CANNABIDIOL ADJUVANT THERAPY FOR TREATMENT OF DISC DEGENERATIVE DISEASE

Abstract

Disclosed is the utilization of cannabidiol, either through systemic and/or local administration, for use as an adjuvant in treatments of disc degenerative disease. In some embodiments, cannabidiol is utilized to enhance therapeutic and/or regenerative activities of fibroblasts. In other embodiments, cannabidiol is utilized to augment reparative effects of other regenerative cells including monocytes, mesenchymal stem cells, and/or hematopoietic stem cells. In some embodiments cannabidiol is utilized in the culture media of regenerative cells prior to administration of said cells.

Claims

1. A method of treating a degenerative disc disease in an individual, comprising administering cannabidiol and at least one therapeutic intervention for a degenerative disc disease to an individual.

2. The method of claim 1, wherein the cannabidiol and the therapeutic intervention are administered to the individual at the same time or at different times.

3. The method of claim 2, wherein the cannabidiol is administered before, during, or after the administration of the therapeutic intervention.

4. The method of any one of claims 1-3, wherein the therapeutic intervention for a degenerative disc disease comprises a therapeutically effective amount of fibroblast cells.

5. The method of any one of claims 1-4, wherein the therapeutic intervention for a degenerative disc disease comprises fibroblast cells differentiated into notochord cells, chondrocyte cells, or a mixture thereof.

6. The method of any one of claims 4-5, wherein the fibroblast cells are from one or more tissues selected from the group consisting of adipose tissue, dermal tissue, bone marrow, peripheral blood, Wharton's Jelly, placenta, omentum, mobilized peripheral blood, and a combination thereof.

7. The method of any one of claims 4-6, wherein the fibroblasts cells are from dermal tissue.

8. The method of any one of claims 1-7, wherein the cannabidiol is administered systemically.

9. The method of any one of claims 1-7, wherein the cannabidiol is administered locally into a disc of the individual.

10. The method of any one of claims 1-9, wherein the cannabidiol is administered at a dosage and frequency sufficient to reduce apoptosis of cells in the nucleus pulposus.

11. The method of claim 10, wherein the cells in the nucleus pulposus are selected from the group consisting of chondrocytes, notochord cells, notochord progenitor cells, chondrocyte progenitor cells, and a combination thereof.

12. The method of claim 10, wherein the cells in the nucleus pulposus comprise exogenously administered cells.

13. The method of claim 10, wherein the cells in the nucleus pulposus comprise the therapeutic intervention for a degenerative disc disease.

14. The method of any one of claims 1-13, wherein the therapeutic intervention for a degenerative disc disease comprises a therapeutically effective amount of fibroblast cells, fibroblast cells differentiated into notochord cells, fibroblast cells differentiated into chondrocyte cells, or a combination thereof.

15. The method of claim 12, wherein said exogenously administered cells are fibroblast regenerative cells.

16. The method of any one of claims 4-15, wherein the fibroblasts are proliferating at a rate of 14-21 hours per cell multiplication.

17. The method of any one of claims 4-16, wherein the fibroblasts secrete 0.1 pg-77 pg of interleukin 1 per culture of 1 million fibroblasts at 75% confluence on a surface.

18. The method of any one of claims 4-16, wherein the fibroblasts secrete 1 pg-500 pg of interleukin FGF-1 per culture of 1 million fibroblasts at 75% confluence on a surface.

19. The method of any one of claims 4-18, wherein the fibroblasts decrease ability of responding T cells to proliferate in a mixed lymphocyte reaction.

20. The method of claim 19, wherein said decrease in proliferation comprises a decrease of more than 20% as compared to a control mixed lymphocyte reaction in which fibroblasts are not added.

21. The method of any one of claims 4-20, wherein the fibroblasts are treated with human chorionic gonadatropin (hCG) to augment immune modulatory activity.

22. The method of claim 21, wherein said hCG is administered to cells at a concentration of 1 nM to 1 μM.

23. The method of claim 21, wherein said hCG is administered to cells at a concentration of 10 nM to 100 nM.

24. The method of any one of claims 4-23, wherein said fibroblasts are treated with oxytocin to augment immune modulatory activity.

25. The method of claim 24, wherein said oxytocin is administered to cells at a concentration of 1 nM to 10 μM.

26. The method of claim 24, wherein the oxytocin is administered to cells at a concentration of 100 nM to 1 μM.

27. The method of any one of claims 1-26, wherein the cannabidiol comprises (−)-cannabidiol.

28. The method of any one of claims 1-26, wherein the cannabidiol consist of (−)-cannabidiol.

29. The method of any one of claims 1-28, wherein the effective amount of cannabidiol is between about 50 mg and about 500 mg total daily.

30. The method of any one of claims 1-29, wherein the cannabidiol comprises a gel formulation.

31. The method of claim 30, wherein the gel formulation comprises a permeation-enhanced gel.

32. The method of any one of claims 1-31, wherein administering the cannabidiol and/or therapeutic intervention comprises administering a single daily dose to the individual.

