Abstract:
A process and medium are disclosed for the lyophilization of red blood cells which comprises the use of solutions including monosaccharide hexoses and pentoses, and/or biocompatible polymers to permit the reconstitution of viable red blood cells.

Description:
This is a continuation of application Ser. No. 07/195,745 filed May 18, 1988, now abandoned. 
    
    
     FIELD OF THE INVENTION 
     This invention relates to the general field of biochemistry and medical sciences, and specifically to processes for the preservation, storage and reconstitution of red blood cells. 
     BACKGROUND AND SUMMARY OF THE INVENTION 
     Blood is a major tissue of the human body, and has as a predominant role the delivery of oxygen from the lungs to peripheral tissues. This role is carried out by erythrocytes, i.e., red blood cells (RBC) . The oxygen is furnished to the peripheral cells by an exchange-diffusion system brought about in the lungs in a red, iron-containing protein called hemoglobin. When hemoglobin combines with oxygen, oxyhemoglobin is formed and after oxygen is given up to the tissues, the oxyhemoglobin is reduced to deoxyhemoglobin. 
     The red cell membrane is composed of two major structural units, the membrane bilayer and a cytoskeleton. A lipid bilayer and integral membrane proteins form the membrane bilayer, which has little structural strength and fragments readily by vesiculation. The other major component, the membrane skeleton, stabilizes the membrane bilayer and provides resistance to deformation. The cytoskeleton is linked to the bilayer in the erythrocyte membrane, possibly by lipid-protein as well as protein-protein associations. The hemoglobin, and other RBC components, are contained within the red cell membrane. 
     In adults, bone marrow is active in the formation of new red blood cells. Once erythrocytes enter the blood, they have an average lifetime of about 120 days. In an average person, about 0.83% of the erythrocytes are destroyed each day by phagocytosis, hemolysis or mechanical damage in the body, and the depleted cells are renewed from the bone marrow. 
     A wide variety of injuries and medical procedures require the transfusion of whole blood or a variety of blood components. Every patient does not require whole blood and, in fact, the presence of all of the blood components can cause medical problems. Separate blood fractions can be stored under those special conditions best suited to assure their biological activity at the time of transfusion. For example, when donor blood is received at a processing center, erythrocytes are separated and stored by various methods. Such cells are storable in citrate-phosphate-dextrose at 4° C. for up to five weeks, generally as a unit of packed erythrocytes having a volume of from 200 to 300 ml and a hematocrit value (expressed as corpuscular volume percent) of 70 to 90. 
     Erythrocytes may also be frozen at from -30° to -196° C. and stored for up to seven years in a glycerol solution, but must be kept frozen at low temperatures in order to survive sufficiently for transfusion. Both these methods require careful maintenance of storage temperature to avoid disruption of the desired biological activity of the erythrocytes, and provide a twenty-four hour survival time for at least 70% of the transfused cells, which is considered to be an acceptable level for use in transfusion practice in accordance with the American Association of Blood Bank standards. 
     It has thus been a desideratum to obtain a method for the storage of red blood cells which is not dependent on the maintenance of specific storage temperatures or other storage conditions. Such a method would facilitate the availability of erythrocytes for medical purposes. 
     One such desired method has been the lyophilization (freeze-drying) of red blood cells, since such cells could be stored at room temperature for an extended period of time and easily reconstituted for use in mammals. However, prior to our invention, it has been impossible to freeze-dry erythrocytes in a manner which permits the reconstitution of the cells to form erythrocytes with an intact cytoskeleton and with biologically-active hemoglobin, i.e., viable red blood cells. When RBCs have been lyophilized according to previous methods, for example in either an aqueous or phosphate-buffered saline (PBS) solution, the reconstituted cells are damaged to the extent that the cells are not capable of metabolizing, and the cell hemoglobin cannot carry oxygen. Glutaraldehyde-fixed erythrocytes, which have been lyophilized and reconstituted, have found use primarily in agglutination assays. 
     The process of the present invention allows for the lyophilization of erythrocytes under conditions which maintain structure of the cell and the biological activity of the hemoglobin, and which permits the reconstitution of the lyophilized red blood cells to allow use on a therapeutic level. Briefly, the process comprises immersing a plurality of erythrocytes in a physiologic buffered aqueous solution containing a carbohydrate and a polymer, freezing the solution, and drying the solution to yield freeze-dried erythrocytes which, when reconstituted, produce a significant percentage of intact and viable red blood cells. 
