Title of Invention	A FORMULATION USEFUL TO IMPROVE CIRCULATION OF STEM CELLS AND PROGENITOR CELLS IN MAMMAL.
Abstract	There is disclosed a formulation useful to improve circulation of stem cells and progenitor cells in the peripheral blood of mammal comprising defibrotide and one or more haematopoietic factor capable of mobilising haematopoietic progenitors, such as herein described, as active ingredients.

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1 The present invention relates to a novel formulation capable of increasing the amount of stem cells and progenitor cells in circulation in the peripheral blood of a mammal; the formulation is characterised in that it contains deilbrotide in combination with at least one haematopoietic factor having the capacity to mobilise haematopoietic progenitors, preferably G-CSF. FIELD OF THE INVENTION The possibility of obtaining an increased amount of stem cells and haematopoietic progenitors in circulation in the peripheral blood of a mammal, and in particular in that of a human being, has for years been the subject of intensive research activity; the availability of stem cells and/or haematopoietic progenitors is in fact particularly important in sectors such as the autologous transplantation of circulating haematopoietic progenitors, the allotransplantation of circulating haematopoietic progenitors and in program for the gene therapy of circulating haematopoietic cells. Although, after birth, stem cells and progenitor cells are located almost exclusively in the bone marrow, they nevertheless exhibit migratory properties; that is to say, under physiological conditions, they migrate through the cavities of the bone marrow and pass into circulation. That process, commonly known as "mobilisation", can be amplified in mammals by various treatments, such as, for example, the administration of cytokines and, in particular, the growth factor of granulocyte colonies (G-CSF); the reverse process, known as "homing", occurs, for example, in irradiated receivers after the transplantation of haematopoietic cells; the mechanisms on which mobilisation and homing are based are, however, still obscure (C.F. Craddock et al., "Antibodies to VLA4 Integrin Mobilize Long-Term Repopulating Cells and Augment Cytokine-Induced Mobilization in Primates and Mice", Blood, Vol. 90, n. 12, 1997, pp. 4779-4788; F. Prosper et al., "Mobilization and Homing of Peripheral Blood Progenitors is Related to Reversible Downregulation of 4 l Integrin Expression and Function", J. Clin. Invest., Vol. 101, n. 11, 1998, pp. 2456-2467; M. Vermeulen et al., "Role of Adhesion 2 Molecules in the Homing and Mobilization of Murine Hematopoietic Stem and Progenitor Cells", Blood, Vol. 92, n.3, 1998, pp. 894-900). G-CSF (CAS registry number 143011-2-7/Merck Index, 1996, page 4558) is a haematopoietic growth factor which is indispensable in the proliferation and differentiation of the progenitor cells of granulocytes; it is a 18-22 kDa glycoprotein normally produced in response to specific stimulation by a variety of cells, including monocytes, fibroblasts and endothelial cells. The term defibrotide (CAS registry number 83712-60-1) normally identifies a polydeoxyribonucleotide obtained by extraction (US 3,770,720 and US 3,899,481) from animal and/or vegetable tissue; this polydeoxyribonucleotide is normally used in the form of a salt of an alkali metal, generally sodium. Defibrotide is used principally for its anti-thrombotic activity (US 3,829,567) although it may be used in different applications, such as, for example, the treatment of acute renal insufficiency (US 4,694,134) and the treatment of acute myocardial ischaemia (US 4,693,995). United States patents US 4,985,552 and US 5,223,609, finally, describe a process for the production of defibrotide which enables a product to be obtained which has constant and well defined physico-chemical characteristics and is also free from any undesired side-effects. For the purposes of the present invention, the term defibrotide should therefore be understood as meaning any oligonucleotide and/or polynucleotide obtained by extraction from animal and/or vegetable tissue, in particular from the organs of mammals. Preferably, defibrotide is produced in accordance with the methods described in the patents listed above which should thus be regarded as an integral part of the present description; even more preferably, it is produced in accordance with the method described in United States patents US 4,985,552 and US 5,223,609. 