raffinose, maltodextrins, and mannitol. Suitable polypeptides include, e.g., aspartame and the like, whereas suitable amino acids include, e.g., alanine and glycine. The carrier materials may be combined with the αlAT prior to spray drying, e.g., by adding the carrier to the αlAT solution. This ensures that the carrier is dried simultaneously with the αlAT to produce a homogenous dry powder. Alternatively, the carriers may be separately dried or obtained as a dry powder, and blended with the αlAT powder. Dry powder carriers for blending with αlAT dry powders are typically crystalline (to reduce water absorption) but may also be amorphous. The size of the carrier may generally be selected to improve the flowability of the αlAT powder, typically in the range of from about from about 25μm to about 100 μm. Crystalline lactose is a particularly preferred dry powder carrier. While it is possible to administer the αlAT ingredient in pure form, i.e., without adjunct ingredients, it is often desirable to include additional components with the αlAT, e.g., provide the αlAT as part of a pharmaceutical formulation. These formulations comprise the αlAT in a therapeutically or pharmaceutically effective dose together with one or more pharmaceutically or therapeutically acceptable carriers and optionally other therapeutic ingredients. Various considerations are described, e.g., in Gilman et al. (eds) (1990) Goodman and Gilman's: The Pharmacological Bases of Therapeutics, 8th Ed., Pergamon Press; Novel Drug Delivery Systems, 2nd Ed., Norris (ed.) Marcel Dekker Inc. (1989), and Remington's Pharmaceutical Sciences, 18th Ed. (Mack Publishing Co. 1990) , the full disclosures of which are incorporated herein by reference. Specific examples of adjunct components in the αlAT formulations described herein include, e.g., bulking agents, buffers, and other pharmaceutical agents for co-administration with the αlAT, such as carbohydrate carriers and the like. III. Administration In a particular aspect, the present invention provides a method of pulmonarily administering αlAT dry powder to a patient. Such methods are particularly useful in the treatment of patients suffering from disorders characterized by a deficiency of αlAT within the tissues of the lung. These disorders may be a result of a genetic deficiency or a consequence of external influences, e.g., chronic smoking, etc. By administering αlAT pulmonarily, as a dry powder composition, an enhanced persistence of αlAT in the tissues of the lung is obtained. By "pulmonary administration" or "administering pulmonarily" is meant a route of administration that delivers an effective amount of the compound so administered to the tissues of the lower respiratory tract. Such administration generally entails inhalation of the subject compound by the patient, thereby drawing the compound into the deep lung. Delivery of powdered medicaments to the lungs is typically accomplished by use of an inhalation device which fluidizes the powdered medicament in an airstream which can then be inhaled by the patient to deliver the medicament to the patient's lungs. By providing the aggregated particles having a desired friability index, as described previously, the aggregated particles can be broken down into powdered form within the inhaler. In this way, the powdered medicaments can remain in agglomerate form for measurement and handling until needed for pulmonary delivery by the inhaler. The aggregated particles are generally delivered to the inhaler in unit dosage receptacles, commonly referred to as blister packs or cartridges. The manufacture of blister packs is typically carried out by methods that are generally well known in the packaging art. To extract the aggregated particles from the receptacle, a wall of the receptacle is pierced when the receptacle is inserted into the inhaler, or while within the inhaler. With the receptacle opened, the aggregated particles are extracted into a gas stream that has sufficient disruptive force, i.e., shear force, to break down the aggregated particles into their constituent fine powder elements. Typically, adequate disruptive forces are supplied by a gas stream having a sonic velocity. In alternative aspects, the blister pack or receptacle may be subjected to vibratory energy prior to piercing of the receptacle to break down the aggregate particles into the substituent fine powder. Typically, the aggregate particles will be substantially broken down to their substituent fine powder elements prior to inhalation. For example, typically greater than 30% of the aggregate particles subjected to the disruptive forces