U.S. patent application number 12/958600 was filed with the patent office on 2011-04-28 for compositions for imaging pain and stress in vivo.
This patent application is currently assigned to The Board of Trustees of the Leland Stanford Junior University. Invention is credited to Sandip Biswal, Francis G. Blankenberg.
Application Number | 20110097267 12/958600 |
Document ID | / |
Family ID | 38194006 |
Filed Date | 2011-04-28 |
United States Patent
Application |
20110097267 |
Kind Code |
A1 |
Biswal; Sandip ; et
al. |
April 28, 2011 |
COMPOSITIONS FOR IMAGING PAIN AND STRESS IN VIVO
Abstract
Briefly described, embodiments of the present disclosure relate
to methods and compositions for imaging pain and/or stress in a
subject and methods and compositions for treating associated
conditions. In particular, the present disclosure relates to the
use of labeled compounds to provide objective diagnosis of pain
and/or stress, for imaging regions associated with pain and/or
stress, and for treating pain in a subject.
Inventors: |
Biswal; Sandip; (Stanford,
CA) ; Blankenberg; Francis G.; (Portola Valley,
CA) |
Assignee: |
The Board of Trustees of the Leland
Stanford Junior University
Palo Alto
CA
|
Family ID: |
38194006 |
Appl. No.: |
12/958600 |
Filed: |
December 2, 2010 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11643249 |
Dec 21, 2006 |
7871623 |
|
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12958600 |
|
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60752566 |
Dec 21, 2005 |
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Current U.S.
Class: |
424/1.69 ;
424/9.34 |
Current CPC
Class: |
A61K 49/1869 20130101;
A61K 51/087 20130101; A61K 49/1866 20130101; A61K 49/1863 20130101;
A61K 51/088 20130101; Y10T 436/24 20150115 |
Class at
Publication: |
424/1.69 ;
424/9.34 |
International
Class: |
A61K 51/08 20060101
A61K051/08; A61K 49/14 20060101 A61K049/14 |
Claims
1-57. (canceled)
58. A method of imaging stress in a subject in vivo comprising:
administering to the subject an imaging composition comprising a
labeled annexin including annexin coupled to a biocompatible
radionuclide; and measuring radiation emission from the
radionuclide in at least a portion of the central nervous system of
the subject to construct an image of radiation emission, wherein
the image is a representation of stress in the subject.
59. The method of claim 58, wherein the radionuclide is selected
from the group consisting of Iodine 123, Iodine 131, Gallium 67,
Indium 111, Fluorine 18, and Technetium 99 m (Tc99m).
60. The method of claim 59, wherein the radionuclide is Tc99m to
form Tc99m-labeled annexin.
61. The method of claim 60, wherein the Tc99m is linked to the
annexin via hydrazino nicotinamide (HYNIC) or via the internal
radionuclide chelating site of annexin V-128.
62. The method of claim 60, wherein the Tc99m is linked to the
annexin via the internal radionuclide chelating site of annexin
V-128.
63. The method of claim 60, wherein the amount of Tc99m-labeled
annexin administered results in a dose of up to about 20 mCi.
64. The method of claim 60, wherein the amount of Tc99m-labeled
annexin administered results in a dose of about 5 to 20 mCi.
65. The method of claim 58, wherein the radiation is measured with
a radiation detector device and wherein the radiation detection
device is a gamma ray detector device and the radiation emission is
gamma ray emission.
66. The method of claim 65, where the gamma ray detector device is
a gamma scintillation camera.
67. The method of claim 65, wherein the measuring of gamma ray
emission to construct the image is done about 5 minutes to 2 hours
after administration of the labeled annexin.
68. The method of claim 65, wherein the measuring of gamma ray
emission to construct the image is done about 1 hour after
administration of the labeled annexin.
69. The method of claim 58, further comprising repeating the step
of measuring radiation emission at selected intervals, wherein said
repeating is effective to track changes in the intensity of
radiation emission from the subject over time, reflecting changes
in the intensity of the stress.
70. The method of claim 58, further comprising repeating the step
of measuring radiation emission at selected intervals, wherein said
repeating is effective to track changes in the localization of
radiation emission in the subject over time, reflecting changes in
the location of cells reacting to stress stimulus.
71. The method of claim 58, wherein the annexin is annexin V.
72. The method of claim 58, wherein the annexin is annexin
V-128.
73. The method of claim 58, wherein the amount of labeled annexin
administered is less than about 300 .mu.g protein/kg.
74. The method of claim 58, wherein the amount of labeled annexin
administered is about 1 to 10 .mu.g protein/kg.
75. The method of claim 58, wherein the labeled annexin is
administered via a route of administration selected from at least
one of the following: intravenously, intraperitoneally,
intrathecally, intrapleurally, intralymphatically, and
intramuscularly.
76. The method of claim 58, wherein the radiation emission is
measured from the head of the subject or a portion thereof.
77. The method of claim 58, wherein radiation emission is measured
from the spine of the subject or a portion thereof.
78. The method of claim 58, wherein the radiation is measured with
a radiation detector device and wherein the radiation detection
device is a positron emission detector device.
79. A method of imaging stress in a subject in vivo comprising:
administering to the subject an imaging composition comprising a
labeled annexin including annexin coupled to a contrast agent; and
obtaining a magnetic resonance image of at least a portion of the
central nervous system of the subject, wherein said image is a
representation of stress in said subject.
80. The method of claim 79, wherein the contrast agent is selected
from at least one of the following: a paramagnetic agent, a
gadolinium-chelating group complex, a gadolinium-diethylenetriamine
penta-acetic acid, a superparamagnetic agent, a metal oxide, an
iron oxide, a polymer coated metal oxide, and a dextran coated iron
oxide.
81. The method of claim 79, wherein the annexin is annexin V.
82. The method of claim 79, wherein the annexin is annexin
V-128.
83. The method of claim 79, wherein the magnetic resonance image is
obtained about 5 minutes to 2 hours after the administration of the
magnetic resonance imaging composition.
84. The method of claim 79, wherein the magnetic resonance image is
obtained about 12 to 30 hours after the administration of the
magnetic resonance imaging composition.
85. The method of claim 79, further comprising obtaining a magnetic
resonance image at a plurality of time points, thereby monitoring
changes in the number of cells responding to stress.
86. The method of claim 79, further comprising obtaining a magnetic
resonance image at a plurality of time points, thereby monitoring
changes in the location of cells responding to stress.
87. The method of claim 79, wherein the magnetic resonance imaging
composition is administered at a concentration of about 1 to 500
.mu.g protein/kg.
88. The method of claim 79, wherein the magnetic resonance imaging
composition is administered at a concentration of less than about
300 .mu.g protein/kg.
Description
CROSS-REFERENCE TO RELATED APPLICATION
[0001] This application is a continuation application of copending
U.S. Utility application entitled "Compositions and Methods for
Imaging Pain and Stress In Vivo", Ser. No. 11/643,249 filed Dec.
21, 2006 which claims priority to U.S. provisional application
entitled "Compositions and Methods for Imaging Pain and Stress In
Vivo", Ser. No. 60/752,566 filed Dec. 21, 2005, both of which are
entirely incorporated herein by reference.
FIELD OF THE INVENTION(S)
[0002] The present disclosure relates to methods and compositions
for imaging pain, nociception and/or stress in vivo and methods and
compositions for treating associated conditions. In particular, the
present disclosure relates to the use of labeled compounds to
provide objective diagnosis of pain, nociception, and/or stress and
for imaging regions associated with pain, nociception, and/or
stress in a subject.
BACKGROUND
[0003] Currently no satisfactory, objective indicia of pain exist
for determining the existence of or the extent of pain experienced
by a subject. While various imaging technologies exist for the
diagnosis and observation of various conditions and diseases, the
capability for using such technologies for identifying and imaging
pain does not currently exist. The ability of a physician to
confirm a patient's complaint of pain and to determine the extent
and possibly the nature and/or source of such pain would provide a
significant advantage to the field of medicine in general and to
the growing field of pain management in particular.
[0004] In the clinical world, physicians currently use tools such
as the "Visual Analog Scale" to help determine a patient's pain
experience relative to their own prior experiences. However, these
evaluations cannot be normalized across human subjects. In the
clinical imaging world, there are some studies using functional
magnetic resonance imaging and brain positron emission tomography
(PET) to image painful stimuli. However, these are restricted to
the study of the brain only and do not give insight into the
peripheral stimuli (a.k.a. drivers) of these unpleasant
experiences.
[0005] Many patients suffer from conditions associated with
atypical and/or generalized pain, such as fibromyalgia, reflex
sympathetic dystrophy, peripheral nerve entrapment syndrome and
chronic fatigue syndrome, where the source/cause of the pain may
not be capable of determination. It can be discouraging for both
the doctor and patient to be unable to confirm the patient's
symptoms and/or locate the source of the pain for treatment
purposes. Thus, there is a need for a technology that offers the
ability to identify and measure pain and to help locate the source
of the pain and/or offer treatment options. Additionally, such
technology would be useful for studying various aspects of pain,
such as its mechanisms, the physiological pathways associated with
pain and its manifestation, and variances in the experience of pain
among different subjects. Such technology would also be useful for
imaging and studying conditions characterized by pain-like
sensation or loss of sensation, such as spinal cord injury or
compression, various neuropathies, and myelitis.
[0006] Similarly, it is difficult to objectively determine and/or
measure a patient's stress level and to treat and/or prevent other
medical conditions, both mental and physical, associated with
elevated stress levels. The ability to image the existence of
and/or the extent of stress experienced by a patient would provide
numerous advantages in the field of psychiatry and psychology. This
ability would provide doctors and researchers with new tools for
studying the causes and physiological effects of stress, its
biological manifestations, and to evaluate the effectiveness of
various treatments. It may also allow detection and diagnosis of
extreme or chronic stress in a subject, and thereby open the door
to treating the stress before it leads to other conditions or
disorders, such as hypertension, depression, and other associated
conditions.
