Source: https://patents.google.com/patent/CN101977632A/en
Timestamp: 2020-01-29 20:30:16
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Matched Legal Cases: ['Application No. 61', 'application No. 61', 'Application No. 11', 'arts 3', 'art.\n12', 'art.\n17', 'art 1']

CN101977632A - Compositions for enhanced uptake of viral vectors in the myocardium - Google Patents
Compositions for enhanced uptake of viral vectors in the myocardium Download PDF
CN101977632A
CN101977632A CN2008801281787A CN200880128178A CN101977632A CN 101977632 A CN101977632 A CN 101977632A CN 2008801281787 A CN2008801281787 A CN 2008801281787A CN 200880128178 A CN200880128178 A CN 200880128178A CN 101977632 A CN101977632 A CN 101977632A
CN2008801281787A
克里斯蒂娜·玛丽亚·热伯
塞拉东公司
2008-02-19 Priority to US61/029,881 priority
2008-10-29 Application filed by 塞拉东公司 filed Critical 塞拉东公司
2011-02-16 Publication of CN101977632A publication Critical patent/CN101977632A/en
201000010238 heart diseases Diseases 0 abstract 3
230000001839 systemic circulation Effects 0 abstract 1
用于增强病毒载体于心肌中的摄取的组合物 Viral vectors for enhancing uptake in the myocardium of the composition
[0002] 本申请案是2008年2月19日申请的美国临时专利申请案第61/029，881号的非临时申请案，根据35USC部分119(e) (1)规定本申请案主张美国临时专利申请案第61/029，881号的优先权，且所述申请案的全部内容以引用方式并入本文中。 [0002] The present application is a U.S. Provisional Patent Application No. 61 / Non-Provisional Application Serial No. 029,881 of February 19, 2008 application, the present application claims priority to US Provisional accordance 35USC portion 119 (e) (1) Patent application No. 61 029,881 priority /, and the entire contents of which application is incorporated herein by reference.
[0003] 本发明涉及用于治疗心脏病、具体来说增强多核苷酸至心脏组织的递送的基因疗法。 [0003] The present invention relates to gene therapy for the treatment of heart disease, particularly polynucleotides to enhance the delivery of the cardiac tissue.
[0004] 尤其在西方世界，心脏病是流行率非常高的重要公共健康问题。 [0004] In particular, in the Western world, heart disease is very high prevalence of major public health problem. 举例来说，心脏病状包括冠状动脉疾病、缺血性心脏病、心绞痛、心脏衰竭、瓣膜性心脏病、心律不整和心脏炎症（心肌炎）。 For example, a heart-shaped including coronary artery disease, ischemic heart disease, angina, heart failure, valvular heart disease, arrhythmia and cardiac inflammation (myocarditis). 冠状动脉疾病和心脏衰竭可能最为严重且流行，而且是西方世界死亡的最主要原因。 Coronary artery disease and heart failure may be the most serious and popular, and is the leading cause of death in the Western world. 急性心肌梗塞和充血性心脏衰竭及其后遗症对患者生活质量及健康护理成本的影响促使寻找新颖疗法。 Acute myocardial infarction and congestive heart failure and its consequences affect the quality of life of patients and health care costs prompted the search for novel therapies.
[0005] 心脏衰竭（HF)是心脏不能有效地泵送血液的非常严重的病状。 [0005] Heart failure (HF) is the heart can not effectively pump blood very serious condition. 美国国家心肺及血液研究所(National Heart, Lung and Blood Institute)的数据表明，仅在美国即有约500万人患有心脏衰竭，且每年另有550，000个新病例被诊断患有心脏衰竭。 National Heart, Lung and Blood Institute (National Heart, Lung and Blood Institute) data show, that is only about 500 million people suffer from heart failure in the United States, and another 550,000 new cases each year are diagnosed with heart failure . HF每年造成或引起约300，000例死亡。 HF cause or causes about 300,000 deaths each year. 所述疾病在65岁或更高年龄的人、妇女及非裔美国人中最为常见。 The disease is most common in people 65 years or more of age, women and African Americans. 心脏衰竭的最常见症状是呼吸短促、感觉疲惫、及踝、脚、腿及有时腹部肿胀。 The most common symptoms of heart failure are shortness of breath, feeling tired, and ankles, feet, legs and sometimes swollen abdomen. 充血性心脏衰竭尚无治愈方法，且业内明确需要有效的疗法。 Congestive heart failure, there is no cure, and the industry a clear need for effective therapies.
[0006] 已经开始受到更多关注的一种治疗心脏病（例如HF)的方法是将多核苷酸（通常于病毒载体中）递送至心脏组织中的基因疗法。 Methods [0006] has begun to attract more attention for treating heart disease (such as HF) is a polynucleotide (usually viral vector) gene therapy delivered to the heart tissue. 已尝试诸多递送病毒载体的手段，包括直接注射至心肌中（刘（Liu)等人，美国实验生物学学会联合会期刊（FASEB J.)2006 ；20 (2)： 207-16 ；李(Li)等人，毒理学与应用药理学(Toxicol. Appl. Pharmacol.) 2006年1月25日(电子出版物)；朱(Zhu)等人，循环(Circulation.) 2005 ；112 (17) :2650_9)、冠脉内递送(尼卡嫩（Nykanen)等人，循环研究（Circ. Res.) 2006 ；98(11) ： 1373-80 ；卡斯帕（Kaspar) 等人，基因医学期刊(J. Gene Med.) 2005 ；7 (3) :316_24)、冠状静脉阻塞下基于导管的顺行性冠脉内递送（哈亚瑟（Hayase)等人，美国生理学心脏与循环生理学期刊（Am. J. Physiol. Heart Circ. Physiol.) 2005 ；288 (6) :H2995_3000)、主动脉与肺动脉横形钳闭、随后近端主动脉注射腺伴随病毒载体（卡斯帕（Kaspar)等人，基因医学期刊（J. Gene Med. ) 2005 ； 7(3) :316-24)。 Have tried many means to deliver viral vectors, including direct injection into the myocardium (Liu (Liu) et al., Journal of the American Federation of Societies for Experimental Biology (FASEB J.) 2006; 20 (2): 207-16; Li (Li ...), et al, Toxicology and applied Pharmacology (Toxicol Appl Pharmacol) January 25, 2006 (electronic publication); Zhu (Zhu) et al., circulation (circulation) 2005; 112 (17):. 2650_9 ), intracoronary delivery (nicardipine tender (Nykanen) et al., circulation Research (Circ Res..) 2006; 98 (11): 1373-80; Caspar (Kaspar) and others, medical journals gene (J. Gene Med) 2005; 7 (3):.. 316_24), delivered under the coronary vein occlusion (Haya Se (Hayase) and others based in the anterograde coronary catheter, American physiological heart and Circulatory physiology journal (Am J. .. Physiol Heart Circ Physiol) 2005; 288 (6):. H2995_3000), aortic cross clamping the pulmonary artery close, and then injecting the proximal aorta adeno-associated virus vector (Casper (Kaspar), et al., Journal of gene Medicine ( J. Gene Med) 2005; 7 (3):. 316-24). 莱顿（Leiden)及斯文森（Svensson)概括提及活体内输注rAAV载体至冠状动脉或窦中，但仅详细描述在心脏已停止跳动的情况下在4°C下使用报告基因离体灌注小鼠心脏（W0 00/38518)-此方法对于治疗诸如人类等大型哺乳动物不实用。 Leiden (Leiden) and Svensson (Svensson) mentioned summarized in vivo infusion rAAV vector or the coronary sinus to, but only in the detailed description uses a reporter gene in a 4 ° C for the case where the heart has stopped beating isolated perfused mouse heart (W0 00/38518) - this method and other large mammals such as humans for the treatment is not practical.
[0007] 因此，所述方法皆不适用于临床环境，这是例如因为所述方法由于需要外科介入(surgical intervention)或中断充氧血至心肌的流动而极其危险，因为实施所述方法所需要的病毒载体的量，因为所转染组织的百分比较低，因为转导仅限于注射/投予部位的事实，或因为所述方法对于治疗大型动物或人类疾病不实用或证据不足。 [0007] Thus, neither method is suitable for the clinical setting, for example because it is due to the need of the method of surgical intervention (surgical intervention), or interrupt the flow of oxygenated blood to the myocardium and extremely dangerous, since the method is required the amount of viral vectors, transfected tissue because a lower percentage because transduction is limited to the injection / cast to the fact that parts of, or because the treatment methods are not practical for large or animal or human disease for lack of evidence. 当前仍需要简单、 微创但有效的使用病毒载体将转基因递送至心脏组织以治疗疾病（尤其人类疾病）的手段。 Current still need a simple, minimally invasive but effective use of viral vectors to deliver a transgene to the heart tissue to treat disease means (in particular human disease).
[0008] 例如，先前在美国专利申请案第11/778，900号（其全部内容以引用方式并入本文中）中阐述利用缓慢输注治疗性多核苷酸至冠状血管中来转染心脏细胞的方法。 [0008] For example, previously in U.S. Patent Application No. 11 / 778,900 (the entire contents of which are incorporated by reference herein) set forth slow infusion using a therapeutic polynucleotide into a blood vessel to the coronary heart cells transfected Methods. 提高使用多核苷酸转染心脏细胞的效率可提高治疗功效。 Improve the use of cardiac cells transfected with a polynucleotide of efficiency can be increased therapeutic efficacy.
[0009] 已在动物的心肌基因转移疗法中使用硝酸甘油作为预治疗混合液的一部分（参见萨萨诺(Sasano T.)等人，“（Targeted High-Efficiency, Homogenous Myocardial Gene Transfer)靶向高效率同源心肌基因转移”，分子与细胞心脏病学期刊（J. Mol. Cell. Cardiol.)，2007年5月；42(5) :954_961，其全部内容以引用方式并入本文中，其阐述涉及使用病毒载体实施心肌基因转移的猪实验）。 [0009] nitroglycerin have been used in gene transfer therapy of myocardial animals as part of the pre-treatment mixture (see Sassano (Sasano T.), et al., "(Targeted High-Efficiency, Homogenous Myocardial Gene Transfer) targeting high homologous myocardial gene transfer efficiency ", Journal of molecular and cellular Cardiology (J. Mol cell Cardiol...), 2007; 42 (5): 954_961, the entire contents of which are incorporated herein by reference in its illustrated embodiment involves the use of viral vectors for gene transfer pig cardiomyocytes). 在努力提高正常健康猪中的基因转移效率的一项成果中，其报导使用包含血管内皮生长因子（VEGF)、硝酸甘油、腺苷和钙的预治疗混合液、随后投用病毒载体及上文所提及药剂的组合。 In an outcome of the efforts to improve the efficiency of gene transfer in the normal healthy pigs, a report containing its vascular endothelial growth factor (VEGF), pre-treatment of the mixture of nitroglycerin, adenosine and calcium, and then put into use viral vectors and above combinations mentioned agents. 然而，由于其治疗方案会导致禁止性低血压及心脏副作用，故所述方案在临床上并不实用。 However, since it will lead to prohibition treatment regimen hypotension and cardiac side effects, so that the scheme is not practical clinically. 例如，萨萨诺（Sasano)报导“输注预治疗及病毒溶液引起收缩血压立即降低30mmHg，其在灌注的第一分钟内稳定。平均心率也降低至50-60/min，随后经相同时间段稳定。”作者还报导“在冠脉输注期间前10头猪中有5头猪（50% )及剩余71头猪中有4头猪（5. 6% )发生心室纤颤（VF)，，(萨萨诺（Sasano)等人，第958页）。倘若患有晚期心脏疾病的大多数人类个体处于虚弱状态，则相比于年轻正常的健康动物这些副作用甚至可能更不耐受。 For example, Sassano (Sasano) reported that "the pre-infusion therapy and reduced systolic blood pressure caused by the virus solution immediately 30mmHg, which stabilized within the first minute of perfusion. The average heart rate decreased to 50-60 / min, subsequently the same period stability. "the authors also reported that" five pigs (50%) in 10 pigs before and during coronary infusion in 4 of the remaining 71 pigs pigs (5.6%) the occurrence of ventricular fibrillation (VF), , (Sassano (Sasano) et al., p. 958). if the majority of human individuals suffering from advanced heart disease in a weak state, compared to the normal of young healthy animals these side effects may be even more intolerant.
[0010] 因此，当前仍需要研发用于提高使用血管舒张及病毒载体（例如腺伴随病毒(AAV))时的心脏转染效率的可用于临床环境且不会发生威胁生命的低血压或心律不整的治疗方法。 [0010] Therefore, the current is still a need for research and development to improve the lives of hypotension or arrhythmias using vasodilation and viral vectors (such as adeno-associated virus (AAV)) heart transfection efficiency when used in a clinical setting can be a threat and will not happen treatment.
[0011] 本发明涉及用于治疗心脏病、具体来说改良或增强治疗剂至心脏组织的递送的用途和疗法，其通过使用血管舒张剂、优选地增加一氧化氮（NO)的物质通过直接冠脉内、静脉内、或皮下注射或输注、或经口投予且不需要阻止血液流动。 [0011] The present invention relates to substances for the treatment of heart disease, particularly to improve or enhance the delivery of therapeutic agents to heart tissue therapy and use, by using the vasodilator, preferably an increase of nitric oxide (NO) by direct intracoronary, intravenous, or subcutaneous injection or infusion, or oral administration and does not need to stop blood flow.
[0012] 本发明的一个优选实施例是通过转染大型哺乳动物的心脏细胞来治疗或预防心血管病的方法，所述方法包含识别需要治疗或预防心血管病的哺乳动物；向所述哺乳动物投予足以使冠脉循环血管舒张的血管舒张物质；及将治疗性多核苷酸投予至所述活体内冠脉循环的血管中；其中所述治疗性多核苷酸经至少约3分钟时间段输注至所述血管中，其中所述冠脉循环不与哺乳动物的体循环隔离或不与其实质隔离，且其中所述治疗性多核苷酸转染所述哺乳动物的心脏细胞以达成所述心血管病的治疗或预防。 [0012] The method of a preferred embodiment of the present invention is by transfecting cardiac cells of a large mammal to treat or prevent cardiovascular disease, the method comprising identifying a mammal in need of treatment or prevention of cardiovascular disease; to said mammal administered to an animal vasodilating substance sufficient to cause vasodilation of the coronary circulation; and therapeutic polynucleotide is administered to the blood vessel of the coronary circulation in vivo; wherein said therapeutic polynucleotide is at least about 3 minutes infused into the blood vessel section, wherein the coronary circulation is not isolated from the systemic circulation of a mammal or substantially isolated, and wherein said therapeutic polynucleotide transfecting cardiac cells of said mammal to achieve the the treatment or prevention of cardiovascular disease. 在一些实施例中，所述血管舒张物质是增加NO的物质。 In some embodiments, said vasodilating substance is a NO increasing substance. 在一些实施例中，所述增加NO的物质是硝酸甘油。 In some embodiments, said NO increasing substance is nitroglycerin.
[0013] 在一些实施例中，将所述增加NO的物质投予至冠脉循环的血管中。 [0013] In some embodiments, the NO increasing substance is administered to blood vessel of the coronary circulation. 在一些实施例中，所述增加NO的物质是以选自由下列组成的群组的方式投予：在所述治疗性多核苷酸的所述输注之前、在所述治疗性多核苷酸的所述输注的同时、和在所述治疗性多核苷酸的所述输注之前和同时投予。 In some embodiments, said NO increasing substance is selected from the group consisting of administration manner: prior to said therapeutic polynucleotide of the infusion of said therapeutic polynucleotide is the infusion while at the same time and prior to the administration of the therapeutic polynucleotide and infusion. 在一些实施例中，在所述治疗性多核苷酸的所述输注之前不长于 In some embodiments, no longer than before the infusion of said therapeutic polynucleotide
85分钟以浓注形式投予所述增加NO的物质。 Administered 85 minutes to inject a concentrated form said NO increasing substance.
[0014] 在一些实施例中，在所述治疗性多核苷酸的所述输注之前不长于5分钟以浓注形式投予所述增加NO的物质且在所述治疗性多核苷酸的所述输注的同时将所述增加NO的物质经至少约10分钟时间段输注至所述血管中。 [0014] In some embodiments, no longer than before the said therapeutic polynucleotide is administered 5 minutes infusion in the form of a concentrated injection to the NO increasing substance and the therapeutic polynucleotide in the while said infusion via the NO increasing substance is at least about 10 minute period infused into the blood vessel.
[0015] 在一些实施例中，增加NO的物质是约50 μ g至约150 μ g硝酸甘油。 [0015] In some embodiments, the NO increasing substance is about 50 μ g to about 150 μ g of nitroglycerin.
[0016] 在一些实施例中，投予所述增加NO的物质包含将1.5mL 100 μ g/mL硝酸甘油溶液经由经皮导管经短于1分钟的时间段顺行性心外膜冠状动脉注射至左或右冠状动脉中的至少一者中，其中所述增加NO的物质的所述投予在所述治疗性多核苷酸的所述输注之前3 分钟内实施，且其中未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 [0016] In some embodiments, administration of said NO increasing substance comprises 1.5mL 100 μ g / mL solution was injected nitroglycerin less than 1 minute period antegrade epicardial coronary artery via percutaneous catheter over to the left right coronary artery, or at least one in which the NO increasing substance is administered the embodiment to 3 minutes prior to said infusion of said therapeutic polynucleotide, and wherein the mammal is not administration other vasodilator or vascular permeation enhancer. 在一些实施例中，所述方法进一步包含在所述治疗性多核苷酸的所述输注的同时将硝酸甘油输注至所述血管中。 In some embodiments, the method further comprising, while the infusion of therapeutic polynucleotide of infusing nitroglycerin into said blood vessel. 在一些实施例中，所述哺乳动物是人类且所述心血管病是心脏衰竭，其中所述治疗性多核苷酸包裹于AAV2/1病毒载体的DNA酶抗性颗粒（DRP)中，且输注至所述血管中的DRP的总数不大于约IX 1013，其中所述治疗性多核苷酸包含SERCA2a编码序列，其中所述血管是左或右冠状动脉中的至少一者，且其中所述治疗性多核苷酸的所述输注持续至少约10分钟。 In some embodiments, the mammal is a human and said cardiovascular disease is heart failure, wherein said therapeutic polynucleotide is packaged in AAV2 / 1 viral vector DNA nuclease resistant particles (DRP), and the output Note the total number of DRP to the blood vessel is not more than about IX 1013, wherein the therapeutic polynucleotide comprises a SERCA2a coding sequence, wherein said blood vessel is a coronary artery of the left or right of at least one, and wherein said therapeutic the infusion polynucleotide for at least about 10 minutes. 在一些实施例中，在所述治疗后6个月与所述治疗之前所述人类心脏的绝对射血分数测量值相比所述治疗使所述人类心脏的绝对射血分数测量值提高。 In some embodiments, as compared to the six months prior to the treatment of human heart ejection fraction measurements of absolute values ​​of said treatment after said treatment of said human heart improved absolute ejection fraction measurements.
[0017] 在一些实施例中，所述增加NO的物质是全身投予。 [0017] In some embodiments, said NO increasing substance is administered systemically. 在一些实施例中，所述增加NO 的物质是以选自由下列组成的群组的方式全身投予：静脉内注射、静脉内输注、经口投予、 经皮投予和皮下投予。 In some embodiments, said NO increasing substance is selected from the group consisting of systemically administered ways: intravenous injection, intravenous infusion, oral administration, subcutaneous administration, and transdermal administration.
[0018] 在一些实施例中，所述增加NO的物质是以选自由下列组成的群组的方式投予：在所述治疗性多核苷酸的所述输注之前、在所述治疗性多核苷酸的所述输注的同时、和在所述治疗性多核苷酸的所述输注之前和同时投予。 [0018] In some embodiments, said NO increasing substance is selected from the group consisting administered in a manner: prior to said therapeutic polynucleotide of the infusion, the therapeutic multicore the nucleotide infusion while at the same time and prior to the administration of said therapeutic polynucleotide and infusion.
[0019] 在一些实施例中，在所述治疗性多核苷酸的所述输注之前经至少30分钟时间段通过静脉内输注来投予约0. 5mg至约2. 5mg硝酸甘油，其中所述治疗性多核苷酸的所述输注在硝酸甘油的所述静脉内输注完成后不长于3分钟内开始，且其中未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 [0019] In some embodiments, prior to said infusion of said therapeutic polynucleotide over a period of at least 30 minutes to be administered by intravenous infusion from about 0. 5mg to about 2. 5mg of nitroglycerin, wherein the infusion of therapeutic polynucleotide is not longer than 3 minutes after the start of the infusion is completed within the venous nitroglycerin, and wherein no other vasodilator or vascular permeation enhancing agent to said mammal agents. 在一些实施例中，所述方法进一步包含在所述治疗性多核苷酸的所述输注的同时输注额外量的硝酸甘油。 In some embodiments, the method further comprises infusing an additional amount of nitroglycerin concurrently with said therapeutic polynucleotide of the infusion. 在一些实施例中，所述哺乳动物是人类且所述心血管病是心脏衰竭，其中所述治疗性多核苷酸包裹于AAV2/1病毒载体的DNA 酶抗性颗粒（DRP)中，且输注至所述血管中的DRP的总数不大于约1X1013，其中所述治疗性多核苷酸包含SERCA2a编码序列，其中所述血管是左或右冠状动脉中的至少一者，且其中所述治疗性多核苷酸的所述输注持续至少约10分钟。 In some embodiments, the mammal is a human and said cardiovascular disease is heart failure, wherein said therapeutic polynucleotide is packaged in AAV2 / 1 viral vector DNA nuclease resistant particles (DRP), and the output Note the total number of DRP to the blood vessel is not more than about 1X1013, wherein the therapeutic polynucleotide comprises a SERCA2a coding sequence, wherein said blood vessel is a coronary artery of the left or right of at least one, and wherein the therapeutic infusion of the polynucleotide for at least about 10 minutes. 在一些实施例中，在所述治疗后6 个月与所述治疗之前所述人类心脏的绝对射血分数测量值相比所述治疗使所述人类心脏的绝对射血分数测量值提高。 In some embodiments, as compared to the six months prior to the treatment of human heart ejection fraction measurements of absolute values ​​of said treatment after said treatment of said human heart improved absolute ejection fraction measurements.
[0020] 本发明的一个实施例是治疗性多核苷酸，其用于通过转染大型哺乳动物的心脏细胞来治疗或预防心血管病的方法中，其中所述方法包含通过在投予所述治疗性多核苷酸之前和/或同时向所述哺乳动物投予血管舒张物质来舒张冠脉循环的血管。 [0020] One embodiment of the present invention is a therapeutic polynucleotide for use in a method of treating or preventing cardiovascular disease by transfecting cardiac cells of a large mammal, in which the method comprises administering by the before therapeutic polynucleotide and / or simultaneous administration vasodilating substance to said mammal also coronary vascular pulse cycle. 在一些实施例中，所述方法包含将治疗性多核苷酸投予至活体内冠脉循环的血管中，其中所述治疗性多核苷酸经至少约3分钟时间段输注至所述血管中，其中所述冠脉循环不与哺乳动物的体循环隔离或不与其实质隔离，且其中所述治疗性多核苷酸转染所述哺乳动物的心脏细胞以达成所述心血管病的治疗或预防。 In some embodiments, the method comprises administering the therapeutic polynucleotide into a blood vessel of the coronary circulation in vivo, wherein said therapeutic polynucleotide over a time period of at least about 3 minutes infused into the blood vessel , wherein the coronary circulation is not isolated from the mammalian circulation or substantially isolated, and wherein said therapeutic polynucleotide transfecting cardiac cells of said mammal to achieve the treatment or prevention of cardiovascular disease.
[0021] 在一些实施例中，所述血管舒张物质是增加NO的物质。 [0021] In some embodiments, said vasodilating substance is a NO increasing substance. 在一些实施例中，所述增加NO的物质是以选自由下列组成的群组的方式投予：在所述治疗性多核苷酸的所述输注之前、在所述治疗性多核苷酸的所述输注的同时、和在所述治疗性多核苷酸的所述输注之前和同时投予。 In some embodiments, said NO increasing substance is selected from the group consisting of administration manner: prior to said therapeutic polynucleotide of the infusion of said therapeutic polynucleotide is the infusion while at the same time and prior to the administration of the therapeutic polynucleotide and infusion.
[0022] 在一些实施例中，将所述增加NO的物质投予至冠脉循环的血管中。 [0022] In some embodiments, the NO increasing substance is administered to blood vessel of the coronary circulation. 在一些实施例中，在所述治疗性多核苷酸的所述输注之前不长于5分钟以浓注形式投予所述增加NO的物质且其中在所述治疗性多核苷酸的所述输注的同时将所述增加NO的物质经至少约10分钟时间段输注至所述血管中。 In some embodiments, the input, no longer than prior to said infusion of said therapeutic polynucleotide is administered five minutes to inject a concentrated form of the NO increasing substance and wherein said therapeutic polynucleotide is Note while the NO increasing substance by at least about 10 minute period infused into the blood vessel.
[0023] 在一些实施例中，增加NO的物质是约50 μ g至约150 μ g硝酸甘油。 [0023] In some embodiments, the NO increasing substance is about 50 μ g to about 150 μ g of nitroglycerin.
