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  Pharmaceutical Patents  

 

Title:  Administration of growth factors for the treatment of CNS disorders
United States Patent: 
7,922,999
Issued: 
April 12, 2011
Inventors:  Bankiewicz; Krystof S. (Oakland, CA)
Assignee:
  The Regents of the University of California (Oakland, CA)
Appl. No.:
 11/740,124
Filed:
 April 25, 2007


 

Web Seminars -- Pharm/Biotech/etc.


Abstract

A method and system that is directed to the local delivery of growth factors to the mammalian CNS to treat CNS disorders associated with neuronal death and/or dysfunction is described.

Description of the Invention

SUMMARY OF INVENTION

The invention stems in part from the discovery that the tissue clearance rate of growth factors in mammalian CNS tissue is lower than previously believed. In particular, the present disclosure establishes that growth factors infused into the brain parenchyma in a typical treatment regimen are detectable for up to about 2-6 weeks post delivery.

Previous trials involving growth factor infusion into the brain parenchyma for the treatment of neurodegenerative disease have employed continuous infusion. However, as a consequence of remarkably low tissue clearance rates, continuous infusion of growth factor is unnecessary to achieve a therapeutically effective level of growth factor in targeted brain tissue, and the accumulation that results from continuous administration can have adverse effects. For example, accumulation of growth factor in brain parenchyma can lead to dose build-up and leakage to secondary sites and CSF, which has the potential to cause undesirable secondary effects as well as immune responses and attendant production of growth factor neutralizing antibodies. Such neutralizing anti-GDNF antibodies have been observed in the sera of patients receiving continuous infusion of GDNF into the striatum. Additionally, cellular toxicity has been observed at secondary sites in a GDNF animal toxicity study, and flow of infusate from the putamen to secondary sites via the perivascular space has been observed in primates.

The present invention is directed to achieving and maintaining an effective therapeutic dose of growth factor in targeted CNS tissue while avoiding dose build-up leading to overdose to reduce the risk of adverse events, including the production of neutralizing antibodies and the initiation of an immune response. The invention achieves these objectives with growth factor administration regimens that counterbalance previously unrecognized tissue clearance rates in order to provide for a sustained effective therapeutic dose of growth factor in compromised CNS tissue. In contrast, prior art efforts to regulate the therapeutic dosage of growth factors employed sensors capable of detecting electrical activity indicative of neuronal degeneration or dysfunction, Elsberry et al., U.S. Pat. No. 6,042,579; an inadequate feedback parameter that fails to address adverse events such as the immune-mediated processes noted above.

In a preferred embodiment, the administration regimen involves intermittent delivery, wherein delivery counterbalances tissue clearance.

In a preferred embodiment, the invention involves the method of convection enhanced delivery ("CED"), preferably in conjunction with a step-design reflux-free cannula for the delivery of growth factor to compromised cell populations in the CNS. In a preferred embodiment, the invention further involves the delivery of a tracing agent with the growth factor, and the tracing agent acts as a surrogate for monitoring distribution of infused growth factor. In a preferred embodiment, the invention further involves the use of a facilitating agent, which provides for increased growth factor mobility in brain parenchyma. Thus, in addition to addressing the problems associated with growth factor accumulation, the present invention overcomes the limitations inherent in diffusion-based delivery with typical catheters, particularly low tissue distribution volume, accumulation at catheter tip, reflux, and leakage to secondary sites and CSF, and provides for the real-time monitoring and optimization of neurotherapeutic administration.

In accordance with the objectives stated above, in one aspect, the invention provides methods for promoting the survival of a growth factor-responsive neuronal population in the mammalian CNS. The methods comprise locally delivering a pharmaceutical composition comprising a growth factor to the growth factor-responsive neuronal population, wherein the growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor, whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue. Such an administration regimen is designed to avoid substantial accumulation of growth factor.

In one embodiment, the method comprises the step of determining the clearance rate of the growth factor that is to be locally delivered to a growth factor-responsive neuronal population in the CNS. In a preferred embodiment, the clearance rate determining step is done preclinically, preferably in a primate. In another preferred embodiment, the clearance rate determining step is done by measurement of a clearance rate indicator in a human subject.

In a preferred embodiment, the pharmaceutical composition is deliverable by convection enhanced delivery (CED).

In a preferred embodiment, the pharmaceutical composition is delivered locally by CED.

In a preferred embodiment, CED comprises an infusion rate of between about 0.5 .mu.L/min and about 10 .mu.L/min.

In a preferred embodiment, CED comprises an infusion rate of greater than about 0.5 .mu.L/min, more preferably greater than about 0.7 .mu.L/min, more preferably greater than about 1 .mu.L/min, more preferably greater than about 1.2 .mu.L/min, more preferably greater than about 1.5 .mu.L/min, more preferably greater than about 1.7 .mu.L/min, more preferably greater than about 2 .mu.L/min, more preferably greater than about 2.2 .mu.L/min, more preferably greater than about 2.5 .mu.L/min, more preferably greater than about 2.7 .mu.L/min, more preferably greater than about 3 .mu.L/min, as well as preferably less than about 25 .mu.L/min, more preferably less than 20 .mu.L/min, more preferably less than about 15 .mu.L/min, more preferably less than about 12 .mu.L/min, more preferably less than about 10 .mu.L/min.

In a preferred embodiment, CED comprises incremental increases in flow rate, referred to as "stepping", during delivery. Preferably, stepping comprises infusion rates of between about 0.5 .mu.L/min and about 10 .mu.L/min.

In a preferred embodiment, stepping comprises infusion rates of greater than about 0.5 .mu.L/min, more preferably greater than about 0.7 .mu.L/min, more preferably greater than about 1 .mu.L/min, more preferably greater than about 1.2 .mu.L/min, more preferably greater than about 1.5 .mu.L/min, more preferably greater than about 1.7 .mu.L/min, more preferably greater than about 2 .mu.L/min, more preferably greater than about 2.2 .mu.L/min, more preferably greater than about 2.5 .mu.L/min, more preferably greater than about 2.7 .mu.L/min, more preferably greater than about 3 .mu.L/min, as well as preferably less than about 25 .mu.L/min, more preferably less than 20 .mu.L/min, more preferably less than about 15 .mu.L/min, more preferably less than about 12 .mu.L/min, more preferably less than about 10 .mu.L/min.

In a preferred embodiment, the pharmaceutical composition is delivered with the use of a CED-compatible reflux-free step-design cannula.

In one embodiment, the step-design cannula is compatible with chronic administration. Such cannulas are preferred for use in the treatment of chronic CNS disorders, as described herein.

In another embodiment, the step-design cannula is compatible with acute administration. Such cannulas are preferred for use in the treatment of acute CNS disorders, as described herein.

In a preferred embodiment, the pharmaceutical composition comprises a tracing agent that provides for guided growth factor delivery. Preferably, the tracing agent is an MRI contrast agent, sometimes referred to herein as an "MRI magnet". In a preferred embodiment, the tracing agent comprises a liposome. In an especially preferred embodiment, the tracing agent comprises a liposome containing gadolinium chelate.

In a preferred embodiment, the pharmaceutical composition comprises a facilitating agent, which facilitates delivery of growth factor to target tissue. In a preferred embodiment, the facilitating agent is low molecular weight heparin.

In one embodiment, the pharmaceutical composition comprises a high molecular weight neurotherapeutic comprising a growth factor and a carrier. In one embodiment, the carrier is a synthetic carrier. A wide variety of synthetic carriers are available for use in the high molecular weight neurotherapeutics of the invention. In a preferred embodiment, the carrier is a liposome. In another preferred embodiment, the carrier is a metal particle, such as a gold particle, or a polymer. In another embodiment, the carrier is a naturally occurring composition or variant thereof. Examples of such natural carriers include virus particles, including modified virus particles (e.g., those having a modified surface protein profile).

In a preferred embodiment, the pharmaceutical composition comprises a growth factor that is selected from the group consisting of NGF, BDNF, NT-3, NT-4/5, NT-6, GDNF, CNTF, LIF, IGF-1, b-FGF, neurturin, persephin, artemin, TGF.alpha., TGF.beta., IGF-2, PDGF, EGF, cardiotropin, EGF, IGF, VEGF, Sonic hedgehog (SHH), BMP, FGF20, VIP, PDGF, pleiotrophin (PTN), and HGF.

In one embodiment, the pharmaceutical composition comprises a nucleic acid encoding a growth factor. In a preferred embodiment, the growth factor is selected from the group consisting of NGF, BDNF, NT-3, NT-4/5, NT-6, GDNF, CNTF, LIF, IGF-1, b-FGF, neurturin, persephin, artemin, TGF.alpha., TGF.beta., IGF-2, PDGF, EGF, cardiotropin, EGF, IGF, VEGF, Sonic hedgehog (SHH), BMP, FGF20, VIP, PDGF, pleiotrophin (PTN), and HGF. In a preferred embodiment, the pharmaceutical composition comprises a vector, which vector comprises such a nucleic acid encoding a growth factor under the control of a regulatable promoter.

In a preferred embodiment, the pharmaceutical composition comprises NGF, or an active fragment or variant thereof, and the growth factor-responsive neuronal population comprises cholinergic neurons of the basal forebrain.

In a preferred embodiment, in addition to NGF, the pharmaceutical composition additionally comprises a bioactive agent selected from the group consisting of cholinergic agonists, cholinesterase inhibitor such as tacrine hydrochloride, neurotrophins, inducers of endogenous neurotrophic factor synthesis or production, inhibitors of senile amyloid plaque formation, and inhibitors of PHF formation.

In another preferred embodiment, the pharmaceutical composition comprises GDNF, or an active fragment or variant thereof, and the growth factor-responsive neuronal population comprises cholinergic neurons of the basal forebrain.

In another preferred embodiment, the pharmaceutical composition comprises GDNF, or an active fragment or variant thereof, and the growth factor-responsive neuronal population comprises dopaminergic neurons having cell bodies or processes in the striatum and/or midbrain.

