ASCORBATE FORMULATIONS AND METHODS OF USE AS CONTRAST AGENTS

Abstract

A sterile aqueous composition suitable for use as an MRI contrast agent includes 100 to 600 mM ascorbate; and 100-600 mM sodium, meglumine, or a combination thereof. The composition preferably has an osmolarity of 200 to 1400 mOsm/L.

Claims

1. A sterile aqueous composition suitable for use as an MRI contrast agent, said composition comprising: 100-600 mM ascorbate; and 100-600 mM sodium, meglumine, or a combination thereof, wherein said composition comprises a spin-spin exchange catalyst, and wherein said composition has an osmolarity of 200-1400 mOsm/L.

2. The composition of claim 1, wherein said spin-spin exchange catalyst is meglumine.

3. The composition of claim 1, wherein said composition further comprises carbonate and/or phosphate.

4. The composition of claim 1, wherein said spin-spin exchange catalyst is a reducing sugar.

5. The composition of claim 1, wherein said spin-spin exchange catalyst is a non-reducing sugar.

6. The composition of claim 1, wherein said composition has an osmolarity of 200-1200 mOsm/L.

7. The composition of claim 1, wherein said composition has a pH of from 6.5 to 7.5.

8. The composition of claim 1, wherein said composition further comprises a stability agent.

9. The composition of claim 1, wherein said composition is provided in unit dosage form.

10. The composition of claim 9, wherein said unit dosage form comprises from 10 to 100 grams of ascorbate.

11. The composition of claim 1, wherein said composition comprises meglumine ascorbate and sodium ascorbate in a molar or millimolar (mM) ratio of from 10:90, 20:80, 30:70, or 40:60, up to 90:10, 80:20, 70:30, or 60:40 (meglumine ascorbate:sodium ascorbate).

12. A powder composition comprising: ascorbate; meglumine, or a combination-of sodium and meglumine; optionally, carbonate and/or phosphate; and optionally, a reducing or non-reducing sugar, said composition suitable for use, upon addition of a sterile liquid carrier, in enhancing a magnetic resonance imaging (MRI) image of a body or body region such as an organ or organ region in a subject.

13. The composition of claim 12, wherein said composition comprises carbonate and/or phosphate.

14. The composition of claim 12, wherein said composition comprises a reducing sugar.

15. The composition of claim 12, wherein said composition comprises a non-reducing sugar.

16. The composition of claim 12, wherein said composition has an osmolarity of 200-1200 mOsm/L.

17. The composition of claim 12, wherein said composition has a pH of from 6.5 to 7.5.

18. The composition of claim 12, wherein said composition further comprises a stability agent.

19. The composition of claim 12, wherein said composition comprises meglumine ascorbate and sodium ascorbate in a molar or millimolar (mM) ratio of from 10:90, 20:80, 30:70, or 40:60, up to 90:10, 80:20, 70:30, or 60:40 (meglumine ascorbate:sodium ascorbate).

20. A method of enhancing a magnetic resonance imaging (MRI) image of a body or body region such as an organ or organ region in a subject, comprising: parenterally administering the sterile aqueous composition of claim 1 to said subject in an MRI image-enhancing amount; and then generating, by MRI of the subject, an image of said body or body region, whereby said MRI image in enhanced.

21. The method of claim 20, wherein said body region is a head, neck, thorax, abdomen, pelvis, limb(s), muscle, fat, or bone.

22. The method of claim 20, wherein said organ comprises an adrenal gland, pituitary, thymus, corpus luteum, retina, brain, spleen, lung, testicle, lymph nodes, liver, thyroid, small intestinal mucosa, leukocytes, pancreas, kidney, or salivary gland tissue.

23. The method of claim 20, wherein said body region is a brain.

24. The method of claim 20, wherein said body region is a heart.

25. The method of claim 20, wherein said administering step is carried out by intravenous administration such as intravenous injection.

26. The method of claim 20, wherein said administering step is carried out by intraperitoneal administration such as intraperitoneal injection.

27. The method of claim 20, wherein said image comprises a T.sub.2 weighted image.

28. The method of claim 20, wherein said image comprises a metabolism image.

29. The method of claim 20, wherein said image comprises a perfusion image.

30. The method of claim 20, wherein the generating is performed during, or up to 5, 10, 30, 40, 60, 90 or 120 minutes after, or up to 1, 2, 3, or 4 hours after, parenterally administering the sterile aqueous composition.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0021] FIGS. 1A-1B. Ascorbate and dismutation of the ascorbate radical. FIG. 1A, Ascorbate is a di-acid, however at physiological pH of 7.4, 99% of ascorbate is present as its mono anion (AscH.sup.−). Ascorbate radical (Asc..sup.−) is present at equilibrium (but also at much lower concentrations) with oxidized and reduced forms of ascorbate. FIG. 1B, The dismutation of Asc..sup.− is the principal route of its transformation, with a rate constant (k.sub.obs) that falls into the “intermediate” proton exchange rate on the NMR timescale. This rate constant can increase by a factor of 10 in the presence of proton exchange catalysts such as phosphate (Bors W, Buettner G R. (1997) The vitamin C radical and its reactions in Vitamin C in Health and Disease, ed. by L. Packer and J. Fuchs, Marcel Dekker, Inc., New York, Chapter 4, pp 75-94).

[0022] FIG. 2. T.sub.2 relaxivity (r2=mM.sup.−1sec.sup.−1) of sugars, sugar alcohols, and ascorbate Comparisons include both mono and disaccharides. As discussed in the text, note the diminishing contrast effect at higher concentration, which is believed to be secondary to self-association of like moieties and reduced proton exchange.

