HK1140431B - Treatment of leaky or damaged tight junctions and enhancing extracellular matrix - Google Patents

Description

The present application is in the field of materials to alter or enhance cell matrix deposition around tissues, especially blood vessels, connective tissue and tissues with tight junctions.

BACKGROUND OF THE INVENTION

There are a number of disorders associated with leakage around blood vessels and within the tight junctions between cells. Such leakage can lead to fluid invading the tissues, causing a loss in blood pressure, organ dysfunction or failure, and death. Many of these disorders are a result of massive cell death, such as that associated with chemotherapy of a large tumor, sepsis following systemic bacterial infection, inflammation associated with burns, and large surgical resections.

Severe sepsis results from the body's systemic over-response to infection. This over-response disrupts homeostasis through an uncontrolled cascade of inflammation, coagulation, and impaired fibrinolysis. Deranged micro-circulatory function leads to global tissue hypoxia and direct tissue damage. This ultimately results in organ failure, and often, death. Anti-infectives, resuscitation, and supportive care do not necessarily prevent the progressive organ dysfunction that occurs in many patients. Microcirculatory dysfunction may persist despite adequate global values of oxygen delivery, making resuscitation procedures ineffective.

The "leaky gut" hypothesis proposes that leakage of enteric bacteria into the body resulting from disruption of the epithelial barrier is a critical step in the pathophysiology of various disorders such as inflammatory bowel disease and sepsis.

One third of women undergoing mastectomy with axillary evacuation for primary breast cancer suffer from postoperative seromas leading to unnecessary costs and complications such as infections and new operations. Different methods to prevent seroma formation have been tried without permanent success.

Another condition for which there are insufficient treatments is the loss of fluid which occurs due to sepsis or burns, where the junctions between cells begin to leak interstitial fluid, causing dehydration, electrolyte imbalance, and cell death.

These disorders can lead to further complications when the release of inflammatory molecules from the damaged tissue elicits further tissue damage.

U.S. Patent Nos. 5,670,483 , 6,548,630 , and 7,098,028 by Zhang et al. describe amphiphilic peptides having alternating hydrophobic and hydrophilic residues. Zhang alleges that the membranes are potentially useful in biomaterial applications such as slow-diffusion drug delivery systems, artificial skin, and separation matrices, and as experimental models for Alzheimer's disease and scrapie infection. However, Zhang does not disclose the use of such materials for treatment and support of disorders associated with leaky, damaged tight junction and weak, diseased, or injured extracellular matrix.

WO 2007/142757 and U.S.S.N. 11/411,745 describe compositions including peptides with alternating hydrophilic and hydrophobic monomers that allow them to self-assemble under physiological conditions are formulated for application to wounds. However, these applications do not describe the use of such materials for treatment and support of disorders associated with leaky, damaged tight junction and weak, diseased, or injured extracellular matrix.

WO 2006/116524 relates to self-assembling peptides for controlling hemostasis, protecting wounds from contamination, decontaminating a site, and inhibiting the movement of bodily fluids other than blood. However, this application does not describe administering the materials as a liquid into the bloodstream of a subject for treatment of leaky or damaged tight junctions and weak, diseased, or injured extracellular matrix.

US 2006/0088510 relates to the use of self-assembling peptides to form a membrane that promotes growth and differentiation of cells. The membrane and the growing cells can then be implanted at a site in need of tissue repair. US 2006/0148703 relates to a gel formed from self-assembling peptides bound to PDGF that can be implanted in vivo to promote sustained release of PDGF. Neither of these applications describes administering the self-assembling peptides to the subject prior to self-assembly. In both cases, a membrane or gel is produced ex vivo and then administered to the subject.

US 2005/0181973 relates to peptides containing a self-assembling peptide domain and a second amino acid domain that does not self-assemble in isolated form. This application does not disclose unmodified self-assembling peptides for use in treating disorders involving leaky or damaged tight junctions or weak, diseased or injured extracellular matrix.

It is therefore an object of the present invention to provide methods and compositions for treating conditions involving not just fluid leakage but pathophysiology of the junctions between cells.

It is another object of the present invention to provide methods and compositions for increasing extracellular matrix around vascular cells. It is still a further object of the present invention to provide methods and compositions for repairing or strengthening tight-junctions.