[0024] 在一些实施例中，所述增加NO的物质的所述投予包含将1. 5mL 100 μ g/mL硝酸甘油溶液经由经皮导管经短于1分钟的时间段顺行性心外膜冠状动脉注射至左或右冠状动脉中的至少一者中，其中所述增加NO的物质的所述投予在所述治疗性多核苷酸的所述输注之前3分钟内实施，且其中未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 [0024] In some embodiments, said NO increasing substance is administered the predetermined crown comprising outer membrane 1. 5mL 100 μ g / mL solution of nitroglycerin via percutaneous catheter over a shorter period than 1 minute heart antegrade arterial injection to the left or right coronary artery least one of, wherein said NO increasing substance is administered the embodiment to 3 minutes prior to said infusion of said therapeutic polynucleotide, and wherein the non- administering to said mammal other vasodilator or vascular permeation enhancer. 在一些实施例中，所述方法进一步包含在所述治疗性多核苷酸的所述输注的同时将硝酸甘油输注至所述血管中。 In some embodiments, the method further comprising, while the infusion of therapeutic polynucleotide of infusing nitroglycerin into said blood vessel. 在一些实施例中，所述哺乳动物是人类且所述心血管病是心脏衰竭， 其中所述治疗性多核苷酸包裹于AAV2/1病毒载体的DNA酶抗性颗粒（DRP)中，且输注至所述血管中的DRP的总数不大于约IX 1013，其中所述治疗性多核苷酸包含SERCA2a编码序列， 其中所述血管是左或右冠状动脉中的至少一者，且其中所述治疗性多核苷酸的所述输注持续至少约10分钟。 In some embodiments, the mammal is a human and said cardiovascular disease is heart failure, wherein said therapeutic polynucleotide is packaged in AAV2 / 1 viral vector DNA nuclease resistant particles (DRP), and the output Note the total number of DRP to the blood vessel is not more than about IX 1013, wherein the therapeutic polynucleotide comprises a SERCA2a coding sequence, wherein said blood vessel is a coronary artery of the left or right of at least one, and wherein said therapeutic the infusion polynucleotide for at least about 10 minutes. 在一些实施例中，在所述治疗后6个月与所述治疗之前所述人类心脏的绝对射血分数测量值相比所述治疗或预防方法使所述人类心脏的绝对射血分数测量值提尚ο In some embodiments, after 6 months of the treatment prior to said treatment with an absolute ejection fraction of said human heart as compared to the measured value of the treatment or prevention of said human heart ejection fraction measurements of absolute ο mention yet
[0025] 在一些实施例中，所述增加NO的物质是以选自由下列组成的群组的方式全身投予：静脉内注射、静脉内输注、经口投予、经皮投予和皮下投予。 [0025] In some embodiments, said NO increasing substance is selected from the group consisting of systemically administered ways: intravenous injection, intravenous infusion, oral administration, transdermal and subcutaneous administration administered. 在一些实施例中，所述增加NO的物质的所述投予包含在所述治疗性多核苷酸的所述输注之前经至少30分钟时间段通过静脉内输注来投予约0. 5mg至约2. 5mg硝酸甘油，其中所述治疗性多核苷酸的所述输注在硝酸甘油的所述静脉内输注完成后不长于3分钟内开始，且其中未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 In some embodiments, said NO increasing substance is administered the contained prior to said infusion of said therapeutic polynucleotide over a period of 30 minutes by intravenous infusion administered at least about 0. 5mg to about 2. 5mg of nitroglycerin, wherein said therapeutic polynucleotide is infused in the vein of nitroglycerin no longer than 3 minutes after the start of the infusion is completed, and which is not administered to the mammal other vasodilator or vascular permeation enhancer. 在一些实施例中，所述方法进一步包含在所述治疗性多核苷酸的所述输注的同时输注额外量的硝酸甘油。 In some embodiments, the method further comprises infusing an additional amount of nitroglycerin concurrently with said therapeutic polynucleotide of the infusion. 在一些实施例中，所述哺乳动物是人类且所述心血管病是心脏衰竭，其中所述治疗性多核苷酸包裹于AAV2/1病毒载体的DNA酶抗性颗粒（DRP)中，且输注至所述血管中的DRP的总数不大于约1X1013，其中所述治疗性多核苷酸包含SERCA2a编码序列，其中所述血管是左或右冠状动脉中的至少一者，且其中所述治疗性多核苷酸的所述输注持续至少约10分钟。 In some embodiments, the mammal is a human and said cardiovascular disease is heart failure, wherein said therapeutic polynucleotide is packaged in AAV2 / 1 viral vector DNA nuclease resistant particles (DRP), and the output Note the total number of DRP to the blood vessel is not more than about 1X1013, wherein the therapeutic polynucleotide comprises a SERCA2a coding sequence, wherein said blood vessel is a coronary artery of the left or right of at least one, and wherein the therapeutic infusion of the polynucleotide for at least about 10 minutes. 在一些实施例中，在所述治疗后6个月与所述治疗之前所述人类心脏的绝对射血分数测量值相比所述治疗或预防方法使所述人类心脏的绝对射血分数测量值提高。 In some embodiments, after 6 months of the treatment prior to said treatment with an absolute ejection fraction of said human heart as compared to the measured value of the treatment or prevention of said human heart ejection fraction measurements of absolute improve.
[0026] 本发明的另一实施例是治疗性多核苷酸用以制造用于治疗或预防大型哺乳动物心血管病的药剂的用途，其中所述治疗性多核苷酸转染所述大型哺乳动物的心脏细胞以达成所述心血管病的治疗或预防，且其中所述药剂是与使所述哺乳动物的冠脉循环血管舒张的血管舒张物质组合投予，所述血管舒张物质在投予所述药剂之前和/或与所述药剂同时投予。 [0026] Another embodiment of the present invention is the use of a therapeutic polynucleotide for the manufacture of a medicament for treating or preventing cardiovascular disease in a large mammal, wherein said therapeutic polynucleotide transfecting the large mammal cardiac cells to achieve the treatment or prevention of cardiovascular disease, and wherein the agent is a combination of the coronary circulation mammal species vasodilation and relaxation administered, said vasodilating substance is administered and / or administered concurrently with the pharmaceutical agent described before. 在一些实施例中，投予药剂包含将治疗性多核苷酸投予至活体内冠脉循环的血管中， 其中所述治疗性多核苷酸经至少约3分钟时间段输注至所述血管中，且其中所述冠脉循环不与哺乳动物的体循环隔离或不与其实质隔离。 In some embodiments, administration of an agent comprises administering the therapeutic polynucleotide into a blood vessel of the coronary circulation in vivo, wherein said therapeutic polynucleotide over a time period of at least about 3 minutes infused into the blood vessel and wherein the coronary circulation is not isolated from the mammalian circulation or substantially isolated. 在一些实施例中，所述血管舒张物质是增加一氧化氮（NO)的物质。 In some embodiments, said vasodilating substance is a substance to increase nitric oxide (NO),. 在一些实施例中，所述增加NO的物质是以选自由下列组成的群组的方式投予：在所述治疗性多核苷酸的所述输注之前、在所述治疗性多核苷酸的所述输注的同时、和在所述治疗性多核苷酸的所述输注之前和同时投予。 In some embodiments, said NO increasing substance is selected from the group consisting of administration manner: prior to said therapeutic polynucleotide of the infusion of said therapeutic polynucleotide is the infusion while at the same time and prior to the administration of the therapeutic polynucleotide and infusion.
[0027] 在一些实施例中，将所述增加NO的物质投予至冠脉循环的血管中。 [0027] In some embodiments, the NO increasing substance is administered to blood vessel of the coronary circulation. 在一些实施例中，在所述治疗性多核苷酸的所述输注之前不长于5分钟以浓注形式投予所述增加NO的物质且其中在所述治疗性多核苷酸的所述输注的同时将所述增加NO的物质经至少约10分钟时间段输注至所述血管中。 In some embodiments, the input, no longer than prior to said infusion of said therapeutic polynucleotide is administered five minutes to inject a concentrated form of the NO increasing substance and wherein said therapeutic polynucleotide is Note while the NO increasing substance by at least about 10 minute period infused into the blood vessel. 在一些实施例中，增加NO的物质是约50 μ g至约150 μ g硝酸甘油。 In some embodiments, the NO increasing substance is about 50 μ g to about 150 μ g of nitroglycerin.
[0028] 在一些实施例中，所述增加NO的物质的所述投予包含将1. 5mL 100 μ g/mL硝酸甘油溶液经由经皮导管经短于1分钟的时间段顺行性心外膜冠状动脉注射至左或右冠状动脉中的至少一者中，其中所述增加NO的物质的所述投予在所述治疗性多核苷酸的所述输注之前3分钟内实施，且其中未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 [0028] In some embodiments, said NO increasing substance is administered the predetermined crown comprising outer membrane 1. 5mL 100 μ g / mL solution of nitroglycerin via percutaneous catheter over a shorter period than 1 minute heart antegrade arterial injection to the left or right coronary artery least one of, wherein said NO increasing substance is administered the embodiment to 3 minutes prior to said infusion of said therapeutic polynucleotide, and wherein the non- administering to said mammal other vasodilator or vascular permeation enhancer. 在一些实施例中，所述方法进一步包含在所述治疗性多核苷酸的所述输注的同时将硝酸甘油输注至所述血管中。 In some embodiments, the method further comprising, while the infusion of therapeutic polynucleotide of infusing nitroglycerin into said blood vessel. 在一些实施例中，所述哺乳动物是人类且所述心血管病是心脏衰竭， 其中所述治疗性多核苷酸包裹于AAV2/1病毒载体的DNA酶抗性颗粒（DRP)中，且输注至所述血管中的DRP的总数不大于约IX 1013，其中所述治疗性多核苷酸包含SERCA2a编码序列， 其中所述血管是左或右冠状动脉中的至少一者，且其中所述治疗性多核苷酸的所述输注持续至少约10分钟。 In some embodiments, the mammal is a human and said cardiovascular disease is heart failure, wherein said therapeutic polynucleotide is packaged in AAV2 / 1 viral vector DNA nuclease resistant particles (DRP), and the output Note the total number of DRP to the blood vessel is not more than about IX 1013, wherein the therapeutic polynucleotide comprises a SERCA2a coding sequence, wherein said blood vessel is a coronary artery of the left or right of at least one, and wherein said therapeutic the infusion polynucleotide for at least about 10 minutes. 在一些实施例中，在所述治疗后6个月与所述治疗之前所述人类心脏的绝对射血分数测量值相比所述治疗或预防方法使所述人类心脏的绝对射血分数测量值提尚ο In some embodiments, after 6 months of the treatment prior to said treatment with an absolute ejection fraction of said human heart as compared to the measured value of the treatment or prevention of said human heart ejection fraction measurements of absolute ο mention yet
[0029] 在一些实施例中，所述增加NO的物质是以选自由下列组成的群组的方式全身投予：静脉内注射、静脉内输注、经口投予、经皮投予和皮下投予。 [0029] In some embodiments, said NO increasing substance is selected from the group consisting of systemically administered ways: intravenous injection, intravenous infusion, oral administration, transdermal and subcutaneous administration administered. 在一些实施例中，投予所述增加NO的物质包含在所述治疗性多核苷酸的所述输注之前经至少30分钟时间段通过静脉内输注来投予约0. 5mg至约2. 5mg硝酸甘油，其中所述治疗性多核苷酸的所述输注在硝酸甘油的所述静脉内输注完成后不长于3分钟内开始，且其中未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 In some embodiments, the administration over a 30 minute period increased by intravenous infusion administered from about 0. 5mg to about 2 at least before the infusion of NO in the therapeutic substance comprises a polynucleotide . 5mg of nitroglycerin, wherein after the infusion of therapeutic polynucleotide is completed within the venous infusion of nitroglycerin started no longer than 3 minutes, and wherein no other vasodilator to said mammal or vascular permeation enhancer. 一些实施例进一步包含在所述治疗性多核苷酸的所述输注的同时输注额外量的硝酸甘油。 Some embodiments further comprising infusing an additional amount of nitroglycerin concurrently with said therapeutic polynucleotide of the infusion. 在一些实施例中，所述哺乳动物是人类且所述心血管病是心脏衰竭，其中所述治疗性多核苷酸包裹于AAV2/1病毒载体的DNA酶抗性颗粒（DRP)中，且输注至所述血管中的DRP的总数不大于约IX 1013，其中所述治疗性多核苷酸包含SERCA2a 编码序列，其中所述血管是左或右冠状动脉中的至少一者，且其中所述治疗性多核苷酸的所述输注持续至少约10分钟。 In some embodiments, the mammal is a human and said cardiovascular disease is heart failure, wherein said therapeutic polynucleotide is packaged in AAV2 / 1 viral vector DNA nuclease resistant particles (DRP), and the output Note the total number of DRP to the blood vessel is not more than about IX 1013, wherein the therapeutic polynucleotide comprises a SERCA2a coding sequence, wherein said blood vessel is a coronary artery of the left or right of at least one, and wherein said therapeutic the infusion polynucleotide for at least about 10 minutes. 在一些实施例中，在所述治疗后6个月与所述治疗之前所述人类心脏的绝对射血分数测量值相比所述治疗或预防方法使所述人类心脏的绝对射血分数测量值提高。 In some embodiments, after 6 months of the treatment prior to said treatment with an absolute ejection fraction of said human heart as compared to the measured value of the treatment or prevention of said human heart ejection fraction measurements of absolute improve.
[0030] 在一些实施例中，所述增加NO的物质包含硝酸甘油。 [0030] In some embodiments, said NO increasing substance comprises nitroglycerin. 在一些实施例中，所述增加NO的物质基本上由硝酸甘油组成。 In some embodiments, said NO increasing substance is substantially composed of nitroglycerin. 在一些实施例中，所述增加NO的物质由硝酸甘油组成。 In some embodiments, said NO increasing substance composed of nitroglycerin. 在一些实施例中，未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 In some embodiments, administering no other vasodilator or vascular permeation enhancer is administered to said mammal. [0031] 在一些实施例中，未非自然地限制冠脉循环的流出。 [0031] In some embodiments, not unnaturally limit the outflow of the coronary circulation.
[0032] 在一些实施例中，可使用定量PCR (RNA或DNA)来检测对前侧心室（anterior lateral ventricle)、下侧心室（inferior lateral ventricle)、隔膜及右心室心脏细胞的转染。 [0032] In some embodiments, using quantitative PCR (RNA or DNA) to detect the ventricular side of the front (anterior lateral ventricle), the ventricle side of the lower (inferior lateral ventricle), cardiac right ventricle and septum cells transfected pair.
[0033] 在一些实施例中，多核苷酸能够表达能够调节心脏细胞的细胞活性的蛋白质。 [0033] In some embodiments, a polynucleotide capable of expressing a protein capable of modulating cellular activity in cardiac cells. 在一些实施例中，所述细胞活性是心肌细胞的钙循环路径。 In some embodiments, the cellular activity is calcium circulation path cardiomyocytes. 在一些实施例中，所述蛋白质是肌质网/内质网ATP酶（SERCA)。 In some embodiments, the protein is sarcoplasmic reticulum / endoplasmic reticulum enzyme ATP (SERCA). 在一些实施例中，SERCA是SERCA2a。 In some embodiments, SERCA is SERCA2a.
[0034] 在一些实施例中，所述多核苷酸存在于选自由下列组成的群组的病毒载体中：腺伴随病毒、腺病毒、逆转录病毒、单纯疱疹病毒、牛乳头状瘤病毒、慢病毒载体、牛痘病毒和多瘤病毒。 Viral vectors [0034] In some embodiments, the polynucleotide is present in a group selected from the group consisting of: adeno-associated virus, adenovirus, retrovirus, herpes simplex virus, bovine papilloma virus, slow viral vectors, vaccinia viruses and polyomavirus. 在一些实施例中，所述病毒载体是AAV病毒。 In some embodiments, said viral vector is AAV virus. 在一些实施例中，所述病毒载体是包含异源衣壳蛋白的AAV病毒，如此衣壳蛋白VP1、VP2及VP3并非全部为相同AAV血清型。 In some embodiments, said viral vector comprising a heterologous capsid protein of AAV virus, such capsid protein VP1, VP2 and VP3 are not all of the same serotype AAV. 在一些实施例中，所述异源衣壳蛋白包含来自AAVl及AAV2的衣壳蛋白。 In some embodiments, the heterologous protein comprises the capsid and capsid proteins from AAVl of AAV2. 在一些实施例中， 所述病毒载体是AAV2/1载体。 In some embodiments, the viral vector is an AAV2 / 1 vector. 在一些实施例中，所述多核苷酸可操作连接至基于CMV的启动子且包裹于所述病毒载体中。 In some embodiments, the polynucleotide is operably linked to a CMV-based promoter and packaged in the viral vector. 在一些实施例中，所述多核苷酸包含SERCA2a编码序列。 In some embodiments, the polynucleotide comprises a SERCA2a coding sequence.
[0035] 在一些实施例中，所述心脏细胞的所述转染提高侧心室缩短分数。 [0035] In some embodiments, said transfection of said cardiac cells increase side ventricular fractional shortening. 在一些实施例中，所述哺乳动物是人类且所述疾病是充血性心脏衰竭。 In some embodiments, the mammal is a human and said disease is congestive heart failure. 在一些实施例中，在所述输注后约4个月时测量时，与输注多核苷酸之前的侧心室缩短分数相比，所述心脏细胞的所述转染使侧心室缩短分数提高至少25%。 In some embodiments, when measured after about four months of the infusion, before infusion polynucleotide side ventricular fractional shortening compared to the cardiac cells transfected ventricular fractional shortening of the side increase at least 25%. 在一些实施例中，所述心脏细胞的所述转染使选自由下列组成的群组的心脏功能测量值提高：SERCA2a蛋白的表达、缩短分数、射血分数、心排出量、 心室松弛时间常数及反流体积。 In some embodiments, said transfection of said cardiac cells makes selected from the group consisting of improved cardiac function measurements: Expression of SERCA2a, the discharge amount of shortening fraction, ejection fraction, heart, ventricular relaxation time constant and the reflux volume.
[0036] 在一些实施例中，以小于或等于约6. OmL/min的速度，在一些实施例中以小于或等于约2. 5mL/min的速度，在一些实施例中以小于或等于约2. OmL/min的速度，在一些实施例中以小于或等于约1. 2mL/min的速度，在一些实施例中以小于或等于约1. OmL/min的速度，在一些实施例中以小于或等于约0. 6mL/min的速度输注至血管中。 [0036] In some embodiments, less than or equal to a speed of about 6. OmL / min, in some embodiments at a rate of less than or equal to about 2. 5mL / min, the embodiments to less than or equal to about, in some embodiments 2. OmL / min speed, a speed of about 1. 2mL / min or less, at a rate of about 1. OmL / min or less, in some embodiments in some embodiments, in some embodiments velocity less than or equal to about 0. 6mL / min infusion into a blood vessel.
[0037] 在一优选实施例中，多核苷酸存在于选自由下列组成的群组的病毒载体中：腺伴随病毒、腺病毒、逆转录病毒、单纯疱疹病毒、牛乳头状瘤病毒、慢病毒载体、牛痘病毒和多瘤病毒。 [0037] In a preferred embodiment, the polynucleotide present in the viral vector is selected from the group consisting of: adeno-associated virus, adenovirus, retrovirus, herpes simplex virus, bovine papilloma virus, lentivirus vector, vaccinia viruses and polyomavirus. 在一更优选实施例中，病毒载体是AAV病毒或AAV分子变体（参见李（Li)等人， 分子疗法(Molecular Therapy)，第16卷第7期，2008年7月，第1252-1260页，其全部内容以引用方式并入本文中），且在一更优选实施例中，病毒载体是AAV2/1载体。 In a more preferred embodiment, the viral vector is AAV virus or AAV molecule variants (see Li (Li) et al., Molecular Therapy (Molecular Therapy), vol. 16, No. 7, July 2008, 1252-1260 of page, the entire contents of which are incorporated herein by reference), and, in a more preferred embodiment, the viral vector is an AAV2 / 1 vector. AAV2/1载体由AAV血清型1衣壳及衍生自AAV血清型2的末端反向重复（ITR)组成。 AAV2 / 1 vector of AAV serotype 1 capsid and derived from AAV serotype 2 terminal inverted repeats (the ITR) composition. 在一些实施例中，所述多核苷酸可操作连接至基于CMV的启动子且包裹于病毒载体中。 In some embodiments, the polynucleotide is operably linked to a CMV-based promoter and packaged in a viral vector. 在一优选实施例中，多核苷酸包含人类SERCA2a cDNA。 In a preferred embodiment, the polynucleotide comprises human SERCA2a cDNA. 优选地，所述载体由AAV血清型1衣壳组成且含有两侧为衍生自AAV血清型2的末端反向重复（ITR)的人类SERCA2a cDNA (AAVl/SERCA2a)。 Preferably, the carrier consists of an AAV serotype 1 capsid and containing both derived from AAV serotype 2 terminal inverted repeats (the ITR) human SERCA2a cDNA (AAVl / SERCA2a).
[0038] 本发明的一个优选实施例是通过转染大型哺乳动物的心脏细胞来治疗或预防心脏病的方法，所述方法包含：经由持续短于1分钟的冠脉内浓注将介于50微克与150微克之间的硝酸甘油注射至冠状血管中；输注约1. 4X1011至约lX1013个具有AAVl/SERCA2a的DRP至活体内冠脉循环的血管中，其中AAVl/SERCA2a经至少约3分钟时间段输注至血管中， 其中所述冠脉循环不与哺乳动物的体循环隔离或不与其实质隔离；且其中AAVl/SERCA2a 转染哺乳动物的心脏细胞以达成心脏病的治疗或预防。 The method of embodiment [0038] A preferred embodiment of the present invention is by transfecting cardiac cells of a large mammal to treat or prevent heart disease, the method comprising: via a shorter duration of 1 minute in the coronary bolus will be between 50 nitroglycerin micrograms and 150 micrograms between injected into the coronary vessels; infusion from about 1. 4X1011 to about lX1013 DRP to a blood vessel of the coronary circulation in vivo with AAVl / SERCA2a in which AAVl / SERCA2a over at least about 3 minutes period infused into the blood vessel, wherein the coronary circulation is not isolated from the mammalian circulation or substantially isolated from the body; and wherein the AAVl / SERCA2a transfection of mammalian cells to achieve a heart treatment or prevention of heart disease. 在一优选实施例中，硝酸甘油是投予的唯一的血管舒张剂或通透性增强剂，且未投予其它血管舒张剂或通透性增强剂。 In a preferred embodiment, nitroglycerin is the only vasodilator or permeability enhancer administered, administration and no other vasodilator or permeability enhancer. 附图说明 BRIEF DESCRIPTION
[0039] 图1。 [0039] FIG. 针对正常哥廷根小型猪（GSttingenMinipig)中SERCA2a的表达进行测试的心脏截面的图。 FIG heart sectional tested for expression (GSttingenMinipig) SERCA2a in normal Göttingen minipigs. （A)左心室（LV)基底层，（B)LV中层，（C)LV顶层。 (A) left ventricular (LV) a base layer, (B) LV middle layer, (C) LV top.
[0040] 图2。 [0040] FIG. 正常哥廷根小型猪中以单一剂量持续30天直接冠脉内输注AAVl/SERCA2a 的心脏分布研究结果。 Heart normal distribution results Göttingen minipigs sustained within 30 days of direct coronary infusion AAVl / SERCA2a as a single dose. 图表展示群组1和3在1个月随访时经由RT-PCR测定的心脏截面中SERCA2a mRNA的表达。 1 and the diagram shows the expression of the group at 1 month follow-up was measured via RT-PCR 3 SERCA2a mRNA in heart section.
[0041] 图3。 [0041] FIG. 正常哥廷根小型猪中以单一剂量持续30天直接冠脉内输注AAVl/SERCA2a 的组织分布研究结果。 Normal Gottingen mini pigs in a single dose within 30 days of continuous direct coronary infusion AAVl / SERCA2a in tissue distribution studies. 图表展示群组1、2、3和4在1个月随访时心脏截面中SERCA2a蛋白的表达。 Charts 3 and 4 shows the expression of the group at 1 month follow-up section cardiac SERCA2a protein.
[0042] 图4。 [0042] FIG. 正常哥廷根小型猪中在投予AAVl/SERCA2a的实验程序期间群组3和4的平均主动脉压。 During the experiment the normal procedure in Gottingen minipigs administration AAVl / SERCA2a mean aortic pressure groups 3 and 4.
[0043] 本技术涉及使用血管舒张剂且不需要阻止血液流动来治疗心脏病、具体来说增强治疗剂至心脏组织的递送的用途和疗法。 [0043] The present art relates to the use of vasodilators and without blocking blood flow to the treatment of heart disease, particularly to enhance the therapeutic agent is delivered to cardiac tissue uses and therapies. 本发明的一个优选实施例是通过转染大型哺乳动物的心脏细胞来治疗或预防心脏病的方法，所述方法包含：识别需要治疗或预防心脏疾病的哺乳动物；注射或输注优选地通过增加冠脉循环中一氧化氮的量来增强血管舒张的物质；将治疗性多核苷酸输注至活体内冠脉循环的血管中，其中所述治疗性多核苷酸经至少约3分钟时间段输注至血管中，其中冠脉循环不与哺乳动物的体循环隔离或不与其实质隔离；且其中所述治疗性多核苷酸转染哺乳动物的心脏细胞以达成心脏病的治疗或预防。 The method of a preferred embodiment of the present invention is by transfecting cardiac cells of a large mammal to treat or prevent heart disease, the method comprising: identifying a mammal in need of treatment or prevention of heart disease; injection or infusion, preferably by increasing the the amount of nitric oxide in the coronary circulation to enhance vasodilation of the substance; therapeutic polynucleotide is infused into the coronary circulation in vivo blood vessel, wherein said therapeutic polynucleotide over a time period of at least about 3 minutes lost injection into a blood vessel, wherein the coronary circulation is not isolated from the mammalian circulation or substantially isolated from the body; and wherein said therapeutic polynucleotide transfection of mammalian cells to achieve a heart treatment or prevention of heart disease.