[0007] In addition, since non-human subjects are unable to
communicate the existence of pain, or its source, a technology that
provides the ability to image pain would offer a significant
advantage in the veterinary field. It is also difficult to diagnose
stress in such subjects, and not much is known about the existence,
experience of or sources of stress in non-human subjects.
Therefore, the ability to objectively determine the existence of
stress in such subjects would provide numerous advantages,
including the ability to diagnose and treat stress in non-human
subjects, as well as the ability to study the condition.
SUMMARY
[0008] Briefly described, the present disclosure provides methods
and compositions for imaging pain and/or stress in vivo. Aspects of
the present disclosure relate to the use of labeled compounds for
imaging pain and/or stress experienced by a subject and for imaging
regions associated with pain and/or stress in a subject. In
particular, methods of the present disclosure relate to the use of
labeled annexin for imaging pain and/or stress in a subject. Other
aspects of the present disclosure relate to methods and
compositions for treating pain and/or stress and conditions
associated with pain and/or stress.
[0009] Accordingly, embodiments of methods of imaging pain and/or
stress in a subject in vivo according to the present disclosure
include administering to the subject an imaging composition
including annexin coupled to a biocompatible radionuclide and
measuring radiation emission from the radionuclide in the subject
to construct an image of radiation emission, where the image is a
representation of pain and/or stress in the subject. Other
embodiments include administering to the subject an imaging
composition including annexin coupled to a contrast agent and
obtaining a magnetic resonance image, where the image is a
representation of pain and/or stress in the subject. Still other
embodiments for imaging pain and/or stress in a subject include
administering to the subject an imaging composition including
annexin coupled to an optically active molecule, illuminating the
subject with a light source, and visually monitoring the presence
of the optical imaging composition in the subject, thereby
obtaining an image, where said image is a representation of pain
and/or stress in said subject.
[0010] Embodiments of the present disclosure also include methods
for treating pain in a subject by administering to the subject a
therapeutic composition comprising a pain relieving compound
coupled to annexin. The present disclosure also includes
embodiments of pharmaceutical compositions for treating pain in a
subject where the pharmaceutical composition includes a pain
relieving compound coupled to annexin.
[0011] Embodiments of the present disclosure also include kits for
identifying pain and/or stress in a subject including an imaging
composition of annexin coupled to a biocompatible radionuclide, a
pharmaceutically acceptable carrier, and instructions for using the
imaging composition to image a subject or a region of the subject
to identify pain or stress experienced by the subject.
[0012] Other systems, methods, compositions, features, and
advantages of the present disclosure will be or will become
apparent to one with skill in the art upon examination of the
following drawings and detailed description. It is intended that
all such additional systems, methods, compositions, features, and
advantages be included within this description, be within the scope
of the present disclosure and claims.
BRIEF DESCRIPTION OF THE FIGURES
[0013] Many aspects of the disclosure can be better understood with
reference to the following drawings. The components in the drawings
are not necessarily to scale, emphasis instead being placed upon
clearly illustrating the principles of the present disclosure.
[0014] The patent or application file contains at least one drawing
executed in color. Copies of this patent or patent application
publication with color drawing(s) will be provided by the Office
upon request and payment of the necessary fee.
[0015] FIG. 1 shows the uptake of radiolabeled annexin V 128 in
mouse spinal cords for a control (A) and pain induced (B)
mouse.
[0016] FIG. 2 illustrates the uptake of fluorescently-labeled
annexin V in rat spinal cords and brains for control rats (A) and
rats with pain induced in either the left front (B) or left hind
(C) paw.
[0017] FIG. 3 shows the uptake of radiolabeled annexin V 128 in
mouse spinal cords for old (D) and young (A and B) control mice and
an old stress induced mouse (C).
[0018] FIG. 4 shows the uptake of radiolabeled annexin V 128 in
mouse brains for an old (D) and young (A and B) control mice and an
old stress induced mouse (C).
[0019] FIG. 5 illustrates the uptake of radiolabeled annexin V 128
in mouse spinal cords for control mice (A) and mice with pain
induced in either the left front (B) or left hind (C) paw.
[0020] FIG. 6 shows SPECT/CT images illustrating the uptake of
labeled annexin-V in rat spines 24 hours after pain induction via
paw injection. FIG. 6A shows a micro CT image, FIG. 6B shows a
microSPECT image, and FIG. 6C shows a SPECT/CT fusion image.
[0021] FIG. 7 shows the sequence for annexin V-128, a mutated
variant of human annexin V.
DETAILED DESCRIPTION
[0022] Embodiments of the present disclosure will employ, unless
otherwise indicated, techniques of synthetic organic chemistry,
biochemistry, nuclear chemistry, molecular biology, radiology and
the like, which are within the skill of the art. Such techniques
are explained fully in the literature.
[0023] The following examples are put forth so as to provide those
of ordinary skill in the art with a complete disclosure and
description of how to perform the methods and use the compositions
disclosed and claimed herein. Efforts have been made to ensure
accuracy with respect to numbers (e.g., amounts, temperature, etc.)
but some errors and deviations should be accounted for. Unless
indicated otherwise, parts are parts by weight, temperature is in
.degree. C., and pressure is at or near atmospheric. Standard
temperature and pressure are defined as 20.degree. C. and 1
atmosphere.
[0024] Before the embodiments of the present disclosure are
described in detail, it is to be understood that, unless otherwise
indicated, the present disclosure is not limited to particular
materials, reagents, reaction materials, manufacturing processes,
or the like, as such can vary. It is also to be understood that the
terminology used herein is for purposes of describing particular
embodiments only, and is not intended to be limiting. It is also
possible in the present disclosure that steps can be executed in
different sequence where this is logically possible. All patents,
patent applications, and publications mentioned herein are hereby
incorporated by reference in their entireties.
[0025] Unless defined otherwise, all technical and scientific terms
used herein have the same meaning as commonly understood by one of
ordinary skill in the art to which this disclosure belongs.
Although any methods and materials similar or equivalent to those
described herein can also be used in the practice or testing of the
present disclosure, the preferred methods and materials are now
described. It must be noted that, as used in the specification and
the appended claims, the singular forms "a," "an" and "the" include
plural referents unless the context clearly dictates otherwise.
Thus, for example, reference to "a support" includes a plurality of
supports.
[0026] It should be noted that ratios, concentrations, amounts, and
other numerical data may be expressed herein in a range format. It
is to be understood that such a range format is used for
convenience and brevity, and thus, should be interpreted in a
flexible manner to include not only the numerical values explicitly
recited as the limits of the range, but also to include all the
individual numerical values or sub-ranges encompassed within that
range as if each numerical value and sub-range is explicitly
recited. To illustrate, a concentration range of "about 0.1% to
about 5%" should be interpreted to include not only the explicitly
recited concentration of about 0.1 wt % to about 5 wt %, but also
include individual concentrations (e.g., 1%, 2%, 3%, and 4%) and
the sub-ranges (e.g., 0.5%, 1.1%, 2.2%, 3.3%, and 4.4%) within the
indicated range.
[0027] All publications and patents cited in this specification are
herein incorporated by reference as if each individual publication
or patent were specifically and individually indicated to be
incorporated by reference and are incorporated herein by reference
to disclose and describe the methods and/or materials in connection
with which the publications are cited. The citation of any
publication is for its disclosure prior to the filing date and
should not be construed as an admission that the present disclosure
is not entitled to antedate such publication by virtue of prior
disclosure. Further, the dates of publication provided could be
different from the actual publication dates that may need to be
independently confirmed.
[0028] In this specification and in the claims that follow,
reference will be made to a number of terms that shall be defined
to have the following meanings unless a contrary intention is
apparent.
DEFINITIONS
[0029] As used herein, "pain" generally refers to the physiological
and psychological sensation or perception of physiological pain.
"Pain," as used herein, also includes nociception, the biological
experience of pain that is mediated through receptors and
neurotransmitters and other aspects of the nervous system. Thus, as
used herein, "imaging pain" refers to a form of visual indication
of the perception of physiological pain by the subject imaged.
"Pain" may be specifically located to a site of injury, or may be
generalized; likewise, and image of pain may visually indicate a
general state of pain perception or it may specifically indicate
the location of the pain or source of pain.
[0030] As used herein, "stress" generally refers to a psychological
sensation or perception of a strong psychological condition and the
physiological response thereto. Although stress includes both
positive (eustress) and negative (distress) stress as used, herein,
stress generally refers to an extreme (positive or negative)
condition and/or a generally unpleasant mental condition
(distress). Examples of stress include, but are not limited to,
psychological pain, fear, anxiety, excitement, panic, and the like.
Although considered a psychological state, stress generally has
physiological origins and/or manifestations. As used herein,
"imaging stress" refers to a form of visual indication of the
perception or sensation of a stressful mental/physical condition by
the subject imaged.
[0031] A "biocompatible radionuclide" or "biocompatible
radioisotope" refers to an isotope that is recognized as being
useful for injection into a patient for nuclear medicine
applications. Examples of biocompatible radionuclides include, but
are not limited to, Iodine 123, Iodine 131, Gallium 67, Indium 111,
Fluorine 18, and Technetium 99 m.
[0032] As used herein, an "optically active molecule" includes any
molecule that has the ability to be optically detected, for
example, by the use of medically available visualization devices
such as endoscopes, bronchoscopes and minimally invasive surgical
devices using optical detection of anatomic structures. Examples of
optically detectable molecules include fluorescein and methylene
blue. Optically active molecules may also include those agents
useful in photodynamic therapy (PDT). PDT works by exposing an
annexin molecule linked to a photosensitizing molecule to specific
wavelengths of light in the presence of oxygen. When this reaction
occurs, the normally innocuous photosensitizing drug becomes
cytotoxic via an activated species of oxygen, known as singlet
oxygen. Examples of optically active agents that could be used in
PDT when linked to annexin include PHOTOFRIN.RTM., Lutrin,
ANTRIN.RTM., FOSCAN.RTM., aminolevulinic acid, aluminum (III)
phthalocyanine tetrasulfonate, Hypericin, verteporfin, and
methylene blue dye.