In another preferred embodiment, the pharmaceutical composition comprises VIP, or an active fragment or variant thereof, and the growth factor-responsive neuronal population comprises dopaminergic neurons having cell bodies or processes in the striatum and/or midbrain.

In another preferred embodiment, the pharmaceutical composition comprises PTN, or an active fragment or variant thereof, and the growth factor-responsive neuronal population comprises dopaminergic neurons having cell bodies or processes in the striatum and/or midbrain.

It will be appreciated that in some embodiments, growth factors may be delivered to neuronal terminals at a distance from cell bodies.

In another preferred embodiment, the pharmaceutical composition comprises BMP, or an active fragment or variant thereof, and the growth factor-responsive neuronal population comprises cells of a CNS locus impacted by stroke.

In a preferred embodiment, the method comprises intermittent local delivery of the pharmaceutical composition.

In a preferred embodiment, administration of the growth factor comprises an intermission of from about 7 days to about 45 days, more preferably from about 14 days to about 45 days, more preferably from about 17 days to about 35 days, more preferably from about 20 days to about 35 days following delivery of the growth factor, which intermission is followed by another delivery of the growth factor. In a preferred embodiment, administration of the growth factor comprises two or more such intermissions.

In another embodiment, administration of the growth factor comprises intermissions of less than 7 days, preferably between about 2 days and about 6 days, or more than 45 days.

In a preferred embodiment, the duration of two or more intermissions is different in an intermittent administration regimen comprising three or more delivery steps. In a preferred embodiment, the duration of an intermission between delivery steps at the beginning of an intermittent administration regimen is substantially shorter that an intermission between subsequent delivery steps.

In one embodiment, the dose of growth factor delivered differs between delivery steps. In a preferred embodiment, the dose of growth factor delivered in an earlier delivery step is higher than the dose of growth factor delivered in a later delivery step in an intermittent administration regimen comprising two or more delivery steps.

In a preferred embodiment, the duration of CED is from about 30 minutes to about 12 hours, more preferably from about 30 minutes to about 6 hours.

In another embodiment, duration of CED is less than about 30 minutes or more than about 12 hours.

In a preferred embodiment, the duration of delivery is informed by use of a tracing agent and monitoring of infusate distribution.

In one aspect, the invention provides methods for reducing the death of growth factor-responsive neurons of the mammalian CNS. The methods comprise locally delivering a pharmaceutical composition comprising a growth factor to a growth factor-responsive CNS neuronal population that is at risk of undergoing cell death in the absence of intervention, wherein the growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor, whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue.

In one aspect, the invention provides methods for modulating synapse formation by growth factor-responsive neurons of the mammalian CNS. The methods comprise locally delivering a pharmaceutical composition comprising a growth factor to a growth factor-responsive CNS neuronal population, wherein the growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor, whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue, and wherein the growth factor modulates synapse formation by the growth factor-responsive neuronal population.

In one aspect, the invention provides methods for modulating neurite outgrowth by growth factor-responsive neurons of the mammalian CNS. The methods comprise locally delivering a pharmaceutical composition comprising a growth factor to a growth factor-responsive CNS neuronal population, wherein the growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor, whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue, and wherein the growth factor modulates neurite outgrowth by the growth factor-responsive neuronal population.

In one aspect, the invention provides methods for increasing neurotransmitter turnover in growth factor-responsive neurons of the mammalian CNS. The methods comprise locally delivering a pharmaceutical composition comprising a growth factor to a growth factor-responsive CNS neuronal population, wherein the growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor, whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue, and wherein the growth factor increases neurotransmitter turnover in the growth factor-responsive neuronal population.

In one aspect, the invention provides methods for modulating phenotypic differentiation of growth factor-responsive neurons of the mammalian CNS. The methods comprise locally delivering a pharmaceutical composition comprising a growth factor to a growth factor-responsive CNS neuronal population, wherein the growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor, whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue, and wherein the growth factor modulates phenotypic differentiation of the growth factor-responsive neuronal population.

In one aspect, the invention provides methods for treating a patient having a CNS disorder characterized by neuronal death and/or dysfunction. In one embodiment, the CNS disorder is a chronic disorder. In another embodiment, the CNS disorder is an acute disorder. In a preferred embodiment, the CNS disorder is selected from the group consisting of Huntington's disease, Alzheimer's disease, amyotrophic lateral sclerosis (ALS), Parkinson's disease, stroke, head trauma, spinal cord injury, multiple sclerosis, dementia with Lewy Bodies, retinal degeneration, epilepsy, psychiatric disorders, disorders of hormonal balance, and cochlear degeneration. Further contemplated are methods for reducing inflammation that is associated with a CNS disorder characterized by neuronal death and/or dysfunction.

The methods comprise locally delivering a pharmaceutical composition comprising a growth factor to a growth factor-responsive CNS neuronal population in the patient, wherein such administration of the growth factor is therapeutically effective in the treatment of the patient. The growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor, whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue.

In embodiments wherein an acute CNS disorder is treated, there is preferably an endpoint at which administration is discontinued.

In one aspect, the invention provides methods for treating a patient diagnosed as having a CNS disorder in its early stages, preferably prior to clinical presentation. The methods comprise locally delivering a pharmaceutical composition comprising a growth factor to a growth factor-responsive CNS neuronal population in the patient, wherein such administration of the growth factor prevents, delays, or reduces the severity of clinical manifestations associated with the CNS disorder. The growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor, whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue.

In one aspect, the invention provides prophylactic methods for treating a patient at risk for a CNS disorder. The methods comprise locally delivering a pharmaceutical composition comprising a growth factor to a growth factor-responsive CNS neuronal population in the patient, wherein such administration of the growth factor prevents or delays onset of a CNS disorder, or reduces the severity of the CNS disorder once it is manifest. The growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor, whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue.

Treatment methods including prophylactic methods herein preferably involve preoperative diagnosis.

In a preferred embodiment, preoperative diagnosis involves genetic screening. In another preferred embodiment, preoperative diagnosis involves neuroimaging. In one embodiment, the neuroimaging performed comprises functional neuroimaging. In another embodiment, the neuroimaging performed involves non-functional imaging. Preferably, the neuroimaging done involves PET, MRI, and/or CT.

Treatment methods herein also preferably comprise neuroimaging, preferably MRI, for target localization and/or guided cannula placement. Preferably a stereotactic holder is used in conjunction with neuroimaging to provide for guided cannula placement at or proximal to a target neuronal population.

Treatment methods herein also preferably comprise neuroimaging, preferably MRI in conjunction with an administered MRI magnet for monitoring infusate distribution.

In one aspect, the invention provides locally deliverable pharmaceutical compositions useful for treating a CNS disorder characterized by the death and/or dysfunction of a CNS neuronal population.

In a preferred embodiment, the pharmaceutical composition is deliverable by CED.

In a preferred embodiment, the pharmaceutical composition comprises a tracing agent.

In a preferred embodiment, the tracing agent is an MRI magnet.

In a preferred embodiment, the tracing agent comprises a liposome. In an especially preferred embodiment, the tracing agent comprises a liposome containing an MRI magnet, preferably gadolinium chelate. In a highly preferred embodiment, the tracing agent consists essentially of a liposome containing an MRI magnet, preferably gadolinium chelate.

In a preferred embodiment, the pharmaceutical composition comprises a facilitating agent.

In a preferred embodiment, the facilitating agent is low molecular weight heparin.

In a preferred embodiment, growth factor is selected from the group consisting of NGF, BDNF, NT-3, NT-4/5, NT-6, GDNF, CNTF, LIF, IGF-1, b-FGF, neurturin, persephin, artemin, TGFa, TGFb, IGF-2, PDGF, EGF, cardiotropin, EGF, IGF, VEGF, Sonic hedgehog (SHH), BMP, FGF20, VIP, PDGF, pleiotrophin (PTN), and HGF.

Methods of producing a pharmaceutical composition of the invention are also provided.

In one aspect, the invention provides a delivery device comprising a pharmaceutical composition of the invention.

In one aspect, the invention provides a catheter or cannula comprising a pharmaceutical composition of the invention.

In one aspect, the invention provides a delivery device comprising a pump that is capable of effecting delivery of a pharmaceutical composition of the invention by CED. In a preferred embodiment, the invention provides a delivery device comprising a pump that is capable of effecting intermittent delivery of a pharmaceutical composition of the invention by CED. In a preferred embodiment, the device further comprises a pharmaceutical composition of the invention. In a preferred embodiment, the device further comprises a CED-compatible, reflux-free step-design cannula, which cannula is compatible with chronic or acute administration.

In one aspect, the invention provides methods of using a growth factor or nucleic acid encoding the same to produce a medicament useful for the treatment of a patient having a CNS disorder characterized by neuronal death and/or dysfunction, wherein the medicament is deliverable to the CNS of the patient having a CNS disorder at a rate that substantially opposes the tissue clearance rate of the growth factor, wherein the growth factor or nucleic acid encoding the same is present in an amount sufficient to provide a therapeutically effective dose when the medicament is delivered to the CNS of the patient without producing substantial accumulation of the growth factor in the CNS of the patient. In a preferred embodiment, the medicament is deliverable by CED. In a preferred embodiment, the medicament may be delivered intermittently.

In one aspect, the invention provides methods of using a growth factor or nucleic acid encoding the same to produce a medicament useful for reducing the death of growth factor-responsive neurons of the mammalian CNS, wherein the medicament is deliverable to the CNS of the patient having a CNS disorder at a rate that substantially opposes the tissue clearance rate of the growth factor, wherein the growth factor or nucleic acid encoding the same is present in an amount sufficient to provide a therapeutically effective dose when the medicament is delivered to the CNS of the patient without producing substantial accumulation of the growth factor in the CNS of the patient. In a preferred embodiment, the medicament is deliverable by CED. In a preferred embodiment, the medicament may be delivered intermittently.

