| PATENT NUMBER | This data is not available for free |
| PATENT GRANT DATE | 09.01.2001 |
| PATENT TITLE |
Methods of controlling beta dimer formation in hemoglobin |
| PATENT ABSTRACT |
The present invention relates to methods of controlling beta dimer formation in hemoglobin solutions by altering the metal binding site adjacent to the N-terminus of beta globins. The invention further relates to methods of producing stable, intramolecularly crosslinked beta globins by exposure to Ni(II) and oxone. -------------------------------------------------------------------------------- |
| PATENT INVENTORS | This data is not available for free |
| PATENT ASSIGNEE | This data is not available for free |
| PATENT FILE DATE | May 14, 1999 |
| PATENT CT FILE DATE | August 1, 1997 |
| PATENT CT NUMBER | This data is not available for free |
| PATENT CT PUB NUMBER | This data is not available for free |
| PATENT CT PUB DATE | February 12, 1998 |
| PATENT REFERENCES CITED |
Russu, et al., A Proton Nuclear Magnetic Resonance Investigation of Histidyl Residues in Human Normal Adult Hemoglobin, Biochemistry, 1982, vol. 21, pp. 5031-5043. Hirel, et al., Extent of N-terminal Methionine Excision From Escherichia coli Proteins is Governed by the Side-chain Length of the Penultimate Amino Acid, Proc. Natl, Acad. Sci., vol. 86, pp. 8247-8251, Nov. 1989. Climent, et al., Derivatization of .gamma.-Glutamyl Semialdehyde Residues in Oxidized Proteins by Fluoresceinamine, Analytical Biochemistry, vol. 182, pp. 226-232, 1989. Stadtman, et al., Metal-Catalyzed Oxidation of Proteins, The Journal of Biological Chemistry, vol. 266, No. 4, pp. 2005-2008, 1991. Schoneich, et al., Iron-thiolate Induced Oxidation of Methionine to Methionine Sulfoxide in Small Model Peptides. Intramolecular Catalysis By Histidine, Biochimica et Biophysica Acta, vol. 1158, ppg. 307, 1993. Shibayama, et al., Oxygen Equilibrium Properties of Nickel (II)--Iron (II Hybrid Hemoglobins Cross-Linked between 82.beta.1 and 82.beta.2 Lysyl Residues by Bis (3,5-dibromosalicyl) fumarate: Determination of the First Two-Step Microscopic Adair Constants for Human Hemoglobin, Biochemistry, vol. 34, pp. 4773-4780, 1995. Brown, et al., Highly Specific Oxidative Cross-Linking of Proteins Mediated by a Nickel-Peptide Complex, Biochemistry, vol. 34, pp. 4733-4739, 1995. Dumoulin, et al., Loss of Allosteric Behaviour in Recombinant Hemoglobin .alpha..sub.2.beta..sub.2 92 (F8) His.fwdarw.Ala: Restoration Upon Addition of Strong Effectors, FEBS Letters, vol. 374, pp. 39-42, 1995. Levin, et al., Methionine Residues as Endogenous Antioxidants in Proteins, Proc. Natl. Acad. Sci., vol. 93, pp. 15036-15040, Dec. 1996. Bravo, et al., Identification of a Novel Bond Between a Histidine and the Essential Tyrosine in Catalas HPII of Escherichia Coli, Protein Science, vol. 6, pp. 1016-1923, 1997. Levine, et al., Identification of a Nickel (II) Binding Site on hemoglobin Which Confers Susceptibility to Oxidative Deamination and Intramolecular Cross-Linking, the Journal of Biological Chemistry, vol. 273, No. 21, pp. 13037-13046, 1998. |
| PATENT PARENT CASE TEXT | This data is not available for free |
| PATENT CLAIMS |
We claim: 1. A method of controlling beta dimer formation in a hemoglobin composition, comprising altering a metal binding site on a beta globin to prevent or reduce said beta dimer formation. 2. The method of claim 1, wherein altering said metal binding site is by substituting a non-metal binding amino acid for the metal binding site. 3. The method of claim 1, wherein said metal binding site is a nickel binding site. 4. The method of claim 3, wherein said nickel binding site is a histidine adjacent to the N-terminus of said beta globin. 5. The method of claim 4, wherein the histidine is substituted with leucine. 6. The method of claim 4, wherein the histidine is substituted with alanine. 7. The method of claim 1, wherein altering said metal binding site is by inserting one or more amino acids between the N-terminus and the metal binding site. 8. The method of claim 7, wherein the metal binding site is a nickel binding site. 9. The method of claim 8, wherein the nickel binding site is a histidine adjacent to the N-terminus of said beta globin prior to said alteration. 10. The method of claim 9, wherein the amino acid to be inserted does not direct N-terminal Met removal when said hemoglobin is expressed in E. coli. 11. A method of producing intramolecularly crosslinked globin dimers, comprising adding Ni(II) and oxone to a hemoglobin solution, wherein said hemoglobin contains a globin having a nickel binding site adjacent to the N-terminus of said globin. 12. The method of claim 11, wherein said globin is a beta globin to produce intramolecularly crosslinked beta dimers. 13. The method of claim 12, wherein said nickel binding site is histidine. -------------------------------------------------------------------------------- |
| PATENT DESCRIPTION |
