Title of Invention

PLATELET DERIVED GROWTH FACTOR COMPOSITIONS AND METHODS OF USE THEREOF.

Abstract A method for promoting growth of bone, periodontium, ligament, or cartilage in a mammal by applying to the bone, periodontium, ligament, or cartilage a composition comprising platelet-derived growth factor at a concentration in the range of about 0.1 mg/mL to about 1.0 mg/mL in a pharmaceutically acceptable liquid carrier and a pharmaceutically-acceptable solid carrier.
Full Text WO 2006/044334 PCT/US2005/036447
PLATELET-DERIVED GROWTH FACTOR COMPOSITIONS
AND METHODS OF USE THEREOF
Field Of The Invention
This invention relates to the healing of bone and connective tissues.
Background Of The Invention
Growth factors are proteins that bind to receptors on a cell surface, with the
primary result of activating cellular proliferation and/or differentiation. Many growth
factors are quite versatile, stimulating cellular division in numerous different cell
types; while others are specific to a particular cell-type. Examples of growth factors
include platelet-derived growth factor (PDGF), insurin-like growth factors IGF-I and
IT), transforming growth factor beta (TGF-/3), epidermal growth factor (EGF), and
fibroblast growth factor (FGF). PDGF is a cationic, heat stable protein found in a
variety of cell types, including the granules of circulating platelets, vascular smooth
muscle cells, endothelial cells, macrophage, and keratinocytes, and is known to
stimulate in vitro protein synthesis and collagen production by fibroblasts. It is also
known to act as an in vitro mitogen and chemotactic agent for fibroblasts, smooth
muscle cells, osteoblasts, and glial cells.
Recombinant human PDGF-BB (rhPDGF-BB) has been shown to stimulate
wound healing and bone regeneration in both animals and humans. It is approved in
both the United States and Europe for human use in topical applications to accelerate
healing of chronic diabetic foot sores. Recombinant hPDGF-BB has also been shown
to be effective either singly or in combination with other growth factors for improving
periodontal regeneration, i.e., regrowth of bone, cementum, and ligament around teeth
(see, e.g., U.S. Patent No. 5124,316, incorporated herein by reference).
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Summary Of The Invention
We have now demonstrated that a low dose of rhPDGF (~0.1 to 1.0 mg/mL)
promotes repair of bone, periodontium, ligament, and cartilage. A low amount of
rhPDGF can be adsorbed to /5-TCP, which can be implanted at the site of repair, such
that the rhPDGF is released in vivo. Addition of rhPDGF to β-TCP has been shown to
enhance osteoblast cell attachment and proliferation compared to untreated β-TCP.
In a first aspect, the invention features a method for promoting bone,
periodontium, ligament, or cartilage growth in a mammal, e.g., a human, by
administering an implant material containing platelet-derived; growth factor (PDGF)
at a concentration of less than about 1.0 mg/ml, such that the implant material
promotes growth of the bone, periodontium, ligament, or cartilage. In an
embodiment, the PDGF is administered in an amount of less than or equal to 0.3
mg/ml. In another embodiment, the PDGF is administered in an amount in the range
of about 0.1 to about 1.0 mg/ml. In several embodiments, the PDGF is administered
in an amount of between about 0.2 to about 0.75 mg/ml, about 0.25 to about 0.6
mg/ml, and about 0.25 to about 0.5 mg/ml. In an embodiment, the PDGF is
administered in an amount of about 0.1 mg/ml, 0.3 mg/ml, or 1.0 mg/ml, preferably
0.3 mg/mL. In another embodiment, the PDGF is either partially or substantially
purified. In yet a further embodiment, the PDGF is isolated or purified from other
contaminants. In a further embodiment, the PDGF is released from the implant
material upon administration at an average rate of 0.3 mg/day. In another
embodiment, the PDGF is released from the implant material upon administration at
an average rate of 300 μg/day. In still further embodiments, the PDGF is released
from the implant material at an average rate of less than 100 μg/day, less than 50
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μg/day, less than 10 μg/day, or less than 1 μg/day. Preferably, the PDGF is delivered
over a few days, e.g., 1, 2, 5,10,15, 20, or 25 days, or up to 28 days or more.
A second aspect of the invention features a method for promoting bone,
periodorrtium, ligament, or cartilage growth in a mammal, e.g., a human, by
administering an implant material containing an amount of platelet-derived growth
factor (PDGF) of less than about 1.0 mg/ml and a pharmaceutically acceptable carrier
such that the implant material promotes the growth of the bone, periodontium,
ligament, or cartilage, and allowing the bone, periodontium, ligament, or cartilage to
grow. Preferably, the PDGF is equal to or less than about 0.3 mg/ml. In an
embodiment, the PDGF is administered in a range of about 0.1 to 1.0 mg/ml. In other
embodiments, the amount of PDGF is about 0.1 mg/ml, 0.3 mg/ml, or 1.0 mg/ml,
preferably 0.3'mg/mL. In another embodiment, the PDGF is either partially or
substantially purified. In yet a further embodiment, the PDGF is isolated or purified
from other contaminants. Prior to administering the implant material to the mammal,
the method can additionally include the step of producing a surgical flap of skin to
expose the bone, periodontium, ligament, or cartilage, and following the
administration step, replacing the flap. In yet another embodiment, after producing
the surgical flap, but prior to administering the implant material to the bone,
periodontium, ligament, or cartilage, the method can additionally include the step of
planing the bone or periodontium to remove organic matter from the bone or
periodontium. In yet another embodiment, the method promotes the growth of
damaged or diseased bone, periodontium, ligament, or cartilage. In yet another
embodiment, the method promotes the growth of bone in locations where new bone
formation is required as a result of surgical interventions, such as, e.g., tooth
extraction, ridge augmentation, esthetic grafting, and sinus lift.
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A third aspect of the invention features an implant material for promoting the
growth of bone, periodontium, ligament, or cartilage in a mammal, e.g., a human.
The implant material includes a pharmaceutically acceptable carrier (e.g., a
biocompatible binder, a bone substituting agent, a liquid, or a gel) and platelet-derived
growth factor (PDGF), which is present at a concentration of less than about 1.0
mg/mL. Preferably, the PDGF is present in the implant material at a concentration
• equal to or less than about 0.3 mg/ml. In an embodiment, the PDGF is administered
in a range of about 0.1 to 1.0 mg/ml. In other embodiments, the amount of PDGF is
about 0.1 mg/ml, 0.3 mg/ml, or 1.0 mg/ml, preferably 0.3 mg/mL. In an embodiment,
the pharmaceutically acceptable carrier of the implant material includes a scaffold or
matrix consisting of a biocompatible binder (e.g., carboxymethylcellulose) or a bone
substituting agent (β-TCP) that is capable of absorbing a solution that includes PDGF
(e.g., a solution containing PDGF at a concentration in the range of about 0.1 mg/mL
to about 1.0 mg/mL). In another embodiment, the pharmaceutically acceptable carrier
is capable of absorbing an amount of the PDGF solution that is equal to at least about
25% of its own weight. In other embodiments, the pharmaceutically acceptable
carrier is capable of absorbing an amount of the PDGF solution that is equal to at least
about 50%, 75%, 100%, 200%, 250%, or 300% or its own weight. In an embodiment,
the PDGF is absorbed by the pharmaceutically acceptable carrier of the implant
material by soaking the pharmaceutically acceptable carrier in a solution containing
PDGF. Preferably, the PDGF is present in the solution at a concentration of less than
about 1.0 mg/mL. In another embodiment, the PDGF is present in the solution at a
concentration equal to or less than about 0.3 rng/ml. In another embodiment, the
PDGF is present in the solution at a concentration in the range of about 0.1 to 1.0
mg/ml. In yet other embodiments, the PDGF is present in the solution in an amount
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of about 0.1 mg/ml, 0.3 mg/ml, or 1.0 mg/ml, preferably 0.3 mg/mL. In another
embodiment, the PDGF is either partially or substantially purified. In yet a further
embodiment, the PDGF is isolated or purified from other contaminants.
A fourth aspect of the invention features a method for preparing an implant
material for promoting growth of bone, periodontium, ligament, or cartilage in a
mammal, e.g., a human. The method includes the step of combining partially purified
or purified platelet-derived growth factor (PDGF) in an amount of less than about 1.0
mg/mL with a pharmaceutically acceptable carrier substance. Preferably, the PDGF
is combined with a pharmaceutically acceptable carrier substance at a concentration
equal to or less than about 0.3 mg/ml. In an embodiment, the PDGF is combined with
a pharmaceutically acceptable carrier substance in an amount in the range of about 0.1
to 1.0 mg/ml. In other embodiments, PDGF is mixed in the amount of 0.1 mg/ml, 0.3
mg/ml, or 1.0 mg/ml. In another embodiment. PDGF is mixed in the amount of 0.3
mg/ml. In yet another embodiment, the PDGF is absorbed by the pharmaceutically
acceptable carrier to produce the implant material.
A fifth aspect of the invention features a vial having platelet-derived growth
factor (PDGF) at a concentration in the range of about 0.1 mg/mL to about 1.0 mg/mL
in a pharmaceutically acceptable liquid. In an embodiment of this aspect of the
invention, the liquid is sterile sodium acetate buffer. In another embodiment, the vial
contains PDGF at a concentration of about 0.3 mg/mL. In yet another preferred
embodiment, the PDGF is PDGF-BB. In yet other embodiments, the PDGF is stable
in the sodium acetate buffer for at least about 12 months, preferably at least about 18
months, more preferably at least about 24 months, and most preferably at least about
36 months when stored at a temperature in the range of about 2°C to 80°C.
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A sixth aspect of the invention features an implant material that includes a
porous calcium phosphate having adsorbed therein a liquid containing platelet-derived
growth factor (PDGF) at a concentration in the range of about 0.1 mg/mL to about 1.0
mg/mL. In several embodiments, the concentration of PDGF is about 0.3 mg/mL, the
calcium phosphate is selected from tricalcium phosphate, hydroxyapatite, poorly
crystalline hydroxyapatite, amorphous calcium phosphate, calcium metaphosphate,
dicalcium phosphate dihydrate, heptacalcium phosphate, calcium pyrophosphate
dihydrate, calcium pyrophosphate, and octacalcium phosphate, and the PDGF is
provided in a sterile liquid, for example, sodium acetate buffer.
A seventh aspect of the invention features a method of preparing an implant
material by saturating a calcium phosphate material in a sterile liquid that includes
platelet-derived growth factor (PDGF) at a concentration in the range of about 0.1
mg/mL to about 1.0 mg/mL. In several embodiments, the concentration of PDGF is
about 0.3 mg/mL, and the calcium phosphate is selected from tricalcium phosphate,
hydroxyapatite, poorly crystalline hydroxyapatite, amorphous calcium phosphate,
calcium metaphosphate, dicalcium phosphate dihydrate, heptacalcium phosphate,
calcium pyrophosphate dihydrate, calcium pyrophosphate, and octacalcium
phosphate.
In an embodiment of all aspects of the invention, PDGF includes PDGF
homo- and heterodimers, for example, PDGF-AA, PDGF-BB, PDGF-AB, PDGF-CC,
and PDGF-DD, and combinations and derivatives thereof.
In an embodiment of all aspects of the invention, the pharmaceutically
acceptable carrier substance of the implant material is or additionally includes one or
more of the following: a biocompatible binder (e.g., a natural or synthetic polymer), a
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bone substituting agent, a liquid, and a gel. In another preferred embodiment, the
implant material includes PDGF present in a pharmaceutically acceptable liquid
carrier which is adsorbed by a pharmaceutically acceptable solid carrier.
In another embodiment of all aspects of the invention, the implant material is
prepared by combining isolated, partially purified, substantially purified, or purified
PDGF in an amount in the range of 0.1 to 1.0 mg/ml, more preferably 0.1 mg/ml, 0.3
mg/ml, or 1.0 mg/ml, most preferably 0.3 mg/ml, or even less; than 0.1 mg/ml, with a
pharmaceutically acceptable carrier substance, e.g., a biocompatible binder, such asa
natural or synthetic polymer (e.g., collagen, polyglycolic acid, and polylactic acid), a
bone substituting agent (e.g., a calcium phosphate (e.g., tricalciurn phosphate or
hydroxyapatite), calcium sulfate, or demineralized bone (e.g., demineralized freeze-
dried cortical or cancellous bone), or a commercially available gel or liquid (i.e., a
viscous or inert gel or liquid).
In several embodiments, the carrier substance of the implant material is, or
additionally includes, one or more biocompatible binders. A biocompatible binder is
an agent that produces or promotes cohesion between the combined substances. Non-
limiting examples of suitable biocompatible binders includepolymers selected from
polysaccharides, nucleic acids, carbohydrates, proteins, polypeptides, poly(a-hydroxy
acids), poly(lactones), poly(amino acids), poly(anhydrides), poly(orthoesters),
poly(anhydride-co-imides), poly(orthocarbonates), poly(a-hydroxy alkanoates),
poly(dioxanones), poly(phosphoesters), polylactic acid, poly(L-lactide) (PLLA),
poly(D,L-lactide) (PDLLA), polyglycolide (PGA), poly(lactide-co-glycolide (PLGA),
poly(L-lactide-co-D, L-lactide), poly(D,L-lactide-co-trimethylene carbonate),
polyglycolic acid, polyhydroxybutyrate (PHB), poly(e-caprolactone), poly(6-
valerolactone), poly(Y-butyrolactone), poly(caprolactone), polyacrylic acid,
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polycarboxylic acid, poly(allylamine hydrochloride), poly(diallyldimethylammonium
chloride), poly(ethyleneimine), polypropylene fumarate, polyvinyl alcohol,
polyvinylpyrrolidone, polyethylene, polymethylmethacrylate, carbon fibers,
poly(ethylene glycol), poly(ethylene oxide), poly(vinyl alcohol),
poly(vinylpyrrolidone), poly(ethyloxazoline), poly(ethylene oxide)-co-poly(propylene
oxide) block copolymers, poly(ethylene terephthalate)polyamide, and copolymers and
mixtures thereof. Additional binders include alginic acid, arabic gum, guar gum,
xantham gum, gelatin, chitin, chitosan, chitosan acetate, chitosan lactate, chondroitin
sulfate, N,0-carboxymethyl chitosan, a dextran (e.g., a-cyclodextrin, /3-cyclodextrin,
γ-cyclodextrin, or sodium dextran sulfate), fibrin glue, glycerol, hyaluronic acid,
sodium hyaluronate, a cellulose (e.g., methylcellulose, carboxy methylcellulose,
hydroxypropyl methylcellulose, or hydroxyethyl cellulose), a glucosamine, a
proteoglycan, a starch (e.g., hydroxyethyl starch or starch soluble), lactic acid, a
pluronic, sodium glycerophosphate, collagen, glycogen, a keratin, silk, and
derivatives and mixtures thereof. In some embodiments, the biocompatible binder is
water-soluble. A water-soluble binder dissolves from the implant material shortly
after its implantation in vivo, thereby introducing macroporosity into the implant
material. This macroporosity increases the osteoconductivity of the implant material
by enhancing the access and, consequently, the remodeling activity of the osteoclasts
and osteoblasts at the implant site.
The biocompatible binder may be added to the implant material in varying
amounts and at a variety of stages during the preparation of the composition. Those
of skill in the art will be able to determine the amount of binder and the method of
inclusion required for a given application.
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In an embodiment, the carrier substance is or includes a liquid selected from
water, a buffer, and a cell culture medium. The liquid may be used in any pH range,
but most often will be used in the range of pH 5.0 to pH 8.0. In an embodiment, the
pH will be compatible with the prolonged stability and efficacy of the PDGF present
in the implant material, or with the prolonged stability and efficacy of another desired
biologically active agent. In most embodiments, the pH of the liquid will be in the
range of pH 5.5 to pH 7.4. Suitable buffers include, but are not limited to, carbonates,
phosphates (e.g., phosphate buffered saline), and organic buffers such as Tris,
HEPES, and MOPS. Most often, the buffer will be selected for its biocompatibility
with the host tissues and its compatibility with the biologically active agent. For most
applications in which nucleic acids, peptides, or antibiotics are included in the implant
material, a simple phosphate buffered saline will suffice.
In another embodiment of all aspects of the invention, the carrier substance of
the implant material is, or additionally includes, one or more bone substituting agents.
A bone substituting agent is one that can be used to permanently or temporarily
replace bone. Following implantation, the bone substituting agent can be retained by
the body or it can be resorbed by the body and replaced with bone. Exemplary bone
substituting agent include, e.g., a calcium phosphate (e.g., tricalcium phosphate (e.g.,
/3-TCP), hydroxyapatite, poorly crystalline hydroxyapatite, amorphous calcium
phosphate, calcium metaphosphate, dicalcium phosphate dihydrate, heptacalcium
phosphate, calcium pyrophosphate dihydrate, calcium pyrophosphate, and
octacalcium phosphate), calcium sulfate, or demineralized bone (e.g., demineralized
freeze-dried cortical or cancellous bone)). In an embodiment, the carrier substance is
bioresorbable. In another embodiment, the bone substituting; agent is provided as a
matrix of micron- or submicron- sized particles, e.g., nano-sized particles. The
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particles can be in the range of about 100 /an to about 5000 fan. in size, more
preferably in the range of about 200 μm to about 3000 μm, and most preferably in the
range of about 250 μm to about 2000 μm, or the particles canibe in the range of about
1 nm to about 1000 run, preferably less than about 500 nm, and more preferably less
than about 250 nm. In another embodiment, the bone substituting agent has a porous
composition. Porosity of the composition is a desirable characteristic as it facilitates
cell migration and infiltration into the composition so that the; cells can secrete
extracellular bone matrix. It also provides access for vascularization. Porosity also
provides a high surface area for enhanced resorption and release of active substances,
as well as increased cell-matrix interaction. Preferably, the composition has a
porosity of greater than 40%, more preferably greater than 65%, and most preferably
greater than 90%. The composition can be provided in a shape suitable for
implantation (e.g., a sphere, a cylinder, or a block) or it can be sized and shaped prior
to use. In a preferred embodiment, the bone substituting agent is a calcium phosphate
(e.g., β-TCP).
The bone substituting agent can also be provided as a flowable, moldable
paste or putty. Preferably, the bone substituting agent is a calcium phosphate paste
that self-hardens to form a hardened calcium phosphate prior to or after implantation
in vivo. The calcium phosphate component of the invention may be any
biocompatible calcium phosphate material known in the art. The calcium phosphate
material may be produced by any one of a variety of methods and using any suitable
starting components. For example, the calcium phosphate material may include
amorphous, apatitic calcium phosphate. Calcium phosphate material may be
produced by solid-state acid-base reaction of crystalline calcium phosphate reactants
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to form crystalline hydroxyapatite solids. Other methods of making calcium
phosphate materials are known in the art, some of which are described below.
The calcium phosphate material can be poorly crystalline apatitic (PCA)
calcium phosphate or hydroxyapatite (HA). PCA material is described in application
U.S. Patent Nos. 5,650,176; 5,783,217; 6,027,742; 6,214,368; 6,287,341; 6,331,312;
and 6,541,037, all of which are incorporated herein by reference. HA is described, for
example, in U.S. PatentNos. Re. 33,221 and Re. 33,161. These patents teach
preparation of calcium phosphate remineralization compositions and of a finely
crystalline, non-ceramic, gradually resorbable hydroxyapatite carrier material based
on the same calcium phosphate composition. A similar calcium phosphate system,
which consists of tetracalcium phosphate (TTCP) and monocalcium phosphate (MCP)
or its monohydrate form (MCPM), is described in U.S. Patent Nos. 5,053,212 and
5,129,905. This calcium phosphate material is produced by solid-state acid-base
reaction of crystalline calcium phosphate reactants to form crystalline hydroxyapatite
solids.
Crystalline HA materials (commonly referred to as dahllite) may be prepared
such that they are flowable, moldable, and capable of hardening in situ (see U.S.
Patent No. 5,962,028). These HA materials (commonly referred to as carbonated
hydroxyapatite) can be formed by combining the reactants with a non-aqueous liquid
to provide a substantially uniform mixture, shaping the mixture as appropriate, and
allowing the mixture to harden in the presence of water (e.g., before or after
implantation). During hardening, the mixture crystallizes into a solid and essentially
monolithic apatitic structure.
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The reactants will generally consist of a phosphate source, e.g., phosphoric
acid or phosphate salts, substantially free of water, an alkali earth metal, particularly
calcium, source, optionally crystalline nuclei, particularly hydroxyapatite or calcium
phosphate crystals, calcium carbonate, and a physiologically acceptable lubricant,
such as any of the non-aqueous liquids described herein. The dry ingredients may be
pre-prepared as a mixture and subsequently combined with the non-aqueous liquid
ingredients under conditions where substantially uniform mixing occurs.
The calcium phosphate material is characterized by its biological resorbability,
biocompatibility, and its minimal crystallinity. Its crystalline character is
substantially the same as natural bone. Preferably, the calcium phosphate material
hardens in less than five hours, and substantially hardens in about one to five hours,
under physiological conditions. Preferably, the material is substantially hardened
within about 10-30 minutes. The hardening rate under physiological conditions, may
be varied according to the therapeutic need by modifying a few simple parameters as
described in U.S. Patent No. 6,027,742, which is incorporated herein by reference.
In an embodiment, the resulting bioresorbable calcium phosphate material will
be "calcium deficient," with a calcium to phosphate molar ratio of less than about 1.6
as compared to the ideal stoichiometric value of approximately 1.67 for
hydroxyapatite.
Desirable calcium phosphates are capable of hardening in a moist
environment, at or around body temperature in less than 5 hours and preferably within
10-30 minutes. Desirable materials are those that, when implanted as a 1 -5 g pellet,
are at least 80% resorbed within one year. Preferably, the material can be fully
resorbed.
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In several embodiments of all aspects of the invention, the implant material
additionally may include one or more biologically active agents. Biologically active
agents that can be incorporated into the implant materials of the invention include,
without limitation, organic molecules, inorganic materials, proteins, peptides, nucleic
acids (e.g., genes, gene fragments, gene regulatory sequences, and antisense
molecules), nucleoproteins, polysaccharides, glycoproterns, and lipoproteins. Classes
of biologically active compounds that can be incorporated into the implant materials
of the invention include, without limitation, anti-cancer agents,-antibiotics, analgesics,
anti-inflammatory agents, immunosuppressants, enzyme inhibitors, antihistamines,
anti-convulsants, hormones, muscle relaxants, anti-spasmodics, ophthalmic agents,
prostaglandins, anti-depressants, anti-psychotic substances, trophic factors,
osteoinductive proteins, growth factors, and vaccines.
Anti-cancer agents include alkylating agents, platinum agents, antimetabolites,
topoisomerase inhibitors, antitumor antibiotics, antimitotic agents, aromatase
inhibitors, thymidylate synthase inhibitors, DNA antagonists, farnesyltransferase
inhibitors, pump inhibitors, histone acetyltransferase inhibitors, metalloproteinase
inhibitors, ribonucleoside reductase inhibitors, TNF alpha agonists/antagonists,
endothelin A receptor antagonists, retinoic acid receptor agonists, immuno-
modulators, hormonal and antihormonal agents, photodynamic agents, and tyrosine
kinase inhibitors.
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Any of the biologically active agents listed in Table 1 can be used.
Table 1.

