AU710142B2 - Fluorocarbon emulsions with reduced pulmonary gas-trapping properties - Google Patents

Description

-lA- FLUOROCARBON EMULSIONS WITH REDUCED PULMONARY GAS-TRAPPING

PROPERTIES

This application is a divisional of application 63566/94, the entire contents of which is incorporated herein by reference.

The present invention relates to emulsions comprising highly fluorinated or perfluorinated compounds. More particularly, it relates to fluorocarbon emulsions exhibiting reduced pulmonary gas-trapping properties.

Fluorocarbon emulsions find uses as therapeutic and diagnostic agents. Most therapeutic uses of fluorocarbons are related to the remarkable oxygen-carrying capacity of these compounds. One commercial biomedical fluorocarbon emulsion, 15 Fluosol (Green Cross Corp., Osaka, Japan), is presently used as an oxygen carrier to enhance oxygen delivery to the myocardium during percutaneous transluminal coronary angioplasty (Fluosol, Summary Basis of Approval, Reference No.

OB-NDA86-0909, Dec. 1989). Fluorocarbon emulsions have also 20been used in diagnostic applications such as imaging.

Radiopaque fluorocarbons such as perflubron (perfluorooctyl bromide or CF,,Br) are particularly useful for this purpose.

Increased pulmonary residual volume (IPRV) has been S..I observed in association with the intravenous administration of 2 5 various perfluorocarbon emulsions in certain animal species.

While the direct correlation between IPRV and pulmonary dysfunction has not been positively identified, dysfunction (including reduced arterial P0 2 signs of respiratory distress, and even lethality) has been observed on occasions 3 0 in certain sensitive animal species in which IPRV was later identified.

IPRV occurs as a result of gas-trapping within the pulmonary system, and prevents the normal deflation of lungs when intrathoracic pressure is equalized to ambient pressure such as during necropsy of an animal. It is believed that gas-trapping occurs as a consequence of foam or bubble 27j formation in the lungs. It is noted that under normal circumstances, bubbles or liquid bridges form and disappear spontaneously within alveoli without a gas-trapping effect.

It is believed, however, that IPRV occurs when these bubbles grow in the presence of fluorocarbon vapors, trapping larger amounts of air within the lung. As stated above, if bubble formation continues, pulmonary dysfunction can result (in certain animal species). IPRV depends on the vapor pressure of the fluorocarbon component(s), with lower vapor pressure fluorocarbons not exhibiting the phenomenon. Diminution of the vapor pressure of the fluorocarbon component(s) also plays a critical role in stabilizing the emulsion droplets against Ostwald ripening, the key destabilizing mechanism at work in small particle fluorocarbon emulsions. The prior art has described fluorocarbon emulsion formulations designed to inhibit Ostwald ripening. See, e.g. Davis et al., U.S. Patent No. 4,859,363; Meinert, U.S. Patent No. 5,120,731; Kabalnov et al., Kolloidn Zh., 48: 27-32 (1986). These formulations contain a mixture of two fluorocarbon components, the secondary fluorocarbon component having a significantly higher molecular weight, and lower vapor pressure relative to the primary fluorocarbon component.

Following intravenous administration, fluorocarbon emulsion particles are taken up and temporarily retained by cells of the reticuloendothelial system (RES). It is desirable to minimize this retention time (all references to organ half-life or organ retention which follow refer specifically to retention in the RES organs, principally liver and spleen) Unfortunately, when the prior art included higher molecular weight fluorocarbons in fluorocarbon 30 emulsions, organ retention times were also increased considerably. Organ retention times for most fluorocarbons bear an exponential relationship to the molecular weight of the fluorocarbon and are critically dependent on dose and animal species. See J.G. Riess, Artificial Organs 8: 44, 49- 51 (1984) J.G. Riess, International Symposium on Blood Substitutes, Bari, Italy: Jun. 19-20, 1987, Proceedings pp.

135-166.

P:\OPER\MC\63566-94.CLM 12/7/99 There is a need for perfluorocarbon emulsions that do not exhibit, or exhibit reduced pulmonary gas-trapping properties, and also have a short organ retention time. Advantageously, this invention may provide fluorocarbon emulsions having these characteristics.

The present invention involves fluorocarbon emulsions which unexpectedly exhibit both reduced pulmonary gas-trapping properties, and a short RES organ retention time.

Thus, in accordance with the parent invention, there is provided a fluorocarbon emulsion which has the following properties: the fluorocarbon components have a vapour 0 .1 pressure at 37 degrees celsius of less than 2.67 kPa (20 torr), 15 preferably less than 1.33 KPa (10 torr), and most preferably less than 1.07 kPa (8 torr), in order to preclude pulmonary gastrapping; and the fluorocarbon components have organ halflives significantly less than would be predicted for their molecular weight, preferably less than about 6 weeks, and more *ee S" 20 preferably less than about 3 to 4 weeks.

According to a first aspect of the present invention there

Q.