[0044] 本文所用的“多核苷酸”具有其业内普通且通常含义，且包括任一聚合核酸（例如DNA或RNA分子）以及所属领域的技术人员已知的化学衍生物。 [0044] As used herein, "polynucleotide" have their ordinary and customary meaning, and includes any polymeric nucleic acids (e.g. DNA or RNA molecules) and known to those skilled in the art of chemical derivatives. 多核苷酸不仅包括编码治疗性蛋白质者，而且还包括可用于使用业内已知技术来降低目标核酸序列的表达的序列(例如，反义、干扰或小干扰核酸）。 Polynucleotides encoding therapeutic proteins include not only those, but also known in the art may be used for technology to reduce the expression of the sequence of the target nucleic acid sequence (e.g., antisense, small interfering nucleic acid or interference). 一个实例是降低或消除受磷蛋白表达的序列。 One example is to reduce or eliminate expression of phospholamban sequence. 多核苷酸还可用于开始或增加心血管系统细胞内目标核酸序列的表达或目标蛋白质的产生。 A polynucleotide may be used to initiate or increase expression or to produce a protein within the cardiovascular system of the target nucleic acid sequence in the cell. 目标核酸和蛋白质包括（但不限于）通常发现于目标组织中的核酸和蛋白质，包括天然存在突变、所述天然存在核酸或蛋白质的衍生物、非通常发现于目标组织中的天然存在核酸或蛋白质、或合成的核酸或蛋白质。 The target nucleic acids and proteins including (but not limited to) the target tissue usually found in proteins and nucleic acids, including natural occurring mutations, derivatives of the naturally occurring nucleic acid or protein, non-typically found in naturally occurring nucleic acid or target tissue protein , or synthetic nucleic acids or proteins. 一或多种多核苷酸可组合使用，同时和/或依序投予以增加和/或减少一或多种目标核酸序列或蛋白质。 One or more polynucleotides may be used in combination, simultaneous and / or sequential administration to be increased and / or reduce one or more of the target nucleic acid sequence or protein.
[0045] 本文所用的术语“输注（infusion、infused和infusing) ”具有其业内普通且通常含义，且是指经一定时间段（通常1分钟或更长时间）投予，所述时间段大大长于业内公认的“注射”或“浓注”术语（通常短于1分钟）。 [0045] As used herein, the term "infusion (infusion, infused and Infusing)" has its ordinary and customary meaning and refer to a certain time period (usually 1 minute or more) administered, the time period significantly longer than the industry recognized "injection" or "bolus injection" term (typically less than a minute). 输注的流速至少部分取决于所投予的体积，然而，“输注”的流速比相同体积时的“注射”流速慢。 Infusion rate of at least partially dependent on the volume administered, however, the "infusion" is slower than the flow rate "injection" at the same volume flow rate.
[0046] “有效量”具有其业内普通且通常含义，且包括足以实现或达成有益或期望治疗效果的量。 [0046] An "effective amount" has its ordinary and customary meaning, and includes reaching an amount sufficient to effect beneficial or desired or therapeutic effect. 例如，“有效量”是达成任一以下效果的量：侧心室缩短分数提高；和/或疾病状况的进展或体征或症状的缓和、改善、稳定、逆转、减缓或延迟。 For example, an "effective amount" is an amount to achieve any one of the following effects: increase lateral ventricle fractional shortening; and / or progression of the disease or condition, or alleviation of symptoms and signs, ameliorate, stabilize, reverse, slow or delay. 有效量可以一或多次投予来投予。 An effective amount of one or multiple administrations can be administered.
13[0047]本文所用的“结合（in conjunction with) ”、“组合（in combination with)”、“同时（concurrent)”或“同时地（concurrently) ”具有其业内普通且通常含义，且包括除一种治疗形式外投予另一种治疗形式。 13 [0047] As used herein, "binding (in conjunction with)", "composition (in combination with)", "simultaneous (Concurrent)" or "simultaneously (concurrently)" has its ordinary and customary meaning, and includes in addition external form of treatment administered to another form of treatment. 例如，除向个体投予一或多种医药组合物外还向所述个体输注多核苷酸。 For example, in addition to administering to the subject one or more pharmaceutical compositions for further polynucleotide to the individual infusion. 本文所用的所述术语包括同时投予或几乎同时投予。 The term as used herein includes administration simultaneously or nearly simultaneously administered.
[0048] 本文所揭示方法及本文所揭示治疗剂可与现有心脏疾病治疗方案（包括上文引言中所列示者，例如药物及经皮或外科介入）组合，以提供与单独现有治疗方案相比增强的治疗效果。 [0048] The herein disclosed methods and therapeutic agents disclosed herein can be used with existing heart disease treatment regimens (including those listed in the introduction above, such as a drug and percutaneous or surgical intervention) combined to provide the conventional treatment alone enhanced therapeutic effect compared to the program. 增强的治疗效果可由以下来展示：例如，距疾病体征或症状恶化的时间段与现有治疗方案的平均或典型时间段相比延长，或需要额外治疗之前的时间与单独标准治疗的平均或典型时间相比延长。 Enhanced therapeutic effect may be the following: for instance, from a worsening of symptoms or signs of disease compared to the average period of time or prior treatment regimen typical time period extended, or time before requiring additional treatment with standard therapy alone average or typical compared to extend the time.
[0049] 本文所用的疾病的“治疗（treat或treatment)，，具有其业内普通且通常含义，且包括疾病的稳定、治愈或较不完全治愈，包括疾病进展或疾病体征或症状的中断或减缓。术语“预防”具有其业内普通且通常含义，且包括完全或不完全预防，或疾病或疾病体征或症状发作延迟。术语“治疗性的（therapeutic)”、“治疗效果”或“临床效果”包括治疗与预防二者。打算使用本技术治疗的与心血管系统有关的疾病的实例包括（但不限于）心脏衰竭、缺血、心律不整、心肌梗塞、充血性心脏衰竭、移植排斥、心脏收缩性异常、非缺血性心肌病、二尖瓣反流、主动脉狭窄或反流、Ca2+代谢异常及先天性心脏病。例如，有益或期望的临床结果或治疗效果包括（但不限于）存活率升高、心血管疾病的体征或症状较大减轻、疾病范围的减小增加、疾病状况的稳定（ [0049] As used herein, "treatment (treat or treatment) ,, it has its ordinary and customary meaning and includes stable, cure or less complete cure, including interrupts disease progression or disease signs or symptoms or slow down the term "preventing" has its ordinary and customary meaning, and includes complete or incomplete prevention, or a disease or sign or symptom onset delayed. the term "therapeutic (therapeutic)", "treatment" or "clinical effect" including both treatment and prevention. examples intend to use this technique in the treatment of cardiovascular and related diseases, including (but not limited to) heart failure, ischemia, arrhythmia, myocardial infarction, congestive heart failure, transplant rejection, cardiac contraction abnormal, non-ischemic cardiomyopathy, mitral regurgitation, aortic stenosis or regurgitation, Ca2 + metabolism and congenital heart disease. For example, beneficial or desired clinical results or effects of treatment include (but are not limited to) the survival rate increased, signs or symptoms of cardiovascular disease, reduce a large, reducing the increase of extent of disease, stabilization of the disease condition ( ，不恶化）、疾病进展的延迟或减缓、疾病状况的改善或缓和、及缓解（无论部分抑或全部），无论可检测到抑或不可检测到。治疗效果的其它实例包括（但不限于）侧心室缩短分数提高；在细胞及完整动物水平上心脏收缩性增强、心脏重构逆转、及细胞溶质钙的异常高舒张水平正常化。在使用本发明实施例治疗的个体中可改良的其它临床特征包括但不限于存活率、心脏代谢、心脏收缩性、心率、心室功能（例如， 左心室射血分数（LVEF)、左心室收缩末期容积（LVESV)、舒张末期压（LVEDP)、左心室收缩压（LVSP) )、Ca2+代谢（例如，细胞内Ca2+浓度、峰值或静息[Ca2+]、SR Ca2+ATP酶活性、受磷蛋白的磷酸化状态）、心脏的力产生、松弛及压力、力-频率关系、心肌细胞存活或凋亡或离子通道活性（例如，钠钙交换、钠通道活性、钙通道活性、钠钾ATP酶泵活性 , Not worsening) of disease progression, delay or slowing, ameliorating a disease condition or relaxation, and remission (whether partial or whether total), whether detectable Other examples Or undetectable. Therapeutic effect include (but are not limited to) the side ventricle increase fractional shortening; enhanced cardiac contractility, to reverse cardiac remodeling, and abnormally high diastolic levels of cytosolic calcium on the cell level and complete normalization of individual animals of the present invention using the embodiment of the treatment may be other clinical features include improved. but are not limited to, survival, cardiac metabolism, heart contractility, heart rate, ventricular function (e.g., left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), end-diastolic pressure (LVEDP), left ventricular systolic pressure ( LVSP)), Ca2 + metabolism (e.g., intracellular Ca2 + concentration, peak or resting [Ca2 +], SR Ca2 + ATP activity, phosphorylation state of phospholamban), and cardiac force, relaxation and pressure, force - frequency relationship, cardiac cell survival or apoptosis or ion channel activity (e.g., sodium calcium exchange, sodium channel activity, calcium channel activity, sodium potassium ATPase pump activity ATP 、肌球蛋白重链的活性、肌钙蛋白I、肌钙蛋白C、肌钙蛋白T、原肌球蛋白、肌动蛋白、肌球蛋白轻链激酶、肌球蛋白轻链1、肌球蛋白轻链2或肌球蛋白轻链3、IGF-I受体、PI3激酶、AKT激酶、钠-钙交换剂、钙通道（L及T)、肌集钙蛋白、钙网蛋白、I型蛋白质磷酸酶的抑制剂-1、或促进受磷蛋白去磷酸化的任一药剂或肌质网钙-泵（SERCA2a)抑制剂。可改良的其它心脏疾病指标包括缩短分数、心排出量、射血分数、Tau、反流体积、住院期缩短、生活质量提高、踏车时间（treadmill time)延长、6分钟步行测试期间的步行距离增加、及最大耗氧量（V02max) 增加。 , Activity of myosin heavy chain, troponin I, troponin C, troponin T, tropomyosin, actin, myosin light chain kinase, myosin light chain 1, myosin light chain 2 or myosin light chain 3, IGF-I receptor, a PI3 kinase, AKT kinase, sodium - calcium exchanger, calcium channel (L and T), calsequestrin, calreticulin, protein phosphatase type I enzyme inhibitor-1, or promoting agent of any one of the sarcoplasmic reticulum calcium or phospholamban dephosphorylated - pumps (of SERCA2a) inhibitors can improve other cardiac disease indicators include fractional shortening, cardiac output, ejection fraction. , Tau, regurgitation volume, shorter hospital stay, improved quality of life, treadmill time (treadmill time) extended walking distance during the six-minute walk test increased, and maximum oxygen consumption (V02max) increase.
[0050] 本文所用的“外源性”核酸或基因是非天然存在于用于核酸转移的载体中者；例如，非天然存在于病毒载体中，但此术语不打算排除编码天然存在于患者或宿主中的蛋白质或多肽（例如，SERCA)的核酸。 [0050] "exogenous" gene or nucleic acid as used herein, non-naturally present in the nucleic acid transfer are used in the carrier; for example, non-naturally present in a viral vector, but this term is not intended to exclude encoding naturally present in the patient or host nucleic acid protein or polypeptide (e.g., SERCA) is.
[0051] 本文所用的“心脏细胞”包括参与维持心脏结构或提供心脏功能的任一心脏细胞， 例如心肌细胞、心脏脉管系统细胞或存在于心脏瓣膜中的细胞。 [0051] As used herein, "cardiac cell" includes cardiac structures involved in maintaining cardiac function or to provide any of a heart cells, such as myocardial cells, heart cells or present in the vasculature of the heart valve cells. 心脏细胞包括心肌细胞(具有正常及异常电特性二者）、上皮细胞、内皮细胞、成纤维细胞、输导组织细胞、心脏起 Cardiac cells include cardiomyocytes (having both normal and abnormal electrical characteristics), epithelial cells, endothelial cells, fibroblasts, conducting tissue cells, heart from
14搏细胞及神经元。 14 stroke and neuronal cells.
[0052] 本文所用的“隔离的”、“实质隔离的，，或“很大程度地隔离的，，及其变体等术语不需要冠状静脉、心脏、全身静脉或体循环完全或绝对隔离；相反，其意指大部分、优选地主要部分或甚至基本上全部指定循环被隔离。 The term does not require the crown [0052] As used herein, "isolated", "substantially isolated from the,,, or," is largely isolated and variants thereof ,, and the like vein, heart, veins or systemic circulation or absolute completely isolated; rather , which means that most of the major part or even preferably substantially all of the specified cycle is isolated. 本文所用的“部分隔离”是指指定循环的任一重要部分被隔离。 As used herein, "partially isolated" means that the specified cycle is a portion of any isolated.
[0053] 本文所用的“非自然地限制”包括限制流体流动通过血管的任一方法，例如，气泡式导管、缝合线等，但不包括天然存在的限制，例如斑块结构（Plaque build-up)(狭窄）。 [0053] As used herein, "unnatural restricted" comprising restrict fluid flow through a blood vessel according to any method, e.g., balloon catheters, sutures, but not limiting naturally occurring, e.g. patch structure (Plaque build-up )(narrow). 非自然限制包括例如冠脉循环的实质或全部隔离。 Unnatural restriction includes, for example, all of the coronary circulation in spirit or isolation.
[0054] 本文所用的“调节”具有其普通含义，且涵盖增加及降低靶标的表达或活性二者。 [0054] As used herein, "modulate" has its ordinary meaning, and encompasses increased expression of the target and reduce the activity, or both.
[0055] 本文所用的术语“微创”打算包括不需要开放手术进入心脏或与心脏紧密相联的血管的任一程序。 [0055] As used herein, the term "minimally invasive" is intended to include not require open surgical access to the heart or vessels closely associated with the heart according to any one program. 所述程序包括使用内窥镜手段进入心脏以及依赖于经由大动脉和静脉(例如股动脉）进入的基于导管的手段。 The program comprises means into the heart using an endoscope and a catheter-based methods rely on the aorta and via the intravenous (e.g., femoral artery) entry.
[0056] 本文所用的术语“腺伴随病毒”或“AAV”涵盖所有亚型、血清型和假型、以及天然存在形式及重组形式或分子变体（参见李（Li)等人）。 [0056] As used herein, the term "adeno-associated virus," or "the AAV" covers all subtypes, and serotypes pseudotyped, as well as naturally occurring forms and in the form of a recombinant molecule or variant thereof (see Li (Li) et al). 业内已知多种AAV血清型及菌株， 且可自诸如ATCC及学术组织或商业来源等来源公开获得。 It is known in the art and a variety of AAV serotype strains, and available from sources such as the ATCC or commercial and academic organizations and other publicly available sources. 或者，可使用已知技术自公开和/或可自多个数据库获得的AAV血清型及菌株合成序列。 Alternatively, and / or a plurality of databases from AAV serotypes and strains obtained using known synthetic sequences from the disclosed techniques.
[0057] 本文所用的术语“血清型”是指基于衣壳蛋白与界定抗血清的反应性加以识别及与其它AAV加以区别的AAV。 [0057] As used herein, the term "serotype" refers to be identified and distinguished from other AAV AAV capsid proteins with defined based reactive antisera. 存在至少12种已知的人类AAV血清型，包括AAVl至AAV12， 然而一直不断地发现其它血清型，且本发明涵盖使用新发现的血清型。 There are at least 12 kinds of known human serotype AAV, including AAVl to AAV12, however, we have continued to discover other serotypes, and the present invention encompasses the use of the newly discovered serotype. 例如，AAV2血清型用以指含有由AAV2衣壳基因（cap gene)编码的衣壳蛋白及含有相同AAV2血清型的5'及3'末端反向重复（ITR)序列的基因组的AAV。 For example, AAV2 serotype means for containing the AAV2 capsid genes (cap gene) encoding the capsid proteins and containing the same serotype AAV2 5 'and 3' inverted terminal repeat of AAV genome (the ITR) sequence.
[0058] “假型”AAV是指含有一种血清型的衣壳蛋白及包括不同或异源血清型的5'及3'末端反向重复（ITR)的病毒基因组的AAV。 [0058] "pseudotyped" AAV comprising AAV refers to a capsid protein of one serotype and include different or heterologous serotype 5 'and 3' inverted terminal repeat (the ITR) of the virus genome. 预期假型rAAV会具有衣壳血清型的细胞表面结合特性及与ITR血清型一致的遗传特性。 Expected pseudotyped rAAV may have genetic characteristics capsid serotypes and cell surface binding properties consistent with the ITR serotype. 假型rAAV可包含AAV衣壳蛋白（包括VPl、 VP2及VP3衣壳蛋白）及来自任一AAV血清型的ITR(包括来自AAVl至AAV12的任一灵长类动物AAV血清型），只要衣壳蛋白具有的血清型与ITR的血清型异源。 Pseudotyped rAAV may comprise AAV capsid proteins (including VPl, VP2 and VP3 capsid protein) and any one from the ITR AAV serotypes (including any AAV12 from AAVl to a primate AAV serotypes), as long as the capsid serotype heterologous protein having the serotype of ITR. 在假型rAAV中， 5'及3' ITR可相同或异源。 In pseudotyped rAAV, the 5 'and 3' ITR may be the same or heterologous. 使用业内所述的标准技术来制备假型rAAV。 Pseudotyped rAAV prepared using standard techniques according to the industry.
[0059] “嵌合”rAAV载体涵盖包含异源衣壳蛋白的AAV载体；即，就其衣壳蛋白VP1、VP2 及VP3来说rAAV载体可以是嵌合的，如此VP1、VP2及VP3并非全部为相同AAV血清型。 [0059] "Chimeric" rAAV vector encompasses AAV vectors comprising a heterologous capsid protein; i.e., its capsid proteins VP1, VP2 and VP3 for rAAV vectors may be chimeric, so VP1, VP2 and VP3 are not all the same serotype AAV. 本文所用的嵌合AAV涵盖衣壳蛋白VPl、VP2及VP3的血清型不同的AAV，包括（例如但不限于)来自AAVl及AAV2的衣壳蛋白、其它细小病毒衣壳蛋白的混合物或包含其它病毒蛋白质或其它蛋白质，例如，将AAV靶向递送至期望细胞或组织的蛋白质。 As used herein, a chimeric AAV capsid proteins VPl covered, different serotypes of AAV VP3 and VP2, including (but not limited to for example) from AAVl and AAV2 capsid protein, mixture with other parvovirus capsid proteins or other viral comprising proteins or other proteins, e.g., the targeted delivery of AAV to the desired cells or tissue proteins. 本文所用的嵌合rAAV 还涵盖包含嵌合5'及3' ITR的rAAV。 As used herein, a chimeric rAAV also encompasses a chimeric 5 'and 3' ITR of rAAV. 本发明涵盖包含不同AAV血清型（例如AAVl及AAV2)的ITR的嵌合rAAV载体，或嵌合rAAV可包含合成序列。 The invention encompasses different AAV serotypes (e.g. AAVl and of AAV2) a chimeric ITR rAAV vector, or chimeric rAAV may comprise synthetic sequences.
[0060] 血管舒张剂 [0060] vasodilators
[0061] 血管舒张是由血管壁、动脉、小动脉、静脉及小静脉内的平滑肌松弛引起的血管变宽。 [0061] vasodilation by the vessel wall, arteries, arterioles, veins and venous smooth muscle relaxation in the small blood vessels caused by widening. 血管舒张使得血管阻力降低及血流量增加。 Vasodilation and vascular resistance decreased blood flow. 内因子及外因子可诱导血管舒张；所述因子称为血管舒张剂。 Inner and outer factors can induce vasodilation factor; referred to as the vasodilator factors. 有两种引起血管舒张的通用机制：细胞内钙减少和/或肌球蛋白轻链(MLC)去磷酸化。 There are two general mechanisms cause vasodilation of: reducing intracellular calcium and / or myosin light chain (MLC) dephosphorylated. 所述机制通过三种通用路径实施：超极化调介、cAMP调介或cGMP调介。 The mechanism by three general paths embodiment: hyperpolarization-mediated, cAMP or cGMP-mediated-mediated. 因此，血管舒张剂可通过所述中介路径（intermediary pathway)中的一或多种来发挥其作用。 Thus, vasodilators can exert their action through the intermediary of one or more paths (intermediary pathway) in. 在一个实施例中，血管舒张剂可包括（但不限于）腺苷、组胺（或组胺诱导剂）、α阻断齐U、可可碱、罂粟碱、乙醇、四氢大麻酚（THC)、米诺地尔（minoxidil)、或一氧化氮（包括增加一氧化氮的物质）。 In one embodiment, a vasodilator may include (but are not limited to) adenosine, histamine (histamine-induced or agents), [alpha] blocking Qi U, theobromine, papaverine, ethanol, tetrahydrocannabinol (THC) , minoxidil (topical minoxidil), or nitric oxide (including substances which increase nitric oxide). 在一个实施例中，仅投予单一血管舒张物质。 In one embodiment, only a single administration vasodilating substance. 在另一实施例中，本发明涵盖共同、依序或以其组合形式使用一或多种血管舒张剂。 In another embodiment, the present invention encompasses co-sequentially or in combination using one or more vasodilator agents. 在一优选实施例中，血管舒张剂是增加一氧化氮的物质。 In a preferred embodiment, the vasodilator nitric oxide are substances that increase.
[0062] 一氧化氮（NO)是自由基分子，其可作为横跨膜自由地扩散的短寿命化学递质。 [0062] Nitric oxide (NO) is a free radical molecules, which may be as short-lived chemical mediators diffusion across the membrane freely. NO具有多种生理学效应。 NO has a variety of physiological effects. 通常参见杰里米伯格（Jeremy Μ. Berg)等人，（2006)，生物化学(Biochemistry)，第6版·弗里曼出版公司(WH Freeman and Company)。 See generally 杰里米伯格 (Jeremy Μ. Berg), et al., (2006), Biochemistry (Biochemistry), 6th Edition Freeman Publishing Company (WH Freeman and Company). 例如，已知在全身或局部递送后通过控制平滑肌收缩性来引起血管舒张。 For example, it is known after systemic or local delivery to vasodilation caused by the control of smooth muscle contractility. 在中枢神经系统中，NO可影响突触传递，进而刺激学习和记忆能力。 In the central nervous system, NO can affect synaptic transmission, to stimulate learning and memory. 作为另一实例，NO可诱导血浆中血小板聚集。 As another example, NO can be induced platelet aggregation in plasma. 由于一氧化氮的亲脂性，其可自其源细胞扩散至其它邻近细胞中，产生信号转导机制。 Due to the lipophilic nature of nitric oxide, which may diffuse from its source cell to another adjacent cell, produce signal transduction mechanisms. 在冠状动脉中，NO可在血管平滑肌细胞中激活细胞溶质鸟苷酸环化酶并刺激环鸟苷酸（cGMP)形成，导致血管舒张。 In the coronary arteries, NO in vascular smooth muscle cells may be activated cytosolic guanylate cyclase and the stimulation of cyclic guanosine monophosphate (cGMP) are formed, leading to vasodilation.
[0063] 不受限于任一特定作用机制，已发现，冠脉循环或向心脏供应血液的动脉的血管舒张可提高下文深层阐述的治疗剂的转导效率。 [0063] Without being bound to any one particular mechanism of action, it has been found, or the coronary circulation supplying blood to the heart vasodilation of the arteries can increase efficiency of transduction of the therapeutic agent deep set forth below. 即，可通过将血管舒张剂或能够诱导血管舒张的药剂的组合（优选地，增加NO的物质）投予至冠脉循环、心脏动脉中或以全身方式投予来增强治疗剂的转导效率。 That is, by the vasodilator or composition capable of inducing vasodilation agents (preferably, NO increasing substance) is administered into the coronary circulation, cardiac artery or systemically administered in a manner to enhance the efficiency of transduction of the therapeutic agent . 除非另有说明，否则本文所用的“增加NO的物质”包括两种、三种、四种、五种或更多种化合物的组合，且可包括通过激活NO受体模拟NO增加且实际上不增加NO的量的化合物（例如NO激动剂）。 Unless otherwise indicated, as used herein, "NO increasing substance" includes two, three, four combinations, five or more compounds, and may include increasing NO by activating receptors and substantially no NO analog increasing the amount of NO compounds (e.g. NO agonist). 在一些实施例中，所述治疗可在使用主要药剂进行治疗之前、至少部分于期间或之后实施。 In some embodiments, the therapeutic agent may be prior to using the primary treatment, at least in part during or after. 因此，在一些实施例中，NO可用作佐剂以提高主要治疗剂的效率、功效或效能。 Thus, in some embodiments, it is used as adjuvants to increase the efficiency of NO, the main efficacy or potency of the therapeutic agent. 实施例包括两种、三种、四种、五种或更多种增加NO的物质的组合。 Example embodiments include two, three, four, five or more compositions NO increasing substance.