33. The method of any one of claims 1-31, wherein administering the cannabidiol and/or therapeutic intervention comprises administering two daily doses to the individual.

34. The method of any one of claims 1-33, wherein administering the cannabidiol and/or therapeutic intervention comprises transdermally administering the cannabidiol to the individual.

35. The method of any one of claims 1-34, wherein administering the cannabidiol comprises intradiscally administering the cannabidiol to the individual.

36. The method of any one of claims 1-35, wherein said cannabidiol is administered together with a localization composition.

37. The method of claim 36, wherein said localization composition comprises an extracellular matrix that can act to provide sustained release.

38. The method of claim 37, wherein said extracellular matrix is hyaluronic acid.

39. The method of claim 38, wherein said hyaluronic acid is comprised of long chained hyaluronic acid molecules.

40. A method of augmenting regenerative activity of fibroblasts, comprising contacting the fibroblasts with an effective amount of cannabidiol.

41. The method of claim 40, wherein augmenting regenerative activity comprises augmenting production of IGF-1.

42. The method of claim 40 or 41, wherein augmenting regenerative activity comprises augmenting production of EGF-1.

43. The method of anyone of claims 40-42, wherein the cannabidiol comprises (−)-cannabidiol.

44. The method of anyone of claims 40-42, wherein the cannabidiol consists of (−)-cannabidiol.

45. The method of any one of claims 40-44, further comprising the step of providing an effective amount of the fibroblasts contacted with cannabidiol to an individual in need thereof.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0017] For a more complete understanding of the present disclosure, reference is now made to the following descriptions taken in conjunction with the accompanying drawing, in which:

[0018] FIG. 1 shows stimulation of IGF-1 from fibroblasts by CBD at various concentrations. In the groupings of three bars, the middle bar at each concentration represents 100,000 fibroblasts co-cultured with CBD at the indicated concentration. The right bar at each concentration represents 200,000 fibroblasts co-cultured with CBD at the indicated concentration. The left bar at each concentration represents 0 fibroblasts co-cultured with CBD at the indicated concentration;

[0019] FIG. 2 shows stimulation of EGF-1 from fibroblasts by CBD at various concentrations. In the groupings of three bars, the middle bar at each concentration represents 100,000 fibroblasts co-cultured with CBD at the indicated concentration. The right bar at each concentration represents 200,000 fibroblasts co-cultured with CBD at the indicated concentration. The left bar at each concentration represents 0 fibroblasts co-cultured with CBD at the indicated concentration.

DETAILED DESCRIPTION

[0020] In keeping with long-standing patent law convention, the words “a” and “an” when used in the present specification in concert with the word comprising, including the claims, denote “one or more.” Some embodiments of the disclosure may consist of or consist essentially of one or more elements, method steps, and/or methods of the disclosure. It is contemplated that any method or composition described herein can be implemented with respect to any other method or composition described herein and that different embodiments may be combined.

[0021] Throughout this specification, unless the context requires otherwise, the words “comprise”, “comprises” and “comprising” will be understood to imply the inclusion of a stated step or element or group of steps or elements but not the exclusion of any other step or element or group of steps or elements. By “consisting of” is meant including, and limited to, whatever follows the phrase “consisting of.” Thus, the phrase “consisting of” indicates that the listed elements are required or mandatory, and that no other elements may be present. By “consisting essentially of” is meant including any elements listed after the phrase, and limited to other elements that do not interfere with or contribute to the activity or action specified in the disclosure for the listed elements. Thus, the phrase “consisting essentially of” indicates that the listed elements are required or mandatory, but that no other elements are optional and may or may not be present depending upon whether or not they affect the activity or action of the listed elements.

[0022] Reference throughout this specification to “one embodiment,” “an embodiment,” “a particular embodiment,” “a related embodiment,” “a certain embodiment,” “an additional embodiment,” or “a further embodiment” or combinations thereof means that a particular feature, structure or characteristic described in connection with the embodiment is included in at least one embodiment of the present invention. Thus, the appearances of the foregoing phrases in various places throughout this specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments.

I. Cannabidiol

[0023] As used herein, “cannabidiol” or “CBD” refers to cannabidiol; cannabidiol prodrugs; pharmaceutically acceptable derivatives of cannabidiol, including pharmaceutically acceptable salts of cannabidiol, cannabidiol prodrugs, and cannabidiol derivatives. CBD includes, 2-[3-methyl-6-(1-methylethenyl)-2-cyclohexen-1-yl]-5-pentyl-1,3-benzenediol as well as to pharmaceutically acceptable salts, solvates, metabolites (e.g., cutaneous metabolites), and metabolic precursors thereof. The synthesis of CBD is described, for example, in Petilka et al., Helv. Chim. Acta, 52:1102 (1969) and in Mechoulam et al., J. Am. Chem. Soc., 87:3273 (1965), which are hereby incorporated by reference.

