U.S. patent application number 11/929031 was filed with the patent office on 2008-07-10 for methods and compositions for healing and repair of articular cartilage.
This patent application is currently assigned to Wyeth. Invention is credited to Elisabeth Morris, Diane Peluso, Renwen Zhang.
Application Number | 20080167237 11/929031 |
Document ID | / |
Family ID | 28456633 |
Filed Date | 2008-07-10 |
United States Patent
Application |
20080167237 |
Kind Code |
A1 |
Zhang; Renwen ; et
al. |
July 10, 2008 |
METHODS AND COMPOSITIONS FOR HEALING AND REPAIR OF ARTICULAR
CARTILAGE
Abstract
Methods and compositions are provided for the treatment of
articular cartilage defects and disease involving the combination
of tissue, such as osteochondral grafts, with active growth factor.
The active growth factor is preferably a composition containing at
least one bone morphogenetic protein and a suitable carrier. The
method results in the regeneration of functional repair of
articular cartilage tissue.
Inventors: |
Zhang; Renwen; (Rutherford,
NJ) ; Peluso; Diane; (Marshfield, MA) ;
Morris; Elisabeth; (Sherborn, MA) |
Correspondence
Address: |
WYETH/FINNEGAN HENDERSON, LLP
901 NEW YORK AVENUE, NW
WASHINGTON
DC
20001-4413
US
|
Assignee: |
Wyeth
|
Family ID: |
28456633 |
Appl. No.: |
11/929031 |
Filed: |
October 30, 2007 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10779638 |
Feb 18, 2004 |
7323445 |
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11929031 |
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09493545 |
Jan 28, 2000 |
6727224 |
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10779638 |
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60118160 |
Feb 1, 1999 |
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Current U.S.
Class: |
514/8.8 ;
514/16.5; 514/16.8; 514/17.1; 514/9.4 |
Current CPC
Class: |
A61K 38/1875 20130101;
A61P 19/00 20180101; A61P 19/04 20180101; A61K 38/00 20130101; C07K
14/51 20130101; A61L 27/3612 20130101; A61L 27/227 20130101; A61L
27/3654 20130101; A61L 27/3608 20130101; A61P 19/02 20180101; A61L
2430/06 20130101 |
Class at
Publication: |
514/12 |
International
Class: |
A61K 38/18 20060101
A61K038/18; A61P 19/00 20060101 A61P019/00 |
Claims
1-14. (canceled)
15. A method for regenerating articular cartilage comprising
administering to an area in need of regeneration of articular
cartilage a composition consisting essentially of (i) cultured
chondrocytic cells, and (ii) at least one purified bone
morphogenetic protein (BMP) in an amount effective for the
regeneration of articular cartilage.
16. The method of claim 15, wherein the chondrocytic cells are
chondrocytes.
17. The method of claim 16, wherein the chondrocytic cells are stem
cells.
18. The method of claim 15, wherein the BMP is selected from the
group consisting of BMP-2, BMP-4, BMP-6, BMP-7, BMP-12, BMP-13, and
heterodimers and mixtures thereof.
19. The method of claim 18, further comprising administering to the
area in need of articular cartilage regeneration a protein that
induces the formation of tendon or ligament tissue selected from
the group consisting of BMP-12, BMP-13, MP-52, and heterodimers
and/or mixtures thereof.
20. The method of claim 15, wherein the BMP is BMP-2.
21. The method of claim 15, wherein the BMP is a heterodimeric
protein comprising one subunit of BMP-2 and one subunit of
BMP-6.
22. A method for regeneration of articular cartilage comprising
administering to an area in need of regeneration of articular
cartilage a composition consisting essentially of (i) cultured
chondrocytic cells; (ii) at least one purified bone morphogenetic
protein (BMP) selected from the group consisting of BMP-2, 4, 5, 6,
7, and heterodimers and mixtures thereof, in an amount effective
for the regeneration of articular cartilage; and (iii) at least one
pharmaceutical carrier material selected from the group consisting
of hyaluronic acid, surgical mesh, surgical suture, polyglyconate,
temperature-sensitive polymers, demineralized bone, calcium
phosphate, ceramic hydroxyapatite, and combinations thereof.
