US20140287066A1 - Dosing regimens and methods of treatment using carbon monoxide - Google Patents
Dosing regimens and methods of treatment using carbon monoxide Download PDFInfo
- Publication number
- US20140287066A1 US20140287066A1 US14/299,772 US201414299772A US2014287066A1 US 20140287066 A1 US20140287066 A1 US 20140287066A1 US 201414299772 A US201414299772 A US 201414299772A US 2014287066 A1 US2014287066 A1 US 2014287066A1
- Authority
- US
- United States
- Prior art keywords
- carbon monoxide
- patient
- administered
- organ
- placebo
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
- 229910002091 carbon monoxide Inorganic materials 0.000 title claims abstract description 148
- UGFAIRIUMAVXCW-UHFFFAOYSA-N Carbon monoxide Chemical compound [O+]#[C-] UGFAIRIUMAVXCW-UHFFFAOYSA-N 0.000 title claims abstract description 147
- 238000000034 method Methods 0.000 title claims abstract description 36
- 210000000056 organ Anatomy 0.000 claims abstract description 31
- 230000002708 enhancing effect Effects 0.000 claims abstract description 7
- 108010003320 Carboxyhemoglobin Proteins 0.000 claims description 53
- 239000007788 liquid Substances 0.000 claims description 26
- 239000000902 placebo Substances 0.000 claims description 18
- 229940068196 placebo Drugs 0.000 claims description 18
- DDRJAANPRJIHGJ-UHFFFAOYSA-N creatinine Chemical compound CN1CC(=O)NC1=N DDRJAANPRJIHGJ-UHFFFAOYSA-N 0.000 claims description 16
- 230000003907 kidney function Effects 0.000 claims description 14
- 239000003795 chemical substances by application Substances 0.000 claims description 11
- 230000006870 function Effects 0.000 claims description 10
- 230000001225 therapeutic effect Effects 0.000 claims description 9
- 229940109239 creatinine Drugs 0.000 claims description 8
- 210000002966 serum Anatomy 0.000 claims description 8
- 210000003734 kidney Anatomy 0.000 claims description 7
- 230000024924 glomerular filtration Effects 0.000 claims description 6
- 210000002216 heart Anatomy 0.000 claims description 6
- 230000010410 reperfusion Effects 0.000 claims description 6
- 230000006872 improvement Effects 0.000 claims description 5
- 230000002526 effect on cardiovascular system Effects 0.000 claims description 3
- 210000002429 large intestine Anatomy 0.000 claims description 3
- 210000004185 liver Anatomy 0.000 claims description 3
- 210000000496 pancreas Anatomy 0.000 claims description 3
- 210000003491 skin Anatomy 0.000 claims description 3
- 210000000813 small intestine Anatomy 0.000 claims description 3
- 230000006735 deficit Effects 0.000 claims 2
- 239000007789 gas Substances 0.000 description 31
- 102000002737 Heme Oxygenase-1 Human genes 0.000 description 22
- 108010018924 Heme Oxygenase-1 Proteins 0.000 description 22
- 239000000203 mixture Substances 0.000 description 22
- 150000001875 compounds Chemical class 0.000 description 19
- IJGRMHOSHXDMSA-UHFFFAOYSA-N Atomic nitrogen Chemical compound N#N IJGRMHOSHXDMSA-UHFFFAOYSA-N 0.000 description 18
- 238000001356 surgical procedure Methods 0.000 description 17
- 210000004027 cell Anatomy 0.000 description 14
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 13
- 210000001519 tissue Anatomy 0.000 description 13
- 201000010099 disease Diseases 0.000 description 12
- 229910052757 nitrogen Inorganic materials 0.000 description 9
- 238000012384 transportation and delivery Methods 0.000 description 9
- 108090000623 proteins and genes Proteins 0.000 description 8
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 7
- 230000007106 neurocognition Effects 0.000 description 7
- 239000001301 oxygen Substances 0.000 description 7
- 229910052760 oxygen Inorganic materials 0.000 description 7
- 239000000243 solution Substances 0.000 description 7
- CURLTUGMZLYLDI-UHFFFAOYSA-N Carbon dioxide Chemical compound O=C=O CURLTUGMZLYLDI-UHFFFAOYSA-N 0.000 description 6
- XEEYBQQBJWHFJM-UHFFFAOYSA-N Iron Chemical compound [Fe] XEEYBQQBJWHFJM-UHFFFAOYSA-N 0.000 description 6
- 241000124008 Mammalia Species 0.000 description 6
- 239000007864 aqueous solution Substances 0.000 description 6
- 230000029058 respiratory gaseous exchange Effects 0.000 description 6
- 102000008857 Ferritin Human genes 0.000 description 5
- 108050000784 Ferritin Proteins 0.000 description 5
- 238000008416 Ferritin Methods 0.000 description 5
- 241000282414 Homo sapiens Species 0.000 description 5
- 229910002092 carbon dioxide Inorganic materials 0.000 description 5
- 230000002980 postoperative effect Effects 0.000 description 5
- 241001465754 Metazoa Species 0.000 description 4
- 206010063837 Reperfusion injury Diseases 0.000 description 4
- 210000004369 blood Anatomy 0.000 description 4
- 239000008280 blood Substances 0.000 description 4
- 230000000694 effects Effects 0.000 description 4
- 208000012947 ischemia reperfusion injury Diseases 0.000 description 4
- 210000004072 lung Anatomy 0.000 description 4
- 102000004169 proteins and genes Human genes 0.000 description 4
- 238000002054 transplantation Methods 0.000 description 4
- 238000010521 absorption reaction Methods 0.000 description 3
- 230000009286 beneficial effect Effects 0.000 description 3
- 238000002347 injection Methods 0.000 description 3
- 239000007924 injection Substances 0.000 description 3
- 229910052742 iron Inorganic materials 0.000 description 3
- 238000004519 manufacturing process Methods 0.000 description 3
- 239000012528 membrane Substances 0.000 description 3
- 238000012986 modification Methods 0.000 description 3
- 230000004048 modification Effects 0.000 description 3
- 241000894007 species Species 0.000 description 3
- 238000012385 systemic delivery Methods 0.000 description 3
- 230000009885 systemic effect Effects 0.000 description 3
- 238000012546 transfer Methods 0.000 description 3
- 230000002792 vascular Effects 0.000 description 3
- AQTFKGDWFRRIHR-UHFFFAOYSA-L 3-[18-(2-carboxylatoethyl)-8,13-bis(ethenyl)-3,7,12,17-tetramethylporphyrin-21,24-diid-2-yl]propanoate;cobalt(2+);hydron Chemical compound [Co+2].[N-]1C(C=C2C(=C(C)C(C=C3C(=C(C)C(=C4)[N-]3)C=C)=N2)C=C)=C(C)C(CCC(O)=O)=C1C=C1C(CCC(O)=O)=C(C)C4=N1 AQTFKGDWFRRIHR-UHFFFAOYSA-L 0.000 description 2
- 102000000546 Apoferritins Human genes 0.000 description 2
- 108010002084 Apoferritins Proteins 0.000 description 2
- BPYKTIZUTYGOLE-IFADSCNNSA-N Bilirubin Chemical compound N1C(=O)C(C)=C(C=C)\C1=C\C1=C(C)C(CCC(O)=O)=C(CC2=C(C(C)=C(\C=C/3C(=C(C=C)C(=O)N\3)C)N2)CCC(O)=O)N1 BPYKTIZUTYGOLE-IFADSCNNSA-N 0.000 description 2
- KSFOVUSSGSKXFI-GAQDCDSVSA-N CC1=C/2NC(\C=C3/N=C(/C=C4\N\C(=C/C5=N/C(=C\2)/C(C=C)=C5C)C(C=C)=C4C)C(C)=C3CCC(O)=O)=C1CCC(O)=O Chemical compound CC1=C/2NC(\C=C3/N=C(/C=C4\N\C(=C/C5=N/C(=C\2)/C(C=C)=C5C)C(C=C)=C4C)C(C)=C3CCC(O)=O)=C1CCC(O)=O KSFOVUSSGSKXFI-GAQDCDSVSA-N 0.000 description 2
- 208000024172 Cardiovascular disease Diseases 0.000 description 2
- 241000725303 Human immunodeficiency virus Species 0.000 description 2
- MHAJPDPJQMAIIY-UHFFFAOYSA-N Hydrogen peroxide Chemical compound OO MHAJPDPJQMAIIY-UHFFFAOYSA-N 0.000 description 2
- GXCLVBGFBYZDAG-UHFFFAOYSA-N N-[2-(1H-indol-3-yl)ethyl]-N-methylprop-2-en-1-amine Chemical compound CN(CCC1=CNC2=C1C=CC=C2)CC=C GXCLVBGFBYZDAG-UHFFFAOYSA-N 0.000 description 2
- MWUXSHHQAYIFBG-UHFFFAOYSA-N Nitric oxide Chemical compound O=[N] MWUXSHHQAYIFBG-UHFFFAOYSA-N 0.000 description 2
- 241000700159 Rattus Species 0.000 description 2
- 238000013459 approach Methods 0.000 description 2
- 230000008901 benefit Effects 0.000 description 2
- 230000009084 cardiovascular function Effects 0.000 description 2
- 238000007796 conventional method Methods 0.000 description 2
- 230000003247 decreasing effect Effects 0.000 description 2
- LOKCTEFSRHRXRJ-UHFFFAOYSA-I dipotassium trisodium dihydrogen phosphate hydrogen phosphate dichloride Chemical compound P(=O)(O)(O)[O-].[K+].P(=O)(O)([O-])[O-].[Na+].[Na+].[Cl-].[K+].[Cl-].[Na+] LOKCTEFSRHRXRJ-UHFFFAOYSA-I 0.000 description 2
- 231100000673 dose–response relationship Toxicity 0.000 description 2
- -1 e.g. Proteins 0.000 description 2
- 230000008030 elimination Effects 0.000 description 2
- 238000003379 elimination reaction Methods 0.000 description 2
- 230000037406 food intake Effects 0.000 description 2
- 238000004817 gas chromatography Methods 0.000 description 2
- RWSXRVCMGQZWBV-WDSKDSINSA-N glutathione Chemical compound OC(=O)[C@@H](N)CCC(=O)N[C@@H](CS)C(=O)NCC(O)=O RWSXRVCMGQZWBV-WDSKDSINSA-N 0.000 description 2
- BTIJJDXEELBZFS-QDUVMHSLSA-K hemin Chemical compound CC1=C(CCC(O)=O)C(C=C2C(CCC(O)=O)=C(C)\C(N2[Fe](Cl)N23)=C\4)=N\C1=C/C2=C(C)C(C=C)=C3\C=C/1C(C)=C(C=C)C/4=N\1 BTIJJDXEELBZFS-QDUVMHSLSA-K 0.000 description 2
- 229940025294 hemin Drugs 0.000 description 2
- 239000000411 inducer Substances 0.000 description 2
- 230000006698 induction Effects 0.000 description 2
- 230000001939 inductive effect Effects 0.000 description 2
- 238000001802 infusion Methods 0.000 description 2
- 238000013152 interventional procedure Methods 0.000 description 2
- 238000001990 intravenous administration Methods 0.000 description 2
- 239000002502 liposome Substances 0.000 description 2
- 230000007246 mechanism Effects 0.000 description 2
- 239000008194 pharmaceutical composition Substances 0.000 description 2
- 239000002953 phosphate buffered saline Substances 0.000 description 2
- 229950003776 protoporphyrin Drugs 0.000 description 2
- 229920006395 saturated elastomer Polymers 0.000 description 2
- 208000024891 symptom Diseases 0.000 description 2
- 230000000699 topical effect Effects 0.000 description 2
- 230000003936 working memory Effects 0.000 description 2
- 102000009027 Albumins Human genes 0.000 description 1
- 108010088751 Albumins Proteins 0.000 description 1
- GWZYPXHJIZCRAJ-UHFFFAOYSA-N Biliverdin Natural products CC1=C(C=C)C(=C/C2=NC(=Cc3[nH]c(C=C/4NC(=O)C(=C4C)C=C)c(C)c3CCC(=O)O)C(=C2C)CCC(=O)O)NC1=O GWZYPXHJIZCRAJ-UHFFFAOYSA-N 0.000 description 1
- RCNSAJSGRJSBKK-NSQVQWHSSA-N Biliverdin IX Chemical compound N1C(=O)C(C)=C(C=C)\C1=C\C1=C(C)C(CCC(O)=O)=C(\C=C/2C(=C(C)C(=C/C=3C(=C(C=C)C(=O)N=3)C)/N\2)CCC(O)=O)N1 RCNSAJSGRJSBKK-NSQVQWHSSA-N 0.000 description 1
- 241000283690 Bos taurus Species 0.000 description 1
- 241000282472 Canis lupus familiaris Species 0.000 description 1
- 241000283707 Capra Species 0.000 description 1
- 208000001408 Carbon monoxide poisoning Diseases 0.000 description 1
- 241000700198 Cavia Species 0.000 description 1
- KRKNYBCHXYNGOX-UHFFFAOYSA-K Citrate Chemical compound [O-]C(=O)CC(O)(CC([O-])=O)C([O-])=O KRKNYBCHXYNGOX-UHFFFAOYSA-K 0.000 description 1
- 241000699800 Cricetinae Species 0.000 description 1
- 241000938605 Crocodylia Species 0.000 description 1
- 102000004127 Cytokines Human genes 0.000 description 1
- 108090000695 Cytokines Proteins 0.000 description 1
- 241000701022 Cytomegalovirus Species 0.000 description 1