SUMMARY OF THE INVENTION

The invention is as defined in the accompanying claims.

The invention provides a formulation comprising an effective amount of self-assembling peptides to form a barrier structure to prevent or limit the movement of bodily fluids;

wherein the self-assembling peptides have a length from 8 to 16 amino acid residues and comprise a sequence conforming to one or more of Formula I-IV:         ((Xaa^neu-Xaa⁺)_x(Xaa^neu-Xaa^-)_y)_n     (I)         ((Xaa^neu-Xaa^-)_x(Xaa^neu-Xaa⁺)_y)_n     (II)         ((Xaa⁺-Xaa^neu)_x(Xaa^--Xaa^neu)_y)_n     (III)         ((Xaa^--Xaa^neu)_x(Xaa⁺-Xaa^neu)_y)_n     (IV) wherein each Xaa^neu is an amino acid residue selected from alanine, leucine, isoleucine, phenylalanine, or tyrosine; Xaa⁺ is arginine or lysine; Xaa^- is aspartic acid or glutamic acid; x and y are integers having a value of 1, 2, 3 or 4, independently; and n is an integer having a value of 1-4; for use in a method for treatment of disorders involving leaky or damaged tight junctions or weak, diseased, or injured extracellular matrix comprising administering the formulation as a liquid into the bloodstream of a subject in need thereof.

Self assembling peptides and peptidomimetics can be utilized for the treatment and support of disorders associated with leaky, damaged tight junctions and weak, diseased, or injured extracellular matrix. The self-assembling materials can anchor or interact with the structural extracellular matrix (ECM) at the edges of blood vessels and/or tissues.

The self-assembling materials generally have alternating hydrophilic or hydrophobic residues or hydrophobic and/or hydrophilic sections which allow the material to react or interact with the glycoproteins found in the ECM. For example, the self-assembling peptides can have a segment of residues having a positive charge under physiological conditions joined to a segment of residues having a negative charge under physiological conditions.

In another embodiment, the self-assembling peptide has a first hydrophobic region operably linked to a first hydrophilic region. The first hydrophobic region can include a segment of amino acid residues that have hydrophobic side chains under physiological conditions and the first hydrophilic region can include a segment of amino acid residues that have hydrophilic side chains under physiological conditions.

In yet another embodiment, the self-assembling material is formed by mixing together a segment of residues having positive charges under physiological conditions with a segment of residues having negative charges under physiological conditions.

In still another embodiment, the self-assembling peptides contain hydrophilic polar amino acid residues and hydrophobic non-polar amino acid residues under physiological conditions. It will be appreciated that the partitioning of the self-assembling peptide into a polar or non-polar environment can be controlled by altering the ratio of hydrophobic amino acid residues to hydrophilic amino acid residues, wherein a ratio greater than 1:1 indicates that the peptide partitions more in hydrophobic conditions compared to hydrophilic conditions. A ratio of less than 1:1 indicates that the peptide partitions more in hydrophilic conditions compared to hydrophobic conditions.

The materials described above can be administered alone, or in combination with each other, or other self-assembling materials.

The self-assembling materials preferably do not cause any secondary toxicity when degraded in the body. Further, the break down product of the self-assembling materials may enhance growth and repair of the surrounding tissues. The formulations can be administered by injection or by catheter.

