Cell culture cassette and automated apparatus
11840682 · 2023-12-12
Assignee
Inventors
- Christophe Valat (Mulhouse, FR)
- Philippe Henon (Mulhouse, FR)
- Claire Saucourt (Mulhouse, FR)
- Raoul Weil (Dorlisheim, FR)
- Jérôme SERRE (PERTUIS, FR)
- Cyrille Marechal (Billom, FR)
Cpc classification
C12M21/00
CHEMISTRY; METALLURGY
International classification
C12M3/00
CHEMISTRY; METALLURGY
Abstract
The invention concerns a cassette for cell culture comprising: an at least partially rigid housing internally defining an internal space inside which a cell culture bag defining an internal volume is arranged and attached; conduits each connected at one end to the internal volume of the bag and each having a second end situated outside the housing; and valves for enabling/preventing the flow of fluid through the conduits that are mounted on the housing.
Claims
1. A cell culture cassette designed to be placed into an incubator, the cell culture cassette comprising: a housing at least partially rigid and internally defining an interior space in which is arranged and fixed a cell culture bag defining an interior volume, conduits each connected at one end to the interior volume of the bag and each having a second end located outside the housing, and valves for opening/closing a fluid flow through the conduits that are mounted on the housing, at least some of the valves include a movable member, each movable member including an end accessible from a same outer face of the housing and provided with a first rotating coupling means intending to cooperate with a second rotating coupling means of an actuator.
2. The cell culture cassette according to claim 1, wherein the conduits are formed by flexible tubing and each movable member is configured for pinching the tubing against a structural member of the housing.
3. The cell culture cassette according to claim 2, wherein each movable member comprises a rotation axis and a radially outer periphery of each movable member comprises at least one spiral surface about the rotation axis forming a pinch surface of the tubing so as to vary a fluid passage section through the tubing as the movable member rotates.
4. The cell culture cassette according to claim 3, wherein the movable members are mounted in recesses of a plate arranged inside the housing and integral with the housing, each recess receiving a corresponding movable member.
5. The cell culture cassette according to claim 4, wherein the movable members are centered and rotatably guided at one end into an opening in the housing and at an opposite end into an opening in the plate.
6. The cell culture cassette according to claim 2, wherein the bag has a substantially rectangular shape comprising a first flexible wall and a second flexible wall substantially parallel to each other in both empty and liquid-filled states.
7. The cell culture cassette according to claim 6, wherein a ratio of a sum of surfaces of the first flexible wall and the second flexible wall to a total internal volume of the bag is between 500 and 690 cm.sup.2/L.
8. The cell culture cassette according to claim 6, wherein a distance between the first flexible wall and the second flexible wall is less than 20 mm.
9. The cell culture cassette according to claim 1, wherein walls of the bag are permeable to gases.
10. The cell culture cassette according to claim 1, wherein the housing has a shape substantially corresponding to that of a rectangular parallelepiped and comprises a lower half-shell and an upper half-shell fixed with each other, the lower half-shell being rigid and the upper half-shell being rigid or flexible.
11. The cell culture cassette according to claim 10, wherein the upper half shell comprises an opening or central recess whose shape and size are determined to allow propagation of a wave of liquid from a pocket into the opening or central recess when the cell culture cassette containing the liquid is oscillated about a horizontal axis, the opening or central recess being disposed upward.
12. The cell culture cassette according to claim 10, wherein the lower half shell comprises a plurality of holes.
13. The cell culture cassette according to claim 10, wherein the conduits extend through a peripheral edge of one of the lower or upper half-shells.
14. The cell culture cassette according to claim 1, further comprising a conduit support strip, arranged outside the housing and traversed by at least some of the conduits.
15. The cell culture cassette according to claim 1, wherein the bag comprises a cell culture medium.
16. The cell culture cassette according to claim 15, wherein the cell culture medium comprises human insulin, human transferrin, and human plasma or serum.
17. The cell culture cassette according to claim 15, wherein the cell culture medium is frozen.
18. The cell culture cassette according to claim 1, wherein the bag comprises CD34+ cells.
19. The cell culture cassette according to claim 1, wherein the housing has a shape substantially corresponding to that of a rectangular parallelepiped.
20. The cell culture cassette according to claim 1, wherein the housing comprises a plurality of holes on said same outer face of the housing.
21. A cell culture incubator comprising a thermostatic enclosure and a support and agitation device for supporting and agitating a cell culture cassette according to claim 1 and means for positioning and locking the cell culture cassette in a given position in the support and agitation device.
22. The incubator according to claim 21, wherein the support and agitation device comprises a tray for supporting the cell culture cassette which is rotatably mounted around a horizontal axis about which the tray is configured to oscillate for agitating and homogenizing contents of the bag.
23. The incubator according to claim 22, wherein the support and agitation device comprises a connecting rod, an upper end of which is connected via an oscillator to a plate and a lower end of which is connected to a crank rotatably driven by a shaft of a motor whose axis is substantially horizontal.
24. The incubator according to claim 22, wherein the tray carries electromechanical actuators for opening/closing the valves, one outlet of which carries a second coupling means for cooperating with a first coupling means of the valves of the cell culture cassette when the cell culture cassette is in said given position.
25. The incubator according to claim 21, further comprising a door for sealing an opening of the enclosure, said opening comprising a peripheral edge in which a recess is formed whose shape is adapted to receive a conduit support strip for the conduits of the cell culture cassette, the conduit support strip forming a sealing member between the door and the peripheral edge when the door is in a closed position of the enclosure.
26. The incubator according to claim 21, further comprising means for controlling a position of the cell culture cassette in the support and agitation device.
27. A cell culture automated apparatus comprising at least one incubator according to claim 21, and a computer control system including data capture and recording means for regulating culture conditions in the enclosure of said at least one incubator and for controlling the valves of the cell culture cassette.
28. A method of cell culture by means of an automated apparatus according to claim 27, the method comprising: a) placing the cell culture cassette inside the enclosure in a thawing position on the support and agitation device; b) feeding the bag with cells to be cultured; c) placing the cell culture cassette on the support and agitation device in a cell culture position; d) agitating the cell culture cassette for a given period of time to homogenize its contents; e) maintaining the cell culture cassette under incubation conditions for several days; and f) recovering the contents of the cell culture cassette by means of one of the conduits of the cell culture cassette.