- 241000702421 Dependoparvovirus Species 0.000 description 1
- 241000283086 Equidae Species 0.000 description 1
- 241000282326 Felis catus Species 0.000 description 1
- 108010024636 Glutathione Proteins 0.000 description 1
- 108010054147 Hemoglobins Proteins 0.000 description 1
- 102000001554 Hemoglobins Human genes 0.000 description 1
- 241000700721 Hepatitis B virus Species 0.000 description 1
- 241000282412 Homo Species 0.000 description 1
- 241000700588 Human alphaherpesvirus 1 Species 0.000 description 1
- 206010058490 Hyperoxia Diseases 0.000 description 1
- 206010021143 Hypoxia Diseases 0.000 description 1
- 206010062016 Immunosuppression Diseases 0.000 description 1
- 206010061216 Infarction Diseases 0.000 description 1
- 206010061218 Inflammation Diseases 0.000 description 1
- 102000008133 Iron-Binding Proteins Human genes 0.000 description 1
- 108010035210 Iron-Binding Proteins Proteins 0.000 description 1
- 241000713666 Lentivirus Species 0.000 description 1
- 241001676635 Lepidorhombus whiffiagonis Species 0.000 description 1
- 241000702623 Minute virus of mice Species 0.000 description 1
- 241000699666 Mus <mouse, genus> Species 0.000 description 1
- 241000699670 Mus sp. Species 0.000 description 1
- 108091061960 Naked DNA Proteins 0.000 description 1
- 241000283973 Oryctolagus cuniculus Species 0.000 description 1
- 241001494479 Pecora Species 0.000 description 1
- YGYAWVDWMABLBF-UHFFFAOYSA-N Phosgene Chemical compound ClC(Cl)=O YGYAWVDWMABLBF-UHFFFAOYSA-N 0.000 description 1
- 241000288906 Primates Species 0.000 description 1
- 241000283984 Rodentia Species 0.000 description 1
- 241000282887 Suidae Species 0.000 description 1
- 206010052779 Transplant rejections Diseases 0.000 description 1
- 239000012840 University of Wisconsin (UW) solution Substances 0.000 description 1
- 206010046865 Vaccinia virus infection Diseases 0.000 description 1
- 241000700605 Viruses Species 0.000 description 1
- 239000005862 Whey Substances 0.000 description 1
- 102000007544 Whey Proteins Human genes 0.000 description 1
- 108010046377 Whey Proteins Proteins 0.000 description 1
- 208000027418 Wounds and injury Diseases 0.000 description 1
- 210000000683 abdominal cavity Anatomy 0.000 description 1
- 230000001154 acute effect Effects 0.000 description 1
- 230000002411 adverse Effects 0.000 description 1
- 239000000443 aerosol Substances 0.000 description 1
- 238000011316 allogeneic transplantation Methods 0.000 description 1
- 238000004458 analytical method Methods 0.000 description 1
- 210000003484 anatomy Anatomy 0.000 description 1
- 230000003466 anti-cipated effect Effects 0.000 description 1
- 235000013405 beer Nutrition 0.000 description 1
- QBUVFDKTZJNUPP-UHFFFAOYSA-N biliverdin-IXalpha Natural products N1C(=O)C(C)=C(C=C)C1=CC1=C(C)C(CCC(O)=O)=C(C=C2C(=C(C)C(C=C3C(=C(C=C)C(=O)N3)C)=N2)CCC(O)=O)N1 QBUVFDKTZJNUPP-UHFFFAOYSA-N 0.000 description 1
- 230000004071 biological effect Effects 0.000 description 1
- 210000004204 blood vessel Anatomy 0.000 description 1
- 210000000988 bone and bone Anatomy 0.000 description 1
- 210000004556 brain Anatomy 0.000 description 1
- 230000000981 bystander Effects 0.000 description 1
- 239000001569 carbon dioxide Substances 0.000 description 1
- 230000008859 change Effects 0.000 description 1
- 230000001684 chronic effect Effects 0.000 description 1
- 208000020832 chronic kidney disease Diseases 0.000 description 1
- 238000011278 co-treatment Methods 0.000 description 1
- 238000004737 colorimetric analysis Methods 0.000 description 1
- 230000001120 cytoprotective effect Effects 0.000 description 1
- 230000006378 damage Effects 0.000 description 1
- 238000001514 detection method Methods 0.000 description 1
- 238000011161 development Methods 0.000 description 1
- 230000037213 diet Effects 0.000 description 1
- 235000005911 diet Nutrition 0.000 description 1
- 238000009792 diffusion process Methods 0.000 description 1
- 231100000676 disease causative agent Toxicity 0.000 description 1
- 208000035475 disorder Diseases 0.000 description 1
- 238000009826 distribution Methods 0.000 description 1
- 238000000835 electrochemical detection Methods 0.000 description 1
- 238000002848 electrochemical method Methods 0.000 description 1
- 239000002158 endotoxin Substances 0.000 description 1
- 238000011156 evaluation Methods 0.000 description 1
- 230000029142 excretion Effects 0.000 description 1
- 108020001507 fusion proteins Proteins 0.000 description 1
- 102000037865 fusion proteins Human genes 0.000 description 1
- 238000001415 gene therapy Methods 0.000 description 1
- 230000002068 genetic effect Effects 0.000 description 1
- 229960003180 glutathione Drugs 0.000 description 1
- 150000003278 haem Chemical class 0.000 description 1
- 230000003862 health status Effects 0.000 description 1
- 229910001385 heavy metal Inorganic materials 0.000 description 1
- 239000001307 helium Substances 0.000 description 1
- 229910052734 helium Inorganic materials 0.000 description 1
- SWQJXJOGLNCZEY-UHFFFAOYSA-N helium atom Chemical compound [He] SWQJXJOGLNCZEY-UHFFFAOYSA-N 0.000 description 1
- 239000005556 hormone Substances 0.000 description 1
- 229940088597 hormone Drugs 0.000 description 1
- 230000000222 hyperoxic effect Effects 0.000 description 1
- 230000001146 hypoxic effect Effects 0.000 description 1
- 238000007654 immersion Methods 0.000 description 1
- 230000008105 immune reaction Effects 0.000 description 1
- 230000001506 immunosuppresive effect Effects 0.000 description 1
- 238000011065 in-situ storage Methods 0.000 description 1
- 230000002779 inactivation Effects 0.000 description 1
- 239000011261 inert gas Substances 0.000 description 1
- 230000007574 infarction Effects 0.000 description 1
- 230000002401 inhibitory effect Effects 0.000 description 1
- 208000014674 injury Diseases 0.000 description 1
- 238000001361 intraarterial administration Methods 0.000 description 1
- 238000007917 intracranial administration Methods 0.000 description 1
- 238000007918 intramuscular administration Methods 0.000 description 1
- 238000007912 intraperitoneal administration Methods 0.000 description 1
- 230000002601 intratumoral effect Effects 0.000 description 1
- MVZXTUSAYBWAAM-UHFFFAOYSA-N iron;sulfuric acid Chemical compound [Fe].OS(O)(=O)=O MVZXTUSAYBWAAM-UHFFFAOYSA-N 0.000 description 1
- 208000017169 kidney disease Diseases 0.000 description 1
- 238000012417 linear regression Methods 0.000 description 1
- 210000005229 liver cell Anatomy 0.000 description 1
- 210000005265 lung cell Anatomy 0.000 description 1
- 210000004216 mammary stem cell Anatomy 0.000 description 1
- 239000003550 marker Substances 0.000 description 1
- 238000005259 measurement Methods 0.000 description 1
- 230000004060 metabolic process Effects 0.000 description 1
- 239000011859 microparticle Substances 0.000 description 1
- 239000008267 milk Substances 0.000 description 1
- 210000004080 milk Anatomy 0.000 description 1
- 235000013336 milk Nutrition 0.000 description 1
- 238000012544 monitoring process Methods 0.000 description 1
- 230000004660 morphological change Effects 0.000 description 1
- 230000000926 neurological effect Effects 0.000 description 1
- 210000002569 neuron Anatomy 0.000 description 1
- 230000036542 oxidative stress Effects 0.000 description 1
- 230000010412 perfusion Effects 0.000 description 1
- 230000002688 persistence Effects 0.000 description 1
- 230000003285 pharmacodynamic effect Effects 0.000 description 1
- 230000000144 pharmacologic effect Effects 0.000 description 1
- 239000013600 plasmid vector Substances 0.000 description 1
- 238000002360 preparation method Methods 0.000 description 1
- 238000004321 preservation Methods 0.000 description 1
- 230000001681 protective effect Effects 0.000 description 1
- 230000002685 pulmonary effect Effects 0.000 description 1
- 239000003642 reactive oxygen metabolite Substances 0.000 description 1
- 238000011160 research Methods 0.000 description 1
- 230000036387 respiratory rate Effects 0.000 description 1
- 238000012216 screening Methods 0.000 description 1
- 230000035939 shock Effects 0.000 description 1
- 230000019491 signal transduction Effects 0.000 description 1
- 230000011664 signaling Effects 0.000 description 1
- 238000001179 sorption measurement Methods 0.000 description 1
- 230000002269 spontaneous effect Effects 0.000 description 1
- 238000007920 subcutaneous administration Methods 0.000 description 1
- 230000004083 survival effect Effects 0.000 description 1
- 208000011580 syndromic disease Diseases 0.000 description 1
- 231100000331 toxic Toxicity 0.000 description 1
- 230000002588 toxic effect Effects 0.000 description 1
- 238000009281 ultraviolet germicidal irradiation Methods 0.000 description 1
- 241000701161 unidentified adenovirus Species 0.000 description 1
- 241000712461 unidentified influenza virus Species 0.000 description 1
- 241001430294 unidentified retrovirus Species 0.000 description 1
- 208000007089 vaccinia Diseases 0.000 description 1
- 239000013598 vector Substances 0.000 description 1
- 210000003462 vein Anatomy 0.000 description 1
- 238000009423 ventilation Methods 0.000 description 1
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 1
- 238000002689 xenotransplantation Methods 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K33/00—Medicinal preparations containing inorganic active ingredients
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
- A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P7/00—Drugs for disorders of the blood or the extracellular fluid
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P9/00—Drugs for disorders of the cardiovascular system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/0012—Galenical forms characterised by the site of application
- A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/0012—Galenical forms characterised by the site of application
- A61K9/007—Pulmonary tract; Aromatherapy
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
- Y10T436/00—Chemistry: analytical and immunological testing
- Y10T436/20—Oxygen containing
- Y10T436/204998—Inorganic carbon compounds
- Y10T436/205831—Carbon monoxide only
Definitions
- the present invention relates to dosing regimens for the administration of carbon monoxide in the treatment of various indications as well as methods for enhancing organ function following transplant thereof.
- Carbon monoxide naturally produced by the human body, is toxic at high concentrations as it binds to hemoglobin to form carboxyhemoglobin (COHb) which is ineffective for delivering oxygen to bodily tissues.
- COHb carboxyhemoglobin
- carbon monoxide has been shown to be a signaling molecule with various therapeutic effects, such as cytoprotection, anti-inflammation and immunosuppression.