S 5: is provided a method for providing oxygen to a patient comprising the steps of: supplying an emulsified oxygen carrier comprising an aqueous phase, an emulsifying agent and a fluorocarbon phase comprising a mixture of two or more fluorocarbons including from about 50 to about 99.9% w/w of a first fluorocarbon and from 0.1% to about 50% w/w of a second fluorocarbon having a lipophilic moiety and a vapour pressure less than the first fluorocarbon wherein said fluorocarbon phase has a vapour pressure less than 2.67 kPa (20 torr) at 370 C and an organ half-life of less than about 6 weeks; and administering an effective oxygen transporting amount of said emulsified oxygen carrier to a patient in need thereof.

P:\OPER\MJC\63566-94.CLM 12/7/99 It has been determined that there are few fluorocarbons presently known which exhibit the above stated characteristics.

Several fluorocarbons which appear suitable as a single lipophilic fluorocarbon component to eliminate IPRV are listed in Table I, and include:

CF

3

(CF

2 8 Br, (CF 3 2

CF(CF

2 3

CF(CF

3

)CF

2 Br, F-octyl ethane and Fbromoethers.

In particular, in the second fluorocarbon, the lipophilic moiety or moieties are advantageously Br, Cl, I, H, CH 3 or a saturated or unsaturated hydrocarbon chain of 2 or 3 carbon atoms. In one preferred embodiment, the second fluorocarbon is an aliphatic perfluorocarbon having the general formula CnF2n+lR or CnF 2 nR 2 wherein n is an integer from 9 to 12 and R is the lipophilic moiety. In various preferred embodiments, the second 15 fluorocarbon is selected from the group consisting of perfluorodecyl bromide, CloF 2 1

CH=CH

2 or C 10

F

21

CH

2

CH

3 or linear or branched brominated perfluorinated alkyl ethers. Most preferably, the second fluorocarbon comprises perfluorodecyl bromide. It is desirable that each second fluorocarbon has a 20 molecular weight greater than about 550 Daltons. Pursuant to an alternative definition of the second fluorocarbon, each second fluorocarbon has a critical solution temperature in hexane at least 10 0 C lower than that of a fully fluorinated fluorocarbon having substantially the same molecular weight a molecular weight within 10, and preferably with 3, 4, or Daltons). In preferred emulsions, the discontinuous fluorocarbon phase comprises from about 60% to about 99.5% w/w of the first fluorocarbon, and from about 0.5% to about 40% w/w of the second fluorocarbon; more preferably from about to about 80% w/w of the first fluorocarbon, and from about to about 40% w/w of the second fluorocarbon. The first fluorocarbon component in these mixtures has a molecular weight from about 460 to 550 Daltons, and has a half-life in the organs of less than about 4 weeks, more preferably less than about 2 or 3 weeks, and most preferably 7 days or less.

In particular, the fluorocarbon phase preferably comprises a suitable mixture of perfluorooctyl bromide (PFOB, USAN perflubron) and perfluorodecyl bromide (PFDB).

According to a preferred emobidment of the present invention there is provided a method for providing oxygen to a patient comprising the steps of: supplying an emulsified oxygen carrier comprising an aqueous phase, an emulsifying agent and a fluorocarbon phase comprising a mixture of two or more fluorocarbons including from about 50 to about 99.9% w/w of F-octyl bromide and from about 0.1% to about 50% w/w of F-decyl bromide wherein said fluorocarbon phase has a vapour pressure less than 2.67 kPa torr) at 37 0 C and an organ half-life of less than about 6 weeks; and administering an effective oxygen transporting amount of said emulsified oxygen carrier to a patient in need thereof.

Focusing specifically on particular embodiments, one aspect of the method of the present invention utilises a fluorocarbon '"25 emulsion exhibiting reduced pulmonary gas-trapping properties, comprising an aqueous phase, an emulsifying agent, and a liquid fluorocarbon phase having a vapor pressure of less than about 2.67 kPa (20 torr) at 37 0 C, having an organ half-life of o *l~e less than about 6 weeks, and having a lipophilic component, the fluorocarbon phase comprising a mixture of at least two fluorocarbons in a weight ratio of from about 20:1 to about 1:20. Preferably, the fluorocarbon phase comprises a first fluorocarbon having an organ half-life of less than about 4 weeks, and a second fluorocarbon having a vapor pressure less than the first fluorocarbon. In one embodiment, the first fluorocarbon has a molecular weight of about 460 to 550 Daltons, and the second fluorocarbon has a molecular weight of about 560 to 700 Daltons. In another embodiment, the fluorocarbon phase has a vapor pressure at 37 0 C of less than about 1.33 kPa (10 torr), preferably less than about 1.07 kPa a (8 torr) In another embodiment, the method of the invention utilises a fluorocarbon emulsion exhibiting reduced pulmonary gas- S: trapping properties, comprising an aqueous phase, an emulsifier, and fluorocarbon phase including at least 10% weight by volume of F-decyl bromide. In this emulsion, the fluorocarbon phase may advantageously additionally comprise F-octyl bromide, and 20 the F-octyl bromide is preferably present in the fluorocarbon phase at about 45% to 80% or 90% weight per volume, and the Fdecyl bromide is present in the fluorocarbon phase at about S. to 55% weight per volume.