29. The method according to claim 28, wherein the method comprises: during step d), one or more sampling steps for sampling the contents of the bag, each sampling step preceded by a step of tilting the tray from a horizontal culture position to an inclined position in which a sampling area of the bag represents a lowest point of the bag.
30. The method according to claim 28, wherein the cells to be cultured are CD34+ cells.
31. A pharmaceutical composition for use in a treatment of heart failure induced by myocardial infarction, wherein the composition comprises cells capable of being produced by culture in the cell culture cassette according to claim 1, said cells: being human cells, being at least 10.sup.7 cells in number, containing at least 70% human CD34+ cells, comprising human CD34− CD14+ cells in a proportion of 1 to 12%, and/or having a cell diameter of 11.2±0.5 μm.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
(1) The invention will be better understood and other details, advantages and characteristics of the invention will appear when reading the following description by way of example, with reference to the annexed drawings in which:
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DETAILED DESCRIPTION
(23) First of all, we refer to
(24) As shown, automated apparatus 10 essentially consists of three elements: an incubator 12 with a thermostatic enclosure comprising a device for supporting and agitating 14 a cell culture cassette 16 according to the invention (
(25) Typically, the computer system includes data entry and recording facilities, data processing facilities, display facilities, and control and monitoring signal transmission facilities for the incubator as well as for valves and pumps of the cassette 16. Preferably, the computer system includes a touch screen display 22 and data entry by an operator or user.
(26) The control and traceability of the biologic protocol steps can be ensured by the computer system and an appropriate human-machine interface (HMI), which allows in particular: to ensure full traceability of the manufacturing process of each stem cell graft, the steps of operator intervention on the automated apparatus, culture parameters such as temperature, CO.sub.2 rate, and time of each step and the validation actions required at certain process steps, to ensure the traceability of consumables and reagents used in the process, via an input interface, means of reading and storing bar code data and RFID labels, and a verification of the consistency of the information collected against an internal database. This traceability can be applied to the entire manufacturing, storage and transport chain of consumables and reagents, as well as to the material conditions for maintaining the temperature of these components. to systematically indicate to the user the details of the protocol steps through animations and images illustrating the progress of the process steps, securely record patient identification data, biological data related to the characterization of stem cell transplants, to control each of the actuator control functions, to record and interpret the data of the various sensors present on the automated apparatus or fluidic cassette.
(27) As shown in
(28) The internal door 22 can be made of transparent glass so that the contents of the chamber 28 of incubator 12 can be observed while keeping incubator 12 in the closed position. The opening 26 of enclosure 28 includes a peripheral edge 24, corresponding to the first contact surface, whose lower edge 24a includes a recess 32 intended to receive a strip 34 for holding tubes or conduits 36, 38 of cassette 16 which will be described in more detail later, in particular with reference to
(29) As shown in
(30) As shown in
(31) The agitation device 52 comprises a connecting rod/crank type system having a connecting rod 64, one upper end of which is connected to a lower end of an oscillator or vertical oscillating rod 66 supporting at its opposite upper end the plate 54 by its lower face. The lower end of connecting rod 64 is connected to a crank handle 68 rotatably driven by a motor shaft with a substantially horizontal rotation axis 70. This axis 70 is perpendicular to axis 63. The upper end 66 of the oscillator is connected to the plate so as to allow the oscillator to move in a plane perpendicular to the rotation axis 70. Also, the upper end of the oscillator 66 is movably connected to the support plate 54 in the direction of axis 70, this connection can possibly be made by sliding a finger from the upper end of the oscillator 66 into a slot 71 or groove in the plate 54.
(32) As shown in
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(34) As shown in
(35) As shown in
(36) The frame 72 is surmounted by a structure 84 supporting the cassette 16 at a distance from the frame 72. This support structure 84 allows the cassette 16 to be supported in a second position corresponding to a thawing phase. This support structure 84 comprises two lateral fins 86 connected to each other by a flat wall 88 and together form a common support plane for cassette 16 in the second position. It should be noted that the support planes of cassette 16 in the first position and in the second position are inclined relative to each other. The second position allows the cassette 16, hermetically vacuum sealed in an envelope, to be supported at a distance from the frame 72 in order to avoid any tearing of the envelope, generally made of plastic, by the pins 78 during the thawing phase.
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(38) The lower 96 and upper 98 half-shells are connected to each other by four peripheral edges 102a, 102b. The two lower half-shell 96 and upper half-shell 98 can be assembled by clipping, gluing or welding their peripheral edges 102a, 102b. In a preferred embodiment, the lower half-shell 96 and upper half-shell 98 are both rigid.
(39) The lower half shell 96 includes a plurality of holes 104 preferably with a diameter of less than 20 mm. For example, cassette 16 is 405 mm long, 305 mm wide and 25 mm thick. It also includes two blind holes 106 spaced from each other and framing a through opening 107. The blind holes 106 are formed by a recess 109 in the lower half-shell 96, extending towards the upper half-shell 98 (
(40) It should be noted that the peripheral edge 102a of the lower half-shell 96, located at the first end 92 of the housing 90, has a straight rib 116 which is intended to cooperate with a slot 118 of the support structure 84 of the plate 54 when the cell culture cassette 16 is mounted in its first position on the plate 54 in the enclosure 28 of the incubator 12 (
(41) A plate 120 is fixed by snap-fastening into the upper half-shell and is suitable for holding the pipes 36, 38 of the cassette 16 in the folded position on the outer face of the upper half-shell 98.
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(43) The cell culture bag 100 is fixed on the lower half-shell 96 by means of pin 124 projecting from the inner side of the lower half-shell 96. These pins 124 pass through holes in the peripheral edges 123 of cell culture bag 100. The inner volume of bag 100 is in communication with the outside through a plurality of conduits. In particular, cassette 16 can include four ducts or flexible tubing 36, 38, three 36 of which being attached to the bar 34 previously described and a fourth 38 being independent.