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Antibiotics include aminoglycosides (e.g., gentaraicin, tobramycin, netilmicin,
streptomycin, amikacin, neomycin), bacitracin, corbapenems (e.g.,
imipenem/cislastatin), cephalosporins, colistin, methenamine, monobactams (e.g.,
aztreonam), penicillins (e.g., penicillin G, penicillin V, methicillin, natcillin, oxacillin,
cloxacillin, dicloxacillin, ampicillin, amoxicillin, carbenicillin, ticarcillin, piperacillin,
mezlocillin, azlocillin), polymyxin B, quinolones, and vancomycin; and bacteriostatic
agents such as chloramphenicol, clindanyan, macrolides (e.g., erythromycin,
azithromycin, clarithromycin), lincomyan, nitrofurantoin, sulfonamides, tetracyclines
(e.g., tetracycline, doxycycline, minocycline, demeclocyline), and trimethoprim. Also
included are metronidazole, fluoroquinolones, and ritampin.
Enzyme inhibitors are substances which inhibit an enzymatic reaction.
Examples of enzyme inhibitors include edrophonium chloride, N-
methylphysostigmine, neostigmine bromide, physostigmine sulfate, tacrine, tacrine,l-
hydroxy maleate, iodotubercidin, p-bromotetramisole, 10-(alpha-
diethylaminopropionyl)-phenothiazine hydrochloride, calmidazolium chloride,
hemicholinium-3, 3,5-dinitrocatechol, diacylglycerol kinase inhibitor I, diacylglycerol
kinase inhibitor II, 3-phenylpropargylamine, "N6-monomethyl-L-arginine acetate,
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carbidopa, 3-hydroxybenzylhydrazine, hydralazine, clorgyline, deprenyl,
hydroxylamine, iproniazid phosphate, 6-MeO~tetrahydro-9H-pyrido-indole,
nialamide, pargyline, quinacrine, semicarbazide, tranylcyprornine, N,N-
diethylaminoethyl-2,2-diphenylvalerate hydrochloride, 3-isobutyl-1 -methylxanfhne,
papaverine, indomethacind, 2-cyclooctyl-2-hydroxyemylamime hydrochloride, 2,3-
dichloro-a-methylbenzylamine(DCMB), 8,9-dichloro-2,3,4,5-tetrahydro-lH-2-
benzazepine hydrochloride, p-aminoglutethimide, p-aminoglutethimide tartrate, 3-
iodotyrosine, alpha-methyltyrosine, acetazolaraide, dichlorphenamide, 6-hydroxy-2-
benzothiazolesulfonamide, and allopurinol.
Antihistamines include pyrilamine, chlorpheniramine, and tetrahydrazohne,
among others.
Anti-inflammatory agents include corticosteroids, nonsteroidal anti-
inflammatory drugs (e.g., aspirin, phenylbutazone, indomethacin, sulindac, tolmetin,
ibuprofen, piroxicam, and fenamates), acetaminophen, phenacetin, gold salts,
chloroquine, D-Penicillamine, methotrexate colchicine, allopurinol, probenecid, and
sulfinpyrazone.
Muscle relaxants include mephenesin, methocarbomal, cyclobenzaprine
hydrochloride, trihexylphenidyl hydrochloride, levodopa/carbidopa, and biperiden.
Anti-spasmodics include atropine, scopolamine, oxyphenonium, and
papaverine.
Analgesics include aspirin, phenybutazone, idomethacm, sulindac, tohnetic,
ibuprofen, piroxicam, fenamates, acetaminophen, phenacetin, morphine sulfate,
codeine sulfate, meperidine, nalorphine, opioids (e.g., codeine sulfate, fentanyl citrate,
hydrocodone bitartrate, loperamide, morphine sulfate, noscapine, norcodeine,
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normorphine, thebaine, nor-binaltorphimine, buprenorphine, chlomaltrexamine,
funaltrexarnione, nalbuphine, nalorphine, naloxone, naloxonazine, naltrexone, and
naltrindole), procaine, lidocain, tetracaine and dibucaine.
Ophthalmic agents include sodium fluorescent, rose bengal, methacholine,
adrenaline, cocaine, atropine, alpha-chymotrypsin, hyaluronidase, betaxalol,
pilocarpine, timolol, timolol salts, and combinations thereof.
Prostaglandins are art recognized and are a class of naturally occurring
chemically related, long-chain hydroxy fatty acids that have a, variety of biological
effects.
Anti-depressants are substances capable of preventing or relieving depression.
Examples of anti-depressants include imipramine, amitriptyline, nortriptyline,
protriptyline, desipramine, amoxapine, doxepin, maprotiline, tranylcypromine,
phenelzine, and isocarboxazide.
Growth factors are factors whose continued presence improves the viability or
longevity of a cell. Trophic factors include, without limitation, neutrophil-activating
protein, monocyte chemoattractant protein, ma crophage-inflammatory protein,
platelet factor, platelet basic protein, and melanoma growth stimulating activity;
epidermal growth factor, transforming growth factor (alpha), fibroblast growth factor,
platelet-derived endothelial cell growth factor, insulin-like growth factor (IGF, e.g.,
IGF-I or IGF-H), glial derived growth neurotrophic factor, ciliary neurotrophic factor,
nerve growth factor, bone growth/cartilage-inducing factor (alpha and beta), bone
morphogenetic proteins (BMPs), interleukins (e.g., interleukin inhibitors or
interleukin receptors, including interleukin 1 through interleultin 10), interferons (e.g.,
interferon alpha, beta and gamma), hematopoietic factors, including erythropoietin,
granulocyte colony stimulating factor, macrophage colony stimulating factor and
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granulocyte-macrophage colony stimulating factor; tumor necrosis factors,
transforming growth factors (beta), including beta-1, beta-2, beta-3, transforming
growth factors (alpha), inhibin, and activin; and bone morphogenetic proteins such as
OP-l,BMP-2and BMP-7.
Hormones include estrogens (e.g., estradiol, estrone, estriol, diethylstibestrol,
quinestrol, chlorotrianisene, ethinyl estradiol, mestranol), anti-estrogens (e.g.,
clomiphene, tamoxifen), progestins (e.g., medroxyprogesterone, norethindrone,
hydroxyprogesterone, norgestrel), antiprogestin (mifepristone), androgens (e.g,
testosterone cypionate, fluoxymesterone, danazol, testolactone), anti-androgens (e.g.,
cyproterone acetate, flutamide), thyroid hormones (e.g., triiodothyronne, tliyroxine,
propylthiouracil, methimazole, and iodixode), and pituitary hormones (e.g.,
corticotropin, sumutotropin, oxytocin, and vasopressin). Hormones are commonly
employed in hormone replacement therapy and/or for purposes of birth control.
Steroid hormones, such as prednisone, are also used as immunosuppressants and anti-
inflammatories.
The biologically active agent is also desirably selected from the family of
proteins known as the transforming growth factors-beta (TGE-β) superfamily of
proteins, which includes the activins, inhibins, and bone morphogenetic proteins
(BMPs). In an embodiment, the active agent includes at least one protein selected
from the subclass of proteins known generally as BMPs, which have been disclosed to
have osteogenic activity, and other growth and differentiation type activities. These
BMPs include BMP proteins BMP-2, BMP-3, BMP-4, BMP-5, BMP-6 and BMP-7,
disclosed for instance in U.S. Patent Nos. 5,108,922; 5,013,649; 5,116,738;
5,106,748; 5,187,076; and 5,141,905; BMP-8, disclosed in PCT publication
WO91/18098; and BMP-9, disclosed in PCT publication WO93/00432, BMP-10,
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WO 2006/044334 PCT/US2005/036447
disclosed in PCT application WO94/26893; BMP-11, disclosed in PCT application
WO94/26892, or BMP-12 or BMP-13, disclosed in PCT application WO 95/16035;
BMP-14; BMP-15, disclosed in U.S. Patent No. 5,635,372; or BMP-16, disclosed in
U.S. Patent No. 5,965,403. Other TGF-β proteins which may be useful as the active
agent in the calcium phosphate compositions of the invention include Vgr-2, Jones et
al., Mol. Endocrinol. 6:1961 (1992), and any of the growth and differentiation factors
(GDFs), including those described in PCT applications WO94/15965; WO94/15949;
WO95/01801; WO95/01802; WO94/21681; WO94/15966; WO95/10539;
WO96/01845; WO96/02559 and others. Also useful in the invention may be BIP,
disclosed in WO94/01557; HP00269, disclosed in JP Publication number: 7-250688;
and MP52, disclosed in PCT application WO93/16099. The disclosures of all of the
above applications are incorporated herein by reference. A subset of BMPs which can
be used in the invention include BMP-2, BMP-4, BMP-5, BMP-6, BMP-7, BMP-10,
BMP-12, BMP-13, BMP-14, and MP52. The active agent is most preferably BMP-2,
the sequence of which is disclosed in U.S. Patent No. 5,013,649, the disclosure of
which is incorporated herein by reference. Other osteogenic agents known in the art
can also be used, such as teriparatide (Forteo™), Chrysalin®, prostaglandin E2, LIM
protein, osteogenin, or demineralized bone matrix (DBM), among others.
The biologically active agent may be synthesized chemically, recombinantly
produced, or purified from a source in which the biologically active agent is naturally
found. The active agent, if a TGF-j3, such as a BMP or other dimeric protein, may be
homodimeric, or may be heterodimeric with other BMPs (e.g., a heterodimer
composed of one monomer each of BMP-2 and BMP-6) or with other members of the
TGF-/3 superfamily, such as activins, inhibins and TGF-jSl (e.g., a heterodimer
composed of one monomer each of a BMP and a related member of the TGF-β
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WO 2006/044334 PCT/US2005/036447
superfamily). Examples of such heterodtmeric proteins are described for example in
Published PCT Patent Application WO 93/09229, the specification of which is
incorporated herein by reference.
Additional biologically active agents include the Hedgehog, Frazzled,
Chordin, Noggin, Cerberus, and Follistatin proteins. These famines of proteins are
generally described in Sasai et al., Cell 79:779-790 (1994) (Chordin); PCT Patent
Publication WO94/05800 (Noggin); and Fukui et al., Devel Biol. 159:131 (1993)
(Follistatin). Hedgehog proteins are described in WO96/16668; WO96/17924; and
WO95/18856. The Frazzled family of proteins is a recently discovered family of
proteins with high homology to the extracellular binding domain of the receptor
protein family known as Frizzled. The Frizzled family of genes and proteins is
described in Wang et al., J. Biol. Chem. 271:4468-4476 (1996). The active agent may
also include other soluble receptors, such as the truncated soluble receptors disclosed
in PCT patent publication WO95/07982. From the teaching of WO95/07982, one
skilled in the art will recognize that truncated soluble receptors can be prepared for
numerous other receptor proteins. The above publications are incorporated by
reference herein.
The amount of the biologically active protein, e.g., an osteogenic protein, that
is effective to stimulate a desired activity, e.g., increased osteogenic activity of
present or infiltrating progenitor or other cells, will depend upon the size and nature
of the defect being treated, as well as the carrier being employed. Generally, the
amount of protein to be delivered is in arange of from about 0.1 to about 100 mg;
preferably about 1 to about 100 mg; most preferably about 10 to about 80 mg.
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WO 2006/044334 PCT/US2005/036447
Standard protocols and regimens for delivery of the above-listed agents are
known in the art. Biologically active agents are introduced into the implant material
in amounts that allow delivery of an appropriate dosage of the- agent to the implant
site. In most cases, dosages are determined using guidelines known to practitioners
and applicable to the particular agent in question. The exemplary amount of
biologically active agent to be included in the implant material of the invention is
likely'to depend on such variables as the type and extent of the condition, the overall
health status of the particular patient, the formulation of the active agent, and the
bioresorbability of the delivery vehicle used. Standard clinical trials may be used to
optimize the dose and dosing frequency for any particular biologically active agent.
In an embodiment of all aspects of the invention, the composition can
additionally contain autologous bone marrow or autologous platelet extracts.
In another embodiment of all of the above aspects, the PDGF and/or other
growth factors can be obtained from natural sources, (e.g., platelets), or more
preferably, produced by recombinant DNA technology. When obtained from natural
sources, the PDGF and/or other growth factors can be obtained from a biological
fluid. A biological fluid includes any treated or untreated fluid (including a
suspension) associated with living organisms, particularly blood, including whole
blood, warm or cold blood, and stored or fresh blood; treated blood, such as blood
diluted with at least one physiological solution, including but not limited to saline,
nutrient, and/or anticoagulant solutions; blood components, such as platelet
concentrate (PC), apheresed platelets, platelet-rich plasma (PRP), platelet-poor
plasma (PPP), platelet-free plasma, plasma, serum, fresh frozen plasma (FFP),
components obtained from plasma, packed red cells (PRC), buffy coat (BC); blood
products derived from blood or a blood component or derived from bone marrow; red
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cells separated from plasma and resuspended in physiological fluid; and platelets
separated from plasma and resuspended in physiological fluid. The biological fluid
may have been treated to remove some of the leukocytes before being processed
according to the invention. As used herein, blood product or biological fluid refers to
the components described above, and to similar blood products or biological fluids
obtained by other means and with similar properties. In an embodiment, the PDGF is
obtained from platelet-rich plasma (PRP). The preparation of PRP is described in,
e.g., U.S. Patent Nos. 6,649,072, 6,641,552, 6,613,566, 6,592,507, 6,558,307,
6,398,972, and 5,599,558, which are incorporated herein by reference.
In an embodiment of all aspects of the invention, the implant material delivers
PDGF at the implant site for a duration of time greater than at least 1 day. In several
embodiments, the implant material delivers PDGF at the implant site for at least 7,14,
21, or 28 days. Preferably, the implant material delivers PDGF at the implant site for
a time between about 1 day and 7,14,21, or 28 days. In another embodiment, the
implant material delivers PDGF at the implant site for a timelgreater than about 1 day,
but less than about 14 days.
By "bioresorbable" is meant the ability of the implant material to be resorbed
or remodeled in vivo. The resorption process involves degradation and elimination of
the original implant material through the action of body fluids, enzymes or cells. The
resorbed materials may be used by the host in the formation of new tissue, or it may
be otherwise re-utilized by the host, or it may be excreted.
By "differentiation factor" is meant a polypeptide, including a chain of at least
6 amino acids, which stimulates differentiation of one or more target cells into cells
with cartilage or bone forming potential.
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By "nanometer-sized particle" is meant a submicron-sized particle, generally
defined as a particle below 1000 nanometers. A nanometer-sized particle is a solid
particle material that is in an intermediate state between molecular and macron
substances. A nanometer is defined as one billionth of a meter (1 nanometer = 109
m). Nanometer material is known as the powder, fiber, film, pr block having
nanoscale size.
By "periodontium" is meant the tissues that surround and support the teeth.
The periodontium supports, protects, and provides nourishment to the teeth. The
periodontium consists of bone, cementum, alveolar process of the maxillae and
mandible, periodontal ligament, and gingiva. Cementum is a thin, calcified layer of
tissue that completely covers the dentin of the tooth root. Cementum is formed during
the development of the root and throughout the life of the tooth and functions as an
area of attachment for the periodontal ligament fibers. The alveolar process is the
bony portion of the maxilla and mandible where the teeth are embedded and in which
the tooth roots are supported. The alveolar socket is the cavity within the alveolar
process in which the root of the tooth is held by the periodontal ligament. The bone
that divides one socket from another is called the interdental septum. When
multirooted teeth are present, the bone is called the interradicular septum.
The alveolar process includes the cortical plate, alveolar crest, trabecular bone, and
the alveolar bone proper.
By "promoting growth" is meant the healing of bone, periodontium, ligament,
or cartilage, and regeneration of such tissues and structures. Preferably, the bone,
periodontium, ligament, or cartilage is damaged or wounded and requires regeneration
or healing.
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WO 2006/044334 PCT/US2005/036447
By "promoting periodontium growth" is meant regeneration or healing of the
supporting tissues of a tooth including alveolar bone, cementum, and interposed
periodontal ligament, which have been damaged by disease or trauma.
By "purified" is meant a growth or differentiation factor, e.g., PDGF, which,
prior to mixing with a carrier substance, is 95% or greater by weight, i.e., the factor is
substantially free of other proteins, lipids, and carbohydrates with which it is naturally
associated. The term "substantially purified" refers to a lesser: purity of factor,
having, for example, only 5%-95% by weight of the factor, preferably 65-95%. A
