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Title: Adenovirus formulations
United States Patent: 7,456,009
Issued: November 25, 2008
Inventors: Evans; Robert K.
(Souderton, PA), Volkin; David B. (Doylestown, PA), Isopi; Lynne A.
(Sellersville, PA)
Assignee:
Merck & Co., Inc. (Rahway, NJ)
Appl. No.: 11/071,095
Filed: March 3, 2005
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George Washington University's Healthcare MBA
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Abstract
The invention relates to viral
formulations and related pharmaceutical products for use in gene therapy
and/or vaccine applications. Especially preferred viral formulations
disclosed herein are liquid adenovirus formulations, which show improved
stability when stored in about the 2-8.degree. C. range while also being
compatible with parenteral administration. These formulations comprise a
buffer, a sugar, a salt, a divalent cation, a non-ionic detergent, as well
as a free radical scavenger and/or a chelating agent to inhibit free
radical oxidation.
Description of the
Invention
SUMMARY OF THE INVENTION
The present invention relates to stabilized virus formulations and related
pharmaceutical products for use in gene therapy and/or vaccine applications.
A preferred viral formulation, as disclosed herein, may related to liquid
formulations which comprise a recombinant adenovirus, formulations which
show improved viral stability when stored in about the 2-8.degree. C. range
and higher while also being compatible with parenteral administration. These
formulations may comprise a buffer, a sugar, a salt, a divalent cation, a
non-ionic detergent, as well as additional components which enhance
stability of the included virus, including but not limited to a free radical
scavenger and/or a chelating agent. The adenoviral-based formulations of the
present invention are amenable to prolonged storage at 2.degree. C. to
8.degree. C. and higher for periods approaching two years. The recombinant
viruses of the present invention which show enhanced storage stability
include but are not limited to adenovirus, adeno-associated virus,
retroviruses, herpes virus, vaccinia virus, rotovirus, pox viruses. The
preferred virus is an adenovirus, including but not limited to human Ad5,
Ad2, Ad6, Ad24 serotypes, and especially recombinant adenoviral virus for
use in human gene therapy or human gene-based vaccination technology,
including a prophylactic or therapeutic application utilizing such a
gene-based vaccination technology.
The formulations of the present invention are (i) optimally a buffered
solution and further comprise (ii) a minimal amount of at least one
non-ionic surfactant; (iii) a divalent cation; (iv) a cryoprotectant; (v) a
salt, and (vi), preferably inclusion of one or more additional excipients
that act as inhibitors of free radical oxidation. The formulations of the
present invention rely on a useful range of total osmolarity which promotes
long term stability at temperatures of 2-8.degree. C., or higher, while also
making the formulation useful for parenteral, and especially intramuscular,
injection.
To this end, a first embodiment of the present invention relates to a series
of adenovirus formulations (including but not limited to a recombinant
adenovirus) which comprise Tris as the buffer, sucrose as the cryoprotectant,
NaCl as the salt, MgCl.sub.2 as the divalent cation and either
Polysorbate-80 or Polysorbate-40 as the surfactant.
A second embodiment of the present invention relates to inclusion of one or
more inhibitors of free radical oxidation, including both metal ion
chelators and hydroxyl radical scavengers, which are shown herein to enhance
short and long term stability of the virus formulations described herein
(again, including but not limited to an adenovirus, including a recombinant
adenovirus containing a transgene, or portion thereof, which is useful in
gene therapy and/or gene vaccination technology). Therefore, a preferred
embodiment of the present invention is a viral formulation which contains
one or more components which act as an inhibitor of free radical oxidation.
It is shown herein that addition of these components enhance long term
stability at temperatures up through the 2-8.degree. C. range, or higher,
when compared to core formulations which do not contains these inhibitors.
These formulations are also compatible with parenteral administration. To
this end, the present invention relates to a virus formulation which
contains at least one inhibitor of free radical oxidation which effectively
enhances stability of the virus-containing formulation. While the
exemplified adenovirus-based formulations such as A113 represent a preferred
formulation, these formulations in no way suggest a limitation to additional
formulations and methods of use based on alternative formulations
components.
A third core embodiment of the present invention comprises inclusion, alone
or in combination with free radical oxidation inhibitors, an effective
amount of plasmid DNA, which is shown to effectively increase the long term
stability of a virus formulation and conditions as described throughout this
specification. Therefore, the present invention also relates to a virus
formulation which contains an amount of a nucleic acid such that addition of
the nucleic acid effectively enhances stability of the virus-containing
formulation.
Another embodiment of the present invention are formulations which comprise
components disclosed herein which result in liquid formulations which
provide enhanced stability of adenoviruses representing multiple subgroups
(e.g., such as B, C and/or D; alone or in combination, depending on the
particular formulation); such formulations will be compatible with
parenteral administration and provide for enhanced stability in liquid form
for sustained periods of time during storage at 2-8.degree. C. and, thus,
amenable to commercial application. These formulations include, but are not
limited to formulations comprising relevant excipients in ranges as
disclosed herein while being buffered to a lower pH (i.e., from about pH 6.0
to about pH 7.5), preferably by histidine, and being low in salt or even
salt free, with the balance of osmolarity being contributed by one or more
cryoprotectants, such as sucrose. To this end, the present invention also
relates to methods of providing for liquid formulations for alternative
(i.e., non-subgroup C adenovirus) and/or multiple adenovirus serotypes,
whereby such formulations provide for increased virus stability over
prolonged storage times. Such method include, but are not limited to,
utilizing formulations disclosed in Example sections 15-18 (see Original Patent),
as well as excipient combinations and/or excipient concentration ranges
thereof.
The enhanced long-term stability up through the 2-8.degree. C. range results
in an extended shelf life of the virus formulations disclosed herein,
allowing for storage and eventual host administration of these liquid
formulations over about a 1-2 year period with acceptable losses in virus
infectivity. In addition, formulations of the present invention show
stability through extended freeze/thaw cycles.