2A BRIEF DESCRIPTION OF THE ACCOMPANYING DRAWINGS Fig. 1 Effect of the Administration of G-CSF and /or Defibrotide on the amount of White Blood Cells (WBC) present in nurine blood. The data are expressed as Mean± Standard Error Mean (SEM). Fig. 2 Mobilisation kinetics of the cells forming the total colonies (CFC) per millilitre of blood of mice following administration of G-CSF and/or Defibrotide. The data are expressed as Mean ± SEM derived from duplicated cultures on samples from each animal. Fig. 3. Influence of G-CSF and/or Defibrotide on changes of total CFCs per 105 buffycoat of peripheral blood. The data are. expressed as Mean ± SEM derived from duplicate cultures on samples from each animal. Fig. 4. Total CFCs per millilitre of blood after 5 days treatment of mice with G- CSF and/or Defibrotide. The data expressed as Mean± SEM derived from the duplicated cultures on sample from each animal. Fig. 5 Effect of Administration of G-CSF and/or Defibrotide on frequency of total CFCs for 105 buffy-coat cells of peripheral blood in mice. The data are expressed as Mean ± SEM derived from duplicated cultures - on samples from each animal. Fig. 6 Effect of Administration of G-CSF and/or Defibrotide on High Proliferative Potential-Colony stimulating cells (HPP-CFC) in circulation of peripheral blood of monkeys. The data are expressed as Mean ± SEM. DETAILED DESCRIPTION OF THE INVENTION It has now surprisingly been found that it is possible to obtain increased mobilisation of stem cells and haematopoietic progenitors by the administration of defibrotide in combination and/or in close temporal proximity with a haematopoietic factor having the capacity to mobilise haematopoietic progenitors. Accordingly, the present invention provides a formulation useful to improve circulation of stem cells and progenitor cells in the peripheral blood of mammal comprising defibrotide and one or more haematopoietic factor capable of mobilising haematopoietic progenitors, as active ingredients, such as herein described, in relative administrable dosage units. 3 As will be appreciated from the Examples, the administration of defibrotide in combination and/or in close temporal proximity with a haematopoietic factor having the capacity to mobilise haematopoietic progenitors permits the attainment of mobilisation levels much higher than those obtainable by the administration of the haematopoietic factor alone. The subject of the present invention is therefore represented by a formulation containing as "active agents" defibrotide in combination with at least one haematopoietic factor having the capacity to mobilise haematopoietic progenitors, preferably G-CSF. In its preferred embodiment, this formulation is constituted by an injectable aqueous solution; alternatively, the formulation could be constituted by two different solutions, one containing defibrotide and the other containing the haematopoietic factor having the capacity to mobilise haematopoietic progenitors. The formulation according to the present invention is therefore shaped as a combined preparation for simultaneous, separate or sequential use of the aforementioned active principles in order to increase the amount of stem cells and/or haematopoietic progenitors in circulation in the pcripherial blood of a mammal. A second subject of the present invention is represented by the use of defibrotide, in combination with at least,one haematopoietic factor having the capacity to mobilise haematopoietic progenitors, for the preparation of formulations capable of increasing the amount of stem cells and/or haematopoietic progenitors in circulation in the peripheral blood of a mammal, preferably a human being. Finally, a further subject of the present invention is represented by a method of increasing the amount of stem cells and/or haematopoietic progenitors in circulation in the peripheral blood of a mammal, characterised in that defibrotide is administered to the mammal in combination or in temporal proximity with at least one haematopoietic factor having the capacity to mobilise haematopoietic progenitors. The haematopoietic factor used to conduct the experiments which led to the present invention is G-CSF; however, it is not to be excluded that similar results may be obtained with haematopoietic factors other than