In one aspect, the invention provides methods of using a growth factor or nucleic acid encoding the same to produce a medicament useful for modulating neurite outgrowth by growth factor-responsive neurons of the mammalian CNS, wherein the medicament is deliverable to the CNS of the patient having a CNS disorder at a rate that substantially opposes the tissue clearance rate of the growth factor, wherein the growth factor or nucleic acid encoding the same is present in an amount sufficient to provide a therapeutically effective dose when the medicament is delivered to the CNS of the patient without producing substantial accumulation of the growth factor in the CNS of the patient. In a preferred embodiment, the medicament is deliverable by CED. In a preferred embodiment, the medicament may be delivered intermittently.

In one aspect, the invention provides methods of using a growth factor or nucleic acid encoding the same to produce a medicament useful for increasing neurotransmitter turnover in growth factor-responsive neurons of the mammalian CNS, wherein the medicament is deliverable to the CNS of the patient having a CNS disorder at a rate that substantially opposes the tissue clearance rate of the growth factor, wherein the growth factor or nucleic acid encoding the same is present in an amount sufficient to provide a therapeutically effective dose when the medicament is delivered to the CNS of the patient without producing substantial accumulation of the growth factor in the CNS of the patient. In a preferred embodiment, the medicament is deliverable by CED. In a preferred embodiment, the medicament may be delivered intermittently.

In one aspect, the invention provides methods of using a growth factor or nucleic acid encoding the same to produce a medicament useful for modulating phenotypic differentiation of growth factor-responsive neurons of the mammalian CNS, wherein the medicament is deliverable to the CNS of the patient having a CNS disorder at a rate that substantially opposes the tissue clearance rate of the growth factor, wherein the growth factor or nucleic acid encoding the same is present in an amount sufficient to provide a therapeutically effective dose when the medicament is delivered to the CNS of the patient without producing substantial accumulation of the growth factor in the CNS of the patient. In a preferred embodiment, the medicament is deliverable by CED. In a preferred embodiment, the medicament may be delivered intermittently.

In one aspect, the invention provides methods of using a growth factor or nucleic acid encoding the same to produce a medicament useful for treating a patient diagnosed as having a CNS disorder in its early stages, wherein the medicament is deliverable to the CNS of the patient having a CNS disorder at a rate that substantially opposes the tissue clearance rate of the growth factor, wherein the growth factor or nucleic acid encoding the same is present in an amount sufficient to provide a therapeutically effective dose when the medicament is delivered to the CNS of the patient without producing substantial accumulation of the growth factor in the CNS of the patient. In a preferred embodiment, the medicament is deliverable by CED. In a preferred embodiment, the medicament may be delivered intermittently.

In one aspect, the invention provides methods of using a growth factor or nucleic acid encoding the same to produce a medicament useful for prophylactic treatment a patient at risk for a CNS disorder, wherein the medicament is deliverable to the CNS of the patient having a CNS disorder at a rate that substantially opposes the tissue clearance rate of the growth factor, wherein the growth factor or nucleic acid encoding the same is present in an amount sufficient to provide a therapeutically effective dose when the medicament is delivered to the CNS of the patient without producing substantial accumulation of the growth factor in the CNS of the patient. In a preferred embodiment, the medicament is deliverable by CED. In a preferred embodiment, the medicament may be delivered intermittently.

In one embodiment, a medicament further comprises a tracing agent.

In one embodiment, a medicament further comprises a facilitating agent.

In one embodiment, methods of producing a medicament involve the use of a high molecular weight neurotherapeutic of the invention comprising (i) a carrier, and (ii) a growth factor or nucleic acid encoding the same.

In one aspect, the invention provides kits for the treatment of CNS disorders, which kits comprise one or more pharmaceutical compositions of the invention.

In another aspect the invention provides kits useful for reducing the death of growth factor-responsive neurons of the mammalian CNS, which kits comprise one or more pharmaceutical compositions of the invention.

In another aspect the invention provides kits useful for modulating neurite outgrowth by growth factor-responsive neurons of the mammalian CNS, which kits comprise one or more pharmaceutical compositions of the invention.

In another aspect the invention provides kits useful for increasing neurotransmitter turnover in growth factor-responsive neurons of the mammalian CNS, which kits comprise one or more pharmaceutical compositions of the invention.

In another aspect the invention provides kits useful for modulating phenotypic differentiation of growth factor-responsive neurons of the mammalian CNS, which kits comprise one or more pharmaceutical compositions of the invention.

In another aspect the invention provides kits useful for treating a patient diagnosed as having a CNS disorder in its early stages, which kits comprise one or more pharmaceutical compositions of the invention.

In another aspect the invention provides kits useful for prophylactic treatment a patient at risk for a CNS disorder, which kits comprise one or more pharmaceutical compositions of the invention.

In one embodiment, a kit of the invention further comprises a delivery device useful for CED, preferably a cannula, and more preferably a step-design reflux-free cannula. In one embodiment, a kit of the invention further comprises a pump useful for CED.

Another aspect of the invention is a method of treating a mammal having a central nervous system (CNS) disorder. In one embodiment, the method involves administering to a mammal having a CNS disorder, a pharmaceutical composition such as a growth factor, by correlating delivery of said pharmaceutical composition with corresponding tissue clearance of the pharmaceutical composition. In one embodiment, the pharmaceutical composition is administered using convection enhanced delivery (CED). In one embodiment, the pharmaceutical composition includes a tracing agent. In another embodiment, the pharmaceutical composition further comprises a facilitating agent. In one embodiment, the pharmaceutical composition is delivered intermittently. In one mode, the intermittent delivery balances the process of tissue clearance.

Another aspect of the invention is a method for promoting the survival of a growth factor-responsive neuronal population in the mammalian CNS. In one embodiment, the method involves locally delivering a pharmaceutical composition comprising a growth factor to the growth factor-responsive neuronal population wherein the growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor such that a therapeutically effective amount of growth factor is achieved in the target CNS tissue. In one mode, the delivery does not produce substantial accumulation of growth factor. In one embodiment, the method as involves determining the tissue clearance rate of the growth factor that is to be locally delivered to a growth factor-responsive neuronal population in the CNS. In one embodiment, determining the tissue clearance rate is performed preclinically in a primate. In another embodiment, determining the tissue clearance rate is carried out by measuring a clearance rate indicator in a human subject.

Another aspect of the invention is a method for reducing the death of growth factor-responsive neurons of the mammalian CNS. In one embodiment, the method involves locally delivering a pharmaceutical composition comprising a growth factor to a growth factor-responsive CNS neuronal population that is at risk of undergoing cell death in the absence of intervention, wherein the growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor and whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue.

Another aspect of the invention is a method of treating a CNS disorder. In one embodiment, the method involves locally administering a pharmaceutical composition comprising a growth factor to a growth factor-responsive CNS neuronal population in the patient, wherein such administration of the growth factor is therapeutically effective in the treatment of the patient. In one embodiment, the growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue. In one embodiment, the CNS disorder comprises an acute CNS disorder and administration is discontinued at an endpoint.

Another aspect of the invention is a method for treating a patient diagnosed as having a CNS disorder in its early stages. In one embodiment, the method involves locally administering a pharmaceutical composition comprising a growth factor to a growth factor-responsive CNS neuronal population in the patient wherein such administration of the growth factor prevents, delays, or reduces the severity of clinical manifestations associated with the CNS disorder at later stages in the absence of administered growth factor. In one embodiment, the growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue.

Another aspect of the invention is a prophylactic method for treating a patient at risk for a CNS disorder. In one embodiment, the method involves locally administering a pharmaceutical composition comprising a growth factor to a growth factor-responsive CNS neuronal population in the patient wherein such administration of the growth factor prevents or delays onset of a CNS disorder, or reduces the severity of the CNS disorder once it is manifest. In one embodiment, the growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor whereby a therapeutically effective amount of growth factor is achieved in the target CNS tissue.

DETAILED DESCRIPTION OF INVENTION

The invention is directed to methods and compositions for the local delivery of growth factors to growth factor-responsive neuronal populations of the mammalian CNS. The invention stems in part from the discovery that tissue clearance of growth factors in the CNS is slow relative to rates at which exogenous growth factors have typically been administered previously. Infusion of a growth factor at a rate greater than tissue clearance results in an unnecessary and potentially toxic accumulation of growth factor. In the present invention, delivery of growth factor at a rate that substantially opposes the tissue clearance rate is done to avoid toxic accumulation of growth factor and achieve levels in target tissue that are maintained within a therapeutically effective window over time. In a preferred embodiment, intermittent growth factor delivery is done.

The phenomenon of slow tissue clearance is not limited to a particular growth factor or brain region. Consequently, the benefit associated with the present administration methods is not limited to a particular growth factor, a particular neuronal population in the CNS, or a particular indication. In principle, given the ability to deliver a wide variety of growth factors to a wide variety of neuronal populations in the CNS, any indication characterized by the death and/or dysfunction of a neuronal population that is responsive to growth factor, or may be functionally compensated for by a neuronal population responsive to growth factor, may be treated.

Administration of Growth Factor

A number of growth factors have been delivered by various means in attempts to treat a variety of neurodegenerative diseases. For review, see for example, Dawbarn et al., Neuropathol and App. Neurobiol, 29:211-230, 2003 incorporated herein by reference in its entirety. The present invention provides novel means of delivering growth factors to growth factor-responsive neuronal populations in these diseases with improved efficacy. In particular, the invention provides methods and compositions for delivering growth factors to target neuronal populations at a rate that counterbalances tissue clearance rates to achieve a sustained effective therapeutic dose without unwanted adverse effects.

In the methods of the invention, growth factor is delivered at a rate that substantially opposes the tissue clearance rate of the growth factor. By "rate that substantially opposes the tissue clearance rate" is meant a delivery rate that is approximately counter to the tissue clearance rate. Rate refers to amount of growth factor over time. The delivery rate need not exactly counter the tissue clearance rate, and the amount of growth factor in target tissue need not remain constant. For example, in a preferred embodiment of the invention, administration involves intermittent delivery of growth factor. It will be appreciated that such administration protocols will result in varied amounts of growth factor in target tissue, with a maxima approximately at the beginning of an intermission and a minima approximately at the end of an intermission. What is called for in the present methods is a delivery rate that provides for maintenance of a therapeutically effective amount of growth factor (within a therapeutic window) in target tissue over time. By considering the empirically determined clearance rate of a particular growth factor in target tissue, one of skill in the art can readily determine an appropriate delivery rate without undue experimentation.