[0064] 冠脉循环中NO的水平增加（甚至暂时地)可通过多种已知技术来达成。 [0064] The coronary circulation increased levels of NO (even temporarily) can be achieved by a variety of known techniques. 本文所用的增加NO的物质包括（但不限于）以下化合物或化合物种类中的任一种、或者两种、三种、四种、五种或更多种以下化合物或化合物种类的任一组合。 As used herein, the NO increasing substances include (but are not limited to) any one of the following types of compounds or compound, or two, three, four, five or more of the following compounds or a combination of any kind. 很长时间以来一直使用在生理学条件下释放NO的药剂来管控心脏病。 It has long been used under physiological conditions to release the agent NO control heart disease. 所述药剂可包括（仅作为实例）NO供体、NO释放分子、NO前体。 The agents may include (as an example only) NO donors, NO releasing molecules, NO precursor. 例如，NO供体可包括硝酸酯，例如三硝酸甘油酯，其通常还可称为“硝酸甘油”。 For example, NO donors may include nitrates such as nitric acid triglycerides, also commonly referred to as "nitroglycerin." 硝酸酯的其它实例包括二硝酸异山梨酯及单硝酸异山梨酯。 Other examples include isopropyl nitrate sorbitan esters dinitrate and isosorbide mononitrate. NO供体还可包括阐述于例如梅格森（Megson IL)，韦布（Webb DJ)，“一氧化氮供体药物：目前的状况和以后的趋势(Nitric oxide donor drugs ：current status and future trends)，，，石开究药物专家i平论（Expert. Opin. Investig. Drugs)，2002 年5 月；11 (5) :587_601 (其全部内容以引用方式并入本文中）中的其它药剂。NO释放分子也可增加冠脉循环或冠状动脉中NO的水平。例如，NO释放分子可包括二醇二氮烯鐺或释放NO的非类固醇消炎药物（NO-NSAID)。NO前体(例如L-精氨酸）也可用于增加NO的水平。可使用的其它增加一氧化氮的物质包括分子一氧化氮、尼可地尔(nicorandil)及一氧化氮合酶、硝普钠(sodium nitroprusside)、及戊四硝酯（pentaerythritol tetranitrate) (PETN)。而且，本发明也涵盖增强NO的效应的药剂，例如5型磷酸二酯酶（PDE5)抑制剂，包括（但不限于）西地那非（sildenafil)、他达拉非(tadalafi NO donors are described in, for example, may further comprise Meige Sen (Megson IL), Webb (Webb DJ), "nitric oxide donor drugs: current status and future trends (Nitric oxide donor drugs: current status and future trends ) ,,, i stone open study drug expert level on (expert Opin Investig drugs), May 2002; 11 (5):... 587_601 (the entire contents of other agents incorporated by reference herein) in. NO release of molecules also increase coronary circulation NO level or the coronary arteries, for example, release of NO molecules may include diazeniumdiolate pan or nonsteroidal antiinflammatory drugs release of NO (NO-NSAID) .NO precursors (e.g., L - arginine) can also be used to increase the level of NO with other substances that increase the nitric oxide molecule comprising nitric oxide, nicorandil (nicorandil) and nitric oxide synthase, SNP (sodium nitroprusside can be used). and pentaerythritol tetranitrate (pentaerythritol tetranitrate) (PETN). Further, the present invention also encompasses an agent that enhances the effect of NO, such as phosphodiesterase type 5 (of PDE5) inhibitors, including (but not limited to) sildenafil (sildenafil), tadalafil (tadalafi l)及伐地那非（vardenafil)。[0065] 在一些实施例中，用以增加冠脉循环中一氧化氮的量的物质包含一氧化氮供体。 在一些实施例中，一氧化氮供体包含硝酸酯。在一优选实施例中，硝酸酯包含三硝酸甘油酯。在一些实施例中，硝酸酯包含选自由下列组成的群组的药剂：戊四硝酯、二硝酸异山梨酯及单硝酸异山梨酯。在一些实施例中，一氧化氮供体包含硝普钠。在一些实施例中，用以增加冠脉循环中一氧化氮的量的物质包含一氧化氮释放分子。在一些实施例中，一氧化氮释放分子包含选自由下列组成的群组的药剂：二醇二氮烯鐺和释放一氧化氮的非类固醇消炎药物。在一些实施例中，用以增加冠脉循环中一氧化氮的量的物质包含选自由下列组成的群组的药剂：分子一氧化氮、尼可地尔及一氧化氮合酶。在一些实施例中，用以增加冠脉循环中一氧化氮的 l) and vardenafil (vardenafil). [0065] In some embodiments, to increase the amount of nitric oxide in the coronary circulation comprises a nitric oxide donor substances. In some embodiments, a nitric oxide donor comprises nitrate in a preferred embodiment, the nitrate glyceryl trinitrate comprising in some embodiments, comprises a nitrate selected from the group consisting of agents: pentaerythritol tetranitrate, isosorbide dinitrate and isosorbide mononitrate. in some embodiments, the nitric oxide donor sodium nitroprusside contained. in some embodiments, to increase the amount of nitric oxide in the coronary circulation comprises a nitric oxide releasing substance molecules. in some embodiments, the nitric oxide releasing molecule comprises an agent selected from the group consisting of the following composition: diazeniumdiolate releases nitric oxide pan and nonsteroidal anti-inflammatory drugs, in some embodiments, to increase coronary artery. the amount of drug circulating nitric oxide comprising a substance selected from the group consisting of: molecular nitric oxide, nicorandil, and nitric oxide synthase, in some embodiments, to increase a coronary circulation. nitric oxide 的物质包含一氧化氮前体。在一些实施例中，一氧化氮前体包含L-精氨酸。 Material comprising a nitric oxide precursor. In some embodiments, the nitric oxide precursor comprises L- arginine.
[0066] 血管舒张物质的投予 [0066] vasodilating substances administered
[0067] 血管舒张物质可以下列方式投予：全身投予，例如经口，包括但不限于舌下和经舌投予；经皮，包括但不限于经由贴剂或软膏；或通过静脉内注射或输注。 [0067] vasodilating substance may be administered in the following manner: administered systemically, for example orally, including, but not limited to sublingual and lingual administration; transdermal, including but not limited to, via a patch or ointment; or by intravenous injection or infusion. 在一优选实施例中，血管舒张物质可通过冠脉内注射或输注来投予。 In a preferred embodiment, the vasodilating substance may be administered by intracoronary injection or infusion. 在另一优选实施例中，血管舒张物质可通过静脉内输注或注射来投予。 In another preferred embodiment, the vasodilating substance may be administered by intravenous infusion or injection. 以下部分进一步阐述这些递送方式。 The following sections further elaborate these modes of delivery.
[0068] 冠脉循环向心脏组织提供血液供应。 [0068] coronary circulation provides blood supply to the heart tissue. 冠脉内投予是通过注射或输注至活体内跳动心脏的冠脉循环的一或多条血管中来达成。 Intracoronary administration is achieved by an injection or infusion into a blood vessel or the coronary circulation in vivo of the beating heart. 存在许多条冠状动脉。 There are many coronary arteries. 通常，四条主干冠状动脉向心脏提供充氧血以分布于整个心脏组织中：左主干及右冠状动脉、左前降动脉及左旋动脉。 In general, the four main coronary arteries provide oxygenated blood to the heart to be distributed throughout the heart tissue: left main and right coronary artery, left anterior descending artery and left artery. 本发明涵盖注射或输注至所述动脉之一或其组合中，例如注射或输注至左和右冠状动脉中。 The present invention encompasses one injection or infusion into the artery or a combination thereof, for example injection or infusion into the left and right coronary arteries. 在一个实施例中，血管舒张物质（包括但不限于增加NO的物质）总量的2/3递送至一条心脏血管中，且1/3投予至另一条心脏血管中。 In one embodiment, the vasodilating substance (including but not limited to NO increasing substance) 2/3 of the total amount delivered to a blood vessel of the heart, and 1/3 is administered to another blood vessel of the heart. 在另一实施例中，注射或输注至多于2条（例如3条、4条、5条或更多条）冠状血管中，且可视需要调节投予至每一条血管中的血管舒张剂占总体积或总量的份额。 In another embodiment, injection or infusion to more than two (e.g. three, four, five or more) of the coronary vessels, and adjusted if necessary administered to each blood vessel vasodilators share of total volume or total. 优选实施例使用左和右主干冠状动脉的顺行性心外膜注射或输注。 It preferred embodiment antegrade epicardial injection or infusion backbone using the left and right coronary arteries. 本发明还涵盖冠状动脉的逆行性注射或输注、或一或多条顺行性与逆行性冠状动脉或静脉的组合。 The present invention also encompasses retrograde coronary artery injection or infusion, or a combination of anterograde and retrograde coronary arteries or veins one or more.
[0069] 视需要使用标准导丝、导管及输注泵来实施一或多种血管舒张物质（包括但不限于增加NO的物质）至冠状血管的注射或输注。 [0069] Optionally the use of a standard guide wire, catheter and infusion pump to one or more embodiments vasodilating substance (including but not limited to NO increasing substance) to coronary injection or infusion. 在一优选实施例中，注射或输注导管经由股动脉在透视导引下指向冠状动脉。 In a preferred embodiment, injection or infusion catheter the coronary artery via the femoral artery under fluoroscopic guidance point. 本文所用的“冠脉循环血管”、“冠状血管”或“心脏血管”包括冠状血管上的移植物，例如由心脏搭桥手术（bypass surgery)产生者。 As used herein "coronary circulation vessel", "coronary" or "cardiovascular" of graft on the coronary blood vessels, for example, a cardiac bypass surgery (bypass surgery) producer. 本文所用的“心外膜”是指位于心脏外部的血管，例如左或右冠状动脉。 As used herein, "epicardial" refers to a blood vessel located outside of the heart, such as the left or right coronary artery.
[0070] 投予至个体的血管舒张物质的量取决于个体的体格及投予途径。 The amount of [0070] administering to the subject of vasodilating substance depends on the individual's physical and route of administration. 在一优选实施例中，在投予病毒载体或其它治疗剂之前约5分钟内将血管舒张物质（包括但不限于增加NO的物质）以单次浓注（通常以0. l-2mL体积，经短于1分钟）形式直接注射至冠状动脉中。 In a preferred embodiment, prior to administration of the viral vector or other therapeutic vascular agents within about 5 minutes relaxation species (including but not limited to NO increasing substance) in a single bolus (typically 0. l-2mL volume, It was shorter than 1 minute) in the form of direct injection into the coronary arteries. 在一些实施例中，在投予病毒载体或治疗剂之前一定时间经局部或全身、优选地通过注射或输注来投予血管舒张剂（包括增加NO的物质），所述一定时间为、约为、至少为、至少约为、不长于或不长于约0. 5、1、2、3、4、5、7、10、12、15、20、25或30分钟、1、2、3或更多小时、 或由任两个前述值界定的范围。 In some embodiments, prior to administration of the viral vector or therapeutic agent for a period of time topically or systemically, preferably be administered by injection or infusion vasodilator (including NO increasing substance), the predetermined time is about is, at least, at least about, no longer or not longer than about 0.5 5,1,2,3,4,5,7,10,12,15,20,25 or 30 minutes, or 1,2,3 more hours, two or defined by the scope of any of the foregoing values. 在一优选实施例中，所述范围是0.5-10分钟。 In a preferred embodiment, the range is 0.5 to 10 minutes. 更优选地， 在投予病毒载体或治疗剂之前即刻优选地通过单次浓注来投予血管舒张剂或增加NO的物质。 More preferably, prior administration of the viral vector or therapeutic agent preferably immediately by a single bolus administration to vasodilator or NO increasing substance. 在一些实施例中，当通过输注来投予血管舒张剂时，病毒载体或治疗剂的投予在血管舒张剂输注结束后一定时间开始，所述一定时间为、约为、至少为、至少约为、不长于或不长于约0. 5、1、2、3、4、5、7、10、12、15、20、25或30分钟、1、2、3或更多小时、或由任两个前述值界 In some embodiments, when a vasodilator is administered by infusion, viral vector or therapeutic agent is administered at a predetermined time after the start vasodilator infusion, the predetermined time is about, at least, at least about, no longer or not longer than about 0.5 5,1,2,3,4,5,7,10,12,15,20,25 or 30 minutes, 2, 3 or more hours, or bounded by any two of the preceding values
[0071 ] 在一些实施例中，在本文所述病毒载体或治疗剂之前注射或输注血管舒张剂或增加NO的物质，且在投予所述病毒载体或治疗剂的同时优选地经至少3分钟时间段、更优选地约4分钟至约10分钟或如下文更详细阐述投予第二剂量的相同或不同血管舒张剂或增加NO的物质。 [0071] In some embodiments, injection or infusion vasodilator or NO increasing substance prior to the viral vector or therapeutic agent described herein, and in administering the viral vector or therapeutic agent while preferably by at least 3 minute period, more preferably from about 4 minutes to about 10 minutes, or as described in more elaborate administered the same or different dose of the vasodilator or NO increasing the second substance. 在其它实施例中，未使用血管舒张剂或增加NO的物质实施预治疗，且血管舒张剂与如本文所述投予的病毒载体或治疗剂同时投予。 In other embodiments, the unused vasodilator or NO increasing substance embodiment pre-treatment, and the vasodilator and administered as described herein, the viral vector or therapeutic agent administered simultaneously. 在一些实施例中，所述同时投予是指血管舒张剂与治疗剂在同一溶液中进行投予。 In some embodiments, the simultaneous administration refers vasodilator therapeutic agent is administered in the same solution. 在其它实施例中，所述同时投予是指血管舒张剂与治疗剂经由不同投予途径投予（例如分别经静脉内及冠脉内）。 In other embodiments, the administration at the same time refers to the therapeutic agent vasodilator administered via different administration routes (e.g., intravenous, respectively and via intracoronary).
[0072] 在一些实施例中，一或多种血管舒张剂（包括但不限于增加NO的物质）是在病毒载体或治疗剂之后投予。 [0072] In some embodiments, one or more vasodilator agents (including but not limited to NO increasing substance) is administered after a viral vector or therapeutic agent. 所述后投予可以是除预治疗和/或与治疗物质同时投予之外的额外投予，且所投予血管舒张剂可以与预治疗和/或同时投予中所投予者相同或不同。 After the administration may be in addition to the pre-treatment and / or administered simultaneously with the additional administration of a therapeutic substance, and vasodilator administered may be pretreated and / or simultaneous administration in the same or administered by different. 在一些实施例中，在投予病毒载体或治疗剂之后一定时间优选地通过注射或输注来投予血管舒张剂或增加NO的物质，所述一定时间为、约为、至少为、至少约为、不长于或不长于约0. 5、 1、2、3、4、5、7、10、12、15、20、25或30分钟、1、2、3或更多小时、或由任两个前述值界定的范围。 In some embodiments, after administration of the viral vector or therapeutic agent for a predetermined time is preferably administered by injection or infusion vasodilator or NO increasing substance, the predetermined time is about, at least, at least about is no longer or not longer than about 0.5, 1,2,3,4,5,7,10,12,15,20,25 or 30 minutes, 2, 3 or more hours, or by either the two values ​​defining a range. 在一优选实施例中，所述范围是投予病毒载体后0. 5-10分钟。 In a preferred embodiment, the range is 0.5 to 10 minutes after administration of the viral vector.
[0073] 在一优选实施例中，增加NO的物质是硝酸甘油，且以一或多种本文所述剂量经由冠脉内注射或输注投予的硝酸甘油的总量是约50 μ g至约500 μ g，更优选地约100 μ g至约150 μ g。 [0073] In a preferred embodiment, the NO increasing substance is nitroglycerin and described herein with one or more of the total amount of dosage g to nitroglycerin via intracoronary injection or infusion is administered from about 50 μ about 500 μ g, more preferably from about 100 μ g to about 150 μ g. 本发明涵盖的经由冠脉内注射或输注投予的硝酸甘油或其它血管舒张剂或增加NO 的物质或物质组合的总量或每一剂量的量为、约为、至少为、至少约为、不大于或不大于约1、2、3、4、5、7、10、12、15、20、30、40、50、60、70、80、90、100、125、150、175、200、250、300、350、 400、450、500、600、700、800、900或ΙΟΟΟμ g、或由任两个前述值界定的范围。 Injection or infusion of nitroglycerin administered via intracoronary or encompassed by the present invention per dose or the total amount of other vasodilator or NO increasing substance or composition of matter is about, at least, at least about , no greater than or no greater than about 1,2,3,4,5,7,10,12,15,20,30,40,50,60,70,80,90,100,125,150,175,200 , 250,300,350, 400,450,500,600,700,800,900, or ΙΟΟΟμ g, or a range defined by any two of the preceding values. 所述量可以是以预治疗形式、与治疗剂一起或在治疗剂之后投予至接受注射或输注或其任一组合的单一冠状动脉或所有冠状动脉的量，或者可以是所投予的总量。 The amount may be in the form of pre-treatment, or the amount administered to all single coronary artery or receiving injection or infusion, or any combination of the therapeutic agent after the therapeutic agent together, or may be administered by of the total. 所属领域的技术人员应了解，用于冠脉内注射或输注的血管舒张剂的剂量是相对于器官的大小，且不一定相对于个体的总体重。 Those skilled in the art will appreciate that the dosage for vasodilator intracoronary injection or infusion is relative to the size of the organs, and not necessarily with respect to the overall weight of the individual. 在一个实施例中，在输注病毒载体之前初始冠脉内注射50μ g硝酸甘油，且与病毒载体一起优选地经至少3分钟、更优选地约4分钟至约10分钟输注第二量的100 μ g硝酸甘油。 In one embodiment, the initial infusion viral vectors prior to injection 50μ g intracoronary nitroglycerin, and together with the viral vector preferably over at least 3 minutes, more preferably from about 4 minutes to about 10 minutes a second amount infusion 100 μ g of nitroglycerin.
[0074] 在一些实施例中，经由静脉内注射或输注全身投予的硝酸甘油的总剂量优选地是约200 μ g至约4000 μ g，更优选地约500 μ g至约2500 μ g。 [0074] In some embodiments, the total dose is preferably via nitroglycerin intravenous injection or infusion systemically administered is from about 200 μ g to about 4000 μ g, more preferably about 500 μ g to about 2500 μ g . 本发明涵盖的经由全身注射或输注投予的硝酸甘油的总剂量为、约为、至少为、至少约为、不大于或不大于约1、2、3、 4、5、7、10、12、15、20、30、40、50、60、70、80、90、100、125、150、175、200、250、300、350、400、 450、500、600、700、800、900、1000、1250、1500、1750、2000、2250、2500、2750、3000、3500 或4000 μ g、或由任两个前述值界定的范围。 Encompassed by the present invention, the total dose of nitroglycerin administered systemically injection or infusion is, is about, at least, at least approximately, no greater than or no greater than about 2,3, 4,5,7,10, 12,15,20,30,40,50,60,70,80,90,100,125,150,175,200,250,300,350,400, 450,500,600,700,800,900, 1000,1250,1500,1750,2000,2250,2500,2750,3000,3500 or 4000 μ g, or defined by the scope of any two of the preceding values. 在一些实施例中，硝酸甘油是经静脉内以5yg/ 分钟或以约5 μ g/分钟每3-5分钟增加5 μ g/分钟直至20 μ g/分钟来投予；如果以20 μ g/ 分钟投予无应答，则每3-5分钟增加10 μ g/分钟剂量直至200 μ g/分钟。 In some embodiments, nitroglycerin is administered intravenously to 5yg / min or about 5 μ g / min increase 5 μ g / min until 20 μ g / min administered every 3-5 min; if 20 μ g / min administered no response, then increase every 3-5 minutes 10 μ g / min dosage until 200 μ g / min. 本发明涵盖的经由全身注射或输注投予的硝酸甘油的剂量率为、约为、至少为、至少约为、不大于或不大于约1、2、3、4、5、7、10、12、15、20、30、40、50、60、70、80、90、100、125、150、175、200、250、300、 The present invention encompasses a dose rate of nitroglycerin via systemic injection or infusion administered, about, at least, at least approximately, no greater than or no greater than about 1,2,3,4,5,7,10, 12,15,20,30,40,50,60,70,80,90,100,125,150,175,200,250,300,
18350或400 μ g/分钟或由任两个前述值界定的范围。 18350 or 400 μ g / min or range defined by any two of the preceding values. 血管舒张剂或增加NO的物质的总输注时间为、约为、至少为、至少约为、小于、小于约5、7、10、12、15、20、25、30、35、40、45、50、55、 60、65、70、75、80、85、90、95、100、110、125、150、175、200、250、300、350、400、450、500 或600 The total infusion time vasodilator or NO increasing substance is about, at least, at least about, less than, less than about 5,7,10,12,15,20,25,30,35,40,45 , 50, 55, or 600 60,65,70,75,80,85,90,95,100,110,125,150,175,200,250,300,350,400,450,500
分钟、或由任两个前述值界定的范围。 Minutes, or defined by the scope of any two of the preceding values. 在一些实施例中，IV输注在投予病毒载体或治疗剂之前开始，且在投予病毒载体或治疗剂期间继续。 In some embodiments, IV infusion prior to beginning administration of the viral vector or therapeutic agent, and administered during the viral vector or therapeutic agent to continue.
[0075] 在一些实施例中，通过口服方式全身投予的硝酸甘油的总剂量优选地是约5mg至约105mg，更优选地约IOmg至约80mg。 [0075] In some embodiments, preferably the total dose of nitroglycerin administered systemically by oral way is from about 5mg to about 105mg, more preferably from about IOmg to about 80mg. 在另一实施例中，优选剂量是约15mg至约80mg。 In another embodiment, the dosage is preferably from about 15mg to about 80mg. 本发明涵盖的经口投予的硝酸甘油的总剂量为、约为、至少为、至少约为、不大于或不大于约0. 4,0. 5,0. 75、1、2、3、4、5、7、10、12、15、20、30、40、50、60、70、80、90、100 或125mg、或由任 The total dose of the glycerol present invention encompasses orally administered nitric acid, about, at least, at least approximately, no greater than about 0.5 or not greater than 4,0. 5,0. 75,1,2,3, 4,5,7,10,12,15,20,30,40,50,60,70,80,90,100 or 125mg, or by either
两个前述值界定的范围。 The two values ​​defining a range.
[0076] 在另一实施例中，通过舌下投予全身给与的硝酸甘油的量为、约为、至少为、至少约为、不大于或不大于约36、54、72、90、108、126、144、162、180、198、216、234、252、270、288、 306、324、342或360mg或由任两个前述值界定的范围。 Volume [0076] In another embodiment, the sublingual administration of nitroglycerin administered systemically is about, at least, at least approximately, no greater than or no greater than about 36,54,72,90,108 , 126,144,162,180,198,216,234,252,270,288, 306,324,342 or 360mg or defined by the scope of any two of the preceding values. 在一些实施例中，经舌下投予硝酸甘油，其中剂量为、约为、至少为、至少约为、不大于或不大于约0. 1,0. 15,0. 2,0. 25,0. 3、 0. 35,0. 4,0. 45,0. 5,0. 55,0. 6,0. 65,0. 7,0. 75,0. 8,0. 85,0. 9,0. 95 或lmg、或由任两个前述值界定的范围。 In some embodiments, nitroglycerin is administered sublingually, wherein the dosage is about, at least, at least approximately, no greater than about 0.5 or not greater than 1,0. 15,0. 2,0. 25, 0.3, 0. 35,0. 4,0. 45,0. 5,0. 55,0. 6,0. 65,0. 7,0. 75,0. 8,0. 85,0. 9,0. 95 or lmg, or defined by the scope of any two of the preceding values. 以一定间隔投予舌下剂量，所述一定间隔为、约为、至少为、至少约为、不长于或不长于约每1、2、3、4、5、6、7、8、9或10分钟或由任两个前述值界定的范围。 Administered at intervals sublingual dose, the predetermined interval is about, at least, at least about, no longer or not longer than about 9, or per 10 minutes or a range defined by any two of the aforementioned values. 在一优选实施例中，每5分钟舌下投予约0. 2mg至约0. 6mg硝酸甘油，最多每15分钟3次剂量。 In a preferred embodiment, the sublingual administration every 5 minutes to about 0. 2mg to about 0. 6mg nitroglycerin, up to 3 doses per 15 minutes. 在另一实施例中，可经舌以喷雾剂、滴剂或薄雾（mist)形式给与硝酸甘油。 In another embodiment, the nitroglycerin can be given a spray, mist, or drops (Mist) form by the tongue. 可每3-5分钟向口腔中给与1次至2次喷雾剂，最多15分钟内3次剂量。 3-5 minutes can be given every 1 to 2 times a spray to the oral cavity, the 3 doses up to 15 minutes.