(44) More specifically, cassette 16 includes a first and a second sampling tube 36a, 36b and an emptying tube 36c. Tubing 38 corresponds to a tubing for injecting cells of interest. As shown in
(45) As shown in
(46) Each of the pipes 36, 38 passes through valves 128, 130a, 130b, 130c for opening/closing the fluid flow through the pipes 36, 38, these pinch valves 128, 130 being arranged in the housing 90. In the example, shown, the three pipes 36 run through a first type of valve 130, the pipe 36a runs through the valve 130a, the pipe 36b runs through the valve 130b and the pipe 36c runs through the valve 130c, while the fourth pipe 38 runs through a second type of valve 128 (
(47) Each movable part 136, 138 comprises a lower end 136a, 138a and an upper end 136b, 138b, with reference to the lower half-shell 96 and upper half-shell 98 and with reference to the arrangement of the cassette in relation to the vertical. Of course, it would be possible to more generally designate the lower end as a first end and the upper end as a second end opposite the first end. Thus, the upper end 136b, 138b of each movable member 136, 138 comprises an annular shoulder 146b intended to support along the rotation axis 136c, 138c on the periphery of an orifice 142 of a recess 134 of the plate 132 and surrounding a cylindrical wall 148b intended to fit into the orifice 142 of the recess. In this case, the surface 146b of member 136 is supported on the bottom surface 140 of a recess 134 of a valve 130a, 130b, 130c. It is thus possible to carry out a rotational guidance and centring of the second ends 136b, 136a of the movable parts 136, 138 in the recesses 134 of the plate 132. The lower end 136a, 138a of each movable member 136, 138 comprises an annular shoulder 146a intended to support along the rotation axis 136c, 138c on the periphery of an orifice 144 of the lower half-shell 96 and a cylindrical wall 148a intended to be inserted into orifice 144 of the lower half-shell 96. In this case, the surface 146b of component 138 is supported on the bottom surface 140 of a recess 134 of valve 128. In this way, each of the movable parts 136, 138 is guided in rotation and centred on the lower half-shell 96 and the plate 142, which is itself fixed to the lower half-shell 96 via ears 150 crossed by studs 152 on the inner face of the lower half-shell 96 and thanks to the upper half-shell 98, whose peripheral edges 102b are fixed to the peripheral edges 102a of the lower half-shell 96. The lower ends 136a, 138a of the movable parts 136, 138 thus open through the lower half shell 96 and are thus accessible from the outer face of the lower half shell 96 as shown in
(48) The movable components 136, as shown in
(49) In the case of valve 138 in
(50) To pinch the tubing 36, 38, each movable member 136, 138 includes a spiral protrusion 160 around the rotation axis 136c, 138c of the movable member 136, 138. The radially outer surface of each protrusion 160 forms a support surface on a tubing 36, 38. Each protrusion 160 has a plane of symmetry in a plane perpendicular to the rotation axis 136c, 138c. Each tubing 36, 38 is partially housed in a rectilinear groove 162 with a semicircular section of the lower half-shell 96 and another part in a rectilinear groove 164 with a semicircular section of the plate 132 so as to pass through the periphery of a recess 134 of the plate 132 in a direction perpendicular to the rotation axis 136c, 138c of the moving part (
(51) Each annular bottom wall 14D of a recess of the plate 132 carries two stop members 166a, 166b projecting into the interior of the recess 134 and which are angularly spaced from each other. A cut-out 167 is formed in each annular bottom wall 140 of a recess 134 so as to delimit an elastic lamella 168 having a free end carrying a protrusion in the recess 134, this protrusion having a convex portion 171 to cooperate slidingly with moving parts 136, 138 (
(52) A semi-spherical cavity 176a, 176b is formed at the angular ends of each groove 170, 172 so as to form stopping positions of the movable member 136, 138 for one corresponding to the opening position where the fluid can flow and for the other corresponding to a closing position where the fluid cannot flow. It is also noted that each movable member 136, 138 includes a radial finger 178 extending laterally from the upper shoulder 146b and is in contact with the face of the flange 174 bearing the groove 172. Thus, in the flow blocking position through the pipes 36, 38, the movable member 136, 138 is positioned so that the protrusion 170 of the elastic lamella 168 is engaged in the cavity or recess 176a of the movable member 136, 138, the radial finger 178 of the movable member 136, 138 being arranged to stop in a counter-clockwise rotation, in
(53) It is easy to understand that the valves described above could well be used in other devices requiring devices to open/close the flow of a fluid through a manifold. Therefore, this description also includes any device integrating the valves described, such as for example a device comprising a plate 132 with a plurality of recesses 134 in which rotating parts are engaged.
(54) It would be possible to equip the cassette 16 and/or the incubator with automatic means of checking the correct positioning of cassette 16 in each of its first and second positions. For this purpose, a magnet could be placed inside the housing 90, on the inner side of the lower half-shell 96, this magnet cooperating with two Hall effect sensors appropriately positioned on the plate in relation to the first and second positions to be detected.
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(57) Prior to the process described below, the cell culture cassette 16 is filled with a cell culture medium using the lateral tubing 38. After filling, this pipe 39 is immediately sealed, for example by welding. The cell culture cassette 16 is then frozen flat, i.e. in a horizontal position, for storage and subsequent use.
(58) A first step in the process 182 is to capture and record culture parameter specific to the biological protocol using the computer system. The entry is made by an operator, the parameters entered being for example the identification of the patient, the identification of the cassette, etc. To facilitate the entry of these parameters, the computer system can be equipped with a bar code reader, the cassette can include a bar code that directly informs the computer system of the number and nature of the cassette. It is then entered by bar code reading or manual entry via the touch screen of the personal identification data indicated on the label of a container, such as a bag, about the cells to be cultured.
(59) In a second step 184, the computer system assigns a given incubator to the operator after checking the availability of the incubator according to a cell culture schedule. The operator installs the cell culture cassette 16 comprising a cell culture liquid in said designated incubator, the other incubators then being, preferably, inaccessible, i.e. doors 22, 30 of the other incubators 12 being locked.
(60) In a third step 186, the process consists in thawing the culture medium housed in the flexible bag of a culture cassette as described above. For this purpose, the cell culture cassette 16, hermetically sealed in a sterile protective envelope, is mounted in the second position on the incubator support and agitation device 52 designated by the computer system, i. e. on the support structure 84 (
(61) In a fourth step 188, after thawing, the cell culture cassette 16 is extracted from the incubator and the outer shell is removed in an area of adequate controlled activity.
(62) In a fifth step 190, cells of interest, excluding human embryonic stem cells, are injected into the cassette. For this purpose, manual valve 128 is positioned in the open position. It is recalled that tubing 36, 38 are equipped with anti-reflux means to prevent the liquid in bag 100 from flowing out. The cells are injected into bag 100 by means of tubing 38 then valve 128 is positioned in the closed position and tubing 38 is sealed with a tight cap.