[0023] FIGS. 3A-3D. In vitro (“phantom”) experiments on ascorbate spin-spin relaxation (T.sub.2-weighted) MRI contrast. FIG. 3A, shows quantitative T.sub.2 mapping in 5 phantoms with progressively increasing ascorbate (AA) concentration. Statistically significant “negative T.sub.2 contrast” (signal loss) is seen as low as 1-5 mM as compared to control (phosphate-buffered saline) with conventional fast spin echo (FSE) acquisition. Sensitivity is therefore at the lower end of expected tissue/cellular concentrations following pharmacological doses of ascorbate in high uptake tissues (e.g., tumors and brain, 10-30 mM). This result also does not take into account any synergistic effects from tissue oxidative substrates or physiological exchange catalysts. FIG. 3B, shows the synergistic effect of H.sub.2O.sub.2 on ascorbate T.sub.2 enhancement. H.sub.2O.sub.2, which rises to 100-200 micromolar in brain and tumors in vivo following parenteral ascorbate, produces a marked synergism on the T.sub.2 contrast effect from ascorbic acid. The synergistic effect slowly diminishes over time in phantoms over 30 min as shown, but will be sustained in vivo as long as H.sub.2O.sub.2 is produced following ascorbate administration. FIG. 3C, demonstrates the influence of pH on ascorbate's T.sub.2 effect, which is maximized at neutral/physiological pH (7.0-7.4). This result is consistent with prior studies on the rate kinetics of ascorbate disproportionation with its radical and oxidized form at equilibrium (FIGS. 1A-1B). FIG. 3D, reveals a marked synergistic effect when ascorbate (Asc) is salified (salted) with meglumine (N-methyl-D-glucamine (MEG)), an amine sugar derivative of sorbital that is commonly employed as an excipient in several FDA-approved drug and contrast formulations.

[0024] FIG. 4. Comparison of Ascorbate as Na or Meglumine (MEG) Salt. Solutions are prepared with physiological concentrations of PO.sub.4 (2 mM) and HCO.sub.3.sup.− (25 mM) buffers.

[0025] FIG. 5. Na Ascorbate (Asc)+Physiological Exchange Catalysts. Each solution is set at neutral (pH=7.0) in deionized water. Concentrations of physiological exchange catalysts are the same as the in vivo in serum and extracellular space: PO.sub.4=2 mM, glucose=5 mM, and HCO.sub.3.sup.− is 25 mM.

[0026] FIG. 6. Exchange Synergism Between Na Ascorbate (Asc)/Meglumine (Meg) and Glucose (Glu). Solutions are compared in the setting of physiological buffers PO.sub.4 (2 mM) and HCO.sub.3.sup.− (25 mM) that also contribute as exchange catalysts.

[0027] FIG. 7. Exchange synergism of Na Asc/Meglumine (Meg) with sugar alcohols, mono- and disaccharides. All solutions are prepared in co-presence of 2 mM PO.sub.4 and 25 mM HCO.sub.3.sup.−.

[0028] FIG. 8. Rescaled data without control for exchange synergism of Na Asc/Meglumine (Meg) with sugar alcohols, mono- and disaccharides. All solutions are prepared with 2 mM PO.sub.4 and 25 mM HCO.sub.3.sup.−.

[0029] FIGS. 9A-9B. In vivo ascorbate T.sub.2 contrast changes following high dose parenteral ascorbate (2 g/kg, right IJ i.v. injection). FIG. 9A, shows a conventional single slice axial FSE T2WI image through the midbrain of a normal C57 black mouse, and the two images on the right demonstrate a ‘first pass’ extraction of contrast change during and following ascorbate administration i.v. T.sub.2 signals in brain tissue are acquired immediately following, and 10 minutes after ascorbate administration, then subtracted from the T2 brain signals acquired before ascorbate administration. Since ascorbate produces a decrease in signal intensity, subtraction from the higher signal pre-dose scan results in a net positive ‘map’ of flow-through perfusion (blood flow) through brain tissue. At 10 minutes, the perfusion effect has nearly resolved and early signal intensity changes related to tissue uptake are beginning to be observed. FIG. 9B, shows the signal changes due to tissue uptake of high-dose ascorbate. Color-lute maps of signal intensity are not subtracted from the pre-dose scan and therefore show the expected decreases in T2 signal over time, maximized between 30-60 min in normal C57 mice.

[0030] FIG. 10. Ascorbate T2 enhancement in a rodent model of neocortical spreading depression (SD). In the illustrated experiment, the lower row of images shows a tiny craniectomy with gelfoam (red arrow) soaked in a high concentration of potassium chloride (KCl), which diffuses locally into the adjacent parietal cortex. The craniectomy site is 1 mm posterior to bregma, a skull landmark representing the posterior third of the underlying brain. The above two rows show T2 images and quantitative color lute T2 maps of signal change in rodent brain that are 3 and 4 mm anterior to bregma, that is, distant from the SD induction site. T2 signal changes in the anterior slices demonstrate clear T2 asymmetry in the right cerebral cortex as compared to the left (again, SD remains confined to the right hemisphere). These marked cortical signal changes are consistent with the known hypermetabolic activity that occurs with SD, as also observed with .sup.18F-FDG PET, and with direct microdialysis and metabolomic determinations. Of note, the opposite observation (focally increased T2 signal) is seen directly under the craniectomy site itself (row three), consistent with localized edema (increased free water) at the site of KCl infusion.

[0031] FIGS. 11A-11B. Perfusion and viability cardiac imaging with parenteral ascorbate. FIG. 11A depicts the two primary imaging planes, coronal and axial, for rat heart imaging at 7T. FIG. 11B shows transient decrease in T2 signal intensity throughout the left ventricle with initial bolus of ascorbate injection i.v.

[0032] FIGS. 12A-12C. T2 contrast changes in guinea pigs following i.v. administration of three different formulations of ascorbate. FIG. 12A, Fast spin echo (FSE) T2 images before and after 60 min slow infusion of ascorbate show dramatic signal intensity differences throughout the brain parenchyma. FIG. 12B and FIG. 12C respectively show normalized signal intensity changes and quantitative relaxivity measurements are shown for both guinea cerebral cortex (Cx) and basal ganglia (BG) after administration of three different ascorbate formulations.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0033] The present invention is now described more fully hereinafter with reference to the accompanying drawings, in which embodiments of the invention are shown. This invention may, however, be embodied in different forms and should not be construed as limited to the embodiments set forth herein; rather these embodiments are provided so that this disclosure will be thorough and complete and will fully convey the scope of the invention to those skilled in the art.

[0034] As used herein, the singular forms “a,” “an” and “the” are intended to include plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” or “comprising” specify the presence of stated features, integers, steps, operations, elements, components and/or groups or combinations thereof, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components and/or groups or combinations thereof.