DETAILED DESCRIPTION OF THE INVENTION
The present invention relates to formulations which stabilize a respective
virus component and to related pharmaceutical products, preferably for use
in gene therapy and/or vaccine applications. A preferred stabilized virus
containing formulation disclosed herein is liquid adenovirus formulation,
which shows improved stability when stored in about the 2-8.degree. C. range
and higher while also being compatible with parenteral administration. These
preferred formulations which are able to stabilize a respective virus (such
as a recombinant adenovirus) may comprise a buffer, a sugar, a salt, a
divalent cation, a non-ionic detergent, as well as additional components
which enhance stability to the added virus, including but not limited to a
free radical scavenger and/or a chelating agent (i.e., an inhibitor of free
radical oxidation). In addition to excellent viral stability for prolonged
periods of time at -70.degree. C. and -20.degree. C., the formulations which
comprise various concentrations of adenovirus are amenable to prolonged
storage at 2.degree. C. to 8.degree. C. and higher for periods up to at
least one to two years. The virus formulations which may show enhanced long
term storage stability include but are not necessarily limited to
adenovirus, adeno-associated virus, retroviruses, herpes virus, vaccinia
virus, rotovirus, pox viruses. The preferred virus is a human adenovirus,
especially a serotype from a subgroup which shows negligible or no tumor
growth in animals, such as subgroup C (Ad1, Ad2, Ad5 and Ad6), subgroup D
(Ad8, Ad9, Ad10, Ad13, Ad15, Ad17, Ad19, Ad20, Ad22, Ad23, Ad24, Ad25, Ad26,
Ad27, Ad28, Ad29, Ad30, Ad32, Ad33, Ad36, Ad37, Ad38, Ad39, Ad42, Ad43,
Ad44, Ad45, Ad46, and Ad4), subgroup B (Ad3, Ad7, Ad11, Ad14, Ad16, Ad21,
Ad34, and Ad35) and subgroup E (Ad4). For an exhaustive adenovirus
classification scheme, see Fundamental Virology, 3.sup.rd Edition, Ch. 30 @
page 980, Ed. Fields, et al. 1996, Lippincott-Raven. Especially preferred
serotypes are selected C serotypes Ad5, Ad2, and Ad6, subgroup D serotype
Ad24, Ad26, Ad34 and Ad35. With the guidance provided by this specification,
the skilled artisan may adapt the formulations disclosed herein to
non-exemplified adenovirus serotypes as well as other viruses. To this end,
the present invention relates to the use of these formulations to stabilize
alternative purified virus, and to the compositions thereof.
The formulations of the present invention provide stability to adenovirus at
varying degrees of virus concentration and may be administered to a variety
of vertebrate organisms, preferably mammals and especially humans. The
stabilized viral formulations of the present invention are preferably
recombinant adenovirus-based compositions, wherein administer as a vaccine,
for example, may offer a prophylactic advantage to previously uninfected
individuals and/or provide a therapeutic effect by reducing viral load
levels within an infected individual, thus prolonging the asymptomatic phase
of a particular microbial infection, such as an HIV infection. A preferred
aspect of the invention is a recombinant adenovirus formulation (i.e., an
adenovirus containing a whole or a portion of a transgene which is expressed
within the target host subsequent to host administration, such as in any
mammalian/human gene therapy- or gene vaccination-based methodology
available to the skilled artisan) which shows enhanced stability
characteristics described herein with a virus concentration in the range
from about 1.times.10.sup.7 vp/mL (virus particles/milliliter) to about
1.times.10.sup.13 vp/mL. A more preferred range is from about
1.times.10.sup.9 to 1.times.10.sup.12 vp/mL, with an especially preferred
virus concentration being from about 1.times.10.sup.11 to 1.times.10.sup.12
vp/mL. Therapeutic, prophylactic or diagnostic compositions of the
formulations of the present invention are administered to an individual in
amounts sufficient to treat, prevent or diagnose the respective disorder.
The effective amount for human administration may, of course, vary according
to a variety of factors such as the individual's condition, weight, sex and
age. Other factors include the mode of administration. The amount of
expressible DNA to be administered to a human recipient will depend on the
strength of the transcriptional and translational promoters used in the
recombinant viral construct, and, if used as a vaccine, on the
immunogenicity of the expressed gene product, as well as the level of
pre-existing immunity to a virus such as adenovirus. The formulations of the
present invention are optimally a buffered solution. It will be known to one
of skill in the art to provide virus formulations of the present invention
in a physiologically acceptable buffer, preferably but not necessarily
limited to a formulation buffered with Tris (tromethamine), histidine,
phosphate, citrate, succinate, acetate, glycine, and borate, within a pH
range including but not limited to about 7.0 to about 9.0, preferably a pH
range from about 7.5 to about 8.5. Tris is a preferred buffer in
formulations disclosed herein (e.g., see Example sections 1-14) for this pH
range; with histidine being a preferred buffering agent to provide for a
formulation pH in a range from about 6.0 to about 7.5 (e.g., see Example
sections 15-18).
An additional aspect of the formulations of the present invention relates to
a formulation which comprises a minimal amount of at least one non-ionic
surfactant added to reduce adsorption to container surfaces as well as
possibly providing increased virus stabilization. Non-ionic surfactants for
use in the formulations of the present invention include but are not limited
to polyoxyethylene sorbitan fatty acid esters, including but not limited to
Polysorbate-80 (Tween 80.RTM.), Polysorbate-60 (Tween 60.RTM.),
Polysorbate-40 (Tween 40.RTM.) and Polysorbate-20 (Tween 20.RTM.),
polyoxyethylene alkyl ethers, including but not limited to Brij 58.RTM.,
Brij 35.RTM., as well as others such as Triton X-100.RTM., Triton
X-114.RTM., NP40.RTM., Span 85 and the Pluronic series of non-ionic
surfactants (e.g., Pluronic 121).
An additional component which further stabilizes the added viral component
comprise the addition of at least one salt of a divalent cation, including
but not necessarily limited to MgCl.sub.2, CaCl.sub.2 and MnCl.sub.2. The
preferred divalent cations are MgCl.sub.2 and CaCl.sub.2 at a concentration
ranging from about 0.1 mM to about 5 mM.
Another component which contributes to virus stabilization over large
temperature ranges and for prolonged storage periods is a cryoprotectant,
especially at concentrations amenable to human administration.
Cyroprotectants include but are not necessarily limited to addition of
polyhydroxy hydrocarbons such as sorbitol (A443), mannitol (A442), glycerol
and dulcitol and/or disaccharides such as sucrose, lactose, maltose or
trehalose.
An additional component of the formulations of the present invention which
enhance viral stability comprise a salt, including but not necessarily
limited to sodium chloride, sodium sulfate, and ammonium sulfate, present at
an ionic strength which is physiologically acceptable to the host. A purpose
of inclusion of a salt in the formulation is to attain the desired ionic
strength or osmolarity. Contributions to ionic strength may come from ions
produced by the buffering compound as well as from the ions of non-buffering
salts.