[0077] 在一些实施例中，可使用经皮贴剂经皮递送硝酸甘油的全身投予。 [0077] In some embodiments, transdermal patches may be used transdermal systemic delivery of nitroglycerin administered. 经由经皮贴剂全身投予的硝酸甘油的总剂量优选地为约2. 4mg至约15. 6mg,更优选地为约4. Smg至约9. 6mg。 Patch total dose of nitroglycerin administered systemically, preferably via percutaneous about 2. 4mg to about 15. 6mg, more preferably from about 4. Smg to about 9. 6mg. 本发明涵盖的经由经皮贴剂投予的硝酸甘油的总剂量为、约为、至少为、至少约为、 不大于或不大于约2. 4,3. 6,4. 8、6、7. 2,8. 4,9. 6,10. 8、12、13. 2,14. 4 或15. 6mg、或由任两个前述值界定的范围。 The total dose administered via a patch transdermal nitroglycerin is encompassed by the present invention is about, at least, at least approximately, no greater than 2 or no more than about 4,3. 6,4. 8,6,7 . 2,8. 4,9. 6,10. 8, 12. 2,14. 4 or 15. 6mg, or range of values ​​defined by either of the two. 在一些实施例中，经由经皮贴剂来投予硝酸甘油，其中剂量为、约为、 至少为、至少约为、不大于或不大于约0. 1,0. 15,0. 2,0. 25,0. 3,0. 35,0. 4,0. 45,0. 5,0. 55、 0. 6或0. 65mg、或由任两个前述值界定的范围。 In some embodiments, via a transdermal patch for administering nitroglycerin, wherein the dose is, is about, at least, at least approximately, no greater than about 0.5 or not greater than 1,0. 15,0. 2,0 . 25,0. 3,0. 35,0. 4,0. 45,0. 5,0. 55, 0.6 or 0. 65mg, or a range defined by any two of the preceding values. 以一定间隔投予经皮贴剂剂量，所述一定间隔为、约为、至少为、至少约为、不长于或不长于约每15、30、45、60、75或90分钟或由任两个前述值界定的范围。 At intervals dose administered transdermal patches, the predetermined interval is about, at least, at least about, no longer or not longer than about 15,30,45,60,75 or 90 minutes each, or by any of the two a range of the values ​​defined. 在另一实施例中，本发明涵盖的经由经皮贴剂投予的硝酸甘油的剂量率为、约为、至少为、至少约为、不大于或不大于约0. 1,0. 15,0. 2,0. 25,0. 3,0. 35,0. 4、 0. 45,0. 5,0. 55,0. 6,0. 65,0. 7,0. 75,0. 8,0. 85,0. 9,0. 95 或lmg/ 小时、或由任两个前述值界定的范围。 In another embodiment, the dose administered via a patch transdermal nitroglycerin present invention encompasses rate of about, at least, at least approximately, no greater than about 0.5 or not greater than 1,0. 15, 0. 2,0. 25,0. 3,0. 35,0. 4, 0. 45,0. 5,0. 55,0. 6,0. 65,0. 7,0. 75,0. 8,0. 85,0. 9,0. 95 or lmg / hour, or defined by the scope of any two of the preceding values. 在一优选实施例中，以约0. 2-0. 4mg/小时的初始剂量直至0. 4-0. 8mg/小时的剂量经皮给与硝酸甘油。 In a preferred embodiment, the initial dose of about 0. 2-0. 4mg / hr until 0. 4-0. 8mg / hr dose of nitroglycerin administered transdermally. 通过使用12-14小时的使用贴剂（patch-on)阶段及约10-12 小时的不使用贴剂（patch-off)阶段使耐受降低至最低程度。 Without using a patch (patch-off) that the tolerance stage reduced to a minimum by the use of 12-14 hours using a patch (patch-on) phase and about 10-12 hours.
[0078] 在另一实施例中，可通过局部施用软膏来经皮递送硝酸甘油的全身投予。 [0078] In another embodiment, may be via systemic transdermal delivery of nitroglycerin ointment is administered by topical administration. 本发明涵盖的经由局部软膏投予的硝酸甘油的总剂量在发病时为、约为、至少为1/2”平方英寸及6小时后1/2”平方英寸的浓度为或约为0. 1%,0. 15%,0. 2%,0. 25%,0. 3%,0. 4%、1%或2%的硝酸甘油、或由任两个前述值界定的范围。 The total dose of the present invention encompasses glycerol via topical ointment nitrate administered at the onset of, about, at least 1/2 "square inches after 6 hours and 1/2" square inch at a concentration of at or about 0.1 %, 0.15%, 0.2%, 0.25%, 0.3%, 0.4%, 1% or 2% of nitroglycerin, or any range defined by two of the foregoing values. 在一优选实施例中，软膏的浓度是0.2%。 In a preferred embodiment, the concentration of the ointment was 0.2%. 剂量可视需要翻倍数次。 Double dose several times as needed. [0079] 一些实施例涵盖通过皮下注射或输注通过皮肤来全身递送硝酸甘油。 [0079] Some embodiments encompassed by systemic delivery by subcutaneous injection or infusion of nitroglycerin through the skin. 在一些实施例中，经皮下投予的硝酸甘油的总剂量优选地为约5mg至约105mg，更优选地为约IOmg至约80mg。 In some embodiments, the total dose of nitroglycerin administered subcutaneously is preferably from about 5mg to about 105mg, more preferably from about IOmg to about 80mg. 在另一实施例中，优选剂量是约15mg至约80mg。 In another embodiment, the dosage is preferably from about 15mg to about 80mg. 本发明涵盖的经皮下投予的硝酸甘油的总剂量为、约为、至少为、至少约为、不大于或不大于约0. 4,0. 5,0. 75、1、2、3、4、5、 7、10、12、15、20、30、40、50、60、70、80、90、100 或125mg、或由任两个前述值界定的范围。 The total dose of the present invention encompasses glycerol subcutaneously administered nitrate, about, at least, at least approximately, no greater than about 0.5 or not greater than 4,0. 5,0. 75,1,2,3, 4, 5, or 7,10,12,15,20,30,40,50,60,70,80,90,100 125mg, or any range defined by two of the foregoing values.
[0080] 在一优选实施例中，投予所述血管舒张剂或增加NO的物质或物质组合，且不投予足以增强血管舒张或血管通透性的量的任何其它血管舒张剂或血管通透增强物质。 [0080] In a preferred embodiment, administration of the vasodilator or NO increasing substance or combination of substances, and is not sufficient to enhance the administration of any other vasodilator or vascular permeability through vasodilation of the blood vessel or the through enhancing substance. 在一些实施例中，增加NO的物质或物质组合（优选地为硝酸甘油）是在投予病毒载体或治疗剂之前、期间和/或之后投予的唯一血管舒张剂或血管通透增强剂。 In some embodiments, the NO increasing substance or combination of substances (preferably nitroglycerin) is administered prior to the viral vector or therapeutic agent, the only vasodilator or vascular permeation enhancer and / or after the administration period. 在一些实施例中，除本文所述增加NO的物质外，在投予病毒载体或治疗剂之前、期间和/或之后未投予其它血管舒张剂或血管通透增强物质。 In some embodiments, in addition to the NO increasing substances described herein, the prior administration of the viral vector or therapeutic agent is not administered during and / or after other vasodilator or vascular permeation enhancing substance. 在一实施例中，除本文所述增加NO的物质（优选地为硝酸甘油） 外，在投予病毒载体或治疗剂之前、期间和/或之后，未使用足以增强病毒载体或治疗剂的摄取的量的任何血管舒张剂或通透增强物质治疗个体。 In one embodiment, in addition to the NO increasing substances described herein (preferably for nitroglycerin), the prior administration of the viral vector or therapeutic agent, and / or after, are not used sufficient to enhance uptake of the viral vector or therapeutic agent during the the amount of any vasodilator or treating permeation enhancing substances. 在一些实施例中，优选地被排除而不投予的血管舒张或通透增强物质包括（但不限于）血管内皮生长因子（VEGF)、腺苷和钙。 In some embodiments, excluded are preferably administered without vasodilation or permeability enhancing substances include (but are not limited to) vascular endothelial growth factor (VEGF), adenosine and calcium.
[0081] 在一些实施例中，血管舒张剂物质的量是转染增强或医药或治疗有效量，其中所述量足以增强病毒载体或治疗剂的转导效率。 [0081] In some embodiments, the amount of vasodilator substances is enhanced transfection or pharmaceutically or therapeutically effective amount, wherein said amount is sufficient to enhance transduction efficiency of the viral vector or therapeutic agent. 转染增强可通过检测转染效率直接测量，或通过测量成功转染的其它指标（例如本文所述一或多种症状或结果的改善）间接测量。 Transfection can be measured directly by detecting enhanced transfection efficiency, or other metrics (e.g., as described herein, or one or more symptoms improvement results) by measuring an indirect measure of successful transfection. 增强量是与未投予血管舒张剂或增加NO的物质时的所检测指标相比同一指标得以改善的量。 Enhancing amount is an amount of the same index is improved as compared with the detected indicator when not administered vasodilator or NO increasing substance.
[0082] 治疗剂的投予 Administration [0082] therapeutic agent
[0083] 在本发明的一个优选实施例中，下文更详细阐述的治疗剂（例如多核苷酸/病毒载体）是通过在特定血管中经至少约3分钟时间段输注至活体内跳动心脏冠脉循环的血管中来投予至个体。 [0083] Examples of therapeutic agents, described in more detail below in a preferred embodiment of the present invention (e.g. a polynucleotide / viral vectors) is a beating heart crown by at least about 3 minutes period infused into the living body through a blood vessel in a particular vessel pulse cycle to be administered to individuals. 在人类心脏及心血管病的大型动物模型中，申请者已发现，出乎意料地， 与浓注或以较短输注时间（例如，短于等于1分钟）输注相同量的病毒载体相比，经相对长的输注时间来投予病毒载体更有效，且达成较高的心脏组织基因转移效率。 In large animal model of the human heart and cardiovascular disease, Applicants have discovered that, unexpectedly, with bolus injection or infusion in a short time (e.g., shorter than or equal to 1 minute) the same amount of viral vectors infusion phase ratio, the relatively long infusion time to administration of the viral vector is more effective, and to achieve higher gene transfer efficiency of the heart tissue. 输注的改良功效可以与注射相比每一细胞的较大转基因拷贝数、每一细胞或组织中mRNA和/或蛋白质水平上转基因的增加表达、和/或所转染特定组织细胞（例如心肌细胞）的较大百分比来测量。 Infusion can be improved efficacy compared to a larger number of copies of the transgene per cell injection, each cell or tissue mRNA and / or increased transgene expression at the protein level, and / or cells transfected particular tissue (e.g., cardiac larger cells) percentage measured. 在另一实施例中，可利用临床或功能测量值来展示相对长输注时间时的转染效率。 In another embodiment, the transfection efficiency can be demonstrate at a relatively long infusion time using the function or clinical measurements. 所述临床和功能评价在本文中进一步阐述。 The clinical and functional assessment further described herein.
[0084] 申请者已指出，所述方法可成功地治疗人类心血管病的大型动物模型。 [0084] The applicant has stated that the method can be successfully treated a large animal model of human cardiovascular disease. 另外，申请者已发现，使用相对长的输注时间时，无需使冠脉循环与体循环隔离或再循环治疗剂（原本需要）、或人为限制冠状静脉循环以增加冠脉循环内的压力或延长治疗剂的停留时间。 Further, Applicants have found that, when using a relatively long infusion times, not necessary to isolate the coronary circulation and the systemic circulation or recirculation therapeutic agents (originally needed), or human coronary venous limit cycles to increase the pressure in the coronary circulation or extended the residence time of the therapeutic agent. 也无需冷却心脏、停止心脏跳动或自动物取出心脏以实施灌注。 There is no need to cool the heart, the heart stops beating or from animal to carry out heart perfusion. 相反，申请者的方法可在标准导管插入术实验室环境中使用用于投予的现有导管来实施。 In contrast, Applicants' method may be implemented using a conventional catheter administered in a standard catheterization laboratory environment. 因此，申请者发现了一种简单、 实用且有效的使用基因疗法治疗大型动物（例如人类）心血管病的手段。 Therefore, applicants have found a simple, practical and effective use of gene therapy to treat large animals (such as humans) means of cardiovascular disease.
[0085] 在本发明的一个优选实施例中，治疗剂是通过输注至冠脉循环血管中来投予至个体中。 [0085] In a preferred embodiment of the present invention, the therapeutic agent is infused into the coronary circulation through the blood vessel to be administered to an individual. 冠脉循环向心脏组织提供血液供应。 Coronary circulation provides blood supply to the heart tissue. 存在许多条冠状动脉。 There are many coronary arteries. 通常，四条主干冠状动脉向心脏提供充氧血以分布于整个心脏组织中；左主干及右冠状动脉、左前降动脉及左旋动脉。 Typically, four backbone provides oxygenated blood to the heart coronary distributed throughout the heart tissue; left main and right coronary artery, left anterior descending artery and the left artery. 本发明涵盖输注至所述动脉之一或其组合中，例如输注至左和右冠状动脉中。 The present invention encompasses arterial infusion to the one or a combination of, for example, infused into the left and right coronary arteries. 优选实施例使用左和右主干冠状动脉的顺行性心外膜输注。 Antegrade epicardial infusion preferred embodiment uses the left and right coronary artery trunk. 本发明还涵盖冠状动脉的逆行性输注、或一或多条顺行性与逆行性冠状动脉或静脉的组合。 The present invention also encompasses retrograde coronary infusion, or a combination of anterograde and retrograde coronary arteries or veins one or more. 使用标准导丝、导管和输注泵来实施至冠状血管的输注。 Using a standard guidewire, and infusion pump to the catheter to the coronary vessels embodiment infusion. 在一优选实施例中，输注导管经由股动脉在透视导引下指向冠状动脉。 In a preferred embodiment, the infusion catheter the coronary artery via the femoral artery under fluoroscopic guidance point. 本文所用的“冠脉循环血管”、“冠状血管”或“心脏血管”包括冠状血管上的移植物，例如由心脏搭桥手术产生者。 As used herein "coronary circulation vessel", "coronary" or "cardiovascular" of graft on the coronary blood vessels, such as those generated by the heart bypass surgery. 本文所用的“心外膜”是指位于心脏外部的血管，例如左或右冠状动脉。 As used herein, "epicardial" refers to a blood vessel located outside of the heart, such as the left or right coronary artery.
[0086] 将输注导管置于目标冠状血管中之后，优选地借助可编程输注泵将治疗剂输注至血管中。 After [0086] The infusion catheter is placed in the target coronary vessel, preferably by means of a programmable infusion pump infusion of the therapeutic agent to the blood vessel. 输注治疗剂所花费时间的量对于获得有效且较高的基因转移效率是重要因素。 The amount of time spent infusion of therapeutic agents for obtaining effective and high gene transfer efficiency is an important factor. 申请者已测定，经至少约3分钟的时间输注至特定血管中比浓注或以较短时间输注更有效。 Applicants have determined the specific infused into the blood vessel at least about three minutes than bolus injection or infusion in a short time more efficiently. 优选地，输注时间为至少约8分钟，更优选地为至少约10分钟，但本发明涵盖至少约15分钟的输注时间。 Preferably, the infusion time is at least about 8 minutes, more preferably at least about 10 minutes, but the present invention encompasses at least an infusion time of about 15 minutes. 申请者还预期输注时间为、约为、至少为、至少约为、不长于或不长于约1、2、 3、4、5、6、7、8、9、10、11、12、13、14、15、16、17、18、19 或20 分钟、或在任两个所述值界定的范围内。 Applicants also contemplated that the infusion time is about, at least, at least about, no longer or not longer than about 1, 2, 3,4,5,6,7,8,9,10,11,12,13 , 14,15,16,17,18,19 or 20 minutes, or in the range of any two of the values ​​defined.
[0087] 由于输注通常涉及使用具有一定死体积的导管及连接管道，所以通常将不含有任何治疗剂的载剂溶液（例如个体血液）注入输注装置中。 [0087] Since the infusion typically involves the use of a catheter having a certain dead volume and the connection pipes, it will generally not contain any therapeutic agent carrier solution (e.g., an individual blood) into the infusion device. 因此，在开启输注泵后治疗剂并非立即投予至冠脉循环中。 Therefore, after opening the infusion pump therapy agent is not immediately administered into the coronary circulation. 同样，当含有治疗剂的注射器排空时，通常会有一定量的治疗剂仍然留在连接管道及导管的死体积中。 Similarly, when emptying the syringe containing the therapeutic agent, generally an amount of therapeutic agent will remain in the dead volume of the connection pipe and the conduit. 在输注治疗剂后即刻，使用合适溶液冲洗死体积。 Infusion immediately after the therapeutic agent, using a suitable solution, rinse dead volume. 上文提及的“输注时间”是指治疗剂实际递送至冠脉循环中所经历的时间，而不是排代输注设备中的死体积所经历的时间。 The above-mentioned "infusion time" refers to the time of delivery of a therapeutic agent actually experienced by the coronary circulation, instead of the time displacement of dead volume in the infusion experienced. 例如，如果将3mL治疗剂加载至具有3mL死体积的输注设备中，且输注速率是lmL/min，则将治疗剂输注至冠脉循环中所需要的时间仅为3分钟，而投予3mL治疗剂及3mL死体积所需要的总时间是6分钟。 For example, if the therapeutic agent is loaded onto an 3mL 3mL dead volume in the infusion device and infusion rate was lmL / min, then the therapeutic agent is infused into the coronary circulation time required only 3 minutes, while the cast the total volume of the dead time to 3mL 3mL therapeutic agent required is 6 minutes. 在一些实施例中，将治疗剂注入导管及任何连接管道中，由此死体积就不成问题了。 In some embodiments, the therapeutic agent into the conduit and any connection pipe, whereby the dead volume is not a problem. 同样，可递送有效量的治疗剂且不需要冲洗管道。 Likewise, the delivery of therapeutic agents effective amount of a conduit and does not require rinsing. 然而，此使得治疗剂留在管道中而浪费治疗剂。 However, this such that the therapeutic agent remain in the waste pipe therapeutic agent.
[0088] 申请者预期治疗剂将以如下流速输注：为、约为、至少为、至少约为、不大于或不大于约0. 1,0. 2,0. 3,0. 4,0. 5,0. 6,0. 7,0. 8,0. 9,1. 0,1. 1、1· 2,1. 3,1. 4,1. 5,1. 6,1. 7,1. 8、 1. 9、2· 0、2· 1、2· 2、2· 3、2· 4、2· 5、2· 6、2· 7、2· 8、2· 9、3· 0、3· 5、4· 0、4· 5、5· 0、5· 5、6· 0、6· 5、 7. 0、7. 5、8. 0、8. 5、9. 0、9. 5或10. OmL/min、或在任两个所述值界定的范围内。 [0088] Applicant intended therapeutic agent infusion flow rate will be as follows: is about, at least, at least approximately, no greater than about 0.5 or not greater than 1,0 2,0 3,0 4,0... . 5,0. 6,0. 7,0. 8,0. 9,1. 0,1. 1,1 * 2,1. 3,1. 4,1. 5,1. 6,1. 7 , 1.8, 1. 9,2 · 0,2 · 1,2 · 2,2 · 3,2 · 4,2 · 5,2 · 6,2 · 7,2 · 8,2 · 9,3 * 0,3 * 5,4 * 0,4 * 5,5 * 0,5 * 5,6 * 0,6 * 5, 7. 0,7. 5,8. 0,8. 5,9. 0 , 9.5 or 10. OmL / min, or any two of the values ​​within the range defined in. 优选地，流速介于约0. 2mL/min与约6. OmL/min.之间，更优选地介于约0. 2mL/min与约2. 5mL/min.之间，更优选地介于约0.2mL/min.与约2. OmL/min.之间。 Preferably, the flow rate between about 0. 2mL / min and about 6. OmL / min., More preferably between between about 0. 2mL / min and about 2. 5mL / min. Between, more preferably between about 0.2mL / min. and about 2. OmL / min. between. 所属领域的技术人员应认识到，可在不使用输注泵下递送治疗剂，然而使用输注泵可获得更准确的流速及始终如一的递送。 Those skilled in the art will recognize, the therapeutic agent can be delivered without the use of an infusion pump, the infusion pump available but using a more accurate and consistent delivery flow rate.
[0089] 通过输注来递送以提供有效量的病毒颗粒或DNA酶抗性颗粒（DRP)的总量优选地介于1 X IO14与约1 X IO11之间，更优选地介于约3X IO12与1 X IO12之间，且更优选地为约3X1012。 [0089] The total amount delivered by infusion to provide an effective amount of a viral particle or a DNA nuclease resistant particles (DRP) is preferably between 1 X IO14 and about 1 X IO11, more preferably between about 3X IO12 and between 1 X IO12, more preferably about 3X1012. 然而，申请者也预期病毒颗粒或DRP的总量为、约为、至少为、至少约为、不大于或不大于约IX 1014、9X 1013、8X 1013、7X 1013、6X 1013、5X 1013、4X 1013、3X 1013、2X 1013、 IX 1013、9X 1012、8X 1012、7X 1012、6X 1012、5X 1012、4X 1012、3X 1012、2X 1012、1X 1012、 9X 10U、8X 10U、7X 10U、6X 10U、5X 10U、4X 10U、3X 10U、2X 10U、1X 10U、9X 1010、 8 X 101CI、7 X 101CI、6 X 101CI、5 X 101CI、4 X 101CI、3 X 101CI、2 X 101CI、1 X 101CI、9 X 109、8 X 109、7 X 109、 6X 109、5X 109、4X 109、3X 109、2X 109、1X IO9或在任两个所述值界定的范围内。 However, the applicant is also contemplated that the total amount of DRP or viral particle is about, at least, at least approximately, no greater than or no greater than about IX 1014,9X 1013,8X 1013,7X 1013,6X 1013,5X 1013,4X 1013,3X 1013,2X 1013, IX 1013,9X 1012,8X 1012,7X 1012,6X 1012,5X 1012,4X 1012,3X 1012,2X 1012,1X 1012, 9X 10U, 8X 10U, 7X 10U, 6X 10U, 5X 10U, 4X 10U, 3X 10U, 2X 10U, 1X 10U, 9X 1010, 8 X 101CI, 7 X 101CI, 6 X 101CI, 5 X 101CI, 4 X 101CI, 3 X 101CI, 2 X 101CI, 1 X 101CI, 9 X 109,8 X 109,7 X 109, 6X 109,5X 109,4X 109,3X 109,2X 109,1X IO9 or any two of the values ​​within a defined range.
[0090] 给定时间内所输注DRP的数量是所输注溶液的浓度及流速的函数。 [0090] The number of times a given DRP infused as an infusion solution is a function of the concentration and flow rate. DRP或病毒颗粒的输注速率优选地介于约IX IO8Aiin.与约IXlO1Vmin.之间，更优选地介于约5X IOltl/ min.与约5X1012/min.之间，更优选地介于约3X IOltVmin.与约lX1012/min.之间，更优选地介于约6X IOltVmin.与约AxiO11Aiin.之间。 Between the rate of DRP or viral particle infusion is preferably between about IX IO8Aiin. And about IXlO1Vmin., More preferably between about 5X IOltl / min. And about 5X1012 / min., More preferably between about 3X between IOltVmin. and about lX1012 / min., more preferably between about 6X IOltVmin. and about AxiO11Aiin. between. 在一优选实施例中，DRP或病毒颗粒的输注速率是1 X IO1Vmin.，且在另一优选实施例中，输注速率是1. 25 X IO11Aiin.。 In a preferred embodiment, the rate of DRP or viral particle infusion is 1 X IO1Vmin., And in another preferred embodiment, the infusion rate was 1. 25 X IO11Aiin ..
[0091] 在一个实施例中，将治疗剂投予至心脏的单一血管中。 [0091] In one embodiment, the therapeutic agent is administered to a single vessel of the heart. 在另一实施例中，将治疗剂总体积的2/3递送至一条心脏血管中，并将1/3投予至另一条心脏血管中。 In another embodiment, the therapeutic agent is 2/3 of the total volume delivered to a blood vessel of the heart, and 1/3 is administered to another blood vessel of the heart. 在另一实施例中，输注至多于2条（例如3条、4条、5条或更多条）冠状血管中，且可视需要调节投予至每一条血管中的含有治疗剂的总输注体积的份额。 In another embodiment, the infusion to more than two (e.g. three, four, five or more) of the coronary vessels, and optionally adjusted to a total administration each containing the therapeutic agent in a blood vessel infusion volume share. 输注的目标是经由顺行性心外膜冠脉输注进行扩散并使左心室心肌均勻暴露于AAV2/l/SERCA2a。 Infusion goal is diffused uniformly exposed to the left ventricle and AAV2 / l / SERCA2a via antegrade epicardial coronary infusion. 基于侧支化方式、闭塞性疾病及解剖学变化（例如手术后旁路解剖）存在多种输注方案，但是临床医师的目标是将1/3的AAV2/l/SERCA2a递送至前外侧，1/3递送至后外侧，且1/3递送至下方/下侧心肌。 Based on collateralization embodiment, anatomic variations and occlusive disease (e.g. anatomical bypass surgery) is present various infusion regimen, but the goal is to clinicians 1/3 AAV2 / l / SERCA2a delivered to the anterolateral, 1 after / 3 is delivered to the outside, and is delivered to the lower 1/3 / lower side of the myocardium. 通过冠状及旁路移植血管造影术来确定解剖以均勻递送至经灌注心肌中。 Determining a uniform delivery to the anatomy of the myocardium perfused by coronary angiography and bypass graft. 另外，所属领域的技术人员应认识到，尽管绵羊及猪是用于人类心血管研究的可接受的动物模型，但90%的绵羊和猪是左侧优势型（left dominant)。 In addition, those skilled in the art will recognize that while sheep and pigs are acceptable animal model for the study of human cardiovascular, but 90% of sheep and pigs are the left-dominant (left dominant). 相比之下，近似约10%的人类群体是左侧优势型，而其余90%是右侧优势型（right dominant)或等优势型(co-dominant)(伍劳达沃（Vlodaver Z.)等人，冠状心脏病：临床、血管造影及病理学性质(Coronary Heart Disease :Clinical, Angiographic, and Pathologic Profiles)施普林格（Spinger-Verlag)，纽约（New York). 1976)。 In contrast, approximately 10% of the human population around the left-dominant, while the remaining 90% is a right side-dominant (right dominant) or other advantages type (co-dominant) (Wulaodawo (Vlodaver Z.) et al., coronary heart disease: clinical, angiographic and pathological nature (coronary Heart Disease: clinical, angiographic, and pathologic Profiles) Springer (Spinger-Verlag), New York (New York) 1976).. 一个病理系列指出患者中71%是右侧优势型，17%是等优势型，12%是左侧优势型（麦凯派恩（McAlpine W.)心脏及冠状动脉（Heart and Coronary Arteries).施普林格（Spinger Verlag)，1975)。 A series of pathology noted in 71% of patients with type is a right side advantage, and other advantages type 17%, 12% of the left-dominant (McKay pine (McAlpine W.) of the heart and coronary artery (Heart and Coronary Arteries). Shi Pringle (Spinger Verlag), 1975). 因此，在人类对猪/ 绵羊中达成类似左心室灌注的最佳输注方案可能不同。 Therefore, to achieve optimal infusion protocol similar left ventricular perfusion may be different pig / sheep in humans.