[0035] As used herein, the term “and/or” includes any and all possible combinations or one or more of the associated listed items, as well as the lack of combinations when interpreted in the alternative (“or”).

[0036] Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the specification and claims and should not be interpreted in an idealized or overly formal sense unless expressly so defined herein.

[0037] Ascorbate. Ascorbate (also known as “ascorbic acid,” “L-ascorbic acid” or “Vitamin C”) is a naturally-occurring organic compound and an essential nutrient, with important properties as an antioxidant and co-factor in at least eight enzymatic reactions, including several collagen synthesis reactions that, when dysfunctional, result in the most conspicuous symptoms of scurvy. Most mammals make ascorbic acid in the liver, where the enzyme L-gulonolactone oxidase converts glucose to ascorbic acid. In humans, higher primates, guinea pigs and most bats, however, a mutation results in low or absent L-gulonolactone oxidase expression so that ascorbate must be consumed in the diet (Lachapelle, M. Y.; Drouin, G. (2010). “Inactivation dates of the human and guinea pig vitamin C genes”. Genetica 139 (2): 199-207). In all animal species, L-ascorbic acid/ascorbate is the most abundant intracellular antioxidant, with intracellular concentrations capable of reaching 10-30 mM in tumors, brain cells, and some other tissues. Those tissues that accumulate over 100 times the level in blood plasma of vitamin C include the adrenal glands, pituitary, thymus, corpus luteum, and retina. Those with 10 to 50 times the concentration include brain, spleen, lung, testicle, lymph nodes, liver, thyroid, small intestinal mucosa, leukocytes, pancreas, kidney, and salivary glands (Hediger M A (May 2002). “New view at C”. Nat. Med 8 (5): 445-6).

[0038] Dietary excesses of vitamin C are not absorbed, and excesses in the blood are rapidly excreted in the urine. Vitamin C exhibits remarkably low toxicity, with an LD.sub.50 in rats generally accepted at ˜11.9 grams per kilogram of body weight. The mechanism of death from such doses (1.2% of body weight, or 0.84 kg for a 70 kg human) is unknown, but may be mechanical rather than chemical (“Safety (MSDS) data for ascorbic acid”. Oxford University. Oct. 9, 2005. Retrieved Feb. 21, 2007). The LD.sub.50 in humans is uncertain given the lack of any accidental or intentional poisoning death data. The rat LD.sub.50 is, therefore, used as a guide for human toxicity.

[0039] At physiological pH, 99% of ascorbate is present as the mono anion (FIG. 1A). The chemistry and therefore imaging properties of vitamin C are dominated by this moiety. As a donor antioxidant, the mono anion donates a hydrogen atom (H. or H.sup.++e.sup.−) to an oxidizing radical to produce a resonance-stabilized tricarbonyl ascorbate free radical, Asc..sup.− (FIG. 1B). The dismutation reaction of Asc..sup.− back to reduced or oxidized ascorbate is the principal route of elimination in vitro. This process is supplemented in vivo by enzymes that aid in ascorbate recycling (May J M, Qu Z C, Neel D R, Li X (May 2003). “Recycling of vitamin C from its oxidized forms by human endothelial cells”. Biochim. Biophys. Acta 1640 (2-3): 153-61). Dismutation of the radical to either ascorbate or dehydroascorbate occurs via loss or gain of hydrogen, which serves as either the electron carrier or the more conventional cation. Also, the rate constant of ascorbic radical dismutation is 10.sup.5-10.sup.6 M.sup.−1s.sup.−1, so that hydrogen exchange accompanying dismutation also occurs at the same rate. On the NMR timescale, these “intermediate” exchange rates are optimal for altering .sup.1H spin-spin relaxation.

[0040] Parenteral Formulations of Ascorbate. Ascorbate for parenteral administration may be provided in a pharmaceutically acceptable carrier (e.g., sterile water, endotoxin-free water, or pyrogen-free water; sterile, endotoxin-free or pyrogen-free saline, etc.) as a formulation suitable for parenteral administration. The term “pharmaceutically acceptable” as used herein means that the compound or composition is suitable for administration to a subject to achieve the treatments described herein, without unduly deleterious side effects in light of the severity of the disease and necessity of the treatment.

[0041] The formulations may be presented in unit/dose or multi-dose containers, for example sealed ampoules and vials, and may be stored in a dried/powdered/freeze-dried (lyophilized) condition requiring only the addition of the sterile liquid carrier, for example, saline or water-for-injection immediately prior to use. Extemporaneous injection solutions and suspensions may be prepared from sterile powders, granules and tablets. For example, in one aspect of the present invention, there is provided an injectable, stable, sterile composition comprising ascorbate in a unit dosage form in a sealed container. The ascorbate may be provided in the form of a lyophilizate which is capable of being reconstituted with a suitable pharmaceutically acceptable carrier to form a liquid composition suitable for injection thereof into a subject.

[0042] Examples of suitable formulations include, but are not limited to, a sterile aqueous solution of ascorbic acid in water for injection, containing 10, 20, 30, 40, or 50, to 80, 90, 100, 150 or 200 mg/mL ascorbate or a salt thereof (e.g., sodium salt, meglumine (N-methyl-D-glutamine) salt, combinations thereof, etc.). In some embodiments, formulations may include 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 mM, to 150, 200, 250, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, or 800 mM ascorbate or a salt thereof (e.g., sodium salt, meglumine (N-methyl-D-glucamine) salt, combinations thereof, etc.). For example, formulations may include from 100 to 700 mM, or from 200 to 650 mM, or from 300 to 600 mM, or from 400 to 550 mM, ascorbate or a salt thereof. The ascorbate concentration may be adjusted as needed depending on the route of administration (e.g., intravenous administration versus direct administration into a localized body region or compartment).

[0043] In some embodiments, the pH is adjusted to approximately 7 (e.g., pH of from 6.5 to 7.5) (e.g., with sodium bicarbonate and/or sodium hydroxide).

[0044] Formulations suitable for parenteral administration may include a stabilizing agent. Example stabilizing agents include chelators such as EDTA (e.g., EDTA disodium). Formulations may also include pH buffers such as bicarbonate (HCO.sub.3.sup.−) and/or phosphate (PO.sub.4).