- cytoprotection cytoprotection
- anti-inflammation and immunosuppression.
- carbon monoxide can be clinically beneficial for treating various indications including ischemia reperfusion injury.
- the present invention provides clinical evidence of carbon monoxide preserving organ functions after transplantation and potential dosing regimens of carbon monoxide for treatment of various indications that are related to ischemia-reperfusion injury (e.g., organ transplant surgeries, vascular interventional procedures, various cardiovascular diseases, etc.).
- ischemia-reperfusion injury e.g., organ transplant surgeries, vascular interventional procedures, various cardiovascular diseases, etc.
- the therapeutic efficacy of carbon monoxide is dose-dependent, that is, the higher the dose the greater the effect.
- methods for treating a patient in need thereof with carbon monoxide including administering to the patient an effective amount of carbon monoxide that results in a carboxyhemoglobin concentration of at least 3%.
- the carboxyhemoglobin concentration is between about 3% and about 15%, where a positive dose-related trend on preservation of renal functions is observed without negative impact on cardiovascular and neurocognitive functions.
- the patient is administered a single dose of carbon monoxide during surgery at 2 mg/kg or 3 mg/kg for a sufficient time period that results in effective carboxyhemoglobin concentrations during surgery.
- the patient is administered carbon monoxide at the time of vascular reperfusion.
- the carboxyhemoglobin concentration is between about 7% and about 15%.
- the organ is selected from kidney, liver, heart, skin, large or small intestine and pancreas.
- the organ is kidney.
- kidney function is improved as indicated by an improvement of renal function (e.g., serum creatinine level and glomerular filtration rate).
- carbon monoxide is administered to the patient in a gaseous form, a liquid form, or a combination thereof.
- an additional agent that has a therapeutic effect is administered to the patient.
- FIG. 1A illustrates the dose-dependency of the carboxyhemoglobin concentration based on total COHb (expressed as % COHb/Hb) when carbon monoxide was given either at 12-48 hours after transplant surgery (post-operatively, referred to therein as “OP:pst”) or during surgery (intra-operatively, referred to therein as “OP:int”).
- Post-operative doses include placebo (i.e., O 2 30% in nitrogen), 0.7 mg/kg or 2 mg/kg carbon monoxide via inhalation for a time period of 1 hour.
- Intra-operative doses include placebo (i.e., O 2 30% in nitrogen), 2 mg/kg or 3 mg/kg carbon monoxide via inhalation for a time period of 1 hour.
- FIG. 1B illustrates the dose-dependency of the area under the blood concentration-time curve calculated to the last measured concentration (AUC 0-t ) of carboxyhemoglobin based on total COHb (expressed as % COHb/Hb) when carbon monoxide was given either at 12-48 hours after transplant surgery (post-operatively, referred to therein as “OP:pst”) or during surgery (intra-operatively, referred to therein as “OP:int”).
- Post-operative doses include placebo (i.e., O 2 30% in nitrogen), 0.7 mg/kg or 2 mg/kg carbon monoxide via inhalation for a time period of 1 hour.
- Intra-operative doses include placebo (i.e., O 2 30% in nitrogen), 2 mg/kg or 3 mg/kg carbon monoxide via inhalation for a time period of 1 hour.
- FIG. 2 illustrates the relationship between calculated glomerular filtration rate (GFR) on Day 1 and Day 2 and carboxyhemoglobin concentration expressed as % COHb/Hb for all subjects.
- GFR calculated glomerular filtration rate
- FIG. 3 illustrates the relationship between the serum creatinine level measured on Day 2 and carboxyhemoglobin concentration expressed as % COHb/Hb.
- Left panel (intra-operatively treated subjects) demonstrates that increased COHb is related to improved renal function (decreased serum creatinine).
- Right panel (post-operatively treated subjects) demonstrates that increased COHb did not improve the renal function (increased serum creatinine), suggesting that carbon monoxide with the post-operative regimen has no beneficial effect on the renal functions of renal transplant recipients.
- FIG. 4 illustrates the relationship between the COHb level (expressed as % COHb/Hb) and QTc change from baseline at 8 hours following carbon monoxide inhalation (both intra-operatively and post-operatively treated).
- subjects were administered either (i) 12-48 hours post-operatively following renal transplant a dose of 0.7 mg/kg or 2 mg/kg carbon monoxide via inhalation for a time period of 1 hour or (ii) intra-operatively during renal transplant surgery 2 mg/kg or 3 mg/kg carbon monoxide via inhalation for a time period of 1 hour.
- the negative correlation demonstrates that carbon monoxide does not have an effect on QT prolongation at a dose level up to 3 mg/kg.
- FIG. 5 , FIG. 6 and FIG. 7 illustrate the impact of carbon monoxide treatment on neurocognitive functions over 6 months in subjects receiving kidney transplants following inhalation of placebo, 0.7 mg/kg, 2 mg/kg or 3 mg/kg carbon monoxide through the evaluation of individual digit vigilance speed ( FIG. 5 ), numeric working memory accuracy ( FIG. 6 ) and picture recognition ( FIG. 7 ).
- the CO doses were administered either 12-48 hours post-operatively following renal transplant (placebo, 0.7 mg/kg or 2 mg/kg) or intra-operatively during renal transplant surgery (placebo, 2 mg/kg or 3 mg/kg).
- Visit #1 Screening; Visit #4: Day 0; Visit #6: Day 1; Visit #14-16: Day 28; Visit #17-18: follow-up Weeks 16-24.
- the open symbols reflect individual observations, the thin lines reflect individual trends and thick lines reflect the average trend based on linear regression. The average trends demonstrate that carbon monoxide at a dose level up to 3 mg/kg does not have negative impact on neurocognitive functions.
- treating refers to the treatment of a disease or condition of interest in a patient (e.g., a mammal) having the disease or condition of interest, and includes, for example:
- the term “patient” refers to an animal, human or non-human, to whom treatment according to the methods of the present invention is provided. Veterinary applications are clearly anticipated by the present invention.
- the term “patient” includes but is not limited to birds, reptiles, amphibians, and mammals, e.g., humans, other primates, pigs, rodents such as mice and rats, rabbits, guinea pigs, hamsters, cows, horses, cats, dogs, sheep and goats.
- carbon monoxide refers to molecular-carbon monoxide in its gaseous state, compressed into liquid form, or dissolved in aqueous solution.
- administering refers to any mode of transferring, delivering, introducing or transporting carbon monoxide or other agent to a subject.
- Administration of carbon monoxide or other agent may be conducted concurrently or sequentially in time. Additionally, administration of carbon monoxide and other agent(s) may be via the same or different route(s).
- Administration of carbon monoxide and other agent(s) may be performed via one or more of the following routes of administration: intravenous, intra-arterial, subcutaneous, intramuscular, intracisternal, intraperitoneal, intradermal, nasal via inhalation, nasal via aerosol, buccal, topical, intralesional, intracranial, intraprostatic, intrapleural, intratracheal, intranasal, intravitreal, intravaginal, intrarectal, intratumoral, intraocular, subconjunctival, intravesicular, mucosal, intrapericardial, intraumbilical, oral, local, by injection, by infusion, by continuous infusion, by absorption, by adsorption, by immersion, by localized perfusion, via a catheter, or via a lavage.
- routes of administration may be performed via one or more of the following routes of administration: intravenous, intra-arterial, subcutaneous, intramuscular, intracisternal, intraperitoneal, intradermal, nasal via inhalation,
- the term “effective amount” refers to that amount of carbon monoxide which, when administered to a patient (e.g., a mammal) for a period of time is sufficient to cause an intended effect or physiological outcome.
- Effective amounts of carbon monoxide for use in the present invention include, for example, amounts that are effective for enhancing organ function following transplant thereof.
- the amount of carbon monoxide which constitutes an “effective amount” will vary depending on the condition and its severity, the manner of administration, and the patient (e.g., the age of the mammal to be treated), but can be determined routinely by one of ordinary skill in the art having regard to his own knowledge and to this disclosure.
- the term “effective amount” refers to the amount that can achieve a measurable result.
- an “effective amount” is, for example, an amount that when administered to a human subject in need of medical treatment in a controlled Phase 2 or Phase 3 clinical trial produces a statistically significant benefit on a predefined clinical endpoint.
- enhancing refers to an increase in organ function following transplant.
- enhancing includes an improvement in renal function as indicated by improvement in serum creatinine level or in glomerular filtration rate.
- organ refers to any anatomical part or member having a specific function in the animal. Further included within the meaning of this term are substantial portions of organs (e.g., cohesive tissues obtained from an organ). Such organs include but are not limited to kidney, liver, heart, skin, large or small intestine, pancreas, and lungs. Further included in this definition are bones and blood vessels (e.g., aortic transplants).
- transplant in the context of an organ transplant refers to the implanting of an organ, tissue, mass of cells, or individual cells into a patient.
- transformation is defined in the art as the transfer of living tissues or cells from a donor to a recipient, with the intention of maintaining the functional integrity of the transplanted tissue or cells in the recipient (see, e.g., The Merck Manual, Berkow, Fletcher, and Beers, Eds., Merck Research Laboratories, Rahway, N.J., 1992). Transplants are categorized by site and genetic relationship between donor and recipient.
- the term includes autotransplantation (i.e., removal and transfer of cells or tissue from one location on a patient to the same or another location on the same patient), allotransplantation (i.e., transplantation between members of the same species), and xenotransplantation (i.e., transplantation between members of different species).
- the term “indications” includes ischemia-reperfusion injury including, but not limited to, organ transplant surgeries, vascular interventional procedures, and various cardiovascular diseases.
- a carbon monoxide composition may be a gaseous carbon monoxide composition.
- Compressed or pressurized gas useful in the methods of the invention can be obtained from any commercial source, and in any type of vessel appropriate for storing compressed gas.
- compressed or pressurized gases can be obtained from any source that supplies compressed gases, such as oxygen, for medical use.
- the pressurized gas including carbon monoxide used in the methods of the present invention can be provided such that all gases of the desired final composition (e.g., CO and O 2 , and optionally N 2 , He, and/or CO 2 ) are mixed together in the same vessel. If desired, the methods of the present invention can be performed using multiple vessels containing individual gases.
- a single vessel can be provided that contains carbon monoxide, with or without other gases, the contents of which can be optionally mixed with room air or with the contents of other vessels (e.g., vessels containing oxygen, nitrogen, carbon dioxide, compressed air, or any other suitable gas or mixtures thereof.
- Gaseous compositions administered to a patient according to the present invention typically contain 0% to about 79% by weight nitrogen, about 21% to about 100% by weight oxygen and about 0.0000001% to about 0.3% by weight (corresponding to about 0.001 ppm (i.e., 1 ppb) to about 3,000 ppm) carbon monoxide.
- the amount of nitrogen in the gaseous composition is about 79% by weight
- the amount of oxygen is about 21% by weight
- the amount of carbon monoxide is about 0.0001% to about 0.25% by weight.
- the amount of carbon monoxide is preferably at least about 0.001%, e.g., at least about 0.005%, 0.01%, 0.02%, 0.025%, 0.03%, 0.04%, 0.05%, 0.06%, 0.08%, 0.10%, 0.15%, 0.20%, 0.22%, or 0.24% by weight.
- Preferred ranges of carbon monoxide include about 0.001% to about 0.24%, about 0.005% to about 0.22%, about 0.010% to about 0.20%, and about 0.015% to about 0.1% by weight.
- a gaseous carbon monoxide composition may be used to create an atmosphere that comprises carbon monoxide gas.
- An atmosphere that includes appropriate levels of carbon monoxide gas can be created, for example, by providing a vessel containing a pressurized gas comprising carbon monoxide gas, and releasing the pressurized gas from the vessel into a chamber or space to form an atmosphere that includes the carbon monoxide gas inside the chamber or space.
- the gases can be released into an apparatus that culminates in a breathing mask or breathing tube, thereby creating an atmosphere comprising carbon monoxide gas in the breathing mask or breathing tube and ensuring the patient is the only person in the room exposed to significant levels of carbon monoxide.