G-CSF but nevertheless having the capacity to mobilise haematopoietic progenitors, such as, for example, the growth factor of granulocyte and macrophage colonies (GM-CSF), "FIt3 ligand" A (FL), "stem cell factor" (SCF), thrombopoietin (TPO), mterleukm 8 (IL-8), and others which will be clear to persons skilled in the art. The defibrotide used in combination with G-CSF in this first experimental stage was the defibrotide currently marketed by Crinos Spa under the mark Prociclide™ and produced in accordance with the process described in United States patents US 4,985,552 and US 5,223,609. As regards the methods of administering the two active ingredients, they are not limiting for the purposes of the invention. That is to say, defibrotide and haematopoietic factor having the capacity to mobilise haematopoietic progenitors can be administered to mammals (and in particular to human beings) in accordance with the methods and the posologies known in the art; generally, they are administered orally, intramuscularly, intraperitoneally, subcutaneously or intravenously, the last-mentioned route being the preferred one. The two active ingredients can also be administered simultaneously or in succession. That is to say, in the first case, they are administered by means of a single formulation which contains both of the active ingredients and to which the usual excipients and/or coadjuvants known in the art have optionally been added; alternatively, the two active ingredients may be administered sequentially, namely, by means of two different formulations, one containing the haematopoietic factor having the capacity to mobilise haematopoietic progenitors, preferably G-CSF, and the other containing the defibrotide. Generally, G-CSF will be administered subcutaneously, at a dosage of 5 to 24 g/kg whereas DEF will be administered by continuous infusion at a dosagefof 5 to 15 mg/kg/hr for 2-7 days. As will be appreciated from the accompanying Examples, which are to be regarded purely as non-limiting illustrations of the invention, the combined administration of G-CSF and defibrotide to mice, as the most common experimental mammal model, and to monkeys, permits the attainment of levels of mobilisation much higher than those obtainable by the administration of G-CSF alone, with clear advantages for all those therapeutic sectors for which a high level of mobilisation is desirable. 5 EXAMPLE 1 This experiment was earned out to evaluate the effect of the administration of G-CSF and/or defibrotide (DEF) on the amount of white blood cells (WBC) present in murine blood. BALB/c mice from 6 to 8 weeks old and having a body weight of from 20 to 25 g were subjected to intraperitoneal (IP) injections of G-CSF (5 g/mouse/day), DEF (1 mg/mouse/day), or a combination of G-CSF (5 g /mouse/day) and increasing doses of DEF (1, 10, 15 mg/mouse/day). A saline solution, buffered to 0.1%, of murine scrum albumin (PBS/MSA) was administered by IP injection to the control mice which had not received G-CSF and/or DEF. The mice were treated for 5 days and sacrificed after 3 or 5 days of treatment, or 3 days after therapy had ceased. The results of this experiment are given in Figure 1. The following symbols were used to represent each group of mice: G-CSF (H) (n-24), DEF 1 (O) (n=3), G-CSF+DEF I (?) (n=13), G-CSF+DEF 10 (A) (n=6), G-CSF+DEF 15 () (n=23). The mean white blood cell count in PBS/MSA in the control mice was 2.87 + 0.2 x 106/ml of blood; the data are expressed as mean + standard error of the mean (SEM). EXAMPLE 2 Mobilisation kinetics of the cells forming the total colonies (CFC) per millilitre of blood of the mice of Example 1. The mean CFC count in PBS/MSA in the control mice was 39 + 12 per ml of blood; the data are given in Figure 2 and are expressed as mean + SEM derived from duplicated cultures on samples from each animal at each point in time. EXAMPLE 3 Changes in the frequency of the total CFCs (CFU-GM + BFU-E + CFU-Mix + HPP-CFC) per 105 buffy-coat cells of peripheral blood in the mice mentioned in Example 1. The mean CFC count in PBS/MSA in the control mice was 3.5 + 1; the data are given in Figure 3 and are expressed as mean + SEM derived from duplicated cultures on samples from each animal at each point in time. EXAMPLE 4 Total CFCs (CFU-GM + BFU-E + CFU-Mix + HPP-CFC) per millilitre of blood after 5 days' treatment of the mice of Example 1; the data are given in Figure 