(63) In a sixth step 192, cassette 16 filled with culture medium and cells of interest is mounted in its first position corresponding to the incubation position. The strip 34 is mounted in the opening 32 of door 22, the ends of the pipes 36 opposite the bag 100 extending into the opening 38 and being connected to the fluid circuit of the system shown in
(64) The process according to the invention then includes an incubation step 194 which can last several days and for example about ten days. Periodically, depending on the protocol parameters, the contents of bag 100 can be homogenized, by oscillating the tray 54 around axis 63 as explained above. This homogenization (duration, repetition frequency, amplitude) is determined by the parameters of the selected protocol.
(65) During the incubation step, the operator can take one or more samples 196 from bag 100 (
(66) To take a first sample, the computer system activates the mobile member 136 associated with its corresponding valve 130a in order to allow fluid to flow through the tubing 36a. When the sampling is carried out by the computer system, a final filling operation of tubing 36a is carried out in such a way as to guarantee asepsis and avoid any subsequent use of the sampling tubing already used. The second sampling is done in the same way but by using tubing 36b.
(67) After each sub-step of sampling 196 from bag 100, the operator may carry out analyses of the sample, the results of which may be entered and recorded in the computer system by the operator or automatically.
(68) In a final step of process 198, the computer system recovers or empties the contents of bag 100 of cassette 16.
(69) Finally, the contents of the bag undergo a purification and packaging step in sterile syringes for later use.
(70) The application also concerns a cell culture process, in particular the culture of mammalian cells, in particular human cells, excluding human embryonic stem cells.
(71) These cells, in particular human cells, excluding human embryonic stem cells, may advantageously be, or include, CD34+ (human) cells, in particular CD34+ (human) hematopoietic cells or CD34+ (human) non-hematopoietic cells. These CD34+ (human) cells may, for example, be cells from (human) peripheral blood, (human) umbilical cord or human tissue, particularly (human) peripheral blood.
(72) These cells, in particular human cells, excluding human embryonic stem cells, may advantageously be, or include, stem or progenitor cells, in particular multipotent or pluripotent cells.
(73) These cells are not, or do not include, human embryonic cells.
(74) These cells, in particular human cells, excluding human embryonic stem cells, may advantageously be, or include, human CD34+ (multipotent or pluripotent) stem cells or progenitors of peripheral blood mobilized by a growth factor such as G-CSF (Growth Colony Stimulating Factor).
(75) These cells, in particular human cells, excluding human embryonic stem cells, may be or have been collected from a human subject or patient (newborn, child, adolescent, adult or elderly). The invention is specially adapted to human CD34+ cells (multipotent or pluripotent) that can be collected from the peripheral blood of a human subject or patient. If the patient is to receive chemotherapy, these cells may have been collected before or at the beginning of the chemotherapy.
(76) A biological sample containing cells intended to be cultured (e. g. a sample of (human) blood, in particular a sample of (human) peripheral blood, (human) cord blood or human tissue, in particular a sample of human peripheral blood) is or has been collected from a human subject or patient.
(77) The means of this application have the advantage of not requiring the use of leukapheresis: a simple blood sample, for example a sample of 200 to 250 mL of blood, in particular 220 mL of blood, is sufficient to obtain a significant number of cells, in particular a number of cells that is sufficient for therapeutic and/or preventive treatment, more particularly for autologous or allogeneic cell therapy of a (human) subject or patient, more particularly for autologous cell therapy of the (human) subject or patient.
(78) This is particularly the case for human CD34+ cells intended for therapeutic and/or preventive treatment, more particularly for autologous or allogeneic cell therapy of the subject or patient, more particularly for autologous cell therapy of the subject or patient. Human CD34+ cells may be non-embryonic human CD34+ cells, excluding human embryonic stem cells. Human CD34+ cells are not or do not include embryonic CD34+ cells.
(79) The cell culture means of this application allow to obtain, from a small volume of blood (for example a sample of 200 to 250 mL of blood, in particular 220 mL of blood), a population of at least 10.sup.7, or at least 10.sup.8, cells comprising at least 70% of human (non-embryonic) CD34+ cells. In comparison, to obtain such a quantity of human CD34+ cells directly (without cell culture) from the blood of a single subject or patient, it would be necessary to treat a volume of 7 to 10 L of blood by leukapheresis.
(80) Cells that are intended for culture, in particular human (non-embryonic) CD34+ cells, may be purified or isolated from the biological sample collected, including a blood sample, in particular a peripheral blood sample (e.g. a sample of 200 to 250 mL of peripheral blood, in particular 220 mL of peripheral blood).
(81) Cells can be purified to reach a minimum level of a certain cell type. For example, they can be purified to include at least 70% or at least 80% or at least 85% or at least 90% of human (non-embryonic) CD34+ cells, particularly of human CD34+ hematopoietic (non-embryonic) cells.
(82) This isolation or purification can be done by any means known to any person skilled in the art.
(83) For example, for human CD34+ cells, excluding human embryonic stem cells, this isolation or purification may be done using a human anti-CD34 monoclonal antibody, for example the human murine anti-CD34 monoclonal antibody marketed as clone QBEnd-10 (code M7165) by DAKO DENMARK AS (Produktionsvej 42; DK-2600 Glostrup; Denmark). CD34+ (human) cell isolation or purification systems are also commercially available, for example, the ISOLEX 3001 magnetic cell separator marketed by BAXTER (Deerfield, IL, U.S.A.), or the CD34 microbead kit marketed by MILTENYI BIOTECH (2303 Lindbergh Street, Auburn, CA 95602, U.S.A.).
(84) Purified or isolated cells are placed on or in a culture medium whose composition is adapted to the multiplication of these cells. Examples of such culture media, including media suitable for the culture of human CD34+ cells, have been described above. For example, it may be a culture medium as described above, including a medium containing human insulin, human transferrin and human plasma or serum. This culture medium can be contained in the bag of the cassette of this application.
(85) The cells are then placed in incubation, for example by placing the bag, or the cassette containing the bag, in an incubator, including an incubator according to the present application. For example, the incubation time may be several days, in particular 8 to 10 days, in particular 9 days, in particular when it concerns a culture of human CD34+ cells, excluding human embryonic stem cells.