- Carbon monoxide levels in an atmosphere or a ventilation circuit can be measured or monitored using any method known in the art. Such methods include electrochemical detection, gas chromatography, radioisotope counting, infrared absorption, colorimetry, and electrochemical methods based on selective membranes (see, e.g., Sunderman et al., Clin Chem, 28:2026-2032 (1982); Ingi et al., Neuron, 16:835-842 (1996)). Sub-parts per million carbon monoxide levels can be detected e.g., by gas chromatography and radioisotope counting.
- carbon monoxide levels in the sub-ppm range can be measured in biological tissue by a midinfrared gas sensor (see, e.g., Morimoto et al., Am J Physiol Heart Circ Physiol, 280:H482-H488 (2001)). Carbon monoxide sensors and gas detection devices are widely available from many commercial sources.
- a carbon monoxide composition may also be a liquid carbon monoxide composition.
- a liquid can be made into a carbon monoxide composition by any method known in the art for causing gases to become dissolved in liquids.
- the liquid can be placed in a so-called “CO 2 incubator” and exposed to a continuous flow of carbon monoxide until a desired concentration of carbon monoxide is reached in the liquid.
- carbon monoxide gas can be “bubbled” directly into the liquid until the desired concentration of carbon monoxide in the liquid is reached. The amount of carbon monoxide that can be dissolved in a given aqueous solution increases with decreasing temperature.
- an appropriate liquid may be passed through tubing that allows gas diffusion, where the tubing runs through an atmosphere comprising carbon monoxide (e.g., utilizing a device such as an extracorporeal membrane oxygenator).
- the carbon monoxide diffuses into the liquid to create a liquid carbon monoxide composition.
- the liquid can be any liquid known to those of skill in the art to be suitable for administration to patients (see, for example, Oxford Textbook of Surgery, Morris and Malt, Eds., Oxford University Press, 1994).
- the liquid will be an aqueous solution.
- solutions include Phosphate Buffered Saline (PBS), CelsiorTM solution, PerfadexTM solution, Collins solution, citrate solution, and University of Wisconsin (UW) solution (Oxford Textbook of Surgery, Morris and Malt, Eds., Oxford University Press, 1994).
- the liquid compositions can include carbon monoxide at concentrations in the range of about 0.0001 to about 0.0044 g CO/100 g liquid, e.g., at least 0.0002, 0.0004, 0.0006, 0.0008, 0.0010, 0.0013, 0.0014, 0.0015, 0.0016, 0.0018, 0.0020, 0.0021, 0.0022, 0.0024, 0.0026, 0.0028, 0.0030, 0.0032, 0.0035, 0.0037, 0.0040, or 0.0042 g CO/100 g aqueous solution.
- Preferred ranges include, e.g., about 0.0010 to about 0.0030 g CO/100 g liquid, about 0.0015 to about 0.0026 g CO/100 g liquid, or about 0.0018 to about 0.0024 g CO/100 g liquid.
- the saturation point is about 0.0044 g CO/100 g medium.
- Any suitable liquid can be saturated to a set concentration of carbon monoxide via gas diffusers.
- pre-made solutions that have been quality controlled to contain set levels of carbon monoxide can be used. Accurate control of dose can be achieved via measurements with a gas permeable, liquid impermeable membrane connected to a carbon monoxide analyzer. Solutions can be saturated to desired effective concentrations and maintained at these levels. In both liquid and gaseous compositions, the inclusion of the inert gas helium can improve carbon monoxide delivery to the tissues of an organ.
- a patient can be treated with a carbon monoxide composition by any method known in the art of administering gases and/or liquids to patients.
- the present invention contemplates the administration of carbon monoxide in gaseous and/or liquid form to patients.
- Exemplary routes of administration include, but are not limited to systemic (e.g., by inhalation and/or ingestion) and topical to the patient's organs or tissues in situ (e.g., by ingestion, insufflation, and/or introduction into the abdominal cavity).
- Carbon monoxide is administered to the patient intra-operatively in an effective amount and at the time of reperfusion that results in a carboxyhemoglobin concentration of at least 7%.
- the carboxyhemoglobin concentration is between about 7% and about 15%.
- the patient is administered carbon monoxide at a dose ranging between about 2 mg/kg to about 3 mg/kg for a sufficient time period that results in an effective carboxyhemoglobin concentration.
- the patient is administered carbon monoxide at a dose of 3 mg/kg for a sufficient time period that results in an effective carboxyhemoglobin concentration.
- carbon monoxide is administered to the patient at the time around reperfusion.
- Gaseous carbon monoxide compositions can be delivered systemically to a patient undergoing a transplant. Typically, such gaseous carbon monoxide compositions are administered by inhalation through the mouth or nasal passages to the lungs, where the carbon monoxide is readily absorbed into the patient's bloodstream.
- concentration of active compound (CO) utilized in the therapeutic gaseous composition will depend on absorption, distribution, inactivation, and excretion (generally, through respiration) rates of the carbon monoxide as well as other factors known to those of skill in the art. It is to be further understood that for any particular subject, specific dosage regimens may be adjusted over time according to the individual need and the professional judgment of the person administering or supervising the administration of the compositions.
- Acute, sub-acute and chronic administration of carbon monoxide is contemplated by the present invention, depending upon, e.g., the severity or persistence of the disease or condition of the patient.
- Carbon monoxide can be delivered to the patient for a time sufficient to treat the disease or condition and exert the intended pharmacological or biological effect.
- Ventilators Carbon monoxide (concentrations can vary) can be purchased mixed with air or another oxygen-containing gas in a standard tank of compressed gas (e.g., 21% O 2 , 79% N 2 ). It is non-reactive, and the concentrations that are required for the methods of the present invention are well below the combustible range (10% in air). In a hospital setting, the gas presumably will be delivered to the bedside where it will be mixed with oxygen or house air in a blender to a desired concentration. The patient will inhale the gas mixture through a ventilator, which will be set to a flow rate based on patient comfort and needs. This is determined by pulmonary graphics (i.e., respiratory rate, tidal volumes, etc.).
- pulmonary graphics i.e., respiratory rate, tidal volumes, etc.
- Fail-safe mechanism(s) to prevent the patient from unnecessarily receiving greater than desired amounts of carbon monoxide can be designed into the delivery system.
- the patient's carbon monoxide level can be monitored by studying (1) carboxyhemoglobin (COHb), which can be measured in venous blood, and (2) exhaled carbon monoxide collected from a side port of the ventilator.
- COHb carboxyhemoglobin
- Carbon monoxide exposure can be adjusted based upon the patient's health status and on the basis of the markers. If necessary, carbon monoxide can be washed out of the patient by switching to 100% O 2 inhalation. Carbon monoxide is not metabolized; thus, whatever is inhaled will ultimately be exhaled except for a very small percentage that is converted to CO 2 .
- Carbon monoxide can also be mixed with any level of O 2 to provide therapeutic delivery of carbon monoxide without consequential hypoxic conditions.
- Face Mask and Tent A carbon monoxide-containing gas mixture is prepared as above to allow inhalation by the patient using a facemask or tent.
- the concentration inhaled can be changed and can be washed out by simply switching over to 100% O 2 .
- Monitoring of carbon monoxide levels would occur at or near the mask or tent with fail-safe mechanism(s) that would prevent too high of a concentration of carbon monoxide from being inhaled.
- Compressed carbon monoxide can be packaged into a portable inhaler device and inhaled in a metered dose, for example, to permit intermittent treatment of a recipient who is not in a hospital setting.
- Different concentrations of carbon monoxide could be packaged in the containers.
- the device could be as simple as a small tank (e.g., under 5 kg) of appropriately diluted CO with an on-off valve and a tube from which the patient takes a whiff of CO according to a standard regimen or as needed.
- Intravenous Artificial Lung An artificial lung (a catheter device for gas exchange in the blood) designed for O 2 delivery and CO 2 removal can be used for carbon monoxide delivery.
- the catheter when implanted, resides in one of the large veins and would be able to deliver carbon monoxide at given concentrations either for systemic delivery or delivery to a local site.
- the delivery can be a local delivery of a high concentration of carbon monoxide for a short period of time at a specific site (this high concentration would rapidly be diluted out in the bloodstream), or a relatively longer systemic exposure to a lower concentration of carbon monoxide (see, e.g., Hattler et al., Artif Organs, 18(11):806-812 (1994); and Golob et al., ASAIO J, 47(5):432-437 (2001)).
- Normobaric Chamber In certain instances, it would be desirable to expose the whole patient to carbon monoxide.
- the patient would be inside an airtight chamber that would be flooded with carbon monoxide (at a level that does not endanger the patient, or at a level that poses an acceptable risk without the risk of bystanders being exposed).
- the chamber Upon completion of the exposure, the chamber could be flushed with air (e.g., 21% O 2 , 79% N 2 ), and samples could be analyzed by carbon monoxide analyzers to ensure no carbon monoxide remains before allowing the patient to exit the exposure system.
- Aqueous Solutions comprising carbon monoxide can be created for systemic delivery to a patient (e.g., for oral delivery) and/or by injection into the body (e.g., intravenously, intra-arterially, intraperitoneally and/or subcutaneously).
- HO-1 hemeoxygenase-1
- HO-1 can be provided to a patient by inducing or expressing HO-1 in the patient, or by administering exogenous HO-1 directly to the patient.
- the term “induce(d)” means to cause increased production of a protein, e.g., HO-1, in isolated cells or the cells of a tissue, organ or animal using the cells' own endogenous (e.g., non-recombinant) gene that encodes the protein.
- HO-1 can be induced in a patient, e.g., a donor and/or recipient, by any method known in the art.
- HO-1 production of HO-1 can be induced by hemin, by iron protoporphyrin, or by cobalt protoporphyrin.
- non-heme agents including heavy metals, cytokines, hormones, nitric oxide, COCl 2 , endotoxin and heat shock are also strong inducers of HO-1 expression (Otterbein et al., Am J Physiol Lung Cell Mol Physiol, 279:L1029-L1037 (2000); Choi et al., Am J Respir Cell Mol Biol, 15:9-19 (1996); Maines, Annu Rev Pharmacol Toxicol, 37:517-554 (1997); and Tenhunen et al., J Lab Clin Med, 75:410-421 (1970)).
- HO-1 is also highly induced by a variety of agents and conditions that create oxidative stress, including hydrogen peroxide, glutathione depletors, UV irradiation and hyperoxia (Choi et al., Am J Respir Cell Mol Biol, 15:9-19 (1996); Maines, Annu Rev Pharmacol Toxicol, 37:517-554 (1997); and Keyse et al., Proc Natl Acad Sci USA, 86:99-103 (1989)).
- a “pharmaceutical composition comprising an inducer of HO-1” means a pharmaceutical composition containing any agent capable of inducing HO-1 in a patient, e.g., any of the agents described above, e.g., hemin, iron protoporphyrin, and/or cobalt protoporphyrin.
- HO-1 expression in a cell can be increased via gene transfer.
- the term “express(ed)” means to cause increased production of a protein, e.g., HO-1 or ferritin, in isolated cells or the cells of a tissue, organ or animal using an exogenously administered gene (e.g., a recombinant gene).
- the HO-1 or ferritin is preferably of the same species (e.g., human, mouse, rat, etc.) as the transplant recipient, in order to minimize any immune reaction.
- Expression could be driven by a constitutive promoter (e.g., cytomegalovirus promoters) or a tissue-specific promoter (e.g., milk whey promoter for mammary cells or albumin promoter for liver cells).
- a constitutive promoter e.g., cytomegalovirus promoters
- tissue-specific promoter e.g., milk whey promoter for mammary cells or albumin promoter for liver cells.
- An appropriate gene therapy vector e.g., retrovirus, adenovirus, adeno associated virus (AAV), pox (e.g., vaccinia) virus, human immunodeficiency virus (HIV), the minute virus of mice, hepatitis B virus, influenza virus, Herpes Simplex Virus-1, and lentivirus
- encoding HO-1 or ferritin would be administered to the patient orally, by inhalation, or by injection at a location appropriate for treatment of transplant rejection.
- plasmid vectors encoding HO-1 or apo-ferritin can be administered, e.g., as naked DNA, in liposomes, or in microparticles.
- exogenous HO-1 protein can be directly administered to a patient by any method known in the art.
- Exogenous HO-1 can be directly administered in addition to, or as an alternative, to the induction or expression of HO-1 in the patient as described above.
- the HO-1 protein can be delivered to a patient, for example, in liposomes, and/or as a fusion protein, e.g., as a TAT-fusion protein (see, e.g., Becker-Hapak et al., Int J Colorectal Dis, 16(4):247-256, (2001)).