purified protein preparation will generally yield a single major band on a
polyacrylamide gel. Most preferably, the purified factor used'in implant materials of
the invention is pure as judged by ammo-terminal amino acid sequence analysis. The
term "partially purified" refers to PDGF that is provided in the context of PRP, PPP,
FFP, or any other blood product that requires collection and separation, e.g., by
centrirugation, to produce.
By way of example, a solution having ~1.0 mg/mL of PDGF, when -50%
pure, constitutes ~2.0 mg/mL of total protein.
The implant materials of this invention aid in regeneration of periodontium, at
least in part, by promoting the growth of connective tissue, bone, and cementum. The
implant materials can be prepared so that they directly promote the growth and
differentiation of cells that produce connective tissue, bone, and cementum.
Alternatively, the implant materials can be prepared so that they act indirectly by, e.g.,
attracting cells that are necessary for promoting the growth of connective tissue, bone,
and cementum. Regeneration using a composition of this invention is a more
effective treatment of periodontal diseases or bone wounds than that achieved using
systemic antibiotics or surgical debridement alone.
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The PDGF, polypeptide growth factors, and differentiation factors may be
obtained from human tissues or cells, e.g., platelets, by solid phase peptide synthesis,
or by recombinant DNA technology. Thus, by the term "polypeptide growth factor"
or "differentiation factor," we mean tissue or cell-derived, recombinant, or
synthesized materials. If the factor is a dimer, e.g., PDGF, the recombinant factor can
be a recombinant heterodimer, made by inserting into cultured prokaryotic or
eukaryotic cells DNA sequences encoding both subunits of the factor, and then
allowing the translated subunits to be processed by the cells to form a heterodimer
(e.g., PDGF-AB). Alternatively, DNA encoding just one of the subunits (e.g., PDGF
B-chain or A-chain) can be inserted into cells, which then are cultured to produce the
homodimeric factor (e.g., PDGF-BB or PDGF-AA homodimers). PDGF for use in
the methods of the invention includes PDGF homo- and heterodimers, for example,
PDGF-AA, PDGF-BB, PDGF-AB, PDGF-CC, and PDGF-DD, and combinations and
derivatives thereof.
The concentration of PDGF or other growth factors of the invention can be
determined by using, e.g., an enzyme-linked immunoassay, as described in, e.g., U.S.
Patent Nos. 6,221,625, 5,141,273, and 5,290,708, incorporated herein by reference, or
any other assay known in the art for determining protein concentration. When
provided herein, the molarconcentration of PDGF is determined based on the
molecular weight of PDGF dimer (e.g., PDGF-BB; MW= approximately 25 kDa).
The methods and implant materials of the invention can be used to heal bony
wounds of mammals, e.g., fractures, implant recipient sites, and sites of periodontal
disease. The implant materials promote connective tissue growth and repair and
enhance bone formation compared to natural healing (i.e., no exogenous agents
added) or healing supplemented by addition of systemic antibiotics. Unlike natural
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WO 2006/044334 PCT/US2005/036447
healing, conventional surgical therapy, or antibiotics, the implant materials of the
invention prompt increased bone, connective tissue (e.g., cartilage and ligament), and
cementum formation when applied to damaged or diseased tissues or to periodontal
disease affected sites. The restoration of these tissues leads to an improved prognosis
for the affected areas. The ability of these factors to stimulate new bone formation
also makes it applicable for treating bony defects caused by other types of infection or
surgical or accidental trauma.
Other features and advantages of the invention will be apparent from the
following description of the embodiments thereof, and from the claims.
Brief Description of the Drawings
Figs. 1A-1G are photomicrographs showing the effect on bone formation 8
weeks following treatment. Fig. 1A is a photomicrograph showing the effect of
surgery alone on bone formation. Fig. 1B is a photomicrograph showing the effect of
/3-TCP alone on bone formation. Fig. 1C is a photomicrograph showing the effect of
(S-TCP + 0.3 mg/mL PDGF on bone formation. Fig. 1D is a photomicrograph
showing the effect of /3-TCP + 1.0 mg/mL PDGF on bone formation. Fig. 1E is a
photomicrograph showing the effect of demineralized freeze dried bone allograft
(DFDBA) alone on bone formation. Fig. IF is a photomicrograph showing the effect
of demineralized freeze dried bone allograft (DFDBA) + 0.3 mg/mL PDGF on bone
formation. Fig. 1G is a photomicrograph showing the effect of demineralized freeze
dried bone allograft (DFDBA) +1.0 mg/mL on bone formation.
Figs. 2A-2C are photomicrographs showing the effect on bone formation 16
weeks following treatment. Fig. 2A is a photomicrograph showing the effect of β-
TCP alone on bone formation. Fig. 2B is a photomicrograph showing the effect of β-
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WO 2006/044334 PCT/US2005/036447
TCP + 0.3 mg/mL PDGF on bone formation. Fig. 2C is a photomicrograph showing
the effect of β-TCP + 1.0 mg/mL PDGF on bone formation.
Detailed Description
We now describe several embodiments of the invention. Two examples
demonstrating the use of PDGF as a bone and periodontum healing agent are
presented below.
EXAMPLES
Example I: Preparation of PDGF
Osseous wounds, e.g., following periodontal disease or trauma, are treated and
periodontium, including bone, cementum, and connective tissue, are regenerated,
according to the invention by combining partially purified or purified PDGF with any
of the pharmaceutically acceptable carrier substances described above. Purified
PDGF can be obtained from a recombinant source or from human platelets.
Commercially available recombinant PDGF can be obtained from R&D Systems Inc.
(Minneapolis, MN), BD Biosciences (San Jose, CA), and Chemicon, International
(Temecula, CA). Partially purified and purified PDGF can also be prepared as
follows:
Five hundred to 1000 units of washed human platelet pellets are suspended in
1M NaCl (2 ml per platelet unit) and heated at 100°C for 15 minutes. The supernatant
is then separated by centrifugation and the precipitate extracted twice with the lm
NaCl.
The extracts are combined and dialyzed against 0.08M NaCl / 0.01M sodium
phosphate buffer (pH 7.4) and mixed overnight at 4°C with CM-Sephadex C-50
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WO 2006/044334 PCT/US2005/036447
equilibrated with the buffer. The mixture is then poured into a column (5 x 100 cm),
washed extensively with 0.08M NaCl / 0.01M sodium phosphate buffer (pH 7.4), and
eluted with 1M NaCl while 10 ml fractions are collected.
Active fractions are pooled and dialyzed against 0.3M NaCl / 0.01M sodium
phosphate buffer (pH 7.4), centrifuged, and passed at 4°C through a 2.5 x 25 cm
column of blue sepharose (Pharmacia) equilibrated with 0.3M NaCl / 0.01M sodium
phosphate buffer (pH 7.4). The column is then washed with the buffer and partially
purified PDGF eluted with a 1:1 solution of 1M NaCl and ethylene glycol.
The partially purified PDGF fractions are diluted (1:1) with 1M NaCl,
dialyzed against 1M acetic acid, and lyophilized. The lyophilized samples are
dissolved in 0.8M NaCl / 0.01M sodium phosphate buffer (pH 7.4) and passed
through a 1.2 x 40 cm column of CM-Sephadex C-50.equilibrated with the buffer.
PDGF is then eluted with a NaCl gradient (0.08 to 1M).
The active fractions are combined, dialyzed against 1M acetic acid,
lyophilized, and dissolved in a small volume of 1M acetic acid. 0.5 ml portions are
applied to a 1.2 x 100 cm column of Biogel P-150 (100 to 200 mesh) equilibrated
with 1M acetic acid. The PDGF is then eluted with 1M acetic acid while 2 mL
fractions are collected.
Each active fraction containing 100 to 200 mg of protein is lyophilized,
dissolved hi 100 mL of 0.4% trifiuoroacetic acid, and subjected to reverse phase high
performance liquid chromatography on aphenyl Bondapak column (Waters). Elution
with a linear acetonitrile gradient (0 to 60%) yields pure PDGF.
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WO 2006/044334 PCT/US2005/036447
PDGF Made By Recombinant DNA Technology Can Be Prepared As Follows:
Platelet-derived growth factor (PDGF) derived from Human platelets contains
two polypeptide sequences (PDGF-B and PDGF-A polypeptides; Antoniades, H.N.
and Hunkapiller, M., Science 220:963-965,1983). PDGF-B is encoded by a gene
localized on chromosome 7 (Betsholtz, C. et al., Nature 320:695-699), and PDGF-A
is encoded by the sis oncogene (Doolittle, R. et al., Science 221:275-277,1983)
localized on chromosome 22 (Dalla-Favera, R., Science 218:686-688,1982). The sis
gene encodes the transforming protein of the Simian Sarcoma Virus (SSV) which is
closely related to PDGF-2 polypeptide. The human cellular c-sis also encodes the
PDGF-A chain (Rao, C. D. et si., Proa Natl. Acad. Sci. USA 83:2392-2396,1986).
Because the two polypeptide chains of PDGF are coded by two different genes
localized in separate chromosomes, the possibility exists that human PDGF consists
of a disulfide-linked heterodimer of PDGF-B and PDGF-A, or a mixture of the two
homodimers (PDGF-BB hornodimer and PDGF-AA homodimer), or a mixture of the
heterodimer and the two homodimers.
Mammalian cells in culture infected with the Simian Sarcoma Virus, which
contains the gene encoding the PDGF-A chain, were shown to synthesize the PDGF-
A polypeptide and to process it into a disulfide-linked homodimer (Robbins et al.,
Nature 305:605-608,1983). In addition, the PDGF-A homoldimer reacts with antisera
raised against human PDGF. Furthermore, the functional properties of the secreted
PDGF-A homodimer are similar to those of platelet-derived iPDGF in that it
stimulates DNA synthesis in cultured fibroblasts, it induces phosphorylation at the
tyrosine residue of a 185 kD cell membrane protein, and it is capable of competing
with human (125I)-PDGF for binding to specific cell surface PDGF receptors (Owen,
'> A. et al., Science 225:54-56,1984). Similar properties were shown for the sis/PDGF-
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WO 2006/044334 PCT/US2005/036447
A gene product derived from cultured normal human cells (fpr example, human
arterial endothelial cells), or from human malignant cells expressing the sis/PDGF-2
gene (Antoniades, H. et al., Cancer Cells 3:145-151,1985).
The recombinant PDGF-B homodimer is obtained by the introduction of
cDNA clones of c-sis/PDGF-B gene into mouse cells using an expression vector. The
c-sis/PDGF-B clone used for the expression was obtained from normal human
cultured endothelial cells (Collins, T., et al., Nature 216:748-750, 1985).
Use of PDGF
PDGF alone or in combination with other growth factors is useful for
promoting bone healing, bone growth and regeneration or healing of the supporting
structures of teeth injured by trauma or disease. It is also useful for promoting healing
of a site of extraction of a tooth, for mandibular ridge augmentation, or at tooth
implant sites. Bone healing would also be enhanced at sites of bone fracture or in
infected areas, e.g., osteomyelitis, or at tumor sites. PDGF is also useful for
promoting growth and healing of a ligament, e.g., the periodontal ligament, and of
cemenrum.
In use, the PDGF or other growth or differentiation factor is applied directly to
the area needing healing or regeneration. Generally, it is applied in a resorbable or
non-resorbable carrier as a liquid or solid, and the site then cpvered with a bandage or
nearby tissue. An amount sufficient to promote bone growth is generally between 500
ng and 5 mg for a 1 cm2 area, but the upper limit is really 1 mg for a 1 cm2 area, with
a preferred amount of PDGF applied being 0.3 mg/mL.
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WO 2006/044334 PCT/US2005/036447
Example II: Periodontal Regeneration With rhPDGF-BB Treated Osteoconductive
Scaffolds
The effectiveness of PDGF in promoting periodontium and bone growth is
demonstrated by the following study.
In Vivo Dog Study
The beagle dog is the most widely used animal model for testing putative
periodontal regeneration materials and procedures (Wikesjo et al., J. Clin.
Periodontol. "15:73-78, 1988; Wikesjo et al.,/. Clin. Periodontol 16:116-119, 1999;
Cho et al., J. Periodontol. 66:522-530,1995; Giamobile et al., J. Periodontol.
69:129-137, 1998; and Clergeau et al., J. Periodontol. 67:140-149, 1996). Plaque and
calculus accumulation can induce gingival inflammation that may lead to marginal
bone loss and the etiology of periodontitis in dogs and humans can be compared. In
naturally occurring disease, however, there is a lack of uniformity between defects.
Additionally, as more attention has been given to oral health in canine breeder
colonies, it has become impractical to obtain animals with natural periodontal disease.
Therefore, the surgically-induced horizontal Class HI furcation model has become one
of the most commonly used models to investigate periodontal healing and
regeneration.
Beagle dogs with horizontal Class III furcation defects were treated using
PDGF compositions of the invention. Fifteen adult beagle dogs contributed 60 treated
defects. Forty-two defects were biopsied two months after treatment and fifteen
defects were biopsied four months after treatment
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Defect Preparation
The "critical-size" periodontal defect model as described by numerous
investigators was utilized (see, e.g., Wikesjo, 1988 and 1999, supra; Giannobile,
supra, Cho, supra, and Park et al., J. Periodontol. 66:462-477, 1995). Both
mandibular quadrants in 16 male beagle dogs (2-3 years old) without general and oral
health problems were used. One month prior to dosing, the animals were sedated with
a subcutaneous injection of atropine (0.02 mg/kg) and acepromazine (0.2 mg/kg)
approximately 30 minutes prior to being anesthetized with an IV injection of
pentobarbital sodium (25 mg/kg). Following local infiltration of the surgical area
with Lidocaine HC1 plus epinephrine 1:100,000, full thickness mucoperiosteal flaps
were reflected and the first and third premolars (P1 and P3) were extracted.
Additionally, the mesial portion of the crown of the 1st molar was resected.
Alveolar bone was then removed around the entire circumference of P2 and
P4, including the furcation areas using chisels and water-cooled carbide and diamond
burs. Horizontal bone defects were created such that there was a distance of 5 mm
from the fornix of the furcation to the crest of the bone. The defects were
approximately 1 cm wide, depending on the width of the tooth. The roots of all
experimental teeth were planed with curettes and ultrasonic instruments and
instrumented with a tapered diamond bur to remove cementum. After the
standardized bone defects were created the grngival flaps were sutured to achieve
primary closure. The animals were fed a soft diet and received daily chlorhexidine
rinses for the duration of the study.
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Application of Graft Material
The periodontal defects of P2 and P4 in each mandibular quadrant of the 15
animals were randomized prior to treatment using sealed envelopes. About four
weeks after defect preparation, animals were re-anesthetized as described above and
full thickness flaps were reflected in both mandibular quadrants. A notch was placed
in the tooth root surfaces at the residual osseous crest using al/2 round bur to serve as
a future histologic reference point. The sites were irrigated with sterile saline and the
roots were treated with citric acid as described previously for the purpose of
decontamination and removal of the smear layer (See, e.g., Cho, supra, and Park,
supra). During this period an amount of β-TCP or DFDBA Sufficient to fill the
periodontal defect was saturated with a solution of rhPDGF-BB solution (0.3 or 1.0
mg/nal) and the rhPDGF-BB/graft mixture was allowed to sit on the sterile surgical
stand for about ten minutes. The rhPDGF-BB saturated graft was then packed into
the defect with gentle pressure to the ideal level of osseous regeneration.
After implantation of the graft material, the mucoperiosteal flaps were sutured
approximately level to the cementoenamel junction (CEJ) using interproximal,
interrupted 4.0 expanded polytetrafiuoroethylene (ePTFE) sutures. Following
suturing of the flaps chlorhexidine gluconate gel was gently placed around the teeth
and gingivae.
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WO 2006/044334 PCT/US2005/036447
Treatment and Control Groups
Defects received either:
1. β-TCP
2. β-TCP plus rhPDGF-BB (0.3 mg/ml rhPDGF-BB)
3. β-TCP plus rhPDGF-BB (1.0 mg/ml rhPDGF-BB)
4. Dog DFDBA
5. Dog DFDBA plus rhPDGF-BB (0.3 mg/ml rhPDGF-BB)
6. Dog DFDBA plus rhPDGF-BB (1.0 mg/ml rhPDGF-BB)
7. Sham surgery (treated by open flap debridement only, no graft)
Six defects per treatment group were biopsied at two months (42 total sites).
In addition, five defects in treatment groups 1, 2, and 3 were biopsied at four months
(15 total sites).