(86) The application also relates to cells, excluding human embryonic stem cells, a cell population comprising such cells, and a pharmaceutical composition comprising such cells or cell population.
(87) These cells or cell populations can be obtained by culture according to this application, as described above.
(88) In this application, cells may include, in particular, (human) CD34+ cells, excluding human embryonic stem cells, in particular (human) hematopoietic CD34+ cells or (human) non-hematopoietic CD34+ cells.
(89) These (human) CD34+ cells may, for example, be cells from (human) peripheral blood, (human) umbilical cord or human tissue, particularly (human) peripheral blood.
(90) These cells may advantageously be, or include, stem or progenitor cells, in particular multipotent or pluripotent cells, excluding human embryonic stem cells.
(91) These cells are not, or do not include, human embryonic cells.
(92) These cells may include, in particular, human CD34+ stem cells or progenitors (multipotent or pluripotent) from peripheral blood mobilized by a growth factor such as G-CSF (Growth Colony Stimulating Factor).
(93) The cells of this application, including the (human) CD34+ cells of the application, excluding human embryonic stem cells, may be in pure or isolated form, or may be included in a cell population.
(94) A cell population according to this application can thus be a population of non-embryonic human cells, which includes human CD34+ cells according to this application.
(95) In particular, cells according to the application may include (a population of) non-embryonic human cells, which are characterized in that: they number at least 10.sup.7 human cells, more particularly at least 10.sup.8, or at least 1.5.Math.10.sup.8, or from 10.sup.7 to 1.7.Math.10.sup.8 human cells, and they contain at least 70% human CD34+ cells (multipotent or pluripotent, and not embryonic), more particularly at least 80%, or at least 85% or at least 90% human CD34+ cells (multipotent or pluripotent, and not embryonic).
(96) These human cells may also all have the same HLA typing, particularly the same HLA-A, HLA-B, HLA-C and HLA-DR typing.
(97) For example, the cells according to this application may include (a population of) human non-embryonic hematopoietic cells, which are characterized in that: they number at least 10.sup.7 human hematopoietic cells, more particularly at least 10.sup.8, or at least 1.5.Math.10.sup.8, or from 10.sup.7 to 1.7.Math.10.sup.8 human hematopoietic cells, and they contain at least 70% human CD34+ cells (multipotent or pluripotent, and not embryonic), more particularly at least 80%, or at least 85% or at least 90% human CD34+ cells (multipotent or pluripotent, and not embryonic).
(98) These human hematopoietic cells may also all have the same HLA typing, particularly the same HLA-A, HLA-B, HLA-C and HLA-DR typing.
(99) The cells of this application may have one or more characteristics, which distinguish them from naive cells.
(100) The term “naive” in this context means that these are cells that have been directly obtained from a human subject or patient, and that may have been purified, but that have not been cultured.
(101) Indeed, it has been observed that after culture in accordance with this application (for example on a culture medium and/or in a bag or cassette as described above), the resulting human cell population differs from the naive population initially placed in culture, in one or more of the following ways: a larger average diameter (diameters of 11.2±0.5 μm, in particular 11.18±0.49 μm), a higher proportion of CD34− CD14+ cells (monocytes, which can have a positive impact on the effectiveness of a cell transplant), a higher proportion (but not 100%) of CD34+ CD33− cells (CD33 being the marker of the myeloid line), a smaller proportion (but still greater than 10%) of CD34+ CD133+ cells (marker of endothelial progenitors).
(102) In particular, the cells of this application may be human cells, excluding human embryonic stem cells, that have one or more of the following characteristics: 1/ they number at least 10.sup.7 human cells, more particularly at least 10.sup.8, or at least 1.5.Math.10.sup.8, or from 10.sup.7 to 1.7.Math.10.sup.8 human cells, 2/ they all have the same HLA typing, more particularly the same HLA-A, HLA-B, HLA-C and HLA-DR typing, 3/ they contain at least 70% human CD34+ cells (multipotent or pluripotent, and not embryonic), more particularly at least 80%, or at least 85% or at least 90% human CD34+ cells (multipotent or pluripotent, and not embryonic), 4/ they have a cell diameter of 11.2±0.5 μm, in particular 11.18±0.49 μm, 5/ they contain (human) CD34− CD14+ cells in a proportion of 1 to 12%, in particular from 2 to 10% or from 3.8 to 10%, 6/ they contain (human) CD34+ CD33− cells in a proportion of more than 10% or more than 20% or more than 25% (and advantageously less than 100%, in particular less than 60% or less than 50% or less than 40% or less than 35%), 7/ they contain (human) CD34+ CD133+ cells in a proportion of less than 60% or less than 50% (and advantageously more than 20%, in particular more than 25% or more than 30%).
(103) According to an embodiment, the cells of this application are human cells, excluding human embryonic stem cells, which have at least two of these seven characteristics, in particular at least three, or at least four, or at least five, or at least six of these seven characteristics, or have all seven characteristics.
(104) For example, the cells of this application may be human hematopoietic cells, which have one or more of the following characteristics: 1/ they number at least 10.sup.7 human hematopoietic cells, more particularly at least 10.sup.8, or at least 1.5.Math.10.sup.8, or from 10.sup.7 to 1.7.Math.10.sup.8 human hematopoietic cells, 2/ they all have the same HLA typing, more particularly the same HLA-A, HLA-B, HLA-C and HLA-DR typing, 3/ they contain at least 70% human CD34+ cells (multipotent or pluripotent, and not embryonic), more particularly at least 80%, or at least 85% or at least 90% human CD34+ cells (multipotent or pluripotent, and not embryonic), 4/ they have a cell diameter of 11.2±0.5 μm, in particular 11.18±0.49 μm, 5/ they contain (human) CD34− CD14+ cells in a proportion of 1 to 12%, in particular from 2 to 10% or from 3.8 to 10%, 6/ they contain (human) CD34+ CD33− cells in a proportion of more than 10% or more than 20% or more than 25% (and advantageously less than 100%, in particular less than 60% or less than 50% or less than 40% or less than 35%), 7/ they contain (human) CD34+ CD133+ cells in a proportion of less than 60% or less than 50% (and advantageously more than 20%, in particular more than 25% or more than 30%).
(105) According to an embodiment, the cells of this application are human hematopoietic cells, which have at least two of these seven characteristics, in particular at least three, or at least four, or at least five, or at least six of these seven characteristics or have all seven characteristics.