- any of the products of metabolism by HO-1 e.g., bilirubin, biliverdin, iron, and/or ferritin
- bilirubin e.g., bilirubin, biliverdin, iron, and/or ferritin
- iron-binding molecules other than ferritin e.g., desferoxamine (DFO), iron dextran, and/or apoferritin
- DFO desferoxamine
- Any of the above compounds can be administered to the patient topically and/or systemically.
- administering regimens of the present invention result in triggering of signaling pathways that provide a therapeutic effect.
- administration of carbon monoxide dosing regimens of the present invention reduce ischemia reperfusion injury associated with organ transplant.
- administration of carbon monoxide intra-operatively during transplant surgery is thought to increase organ function and survival thereof by providing a protective effect against reactive oxygen species which are most generated at that time.
- Study subjects receive either (i) 12-48 hours post-operatively following renal transplant, a single dose of placebo (i.e., O 2 30% in nitrogen) or carbon monoxide (Covox 12 mg/L) at 0.7 mg/kg or 2 mg/kg via inhalation for a time period of 1 hour, or (ii) intra-operatively during renal transplant surgery (at the time of re-anastomosis), a dose of placebo (i.e., O 2 30% in nitrogen), 2 mg/kg or 3 mg/kg carbon monoxide via inhalation for a time period of 1 hour.
- placebo i.e., O 2 30% in nitrogen
- COvox 12 mg/L carbon monoxide
- COHb exposure is measured using conventional methods. For example, COHb exposure can be ascertained by measuring the amount present in venous blood using a device known as a CO-OXI meter. For both post- and intra-operative dosing regimens, dose-dependency of COHb Cmax and AUC is evaluated, the results of which are shown graphically in FIGS. 1A and 1B . Notably, % COHb/Hb increased with an increase in the dose of inhaled carbon monoxide in an approximately proportional manner. Based on these results as well as previous studies in healthy volunteers (data not shown), COHb pharmacokinetics are used as a surrogate marker for systemic carbon monoxide exposure.
- the elimination t 1/2 of COHb in CO treated subjects ranged from 2.2 to 9.9 hours.
- the COHb levels in placebo subjects ranged from 0.8 to 2.2%.
- COHb levels during surgery ranged from 0.6 to 1.3%, similar to those with spontaneous breathing (post-operative).
- the net gain of COHb from CO inhalation peaked around 1 hour with C max of 7.1 ⁇ 0.74% (2 mg/kg) and 11.0 ⁇ 1.4% (3 mg/kg).
- the elimination t 1/2 estimated from the net COHb levels averaged about 6 hours for both dose levels.
- Organ function is assessed in subjects using pharmacodynamic markers representing renal functions.
- COHb carbon monoxide exposure
- QTc cardiovascular function
- FIG. 4 cardiovascular function
- PKPD pharmacokinetic-pharmacodynamic
- the relationship between subjects receiving one of various inhaled carbon monoxide doses or placebo and key neurocognitive functions i.e., individual digit vigilance speed ( FIG. 5 ), numeric working memory accuracy ( FIG. 6 ) and picture recognition ( FIG. 7 )) up to 24 weeks post-treatment is assessed via a pharmacokinetic-pharmacodynamic (PKPD) approach.
- PKPD pharmacokinetic-pharmacodynamic
- PKPD analysis revealed a negative correlation between CO exposure and QTc ( FIG. 4 ) and between CO exposure and neurocognitive functions ( FIGS. 5 , 6 and 7 ) in renal transplant recipients receiving up to 3 mg/kg carbon monoxide via inhalation for a time period of 1 hour.
- the negative correlations demonstrate that carbon monoxide is unlikely to cause QT prolongation and affect neurocognitive functions when given via inhalation for a time period of 1 hour at a dose of up to 3 mg/kg.
Landscapes
- Health & Medical Sciences (AREA)
- Pharmacology & Pharmacy (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- General Health & Medical Sciences (AREA)
- Chemical & Material Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Medicinal Chemistry (AREA)
- Life Sciences & Earth Sciences (AREA)
- Epidemiology (AREA)
- Chemical Kinetics & Catalysis (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- General Chemical & Material Sciences (AREA)
- Organic Chemistry (AREA)
- Inorganic Chemistry (AREA)
- Engineering & Computer Science (AREA)
- Bioinformatics & Cheminformatics (AREA)
- Heart & Thoracic Surgery (AREA)
- Hematology (AREA)
- Diabetes (AREA)
- Cardiology (AREA)
- Pain & Pain Management (AREA)
- Rheumatology (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
Abstract
Description
- This application is a continuation application of U.S. patent application Ser. No. 13/106,437, filed May 12, 2011, now allowed, which claims the benefit of U.S. Provisional Patent Application No. 61/334,755, filed May 14, 2010, the entire contents of which are hereby incorporated by reference.
- The present invention relates to dosing regimens for the administration of carbon monoxide in the treatment of various indications as well as methods for enhancing organ function following transplant thereof.
- Carbon monoxide, naturally produced by the human body, is toxic at high concentrations as it binds to hemoglobin to form carboxyhemoglobin (COHb) which is ineffective for delivering oxygen to bodily tissues. Paradoxically, carbon monoxide has been shown to be a signaling molecule with various therapeutic effects, such as cytoprotection, anti-inflammation and immunosuppression. When given at appropriate doses, carbon monoxide can be clinically beneficial for treating various indications including ischemia reperfusion injury. There is a medical need for identifying dosing regimens for the administration of carbon monoxide that are therapeutic while minimizing the risk of adverse effects associated with administration of the same.
- The present invention provides clinical evidence of carbon monoxide preserving organ functions after transplantation and potential dosing regimens of carbon monoxide for treatment of various indications that are related to ischemia-reperfusion injury (e.g., organ transplant surgeries, vascular interventional procedures, various cardiovascular diseases, etc.). The therapeutic efficacy of carbon monoxide is dose-dependent, that is, the higher the dose the greater the effect.
- In one aspect of the invention, there is provided methods for treating a patient in need thereof with carbon monoxide, including administering to the patient an effective amount of carbon monoxide that results in a carboxyhemoglobin concentration of at least 3%. In one embodiment, the carboxyhemoglobin concentration is between about 3% and about 15%, where a positive dose-related trend on preservation of renal functions is observed without negative impact on cardiovascular and neurocognitive functions.
- In one embodiment, the patient is administered a single dose of carbon monoxide during surgery at 2 mg/kg or 3 mg/kg for a sufficient time period that results in effective carboxyhemoglobin concentrations during surgery.
- In one embodiment, the patient is administered carbon monoxide at the time of vascular reperfusion. In one embodiment, the carboxyhemoglobin concentration is between about 7% and about 15%.
- In one embodiment, the organ is selected from kidney, liver, heart, skin, large or small intestine and pancreas. In one embodiment, the organ is kidney. In one embodiment, kidney function is improved as indicated by an improvement of renal function (e.g., serum creatinine level and glomerular filtration rate).
- In one embodiment of any of the aforementioned methods, carbon monoxide is administered to the patient in a gaseous form, a liquid form, or a combination thereof.
- In one embodiment of any of the aforementioned methods, an additional agent that has a therapeutic effect is administered to the patient.
-
FIG. 1A illustrates the dose-dependency of the carboxyhemoglobin concentration based on total COHb (expressed as % COHb/Hb) when carbon monoxide was given either at 12-48 hours after transplant surgery (post-operatively, referred to therein as “OP:pst”) or during surgery (intra-operatively, referred to therein as “OP:int”). Post-operative doses include placebo (i.e., O2 30% in nitrogen), 0.7 mg/kg or 2 mg/kg carbon monoxide via inhalation for a time period of 1 hour. Intra-operative doses include placebo (i.e., O2 30% in nitrogen), 2 mg/kg or 3 mg/kg carbon monoxide via inhalation for a time period of 1 hour. -
FIG. 1B illustrates the dose-dependency of the area under the blood concentration-time curve calculated to the last measured concentration (AUC0-t) of carboxyhemoglobin based on total COHb (expressed as % COHb/Hb) when carbon monoxide was given either at 12-48 hours after transplant surgery (post-operatively, referred to therein as “OP:pst”) or during surgery (intra-operatively, referred to therein as “OP:int”). Post-operative doses include placebo (i.e., O2 30% in nitrogen), 0.7 mg/kg or 2 mg/kg carbon monoxide via inhalation for a time period of 1 hour. Intra-operative doses include placebo (i.e., O2 30% in nitrogen), 2 mg/kg or 3 mg/kg carbon monoxide via inhalation for a time period of 1 hour. -
FIG. 2 illustrates the relationship between calculated glomerular filtration rate (GFR) onDay 1 andDay 2 and carboxyhemoglobin concentration expressed as % COHb/Hb for all subjects. Left panel (intra-operatively treated subjects) demonstrates that increased COHb is related to improved renal function (GFR). Right panel (post-operatively treated subjects) demonstrates that increased COHb is not related to the improvement of GFR, suggesting that carbon monoxide with the post-operative regimen has no beneficial effect on the renal function of renal transplant recipients. -
FIG. 3 illustrates the relationship between the serum creatinine level measured onDay 2 and carboxyhemoglobin concentration expressed as % COHb/Hb. Left panel (intra-operatively treated subjects) demonstrates that increased COHb is related to improved renal function (decreased serum creatinine). Right panel (post-operatively treated subjects) demonstrates that increased COHb did not improve the renal function (increased serum creatinine), suggesting that carbon monoxide with the post-operative regimen has no beneficial effect on the renal functions of renal transplant recipients. -
FIG. 4 illustrates the relationship between the COHb level (expressed as % COHb/Hb) and QTc change from baseline at 8 hours following carbon monoxide inhalation (both intra-operatively and post-operatively treated). Specifically, subjects were administered either (i) 12-48 hours post-operatively following renal transplant a dose of 0.7 mg/kg or 2 mg/kg carbon monoxide via inhalation for a time period of 1 hour or (ii) intra-operatively duringrenal transplant surgery 2 mg/kg or 3 mg/kg carbon monoxide via inhalation for a time period of 1 hour. The negative correlation demonstrates that carbon monoxide does not have an effect on QT prolongation at a dose level up to 3 mg/kg. -
FIG. 5 ,FIG. 6 andFIG. 7 illustrate the impact of carbon monoxide treatment on neurocognitive functions over 6 months in subjects receiving kidney transplants following inhalation of placebo, 0.7 mg/kg, 2 mg/kg or 3 mg/kg carbon monoxide through the evaluation of individual digit vigilance speed (FIG. 5 ), numeric working memory accuracy (FIG. 6 ) and picture recognition (FIG. 7 ). The CO doses were administered either 12-48 hours post-operatively following renal transplant (placebo, 0.7 mg/kg or 2 mg/kg) or intra-operatively during renal transplant surgery (placebo, 2 mg/kg or 3 mg/kg). Visit #1: Screening; Visit #4:Day 0; Visit #6:Day 1; Visit #14-16: Day 28; Visit #17-18: Follow-up Weeks 16-24. The open symbols reflect individual observations, the thin lines reflect individual trends and thick lines reflect the average trend based on linear regression. The average trends demonstrate that carbon monoxide at a dose level up to 3 mg/kg does not have negative impact on neurocognitive functions. - As used herein the following terms shall have the definitions set forth below.
- As used herein, the term “treating” refers to the treatment of a disease or condition of interest in a patient (e.g., a mammal) having the disease or condition of interest, and includes, for example:
- (i) preventing the disease or condition from occurring in a mammal, in particular, when such mammal is predisposed to the condition but has not yet been diagnosed as having it;
- (ii) inhibiting the disease or condition (i.e., arresting its development);
- (iii) reducing the extent of disease or condition (i.e., causing regression of the disease or condition); or
- (iv) ameliorating the symptoms resulting from the disease or condition (i.e., relieving pain without addressing the underlying disease or condition). As used herein, the terms “disease” and “condition” may be used interchangeably or may be different in that the particular malady or condition may not have a known causative agent (so that etiology has not yet been worked out) and it is therefore not yet recognized as a disease but only as an undesirable condition or syndrome, wherein a more or less specific set of symptoms have been identified by clinicians.