of the gas stream will be broken down. Preferably, at least about 50% of the aggregate particles will be broken down and most preferably, greater than about 70% of the aggregate particles will be broken down when subjected to the gas stream, etc. prior to inhalation by the patient. By "broken down" is meant disintegration of the larger aggregate particles, as described above to the smaller fine powder particles, also described above, e.g., the fine powder particles having a diameter of from about 1 μm to about 5 μm. When the aggregate particles are within the desired size range of 200-500μm, substantially complete removal of the aggregate particles from the receptacle is obtainable, as larger sized aggregates may become trapped behind the pierced walls of the receptacle. By "substantially complete removal" is meant greater than about 55%, preferably, greater than about 70%, and more preferably, greater than about 90% by weight. A variety of inhalation devices have been previously described for aerosol administration. See, e.g., U.S. Patent Nos. 4,137,914, 4,174,712, 4,524,769, 4,667,688, and Published PCT Application Nos. PCT/SE93/00389, PCT/SE93/01053, PCT/DK90/00005 and U.S. Patent Application Serial No. 08/309,691, filed September 21, 1994. A particularly preferred dry powder inhaler is that described in U.S. Patent Application Serial No. 08/487,184. Generally, this inhaler device is particularly suited for the delivery of dry powder compositions that are formed from discrete fine powder particles ranging in size from 1-5 μm. The preferred device generally employs a two-step dispersion technique to achieve optimal dispersion of the dry powder composition. Typically, the powder composition, e.g., the aggregate or agglomerate composition, is fluidized within a unit dosage receptacle, such as a blister pack. The fluidized agglomerate particles are then dispersed in the high velocity gas stream under conditions which break up such agglomerated particles into their constituent powder elements. Such complete dispersion can be achieved with very low volumes of high velocity air and having relatively high particle concentrations. This apparatus is also capable of use with compositions containing greater amounts of diluents, e.g., bulking agents, and the like. The device generally incorporates a feed tube having a powder inlet end which is inserted into the receptacle, i.e. through a penetration in the lid or access surface of the receptacle. A high velocity airstream is flowed past the outlet end of the feed tube, drawing the powder from the receptacle into the airstream to form the desired aerosol. The velocity of the airstream, as described above, is typically sonic, to allow for break-up of agglomerate particles. Typically, a second penetration is also provided in the receptacle to allow a separate stream of fluidization air to enter the receptacle and sweep the aerosolized powder, ensuring maximal recovery of the powder from the receptacle. The high pressure gas stream is typically generated by abruptly releasing a charge of pressurized gas through a flow path that intersects with the outlet end of the feed tube at an angle selected to both (1) induce sufficient fluidization air flow through the feed tube to fluidize and transport the powder in the receptacle and (2) break up powder agglomerates which remain as the powder exits from the outlet end of the feed tube. The gas pressure prior to release will usually be at least about 15 psig (to achieve sonic velocity) , preferably being at least 20 psig, and usually being in the range from 40 to 80 psig. The expanded volume of gas (measured at standard temperature and pressure ("STP") of 14.7 psig and 20°C) will therefore usually be in the range of from 2 ml to 25 ml, and preferably 4 ml to 15 ml. The release of the high pressure gas can be effected by a manual trigger or optionally by sensing negative pressure caused by a patient's inhalation (i.e., breath activated). The aerosolized powder will also typically be captured within a plume capture chamber, prior to inhalation by the patient, to avoid difficulties associated with delivering a high pressure dose directly to the patient. The aerosolized powder within the plume chamber is then inhaled by the patient concurrently with, and/or followed by breathing ambient air, i.e., through a separate inlet in the plume chamber, which aids in sweeping the entire dose of the powder from the plume chamber and forcing the powder into the deep lung. IV. Therapeutic Applications The methods of the present invention are particularly applicable in therapeutic applications for the