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Accordingly, at 8 weeks there are 7 groups divided among 42 sites in 11 dogs.
At 16 weeks, there are 3 groups divided among 15 sites in 4 dogs (one dog received
two treatment surgeries staggered eight weeks apart and thus contributed two sites to
each, the 8 and 16 week time points).
Post-surgical Treatment
The surgical sites were protected by feeding the dogs a soft diet during the
first 4 weeks post-operative. To insure optimal healing, systemic antibiotic treatment
with penicillin G benzathine was provided for the first two weeks and plaque control
was maintained by daily irrigation with 2 % chlorhexidine gluconate throughout the
experiment. Sutures were removed after 3 weeks.
Data Collection
Rationale for Data Collection Points
The eight week time point was chosen because this is the most common time
point reported for this model in the literature and therefore there are substantial
historical data. For example, Wikesjo et al, supra, and Giannobile et al., supra, also
chose 8 weeks to assess the regenerative effects of BMP-2 and OP-1, respectively, in
the same model. Additionally, Park et al., supra, evaluated the effect or rhPDGF-BB
applied directly to the conditioned root surface with and without GTR membranes in
the beagle dog model at 8 weeks. These studies, strongly suggest that the 8 week
period should be optimal for illustrating potential significant effects among the
various treatment modalities.
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The sixteen week time point was chosen to assess long-term effects of growth
factor treatment. Previous studies (Park et al., supra) suggest that by this time there is
substantial spontaneous healing of the osseous defects. Nevertheless, it is possible to
assess whether rhPDGF-BB treatment leads to any unusual or: abnormal tissue
response, such as altered bone remodeling, tumorgenesis or root resorption.
Biopsies and Treatment Assessments
At the time of biopsy, the animals were perfused with 4% paraformaldehyde
and sacrificed. The mandibles were then removed and placed in fixative. Periapical
radiographs were taken and the treated sites were cut into individual blocks using a
diamond saw. The coded (blinded) blocks were wrapped in gauze, immersed in a
solution of 4% formaldehyde, processed, and analyzed.
During processing the biopsies were dehydrated in ethanol and infiltrated and
embedded in methylmethacrylate. Undecalcified sections of approximately 300 μm in
thickness were obtained using a low speed diamond saw with coolant The sections
were glued onto opalescent acrylic glass, ground to a final thickness of approximately
80 μm, and stained with toludine blue and basic fuchsin. Step serial sections were
obtained in a mesiodistal plane.
Histomorphometric analyses were performed on the masked slides. The
following parameters were assessed:
1. Length of Complete New Attachment Apparatus (CNAA): Periodontal
regeneration measured as the distance between the coronal level of the old bone and
the coronal level of the new bone, including only that new bone adjacent to new
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cementum with functionally oriented periodontal ligament between the new bone and
new cementum.
2. New Bone Fill (NB): Measured as the cross-sectional area of new bone
formed within the furcation.
3. Connective Tissue fill (CT): Measured as the area within the furcation
occupied by gingival connective tissue.
4. Void (VO): The area of recession where there is an absence of tissue.
Results
A. Clinical observations
Clinically, all sites healed well. There was an impression that the sites treated
with rhPDGF-BB healed more quickly, as indicated by the presence of firm, pink
gingivae within one week post-operatively. There were no adverse events
experienced in any treatment group as assessed by visual inspection of the treated
sites. There appeared to be increased gingival recession in groups that received /3-
TCP or DFDBA alone.
B. Radiograpkic observations
Radiographically, there was evidence of increased bone formation at two
months as judged by increased radiopacity in Groups 2, 3 (/3-TCP + rhPDGF-BB 0.3
and 1.0 mg/ml, respectively) and 6 (DFDBA + rhPDGF-BB 1.0 mg/ml) compared to
the other groups (Figures 1A-G). At four months, there was evidence of increased
bone formation in all groups compared to the two month time point. There was no
radiographic evidence of any abnormal bone remodeling, root resorption, or ankylosis
in any group.
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Table 3. Radiographic results. Rank order.