- As used herein, the term “patient” refers to an animal, human or non-human, to whom treatment according to the methods of the present invention is provided. Veterinary applications are clearly anticipated by the present invention. The term “patient” includes but is not limited to birds, reptiles, amphibians, and mammals, e.g., humans, other primates, pigs, rodents such as mice and rats, rabbits, guinea pigs, hamsters, cows, horses, cats, dogs, sheep and goats.
- As used herein, the term “carbon monoxide” refers to molecular-carbon monoxide in its gaseous state, compressed into liquid form, or dissolved in aqueous solution.
- As used herein, the term “administering” refers to any mode of transferring, delivering, introducing or transporting carbon monoxide or other agent to a subject. Administration of carbon monoxide or other agent may be conducted concurrently or sequentially in time. Additionally, administration of carbon monoxide and other agent(s) may be via the same or different route(s). Administration of carbon monoxide and other agent(s) may be performed via one or more of the following routes of administration: intravenous, intra-arterial, subcutaneous, intramuscular, intracisternal, intraperitoneal, intradermal, nasal via inhalation, nasal via aerosol, buccal, topical, intralesional, intracranial, intraprostatic, intrapleural, intratracheal, intranasal, intravitreal, intravaginal, intrarectal, intratumoral, intraocular, subconjunctival, intravesicular, mucosal, intrapericardial, intraumbilical, oral, local, by injection, by infusion, by continuous infusion, by absorption, by adsorption, by immersion, by localized perfusion, via a catheter, or via a lavage.
- As used herein, the term “effective amount” refers to that amount of carbon monoxide which, when administered to a patient (e.g., a mammal) for a period of time is sufficient to cause an intended effect or physiological outcome. Effective amounts of carbon monoxide for use in the present invention include, for example, amounts that are effective for enhancing organ function following transplant thereof. The amount of carbon monoxide which constitutes an “effective amount” will vary depending on the condition and its severity, the manner of administration, and the patient (e.g., the age of the mammal to be treated), but can be determined routinely by one of ordinary skill in the art having regard to his own knowledge and to this disclosure. For example, in one embodiment, the term “effective amount” refers to the amount that can achieve a measurable result. In one embodiment, an “effective amount” is, for example, an amount that when administered to a human subject in need of medical treatment in a controlled
Phase 2 orPhase 3 clinical trial produces a statistically significant benefit on a predefined clinical endpoint. - As used herein, the term “enhancing” refers to an increase in organ function following transplant. For example, with respect to a kidney transplant, enhancing includes an improvement in renal function as indicated by improvement in serum creatinine level or in glomerular filtration rate.
- As used herein, the term “organ” refers to any anatomical part or member having a specific function in the animal. Further included within the meaning of this term are substantial portions of organs (e.g., cohesive tissues obtained from an organ). Such organs include but are not limited to kidney, liver, heart, skin, large or small intestine, pancreas, and lungs. Further included in this definition are bones and blood vessels (e.g., aortic transplants).
- As used herein, the term “transplant” in the context of an organ transplant refers to the implanting of an organ, tissue, mass of cells, or individual cells into a patient. The term “transplantation” is defined in the art as the transfer of living tissues or cells from a donor to a recipient, with the intention of maintaining the functional integrity of the transplanted tissue or cells in the recipient (see, e.g., The Merck Manual, Berkow, Fletcher, and Beers, Eds., Merck Research Laboratories, Rahway, N.J., 1992). Transplants are categorized by site and genetic relationship between donor and recipient. The term includes autotransplantation (i.e., removal and transfer of cells or tissue from one location on a patient to the same or another location on the same patient), allotransplantation (i.e., transplantation between members of the same species), and xenotransplantation (i.e., transplantation between members of different species).
- As used herein, the term “indications” includes ischemia-reperfusion injury including, but not limited to, organ transplant surgeries, vascular interventional procedures, and various cardiovascular diseases.
- A carbon monoxide composition may be a gaseous carbon monoxide composition. Compressed or pressurized gas useful in the methods of the invention can be obtained from any commercial source, and in any type of vessel appropriate for storing compressed gas. For example, compressed or pressurized gases can be obtained from any source that supplies compressed gases, such as oxygen, for medical use. The pressurized gas including carbon monoxide used in the methods of the present invention can be provided such that all gases of the desired final composition (e.g., CO and O2, and optionally N2, He, and/or CO2) are mixed together in the same vessel. If desired, the methods of the present invention can be performed using multiple vessels containing individual gases. For example, a single vessel can be provided that contains carbon monoxide, with or without other gases, the contents of which can be optionally mixed with room air or with the contents of other vessels (e.g., vessels containing oxygen, nitrogen, carbon dioxide, compressed air, or any other suitable gas or mixtures thereof. Gaseous compositions administered to a patient according to the present invention typically contain 0% to about 79% by weight nitrogen, about 21% to about 100% by weight oxygen and about 0.0000001% to about 0.3% by weight (corresponding to about 0.001 ppm (i.e., 1 ppb) to about 3,000 ppm) carbon monoxide. Preferably, the amount of nitrogen in the gaseous composition is about 79% by weight, the amount of oxygen is about 21% by weight and the amount of carbon monoxide is about 0.0001% to about 0.25% by weight. The amount of carbon monoxide is preferably at least about 0.001%, e.g., at least about 0.005%, 0.01%, 0.02%, 0.025%, 0.03%, 0.04%, 0.05%, 0.06%, 0.08%, 0.10%, 0.15%, 0.20%, 0.22%, or 0.24% by weight. Preferred ranges of carbon monoxide include about 0.001% to about 0.24%, about 0.005% to about 0.22%, about 0.010% to about 0.20%, and about 0.015% to about 0.1% by weight.
- A gaseous carbon monoxide composition may be used to create an atmosphere that comprises carbon monoxide gas. An atmosphere that includes appropriate levels of carbon monoxide gas can be created, for example, by providing a vessel containing a pressurized gas comprising carbon monoxide gas, and releasing the pressurized gas from the vessel into a chamber or space to form an atmosphere that includes the carbon monoxide gas inside the chamber or space. Alternatively, the gases can be released into an apparatus that culminates in a breathing mask or breathing tube, thereby creating an atmosphere comprising carbon monoxide gas in the breathing mask or breathing tube and ensuring the patient is the only person in the room exposed to significant levels of carbon monoxide.
- Carbon monoxide levels in an atmosphere or a ventilation circuit can be measured or monitored using any method known in the art. Such methods include electrochemical detection, gas chromatography, radioisotope counting, infrared absorption, colorimetry, and electrochemical methods based on selective membranes (see, e.g., Sunderman et al., Clin Chem, 28:2026-2032 (1982); Ingi et al., Neuron, 16:835-842 (1996)). Sub-parts per million carbon monoxide levels can be detected e.g., by gas chromatography and radioisotope counting. Further, it is known in the art that carbon monoxide levels in the sub-ppm range can be measured in biological tissue by a midinfrared gas sensor (see, e.g., Morimoto et al., Am J Physiol Heart Circ Physiol, 280:H482-H488 (2001)). Carbon monoxide sensors and gas detection devices are widely available from many commercial sources.
- A carbon monoxide composition may also be a liquid carbon monoxide composition. A liquid can be made into a carbon monoxide composition by any method known in the art for causing gases to become dissolved in liquids. For example, the liquid can be placed in a so-called “CO2 incubator” and exposed to a continuous flow of carbon monoxide until a desired concentration of carbon monoxide is reached in the liquid. As another example, carbon monoxide gas can be “bubbled” directly into the liquid until the desired concentration of carbon monoxide in the liquid is reached. The amount of carbon monoxide that can be dissolved in a given aqueous solution increases with decreasing temperature. As still another example, an appropriate liquid may be passed through tubing that allows gas diffusion, where the tubing runs through an atmosphere comprising carbon monoxide (e.g., utilizing a device such as an extracorporeal membrane oxygenator). The carbon monoxide diffuses into the liquid to create a liquid carbon monoxide composition.
- The liquid can be any liquid known to those of skill in the art to be suitable for administration to patients (see, for example, Oxford Textbook of Surgery, Morris and Malt, Eds., Oxford University Press, 1994). In general, the liquid will be an aqueous solution. Examples of solutions include Phosphate Buffered Saline (PBS), Celsior™ solution, Perfadex™ solution, Collins solution, citrate solution, and University of Wisconsin (UW) solution (Oxford Textbook of Surgery, Morris and Malt, Eds., Oxford University Press, 1994). The liquid compositions can include carbon monoxide at concentrations in the range of about 0.0001 to about 0.0044 g CO/100 g liquid, e.g., at least 0.0002, 0.0004, 0.0006, 0.0008, 0.0010, 0.0013, 0.0014, 0.0015, 0.0016, 0.0018, 0.0020, 0.0021, 0.0022, 0.0024, 0.0026, 0.0028, 0.0030, 0.0032, 0.0035, 0.0037, 0.0040, or 0.0042 g CO/100 g aqueous solution. Preferred ranges include, e.g., about 0.0010 to about 0.0030 g CO/100 g liquid, about 0.0015 to about 0.0026 g CO/100 g liquid, or about 0.0018 to about 0.0024 g CO/100 g liquid. For water at 0° C., the saturation point is about 0.0044 g CO/100 g medium.
- Any suitable liquid can be saturated to a set concentration of carbon monoxide via gas diffusers. Alternatively, pre-made solutions that have been quality controlled to contain set levels of carbon monoxide can be used. Accurate control of dose can be achieved via measurements with a gas permeable, liquid impermeable membrane connected to a carbon monoxide analyzer. Solutions can be saturated to desired effective concentrations and maintained at these levels. In both liquid and gaseous compositions, the inclusion of the inert gas helium can improve carbon monoxide delivery to the tissues of an organ.
- Treatment of Patients with Carbon Monoxide
- A patient can be treated with a carbon monoxide composition by any method known in the art of administering gases and/or liquids to patients. The present invention contemplates the administration of carbon monoxide in gaseous and/or liquid form to patients. Exemplary routes of administration include, but are not limited to systemic (e.g., by inhalation and/or ingestion) and topical to the patient's organs or tissues in situ (e.g., by ingestion, insufflation, and/or introduction into the abdominal cavity).
- Carbon monoxide is administered to the patient intra-operatively in an effective amount and at the time of reperfusion that results in a carboxyhemoglobin concentration of at least 7%. In one embodiment, the carboxyhemoglobin concentration is between about 7% and about 15%. In one embodiment, the patient is administered carbon monoxide at a dose ranging between about 2 mg/kg to about 3 mg/kg for a sufficient time period that results in an effective carboxyhemoglobin concentration. In certain embodiments, the patient is administered carbon monoxide at a dose of 3 mg/kg for a sufficient time period that results in an effective carboxyhemoglobin concentration.
- In certain embodiments of the methods provided herein for enhancing organ function following transplant thereof, carbon monoxide is administered to the patient at the time around reperfusion.
- Gaseous carbon monoxide compositions can be delivered systemically to a patient undergoing a transplant. Typically, such gaseous carbon monoxide compositions are administered by inhalation through the mouth or nasal passages to the lungs, where the carbon monoxide is readily absorbed into the patient's bloodstream. The concentration of active compound (CO) utilized in the therapeutic gaseous composition will depend on absorption, distribution, inactivation, and excretion (generally, through respiration) rates of the carbon monoxide as well as other factors known to those of skill in the art. It is to be further understood that for any particular subject, specific dosage regimens may be adjusted over time according to the individual need and the professional judgment of the person administering or supervising the administration of the compositions. Acute, sub-acute and chronic administration of carbon monoxide is contemplated by the present invention, depending upon, e.g., the severity or persistence of the disease or condition of the patient. Carbon monoxide can be delivered to the patient for a time sufficient to treat the disease or condition and exert the intended pharmacological or biological effect.
- The following are examples of some methods and devices that can be utilized to administer gaseous carbon monoxide compositions to patients.
