Patent ID: 12226520

DETAILED DESCRIPTION OF THE INVENTION

Compositions of this invention comprise a carbonate salt and an acid and are therefore moisture sensitive. The composition should be prepared such that there is minimal opportunity for reaction of the carbonate salt and the acid until the composition is contacted with an aqueous medium. The salts may be physiologically acceptable salts. Examples of carbonate salts that are physiologically acceptable include CaCO3and Na2CO3. However, in applications where wound healing is enhanced and particularly in cases where the composition is employed to enhance blood clotting, the preferred salt is CaCO3. The particles may be prepared by any means but in some cases, it can be advantageous to prepare porous particles to increase particle surface area and/or to provide for at least partial encapsulation of a cargo molecule or particle. Methods for producing porous carbonate salt particles are known in the art, such as in the above-described publication of Volodkin et al.9

The acid component a composition of this invention may be any acid suitable for preparation of the composition in solid form and/or for the intended use of the composition. For example, the acid may be physiologically acceptable for use in biological systems. Examples of suitable acids include organic acids. Examples of physiologically acceptable organic acids include citric acid and malic acid. However, in applications for promotion of blood clotting, it is desirable that the organic acid not be capable of chelating calcium cations at physiological pH (i.e., from pH 6.5 to 8.0). Amino acids and organic acids derived from amino acids that are not chelators at physiological pH are suitable. These include amino acids that are protonated at physiological pH (e.g., glycine) or which can be protonated in that pH (e.g., tranexamic acid). The latter substance is approved for clinical use as an anti-lytic agent and will enhance blood clotting. Another example of an organic acid derived from an amino acid that enhances blood clotting is aminocaproic acid. However, where the indication requires lysing of blood clots, anti-fibrinolytic agents such as tranexamic acid or aminocaproic acid or procoagulants should be avoided.

Cargo particles or molecules that may be associated with the carbonate salt particles for use in this invention may be any substance that can be so associated. The cargo may be present to act as a label or the cargo may have another function such as a biological function. The term “associated” is meant to include any form of binding, including electrostatic interaction. Polyelectrolytes such as CaCO3particles are particularly suitable for adsorbing biological material such as proteins, nucleic acids, polysaccharides and other charged substances such as dextrans. The term “associated” is also intended to include physical constraints such as encapsulating or otherwise enclosing an associated substance.

Cargo particles to be associated with the carbonate salt particles for use in this invention should be of a size approximately similar to the carbonate salt particle or smaller. Thus, in, particular embodiments, it is desirable for a cargo particle to be 10 μm or 5 μm or less in size.

Biologically active agents that may be associated as cargo molecules with carbonate salt particles in this invention may be any active macromolecule (such as a protein) or a small molecule that can be so associated and may include, without limitation: growth factors; antimicrobials; antibiotics; styptics; anesthetics; anti-proliferative drugs such as methotrexate and other anti-cancer drugs; procoagulants such as thrombin; anti-fibrinolytic agents; fibrinolytic agents such as urokinase-type plasminogen activator (uPA); antifibrotics such as acetylsalicylic acid (ASA); and anti-inflammatory agents such as dexamethasone.

Carbonate salt particles employed in the invention may be of a size which is not desirable for systemic delivery nor would systemic delivery be recommended if a particular composition of this invention comprises a procoagulant. Nevertheless, compositions of this invention can be suitable for direct application to an area to be treated. Such application includes local administration, topical administration, placement of a composition of this invention on an area during surgical treatment, and the like. Local administration may comprise delivery of a composition of this invention by means of a device such as a catheter to a particular target area. Topical administration may comprise placement of a composition of this invention directly on a wound or area of bleeding. Compositions comprising nonparticles may be useful for systemic administration.