C. Histomorphometric analyses:
Histomorphometric assessment of the length of new cementum, new bone, and
new periodontal ligament (CNAA) as well as new bone fill, connective tissue fill, and
void space were evaluated and are expressed as percentages. In the case of CNAA,
values for each test group represent the CNAA measurements (length in mm)/ total
available CNAA length (in mm) x 100%. Bone fill, connective tissue fill and void
space were evaluated and are expressed as percentages of the total furcation defect
area.
One-way analysis of variance (ANOVA) was used to test for overall
differences among treatment groups, and pairwise comparisons were made using the
student's t-test. Significant differences between groups were found upon analyses of
the coded slides. Table 4 shows the results at two months.
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Table 4. Two month histometric analyses

The mean percent periodontal regeneration (CNAA) in the surgery without
grafts and surgery plus /3-TCP alone groups were 27% and 37%, respectively. In
contrast, β-TCP groups containing rhPDGF-BB exhibited significantly greater
periodontal regeneration (p and 46% respectively for the 0.3 and 1.0 mg/ml concentrations versus 27% for
surgery alone and 13% for DFDBA alone). Finally, the β-TCP group containing 0.3
mg/ml rhPDGF-BB demonstrated significantly greater periodontal regeneration
(p versus 21%).
Bone fill was significantly greater (p rhPDGF-BB (84.0%) and the β-TCP + 1.0 mg/ml rhPDGF-BB (74.2%) groups than
in the /3-TCP alone (28.0%), surgery alone (34%) or DFDBA alone (6%) treatment
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groups. There was also significantly greater bone fill (p mg/ml rhPDGF-BB group compared to the DFDBA + 0.3 mg/ml rhPDGF-BB group
(84% and 20% respectively).
The group of analyses examining the 8-week data from the DFDBA groups
and the surgery alone group (Groups 4, 5, 6, and 7) demonstrated no statistically
significant differences between the DFDBA groups and surgery alone for periodontal
regeneration (CNAA). There was a trend toward greater regeneration for those sites
treated with the 1.0 mg/ml rhPDGF-BB enhanced DFDBA versus DFDBA alone.
There was significantly greater bone fill (p mg/ml rhPDGF-BB than DFDBA alone (46 and 6% respectively). There was a trend
toward greater bone fill for sites treated with DFDBA containing 0.3 mg/ml rhPDGF-
BB compared to DFDBA alone or surgery alone. However, sites treated with DFDBA
alone demonstrated less bone fill into the defect than surgery alone (6 and 34%,
respectively), with most of the defect being devoid of any fill or fill consisting of
gingival (soft) connective tissue.
At four months following treatment, there remained significant differences in
periodontal regeneration. β-TCP alone, as a result of extensive ankylosis, resulted in
36% regeneration, while the sites treated with β-TCP containing rhPDGF-BB had a
mean regeneration of 58% and 49% in the 0.3 and 1.0 mg/ml rhPDGF-BB
concentrations. Substantial bone fill was present in all three treatment groups. /3-TCP
alone resulted in 70% bone fill, β-TCP plus 0.3 mg/ml rhPDGF yielded 100% fill
while the 1.0 mg/ml rhPDGF group had 75% fill.
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D. Histologic Evaluation
Histologic evaluation was performed for all biopsies except one, in which
evaluation was not possible due to difficulties encountered during processing.
Representative photomicrographs are shown in Figures 1A-G and 2A-C.
Figure 1A shows results from a site treated with surgery alone (no grafts). This
specimen demonstrates limited periodontal regeneration (new bone (NB), new
cementum (NC), and periodontal ligament (PDL)) as evidenced in the area of the
notches and extending only a short distance coronally. The area of the furcation is
occupied primarily by dense soft connective tissue (CT) with; minimal new bone (NB)
formation.
For sites treated with β-TCP alone (Figure 1B) there is periodontal
regeneration, similar to that observed for the surgery alone specimen, that extends
from the base of the notches for a short distance coronally. As was seen in the
surgery alone specimens, there was very little new bone formation with the greatest
area of the furcation being occupied by soft connective tissue.
In contrast, Figure 1C illustrates results obtained for sites treated with /3-TCP
+ 0.3 mg/ml rhPDGF-BB. Significant periodontal regeneration is shown with new
bone, new cementum, and periodontal ligament extending along the entire surface of
the furcation. Additionally, the area of the furcation is filled; with new bone that
extends the entire height of the furcation to the fornix.
Representative results for sites treated with β-TCP + 1.0 mg/ml rhPDGF-BB
are shown in Figure 1D. While there is significant periodontal regeneration in the
furcation, it does not extend along the entire surface of the furcation. There is new
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WO 2006/044334 PCT/US2005/036447
bone formation present along with soft connective tissue that is observed at the
coronal portion of the defect along with a small space which is void of any tissue
(VO) at the fornix of the furcation.
Figures 2A, 2B, and 2C illustrate results obtained for the allograft treatment
groups. Representative results for the DFDBA alone group (Figure 2A) shows very
poor periodontal regeneration that is limited to the area of the notches extending only
slightly in a coronal direction. New bone formation is limited and consists of small
amounts of bone formation along the surface of residual DFDBA graft material (dark
red staining along lighter pink islands). Additionally, the new bone is surrounded by
extensive soft connective tissue that extends coronally to fill a significant area within
the furcation. Finally, a large void space extends from the coronal extent of the soft
connective tissue to the fornix of the furcation.
Histologic results for the DFDBA + 0.3 and 1.0 mg/ml rhPDGF-BB are shown
in Figures 2B and 2C, respectively. Both groups demonstrate greater periodontal
regeneration compared to DFDBA alone with a complete new attachment apparatus
(new bone, new cementum, and periodontal ligament) extending from the base of the
notches in the roots for a short distance coronally (arrows). They also had greater
bone fill within the area of the furcation, although there was significant fill of the
furcation with soft connective tissue.
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Conclusions
Based on the results of the study, treatment of a periodontal defect using
rhPDGF-BB at either 0.3 mg/mL or 1.0 mg/mL in combination with a suitable carrier
material (e.g., β-TCP) results in greater periodontal regeneration than the current
products or procedures, such as grafts with jS-TCP or bone allograft alone, or
periodontal surgery without grafts.
Treatment with the 0.3 mg/mL and 1.0 mg/mL concentration of rhPDGF
resulted in periodontal regeneration. The 0.3 mg/ml concentration of rhPDGF
demonstrated greater periodontal regeneration and percent bone fill as compared to
the 1.0 mg/ml concentration of rhPDGF when mixed with./3-TCP.
β-TCP was more effective than allograft when mixed with rhPDGF-BB at any
concentration. The new bone matured (remodeled) normally over time (0, 8, and 16
weeks) in all groups. There was no increase in ankylosis or root resorption in the
rhPDGF groups, in fact, sites receiving rhPDGF-BB tended; to have less ankylosis
than control sites. This finding may result from the fact thatrhPDGF-BB is mitogenic
and chemotactic for periodontal ligament cells.
MATERIALS AND METHODS
Materials Utilized: Test and Control Articles
The β-TCP utilized had a particle-size (0.25 mm - 1.0 mm) that was optimized
for periodontal use. Based on studies using a canine model,, administered /3-TCP is
~80% resorbed within three months and is replaced by autologous bone during the
healing process.
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The DFDBA was supplied by Musculoskeletal Transplant Foundation (MTF).
The material was dog allograft, made by from the bones of a dog that was killed
following completion of another study that tested a surgical procedure that was
deemed to have no effect on skeletal tissues.
Recombinant hPDGF-BB was supplied by BioMimetic Pharmaceuticals and
was manufactured by Chiron, Inc, the only supplier of FDA-approved rhPDGF-BB
for human use. This rhPDGF-BB was approved by the FDA as a wound healing
product under the trade name of Regranex®.
One ml syringes containing 0.5 ml of sterile rhPDGF-BB at two separate
concentrations prepared in conformance with FDA standards for human materials and
according to current applicable Good Manufacturing Processes (cGMP).
Concentrations tested included 0.3 mg/ml and 1.0 mg/ml.
β-TCP was provided in vials containing 0.5 cc of sterile particles.
DFDBA was provided in 2.0 ml syringes containing 1.0 cc of sterile,
demineralized fireeze-dried dog bone allograft.
Material Preparation
At the time of the surgical procedure, the final implanted grafts were prepared
by mixing the rhPDGF-BB solution with the matrix materials. Briefly, an amount of
TCP or allograft sufficient to completely fill the osseous defect was placed into a
sterile dish. The rhPDGF-BB solution sufficient to completely saturate the matrix
was then added, the materials were mixed and allowed to sit on the surgical tray for
about 10 minutes at room temperature prior to being placed in the osseous defect.
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A 10 minute incubation time with the β-TCP material is sufficient to obtain
maximum adsorption of the growth factor (see Appendix A). This is also an
appropriate amount of time for surgeons in a clinical setting to have prior to
placement of the product into the periodontal defect. Similarly, in a commercial
market, the rhPDGF-BB and the matrix material can be supplied in separate
containers in a kit and that the materials can be mixed directly before placement. This
kit concept would greatly simplify product shelf life/stability considerations.
Example HI: Use of PDGF For The Treatment Of Periodontal Bone Defects in
Humans
Recombinant human PDGF-BB (rhPDGF-BB) was tested for its effect on the
regeneration of periodontal bone in human subjects. Two test groups were
administered rhPDGF-BB at either 0.3 mg/rnL (Group I) or 1.0 mg/mL (Group IT).
rhPDGF-BB was prepared in sodium acetate buffer and administered in a vehicle of
beta-tricalcium phosphate (β-TCP). The control group, Group EH, was administered
/3-TCP in sodium acetate buffer only.
The objective of clinical study was to evaluate the safety and effectiveness of
graft material comprising β-TCP and rhPDGF-BB at either 0.3 mg/mL or 1.0 mg/mL
in the management of one (1) to three (3) wall intra-osseous periodontal defects and to
assess its regenerative capability in bone and soft tissue.
Study Design and Duration of Treatment
The study was a double-blind, controlled, prospective, randomized, parallel
designed, multi-center clinical trial in subjects who required surgical intervention to
treat a bone defect adjacent to the natural dentition. The subjects were randomized in
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equal proportions to result in three (3) treatment groups of approximately 60 subjects
each (180 total). The duration of the study was six (6) months following implantation
of the study device. The study enrolled 180 subjects.
Diagnosis and Main Entry Criteria
Male and female subjects, 25-75 years of age, with advanced periodontal
disease in at least one site requiring surgical treatment to correct a bone defect were
admitted to the study. Other inclusion criteria included: 1) a probing pocket depth
measuring 7 mm or greater at the baseline visit; 2) after surgical debridement, 4 mm
or greater vertical bone defect (BD) with at least 1 bony wall; 3) sufficient keratinized
tissue to allow complete tissue coverage of the defect; and, 4) radiographic base of
defect at least 3 mm coronal to the apex of the tooth. Subjects who smoked up to 1
pack a day and who had teeth with Class I & It furcation involvement were
specifically allowed.
Dose and Mode of Administration
All treatment kits contained 0.25 g of /3-TCP (an active control) and either 0.5
mL sodium acetate buffer solution alone (Group HI), 0.3 mg/mL rbPDGF-BB (Group
I), or 1.0 mg/mL rhPDGF-BB (Group II).
Following thorough debridement and root planing, the test solution was mixed
with β-TCP in a sterile container, such that the β-TCP was fully saturated. Root
surfaces were conditioned using either tetracycline, EDTA, or citric acid. The
hydrated graft was then packed into the osseous defect and the tissue flaps were
secured with interdental sutures to achieve complete coverage of the surgical site.
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Effectiveness Measurement
The primary effectiveness measurement included the change in clinical
attachment level (CAL) between baseline and six months post-surgery (Group I vs.
Group III). The secondary effectiveness measurements consisted of the following
outcomes: 1) linear bone growth (LBG) and % bone fill (%BF) from baseline to six
months post-surgery based on the radiographic assessments (Group I and Group II vs.
Group III); 2) change in CAL between baseline and six months post-surgery (Group II
vs. Group III); 3) probing pocket depth reduction (PDR) between baseline and six
months post-surgery (Group I and Group II vs. Group HI); 4) gingival recession (GR)
between baseline and six months post-surgery (Group I and Group H vs. .Group HI);
5) wound healing (WH) of the surgical site during the first three weeks post-surgery
(Group I and Group II vs. Group IE); 6) area under the curve for the change in CAL
between baseline and three (3) and six (6) months (Group I and Group II vs. Group
HI); 7) the 95% lower confidence bound (LCB) for %BF at six (6) months post-
surgery (Groups I, II and HI vs. demineralized freeze-dried bone allograft (DFDBA)
as published in the literature; Parashis et al., J. Periodontol. 69:751-758,1998); 8) the
95% LCB for linear bone growth at six (6) months post-surgery (Groups I, II, and HI
vs. demineralized freeze-dried bone allograft (DFDBA) as published in the literature;
Persson et al., J. Clin. Periodontol. 27:104-108, 2000); 9) the 95% LCB for the change
in CAL between baseline and six (6) months (Groups L n, and II vs. EMDOGATN® -
PMA P930021,1996); and 10) the 95% LCB for the change in CAL between baseline
and six (6) months (Groups I, E and m vs. PEPGEN P-15™ - PMA P990033,1999).
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Statistical Methods
Safety and effectiveness data were examined and summarized by descriptive
statistics. Categorical measurements were displayed as counts andpercents, and
continuous variables were displayed as means, medians, standard deviations and
ranges. Statistical comparisons between the test product treatment groups (Groups I
and II) and the control (Group III) were made using Chi-Square and Fisher's Exact
tests for categorical variables and t-tests or Analysis of Variance Methods (ANOVA)
for continuous variables. Comparisons between treatment grpups for ordinal
variables were made using Cochran-Mantel-Haenszel methods. A p was considered to be statistically significant for CAL, LBG and %BF.
Safety data were assessed by the frequency and severity of adverse events as
evaluated clinically and radiographically. There were no significant differences between the
three treatment groups at baseline. There were also no statistically significant
differences observed in the incidence of adverse events (AEs; all causes) among the
three treatment groups. The safety analysis did not identify any increased risk to the
subject due to implantation of the graft material.
Summary of Effectiveness Results
The results from the statistical analyses revealed both: clinically and
statistically significant benefits for the two treatment groups (Groups I and II),
compared to the active control of β-TCP alone (Group III) and historical controls
including DFDBA, EMDOGAIN®, and PEPGEN P-15™.
At three months post-surgery, a statistically significant CAL gain from
baseline was observed in favor of Group I versus Group III (p = 0.041), indicating
that there are significant early benefits of PDGF on the gain in CAL. At six months
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WO 2006/044334 PCT/US2005/036447
post-surgery, this trend continued to favor Group I over Group III, although this
difference was not statistically significant (p = 0.200). The area under the curve
analysis (AUC) which represents the cumulative effect (i.e. speed) for CAL gain
between baseline and six months approached statistical significance favoring Group I
in comparison to Group III (p=0.054). Further, the 95% lower, confidence bound
(LCB) analyses for all treatment groups substantiated the effectiveness of Groups I
and II compared to the CAL gains observed at six (6) months for EMDOGAIN® and
PEPGENP-15™.
In addition to the observed clinical benefits of CAL, radiographic analyses
including Linear Bone Growth (LBG) and Percent Bone Fill (%BF), revealed
statistically significant improvement in bone gain for Groups I and II vs. Group III.
%BF was defined as the percent of the original osseous defect filled with new bone as
measured radiographically. LBG showed significant improvement in Group I
(2.5mm) when compared to Group III (0.9mm, pO.OOl). LBG was also significant
for Group II (1.5mm) when compared to Group IE (p=0.021).
Percent Bone Fill (%BF) was significantly increased at six months post-
surgical in Group I (56%) and Group II (34%) when compared to Group III (18%), for
a p interval at six months post-surgery, for both linear bone growth and % bone fill,
substantiated the effectiveness of Groups I and II compared to the published
radiographic results for DFDBA, the most widely used material for periodontal
grafting procedures.
At three months, there was significantly less Gingival Recession (GR)
(p=0.041) for Group I compared to Group IE consistent with the beneficial effect
observed with CAL. No statistically significant differences were observed in PDR
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and GR at six months. Descriptive analysis of the number of sites exhibiting
complete wound healing (WE) at three weeks revealed improvements in Group I
(72%) vs. Group II (60%) and Group HI (55%), indicating a trend toward improved
healing.
To assess the cumulative beneficial effect for clinical and radiographic
outcomes, a composite effectiveness analysis was performed to determine the percent
of patients with a successful outcome as defined by CAL > 2.7mm and LBG > 1.1mm
at six (6) months. The CAL and LBG benchmarks of success were established by the
mean levels achieved for these parameters by the implanted grafts, as identified in the
"Effectiveness Measures" section above. The results showed that 61.7% of Group I
patients and 37.9% of Group II patients met or exceeded the composite benchmark for
success compared to 30.4% of Group HI patients, resulting in a statistically significant
benefit of Group I vs. Group III (p (70.0%) vs. Group HI (44.6%) for p-value of 0.003.
In summary, Group I achieved statistically beneficial results for CAL and GR
at three (3) months as well as LBG and %BF at six (6) months, compared to the β-
TCP alone active control group (Group III). The clinical significance of these results
is further confirmed by comparison to historical controls. It is concluded that PDGF-
containing graft material was shown to achieve clinical and radiographic effectiveness
by six months for the treatment of periodontal osseous defects.
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Graft material (i.e., β-TCP) containing PDGF at 0.3 mg/mL and at 1.0 mg/mL
was shown to be safe and effective in the restoration of alveolar bone and clinical
attachment around teeth with moderate to advanced periodontitis in a large,
randomized, clinical trial involving 180 subjects studied for up to 6 months. These
conclusions are based upon validated radiographic and clinical measurements as
summarized below.
Consistent with the biocompatibility data of the PDGF-containing graft
material, discussed above, and the historical safe use of each individual component
(i.e., /3-TCP alone or PDGF alone), the study revealed no evidence of either local or
systemic adverse effects. There were no adverse outcomes attributable to the graft
material, which was found to be safe.
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Conclusion
Implantation of /3-TCP containing PDGF at either 0.3 mg/mL or 1.0 mg/mL
was found to be an effective treatment for the restoration of soft tissue attachment
level and bone as shown by significantly improved CAL at 3 months compared to the
active control. Our findings are also consistent with the AUC; analysis that showed an
improvement in CAL gain between baseline and six months. Implantation of (3-TCP
containing PDGF at either 0.3 mg/mL or 1.0 mg/mL was also found to be an effective
treatment based on significantly improved LBG and %BF compared to the active
control. Significantly improved clinical outcomes as shown by the composite analysis
of both soft and hard tissue measurements compared to the /3-TCP alone active control
also demonstrate the effectiveness of the treatment protocol described above. Finally,
the results of administering /3-TCP containing PDGF at either 0.3 mg/rnL or 1.0
mg/mL were found to exceed established benchmarks of effectiveness both clinically
and radiographically.
The results of this trial together with extensive and confirmatory data from in
vitro, animal and human studies demonstrate that PDGF-containing graft material
stimulates soft and hard tissue regeneration in periodontal defects, although the effects
were more significant when PDGF in the range of 0.1 to 1.0 mg/mL (e.g., 0.1 mg/mL,
0.3 mg/mL, or 1.0 mg/mL) was administered in the graft material. Moreover, PDGF
administered in the graft material in the amount of 0.3 mg/mL effectively regenerated
soft tissue and bone.
Other embodiments are within the following claims.
What is claimed is:
54