(106) In particular, the cells of this application may be human cells, excluding human embryonic stem cells, that have one or more of the following characteristics: 1/ they number at least 10.sup.7 human cells, more particularly at least 10.sup.8, or at least 1.5.Math.10.sup.8, or from 10.sup.7 to 1.7.Math.10.sup.8 human cells, 2/ they all have the same HLA typing, more particularly the same HLA-A, HLA-B, HLA-C and HLA-DR typing, 3/ they contain at least 70% human CD34+ cells (multipotent or pluripotent, and not embryonic), more particularly at least 80%, or at least 85% or at least 90% human CD34+ cells (multipotent or pluripotent, and not embryonic), 4/ they have a cell diameter of 11.2±0.5 μm, in particular 11.18±0.49 μm, 5/ they contain (human) CD34− CD14+ cells in a proportion of 1 to 12%, in particular from 2 to 10% or from 3.8 to 10%.
(107) According to an embodiment, the cells of this application are human cells, excluding human embryonic stem cells, which have at least two of these five characteristics, in particular at least three, or at least four of these five characteristics, or all five characteristics.
(108) For example, the cells of this application may be human hematopoietic cells, which have one or more of the following characteristics: 1/ they number at least 10.sup.7 human hematopoietic cells, more particularly at least 10.sup.8, or at least 1.5.Math.10.sup.8, or from 10.sup.7 to 1.7.Math.10.sup.8 human hematopoietic cells, 2/ they all have the same HLA typing, more particularly the same HLA-A, HLA-B, HLA-C and HLA-DR typing, 3/ they contain at least 70% human CD34+ cells (multipotent or pluripotent, and not embryonic), more particularly at least 80%, or at least 85% or at least 90% human CD34+ cells (multipotent or pluripotent, and not embryonic), 4/ they have a cell diameter of 11.2±0.5 μm, in particular 11.18±0.49 μm, 5/ they contain (human) CD34− CD14+ cells in a proportion of 1 to 12%, in particular from 2 to 10% or from 3.8 to 10%.
(109) According to an embodiment, the cells of this application are human hematopoietic cells, which have at least two of these five characteristics, in particular at least three, or at least four of these five characteristics, or all five characteristics.
(110) In particular, the cells of this application may be human cells, excluding human embryonic stem cells, which have the following characteristics: they number at least 10.sup.7 human cells, more particularly at least 10.sup.8, or at least 1.5.Math.10.sup.8, or from 10.sup.7 to 1.7.Math.10.sup.8 human cells, and they comprise at least 70% human CD34+ cells (multipotent or pluripotent, and non-embryonic), more particularly at least 80%, or at least 85% or at least 90% human CD34+ cells (multipotent or pluripotent, and non-embryonic), and which also have at least one or both of the following characteristics: they have a cell diameter of 11.2±0.5 μm, in particular 11.18±0.49 μm, they contain (human) CD34− CD14+ cells in a proportion of 1 to 12%, in particular from 2 to 10% or from 3.8 to 10%.
(111) For example, the cells of this application may be human hematopoietic cells, which have the following characteristics: they number at least 10.sup.7 human hematopoietic cells, more particularly at least 10.sup.8, or at least 1.5.Math.10.sup.8, or from 10.sup.7 to 1.7.Math.10.sup.8 human hematopoietic cells, and they contain at least 70% human CD34+ cells (multipotent or pluripotent, and not embryonic), more particularly at least 80%, or at least 85% or at least 90% human CD34+ cells (multipotent or pluripotent, and not embryonic),
(112) and which also have at least one (or both) of the following characteristics: they have a cell diameter of 11.2±0.5 μm, in particular 11.18±0.49 μm, they contain (human) CD34− CD14+ cells in a proportion of 1 to 12%, in particular from 2 to 10% or from 3.8 to 10%.
(113) Cells in this population may all have the same HLA-A, HLA-B, HLA-C and HLA-DR typing.
(114) Cells in this population may also include: (Human) CD34+ CD33− cells in a proportion of more than 10% or more than 20% or more than 25% (and advantageously less than 100%, in particular less than 60% or less than 50% or less than 40% or less than 35%), (Human) CD34+ CD133+ cells in a proportion of less than 60% or less than 50% (and advantageously more than 20%, in particular more than 25% or more than 30% CD34+ CD133+ cells).
(115) Alternatively or in addition, the cells of this application may have one or more characteristics identical (or not significantly different) to those of naïve cells, in particular naïve human cells, in particular naïve human hematopoietic cells.
(116) Indeed, it has been observed that after culture in accordance with the application (e.g. on a culture medium and/or in a cassette bag as described above), the resulting human cell population (including the resulting human hematopoietic cell population) may have characteristics common to those of the naive (hematopoietic) cell population initially placed in culture.
(117) In particular, the cells of this application may be cells (including hematopoietic cells), which, compared to naïve cells (including naïve hematopoietic cells), and more particularly compared to (naïve) cells initially placed in culture, have one or more of the following characteristics: 1/ the same number or proportion (or not significantly different) of CD34 epitopes, 2/ an identical (or not significantly different) ability to divide, in particular an identical relative length of the telomer (or not significantly different), 3/ the same absence of chromosomal anomalies and polyploidy (or the same chromosomal anomalies or polyploidy, in the same proportions), 4/ identical (or not significantly different) viability, in particular identical (or not significantly different) CD34+ cell viability, for example at least 90% or at least 95% CD34+ cell viability, 5/ an identical (or not significantly different) proportion of CD34− CD2+/CD3+ cells, 6/ an identical (or not significantly different) proportion of CD34− CD19+/CD20+ cells, 7/ an identical (or not significantly different) proportion of CD34− CD56+ cells, 8/ an identical (or not significantly different) proportion of CD34− CD15+ cells.
(118) According to a further embodiment, the cells of this application have at least two, or at least three, or at least four, or at least five, or at least six, or at least seven of these eight characteristics, or have all eight characteristics.
(119) In particular, the cells of this application may be cells (including hematopoietic cells), which, compared to naïve (hematopoietic) cells, in particular compared to initially cultured (naïve) cells, have one or more of the following characteristics: 1/ the same number or proportion (or not significantly different) of CD34 epitopes, 2/ an identical (or not significantly different) ability to divide, in particular an identical relative length of the telomer (or not significantly different), 3/ the same absence of chromosomal anomalies and polyploidy (or the same chromosomal anomalies or polyploidy, in the same proportions).