In a preferred embodiment, the fluorocarbon has a vapour pressure at 37° C of less than 1.07 kPa (8 torr). In another embodiment, the invention is a method of preparing a fluorocarbon emulsion for intravenous administration to a patient, by forming an emulsion of an aqueous phase, an emulsifier, and a first fluorocarbon in a fluorocarbon phase wherein the vapor pressure of the fluorocarbon phase is greater than about 1.07 kPa (8 torr) at 37°C, the improvement comprising reducing the pulmonary gas trapping effect of the emulsion upon intravenous administration by providing in combination with the first fluorocarbon in the fluorocarbon phase an effective amount of a second fluorocarbon, wherein the addition of the second fluorocarbon reduces the vapor pressure of the fluorocarbon phase at 37°C to less than about 1.07 kPa (8 torr), wherein the fluorocarbon phase has a melting point less than about 37°C and an organ retention half-life less than about 4 weeks.

As above, the second fluorocarbon preferably includes a lipophilic moiety, and more preferably is a bromofluorocarbon.

Finally, the invention includes a method for administering a fluorocarbon emulsion to a mammal, wherein the emulsion comprises an aqueous phase, an emulsifier, and a first fluorocarbon in a fluorocarbon phase wherein the vapor pressure of the fluorocarbon phase is greater than about 1.07 kPa (8 torr) at 37 0 C, and wherein the improvement comprises reducing the pulmonary gas trapping effect of the emulsion o• upon intravenous administration by providing in combination with the first fluorocarbon in the fluorocarbon phase an 25 effective amount of a second fluorocarbon, wherein the addition of the second fluorocarbon reduces the vapor pressure of the fluorocarbon phase at 370°C to less than about 1.07 kPa (8 torr), wherein the fluorocarbon phase has a melting point less than about 370°C and an organ retention half-life less than about 4 weeks.

As noted, one of the criteria for the emulsions of this invention is that the fluorocarbon component(s) exhibit a short organ retention time. One low vapor pressure lipophilic fluorocarbon, perfluorodecyl bromide, for example, has a RES 35 half life in vivo of approximately 23 days, while those of nonlipophilic perfluorocarbons having about the same molecular weight vary from about 60 to 300 days (See Table I/Figure This distinction is critical; it spells the difference between formulations which are physiologically acceptable and those which are not. Note that none of the prior art low vapor pressure fluorocarbons are lipophilic; thus, none share the advantageous properties of the present invention. For example, with reference to Table I and Figure 3, the fluorocarbons of the present invention all have critical solution temperatures (CSTs) and projected organ retention times much lower than those of the prior art fluorocarbons of Davis, et al., Kabalnov, and Meinert. Aside from the fluorocarbons of the present invention, conventional fluorocarbons exhibit a direct correlation between retention Stime in RES organs and molecular weight. Also, aside from the S: lipophilic fluorocarbons used in the present invention, the perfluorochemical structure has little effect on the strong.

'y retention time/molecular weight relationship. Thus, the presence of heteroatoms or cyclic structure has little effect on organ retention time.

A particularly preferred emulsifier for use in the present invention is egg yolk phospholipid, and preferred amounts of this emulsifier are 1%-10% w/v. Also preferred are the fluorinated surfactants.

o9 9 FIG. 1 is a graph which illustrates the increase in lung volume which occurs in rats as a result of pulmonary gas trapping following intravenous administration at a dose of 5.4 g PFC/kg. The formulations tested are concentrated (90% w/v) fluorocarbon emulsions stabilized by 4% egg yolk phospholipid.

The conversion factor for torr to kPa is is 1 torr 0.13329 kPa.

FIG. 2 is a graph which illustrates the increase in lung volume which occurs in rabbits as a result of pulmonary gas trapping following intravenous administration at a dose of 5.4 g PFC/kg. The formulations tested are concentrated (90% w/v) fluorocarbon emulsions stabilized by 4% egg yolk phospholipid.

mm FIG. 3 represents a plot of fluorocarbon molecular weight (g/mol) versus critical solution temperature in hexane (oK) for various fluorocarbons including the prior art emulsion stabilizers proposed by Davis, Meinert, and Kabalnov.

FIG. 4 is a plot illustrating the organ half-life in days vs. molecular weight of various fluorocarbons in g/mol. The plot includes a lower molecular weight cutoff which is related to the formation of gas emboli for fluorocarbons with vapor pressures greater than 2.67 kPa (20 torr). The plot also includes an upper molecular weight cutoff which is related to compounds having organ retention times of less than 4 weeks.

FIG. 5 is a plot illustrating the organ half-life in days vs. molecular weight of various fluorocarbons in g/mol. The plot includes a lower molecular weight cutoff of 520 g/mol to take into account pulmonary gas trapping limit to less than 1.07 kPa (8 torr)).

FIG. 6 is a graph of fluorocarbon vapor pressure in torr at 37 degrees celsius for various mole fractions in mixtures of perfluorooctyl bromide (PFOB) and perfluorodecyl bromide 20 (PFDB) FIG. 7 is a table listing various properties of fluorocarbons.