The rate of growth factor delivery in the present methods is informed by the rate of tissue clearance of the growth factor and substantially opposes the rate of tissue clearance. The desired rate of growth factor delivery may be achieved with continuous or intermittent delivery and appropriate concentrations of growth factor. CED is preferred as a means of delivery in the present invention, and intermittent delivery of a pharmaceutical composition having an appropriate concentration of growth factor is preferred. However, in alternative embodiments, delivery at an infusion rate of less than 0.5 .mu.l/min may be done, and an administration regimen comprising intermittent delivery with very short intermissions (days, hours, minutes), and even continuous delivery may be done with appropriate concentrations of growth factor such that the rate of delivery substantially opposes the rate of tissue clearance.

By "substantial accumulation" or "harmful accumulation" of growth factor is meant achievement of an amount of growth factor that is higher than the minimum therapeutically effective amount of growth factor and capable of producing undesirable deleterious effects, which is typically well above the maximally effective therapeutic amount of growth factor (i.e., higher than the effective ceiling amount of growth factor) for a period of time. By "intermittent delivery" is meant discontinuous delivery. In accordance with the invention, in a preferred embodiment, a particular growth factor is administered as its level in target tissue is declining in order to maintain a therapeutically effective amount of the factor in target tissue. The growth factor is infused into the target population for a period of time, typically from about 30 minutes to about 12 hours, more preferably from about 30 minutes to about 6 hours, at which point delivery ceases. The duration of delivery will be informed by a tracing agent in preferred embodiments. During delivery, the level of growth factor in the target tissue increases. Preferably, cessation of delivery occurs when the maximally effective therapeutic dose (therapeutic dosage ceiling) is achieved in target tissue. Though less preferred, cessation of delivery may occur when maximally effective therapeutic dose has been surpassed. Preferably, cessation of delivery occurs when infusate is distributed throughout the substantial whole of the target tissue, as may be monitored with a tracing agent as disclosed herein. Preferably, cessation of delivery occurs while infusate remains substantially confined to target tissue. Following cessation, tissue clearance mechanisms act to slowly decrease the level of growth factor in the target tissue. Delivery is repeated when the growth factor in target tissue is declining, preferably while a therapeutically effective amount of growth factor remains in target tissue, more preferably when the growth factor is above or slightly above the minimum therapeutically effective amount of growth factor. Though less preferred, delivery may be repeated when the growth factor is below the minimum therapeutically effective amount of growth factor. In one embodiment, a therapeutically effective dose is not maintained continuously without interruption.

In a preferred embodiment, administration of the growth factor comprises an intermission of from about 7 days to about 45 days, more preferably from about 14 days to about 45 days, more preferably from about 17 days to about 35 days, more preferably from about 20 days to about 35 days following delivery of the growth factor, which intermission is followed by another delivery of the growth factor. In a preferred embodiment, administration of the growth factor comprises two or more such intermissions.

In another embodiment, administration of the growth factor comprises intermissions of less than about 7 days or more than about 45 days.

In the methods herein, growth factors are locally delivered to a target population of growth factor-responsive neurons in the mammalian CNS by infusion. Especially preferred is the method of CED. By "CED" is meant infusion at a rate greater than 0.5 .mu.l/min. In a preferred embodiment, growth factor is delivered by CED through a suitable catheter or cannula, preferably a step-design reflux-free cannula. In a preferred embodiment, the method of CED is done with a CED-compatible reflux-free step design cannula. See Krauze et al., J. Neurosurg., 103:923-929, 2005, incorporated herein by reference in its entirety. See also, U.S. Patent Application Publication No. 2007/0088295 A1 and 2006/0135945 A1, both of which are incorporated herein by reference in their entirety. The method involves positioning the tip of the cannula at least in close proximity to the target tissue. After the cannula is positioned, it is connected to a pump which delivers the growth factor through the cannula tip to the target tissue. A pressure gradient from the tip of the cannula is maintained during infusion.

By "proximal to" a target population is meant within an effective distance of the target population. In particular, with respect to the positioning of a cannula relative to target tissue, proximity refers to a distance such that infusate will reach the target tissue. As the highly preferred means of delivering a pharmaceutical composition is CED, proximity in most instances herein refers to being within a distance from target tissue that is reached by CED of pharmaceutical composition.

In a preferred embodiment, a step-design reflux-free cannula is joined with a pump that withdraws the growth factor from a container and produces enough pressure to cause the growth factor to flow through the catheter to the target tissue at controlled rates. Any suitable flow rate can be used such that the intracranial pressure is maintained at suitable levels so as not to injure the brain tissue. More than a single cannula can be used.

Penetration of the growth factor into target tissue is greatly facilitated by positive pressure infusion over a period of hours. Penetration is further augmented by the use of a facilitating agent, such as low molecular weight heparin. Additionally, the inclusion of a tracing agent, preferably an MRI magnet, provides for real-time monitoring of tissue penetration by infusate, and informs the cessation of delivery.

Any suitable amount of growth factor can be administered in this manner. Suitable amounts are amounts that are therapeutically effective, and thus capable of provoking a response from growth factor responsive neurons in target tissue, without causing an overabundance of undesirable side effects. Typically, the amount of growth factor will be between about 1 .mu.g and about 1000 .mu.g, more preferably between about 1 .mu.g and about 500 .mu.g, more preferably between about 1 .mu.g and about 250 .mu.g, more preferably between about 1 .mu.g and about 100 .mu.g. In an especially preferred embodiment, the amount of growth factor is between about 10 .mu.g and about 100 .mu.g. In a preferred embodiment, CED comprises an infusion rate of between about 0.5 .mu.L/min and about 10 .mu.L/min.

In a preferred embodiment, CED comprises an infusion rate of greater than about 0.5 .mu.L/min, more preferably greater than about 0.7 .mu.L/min, more preferably greater than about 1 .mu.L/min, more preferably greater than about 1.2 .mu.L/min, more preferably greater than about 1.5 .mu.L/min, more preferably greater than about 1.7 .mu.L/min, more preferably greater than about 2 .mu.L/min, more preferably greater than about 2.2 .mu.L/min, more preferably greater than about 2.5 .mu.L/min, more preferably greater than about 2.7 .mu.L/min, more preferably greater than about 3 .mu.L/min, as well as preferably less than about 25 .mu.L/min, more preferably less than 20 .mu.L/min, more preferably less than about 15 .mu.L/min, more preferably less than about 12 .mu.L/min, more preferably less than about 10 .mu.L/min.

In a preferred embodiment, CED comprises incremental increases in flow rate, referred to as "stepping", during delivery. Preferably, stepping comprises infusion rates of between about 0.5 .mu.L/min and about 10 .mu.L/min.

In a preferred embodiment, stepping comprises infusion rates of greater than about 0.5 .mu.L/min, more preferably greater than about 0.7 .mu.L/min, more preferably greater than about 1 .mu.L/min, more preferably greater than about 1.2 .mu.L/min, more preferably greater than about 1.5 .mu.L/min, more preferably greater than about 1.7 .mu.L/min, more preferably greater than about 2 .mu.L/min, more preferably greater than about 2.2 .mu.L/min, more preferably greater than about 2.5 .mu.L/min, more preferably greater than about 2.7 .mu.L/min, more preferably greater than about 3 .mu.L/min, as well as preferably less than about 25 .mu.L/min, more preferably less than 20 .mu.L/min, more preferably less than about 15 .mu.L/min, more preferably less than about 12 .mu.L/min, more preferably less than about 10 .mu.L/min.

For further teaching on the method of CED, see for example Saito et al., Exp. Neurol., 196:3891-389, 2005; Krauze et al., Exp. Neurol., 196:104-111, 2005; Krauze et al., Brain Res. Brain Res. Protocol., 16:20-26, 2005; U.S. Patent Application Publication No. 2006/0073101; U.S. Pat. No. 5,720,720, each of which is incorporated herein by reference in its entirety.

The present methods of treatment preferably involve one or more pre-operative diagnostic determinations for the presence or risk of a CNS disorder. "CNS disorder" as used herein refers to disorders of the mammalian CNS characterized by the death and/or dysfunction of one or more neuronal populations. CNS disorders include chronic disorders, such as neurodegenerative diseases, for example Alzheimer's disease, as well as acute disorders, such as stroke. Many biomarkers associated with various CNS disorders are known. For example, see Henley et al., Curr. Opin. Neurol., 18:698-705, 2005, incorporated herein by reference in its entirety. The diagnostic determination done preferably includes neuroimaging. For example, see Mathis et al., Arch. Neurol., 62: 196-200, 2005, incorporated herein by reference in its entirety. In a preferred embodiment, the diagnostic determination involves a genetic test.

The methods also preferably involve pre-operative imaging to stereotactically define the location of the targeted neuronal population.

In a highly preferred embodiment, the methods additionally comprise imaging during administration in order to monitor cannula positioning. In one embodiment, the method comprises use of a neuronavigation system, for example, see U.S. Patent Application Publication No. 2002/0095081, incorporated herein by reference in its entirety. In a preferred embodiment, the methods additionally comprise neuroimaging to monitor infusate distribution.

In one aspect, the invention provides methods for the treatment of a CNS disorder.

In a preferred embodiment, the invention provides methods for the treatment of Alzheimer's disease. The methods comprise administering NGF, or an active fragment or variant thereof, locally, and preferably intermittently, to cholinergic neurons of the basal forebrain.

In a preferred embodiment, the invention provides methods for the treatment of Alzheimer's disease. The methods comprise administering GDNF, or an active fragment or variant thereof, locally, and preferably intermittently, to cholinergic neurons of the basal forebrain.