A centerpiece of the formulations of the present invention which enhance
viral stability relate to inclusion of components that act as inhibitors of
free radical oxidation. As noted throughout the specification, virus
stability in a pharmaceutical formulation may be effected by the type of
buffer, salt concentration, pH, light exposure, temperature storage and the
such. It is also shown herein that components which may inhibit free radical
oxidation further enhance the stability characteristics of the core
adenoviral formulations disclosed herein. Free radical oxidation inhibitors
which may be utilized include but are not necessarily limited to ethanol (EtOH),
EDTA, an EDTA/ethanol combination, triethanolamine (TEOA), mannitol,
histidine, glycerol, sodium citrate, inositol hexaphosphate,
tripolyphosphate, succinic and malic acid, desferal,
ethylenediamine-Di(o-hydoxy-phenylacetic acid (EDDHA) and
diethylenetriaminepenta-acetic acid (DTPA), or specific combinations
thereof. It is preferred that the inhibitor of free radical oxidation be
either an EDTA/EtOH combination, EtOH alone, or triethanolamine (TEOA). It
is shown herein that the combination with other components may determine the
effectiveness of the free radical oxidation inhibitor. For example, the
combination of EDTA/EtOH is shown to be very effective at increasing
stability, while DTPA (alone) in the absence of MgCl.sub.2 also enhances
stability. Therefore, the skilled artisan may "mix and match" various
components, in some cases a scavenger and a chelator are required, while
other formulations only a chelator may be required. Preferably, the choice
of chelator will determine whether or not the addition of a scavenger is
needed. Additional free radical scavengers and chelators are known in the
art and apply to the formulations and methods of use described herein. It is
disclosed herein that addition of such inhibitors of free radical oxidation
results in a substantial increase in long term stability of liquid virus
formulations. It is noted that the present invention is not limited to use
of these excipients only in the preferred formulations described herein, but
are in fact meant to include additional, non-exemplified virus formulations
which will be amenable to increased stability within useful temperature
ranges by the addition of one or more of these compounds.
The formulations of the present invention which enhance viral stability rely
on a useful range of total osmolarity which both promotes long term
stability at temperature of 2-8.degree. C., or higher, while also making the
formulation useful for parenteral, and especially intramuscular, injection.
To this end the effective range of total osmolarity (the total number of
molecules in solution) is from about 200 mOs/L to about 800 mOs/L, with a
preferred range from about 250 mOs/L to about 450 mOs/L. An especially
preferred osmolarity for the formulations disclosed herein is about 300 mOs/L.
Therefore, it will be apparent that the amount of a cyroprotectant, such as
sucrose or sorbitol, will depend upon the amount of salt in the formulation
in order for the total osmolarity of the solution to remain within an
appropriate range. Therefore a salt free formulation may contain from about
5% to about 25% sucrose, with a preferred range of sucrose from about 7% to
about 15%, with an especially preferred sucrose concentration in a salt free
formulation being from 10% to 12%. Alternatively, a salt free sorbitol-based
formulation may contain sorbitol within a range from about 3% to about 12%,
with a preferred range from about 4% to 7%, and an especially preferred
range is from about 5% to about 6% sorbitol in a salt-free formulation.
Salt-free formulations will of course warrant increased ranges of the
respective cryoprotectant in order to maintain effective osmolarity levels.
To again utilize sucrose and sorbitol as examples, and not as a limitation,
an effective range of a sucrose-based solution in 75 mM NaCl is from about
2% about 7.5% sucrose, while a sorbitol-based solution in 75 mM NaCl is from
about 1% to about 4% sorbitol.
In view of the discussion above, the present invention relates to a
formulation containing an adenovirus, such as a recombinant adenovirus for
use in gene therapy and/or gene vaccination applications, with show
increased viral stability properties and which at least contain a buffer, a
salt, a sugar and a surfactant.
A particular embodiment of the present invention relates to such a
recombinant adenovirus formulation which comprises Tris as the buffer,
sucrose as the cryoprotectant, NaCl as the salt, MgCl.sub.2 as the divalent
cation and either Polysorbate-80 or Polysorbate-40 as the surfactant.
In a particular embodiment of the present invention the formulation is
buffered with Tris to a range from about pH 7.5 to about pH 8.5; sucrose is
added within a range upwards of a weight to volume percentage of 10,
depending upon the salt concentration; the salt being NaCl which is added at
concentration within a range of upwards of 250 mM NaCl, complementing the
sucrose concentration such that total osmolarity ranges from about 200 mOs/L
to about 800 mOs/L; the divalent cation is MgCl.sub.2 in a range from about
0.1 mM to about 10 mM, and the surfactant is either Polysorbate-80 at a
concentration from about 0.001% to about 1% or Polysorbate-40 at a
concentration from about 0.001% to about 1%.
In a further embodiment of the present invention the formulation is buffered
with about 1 mM to about 10 mM Tris to a range from about pH 7.5 to about pH
8.5; sucrose is present in a weight to volume range of about 2% to about 8%
and NaCl is present from a range of about 25 mM to about 250 mM, the sucrose
and NaCl concentrations being complementary such that the total osmolarity
ranges from about 200 mOs/L to about 800 mOs/L; the divalent cation is
MgCl.sub.2 in a range from about 0.1 mM to about 5 mM, and the surfactant is
either Polysorbate-80 at a concentration from about 0.001% to about 0.25% or
Polysorbate-40 at a concentration from about 0.001% to 0.25%.
In another embodiment of the present invention the formulation is buffered
with about 2.5 mM to about 7.5 mM Tris to a pH of about 8.0; sucrose is
present in a weight to volume range of about 2% to about 8% and NaCl is
present from a range of about 25 mM to about 250 mM, the sucrose and NaCl
contributing to a total osmolarity range from about 250 mOs/L to about 450
mOs/L; the divalent cation is MgCl.sub.2 in a range from about 0.5 mM to
about 2.5 mM, and the surfactant is either Polysorbate-80 at a concentration
from about 0.001% to about 0.1% or Polysorbate-40 at a concentration from
about 0.001% to 0.1%.