[0024] Certain embodiments of the disclosure concern the use of cannabidiol (CBD), including as an adjuvant to regenerative cell activity or regenerative cell therapy. In particular embodiments, cannabidiol is administered together with regenerative cells for the treatment of disc degeneration or a degenerative disc disease. Administration of cannabidiol may be performed systemically and/or locally. In some embodiments, CBD is utilized to activate regenerative cells in vitro or ex vivo prior to implantation. In particular embodiments, CBD is administered systemically, which may increase suitability of the microenvironment for sustaining regenerative cell activity, suppress inflammation, and/or directly stimulate regenerative cells to perform healing functions.

[0025] The CBD may or may not be synthetic CBD. The CBD may be purified CBD. The CBD may be botanically derived. CBD may be administered transdermally on the subject's upper arm and shoulder. In some embodiments, the CBD is administered transdermally on the subject's thigh or back. The CBD may be administered directly to a disc, whether or not it is showing signs of degeneration. Locally administering an effective amount of cannabidiol (CBD) in specific cases can reduce an intensity of at least one adverse event or side effect relative to orally administering CBD. The at least one adverse event or side effect may be a gastrointestinal (GI) adverse event. The at least one adverse event or side effect can be an adverse event or side effect affecting liver function. In some embodiments, the at least one adverse event is somnolence. In some embodiments, the frequency and intensity of somnolence is reduced as an adverse event by transdermal administration.

[0026] In some embodiments, the CBD comprises or consists of (−)-CBD. An effective amount, such as a therapeutically effective amount, of CBD may be between about 50 mg to about 500 mg daily. In some embodiments, the effective amount of CBD, which may be administered to an individual, is initiated at about 50 mg daily and titrated up to about 500 mg daily. In some embodiments, the effective amount of CBD, which may be administered to an individual, initiated at about 50 mg daily and titrated up to about 250 mg daily. In some embodiments, the effective amount of CBD, which may be administered to an individual, is initiated at 250 mg daily. In some embodiments, the effective amount of CBD, which may be administered to an individual, is initiated at 500 mg daily. In some embodiments, the 500 mg daily dose is administered to patients that weigh greater than 35 kg. The CBD may be administered at a frequency useful for a therapeutic effect, including in a single daily dose or in two daily doses. In some embodiments, the effective amount of CBD can be 390 mg in divided daily doses.

[0027] As used herein, the term “transdermally” when in the context of administration, refers to contacting the CBD with the patient's or subject's skin under conditions effective for the CBD to penetrate the skin. In particular embodiments, the CBD is formulated as a gel or an oil. In some embodiments, the CBD is formulated as a permeation-enhanced gel. The gel may contain between 1% (wt/wt) CBD to 7.5% (wt/wt) CBD. In some embodiments, the gel contains 4.2% (wt/wt) CBD. In some embodiments, the gel contains 7.5% (wt/wt) CBD. In some embodiments, the transdermal preparation can be a cream, a salve or an ointment. The CBD can be delivered by a bandage, pad or patch. The CBD can be in a gel form and can be pharmaceutically-produced as a clear, permeation-enhanced gel that is designed to provide controlled drug delivery transdermally with once- or twice-daily dosing. The CBD gel can between 1% (wt/wt) CBD to 7.5% (wt/wt) CBD, or any range derivable therein. The CBD gel can have, for example, 4.2% (wt/wt) CBD or 7.5% (wt/wt) CBD). The CBD gel can be applied topically by the patient or caregiver to the patient's upper arm and shoulder, back, thigh, or any combination thereof. The CBD gel can include diluents and carriers as well as other conventional excipients, such as wetting agents, preservatives, and suspending and dispersing agents.

[0028] The CBD gel can comprise a solubilizing agent, a permeation enhancer, a solubilizer, antioxidant, bulking agent, thickening agent, and/or a pH modifier. The composition of the CBD gel can be, for example, cannabidiol present in an amount of about 0.1% to about 20% (wt/wt) of the composition; a lower alcohol having between 1 and 6 carbon atoms present in an amount of about 15% to about 95% (wt/wt) of the composition; a first penetration enhancer present in an amount of about 0.1% to about 20% (wt/wt) of the composition; and water in a quantity sufficient for the composition to total 100% (wt/wt). Other formulations of the CBD gel can be found in International Publication No. WO 2010/127033, the entire contents of which are incorporated herein by reference.