In a preferred embodiment, the invention provides methods for the treatment of Parkinson's disease. The methods comprise administering GDNF, or an active fragment or variant thereof, locally, and preferably intermittently, to the striatum and/or midbrain.

In a preferred embodiment, the invention provides methods for the treatment of Parkinson's disease. The methods comprise administering VIP, or an active fragment or variant thereof, locally, and preferably intermittently, to the striatum and/or midbrain.

In a preferred embodiment, the invention provides methods for the treatment of Parkinson's disease. The methods comprise administering PTN, or an active fragment or variant thereof, locally, and preferably intermittently, to the striatum and/or midbrain.

In a preferred embodiment, the invention provides methods for the treatment of stroke. The methods comprise administering BMP, or an active fragment or variant thereof, locally, and preferably intermittently, to the CNS locus impacted by the stroke.

Table 1 (see Original Patent) provides a list of growth factors that can be used in the present invention to produce desired effects in a variety of target neuronal populations. This description is exemplary, and is not intended to be limiting.

More generally, Table 2 (see Original Patent) provides a list of growth factors that are generally able to produce beneficial effects, such as survival, neurite outgrowth and phenotypic maintenance, in the particular types of neurons listed. This description is exemplary, and not intended to be limiting.

The dose of growth factor delivered is determined by the particular growth factor, the target tissue density, the target tissue volume, and the tissue clearance rate. Typically, the amount of growth factor will be between about 1 .mu.g and about 1000 .mu.g, more preferably between about 1 .mu.g and about 500 .mu.g, more preferably between about 1 .mu.g and about 250 .mu.g, more preferably between about 1 .mu.g and about 100 .mu.g. In an especially preferred embodiment, the amount of growth factor is between about 10 .mu.g and about 100 .mu.g. In a preferred embodiment, following an intermission of from about 7 days to about 45 days, more preferably from about 14 days to about 45 days, more preferably from about 17 days to about 35 days, more preferably from about 20 days to about 35 days, delivery, if required, is repeated at a dose again designed to maintain a therapeutically effective amount of growth factor in tissue without producing harmful accumulation.

In a preferred embodiment, administration of the growth factor comprises two or more such intermissions.

In a preferred embodiment, the duration of a later occurring intermission is longer than the duration of an earlier occurring intermission in an administration regiment comprising three or more delivery steps.

In a preferred embodiment, the dose of growth factor given in an earlier delivery is greater than the dose of growth factor given in a later delivery in an administration regimen comprising two or more delivery steps.

It is further contemplated that the growth factor be administered with an effective amount of a second therapeutic agent. For example, in the treatment of Alzheimer's disease, such second therapeutic agents may include: cholinergic agonists, particularly those specific to the CNS and not to peripheral muscles, cholinesterase inhibitors such as tacrine hydrochloride, neurotrophins such as NGF, BDNF, NT-3, NT-4/5, basic fibroblast growth factor (bFGF), ciliary neurotrophic factor (CNTF), inhibitors of senile amyloid plaque formation, inhibitors of PHF formation, and inducers of endogenous neurotrophic factor synthesis or production.

The growth factor protein products according to this invention may be isolated or generated by any means known to those skilled in the art.

Naturally-occurring growth factor protein products may be isolated from mammalian neuronal cell preparations, or from a mammalian cell line secreting or expressing growth factor. For example, PCT International Publication No. WO93/06116, incorporated herein by reference in its entirety, describes the isolation of GDNF from serum-free growth conditioned medium of B49 glioblastoma cells. GDNF protein products may also be chemically synthesized by any means known to those skilled in the art. GDNF protein products are preferably produced via recombinant techniques because they are capable of achieving comparatively higher amounts of protein at greater purity. Recombinant GDNF protein product forms include glycosylated and non-glycosylated forms of the protein, and protein expressed in bacterial, mammalian or insect cell systems.

In general, recombinant techniques involve isolating the genes responsible for coding growth factor, cloning the gene in suitable vectors and cell types, modifying the gene if necessary to encode a desired variant, and expressing the gene in order to produce the growth factor protein product. Alternatively, a nucleotide sequence encoding the desired growth factor protein product may be chemically synthesized. It is contemplated that growth factor protein product may be expressed using nucleotide sequences which differ in codon usage due to the degeneracies of the genetic code or allelic variations.

In some embodiments herein, growth factor is administered in the form of an encoding nucleic acid that may be expressed in a transduced cell. In one embodiment, a high molecular weight neurotherapeutic is administered to a patient, wherein the high molecular weight neurotherapeutic comprises a nucleic acid encoding a growth factor, wherein the nucleic acid is expressed in a transduced CNS cell of the patient and the encoded growth factor is produced. Thus, the growth factor is produced in situ. Nucleic acids encoding growth factor proteins of the invention are well known in the art.

In a preferred embodiment, the nucleic acid encoding a growth factor is regulatable in situ. In one embodiment, a pharmaceutical composition comprising a vector comprising a nucleic acid encoding a growth factor under the control of a regulatable promoter is administered. It will be appreciated that regulatable expression of a nucleic acid encoding a growth factor provides for intermittent delivery of growth factor.

A therapeutic infusate composition is a volume of pharmaceutical composition to be delivered by CED in a single administration. The volume of infusate will be largely determined by the target tissue and its volume. Typical volumes will be between about 10 .mu.l and about 10 cc, though larger and smaller volumes may be used.

The term "target tissue" refers to a physical (usually anatomical) target in the CNS comprising a neuronal population of interest.

A tracing agent is preferably detectable by magnetic resonance imaging (MRI) or X-ray computed tomography. The distribution of tracing agent is monitored and used as an indirect measure of the distribution of growth factor or high molecular weight neurotherapeutic. This monitoring is done to verify that the growth factor is reaching target tissue and achieving an effective concentration therein and to detect unwanted delivery of infusate to non-target tissue.

In a preferred embodiment, a tracing agent is separate from the growth factor. The tracing agent is distributed in a manner that correlates with that of the growth factor and thus is an indirect indicator of growth factor distribution.

In a preferred embodiment, the tracing agent and the growth factor are each in the form of carrier compositions, which confers highly similar distribution characteristics thereto.

In a highly preferred embodiment, the tracing agent and the growth factor are in the form of liposomal compositions. Liposome-based tracing agents are very highly accurate indirect indicators of the distribution of liposome-based high molecular weight neurotherapeutics.

The act of "monitoring" refers to obtaining serial images of the tracing agent over time. By monitoring the distribution of the tracing agent, the location and volume of distribution of the high molecular weight neurotherapeutic within the tissue may be determined at any time during the infusion process. Serial images may be obtained at any rate up to the maximum rate that the imaging instrument can obtain images. For example, serial images may be obtained at intervals ranging from a few milliseconds to hours, but more typically at intervals of minutes, such as intervals of 1, 2, 5, 10, 15, 20 or 30 minutes. The interval between serial images may be varied during infusion. In some instances, it may be desirable to obtain images at short intervals (for example, every 5, 10, or 15 seconds) at the beginning of the infusion process to detect backflow along the cannula, or to verify that the infusate is entering the desired target tissue. Once delivery to the proper site is confirmed, the interval between images may be lengthened, and the images used to follow the progress of infusion.

In one aspect, the invention provides treatment methods that comprise delivering a pharmaceutical composition of the invention by CED, wherein the pharmaceutical composition comprises a tracing agent, monitoring the distribution of the tracing agent as it moves through the CNS, and ceasing delivery of the pharmaceutical composition when the high molecular weight neurotherapeutic is distributed in a predetermined volume within the CNS. The movement of the tracing agent through the solid tissue may be monitored by an imaging technique such as magnetic resonance imaging (MRI) or X-ray computed tomography (CT). The tracing agent has a mobility in CNS tissue that is substantially similar to the therapeutic agent, and delivery is ceased when the tracing agent is observed to reach a desired region or achieve a desired volume of distribution, or to reach or nearly reach or exceed the borders of the target tissue.

The predetermined volume may correspond to a particular region of the brain. The predetermined volume of distribution is "substantially similar" to the volume of distribution observed for a tracing agent that is being monitored to follow the infusion. "Substantially similar" refers to a difference in volume of less than 20%. More preferably, the difference in volume is less than 15%, more preferably less than 10%, more preferably less than 5%. By monitoring the distribution of the tracing agent, infusion may be ceased when the predetermined volume of distribution is reached.

Volume of distribution may be determined, for example, by using imaging software that is standard in the art, e.g., iFLOW.TM.. See also, for example, Krautze et al., Brain Res. Protocols, 16:20-26, 2005; and Saito et al., Exp. Neurol., 196:3891-389, 2005, incorporated herein by reference in its entirety.

Growth Factor Variants

The term "growth factor variant" as used herein includes polypeptides in which amino acids have been deleted from ("deletion variants"), inserted into ("addition variants"), or substituted for ("substitution variants"), residues within the amino acid sequence of naturally-occurring growth factor. Such variants are prepared by introducing appropriate nucleotide changes into the DNA encoding the polypeptide or by in vitro chemical synthesis of the desired polypeptide. It will be appreciated by those skilled in the art that many combinations of deletions, insertions, and substitutions can be made provided that the final molecule is biologically active.

The term "biologically active" as used herein means that the fragment of variant demonstrates similar properties, but not necessarily all of the same properties, and not necessarily to the same degree, as the growth factor on which it is based.

Mutagenesis techniques for the replacement, insertion or deletion of one or more selected amino acid residues are well known to one skilled in the art (e.g., U.S. Pat. No. 4,518,584, the disclosure of which is hereby incorporated herein by reference in its entirety.) There are two principal variables in the construction of variants: the location of the mutation site and the nature of the mutation. In designing growth factor variants, the selection of the mutation site and nature of the mutation will depend on the growth factor characteristic(s) to be modified. The sites for mutation can be modified individually or in series, e.g., by (1) substituting first with conservative amino acid choices and then with more radical selections depending upon the results achieved (2) deleting the target amino acid residue, or (3) inserting amino acid residues adjacent to the located site. Conservative changes in from 1 to 20 amino acids are preferred. Once the amino acid sequence of the desired growth factor protein product is determined, the nucleic acid sequence to be used in the expression of the protein is readily determined. N-terminal and C-terminal deletion variants may also be generated by proteolytic enzymes.