[0033] As used herein, a "contrast agent" is intended to include
any agent that is physiologically tolerable and capable of
providing enhanced contrast for magnetic resonance imaging.
Contrast agents typically have the capability of altering the
response of a tissue to magnetic fields. Contrast agents include
paramagnetic agents, e.g., a gadolinium-chelating group complex,
such as gadolinium-diethylenetriamine penta-acetic acid, or a
manganese chelating group complex; or biologically compatible
superparamagnetic agents, such as iron oxide. Contrast agents, such
as those described in U.S. Pat. No. 4,687,658; U.S. Pat. No.
5,314,680; and U.S. Pat. No. 4,976,950 can be used in preparing the
compositions of the present disclosure, and are included herein by
reference. Contrast agents are commercially available (e.g., the
gadolinium chelate Prohance.TM. is available from Squibb and the
gadolinium chelate Dotarem.TM. is available from Guerbet).
[0034] A suitable contrast agent is preferably biocompatible, e.g.,
non-toxic, chemically stable, not absorbed by the body or reactive
with a tissue, and eliminated from the body within a short time. In
one embodiment, the contrast agent may be coupled to a carrier that
is cleared or metabolized by a desirable route. Examples of such
carriers include, but are not limited to, dextran particles or
colloidal particles (which are typically phagocytosed in the
liver).
[0035] As used herein, the term subject includes animals,
preferably warm-blooded animals, more preferably mammals, including
humans. In a preferred embodiment, the subject is a primate. In an
even more preferred embodiment, the subject is a human. Pain or
stress may be imaged or detected in, for example, an organ of a
subject or a portion or specimen thereof (e.g., brain, spinal cord,
heart, liver lung, pancreas, and colon) or a gland of a subject or
a portion thereof (e.g., prostate, pituitary or mammary gland).
[0036] As used herein, the term "administering" to a subject
includes dispensing, delivering or applying an imaging composition
according to the present disclosure to a subject by any suitable
route for delivery of the composition to the desired location in
the subject. The preferred route of administration of the compounds
is intravenous. However, any route of administration, such as oral,
topical, buccal, parenteral, subcutaneous, peritoneal,
intraarterial, intralymphatic, insufflation, intramuscular,
intrapleural, inhalation, intrathecal, transdermal, vaginal,
rectal, colonic, nasal, introduction into the cerebrospinal fluid,
or instillation into body compartments can be used.
[0037] The compositions of the disclosure may be administered to a
subject in an amount effective to achieve the desired result at the
appropriate dosages and for the desired periods of time. An
effective amount of the compositions of the disclosure may vary
according to factors such as disease state, age, and weight of the
subject, and the ability of the composition to elicit a desired
response in the subject. An effective amount is also one in which
any toxic or detrimental effects (e.g., side effects) of the
compositions are outweighed by the therapeutically or
diagnostically beneficial effects. The compositions of the
disclosure may be administered at a concentration of, for example,
about 1-1000 .mu.g protein/kg, about 1-900 .mu.g protein/kg, about
1-800 .mu.g protein/kg, about 1-700 .mu.g protein/kg, about 1-600
.mu.g protein/kg, about 1-500 .mu.g protein/kg, about 1-400 .mu.g
protein/kg, about 1-300 .mu.g protein/kg, about 1-200 .mu.g
protein/kg, about 1-100 .mu.g protein/kg, about 10-100 .mu.g
protein/kg, about 10-80 .mu.g protein/kg, about 10-60 .mu.g
protein/kg, about 10-40 .mu.g protein/kg, or about 10-20 .mu.g
protein/kg.
[0038] As used herein, "treat", "treating", and "treatment" are an
approach for obtaining beneficial or desired clinical results. For
purposes of embodiments of this disclosure, beneficial or desired
clinical results include, but are not limited to, preventing the
condition/disease from occurring in a subject that may be
predisposed to the condition/disease but does not yet experience or
exhibit symptoms of the disease (prophylactic treatment),
alleviation of symptoms of the condition/disease, diminishment of
extent of the condition/disease, stabilization (i.e., not
worsening) of the condition/disease, preventing spread of the
condition/disease, delaying or slowing of the condition/disease
progression, amelioration or palliation of the condition/disease
state, and combinations thereof. Thus, treating pain refers to the
reduction and/or elimination of actual and/or perceived pain in a
subject receiving treatment and/or the reduction of annexin uptake
in the subject.
[0039] The terms "including", "such as", "for example" and the like
are intended to refer to exemplary embodiments and not to limit the
scope of the present disclosure.
Discussion:
Annexin and the Asymmetry of Biological Membranes
[0040] Annexin V is normally found in high levels in the cytoplasm
of a number of cells including placenta cells, Lymphocytes,
monocytes, and biliary and renal (cortical) tubular epithelium.
Although the physiological function of annexins has not been fully
elucidated, several properties of annexins make them useful as
diagnostic and/or therapeutic agents. In particular, it has been
discovered that annexins possess a very high affinity for anionic
phospholipid surfaces, such as a membrane leaflet having an exposed
surface of phosphatidylserine (PS), which is significant for the
imaging of pain and stress as explained in greater detail
below.
[0041] It is generally believed that biological membranes are
asymmetric with respect to specific membrane phospholipids. In
particular, the outer leaflet of eukaryotic plasma membranes is
formed predominantly with the cholinephospholipids, such as
sphingomyelin and phosphatidylcholine (PC), whereas the inner
leaflet contains predominantly aminophospholipids, such as
phosphatidylserine (PS) and phosphatidylethanolamine (PE). This
asymmetry is thought to be maintained by the activity of an
adenosine triphosphate (ATP)-dependent aminophospholipid
translocase, which selectively transports PS and PE between bilayer
leaflets. Other enzymes thought to be involved in the transport of
phospholipids between leaflets include ATP-dependent floppase and
lipid scramblase.
[0042] Although asymmetry appears to be the rule for normal cells,
the loss of such asymmetry is associated with certain physiological
processes, as well as pathogenic processes. For example, it has
been recognized that membrane asymmetry, detected as the appearance
of PS on the outer leaflet of the plasma membrane ("PS exposure"),
is one of the earliest manifestations of apoptosis, preceding DNA
fragmentation, plasma membrane blebbing, and loss of membrane
integrity.
[0043] Similar re-orientation has been observed in sickle cell
disease B-thalassemia, platelet activation, and in some mutant
tumor cell lines with defective PS transport. A gradual appearance
of PS on the outer leaflet has also been observed to occur in aging
red blood cells. When the PS exposure on such cells reaches a
threshold level, the cells are removed from circulation by
macrophages. All of the above conditions proximately culminate in
the death of the affected cells (e.g., cells with significant PS
exposure).
[0044] However, the examples presented below demonstrate the
unexpected result that PS exposure occurs, along with the
associated increased uptake of annexins, during periods of cell
stress (such as that induced by pain or mental stress experienced
by a subject) that do not necessarily lead to a commitment to
apoptosis and the self-destruction of a cell. Annexins can also be
selectively taken up in the neurons of regions of ischemia and
stress, even in the presence of an intact blood brain barrier.
Imaging Pain and Stress
[0045] Annexins, particularly annexin V, has been demonstrated as a
useful in vivo imaging marker for apoptosis and/or necrosis, as
described in U.S. Pat. Nos. 6,197,278 and 6,726,895 and in
Published U.S. Applications 20040170603, 20030152513, and
20030003047, which are each incorporated herein by reference in
their entirety. However, it has presently been discovered, as
demonstrated in the examples below, that annexins are also taken up
by non-apoptotic cells, particularly in tissues of the peripheral
and central nervous system as well cells of the vascular system,
when such cells are responding to stimuli caused by pain, stress,
or other noxious stimuli.
[0046] Thus, the present disclosure provides methods for using
annexin labeled with various imaging compounds, such as, but not
limited to, isotopes, fluorochromes and magnetic resonance agents
to image acute and/or chronic pain in vivo. Other embodiments of
the present disclosure provide using the labeled annexin to image
stress in vivo.
[0047] The ability to image pain and/or stress provides objective
indicia of those conditions, as well as the possibility of
determining the degree and/or intensity of the pain and/or stress.
For pain, it also may allow the location of the source or origin of
the pain, if not apparent from examining the subject. The methods
of the present disclosure also provide the ability to target,
diagnose, and/or research various disorders associated with pain
and/or stress. This includes atypical pain syndromes such as, but
not limited to, fibromyalgia, chronic fatigue syndrome, reflex
sympathetic dystrophy, and peripheral nerve entrapment syndrome.
The methods can also be used to detect and study conditions and/or
disorders that cause stress on the neurological system such as, but
not limited to, depression, physical stress, mental stress, and
stress caused by hormonal imbalances (e.g., estrogen, progesterone,
thyroid hormones, insulin, various steroids, and the like). The
ability to image stress associated with such disorders provides not
only new avenues for understanding the mechanisms and effects of
the disease, but also new tools for designing and testing new
therapies for treating such diseases and conditions.
[0048] Other conditions related to the central and peripheral
nervous system that could also be targeted by use of the methods of
the present disclosure include, but are not limited to, myelitis
(e.g., caused by radiation treatment, chemotherapy, infection,
post-infectious transverse myelitis, etc.), spinal cord injury (for
instance, predicting reversible vs. irreversible lesions based on
uptake of labeled annexin), neurophathy (e.g., that associated with
Guillain-Barre syndrome, ALS, and other neurologic disorders with
peripheral manifestations such as Parkinsons, Dyskinesias,
Alcoholism, and Diabetes), and spinal cord compression (e.g., the
chronic conditions caused by disc disease and spinal stenosis).
[0049] The methods of the present disclosure are useful with
various imaging technologies including, but not limited to,
radiation emission imaging, optical imaging, and magnetic resonance
imaging. Various embodiments of these methods are described in
greater depth below.