In a further embodiment of the present invention the formulation is buffered
with about 5.0 mM Tris to a pH of about 8.0; sucrose is present in a weight
to volume range of about 4% to about 6% and NaCl is present from a range of
about 50 mM to about 100 mM, the sucrose and NaC contributing to a total
osmolarity range from about 250 mOs/L to about 450 mOs/L; the divalent
cation is MgCl.sub.2 in a range from about 1 mM to about 2 mM, and the
surfactant is either Polysorbate-80 at a concentration from about 0.001% to
about 0.1% or Polysorbate-40 at a concentration from about 0.001% to 0.1%.
In a still further embodiment of the present invention the formulation is
buffered with about 5.0 mM Tris, at pH 8.0; sucrose is present in a weight
to volume of about 5%; NaCl is present at about 75 mM, with the total
osmolarity at about 300 mOs/L; MgCl.sub.2 in at about 1 mM to 2 mM, and
either Polysorbate-80 is present at a concentration of about 0.02% or
Polysorbate-40 at a concentration of about 0.005%.
An exemplified portion of the present invention the formulation is buffered
with about 5.0 mM Tris, at pH 8.0; sucrose is present in a weight to volume
of 5% (146 mM); NaCl is present at 75 mM, with the total osmolarity
approximately 310 mOs/L; MgCl.sub.2 at 1 mM, and Polysorbate-80 is present
at a concentration of 0.005%. This formulation is herein designated A105.
Another exemplification shows an effective PS-80 range to at least 0.1%, as
opposed to A105, where PS-80 is found at 0.005%. This formulation is
buffered with about 5.0 mM Tris, at pH 8.0; sucrose is present in a weight
to volume of 5% (146 MM); NaCl is present at 75 mM, MgCl.sub.2 is at 1 mM,
and Polysorbate-80 is present at a concentration of 0.1%. This formulation
is herein designated A111.
Another embodiment of the present invention is exemplified by a formulation
buffered with about 5.0 mM Tris, at pH 8.0; sucrose is present in a weight
to volume of 5% (146 mM); NaCl is present at 75 mM, MgCl.sub.2 at 1 mM, and
Polysorbate-40 is present at a concentration of 0.005%. This formulation is
herein designated A128, as shown in Example 1 (see Original Patent).
Yet another exemplification is a formulation identical to A128, except that
Polysorbate-40 is present at a concentration of 0.1%, showing an effective
range of Polysorbate-40. This formulation is herein designated A129, as
shown in Example 1.
The present invention further relates recombinant adenovirus formulations
which omit at least one component of the above-disclosed component,
including but not limited to formulation A108 (no divalent cation) or
formulation A109 (no surfactant).
An essential quality of the present invention is the finding that
non-reducing free radical scavengers and/or chelators are important for
maximizing both short and long term stability of viral formulations,
especially recombinant adenoviral formulations disclosed herein. To this
end, and as noted above, a critical preferred embodiment of the present
invention is a viral formulation which contains one or more components which
act as an inhibitor of free radical oxidation. It is shown herein that
addition of these components enhance long term stability at temperatures up
through the 2-8.degree. C. range, or higher, when compared to core
formulations which do not contains these inhibitors. In addition, these
formulations are compatible with parenteral administration. The increased
stability of these formulations shows that oxidation is a major pathway of
adenovirus inactivation which results in a loss of infectivity during
storage.
The present invention relates to a recombinant adenoviral formulation
buffered with Tris to a range from about pH 7.5 to about pH 8.5; sucrose is
added within a range upwards of a weight to volume percentage of 10,
depending upon the salt concentration; the salt being NaCl which is added at
concentration within a range of upwards of 250 mM NaCl, complementing the
sucrose concentration such that total osmolarity ranges from about 200 mOs/L
to about 800 mOs/L; the divalent cation is MgCl.sub.2 in a range from about
0.1 mM to about 10 mM, and the surfactant is either Polysorbate-80 at a
concentration from about 0.001% to about 2% or Polysorbate-40 at a
concentration from about 0.001% to about 1%, wherein the formulation further
comprises one or more components described herein which inhibit free radical
oxidation, including but not limited to ethanol (EtOH), EDTA, an EDTA/ethanol
combination, triethanolamine (TEOA), mannitol, histidine, glycerol, sodium
citrate, inositol hexaphosphate, tripolyphosphate, succinic and malic acid,
desferal, ethylenediamine-Di(o-hydoxy-phenylacetic acid (EDDHA) and
diethylenetriaminepenta-acetic acid (DTPA).
In a further embodiment of the present invention the formulation is buffered
with about 1 mM to about 10 mM Tris to a range from about pH 7.5 to about pH
8.5; sucrose is present in a weight to volume range of about 2% to about 8%
and NaCl is present from a range of about 25 mM to about 250 mM, the sucrose
and NaCl concentrations being complementary such that the total osmolarity
ranges from about 200 mOs/L to about 800 mOs/L; the divalent cation is
MgCl.sub.2 in a range from about 0.1 mM to about 5 mM, and the surfactant is
either Polysorbate-80 at a concentration from about 0.001% to about 0.25% or
Polysorbate-40 at a concentration from about 0.001% to 0.5%, wherein the
formulation further comprises one or more components described herein which
inhibit free radical oxidation, including but not limited to ethanol (EtOH),
EDTA, an EDTA/ethanol combination, triethanolamine (TEOA), mannitol,
histidine, glycerol, sodium citrate, inositol hexaphosphate,
tripolyphosphate, succinic and malic acid, desferal,
ethylenediamine-Di(o-hydoxy-phenylacetic acid (EDDHA) and
diethylenetriaminepenta-acetic acid (DTPA).
In a specific embodiment of the present invention the formulation is
buffered with about 2.5 mM to about 7.5 mM Tris to a pH of about 8.0;
sucrose is present in a weight to volume range of about 2% to about 8% and
NaCl is present from a range of about 25 mM to about 250 mM, the sucrose and
NaCl contributing to a total osmolarity range from about 250 mOs/L to about
450 mOs/L; the divalent cation is MgCl.sub.2 in a range from about 0.5 mM to
about 2.5 mM, and the surfactant is either Polysorbate-80 at a concentration
from about 0.001% to about 0.1% or Polysorbate-40 at a concentration from
about 0.001% to 0.05%, wherein the formulation further comprises one or more
components described herein which inhibit free radical oxidation, including
but not limited to ethanol (EtOH), EDTA, an EDTA/ethanol combination,
triethanolamine (TEOA), mannitol, histidine, glycerol, sodium citrate,
inositol hexaphosphate, tripolyphosphate, succinic and malic acid, desferal,
ethylenediamine-Di(o-hydoxy-phenylacetic acid (EDDHA) and
diethylenetriaminepenta-acetic acid (DTPA).