*25 The fluorocarbon emulsions of the present invention comprise two phases: a continuous aqueous phase and a discontinuous fluorocarbon phase. Osmotic agents and buffers, generally, are also included in the continuous phase to maintain osmolality and pH to promote physiological acceptability.

The discontinuous phase of modern fluorocarbon emulsions for therapeutic use generally comprises from 20% w/v to up to 125% w/v of a fluorocarbon or a highly fluorinated compound (hereinafter referred as a "fluorocarbon" or a "perfluorocarbon"). As used herein, the expression "weight per volume" or will mean grams per 100 cubic centimeters or milliliters.

q The present invention provides a fluorocarbon emulsion which exhibits reduced pulmonary gas-trapping properties, and which has a short organ retention time.

In the first instance, in order to reduce pulmonary gastrapping, it is desired that the fluorocarbon emulsion include a fluorocarbon, or mixture thereof, which has a vapor pressure of less than 2.67 kPa (20 torr), and most preferably less than 1.07 kPa (8 torr).

Further, in order to prevent long body retention time, it is desired that the single fluorocarbon be lipophilic.

Alternatively, as stated above, the emulsion may comprise a mixture of fluorocarbons in which a second fluorocarbon is added to a first, the second fluorocarbon having a relatively higher molecular weight and lower vapor pressure, and includes in its molecular structure a lipophilic moiety. In such form, emulsions of the present invention will exhibit reduced IPRV.

9 9 9 The Compositions A. The Fluorocarbon 0 The characteristics of fluorocarbons suitable for use in the present invention are discussed in more detail below.

Examples of suitable fluorocarbons are provided.

1. The fluorocarbon which is to be administered in .emulsion form is chosen in order to prevent or reduce pulmonary gas-trapping. It has previously been found that intravascular administration of fluorocarbon emulsions having vapor pressures of around 3.99 kPa (30 torr) cause gas/vapor microbubble intravascular embolism. In order to prevent this effect, it is desired that the fluorocarbon have, in the first instance, a vapor pressure of less than about 2.67 kPa torr) Referring to Figures 1 and 2, the effect of vapor pressure of the administered fluorocarbon upon pulmonary gastrapping (PGT) is illustrated in rats and rabbits. As is clearly seen, there is an increase in PGT once the vapor pressure of the fluorocarbon exceeds approximately 1.07 kPa (8 torr). At intermediate vapor pressure levels, such as 1.60- 1.73 kPa (12-13 torr), it has been found that gas/vapor intravascular emboli does not occur, however, a larger degree of increased pulmonary residual volume (IPRV) occurs. It is therefore desired that any fluorocarbon used in such a fluorocarbon emulsion have a vapor pressure of less than about 2.67 kPa (20 torr), and it is preferred that the vapor pressure be less than 2.00, 1.86, or 1.73 kPa (15, 14, or 13 torr), and more preferedly that -the vapor pressure be less than about 1.60, 1.46 or 1.33 kPa (12, 11, or 10 torr), and most preferedly that the vapor pressure be less than 1.20, 1.06, or .931 kPa 8, or 7 torr).

As stated above, however, vapor pressure as related to IPRV is not the sole criteria for selecting the fluorocarbon.

In particular, it is desired that the fluorocarbon have a short body retention time. Preferably, the half-life of the fluorocarbon in organs is less than 6 weeks, and most preferedly that the half-life is less than 3 to 4 weeks.

h For single fluorocarbons, the fluorocarbon component must S have a low vapor pressure and be lipophilic. Possible 20 alternatives include those listed in Table I and Figure 7, although other low vapor pressure, lipophilic fluorocarbons can be contemplated. Figures 4 and 5 illustrate the relationship between the molecular weight of various fluorocarbons and their half life time in days.

For mixtures of fluorocarbons, the first fluorocarbon may be selected from the list below. Such fluorocarbons must have a molecular weight of less than about 550 Daltons, and include bis(F-alkyl)ethenes such as C 4

F

9

CH=CHC

4

F

9 i-

CF

3

CF

9

CH=CHC

6 Fl 3 ("F-i36E") and cyclic fluorocarbons, such as 30 C 10

F

18 (F-decalin, perfluorodecalin or FDC) F-adamantane (FA); perfluoroindane; F-methyladamantane (FMA); F-1,3dimethyladamantane (FDMA); perfluoro-2,2,4,4tetramethylpentane; F-di- or F-tri-methylbicyclo[3,3,1]nonane (nonane); C 7 12 perfluorinated amines, such as Ftripropylamine, F-4-methyloctahydroquinolizine (FMOQ), F-Nmethyl-decahydroisoquinoline (FMIQ) F-n- -11methyldecahydroquinoline (FHQ), and F-N-cyclohexylpyrrolidine

(FCHP).

Other examples of appropriate first fluorocarbons include brominated perfluorocarbons, such as perfluorooctyl bromide (CFiBr, USAN perflubron), 1-bromopentadecafluoroheptane

(C

7 FisBr), and 1-bromotridecafluorohexane (CFl 3 Br, also known as perfluorohexyl bromide or PFHB). Other brominated fluorocarbons are disclosed in U.S. Patent Nos. 3,975,512 and 4,987,154 to Long.