[0029] In some embodiments, a cannabinoid, such as cannabidiol or a prodrug of cannabidiol, is delivered systemically to achieve therapeutically effective plasma concentrations in an individual. However, cannabinoid oral dosage forms, including those comprising cannabidiol, must overcome several obstacles in order to achieve a therapeutically-effective systemic concentration. First, cannabinoids are generally highly lipophilic. Their limited water solubility thereby restricts the amount of cannabinoid available for absorption in the gastrointestinal tract. Second, cannabidiol, as with the other cannabinoids, undergoes substantial first-pass metabolism when absorbed from the human gastrointestinal tract. Finally, the oral bioavailability of any product is further diminished when a patient suffers from nausea or emesis, as either the patient avoids taking his oral medications or the oral dosage form does not remain in the gastrointestinal tract for a sufficient period of time to release the entire dose and achieve a therapeutic concentration. Therefore, in view of the foregoing, it would be desirable to systemically deliver therapeutically effective amounts of a cannabinoid, such as cannabidiol or cannabidiol prodrug, to a mammal in need thereof for the treatment of one or more medical conditions responsive to cannabinoids, including pain, degenerative disc disease, nausea or appetite stimulation, by a route of administration that does not depend upon absorption from the gastrointestinal tract of the mammal.

[0030] One non-oral route of administration for the systemic delivery of cannabidiol is transdermal administration. In addition, the epidermis and dermis of many mammals, such as humans and guinea pigs, contains enzymes which are capable of metabolizing active pharmaceutical agents which pass through the stratum corneum. The metabolic process occurring in the skin of mammals, such as humans, can be utilized to deliver pharmaceutically effective quantities of a cannabinoid, such as cannabidiol, to the systemic circulation of a mammal in need thereof. Encompassed herein are prodrugs of cannabinoids, such as cannabidiol prodrugs, and compositions comprising prodrugs of cannabinoids that can be transdermally administered to a mammal, such as a human, so that the metabolic product resulting from metabolism in the skin is the cannabinoid which is systemically available for the treatment of a medical condition responsive to cannabinoid. Unfortunately, due to its highly lipophilic nature, cannabidiol is poorly absorbed through membranes such as the skin of mammals, including humans. Therefore, the success of transdermally administering therapeutically effective quantities of cannabidiol to a mammal in need thereof within a reasonable time frame and over a suitable surface area has been substantially limited.

[0031] In some embodiments, cannabidiol is administered to an individual locally, for example, administered to a disc of the individual. The cannabidiol may be administered locally to the individual at any dosage and frequency, including dosages and frequencies encompassed herein. The locally-administered cannabidiol may be administered with one or more other compositions, including the cellular therapies encompassed herein. In some embodiments, the cannabidiol administered to a disc in the individual reduces apoptosis of cells comprising the disc of the individual. The cells comprising the disc may be endogenous (including notochord cells, notochord progenitor cells, chondrocytes, and/or chondrocyte progenitor cells) and/or exogenous cells, including exogenous cells comprising any cellular therapy administered to the individual.

[0032] In some embodiments, administration of cannabidiol to an individual are performed together with other agents that inhibit inflammation. In one embodiment, administration of interleukin-1 (IL-1) receptor antagonist, including as a protein, a gene, and/or a mRNA, is performed to reducing some aspects of inflammation, which synergizes unexpectedly with administration of cannabidiol.

[0033] In some embodiments, cannabidiol or cannabidiol with one or more therapeutic interventions for a degenerative disc disease is administered with a localization composition. The localization composition may be one or more extracellular matrix molecules, including hyaluronic acid and/or long chained hyaluronic acid.

[0034] In some embodiments, cannabidiol is contacted with, cultured with, or administered to cells such as fibroblasts, which may augment regenerative activity in the cells. Cells, including fibroblasts, contacted with, cultured with, or administered cannabidiol (including cannabidiol comprising or consisting of (−)-cannabidiol) may increase the production of IGF-1 and/or EGF-1. The fibroblasts contacted with, cultured with, or administered cannabidiol (including cannabidiol comprising or consisting of (−)-cannabidiol) may be used for methods encompassed herein. The fibroblasts contacted with, cultured with, or administered cannabidiol (including cannabidiol comprising or consisting of (−)-cannabidiol) may be administered locally (including intradiscally) and/or systemically to an individual, including an individual having, or at risk of having, a degenerative disc disease.

II. Therapeutic Intervention for a Degenerative Disc Disease

[0035] Particular embodiments of the disclosure concern the use of one or more therapeutic interventions for a degenerative disc disease, which may include a variety of cellular therapies comprising regenerative cells, including fibroblasts, mesenchymal stem cells, hematopoietic stem cells, and other cells possessing ability to heal tissue. In particular embodiments, fibroblasts together with cannabidiol are administered to an individual. Fibroblasts may be from any autologous, allogenic, or xenogeneic source. Fibroblasts may be from tissue selected from the group consisting of adipose tissue, dermal tissue, bone marrow, peripheral blood, Wharton's Jelly, placenta, omentum, mobilized peripheral blood, and a combination thereof.