Compositions of this invention may be for use in propelling a cargo through an aqueous fluid that is in motion in virtually any system, including biological systems. Compositions of this invention may be formulated for therapeutic use using known techniques and materials such as is described in texts such as Remington: The Science and Practice of Pharmacy (latest edition). A composition of the present invention may be formulated into therapeutic compositions with appropriate pharmaceutically acceptable carriers or diluents. Preparations may be solid or non-aqueous, semi-solid and liquid forms, such as tablets, capsules, pills, powders, granules, dragées, gels, creams, slurries, ointments, and suspensions.

Compositions of this invention may be present on microcarriers known in the art, including physical microstructures that have been previously employed as self-propelling particles. These include tubular structures, including ones with open ends as well as ones in conical shape having open ends of different diameters. Such microcarriers may also be in the form of a bead, microcapsule, etc. They may be comprised of materials such as glass, metal and/or polymers and may be magnetic and/or labelled. Degradable polymer microspheres are known for use with therapeutic proteins. Microspheres can be prepared from degradable polymers such as poly(lactide-co-glycolide) (PLG), polyanhydrides, poly (ortho esters), non-biodegradable ethylvinyl acetate polymers, in which proteins are entrapped in the polymer (e.g., see: Ranade and Hollinger, “Drug Delivery Systems” (CRC Press 1996).

Compositions of this invention may be associated with another material that has a desirable biological effect, including materials that affect clotting. For example, compositions of this invention may contain or be associated with silica or kaolin based compositions as currently employed for control of hemorrhaging.

Compositions of this invention may be distributed on or within various materials that are employed for therapeutic purposes, including gauze, packing, balloons, etc. Various means may be used for adhering or impregnating a composition of this invention to such materials. In particular embodiments, such material present in the faun of sheets or layers may separately contain the carbonate salt and acid components of a composition of this invention, to assist localization of the components and to minimize reaction prior to application to an area where the material will be wetted by a bodily fluid.

Compositions of this invention and materials comprising such compositions are typically dry but may also be present in a non-aqueous gel or a liquid such as an oil. Preparation of non-aqueous carriers for therapeutic purposes which employ hydrophilic polymers is known in the art. For example, non-aqueous gels for topical delivery of moisture-sensitive drugs are known14.

This invention also provides kits comprising the carbonate salt and acid components of a composition as defined above, which components are present in separate containers or packaging. Such a kit may include instructions for use of the components for preparation and use of a composition of this invention.

Delivery devices may comprise a composition of this invention. Such devices may be for use in therapeutic administration of a composition of this invention and can include catheter containing apparatus suitable for delivery of a biological agent such as tPA locally to a target area.

Exemplary embodiments of the present invention including ones suitable for treatment of bleeding are described in the following examples.

Examples

To prepare self-propelling particles that would be particularly applicable for treating hemorrhaging, we chose materials that were already approved for clinical use and that can be formulated into a powder that only requires water to produce gas. Calcium carbonate (CaCO3) is a commonly used substance in antacid tablets and drug formulations and rapidly produces gas bubbles of CO2in acidic solutions. Microparticles of CaCO3had been prepared previously that are porous and can adsorb protein.9

Porous microparticles used in this example can be prepared by precipitation of CaCO3when Na2CO3is added to a solution containing CaCl2, based on the procedure described by Volodkin et al.9For example, ice cold 0.33 M Na2CO3can be added to an equal volume of ice cold 0.33 M CaCl2with rapid mixing. The particles can be fluorescently labeled, for example by precipitating the CaCO3in the presence of 0.1 mg/mL FITC-dextran (4 KDa mw) or with fluorescent polystyrene micro or nanoparticles (such as green-fluorescent microspheres available from Polysciences, Inc. or dark red-fluorescent carboxylate-modified polystyrene nanoparticles available from Life Technologies).

Precipitated CaCO3particles can be purified by centrifugation, washed with deionized water, and dried (for example at 60° C.). Such particles will generally have spherical geometry and may typically have diameters ranging from about 2 to about 10 μm (FIG.1B). We found that when such CaCO3microparticles were mixed with a solid organic acid, they were rapidly propelled though both buffered aqueous solutions and whole blood (FIG.1A).