[0092] 对于两条血管来说，占溶液体积的1/3及2/3份额优选，然而，注射至特定血管中的注射体积的份额可以为、约为、至少为、至少约为、不大于或不大于约总体积的20%、 25%、30%、35%、40%、45%、50%、55%、60%、65%、70%、75% 或80%、或在任两个所述值界定的范围内。 [0092] For two blood vessels, the volume of the solution accounts for 1/3 and preferably 2/3 share, however, is injected into the injection volume share of a particular blood vessel may be about, at least, at least about, is not is greater than or not greater than about 20% of the total volume, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75% or 80%, or any two the value within a defined range. 含有治疗剂的溶液的总体积应随所治疗动物的体格而变化。 The total volume of the solution containing the therapeutic agent varies with the physical being treated animals. 对于人类个体， 总治疗剂体积优选为60mL。 For a human subject, the total volume of the therapeutic agent is preferably 60mL. 然而，治疗剂总体积可以为、约为、至少为、至少约为、不大于或不大于约1、2、3、4、5、10、15、20、25、30、35、40、45、50、55、60、65、70、75、80、85、90、95、100、 105、110、115、120、125、130、135、140、145或150mL的体积、或在任两个所述值界定的范围内。 However, the total volume of therapeutic agent can be about, at least, at least approximately, no greater than or no greater than about 1,2,3,4,5,10,15,20,25,30,35,40,45 , 50,55,60,65,70,75,80,85,90,95,100, 105,110,115,120,125,130,135,140,145 or volume of 150mL, or any two of the value within a range defined above.
[0093] 本文所述治疗剂可以呈溶液形式，优选地呈适于直接投予至冠脉循环中的医药组合物形式。 [0093] The therapeutic agents described herein may be in the form of a solution, preferably in a form suitable for direct administration to a pharmaceutical composition of the coronary circulation. 可接受医药组合物的成份已为所属领域的技术人员所了解，且可包括诸如缓冲剂及适宜载剂等成份。 Acceptable pharmaceutical composition ingredients are by those skilled in the art appreciate, and may comprise a suitable carrier such as buffers and the like ingredients. 在另一实施例中，含有治疗剂（例如病毒载体，且更优选地AAV2/1/ SERCA2a载体）的医药组合物是试剂盒的一部分。 In another embodiment, a therapeutic agent (e.g., a viral vector, more preferably AAV2 / 1 / SERCA2a vector) pharmaceutical composition is part of a kit. 在一些实施例中，试剂盒含有治疗剂的储备溶液及用于稀释所述储备溶液的溶液。 In some embodiments, a kit containing the therapeutic agent stock solution and for diluting the stock solution Solution. 试剂盒中还包括用于投予病毒载体的说明书，优选地如任一本文所揭示实施例中所述通过直接输注至冠脉循环中来投予。 The kit further comprising means for administration of the viral vector instructions, preferably as any of the herein disclosed embodiment by direct infusion into the coronary circulation to be administered. 本文所述治疗剂和血管舒张剂（包括但不限于增加NO的物质）可用以制造用于治疗本文所揭示疾病的药剂，其中按照任一本文所揭示方法或在任一本文所揭示方法的实践中投予所述药剂。 Therapeutic agents described herein, and vasodilators (including but not limited to NO increasing substance) may be used to manufacture an agent for the treatment of diseases disclosed herein, wherein a according to any method disclosed herein in either practice or methods disclosed herein administering the agent.
[0094] 多核苷酸递送方法 [0094] The method of polynucleotide delivery
[0095] 本发明的一个方面涵盖将治疗性多核苷酸转移至细胞中。 One aspect of the [0095] present invention encompasses the therapeutic polynucleotide transferred into the cells. 所述转移可使用病毒或 The virus may be used or transfer
22非病毒基因转移方法。 22 Non-viral gene transfer methods. 此部分提供关于基因或核酸转移（包括反义、干扰及小干扰序列的转移）的方法和组合物的论述。 This section provides a discussion of the gene or nucleic acid transfer (including transfer of antisense, interference and small interfering sequences) methods and compositions.
[0096] 在一个实施例中，将治疗上有意义的多核苷酸纳入病毒载体中以调介至细胞的转移。 [0096] In one embodiment, the therapeutically significant polynucleotide into a viral vector to mediate the transfer to cells. 编码本文所述其它治疗剂的其它表达构建体也可经由病毒转导使用感染性病毒颗粒进行转移，例如，通过使用本发明的腺伴随病毒（AAV)或AAV分子变体进行转化。 Encoding the additional therapeutic agents herein, other expression constructs may be via viral transduction using infectious viral particles are transferred, e.g., by use of the present invention, adeno-associated virus (AAV) AAV molecule or variant thereof transformation. 或者，可使用经改造以表达的逆转录病毒、牛乳头状瘤病毒、腺病毒载体、慢病毒载体、牛痘病毒、多瘤病毒或感染性病毒。 Alternatively, you can use engineered to express the retrovirus, bovine papilloma virus, adenovirus vectors, lentiviral vectors, vaccinia virus, polyoma virus or infectious virus. 同样，可使用非病毒方法，其包括（但不限于）直接递送DNA(例如通过灌注）、裸DNA转染（naked DNA transfection)、脂质体调介的转染、包囊作用(encapsulation)及受体调介的胞吞作用。 Similarly, non-viral methods may be used, including (but not limited to) direct delivery of DNA (e.g. by infusion), naked DNA transfection (naked DNA transfection), liposome-mediated transfection, for encapsulation (encapsulation) and receptor-mediated endocytosis. 所述技术已为所属领域的技术人员所熟知，且其细节并非本发明的关键点，且因此在本文中无需详尽无遗地赘述。 The techniques are well known in those skilled in the art, and its details are not the key points of the present invention, and therefore need not be exhaustively repeated herein. 然而，在一个优选实例中，使用病毒载体来转导心脏细胞以将治疗上有意义的多核苷酸递送至细胞中。 However, in one preferred example, the use of viral vectors to cardiac cells transduced therapeutically meaningful polynucleotide delivered to the cells. 病毒可通过诸如受体调介的胞吞作用等特异性方式或通过诸如胞饮作用等非特异性方式进入细胞内部。 Virus-specific manner, such as by receptor-mediated endocytosis or the like into the interior of the cell by non-specific manner, such as pinocytosis.
[0097] 腺伴随病毒载体 [0097] The adeno-associated virus vector
[0098] 本发明的一个优选实施例使用纯化的复制缺陷型假型重组腺伴随病毒（rAAV)颗粒。 Purified recombinant replication-defective pseudotyped adenovirus preferred embodiment of a [0098] embodiment of the present invention associated virus (the rAAV) particles. 腺伴随病毒（AAV)是属于依赖病毒属（D印endovirus)的细小病毒。 Adeno-associated virus (AAV) is a dependent virus belonging to the genus (D printing endovirus) of parvovirus. 其是需要辅助病毒来进行复制的小的无包膜单链DNA病毒。 Which it requires helper virus for replication of small, non-enveloped single-stranded DNA virus. 形成功能完全的AAV病毒粒子需要与辅助病毒(例如，腺病毒、疱疹病毒或牛痘病毒）共感染。 Forming a fully functional AAV virion requires co-infection with a helper virus (e.g., adenovirus, herpes virus, or vaccinia virus). 在活体外，在不与辅助病毒共感染下，AAV 处于一种潜伏状态，其中病毒基因组以附加型（印isomal)形式存在，但不产生感染性病毒粒子。 In vitro, without co-infection with helper virus, the AAV is in a latent state in which the viral genome is present in an episomal (printing isomal) form, but does not produce infectious virions. 随后受辅助病毒感染而“拯救”基因组，使其能够复制并包裹于病毒衣壳中，由此重新构成感染性病毒粒子。 Followed by helper virus infection "save" the genome, it is possible to copy and packaged in the viral capsid, thereby reconstituting the infectious virion. 最新数据表明，在活体内，野生型AAV及重组AAV 二者主要以大的附加型多联体形式存在。 The latest data show that, in vivo, both wild-type AAV and recombinant AAV mainly in the form of large multi-linked additional type.
[0099] AAV不与任何已知的人类疾病有联系，通常视为无病原性，且在整合后似乎不改变宿主细胞的生理学特性。 [0099] AAV does not have any known human disease contact, usually regarded as non-pathogenic and does not appear to alter the physiological properties of the host cell upon integration. AAV能够感染诸多种宿主细胞，包括非分裂细胞，且能够感染来自不同物种的细胞。 AAV can infect many types of host cells, including non-dividing cells and can infect cells from different species. 与由细胞及体液应答快速清除或失活的一些载体相比，AAV载体在活体内多种组织中显示持久表达。 Some vectors compared to rapid clearance of cellular and humoral responses or inactivated, AAV vector expression in vivo persistence display various tissues. 重组AAV载体在活体内非分裂细胞中的持久性可能归因于缺少天然AAV病毒基因及载体形成附加型多联体的能力。 The recombinant AAV vectors in non-dividing cells in vivo persistence of AAV may be due to a lack of viral genes and native ability episomal vectors forming concatemers.
[0100] 腺伴随病毒（AAV)是用于细胞转导的有吸引力的载体系统，这是因为其在大多数情况下可保持为附加型多联体，且其能够感染非分裂细胞，由此其可用于将基因递送至哺乳动物细胞（例如，在组织培养物中及在活体内）中。 [0100] Adeno-associated virus (AAV) vector for cell transduction system attractive, because it can be kept in most cases episomal concatemers, and which are capable of infecting non-dividing cells, the this which it may be used to deliver genes into mammalian cells (e.g., in tissue culture and in vivo) in. 展示在基因递送中使用AAV的研究包括弗洛特(Flotte)等人，美国国家科学院院刊（Proc. Natl. Acad. Sci. USA)，1993 ；90 ： 10613-17 和沃尔什(Walsh)等人，临床研究期刊(J. Clin. Invest.)，1994 ；94 ： 1440-48。 Demonstrate the use of AAV in gene delivery in the study include Flatt (Flotte) et al., PNAS (Proc Natl Acad Sci USA....), 1993; 90: 10613-17 and Walsh (Walsh) et al., Journal of clinical Research, 1994; 94 (J. Clin Invest..): 1440-48. 已成功地使用重组AAV载体在活体外和活体内转导标记基因及与人类疾病有关的基因（参见例如，沃尔什(Walsh)等人，临床研究期刊(J. Clin. Invest.) 1994 ；94 ： 1440-48)。 Have been used successfully recombinant AAV vectors in vitro and in vivo transduction of marker genes and genes associated with human disease (see, Walsh (Walsh) et al., Journal of Clinical Study e.g. (J. Clin Invest) 1994..; 94: 1440-48). AAV对宽范围的宿主具有感染性。 AAV has a wide host range of infectivity of. 关于rAAV载体的产生及使用的细节阐述于美国专利第5，139,941 号和/或美国专利第4，797，368号中，所述案件以引用方式并入本文中。 Details regarding the generation and use of rAAV vectors are described in U.S. Patent No. 5,139,941 or U.S. Pat. No. and / of 4,797,368, the cases incorporated herein by reference.
[0101] 通常，通过共转染含有两侧有两个AAV末端重复的目标基因的质粒和/或含有野生型AAV编码序列而不含有末端重复的表达质粒（例如pIM45)来制备重组AAV (rAAV)病毒。 [0101] Generally, by co-transfection with a plasmid containing the two AAV terminal repeats of the target genes and / or wild-type AAV coding sequences without prepared containing a recombinant AAV terminal repeats containing expression plasmids (e.g. pIM45) (rAAV sides )virus. 也使用腺病毒和/或带有AAV辅助功能所需要的腺病毒基因的质粒来感染和/或转染细胞。 Adenovirus plasmids also be used and / or with an adenoviral genes required for AAV helper function to infect and / or transfect cells. 以所述方式制备的rAAV病毒原液带有腺病毒杂质，必须以物理方式将其自rAAV颗粒分离出来（例如，通过氯化铯密度离心或柱色谱）。 rAAV virus stocks prepared in the manner described with adenovirus impurities must be physically separated (e.g., by cesium chloride density centrifugation or column chromatography) from which rAAV particles. 或者，可使用含有AAV编码区的腺病毒载体和/或含有AAV编码区和/或一些或全部腺病毒辅助基因的细胞系。 Alternatively, an adenoviral vector containing the AAV coding regions and / or containing the AAV coding regions and / or some or all of the adenovirus helper cell line gene. 也可使用带有呈整合的原病毒形式的rAAV DNA的细胞系。 It may also be used with the integrated proviral form of a cell line of rAAV DNA.
[0102] 自然界中存在多种AAV血清型，当前已知至少12种血清型（AAV1-AAV12)。 [0102] There are many nature AAV serotype, currently at least 12 known serotypes (AAV1-AAV12). 而且， 已通过定向进化（DNA改组）技术来制备嵌合变体（参见李（Li)等人）。 Further, chimeric variants have been prepared (see Li (Li) et al) by directed evolution (DNA shuffling) technology. 除高程度同源性外，不同血清型对不同组织具有向性（tropism)。 In addition to a high degree of homology, the different serotypes tropic (tropism) for different tissues. AAVl的受体尚不清楚；然而，已知AAVl比AAV2更有效地转导骨骼肌和心肌。 AAVl receptor unknown; however, it is known AAVl more effectively transduce skeletal and cardiac muscles than AAV2. 由于大多数研究是使用假型载体（其中两侧有AAV2 ITR 的载体DNA包裹于替代血清型的衣壳中）来实施，所以显然生物学差异与衣壳而非基因组有关。 Since most of the studies using pseudotyped vectors (which has both DNA AAV2 ITR vector is encapsulated in an alternative serotype capsids) implemented, it is clear that biological differences capsid not related genome. 最新证据表明，包裹于AAVl衣壳中的DNA表达盒在转导心肌细胞方面比包裹于AAV2 衣壳中者更有效至少llogl。 Recent evidence indicates that, DNA expression cassette is packaged in the capsid AAVl in transduced cardiac myocytes AAV2 capsids were more effective than the parcel in the at least llogl. 。 .
[0103] 改造的rAAV载体 [0103] transformation of rAAV vectors
[0104] 在一个实施例中，可改造AAV载体以降低中和抗体（NAb)滴度和/或交叉反应性。 [0104] In one embodiment, AAV vectors can be engineered to reduce neutralizing antibodies (NAbs) titer and / or cross-reactivity. 优选地，改造或嵌合载体与Nab的交叉反应性比野生型载体的交叉反应性低至少50%、 55%、60%、65%、70%、75%、80%、85%、90%、95%、97%或99%。 Preferably, modified or cross-reactive with chimeric vectors Nab cross reactivity lower than wild-type carrier at least 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90% , 95%, 97% or 99%. 更优选地，基本上不存在交叉反应性。 More preferably, substantially the absence of cross-reactivity. 降低交叉反应性和/或NAb滴度可通过改造AAV衣壳蛋白以产生嵌合和/或经改变rAAV载体来实施。 Reducing the cross-reactivity and / or NAb titers by engineering AAV capsid proteins to create chimeric and / or altered rAAV vectors implemented. 业内已知数种改造基因（例如，衣壳基因）的方法，包括（但不限于） DNA改组（一类或单一基因）（参见李（Li)等人，克若迈瑞（Crameri，A)等人，（1998). “来自各种物种的一类基因的DNA改组加速定向进化（DNA shuffling of a family of genes from diverse species accelerates directed evolution·)，，自然(Nature) 391 ： 288-291 ；及斯代默（Stemmer，WP) (1994). “通过DNA改组来加速活体外蛋白质进化.（Rapid evolution of a protein in vitro by DNA shuffling.)”自然（Nature) 370 :389-391，所有文献的全部内容均以引用方式并入本文中）、定点诱变、易错PCR(穆尔（Moore，GL)， 马拉娜斯（Maranas，⑶.），2000. “模拟用于定向进化实验的DNA突变及重组.（Modeling DNA mutation and recombination for directed evolution experiments.)，，理论生物学期刊（工11^01~.8丨01.)205，483-503，其以引用方式并入本文中）、产生嵌合体或其 Method industry known number of species of modified genes (e.g., capsid gene), including (but not limited to) the DNA shuffling (a class or single gene) (see, Li (Li) et al., If Mairui g (Crameri, A), etc. . al., (1998) "DNA shuffling a class of genes from various species acceleration directed evolution (DNA shuffling of a family of genes from diverse species accelerates directed evolution ·) ,, Nature (Nature) 391: 288-291; and . Stetson Mo (Stemmer, WP) (1994) "DNA shuffling by accelerated in vitro protein evolution (Rapid evolution of a protein in vitro by DNA shuffling.)." Nature (Nature) 370: 389-391, all documents entire contents of which are incorporated by reference herein), site-directed mutagenesis, error prone PCR (Moore (Moore, GL), Mara Lady (Maranas, ⑶.), 2000. "directed evolution simulation experiments for DNA mutation and recombination. (Modeling DNA mutation and recombination for directed evolution experiments.) ,, Journal of theoretical Biology (11 ^ 01 ~ .8 station 01. Shu) 205,483-503, which is incorporated herein by reference), generating chimeras, or 合， 例如交错延伸方法，所述方法纳入DNA改组及易错PCR技术（马赫世瑞（Maheshri，N)等人，(2006). “腺伴随病毒的定向进化产生增强的基因递送载体.（Directed evolution of adeno-associated virus yields enhanced gene delivery vectors.)，，自然生物技术(Nat BioteChnol)24 :198-204，其全部内容以引用方式并入本文中）。衣壳蛋白经历改造后，针对期望特性对rAAV载体进行分析，针对所述期望特性对其进行选择或筛选。例如，可利用选择和/或筛选来分离已纳入与NAb的反应性或交叉反应性降低的特性的rAAV无性系。如李（Li)等人所述，在对负责编码AAV衣壳蛋白的基因（S卩，衣壳基因）实施DNA改组技术后产生经改变rAAV载体。作者制备的改造rAAV无性系是自多种血清型的组合产生， 且因此含有代表各种亲代血清型的基因组片段。为评价经改变rAAV载体的免疫学性质，对其实施一系列交 Together, e.g. staggered extension, the method into DNA shuffling and error-prone PCR technique (Mach Shi Rui (Maheshri, N) et al., (2006). "Enhanced generation of adeno-associated virus gene delivery vehicle directed evolution. (Directed after 198-204, the entire contents of which are incorporated herein by reference) capsid protein undergoes transformation, for the desired properties: evolution of adeno-associated virus yields enhanced gene delivery vectors) ,, Nature biotechnology (Nat BioteChnol) 24.. analysis for rAAV vector, subjected to selection or screening for the desired characteristic. for example, selection may be utilized and / screening has been isolated and incorporated into the reactive NAb or reduced cross-reactivity characteristics rAAV clones or as Li (Li) et al., produce a change in the rAAV vectors of the AAV capsid proteins responsible for encoding gene (S Jie, capsid gene) embodiments DNA shuffling techniques. transformation rAAV clone is prepared from various serotypes of the combination yields, and thus contains serotypes representing various parental genomic fragments. to evaluate altered immunological properties of rAAV vectors, a series of its cross- 反应性测试。 Reactivity testing. 在所述测试中，自经特定AAV血清型（即，亲代血清型）免疫的小鼠取抗血清，改造的rAAV载体衍生自所述特定AAV血清型。 In the test, the self rAAV vector was AAV serotype-specific (i.e., parental serotypes) mice immunized antiserum taken, the transformation is derived from a particular AAV serotype. 所述分析（在李（Li) 等人的研究中）评价NAb滴度及改造的rAAV载体与自经AAV亲代血清型免疫的小鼠产生的抗血清的交叉反应程度。 The analysis (Lee study (Li) et al) the degree of cross-reaction of antisera titers of rAAV vector NAb Evaluation and Improvement of self through the parental AAV serotypes of immunized mice. 结果显示，来自4种亲代血清型中的3种的抗血清不与改造的rAAV无性系交叉反应，而其余试样显示NAb滴度降低至1/25。 The results show that antisera from the four parental serotype 3 thereof is not cross-react with the engineered rAAV clone, while other samples exhibit reduced NAb titers to 1/25.
[0105] 在另一实施例中，可改造AAV载体以提高转导效率和/或特异性。 [0105] In another embodiment, AAV vectors can be engineered to increase transduction efficiency and / or specificity. 提高转导效率和/或特异性可通过改造AAV衣壳蛋白以产生嵌合和/或经改变rAAV载体来实施。 Improve the transduction efficiency and / or specificity can be obtained by transformation to generate a chimeric AAV capsid protein and / or altered rAAV vectors implemented. 业内已知数种改造基因的方法，包括（但不限于）DNA改组（一类或单一基因）、定点诱变、易错PCR、产生嵌合体或其组合，例如交错延伸方法，所述技术纳入DNA改组及易错PCR。 Several methods are known in the industry of transformation of genes, including (but not limited to) the DNA shuffling (or a single class of genes), site-directed mutagenesis, error prone the PCR, generating chimeras, or combinations thereof, for example, staggered extension process technology into the DNA shuffling and error-prone PCR. 衣壳蛋白经历改造后，针对期望特性对rAAV载体进行分析，针对所述期望特性对其进行分析。 After undergoing renovation capsid protein for desired characteristics analysis of rAAV vectors, analyze them for the desired characteristics. 例如，可利用选择和/或筛选来分离对目标组织或细胞具有提高的效率和/或特异性的rAAV 变体。 For example, using the selection and / or screening to isolate having an increased efficiency of the target cells or tissue and / or specificity of the rAAV variants.
[0106] 治疗效果 [0106] therapeutic effect
[0107] 在一优选实施例中，利用输注本文所揭示的治疗剂在患有心脏疾病的患者中达成治疗效果。 [0107] In a preferred embodiment, the infusion of the therapeutic agent using the herein disclosed to achieve a therapeutic effect in patients suffering from heart disease. 可针对伴随心脏病症的临床特征对所治疗个体进行监测以确定是否达成治疗效果。 It can be monitored on the subject being treated for a heart condition associated with clinical features to determine whether to achieve a therapeutic effect. 例如，可针对与心血管病有关的不良体征及症状的减轻来监测个体。 For example, an individual can be monitored for and mitigate associated with adverse cardiovascular signs and symptoms. 例如，在使用本文所揭示方法治疗个体的充血性心脏衰竭后，可针对以下多个参数的改良来评价个体：包括(但不限于）侧心室缩短分数提高、在细胞及完整动物水平上心脏收缩性增强、心脏重构逆转、及细胞溶质钙的异常高舒张水平正常化。 For example, after using the herein disclosed methods for treating congestive heart failure, an individual can be evaluated for a plurality of the following parameters modified: include (but are not limited to) the side ventricle fractional shortening improved at the cellular and intact animal levels systole enhancement, reversal of cardiac remodeling, and the normalization of abnormally high diastolic levels of cytosolic calcium cells. 在使用本技术治疗的个体中可监测的其它临床及心脏参数包括但不限于存活率、心脏代谢、心脏收缩性、心率、心室功能（例如，左心室舒张末期压（LVEDP)、左心室收缩压（LVSP))、Ca2+代谢（例如，细胞内Ca2+浓度、峰值或静息[Ca2+]、SR Ca2+ATP酶活性、受磷蛋白的磷酸化状态）、力产生、松弛、力-频率关系、心肌细胞存活或凋亡或离子通道活性（例如，钠钙交换、钠通道活性、钙通道活性、钠钾ATP酶泵活性）、肌球蛋白重链的活性、BNP及NT-proBNP、肌钙蛋白I、肌钙蛋白C、肌钙蛋白T、CK-MB, 原肌球蛋白、肌动蛋白、肌球蛋白轻链激酶、肌球蛋白轻链1、肌球蛋白轻链2或肌球蛋白轻链3、IGF-1受体、PI3激酶、AKT激酶、钠-钙交换剂、钙通道（L及T)、肌集钙蛋白或钙网蛋白。 Other clinical and cardiac parameters in an individual using techniques such treatment may be monitored include, but are not limited to survival, cardiac metabolism, heart contractility, heart rate, ventricular function (e.g., left ventricular end-diastolic pressure (LVEDP), left ventricular systolic pressure (LVSP)), Ca2 + metabolism (e.g., intracellular Ca2 + concentration, peak or resting [Ca2 +], SR Ca2 + ATP activity, phosphorylation state of phospholamban), the force, relaxation force - frequency relationship, myocardial cell survival or apoptosis or ion channel activity (e.g., sodium calcium exchange, sodium channel activity, calcium channel activity, ATP sodium-potassium ATPase pump activity), activity of myosin heavy chain, of BNP and NT-proBNP, troponin I , troponins C, T, CK-MB, tropomyosin, actin, myosin light chain kinase, myosin light chain 1, myosin light chain 2 or myosin light chain 3, IGF-1 receptor, a PI3 kinase, AKT kinase, sodium - calcium exchanger, calcium channel (L and T), calsequestrin or calreticulin. 可在治疗之前、之后及期间实施评价。 It may be prior to treatment, and after performing the evaluation period. 可监测的其它心脏疾病指标包括缩短分数、心排出量、射血分数、Tau、反流体积、住院期长短、生活质量、及踏车时间、6分钟步行测试期间的步行距离、及最大耗氧量（V02max)。 Other indicators of heart disease can be monitored include fractional shortening, cardiac output, ejection fraction, Tau, regurgitation volume, length of hospitalization, quality of life, and treadmill time, walking distance during the six-minute walk test, and maximum oxygen consumption amount (V02max). 在一个实施例中，可使用业内已知的测量存在于细胞和/或组织中的rAAV载体DNA、RNA和/或蛋白质的分子生物学技术来监测患者。 In one embodiment, measurements known in the art present in the cell and / or tissue rAAV vector DNA, RNA molecular biological techniques and / or proteins can be used to monitor a patient. 在一些实施例中，可评价每一细胞的转基因拷贝数、每一细胞或组织中mRNA和/或蛋白质水平上转基因的表达、和/或所转染特定组织细胞（例如心肌细胞）的百分比。 In some embodiments, may be evaluated copy number of the transgene per cell, each cell or tissue mRNA and / or transgene expression at the protein level, and / or the percentage of transfected particular tissue cells (e.g., cardiomyocytes) that turn.