For growth factor deletion variants, deletions generally range from about 1 to 30 residues, more usually from about 1 to 10 residues, and typically from about 1 to 5 contiguous residues. N-terminal, C-terminal and internal intrasequence deletions are contemplated. Deletions may be introduced into regions of low homology with other family members to modify the activity of a particular growth factor. Deletions in areas of substantial homology with other family sequences will be more likely to modify biological activity of the particular growth factor more significantly. The number of consecutive deletions will be selected so as to preserve the tertiary structure of the growth factor protein product in the affected domain.

Examples of variants include those disclosed in U.S. Pat. Nos. 6,723,701; 6,468,970; 6,440,702; 5,741,778; 5,731,284; 5,830,857; 5,733,875, each of which is incorporated herein by reference in its entirety.

For growth factor addition variants, amino acid sequence additions typically include N- and/or C-terminal fusions ranging in length from one residue to polypeptides containing a hundred or more residues, as well as internal intrasequence additions of single or multiple amino acid residues. Internal additions may range generally from about 1 to 10 residues, more typically from about 1 to 5 residues, and usually from about 1 to 3 amino acid residues. Examples of N-terminal addition variants include growth factor with an N-terminal methionyl residue (an artifact of the direct expression of GDNF in bacterial recombinant cell culture) and fusion of a heterologous N-terminal signal sequence to the N-terminus of growth factor to facilitate the secretion of mature growth factor from recombinant host cells. Such signal sequences generally will be obtained from, and thus be homologous to, the intended host cell species. Additions may also include amino acid sequences derived from the sequence of other growth factors.

Growth factor substitution variants have at least one amino acid residue of the growth factor amino acid sequence removed and a different residue inserted in its place. Such substitution variants include allelic variants, which are characterized by naturally-occurring nucleotide sequence changes in the species population that may or may not result in an amino acid change.

Specific mutations of the growth factor amino acid sequence may involve modifications to a glycosylation site (e.g., serine, threonine, or asparagine). The absence of glycosylation or only partial glycosylation results from amino acid substitution or deletion at any asparagine-linked glycosylation recognition site or at any site of the molecule that is modified by addition of an O-linked carbohydrate. An asparagine-linked glycosylation recognition site comprises a tripeptide sequence which is specifically recognized by appropriate cellular glycosylation enzymes. These tripeptide sequences are either Asn-Xaa-Thr or Asn-Xaa-Ser, where Xaa can be any amino acid other than Pro. A variety of amino acid substitutions or deletions at one or both of the first or third amino acid positions of a glycosylation recognition site (and/or amino acid deletion at the second position) result in non-glycosylation at the modified tripeptide sequence. Thus, the expression of appropriate altered nucleotide sequences produces variants which are not glycosylated at that site. Alternatively, the growth factor amino acid sequence may be modified to add glycosylation sites.

One method for identifying growth factor amino acid residues or regions for mutagenesis is called "alanine scanning mutagenesis" as described by Cunningham and Wells (Science, 244:1081-1085, 1989), incorporated herein by reference in its entirety. In this method, an amino acid residue or group of target residues are identified (e.g., charged residues such as Arg, Asp, His, Lys, and Glu) and replaced by a neutral or negatively charged amino acid (most preferably alanine or polyalanine) to affect the interaction of the amino acids with the surrounding aqueous environment in or outside the cell. Those domains demonstrating functional sensitivity to the substitutions then are refined by introducing additional or alternate residues at the sites of substitution. Thus, the target site for introducing an amino acid sequence variation is determined, alanine scanning or random mutagenesis is conducted on the corresponding target codon or region of the DNA sequence, and the expressed growth factor variants are screened for the optimal combination of desired activity and degree of activity.

The sites of greatest interest for substitutional mutagenesis include sites where the amino acids found in a particular growth factor from various species are substantially different in terms of side-chain bulk, charge, and/or hydrophobicity. Other sites of interest are those in which particular residues of growth factor-related proteins, obtained from various species, are identical. Such positions are generally important for the biological activity of a protein. Initially, these sites are substituted in a relatively conservative manner. Such conservative substitutions are shown in Table 3 (see Original Patent) under the heading of exemplary substitutions. If such substitutions result in a change in biological activity, then more substantial changes (exemplary substitutions) are introduced, and/or other additions or deletions may be made, and the resulting products screened for activity.

Conservative modifications to the amino acid sequence (and the corresponding modifications to the encoding nucleic acid sequences) are expected to produce growth factor protein products having functional and chemical characteristics similar to those of natural growth factor correlate. In contrast, substantial modifications in the functional and/or chemical characteristics of growth factor protein products may be accomplished by selecting substitutions that differ significantly in their effect on maintaining (a) the structure of the polypeptide backbone in the area of the substitution, for example, as a sheet or helical conformation, (b) the charge or hydrophobicity of the molecule at the target site, or (c) the bulk of the side chain. Naturally occurring residues are divided into groups based on common side chain properties:

(1) hydrophobic: norleucine, Met, Ala, Val, Leu, Ile;

(2) neutral hydrophilic: Cys, Ser, Thr;

(3) acidic: Asp, Glu;

(4) basic: Asn, Gln, His, Lys, Arg;

(5) residues that influence chain orientation: Gly, Pro; and

(6) aromatic: Trp, Tyr, Phe.

Non-conservative substitutions may involve the exchange of a member of one of these classes for another. Such substituted residues may be introduced into regions of the growth factor protein that are homologous with other growth factor proteins, or into the non-homologous regions of the molecule.

Growth Factor Derivatives

Chemically modified derivatives of growth factor or growth factor variants may be prepared by one of skill in the art given the disclosures herein. The chemical moieties most suitable for derivatization include water soluble polymers. A water soluble polymer is desirable because the protein to which it is attached does not precipitate in an aqueous environment, such as a physiological environment. Preferably, the polymer will be pharmaceutically acceptable for the preparation of a therapeutic product or composition. One skilled in the art will be able to select the desired polymer based on such considerations as whether the polymer/protein conjugate will be used therapeutically, and if so, the desired dosage, circulation time, resistance to proteolysis, and other considerations. The effectiveness of the derivatization may be ascertained by administering the derivative, in the desired form (i.e., by osmotic pump, or, more preferably, by injection or infusion, or, further formulated for oral, pulmonary or other delivery routes), and determining its effectiveness.

Suitable water soluble polymers include, but are not limited to, polyethylene glycol, copolymers of ethylene glycol/propylene glycol, carboxymethylcellulose, dextran, polyvinyl alcohol, polyvinyl pyrrolidone, poly-1,3-dioxolane, poly-1,3,6-trioxane, ethylene/maleic anhydride copolymer, polyaminoacids (either homopolymers or random copolymers), and dextran or poly(n-vinyl pyrrolidone)polyethylene glycol, propropylene glycol homopolymers, polypropylene oxide/ethylene oxide co-polymers, polyoxyethylated polyols (e.g., glycerol), polyvinyl alcohol, and mixtures thereof. Polyethylene glycol propionaldehyde may have advantages in manufacturing due to its stability in water.

The polymer may be of any molecular weight, and may be branched or unbranched. For polyethylene glycol, the preferred molecular weight is between about 2 kDa and about 100 kDa for ease in handling and manufacturing (the term "about" indicating that in preparations of polyethylene glycol, some molecules will weigh more, some less, than the stated molecular weight). Other sizes may be used, depending on the desired therapeutic profile (e.g., the duration of sustained release desired, the effects, if any on biological activity, the ease in handling, the degree or lack of antigenicity and other known effects of polyethylene glycol on a therapeutic protein or variant).

The number of polymer molecules so attached may vary, and one skilled in the art will be able to ascertain the effect on function. One may mono-derivatize, or may provide for a di-, tri-, tetra- or some combination of derivatization, with the same or different chemical moieties (e.g., polymers, such as different weights of polyethylene glycols). The proportion of polymer molecules to protein (or peptide) molecules will vary, as will their concentrations in the reaction mixture. In general, the optimum ratio (in terms of efficiency of reaction in that there is no excess unreacted protein or polymer) will be determined by factors such as the desired degree of derivatization (e.g., mono, di-, tri-, etc.), the molecular weight of the polymer selected, whether the polymer is branched or unbranched, and the reaction conditions.

The polyethylene glycol molecules (or other chemical moieties) should be attached to the protein with consideration of effects on functional or antigenic domains of the protein. There are a number of attachment methods available to those skilled in the art. See for example, EP 0 401 384, the disclosure of which is hereby incorporated by reference (coupling PEG to G-CSF), see also Malik et al., Exp. Hematol. 20:1028-1035 (1992) (reporting pegylation of GM-CSF using tresyl chloride). For example, polyethylene glycol may be covalently bound through amino acid residues via a reactive group, such as, a free amino or carboxyl group. Reactive groups are those to which an activated polyethylene glycol molecule may be bound. The amino acid residues having a free amino group may include lysine residues and the N-terminal amino acid residue. Those having a free carboxyl group may include aspartic acid residues, glutamic acid residues, and the C-terminal amino acid residue. Sulfhydryl groups may also be used as a reactive group for attaching the polyethylene glycol molecule(s). For therapeutic purposes, attachment at an amino group, such as attachment at the N-terminus or lysine group is preferred. Attachment at residues important for receptor binding should be avoided if receptor binding is desired.