[0045] Formulations according to some embodiments may include a sugar, such as a reducing or non-reducing sugar. A “reducing sugar” is an open-chain sugar having a free aldehyde group or a free ketone group, which includes all monosaccharides and some disaccharides, oligosaccharides and polysaccharides. Example reducing sugars include, but are not limited to, glucose, galactose, glyceraldehyde, fructose, ribose, xylose, lactose, maltose, etc. A “non-reducing sugar” is a sugar without a free aldehyde group or free ketone group. Example non-reducing sugars include, but are not limited to, sucrose, trehalose, etc.

[0046] The spin-spin exchange catalysts that may be used in the ascorbate formulations as taught herein may include, but are not limited to, meglumine (N-methyl-D-glucamine), reducing sugars (e.g., glucose, galactose, glyceraldehyde, fructose, ribose, xylose, lactose, maltose, combinations thereof, etc.), and non-reducing sugars (e.g., sucrose, trehalose, combinations thereof, etc.).

[0047] Formulations suitable for parenteral administration may have an osmolarity in the range of from 200 to 1200 or 1400 mOsm/L. In some embodiments, the formulation has an osmolarity of from 200, 300, 400, 500 or 600 to 700, 800, 900, 1000, 1100, 1200, 1300, or 1400 mOsm/L.

[0048] In some embodiments, the formulation is suitable for injection into an artery or vein, and/or into a body region such as an organ or organ region. In some embodiments, the formulation is suitable for intravenous infusion. In some embodiments, the formulation is suitable for intraarterial infusion. In some embodiments, the formulation is suitable for intrathecal infusion.

[0049] In some embodiments, the formulation is de-oxygenated. Methods of de-oxygenation of aqueous compositions are known, e.g., preparing the formulation under, or purging with, an inert gas, such as nitrogen. See, e.g., U.S. Patent Application publication 2014/0048290 to Bodemann.

[0050] In some embodiments, the formulation is provided as a dried/powdered/lyophilized composition of meglumine ascorbate, sodium ascorbate, or a combination of these salts, with or without exchange catalysts, chelators, etc., which may be reconstituted in sterile aqueous media (e.g., water, normal saline, lactated Ringers, or other accepted aqueous vehicle used for parenteral drug delivery) at point of care just prior to administration. Suitable dried formulations may include, but are not limited to, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95 or 100 grams of ascorbate of a salt thereof.

[0051] In some embodiments, the formulation is provided in a container suitable for light-sensitive liquid compositions, such as an opaque plastic or glass container (e.g., a high density polyethylene container, a plastic or glass container coated with black polyvinyl chloride, etc.), amber glass, etc. See, e.g., U.S. Pat. No. 8,309,191 to Wang et al.; U.S. Patent Application publication 2004/0048206 to Miyake et al.

[0052] In some embodiments, the formulation is provided in unit dosage form suitable for parenteral administration for MRI imaging. As non-limiting examples, unit dosage forms suitable for intravenous administration may be: 1) 0.25 g/min, up to 60 min, up to 15 grams; 2) 0.5 g/min, up to 60 min, up to 30 grams; 3) 1.0 g/min, up to 60 min, up to 60 grams; or 4) 1.5 g/min, up to 60 min, up to 90 grams.

[0053] Methods of use. As noted above, the parenteral ascorbate compositions as taught herein are useful for magnetic resonance imaging (MRI) to provide a contrast agent for the detection and characterization of perfusion, metabolism, and/or oxidative stress in human and non-human tissues, without the need for radioactivity or chemical labeling.

[0054] Ascorbate, especially in the presence of, and co-formulated with, spin-spin exchange catalysts (for example, simple sugars, sugar alcohols or amino acids) is a safe and biodegradable MRI contrast agent that requires neither the use of metal-based (e.g., gadolinium or iron) contrast material nor ionizing radiation. The technique enables assessment of tissue perfusion as well as high-resolution molecular characterization of tissue viability and metabolism that is analogous to .sup.18F-FDG PET. The latter is possible by virtue of ascorbate's uptake (via dehydroascorbate) into cells through the same glucose transport mechanisms that take up .sup.18F-FDG (i.e., GLUT 1 and 3 transporters) (Rumsey S C, Kwon O, Xu G W, Burant C F, Simpson I, Levine M (July 1997). “Glucose transporter isoforms GLUT1 and GLUT3 transport dehydroascorbic acid”. J Biol. Chem. 272 (30): 18982-9).

[0055] “Parenteral administration” as used herein includes, but is not limited to, intravenous, subcutaneous, intramuscular, intraperitoneal, intraarterial, intraosseous, intrathecal or intraventricular administration, e.g., through injection or infusion. As a non-limiting example, intraperitoneal or other parenteral administration may be used where intravenous (i.v.) access is difficult for a subject (e.g., low blood pressure), or the route of administration otherwise would result in a suitable MRI image.

[0056] In some embodiments the MRI is performed during, or up to 5, 10, 30, 40, 60, 90 or 120 minutes after, or up to 1, 2, 3, or 4 hours after, parenterally administering the ascorbate composition.

[0057] Subjects benefitting from the present invention are, in general, mammalian subjects, including both human subjects and animal subjects (e.g., dogs, cats, rabbits, cattle, horses, etc.), for diagnostic, therapeutic, research or veterinary purposes. Subjects may be male or female and may be any age, including neonate, infant, juvenile, adolescent, adult, and geriatric subjects. MRI is known, and may be carried out by commercially available equipment, and by techniques known in the field. See, e.g., S. Bushong and G. Clarke, Magnetic Resonance Imaging: Physical and Biological Principles (Mosby, 4.sup.th Ed. 2014). In some embodiments, the MRI is perfusion (e.g., blood flow) imaging. In some embodiments, the MRI is metabolism imaging. Metabolism imaging may be used as a diagnostic biomarker analogous to .sup.18F FDG PET, including, but not limited to, identification/characterization of tumors or dysfunctional tissues demonstrating hyper- or hypo-metabolism.