[0108] 在一优选实施例中，投予血管舒张物质（优选地本文所述的增加NO的物质，更优选地硝酸甘油）可提高治疗剂的转导效率。 [0108] In a preferred embodiment, administration of vasodilating substance (the NO increasing substance is preferably used herein, the nitrate, more preferably glycerol) can improve the efficiency of transduction of the therapeutic agent. 在一些实施例中，投予血管舒张剂或增加NO的物质可提高由单独投予治疗剂所达成的治疗效果，其中如本文所述监测所述治疗效果。 In some embodiments, administration of a vasodilator or NO increasing substance can enhance the therapeutic effect of the therapeutic agent administered alone reached, wherein as the monitoring of the therapeutic effect described herein. 在一些实施例中，投予血管舒张剂或增加NO的物质可达成治疗剂的改良功效，由此使用较少治疗剂即可达成相同水平的治疗效果。 In some embodiments, administration of a vasodilator or NO increasing substance improved efficacy of the therapeutic agent can be achieved, thereby to achieve the same level of therapeutic effects using less of therapeutic agents. 改良功效可使单次投予中所需要的治疗剂减少，或在一定时间内治疗剂的投予次数减少。 Enable improved efficacy of a single administration of the therapeutic agent required to reduce, over time, or the therapeutic agents administered to reduce the number. 在一些实施例中，投予血管舒张物质通过延长治疗效果的持续时间来改良由单独投予治疗剂所达成的治疗效果。 In some embodiments, administration of vasodilating substance modified by the therapeutic effects of therapeutic agents administered alone reached by the duration prolonged therapeutic effect. 在一些实施例中，与不投予血管舒张物质时所达成的值相比，治疗剂的转导效率、治疗效果或功效的改良为、约为、至少、至少约5、10、15、20、25、30、35、40、45、50、55、60、65、70、75、80、90、100、125、150、175 或200%、或2、3、4、5、7、10、15或20倍、或由任两个前述值界定的范围。 In some embodiments, as compared with the value reached at the vasodilating substance is not administered, transduction efficiency, or efficacy of treatment improved the therapeutic agent is about, at least, at least about 5,10,15,20 , 25,30,35,40,45,50,55,60,65,70,75,80,90,100,125,150,175 or 200%, or 2,3,4,5,7,10 , 15 or 20 fold, or a range defined by any two of the preceding values. 例如，如果观测到在不使用血管舒张剂治疗后射血分数提高持续3个月，那么在使用血管舒张剂治疗后治疗效果提高50%会使得射血分数提高持续4. 5个月。 For example, if the observed increase in the ejection fraction is not treated using vasodilators for 3 months, then after treatment with the vasodilator treatment ejection fraction of 50% will increase so that the duration 4.5 months.
[0109] 本文所揭示方法及本文所揭示治疗剂可与现有心脏疾病治疗方案（例如药物或外科介入）组合以提供与单独现有治疗方案相比增强的治疗效果。 [0109] As used herein disclosed methods and therapeutic agents disclosed herein can be used with conventional treatment regimens heart disease (e.g., drugs or surgical intervention) to provide a combination treatment regimen alone enhanced as compared to the conventional treatment. 增强的治疗效果可由以下来展示：例如，距疾病体征或症状恶化的时间段与现有治疗方案的平均或典型时间段相比延长，或需要额外治疗之前的时间与单独标准治疗的平均或典型时间相比延长。 Enhanced therapeutic effect may be the following: for instance, from a worsening of symptoms or signs of disease compared to the average period of time or prior treatment regimen typical time period extended, or time before requiring additional treatment with standard therapy alone average or typical compared to extend the time.
[0110] 试剂盒 [0110] Kit
[0111] 本发明涵盖的其它实施例是包含治疗剂（例如病毒载体，且更优选地AAV2/1/ SERCA2a载体）容器和血管舒张物质容器的试剂盒。 [0111] Other embodiments of the present invention is contemplated comprising a therapeutic agent (e.g., a viral vector and, more preferably, AAV2 / 1 / SERCA2a vector) vasodilating substance container and the container kit. 在一些实施例中，试剂盒含有储备量的治疗剂及用于溶解或稀释所述储备量的载剂溶液。 In some embodiments, the kit contains a reserve of treatment agents for dissolving or diluting the stock amount of the carrier solution. 在一些实施例中，试剂盒含有储备量的血管舒张剂（包括但不限于增加NO的物质）及用于溶解或稀释所述储备量的载剂溶液。 In some embodiments, the kit contains a stock amount of a vasodilator (including but not limited to NO increasing substance) and for dissolving or diluting the stock amount of the carrier solution. 在一些实施例中，试剂盒含有具有治疗剂与一定量的血管舒张物质的混合物的容器。 In some embodiments, the kit comprising a container having a vasodilating substance mixture with an amount of a therapeutic agent of. 储备量的治疗剂和/或血管舒张物质可以呈需要溶解或混合于载剂溶液中的干燥形式、需要稀释的浓缩溶液形式、或已准备好投予至患者且不需额外准备的形式。 Reserves of the therapeutic agent and / or vasodilating substance may take the form needs to be dissolved or mixed in a carrier solution in dry form, the need to dilute a solution concentrated form, or ready to be administered to a patient, and no additional preparation. 在一些实施例中，试剂盒包括一或多条用于冠脉内投予血管舒张物质和/或治疗剂的血管内输注或注射导管。 In some embodiments, the kit comprises one or more strips vasodilating substance for administration and / or the injection or intravascular infusion catheter coronary therapeutic agent. 在一些实施例中，试剂盒包括一或多种用于将试剂盒中的化合物投予通过导管的装置，例如注射器。 In some embodiments, the kit comprises one or more compounds of the kit for the administration through the conduit means, such as a syringe. 试剂盒还可包括用于投予病毒载体和/或治疗剂（如任一本文所揭示实施例中所述，优选地通过直接输注至冠脉循环中来投予）的说明书。 The kit may also include administration of the viral vector and / or therapeutic agent (e.g., any of the embodiments herein disclosed embodiment, preferably to be administered by infusion directly into the coronary circulation) instructions.
[0112] 现将在以下非限制性实例中进一步阐述本发明实施例。 [0112] The present invention will now be further illustrated in the following non-limiting embodiment examples. 本文所揭示的所有参考文献（包括专利及非专利文献）的全部内容且尤其本文所提及的揭示内容均以引用方式并入本文中。 The entire contents disclosed herein all references (including patents and non-patent literature) and in particular the disclosure referred to herein are incorporated by reference herein.
[0113] 1 ： IH常哥廷t艮小型猪中以单一齐1丨量#寺续30天内输沣AAVl/ SERCA2a (美迪卡® (MYDICAR®)的组织分布研究 [0113] 1: IH Chang Ge Ting t Burgundy mini pig tissue distribution studies within 30 days of lost Feng AAVl / SERCA2a (US Di ® (MYDICAR®) renewal together in a single volume # 1 Shu Temple
[0114] I.方案概要 [0114] I. Program Summary
硝酸甘油投予群组3: Administration of nitroglycerin Group 3:
在投予AAVl/SERCA2a之前即刻以冠脉内浓注形式投予50 硝酸甘油（参见下文“投予方法”） 硝酸甘油投予群组4: Before administration AAVl / SERCA2a in concentrated form immediately administered intracoronary injection of nitroglycerin to 50 (see below "method of administration") administration of nitroglycerin Group 4:
在投予AAVl/SERCA2a之前即刻以冠脉内浓注形式投予50 μξ Prior to administration of AAVl / SERCA2a in a concentrated form immediately intracoronary injection administered 50 μξ
硝酸甘油，并且 Nitroglycerin, and
还将100昭硝酸甘油与AAVl/SERCA2a共投予 100 Sho also nitroglycerin with AAVl / SERCA2a co-administered
未向任一群组投予其它通透性增强剂（参见下文“投予方法”） No other administration permeability enhancer in either group (see below "method of administration")
总样本量： 总共26只动物（参见表1) The total sample size: A total of 26 animals (see Table 1)
研究持续时间：总共持续30天：在第0天投药，在投药后30天时屠宰 Study duration: total duration of 30 days: dosing on day 0, 30 days after the slaughter administration
mt： 实施以下评价： mt: the implementation of the following evaluation:
•输注期间：生命体征及血液动力学监测（血压、心率及心律、 呼吸速率、及02脉搏血氧计、及呼气末二氧化碳）。 • During infusion: vital signs and hemodynamic monitoring (blood pressure, heart rate and rhythm, respiration rate, pulse oximeter and 02, and end-tidal carbon dioxide). •血液学/凝固参数•临床化学参数 • hematology / coagulation parameters • clinical chemistry parameters
•心肌酶（肌酸激酶(CK)(总数及同工酶BB、MB及MM)及肌钙蛋白I) • cardiac enzymes (creatine kinase (CK) (total and isoenzyme BB, MB and MM) and troponin I)
•筛选之前的AAVl中和抗体 • AAVl before the screening and antibody
•经由RT-PCR及蛋白质印迹法测定心脏组织中SERCA2a的表达 • SERCA2a expression in cardiac tissue determined via RT-PCR and Western blotting
•体重及器官重量 • weight and organ weight
_•肉眼所见或宏观所见_ _ • naked eye can see or macroscopic findings _
SERCA2a的表达：•在第30天屠宰结束时经由RT-PCR评价心脏中（12个区域） SERCA2a mRNA 的表达 SERCA2a expression: • The expression of SERCA2a mRNA via RT-PCR evaluation of the heart (12 regions) at the end of the 30th day slaughter
•在第30天屠宰结束时在群组1的3只动物、群组3的3只动物及群组5的1只动物中经由蛋白质印迹法评价心脏中（12个_I区域）SERCA2a蛋白的表达。 • At the end of day 30 in the group 3 animals slaughtered 1, 3 groups of 3 animals and 1 group of 5 animals via cardiac assessment western blotting (_I region 12) of SERCA2a protein expression. _ _
[0117] 表1 ：群组名称及剂量水平 [0117] Table 1: Group name and dose levels
摘酸甘油硝酸甘油输注持续测试盐水预处理共投予时间物品对照 Abstract acid glycerol infusing nitroglycerin saline pretreatment persistence test article were administered to control the time
_治疗组_总数 (Mg) (min)_ _ Number of treatment group _ (Mg) (min) _
群组#1未实施硝酸甘油预治疗/ 6 i ^ 10 V Group # 1 is not nitroglycerin embodiment pretreatment / 6 i ^ 10 V
经10 min 输注AAVl/SERCA2a[0119] Infusion over 10 min AAVl / SERCA2a [0119]
100 硝酸甘油群组#5未实施硝酸甘油预治疗/ 2 经10 min输注盐水对照_ 100 Nitroglycerin Group # 5 No pretreatment embodiments nitroglycerin / 10 min 2 after saline control infusion _
[0120] 投予方法 [0120] method of administration
[0121] 在第0天经由下文所述的直接冠脉输注程序实施投予。 [0121] On day 0 the program directly via coronary infusion administered embodiments described hereinafter. 给群组1-3的动物投用12mL总体积的AAVl/SERCA2a溶液，所述溶液是以1. 2mL/分钟的恒定速率经10分钟时间段输注。 To a group of animals administered with 1-3 12mL total volume of AAVl / SERCA2a solution, the solution is 1. 2mL / min at a constant rate infusion over a 10 minute period. 群组3及4的动物在投予AAVl/SERCA2a之前即刻以冠脉内浓注形式接受硝酸甘油。 Group 3 and 4 animals immediately accept the nitroglycerin in the form of an intracoronary bolus injection prior to administration AAVl / SERCA2a. 给群组3的动物投用12mL总体积的AAVl/SERCA2a及硝酸甘油溶液，所述溶液是以1. 2mL/分钟的恒定速率经10分钟时间段输注。 Group 3 animals were administered with the AAVl / SERCA2a and nitroglycerin 12mL total volume of the solution, the solution is 1. 2mL / min at a constant rate infusion over a 10 minute period. 给群组4的动物投用12mL总体积的生理盐水，其是以1. 2mL/分钟的恒定速率经10分钟时间段输注。 4 to a group of animals administered with 12mL total volume of saline, which is a constant rate of 1. 2mL / min over a 10 minute infusion period. 直接输注系统由标准（市面有售）组件构成，包括常用导引套管（guide sheath)、0. 014”导丝、5F输注（导引）导管及两个可编程注射泵。直接冠脉内输注程序以使用常见颈动脉或股动脉途径弓丨入常用导引套管开始。随后在透视导引下将冠脉输注导管（例如，科尔迪斯-维斯塔_布里特-提普(Cordis Vista Brite Tip)导引导管或适于左主干冠状动脉套管插入术的类似型号）置于左主干冠状动脉中。将导管置于适当位置后，使用标准管道装配及吹扫技术使其与第一可编程注射泵（例如，NE-1000可编程注射泵、纽易若（New Era)泵系统）连接。随后递送AAVl/SERCA2a，然后使用第二可编程注射泵使用无菌盐水冲洗导管的死体积。 Direct infusion system by a standard (commercially available) assembly configuration, including conventional guide cannula (guide sheath), 0. 014 "guidewire, 5F infusion (guide) catheter and two programmable syringe pump. Direct crown the pulse infusion program to use common carotid or femoral artery into the common guide arch Shu sleeve then begins under fluoroscopic guidance to the coronary infusion catheter (e.g., Cole Dis. - _ Vista Bridgend Patent - after Tipton (Cordis Vista Brite Tip) adapted to guide catheter left main coronary artery or cannulation of a similar type) was placed in the left main coronary artery catheter placed in position, using a standard blow pipe assembly and technical sweeping it with a first programmable syringe pump (e.g., NE-1000 programmable syringe pump, New easily if (New Era) pump system) connected subsequent delivery AAVl / SERCA2a, programmable syringe pump and a second non-use sterile saline flushing the dead volume of the catheter.
[0122] Mrk [0122] Mrk
[0123] 结果显示，与使用AAVl/SERCA2a但不使用硝酸甘油治疗的个体相比，在使用AAVl/SERCA2a及硝酸甘油治疗的个体中一或多种生物活性/功效指标显著改良。 [0123] The results show that the use of AAVl SERCA2a but does not use / treatment compared to individuals nitroglycerin, using individual AAVl SERCA2a and nitroglycerin therapy in a more biologically active or / index significantly improved efficacy /. 在第30 天屠宰结束时经由RT-PCR(mRNA)及蛋白质印迹法（蛋白质）评价心脏（LV游离壁、LV后(下方）段及LV前段）中SERCA2a的表达，心脏截面如图1中所示（用于SERCA2a表达的心脏截面图：A(LV基底层):#1隔膜；#2LV前壁；#3LV游离壁；#4LV后壁；B (LV中层):#5 隔膜；#6LV前壁；#7LV游离壁；#8LV后壁；C (LV顶层）：#9LV前壁；#10LV后壁；（RV) :#11RV 游离壁基底层；#12RV游离壁顶层)。 Via RT-PCR (mRNA) and Western blotting (protein) cardiac assessment at the end of the slaughter 30 days (LV free wall, the LV (below) and LV anterior segment) in expression of SERCA2a, heart cross section as in FIG. 1 diagram (cross-sectional view for cardiac expression of SERCA2a: a (LV layer): membrane # 1; # 2LV front wall; # 3LV free wall; # 4LV rear wall; B (LV middle layer): membrane # 5; # front 6LV walls; # 7LV free wall; # 8LV rear wall; C (LV top): # 9LV front wall; # 10LV rear wall; (RV): # 11RV free wall of the base layer; # 12RV free top wall). 计算各部分左心室中总mRNA及蛋白质的表达（图1 中1-10部分的总和），并且单独分析隔膜（图1中的部分#5)及中层前壁（图1中的部分#6)，这是因为所述区域是距离输注部位最远的深处心肌。 Expression of the left ventricle of each part calculated total mRNA and protein (the sum of 1-10 parts in FIG. 1), and individually analyzed diaphragm (section # 1 in FIG. 5) and the middle front wall (section # 6 in FIG. 1) this is because the region is furthest from the infusion site deep in the myocardium. 足够基因转移至所述深处心肌区域中最为困难；然而，投予硝酸甘油可增强尤其所述区域中的载体摄取。 Gene transfer to the deep enough myocardial region most difficult; however, administration of nitroglycerin can be enhanced, in particular in the region of the carrier uptake. 下文结果显示当组合投予AAVl/SERCA2a与硝酸甘油时SERCA2a mRNA及蛋白质的表达改良，尤其LV中前壁及隔膜中，分别参见图2和3。 The results are shown below, when administered in combination with AAVl / SERCA2a expression improved nitroglycerin SERCA2a mRNA and protein, in particular separator and LV anterior wall, see Figures 2 and 3, respectively. 这些图中所显示的mRNA及蛋白质的增加是高于SERCA2a mRNA 及蛋白质的正常背景水平的部分。 MRNA and protein increase in these figures shows the higher than normal background levels of SERCA2a mRNA and protein portion. 这是与SERCA2a表达水平低于正常水平的患有心脏衰竭表达的基线水平较低，预期AAVl/SERCA2a治疗对心脏衰竭患者SERCA2a表达水平的影响甚至会比图2及3中所报告的影响更明显。 This is a lower level of expression of SERCA2a and suffering from heart failure than normal levels of baseline levels of expression, expected AAVl / SERCA2a treatment effects on the expression levels of SERCA2a in patients with heart failure even more pronounced than the influence of the three reported in Figure 2 and .
[0124] 安全件 [0124] security elements
[0125] 群组3及4的平均主动脉压显示于图4中。 [0125] Group 3 and 4 mean aortic pressure is shown in FIG. 4. 整个实验期间所看到的变化多半在预料之中。 We see the entire duration of the experiment changes mostly expected. 注意到群组4中除一个时间点外，与基线相比平均动脉压（MAP)最大降低6mmHg， 硝酸甘油治疗动物的所有其它变化均在所述范围内。 He noted that Group 4 in addition to a time point compared to baseline mean arterial pressure (MAP) Maximum 6 mmHg reduction, all other variations of nitroglycerin treated animals were within the range. 此并无意义且未造成安全问题，所以所述MAP的降低适度。 This is not meaningful and does not pose a safety problem, so lowering the MAP moderate. 相比之下，萨萨诺（Sasano)等人报导在输注预治疗及病毒溶液后血压降低30mmHg。 In contrast, Sassano (Sasano) decrease in blood pressure 30mmHg et al reported that the pre-treatment and post-infusion in the virus solution. 而且，萨萨诺（Sasano)研究中的个体经历心率降低，心率平均约为50-60/ 分钟。 Further, Sassano (Sasano) individual experiences their heart rate is reduced, the average heart rate of about 50-60 / min. 作者报导血压及心率在灌注的第一分钟内稳定。 The authors reported a stable blood pressure and heart rate in the first minute of perfusion. 尽管如此，前10头猪以50%比率在冠脉输注期间发生心室纤颤（VF)，但是剩余71头猪发生心室纤颤的比率降低至5. 6%。 Nevertheless, the first 10 pigs at a ratio of 50% occurrence of ventricular fibrillation (VF) during coronary infusion, but the remaining 71 pigs to reduce the occurrence of ventricular fibrillation rate to 5.6%.
[0126] 糊2:1_雜總果-石肖___•迪卡@_雜心,遍粘撒示的影响 [0126] Paste 2: 1_ heteroaryl Total Fruit - Stone Shaw Di _ ___ • heart heteroaryl, spread over the impact viscosity illustrated
[0135]碰 [0135] touch
[0136] 下表2显示所述研究的初步结果。 Table 2 shows the study [0136] Preliminary results under. 这些结果显示使用美迪卡⑧及硝酸甘油治疗的个体与使用美迪卡®而不使用硝酸甘油治疗的个体相比一或多种活性/功效终点的实质且显著改良。 These results show that the use of the United States and di ⑧ nitroglycerin treatment compared to individuals subject using di ® US without using nitroglycerin treatment endpoint or more of the active substance of a / efficacy and significantly improved. 其它细节参见哈耶（Hajjar)等人，心脏衰竭期刊（Journal of Cardiac Failure)，200814 (5) ；355-67，其全部内容以引用方式并入本文中。 Other details see Hayes (the Hajjar) et al., Journal of heart failure (Journal of Cardiac Failure), 200814 (5); 355-67, the entire contents of which are incorporated by reference herein.
一种治疗性多核苷酸，其用于通过转染大型哺乳动物的心脏细胞来治疗或预防心血管病的方法中，其中所述方法包含通过在投予所述治疗性多核苷酸之前和/或同时向所述哺乳动物投予血管舒张物质来舒张冠脉循环的血管。 A therapeutic polynucleotide for the treatment or prophylaxis of cardiovascular disease by transfecting cardiac cells of a large mammal, wherein the method comprises administering by prior to said therapeutic polynucleotide and / or administered concurrently vasodilating substance to said mammal also coronary vessel pulse cycle.
2.如权利要求1所述的治疗性多核苷酸，其中所述方法包含将所述治疗性多核苷酸投予至所述活体内冠脉循环的血管中，其中所述治疗性多核苷酸经至少约3分钟时间段输注至所述血管中，其中所述冠脉循环不与所述哺乳动物的体循环隔离或不与其实质隔离，且其中所述治疗性多核苷酸转染所述哺乳动物的心脏细胞以达成所述心血管病的所述治疗或预防。 2. The therapeutic polynucleotide of claim 1, wherein said method comprises the therapeutic polynucleotide is administered into the coronary circulation in vivo blood vessel, wherein said therapeutic polynucleotide over a time period of at least about 3 minutes infused into the blood vessel, wherein the coronary circulation is not isolated or cyclic and substantially isolated from the mammal body, and wherein said therapeutic polynucleotide transfecting the mammalian the animal heart cells to achieve the treatment or prevention of cardiovascular disease.
3.如权利要求2所述的治疗性多核苷酸，其中所述血管舒张物质是增加一氧化氮（NO) 的物质。 2, the therapeutic polynucleotide of claim 3, wherein said vasodilating substance is a substance to increase nitric oxide (NO),.
4.如权利要求3所述的治疗性多核苷酸，其中所述增加NO的物质是以选自由下列组成的群组的方式投予：在所述治疗性多核苷酸的所述输注之前、在所述治疗性多核苷酸的所述输注的同时、和在所述治疗性多核苷酸的所述输注之前和同时投予。 Prior to said infusion of said therapeutic polynucleotide: as claimed in claim 3, said therapeutic polynucleotide, wherein said NO increasing substance is selected from the group consisting of ways administered while the infusion of therapeutic polynucleotide, and prior to and concurrently with the therapeutic polynucleotide and infusion.
5.如权利要求4所述的治疗性多核苷酸，其中将所述增加NO的物质投予至所述冠脉循环的血管中。 4 5. The therapeutic polynucleotide of claim, wherein said NO increasing substance is administered to blood vessel of the coronary circulation.
6.如权利要求5所述的治疗性多核苷酸，其中在所述治疗性多核苷酸的所述输注之前不长于5分钟以浓注形式投予所述增加NO的物质且其中在所述治疗性多核苷酸的所述输注的同时将所述增加NO的物质经至少约10分钟时间段输注至所述血管中。 5 6. The therapeutic polynucleotide of claim, wherein not longer than prior to said therapeutic polynucleotide is administered five minutes of the infusion in the form of a concentrated injection of said NO increasing substance, and wherein the the said therapeutic polynucleotide is infused while said NO increasing substance over a time period of at least about 10 minutes infused into the blood vessel.
7.如权利要求5所述的治疗性多核苷酸，其中所述增加NO的物质是约50 μ g至约150 μ g硝酸甘油。 5 7. The therapeutic polynucleotide of claim, wherein said NO increasing substance is nitroglycerin, from about to about 150 μ g to 50 μ g.
8.如权利要求3所述的治疗性多核苷酸，其中所述增加NO的物质的所述投予包含将1. 5mL 100 μ g/mL硝酸甘油溶液经由经皮导管经短于1分钟的时间段顺行性心外膜冠状动脉注射至左或右冠状动脉中的至少一者中，其中所述增加NO的物质的所述投予在所述治疗性多核苷酸的所述输注之前3分钟内实施，且其中未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 8. The therapeutic polynucleotide of claim 3, wherein said increasing said substance comprises administering NO 1. 5mL 100 μ g / mL solution of nitroglycerin via percutaneous catheter over less than 1 minute period antegrade epicardial coronary artery injection into the left or right coronary artery least one of, wherein said NO increasing substance of the administered prior to said infusion of said therapeutic polynucleotide for 3 minutes the embodiment, and wherein no other vasodilator or vascular permeation enhancer is administered to said mammal.
9.如权利要求8所述的治疗性多核苷酸，其中所述方法进一步包含在所述治疗性多核苷酸的所述输注的同时将硝酸甘油输注至所述血管中。 9. The therapeutic polynucleotide of claim 8, wherein said method further comprises, while said therapeutic polynucleotide is infused infusing nitroglycerin into said blood vessel.