FIELD OF THE INVENTION The present invention generally relates to expression of recombinant hemoglobin, and more particularly to methods of controlling beta dimer formation during the recombinant expression of the beta subunit. BACKGROUND OF THE INVENTION It is not always practical or safe to transfuse a patient with donated blood. In these situations, use of a red blood cell substitute is desirable. When human blood is not available or the risk of transfusion is too great, plasma expanders can be administered. However, plasma expanders, such as colloid and crystalloid solutions, replace only blood volume, and not oxygen carrying capacity. In situations where blood is not available for transfusion, a red blood cell substitute that can transport oxygen in addition to providing replacement is desirable. Hemogloblin has been identified as a desirable red blood cell substitute. Hemoglobin (also referred to herein as "Hb") is the oxygen-carrying component of blood. Hemoglobin circulates through the bloodstream inside small enucleate cells called erythrocytes (red blood cells). Hemoglobin is a protein constructed from four associated polypeptide chains, and bearing prosthetic groups known as hemes. The erythrocyte helps maintain hemoglobin in its reduced, functional form. The heme iron atom is susceptible to oxidation, but may be reduced again by one of two enzyme systems within the erythrocyte, the cytochrome b.sub.5 and glutathione reduction systems. Hemoglobin binds oxygen at a respiratory surface (skin, gills, trachea, lung, etc.) and transports the oxygen to inner tissues, where it is released and used for metabolism. In nature, low molecular weight hemoglobins (16-120 kilodaltons) tend to be enclosed in circulating red blood cells, while the larger polymeric hemoglobins circulate freely in the blood or hemolymph. The structure of hemoglobin is well known as described in Bunn & Forget, eds., Hemoglobin: Molecular, Genetic and Clinical Aspects (W.B. Saunders Co., Philadelphia, Pa.: 1986) and Fermi & Perutz "Hemoglobin and Myoglobin," in Phillips and Richards, Atlas of Molecular Structures in Biology (Clarendon Press: 1981). About 92% of normal adult human hemolysate is Hb A.sub.o (designated alpha.sub.2 beta.sub.2 because it comprises two alpha and two beta chains). In a hemoglobin tetramer, each alpha subunit is associated with a beta subunit to form a stable alpha/beta dimer, two of which in turn associate to form the tetramer. The subunits are noncovalently associated through Van der Waals forces, hydrogen bonds and salt bridges. The amino acid sequences of the alpha and beta globin polypeptide chains of Hb A.sub.o are given in Table 1 of PCT Publication No. WO 93/09143. The wild-type alpha chain consists of 141 amino acids. The iron atom of the heme (ferroprotoporphyrin IX) group is bound covalently to the imidazole of His 87 (the "proximal histidine"). The wild-type beta chain is 146 residues long and heme is bound to it at His 92. The human alpha and beta globin genes reside on chromosomes 16 and 11, respectively. Bunn and Forget, infra at 172. Both genes have been cloned and sequenced, Liebhaber, et al., PNAS 77: 7054-58 (1980) (alpha-globin genomic DNA); Marotta, et al., J. Biol. Chem., 252: 5040-53 (1977) (beta globin cDNA); Lawn, et al., Cell, 21:647 (1980) (beta globin genomic DNA). Hemoglobin exhibits cooperative binding of oxygen by the four subunits of the hemoglobin molecule (the two alpha globins and two beta globins in the case of Hb A.sub.o), and this cooperativity greatly facilitates efficient oxygen transport. Cooperativity, achieved by the so-called heme-heme interaction, allows hemoglobin to vary its affinity for oxygen. Cooperativity can also be determined using the oxygen dissociation curve (described below) and is generally reported as the Hill coefficient, "n" or "n.sub.max." Hemoglobin reversibly binds up to four moles of oxygen per mole of hemoglobin. Oxygen-carrying compounds are frequently compared by means of a device known as an oxygen dissociation curve. This curve is obtained when, for a given oxygen carrier, oxygen saturation or content is graphed against the partial pressure of oxygen. For Hb, the percentage of saturation increases with partial pressure according to a sigmoidal relationship. The P.sub.50 is the partial pressure at which the oxygen-carrying species is half saturated with oxygen. It is thus a measure of oxygen-binding affinity; the higher the P.sub.50, the more readily oxygen is released. The production of recombinant hemoglobin particularly in E.coli can lead to multiple species of recombinant hemoglobin. For example, in producing recombinant beta globins in bacterial systems, particularly E.coli, the beta globin can be expressed as a mixture of monomeric and dimeric beta globins. Thus, a need exists to control the formation of dimeric beta globins. The present invention satisfies this need and provides related advantages as well. SUMMARY OF THE INVENTION The present