[0058] “Body or body region” that may be imaged with MRI as taught herein includes the body or any region of the body of a subject, such as an organ or organ system, soft tissue, bone, etc., or any portion thereof. Examples of body regions include, but are not limited to, head, neck, thorax, abdomen, pelvis, limb(s), muscle, fat, other soft tissues, bone, etc. Examples of organs include, but are not limited to, adrenal gland, pituitary, thymus, corpus luteum, retina, brain, spleen, lung, testicle, lymph nodes, liver, thyroid, small intestinal mucosa, leukocytes, pancreas, kidney, salivary gland tissue, heart, etc.

[0059] “Enhancing” an MRI image as used herein is inclusive of facilitating the MRI visualization by enhancing the contrast of structures, tissues or fluids in an MRI signal.

[0060] An “MRI contrast agent” is a substance that can enhance the contrast of structures, tissues or fluids within the body during an MRI scan. Examples include, but are not limited to, paramagnetic contrast agents such as Gd-containing agents or manganese chelates, and superparamagnetic agents such as iron platinum particles. See also U.S. Patent Application Publication Nos. 2014/0350193 to Axelsson et al.; and 2014/0234210 to Lin et al.

[0061] Potential applications for ascorbate MRI include several clinical scenarios where current medical practice often utilizes PET scanning but where improvements in methodology using MRI as an alternative scanning technology will potentially yield further clinical benefit. These scenarios include diagnostic studies for cancer, neurological disease (e.g., dementia, TBI and epilepsy) and cardiovascular imaging. Heart studies using Tc99m-labeled agents (e.g., Tc-99m sestimibi or “Cardiolite”) represent a particularly noteworthy potential diagnostic application in need of an alternative approach given the projected contraction of supply of Tc-99m. Myocardial perfusion and viability imaging with Tc-99m-related agents is an essential and widely performed procedure, yet to date no commercially feasible solution has been developed to replace these Tc-99m-dependent agents.

[0062] MR imaging and clinical application of contrast media. Clinical magnetic resonance imaging (MRI) generates high-resolution images of the body through the acquisition of proton (.sup.1H) nuclear magnetic resonance (NMR) signals from water and macromolecules in tissue. For “T.sub.1-weighted” MR images, signal intensity increases in regions where longitudinal relaxation rate (spin lattice relaxation rate, 1/T.sub.1) increases. With “T.sub.2-weighted” MRI, signal intensity decreases when transverse relaxation rate (spin-spin relaxation rate, 1/T.sub.2) increases. Both T.sub.1 and T.sub.2 weighted images are routinely acquired in virtually all clinical MRI studies.

[0063] Intravenous contrast agents are routinely administered in MRI to further increase 1/T.sub.1 or 1/T.sub.2, in an effort to better delineate diseased tissue from normal tissue, improve anatomical definition, and enhance characterization of physiological or pathological function. Almost all currently approved MRI contrast agents are based on chelates of the lanthanide metal Gd, with a small subset of angiographic and perfusion studies conducted using iron-oxide materials (e.g., Feraheme) off-label in patients with renal insufficiency/failure. Commercial Gd-based materials are used most commonly to increase 1/T.sub.1 in diseased tissue, where contrast material is prone to accumulate.

[0064] For tissue perfusion determinations with MRI, Gd-based agents or iron-oxide nanoparticles may be used, with acquisition strategies based on either 1/T.sub.1 or 1/T.sub.2 contrast, although 1/T.sub.2 contrast approaches are increasingly favored. Perfusion imaging is currently used clinically to characterize tumor aggressiveness, tumor response to therapy, and tissue viability in heart, brain and other organs.

[0065] Without wishing to be bound by theory, the mechanism of ascorbate signal change without paramagnetism, which is also described as “T.sub.2-weighted contrast,” is based on enhancement of the water proton (.sup.1H) spin-spin relaxation rate 1/T.sub.2 (or reciprocally, spin-spin relaxation time, T.sub.2), as solvent water protons are exchanged with hydroxyl protons on ascorbate molecules. The effect of proton exchange on T.sub.2 contrast is amplified further by the dismutation reaction of the ascorbate radical at physiological pH. Ascorbate oxidation and ascorbate radical dismutation are, in turn, driven by the co-presence of oxidizing substrates such as hydrogen peroxide (H.sub.2O.sub.2) and/or hydrogen (“proton”) exchange catalysts.

[0066] Ascorbate transport and excretion. Ascorbic acid is absorbed in the body by both active transport and simple diffusion. The two major active transport pathways are sodium-ascorbate co-transporters (SVCTs) and hexose transporters (GLUTs). SVCT1 and SVCT2 import the reduced form of ascorbate across the plasma membrane (Savini I, Rossi A, Pierro C, Avigliano L, Catani M V (April 2008). “SVCT1 and SVCT2: key proteins for vitamin C uptake”. Amino Acids 34 (3): 347-55), whereas GLUT1 and GLUT3 glucose transporters transfer the oxidized form, dehydroascorbic acid (Rumsey S C, Kwon O, Xu G W, Burant C F, Simpson I, Levine M (July 1997). “Glucose transporter isoforms GLUT1 and GLUT3 transport dehydroascorbic acid”. J. Biol. Chem. 272 (30): 18982-9). Although dehydroascorbic acid concentrations are low in plasma under normal conditions, the oxidized molecule is absorbed at much higher rates across GLUT1 and GLUT3 than the reduced form is across the SVCTs. When ascorbate concentrations are pharmacologically elevated, dehydroascorbate concentration also increases, enabling marked absorption where GLUT transporters exist in high copy such as in the brain (and blood brain barrier) and tumor cells. Once transported, dehydroascorbic acid is rapidly reduced back to ascorbate.

[0067] Ascorbate concentrations over the renal re-absorption threshold pass freely into the urine and are excreted with a half-life of about 30 minutes. At high dietary doses (corresponding to several hundred mg/day in humans) the renal resorption threshold is 1.5 mg/dL in men and 1.3 mg/dL in women (Oreopoulos D G, Lindeman R D, VanderJagt D J, Tzamaloukas A H, Bhagavan H N, Garry P J (October 1993). “Renal excretion of ascorbic acid: effect of age and sex”. J Am Coll Nutr. 12 (5): 537-42). Ascorbate that is not directly excreted in the urine or destroyed by other body metabolism is oxidized by L-ascorbate oxidase and removed.