(120) According to a further embodiment, the cells of this application have at least two of these three characteristics, or all three.
(121) This application explicitly includes any combination of cell characteristics among those described her, including the combination of: characteristics that differ cells of this application from naive cells, and from characteristics that are identical to those of naive cells.
(122) The means of cell culture of this application correspond essentially to means of ex vivo cell amplification. It has the advantage of providing a significant number (more particularly a therapeutically sufficient number) of autologous or allogeneic cells, in particular autologous cells (more particularly autologous or allogeneic CD34+ cells, more particularly autologous CD34+ cells) from a small sample of peripheral blood from a patient or subject, without introducing harmful modifications in these cells.
(123) Table 1 below provides an illustration of the characteristics of a population of cells obtained from the peripheral blood of a cohort of healthy human volunteers before and after implementation of a culture in a culture bag in accordance with this application (9-day culture on IMDM medium supplemented with glutamine and free of fibroblasts, and containing 0.01 mg/mL insulin, 330 pg/ml transferrin, and 5% (VN) human serum, from cells isolated by sedimentation and purified by immuno-affinity on anti-CD34 magnetic beads):
(124) TABLE-US-00001 TABLE 1 CD34+ cell population Cohort of 71 Example of popula- Male healthy human tion obtained after volunteers cultivation in between 21 and 57 accordance with years of age the application Biological sample = Naive population (average value 220 ml of peripheral (as obtained without per patient, after blood per patient cell culture) cell culture) Number of CD34+ From 5.1 .Math. 10.sup.6 From 1 .Math. 10.sup.7 cells to 40.9 .Math. 10.sup.6 to 1.7 .Math. 10.sup.8 Viability of CD34+ More than 95% More than 95% cells Cellular diameter of .sup. 8.8 ± 0.1 μm 11.18 ± 0.49 μm CD34+ Percentage of CD34+ At least 70% At least 70% Cells (or at least 80%, (or at least 80%, (after purification) or at least 85%, or at least 85%, or at least 90%) or at least 90%) CD34− cells From 0.2 to 0.8% From 3.8 to 10% CD14+ CD34+ Cells 4.2% 33% CD33− CD34+ CD133+ Cells 75.8% 44.5% Number of CD34+ 14 804 ± 2 294 .sup. 15 363 ± 2 730 .sup. epitopes per cell Relative length 9.17 ± 1.32% 8.35 ± 2.07% of telomeres Chromosomal none none anomaly Polyploidy none none CD34− From 0 to 0.3% From 0 to 1% CD2+/CD3+ cells CD34−C19+/CD20+ From 0 to 0.6% From 0.1 to 1% cells CD34− CD56+ 0% From 0 to 1% cells CD34− CD15+ From 2 to 5.8% From 2.5 to 5% cells * Values from a cohort of 8 volunteers.
(125) Once the culture is complete, the obtained cells, especially the (human) CD34+ cells obtained, can be collected.
(126) The collected cells can be purified or isolated, more particularly purified. In particular, CD34+ cells can be purified, for example by using the means of purification available to the person skilled in the art as indicated above.
(127) The collected and possibly purified cells may be placed in a composition, in particular a pharmaceutical composition, in particular a liquid pharmaceutical composition, for example a non-toxic and isotonic pharmaceutical solution for humans. The resulting composition or solution is a subject of the application.
(128) The composition may include a physiologically acceptable vehicle for humans.
(129) The composition can be formulated to be administrable, more particularly injectable, to or in a human being. It can therefore be liquid and include compounds that are non-toxic to humans, preferably non-toxic compounds at an isotonic concentration for humans.
(130) Thus, in addition to cells, the composition may for example include a buffer solution that is non-toxic to humans, such as a saline phosphate buffer solution (Phosphate Buffer Saline or PBS), or a gluconate and/or acetate buffer solution.
(131) The composition may also include at least one additive that is not toxic to humans, such as a protein from human serum or human plasma, including human serum albumin (HSA).
(132) The composition or solution of the application can be stored until use, for example by cold storage (freezing).
(133) The means of the application may be used for cellular treatment (therapeutic and/or preventive), in particular for autologous or allogeneic cell treatment, advantageously autologous cell treatment.
(134) This cellular treatment may include administration to a patient or subject: Of cells of the application, in particular human cells containing CD34+ cells, excluding human embryonic stem cells, as described above, or a pharmaceutical composition or solution containing these cells.
(135) This patient or subject may be the same as the one from whom the cells were initially collected for cell culture (autologous cell treatment or therapy). Alternatively, this patient or subject may be different from the one from whom the cells were initially collected for cell culture (allogeneic cell treatment or therapy).
(136) Cellular treatment, more particularly autologous or allogeneic (in particular autologous) cell treatment, may include the treatment or prevention of heart failure or non-cardiac diseases.
(137) Heart failure can be, in particular: heart failure, which includes ventricular failure, particularly left ventricular failure, especially heart failure with impaired systolic function, more particularly cardiac failure with alteration of the contractile function of a ventricle, particularly the left ventricle, more specifically, heart failure with increased telesystolic volume associated with a decrease in Left Ventricular Ejection Fraction (LVEF).
(138) This may include heart failure of level II or higher according to the New York Heart Association (NYHA) classification [The Criteria Committee of the New York Heart Association]. 1994. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. .sup.(9th edition). Boston: Little, Brown & Co., pages 253-256], particularly level II or higher heart failure (according to NYHA classification) which is induced by mitral regurgitation.
(139) Heart failure can include heart failure induced by high blood pressure, valve damage, a congenital disease, refractory angina pectoris (for example, angina pectoris refractory to treatment with Enhanced Extracorporeal CounterPulse (EECCP) or neurostimulation treatment (in particular Transcutaneous NeuroStimulation (TNS) or Spinal Cord Stimulation (SMS), or chelation treatment (in particular EDTA administration treatment), cardiomyopathy, in particular ischemic cardiomyopathy, in particular myocardial infarction, in particular acute myocardial infarction, dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). Heart failure may include heart failure induced by cardiomyopathy, in particular by ischemic cardiomyopathy, in particular myocardial infarction, in particular acute myocardial infarction, dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic Right Ventricular Cardiomyopathy (ARVC).
(140) Heart failure may include heart failure induced by cardiomyopathy, in particular ischemic cardiomyopathy, in particular myocardial infarction, in particular acute myocardial infarction.