In another embodiment of the present invention the formulation is buffered
with about 5.0 mM Tris to a pH of about 8.0; sucrose is present in a weight
to volume range of about 4% to about 6% and NaCl is present from a range of
about 50 mM to about 100 mM, the sucrose and NaCl contributing to a total
osmolarity range from about 250 mOs/L to about 450 mOs/L; the divalent
cation is MgCl.sub.2 in a range from about 1 mM to about 2 mM, and the
surfactant is either Polysorbate-80 at a concentration from about 0.001% to
about 0.1% or Polysorbate-40 at a concentration from about 0.001% to 0.01%,
wherein the formulation further comprises one or more components described
herein which inhibit free radical oxidation, including but not limited to
ethanol (EtOH), EDTA, an EDTA/ethanol combination, triethanolamine (TEOA),
mannitol, histidine, glycerol, sodium citrate, inositol hexaphosphate,
tripolyphosphate, succinic and malic acid, desferal,
ethylenediamine-Di(o-hydoxy-phenylacetic acid (EDDHA) and
diethylenetriaminepenta-acetic acid (DTPA).
In a still further embodiment of the present invention the formulation is
buffered with about 5.0 mM Tris, at pH 8.0; sucrose is present in a weight
to volume of about 5%; NaCl is present at about 75 mM, with the total
osmolarity at about 300 mOs/L; MgCl.sub.2 in at about 1 mM, and either
Polysorbate-80 is present at a concentration of about 0.02% or
Polysorbate-40 at a concentration of about 0.005%, wherein the formulation
further comprises one or more components described herein which inhibit free
radical oxidation, including but not limited to ethanol (EtOH), EDTA, an
EDTA/ethanol combination, triethanolamine (TEOA), mannitol, histidine,
glycerol, sodium citrate, inositol hexaphosphate, tripolyphosphate, succinic
and malic acid, desferal, ethylenediamine-Di(o-hydoxy-phenylacetic acid (EDDHA)
and diethylenetriaminepenta-acetic acid (DTPA).
In the above-described formulations, at least one non-reducing free radical
scavenger may be added to concentrations which effectively enhance stability
of the core formulation. Especially useful ranges include (i) EDTA from
about 1 .mu.M to about 500 .mu.M; with some formulations containing EDTA at
concentrations up to 1000 .mu.M (A461 at 750 .mu.M), preferably in a range
from about 50 .mu.M to about 250 .mu.M, and an especially preferred
concentration of at or around 100 .mu.M; (ii) ethanol from about 0.1% to
about 5.0%, preferably in a range from about 0.25% to about 2.0%, and an
especially preferred amount totaling at or around 0.5%; (iii) DTPA from
about 1 .mu.M to about 500 .mu.M, preferably in a range from about 50 .mu.M
to about 250 .mu.M, and an especially preferred concentration at or around
100 .mu.M; (iv) CaCl.sub.2 from about 0.1 mM to about 10 mM, preferably in a
range from about 0.5 mM to about 5 mM, and an especially preferred
concentration at or around 1 mM; and, (v) sodium citrate from about 1 mM to
about 100 mM, preferably in a range from about 5 mM to about 25 mM, and an
especially preferred concentration at or around 10 mM. These inhibitors of
free radical oxidation may also be added in various combinations, including
but not limited to two scavengers (e.g., 113), a sole (e.g., A114), or
possible a sole scavenger in the absence of another component, such as a
divalent cation (e.g., A116).
In another embodiment of the formulation is buffered with about 5.0 mM Tris,
at pH 8.0; sucrose is present in a weight to volume of 5% (146 mM); NaCl is
present at 75 mM, with the total osmolarity approximately 400 mOs/L;
MgCl.sub.2 at 1 mM, and Polysorbate-80 is present at a concentration of
0.005%, EDTA is present at 100 .mu.M and ethanol at 0.5%. This formulation
is designated A113, as shown in Example 1.
In an additional embodiment the formulation is buffered with about 5.0 mM
Tris, at pH 8.0; sucrose is present in a weight to volume of 5% (146 mM);
NaCl is present at 75 mM, with the total osmolarity approximately 310 mOs/L;
MgCl.sub.2 at 1 mM, and Polysorbate-80 is present at a concentration of
0.005%, and triethanolamine (TEOA) is present at 1 mM. This formulation is
herein designated A114, as shown in Example 1.
In another embodiment the formulation is buffered with about 5.0 mM Tris, at
pH 8.0; sucrose is present in a weight to volume of 5% (146 mM); NaCl is
present at 75 mM, with the total osmolarity approximately 350 mOs/L;
MgCl.sub.2 at 1 mM, and Polysorbate-80 is present at a concentration of
0.005%, and sodium citrate at 10 mM. This formulation is herein designated
A115, also as shown in Example 1.
In still another embodiment the formulation is buffered with about 5.0 mM
Tris, at pH 8.0; sucrose is present in a weight to volume of 5% (146 mM);
NaCl is present at 75 mM, Polysorbate-80 is present at a concentration of
0.005%, and DTPA at 100 .mu.M. This formulation is herein designated A116,
also as shown in Example 1.
In another embodiment of the present invention the formulation is buffered
with about 5.0 mM Tris-HCl, at pH 8.0; sucrose is present in a weight to
volume range of 5% (146 mM); NaCl is present at 75 mM, MgCl.sub.2 at 1 mM,
and Polysorbate-80 is present at a concentration of 0.005%, and mannitol is
present at 3% (w/v). This formulation is herein designated A121.
In yet another embodiment the formulation is buffered with about 5.0 mM Tris,
at pH 8.0; sucrose is present in a weight to volume of 5% (146 mM); NaCl is
present at 75 mM, MgCl.sub.2 at 1 mM, Polysorbate-80 is present at a
concentration of 0.005%, and ethanol is present at a concentration of 0.5%
(A132) and 1.0% (A134). These two formulations are disclosed in Example 1.
Another embodiment shows a formulation buffered with about 5.0 mM Tris, at
pH 8.0; sucrose is present in a weight to volume of 5% (146 mM); NaCl is
present at 75 mM, with the total osmolarity approximately 310 mOs/L;
MgCl.sub.2 at 1 mM, Polysorbate-80 is present at a concentration of 0.005%,
and EDTA at 100 .mu.M. This formulation is herein designated A133, also as
shown in Example 1.