In order to convert tranexamic acid (TXA) to its doubly-protonated form (TXA-NH3), 6 M HCl was added to 0.5 M neutrally-charged TXA (TXA-NH2) until pH 4.3. The acidified solution was lyophilized yielding solid TXA-NH3+.

In order to assess propulsion capabilities, CaCO3microparticles were mixed at approximately 1:1 molar ratio with TXA-NH3+and injected directly to phosphate-buffered saline (PBS) or whole blood, 16 mm below the surface via a needle (FIG.1C). The particles reacted vigorously, rising and spreading at the surface within seconds (FIG.1D). After the reaction, the pH of the solution was neutral, as the acid was neutralized when CO32−protonated and reacted.

When the CaCO3microparticles were mixed with unprotonated tranexamic acid (TXA-NH2), rather than TXA-NH3+, the particles did not react or propel. It had recently been suggested that propulsion of particles through whole blood would be unachievable by catalytic microengines.2However, the results here show that generating gaseous bubbles can achieve propulsion through blood.

To illustrate the range of applications in which the CaCO3particles may be useful, velocity of the particles in both stagnant and flowing solutions was quantified. To simplify the initial analysis, the organic acid (TXA-NH2) was first dissolved in water. CaCO3microparticles were injected at the bottom of the container and particle trajectories imaged at 35 ms resolution (FIG.2A). The microparticles usually reacted as aggregates, with a diameter of 0.4±0.16 mm, which broke apart into smaller particles as they reacted and propelled. Particles had upward velocities of 71±23 mm/s and lateral velocities of 3.6±3.5 mm/s. These velocities are among the fastest reported for any self-propelling particles.1,4The particle velocity increased as a function of bubble volume (FIG.2B). We also used this approach to demonstrate upward propulsion of such particles from a gauze impregnated with the CaCO3microparticles and TXA-NH3+placed at the bottom of an inverted tubular container containing water.

The rapid propulsion of particles in the vertical direction was attributed to CO2bubbles carrying the CaCO3particles upward as they reacted (FIG.2C). When particles were clumped together into even larger and heavier aggregates, they tended to sink and propel with similar horizontal velocities of 3 mm/s. Large carbonate particles such as Na2CO3particles of about 1 mm diameter were found to propel horizontally in 0.4 mm malic acid in water.

To illustrate propulsion upstream through a flowing solution, CaCO3and TXA-NH3+, were mixed together and added to a solution flowing at speeds between 0.06 and 5.9 mm/s through a glass capillary (FIG.2D). The aqueous solution of water contained 0.1% of a surfactant, to mimic surfactants in plasma, and had neutral pH. The particles were applied at the bottom of the tube and propelled upward. The area of the tube that filled with particles and bubbles was measured (FIG.2E). Particles traveled through the capillary even when against flow velocities up to 3.0 mm/s. The amount of particles that entered the flowing solution decreased at higher flow velocities. Fluorescence images showed that fluorescently-labeled CaCO3particles traveled with the CO2bubbles and reached the top of the flowing solution. Using this approach, we have observed particles travelling up to about 1 meter upstream in the tubing.

The flow velocity of blood varies widely between different sized blood vessels and different types of wounds. In capillaries the flow velocity is approximately 1 mm/s, whereas in arteries with diameters of several millimeters, such as coronary arteries, the velocity is between 10 and 100 mm/s.10The CaCO3particles described above were capable of a velocity of 3 mm/s. While such a velocity would be insufficient to move against the flow of blood within an artery, such particles are capable of propulsion through blood flow in wounds and capillary beds.

