阅读说明：本技术 Rmp组合物及使用方法 (RMP compositions and methods of use ) 是由 Y.S.安 W.希 L.L.霍尔斯特曼 R.帕穆库 于 2017-11-29 设计创作，主要内容包括：本公开提供了包含红细胞衍生微粒(RMP)的组合物,所述RMP显示出临床上有利的特征。(The present disclosure provides compositions comprising red blood cell-derived microparticles (RMPs) that exhibit clinically beneficial characteristics.)

1. A composition comprising red blood cell-derived microparticles (RMPs) exhibiting less than 350pmol/min/10⁶Acetylcholinesterase (AchE) activity per particle/. mu.l.

2. The composition of claim 1, wherein the RMP exhibits less than 200pmol/min/10⁶Acetylcholinesterase (AchE) activity per particle/. mu.l.

3. The composition of claim l or claim 2, wherein 20-50% of the RMPs in the composition display phosphatidylserine.

4. The composition of claim 3, wherein 30% -45% of the RMPs in the composition display phosphatidylserine.

5. The composition of any one of claims 1-4, wherein the composition shortens the time to initial clot formation by at least two minutes as measured by Thromboelastography (TEG) in whole blood and plasma.

6. The composition of any of claims 1-5, wherein the RMP is about 0.40 μm to 0.6 μm in diameter.

7. The composition of claim 6, wherein the RMP is about 0.40 μm to 0.5 μm in diameter.

8. The composition of claim 7, wherein the RMP is about 0.47 μm in diameter.

9. The composition of any of claims 1-8, wherein the RMP has an internal density that is less than 3.5% of the internal density of whole blood red blood cells.

10. The composition of claim 9, wherein the RMP has an internal density of about 0.5% -3.0% of the internal density of whole blood red cells as measured by flow cytometry side scatter signals.

11. The composition of any one of claims 1-10, wherein the RMP is produced by forcing red blood cells through a pore to produce ruptured red blood cells and further disrupting the ruptured red blood cells by bombardment on a solid surface.

12. A method for treating excessive bleeding in a subject, the method comprising administering to the subject a composition according to any one of claims 1-11.

13. The method of claim 12, wherein the excessive bleeding is caused by thrombocytopenia or platelet dysfunction.

14. The method of claim 13, wherein the platelet dysfunction is caused by drug therapy.

15. The method of claim 12, wherein the excessive bleeding is caused by an anticoagulant.

16. The method of claim 15, wherein the anticoagulant agent is coumarin, low molecular weight heparin, a prothrombinase complex inhibitor, a FXa inhibitor, or a thrombin inhibitor.

Technical Field

The present disclosure relates to compositions comprising red blood cell-derived microparticles (RMPs) and methods of use.

Background

Excessive bleeding is one of the most common life-threatening complications of trauma and bleeding complications. Blood transfusion is the primary method of treating excessive blood loss. Therapies directed at the root cause of bleeding disorders vary from disease to disease. Platelet transfusions or interventions to increase platelet counts are used to stop bleeding due to low platelet counts (thrombocytopenia). In the case of coagulation disorders, blood factor replacement is usually given. In hemophilia a, factor VIII is administered to a subject, while hemophilia B requires factor IX treatment.

Existing therapies have significant drawbacks. For example, due to increased demand, limited supply, and stricter regulations, donated blood for transfusion becomes increasingly scarce and expensive. According to the statistics of the united states red cross, approximately 36000 units of red blood cells are required per day in the united states alone. See www.redcrossblood.org/spare-about-blood/blood-products-and-standards. Hospitalization costs for transfusion-related adverse events exceed $ 100 million per year. Hannon & Gjerde: the conditional orders of transfer. In Perioperic transfusion medicine; speiss R D, Spence R K, Shandera (eds.), Lippincott Williams and Wilkins, p.13 (2006). Transfusion is also associated with a number of short-term and long-term complications, including anaphylaxis, hemolytic reactions, transfusion-induced immunosuppression, graft versus host disease, and transfusion-associated acute lung injury (TRALI). Platelet mp (pmp) and lyophilized whole blood platelets (LyoPLT) have disadvantages such as high cost, platelet scarcity, risk of thrombosis, and immunoreactivity. Adverse reactions are common because platelets are highly immunogenic due to HLA, ABO, Rh and platelet-specific antigens, which is impractical for cross-matching. In addition, platelets are known to carry Tissue Factor (TF) for thrombosis.

There remains a need in the art for agents that can be safely and immediately administered at a reasonable cost after excessive bleeding is detected.