[0036] In certain embodiments, fibroblasts, including manipulated or un-manipulated fibroblasts, are delivered locally, such as to a disc, to an individual, such as an individual in need of treatment for a degenerative disc disease. The fibroblasts may be administered as a formulation including a formulation comprising a hydrogel. The hydrogel may be comprised of, for example, platelet rich plasma (PRP) and hyaluronic acid (HA) blended with batroxobin (BTX) as gelling agent. The fibroblasts may be encapsulated in PRP/HA/BTX hydrogel and cultured in both growing medium and medium with or without TGF-β1 up to day 21. In one embodiment, the hydrogel jellifies in 15 minutes 20° C. and in 3 minutes at 37° C. in a manner such that said fibroblasts maintain high cell viability and proliferation. In one embodiment, fibroblasts are used for intra-disc injections in patients with degenerative disc disease. In such an embodiment, said fibroblasts are cultured in means to enhance GAG production, which may be achieved by culture with cytokines such as TGF-beta. Methodologies for growth of mesenchymal stem cells, which may be modified for fibroblast-specific use are provided in the following, which is incorporated by reference (44).

[0037] Certain embodiments concern the activation of fibroblasts prior to therapeutic use, and/or administration of agents which act as “regenerative adjuvants” for the fibroblasts. The cells in the formulation may display typical fibroblast morphologies when growing in cultured monolayers. Specifically, cells may display an elongated, fusiform or spindle appearance with slender extensions, or cells may appear as larger, flattened stellate cells which may have cytoplasmic leading edges. A mixture of these morphologies may also be observed. The cells may express proteins characteristic of normal fibroblasts including the fibroblast-specific marker, CD90 (Thy-1), a 35 kDa cell-surface glycoprotein, and the extracellular matrix protein, collagen. The fibroblast dosage formulation may be an autologous cell therapy product composed of a suspension of autologous fibroblasts, grown from a biopsy of each individual's own skin using standard tissue culture procedures. In particular embodiments, the fibroblasts can also be used to create other cell types for tissue repair or regeneration.

[0038] The fibroblasts encompassed herein may be generated by outgrowth from a biopsy of skin of an individual receiving administrations encompassed herein (in the case of autologous preparations), or skin of healthy donors (for allogeneic preparations). Skin-derived fibroblasts are disclosed as an example, however fibroblasts encompassed in the disclosure may be from any source or tissue. In some embodiments, fibroblasts are used from young donors. In another embodiment fibroblasts are transfected with genes to allow for enhanced growth and overcoming of the Hayflick limit. Subsequent to derivation of cells expansion in culture using standard cell culture techniques. Said techniques include expansion in liquid media, utilization of media such as RPMI 1640, DMEM, OPTI-MEM, or AIM-V. Standard techniques for tissue culture are well known in the art and include the need for dissociating cells. In some embodiments dissociation involves treatment with trypsin or collagen to allow for cell passaging. Skin tissue (dermis and epidermis layers) may be biopsied from a subject's post-auricular area. In one embodiment disclosed for the purpose of describing a non-limiting example, the starting material is composed of three 3-mm punch skin biopsies collected using standard aseptic practices. The biopsies are collected by a skilled artisan, placed into a vial containing sterile phosphate buffered saline (PBS). The biopsies are shipped in a 2-8° C. refrigerated shipper back to the manufacturing facility. In one embodiment, after arrival at the manufacturing facility, the biopsy is inspected and, upon acceptance, transferred directly to the manufacturing area. Upon initiation of the process, the biopsy tissue is then washed prior to enzymatic digestion. After washing, a Liberase Digestive Enzyme Solution is added without mincing, and the biopsy tissue is incubated at 37.0+/−2.0° C. for one hour. Time of biopsy tissue digestion is a critical process parameter that can affect the viability and growth rate of cells in culture. Liberase is a collagenase/neutral protease enzyme cocktail obtained formulated from Lonza Walkersville, Inc. (Walkersville, Md.) and unformulated from Roche Diagnostics Corp. (Indianapolis, Ind.). Alternatively, other commercially available collagenases may be used, such as Serva Collagenase NB6 (Helidelburg, Germany). After digestion, Initiation Growth Media (IMDM, GA, 10% Fetal Bovine Serum (FBS)) is added to neutralize the enzyme, cells are pelleted by centrifugation and resuspended in 5.0 mL Initiation Growth Media. Alternatively, centrifugation is not performed, with full inactivation of the enzyme occurring by the addition of Initiation Growth Media only. Initiation Growth Media is added prior to seeding of the cell suspension into a T-175 cell culture flask for initiation of cell growth and expansion. A T-75, T-150, T-185 or T-225 flask can be used in place of the T-75 flask. Cells are incubated at 37+/−2.0° C. with 5.0+/−1.0% CO.sub.2 and fed with fresh Complete Growth Media approximately every three to five days. All feeds in the process are performed by removing half of the Complete Growth Media and replacing the same volume with fresh media. Alternatively, full feeds can be performed. Cells should not remain in the T-175 flask greater than approximately 30 days prior to passaging. Confluence is monitored throughout the process to ensure adequate seeding densities during culture splitting. When cell confluence is greater than or equal to 40% in the T-175 flask, they are passaged by removing the spent media, washing the cells, and treating with Trypsin-EDTA to release adherent cells in the flask into the solution. Cells are then trypsinized and seeded into a T-500 flask for continued cell expansion. Alternately, one or two T-300 flasks, One Layer Cell Stack (1 CS), One Layer Cell Factory (1 CF) or a Two Layer Cell Stack (2 CS) can be used in place of the T-500 Flask.