In advanced clinical settings, intravascular catheters can sometimes be used to deliver agents to the vasculature feeding damaged vessels, and this approach is used to deliver embolic agents to halt blood flow. However treating severe bleeding from vessels that cannot be targeted with catheters, or when immediate treatment is necessary, requires more traditional approaches, such as topical compression. Compressing or packing materials into the area of bleeding is the standard treatment.11Many technologies and materials have been developed for this purpose, such as gelatin foams, modified cellulose and other functionalized dressings, and powders composed of zeolites. Thrombin can also be applied topically in solution. However, none of these methods are highly effective during severe bleeding or when external blood loss originates from inside a cavity of the body.

To create particles that affect blood clotting, thrombin (a serine protease that activates the coagulation system and directly cleaves fibrinogen) was adsorbed onto porous CaCO3particles prepared as described above. The carbonate microparticles were suspended at 10% w/v in 447 μM bovine thrombin (Thr) in 10 mM HEPES and incubated at 4° for 1 hr. The particles were purified by centrifugation (5 min at 10,000 g) to remove excess liquid, and were dried by lyophilization. We have also made porous CaCO3particles associated with the fibrolytic agent, uPA.

To determine the concentration of active Thr immobilized to the particles, we used a fluorescent thrombin substrate (Boc-Val-Pro-Arg-MCA, Peptide Institute Inc.), the cleavage of which by thrombin yields a blue fluorescent product detectable by spectrophotometry. To determine total thrombin content, the thrombin-calcium carbonate (Thr-CaCO3) particles were solubilized in 100 mM HCl prior to addition of fluorescent substrate. To determine thrombin adsorbed within the pores of the microparticles, particles were washed with HEPES-buffered saline (HBS) prior to solubilization. To determine thrombin on the exterior of particles, particles were not solubilized prior to addition of fluorescent substrate. The unwashed particles contained 0.9 μmol of active thrombin per gram of CaCO3, and after washing the particles with an aqueous solution, the particles retained 0.2 μmol/g (FIG.3A). Approximately 0.6 μmol of active thrombin per gram of CaCO3was seen to be adsorbed to the particles. These particles rapidly clotted blood, both alone and when combined with TXA-NH3+(FIG.3B,C).

Thr-CaCO3was mixed at a 1:1 mass ratio with TXA-NH3+to yield a propelling particle mixture. A non-propelling mixture consisted of a 1:1 ratio of Thr-CaCO3with lyophilized TXA-NH2. The ability of the two mixtures to initiate clotting in platelet-poor blood plasma was measured and compared against addition of a similar amount of thrombin (approximately 1 pmol) in HEPES buffer and a control receiving no treatment.

As described above, CaCO3particles propel upward at a greater velocity than in a lateral direction. The ability of particles to clot both at the site of application and below the site was assessed by injecting particles near the top of a column of plasma that was 25 mm tall. Initiation of clotting was measured both at the top and the bottom of the column by monitoring the formation of fibrin. The blood plasma was laced with green-fluorescent beads in order to monitor movement and formation of solid fibrin mesh and clot initiation. Clotting at the top was measured visually, and when the plasma became opaque or appeared gelled, clotting was confirmed by gentle manipulation with a micropipette.

Both propelling and non-propelling particles immediately clotted plasma at the top of the column, which was detected within 2 min. The same response occurred when a solution containing an equivalent amount of dissolved thrombin was added. However, there were much larger differences in the clot times at the bottom of the columns of plasma between these samples.

Notably, the thrombin solution caused no acceleration of clot initiation at the bottom compared to the control. Clotting took about 30 min, as the clot needed to propagate down through the column by diffusion. Clotting at the bottom was faster using non-propelled particles, occurring in 3.7 min as compared to 10 min for the propelled particles. However, this enhanced downward clotting rate was due to the unreacted thrombin-loaded CaCO3particles sinking to the bottom. Most propelled particles reacted and produced gas at the top so only a fraction of the particles sank to the bottom yielding a slightly slower clot time compared to non-propelling particles. Although the propelled particles out-performed the thrombin solution in this assay, a particular advantage for the propelling particles would come from an ability to propel though flowing solutions.