Another preferred embodiment shows a formulation buffered with about 5.0 mM
Tris, at pH 8.0; sucrose is present in a weight to volume of 5% (146 mM);
NaCl is present at 75 mM, with the total osmolarity approximately 500 mOs/L;
MgCl.sub.2 at 1 mM, Polysorbate-80 is present at a concentration of 0.005%,
EDTA at 100 .mu.M and ethanol 1.0%. This formulation is herein designated
A135, also as shown in Example 1.
In another embodiment of the present invention the formulation is buffered
with about 5.0 mM Tris, at pH 8.0; sucrose is present in a weight to volume
of 5% (146 mM); NaCl is present at 75 mM, with the total osmolarity
approximately 400 mOs/L; MgCl.sub.2 at 1 mM, Polysorbate-80 is present at a
concentration of 0.1%, EDTA at 100 .mu.M and ethanol 0.5%. This formulation
is herein designated A136, also shown in Example 1.
As noted above, it is also within the scope of the present invention to
substitute a preferred divalent cation such as MgCl.sub.2 with a difference
divalent cation, CaCl.sub.2. Such a substitution may relate to any of the
formulations disclosed herein. An example of such a substitution is
formulation A120, which comprises 5.0 mM Tris-HCl, at pH 8.0; sucrose is
present in a weight to volume of 5% (146 mM); NaCl is present at 75 mM,
Polysorbate-80 at 0.005%, EDTA at 100 .mu.M, ethanol at 0.5% and CaCl.sub.2
at 1 mM. Formulation A120 is shown in Example 1.
The present invention further relates recombinant adenovirus formulations
which omit at least one component of the above-disclosed components,
including but not limited to formulation A116 (excipient: DTPA at 100 .mu.M;
no divalent cation), formulation A117 (excipients: EDTA at 100 .mu.M and
EtOH at 0.5%; no divalent cation), formulation A459 and A461 (excipient:
EDTA at 250 .mu.M and 750 .mu.M, respectively, no divalent cation)
formulation A118 (triethanolamine at 1.0 mM; no divalent cation),
formulation A119 (excipient: sodium citrate at 10 mM; no divalent cation).
In addition to the above-disclosed excipients which act as inhibitor of free
radical oxidation, the present invention further relates to a recombinant
viral formulation which additionally comprises plasmid DNA at a
concentration from about 0.01 mg/ml to about 10 mg/ml. The addition of
plasmid DNA effectively increases the stability of a recombinant virus
formulation, such as the recombinant adenovirus exemplified herein.
Therefore, plasmid DNA may be added to any core formulations (e.g., A105 and
A128, which do not contain additional excipients such as free radical
oxidation inhibitors), as well as core formulations comprising such
excipients. A preferred concentration range for the plasmid DNA is from
about 0.5 mg/l to about 5.0 mg/ml, with an additionally preferred plasmid
DNA concentration at 1 mg/ml.
In another embodiment of the present invention the formulation is buffered
with about 5.0 mM Tris-HCl, at pH 8.0; sucrose is present in a weight to
volume range of 5% (146 mM); NaCl is present at 75 mM, MgCl.sub.2 at 1 mM,
and Polysorbate-80 is present at a concentration of 0.005%, and plasmid DNA
is present at 1 mg/ml. This formulation is herein designated A137.
In still another embodiment of the present invention the formulation is
buffered with about 5.0 mM Tris, at pH 8.0; sucrose is present in a weight
to volume of 5% (146 mM); NaCl is present at 75 mM, with the total
osmolarity approximately 400 mOs/L; MgCl.sub.2 at 1 mM, and Polysorbate-80
is present at a concentration of 0.005%, EDTA is present at 100 .mu.M,
ethanol is present at 0.5% and plasmid DNA is present at 1 mg/mL. This
formulation is designated A138, as shown in Example 1.
In another preferred embodiment of the present invention the formulation is
buffered with about 5.0 mM Tris, at pH 8.0; mannitol is present in a weight
to volume of 2.7% (147 mM); NaCl is present at 75 mM, with the total
osmolarity approximately 400 mOs/L; MgCl.sub.2 at 1 mM, and Polysorbate-80
is present at a concentration of 0.005%, EDTA is present at 100 .mu.M and
ethanol at 0.5%. This formulation is designated A149, as shown in Example 1.
Another embodiment shows a formulation buffered with about 5.0 mM Tris, at
pH 8.0; sucrose is present in a weight to volume of 5% (146 mM); NaCl is
present at 75 mM, with the total osmolarity approximately 400 mOs/L;
MgCl.sub.2 at 1 mM, and Polysorbate-80 is present at a concentration of
0.005%, EDTA is present at 100 .mu.M, ethanol is present at 0.5% and
histidine is present at 5 mM. This formulation is designated A151a, as shown
in Example 1.
Another embodiment of the present invention disclosed a formulation buffered
with about 5.0 mM Tris, at pH 7.5 at 30.degree. C.; while sucrose is present
in a weight to volume of 5% (146 mM); NaCl is present at 75 mM, with the
total osmolarity approximately 400 mOs/L; MgCl.sub.2 at 1 mM, and
Polysorbate-80 is present at a concentration of 0.005%, EDTA is present at
100 .mu.M, ethanol is present at 0.5% and histidine is present at 5 mM. This
formulation is designated A151b, as shown in Example 1.
In another embodiment of the present invention the formulation is buffered
with about 5.0 mM Tris, at pH 7.5 at 30.degree. C.; sucrose is present in a
weight to volume of 5% (146 mM); NaCl is present at 75 mM, with the total
osmolarity approximately 400 mOs/L; MgCl.sub.2 at 2 mM, and Polysorbate-80
is present at a concentration of 0.005%, EDTA is present at 100 .mu.M,
ethanol is present at 0.5%, histidine is present at 5 mM and triethanolamine
is present at 5 mM. This formulation is designated A152, as shown in Example
1.