23. A method for regeneration of articular cartilage comprising
administering to an area in need of regeneration of articular
cartilage a composition consisting essentially of cultured
chondrocytic cells and at least one purified bone morphogenetic
protein (BMP) selected from the group consisting of BMP-2, 4, 5, 6,
7, and heterodimers and mixtures thereof, in an amount effective
for the regeneration of articular cartilage, wherein the bone
morphogenetic protein is also applied directly to the site in need
of tissue repair in conjunction with the composition.
24. A method for regeneration of articular cartilage comprising
administering to an area in need of regeneration of articular
cartilage a composition consisting essentially of cultured
chondrocytic cells and at least one purified bone morphogenetic
protein (BMP) selected from the group consisting of BMP-2, 4, 5, 6,
and 7, and heterodimers and mixtures thereof, in an amount
effective for the regeneration of articular cartilage, wherein the
area in need of regeneration of articular cartilage is selected
from the group consisting of the hip and the knee.
25. A method for regeneration of articular cartilage comprising
administering to an area in need of regeneration of articular
cartilage a composition consisting essentially of cultured
chondrocytic cells and a heterodimeric protein in an amount
effective for the regeneration of articular cartilage, wherein the
heterodimeric protein comprises one purified bone morphogenetic
protein (BMP) selected from the group consisting of BMP-2, 4, 5, 6,
and 7 and one protein that induces the formation of tendon or
ligament tissue selected from the group consisting of BMP-12,
BMP-13, and MP-52.
Description
FIELD OF THE INVENTION
[0001] The present invention relates to the field of tissue repair,
specifically, the regeneration of stable and functional articular
cartilage repair. Thus, the present invention may be useful in
reconstructive surgery or other procedures for the regeneration or
repair of articular cartilage.
BACKGROUND OF THE INVENTION
[0002] The repair of articular cartilage injuries remains a
challenge in present day orthopedics. Several of the current
therapeutic strategies are based upon the grafting of chondral and
osteochondral tissues. Autologous osteochondral grafting provides
the most appropriate physiological material. However, donor tissue
is limited, and often requires surgery at a secondary site in order
to harvest tissue for transplant. Accordingly, despite substantial
endeavors in this field, there remains a need for an effective
method of repair of articular cartilage defects and injuries which
provides appropriate physiological repair without the need to
collect autologous tissue from the patient.
SUMMARY OF THE INVENTION
[0003] The present invention provides methods and compositions for
regenerating functional and physiologically appropriate tissue
repair for the repair of articular cartilage injuries and defects.
In particular, the present invention comprises methods of treating
patients with articular cartilage injuries or defects. The methods
and compositions of the present invention are advantageous in that
they utilize bone morphogenetic proteins (BMPs), which are known to
have osteogenic and/or chondrogenic properties, and which may be
produced via recombinant DNA technology, and therefore are of
potentially unlimited supply. The methods and compositions of the
present invention are further advantageous in that regeneration of
functional articular cartilage may be accelerated or may be of
greater ultimate strength and stability, and the tissue formed at
the site of the defect or injury is physiologically
appropriate.
[0004] The use of BMP to augment the repair of articular cartilage
defects and injuries may result in better methods for treatment of
osteoarthritis, thus obviating, delaying or reducing the need for
artificial hip replacements and other common interventions.
Preclinical evaluations indicate that rhBMP-2 improves early
healing of full thickness defects of articular cartilage in
rabbits.
DETAILED DESCRIPTION OF THE INVENTION
[0005] According to the present invention, methods and compositions
are provided for treatment of patients who suffer from some form of
articular cartilage injury or defect. The injury may be the result
of acute stress, or injury, such as resulting from participation in
athletics, or from accidental occurrences which tear, mar or
otherwise injure the articular cartilage.
[0006] The methods and composition are advantageous in that repair
or improvement of articular cartilage defects, particularly full
thickness articular cartilage defects. Other- defects may also be
treated by the methods and compositions of the present invention,
particularly with an additional procedure in which the site of the
defect is further aggravated so as to reach the underlying
subchondral bone.