MODIFIED PCT Claims
Revisions shown
WE CLAIM :
1. An implant material consisting of a porous calcium phosphate having
incorporated therein a liquid consisting of platelet derived growth factor (PDGF) at a
concentration in a range of 0.1 mg/mL to 1.0 mg/mL in a buffer, wherein the calcium phosphate
has interconnected pores, a porosity greater than 40%, and consists of particles in a range of 100
microns to 5000 microns in size.
2. The implant material as claimed in claim 1, wherein the PDGF is recombinant
PDGF.
3. The implant material as claimed in any one of claims 1 and 2, wherein the PDGF
is recombinant PDGF-BB.
4. The implant material as claimed in any one of claims 1-3, wherein the liquid
consists of PDGF at a concentration in a range of 0.2 mg/mL to 0.75 mg/mL in a buffer.
5. The implant material as claimed in any one of claims 1-4, wherein the liquid
consists of PDGF at a concentration in a range of 0.25 mg/mL to 0.5 mg/mL in a buffer.
6. The implant material as claimed in any one of claims 1-5, wherein the liquid
consists of PDGF at a concentration of 0.3 mg/mL in a buffer.
7. The implant material as claimed in any one of claims 1-6, wherein the calcium
phosphate is tricalcium phosphate.
8. The implant material as claimed in any one of claims 1-7, wherein the calcium
phosphate consists of particles in a range of 100 microns to 3000 microns in size.
9. The implant material as claimed in any one of claims 1-8, wherein the calcium
phosphate consists of particles in a range of 250 microns to 1000 microns in size.