In still another embodiment of the present invention the formulation is
buffered with about 5.0 mM Tris, at pH 7.5 at 30.degree. C.; sucrose is
present in a weight to volume of 5% (146 mM); NaCl is present at 75 mM, with
the total osmolarity approximately 400 mOs/L; MgCl.sub.2 at 2 mM, and
Polysorbate-80 is present at a concentration of 0.005%, EDTA is present at
100 .mu.M, ethanol is present at 0.5%, histidine is present at 5 mM,
triethanolamine is present at 5 mM and glycerol is present at 5% (v/v). This
formulation is designated A153, as shown in Example 1. As noted above, the
dosage regimen utilizing the compounds of the present invention is selected
in accordance with a variety of factors including type, level of
pre-existing immunity to adenovirus, species, age, weight, sex and medical
condition of the patient; the severity of the condition to be treated; the
route of administration; the renal, hepatic and cardiovascular function of
the patient; and the particular compound thereof employed. A physician or
veterinarian of ordinary skill can readily determine and prescribe the
effective amount of the drug required to prevent, counter or arrest the
progress of the condition. Optimal precision in achieving concentrations of
drug within the range that yields efficacy without toxicity requires a
regimen based on the kinetics of the drug's availability to target sites.
This involves a consideration of the distribution, equilibrium, and
elimination of a drug.
The formulated recombinant viruses described herein may also be formulated
with an adjuvant or adjuvants which may increase immunogenicity of the
expressed transgene. A number of these adjuvants are known in the art and
are available for use, including but not limited to saponin, monophosphoryl
lipid A, non-ionic block copolymers composed of polyoxyethylene and
polyoxypropylene or other compounds which increase immunogenicity of
expressed transgene. Another adjuvant for use with the recombinant viruses
described herein are one or more forms of an aluminum phosphate-based
adjuvant wherein the aluminum phosphate-based adjuvant possesses a molar
PO.sub.4/Al ratio of approximately 0.9. An additional mineral-based adjuvant
may be generated from one or more forms of a calcium phosphate. These
mineral-based compounds for use as DNA vaccines adjuvants are disclosed in
PCT International Application No. PCT/US98/02414 (WO 98/35562), which is
hereby incorporated by reference.
The recombinant virus formulations described herein are administered to the
vertebrate host (preferably a mammalian host and especially a human
recipient) by any means known in the art, such as enteral and parenteral
routes. These routes of delivery include but are not limited to intramusclar
injection, intraperitoneal injection, intravenous injection, inhalation or
intranasal delivery, oral delivery, sublingual administration, subcutaneous
administration, transdermal administration, transcutaneous administration,
percutaneous administration or any form of particle bombardment, such as a
biolostic device such as a "gene gun" or by any available needle-free
injection device. The preferred methods of delivery of the recombinant
viruses described herein are intramuscular injection and needle-free
injection. An especially preferred method is intramuscular delivery.
Another embodiment of the present invention relates to formulations
comprising components disclosed herein which provide for enhanced adenovirus
stability for multiple subgroups (e.g., such as B, C and/or D; alone or in
combination, depending on the particular formulation). These formulations
are compatible with parenteral administration, stable in liquid form for
sustained periods of time during storage at 2-8.degree. C. and, thus,
amenable to commercial application. Such formulations include, but are not
limited to formulations comprising excipients in ranges as disclosed herein
while being buffered to a lower pH range by, for example, histidine, and
being low in salt or even salt free, with the balance of osmolarity being
contributed by a cryoprotectant, such as sucrose. More specifically, this
portion of the invention embodies liquid virus formulations (including but
not limited to recombinant adenovirus-based formulations) which are
preferably buffered by histidine in a range from about pH 6.0 to pH 7.5;
containing NaCl in a range from no salt up to about 75 mM-100 mM, with a
preference to up to about 50 mM (e.g., as exemplified in several
formulations as a NaCl concentration at 35 mM); a cryoprotectant (including
but not limited to sucrose) from about 7.5% to 25%; with MgCl.sub.2,
polysorbate (including but not limited to PS-80), EDTA and/or ethanol within
ranges disclosed herein. Such formulations include but are not limited to
histidine-buffered virus formulations listed in Example 15 (see Original Patent),
and any such excipient combination and/or excipient concentration range
thereof.
It is shown herein that manipulation of sugar/salt (e.g., sucrose/NaCl)
concentrations and/or reduction of pH may offer an enhanced level for
stabilizing alternate (i.e., non subgroup C adenovirus) or multiple
adenovirus serotypes. As shown in Example 17 (see Original Patent),
formulations A423, A424, A428 and A429 show enhanced stability of serotype B
adenovirus. Therefore, virus formulations which may be especially useful for
providing enhanced stability of Ad B serotypes will be a formulation with a
virus concentration in the range from about 1.times.10.sup.7 vp/mL to about
1.times.10.sup.13 vp/mL and a total osmolarity in a range from about 200 mOs/L
to about 800 mOs/L. This formulation is preferably buffered by histidine at
a pH from about 6.0 to about 7.5 and also contains sucrose in a weight to
volume range from about 7.5% to about 25% (w/v); NaCl up to about 75 mM,
MgCl.sub.2 at about 1 mM to 2 mM, either Polysorbate-80, Polysorbate-40 or
Polysorbate-20 at a concentration from about 0.001%, with EDTA at about 100
.mu.M and ethanol at about 0.5% (w/v). It will be evident from review of
this specification that narrower ranges may be applicable to preferred
applications, including but not limited to the exclusion of NaCl from the
formulation coupled with an increase in sucrose concentration, to a range
from about 10% to 25% (w/v) sucrose, with a preference for the higher end of
range for serotype B adenoviruses. To this end, a portion of the present
invention relates to a virus formulation, especially an adenovirus B
serotype virus formulation buffered to a pH range from about 6.0 to about pH
7.5 and comprising purified virus, at least one inhibitor of free radical
oxidation selected from the group consisting of ethanol, EDTA, histidine,
triethanolamine, and sodium citrate; and, at least one sugar (e.g., sucrose)
at a combined weight to volume percentage from about 7.5% to about 25% w/v
and optionally a salt (e.g., NaCl) up to a combined concentration of about
100 mM, such that the total osmolarity of the formulation is a range from
about 200 mOs/L to about 800 mOs/L. These formulations may further comprise
a non-ionic detergent selected, especially a non-ionic detergent selected
from the group consisting of Polysorbate-80, Polysorbate-40 and
Polysorbate-20 at a concentration range from about 0.001% to about 2%;
and/or a divalent cation selected from the group consisting of MgCl.sub.2
and CaCl.sub.2 in an amount from about 0.1 mM to about 5 mM; and/or EDTA
from about 1 .mu.M to about 1000 .mu.M and ethanol from about 0.1 to 1.0%
(w/v). A423, A424, A428, and A429 exemplify this group of Ad-B stabilizing
formulations. To this end, the present invention also relates to a method of
preserving a subgroup B adenovirus which comprises generating a formulation
comprising a combination and range of components discussed within this
paragraph.