10.如权利要求8所述的治疗性多核苷酸，其中所述哺乳动物是人类且所述心血管病是心脏衰竭，其中所述治疗性多核苷酸包裹于AAV2/1病毒载体的DNA酶抗性颗粒（DRP) 中，且输注至所述血管中的DRP的总数不大于约1X1013，其中所述治疗性多核苷酸包含SERCA2a编码序列，其中所述血管是所述左或右冠状动脉中的至少一者，且其中所述治疗性多核苷酸的所述输注持续至少约10分钟。 DNA enzymes 10. The therapeutic polynucleotide of claim 8, wherein said mammal is a human and said cardiovascular disease is heart failure, wherein said therapeutic polynucleotide is packaged in AAV2 / 1 viral vector resistant particles (DRP), and the total number of infused into the blood vessel of the DRP is not greater than about 1X1013, wherein the therapeutic polynucleotide comprises a SERCA2a coding sequence, wherein said blood vessel is a coronary artery of the left or right At least one, and wherein said therapeutic polynucleotide is infused for at least about 10 minutes.
11.如权利要求10所述的治疗性多核苷酸，其中在所述治疗后6个月与所述治疗之前所述人类心脏的绝对射血分数测量值相比所述治疗或预防方法使所述人类心脏的绝对射血分数测量值提高。 11. The therapeutic polynucleotide of claim 10, wherein after 6 months of treatment prior to said treatment with said absolute ejection fraction measurements compared to the human heart so that the method of treating or preventing absolute ejection fraction measured value increase above the human heart.
12.如权利要求3所述的治疗性多核苷酸，其中所述增加NO的物质是以选自由下列组成的群组的方式全身投予：静脉内注射、静脉内输注、经口投予、经皮投予和皮下投予。 12. The therapeutic polynucleotide of claim 3, wherein said NO increasing substance is selected from the group consisting of systemically administered ways: intravenous injection, intravenous infusion, oral administration , and administered subcutaneously administered percutaneously.
13.如权利要求12所述的治疗性多核苷酸，其中所述增加NO的物质的所述投予包含在所述治疗性多核苷酸的所述输注之前经至少30分钟时间段通过静脉内输注来投予约`0. 5mg至约2. 5mg硝酸甘油，其中所述治疗性多核苷酸的所述输注在硝酸甘油的所述静脉内输注完成后不长于3分钟内开始，且其中未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 12 13. The therapeutic polynucleotide of claim, wherein said NO increasing substance is administered the contained prior to said infusion of said therapeutic polynucleotide over a period of at least 30 minutes by intravenous infusion is administered within about `0. 5mg to about 2. 5mg of nitroglycerin, wherein said therapeutic polynucleotide is not longer than the infusion after completion of said intravenous infusion of nitroglycerin started 3 minutes , and wherein no other vasodilator or vascular permeation enhancer is administered to said mammal.
14.如权利要求13所述的治疗性多核苷酸，其中所述方法进一步包含在所述治疗性多核苷酸的所述输注的同时输注额外量的硝酸甘油。 14. The therapeutic polynucleotide of claim 13, wherein said method further comprises infusing an additional amount of nitroglycerin concurrently with said therapeutic polynucleotide of the infusion.
15.如权利要求13所述的治疗性多核苷酸，其中所述哺乳动物是人类且所述心血管病是心脏衰竭，其中所述治疗性多核苷酸包裹于AAV2/1病毒载体的DNA酶抗性颗粒（DRP) 中，且输注至所述血管中的DRP的总数不大于约1X1013，其中所述治疗性多核苷酸包含SERCA2a编码序列，其中所述血管是所述左或右冠状动脉中的至少一者，且其中所述治疗性多核苷酸的所述输注持续至少约10分钟。 DNA enzymes 15. The therapeutic polynucleotide of claim 13, wherein said mammal is a human and said cardiovascular disease is heart failure, wherein said therapeutic polynucleotide is packaged in AAV2 / 1 viral vector resistant particles (DRP), and the total number of infused into the blood vessel of the DRP is not greater than about 1X1013, wherein the therapeutic polynucleotide comprises a SERCA2a coding sequence, wherein said blood vessel is a coronary artery of the left or right At least one, and wherein said therapeutic polynucleotide is infused for at least about 10 minutes.
16.如权利要求15所述的治疗性多核苷酸，其中在所述治疗后6个月与所述治疗之前所述人类心脏的绝对射血分数测量值相比所述治疗或预防方法使所述人类心脏的绝对射血分数测量值提高。 16. The therapeutic polynucleotide of claim 15, wherein after 6 months of treatment prior to said treatment with said absolute ejection fraction measurements compared to the human heart so that the method of treating or preventing absolute ejection fraction measured value increase above the human heart.
17.如权利要求1至6和12中任一权利要求所述的治疗性多核苷酸，其中所述增加NO 的物质是硝酸甘油。 1-6 and 12 wherein said therapeutic polynucleotide of claim 17 as claimed in claim, wherein said NO increasing substance is nitroglycerin.
18. 一种治疗性多核苷酸的用途，其用以制造用于治疗或预防大型哺乳动物心血管病的药剂，其中所述治疗性多核苷酸转染所述大型哺乳动物的心脏细胞以达成所述心血管病的所述治疗或预防，且其中所述药剂是与使所述哺乳动物的冠脉循环血管舒张的血管舒张物质组合投予，所述血管舒张物质在投予所述药剂之前和/或与所述药剂同时投予。 18. A use of therapeutic polynucleotide, which is used for the manufacture of a medicament for treating or preventing cardiovascular disease in a large mammal, wherein said therapeutic polynucleotide transfecting cardiac cells of said large mammal to achieve the prior to the treatment or prevention of cardiovascular disease, and wherein the agent is a combination of the vasodilating substance mammal vasodilatation of the coronary circulation and the administration, the vasodilating substance to the agent administered and / or administered simultaneously with the agent.
19.如权利要求18所述的用途，其中所述药剂的所述投予包含将所述治疗性多核苷酸投予至所述活体内冠脉循环的血管中，其中所述治疗性多核苷酸经至少约3分钟时间段输注至所述血管中，且其中所述冠脉循环不与所述哺乳动物的体循环隔离或不与其实质隔罔。 19. The use of claim 18 wherein said therapeutic polynucleotide claim wherein said medicament comprises administering said therapeutic polynucleotide is administered into the coronary circulation in vivo blood vessel, acid, at least about three minute period infused into the blood vessel, and wherein the coronary circulation is not isolated from the mammalian circulation or compartment without substantial thereto indiscriminately.
20.如权利要求19所述的用途，其中所述血管舒张物质是增加一氧化氮（NO)的物质。 20. Use according to claim 19, wherein said vasodilating substance is a substance to increase nitric oxide (NO),.
21.如权利要求20所述的用途，其中所述增加NO的物质是以选自由下列组成的群组的方式投予：在所述治疗性多核苷酸的所述输注之前、在所述治疗性多核苷酸的所述输注的同时、和在所述治疗性多核苷酸的所述输注之前和同时投予。 21. The use according to claim 20, wherein said NO increasing substance is selected from the group consisting of ways administered: prior to the therapeutic polynucleotide of the infusion, the the therapeutic polynucleotide infusion while at the same time and prior to the administration of said therapeutic polynucleotide and infusion.
22.如权利要求21所述的用途，其中将所述增加NO的物质投予至所述冠脉循环的血管中。 22. The use according to claim 21, wherein said NO increasing substance is administered to blood vessel of the coronary circulation.
23.如权利要求22所述的用途，其中在所述治疗性多核苷酸的所述输注之前不长于5 分钟以浓注形式投予所述增加NO的物质且其中在所述治疗性多核苷酸的所述输注的同时将所述增加NO的物质经至少约10分钟时间段输注至所述血管中。 23. The use according to claim 22, wherein prior to not longer than the therapeutic polynucleotide is administered 5 minutes infusion in the form of a concentrated injection to the NO increasing substance and wherein said therapeutic multicore the nucleotide infusion while the NO increasing substance by at least about 10 minute period infused into the blood vessel.
24.如权利要求22所述的用途，其中所述增加NO的物质是约50 μ g至约150 μ g硝酸甘油。 24. The use according to claim 22, wherein said NO increasing substance is nitroglycerin, from about to about 150 μ g to 50 μ g.
25.如权利要求20所述的用途，其中所述增加NO的物质的所述投予包含将1. 5mL 100 μ g/mL硝酸甘油溶液经由经皮导管经短于1分钟的时间段顺行性心外膜冠状动脉注射至左或右冠状动脉中的至少一者中，其中所述增加NO的物质的所述投予在所述治疗性多核苷酸的所述输注之前3分钟内实施，且其中未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 25. The use according to claim 20, wherein said NO increasing substance is the administration comprises antegrade heart 1. 5mL 100 μ g / mL solution of nitroglycerin via percutaneous catheter over a shorter time period than 1 minute adventitia intracoronary injection to the left or right coronary artery least one of, wherein said NO increasing substance is administered the embodiment to 3 minutes prior to said infusion of said therapeutic polynucleotide, and wherein no other vasodilator administered or vascular permeation enhancer is administered to said mammal.
26.如权利要求25所述的用途，其进一步包含在所述治疗性多核苷酸的所述输注的同时将硝酸甘油输注至所述血管中。 26. Use according to claim 25, further comprising, while the infusion of therapeutic polynucleotide of infusing nitroglycerin into said blood vessel.
27.如权利要求25所述的用途，其中所述哺乳动物是人类且所述心血管病是心脏衰竭，其中所述治疗性多核苷酸包裹于AAV2/1病毒载体的DNA酶抗性颗粒（DRP)中，且输注至所述血管中的DRP的总数不大于约IX 1013，其中所述治疗性多核苷酸包含SERCA2a编码序列，其中所述血管是所述左或右冠状动脉中的至少一者，且其中所述治疗性多核苷酸的所述输注持续至少约10分钟。 27. Use according to claim 25, wherein said mammal is a human and said cardiovascular disease is heart failure, wherein said therapeutic polynucleotide is packaged in AAV2 / 1 viral vector DNA enzyme resistant particles ( DRP), and the total number of infused into the blood vessel is not more than about a DRP IX 1013, wherein the therapeutic polynucleotide comprises a SERCA2a coding sequence, wherein said blood vessel is a coronary artery of the left or right of at least one, and wherein said therapeutic polynucleotide is infused for at least about 10 minutes.
28.如权利要求27所述的用途，其中在所述治疗后6个月与所述治疗之前所述人类心脏的绝对射血分数测量值相比所述治疗或预防方法使所述人类心脏的绝对射血分数测量值提高。 28. The use according to claim 27, wherein after 6 months of treatment prior to said treatment with an absolute ejection fraction of said human heart measurement value as compared to the treatment or prevention of said human heart absolute ejection fraction measurements improve.
29.如权利要求20所述的用途，其中所述增加NO的物质是以选自由下列组成的群组的方式全身投予：静脉内注射、静脉内输注、经口投予、经皮投予和皮下投予。 Percutaneous administration, intravenous injection, intravenous infusion, oral administration,: 29. The use as claimed in claim 20, wherein said NO increasing substance is selected from the group consisting of systemically administered way I and subcutaneously.
30.如权利要求29所述的用途，其中所述增加NO的物质的所述投予包含在所述治疗性多核苷酸的所述输注之前经至少30分钟时间段通过静脉内输注来投予约0. 5mg至约2. 5mg 硝酸甘油，其中所述治疗性多核苷酸的所述输注在硝酸甘油的所述静脉内输注完成后不长于3分钟内开始，且其中未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 30. The use according to claim 29, wherein said NO increasing substance said administering comprises intravenously prior to infusion of said therapeutic polynucleotide over at least 30 minutes of the infusion time period administered from about 0. 5mg to about 2. 5mg of nitroglycerin, wherein said therapeutic polynucleotide is infused not longer than 3 minutes after the start of the infusion is completed within the venous nitroglycerin, and which are not to administering to said mammal other vasodilator or vascular permeation enhancer.
31.如权利要求30所述的用途，其进一步包含在所述治疗性多核苷酸的所述输注的同时输注额外量的硝酸甘油。 31. Use according to claim 30, further comprising infusing an additional amount of nitroglycerin concurrently with said therapeutic polynucleotide of the infusion.
32.如权利要求30所述的用途，其中所述哺乳动物是人类且所述心血管病是心脏衰竭，其中所述治疗性多核苷酸包裹于AAV2/1病毒载体的DNA酶抗性颗粒（DRP)中，且输注至所述血管中的DRP的总数不大于约IX 1013，其中所述治疗性多核苷酸包含SERCA2a编码序列，其中所述血管是所述左或右冠状动脉中的至少一者，且其中所述治疗性多核苷酸的所述输注持续至少约10分钟。 32. The use according to claim 30, wherein said mammal is a human and said cardiovascular disease is heart failure, wherein said therapeutic polynucleotide is packaged in AAV2 / 1 viral vector DNA enzyme resistant particles ( DRP), and the total number of infused into the blood vessel is not more than about a DRP IX 1013, wherein the therapeutic polynucleotide comprises a SERCA2a coding sequence, wherein said blood vessel is a coronary artery of the left or right of at least one, and wherein said therapeutic polynucleotide is infused for at least about 10 minutes.
33.如权利要求32所述的用途，其中在所述治疗后6个月与所述治疗之前所述人类心脏的绝对射血分数测量值相比所述治疗或预防方法使所述人类心脏的绝对射血分数测量值提高。 33. The use according to claim 32, wherein after 6 months of treatment prior to said treatment with an absolute ejection fraction of said human heart measurement value as compared to the treatment or prevention of said human heart absolute ejection fraction measurements improve.
34.如权利要求18至23和29中任一权利要求所述的用途，其中所述增加NO的物质是硝酸甘油。 34. The use according to any one of claims 18 to 23 and as claimed in claim 29, wherein said NO increasing substance is nitroglycerin.
35. 一种治疗或预防心血管病的方法，其通过转染大型哺乳动物的心脏细胞来实施，所述方法包含：识别需要治疗或预防心血管病的哺乳动物；向所述哺乳动物投予足以使冠脉循环血管舒张的血管舒张物质；和将治疗性多核苷酸投予至所述活体内冠脉循环的血管中；其中所述治疗性多核苷酸经至少约3分钟时间段输注至所述血管中，其中所述冠脉循环不与所述哺乳动物的体循环隔离或不与其实质隔离，且其中所述治疗性多核苷酸转染所述哺乳动物的心脏细胞以达成所述心血管病的所述治疗或预防。 35. A method of treating or preventing cardiovascular disease, which is carried out by transfecting cardiac cells of a large mammal, the method comprising: identifying a mammal in need of treatment or prevention of cardiovascular disease; and administering to said mammal vasodilating substance sufficient to cause vasodilation of the coronary circulation; and administering a therapeutic polynucleotide into a blood vessel of the coronary circulation in vivo; wherein said therapeutic polynucleotide is at least about 3 minutes infusion period to the vessel, wherein the coronary circulation is not isolated from the systemic circulation of the mammal, or substantially isolated, and wherein said therapeutic polynucleotide transfecting cardiac cells of said mammal to reach the heart the treatment or prevention of disease.
36.如权利要求35所述的方法，其中所述血管舒张物质是增加一氧化氮（NO)的物质。 36. The method according to claim 35, wherein said vasodilating substance is a substance to increase nitric oxide (NO),.
37.如权利要求36所述的方法，其中所述增加NO的物质是硝酸甘油。 37. The method according to claim 36, wherein said NO increasing substance is nitroglycerin.
38.如权利要求36所述的方法，其中将所述增加NO的物质投予至所述冠脉循环的血管中。 38. The method according to claim 36, wherein said NO increasing substance is administered to blood vessel of the coronary circulation.
39.如权利要求38所述的方法，其中所述增加NO的物质是以选自由下列组成的群组的方式投予：在所述治疗性多核苷酸的所述输注之前、在所述治疗性多核苷酸的所述输注的同时、和在所述治疗性多核苷酸的所述输注之前和同时投予。 39. The method according to claim 38, wherein said NO increasing substance is selected from the group consisting of ways administered: prior to the therapeutic polynucleotide of the infusion, the the therapeutic polynucleotide infusion while at the same time and prior to the administration of said therapeutic polynucleotide and infusion.
40.如权利要求38所述的方法，其中在所述治疗性多核苷酸的所述输注之前不长于5 分钟以浓注形式投予所述增加NO的物质。 40. The method according to claim 38, wherein prior to not longer than the infusion of therapeutic polynucleotide is administered 5 minutes in concentrated form said NO increasing substance injection.
41.如权利要求38所述的方法，其中在所述治疗性多核苷酸的所述输注之前不长于5 分钟以浓注形式投予所述增加NO的物质且其中在所述治疗性多核苷酸的所述输注的同时将所述增加NO的物质经至少约10分钟时间段输注至所述血管中。 41. The method according to claim 38, wherein prior to not longer than the said therapeutic polynucleotide is administered 5 minutes infusion in the form of a concentrated injection of said NO increasing substance and wherein said therapeutic multicore the nucleotide infusion while the NO increasing substance by at least about 10 minute period infused into the blood vessel.
42.如权利要求38所述的方法，其中所述增加NO的物质是约50 μ g至约150 μ g硝酸甘油。 42. The method according to claim 38, wherein said NO increasing substance is about 50 μ g to about 150 μ g of nitroglycerin.
43.如权利要求38所述的方法，其中所述增加NO的物质的所述投予包含将1. 5mL 100 μ g/mL硝酸甘油溶液经由经皮导管经短于1分钟的时间段顺行性心外膜冠状动脉注射至左或右冠状动脉中的至少一者中，其中所述增加NO的物质的所述投予在所述治疗性多核苷酸的所述输注之前3分钟内实施，且其中未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 43. The method according to claim 38, wherein said increasing said substance comprises administering NO 1. 5mL 100 μ g / mL solution of nitroglycerin period of 1 min anterograde heart via a percutaneous catheter through shorter adventitia intracoronary injection to the left or right coronary artery least one of, wherein said NO increasing substance is administered the embodiment to 3 minutes prior to said infusion of said therapeutic polynucleotide, and wherein no other vasodilator administered or vascular permeation enhancer is administered to said mammal.
44.如权利要求43所述的方法，其进一步包含在所述治疗性多核苷酸的所述输注的同时将硝酸甘油输注至所述血管中。 44. The method of claim 43, further comprising, while the infusion of therapeutic polynucleotide of infusing nitroglycerin into said blood vessel.
45.如权利要求43所述的方法，其中所述哺乳动物是人类且所述心血管病是心脏衰竭，其中所述治疗性多核苷酸包裹于AAV2/1病毒载体的DNA酶抗性颗粒（DRP)中，且输注至所述血管中的DRP的总数不大于约IX 1013，其中所述治疗性多核苷酸包含SERCA2a编码序列，其中所述血管是所述左或右冠状动脉中的至少一者，且其中所述治疗性多核苷酸的所述输注持续至少约10分钟。 45. The method according to claim 43, wherein said mammal is a human and said cardiovascular disease is heart failure, wherein said therapeutic polynucleotide is DNA nuclease resistant particles encapsulated in a AAV2 / 1 viral vector ( DRP), and the total number of infused into the blood vessel is not more than about a DRP IX 1013, wherein the therapeutic polynucleotide comprises a SERCA2a coding sequence, wherein said blood vessel is a coronary artery of the left or right of at least one, and wherein said therapeutic polynucleotide is infused for at least about 10 minutes.
46.如权利要求45所述的方法，其中在所述治疗后6个月与所述治疗之前所述人类心脏的绝对射血分数测量值相比所述治疗使所述人类心脏的绝对射血分数测量值提高。 46. ​​The method according to claim 45, wherein after 6 months of treatment before the treatment of absolute ejection fraction of said human heart as compared to the measured value of the treatment the human heart ejection absolute fractional measurements improve.
47.如权利要求36所述的方法，其中所述增加NO的物质是全身投予。 47. A method according to claim 36, wherein said NO increasing substance is administered systemically.
48.如权利要求47所述的方法，其中所述增加NO的物质是以选自由下列组成的群组的方式全身投予：静脉内注射、静脉内输注、经口投予、经皮投予和皮下投予。 48. The method according to claim 47, wherein said NO increasing substance is selected from the group consisting of systemically administered ways: intravenous injection, intravenous infusion, oral administration, percutaneous administration I and subcutaneously.
49.如权利要求48所述的方法，其中所述增加NO的物质是以选自由下列组成的群组的方式投予：在所述治疗性多核苷酸的所述输注之前、在所述治疗性多核苷酸的所述输注的同时、和在所述治疗性多核苷酸的所述输注之前和同时投予。 49. The method according to claim 48, wherein said NO increasing substance is selected from the group consisting of ways administered: prior to the therapeutic polynucleotide of the infusion, the the therapeutic polynucleotide infusion while at the same time and prior to the administration of said therapeutic polynucleotide and infusion.
50.如权利要求47所述的方法，其中所述增加NO的物质是硝酸甘油。 50. The method according to claim 47, wherein said NO increasing substance is nitroglycerin.
51.如权利要求50所述的方法，其中在所述治疗性多核苷酸的所述输注之前经至少30 分钟时间段通过静脉内输注来投予约0. 5mg至约2. 5mg硝酸甘油，其中所述治疗性多核苷酸的所述输注在硝酸甘油的所述静脉内输注完成后不长于3分钟内开始，且其中未向所述哺乳动物投予其它血管舒张剂或血管通透增强剂。 51. The method according to claim 50, wherein the time period of 30 minutes is administered from about 0. 5mg to about 2. 5mg least nitric acid by intravenous infusion prior to said infusion of said therapeutic polynucleotide glycerol, wherein said therapeutic polynucleotide is infused not longer than 3 minutes after the start of the infusion is completed within the venous nitroglycerin, and wherein no other vasodilator or vascular agent to said mammal permeation enhancer.
52.如权利要求51所述的方法，其进一步包含在所述治疗性多核苷酸的所述输注的同时输注额外量的硝酸甘油。 52. A method according to claim 51, further comprising infusing an additional amount of nitroglycerin concurrently with said therapeutic polynucleotide of the infusion.
53.如权利要求51所述的方法，其中所述哺乳动物是人类且所述心血管病是心脏衰竭，其中所述治疗性多核苷酸包裹于AAV2/1病毒载体的DNA酶抗性颗粒（DRP)中，且输注至所述血管中的DRP的总数不大于约IX 1013，其中所述治疗性多核苷酸包含SERCA2a编码序列，其中所述血管是所述左或右冠状动脉中的至少一者，且其中所述治疗性多核苷酸的所述输注持续至少约10分钟。 53. A method according to claim 51, wherein said mammal is a human and said cardiovascular disease is heart failure, wherein said therapeutic polynucleotide is DNA nuclease resistant particles encapsulated in a AAV2 / 1 viral vector ( DRP), and the total number of infused into the blood vessel is not more than about a DRP IX 1013, wherein the therapeutic polynucleotide comprises a SERCA2a coding sequence, wherein said blood vessel is a coronary artery of the left or right of at least one, and wherein said therapeutic polynucleotide is infused for at least about 10 minutes.
54.如权利要求53所述的方法，其中在所述治疗后6个月与所述治疗之前所述人类心脏的绝对射血分数测量值相比所述治疗使所述人类心脏的绝对射血分数测量值提高。 54. A method according to claim 53, wherein after 6 months of treatment before the treatment of absolute ejection fraction of said human heart as compared to the measured value of the treatment the human heart ejection absolute fractional measurements improve.
CN2008801281787A 2008-02-19 2008-10-29 Compositions for enhanced uptake of viral vectors in the myocardium CN101977632A (en)
US61/029,881 2008-02-19
CN101977632A true CN101977632A (en) 2011-02-16
CN2008801281787A CN101977632A (en) 2008-02-19 2008-10-29 Compositions for enhanced uptake of viral vectors in the myocardium
WO2008013692A2 (en) * 2006-07-25 2008-01-31 Celladon Corporation Extended antegrade epicardial coronary infusion of adeno-associated viral vectors for gene therapy
CN101977632A (en) 2008-02-19 2011-02-16 塞拉东公司 Compositions for enhanced uptake of viral vectors in the myocardium
DE69331526T2 (en) 1992-11-18 2002-10-24 Arch Dev Corp Adenovirus gene-guided transfer to the cardiac and vascular smooth muscle
DE69737062D1 (en) 1996-09-05 2007-01-18 Univ California Gene therapy for congestive heart failure
EP1053025A2 (en) 1998-02-11 2000-11-22 The Regents of the University of California Combination of a nucleic acid and a vasoactive agent for enhanced gene delivery
AT353222T (en) 1998-11-02 2007-02-15 Univ California A mutant phospholamban molecules and their use for the treatment of heart diseases and heart failures
AT362542T (en) 1998-11-05 2007-06-15 Univ Pennsylvania Nucleic acid sequences of adeno-associated virus of serotype i, and vectors and host cells thereof containing them
CA2356551A1 (en) 1998-12-28 2000-07-06 Arch Development Corporation Efficient and stable in vivo gene transfer to cardiomyocytes using recombinant adeno-associated virus vectors
WO2006089340A2 (en) 2005-02-23 2006-08-31 V-Kardia Pty Ltd Polynucleotide delivery to cardiac tissue
WO2008013692A2 (en) 2006-07-25 2008-01-31 Celladon Corporation Extended antegrade epicardial coronary infusion of adeno-associated viral vectors for gene therapy
CN101977632A (en) * 2008-02-19 2011-02-16 塞拉东公司 Compositions for enhanced uptake of viral vectors in the myocardium
Zincarelli et al. 2008 Analysis of AAV serotypes 1–9 mediated gene expression and tropism in mice after systemic injection
JP2011512326A (en) 2011-04-21 RNA interference for the treatment of heart failure
US8445267B2 (en) 2013-05-21 Tyrosine-modified recombinant rAAV vector compositions and methods for use
Klein et al. 1984 New perspectives on thyroid hormone, catecholamines, and the heart
Suckau et al. 2009 CLINICAL PERSPECTIVE
Shi et al. 2003 Gene therapy delivery of endostatin enhances the treatment efficacy of radiation
US10300146B2 (en) 2019-05-28 Isolation of novel AAV&#39;s and uses thereof