treatment of patients who are deficient in, or could otherwise benefit from augmentation of increased levels of αlAT in the tissues of the lung. As described above, examples of such patients include genetic disorders characterized by low plasma and lung levels of the αlAT inhibitor and the functional derangements of pulmonary emphysema. By "patient" is generally meant a mammalian patient for whom treatment is sought. Although the methods described herein may be generally applicable to a variety of mammalian species, preferably, as used herein, the term patient will generally refer to human patients. By "treatment of a patient" is meant the full spectrum of therapeutic treatments for a particular disorder ranging from a partial alleviation of symptoms to an outright cure for the particular disorder. Treatment is typically effected by the pulmonary administration of a therapeutically effective amount of dry powder αlAT. By "therapeutically effective amount" is meant an amount of αlAT that is sufficient to effect treatment of the particular disorder for which treatment is sought, i.e., sufficient augmentation of αlAT levels in the lower respiratory tract. Typically, such therapeutically effective amounts will be sufficient to provide an amount of αlAT within the tissue of the lower respiratory tract that is similar to that of non-deficient individuals. Typically, treatment of the above described disorders will be affected by administering dosages of αlAT dry powder that total in the range of from about 1 to about 80 mg of αl-antitrypsin daily. Preferably, a therapeutically effective amount will range from about 5 to about 25 mg of αl- antitrypsin daily, and more preferably, from about 10 to about 20 mg of αl-antitrypsin daily. In particularly preferred aspects, the methods of the present invention and as described above, may be used in the treatment of patients suffering from pulmonary emphysema. To achieve the desired therapeutic amount, it may be desirable to provide for repeated administrations, i.e., repeated individual inhalations of a metered dose. The individual administrations are repeated until the desired daily dose is achieved. As described above, the methods of administering the dry powder αlAT to the patient generally include providing αlAT as a dry powder, aerosolizing that powder, and presenting it to a patient for inhalation. This is generally carried out using the methods and apparatuses that are substantially described above. The present invention is further illustrated by the following examples. These examples are merely to illustrate aspects of the present invention and are not intended as limitations of this invention. V. Examples Example 1- Spray Drvinσ of αlAT Purified human plasma αlAT was supplied by Armour Pharmaceutical Co. , Kankakee, IL. The αlAT was formulated in citrate buffer. The buffered αlAT was spray dried into a fine dry powder composition. Spray drying was carried out using a Buchi-190 spray dryer with a feed rate of 5 ml/min, an atomization pressure of 120 psi, an atomizing feed rate of 80 lpm and a drying temperature of 80°C. The majority of the mass of the composition had a respirable particle size (aerodynamic diameter less than 5μm) . The dry powder composition contained approximately 73% αlAT, 3.7% moisture and 16.9% bulking agent. The specific inhibitory activity of the powder was determined by assaying the inhibitory activity of the powder against trypsin. The powder assayed at approximately the same specific activity as the protein prior to drying. Blister packages were filled with 5 mg of the powder composition under controlled conditions and were stored in desiccated pouches at room temperature until used. Stability analysis of αlAT in the dry powder aerosol over time of the experiments confirmed that there was no detectable loss of activity as measured by the trypsin inhibition assay. Physical stability of αlAT dry powder was characterized by the following parameters: (1) Mass median aerodynamic diameter (MMAD) , as determined by a California Instrument cascade impactor operated at 12.5 lpm; (2) respirable fraction (mass having an aerodynamic particle size less than 5 μm) ; and (3) diεperεibility as measured by filter collection at the mouthpiece of the aerosolization device at 30 lpm for 2.5 seconds (see Table I). Table I Time Dispersibility MMAD Resp. Fract. (STP) % < 5μm Initial 6 633. .66 1.3 90 ( 3 . 5 ) Pre-study 7722 ..66 1.3 90 (3 mos. ) ( 9 . 