Also contemplated are first fluorocarbons having other nonfluorine substituents, such as 1-chloroheptadecafluorooctane (C 8

F

17 C1, also referred to as perfluorooctyl chloride or PFOC1); perfluorooctyl hydride, and similar compounds having different numbers of carbon atoms.

Additional first fluorocarbons contemplated in accordance with this invention include perfluoroalkylated ethers, halogenated ethers (especially brominated ethers), or polyethers, such as (CF 3 2

CFO(CF

2

CF

2 2

OCF(CF

3

(C

4 F) 2 0.

Further, fluorocarbon-hydrocarbon compounds may be used, such 20 as, for example compounds having the general formula CnF2n- 1 Cn,H2n,,i; CnF2nlOCn.H 2 or CnF 2 n 1 CH=CHCn,H2n'.,, wherein n and n' are the same or different and are from about 1 to about 10 (so long as the compound is a liquid at room temperature). Such compounds, for example, include CsF 1

,C

2 H, and C 6

F

3

,CH=CHC

6

H

3 Particularly preferred fluorocarbons for use as the first fluorocarbon include perfluoroamines, terminally substituted linear aliphatic perfluorocarbons having the general structure: CnF2niR, wherein n is an integer from 6 to 8 and R 30 comprises a lipophilic moiety selected from the group of Br, Cl, I, CH 3 or a saturated or unsaturated hydrocarbon of 2 or 3 carbon atoms, bis (F-alkyl) ethenes having the general structure: CnF2n i-CH=CH-CnF2n,'I, wherein the sum of n and n' equals 6 to 10, and perfluoroethers having the general structure: -12- F2n 1 wherein the sum of n and n' equals 6 to 9.

In addition, fluorocarbons selected from the general groups of perfluorocycloalkanes or perfluoroalkylcycloalkanes, perfluoroalkyl saturated heterocyclic compounds, or perfluorotertiary amines may be suitably utilized as the first fluorocarbon. See generally Schweighart, U.S. Patent No. 4,866,096.

It will be appreciated that esters, thioethers, and other variously modified mixed fluorocarbon-hydrocarbon compounds, including isomers, are also encompassed within the broad definition of fluorocarbon materials suitable for use as the first fluorocarbon of the present invention. Other suitable mixtures of fluorocarbons are also contemplated.

Additional fluorocarbons not listed here, but having the properties described in this disclosure that would lend themselves to therapeutic applications, are also contemplated.

Such fluorocarbons may be commercially available or specially 0: prepared. As will be appreciated by one skilled in the art, 20 there exist a variety of methods for the preparation of fluorocarbons that are well known in the art. See for example, Schweighart, U.S. Patent No. 4,895,876.

The second fluorocarbon is preferably an aliphatic fluorocarbon substituted with one or more lipophilic moieties and having a higher molecular weight and lower vapor pressure than the first fluorocarbon. Advantageously, the lipophilic 5 moiety is a terminal substitution on the fluorocarbon molecule. Preferably, the molecular weight of the second fluorocarbon is greater than about 540 Daltons. Constraints on the upper limit of the molecular weight of the second a fluorocarbon will generally be related to its organ retention time and its ability to be solubilized by the first fluorocarbon. Usually, the second fluorocarbon has a molecular weight less than about 700 Daltons.

Most preferred second fluorocarbons have boiling points greater than about 150 0 C and water solubilities of less than about 1X10- 9 moles/liter.

-13- Of course, as will be appreciated by one skilled in the art, many fluorocarbons substituted with different lipophilic groups could be suitably used as the second fluorocarbon in the present invention. Such fluorocarbons may include esters, thioethers, and various fluorocarbon-hydrocarbon compounds, including isomers. Mixtures of two or more fluorocarbons satisfying the criteria set forth herein are also encompassed within the broad definition of fluorocarbon materials suitable for use as the second fluorocarbon of the present invention.

Fluorocarbons not listed here, but having the properties described in this disclosure that would lend themselves to therapeutic applications are additionally contemplated.

The lipophilic moiety is optimally selected from the group consisting of Br, Cl, I, CH 3 or a saturated or unsaturated hydrocarbon of 2 or 3 carbon atoms. Consequently, preferred second fluorocarbons may be selected from the group of terminally substituted perfluorocarbon halides as represented by the general formula: S:nF CF2nX or CnF2nX 2 wherein n is 8 or greater, preferably 10 to 12, and X is a halide selected from the group consisting of Br, Cl, or I; *5 1-alkyl-perfluorocarbons or dialkylperfluorocarbons as represented by the general formula: CnF 2

(CH

2 )nCH 3 wherein n is 8 or greater, preferably 10 to 12, and n' is 0 to 2; 1-alkenyl-perfluorocarbons as represented by the general formula: CnF 2 n.l-CnH(2n,-l), wherein n is 10 or more, preferably 10 to 12, and n' is either 2 or 3; or 30 brominated linear or branched perfluoroethers or polyethers having the following general structure: Br- (CnF2n,-O-CnF2n wherein n and n' are each at least 2 and the sum of n and n' is greater than or equal to 8.