Synthesis of Annexin Containing Compounds
[0050] The methods and compositions of the present disclosure can
be practiced using purified native, recombinant, or
synthetically-prepared annexin. Annexin V, for example, may be
conveniently purified from human placenta. Recombinant annexin
offers several advantages, however, including ease of preparation
and economic efficiency. A number of different annexins have been
cloned from humans and other organisms. Their sequences are
available in sequence databases, including GenBank.
[0051] Preferably the annexin used for practicing the methods of
the present disclosure is annexin V, for several reasons. First,
annexin V is one of the most abundant annexins, (ii) it is simple
to produce from natural or recombinant sources, and (iii) it has a
high affinity for phospholipid membranes. Human annexin V has a
molecular weight of 36 kD and high affinity (kd=7 nmol/L) for
phosphatidylserine (PS). The sequence of human annexin V can be
obtained from GenBank under accession numbers U05760-U05770.
Annexin V is typically administered at doses less than about 300
.mu.g protein/kg, preferably between about 1 and 10 .mu.g
protein/kg. Several administration routes are possible, including
intravenous (i.v.), intraperitoneal (i.p.), intrathecal, and
intrapleural administration.
[0052] Even more preferably, the annexin is annexin V-128. Annexin
V-128 (SEQ ID NO: 1, FIG. 7) is a modified annexin V having an
endogenous radionuclide (e.g., Tc) chelation site
(Ala-Gly-Gly-Cys-Gly-His) (amino acids 1 to 6 of SEQ ID NO: 1)
added to the N-terminus. Annexin V-128 has the same or higher
uptake as wild type annexin V, except that it has 88% lower renal
uptake. Methods of making annexin V-128 and other information
related to its uptake are described in Tait J F, Smith C,
Blankenberg F G; Structural Requirements for In vivo Detection of
Cell Death with 99mTc-Annexin V; J. Nucl. Med. 2005; 46; 807-815,
which is hereby incorporated by reference.
[0053] An exemplary expression system suitable for making annexin
for use with the present disclosure employs the pET12a expression
vector (Novagen, Madison, Wis.) in E. coli. (described in Wood, et
al. (1996) Blood 88:1873-1880, incorporated herein by reference).
Other bacterial expression vectors and other commercially-available
expression systems, such as yeast expression systems, may be
utilized as well.
[0054] Annexin produced as described above may then be coupled to a
radionuclide, a contrast agent, an optically active molecule,
and/or an analgesic compound. The particular radionuclide, the
contrast agent, the optically active molecule, or the analgesic
compound selected will depend on the particular application the
skilled artisan intends to use.
Radiolabeled Imaging
[0055] Embodiments of the present disclosure include methods of
imaging pain and/or stress in a subject, particularly a mammalian
subject, in vivo using annexin labeled with a radionuclide. The
method includes administering annexin labeled with a biocompatible
radionuclide to the subject. After a period of time in which the
labeled annexin can achieve localization in the subject, the
subject is positioned within the detection field of a radiation
detector device, and radiation emission from the radionuclide
localized in the subject is measured with the radiation detector
device. The radiation detector device then constructs an image of
radiation emission, where the image is a representation of pain
and/or stress experienced by the mammalian subject. In one
embodiment, the method further includes a step of processing the
image to subtract signal resulting from non-specific localization
of the labeled annexin, such as non-specific localization in the
kidney.
[0056] The annexin may be coupled with any one of a variety of
radionuclides presently available. In selecting a suitable
radionuclide, the practitioner typically considers the particular
application, along with factors common to nuclear imaging in
general. Such factors include minimum of particle emission, primary
photon energy of between about 50 and 500 kEv, physical half-life
greater that the time required to prepare material for
administration, effective half life longer than the examination
time, suitable chemical form and reactivity, low toxicity, and
stability at or near the stability of annexin labeled with that
radionuclide.
[0057] Radionuclides useful with the method include, but are not
limited to, Iodine 123, Iodine 131, Iodine 125, Iodine 124, Carbon
11, Chlorine 32, Chlorine 33, Chlorine 34, Bromine 74, Bromine 75,
Bromine 76, Bromine 77, Bromine 78, Rhenium 186, Rhenium 188,
Yttrium 90, Yttrium 86, Samarium 153, Lutetium 177, Gallium 67,
Indium 111, Fluorine 18, and Technetium 99 m (Tc99m). It is
appreciated that Fluorine 18 is a positron emitter, and is thus
useful in positron emission tomography (PET). Other compounds
useful in PET include, but are not limited to, Cu-64 (PET emitting
isotope of copper), Ga-68 (PET emitting isotope of Gallium), Tc-94
(PET emitting isotope of technetium), and 1-124 (PET emitting
isotope of iodine). Iodine 123, Iodine 131, Gallium 67, Indium 111,
and Technetium 99 m (Tc99m) are useful with standard gamma emission
detection. Tc99m is a preferred radionuclide for use with the
methods of the disclosure. In a preferred embodiment, the Tc99m is
linked to the annexin via hydrazino nicotinamide (HYNIC).
Tc99m-labelled annexin is typically administered at a dose of about
5 to about 20 mCi.
[0058] Linking of the isotope to annexin can be accomplished using
known techniques. For example, Tc99m can be linked to annexin
through the use of a hydrazino nicotinamide (HYNIC) group,
available, e.g., from AnorMED, Langley, British Columbia, Canada,
as described in the examples below. Gallium 67 and Indium 111 can
be used to radiolabel proteins using, for example, the method
described by Hnatowich, et al., The Preparation of DTPA-Coupled
Antibodies Radiolabeled with Metallic Radionuclides: an Improved
Method. J Immunol Methods. 1983 Dec. 16; 65(1-2):147-57.),
incorporated herein by reference.
[0059] Other methods for labeling proteins with radionuclides are
known. For example, U.S. Pat. No. 5,552,525, which is hereby
incorporated by reference herein, teaches the making of
technetium-99m (Tc-99m) labeled peptides. Methods for labeling
peptides and polypeptides with Tc-99m are also disclosed in U.S.
Pat. Nos. 5,443,815 and 5,508,020, which are hereby incorporated by
reference herein. Additional methods for labeling polypeptides with
Tc-99m are described in the following references, which are hereby
incorporated by reference in their entireties: Lind, et al.,
Immunoscintigraphy of Inflammatory Processes With a
Technetium-99m-labeled Monoclonal Antigranulocyte Antibody (MAb BW
250/183), J Nucl Med. 1990 April; 31(4):417-23 (Tc-99m labeled
monoclonal antibodies); LaMuraglia, et al., Utility of the indium
111-labeled human immunoglobulin G scan for the detection of focal
vascular graft infection. J Vasc Surg. 1989 July; 10(1):20-7
(.sup.111In-labeled non-specific human immunoglobulin); and
Fischman, et al., Imaging focal sites of bacterial infection in
rats with indium-111-labeled chemotactic peptide analogs. J Nucl
Med. 1991 March; 32(3):483-91 (chemotactic formyl peptide (fMLF)
in-labeled DTPA conjugates).
[0060] Radiolabeled annexin may be administered using standard
protocols for administration of radiolabeled compounds. The amounts
include the ranges listed above, but individual dosages will vary
based on various considerations. The dosage generally relates to
two considerations: (i) the amount and type of radionuclide
injected, and (ii) the amount of annexin protein injected.
Technetium 99m can be administered to adult humans at doses up to
about 20 mCi. The preferred dose for a single Tc99m administration
is between about 5 and 20 mCi.
[0061] Annexin V begins to have pharmacological effects
(anti-coagulant effects) at doses greater than about 300 .mu.g/kg.
Accordingly, the diagnostic methods of the present disclosure
(which seek to generally avoid pharmacological effects of the
labeled annexin) are preferably practiced at doses lower than about
300 .mu.g/kg, typically less than about 50 .mu.g/kg. Such tracer
doses (e.g., 10 mg/kg to 50 .mu.g/kg) have no reported
pharmacologic or toxic side effects in animal or human
subjects.
[0062] The radiolabeled annexin is typically suspended in a
suitable delivery vehicle/pharmaceutically acceptable carrier, such
as sterile saline. The vehicle may also contain stabilizing agents,
carriers, excipients, stabilizers, emulsifiers, and the like, as is
recognized in the art.
[0063] Radiolabeled annexin can be administered by any of several
routes known to be effective for administration of radiolabeled
proteins for nuclear medicine imaging. A preferred method of
administration is intravenous injection (i.v.). It is particularly
suitable for imaging of well-vascularized internal organs, such as
the heart, liver, spleen, etc. Methods for i.v. injection of
radiopharmaceuticals are known. For example, it is recognized that
a radiolabeled pharmaceutical is typically administered as a bolus
injection using either the Oldendorf/Tourniquet method or the
intravenous push method (see, e.g., Mettler and Guierbteau, 1985,
Essentials Of Nuclear Medicine Imaging, Second Edition, W.B.
Saunders Company, Philadelphia, Pa.). For imaging the brain, the
labeled annexin can be administered intrathecally. Intrathecal
administration delivers compound directly to the sub-arachnoid
space containing cerebral spinal fluid (CSF). Delivery to spinal
cord regions can also be accomplished by epidural injection to a
region of the spinal cord exterior to the arachnoid membrane.
[0064] Other modes of administration include intraperitoneal (e.g.,
for patients on kidney dialysis), and intrapleural administration.
For specific applications, this disclosure contemplates additional
modes of delivery, including intramuscular injection, subcutaneous,
intralymphatic, insufflation, and oral, intravaginal and/or rectal
administration. Methods for practicing the modes of administration
listed above are known in the art.
[0065] After the labeled annexin is administered, it is allowed to
localize to the target tissue or organ. Localization in this
context refers to a condition when either an equilibrium or a
pseudo-steady state relationship between bound, "localized", and
unbound, "free" labeled annexin within a subject has been achieved.
The amount of time for such localization to occur is typically on
the order of minutes to tens of minutes. It can be estimated by the
serum half-life of the labeled annexin. In the case of
Tc99m-labeled annexin V injected i.v., the serum half life is
between about 3 and 7 minutes. The localization time also depends
on the accessibility of the target tissue to the labeled annexin.