3 ) Post-Study 72.5 1.2 92 (6 mos.) (6.3) Example 2- Evaluation of Aerosol Exposure of αlAT in Sheep Models Mixed breed sheep (36 ± 3 kg) were used to determine optimal administration methods for the dry powder αlAT composition. One sheep was studied at a time. Two days prior to aerosol exposure, the caudal efferent lymphatic duct, carotid artery and jugular vein of the sheep were cannulated under general anesthesia (lymph duct cannula: 030 X 050 Tygon tubing, Fisher Scientific Co., artery and vein cannula: Extension tube, Baxter-Pharmaceal, CAT No. K751L) . On the day of exposure, the sheep to be studied was anesthetized with 500 mg pentothal administered intravenously (thiopental sodium, Abbott Labs, IL) and intubated with a size 10 ID endotracheal tube. Three different exposure techniques were examined (See, Table II) , two positive pressure ventilation techniques and one spontaneous breathing technique. In the positive pressure inhalation models, two ventilation modes were evaluated in two separate sheep (sheep #1 and #3) . Sheep #1 was ventilated 15 breaths/minute at 400 ml/breath with breathing-quality oxygen containing 1% Halothane (Halocarbon, NJ) using a Harvard ventilator piped through a dry powder inhalation device. Sheep # 3 was injected with 60 mg i.v. succinylcholine, a muscle relaxant, and was ventilated 10 breaths/minute at 600 ml/breath with oxygen containing 1% Halothane. In the spontaneous breathing model, Sheep # 2 was injected with Ketamine to provide anesthesia, 25 mg/kg i.v. (Ketaset, Fort Dodge Lab, Inc. IA) , and was allowed to breath ambient air through the dry powder inhalation device. Aerodynamic size distribution was measured using the California Measurements cascade impactor. The aerosol mass median aerodynamic diameter and the respirable fraction (mass fraction having less than 5 μm aerodynamic particle size) were 1.3 ± 0.1 μm and 90%, respectively. This formulation had a dispersibility of 63 ± 3% in the device used. Evaluation of the three exposure techniques involved measurement of (1) the portion of aerosol available for inhalation (% of aerosol available at the mouthpiece of the inhalation device) and (2) lymph and plasma levels of αlAT. Evaluation of the device efficiency, e.g., the ability to deliver aerosol to the endotracheal tube, was measured to be 23 ± 1%, 32 ± 4% and 31 ± 1%, for the positive pressure inhalation model without the muscle relaxant ("PPI") (15 breaths/minute, 400 ml/breath) the positive pressure with muscle relaxant ("PPIMR") (10 breath/minute, 600 ml/breath) and the spontaneous breathing model (100-200 ml/breath) , respectively. Prior to exposure, lymph and blood were sampled to establish background levels of αlAT. Each animal was exposed to 100 mg of packaged αlAT dry powder aerosol. Lymph and blood samples were taken every 30-60 minutes for 6 hours and then at 24-26 and 48-50 hours, post dosing. Sheep #2, the spontaneous breathing animal was exposed again to aerosol αlAT at 50 hours after the first exposure and was lavaged 5 hours later. At the end of each study, blood was drained while the lungs were kept ventilated to prevent them from collapsing, then each lung was completely lavaged. This was carried out by surgically exposing the neck and chest, and lavaging one lung at a time by clipping the other lung shut and injecting 6 X 200 ml isotonic saline washes through a Tygon tube connected to a 50 ml syringe. The recovered washes from each lung were pooled together to give a total lung lavage sample. All samples, lymph and blood, were placed on ice until they were centrifuged for 3 minutes at 3000 rpm. They were kept frozen at -70°C until they were analyzed by ELISA. Table II shows the efficiency of the devices used for the aerosol delivery of the αlAT to the entrance of the endotracheal tube (shown as Respirable %) for the various delivery methods. Also shown is the peak lymph level of αlAT. Table II Sheep # Inhalation Model Respirable % Peak Lymph Level of αlAT (nM) Positive pressure: 23±1 5.8 15 breaths/minute; 400 ml/breath Spontaneous breathing: 32±4 12.2 100-200 ml/breath Positive Pressure: 31±1 29.4 10 breaths/minute; 600 ml/breath; paralyzed animal αlAT dry powder aerosol administered pulmonarily to sheep, as described above, increased the levels of αlAT in the lymph from 0.3 nM (0.014 μg/ml) to 5.8 nM (0.29 μg/ml), 12.2 nM (0.61 μg/ml) and 29.4 nM (1.47 μg/ml) and increased blood αlAT levels from 0.6 nM (0.03 μg/ml) to 1.9 nM (0.093 μg/ml), 4.3 nM (0.217 μg/ml) and 7.6 nM (0.38 μg/ml) at 48 hours post exposure in Sheep # 1, 2 and 3, respectively. See Figure 1. In sheep #2, which was initially exposed to αlAT aerosol by the spontaneous breathing method, described above, and again after 50 hours by positive pressure inhalation (600 ml/breath, without