One may specifically desire an N-terminal chemically modified protein. Using polyethylene glycol as an illustration of the present compositions, one may select from a variety of polyethylene glycol molecules (by molecular weight, branching, etc.), the proportion of polyethylene glycol molecules to protein (or peptide) molecules in the reaction mix, the type of pegylation reaction to be performed, and the method of obtaining the selected N-terminally pegylated protein. The method of obtaining the N-terminally pegylated preparation (i.e., separating this moiety from other monopegylated moieties if necessary) may be by purification of the N-terminally pegylated material from a population of pegylated protein molecules. Selective N-terminal chemical modification may be accomplished by reductive alkylation which exploits differential reactivity of different types of primary amino groups (lysine versus the N-terminal) available for derivatization in a particular protein. Under the appropriate reaction conditions, substantially selective derivatization of the protein at the N-terminus with a carbonyl group containing polymer is achieved. For example, one may selectively N-terminally pegylate the protein by performing the reaction at a pH which allows one to take advantage of the pKa differences between the e-amino group of the lysine residues and that of the a-amino group of the N-terminal residue of the protein. By such selective derivatization, attachment of a water soluble polymer to a protein is controlled: the conjugation with the polymer takes place predominantly at the N-terminus of the protein and no significant modification of other reactive groups, such as the lysine side chain amino groups, occurs. Using reductive alkylation, the water soluble polymer may be of the type described above, and should have a single reactive aldehyde for coupling to the protein. Polyethylene glycol propionaldehyde, containing a single reactive aldehyde, may be used.

The present invention contemplates use of derivatives which are prokaryote-expressed growth factor, or variants thereof, linked to at least one polyethylene glycol molecule, as well as use of growth factor, or variants thereof, attached to one or more polyethylene glycol molecules via an acyl or alkyl linkage.

Pegylation may be carried out by any of the pegylation reactions known in the art. See, for example: Focus on Growth Factors, 3 (2):4-10 (1992); EP 0 154 316, the disclosure of which is hereby incorporated by reference in its entirety; EP 0 401 384, the disclosure of which is hereby incorporated by reference in its entirety; and the other publications cited herein that relate to pegylation, the disclosures of which are incorporated herein by reference in their entirety. The pegylation may be carried out via an acylation reaction or an alkylation reaction with a reactive polyethylene glycol molecule (or an analogous reactive water-soluble polymer).

Pegylation by acylation generally involves reacting an active ester derivative of polyethylene glycol (PEG) with the growth factor or variant. Any known or subsequently discovered reactive PEG molecule may be used to carry out the pegylation of growth factor protein or variant. A preferred activated PEG ester is PEG esterified to N-hydroxysuccinimide ("NITS"). As used herein, "acylation" is contemplated to include without limitation the following types of linkages between the therapeutic protein and a water soluble polymer such as PEG: amide, carbamate, urethane, and the like. See Bioconjugate Chem., 5:133-140 (1994), incorporated herein by reference in its entirety. Reaction conditions may be selected from any of those known in the pegylation art or those subsequently developed, but should avoid conditions such as temperature, solvent, and pH that would inactivate the growth factor or variant to be modified.

Pegylation by acylation will generally result in a poly-pegylated growth factor protein or variant. Preferably, the connecting linkage will be an amide. Also preferably, the resulting product will be substantially only (e.g., >95%) mono, di- or tri-pegylated. However, some species with higher degrees of pegylation may be formed in amounts depending on the specific reaction conditions used. If desired, more purified pegylated species may be separated from the mixture, particularly unreacted species, by standard purification techniques, including, among others, dialysis, salting-out, ultrafiltration, ion-exchange chromatography, gel filtration chromatography and electrophoresis.

Pegylation by alkylation generally involves reacting a terminal aldehyde derivative of PEG with the growth factor protein or variant in the presence of a reducing agent. Pegylation by alkylation can also result in poly-pegylated growth factor protein or variant. In addition, one can manipulate the reaction conditions to favor pegylation substantially only at the a-amino group of the N-terminus of the growth factor protein or variant (i.e., a mono-pegylated protein). In either case of monopegylation or polypegylation, the PEG groups are preferably attached to the protein via a --CH2-NH-- group. With particular reference to the --CH2- group, this type of linkage is referred to herein as an "alkyl" linkage.

Derivatization via reductive alkylation to produce a monopegylated product exploits differential reactivity of different types of primary amino groups (lysine versus the N-terminal) available for derivatization. The reaction is performed at a pH which allows one to take advantage of the pKa differences between the e-amino groups of the lysine residues and that of the a-amino group of the N-terminal residue of the protein. By such selective derivatization, attachment of a water soluble polymer that contains a reactive group such as an aldehyde, to a protein is controlled: the conjugation with the polymer takes place predominantly at the N-terminus of the protein and no significant modification of other reactive groups, such as the lysine side chain amino groups, occurs. In one important aspect, the present invention contemplates use of a substantially homogeneous preparation of monopolymer/growth factor protein (or variant) conjugate molecules (meaning growth factor protein or variant to which a polymer molecule has been attached substantially only (i.e., >95%) in a single location). More specifically, if polyethylene glycol is used, the present invention also encompasses use of pegylated growth factor protein or variant lacking possibly antigenic linking groups, and having the polyethylene glycol molecule directly coupled to the growth factor protein or variant.

Thus, presently preferred growth factor protein products according to the present invention are pegylated growth factor protein or variants, wherein the PEG group(s) is (are) attached via acyl or alkyl groups. As discussed above, such products may be mono-pegylated or poly-pegylated (e.g., containing 2-6, and preferably 2-5, PEG groups). The PEG groups are generally attached to the protein at the a- or e-amino groups of amino acids, but it is also contemplated that the PEG groups could be attached to any amino group attached to the protein, which is sufficiently reactive to become attached to a PEG group under suitable reaction conditions.

The polymer molecules used in both the acylation and alkylation approaches may be selected from among water soluble polymers as described above. The polymer selected should be modified to have a single reactive group, such as an active ester for acylation or an aldehyde for alkylation, preferably, so that the degree of polymerization may be controlled as provided for in the present methods. An exemplary reactive PEG aldehyde is polyethylene glycol propionaldehyde, which is water stable, or mono C1-C10 alkoxy or aryloxy derivatives thereof (see, U.S. Pat. No. 5,252,714, incorporated herein by reference in its entirety). The polymer may be branched or unbranched. For the acylation reactions, the polymer(s) selected should have a single reactive ester group. For the present reductive alkylation, the polymer(s) selected should have a single reactive aldehyde group. Generally, the water soluble polymer will not be selected from naturally-occurring glycosyl residues since these are usually made more conveniently by mammalian recombinant expression systems. The polymer may be of any molecular weight, and may be branched or unbranched.

A particularly preferred water-soluble polymer for use herein is polyethylene glycol. As used herein, polyethylene glycol is meant to encompass any of the forms of PEG that have been used to derivatize other proteins, such as mono- (C1-C10) alkoxy- or aryloxy-polyethylene glycol.

In general, chemical derivatization may be performed under any suitable condition used to react a biologically active substance with an activated polymer molecule. Methods for preparing pegylated growth factor protein or variant will generally comprise the steps of (a) reacting a growth factor protein or variant with polyethylene glycol (such as a reactive ester or aldehyde derivative of PEG) under conditions whereby the protein becomes attached to one or more PEG groups, and (b) obtaining the reaction product(s). In general, the optimal reaction conditions for the acylation reactions will be determined case-by-case based on known parameters and the desired result. For example, the larger the ratio of PEG:protein, the greater the percentage of poly-pegylated product.

Reductive alkylation to produce a substantially homogeneous population of mono-polymer/growth factor protein (or variant) conjugate molecule will generally comprise the steps of: (a) reacting a growth factor protein or variant with a reactive PEG molecule under reductive alkylation conditions, at a pH suitable to permit selective modification of the a-amino group at the amino terminus of said growth factor protein or variant; and (b) obtaining the reaction product(s).

For a substantially homogeneous population of mono-polymer/growth factor protein (or variant) conjugate molecules, the reductive alkylation reaction conditions are those which permit the selective attachment of the water soluble polymer moiety to the N-terminus of growth factor protein or variant. Such reaction conditions generally provide for pKa differences between the lysine amino groups and the a-amino group at the N-terminus (the pKa being the pH at which 50% of the amino groups are protonated and 50% are not). The pH also affects the ratio of polymer to protein to be used. In general, if the pH is lower, a larger excess of polymer to protein will be desired (i.e., the less reactive the N-terminal a-amino group, the more polymer needed to achieve optimal conditions). If the pH is higher, the polymer:protein ratio need not be as large (i.e., more reactive groups are available, so fewer polymer molecules are needed). For purposes of the present invention, the pH will generally fall within the range of 3-9, preferably 3-6.

Another important consideration is the molecular weight of the polymer. In general, the higher the molecular weight of the polymer, the fewer polymer molecules may be attached to the protein. Similarly, branching of the polymer should be taken into account when optimizing these parameters. Generally, the higher the molecular weight (or the more branches) the higher the polymer:protein ratio. In general, for the pegylation reactions contemplated herein, the preferred average molecular weight is about 2 kDa to about 100 kDa. The preferred average molecular weight is about 5 kDa to about 50 kDa, particularly preferably about 12 kDa to about 25 kDa. The ratio of water-soluble polymer to GDNF protein or variant will generally range from 1:1 to 100:1, preferably (for polypegylation) 1:1 to 20:1 and (for monopegylation) 1:1 to 5:1.

Using the conditions indicated above, reductive alkylation will provide for selective attachment of the polymer to any growth factor protein or variant having an a-amino group at the amino terminus, and provide for a substantially homogenous preparation of monopolymer/growth factor protein (or variant) conjugate. The term "monopolymer/growth factor protein (or variant) conjugate" is used here to mean a composition comprised of a single polymer molecule attached to a molecule of growth factor protein or growth factor variant protein. The monopolymer/growth factor protein (or variant) conjugate preferably will have a polymer molecule located at the N-terminus, but not on lysine amino side groups. The preparation will preferably be greater than 90% monopolymer/growth factor protein (or variant) conjugate, and more preferably greater than 95% monopolymer/growth factor protein (or variant) conjugate, with the remainder of observable molecules being unreacted (i.e., protein lacking the polymer moiety).