BRIEF DESCRIPTION OF THE DRAWINGS

• Figure 1 shows the extension of extracellular matrix using self-assembling peptides. The peptides contain one or more tail moieties that bind to or interact with the extracellular matrix of a vessel or tissue, such as a blood vessel, thus anchoring the peptides to the vessel.
• Figure 2 shows self-assembling peptides bridging the gap between blood vessel wall cells. The peptides can contain a tail, such as a hydrophobic or hydrophilic tail, which binds to or interacts with the extracellular matrix of the blood vessel anchoring the peptides to the vessel wall. Upon self-assembly, the peptides can pull the ends of the vessel together, allowing the wound or injury to heal.
• Figures 3a-d show bar graphs of the time taken to achieve hemostasis. These graphs illustrate bleeding durations in cases treated with 1% solution of RADA16-I (SEQ ID NO: 60) (NHS-1) self-assembling solution compared with those cautery and saline treated controls for brain, femoral artery and liver cuts (a), liver punches (b) and skin punches (c). Each bar shows the mean time in seconds for NHS-1 treated cases in (red), saline controls in (blue) and cautery controls in (yellow). (a) Rat Brain. Durations were measured from the start of application of self-assembling NHS-1 to the completion of hemostasis after transection of the veins leading to the superior sagittal sinus in the brain of adult rats. Complete hemostasis was achieved in 8.4 + 2.1 seconds. In the saline controls, bleeding continued until 227.0 + 36.6 seconds. Hamster brain. Complete hemostasis was achieved in 9.0 + 1.8 seconds. In the saline controls, bleeding continued until 187.6 + 34.7 seconds. Femoral artery. Complete hemostasis was achieved in 10.5 + 4.1 seconds. In the saline controls, bleeding continued until 367.5 + 37.7 seconds. Liver sagittal cut. Complete hemostasis was achieved in 8.6 + 1.7 seconds. In the cautery control (yellow), bleeding continued until 90.0 + 5.0 seconds, and the saline controls bled for 301.6 + 33.2 seconds. (b) Liver 4mm punch biopsy. A 4mm core was removed from the left liver lobe and the hole was treated with NHS-1, heat cautery, or saline. Treatment of 3% NHS-1 brought about complete hemostasis in 9.7 + 1.2 seconds. In the cautery controls (yellow), bleeding continued for 81.2 + 6.7 seconds and the saline controls bled 204.3 + 49.6 seconds. (c) Skin 4mm punch biopsy. A 4 mm punch biopsy was made on the backs of nude mice. The biopsy extended through the dermis and the core was removed. Care was taken not to disrupt the underlying muscle. The three wounds on one side were treated with 1% NHS-1 and complete hemostasis was achieved in 6.4 + 1.5 seconds. On the opposite side of the animal the wounds were not treated. Bleeding continued until normal clotting occurred at 75.5 + 16.3 seconds. (d) Concentration response curves of NHS-1 and EAK-16 (TM-3). The left lateral liver lobe received a transverse cut severing a portion of the liver lobe and branch of the portal vein. A higher concentration of NHS-1 (open circles) is more effective in higher pressure and volume bleeds. 4%, 3%, and 2% concentrations of NHS-1 were effective in achieving hemostasis in 11.0 + 1.0 seconds, 10.0 + 1.0 seconds and 10.3 + 0.5 seconds respectively. 1% NHS-1 took 86.6 + 20.8 seconds at the area of the most severe bleeding. M-3 (diamonds) was not effective at any concentration; in the saline controls bleeding continued until 377.5 + 85.0 seconds and one animal died. X axis is time (seconds); y axis is concentration.
• Figures 4a-d are schematics of surgical procedures. Rostral is up and caudal is down in all figures. (a) Dorsal view of the rat brain. The blue lines depict the blood vessels superficial to the cortex. The boxed area corresponds to location of the lesion and treatment. (b) Drawing of ventral view of the lower limb of a rat with the femoral artery in red and sciatic nerve in yellow. (c and d) Drawings of a ventral view of rat with abdomen open, overlying structures have been removed exposing the liver. The lobe was transected with a cut (depicted in red) in sagittal (c) and transverse (d) directions.

DETAILED DESCRIPTION OF THE INVENTION I. Definitions

"Biocompatible", as used herein, refers to compatibility with living tissue or a living system by not being toxic, injurious, or physiologically reactive and not causing immunological rejection.

"Complementary" means having the capability of forming ionic or hydrogen bonding interactions between hydrophilic residues from adjacent peptides in a structure. Each hydrophilic residue in a peptide either hydrogen bonds or ionically pairs with a hydrophilic residue on an adjacent peptide, or is exposed to solvent. Pairing may also involve van der Waals forces.

"Effective amount", in reference to an active agent such as a self-assembling peptide or biomolecule, pharmaceutical agent, etc. refers to the amount necessary to elicit a desired biological response. As will be appreciated by those of ordinary skill in this art, the effective amount of an agent may vary depending on such factors as the desired biological endpoint, the agent to be delivered, the nature of the site to which the agent is delivered, the nature of the conditions for which the agent is administered, etc. For example, the effective amount of a composition for treatment of diabetic retinopathy may be an amount sufficient to promote recovery to a greater extent than would occur in the absence of the composition.