relaxant) , the lymph level of αlAT after the second exposure rose from 0.61 μg/ml to 0.92 μg/ml within 5 hours after the second exposure. αlAt levels in the epithelial lining fluid ("ELF") were 0.4 μM in Sheep #1 (lavaged 50 hours post exposure) and 1.3 μM in sheep #3 (lavaged 72 hours post exposure) . In sheep #2, which was exposed a second time at 50 hours after the initial exposure, αlAT levels in the ELF were 2.9 μM (lavaged 21 5 hours after the second exposure) . These values were calculated from the lavage washes assuming 20 ml of ELF. The PPMR technique used in Sheep #3 gave the highest lymph levels of αlAT and was selected for use in subsequent examples. Example 3- Determination of Deposited Dose in Sheep Three sheep were pulmonarily administered αlAT dry powder according to the PPIMR method described above. The lungs were lavaged immediately following aerosol administration. The average deposited dose was calculated by multiplying the concentration of αlAT in the lavage by the lavage volume. The average deposited dose was calculated at 7.213.1 mg. This translated to a deposition efficiency of approximately 8% for this sheep exposure system. The data for each sheep is shown in Table III, below. Table III Sheep Recov'd Lavage αlAT in Lavage Deposited # (ml) (μg/ml) Dose Right Left Right Left 5 850 825 1.53 12.8 10.6 8 950 930 0.10 4.83 4.6 9 925 950 2.80 3.85 6.3 Average ± STD 7.213.1 Pulmonary absorption of pulmonarily administered dry powder αlAT was tested using the PPIMR technique described above. Again, three sheep were administered αlAT dry powder aerosol in three doses each, at time 0, at 24 hours and at 48 hours. Levels of αlAT were measured in the lymph, plasma and in the 'end-of-study' epithelial lining fluid (ELF) . αlAT dry powder deposited in sheep lungs increased lymph levels of exogenous αlAT to an average peak level of 142+73 nM (7.4+3.8 μg/ml). Figure 3 shows the lymph profiles of each of the individual sheep, with the mean profile being shown in Figure 4 (o) . The concentration/time curves exhibited a prolonged absorption profile (Figure 3 and 4) . The total amount of αlAT cleared by the lymph was calculated by multiplying the area under the curve (AUC) of the concentration profile by the average lymph flow rate (See Table IV) . Levels of exogenous αlAT in plasma were also increased to an average level 36.2 nM (1.910.1 μg/ml). The mean plasma levels of αlAT over time are shown in Figure 4 (•). The amount of αlAT absorbed from the lungs into the circulation is the peak concentration multiplied by the volume of distribution of plasma (steady state volume of distribution of sheep plasma is 109116 ml/kg body weight as measured by IV injections of radio-labeled αlAT, Smith, et al., J. Clin. Invest. 84:1145-1154 (1989) . The amounts of αlAT found in the plasma are also shown in Table IV. Addition of the contributions of both plasma and lymph levels gives the total recovery of 12.0+2.9 mg which equals 55113% of the deposited dose (See, Table 4) . Table IV Sheep AUC Avg. Amt (mg) Total Fraction # Lymph cleared by: Clearance Absorbed Flow Rate (ml/hr) Lymph Plasma (%) 4 0.402 6.5+2.6 2.6 6.1 8.7 40 6 0.712 9.213.6 6.6 7.4 14.0 65 7 0.795 7.913.2 6.3 6.6 13.2 61 Avg. 0.636 7.8 5.2 6.7 12.0 55 + 13.2 12.2 10.6 12.9 113 0.207 Epithelial lining fluid (ELF) volume was measured by Peterson, et al., Am. Rev. Respir. Dis. 141:314-320 (1990) to be 11.4 ml in a 38 kg sheep. To measure ELF levels of αlAT, sheep having an average weight of 29 kg were used. In a 29 kg sheep, the ELF volume was assumed to be approximately 10 ml, or 5 ml/lung. αlAT levels in ELF were determined as the amounts recovered by lavage from each lung, divided by 5 ml. Table V lists the number of aerosol doses, time of lavage after the last dose and the calculated ELF levels of αlAT in each lung. Protective levels of αlAT in ELF (1.7 μM) were easily achieved in all sheep studied in the absorption experiments, even when lavaged 3 days after the final dose. Additionally, the amounts of αlAT recovered in the lavage of the three sheep used in the absorption study (Sheep 4, 6 and 7) were measured at 13.417.3 mg or approximately 62% of the deposited dose. Although the deposition efficiency in these models is somewhat low (8%) , this appears to be attributable to the inefficiency of the aerosolization device when it is connected to the ventilator. In particular, losses due to the plumbing leading up to the endotracheal tube and the low inhalation volume using the ventilator account for a large amount of the lost material. Additionally, the build up of mucous around the endotracheal tube results