(141) Heart failure can be treated or prevented, in particular by reducing or even eliminating heart failure and/or limiting the development of heart failure.
(142) Heart failure induced by ischemic cardiomyopathy, in particular myocardial infarction, in particular acute myocardial infarction, can be treated or prevented by reducing or eliminating this heart failure and/or limiting the development of this heart failure.
(143) Indeed, the cells (in particular CD34+ cells) obtained by culture in accordance with this application and possibly by purification, or a pharmaceutical composition or solution containing these cells, may be used for one or more of the following purposes: reduce or even eliminate post-ischemic myocardial damage, including post-infarction necrosis and/or post-infarction scar size, partially or completely regenerate the structure and/or revascularize the myocardium or infarcted area, improve or restore ventricular function, in particular left ventricular function, in particular ventricular contractility, in particular left ventricular contractility, for example to reduce telesystolic volume in combination with an increase in the left ventricular ejection fraction (LVEF) (in particular to achieve an LVEF of more than 45%).
(144) More specifically, the treatment or prevention of heart failure induced by (acute) myocardial infarction, more particularly (acute) myocardial infarction due to coronary heart disease or heart attack, is targeted. This use is more particularly intended for: patients with impaired left ventricular function or contractility, and patients have an acute myocardial infarction occurring de novo after a first incident or cardiac syndrome (this first incident or cardiac syndrome may have resulted in stent implantation(s) and percutaneous transluminal coronary angioplasty (PTCA), and/or coronary artery bypass graft surgery (CABG), and who at least 10 days after this first cardiac incident (for example, at least 3 months or at least 6 months after this first cardiac incident or syndrome) have a Left Ventricular Ejection Fraction (LVEF) of 45% or less.
(145) The administration of the cells, of cells or of a pharmaceutical composition or solution of the application may, for example, be carried out within a few weeks, in particular 3 to 6 weeks after an ischemic accident.
(146) The treatment or prevention of heart failure may include cellular cardiomyoplasty (by implanting the cells administered in the infarcted heart zone).
(147) Such treatment or prevention may include administering a population of cells according to this application (including a population of human cells including CD34+ cells, excluding human embryonic stem cells), of cells (including human CD34+ cells, excluding human embryonic stem cells) according to this application, or a composition or solution according to this application, by injecting them by surgery or catheter.
(148) Surgical injection can be an injection directly into the infarcted area, for example, during Coronary Artery Bypass Graft Surgery (CABG).
(149) Catheter injection may include percutaneous transfemoral injection.
(150) The catheter may include an intracoronary, epicardial or transendocardial injection or infusion catheter.
(151) For example, the injection or infusion catheter can be equipped with a helix needle such as the HELIX® catheter marketed by BIOCARDIA® (125 Shoreway Road, Suite B, San Carlos, CA 94070, U.S.A.), which can be coupled to a 2-dimensional (2D) guidance system such as a 2D fluoroscopic guidance system.
(152) The injection or infusion catheter may be, for example, the MYOSTAR® catheter marketed by BIOSENSE WEBSTER, INC. (15715 Arrow Highway; Irwindale; Calif. 91706; U.S.A.).
(153) The injection or infusion catheter can, for example, be coupled to a 3-dimensional (3D) guidance system such as the NOGA® XP electromagnetic 3D cardiac mapping system marketed by BIOLOGICS DELIVERY SYSTEMS GROUP (CORDIS Corp., Diamond Bar, CA U.S.A.).
(154) One or more chemokines, in particular one or more chemokines of the CXC family, in particular the chemokine CXCL12 (Stromal cell-Derived Factor-1 or SDF-1), may be administered, more particularly injected into the patient or subject. Such administration or injection may be simultaneous, joint or delayed in time with respect to the administration, more particularly the injection, of a population of cells according to the application (including a population of human cells including CD34+ cells, excluding human embryonic stem cells), of cells (including human CD34+, excluding human embryonic stem cells) of the application, or a composition or solution of the application.
(155) The uses of the means of the application are not limited to the treatment or prevention of cardiac failure induced by ischemic cardiomyopathy, or cardiac failure induced by chemotherapeutic treatment. The means of the application (in particular the CD34+ means of the application) can alternatively be used to treat or prevent non-cardiac diseases.
(156) It may be a non-cardiac condition, which is not induced by cardiac intervention.
(157) The means of the application can be used to treat myelosuppression, including myelosuppression induced by the treatment of lymphoma, particularly non-Hodgkin's lymphoma, Hodgkin's lymphoma, chronic lymphoid leukaemia. The means of the application may then be used to implant hematopoietic cells (autologous or from another subject), including a population of hematopoietic cells (autologous or allogeneic) containing CD34+ cells, into the patient's bone marrow, by intravenous implantation, as described above. The implanted cells are then used to regenerate the patient's bone marrow.
(158) The means of the application can alternatively be used to treat or prevent a pathology inducing cartilage degeneration, such as osteoarthritis. The means of the application can then be used to implant cells (autologous or from another subject) according to the application into the patient, particularly in the arthritic area, including a population of cells including CD34+ cells, as described above. The implanted cells are then used to regenerate the patient's cartilage.
(159) The means of the application may alternatively be used to treat or prevent hepatic insufficiency, in particular chronic hepatic insufficiency, in particular chronic non-alcoholic hepatic insufficiency (for example to prevent the development of hepatocellular carcinoma). The means of the application may then be used to implant cells (autologous or from another subject) according to the application into the patient, particularly in the hepatic zone, including a population of cells (autologous) including CD34+ cells, as described above. The implanted cells are then used to regenerate the patient's liver.
(160) The term “including”, with which “including” or “containing” is synonymous, is an open term, and does not exclude the presence of one or more additional element(s), ingredient(s) or method step(s) that would not be explicitly indicated, while the term “consisting” or “constituted” is a closed term, which excludes the presence of any other additional element, step, or ingredient that is not explicitly stated. The term “consisting essentially” or “essentially constituted” is a partially open term, which does not exclude the presence of one or more additional element(s), ingredient(s) or step(s), insofar as such additional element(s), ingredient(s) or step(s) do not materially affect the basic properties of the invention.
(161) Therefore, the term “including” (or “includes”) includes the terms “consisting”, “constituted”, as well as the terms “essentially consisting” and “essentially constituted”.