invention relates to methods of controlling beta dimer formation in a hemoglobin solution. The methods are accomplished by altering a metal binding site, particularly a nickel binding site, on a beta globin or globin-like polypeptide to prevent or reduce said beta dimer formation. The methods are particularly suitable in the recombinant production of hemoglobin. Preferably, the metal binding site is the histidine adjacent to the N-terminal amino acid of the beta globin or globin-like polypeptide. For example, the histidine can be substituted with leucine or alanine in order to control the formation of beta dimers. The present invention is further directed to methods of producing stable, intramolecularly crosslinked beta dimers by adding Ni(II) and oxone to a hemoglobin solution. Such methods will produce stable dimers within the hemoglobin contained in the solution between globins containing histidine adjacent to the N-terminal residue (hereinafter also referred to as "His2"). The hemoglobin can be derived from any source, for example, those sources described in WO 95/24213, published on Sep. 14, 1995, and incorporated herein by reference. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 shows the SDS-PAGE of human hemoglobin A.sub.o before and after reaction with Ni(II)/oxone. Gel contents: protein size markers (lane 1), Hb A.sub.o before reaction under reducing conditions with DTT (lane 4), Hb A.sub.o after reaction under reducing conditions with DTT (lane 5). FIG. 2 shows the proposed scheme of oxidative damage occurring at the N-terminus of the beta chain in hemoglobins containing His residue in position 2 (His2). FIG. 3 shows the plasmid for p733. DETAILED DESCRIPTION OF THE INVENTION The present invention generally relates to methods of controlling beta dimer formation during the production of recombinant hemoglobin. The invention is based on the discovery that the beta chain of human hemoglobin contains a histidine adjacent to the N-terminal amino acid that confers susceptibility to metal catalyzed oxidation leading to the formation of stable beta globin dimers. Transition metal catalyzed oxidative damage to proteins has been implicated in a variety of adverse physiological processes including aging, arteriosclerosis and ischemic reperfusion. The metal binding site-specific nature of metal catalyzed oxidation of proteins has been well established (Amici et al., J. Biol. Chem. 264:3341 (1989); Stadtman, Ann. Rev. Biochem. 62:797-821 (1993)). Oxidative modification of proteins in vivo have been postulated to produce carbonyl groups on amino acid side chains, including the formation of gamma-glutamyl semialdehyde from arginine (Climent et al., Anal. Biochem. 182:226 (1989) and 2-amino adipic semialdehyde from lysine (Stadtman & Oliver, J. Biol. Chem. 266:2005 (1991)). Investigators have used model systems employing Fe(II), and H.sub.2 O.sub.2 to study oxidative modification of proteins and peptides in vitro, and the physiological relevance of such Fenton chemistry models in elucidating mechanisms of in vivo oxidation of proteins is widely accepted (Stadtman & Oliver, supra; Schoneich et al., Biochim. Biophys. Acta 1158:307 (1993)). Oxidative intermolecular crosslinking of other proteins associatively complexed in solution has been recently reported (Brown et al., Biochemistry 34:4733-4739 (1995) in which an exogenous tripeptide (NH.sub.2 -Gly-Gly-His-COOH) was added to the proteins to serve as a nickel binding site for the peracid mediated formation of a high valent nickel complex. This complex propagated covalent bond formation between the associated proteins, presumably by attack of aromatic amino acids. Intramolecular oxidations promoted by high valent nickel and iron complexes directed to the amino and/or carboxyl termini of peptides with vicinal histidine residues has also been reported in Schoenich et al., Biochimica et Biophysica Acta. 1158:307-322 (1993). Hemoglobin in contrast contains metal binding sites without the need to insert such sites. However, previously, the investigation of metal catalyzed protein oxidation of hemoglobin and other heme proteins, has been complicated by the catalytic interaction of the heme iron with peroxides. This reaction can produce significant heme oxidation and protein degradation through the formation of the highly unstable ferryl-heme species. The present invention, however, relates to a reaction of hemoglobin and oxidants under conditions in which oxidative crosslinks between protein subunits can be generated without causing appreciable heme iron oxidation, protein denaturation, or aggregation. These metal binding sites appear to promote covalent bond formation between the beta globin subunits in the presence of nickel ions and an oxidant. Covalent bond formation can, in fact, be driven in vitro by potassium peroxymonosultate known as "oxone." The beta globin dimerization results in relatively little formation (<5%) of multi-tetrameric (i.e., intermolecular crosslinked) hemoglobin species. The dimers are therefore predominantly intramolecularly crosslinked with no disulfide bond involvement. As noted above, a metal binding site on hemoglobin appears to promote covalent bond formation between the beta globin subunits upon addition of oxone in the presence of nickel. This reaction also results in a substanial yield of a modification which has been identified as oxidative deamination of the beta globin amino terminus, generating in its place a beta-ketoamide. Results from the present studies indicate the beta globin His2 is required for active nickel complexation, oxidative deamination, and intramolecular crosslinking. It has now been discovered that a reaction of human hemoglobin A.sub.o with oxone in the presence of nickel (II) ions produces predominantly intramolecular crosslinking of the beta globins of the protein and significant oxidative deamination of the beta globin amino termini. The oxidative conditions used were not sufficiently harsh to oxidize the ferrous hemes of the carbon monoxide liganded hemoglobin, and no catlytic activity of the heme centers appears to be involved. No evidence was found that the alpha globins are similarly susceptible to N-terminal oxidative deamination under the conditions used. One primary sequence difference between the beta and alpha chains of human hemoglobin is that the beta chain contains a histidine adjacent to the N-terminal amino acid. alpha globin V-LSPADK . . . (SEQ ID No:1) beta globin VHLTPEEK . . . (SEQ ID No:2) It is believed that histidine at this position may confer susceptibility to metal catalyzed oxidation. Results with different recombinant hemoglobin variants confirm that the histidine at position 2 is required for both Ni(II) catalyzed oxidative deamination of the beta globin amino terminus, and intramolecular crosslinking of the beta globins. It was found that a spectrophotometrically observable absorbance change induced in hemoglobin by complexation with Ni(II) is absent in hemoglobins lacking a histidine at position 2 of the beta globins provides further evidence that the beta globin His2 is an essential part of a unique, redox active Ni(II) complexation site on hemoglobin. Experimental results suggest that Ni(II) catalyzed oxidative intramolecular crosslinking of the beta globins occurs between the N-terminus of one and the C-terminal region of the other globin. Peptide mapping did not, however, provide identification of a primary crosslink, but rather indicated the heterogeneous character of crosslinks produced by the reaction. Characterization of an amine doublet of crosslinked peptides found following sodium cyanoborohydride treatment of the still-native state hemoglobin reaction appears consistent with a Schiff's base reduction, resulting in a secondary amine bond between the oxidatively deaminated beta globin terminus and the epsilon-amino group of Lys144 at an opposing beta globin from within the same protein molecule. However, recombinant hemoglobin variants lacking lysine at position 144 remain susceptible to beta globin dimerization. The reported structure of R-state hemoglobin indicates close spatial contact between the amino terminus and the carboxyl terminus of opposing beta globins in the hemoglobin tetramer (Baldwin, J. Mol. Biol. 136:103 (1980)). Hemoglobin variants containing substitutions: His143 Ala, Tyrl45His, or deletion of His146 all exhibited comparable susceptibility to crosslinking, suggesting no specific side chain of C-terminal residue is strictly required. Two recombinant hemoglobin variants containing 3, or 4 amino acid deletions at the C-terminus, respectively, did show significantly decreased susceptibility for dimerization. This may be due to steric considerations, in that the new C-terminal region of these variants is likely no longer in close enough proximity contact with the beta globin N-terminus for crosslink formation. From these findings, it is believed that histidine at beta globin position 2 confers susceptibility, under oxidizing conditions, to the nickel catalyzed formation of a carbon-centered radical at the alpha-carbon of the beta globin amino terminal residue, analogous to that proposed by Stadtman on the epsilon carbon in the iron catalyzed deamination of lysine . The "activated" alpha carbon can react in one of three ways. First, the radical can react immediately with water resulting in oxidative deamination, analogous to that proposed by Stadtman. Second, the radical can attack a variety of sites on a spatially adjacent beta C-terminal region, leading to a heterogeneous set of carbon-carbon and/or carbon-nitrogen bonds. The numerous combinations of potential products resulting from this pathway may, in part, explain the difficulty in identifying specific N-terminal to C-terminal region crosslinked peptides. A similar type of labile bond has recently been proposed to form between the beta carbon of the essential