[0007] In the present invention, active growth factor, such as a
BMP, is added to a suitable tissue source. The tissue source may be
an osteochondral graft, either autologous to the patient, or may
comprise allograft or artificially prepared tissue. In a preferred
embodiment, the tissue source may be chondrocytic cell cultures,
such as chondrocyte or stem cell cultures which have been prepared
through ex vivo cell culture methods, with or without additional
growth factors. For example, see the disclosure of U.S. Pat. No.
5,226,914; U.S. Pat. No. 5,811,094; U.S. Pat. No. 5,053,050; U.S.
Pat. No. 5,486,359; U.S. Pat. No. 5,786,217 and U.S. Pat. No.
5,723,331. The disclosures of all of these applications are hereby
incorporated herein by reference.
[0008] The tissue may also be harvested by traditional non-cell
culture based means, using techniques such as mosaicplasty, in
which cartilage is harvested using commercially available
instruments such as Acufex7 [Smith and Nephew, Inc., Andover
Mass.]; COR System [Innovasive Technologies, Marlborough Mass.]; or
Arthrex7 Osteochondral Autograft Transfer System [Arthrex, Munich,
Germany]. The tissue harvested may be applied directly in the
methods of the present invention, or may be combined with the
tissue based cell culture systems described above.
Growth Factor
[0009] The active growth factor used in the present invention is
preferably from the subclass of proteins known generally as bone
morphogenetic proteins (BMPs), which have been disclosed to have
osteogenic, chondrogenic and other growth and differentiation type
activities. These BMPs include rhBMP-2, rhBMP-3, rhBMP4 (also
referred to as rhBMP-2B), rhBMP-5, rhBMP-6, rhBMP-7 (rhOP-1),
rhBMP-8, rhBMP-9, rhBMP-12, rhBMP-13, rhBMP-15, rhBMP-16, rhBMP-17,
rhBMP-18, rhGDF-1, rhGDF-3, rhGDF-5, rhGDF-6, rhGDF-7, rhGDF-8,
rhGDF-9, rhGDF-10, rhGDF-11, rhGDF-12, rhGDF-14. For example,
BMP-2, BMP-3, BMP-4, BMP-5, BMP-6 and BMP-7, disclosed in U.S. Pat.
Nos. 5,108,922; 5,013,649; 5,116,738; 5,106,748; 5,187,076; and
5,141,905; BMP-8, disclosed in PCT publication WO91/18098; and
BMP-9, disclosed in PCT publication WO93/00432, BMP-10, disclosed
in U.S. Pat. No. 5,637,480; BMP-11, disclosed in U.S. Pat. No.
5,639,638, or BMP-12 or BMP-13, disclosed in U.S. Pat. No.
5,658,882, BMP-15, disclosed U.S. Pat. No. 5,635,372 and BMP-16,
disclosed in co-pending patent application Ser. No. 08/715,202.
Other compositions which may also be useful include Vgr-2, and any
of the growth and differentiation factors [GDFs], including those
described in PCT applications WO94/15965; WO94/15949; WO95/01801;
WO95/01802; WO94/21681; WO94/15966; WO95/10539; WO96/01845;
WO96/02559 and others. Also useful in the present invention may be
BIP, disclosed in WO94/01557; HP00269, disclosed in JP Publication
number: 7-250688; and MP52, disclosed in PCT application
WO93/16099. The disclosures of all of these applications are hereby
incorporated herein by reference. Also useful in the present
invention are heterodimers of the above and modified proteins or
partial deletion products thereof. These proteins can be used
individually or in mixtures of two or more, and rhBMP-2 is
preferred.
[0010] The BMP may be recombinantly produced, or purified from a
protein composition. The BMP may be homodimeric, or may be
heterodimeric with other BMPs (e.g., a heterodimer composed of one
monomer each of BMP-2 and BMP-6) or with other members of the
TGF-.beta. superfamily, such as activins, inhibins and TGF-.beta.1
(e.g., a heterodimer composed of one monomer each of a BMP and a
related member of the TGF-.beta. superfamily). Examples of such
heterodimeric proteins are described for example in Published PCT
Patent Application WO 93/09229, the specification of which is
hereby. incorporated herein by reference. The amount of osteogenic
protein useful herein is that amount effective to stimulate
increased osteogenic activity of infiltrating progenitor cells, and
will depend upon the size and nature of the defect being treated,
as well as the carrier being employed. Generally, the amount of
protein to be delivered is in a range of from about 0.05 to about
1.5 mg.