"Hemostasis" refers to the cessation of bleeding.

"Preventing" refers to causing a condition, state, or disease, or symptom or manifestation of such, or worsening of the severity of such, not to occur. Preventing includes reducing the risk that a condition, state, or disease, or symptom or manifestation of such, or worsening of the severity of such, will occur.

"Repair", as used in reference to the repair of tissue in various embodiments, may include any aspect of anatomical or functional restoration of the condition of the tissue prior to an injury, deterioration, or other damage. For example, it may include restoration of physical continuity between portions of tissue that were separated by injury, deterioration, or other damage. Preferably such restoration of physical continuity includes reposition or reconnection of the portions of tissue without appreciable separation by tissue of a type that was not present prior to the injury, such as scar tissue. Repair may, but need not, include growth or development of new tissue. "Repair" and "Healing" are used interchangeably herein.

II. Self-Assembling Materials

Self-assembling materials that can anchor or interact with the structural extracellular matrix (ECM) at the edges of blood vessels and/or tissues are described herein. These self-assembling materials typically have hydrophobic and/or hydrophilic residues or sections which allow the material to react or interact with the glycoproteins found in the ECM.

Preferably, the self-assembling materials do not cause any secondary toxicity when they break down. Further, the break down product of the self-assembling materials may enhance growth and repair of the surrounding tissues.

A. Self-assembling peptides

The term "peptide," as used herein includes "polypeptide," "oligopeptide," and "protein," and refers to a chain of at least two α-amino acid residues linked together by covalent bonds (e.g., peptide bonds). Useful peptides can vary in length so long as they retain the ability to self-assemble to an extent useful for one or more of the purposes described herein. The peptides which self-assemble have a length from 8 to 16 amino acid residues. "Peptide" may refer to an individual peptide or to a collection of peptides having the same or different sequences, any of which may contain naturally occurring α-amino acid residues, non-naturally occurring α-amino acid residues, and combinations thereof. α-Amino acid analogs are also known in the art and may alternatively be employed. In particular, D-α-amino acid residues may be used.

In addition, one or more of the amino acid residues in a self-assembling peptide can be altered or derivatized by the addition of one or more chemical entities including, but not limited to, acyl groups, carbohydrate groups, carbohydrate chains, phosphate groups, farnesyl groups, isofarnesyl groups, fatty acid groups, or a linker which allows for conjugation or functionalization of the peptide. For example, either or both ends of a given peptide can be modified. For example, the carboxyl and/or amino group of the carboxyl- and amino-terminal residues, respectively can be protected or not protected. The charge at a terminus can also be modified. For example, a group or radical such as an acyl group (RCO-, where R is an organic group (e.g., an acetyl group (CH₃CO-)) can be present at the N-terminus of a peptide to neutralize an "extra" positive charge that may otherwise be present (e.g., a charge not resulting from the side chain of the N-terminal amino acid). Similarly, a group such as an amine group (RNH-, where R is an organic group (e.g., an amino group -NH2)) can be used to neutralize an "extra" negative charge that may otherwise be present at the C-terminus (e.g., a charge not resulting from the side chain of the C-terminal amino acid residue). Where an amine is used, the C-terminus bears an amide (-CONHR). The neutralization of charges on a terminus may facilitate self-assembly. One of ordinary skill in the art will be able to select other suitable groups.

Useful peptides can also be branched, in which case they will contain at least two amino acid polymers, each of which consists of at least three amino acid residues joined by peptide bonds. The two amino acid polymers may be linked by a bond other than a peptide bond.