     The carbohydrate of the invention is biologically compatible with the RBCs, that is, non-disruptive to the cells, and one which permeates, or is capable of permeating, the membrane of the erythrocytes. The carbohydrate may be selected from the group consisting of monosaccharides, since disaccharides do not permeate the membrane to any significant extent. Monosaccharide pentoses and hexoses are preferred in concentrations of from about 0.5 to about 4.0 molar, preferably about two molar. Xylose, glucose, ribose, mannose and fructose are employed to particular advantage. The lyophilization of RBCs in such a carbohydrate solution improves the recovery after lyophilization to at least 50% intact cells, as opposed to the fusing and destruction of the cell membrane in water solutions without the carbohydrate. Such reconstituted cells are useful in producing ghost cells for agglutination assays or biochemical research, i.e., as model membrane systems. 
     In another aspect of the invention, the addition to the carbohydrate solution of a water soluble, biologically compatible polymer adds significantly to the percentage of biologically-active hemoglobin which is retained in the cells and recovered after reconstitution of red blood cells after lyophilization. The polymer may be present in the solution in concentrations of from 0.1 millimolar up to saturation. Preferably, the polymer has a molecular weight of at least about 10 K, most preferably from about 20 K to 50 K, and is present in a concentration of from about 5% up to the limit of solubility of the polymer in the solution. Polymers selected from the group consisting of polyvinylpyrrolidone (PVP) and polyvinylpyrrolidone derivatives, and dextran and dextran derivatives provide significant advantages. Amino acid based polymers (i.e., proteins) or hydroxyethyl starch may also be employed. The use of the carbohydrate-polymer solution in the lyophilization of red blood cells allows for the recovery of intact cells, a significant percentage of which contain biologically-active hemoglobin. 
     As is shown by the data set forth below, the described solutions provide media which permit red blood cells to be subjected to the stresses of freezing, sublimation and reconstitution and to form freeze-dried red blood cells which may be reconstituted to yield cells which are capable of functioning normally in mammals. Unless indicated otherwise by the terminology or the context, all percentages set forth herein are expressed as weight percentages. 
     DESCRIPTION OF THE PREFERRED EMBODIMENT 
     As noted above, the process of the invention provides a medium for the lyophilization and reconstitution of intact and biologically-active erythrocytes. While the media of the invention are novel it will be understood that apparatus and related techniques are known by those of skill in the art for the lyophilization of various materials, and cells in particular, and only the specific temperatures and apparatus employed in the examples are described herein. From this description, one of ordinary skill in the art will be capable of employing the media of the invention in a process for the freeze-drying and reconstitution of intact, viable red blood cells. 
     Example One 
     Packed red blood cells of variable blood type were obtained from a hospital blood donor center or drawn from healthy volunteers using heparin as an anticoagulant. 
     Repeated samples of these blood cells were washed with a phosphate buffered saline solution (10 mM mono- and di-basic sodium phosphate, 150 mM sodium chloride, 5 mM dextrose, and 10 mM adenosine at pH 7.2) three times with centrifugation at 14,000 rpm for 6 to 10 seconds to separate plasma and/or other cell types from the red blood cells. 
     Samples of the packed red blood cells were then suspended in a lyophilizing buffer containing a 2 molar concentration of glucose in PBS solution at pH 7.2. 
     The suspension was then transferred to a flask which was subsequently immersed in liquid nitrogen (-196° C.) until the sample was frozen. The flask was rotated evenly in the liquid nitrogen to assure even dispersion of solution on the walls of the flask. 
     The frozen samples were transferred to a bench top lyophilizer (Labconco model 4.5) operating at less than 100 microns of mercury vacuum with an inner chamber temperature of -56° C. Samples were allowed to dry thoroughly (6-24 hours) until crystalline in appearance and brittle to touch and the flask was allowed to return to room temperature. 
     The samples were rehydrated at 37° C. using a solution containing 1 M sucrose in a phosphate buffered saline solution. A volume of the rehydrating solution was added equivalent to the initial volume of the sample prior to drying. 
     It was found upon examination of the cells with an optical microscope that about 50% of the red blood cells had intact cell membranes. However, the hemoglobin was found not to be cell associated. Nonetheless, the hemoglobin in the solution was active and if present in the cells would be effective as an oxygen carrier. Repeating this procedure with fructose and ribose solutions having concentrations of from about 0.5 to 4 molar produced nearly equal results, as did buffered solutions of xylose and mannose at concentrations of from about 0.5 to 4 molar. 
     Specifically, various monosaccharides were employed in the lyophilization of RBCs as described in this example, and the distribution of the hemoglobin in the recovered solution was noted. Oxyhemoglobin is capable of transporting oxygen to mammalian tissue. Methemoglobin is hemoglobin which cannot bind oxygen, but can possibly be reversed to form oxyhemoglobin when found in lower concentrations by the enzyme NADH methemoglobin reductase. Hemochrome is irreversibly degraded hemoglobin. In Table I, the recovery of greater than 90% oxyhemoglobin from cells lyophilized with solutions of ribose, mannose, fructose, xylose and glucose is shown. No significant variation in cell recovery is found, and oxyhemoglobin is still recovered, when the concentrations of these monosaccharides are varied from 0.5 to 4.0 molar. 
     