[0011] In a preferred embodiment, the osteogenic protein is
administered together with an effective amount of a protein which
is able to induce the formation of tendon- or ligament-like tissue.
Such proteins, include BMP-12, BMP-13, and other members of the
BMP-12 subfamily, as well as MP52. These proteins and their use for
regeneration of tendon and ligament-like tissue are disclosed in
U.S. application serial number Ser. No. 08/362,670, filed on Dec.
22, 1994, the disclosure of which is hereby incorporated herein by
reference. In another preferred embodiment, a heterodimer in which
one monomer unit is an osteogenic protein such as BMP-2, and the
other monomer subunit is a tendon-inducing protein, such as BMP-12,
is administered in accordance with the methods described below, in
order to induce the formation of a functional attachment between
connective tissue and bone.
Application of Growth Factor
[0012] Growth factor may be applied to the tissue source in the
form of a buffer solution. One preferred buffer solution is a
composition comprising, in addition to the active growth factor,
about 1.0 to about 10.0% (w/v) glycine, about 0.1 to about 5.0%
(w/v) of a sugar, preferably sucrose, about 1 to about 20 mM
glutamic acid hydrochloride, and optionally about 0.01 to about
0.1% of a non-ionic surfactant, such as polysorbate 80. Preferred
solutions are from about 1% to about 20% w/v cellulosic
carrier/buffer. If desired, a salt may be added.
[0013] Other materials which may be suitable for use in application
of the growth factors in the methods and compositions of the
present invention include hyaluronic acid, surgical mesh or
sutures, polyglyconate, temperature-sensitive polymers,
demineralized bone, minerals and ceramics, such as calcium
phosphates, hydroxyapatite, etc., as well as combinations of the
above described materials. In the preferred embodiment of the
present invention, however, no carrier is employed.
[0014] The growth factor of the present invention, in a suitable
buffer such as that described above, or combined with a suitable
carrier, may be applied directly to the tissue and/or to the site
in need of tissue repair. For example, the growth factor may be
physically applied to the tissue through spraying or dipping, or
using a brush or other suitable applicator, such as a syringe for
injection. Alternatively, or in conjunction, the protein may be
directly applied to the site in need of tissue repair.
[0015] The following examples further describe the practice of
embodiments of the invention with BMP-2. The examples are not
limiting, and as will be appreciated by those skilled in the art,
can be varied in accordance with the above specification.
EXAMPLES
I. Rabbit Allograft
[0016] All procedures were carried out with approval from IACUC.
Twelve male New Zealand white rabbits (6 months old) were used. Two
rabbits served as donors and 10 as recipients. Osteochondral grafts
(3.5 mm diameter) were harvested from the trochlear groove or the
medial femoral condyle of the donors, and transplanted into a 3.5
mm deep defect in the trochlear groove of the recipient. The graft
was bathed in either rhBMP-2 (0.5 mg/ml) or buffer control prior to
implantation. The rabbits were sacrificed 4 weeks after surgery and
the transplants and surrounding tissue were evaluated by a
histologic-histochemical grading scale, as described in Sellers et
al., J. Bone Joint Surg., 79-A: 1452-1463 (1997). Computerized
image analysis of histologic sections was also performed. Results
were evaluated using the unpaired Students t-test.
[0017] On gross examination, the joints showed no signs of
inflammation. All the defects were filled by repair tissue. The
surface appearance of the defects was variable but acceptable and
did not correlate with form of treatment. Osteophytes were found in
3 joints (2 in the experimental group; 1 in control buffer
group).
[0018] There was no correlation between the gross and histologic
appearance in any of the defects. The presence of chondrocytes in
the lacunae and sporadic cloning of cells in the donor cartilage
indicated survival of the tissue. Focal degeneration of the donor
cartilage was present in all of the control groups, but only one of
the rhBMP-2 treated group. The healing of the defect in the rhBMP-2
treated group was significantly improved compared to that in the
control group. The rhBMP-2 treated group had improved bony
integration indicated by less fibrous repair tissue in the
subchondral bone compartment. Treatment with rhBMP-2 also resulted
in more cartilage above the original tidemark, apparently
consisting of both donor tissue and newly regenerated recipient
cartilage. There was no significant difference in the total amount
of bone observed between the two groups.