[0039] Morphology is evaluated at each passage and prior to harvest to monitor the culture purity throughout the culture purity throughout the process. Morphology is evaluated by comparing the observed sample with visual standards for morphology examination of cell cultures. The cells display typical fibroblast morphologies when growing in cultured monolayers. Cells may display either an elongated, fusiform or spindle appearance with slender extensions, or appear as larger, flattened stellate cells which may have cytoplasmic leading edges. A mixture of these morphologies may also be observed. Fibroblasts in less confluent areas can be similarly shaped, but randomly oriented. The presence of keratinocytes in cell cultures is also evaluated. Keratinocytes appear round and irregularly shaped and, at higher confluence, they appear organized in a cobblestone formation. At lower confluence, keratinocytes are observable in small colonies. Cells are incubated at 37+/−2.0° C. with 5.0+/−1.0% CO.sub.2 and passaged every three to five days in the T-500 flask and every five to seven days in the ten layer cell stack (10CS). Cells should not remain in the T-500 flask for more than 10 days prior to passaging. Quality Control (QC) release testing for safety of the Bulk Drug Substance (cells) includes sterility and endotoxin testing. When cell confluence in the T-500 flask is >95%, cells are passaged to a 10 CS culture vessel. Alternately, two Five Layer Cell Stacks (5 CS) or a 10 Layer Cell Factory (10 CF) can be used in place of the 10 CS. Passage to the 10 CS is performed by removing the spent media, washing the cells, and treating with Trypsin-EDTA to release adherent cells in the flask into the solution. Cells are then transferred to the 10 CS. Additional Complete Growth Media is added to neutralize the trypsin and the cells from the T-500 flask are pipetted into a 2 L bottle containing fresh Complete Growth Media. The contents of the 2 L bottle are transferred into the 10 CS and seeded across all layers. Cells are then incubated at 37+/−2.0° C. with 5.0+/−1.0% CO.sub.2 and fed with fresh Complete Growth Media every five to seven days. Cells should not remain in the 10 CS for more than 20 days prior to passaging. In one embodiment, the passaged dermal fibroblasts are rendered substantially free of immunogenic proteins present in the culture medium by incubating the expanded fibroblasts for a period of time in protein free medium, Primary Harvest When cell confluence in the 10 CS is 95% or more, cells are harvested. Harvesting is performed by removing the spent media, washing the cells, treating with Trypsin-EDTA to release adherent cells into the solution, and adding additional Complete Growth Media to neutralize the trypsin. Cells are collected by centrifugation, resuspended, and in-process QC testing performed to determine total viable cell count and cell viability.

[0040] In some embodiments, when large numbers of cells are required after receiving cell count results from the primary 10 CS harvest, an additional passage into multiple cell stacks (up to four 10 CS) is performed. For additional passaging, cells from the primary harvest are added to a 2 L media bottle containing fresh Complete Growth Media. Resuspended cells are added to multiple cell stacks and incubated at 37+/−2.0° C. with 5.0+/−1.0% CO.sub.2. The cell stacks are fed and harvested as described above, except cell confluence must be 80% or higher prior to cell harvest. The harvest procedure is the same as described for the primary harvest above. A mycoplasma sample from cells and spent media is collected, and cell count and viability performed as described for the primary harvest above. The method decreases or eliminates immunogenic proteins by avoiding their introduction from animal-sourced reagents. To reduce process residuals, cells are cryopreserved in protein-free freeze media, then thawed and washed prior to prepping the final injection to further reduce remaining residuals. If additional Drug Substance is needed after the harvest and cryopreservation of cells from additional passaging is complete, aliquots of frozen Drug Substance—Cryovial are thawed and used to seed 5 CS or 10 CS culture vessels. Alternatively, a four layer cell factory (4 CF), two 4 CF, or two 5 CS can be used in place of a 5 CS or 10 CS. A frozen cryovial(s) of cells is thawed, washed, added to a 2 L media bottle containing fresh Complete Growth Media and cultured, harvested and cryopreserved as described above. The cell suspension is added Cell confluence must be 80% or more prior to cell harvest.