Disclosure of Invention

The present disclosure provides compositions comprising red blood cell-derived microparticles (RMPs) exhibiting less than 350pmol/min/10⁶Particles (e.g., less than 200 pmol/min/10)⁶Individual particles) of acetylcholinesterase (AchE) activity. In various aspects, 20% to 50% of the RMP in the composition exhibits phosphatidylserine. Optionally, the composition shortens the time to initial clot formation as measured by Thromboelastography (TEG) in whole blood and plasma, for example, by at least two minutes. Also optionally, the RMP has an average diameter of about 0.40 to 0.6. mu.m. Also provided are methods of treating excessive bleeding in a subject, comprising administering to the subject an RMP composition described herein.

Drawings

FIG. 1 is a graph showing acetylcholinesterase (AChE) activities expressed in RMP-1, RMP-2 and RMP-3 (. mu.M/min/10) described in comparative examples⁶RMP; y-axis).

FIG. 2 is a bar graph of the clotting time reduction (minutes; y-axis) mediated by 5 μ M (left bar) or 10 μ M (right bar) RMP-1, RMP-2 and RMP-3 as described in the comparative examples.

FIG. 3 is a bar graph of clot strength (increase in TEG MA; y-axis) mediated by RMP-1, RMP-2 and RMP-3 as described in the comparative examples.

FIG. 4 is a bar graph of anti-tPA mediated fibrinolysis (increase in TG compared to control (mm/min); y-axis) induced by RMP-1, RMP-2, and RMP-3 as described in the comparative examples.

Detailed Description

Provided herein are improved compositions of red blood cell-derived microparticles (RMPs) and methods for reducing bleeding in a subject. RMP has many advantages as a hemostatic agent, including (but not limited to) ease and economy of production and minimal immunogenicity. Red Blood Cells (RBCs) are the most abundant blood cell type, ensuring an essentially unlimited and economical source of RMP production. RMPs have an unlimited shelf life in room temperature storage, and do not need to be stored in blood banks, which makes them particularly advantageous in emergency situations. In addition, RMP produced by O-type Rh negative erythrocytes (universal RMP) can be administered immediately without cross-matching.

The present disclosure is based, at least in part, on the surprising identification of a subset of RMPs that have characteristics that are particularly advantageous for therapeutic applications. The particular subpopulations that exhibit the characteristics described herein are novel and offer technical advantages over previously described RMP populations in terms of, for example, efficacy and reduced toxicity. RBC degradation products (including RMP) have been associated with proinflammatory responses, toxicity, and serious side effects. See, e.g., Danesh et al, blood.2014; 123(5): 687-; and Zwicker et al, Br jhaematol.2013; 160(4): 530-537. Indeed, MP elevation has been implicated in a variety of thrombotic diseases, such as sickle cell disease (Camus et al, blood.2012; 120 (2): 5050) and Thrombotic Thrombocytopenia (TTP) (Galli et al, ThrombHaemost 1996.75 (3): 427-31), and in post-transfusion toxic events (Donadee et al, Circulation 2011; 124: 465-. The previously described RMP compositions are at risk of adverse events. Notably, the RMP subpopulations described herein effectively reduced bleeding while significantly reducing toxicity and adverse side effects.

The disclosure herein describes various aspects of the RMP subpopulations provided in a composition. Compositions comprising RMPs exhibiting any one, any combination, or all of the features described herein are encompassed and encompassed by the present invention.

In one aspect, the present disclosure provides compositions comprising red blood cell-derived RMP that exhibit significantly reduced acetylcholinesterase (AchE) activity. The decrease in AchE activity correlates with decreased RMP toxicity in vivo. In various embodiments, the RMP in the composition exhibits less than 20000pmol/min/10⁶AchE activity per particle (e.g., 20000 pmol/min/10)⁶Particles and 50pmol/min/10⁶Particles, wherein for any range described herein, 50pmol/min/10⁶Particles or 25pmol/min/10⁶Each granuleParticles are an optional lower limit. In a preferred embodiment, the RMP exhibits a RMP of less than 10000pmol/min/10⁶Particles of less than 5000pmol/min/10⁶Particles of less than 2500pmol/min/10⁶Particles of less than 1000pmol/min/10⁶Particles of less than 500pmol/min/10⁶Particles of less than 350pmol/min/10⁶Particles of less than 250pmol/min/10⁶Particles of less than 200pmol/min/10⁶Particles, or less than 150pmol/min/10⁶AchE activity of individual particles. In an exemplary aspect, the RMP exhibits less than 350pmol/min/10⁶AchE activity of individual particles. Methods for detecting AchE activity are known in the art (see, e.g., Ellman et al, Biochemical Pharmacology 1961; 7 (2): 88-95; Xie et al, J.biol.chem.2007; 282: 11765-.