TABLE-US-00001 TABLE I HISTOLOGIC SCORE AND HISTOMORPHOMETRIC
MEASUREMENT FOR CARTILAGE REPAIR, MEAN VALUE (SD) Parameter rhBMP-2
Control Average Score** 10.0 (5.42)* 20.6 (5.18) % of bone under
tidemark 73.26 (13.28) 62.88 (18.07) % of fibrous tissue under
tidemark 2.19 (2.04)* 15.81 (9.88) % of cartilage above tidemark
74.70 (41.08)* 18.17 (26.70) % of filing of the defect 96.53
(4.86)* 88.79 (8.04) *Statistically significant difference from
control (p < 0.05). **Scale system ranges from 0 (normal
cartilage) to 31 (no repair).
[0019] Additional histomorphometric analysis data further supports
the beneficial effects of rhBMP-2 on the healing of graft. For
example, the percentage filling of the new tissue above tide marker
has been shown to be 81.52% in a rhBMP-2 treated group vs. 57.63%
in control. There was less graft cartilage degeneration in rhBMP-2
treated group (23.83%) than in control group (44.52%). The
integration of the graft or newly formed cartilage with the host
cartilage was improved by rhBMP-2 treatment (56.48%) compared to
that of control group (21.89%). More new cartilage formed under the
influence of rhBMP-2 either at the edge of graft, which eliminated
the gap between the graft and host, or at the top of graft, which
made the graft more congruent with the joint surface.
[0020] The above results demonstrate that the healing of allogeneic
osteochondral grafts in articular cartilage defects was improved by
the addition of rhBMP-2. The active growth factor may have
accelerated subchondral bone union, providing support and nutrition
to the articular cartilage tissue. Addition of growth factor may
also have stimulated new cartilage formation from recipient
mesenchymal stem cells in the bone marrow and/or the synovial
tissue. These results suggest that the combination of active growth
factor, particularly the bone morphogenetic proteins, and
osteochondral allografts might present a potent strategy for
treatment of articular cartilage defects, particularly full
thickness articular cartilage defects.
II. Rabbit Autograft
[0021] Osteochondral grafts (2.7 mm in diameter and 3.0 mm long)
were harvested from the trochlear groove or femoral condyle and
transplanted into a donor site 2.7 mm wide and 3.5 mm long on the
trochlear groove or femoral condyle of the knee joint in rabbits.
Half the animals had buffer dripped into the recipient site prior
to transplantation, and then the grafts were dipped in buffer for 2
minutes and placed into the recipient site. The other half had 5
.mu.g rhBMP-2 dripped into the recipient site prior to
transplantation, and then the graft was dipped into buffer
containing 500 .mu.g/ml rhBMP-2 for 2 minutes and then transplanted
into the recipient site. The animals were sacrificed 4 weeks after
surgery, and the recipient sites were evaluated histologically
using both a histologic-histochemical grading scale [Sellers, et
al., J. Bone Joint Surg., 79-A: 1452-63 (1997)] and quantitative
computerized image analysis of the tissue. The data indicated that
treatment with rhBMP-2 improved the healing of the autograft. The
most dramatic effects were the reduction of graft cartilage
degeneration (rhBMP-2 8.18% vs. control 36.25%), and more cartilage
formed at the edge of graft (rhBMP-2 88.23% vs. control 50%).)
III. Non-Human Primate Autograft
[0022] The non human primates used for autografts experiments were
cynomologous macaques. Osteochondral grafts (3.5 mm
diameter.times.6 mm long) were harvested from the trochlear groove
of 6 cynomologous macaques and transplanted into recipient sites
drilled into both the medial and lateral femoral condyle of the
same animal (n=12 transplants total). Prior to transplantation 25
.mu.g rhBMP-2 was dripped into 6 recipient sites, and the grafts
from those 6 transplants were dipped into a solution of 1.25 mg/ml
rhBMP-2 for 2 minutes. In the other 6 transplants, buffer alone was
dripped into the recipient sites and the grafts were dipped into
buffer alone for 2 minutes prior to transplantation. The limbs were
immobilized in a cast for 2 weeks post-operatively, and the animals
were sacrificed 9 weeks post operatively.