                       TABLE I______________________________________Carbohydrate     % OxyHb   % MetHb    % Hemochrome______________________________________2M Ribose 93.1      5.4        1.52M Mannose     94.2      6.0        02M Fructose     98.0      1.3        0.72M Sorbose     56.9      40.9       2.31M Galactose     81.0      17.3       1.72M Xylose 96.7      3.6        02M Glucose     98.1      1.8        0.1______________________________________ 
    
     EXAMPLE TWO 
     A number of samples of packed red blood cells, obtained and washed as described in Example One, were suspended in a lyophilizing buffer containing a 2 molar concentration of glucose and a concentration of either (a) 30 mM of 10 K or (b) 6 mM of 40 K polyvinylpyrrolidone in PBS at pH 7.2. 
     The suspension was then transferred to a flask which was subsequently immersed in liquid nitrogen (-196° C.) until the sample was frozen. The flask was rotated evenly in the liquid nitrogen to assure even dispersion of solution on the walls of the flask. 
     The frozen sample was transferred to a bench top lyophilizer (Labconco model 4.5) operating at less than 100 microns of mercury vacuum with an inner chamber temperature of -56° C. Samples were allowed to dry thoroughly (6-24 hours) until crystalline in appearance and brittle to touch and the flask was allowed to return to room temperature. 
     The samples were rehydrated at 37° C. using a solution containing 1 M sucrose in a phosphate buffered saline solution. A volume of the rehydrating solution was added equivalent to the initial volume of the sample prior to drying. 
     The samples were centrifuged at 14,000 rpm in an Eppendorf microcentrifuge to pellet the rehydrated red blood cells in suspension. The pelleted cells were resuspended and washed successively with solutions containing decreasing amounts of polyvinylpyrrolidone (10 K average molecular weight at 30 weight percent) in phosphate buffered saline with glucose and adenosine solution. For example, cells were resuspended and washed in solutions containing 30 mM, 15 mM and 5 mM of 10 K polyvinylpyrrolidone. Cells were resuspended in a phosphate buffered saline solution. 
     The results of incorporating the polymer with the above described carbohydrate in the buffered lyophilizing solution produced surprising results not only in that the recovery of intact cells was maintained at 52.9±7.9%, but in addition the solution allowed hemoglobin retention by the cells of from 27.4 up to 42.2% for the 10 K PVP and from 57.3 up to 65.5% for the 40 K PVP, with greater than 80% of the hemoglobin being oxyhemoglobin. Further testing has shown that a solution with 2 M glucose, 24 K PVP at a concentration of 8 mM and glucose-1-phosphate at 30 mM produces even better results both in cell and hemoglobin recovery. 
     EXAMPLE THREE 
     The procedure described in Example Two was repeated, with various carbohydrates substituted for glucose in the lyophilizing buffer, at two different concentrations of polyvinylpyrrolidone. The results are shown in Table II. 
     
                       TABLE II______________________________________PVPMW     Carbohydrates              % Cell Recovery                           % Hb Recovery______________________________________10K    1M Galactose              27.7         10.3  2M Mannose  57.6         30.6  2M Xylose   63.9         32.3  2M Fructose 54.6         28.1  2M Glucose  59.0         28.624K    1M Galactose              26.3         13.8  2M Mannose  51.8         57.2  2M Xylose   48.4         55.9  2M Fructose 48.8         59.3  2M Glucose  59.0         52.7______________________________________ 
    
     EXAMPLE FOUR 
     The procedure described in Example Two (using two molar glucose as the carbohydrate) was repeated substituting polyvinylpyrrolidone of different molecular weights and concentrations for those used in the lyophilizing buffer of the previously described Example. All other conditions were repeated as described in Example Two. The results are shown in Table III. The column headed MCHC refers to the mean cell hemoglobin content of the reconstituted cells. The MCHC of normal RBCs is 34±2. Table III demonstrates that PVP may be employed with molecular weights of from 10 to 40 K in concentrations of from 3 to 30 mM. The 40 KT PVP had a viscosity of about 26 to 35 poise, and the 40 K PVP had a viscosity of about 28 to 32 poise. 
     