tyrosine and nitrogen of histidine in catalase HPII of E. coli (Bravo et al., Protein Sci. 6:1016 (1997)). Finally, in the case when the N-terminal residue is methionine, the radical can transfer to the side chain sulfur atom leading to the formation of methionine sulfoxide, effectively "quenching" oxidative deamination. This finding provides a unique example of methionine serving as an intrinsic antioxidant in a protein, a role recently postulated by Levine et al., Proc. Nat'l Acad. Sci. U.S.A., 93:15036 (1996). Although beta dimerization can be useful for certain hemoglobin applications, it is not always desirable. Therefore, in one aspect, the present invention relates to methods of preventing the formation of such beta dimers. Such methods are accomplished by mutations in the beta globin. For example, in one embodiment, the histidine adjacent to the N-terminal amino acid in the beta globin can be substituted with one or more amino acids so that the expressed protein does not have a histidine in the second position from the N-terminus. Similarly, one or more amino acids can be inserted between the N-terminal amino acid and histidine as long as the inserted amino acid is not an amino acid directing N-terminal Met removal, for example, alanine, glycine, proline, serine, threonine, valine and cysteine if the beta globin in expressed by an E.coli host cell (Hirel et al., Proc. Nat'l Acad. Sci. U.S.A., 86:8247-51 (1989)). For example, in the E.coli system, the initating methionine (Met) residue is quantitatively removed by endogenous E.coli methionylaminopeptidase when the second amino acid expressed is alanine. Therefore, if alanine is inserted in front of the histidine, the resulting expressed protein would contain a histidine at the second position due to the cleavage of Met. Methods for the addition or substitution of amino acids can be accomplished by means known in the art or as described in the Examples below. The present invention further relates to the mutated beta globins and to the nucleic acids useful for the expression of such mutations. Such nucleic acids can be used to construct plasmids to be inserted into appropriate recombinant host cells according to conventional methods or as described in the Examples below. Briefly, plasmids were constructed with various mutations in beta and used to transform E.coli host cells. Crosslinking reactions were carried out using NiCl.sub.2, followed by the addition of oxone. The reaction of the native hemoglobin (i.e., with histidine at position 2--His2) in solution with Ni(II) and oxone resulted in the formation of intramolecular, dimeric beta globin. This reaction is blocked by inclusion of EDTA in the reaction mixture, as well as by substitution of the His2 in the beta globin with Leu or Ala. These results indicate that the beta globin His2 can serve as a binding site for a high valent nickel complex. This complex promotes predominantly intramolecular crosslinking to form stable beta dimers. The present invention is also directed to any suitable host cell containing a desired beta globin mutation. Suitable host cells include, for example, bacterial, yeast, mammalian, reptilian and insect cells. E. coli cells are particularly useful for expressing the novel polypeptides. Preferably, when multiple subunits are expressed in bacteria, it is desirable, but not required, that the subunits be co-expressed in the same cell polycistronically as described in WO 93/09143. The use of a single promoter is preferable in E. coli to drive the expression of the genes encoding the desired proteins. The recombinant hemoglobin containing the beta mutations of the present invention can be used for a number of in vitro or in vivo applications. Such in vitro applications include, for example, the delivery of oxygen by compositions of the instant invention for the enhancement of cell growth in cell culture by maintaining oxygen levels in vitro (DiSorbo and Reeves, PCT publication WO 94/22482, herein incorporated by reference). Moreover, the hemoglobins of the instant invention can be used to remove oxygen from solutions requiring the removal of oxygen (Bonaventura and Bonaventura, U.S. Pat. No. 4,343,715, incorporated herein by reference) and as reference standards for analytical assays and instrumentation (Chiang, U.S. Pat. No. 5,320,965, incorporated herein by reference) and other such in vitro applications known to those of skill in the art. In a further embodiment, the hemoglobins of the present invention can be formulated for use in therapeutic applications. Example formulations suitable for the hemoglobin of the instant invention are described in Milne, et al., WO 95/14038 and Gerber et al., PCT/US95/10232, both herein incorporated by reference. Pharmaceutical compositions of the invention can be administered by, for example, subcutaneous, intravenous, or intramuscular injection, topical or oral administration, large volume parenteral solutions useful as blood