- Ventilators: Carbon monoxide (concentrations can vary) can be purchased mixed with air or another oxygen-containing gas in a standard tank of compressed gas (e.g., 21% O2, 79% N2). It is non-reactive, and the concentrations that are required for the methods of the present invention are well below the combustible range (10% in air). In a hospital setting, the gas presumably will be delivered to the bedside where it will be mixed with oxygen or house air in a blender to a desired concentration. The patient will inhale the gas mixture through a ventilator, which will be set to a flow rate based on patient comfort and needs. This is determined by pulmonary graphics (i.e., respiratory rate, tidal volumes, etc.). Fail-safe mechanism(s) to prevent the patient from unnecessarily receiving greater than desired amounts of carbon monoxide can be designed into the delivery system. The patient's carbon monoxide level can be monitored by studying (1) carboxyhemoglobin (COHb), which can be measured in venous blood, and (2) exhaled carbon monoxide collected from a side port of the ventilator. Carbon monoxide exposure can be adjusted based upon the patient's health status and on the basis of the markers. If necessary, carbon monoxide can be washed out of the patient by switching to 100% O2 inhalation. Carbon monoxide is not metabolized; thus, whatever is inhaled will ultimately be exhaled except for a very small percentage that is converted to CO2. Carbon monoxide can also be mixed with any level of O2 to provide therapeutic delivery of carbon monoxide without consequential hypoxic conditions.
- Face Mask and Tent: A carbon monoxide-containing gas mixture is prepared as above to allow inhalation by the patient using a facemask or tent. The concentration inhaled can be changed and can be washed out by simply switching over to 100% O2. Monitoring of carbon monoxide levels would occur at or near the mask or tent with fail-safe mechanism(s) that would prevent too high of a concentration of carbon monoxide from being inhaled.
- Portable Inhaler: Compressed carbon monoxide can be packaged into a portable inhaler device and inhaled in a metered dose, for example, to permit intermittent treatment of a recipient who is not in a hospital setting. Different concentrations of carbon monoxide could be packaged in the containers. The device could be as simple as a small tank (e.g., under 5 kg) of appropriately diluted CO with an on-off valve and a tube from which the patient takes a whiff of CO according to a standard regimen or as needed.
- Intravenous Artificial Lung: An artificial lung (a catheter device for gas exchange in the blood) designed for O2 delivery and CO2 removal can be used for carbon monoxide delivery. The catheter, when implanted, resides in one of the large veins and would be able to deliver carbon monoxide at given concentrations either for systemic delivery or delivery to a local site. The delivery can be a local delivery of a high concentration of carbon monoxide for a short period of time at a specific site (this high concentration would rapidly be diluted out in the bloodstream), or a relatively longer systemic exposure to a lower concentration of carbon monoxide (see, e.g., Hattler et al., Artif Organs, 18(11):806-812 (1994); and Golob et al., ASAIO J, 47(5):432-437 (2001)).
- Normobaric Chamber: In certain instances, it would be desirable to expose the whole patient to carbon monoxide. The patient would be inside an airtight chamber that would be flooded with carbon monoxide (at a level that does not endanger the patient, or at a level that poses an acceptable risk without the risk of bystanders being exposed). Upon completion of the exposure, the chamber could be flushed with air (e.g., 21% O2, 79% N2), and samples could be analyzed by carbon monoxide analyzers to ensure no carbon monoxide remains before allowing the patient to exit the exposure system.
- Aqueous Solutions: The present invention further contemplates that aqueous solutions comprising carbon monoxide can be created for systemic delivery to a patient (e.g., for oral delivery) and/or by injection into the body (e.g., intravenously, intra-arterially, intraperitoneally and/or subcutaneously).
- Also contemplated by the present invention is the induction or expression of hemeoxygenase-1 (HO-1) in conjunction with administration of carbon monoxide. HO-1 can be provided to a patient by inducing or expressing HO-1 in the patient, or by administering exogenous HO-1 directly to the patient. As used herein, the term “induce(d)” means to cause increased production of a protein, e.g., HO-1, in isolated cells or the cells of a tissue, organ or animal using the cells' own endogenous (e.g., non-recombinant) gene that encodes the protein. HO-1 can be induced in a patient, e.g., a donor and/or recipient, by any method known in the art. For example, production of HO-1 can be induced by hemin, by iron protoporphyrin, or by cobalt protoporphyrin. A variety of non-heme agents including heavy metals, cytokines, hormones, nitric oxide, COCl2, endotoxin and heat shock are also strong inducers of HO-1 expression (Otterbein et al., Am J Physiol Lung Cell Mol Physiol, 279:L1029-L1037 (2000); Choi et al., Am J Respir Cell Mol Biol, 15:9-19 (1996); Maines, Annu Rev Pharmacol Toxicol, 37:517-554 (1997); and Tenhunen et al., J Lab Clin Med, 75:410-421 (1970)). HO-1 is also highly induced by a variety of agents and conditions that create oxidative stress, including hydrogen peroxide, glutathione depletors, UV irradiation and hyperoxia (Choi et al., Am J Respir Cell Mol Biol, 15:9-19 (1996); Maines, Annu Rev Pharmacol Toxicol, 37:517-554 (1997); and Keyse et al., Proc Natl Acad Sci USA, 86:99-103 (1989)). A “pharmaceutical composition comprising an inducer of HO-1” means a pharmaceutical composition containing any agent capable of inducing HO-1 in a patient, e.g., any of the agents described above, e.g., hemin, iron protoporphyrin, and/or cobalt protoporphyrin.
- HO-1 expression in a cell can be increased via gene transfer. As used herein, the term “express(ed)” means to cause increased production of a protein, e.g., HO-1 or ferritin, in isolated cells or the cells of a tissue, organ or animal using an exogenously administered gene (e.g., a recombinant gene). The HO-1 or ferritin is preferably of the same species (e.g., human, mouse, rat, etc.) as the transplant recipient, in order to minimize any immune reaction. Expression could be driven by a constitutive promoter (e.g., cytomegalovirus promoters) or a tissue-specific promoter (e.g., milk whey promoter for mammary cells or albumin promoter for liver cells). An appropriate gene therapy vector (e.g., retrovirus, adenovirus, adeno associated virus (AAV), pox (e.g., vaccinia) virus, human immunodeficiency virus (HIV), the minute virus of mice, hepatitis B virus, influenza virus, Herpes Simplex Virus-1, and lentivirus) encoding HO-1 or ferritin would be administered to the patient orally, by inhalation, or by injection at a location appropriate for treatment of transplant rejection. Particularly preferred is local administration directly to the donors organ, tissue or cells to be transplanted, or to the site of the transplant in the recipient. Similarly, plasmid vectors encoding HO-1 or apo-ferritin can be administered, e.g., as naked DNA, in liposomes, or in microparticles.
- Further, exogenous HO-1 protein can be directly administered to a patient by any method known in the art. Exogenous HO-1 can be directly administered in addition to, or as an alternative, to the induction or expression of HO-1 in the patient as described above. The HO-1 protein can be delivered to a patient, for example, in liposomes, and/or as a fusion protein, e.g., as a TAT-fusion protein (see, e.g., Becker-Hapak et al., Int J Colorectal Dis, 16(4):247-256, (2001)).
- Alternatively or in addition, any of the products of metabolism by HO-1, e.g., bilirubin, biliverdin, iron, and/or ferritin, can be administered to a patient in conjunction with, or instead of, carbon monoxide in order to prevent or treat the disorder. Further, the present invention contemplates that iron-binding molecules other than ferritin, e.g., desferoxamine (DFO), iron dextran, and/or apoferritin, can be administered to the patient. Any of the above compounds can be administered to the patient topically and/or systemically.
- Though not meant to be bound by theory, it is believed that administration of carbon monoxide dosing regimens of the present invention result in triggering of signaling pathways that provide a therapeutic effect. In particular, it is believed that administration of carbon monoxide dosing regimens of the present invention reduce ischemia reperfusion injury associated with organ transplant. Importantly, administration of carbon monoxide intra-operatively during transplant surgery is thought to increase organ function and survival thereof by providing a protective effect against reactive oxygen species which are most generated at that time.
- The present invention is further described by means of the examples, presented below. The use of such examples is illustrative only and in no way limits the scope and meaning of the invention or of any exemplified term. Likewise, the invention is not limited to any particular preferred embodiments described herein. Indeed, many modifications and variations of the invention will be apparent to those skilled in the art upon reading this specification. The invention is therefore to be limited only by the terms of the appended claims along with the full scope of equivalents to which the claims are entitled.
- Study subjects receive either (i) 12-48 hours post-operatively following renal transplant, a single dose of placebo (i.e., O2 30% in nitrogen) or carbon monoxide (
Covox 12 mg/L) at 0.7 mg/kg or 2 mg/kg via inhalation for a time period of 1 hour, or (ii) intra-operatively during renal transplant surgery (at the time of re-anastomosis), a dose of placebo (i.e., O2 30% in nitrogen), 2 mg/kg or 3 mg/kg carbon monoxide via inhalation for a time period of 1 hour. - COHb exposure is measured using conventional methods. For example, COHb exposure can be ascertained by measuring the amount present in venous blood using a device known as a CO-OXI meter. For both post- and intra-operative dosing regimens, dose-dependency of COHb Cmax and AUC is evaluated, the results of which are shown graphically in
FIGS. 1A and 1B . Notably, % COHb/Hb increased with an increase in the dose of inhaled carbon monoxide in an approximately proportional manner. Based on these results as well as previous studies in healthy volunteers (data not shown), COHb pharmacokinetics are used as a surrogate marker for systemic carbon monoxide exposure. - In post-operatively treated subjects, Cmax values (Mean±SD) of COHb were 2.77±0.77% at 0.7 mg/kg (n=6) ranging from 1.8% to 3.9% and 6.7±0.71% at 2 mg/kg (n=6) ranging from 5.6 to 7.7%. The elimination t1/2 of COHb in CO treated subjects ranged from 2.2 to 9.9 hours. The COHb levels in placebo subjects ranged from 0.8 to 2.2%.
- Key pharmacokinetic parameters of intra-operatively treated subjects are summarized in Table 1 below.
-
TABLE 1 Based on Total COHb Based on Net COHb* Dose Cmax Tmax AUC0-t Cmax AUC0-t Vss/F CL/F T1/2 (mg/kg) Subject (%) (hr) (% * hr) (%) (% * hr) (mg/kg/%) (mg/kg/(% * h)) (hr) 0 A 1.3 6 NA NA NA NA NA NA B 0.6 48 NA NA NA NA NA NA C 0.8 0 NA NA NA NA NA NA D 1.2 8 NA NA NA NA NA NA Mean 0.975 15.5 NA NA NA NA NA NA Std Dev 0.33 21.9 NA NA NA NA NA NA 2.0 E 7.5 1.5 52.36 6 38.52 0.27 0.0519 3.59 (intra- F 7.4 1 45.15 6.8 22.38 0.27 0.0894 2.19 G 8.3 1 60.41 8.3 62.73 0.32 0.0319 8.04 H 7.2 1 48.25 7.2 49.71 0.24 0.0402 5.06 I 7.6 1 96.41 7.1 77.66 0.38 0.0258 12.12 J 7.7 1 66.43 7.2 44.28 0.22 0.0452 3.69 Mean 7.62 1.08 61.50 7.1 49.21 0.282 0.0474 5.78 Std Dev 0.38 0.2 18.82 0.74 19.24 0.057 0.0226 3.68 3.0 K 10.9 1.08 84.26 10.8 84.44 0.458 0.0355 6.93 (intra- L 14.8 0.75 59.33 13.1 30.65 0.12 0.0979 0.65 M 9.8 1 68.04 9.5 52.93 0.378 0.0567 6.66 N 11.4 1 121.64 9.9 65.19 0.331 0.046 5.97 O 12.6 1 126.38 11.5 78.47 0.482 0.0382 8.47 Mean 11.9 0.967 91.93 11.0 62.34 0.354 0.0549 5.74 Std Dev 1.9 0.126 30.67 1.4 21.50 0.144 0.0254 2.99 *COHb levels were subtracted from pre-dose level. - The COHb levels (mean±SD) were 7.62±0.38% (7.2-8.3%) at 2 mg/kg (n=6) and 11.9±1.9% (9.8-14.8%) at 3 mg/kg (n=5). In placebo subjects, COHb levels during surgery (intra-operative) ranged from 0.6 to 1.3%, similar to those with spontaneous breathing (post-operative). In the intra-operative subjects, the net gain of COHb from CO inhalation (subtracted from the pre-dose levels) peaked around 1 hour with Cmax of 7.1±0.74% (2 mg/kg) and 11.0±1.4% (3 mg/kg). The elimination t1/2 estimated from the net COHb levels averaged about 6 hours for both dose levels.