[0041] At the completion of culture expansion, the cells are harvested and washed, then formulated to contain 100,000 cells to 2.7×10.sup.7 cells/mL, or more, with a target of 2.2×10.sup.7 cells/mL. Alternatively, the target can be adjusted within the formulation range to accommodate different indication doses. The drug substance comprises a population of viable, autologous human fibroblast cells suspended in a cryopreservation medium consisting of Iscove's Modified Dulbecco's Medium (IMDM) and Profreeze-CDM™ (Lonza, Walkerville, Md.) plus 7.5% dimethyl sulfoxide (DMSO). Alternatively, a lower DMSO concentration may be used in place of 7.5% or CryoStor™ CS5 or CryoStor™ CS10 (BioLife Solutions, Bothell, Wash.) may be used in place of IMDM/Profreeze/DMSO. In addition to cell count and viability, purity/identity of the Drug Substance is performed and must confirm the suspension contains 98% or more fibroblasts. The usual cell contaminants include keratinocytes. The purity/identify assay employs fluorescent-tagged antibodies against CD90 and CD 104 (cell surface markers for fibroblast and keratinocyte cells, respectively) to quantify the percent purity of a fibroblast cell population. CD90 (Thy-1) is a 35 kDa cell-surface glycoprotein. Antibodies against CD90 protein have been shown to exhibit high specificity to human fibroblast cells. CD104, integrin β4 chain, is a 205 kDa transmembrane glycoprotein which associates with integrin α6 chain (CD49f) to form the α6/β4 complex. This complex has been shown to act as a molecular marker for keratinocyte cells (Adams and Watt 1991).

[0042] Antibodies to CD 104 protein bind to 100% of human keratinocyte cells. Cell count and viability is determined by incubating the samples with Viacount Dye Reagent and analyzing samples using the Guava PCA system. The reagent is composed of two dyes, a membrane-permeable dye which stains all nucleated cells, and a membrane-impermeable dye which stains only damaged or dying cells. The use of this dye combination enables the Guava PCA system to estimate the total number of cells present in the sample, and to determine which cells are viable, apoptotic, or dead. The method was custom developed specifically for use in determining purity/identity of autologous cultured fibroblasts.

[0043] Alternatively, cells can be passaged from either the T-175 flask (or alternatives) or the T-500 flask (or alternatives) into a spinner flask containing microcarriers as the cell growth surface. Microcarriers are small bead-like structures that are used as a growth surface for anchorage-dependent cells in suspension culture. They are designed to produce large cell yields in small volumes. In this apparatus, a volume of Complete Growth Media ranging from 50 mL-300 mL is added to a 500 mL, IL or 2 L sterile disposable spinner flask. Sterile microcarriers are added to the spinner flask. The culture is allowed to remain static or is placed on a stir plate at a low RPM (15-30 RRM) for a short period of time (1-24 hours) in a 37+/−2.0° C. with 5.0+/−1.0% CO.sub.2 incubator to allow for adherence of cells to the carriers. After the attachment period, the speed of the spin plate is increased (30-120 RPM). Cells are fed with fresh Complete Growth Media every one to five days, or when media appears spent by color change. Cells are collected at regular intervals by sampling the microcarriers, isolating the cells and performing cell count and viability analysis. The concentration of cells per carrier is used to determine when to scale-up the culture. When enough cells are produced, cells are washed with PBS and harvested from the microcarriers using trypsin-EDTA and seeded back into the spinner flask in a larger amount of microcarriers and higher volume of Complete Growth Media (300 mL-2 L). Alternatively, additional microcarriers and Complete Growth Media can be added directly to the spinner flask containing the existing microcarrier culture, allowing for direct bead-to-bead transfer of cells without the use of trypsinization and reseeding. Alternatively, if enough cells are produced from the initial T-175 or T-500 flask, the cells can be directly seeded into the scale-up amount of microcarriers. After the attachment period, the speed of the spin plate is increased (30-120 RPM). Cells are fed with fresh Complete Growth Media every one to five days, or when media appears spent by color change. When the concentration reaches the desired cell count for the intended indication, the cells are washed with PBS and harvested using trypsin-EDTA. Microcarriers used within the disposable spinner flask may be made from poly blend such as BioNOC II®. (Cesco Bioengineering, distributed by Bellco Biotechnology, Vineland, N.J.) and FibraCel®. (New Brunswick Scientific, Edison, N.J.), gelatin, such as Cultispher-G (Percell Biolytica, Astrop, Sweden), cellulose, such as Cytopore™ (GE Healthcare, Piscataway, N.J.) or coated/uncoated polystyrene, such as 2D MicroHex™ (Nunc, Weisbaden, Germany), Cytodex®. (GE Healthcare, Piscataway, N.J.) or Hy-Q Sphere™ (Thermo Scientific Hyclone, Logan, Utah).

[0044] In another embodiment, cells can be processed on poly blend 2D microcarriers such as BioNOC II®. and FibraCel®. using an automatic bellow system, such as FibraStage™ (New Brunswick Scientific, Edison, N.J.) or BelloCell®. (Cesco Bioengineering, distributed by Bellco Biotechnology, Vineland, N.J.) in place of the spinner flask apparatus. Cells from the T-175 (or alternatives) or T-500 flask (or alternatives) are passaged into a bellow bottle containing microcarriers with the appropriate amount of Complete Growth Media, and placed into the system. The system pumps media over the microcarriers to feed cells, and draws away media to allow for oxygenation in a repeating fixed cycle. Cells are monitored, fed, washed and harvested in the same sequence as described above. Alternatively, cells can be processed using automated systems. After digestion of the biopsy tissue or after the first passage is complete (T-175 flask or alternative), cells may be seeded into an automated device. One method is an Automated Cellular Expansion (ACE) system, which is a series of commercially available or custom fabricated components linked together to form a cell growth platform in which cells can be expanded without human intervention. Cells are expanded in a cell tower, consisting of a stack of disks capable of supporting anchorage-dependent cell attachment. The system automatically circulates media and performs trypsinization for harvest upon completion of the cell expansion stage.