This in turn depends on the mode of administration, as is
recognized in the art. A reasonable estimate of the time to achieve
localization may be made by one skilled in the art. Furthermore,
the state of localization as a function of time may be followed by
imaging the gamma ray signal from the labeled annexin according to
the methods of the present disclosure.
[0066] In one general embodiment of the present disclosure, the
radiation detector device is a gamma ray detector device, and the
measured radiation emission is gamma ray emission. In another
general embodiment, the radiation detector device is a positron
emission detector device and the measured radiation emission is
positron emission. The radiation detector device may be, for
example, an Anger gamma scintillation camera or a 3-dimensional
imaging camera.
[0067] In yet another general embodiment, the method of imaging
pain and/or stress in a subject further includes repeating the
steps of positioning the subject within the detection field of a
radiation detector device and measuring radiation emission from the
radionuclide to create an image of the radiation emission at
selected intervals, where the repeating is effective to track
changes in the intensity of radiation emission (e.g., gamma ray or
positron emission) from the region over time, reflecting changes in
the intensity of the pain as demonstrated by the degree of uptake
of labeled annexin.
[0068] Still another general embodiment includes repeating the
steps above at selected intervals, where the repeating is effective
to track changes in the localization of gamma ray emission in the
region over time, reflecting changes in the location of cells
reacting to the pain or stress stimuli. For instance, as FIG. 1
demonstrates, annexin uptake can be tracked to the pain source at
the left hindpaw.
[0069] The measuring of gamma ray emission to construct an image is
typically done between about 5 minutes and 2 hours after
administration of the labeled annexin. In one embodiment, the
measuring of gamma ray emission to construct the image is done
about 1 hour after administration of the labeled annexin.
[0070] Different portions of the subject may be imaged using the
method disclosed herein. For example, the region may include
substantially the whole subject, or a portion of the subject, such
as the head or portion thereof, the heart or portion thereof, the
liver or portion thereof, and the like. Preferably, the region
imaged includes the brain and/or spinal cord, as the pattern for
pain and/or stress induced uptake tends to involve the entire
neuro-axis and is not limited to particular neural pathways.
[0071] Images generated by methods of the present disclosure may be
analyzed by a variety of methods. They range from a simple visual
examination, mental evaluation and/or printing of a hardcopy, to
sophisticated digital image analysis.
[0072] Additional details regarding the synthesis of radiolabeled
annexin, administration of the radiolabeled annexin composition to
a subject, localizing the radiolabeled annexin, and creating and
processing the images, are described in U.S. Pat. No. 6,197,278,
which is incorporated by reference above.
Magnetic Imaging
[0073] In another aspect, the present disclosure provides a method
for the in vivo imaging of pain and/or stress in a subject,
preferably a mammalian subject, by administering to the subject a
magnetic resonance imaging composition including annexin coupled to
a contrast agent. Then a magnetic resonance image is obtained,
wherein the image is a representation of pain and/or stress in the
mammalian subject.
[0074] Contrast agents useful in practicing the methods of the
present disclosure include, but are not limited to, paramagnetic
agents (e.g., a gadolinium-chelating group complex, such as
gadolinium-diethylenetriamine penta-acetic acid, or a lanthanum
chelating group complex) or superparamagnetic agents (e.g., a metal
oxide, such as Fe, Co, Ni, Cu, Zn, As, Se, Mo, Tc, Ru, Rh, Pd, Ag,
Cd, In, Sn, Re, Os, Ir, Pt, Au, Hg, Tl, Pb, Bi, Po, or At oxide).
The metal oxide is preferably coated with a polymer, e.g., dextran
or variants thereof. The annexin may be coupled (e.g., chemically,
biologically, or a combination thereof) to the contrast agent
directly or indirectly.
[0075] In another embodiment, the contrast agent may be a polymer
coated metal oxide, and a radioisotope, e.g., a diagnostic or
therapeutic radioisotope. Such compositions are suitable for both
MRI and nuclear medicine imaging. For example, the composition may
include annexin V coupled to a contrast agent and a radioisotope
(linked to the annexin via hydrazino nicotinamide (HYNIC)). In one
embodiment, the annexin may be coupled to a carrier that is cleared
or metabolized by a desirable route. Examples of such carriers
include, but are not limited to, dextran particles or colloidal
particles or metal oxide particles, such as superparamagnetic iron
oxide particles (which are typically phagocytosed in the
liver).
[0076] The magnetic resonance image may be obtained using any of
the art known techniques, for example, using a Picker Corp. Whole
Body Superconducting System operating at 0.3 T using a 30 cm
transmitter coil tuned to 0.26 T (10.08 MHz) or other MRI devices
with field strengths ranging from 0.05 Tesla to 4.0 Tesla.
Typically, the subject is placed in a powerful, highly uniform,
static magnetic field. Magnetized protons (hydrogen nuclei) within
the subject align like small magnets in this field. Radiofrequency
pulses are then utilized to create an oscillating magnetic field
perpendicular to the main field, from which the nuclei absorb
energy and move out of alignment with the static field, in a state
of excitation. As the nuclei return from excitation to the
equilibrium state, a signal induced in the receiver coil of the
instrument by the nuclear magnetization can then be transformed by
a series of algorithms into images. Images based on different
tissue characteristics can be obtained by varying the number and
sequence of pulsed radiofrequency fields in order to take advantage
of magnetic relaxation properties of the tissues.
[0077] If it is desired to follow the localization and/or the
signal over time, for example, to record the effects of a treatment
on the intensity, distribution and/or localization of cells
responding to pain or stress, the imaging can be repeated at
selected time intervals to construct a series of images. The
intervals can be as short as minutes, or as long as days, weeks,
months or years. Images generated by methods of the present
disclosure may be analyzed by a variety of methods. They range from
a simple visual examination, mental evaluation and/or printing of a
hardcopy, to sophisticated digital image analysis.
[0078] The magnetic resonance image may be obtained about 5, 10,
15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95,
100, 105, 110, 115, or 120 minutes after the administration of the
magnetic resonance imaging composition to the subject. In another
embodiment, the magnetic resonance image is obtained about 10-30,
15-25, 20-25, or 20-30 hours after the administration of the
magnetic resonance imaging composition to the subject. Ranges
intermediate to the above-recited values are also intended to be
part of this disclosure. For example, ranges using a combination of
any of the above-recited values as upper and/or lower limits are
intended to be included. In a preferred embodiment, the magnetic
resonance image is obtained at a plurality of time points, thereby
monitoring changes in the number of cells responding to pain and/or
stress, or monitoring changes in the location of cells responding
to pain and/or stress.
Coupling of Annexin to Contrast Agents
[0079] Coupling of annexin to contrast agents may be performed
using any of the art known techniques, e.g., chemical chelation
techniques. Coupling of annexin to a metal oxide may be performed
as described in Chelating Agents and Metal Chelates, Dwyer &
Mellor, Academic Press (1964), Chapter 7 and U.S. Pat. No.
5,443,816, the contents of each of which are incorporated herein by
reference. Ionic forms of the elements iron, cobalt, nickel,
copper, zinc, arsenic, selenium, technetium, ruthenium, palladium,
silver, cadmium, indium, antimony, rhenium, osmium, iridium,
platinum, gold, mercury, thallium, lead, bismuth, polonium, and
astatine, among others may be used.
[0080] For example, annexin may be incubated with a first reducing
agent for a period sufficient to reduce available disulfide bonds
to thiolate groups while preventing excessive fragmentation of the
annexin. The first reducing agent may then be substantially removed
from the thiolate-containing annexin and a source of Sn (II) agent
may then be added to the thiolate-containing annexin in a
sufficient amount to form Sn (II)-containing and sulfur-containing
complexes. The Sn (II)-containing and sulfur-containing complexes
may then be labeled by adding the metal oxide, whereby the metal
oxide displaces the Sn (II) agent and the metal oxide and
thiolate-containing annexin form a complex. The order of the
foregoing steps may be altered. For example, it is possible, and in
some cases advantageous, to add the Sn (II) to form Sn
(II)-containing and sulfur-containing complexes prior to removing
excess reducing agent from the thiolate-containing annexin. In this
way, oxidation of thiolate groups or reformation of disulfide bonds
and other cross-linkages can be minimized.
[0081] A compound of the disclosure may be created by associating
annexin with biodegradable superparamagnetic metal oxides such as
iron oxide. Annexin associated with superparamagnetic or
paramagnetic contrast agents provides the advantage of directing
the magnetic resonance contrast agent to those cells that are
stressed (e.g., expressing PS but not apoptotic), apoptotic or
necrotic, or in the methods of the present disclosure, to those
cells or regions of a subject identified with pain and/or stress. A
compound prepared from annexin and biodegradable superparamagnetic
iron oxide, for example, binds to hepatocytes that are rendered
apoptotic by treatment with fas. A magnetic resonance experiment or
imaging procedure carried out after administration to a subject of
the compounds of the disclosure can, thus, provide a method for
obtaining an enhanced magnetic resonance image, as well as valuable
information regarding the distribution and/or intensity of pain
and/or stress in the subject. Annexin can be labeled with
biodegradable superparamagnetic metal oxides for MR imaging by
procedures known to those of skill in the art (e.g., as described
in Hiller et al., Assessment of cardiovascular apoptosis in the
isolated rat heart by magnetic resonance molecular imaging. Mol
Imaging. 2006 April-June; 5(2):115-21; van Tilborg et al., Annexin
A5-functionalized bimodal lipid-based contrast agents for the
detection of apoptosis. Bioconjug Chem. 2006 May-June; 17(3):741-9;
and Sosnovik et al., Magnetic resonance imaging of cardiomyocyte
apoptosis with a novel magneto-optical nanoparticle. Magn Reson
Med. 2005 September; 54(3):718-24, each of which are hereby
incorporated by reference in their entireties).