Alternatively or additionally, the RMP comprises significantly reduced levels of lipid rafts or components thereof as compared to the previously described population of RMPs. Lipid rafts, also known as "detergent resistant membranes" (DRM), are membrane microdomains rich in cholesterol and sphingolipids. Substantially all native cell-derived Microparticles (MPs) are composed primarily of lipid rafts. Notably, in various embodiments, the compositions of the present disclosure comprise less lipid raft content than previously achieved (which is not limited to complete lipid rafts, but includes components of lipid rafts). For convenience only in describing this aspect of the disclosure, the lipid raft content of RMP may be compared to that of whole (i.e., non-fragmented) red blood cells. In various aspects, the composition has a lipid raft content of RMP that is 10% or less (e.g., 5% or less, 3% or less, 2% or less, 1% or less, 0.5% or less (e.g., 0.1% or 0.05%) of the lipid content of whole blood red blood cells). While not wishing to be bound by any particular theory, AChE may serve as an alternative indicator of lipid rafts, as proteins are anchored in the cell membrane and integrated in the lipid raft microdomains by the transmembrane protein PRiMA (proline-rich membrane anchor). See, e.g., Xie et al, j.biol.chem.2010; 285(15): 11537-11546, which also provides materials and methods for determining the lipid raft content of a biological sample. Surrogate markers for lipid rafts include, but are not limited to, erythrocyte membrane integrin (stomatin), buoy protein (flotillin), and caveolae (caveolae). Lipid rafts can also be characterized using proteomic methods. See, e.g., Foster and Chan, Subcell biochem.2007; 43: 35-47.

Alternatively or additionally, 20% to 50% of the RMP in the composition exhibits phosphatidylserine. For example, optionally, 30% to 45% of the RMP in the composition exhibits phosphatidylserine. In this regard, the compositions provide a subpopulation of RMPs with an optimal level of phosphatidylserine activity to promote hemostasis (e.g., promote clotting, reduce bleeding) while minimizing the potential for thrombosis. Phosphatidylserine can be measured in a variety of ways. For example, surrogate markers of phosphatidylserine include the detection of annexin V binding by flow cytometry. See, e.g., Koopman et al, "Annexin V for flow cytometry of phosphatylserine expression B cells during apoptosis". Blood 1994; 84(5): 1415-20. In one exemplary method, the ratio of annexin V binding + to CD235a + (a general marker for RMP) cells is determined. In various aspects, the ratio of AnV +/CD235a + is from 0.2 to 0.5, such as from 0.3 to 0.4.

Optionally, the composition has an internal density of RMP that is less than 3.5% of the internal density of whole blood red blood cells. In some aspects, the internal density of the RMP is about 0.1% -3.5% (e.g., about 0.5% -3%, about 0.5% -2.5%, or about 1% -2%) of the internal density of whole blood red blood cells. The internal density of RMP can be determined using a variety of techniques, including but not limited to flow cytometry side scatter signals, as described herein. While not wishing to be bound by any particular theory, it is believed that decreasing internal density is associated with decreased hemoglobin content. Free hemoglobin can be toxic in the body, leading to, for example, renal failure. See, e.g., Gladwin et al, J Clin invest.2012; 122(4): 1205-1208. The RMP of the compositions of the present disclosure exhibit reduced toxicity.

In various embodiments, the compositions shorten the time to initial clot formation as measured by Thromboelastography (TEG) in whole blood and plasma. In this regard, the composition optionally shortens the time to initial clot formation by at least two minutes (e.g., at least three minutes or at least four minutes), as measured by thromboelastography. In various embodiments, the composition shortens the time to initial clot formation by about 2 to about 5 minutes as measured by Thromboelastography (TEG) in whole blood and plasma. Indeed, in various embodiments, the compositions restore normal coagulation as indicated by shorter clot times, faster clot formation, or more stable clot development, as measured by TEG or rotational thromboelastometry (ROTEM) in whole blood and plasma.

Alternatively or additionally, the RMP in the composition exhibits an average diameter of about 0.40 to 0.70 μm, for example about 0.40 to 0.60 μm or about 0.40 to 0.50 μm. Optionally, the RMP has an average diameter of about 0.45 to 0.50 μm. RMP size may be determined using any of a variety of conventional laboratory techniques, including the methods described in the examples.