As shown in Example 18 (see Original Patent), formulations A442, A443, A444,
A448, A459 and A461 show enhanced stability for serotype D adenovirus. Such
a formulation is buffered at a pH range from about pH 6.0 to about pH 9.0;
and further comprises sucrose in a weight to volume range from up to about
15% (w/v); NaCl up to about 75 mM, MgCl.sub.2 at about 1 mM to 2 mM, either
Polysorbate-80, Polysorbate-40 or Polysorbate-20 at a concentration from
about 0.001%, with EDTA at about 100 .mu.M, ethanol at about 0.5% (w/v) and
histidine at about 10 mM. To this end, the present invention relates in part
to a formulation comprising a purified virus, especially an adenovirus,
having an adenovirus concentration in the range from about 1.times.10.sup.7
vp/mL to about 1.times.10.sup.13 vp/rnL and a total osmolarity in a range
from about 200 mOs/L to about 800 mOs/L which is preferably buffered with
Tris to a pH from about 6.0 to about 7.5, further comprising sucrose in a
weight to volume range from greater than 5% to about 25% (w/v); NaCl up to
about 50 mM, MgCl.sub.2 at about 1 mM to 2 mM, either Polysorbate-80,
Polysorbate-40 or Polysorbate-20 at a concentration from about 0.001% to
about 2%, EDTA from about 1 .mu.M to about 1000 .mu.M, ethanol from about
0.1 to 1.0% (w/v) and histidine from about 5mM to about 10 mM. Such serotype
D-based formulations may optionally include mannitol at a concentration up
to about 250 mM (A442), sorbitol at a concentration up to about 250 mM
(A443) and/or triethanolamine at a concentration up to about 5 mM (A448).
Additionally, the present invention also relates to a method of preserving a
subgroup D adenovirus which comprises generating a formulation comprising a
combination and range of components discussed within this paragraph.
It is also disclosed herein that certain formulations have the ability to
provide enhanced adenovirus stability across multiple serotypes, such as
A438, which provides enhanced adenovirus stability for serotype B, C and D
virus. A A438-type formulation will preferably be a histidine buffered
formulation containing a least one additional inhibitor of free radical
oxidation selected from the group consisting of ethanol, EDTA, histidine,
triethanolamine, and sodium citrate, with sucrose being present up to about
a volume percentage up to about 10%, with a preference in the 5%-10% range,
and sodium chloride up to about 50 mM, such that the total osmolarity of the
formulation is a range from about 200 mOs/L to about 800 mOs/L. Additional
excipients are as disclosed herein, namely MgCl.sub.2 at about 1 mM to 2 mM,
Polysorbate-80, Polysorbate-40 or Polysorbate-20 at about 0.1%, EDTA at
about 100 .mu.M, and ethanol at about 0.5% (w/v). Therefore, the present
invention relates in part to a virus formulation wherein the purified virus
is preferably adenovirus. As noted throughout this application, such a
formulation has an adenovirus concentration in the range from about
1.times.10.sup.7 vp/mL to about 1.times.10.sup.13 vp/mL and a total
osmolarity in a range from about 200 mOs/L to about 800 mOs/L. This type of
adenovirus formulation is buffered to a pH range of about pH 6.0 to about pH
7.5 (preferably with histidine)and may further comprise a sugar, such as
sucrose, in a weight to volume range from greater than 5% to about 10%
(w/v); a salt, such as NaCl, up to about 50 mM, MgCl.sub.2 at about 1 mM to
2 mM, either Polysorbate-80, Polysorbate-40 or Polysorbate-20 at a
concentration from about 0.001% to about 2%, EDTA from about 1 .mu.M to
about 1000 .mu.M and ethanol from about 0.1 to 1.0% (w/v). An exemplified
multiple serotype adenovirus formulation is disclosed herein as formulation
A438. The present invention also relates to a method of preserving a
multiple serotype adenovirus formulation (e.g., A438 for a subtype B, C and
D-based adenovirus formulation) by generating a formulation comprising a
combination and range of components discussed within this paragraph.
In accordance with the formulation compositions disclosed herein, the
present invention also relates to methods of stabilizing virus formulation
which comprises generating virus-containing formulations disclosed herein,
such formulations which result in improved viral stability when stored in
about the 2-8.degree. C. range and higher while also being compatible with
parenteral administration, especially parenteral administration to humans.
Therefore, these prescribed methods relate to the disclosed, and especially,
the exemplified virus-containing formulations of the present invention. In
addition, the present invention relates to a method of stabilizing a virus
formulation which comprises adding at least one inhibitor of free radical
oxidation to the formulation, such that the resultant formulation shows
improved stability in about the 2-8.degree. C. range and higher while also
being compatible with parenteral administration. Also, the present invention
relates to a method of stabilizing a virus formulation which comprises
adding a nucleic acid to the formulation, such that the resultant
formulation also shows improved stability in about the 2-8.degree. C. range
and higher while also being compatible with parenteral administration.
Therefore, the present invention relates to a method of stabilizing a virus
formulation which comprises preserving the virus of interest, preferably a
recombinant virus, in any of the formulations described herein, and
especially methods which comprise preservation of the virus by addition of
at least one inhibitor of free radical oxidation and/or addition a nucleic
acid to the formulation, such that the resultant formulation also shows
improved stability in about the 2-8.degree. C. range and higher while also
being compatible with parenteral administration. The present invention also
relates to methods of providing for liquid formulations for alternative
(i.e., non-subgroup C adenovirus) and/or multiple adenovirus serotypes,
whereby such formulations provide for increased virus stability over
prolonged storage times. Such methods prefer, but are not limited to,
utilizing formulations disclosed in Example 15, as well as excipient
combinations and/or excipient concentration ranges that the artisan will
understand subsequent to a review of the formulations listed in Example 15.
Claim 1 of 26 Claims
1. A virus formulation, comprising: a) a
purified adenovirus; b) at least one inhibitor of free radical oxidation
selected from the group consisting of ethanol, EDTA, histidine,
triethanolamine, and sodium citrate; and, c) at least one sugar at a
combined weight to volume percentage from about 7.5% to about 25% w/v and
optionally a salt up to a combined concentration of about 100 mM, such
that the total osmolarity of the formulation is a range from about 200 mOs/L
to about 800 mOs/L, wherein the formulation is buffered at a pH from about
6.0 to 7.0.
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