Most preferably, the second fluorocarbon of the present invention is selected from the group consisting of linear or branched brominated perfluorinated alkyl ethers, -14perfluorodecyl bromide (CF 2 perfluorododecyl bromide

(C

12

F

2 Br) 1-perfluorodecylethene (C, 0

F

21

CH=CH

2 and 1-perfluorodecylethane (C, 0 FnCH 2

CH

3 with perfluorodecyl bromide particularly preferred.

In accordance with a first alternative definition, whether or not they satisfy the foregoing definitions, fluorocarbons having critical solution temperatures (CSTs) vs hexane more than 10 0 C below the CST of a fluorocarbon having substantially the same molecular weight (variations of up to about 10 daltons being acceptable) are also suitable for use in the present invention. A comparison between the CST and molecular weight of a number of perfluorocarbons is presented in Table I. Methodology for determining CST is presented in Example 2.

Specifically, it has been found that a mixture of F-octyl bromide and F-decyl bromide satisfies the above stated requirements. In particular, a fluorocarbon phase which includes at least 10% wt/v of F-decyl bromide is preferred.

Most preferably, the fluorocarbon phase includes F-octyl 20 bromide at about 45% to 80% or 90% wt/v, and the F-decyl bromide is present in the fluorocarbon phase at about 10 to 55% wt/v.

a

C

C C o -is- TABLE I Physical Properties of Minor Components Discussed In Lite rature Name Formula MW(g/mol) b.p.(C) CSTH(C) ti,1 2 (days) Davis, et al. Patent No. 4,859,363) F-perhydrofluorene F-perhydrophenanthrene F-perhydrofluoranthene

C

13 F22

C

14

F

24 016 F 2 6 574 624 686 192-193 215-216 242-243 n.a.

48 n.a.

Kabalnov, et al. (Kolloidin Zh. 48:27-32(1986)) F-N-methylcyclohexylpiperidine 0 12

F

21

N

Meinert Patent No. 5,120,731); note these values are calculated, not measured.

F-N-cyclohexylmorpholine F-dimorpholinoethane F-d imo rpho 1mb pro pan e F-dimorpholinopentane *F-dipiperidine *F-dipiperidinomethane :::F-dipiperidinoethane *.F-dipiperidinopropane F-dipiperidinobutane

C,

0

F

18 N0 Cj 0

F

20

N

2 0 2

C

11 F22N 2

O

2

C

13 F26N 2

O

2 Cj 0

F

1 6

N

2

C

12 F2ON 2

C

13 F22N 2 014 F 2 4

N

2 492 560 610 710 452 502 552 602 652 n .a.

164 182 215 145-1 50 165-175 181-1 86 195-203 231 -238 13 24 280 24 124 282 1460 Present Invention F-decalin F-hexyl bromide *:.F-octyl bromide F-decyl bromide F-bromopolyether

C,

0 1 1

C

6

F

13 Br

CF

17 Br

C,

0

F

2 1 Br

CJ

1 23

O

3 Br 142 na.

143 (198)b n.a.

22 n.a.

(<0)a 32 values frteciiasouontemperature wihhexane are estimated from exrpltoslna plots o h critical solution temperature vs. hydrocarbon chain length.

the value of the boiling point of F-decyl bromide is estimated from Hildebrand solution theory.

-16- B. The Emulsifying Agent The fluorocarbon emulsion also includes an emulsifying agent. As used in this specification, an emulsifying agent is any compound or composition that aids in the formation and maintenance of the droplets of the discontinuous phase by forming a layer at the interface between the discontinuous and continuous phases. The emulsifying agent may comprise a single compound or any combination of compounds, such as in the case of co-surfactants.

In the present invention, preferred emulsifying agents are selected from the group consisting of phospholipids, nonionic surfactants, fluorinated surfactants, which can be neutral or anionic, and combinations of such emulsifying agents.

Lecithin is a phospholipid that has frequently been used as a fluorocarbon emulsifying agent, as is more fully described in U.S. Patent No. 4,865,836. Egg yolk phospholipids have shown great promise as emulsifying agents for fluorocarbons. See Long, U.S. Patent No.

20 4,987,154.

Other emulsifying agents may be used with good effect, such as fluorinated surfactants, also known as fluorosurfactants. Fluorosurfactants that can provide stable emulsions include triperfluoroalkylcholate; perfluoroalkylcholestanol; perfluoroalkyloxymethylcholate;

C

3

FO(CF

2 3

C(=O)NH(CH

2 3 N(O) (CH) 2 (XMO-10) and fluorinated polyhydroxylated surfactants, such as, for example, those discussed in "Design, Synthesis and Evaluation of Fluorocarbons and Surfactants for In Vivo Applications New 30 Perfluoroalkylated Polyhydroxylated Surfactants" by J.G.

Riess, et al., Biomat. Artif. Cells Artif. Organs 16: 421-430 (1988).