10. The implant material as claimed in any one of claims 1-9, wherein the implant
material is resorbable such that at least 80% of the calcium phosphate is resorbed within one year
of being implanted.
11. The implant material as claimed in claim 10, wherein the implant material is
resorbable such that at least 80% of the calcium phosphate is resorbed within three months of
being implanted.
12. The implant material as claimed in any one of claims 1-11, wherein the
incorporated liquid is absorbed or adsorbed to the calcium phosphate.
13. An implant material consisting of a calcium phosphate having incorporated
therein a liquid consisting of platelet derived growth factor (PDGF) at a concentration in a range
of 0.1 mg/mL to 1.0 mg/mL in a buffer, wherein the implant material is a composition having a
porosity that facilitates cell migration into the composition and the calcium phosphate has
interconnected pores and consists of particles in a range of 100 microns to 5000 microns in size.
14. The implant material as claimed in claim 13, wherein said porosity is
macroporosity.
15. The implant material as claimed in any one of claims 13 and 14, wherein said
porosity consists of porous calcium phosphate particles having a porosity greater than 40%.
16. The implant material as claimed in any one of claims 13-15, wherein the PDGF is
recombinant human (rh) PDGF-BB.
17. The implant material as claimed in any one of claims 13-16, wherein the calcium
phosphate is tricalcium phosphate.
18. The implant material as claimed in any one of claims 13-17, wherein the calcium
phosphate consists of particles in a range of 100 microns to 3000 microns in size.
19. The implant material as claimed in any one of claims 13-18, wherein the calcium
phosphate consists of particles in a range of 250 microns to 2000 microns in size.

20. The implant material as claimed in any one of claims 13-19, wherein the calcium
phosphate consists of particles in a range of 250 microns to 1000 microns in size.
21. The implant material as claimed in any one of claims 13-20, wherein the liquid
consists of PDGF at a concentration in a range of 0.2 mg/mL to 0.75 mg/mL in a buffer.
22. The implant material as claimed in any one of claims 13-21, wherein the liquid
consists of PDGF at a concentration in a range of 0.25 mg/mL to 0.5 mg/mL in a buffer.
23. The implant material as claimed in any one of claims 13-22, wherein the liquid
consists of PDGF at a concentration of 0.3 mg/mL in a buffer.
24. The implant material as claimed in any one of claims 13-23, wherein the implant
material is resorbable such that at least 80% of the calcium phosphate is resorbed within one year
of being implanted.
25. An implant material consisting of collagen and a porous calcium phosphate
having incorporated therein a liquid consisting of platelet derived growth factor (PDGF) at a
concentration in a range of 0.1 mg/mL to 1.0 mg/mL in a buffer, wherein the calcium phosphate
has interconnected pores, a porosity greater than 40%, and consists of particles in a range of 100
microns to 5000 microns in size.
26. The implant material as claimed in claim 25, wherein the PDGF is recombinant
human (rh) PDGF-BB and the calcium phosphate is tricalcium phosphate.
27. The implant material as claimed in any one of claims 25 and 26, wherein the
calcium phosphate consists of particles in a range of 100 microns to 3000 microns in size.
28. The implant material as claimed in any one of claims 25-27, wherein the calcium
phosphate consists of particles in a range of 250 microns to 1000 microns in size.
29. The implant material as claimed in any one of claims 25-28, wherein the liquid
consists of PDGF at a concentration in a range of 0.2 mg/mL to 0.75 mg/mL in a buffer.

30. The implant material as claimed in any one of claims 25-29, wherein the liquid
consists of PDGF at a concentration in a range of 0.25 mg/mL to 0.5 mg/mL in a buffer.
31. The implant material as claimed in any one of claims 25-30, wherein the liquid
consists of PDGF at a concentration of 0.3 mg/mL in a buffer.
32. The implant material as claimed in any one of claims 25-31, wherein the implant
material is resorbable such that at least 80% of the calcium phosphate is resorbed within one year
of being implanted.
33. An implant material consisting of collagen and a calcium phosphate having
incorporated therein a liquid consisting of platelet derived growth factor (PDGF) at a
concentration in a range of 0.1 mg/mL to 1.0 mg/mL in a buffer, wherein the implant material is
a composition having a porosity that facilitates cell migration into the composition and the
calcium phosphate has interconnected pores and consists of particles in a range of 100 microns to
5000 microns in size.
34. The implant material as claimed in claim 33, wherein said porosity is
macroporosity.
35. The implant material as claimed in any one of claims 33 and 34, wherein said
porosity consists of porous calcium phosphate particles having a porosity greater than 40%.
36. The implant material as claimed in any one of claims 33-35, wherein the PDGF is
recombinant human (rh) PDGF-BB and the calcium phosphate is tricalcium phosphate.
37. The implant material as claimed in any one of claims 33-36, wherein the calcium
phosphate consists of particles in a range of 100 microns to 3000 microns in size.
38. The implant material as claimed in any one of claims 33-37, wherein the calcium
phosphate consists of particles in a range of 250 microns to 1000 microns in size.
39. The implant material as claimed in any one of claims 33-38, wherein the liquid
consists of PDGF at a concentration in a range of 0.2 mg/mL to 0.75 mg/mL in a buffer.

40. The implant material as claimed in any one of claims 33-39, wherein the liquid
consists of PDGF at a concentration in a range of 0.25 mg/mL to 0.5 mg/mL in a buffer.
41. The implant material as claimed in any one of claims 33-40, wherein the liquid
consists of PDGF at a concentration of 0.3 mg/mL in a buffer.
42. An implant material consisting of a calcium phosphate having incorporated
therein a liquid consisting of platelet derived growth factor (PDGF) at a concentration in a range
of 0.1 mg/mL to 1.0 mg/mL in a buffer, wherein the calcium phosphate has interconnected pores
and consists of particles in a range of 100 microns to 5000 microns in size, and wherein the
calcium phosphate is capable of absorbing an amount of the liquid consisting of PDGF that is
equal to at least 25% of the calcium phosphate's own weight.
43. The implant material as claimed in claim 42, wherein the calcium phosphate is
capable of absorbing an amount of the liquid consisting of PDGF that is equal to at least 50% of
the calcium phosphate's own weight.
44. The implant material as claimed in any one of claims 42 and 43, wherein the
calcium phosphate is capable of absorbing an amount of the liquid consisting of PDGF that is
equal to at least 200% of the calcium phosphate's own weight.
45. The implant material as claimed in any one of claims 42-44, wherein the calcium
phosphate is capable of absorbing an amount of the liquid consisting of PDGF that is equal to at
least 300% of the calcium phosphate's own weight.
46. An implant material consisting of collagen and a calcium phosphate having
incorporated therein a liquid consisting of platelet derived growth factor (PDGF) at a
concentration in a range of 0.1 mg/mL to 1.0 mg/mL in a buffer, wherein the calcium phosphate
has interconnected pores and consists of particles in a range of 100 microns to 5000 microns in
size, and wherein the calcium phosphate and collagen are capable of absorbing an amount of the
liquid consisting of PDGF that is equal to at least 25% of the weight of the calcium phosphate
and collagen.

47. The implant material as claimed in claim 46, wherein the calcium phosphate and
collagen are capable of absorbing an amount of the liquid consisting of PDGF that is equal to at
least 50% of the weight of the calcium phosphate and collagen.
48. The implant material as claimed in any one of claims 46 and 47, wherein the
calcium phosphate and collagen are capable of absorbing an amount of the liquid consisting of
PDGF that is equal to at least 200% of the weight of the calcium phosphate and collagen.
49. The implant material as claimed in any one of claims 46-48, wherein the calcium
phosphate and collagen are capable of absorbing an amount of the liquid consisting of PDGF that
is equal to at least 300% of the weight of the calcium phosphate and collagen.
50. An implant material consisting of a porous calcium phosphate having
incorporated therein a liquid consisting of platelet derived growth factor (PDGF) at a
concentration that is equal to or less than 0.3 mg/mL in a buffer, wherein the calcium phosphate
has interconnected pores, a porosity greater than 40%, and consists of particles in a range of 100
microns to 5000 microns in size.
51. An implant material consisting of a calcium phosphate having incorporated
therein a liquid consisting of platelet derived growth factor (PDGF) at a concentration that is
equal to or less than 0.3 mg/mL in a buffer, wherein the implant material is a composition having
a porosity that facilitates cell migration into the composition and the calcium phosphate has
interconnected pores and consists of particles in a range of 100 microns to 5000 microns in size.
52. An implant material consisting of collagen and a porous calcium phosphate
having incorporated therein a liquid consisting of platelet derived growth factor (PDGF) at a
concentration that is equal to or less than 0.3 mg/mL in a buffer wherein the calcium phosphate
has interconnected pores, a porosity greater than 40%, and consists of particles in a range of 100
microns to 5000 microns in size.
53. An implant material consisting of collagen and a calcium phosphate having
incorporated therein a liquid consisting of platelet derived growth factor (PDGF) at a
concentration that is equal to or less than 0.3 mg/mL in a buffer, wherein the implant material is

a composition having a porosity that facilitates cell migration into the composition and the
calcium phosphate has interconnected pores and consists of particles in a range of 100 microns to
5000 microns in size.
54. An implant material consisting of a calcium phosphate having incorporated
therein a liquid consisting of platelet derived growth factor (PDGF) at a concentration of 0.3
mg/mL in a buffer, wherein the calcium phosphate has interconnected pores and consists of
particles in a range of 100 microns to 5000 microns in size, and wherein the calcium phosphate is
capable of absorbing an amount of the liquid consisting of PDGF that is equal to at least 25% of
the calcium phosphate's own weight.
55. An implant material consisting of collagen and a calcium phosphate having
incorporated therein a liquid consisting of platelet derived growth factor (PDGF) at a
concentration of 0.3 mg/mL in a buffer, wherein the calcium phosphate has interconnected pores
and consists of particles in a range of 100 microns to 5000 microns in size, and wherein the
calcium phosphate and collagen are capable of absorbing an amount of the liquid consisting of
PDGF that is equal to at least 25% of the weight of the calcium phosphate and collagen.
56. An implant material consisting of an allograft having incorporated therein a liquid
consisting of platelet derived growth factor (PDGF) at a concentration in a range of 0.1 mg/mL
to 1.0 mg/mL in a buffer, wherein the allograft has interconnected pores, a porosity greater than
40%, and consists of particles in a range of 100 microns to 5000 microns in size.
57. The implant material as claimed in claim 56, wherein the PDGF is recombinant
PDGF.
58. The implant material as claimed in any one of claims 56 and 57, wherein the
PDGF is recombinant PDGF-BB.
59. The implant material as claimed in any one of claims 56-58, wherein the liquid
consists of PDGF at a concentration in a range of 0.2 mg/mL to 0.75 mg/mL in a buffer.

60. The implant material as claimed in any one of claims 56-59, wherein the liquid
consists of PDGF at a concentration in a range of 0.25 mg/mL to 0.5 mg/mL in a buffer.
61. The implant material as claimed in any one of claims 56-60, wherein the liquid
consists of PDGF at a concentration of 0.3 mg/mL in a buffer.
62. The implant material as claimed in any one of claims 56-61, wherein the allograft
consists of particles in a range of 100 microns to 3000 microns in size.
63. The implant material as claimed in any one of claims 56-62, wherein the allograft
consists of particles in a range of 250 microns to 1000 microns in size.
64. The implant material as claimed in any one of claims 56-63, wherein the implant
material is resorbable such that at least 80% of the allograft is resorbed within one year of being
implanted.
65. The implant material as claimed in claim 64, wherein the implant material is
resorbable such that at least 80% of the calcium phosphate is resorbed within three months of
being implanted.
66. The implant material as claimed in any one of claims 56-65, wherein the
incorporated liquid is absorbed or adsorbed to the allograft.
67. An implant material consisting of an allograft having incorporated therein a liquid
consisting of platelet derived growth factor (PDGF) at a concentration in a range of 0.1 mg/mL
to 1.0 mg/mL in a buffer, wherein the implant material is a composition having a porosity that
facilitates cell migration into the composition and the allograft has interconnected pores and
consists of particles in a range of 100 microns to 5000 microns in size.
68. The implant material as claimed in claim 67, wherein said porosity is
macroporosity.
69. The implant material as claimed in any one of claims 67 and 68, wherein said
porosity consists of allograft particles having a porosity greater than 40%.