in increased deposition within the plumbing and device as a result of the narrowed windpipe and disturbed air flow patterns. Table V 1 1 52 1.5 2.7 1.1 2 2 51 10.0 9.4 5.0 3 1 52 5.0 2.5 2.0 4 3 72 6.1 11.8 13.2 6 3 96 24.4 55.8 20.8 7 3 72 12.3 9.3 6.2 5 1 <1 5.4 45.8 10.6 8 1 <1 0.4 17.3 4.6 9 1 <1 10.0 14.1 6.3 Example 4- Estimation of Interstitial αlAT The above described experiments illustrate that dry powder αlAT administered as an aerosol is absorbed from the alveolar surface into the lung. Once in the interstitium, αlAT may either be absorbed directly into the blood or it may diffuse into the lymphatics (See Figure 5) . In the above experiments, the majority of inhaled αlAT crosses directly through the interstitium into the blood. The rest was transported into the circulation by lymphatic filtration. Staub et al., J. Surg. Res. 19:315 (1975). In this sheep model, the average amount of αlAT cleared in 24 hours by the lymph following one aerosol administration was approximately 1/6 the amount that was found in the plasma (See Table VI) . In a similar sheep model, Smith et al. (J. Clin. Invest. 84:1145-1154(1989)) calculated the rate of clearance of αlAT out of the lungs at 16.1110.4% of the total rate of αlAT transported out of the lung. This is consistent with the instant results (See Table VI) . Plasma and lymph levels exhibited a similar profile (See Figure 4) . Thus, it may be assumed that for each αlAT molecule cleared by the lymph, 6 molecules are transported across the endothelial barrier into the bloodstream. Taking the non-lymph clearance into account, the concentration of αlAT in the interstitial fluid should be approximately 7 times that measured in the lymph (See Figure 5) . Table VI Sheep # Lymph Plasma Plasma/ (μg) (μg) Lymph 1 32.4 239 7.4 2 73.2 631 8.6 3 144.6 752 5.2 4 278 2200 7.9 6 757 3100 4.1 7 489 1300 2.7 Avg. 6.0+2.4 25 In addition to the alveolar interstitial fluid, lymphatics also contain a significant amount of extraseptal filtrates from vessels outside the alveolar walls. This was illustrated by Nicolaysen, et al., Microvasc. Res. 9:29-37 (1975) who injected albumin tagged with Evans blue and followed the appearance of the dye in the lung interstitium. The dye appeared in the lymphatics within 10 minutes while the appearance of dye within the interstitium took approximately twice as long, indicating the presence of non-alveolar filtration. It was estimated by Gropper, et al. , Federation Proc. 43:1032 (1984) that a minimum of 40% of the total lung lymph filtration was of non-alveolar origin. Thus, to account for non-alveolar dilution of the lymph, the concentration in the interstitial fluid is multiplied by 1.7. Table VII lists the calculated interstitial levels of αlAT while accounting for 40% extraseptal contribution and 84% plasma clearance. Table VII Sheep # Calc. Peak Interstitial Levels 4 1.3 6 1.5 7 3.2 Avg. 2.011.0 Example 5- Estimation of Human Dose from Sheep Data The results of the αlAT deposited dose experiments and absorption experiments, described above, indicate that a protective level for humans of αlAT in interstitial fluid (approx. 6M, or 324g/ml) may be achieved in humans using pulmonary administration of dry powder αlAT. In particular, extrapolating the sheep data to humans suggests that in order to augment interstitial levels of αlAT in deficient individuals to a protective level (i.e., to approx. 6M from 3.4 M in deficient individuals) a 70 kg human would need to inhale approximately 20 to 60 mg of αlAT per day for three days. After the three day therapy, the patent would then be able to inhale 10 to 20 mg per day to replace the αlAT transported out of the lungs and maintain the protective levels. This is substantially reduced from projected doses for liquid aerosol forms of 200 mg per day (see, Hubbard and Crystal, Lung Suppl:565-578 (1990). These estimated doses are approximated based upon average data. Appropriate dosages would likely vary from individual to individual depending upon the nature of the αlAT deficiency, i.e., acquired or genetic, as well as the base level of the individual. While the foregoing invention has been described in some detail for purposes of clarity and understanding, it will be clear to one skilled in the art from a reading of this disclosure that various changes in form and detail can be made without departing from the true scope of the invention. All publications and patent documents cited in this application are incorporated by reference in their entirety for all purposes to the same extent as if each individual publication or patent document were so individually denoted.