[0023] All the animals had normal function of their knee joints. On
gross examination, the joints showed no signs of inflammation.
Osteophytes were not found in any joint. Although the surface of
the defects appeared level with the surrounding cartilage on gross
examination, microscopic observation revealed subsidence of the
grafts in most of the cases. The tissue observed grossly covering
the surface was actually new-formed tissue on the top of graft.
Computerized image analysis was performed by a blinded evaluator to
quantitate percent filling of the defect, the new tissue types
formed above the original tide mark, and the integration of the
grafts and the surrounding cartilage. Favorable results were
observed in the rhBMP-2 treated group in all these parameters. More
new cartilage formed between the graft and host cartilage to
eliminate the gap resulting in better integration of the graft with
the surrounding cartilage (rhBMP-2 88.59% vs. control 64.82%). The
filling of the cartilage defect was better in rhBMP-2 treated group
(95.02%) than in the control group (86.68%). There was more fibrous
tissue in the control group (11.90% vs. rhBMP-2 5.65%), while more
transitional tissue was found in the rhBMP-2 treated group (36.38%
vs. control 20.53%). There was no significant difference on the
overall histologic-histochemical score between the two groups.
Peripheral quantitative computered tomography (pQCT) showed that
the bone density increased in the donor sites with time. At 6 weeks
and 9 weeks after the operation, the tissue in the rhBMP-2 treated
donor sites was significantly denser and the healing process was
more advanced compared to control sites. Histologically, the donor
sites contained regenerated bone trabeculae with fibrous tissue at
the surface in all the cases.
IV. rhBMP-2 Retention Ex Vivo
[0025] Retention of rhBMP-2 in osteochondral graft with this
technique was evaluated with the grafts from non-human primates.
The graft was dipped in a mixture solution of .sup.125I labeled
rhBMP-2 and unlabeled rhBMP-2. Results showed that the amount of
rhBMP-2 absorbed to graft was proportional to the concentration of
the protein, and the time of soaking. Other factors, which affect
the retention of rhBMP-2, included the size of graft, and the
presence of marrow elements between trabecular bone.
V. rhBMP-2 Retention Time Course In Vivo
[0026] The time course of rhBMP-2 retention in osteochondral graft
was evaluated in rabbits. A mixture solution of .sup.125I labeled
rhBMP-2 and unlabeled rhBMP-2, which contained 5 ug rhBMP-2 and 20
uCi .sup.125I, was loaded to the graft before implantation. The
animals were scanned with .gamma.-camera during the follow-up time
for 22 days post-operatively. Compared to the time course of
collagen sponge as a carrier, the half time of rhBMP-2 in
osteochondral graft was increased from 1 day to 3 days. The
radioactivity of 10% of the starting point was maintained from 11
days of collagen sponge to 22 days of graft.
VI. Non-Human Primate Allografts
[0027] Donor sites (3.5 mm wide.times.6 mm long) were removed from
the trochlear grooves of 12 adult cynomologous macaques and
transplanted into 3.5.times.6 mm recipient sites in the medial and
lateral femoral condyles of unrelated individuals. Half of the
transplants were soaked in 1.25 mg/ml rhBMP-2 for 2 minutes prior
to transplantation, and half were soaked in buffer. The identical
procedure was performed on the other limb 7 weeks after the first
surgery. The limb was immobilized in a cast for 2 weeks post
operatively after each surgery, and the animals were sacrificed 9
weeks after the second surgery for histologic analysis.
[0028] These results suggest that the combination of active growth
factor, particularly the bone morphogenetic proteins, and
osteochondral autografts might present a potent strategy for
treatment of articular cartilage defects, particularly full
thickness articular cartilage defects.
[0029] In other embodiments BMP-2 may also be applied to frozen
osteochondral allograft for treatment of focal articular cartilage
defect.
[0030] The foregoing descriptions detail presently preferred
embodiments of the present invention. Numerous modifications and
variations in practice thereof are expected to occur to those
skilled in the art upon consideration of these descriptions. Those
modifications and variations are believed to be encompassed within
the claims appended hereto.
* * * * *