4 6 and are expressed as mean + SEM derived from duplicated cultures on samples from each animal. EXAMPLE 5 Frequency of the total CFCs (CFU-GM + BFU-E + CFU-Mix + HPP-CFC) for 105 buffy-coat cells of peripheral blood in the mice mentioned in Example 1; the data are given in Figure 5 and are expressed as mean + SEM derived from duplicated cultures on samples from each animal. EXAMPLE 6 This experiment was carried out to evaluate the effect of the administration of G-CSF and/or DEF on the amount of haematopoietic progenitors/stem cells (High-Proliferative Potentia-Colony Stimulating Cells, or HPP-CFC) in circulation in the peripheral blood of monkeys. The study was carried out in rhesus monkeys (Ma-caca Mulatta) of 4-6 years in good health and which showed normal values for hematology and clinical chemistry. The G-CSF was dosed subcutaneously, 100 g/kg, for 5 days for two cycles; DEF was dosed 15 mg/kg/hr by a continuous infusion system for 5 days at the second cycle. The animals were anaesthetised for bleeding, administration of G-CSF and changing the drug-bag. The results of this experiment are given in Figure 6, from which it can be appreciated that the combined administration of G-CSF and defibrotide enables an HPP-CFC mobilisation in monkeys which is about 8 times higher than that obtainable by the administration of G-CSF alone. CONCLUSIONS As will be readily appreciated from the data given in Figure 1, the combined administration of G-CSF and defibrotide produces a substantial increase in the amount of white blood cells in circulation in murine blood. It should, in particular, be noted that the administration of defibrotide alone does not have a positive influence on the amount of white blood cells in circulation; the combination of G-CSF and defibrotide therefore produces a surprising dose-dependent effect of increasing the number of white blood cells, which is not merely the sum of two effects which are independent of one another- 7 Figures 2 to 5 clearly indicate that the combined administration of G-CSF and de-fibrotide enables levels of mobilisation to be obtained in mice that are from 10 to 100 times higher than those obtainable by the administration of G-CSF alone. Finally, figure 6 confirms that the combined administration of G-CSF and defi-brotide enables a stem cell (HPP-CFC) mobilisation in monkeys which is about 8 times higher than that obtainable by the administration of G-CSF alone. The combined effect of the two active ingredients is dose-dependent because the levels of mobilisation increase proportionally with the amount of defibrotide administered; the highest mobilisation peak is reached in all cases on approximately the fifth day from administration. 8 WE CLAIM: 1. A formulation useful to improve circulation of stem cells and progenitor cells in the peripheral blood of mammal comprising defibrotide and one or more haematopoietic factor capable of mobilising haematopoietic progenitors, such as herein described, as active ingredients. 2. A formulation as claimed in claim 1, wherein the haematopoietic factor having the capacity to mobilise haemotopoietic progenitors is G-CSF. 3. A formulation, as claimed in claim 1, wherein it is an aqueous solution. 4. A formulation according to claim 1, constituted by two different separately administrable formulations, one containing the haematopoietic factor having the capacity to mobilise haematopoietic progenitors and the other containing defi brotide. 5. A formulation containing defibrotide and at least one haematopoietic factor having the capacity to mobilise haematopoietic progenitors, preferably G-CSF, as a combined preparation for simultaneous, separate or sequential use to increase the amount of stem cells and/or haematopoietic progenitors in the peripheral blood of a mammal. There is disclosed a formulation useful to improve circulation of stem cells and progenitor cells in the peripheral blood of mammal comprising defibrotide and one or more haematopoietic factor capable of mobilising haematopoietic progenitors, such as herein described, as active ingredients.

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in-pct-2002-01302-kol abstract.pdf

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in-pct-2002-01302-kol claims.pdf

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in-pct-2002-01302-kol-granted-abstract.pdf

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