Claims: WHAT IS CLAIMED IS: 1. A method of administering αl-antitrypsin to a patient, comprising: providing said αl-antitrypsin as a dry powder; aerosolizing said dry powder composition; and administering said aerosolized dry powder composition pulmonarily to said patient. 2. The method as recited in claim 1, comprising: dispersing an amount of the αl-antitrypsin dry powder in a gas stream to form an aerosol; and capturing the aerosol in a chamber suitable for subsequent inhalation by the patient. 3. The method as recited in claim l, wherein in said providing step said αl-antitrypsin dry powder is greater than about 50% pure. 4. The method as recited in claim l, wherein in said providing step said αl-antitrypsin dry powder is greater than about 90% pure. 5. The method as recited in claim 1, wherein in said providing step said αl-antitrypsin dry powder is greater than about 95% pure. 6. The method as recited in claim 1, wherein in said providing step said αl-antitrypsin dry powder is greater than about 99% pure. 7. The method of claim 1, wherein in said providing step said αl-antitrypsin dry powder comprises aggregates of fine particles, wherein said fine particles have a mean particle size of from about 1 μm to about 5 μm and said aggregates have a mean size of from about 50 μm to about 600 μm, and wherein said agglomerates have a friability index of from about 10 to about 60. 8. The method of claim 7, wherein said aggregates are spherical in shape. 9. The method of claim 7, wherein said aggregates are formed with a nonaqueous solvent binding liquid. 10. The method of claim 9, wherein said nonaqueous solvent binding liquid compr: Lses a fluorocarbon liquid. 11. The method of claim 10, wherein said fluorocarbon liquid is selected from the group consisting of perfluorodecalin and perfluorooctyl bromide. 12. The method as recited in claim 7, wherein said dispersible dry powder composition of αl-antitrypsin is from about 70% to about 90% pure. 13. A method of treating a patient deficient in αl- antitrypsin, comprising administering pulmonarily to said patient, a therapeutically effective amount of a αl- antitrypsin dry powder. 14. The method of claim 13, wherein said therapeutically effective amount comprises from about 1 to about 50 mg of αl-antitrypsin daily. 15. The method as recited in claim 13, wherein said therapeutically effective amount comprises from about 5 to about 25 mg of αl-antitrypsin daily. 16. The method as recited in claim 13, wherein said therapeutically effective amount comprises from about 10 to about 15 mg of αl-antitrypsin daily. 17. A method of treating a patient suffering from emphysema, comprising administering pulmonarily to said patient a therapeutically effective amount of aerosolized dry powder αl-antitrypsin. SUBSTITUTE SHEET (RULE 26 18. An apparatus for administering αl-antitrypsin to a patient, the apparatus comprising: a housing having a chamber disposed therein, said chamber containing an amount of an αl-antitrypsin dry powder composition; a gas pressure source fluidly connected to said chamber, for delivering a gas stream to said chamber to aerosolize said dry powder composition; and a means for delivering said aerosolized dry powder composition for inhalation by said patient, said means for delivering being fluidly connected to said chamber.

Inventors: ELJAMAL MOHAMED, PATTON JOHN S, ELJAMAL, MOHAMED, PATTON, JOHN, S.
Applicants: INHALE THERAPEUTIC SYST, INHALE THERAPEUTIC SYSTEMS
Application year: 1996
Main classification: A61M15
IPC codes: A61K9, A61K35, A61K38, A61M15, A61P11