RMP is a degradation product of RBCs. RMP may be produced from fresh RBCs (i.e., RBCs isolated from a blood sample within 24 hours of RMP production) or stored RBCs. In this regard, RBCs are optionally frozen prior to production of RMP. For example, in various aspects, RBCs have been frozen for up to one month, up to two months, up to three months, up to four months or more. RMP can disrupt red blood cell membranes using any of a number of techniques, including sonication, centrifugation, heating, and treatment with an ionophore. In various embodiments, the RMP is generated by forcing red blood cells through a pore to produce ruptured red blood cells, and disrupting the ruptured red blood cells by bombardment on a solid surface. The shear stress created by forcing RBCs through the pores at a pressure of, for example, at least 25000psi (e.g., a pressure of about 35000psi) shears the RBCs, and the subsequent bombardment step further fragments the RBCs to create an RMP having the characteristics described herein. The RMP in the composition may be fresh (i.e., prepared from RBCs within 24 hours of administration to a subject) or stored. Since RMP has an extended shelf life, the composition can be stored for a long period of time. RMP produced from expired blood is as effective as RMP from very fresh blood; thus, the present disclosure provides a means to utilize donated blood that may not be suitable for clinical use.

And also provideMethods of treating excessive bleeding in a subject. The method comprises administering to the subject a composition comprising RMP described herein. For example, the method comprises administering a composition comprising RMP that exhibits acetylcholinesterase (AchE) activity less than 350pmol/min/10⁶Individual particles and/or having an average diameter of about 0.40-0.6 μm and/or wherein 20% -50% of the RMP in the composition exhibits phosphatidylserine and/or wherein the composition shortens the time to initial clot formation (e.g., by at least two minutes) as measured by Thromboelastography (TEG) in whole blood and plasma.

As used herein, "treatment" refers to any reduction in bleeding in a subject. "treatment" includes both therapeutic and prophylactic measures. One of ordinary skill in the art will appreciate that any degree of protection or amelioration of excessive bleeding is beneficial to a subject (e.g., a human patient). Thus, one aspect of the method is performed as soon as possible after a subject has been determined to be at risk of abnormal blood loss (e.g., before surgery is performed in a subject having or at risk of having a coagulation or platelet disorder) or after a bleeding event has occurred.

Excessive bleeding may be caused by a variety of conditions or disorders, and may be congenital or acquired (e.g., by other therapeutic agents). Subjects may suffer from, for example, platelet disorders or coagulation disorders (i.e., excessive bleeding caused thereby). Thromboderma includes bleeding disorders caused by insufficient blood clotting factor activity.blood clotting factors include, but are not limited to, Factor V (FV), FVII, FVIII, FIX, FX, FXI, FXIII, FII (responsible for hypoprothrothrothrothrothrothromobemia) and von Willebrand factor.

Optionally, the excessive bleeding is caused by drug treatment. For example, in various embodiments, excessive bleeding is caused by an anticoagulant, e.g., a blood diluent such as coumarin (warfarin, which is also a vitamin K antagonist), heparin (e.g., a low molecular weight heparin, such as enoxaparin or dalteparin), a prothrombinase complex inhibitor (e.g., fondaparinux or rivaroxaban), a FXa inhibitor (e.g., apixaban (Eliquis)) or a thrombin inhibitor (e.g., dabigatran). Excessive bleeding may also be caused by aspirin (which inhibits platelet function and can lead to severe bleeding, particularly in combination with other diseases or drugs), clopidogrel (plaix), and the like. These anticoagulants have no antidotes and the bleeding complications caused by these anticoagulants are dangerous to the patient. In these cases, the compositions of the present disclosure are effective in treating and/or preventing excessive bleeding.

In various embodiments, the subject is receiving a hemodiluent treatment (or the hemodiluent treatment has been discontinued for a period of time such that the biological effect of the hemodiluent remains unchanged). One advantage of the composition of the invention is that the RMP of the composition of the invention corrects the haemostasis defect induced by the blood diluent even in the presence of the blood diluent. The compositions of the present invention exhibit universal hemostatic activity and are therefore suitable for treating bleeding in patients suffering from a variety of hemostatic deficiencies.

A composition (e.g., a pharmaceutical composition) is formulated with a physiologically acceptable (i.e., pharmaceutically acceptable) carrier, buffer, excipient or diluent. The particular carrier used is limited only by chemical-physical factors such as insufficient solubility and reactivity with RMP, and by the route of administration. Physiologically acceptable carriers are well known in the art. Exemplary pharmaceutical forms suitable for injectable use include, but are not limited to, sterile aqueous solutions or dispersions. Injectable formulations are further described, for example, in pharmaceuticals and pharmaceutical Practice, J.B.Lippincott Co., Philadelphia.Pa., Bank and Chalmers. ed, pp.238-250 (1982) and ASHP Handbook on Injectable Drugs, Toissel, 4th ed., pp.622-630 (1986)). Pharmaceutical compositions comprising RMPs provided herein are optionally placed within a container with packaging materials that provide instructions regarding the use of such pharmaceutical compositions. Generally, such instructions include tangible expressions that describe the concentration of the agent and, in certain embodiments, the relative amounts of excipient ingredients or diluents that may be required to dilute the pharmaceutical composition.