[0045] Alternatively, the ACE system can be a scaled down, including as a single lot unit version comprised of a disposable component that consists of cell growth surface, delivery tubing, media and reagents, and a permanent base that houses mechanics and computer processing capabilities for heating/cooling, media transfer and execution of the automated programming cycle. Upon receipt, each sterile irradiated ACE disposable unit will be unwrapped from its packaging and loaded with media and reagents by hanging pre-filled bags and connecting the bags to the existing tubing via aseptic connectors. The process continues as follows: a) Inside a biological safety cabinet (BSC), a suspension of cells from a biopsy that has been enzymatically digested is introduced into the “pre-growth chamber” (small unit on top of the cell tower), which is already filled with Initiation Growth Media containing antibiotics. From the BSC, the disposable would be transferred to the permanent ACE unit already in place; b) After approximately three days, the cells within the pre-growth chamber are trypsinized and introduced into the cell tower itself, which is pre-filled with Complete Growth Media. Here, the “bubbling action” caused by CO.sub.2 injection force the media to circulate at such a rate that the cells spiral downward and settle on the surface of the discs in an evenly distributed manner; c) For approximately seven days, the cells are allowed to multiply. At this time, confluence will be checked (method unknown at time of writing) to verify that culture is growing. Also at this time, the Complete Growth Media will be replaced with fresh Complete Growth Media. CGM will be replaced every seven days for three to four weeks. At the end of the culture period, the confluence is checked once more to verify that there is sufficient growth to possibly yield the desired quantity of cells for the intended treatment; d) If the culture is sufficiently confluent, it is harvested. The spent media (supernatant) is drained from the vessel. PBS will then is pumped into the vessel (to wash the media, FBS from the cells) and drained almost immediately. Trypsin-EDTA is pumped into the vessel to detach the cells from the growth surface. The trypsin/cell mixture is drained from the vessel and enter the spin separator. Cryopreservative is pumped into the vessel to rinse any residual cells from the surface of the discs, and be sent to the spin separator as well. The spin separator collects the cells and then evenly resuspend the cells in the shipping/injection medium. From the spin separator, the cells will be sent through an inline automated cell counting device or a sample collected for cell count and viability testing via laboratory analyses. Once a specific number of cells has been counted and the proper cell concentration has been reached, the harvested cells are delivered to a collection vial that can be removed to aliquot the samples for cryogenic freezing.

[0046] In some embodiments, the fibroblasts are cultured with or administered hCG and/or oxytocin, which may augment immune modulatory activity. Fibroblasts may be cultured with or administered hCG at a concentration between 1 nM to 1 μM or 10 nM to 100 nM or any range derivable therein. Fibroblast may be cultured with or administered oxytocin at a concentration between 1 nm to 10 μM or between 100 nm to 1 μM or any range derivable therein.

EXAMPLES

[0047] The following examples are included to demonstrate preferred embodiments of the invention. It should be appreciated by those of skill in the art that the techniques disclosed in the examples that follow represent techniques discovered by the inventor to function well in the practice of the invention, and thus can be considered to constitute preferred modes for its practice. However, those of skill in the art should, in light of the present disclosure, appreciate that many changes can be made in the specific embodiments which are disclosed and still obtain a like or similar result without departing from the spirit and scope of the invention.

Example 1

Cannabidiol Stimulates Fibroblast Production of IGF-1 and EGF-1

[0048] Dermal fibroblasts were obtained from Allcells, Inc. and cultured for 48 hours in the indicated concentrations of CBD. As seen in FIG. 1, augmentation of IGF-1 was observed. As seen in FIG. 2, augmentation of EGF-1 was observed. Cultures were performed in OPTI-MEM media with 10% fetal calf serum.

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[0094] Although the present disclosure and its advantages have been described in detail, it should be understood that various changes, substitutions and alterations can be made herein without departing from the spirit and scope of the design as defined by the appended claims. Moreover, the scope of the present application is not intended to be limited to the particular embodiments of the process, machine, manufacture, composition of matter, means, methods and steps described in the specification. As one of ordinary skill in the art will readily appreciate from the present disclosure, processes, machines, manufacture, compositions of matter, means, methods, or steps, presently existing or later to be developed that perform substantially the same function or achieve substantially the same result as the corresponding embodiments described herein may be utilized according to the present disclosure. Accordingly, the appended claims are intended to include within their scope such processes, machines, manufacture, compositions of matter, means, methods, or steps.