70. The implant material as claimed in any one of claims 67-69, wherein the PDGF is
recombinant human (rh) PDGF-BB.
71. The implant material as claimed in any one of claims 67-70, wherein the allograft
consists of particles in a range of 100 microns to 3000 microns in size.
72. The implant material as claimed in any one of claims 67-71, wherein the allograft
consists of particles in a range of 250 microns to 2000 microns in size.
73. The implant material as claimed in any one of claims 67-72, wherein the allograft
consists of particles in a range of 250 microns to 1000 microns in size.
74. The implant material as claimed in any one of claims 67-73, wherein the liquid
consists of PDGF at a concentration in a range of 0.2 mg/mL to 0.75 mg/mL in a buffer.
75. The implant material as claimed in any one of claims 67-74, wherein the liquid
consists of PDGF at a concentration in a range of 0.25 mg/mL to 0.5 mg/mL in a buffer.
76. The implant material as claimed in any one of claims 67-75, wherein the liquid
consists of PDGF at a concentration of 0.3 mg/mL in a buffer.
77. The implant material as claimed in any one of claims 67-76, wherein the implant
material is resorbable such that at least 80% of the allograft is resorbed within one year of being
implanted.
78. An implant material consisting of collagen and an allograft having incorporated
therein a liquid consisting of platelet derived growth factor (PDGF) at a concentration in a range
of 0.1 mg/mL to 1.0 mg/mL in a buffer, wherein the allograft has interconnected pores, a
porosity greater than 40%, and consists of particles in a range of 100 microns to 5000 microns in
size.
79. The implant material as claimed in claim 78, wherein the PDGF is recombinant
human (rh) PDGF-BB.

80. The implant material as claimed in any one of claims 78 and 79, wherein the
allograft consists of particles in a range of 100 microns to 3000 microns in size.
81. The implant material as claimed in any one of claims 78-80, wherein the allograft
consists of particles in a range of 250 microns to 1000 microns in size.
82. The implant material as claimed in any one of claims 78-81, wherein the liquid
consists of PDGF at a concentration in a range of 0.2 mg/mL to 0.75 mg/mL in a buffer.
83. The implant material as claimed in any one of claims 78-82, wherein the liquid
consists of PDGF at a concentration in a range of 0.25 mg/mL to 0.5 mg/mL in a buffer.
84. The implant material as claimed in any one of claims 78-83, wherein the liquid
consists of PDGF at a concentration of 0.3 mg/mL in a buffer.
85. The implant material as claimed in any one of claims 78-84, wherein the implant
material is resorbable such that at least 80% of the allograft is resorbed within one year of being
implanted.
86. An implant material consisting of collagen and an allograft having incorporated
therein a liquid consisting of platelet derived growth factor (PDGF) at a concentration in a range
of 0.1 mg/mL to 1.0 mg/mL in a buffer, wherein the implant material is a composition having a
porosity that facilitates cell migration into the composition and the allograft has interconnected
pores and consists of particles in a range of 100 microns to 5000 microns in size.
87. The implant material as claimed in claim 86, wherein said porosity is
macroporosity.
88. The implant material as claimed in any one of claims 86 and 87, wherein said
porosity consists of allograft particles having a porosity greater than 40%.
89. The implant material as claimed in any one of claims 86-88, wherein the PDGF is
recombinant human (rh) PDGF-BB.

90. The implant material as claimed in any one of claims 86-89, wherein the allograft
consists of particles in a range of 100 microns to 3000 microns in size.
91. The implant material as claimed in any one of claims 86-90, wherein the allograft
consists of particles in a range of 250 microns to 1000 microns in size.
92. The implant material as claimed in any one of claims 86-91, wherein the liquid
consists of PDGF at a concentration in a range of 0.2 mg/mL to 0.75 mg/mL in a buffer.
93. The implant material as claimed in any one of claims 86-92, wherein the liquid
consists of PDGF at a concentration in a range of 0.25 mg/mL to 0.5 mg/mL in a buffer.
94. The implant material as claimed in any one of claims 86-93, wherein the liquid
consists of PDGF at a concentration of 0.3 mg/mL in a buffer.
95. An implant material consisting of an allograft having incorporated therein a liquid
consisting of platelet derived growth factor (PDGF) at a concentration in a range of 0.1 mg/mL
to 1.0 mg/mL in a buffer, wherein the allograft has interconnected pores and consists of particles
in a range of 100 microns to 5000 microns in size, and wherein the allograft is capable of
absorbing an amount of the liquid consisting of PDGF that is equal to at least 25% of the
allograft's own weight.
96. The implant material as claimed in claim 95, wherein the allograft is capable of
absorbing an amount of the liquid consisting of PDGF that is equal to at least 50% of the
allograft's own weight.
97. The implant material as claimed in any one of claims 95 and 96, wherein the
allograft is capable of absorbing an amount of the liquid consisting of PDGF that is equal to at
least 200% of the allograft's own weight.
98. The implant material as claimed in any one of claims 95-97, wherein the allograft
is capable of absorbing an amount of the liquid consisting of PDGF that is equal to at least 300%
of the allograft's own weight.

99. An implant material consisting of collagen and an allograft having incorporated
therein a liquid consisting of platelet derived growth factor (PDGF) at a concentration in a range
of 0.1 mg/mL to 1.0 mg/mL in a buffer, wherein the allograft has interconnected pores and
consists of particles in a range of 100 microns to 5000 microns in size, and wherein the allograft
and collagen are capable of absorbing an amount of the liquid consisting of PDGF that is equal
to at least 25% of the weight of the allograft and collagen.
100. The implant material as claimed in claim 99, wherein the allograft and collagen
are capable of absorbing an amount of the liquid consisting of PDGF that is equal to at least 50%
of the weight of the allograft and collagen.
101. The implant material as claimed in any one of claims 99 and 100, wherein the
allograft and collagen are capable of absorbing an amount of the liquid consisting of PDGF that
is equal to at least 200%) of the weight of the allograft and collagen.
102. The implant material as claimed in any one of claims 99-101, wherein the
allograft and collagen are capable of absorbing an amount of the liquid consisting of PDGF that
is equal to at least 300% of the weight of the allograft and collagen.
103. An implant material consisting of an allograft having incorporated therein a liquid
consisting of platelet derived growth factor (PDGF) at a concentration that is equal to or less than
0.3 mg/mL in a buffer, wherein the allograft has interconnected pores, a porosity greater than
40%o, and consists of particles in a range of 100 microns to 5000 microns in size.
104. An implant material consisting of an allograft having incorporated therein a liquid
consisting of platelet derived growth factor (PDGF) at a concentration that is equal to or less than
0.3 mg/mL in a buffer, wherein the implant material is a composition having a porosity that
facilitates cell migration into the composition and the allograft has interconnected pores and
consists of particles in a range of 100 microns to 5000 microns in size.
105. An implant material consisting of collagen and an allograft having incorporated
therein a liquid consisting of platelet derived growth factor (PDGF) at a concentration that is
equal to or less than 0.3 mg/mL in a buffer wherein the allograft has interconnected pores, a

porosity greater than 40%, and consists of particles in a range of 100 microns to 5000 microns in
size.
106. An implant material consisting of collagen and an allograft having incorporated
therein a liquid consisting of platelet derived growth factor (PDGF) at a concentration that is
equal to or less than 0.3 mg/mL in a buffer, wherein the implant material is a composition having
a porosity that facilitates cell migration into the composition and the allograft has interconnected
pores and consists of particles in a range of 100 microns to 5000 microns in size.
107. An implant material consisting of an allograft having incorporated therein a liquid
consisting of platelet derived growth factor (PDGF) at a concentration of 0.3 mg/mL in a buffer,
wherein the allograft has interconnected pores and consists of particles in a range of 100 microns
to 5000 microns in size, and wherein the allograft is capable of absorbing an amount of the liquid
consisting of PDGF that is equal to at least 25% of the allograft's own weight.
108. An implant material consisting of collagen and an allograft having incorporated
therein a liquid consisting of platelet derived growth factor (PDGF) at a concentration of 0.3
mg/mL in a buffer, wherein the allograft has interconnected pores and consists of particles in a
range of 100 microns to 5000 microns in size, and wherein the allograft and collagen are capable
of absorbing an amount of the liquid consisting of PDGF that is equal to at least 25% of the
weight of the allograft and collagen.
109. A method of preparing an implant material comprising saturating a porous
implant material in a sterile liquid consisting of platelet-derived growth factor (PDGF) at a
concentration in the range of 0.1 mg/mL to 1.0 mg/mL in a buffer, wherein the implant material
(i) consists of a porous calcium phosphate, (ii) consists of collagen and a porous calcium
phosphate, (iii) consists of an allograft, or (iv) consists of collagen and an allograft, and wherein
the calcium phosphate or allograft has interconnected pores, a porosity greater than 40%, and
consists of particles in a range of 100 microns to 5000 microns in size.
110. The method as claimed in claim 109, wherein the concentration of PDGF is 0.3
mg/mL.

111. The method as claimed in any one of claims 109 and 110, wherein the calcium
phosphate is selected from tricalcium phosphate, hydroxyapatite, poorly crystalline
hydroxyapatite, amorphous calcium phosphate, calcium metaphosphate, dicalcium phosphate
dihydrate, heptacalcium phosphate, calcium pyrophosphate dihydrate, calcium pyrophosphate,
and octacalcium phosphate.


A method for promoting growth of bone, periodontium, ligament, or cartilage in a mammal by applying to the bone,
periodontium, ligament, or cartilage a composition comprising platelet-derived growth factor at a concentration in the range of about
0.1 mg/mL to about 1.0 mg/mL in a pharmaceutically acceptable liquid carrier and a pharmaceutically-acceptable solid carrier.

Documents:

01712-kolnp-2007-abstract.pdf

01712-kolnp-2007-assignment.pdf

01712-kolnp-2007-claims.pdf

01712-kolnp-2007-correspondence others 1.1.pdf

01712-kolnp-2007-correspondence others.pdf

01712-kolnp-2007-description complete.pdf

01712-kolnp-2007-drawings.pdf

01712-kolnp-2007-form 1.pdf

01712-kolnp-2007-form 13.pdf

01712-kolnp-2007-form 3 1.1.pdf

01712-kolnp-2007-form 3.pdf

01712-kolnp-2007-form 5.pdf

01712-kolnp-2007-international publication.pdf

01712-kolnp-2007-pct request form.pdf

1712-KOLNP-2007-(02-01-2012)-AMANDED CLAIMS.pdf

1712-KOLNP-2007-(02-01-2012)-DESCRIPTION (COMPLETE).pdf

1712-KOLNP-2007-(02-01-2012)-DRAWINGS.pdf

1712-KOLNP-2007-(02-01-2012)-EXAMINATION REPORT REPLY RECEIVED.pdf

1712-KOLNP-2007-(02-01-2012)-FORM-1.pdf

1712-KOLNP-2007-(02-01-2012)-FORM-2.pdf

1712-KOLNP-2007-(02-01-2012)-OTHER PATENT DOCUMENT-1.pdf

1712-KOLNP-2007-(02-01-2012)-OTHER PATENT DOCUMENT.pdf

1712-KOLNP-2007-(02-01-2012)-OTHERS.pdf

1712-KOLNP-2007-(10-02-2012)-CORRESPONDENCE.pdf

1712-KOLNP-2007-(11-06-2012)-CORRESPONDENCE.pdf

1712-KOLNP-2007-(11-06-2012)-PA-CERTIFIED COPIES.pdf

1712-KOLNP-2007-(14-05-2007)-FORM-13.pdf

1712-KOLNP-2007-CORRESPONDENCE 1.2.pdf

1712-KOLNP-2007-CORRESPONDENCE 1.3.pdf

1712-KOLNP-2007-CORRESPONDENCE 1.4.pdf

1712-KOLNP-2007-FORM 13 1.1.pdf

1712-KOLNP-2007-FORM 13.1.2.pdf

1712-kolnp-2007-form 18.pdf

1712-KOLNP-2007-PA.pdf


Patent Number 253904
Indian Patent Application Number 1712/KOLNP/2007
PG Journal Number 36/2012
Publication Date 07-Sep-2012
Grant Date 31-Aug-2012
Date of Filing 14-May-2007
Name of Patentee BIOMIMETIC THERAPEUTICS, INC.
Applicant Address 389-A NICHOL MILL LANE, FRANKLIN, TN
Inventors:
# Inventor's Name Inventor's Address
1 LYNCH, SAMUEL, E. 6015, SADDLEVIEW DRIVE, FRANKLIN, TN 37067
PCT International Classification Number A61K 48/00
PCT International Application Number PCT/US2005/036447
PCT International Filing date 2005-10-12
PCT Conventions:
# PCT Application Number Date of Convention Priority Country
1 11/159,533 2005-06-23 U.S.A.
2 10/965,319 2004-10-14 U.S.A.