For the present reductive alkylation, the reducing agent should be stable in aqueous solution and preferably be able to reduce only the Schiff base formed in the initial process of reductive alkylation. Preferred reducing agents may be selected from sodium borohydride, sodium cyanoborohydride, dimethylamine borane, trimethylamine borane and pyridine borane. A particularly preferred reducing agent is sodium cyanoborohydride. Other reaction parameters, such as solvent, reaction times, temperatures, etc., and means of purification of products, can be determined case-by-case based on the published information relating to derivatization of proteins with water soluble polymers (see the publications cited herein).

Growth Factor Pharmaceutical Compositions

Growth factor pharmaceutical compositions typically include a therapeutically effective amount of a growth factor protein product in admixture with one or more pharmaceutically and physiologically acceptable formulation materials. Suitable formulation materials include, but are not limited to, antioxidants, preservatives, coloring, diluting agents, emulsifying agents, suspending agents, solvents, fillers, bulking agents, buffers, delivery vehicles, diluents, and excipients. For example, a suitable vehicle may include water, physiological saline solution, or artificial CSF, possibly supplemented with other materials. Neutral buffered saline or saline mixed with serum albumin are further exemplary vehicles.

Once the therapeutic composition has been formulated, it may be stored in sterile vials as a solution, suspension, gel, emulsion, solid, or dehydrated or lyophilized powder. Such formulations may be stored either in a ready to use form or in a form, e.g. lyophilized, requiring reconstitution prior to administration.

The optimal pharmaceutical formulation will be determined by one skilled in the art. See for example, Remington's Pharmaceutical Sciences, 18th Ed. (1990, Mack Publishing Co., Easton, Pa. 18042) pages 1435-1712, the disclosure of which is hereby incorporated by reference. The final dosage regimen involved in a method for treating the above-described conditions will be determined by the attending physician, considering various factors which modify the action of drugs, e.g. the age, condition, body weight, sex and diet of the patient, the severity of any infection, time of administration and other clinical factors. As studies are conducted, further information will emerge regarding the appropriate dosage levels for the treatment of various diseases and conditions.

The pharmaceutical composition can typically include an effective amount of the respective growth factor in combination with a pharmaceutically acceptable carrier and, in addition, may include other medicinal agents, pharmaceutical agents, carriers, diluents, etc. By "pharmaceutically acceptable" is meant a material that is not biologically or otherwise undesirable, i.e., the material may be administered to an individual along with the selected agent without causing any undesirable biological effects or interacting in a deleterious manner with any of the other components of the pharmaceutical composition in which it is contained.

In a preferred embodiment, growth factor is selected from the group consisting of NGF, BDNF, NT-3, NT-4/5, NT-6, GDNF, CNTF, LIF, IGF-1, b-FGF, neurturin, persephin, artemin, TGFa, TGFb, IGF-2, PDGF, EGF, cardiotropin, EGF, IGF, VEGF, Sonic hedgehog (SHH), BMPs, FGF20, VIP, PDGF, pleiotrophin (PTN), and HGF.

In a preferred embodiment, a pharmaceutical composition of the invention is locally deliverable into the mammalian CNS by CED.

In a preferred embodiment, the pharmaceutical composition comprises a tracing agent.

A tracing agent preferably comprises a paramagnetic ion for use with MRI. Suitable metal ions include those having atomic numbers of 22-29 (inclusive), 42, 44 and 58-70 (inclusive) and have oxidation states of +2 or +3. Examples of such metal ions are chromium (III), manganese (II), iron (II), iron (III), cobalt (II), nickel (II), copper (II), praseodymium (III), neodymium (III), samarium (III), gadolinium (III), terbium (III), dysprosium (III), holmium (III), erbium (III) and ytterbium (III).

In a preferred embodiment, the tracing agent comprises an MRI magnet that may be used in conjunction with MRI to monitor distribution of infused pharmaceutical composition.

In a preferred embodiment, the MRI magnet is gadolinium chelate.

In a preferred embodiment, the tracing agent comprises a liposome, which comprises an MRI magnet. In a preferred embodiment, the MRI magnet is gadolinium chelate.

In embodiments wherein X-ray imaging (such as CT) is used to monitor CED, the tracer may comprise a radiopaque material. Suitable radiopaque materials are well known and include iodine compounds, barium compounds, gallium compounds, thallium compounds, and the like. Specific examples of radiopaque materials include barium, diatrizoate, ethiodized oil, gallium citrate, iocarmic acid, iocetamic acid, iodamide, iodipamide, iodoxamic acid, iogulamide, iohexol, iopamidol, iopanoic acid, ioprocemic acid, iosefamic acid, ioseric acid, iosulamide meglumine, iosumetic acid, iotasul, iotetric acid, iothalamic acid, iotroxic acid, ioxaglic acid, ioxotriroic acid, ipodate, meglumine, metrizamide, metrizoate, propyliodone, and thallous chloride.

In a preferred embodiment, the pharmaceutical composition comprises a facilitating agent. A facilitating agent is capable of facilitating the delivery of growth factor to target tissue, preferably when both facilitating agent and growth factor are delivered by CED. In a preferred embodiment, a facilitating agent is a biomolecule that is efficiently cleared from tissue. In a preferred embodiment, a facilitating agent has a short half life relative to growth factor. In a preferred embodiment, a facilitating agent is capable of competing with growth factor for binding to growth factor binding sites in brain parenchyma, which binding sites are other than cognate growth factor receptors. For additional description of facilitating agents, see U.S. 2002/0114780.

An especially preferred facilitating agent for use in the present invention is low molecular weight heparin. Low molecular weight heparin (LMW Hep) efficiently enhances the volume of distribution of infused GDNF, has a broad therapeutic window, and is safer than high molecular weight heparin (which may cause hemorrhage at same dose). When LMW Hep (1 microgram/microliter) with GDNF is infused a large improvement of the GDNF distribution is seen (FIGS. 1 and 2 (see Original Patent)). High molecular weight heparin is an unfractionated form with a molecular weight range of 5,000-35,000 daltons

High Molecular Weight Neurotherapeutics

In one embodiment, growth factors are provided as high molecular weight neurotherapeutics. High molecular weight neurotherapeutic compositions of the invention comprise a growth factor and a carrier. In one aspect, the invention provides pharmaceutical compositions comprising high molecular weight neurotherapeutics. Further regarding high molecular weight neurotherapeutics, see U.S. provisional patent application Ser. No. 60/795,371 filed on Apr. 26, 2006, incorporated herein by reference in its entirety, and U.S. provisional patent application Ser. No. 60/900,492 filed on Feb. 9, 2007, incorporated herein by reference in its entirety.

High molecular weight neurotherapeutics of the invention have a molecular weight greater than about 200 kDa, more preferably greater than about 500 kDa, more preferably greater than about 1000 kDa, more preferably greater than about 1500 kDa, more preferably greater than about 2000 kDa, more preferably greater than about 2500 kDa, more preferably greater than about 3000 kDa, more preferably greater than about 3500 kDa, more preferably greater than about 4000 kDa, more preferably greater than about 4500 kDa, more preferably greater than about 5000 kDa, more preferably greater than about 5500 kDa, more preferably greater than about 6000 kDa, more preferably greater than about 6500 kDa, more preferably greater than about 7000 kDa, more preferably greater than about 7500 kDa, more preferably greater than about 8000 kDa, more preferably greater than about 8500 kDa, more preferably greater than about 9000 kDa, more preferably greater than about 9500 kDa, more preferably greater than about 10000 kDa.

In one embodiment, a high molecular weight neurotherapeutic of the invention has a diameter or length greater than about 10 nm, more preferably greater than about 20 nm, more preferably greater than about 30 nm, more preferably greater than about 40 nm, more preferably greater than about 50 nm, more preferably greater than about 60 nm, more preferably greater than about 70 nm, more preferably greater than about 80 nm, more preferably greater than about 90 nm, more preferably greater than about 100 nm, more preferably greater than about 110 nm, more preferably greater than about 120 nm. In some embodiments, a high molecular weight neurotherapeutic of the invention has a diameter or length greater than about 130 nm, or greater than about 140 nm, or greater than about 150 nm, or greater than about 160 nm, or greater than about 170 nm, or greater than about 180 nm, or greater than about 190 nm, or greater than about 200 nm.

In one embodiment, the carrier is a synthetic carrier.

A wide variety of synthetic carriers are available for use in the high molecular weight neurotherapeutics of the invention. In a preferred embodiment, the carrier is a liposome. In another preferred embodiment, the carrier is a metal particle, such as a gold particle, or a polymer. Regarding carriers, see, for example, Felgner et al., Ann N Y Acad Sci. 1995 November 27; 772:126-39; Ramsay et al., Curr Drug Deliv. 2005 October; 2(4):341-51; Allen et al., Anticancer Agents Med Chem. 2006 November; 6(6):513-23; Mitra et al., Curr Pharm Des. 2006; 12(36):4729-49, each of which is incorporated herein by reference in its entirety.

In one embodiment, the carrier is a naturally occurring composition or variant thereof. Examples of such carriers include virus particles, including modified virus particles (e.g., those having a modified surface protein profile). For example, see de Jonge, et al., Gene Therapy (2006) 13, 400-411, expressly incorporated herein in its entirety by reference.

In one embodiment, the high molecular weight neurotherapeutic is larger than an AAV virus.

In one embodiment, the high molecular weight neurotherapeutic has a higher molecular weight than an AAV virus.

In one embodiment, the high molecular weight neurotherapeutic comprises a carrier other than AAV.
 

Claim 1 of 19 Claims

1. A method of treating a human patient having Parkinson's disease, comprising: administering to the putamen of said patient a therapeutically effective amount of a pharmaceutical composition comprising a growth factor that promotes the survival of dopaminergic neurons; wherein said growth factor is administered by intermittent convection enhanced delivery (CED) at a rate that counters the tissue clearance rate of said growth factor, wherein there is cessation of growth factor delivery during the intermissions between administrations, wherein the intermissions between administration of said growth factor are at least about one week; wherein said human patient is treated for Parkinson's disease.
 

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