Compositions for use in cardioplegia comprising esmolol and adenosine

a technology of adenosine and esmolol, which is applied in the field of compositions for use in cardioplegia, can solve the problems of undesirable side effects of toxicity, drawbacks and complications, and application of prior art arresting agents such as lidocaine to patients at the required dose, and achieves no or minimal toxic effect, and clears quickly and reliably.

Inactive Publication Date: 2012-03-29
CHAMBERS DAVID +1
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Benefits of technology

[0101]It is an advantage of the invention that as much cardioplegic solution as is needed can be freely given to a subject without having to restrict administration according to concerns regarding side effects such as toxicity.
[0113]Have no or minimal toxic effect on another organ that might linger after cessation of cardiopulmonary bypass. This may be augmented by ensuring that the plasma concentration levels in the peripheral circulation are within the safety margin of each pharmacological agent used in the cardioplegic solution.
[0114]This suggests that any pharmacological agent should be used in quantities sufficient to cause arrest and at the same time can be reversed and cleared from the body quickly and reliably in an independent manner from the liver or the kidneys. Examples of such an agent are drug(s) metabolised by the red blood cells (RBCs).

Problems solved by technology

Prior art arresting agents such as lidocaine are toxic.
Application of these agents to a patient at the doses required therefore has undesirable side-effects of toxicity.
Moreover, in addition to toxicity at the dose given, there is a build up of the compounds used in the periphery of the patient's body, which can lead to further drawbacks and complications.
This has made the use of esmolol only as an arrestant problematic in the prior art.

Method used

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  • Compositions for use in cardioplegia comprising esmolol and adenosine
  • Compositions for use in cardioplegia comprising esmolol and adenosine
  • Compositions for use in cardioplegia comprising esmolol and adenosine

Examples

Experimental program
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Effect test

example 1

Esmolol and Adenosine Combination

[0118]Esmolol and adenosine are rapidly inactivated by the red blood cell esterases and the blood vessel adenosine deaminase respectively. This makes the clearance of these agents fast and independent from the kidneys or the liver, contrary to most other pharmacological agents used as arresting agents in cardioplegia. This makes these two agents an effective combination to be used in a cardioplegic preparation such as a crystalloid preparation at high concentrations to arrest the heart and at the same time they can be cleared from the system rapidly and effectively as when the heart is ready to be started during cardiac surgery e.g. by washing out the drug with blood reperfusion.

[0119]We teach the use of Esmolol at concentrations higher than its p-blocking effect (0.01-0.1 mmol / L) to induce arrest and we add adenosine as a synergistic arresting agent in order to use lower amounts of esmolol, yet still surprisingly induce effective arrest. This combin...

example 2

Dose Determination

[0121]All the following experiments performed in a Langendorff perfused rat heart.

[0122]The first study is to determine the reversibility of esmolol at different concentrations after treatment with esmolol for 10 minutes then washout without ischaemia and LVDP was measured 9 minutes after starting the treatment and 3 minutes and 15 minutes after washing out the drug.

[0123]The following doses were studied 0.03, 0.1, 0.3, 1, 3 mM. (n=5 each group) 1 mM of esmolol was required to induce arrest but 0.3 mM had a better reversibility (LVDP recovery) profile (FIG. 1). It is therefore decided that esmolol concentration between 0.3 and 1 mM offers reasonable arresting effect with good reversibility profile.

example 3

Combination Dosing

[0124]Adenosine was added to esmolol (0.6 mM) at the following concentration: 0.125 mM, 0.25 mM, 1 mM. With normothermic (37° C.) 30 minutes ischaemia.

[0125]Esmolol 0.6 mM+adenosine 0.125 mM arrest time was prolonged cal (70 sec). (Table 1)

[0126]Esmolol 0.6 mM+adenosine 1 mM arrest time was fast but recovery was poor 6 to 40% (Table 2)

[0127]It was then decided to study adenosine at 0.25 mM which gives acceptable arresting time (50 seconds) with reasonable recovery

TABLE 1Arrest timeEsmololAdenosine(Sec)0.6 mM0.125 mM 700.6 mM0.25 mM 530.6 mM0.5 mM500.6 mM1.0 mM38

TABLE 2Examples of different concentrations of esmolol + Adenosine (30 minutes ischaemia at 37° C.)102030405060EsmololAdenosineBaselineminminminminminmin0.6 mM0.25 mM135455570777578LVDP291276275278279278274HR6605753515153EDP33.3340.7451.8557.0455.5657.78LVDP(% base)0.6 mM  1 mM156102037636462LVDP333240260290287274282HR4807063646165EDP6.4112.8223.7240.3841.0339.74LVDP(% base)0.6 mM0.125 mM 127182143616572LVDP...

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Abstract

The invention related to a composition for use in cardioplegia, said composition comprising (i) esmolol; and (ii) adenosine, wherein in use the concentration of said esmolol is in the range 0.3-1.5 mM, and wherein in use the concentration of said adenosine is in the range 0.1-1.5 mM. The invention also relates to methods of making and using such compositions.

Description

FIELD OF THE INVENTION[0001]The invention is in the field of cardioplegia, in particular in the field of compositions for use in cardioplegia such as cardioplegic solutions.BACKGROUND TO THE INVENTION[0002]Cardioplegia refers to paralysis of the heart using chemicals. Typically this is effected in order to stop a heart during cardiac surgery. During cardiac surgery, the heart is subjected to an elective period of global ischaemia to provide the surgeon with a blood-free operating field and a still, flaccid heart. To protect the heart during ischaemia, a cardioplegic solution is used for rapid arrest and to help protect the heart from ischaemic injury.[0003]Historically the heart used to be stopped in cardiac surgery by clamping the aorta, inducing ischaemia and cooling the heart down. This was called hypothermic ischaemic arrest. Hypothermic arrest led to an invariably lethal condition called the stone heart in up to one out of ten patients undergoing cardiac surgery.[0004]Subsequen...

Claims

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Application Information

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Patent Type & Authority Applications(United States)
IPC IPC(8): A61K31/7076A61P9/00
CPCA61K31/24A61K31/7076A61K33/06A61K2300/00A61K31/216A61P9/00A61P41/00A61K9/08
Inventor FALLOUH, HAZEM B.KENTISH, JONATHAN C.CHAMBERS, DAVID J.
Owner CHAMBERS DAVID
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