[0068] Ascorbate is understood to have a pharmacokinetic profile that resembles vancomycin. Biodistribution of oral ascorbate is under tight control, with plasma concentrations rarely exceeding 200 μM even at oral doses more than 100 times the recommended daily allowance (Levine M, Conry-Cantilena C, Wang Y, Welch R W, Washko P W, Dhariwal K R, Park J B, Lazarev A, Graumlich J F, King J, Cantilena L R (April 1996). “Vitamin C pharmacokinetics in healthy volunteers: evidence for a recommended dietary allowance”. Proc. Natl. Acad. Sci. USA 93 (8): 3704-9). Ascorbate administered intravenously, however, bypasses these tight control systems, with plasma concentrations of 10 mM or higher achievable. Plasma concentrations higher than 10 mM are safely sustained in humans for up to 4 hours with remarkably low toxicity (Hoffer L J., Levine M., Assouline S., Melnychuk D., Padayatty S J., Rosadiuk K., Rousseau C., Robitaille L., and Miller W H., Jr., Phase I clinical trial of i.v. ascorbic acid in advanced malignancy. Ann Oncol 19: 1969-1974, 2008).

[0069] The present invention is explained in greater detail in the following non-limiting examples.

In Vitro Examples

Ascorbate Enhancement of Spin-Spin Relaxation Rate, 1/T.SUB.2

[0070] Previous studies have reported on the NMR/MRI contrast effects on T.sub.2-weighting arising from exchange of bulk water protons with mobile protons of low molecular weight solutes and macromolecules (e.g., —NH.sub.2, —OH, —SH, —NH). The contrast effect on 1/T.sub.2 from this proton exchange is described as follows:

[00001]$\frac{1}{T_2}=\frac{1}{T_{2a}}+f_{CR}\left(P_b,{\mathrm{\delta \omega }}_b,k,T_{2b},\tau \right)$

[0071] Bulk water is related to .sub.a and exchangeable protons (e.g., from an ascorbate OH group) to .sub.b. f.sub.CR is a Closed Function with Five Parameters, Derived from Carver and Richards and Refined by Hill et al. (Carver, J. P.; Richards, R. E. J. General 2-Site Solution For Chemical Exchange Produced Dependence Of T2 Upon Carr-Purcell Pulse Separation J. Magn. Reson. 1972, 6, 89-105; Hills, B. P.; Wright, K. M.; Belton, P. S. N.M.R. studies of water proton relaxation in Sephadex bead suspensions Mol. Phys. 1989, 67, 1309-1326). For the hydroxyl protons of ascorbate, Pb would be the fraction of exchangeable protons, k is the exchange rate between exchangeable protons and water protons, stub is the chemical shift between hydroxyl and bulk water protons, and T.sub.2b is the local spin-spin relaxation time of hydroxyl protons. T is the inter-pulse (90°-180°) spacing in the T.sub.2-weighted acquisition sequence.

[0072] An essential but often neglected parameter influencing proton exchange on T.sub.2 contrast is the role of exchange catalysis (Liepinsh E and Otting, G Proton exchange rates from amino acid side chains—implications for image contrast. Magn Reson Med. 1996 35(1): 30-42). The rate constant k for proton exchange between OH or NH groups and water can be described by

k=k.sub.a[H.sup.+]+k.sub.b[OH.sup.−]+Σk.sub.c[catalyst].sup.y

K.sub.a, K.sub.b and K.sub.c denote the exchange rate constants due to catalysis by H.sup.+, OH.sup.− and other exchange catalysts, respectively. The exponent y is 1 or 2 depending on the mechanism of a given exchange catalyst. The rate constants K.sub.a and K.sub.b can be calculated in turn by:

[00002]$k_{a,b}=k_D\frac{1}{1+{10}^{\mathrm{pKD}\text{-}\mathrm{pKA}}}$

where K.sub.D is the rate constant for diffusion controlled encounter of the proton donor and acceptor (˜10.sup.10 mol.sup.−1s.sup.−1), and pK.sub.D and pK.sub.A are the pK values of the proton donor and acceptor. Although pK.sub.H3O+ and pK.sub.OH−=15.7, K.sub.c is more challenging to predict because of the nonlinear dependence of proton transfer on catalyst concentration. Nonetheless, efficient exchange catalysis at neutral pH is attained with at least a moderate difference between pK.sub.D−pK.sub.A and a significant concentration of catalytically active acidic or basic forms of the exchange catalysts at physiological pH.

[0073] Thus H.sub.2O, despite its high concentration, is a relatively poor proton donor and therefore an inefficient exchange catalyst at physiological pH because the pK.sub.A of the primary species (H.sub.3O.sup.+ and OH.sup.−) is 15.7. On the other hand, recognized exchange catalysts in physiological conditions include organic phosphates, carbonates (e.g., bicarbonate, HCO.sub.3.sup.−), and molecules with carboxyl and amino groups (Liepinsh E and Otting, G Proton exchange rates from amino acid side chains—implications for image contrast. Magn Reson Med. 1996, 35(1): 30-42).

[0074] As shown below, another powerful catalyst not previously recognized is ascorbate, which possesses one hydroxyl group having a favorable pK.sub.A=6.75 at the 4 position, as well as an equilibrium disproportionation reaction with a pK.sub.A=7.0. Thus, ascorbate has the potential to not only ‘self-catalyze’ but also to be an efficient catalyst of proton exchange for basic hydroxyl groups on sugars and other macromolecules.

[0075] FIG. 2 shows a comparison on T.sub.2 enhancement of pure solutions of several sugars, sugar alcohols, and ascorbate in deionized water at pH 7. Data are provided from quantitative T.sub.2 mapping at 7T using a RARE FSE protocol with at least 6 different echo times, at solute concentrations of 10 and 20 mM. As shown, T.sub.2 relaxivity is roughly a function of the number of exchangeable OH protons available on each molecule, with disaccharides, as predicted, producing proportionally greater contrast effect than monosaccharides. Noteworthy is the nonlinear dependence on solute concentration, with relaxivity enhancement decreasing as concentration is increased, a phenomenon that is likely related to self-association of sugars in pure solutions. The latter is particularly relevant to observations described below, where overall T.sub.2 effects are instead synergistically enhanced when ascorbate and sugars are combined together at higher total solute concentrations. Formulations combining ascorbate with mono or disaccharides provide a means to deliver higher concentrations of both species in order to increase T.sub.2 contrast effects for MR imaging.