                                           TABLE III__________________________________________________________________________PVP MW Molarity       % Conc.            % Hb Recovery                      MCHC__________________________________________________________________________10K   5  mM 5    13.6      -- 10 mM 10   15.0      34.9 20 mM 20   30.1 ± 4.1 (n = 3)                      20.9 ± 3.1 (n = 3) 30 mM 30   36.5      28.124K   2  mM 5    24.7      17.3 4  mM 10   52.9      20.9 8  mM 20   52.7 ± 6.3 (n = 4)                      27.4 ± 4.3 (n = 4) 12 mM 30   52.2 ± 6.9 (n = 2)                      --40K   1.5    mM 5    17.7      -- 3  mM 10   31.0      22.5 6  mM 20   61.4 ± 4.1 (n = 3)                      25.7 ± 9.2 (n = 3) 9  mM 30   52.0 ± 1.7 (n = 2)                      37.440KT  1.5    mM 5    17.7      -- 3  mM 10   31.8      25.0 6  mM 20   56.8 ± 0.4 (n = 2)                      36.3 ± 2.8 (n = 2) 9  mM 30   50.0      29.4360K  0.13    mM 1     9.4      -- 0.14    mM 5    12.2      --__________________________________________________________________________ 
    
     EXAMPLE FIVE 
     The experiment described in Example Two was repeated using polymers other than polyvinylpyrrolidone in the lyophilizing buffer. The results are summarized in Table IV. 
     
                       TABLE IV______________________________________Polymer    MW       % Conc.  % Hb Recovery______________________________________Dextran    10K      5        26.1               10       29.8               20       26.5               30       30.2      40K      5        24.7               10       19.5               20       25.9               30       16.6      80K      5        15.2               10       26.5               20       20.2               30       18.7Dextran    40K      10       25.9PhosphateDextran    500K     10       11.4SulfateFicoll     70K      5        17.3               10       19.1      400K     1        17.2               5        17.9Fish Gelatin        2        19.0               10       18.4Dextrin             2        20.4               10       13.1Albumin             2        29.7______________________________________ 
    
     EXAMPLE SIX 
     Samples of packed red blood cells were obtained and washed as described in Example One. These cells were suspended in a lyophilizing buffer of 20% 24 K PVP (8 mM) and 2 M glucose in phosphate buffered saline. The samples were lyophilized and reconstituted as described in Example Two, but with the various solutions used in the reconstitution of the cells. When water was the sole reconstituting liquid, the cells lysed within thirty minutes after reconstitution. An isotonic reconstituting solution, such as PBS or PBSGA (PBS with the addition of 5 mmol glucose and 10 mmol adenosine) showed improvement, as did the use of reverse PBS, which employs potassium rather than sodium salts. Significant improvements were shown by the use of concentrations of up to 20% of either 10 K or 24 K PVP in the reconstitution solution. 
     The use of a carbohydrate in a minimum concentration of at least 250 mM, preferably 0.05 M and most preferably at least 0.25 M, provides better cell morphology after reconstitution. Both mono- and disaccharides may be employed for this purpose, although glucose, mannose, trehalose and sucrose are preferred with sucrose being the most preferred carbohydrate. These data are shown in Table V, wherein all carbohydrate and polymer solutions are formed in PBS. 
     
                       TABLE V______________________________________                    % HbSolution   % Cell Recovery                    Recovery  MCHC______________________________________Water      49.3 ± 3.0 37.4 ± 1.1                              29.9 ± 1.8PBS        59.2          34.4      24.8PBSGA      60.6          42.4      31.2Reverse PBS      52.6          51.3      25.8Glucose 1M 52.5          57.3      32.9Mannose 1M 55.5          60.7      28.0Trehalose 1M      65.7          59.4      24.9Sucrose0.05M      61.7          45.6      24.40.10M      43.8          46.2      27.30.25M      49.5          52.8      24.61M         49.6 ± 10.6                    51.4 ± 5.1                              25.5 ± 2.15% 10K PVP 55.6 ± 11  52.3 ± 3.0                              23.5 ± 1.420% 10K PVP      60.8          67.7      28.45% 24K PVP 52.2          38.8      26.020% 24K PVP      53.8 ± 9.4 73.1 ± 8.1                              28.2 ± 8.75% 10K PVP +      65.0 ± 6.5 59.0 ± 7.6                              28.2 ± 8.71M Sucrose20% 10K PVP +      39.5          61.6      27.81M Sucrose5% 24K PVP +      64.8          59.3 ± 6.9                              26.51M Sucrose20% 24K PVP +      77.7          76.4 ± 4.2                              31.51M Sucrose______________________________________ 
    
     From the foregoing description, one skilled in the art can readily ascertain the essential characteristics of the invention and, without departing from the spirit and scope thereof, can adapt the invention to various usages and conditions. Changes in form and substitution of equivalents are contemplated as circumstances may suggest or render expedient, and although specific terms have been employed herein they are intended in a descriptive sense and not for purposes of limitation.