[0082] The use of magnetic particles for the attachment of
biomolecules has been described by Molday (U.S. Pat. No. 4,452,773,
the entire contents of which are incorporated herein by reference).
Briefly, a dextran coated magnetic particle is formed and then
treated with periodate to produce aldehyde groups. The aldehydes
react with amino groups on a biological molecule, to form a Schiff
base. The Schiff base may be stabilized by treatment with a
reducing agent like sodium borohydride. After treatment with a
reducing agent a methylene amino linker connects the biomolecule to
the nanoparticle. Other methods of attaching biomolecules to
nanoparticles, which use the reactivity of the aldehyde group, may
also be used, including the methods of Rembaum and Owen (see Table
I).
[0083] The development of amine functionalized crosslinked iron
oxide nanoparticle is another method of synthesizing magnetic
particle-biomolecule conjugates that may be used to attach annexins
to a metal oxide particle. Amino-CLIO is prepared by first
synthesizing a dextran coated magnetic nanoparticle, followed by
crosslinking the dextran with epichlorohydrin. Amine groups are
incorporated by reacting the dextran with ammonia.
[0084] Table I (below) summarizes the types of magnetic particles
that may be used for the attachment of annexins, e.g., annexin V
and annexin V-128.
TABLE-US-00001 TABLE I Magnetic Particles That Can Be Used for the
Attachment of Annexins Attachment Chem/ Particle Size Biomolecule
Attached Polymer Reference <100 nm Periodate/antibody Dextran
Abts (1989) J. Immunol Methods 125, 19. 10-70 nm/dextran
Periodate/antibody Dextran U.S. Pat. No. 4,452,773 (Molday);
Molday, (1982) J. Immunol. Methods 52, 353. 10-200 nm/albumin
SPDP/antibody BSA U.S. Pat. No. 4,795,698 (Owen). 10-50 nm
Periodate/Synaptotagmin 1 Carboxy Dextran Zhoe (2001) Nat. Med. 7,
1241. 40 nm SPDP.Oligonucleotides Crosslinked Josephson (1999)
Bioconjug. and Peptides Dextran Chem. 10, 186. 10-200 nm
Aldehydes/Enzymes, Polyglutaraldehyde U.S. Pat. No. 4,438,239
Biomolecules Polymer (Rembaum) U.S. Pat. No. 4,369,226. 10-100 nm
Periodate/Antibody Dextran U.S. Pat. No. 5,492,814 (Weissleder)
[0085] The conjugation of annexins to magnetic molecules yields
materials that can be used in a variety of fields such as magnetic
affinity chromatography, magnetic cell sorting, magnetic
immunoassay, and as MR imaging contrast agents. The preferred
characteristics of the particle vary greatly with the intended
application. For imaging applications, the magnetic particles
preferably have one or more of a series of properties
including:
[0086] (1) Size and size homogeneity. Magnetic particles are
preferably smaller than the size of red blood cells (about 10
microns) to avoid clogging capillary beds. To achieve efficient
targeting to a target cell or organ after injection, they are
preferably in the nanoparticle size range (1-500 nm). Larger
particles are rapidly withdrawn from the vascular compartment by
the phagocytic cells of the reticuloendothelial system, limiting
their ability to react with a limited number of sites on the
desired target. Magnetic particles preferably have a narrow size
distribution, e.g., do not have a small percentage of large
particles which can occlude capillaries.
[0087] (2) Biodegradability. To be useful as a clinical diagnostic
tool, magnetic particles preferably can be broken down and excreted
or broken down and utilized by the body. Materials like
polystyrene, while useful in the synthesis of magnetic particles
for cell sorting, generally cannot be used in parenteral, clinical
applications. The most common type of particle used for imaging
applications are polymer coated iron oxides, with dextran or
modified dextran being most often employed.
[0088] (3) Safety. The magnetic particles should be generally
non-toxic. Typically, the safety factor (the dose used for imaging
divided by the dose killing 50% of a group of animals) is greater
than 100 and preferably greater than 1000. Toxicity may also
include not only the generation of reversible or irreversible
tissue damage, but also the induction of transient but annoying
physiological reactions in selected subjects (such as humans)
taking the preparation. These include fever, urticaria, mild pain,
vomiting, and the like. To be useful as a clinical diagnostic
agent, such as an MR imaging agent, the magnetic particle
preferably produces no discernable physiological response, except
for the desired diagnostic information, in individuals taking
preparation.
[0089] (4) Stability. To be used as a parenteral agent, the
particle preferably maintains its size distribution during a
storage period, which, for practical commercial reasons, is
typically longer than 6 months and preferably as long as two years,
but may be shorter, depending upon the intended application.
Instability, evident as the growth in the number of large particles
in the preparation, can result in particle induced toxicity.
[0090] A wide variety of conjugating strategies have been employed
to couple proteins to each other and can be adapted to couple
Annexins, e.g., Annexin V and annexin V-128 to magnetic particles,
as would be understood to one skilled in the art. Many of these
reagents consist of an N-hydroxysuccinimide ester, which reacts
with an amine, and a second moiety that reacts with a sulfhydryl
group. A wide selection of bifunctional conjugating reagents, such
as SPDP, SMCC, SATA and SIAt are available from Piece Chemical
Company. Detailed procedures for their use are available from the
Piece Chemical web site (see http://www.piercenet.com).
[0091] Administration of the annexin-coupled contrast agents is
generally as described above for radiolabeled annexin.
Optical Imaging
[0092] In yet another aspect, the present disclosure provides
methods for imaging pain and/or stress in a subject in vivo by
administering to the subject an optical imaging composition
comprising annexin coupled to an optically active molecule;
illuminating the subject with a light source; and visually
monitoring the presence of the optical imaging composition in the
subject, thereby obtaining an image, where the image is a
representation of pain and/or stress in the mammalian subject.
[0093] Optically active molecules useful in practicing the present
disclosure are preferably biologically compatible, such as, but not
limited to, fluorescent dyes (such as, but not limited to,
fluorescein), luminescent molecules (such as, but not limited to,
luminol), and bioluminescent molecules (such as, but not limited
to, luciferase, luciferin, and aequorin). Many of these molecules,
for instance fluorescein, can be visualized during optical
evaluations such as endoscopy, bronchoscopy, peritonoscopy, direct
visualization, surgical microscopy and retinoscopy.
[0094] Other examples of optically active agents that could be
linked to annexin include, but are not limited to, PHOTOFRIN.RTM.,
Lutrin, ANTRIN.RTM., FOSCAN.RTM., aminolevulinic acid, aluminum
(III) phthalocyanine tetrasulfonate, Hypericin, verteporfin, and
methylene blue dye.
[0095] Coupling of annexin to optically active molecules may be
performed using any of the art known techniques, e.g., those
described in U.S. Pat. No. 5,312,922; U.S. Pat. No. 5,928,627; U.S.
Pat. No. 6,096,289; Weir, ed., Handbook of Experimental Immunology,
Vol. 1, Chapter 28, pp. 28.1-28.21, Oxford, Blackwell Scientific,
1986, the entire contents of each of which are incorporated herein
by reference.
[0096] Administration of the annexin-coupled optically active
molecules is generally as described above for radiolabeled
annexin.
Therapeutic Compositions
[0097] The present disclosure also provides therapeutic
compositions for treating pain and/or stress in a subject and
methods for treating pain and/or stress in a patient by
administering a therapeutic composition of the disclosure.
[0098] Generally described, the therapeutic compositions comprise
annexin coupled to an analgesic compound. Such compounds include
those now known and those to be discovered. Exemplary analgesic
compounds include, but are not limited to, non-steroidal
anti-inflammatory drugs (NSAIDs), including salicylates,
paracetamol (e.g., acetaminophen), and narcotics/opioids.
[0099] The compositions are generally administered in an amount
effective to treat the pain and/or stress, as evidenced by the
regression of symptoms and/or by taking additional images as
described in the present disclosure to determine a change in the
uptake of labeled annexin.
[0100] Such compositions may be administered via various routes of
administration, including those described above for delivery of
labeled annexin. The dosages are generally similar to or the same
as the dosage amounts for the respective analgesic compound when
not coupled to annexin.
Dosage Forms
[0101] The composition, shape, and type of dosage forms of the
imaging and therapeutic compositions of the disclosure typically
vary depending on their use. For example, a parenteral dosage form
may contain smaller amounts of the active ingredient than an oral
dosage form used to treat the same condition or disorder. These and
other ways in which specific dosage forms encompassed by this
disclosure vary from one another will be readily apparent to those
skilled in the art (See, e.g., Remington's Pharmaceutical Sciences,
18th ed., Mack Publishing, Easton, Pa. (1990)).
[0102] For the imaging and/or therapeutic compositions of the
present disclosure the labeled annexin (labeled with a
radionuclide, contrast agent, or optical agent) or annexin coupled
to an analgesic agent is typically suspended in a suitable delivery
vehicle/pharmaceutically acceptable carrier, such as sterile
saline. The vehicle may also contain stabilizing agents, carriers,
excipients, stabilizers, emulsifiers, and the like, as is
recognized in the art.
[0103] A "pharmaceutically acceptable carrier" refers to a
biocompatible solution, having due regard to sterility, pH,
isotonicity, stability, and the like and can include any and all
solvents, diluents (including sterile saline, Sodium Chloride
Injection, Ringer's Injection, Dextrose Injection, Dextrose and
Sodium Chloride Injection, Lactated Ringer's Injection and other
aqueous buffer solutions), dispersion media, coatings,
antibacterial and antifungal agents, isotonic agents, and the like.
The pharmaceutically acceptable carrier may also contain
stabilizers, preservatives, antioxidants, or other additives, which
are well known to one of skill in the art, or other vehicles as
known in the art.