substitutes, etc. Pharmaceutical compositions of the invention can be administered by any conventional means such as by oral or aerosol administration, by transdermal or mucus membrane adsorption, or by injection. For example, the hemoglobins of the present invention can be used in compositions useful as substitutes for red blood cells in any application that red blood cells are used or for any application in which oxygen delivery is desired. Such hemoglobins of the instant invention formulated as red blood cell substitutes can be used for the treatment of hemorrhages, traumas and surgeries where blood volume is lost and either fluid volume or oxygen carrying capacity or both must be replaced. Moreover, because the hemoglobins of the instant invention can be made pharmaceutically acceptable, the hemoglobins of the instant invention can be used not only as blood substitutes that deliver oxygen but also as simple volume expanders that provide oncotic pressure due to the presence of the large hemoglobin protein molecule. In a further embodiment, the crosslinked hemoglobin of the instant invention can be used in situations where it is desirable to limit the extravasation or reduce the colloid osmotic pressure of the hemoglobin-based blood substitute. The hemoglobins of the present invention can be synthesized with a high molecular weight. Thus the hemoglobins of the instant invention can act to transport oxygen as a red blood cell substitute, while reducing the adverse effects that can be associated with excessive extravasation. A typical dose of the hemoglobins of the instant invention as an oxygen delivery agent can be from 2 mg to 5 grams or more of extracellular hemoglobin per kilogram of patient body weight. Thus, a typical dose for a human patient might be from a few grams to over 350 grams. It will be appreciated that the unit content of active ingredients contained in an individual dose of each dosage form need not in itself constitute an effective amount since the necessary effective amount could be reached by administration of a plurality of administrations as injections, etc. The selection of dosage depends upon the dosage form utilized, the condition being treated, and the particular purpose to be achieved according to the determination of the skilled artisan in the field. Administration of the hemoglobins of the instant invention can occur for a period of seconds to hours depending on the purpose of the hemoglobin usage. For example, as an oxygen delivery vehicle, the usual time course of administration is as rapid as possible. Typical infusion rates for hemoglobin solutions as blood replacements can be from about 100 ml to 3000 ml/hour. In a further embodiment, the hemoglobins of the instant invention can be used to treat anemia, both by providing additional oxygen carrying capacity in a patient that is suffering from anemia, and/or by stimulating hematopoiesis as described in PCT publication WO 95/24213. When used to stimulate hematopoiesis, administration rates can be slow because the dosage of hemoglobin is much smaller than dosages that can be required to treat hemorrhage. Therefore the hemoglobins of the instant invention can be used for applications requiring administration to a patient of high volumes of hemoglobin as well as in situations where only a small volume of the hemoglobin of the instant invention is administered. Because the distribution in the vasculature of the hemoglobins of the instant invention is not limited by the size of the red blood cells, the hemoglobin of the present invention can be used to deliver oxygen to areas that red blood cells cannot penetrate. These areas can include any tissue areas that are located downstream of obstructions to red blood cell flow, such as areas downstream of thrombi, sickle cell occlusions, arterial occlusions, angioplasty balloons, surgical instrumentation, any tissues that are suffering from oxygen starvation or are hypoxic, and the like. Additionally, any types of tissue ischemia can be treated using the hemoglobins of the instant invention. Such tissue ischemias include, for example, stroke, emerging stroke, transient ischemic attacks, myocardial stunning and hibernation, acute or unstable angina, emerging angina, infarct, and the like. Because of the broad distribution in the body, the hemoglobins of the instant invention can also be used to deliver drugs and for in vivo imaging. The hemoglobins of the instant invention can also be used as replacement for blood that is removed during surgical procedures where the patient's blood is removed and saved for reinfusion at the end of surgery or during recovery (acute normovolemic hemodilution or hemoaugmentation). In addition, the hemoglobins of the instant invention can be used to increase the amount of blood that can be predonated prior to surgery, by acting to replace some of the oxygen carrying capacity that is donated. |
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