The nonionic surfactants suitable for use in the present invention include polyoxyethylene-polyoxypropylene copolymers. An example of such class of compounds is Pluronic, such as Pluronic F-68. Anionic surfactants, particularly fatty acids (or their salts) having 12 to 24 carbon atoms, may also be used. One example of a suitable anionic surfactant is oleic acid, or its salt, sodium oleate.

It will be appreciated that choice of a particular emulsifying agent is not central to the present invention.

Indeed, virtually any emulsifying agent (including those still to be developed) capable of facilitating formation of a fluorocarbon-in-water emulsion can form improved emulsions when used in the present invention. The optimum emulsifying agent or combination of emulsifying agents for a given application may be determined through empirical studies that do not require undue experimentation. Consequently, one practicing the art of the present invention should choose the emulsifying agent or combination of emulsifying agents for such properties as biocompatibility.

C. The Continuous Phase The continuous phase comprises an aqueous medium.

Preferably, the medium is physiologically acceptable. For instance, a preferred emulsion will have the ability to buffer and maintain pH, as well as provide an appropriate 20 osmolality. This typically has been achieved in the art through the inclusion in the aqueous phase of one or more conventional buffering and/or osmotic agents, or an agent that combines these properties.

55*. Additionally, one may supplement the continuous phase *5*9 25 with other agents or adjuvants for stabilizing or otherwise increasing the beneficial aspects of the emulsion. These 5 agents or adjuvants include: cholesterol, tocopherols, and/or mixtures or combinations thereof.

D. Preparation of the Emulsion Fluorocarbon emulsions according to the invention are prepared by means of conventional emulsification procedures, such as, for example, mechanical or ultrasonic emulsification of an emulsion formulation in a Manton-Gaulin mixer or Microfluidizer (Microfluidics Corp., Newton, MA) as described in Example 1.

The single fluorocarbon, or the first and second fluorocarbons, are combined with the aqueous phase in the desired ratios, together with the surfactant. Usually, a pre-emulsion mixture is prepared by simple mixing or blending of the various components. This pre-emulsion is then emulsified in the desired emulsification apparatus.

When a composition of fluorocarbons is used, the second fluorocarbon can comprise from about 0.1% to 50% of the total amount of fluorocarbon; in preferred embodiments, the second fluorocarbon comprises from about 0.5% to about of the total amount of fluorocarbon, with the first fluorocarbon comprising the remainder of the total fluorocarbon. The combined fluorocarbon concentration in the emulsion is preferably anywhere within the range of about to about 125% In preferred emulsions, the total perfluorocarbon concentration is from about 30%, 40%, or to about 70%, 80%, 90%, or 100% Emulsifiers are added in concentrations of from about 0.1% to 10%, more preferably 1% or 2% to about 6% EXAMPLE 1 20 Preparation of Reference Emulsion Composition of Reference Emulsion: Perflubron/Lecithin (90/4% w/v) A reference emulsion containing 90 g PFOB, 4 g egg yolk phospholipid (EYP), and physiological levels of salts and buffers was prepared by high pressure homogenization according to the method of Long Patent No. 4,987,154) .e 4 EXAMPLE 2 Measurement of Critical Solution Temperature (CST) Critical solution temperature for fluorocarbon liquids was measured in the following manner: Equivolume mixtures of the test fluorocarbon and hydrocarbon hexane) are placed in a sealed vial and submerged in a temperature controlled water bath. Samples are cooled until two distinct phases are present. At this point, the temperature is increased slowly. The lowest temperature at which the two phases are completely miscible a single liquid phase) is defined as the CST.

For comparison purposes, all CST temperatures used in this patent are reported versus hexane. It is often not possible, however, to measure the CST for lipophilic fluorocarbons versus hexane, since the CSTs for these substances are very low. Thus, the CST for lipophilic substances is often measured .in longer chain length hydrocarbons, and the value versus hexane is determined via extrapolation of linear plots of CST vs. alkane chain length.

Further, several other second fluorocarbons are considered similary acceptable. In particular, it appears that perfluorobromoethers, perfluorooctylethane (PFOE), perfluorononyl bromide, perfluorooctyl ethane, and other compounds selected from the group of alkyl-perfluoro-alkanes (such as C 8

F

1 7

C

2 Hs and CjoF 21

C

2

F

5 either individually or in mixtures, are believed suitable.

In any case, the second fluorocarbon is chosen such that when mixed with the first fluorocarbon in appropriate ratios, 20 it eliminates pulmonary gas trapping the fluorocarbon phase has a vapor pressure of less than 2.67 kPa (20 torr), and preferably less than 1.07 kPa (8 torr), and has an organ half-life of about 3 to 4 weeks. It is possible to derive acceptable compositions through calculation of the vapor 25 pressure of the mixture of fluorocarbons with Raoult's law, as was done in Figure 6, or by determining the vapor pressure empirically.

a EXAMPLE 3 30 Effect of Vapor Pressure on IPRV Figures 1 and 2 illustrate the effect of vapor pressure on IPRV in rats and rabbits respectively. It is clear that at vapor pressures less than about 1.07 kPa (8 torr) IPRV is substantially reduced. Further, as illustrated in Figure 6, mixtures of 60% w/v PFOB and 30% w/v PFDB obey Raoult's law and have a vapor pressure of about 1.07 kPa (8 torr) These mixtures are able to effectively decrease IPRV to levels observed for single fluorocarbons with vapor pressures of about .013 kPa (0.1 torr).