[0104] Typical compositions and dosage forms of the compositions of
the disclosure can include one or more excipients. Suitable
excipients are well known to those skilled in the art of pharmacy
or pharmaceutics, and non-limiting examples of suitable excipients
are provided herein. Whether a particular excipient is suitable for
incorporation into a composition or dosage form depends on a
variety of factors well known in the art including, but not limited
to, the way in which the dosage form will be administered to a
patient. For example, oral dosage forms, such as tablets or
capsules, may contain excipients not suited for use in parenteral
dosage forms. The suitability of a particular excipient may also
depend on the specific active ingredients in the dosage form. For
example, the decomposition of some active ingredients can be
accelerated by some excipients, such as lactose, or by exposure to
water. Active ingredients that include primary or secondary amines
are particularly susceptible to such accelerated decomposition.
[0105] The disclosure encompasses compositions and dosage forms of
the compositions of the disclosure that can include one or more
compounds that reduce the rate by which an active ingredient will
decompose. Such compounds, which are referred to herein as
"stabilizers," include, but are not limited to, antioxidants such
as ascorbic acid, pH buffers, or salt buffers. In addition,
pharmaceutical compositions or dosage forms of the disclosure may
contain one or more solubility modulators, such as sodium chloride,
sodium sulfate, sodium or potassium phosphate, or organic acids. An
exemplary solubility modulator is tartaric acid.
[0106] Like the amounts and types of excipients, the amounts and
specific type of active ingredient in a dosage form may differ
depending on various factors. Dosage ranges for annexin and the
various imaging agents (radionuclides, contrast agents, optical
imaging agents) are set forth above and/or are known to those of
skill in the art. Dosage ranges for analgesic compounds will be
within the ranges typically employed for such compounds, as known
to one of skill in the art. It will be understood, however, that
the total daily usage of the compositions of the present disclosure
will be decided by the attending physician or other attending
professional within the scope of sound medical judgment. The
specific effective dose level for any particular host will depend
upon a variety of factors, including for example, the activity of
the specific composition employed; the specific composition
employed; the age, body weight, general health, sex, and diet of
the host; the time of administration; the route of administration;
the rate of excretion of the specific compound employed; the
duration of the treatment; the existence of other drugs used in
combination or coincidental with the specific composition employed;
and like factors well known in the medical arts. For example, it is
well within the skill of the art to start doses of the composition
at levels lower than those required to achieve the desired effect
and to gradually increase the dosage until the desired effect is
achieved.
[0107] For the methods of imaging pain and stress of the present
disclosure, preferably, a detectably effective amount of the
imaging composition of the present disclosure is administered to a
subject. In accordance with the present disclosure, "a detectably
effective amount" of the imaging composition of the present
disclosure is defined as an amount sufficient to yield an
acceptable image using equipment that is available for clinical
use. A detectably effective amount of the imaging composition of
the present disclosure may be administered in more than one dosage.
The detectably effective amount of the imaging composition of the
present disclosure can vary according to factors such as the degree
of susceptibility of the individual, the age, sex, and weight of
the individual, idiosyncratic responses of the individual, the
dosimetry, and the like. Detectably effective amounts of the
imaging composition of the present disclosure can also vary
according to instrument and film-related factors. Optimization of
such factors is well within the level of skill in the art.
Kits
[0108] The present disclosure also provides kits including a
pharmaceutically acceptable carrier and an imaging composition
including annexin coupled to a biocompatible radionuclide. In
certain embodiments, the kit includes the reaction precursors to be
used to generate the imaging composition upon combination of
annexin with a radiolabeled precursor. The kits provided by the
present disclosure further include indicia including at least one
of: instructions for using the composition to image a subject or a
region of the subject to identify the location and/or intensity of
pain experienced by the subject, and instructions for using the
composition to image a subject or a region of the subject to
identify the location and/or intensity of stress experienced by the
subject.
[0109] In certain preferred embodiments, the present disclosure
provides a kit including from about 5 to 20 mCi of an imaging
composition including radiolabeled annexin in combination with a
pharmaceutically acceptable carrier. The imaging composition and
carrier may be provided in solution or in lyophilized form. When
the imaging composition and carrier of the kit are in lyophilized
form, the kit may optionally contain a sterile and physiologically
acceptable reconstitution medium such as water, saline, buffered
saline, and the like.
EXAMPLES
[0110] Now having described the embodiments of the compositions and
methods for in vivo imaging of pain and/or stress in a subject and
methods and compositions for treating pain and/or stress in a
subject in general, the following examples describe certain
embodiments of compositions and methods for in vivo imaging of pain
and/or stress in a subject and methods and compositions for
treating pain and/or stress in a subject. While such embodiments
are described in connection with Examples 1-7 and the corresponding
text and figures, there is no intent to limit the embodiments of
the present disclosure to these descriptions. On the contrary, the
intent is to cover all alternatives, modifications, and equivalents
included within the spirit and scope of embodiments of the present
disclosure.
Example 1
Preparation of Labeled Annexin
[0111] Protein production and fluorescence labeling: Recombinant
wild-type human annexin V was produced from plasmid pET12a-PAP1 in
E. coli strain BL21(DE3) as described in Wood, et al., Increased
erythrocyte phosphatidylserine exposure in sickle cell disease:
Flow-cytometric measurement and clinical associations, Blood 88
(1996) 1873-1880 (incorporated by reference herein) and labeled
with FITC as described in Tait, et al., Phospholipid binding
properties of human placental anticoagulant protein-I, a member of
the lipocortin family, J. Biol. Chem. 264 (1989) 7944-7949
(incorporated by reference herein). Recombinant annexin V-128 was
produced from plasmid pJ128 in E. coli strain Tuner(DE3)pLacI as
described in Smith, et al., Essential role of B-helix calcium
binding sites in annexin V-membrane binding, J Biol. Chem. 2004
Sep. 24; 279(39):40351-7 (incorporated by reference herein) and
labeled with IAF as described in Tait, et al., Measurement of the
affinity and cooperativity of annexin V-membrane binding under
conditions of low membrane occupancy, Anal Biochem. 2004 Jun. 1;
329(1):112-9 (incorporated by reference herein). Annexin-V-128
(SEQ. ID. NO: 1) has an amino-terminal extension of
Ala-Gly-Gly-Cys-Gly-His (amino acids 1 to 6 of SEQ. ID. NO: 1)
added to the wild-type sequence. The expression plasmids are
available from the authors. IAF-annexin V-128 was purified by
anion-exchange chromatography at pH 8.0 on a MonoQ HR5/5 column as
described in Smith, et al., (2004). The degree of labeling in each
fraction was determined from the ratio of absorbance measurements
at 494 nm and protein measurement by the BCA assay (Pierce,
Rockford, Ill.).
[0112] Radiolabeling: In preparation for technetium labeling,
protein (0.6 mg) was diluted with PBS pH 7.4 to a final volume of
0.2 ml and reduced with 1 mM dithiothreitol at 37.degree. C. for 15
min under anaerobic conditions. The protein was then applied to a
Sephadex G-25 column (NAP-5; Pharmacia, Piscataway, N.J.), which
had been pre-equilibrated with deoxygenated buffer (20 mM trisodium
citrate, pH 5.4, 100 mM NaCl), and the breakthrough (0.2 ml) was
discarded. Elution was performed with the same buffer; the first
0.5 ml of eluate was discarded, and the subsequent 0.5 ml,
containing the protein, was collected in argon-flushed glass vials.
Aliquots of 0.1 ml (containing 0.1 mg protein, 0.59 mg trisodium
citrate, and 0.58 mg NaCl) were stored frozen at -20.degree. C. in
glass vials with teflon-sealed screw caps. Just prior to use for
labeling, a vial was thawed and mixed. Tin reagent was prepared as
described in Larsen, et al., Technetium complex of tricine: useful
precursor for the 99mTc labeling of hydrazino nicotinamide modified
proteins, J. Labelled Compds. Radiopharm. 35, 1-2 (1994)
(incorporated by reference herein). Each vial of lyophilized
reagent contained 5 mg of sodium glucoheptonate, 0.128 mg
SnCl.sub.22H.sub.2O, and 0.128 mg of sodium gentisate. Just prior
to use, the vial was reconstituted with 0.2 ml of deoxygenated
water.
[0113] For in vivo studies, 99mTc-annexin V-128 was prepared as
described in Tait, et al., Structural requirements for in vivo
detection of cell death with 99mTc-Annexin V, J. Nucl. Med. 46,
807-815 (2005) (incorporated by reference herein).
99mT.sub.cO.sub.4 5-10 mCi in .about.0.1 ml of 0.9% NaCl was
diluted with 0.6 ml deoxygenated PBS pH 7.4. To this, 0.005 ml of
tin reagent and 0.05 ml (0.05 mg) of reduced protein was added.
After a 60-min anaerobic incubation at 37.degree. C., the reaction
mixture was applied to a Sephadex G-25 column (Pharmacia PD-10) and
eluted in 1-ml fractions with 10 ml PBS pH 7.4; fractions 3 and 4
contained the labeled protein and were pooled for in vivo use.
Percent incorporation of technetium was routinely 90%,
corresponding to a specific activity of about 100 .mu.Ci/.mu.g.
Example 2
In Vivo Pain Studies
[0114] Wistar or Swiss-Webster mice used in the experiment were
either young, 8-10 weeks in age, or old, 4-6 months in age. Pain
was induced by intrapaw injection of a constant noxious stimulus
induced by subcutaneous injection of CFA (bovine collagen dissolved
in Freund's Adjuvant), in either the forepaw or hindpaw.
Approximately 24 hours after intrapaw injection, imaging was
performed. Pain and control mice were injected, via tail vein, with
of 10 to 200 .mu.g/kg of radiolabeled annexin V-128, and after
approximately one hour, imaging was performed by microSPECT and
autoradiography.
[0115] Imaging showed that uptake of radiolabeled annexin V in the
spine was 3 to 4 times the uptake seen in non-pain control mice,
and uptake was 5 to 7 times greater in the brain. FIG. 1
illustrates uptake of radiolabeled annexin V 128 in pain versus
control mice. FIG. 1A illustrates the spinal cord 10 and the nerve
to the left hindpaw 12 in a normal mouse, while FIG. 1B illustrates
the spinal cord 10 and nerve 12 to the inflamed left hindpaw in a
pain-induced mouse. FIG. 5 shows microSPECT coronal images
illustrating uptake of radiolabeled annexin V-128 in intact spinal
cords of control mice (FIG. 5A) and mice with pain induced in the
left forepaw (FIG. 5B) or left hindpaw (FIG. 5C).