- Organ function is assessed in subjects using pharmacodynamic markers representing renal functions. In particular, serum creatinine (SCr) levels are measured (using conventional methods) and glomerular filtration rate (GFR) is calculated via MDRD (GFR (mL/min/1.73 m2)=175×(Scr)−1.154×(Age)−0.203×(0.742 if female)×(1.212 if African American); as described by Levey et al., “Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate,” Ann Intern Med, 145(4):247-254 (2006)). Importantly, when carbon monoxide is given during surgery (intra-operatively), treatment with carbon monoxide improves renal function in a dose-dependent manner as indicated by a positive correlation between COHb and markers of renal function (GFR and Scr) illustrated in the left panels of
FIGS. 2 and 3 , respectively. When carbon monoxide is given 12-48 hours after the surgery, it does not improve renal function as illustrated in the right panels ofFIGS. 2 and 3 . These findings suggest that carbon monoxide must be present at the time of reperfusion to exert its cytoprotective effect and to prevent injuries caused by reperfusion. - All renal transplant recipients receiving carbon monoxide up to 3 mg/kg carbon monoxide (both intra-operatively and post-operatively dosed) are evaluated for safety. At all dose levels evaluated, CO is found to be well tolerated. Incidence of cardiovascular and neurological AEs is comparable between CO and placebo treated subjects. In particular, no ECG changes observed on heart rate, PR interval, QRS duration or QTcF duration. Likewise, no evidence observed on new morphological changes or new infarction potentials. Additionally, CO treatment does not show any negative impact on neurocognitive functions. The most sensitive organs to carbon monoxide poisoning are heart and brain. As presented herein, the relationship between carbon monoxide exposure (COHb) and cardiovascular function (i.e., QTc) at 8 hours post-treatment of subjects receiving inhaled carbon monoxide or placebo (
FIG. 4 ) is assessed via a pharmacokinetic-pharmacodynamic (PKPD) approach. Similarly, as presented herein, the relationship between subjects receiving one of various inhaled carbon monoxide doses or placebo and key neurocognitive functions (i.e., individual digit vigilance speed (FIG. 5 ), numeric working memory accuracy (FIG. 6 ) and picture recognition (FIG. 7 )) up to 24 weeks post-treatment is assessed via a pharmacokinetic-pharmacodynamic (PKPD) approach. - PKPD analysis revealed a negative correlation between CO exposure and QTc (
FIG. 4 ) and between CO exposure and neurocognitive functions (FIGS. 5 , 6 and 7) in renal transplant recipients receiving up to 3 mg/kg carbon monoxide via inhalation for a time period of 1 hour. The negative correlations demonstrate that carbon monoxide is unlikely to cause QT prolongation and affect neurocognitive functions when given via inhalation for a time period of 1 hour at a dose of up to 3 mg/kg. - It will be appreciated by those skilled in the art that changes could be made to the embodiments described above without departing from the broad inventive concept thereof. It is understood, therefore, that this invention is not limited to the particular embodiments disclosed, but is intended to cover modifications that are within the spirit and scope of the invention, as defined by the appended claims.
- Each document (including granted patents, published patent applications, and nonpatent publications such as journal articles) referred to in this application is incorporated in its entirety by reference for all purposes.
Claims (17)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US14/299,772 US20140287066A1 (en) | 2010-05-14 | 2014-06-09 | Dosing regimens and methods of treatment using carbon monoxide |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US33475510P | 2010-05-14 | 2010-05-14 | |
US13/106,437 US8778413B2 (en) | 2010-05-14 | 2011-05-12 | Dosing regimens and methods of treatment using carbon monoxide |
US14/299,772 US20140287066A1 (en) | 2010-05-14 | 2014-06-09 | Dosing regimens and methods of treatment using carbon monoxide |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US13/106,437 Continuation US8778413B2 (en) | 2010-05-14 | 2011-05-12 | Dosing regimens and methods of treatment using carbon monoxide |
Publications (1)
Publication Number | Publication Date |
---|---|
US20140287066A1 true US20140287066A1 (en) | 2014-09-25 |
Family
ID=44911995
Family Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US13/106,437 Active 2031-10-27 US8778413B2 (en) | 2010-05-14 | 2011-05-12 | Dosing regimens and methods of treatment using carbon monoxide |
US14/299,772 Abandoned US20140287066A1 (en) | 2010-05-14 | 2014-06-09 | Dosing regimens and methods of treatment using carbon monoxide |
Family Applications Before (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US13/106,437 Active 2031-10-27 US8778413B2 (en) | 2010-05-14 | 2011-05-12 | Dosing regimens and methods of treatment using carbon monoxide |
Country Status (1)
Country | Link |
---|---|
US (2) | US8778413B2 (en) |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9789133B2 (en) | 2014-04-15 | 2017-10-17 | Proterris, Inc. | Systems and methods to improve organ or tissue function and organ or tissue transplant longevity |
Families Citing this family (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2015073912A1 (en) * | 2013-11-14 | 2015-05-21 | Wager Jeffrey | Treatment or prevention of pulmonary conditions with carbon monoxide |
Citations (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20030068387A1 (en) * | 2001-03-30 | 2003-04-10 | Roland Buelow | Carbon monoxide generating compounds for treatment of vascular, inflammatory and immune disorders |
US20060093681A1 (en) * | 2002-07-04 | 2006-05-04 | Christian Krebs | Method and apparatus for the administration of co |
US8128963B2 (en) * | 1996-09-27 | 2012-03-06 | The Trustees Of Columbia University In The City Of New York | Methods for treating ischemic disorders using carbon monoxide |
Family Cites Families (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP1480658B1 (en) * | 2002-02-13 | 2017-01-25 | Beth Israel Deaconess Medical Center, Inc. | Methods of treating vascular disease |
US7727562B2 (en) * | 2007-06-21 | 2010-06-01 | Blackman Steven T | Liquid compositions containing solubilized benzoyl peroxide |
-
2011
- 2011-05-12 US US13/106,437 patent/US8778413B2/en active Active
-
2014
- 2014-06-09 US US14/299,772 patent/US20140287066A1/en not_active Abandoned
Patent Citations (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8128963B2 (en) * | 1996-09-27 | 2012-03-06 | The Trustees Of Columbia University In The City Of New York | Methods for treating ischemic disorders using carbon monoxide |
US20030068387A1 (en) * | 2001-03-30 | 2003-04-10 | Roland Buelow | Carbon monoxide generating compounds for treatment of vascular, inflammatory and immune disorders |
US20060093681A1 (en) * | 2002-07-04 | 2006-05-04 | Christian Krebs | Method and apparatus for the administration of co |
Non-Patent Citations (1)
Title |
---|
Guo et al., "Administration of a CO-releasing molecule at the time of reperfusion reduces infarct size in vivo," 2004, Am. J. Physiol. Heart Circ. Physiol., Vol. 286, pp. H1649-H1653. * |
Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9789133B2 (en) | 2014-04-15 | 2017-10-17 | Proterris, Inc. | Systems and methods to improve organ or tissue function and organ or tissue transplant longevity |
US10342821B2 (en) | 2014-04-15 | 2019-07-09 | Proterris, Inc. | Systems and methods to improve organ or tissue function and organ or tissue transplant longevity |
US11389471B2 (en) | 2014-04-15 | 2022-07-19 | Proterris Inc. | Systems and methods to improve organ or tissue function and organ or tissue transplant longevity |
Also Published As
Publication number | Publication date |
---|---|
US8778413B2 (en) | 2014-07-15 |
US20110280966A1 (en) | 2011-11-17 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US20040228930A1 (en) | Treatment for hemorrhagic shock | |
US7981448B2 (en) | Methods of treating necrotizing enterocolitis | |
EP1404811B1 (en) | Carbon monoxide improves outcomes in tissue and organ transplants and suppresses apoptosis | |
JP4549847B2 (en) | How to treat hepatitis | |
AU2002308676B2 (en) | Carbon monoxide as a biomarker and therapeutic agent | |
AU2003248621A1 (en) | Methods of treating angiogenesis, tumor growth, and metastasis | |
AU2002318377A1 (en) | Carbon monoxide improves outcomes in tissue and organ transplants and suppresses apoptosis | |
US8778413B2 (en) | Dosing regimens and methods of treatment using carbon monoxide | |
US20140314879A1 (en) | Treatment of compartment syndrome | |
EP2741821A1 (en) | Methods of treating dna damage |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AS | Assignment |
Owner name: INO THERAPEUTICS LLC, NEW JERSEY Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:IKARIA;REEL/FRAME:033848/0093 Effective date: 20130626 |
|
AS | Assignment |
Owner name: DEUTSCHE BANK AG NEW YORK BRANCH, NEW YORK Free format text: SECURITY INTEREST;ASSIGNOR:INO THERAPEUTICS LLC;REEL/FRAME:035454/0768 Effective date: 20150416 |
|
AS | Assignment |
Owner name: MALLINCKRODT CRITICAL CARE FINANCE INC., MISSOURI Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:THERAKOS, INC.;REEL/FRAME:038008/0824 Effective date: 20160304 Owner name: MALLINCKRODT IP, IRELAND Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:MALLINCKRODT PHARMA IP TRADING DAC;REEL/FRAME:038009/0058 Effective date: 20160301 Owner name: THERAKOS, INC., PENNSYLVANIA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:INO THERAPEUTICS LLC;REEL/FRAME:038008/0956 Effective date: 20160304 Owner name: MALLINCKRODT HOSPITAL PRODUCTS IP LIMITED, IRELAND Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:MALLINCKRODT IP;REEL/FRAME:038009/0016 Effective date: 20160301 Owner name: MALLINCKRODT PHARMA IP TRADING DAC, IRELAND Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:MALLINCKRODT CRITICAL CARE FINANCE INC.;REEL/FRAME:038038/0009 Effective date: 20160304 |
|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |
|
AS | Assignment |
Owner name: INO THERAPEUTICS LLC, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: IKARIA THERAPEUTICS LLC, NEW JERSEY Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: THERAKOS, INC., MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: ST SHARED SERVICES LLC, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: INFACARE PHARMACEUTICAL CORPORATION, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT PHARMA IP TRADING UNLIMITED COMPANY (F/K/A MALLINCKRODT PHARMA IP TRADING D.A.C.), IRELAND Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT PHARMACEUTICALS IRELAND LIMITED, IRELAND Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: VTESSE LLC (F/K/A VTESSE INC.), MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: SUCAMPO PHARMA AMERICAS LLC, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: STRATATECH CORPORATION, WISCONSIN Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: SPECGX LLC, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: OCERA THERAPEUTICS LLC (F/K/A OCERA THERAPEUTICS, INC.), MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT ARD IP UNLIMITED COMPANY (F/K/A MALLINCKRODT ARD IP LIMITED), IRELAND Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT HOSPITAL PRODUCTS IP UNLIMITED COMPANY (F/K/A MALLINCKRODT HOSPITAL PRODUCTS IP LIMITED), IRELAND Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MEH, INC., MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: IMC EXPLORATION COMPANY, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT US HOLDINGS LLC, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT VETERINARY, INC., MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT BRAND PHARMACEUTICALS LLC (F/K/A MALLINCKRODT BRAND PHARMACEUTICALS, INC.), MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: LIEBEL-FLARSHEIM COMPANY LLC, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: LAFAYETTE PHARMACEUTICALS LLC, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT LLC, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT ENTERPRISES LLC, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT ENTERPRISES HOLDINGS LLC (F/K/A MALLINCKRODT ENTERPRISES HOLDINGS, INC.), MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: CNS THERAPEUTICS, INC., MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: LUDLOW LLC (F/K/A LUDLOW CORPORATION), MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MNK 2011 LLC (F/K/A MALLINCKRODT INC.), MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT US POOL LLC, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT CARRIBEAN, INC., MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT US HOLDINGS LLC (F/K/A MALLINCKRODT US HOLDINGS INC.), MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT FINANCE GMBH, SWITZERLAND Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT CB LLC, MISSOURI Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 Owner name: MALLINCKRODT INTERNATIONAL FINANCE S.A., LUXEMBOURG Free format text: RELEASE OF PATENT SECURITY INTERESTS RECORDED AT REEL 035454, FRAME 0768;ASSIGNOR:DEUTSCHE BANK AG NEW YORK BRANCH, AS COLLATERAL AGENT;REEL/FRAME:065610/0035 Effective date: 20231114 |