Although the present invention has been disclosed in the context of certain preferred embodiments, it is intended that the scope of the invention be measured by the claims that follow, and not be limited to those preferred embodiments.

Throughout this specification and the claims which follow, unless the context requires otherwise, the word "comprise", or variations such as "comprises" or "comprising", will be understood to imply the inclusion of a stated integer or group of integers but not the exclusion of any other integer or group of integers.

0 0 0 *0 0 P:\QPER\MJC\63566-94.CLM 19/9/97 -21- THE CLAIMS DEFINING THE INVENTION ARE AS FOLLOWS: 1. A method for providing oxygen to a patient comprising the steps of: supplying an emulsified oxygen carrier comprising an aqueous phase, an emulsifying agent and a fluorocarbon phase comprising a mixture of two or more fluorocarbons including from about 50 to about 99.9% w/w of a first fluorocarbon and from 0.1% to about 50% w/w of a second fluorocarbon having a lipophilic moiety and a vapor pressure less than the first fluorocarbon wherein said fluorocarbon phase has a vapor pressure less than 2.67 kPa (20 torr) at 37 0 C and an organ halflife of less than about 6 weeks; and administering an effective oxygen transporting amount of said emulsified oxygen carrier to a patient in need thereof.

2. The method of claim 1 wherein said lipophilic moiety is selected from the group consisting of Br, Cl, I, H, CH 3 and a saturated or unsaturated hydrocarbon chain of 2 or 3 carbon atoms.

3. The method of claims 1 or 2 wherein said second fluorocarbon has a molecular weight in the range from about 560 Daltons to about 700 Daltons.

25 4. The method of any one of claims 1 to 3 wherein said second fluorocarbon has a vapor pressure at 37 0 C less than about 1.33 kPa(10 torr).

5. The method of any one of claims 1 to 4 wherein said first fluorocarbon is a brominated fluorocarbon.

6. The method of any one of claims 1 to 5 wherein said first fluorocarbon is F-octyl bromide.

7. The method of any one of claims 1 to 6 wherein said second fluorocarbon is selected from the group consisting of F-

Claims (8)

1. 8. The method of any one of claims 1 to 7 wherein said first fluorocarbon is F-octyl bromide and said second fluorocarbon is F-decyl bromide.
2. 9. The method of any one of claims 1 to 8 wherein said fluorocarbon phase comprises from about 0.5% w/w to about w/w of said second fluorocarbon. The method of claim 1 wherein said first fluorocarbon is a chlorinated fluorocarbon. S
3. 11. The method of any one of claims 1 to 10 wherein said 15 patient is undergoing a medical procedure. 9 9
4. 12. The method of any one of claims 1 to 11 wherein said patient is undergoing percutaneous transluminal coronary angioplasty. S
5. 13. A method for providing oxygen to a patient comprising the steps of: ~supplying an emulsified oxygen carrier comprising an aqueous phase, an emulsifying agent and a fluorocarbon phase comprising a mixture of two or more fluorocarbons including from about 50 to about 99.9% w/w of F-octyl bromide and from about 0.1% to about 50% w/w of F-decyl bromide wherein said fluorocarbon phase has a vapour pressure less than 2.67 kPa torr) at 37 0 C and an organ half-life of less than about 6 weeks; and administering an effective oxygen transporting amount of said emulsified oxygen carrier to a patient in need thereof.
6. 14. The method of claim 13 wherein said fluorocarbon phase comprises from about 0.5% w/w to about 5% w/w of said second S fluorocarbon. P:\OPER\MJC\63566-94.CLM 12/7/99 -23- The method of claims 13 or 14 wherein said patient is undergoing a medical procedure.
7. 16. The method of any one of claims 13 to 15 wherein said patient is undergoing percutaneous transluminal coronary angioplasty.
8. 17. The method of claim 1 or claim 13 substantially as hereinbefore described with reference to the Examples and/or Drawings. DATED this 12th day of July 1999 a Alliance Pharmaceutical Corp. By DAVIES COLLISON CAVE Patent Attorneys for the Applicant -M Q:\OPER\MJC\1937007ABS -6/10/97 ABSTRACT This invention relates to a method for providing oxygen to a patient comprising the steps of: supplying an emulsified oxygen carrier comprising an aqueous phase, an emulsifying agent and a fluorocarbon phase comprising a mixture of two or more fluorocarbons including from about 50 to about 99.9% w/w of a first fluorocarbon and from 0.1% to about 50% w/w of a second fluorocarbon having a lipophilic moiety and a vapor pressure less than the first fluorocarbon wherein said fluorocarbon phase has a vapor pressure less than 2.67 kPa (20 torr) at 37 0 C and an organ half- life of less than about 6 weeks; and administering an effective oxygen transporting amount of said emulsified oxygen carrier to a patient in need thereof. 4 e e 2 V.