[0076] FIG. 3A depicts a more detailed demonstration of T.sub.2 effects of pure ascorbate solutions at different concentrations at neutral pH. FIG. 3B reveals the marked enhancement of the T.sub.2 effect when ascorbate is in the presence of only μM (i.e., physiological) concentrations of hydrogen peroxide (H.sub.2O.sub.2), which drives oxidation to dehydroascorbate as well as ascorbate radical dismutation. Although H.sub.2O.sub.2 is also considered an exchange catalyst in its own right, the dramatic effect observed on ascorbate-mediated 1/T.sub.2 enhancement when H.sub.2O.sub.2 is present at 100-fold less concentration than ascorbate suggests that proton exchange from H.sub.2O.sub.2-driven ascorbate oxidation/dismutation, rather than direct exchange from OH ascorbyl protons, is an important contributory mechanism responsible for T.sub.2 changes. Further evidence of the contribution from dehydroascorbate oxidation/dismutation on proton exchange is depicted in FIG. 3C showing that the 1/T.sub.2 enhancement effect is by far the most significant at neutral pH where the reaction rate of ascrobate-dehydroascorbate dispropotionation is also greatest.

[0077] Data in FIG. 3D provide the first suggestion that exchange catalysis between ascorbate and an acceptor/donor molecule with an appropriate pK can markedly drive 1/T.sub.2 enhancement change. Data here compare solutions of ascorbate (10 mM) as sodium salt and as meglumine (aminosugar) salt. Here the T.sub.2 contrast effect (T.sub.2 relaxation in ms) is approximately 4 times greater with meglumine ascorbate as compared to either meglumine or ascorbate alone in water at neutral pH.

[0078] It was subsequently investigated whether the impressive synergistic effect of meglumine with ascorbate was dependent on chemical association with ascorbate as a salting cation (even though in theory the two moieties should be fully dissociated in water). FIG. 4 reveals that proton exchange is actually synergized when the ‘salting function’ is performed by Na.sup.+ cations, presumably leaving the amine group in addition to the basic OH groups of meglumine to participate in exchange catalysis with ascorbate. Note that here control T.sub.2 relaxation (ms) values (T.sub.2=840 ms) are not shown to better illustrate differences between experimental groups.

[0079] FIG. 5 summarizes T.sub.2 relaxation data from a series of experiments looking at the influence of various physiological exchange catalysts on the contrast effect from ascorbate. Using known serum and extracellular concentrations of PO.sub.4=2 mM, glucose=5 mM, and HCO.sub.3.sup.− of 25 mM, with ascorbate at 10 mM, T.sub.2 relaxation of each of these moieties was examined individually and in combination. As shown, the T.sub.2 relaxation effect of ascorbate alone or with PO.sub.4 in water is modest but in the presence of physiological concentrations of either glucose or HCO.sub.3.sup.− is dramatically increased, with 10 mM ascorbate, (a plasma concentration easily and safely achieved with parenteral administration) producing a remarkable 50% change in T.sub.2 relaxation. The greatest enhancement is seen with ascorbate in the presence of glucose, HCO.sub.3.sup.−, and PO.sub.4 together at known concentrations in vivo. Thus, by simply administering ascorbate i.v., the T.sub.2 enhancement effect of ascorbate in vivo will be much greater than what might be expected after only looking at ascorbate alone in phantom studies without physiological exchange catalysts present.

[0080] Also predicted from the experiments above is the possibility that formulation of ascorbate with other sugars that are not normally present in vivo may further catalyze the ascorbate contrast effect. FIG. 6, for example, demonstrates additional synergism when meglumine is added to a solution of sodium ascorbate at equivalent concentration (20 mM) and into a background of 2 mM PO.sub.4, 25 mM HCO.sub.3.sup.−. Data show comparison with or without physiological concentrations (5 mM) of glucose, as well as the effect of meglumine alone added to the physiological catalysts. As seen the greatest contrast effect is observed when all moieties are combined. One implication therefore is that higher contrast effects may be achievable by combining different exchange catalysts with each other, thus limiting the concentration of any one exogenously administered species.

[0081] FIG. 7 summarizes data extending this concept, testing potential synergisms when Na ascorbate and meglumine are formulated with other mono and disaccharides and sugar alcohols. As shown the contrast effects are dramatic with each potential formulation. In FIG. 8, the control solution (2 mM PO.sub.4 and 25 mM HCO.sub.3.sup.−) to better illustrate the differences in contrast changes between groups. The strongest effect thus observed is when ascorbate and meglumine are combined with the common disaccharide sucrose, thus suggesting a promising candidate formulation (i.e., ascorbate/meglumine/sucrose) for MRI using only moieties that may all be safely administered parenterally.

In Vivo Example 1

Normal Brain Perfusion and Metabolic Change

[0082] In vivo ascorbate T.sub.2 contrast changes were determined following high dose parenteral ascorbate (2 g/kg, right IJ i.v. injection.) FIG. 9A, shows a conventional single slice axial FSE T2WI image through the midbrain of a normal C57 black mouse, and the two images on the right demonstrate a ‘first pass’ extraction of contrast change during and following ascorbate administration i.v. T2 signal in brain tissue immediately following, and 10 minutes after, ascorbate administration is acquired and then subtracted from the T2 brain signal acquisition pre-ascorbate administration. Since ascorbate produces a decrease in signal intensity, subtraction from the higher signal pre-dose scan results in a net positive ‘map’ of flow-through perfusion (blood flow) through brain tissue. At 10 minutes, the perfusion effect has nearly resolved and early signal intensity changes related to tissue uptake are beginning to be observed. FIG. 9B, show the signal changes due to tissue uptake of high-dose ascorbate. Color-lute maps of signal intensity are not subtracted from the pre-dose scan and therefore show the expected decreases in T2 signal over time, maximized between 30-60 min in normal C57 mice.