If desired, the composition comprises one or more additional pharmaceutically effective agents. Alternatively or additionally, the compositions are provided as a therapeutic regimen, including the administration of other pharmaceutically effective agents (either concurrently or at spaced intervals). The compositions may be administered in combination with other agents and/or other therapeutic modalities to achieve additional or enhanced biological effects. Co-treatments include, but are not limited to, plasma derived or recombinant coagulation factors, hemophilia prophylaxis treatments, immunosuppressive agents, plasma factor inhibitory antibody antagonists (i.e., anti-inhibitors), anti-fibrinolytic agents, antibiotics, hormone therapy, anti-inflammatory agents (e.g., non-steroidal anti-inflammatory drugs (NSAIDs) or steroidal anti-inflammatory substances), procoagulants, blood thinners, and analgesics. In one aspect, administration of the composition allows for a reduction in the dosage of the co-therapeutic agent required to achieve the desired biological response.

Thus, the invention includes administering to a subject a composition of the present disclosure in combination with one or more additional suitable agents, each agent administered according to a regimen appropriate for the drug. Administration strategies include simultaneous administration (i.e., substantially simultaneous administration) and non-simultaneous administration (i.e., administration in any order at different times, whether overlapping or not) of the RMP composition and one or more additional suitable agents. It is to be understood that the different components are optionally administered in the same or different compositions and by the same or different routes of administration.

The specific administration regimen for a particular subject will depend, in part, on the amount of composition administered, the route of administration, the particular disease being treated, considerations associated with the recipient, and the cause and extent of any side effects. The amount of the composition and the conditions of administration (e.g., time of administration, route of administration, administration regimen) administered to a subject (e.g., a mammal, such as a human) are sufficient to affect a desired biological response within a reasonable time frame. Purely by way of example, in one aspect the method comprises administering to the subject, for example, about 1 x 10¹⁰RMP/kg to about 3X 10¹¹RMP/kg (e.g., about 5X 10)¹⁰RMP/kg to about 2X 10¹¹RMP/kg)。

In various aspects, the methods comprise administering the composition to treat an acute condition (e.g., bleeding caused by surgery or trauma) for a relatively short treatment period, e.g., 1 to 14 days. It is also contemplated that the composition may be administered over a longer course of treatment (e.g., for weeks or months) if the nature of the patient's condition requires extended treatment. The methods in various embodiments comprise administering the composition to the subject multiple times (e.g., once daily, twice daily, three times daily, four times daily or more).

Suitable methods of administering physiologically acceptable compositions (e.g., compositions comprising RMP as described herein) are well known in the art. Although more than one route may be used to administer the composition, a particular route may provide a more immediate and more effective response than another route. In one aspect, the compositions of the present disclosure are administered intravenously, intraarterially, or intraperitoneally to introduce RMP into the circulation. Non-intravenous administration is also suitable, particularly for low molecular weight therapies. In some cases, it is desirable to treat the skin in the vagina, rectum, lung; by intracerebral (intraparenchymal), intracerebroventricular, intramuscular, intraocular, intramenal, intralesional, intramedullary, intrathecal, intraventricular, transdermal, subcutaneous, intranasal, urethral or enteral injection; by a sustained release system; or delivering a pharmaceutical composition comprising RMP as described herein by an implant device. If desired, the composition is administered topically by intra-arterial or intravenous administration, e.g., by femoral artery feeding the region of interest for delivery to the legs. Where an implant device is used, the device of one aspect is implanted into any suitable tissue and the composition is delivered in various aspects by diffusion, timed release bolus injection or continuous administration. In other aspects, the composition is administered directly to exposed tissue during surgery or injury treatment, or by a blood transfusion method.

In view of the above, the present invention provides compositions described herein for use in methods of treating a subject, e.g., methods of treating a disorder in which RMP is beneficial. In one aspect, the present disclosure provides a composition described herein for use in treating excessive bleeding or blood loss in a subject in need thereof. The method comprises administering to the subject a composition of the invention in an amount and under conditions effective to treat or prevent all or part of the excessive blood loss. The present invention further provides RMPs having one or more (or all) of the features described herein for use in the preparation of a medicament. For example, RMP can be used to prepare a medicament (e.g., a composition) for treating excessive bleeding or blood loss in a subject in need thereof.