[0116] The above results were confirmed by fluorescence imaging
with IAF-labeled annexin V 128 in Sprague Dalwey rats 8 to 12 weeks
in age. Pain was induced as described above for mice. For
fluorescent imaging, the pain and control rats were injected with
100-200 .mu.g/kg of IAF-annexin V-128. A dose of 2 to 10 mCi of
tracer (500 to 700 .mu.l volume) was injected via tail vein one
hour before sacrifice. Results are shown in FIG. 2, which
illustrates the uptake of fluorescently-labeled Annexin V 128 in
the spinal cords and brains of control rats (FIG. 2A) and those
with pain induced in the forepaw (FIG. 2B) or in the hindpaw (FIG.
2C). In the figures, green is background and red indicates a
positive signal. FIG. 6 shows SPECT/CT images of rat spines
illustrating uptake of labeled annexin 24 hours after paw injection
to induce pain. FIG. 6A shows a microCT image, FIG. 6B shows a
microSPECT image, and FIG. 6B shows a SPECT/CT fusion image.
Example 3
In Vivo Stress Studies
[0117] Stress can be induced in animals by performing tail vein
injections while the animals are awake. In contrast, control
animals are anesthetized using 2-3% isoflurane gas anesthesia
(administered via inhalation) immediately prior to tail vein
injections.
[0118] In the present Example, 8-10 week-old and 4-6 month-old male
Swiss Webster mice were studied. Stress was induced in animals by
placing awake animals in a commercially-available mouse restrainer
that is used specifically for holding mice for tail vain
injections. After positioning the mice within the confined space of
the restrainer, mice were immediately injected via tail vein with
10 to 200 .mu.g/kg of radiolabeled annexin V-128. Stressed mice
experienced a 1 minute time period within the restrainer. Control
animals were anesthetized in a gas chamber prior to injection and
were continuously anesthetized during the tail vein injection.
[0119] In both the experimental and control groups, animals were
euthanized after one hour and central nervous system tissues was
harvested for autoradiography. Spinal cord and brain uptake of
radiolabeled Annexin V 128 in stress versus control mice are
demonstrated in FIGS. 3 and 4, respectively. Dramatically increased
uptake can be seen in the spinal cord (4-5 fold increase) and brain
(2 to 3-fold increase) of a stressed older mouse (FIGS. 3C and 4C)
when compared to younger controls (FIGS. 3A, 3B, 4A and 4B) and old
(FIGS. 3D and 4D) controls.
Example 4
Attachment of Annexin V to Dextran Coated Magnetic Iron Oxides
through the Use of Periodate
[0120] Periodate treatment of the dextran coated magnetic particle
produces an aldehyde, which forms a Schiff base with the amines of
the Annexin V. The complex is stabilized by treatment with sodium
borohydride.
[0121] A dextran coated superparamagnetic iron oxide nanoparticle
was synthesized according to the methods of Molday (1982) J.
Immunol. Methods 52, 353, which is incorporated herein by
reference. Iron oxide (10 mg Fe in about 1 mL of water) and
purified Annexin V were dialyzed against sodium acetate (0.01 M, pH
6). Annexin V was purified by the method of Wood (1996) Blood 88,
1873, which is incorporated herein by reference. The amount of
Annexin V can be varied from 1 to about 50 mg, preferably 5-10 mg
of protein. At lower amounts the ratio of protein to iron on the
resulting magnetic nanoparticle will be lower, but the offered
protein will couple more efficiently. At higher amounts of protein,
the ratio of protein to iron on the resulting nanoparticle will be
higher, but the percent of protein coupled will be lower.
[0122] Freshly made sodium periodate (50 mg/mL, 0.2 mL) was added
to the iron oxide. The mixture was then incubated for 30 minutes at
room temperature in the dark, and dialyzed against 0.15 M NaGI. The
oxidized magnetic iron oxide was then mixed with the Annexin V and
the pH adjusted by the addition of 100 .mu.l of 0.2 M sodium
bicarbonate, pH 9.5. The mixture was incubated for 3 hours with
stirring. Freshly made sodium cyanoborohydride was then added (25
mg/mL, 0.2 mL) and the mixture was incubated for 6 hours at room
temperature. The annexin V-magnetic nanoparticle can be separated
from the unreacted annexin by a variety of sized based separation
methods. These include gel filtration, ultrafiltration or magnetic
separation.
Example 5
Attachment of Annexin V with a Sulfhydryl Group to Amino CLIO
[0123] The amino-CLIO nanoparticle was made as described in
Josephson (1999) Bioconjug. Chem. 10, 186. Annexin V with a
sulfhydryl group added through mutagenesis (Tait (2000) Bioconjug
Chem 11, 918) was employed. To 1.2 mL of amino-CLIO in (30 mg Fe)
was added 1.2 mL of 0.1 M phosphate buffer, pH 7.4, and 2 mL of N--
succinimidyl 3-(2-pyridyldithio)propionate (SPDP, 25 mM) (Molecular
Bio-sciences, Boulder, Colo.) in DMSO. The mixture was allowed to
stand for 60 minutes at room temperature. Low molecular impurities
were removed by PD-10 columns (Sigma Chemical, St-Louis, Mo.)
equilibrated with 0.01 M Tris and 0.02 M citrate, pH 7.4
buffer.
[0124] Between 2 and 50 mg of Annexin V was subsequently added to
10 mg Fe of the SPDP activated nanoparticle at room temperature,
and the mixture was allowed to stand overnight. The Annexin
V-magnetic nanoparticle can be separated from the unreacted annexin
by a variety of sized based separation methods.
Example 6
Reaction of Annexin V to Add a Sulfhydryl Group, Followed by
Reaction with Amino CLIO
[0125] A sulfhydryl group was added to the annexin (obtained as in
Example 4) by use of the reagent SATA following the manufacturer's
instructions, Pierce Chemical Company. Amino-CLIO was reacted with
SPDP as in Example 2 and then reacted with the SAT A reacted
annexin.
Example 7
Attachment of Annexin V to a BSA Coated Magnetic Particle
[0126] BSA coated magnetic particles were made as described in U.S.
Pat. No. 4,795,698 (which is incorporated by reference herein).
Some of the amine groups of the BSA coating of the magnetic
particle are converted to sulfhydryl groups by use of the reagent
SPDP (see Example 5). SPDP or SATA can then be used to add one or
more sulfhydryl groups on Annexin V. After treatment of the Annexin
V with DTT, to expose a sulfhydryl group, the protein is reacted
with the magnetic particle.
[0127] It should be emphasized that the above-described embodiments
of the present disclosure are merely possible examples of
implementations, and are set forth only for a clear understanding
of the principles of the disclosure. Many variations and
modifications may be made to the above-described embodiments of the
disclosure without departing substantially from the spirit and
principles of the disclosure. All such modifications and variations
are intended to be included herein within the scope of this
disclosure and the following claims.
Sequence CWU 1
1
11325PRTHomo sapiens 1Ala Gly Gly Cys Gly His Ala Gln Val Leu Arg
Gly Thr Val Thr Asp1 5 10 15Phe Pro Gly Phe Glu Asp Arg Ala Asp Ala
Glu Thr Leu Arg Lys Ala 20 25 30Met Lys Gly Leu Gly Thr Asp Glu Glu
Ser Ile Leu Thr Leu Leu Thr 35 40 45Ser Arg Ser Asn Ala Gln Arg Gln
Glu Ile Ser Ala Ala Phe Lys Thr 50 55 60Leu Phe Gly Arg Asp Leu Leu
Asp Asp Leu Lys Ser Glu Leu Thr Gly65 70 75 80Lys Phe Glu Lys Leu
Ile Val Ala Leu Met Lys Pro Ser Arg Leu Tyr 85 90 95Asp Ala Tyr Glu
Leu Lys His Ala Leu Lys Gly Ala Gly Thr Asn Glu 100 105 110Lys Val
Leu Thr Glu Ile Ile Ala Ser Arg Thr Pro Glu Glu Leu Arg 115 120
125Ala Ile Lys Gln Val Tyr Glu Glu Glu Tyr Gly Ser Ser Leu Glu Asp
130 135 140Asp Val Val Gly Asp Thr Ser Gly Tyr Tyr Gln Arg Met Leu
Val Val145 150 155 160Leu Leu Gln Ala Asn Arg Asp Pro Asp Ala Gly
Ile Asp Glu Ala Gln 165 170 175Val Glu Gln Asp Ala Gln Ala Leu Phe
Gln Ala Gly Glu Leu Lys Trp 180 185 190Gly Thr Asp Glu Glu Lys Phe
Ile Thr Ile Phe Gly Thr Arg Ser Val 195 200 205Ser His Leu Arg Lys
Val Phe Asp Lys Tyr Met Thr Ile Ser Gly Phe 210 215 220Gln Ile Glu
Glu Thr Ile Asp Arg Glu Thr Ser Gly Asn Leu Glu Gln225 230 235
240Leu Leu Leu Ala Val Val Lys Ser Ile Arg Ser Ile Pro Ala Tyr Leu
245 250 255Ala Glu Thr Leu Tyr Tyr Ala Met Lys Gly Ala Gly Thr Asp
Asp His 260 265 270Thr Leu Ile Arg Val Met Val Ser Arg Ser Glu Ile
Asp Leu Phe Asn 275 280 285Ile Arg Lys Glu Phe Arg Lys Asn Phe Ala
Thr Ser Leu Tyr Ser Met 290 295 300Ile Lys Gly Asp Thr Ser Gly Asp
Tyr Lys Lys Ala Leu Leu Leu Leu305 310 315 320Ser Gly Glu Asp Asp
325
* * * * *
References