In Vivo Example 2

Focal Cerebral Hypermetabolism in Association with Neocortical Spreading Depression

[0083] FIG. 10 shows ascorbate T2 enhancement in a rodent model of neocortical spreading depression. Spreading depression (SD) is an experimentally reproducible pathophysiological phenomenon of CNS tissues originally described 60 years ago by Loao. After a focal region of cortex reaches a critical threshold of ionic perturbation, a massive spreading wave of cellular depolarization may begin and spread through gray matter tissue, but remain confined to the gray matter zone in which it was induced, not crossing white matter pathways. If the induction mechanism (e.g., a local high concentration of applied potassium chloride) is continuous to the same region, these waves of SD will recur once every 8-10 minutes and last over a 2-3 hour period. Marked changes in brain metabolism accompany SD, and, since no histologically detectable neuronal injury is present after SD, these metabolic changes parallel metabolic fluxes in non-ischemic, hyperexcitable brain tissue such as epileptogenic foci.

[0084] In the above experiment, the lower row of images shows a tiny craniectomy with gelfoam (red arrow) soaked in a high concentration of KCl, which diffuses locally into the adjacent parietal cortex. The craniectomy site is 1 mm posterior to bregma, a skull landmark representing the posterior third of the underlying brain. The above two rows show T2 images and quantitiative color lute T2 maps of signal change in rodent brain that are 3 and 4 mm anterior to bregma, that is, distant from the SD induction site. T2 signal changes in the anterior slices demonstrate clear T2 asymmetry in the right cerebral cortex as compared to the left (again, SD remains confined to the right hemisphere). These marked cortical signal changes are consistent with the known hypermetabolic activity that occurs with SD, as also observed with .sup.18F-FDG PET, and with direct microdialysis and metabolomic determinations. Of note, the opposite observation (focally increased T2 signal) is seen directly under the craniectomy site itself (row three), consistent with localized edema (increased free water) at the site of KCl infusion.

In Vivo Example 3

Cardiac Perfusion and Metabolic Imaging

[0085] Perfusion and viability cardiac imaging with parenteral ascorbate was assessed. FIG. 11A, depicts the two primary imaging planes, coronal and axial, for rat heart imaging at 7T. Retrospective gating with respiratory coupling was employed to collect images at 7T. The acquisition sequence is moderately T2-weighted and can be further optimized to enhance the contrast effect. FIG. 11B, shows transient decrease in T2 signal intensity throughout the left ventricle with initial bolus of ascorbate injection i.v. After the initial bolus for first pass flow or ‘perfusion imaging’ quantitative T2 maps using variable flip angles show gradual T2 contrast change in heart tissue reflecting ascorbate uptake. Only viable, metabolically active cells will take up ascorbate.

TABLE-US-00001 TABLE 1 Example 4 Example parenteral formulations useful for MRI imaging T.sub.2W contrast agent Cation Exchange catalyst Osmolarity I ascorbate 100-600 mM sodium 100-600 mM* 200-1200 mOsm/L II ascorbate 100-600 mM meglumine 100-600 mM meglumine 200-1200 mOsm/L 100-600 mM III ascorbate 100-600 mM sodium 250-300 mM; meglumine 200-1200 mOsm/L N-methyl-D-glucamine 100-300 mM 250-300 mM IV ascorbate 100-300 mM sodium 100-300 mM meglumine 200-1200 mOsm/L 100-300 mM V ascorbate 100-300 mM sodium 100-300 mM reducing sugars 200-1400 mOsm/L 100-300 mM VI ascorbate 100-300 mM sodium 100-300 mM non-reducing sugars 200-1400 mOsm/L 100-300 mM VII non-reducing sugars.sup.a meglumine 200-1400 mOsm/L 0.1-1.0M 0.0-1.0M VIII reducing sugars.sup.b meglumine 200-1400 mOsm/L 0.1-1.0M 0.0-1.0M *sodium may be provided, e.g., as NaOH or NaHCO.sub.3− .sup.anon-reducing sugars include, e.g., sucrose, trehalose .sup.breducing sugars include, e.g., glucose, galactose, glyceradledyde, fructose, ribose, xylose, lactose, maltose

Example 5

Example Preparation of Parenteral Formulation Useful for MRI Imaging

[0086] Formulation II above is prepared in the following manner: Into 500 mL sterile water are added 50 g of ascorbic acid (568 mM) and 55.4 g N-methyl-D-glucamine (568 mM). Stir until solution clears. mOsm/L˜1100. pH˜7.0. To promote long-term stability, add 0.025% EDTA disodium, prepare in de-oxygenated solution under nitrogen blanket and under light-sensitive conditions.

In Vivo Example 6

T2 Contrast Changes in Guinea Pigs Following Intravenous Administration of Three Different Formulations of Ascorbate

[0087] We examined T2 contrast changes in whole brains of lightly anesthetized guinea pigs at 7T. Since guinea pigs share humans' inability to synthesize ascorbate endogenously, MRI effects in this model may be more predictive of MRI changes in patients. Ascorbate was administered parenterally via femoral or jugular vein access using controlled infusion for a total dose of 2 g/kg over 60 minutes. MRI was performed for 90 minutes.

[0088] FIG. 12A shows Fast spin echo (FSE) T2 images before and after 60 min slow infusion of ascorbate show dramatic signal intensity differences throughout the brain parenchyma.

[0089] In FIG. 12B and FIG. 12C, normalized signal intensity changes and quantitative relaxivity measurements are shown for both guinea cerebral cortex (Cx) and basal ganglia (BG) after administration of three different ascorbate formulations: (1) 100% sodium ascorbate; (2) 50% sodium ascorbate and 50% meglumine ascorbate; and (3) 100% meglumine ascorbate. In FIG. 12B, signal intensity changes are greatest at each time point during and following administration of the second formulation (2) consisting of 50% Na AA: 50% Meg AA, with observed cortical FSE T2 intensity decreases exceeding 40%. Calculated T2 relaxivity values in FIG. 12C also show a greater than 10% from baseline with formulation (2), with maximal values statistically greater than either formulation (1) or (3). On conventional FSE T2 weighted images, signal intensity changes with Meg AA (3) are also noted to be greater than those observed with sodium ascorbate (1) at nearly every time point, however T2 relaxivity calculations do not show statistical differences between these latter two formulations.

[0090] The foregoing is illustrative of the present invention, and is not to be construed as limiting thereof. The invention is defined by the following claims, with equivalents of the claims to be included therein.