To show propelling thrombin particles clotting flowing plasma, particles were applied to the bottom of plasma flowing through a glass capillary tube (FIG.3D,E). A microfluidic system was used to control the flow of plasma, and monitor the flow to determine when clotting occluded flow in the capillary tube. At flow velocities between 0.006 and 3.4 mm/s, the background occlusion times in the system were approximately 30 min. When no treatment was applied, or when propelled particles that did not contain thrombin were applied, occlusion also occurred at approximately 30 min. The thrombin alone occluded at very slow velocities of up to 0.06 mm/s, and showed no difference from controls at 0.6 mm/s. The non-propelled thrombin was able to form a clot at the exit of the tubing, but only at low flows was this clot able to persist and propagate up the tubing. At high flows, the clot was easily pushed out and the flow of plasma resumed. The propelled thrombin initiated clotting and occluded flow at velocities much higher than non-propelled thrombin. The particles propelled upwards, against flow, and accumulated high within the tubing. Clotting was seen to initiate at regions with the highest concentration of particles. At a flow velocity of 3 mm/s, the time of occlusion was still considerably faster than the non-propelled mixture or controls. This shows that the self-propelling particles loaded with thrombin would be effective at clotting flowing plasma by initiating clotting upstream of the site of application.

Ability of the self-propelling particles to halt bleeding in a mouse model of hemorrhage was also tested. Mouse tails were amputated 8 mm from the tip to achieve severe hemorrhage (FIG.4A). To the site of amputation, 20 mg of either propelling or non-propelling thrombin-loaded particles were applied for 30 sec. Control mice received no treatment following amputation. After application, tails were immersed in warm phosphate-buffered saline (PBS) that contained citrate, and bleeding was monitored for 10 min. The experiment concluded after 10 min to ensure the death of the mouse was not an endpoint. The propelled thrombin significantly decreased the bleeding time compared to both other groups (FIG.4B). In 7 out of 9 mice (78%) that received that propelled mixture, bleeding stopped during observation. In contrast, without propulsion, only 3 out of 9 mice (33%) and 2 out of 8 mice (25%) stopped bleeding in the groups receiving non-propelled thrombin and no treatment, respectively. Fluorescent labelled particles were also employed to determine distance of travel within the mouse tail. FITC-dextran labelled particles were located up to 10 mm upstream in the tail, whereas CaCO3particles carried labelled cargo particles (0.2 μm diameter fluorescent polystyrene beads) up to 4 mm upstream in the tail. Also, there was no increase in inflammation in the mice treated with the self-propelled particles 3 days post-procedure. These results demonstrate use of this embodiment as a local or topically applied procoagulant in vivo.

We also employed a mouse model to quantify blood loss from a hemorrhage resulting from liver puncture. Blood loss following liver puncture was quantified by collecting blood into pre-weighed filter papers of approximately 2 cm by 2 cm, arranged to line the site of puncture, which were compared to control papers pre-soaked with known volumes of fresh blood. We found that total blood loss was significantly decreased by application of Thr-CaCO3particles with TXA-NH3+, as compared to no treatment or application of the particles without associated thrombin. Furthermore, there was a significant reduction in blood loss when the Thr-CaCO3particles were employed, as compared to application of a solution of recombinant thrombin (FIG.5). In addition, we found that intravenous administration of the CaCO3microparticles or a reacted mixture of the microparticles with TXA-NH3+to mice resulted in no significant sign of liver toxicity or pulmonary embolism in the mice three days after injection, as compared to injection of saline. This was determined by measuring serum levels of alanine aminotransferase and asparate aminotransferase as well as histological examination of H & E-stained and Masson's trichrome-stained lung sections.

Although the foregoing invention has been described in some detail by way of illustration and example for purposes of clarity of understanding, it will be readily apparent to those of skill in the art in light of the teachings of this invention that changes and modification may be made thereto without departing from the spirit and scope of the invention. All patents, patent applications and published documents referred to herein are hereby incorporated by reference.

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