While the sequences of the peptides can vary, useful sequences include those that convey an amphiphilic nature to the peptides (e.g., the peptides can contain approximately equal numbers of hydrophobic and hydrophilic amino acid residues), and the peptides can be complementary and structurally compatible. Any naturally occurring or non-naturally occurring hydrophilic or hydrophobic residue can be used. Hydrophilic residues are those residues that typically contain a polar functional group or a functional group that is charged at physiological conditions. Exemplary functional groups include, but are not limited to, carboxylic acid groups, amino groups, sulfate groups, hydroxy groups, halogen groups, nitro groups, phosphate groups, etc. Hydrophobic residues are those residues that contain non-polar functional groups. Exemplary functional groups include, but are not limited to, alkyl groups, alkene groups, alkyne groups, and phenyl groups.

In one embodiment, the hydrophilic residue has the formula -NH-CH(X)-COO-, wherein X has the formula (CH₂)_yZ, wherein y = 0-8, preferably 1-6, more preferably 1-4 and most preferably 1-3, and Z is a polar or charged functional group such as a carboxylic acid group, amino group, sulfate group, hydroxy group, halogen group, nitro group, phosphate group, or functional group containing a quaternary amine. The alkyl chain can be in a linear, branched, or cyclic arrangement. X may also contain one or more heteroatoms within the alkyl chain and/or X may be substituted with one or more additional substituents. In a preferred embodiment, Z is a carboxylic acid group or an amino group. In one embodiment, the hydrophobic residue has the formula -NH-CH(X)-COO-, wherein X has the formula (CH₂)_yZ, wherein y = 0-8, preferably 1-6, more preferably 1-4, and more preferably 1-3, and Z is a non-polar functional group such as an alkyl group, alkylene group, alkyne group, or a phenyl group. The alkyl chain can be in a linear, branched, or cyclic arrangement. X may also contain one or more heteroatoms within the alkyl chain and/or X may be substituted with one or more additional substituents. In a preferred embodiment, X is an alkyl group, such as a methyl group.

Complementary peptides have the ability to form ionic or hydrogen bonds between residues (e.g., hydrophilic residues) on adjacent peptides in a structure. For example, one or more hydrophilic residues in a peptide can either hydrogen bond or ionically pair with one or more hydrophilic residues on an adjacent peptide. Unpaired residues can interact (e.g. form hydrogen bonds, etc.,) with the solvent. Peptide-peptide interactions may also involve van der Waals forces and/or forces that do not constitute covalent bonds. The peptides are structurally compatible when they are capable of maintaining a sufficiently constant intrapeptide distance to allow self-assembly and structure formation. The intrapeptide distance can vary. "Intrapeptide distance", as used herein, refers to the average of a representative number of distances between adjacent amino acid residues. In one embodiment, the intrapeptide distance is less than about 4 angstroms, preferably less than about 3, more preferably less than about 2 angstroms, and most preferably less than about 1 angstrom. The intrapeptide distance may be larger than this, however. These distances can be calculated based on molecular modeling or based on a simplified procedure described in U.S. Patent Number No. 5,670,483 to Zhang et al.

The structures described herein can be formed through self-assembly of the peptides described in U.S. Patent Nos. 5,670,483 ; 5,955,343 ; 6,548,630 ; and 6,800,481 to Zhang et al. ; Holmes et al., Proc. Natl. Acad. Sci. USA, 97:6728-6733 (2000); Zhang et al., Proc. Natl. Acad. Sci. USA, 90:3334-3338 (1993); Zhang et al., Biomaterials, 16:1385-1393 (1995); Caplan et al., Biomaterials, 23:219-227 (2002); Leon et al., J. Biomater. Sci. Polym. Ed., 9:297-312 (1998); and Caplan et al., Biomacromolecules, 1:627-631 (2000).

Self-assembling peptides containing alternating hydrophobic and hydrophilic amino residues can be used. Examples of hydrophobic and hydrophilic peptides are listed in Table 1. Table 1. Self-Assembling Peptides

No.	Sequence (N → C)
1.	n-SGSGSGSGSGSGSGSG-c (SEQ ID NO: 5)
2.	n-SASASASASASASASA-c (SEQ ID NO: 6)
3.	n-SVSVSVSVSVSVSVSV-c (SEQ ID NO: 7)
4.	n-SLSLSLSLSLSLSLSL-c (SEQ ID NO: 8)
5.	n-SISISISISISISISI-c (SEQ ID NO: 9)
6.	n-SMSMSMSMSMSMSMSM-c (SEQ ID NO: 10)
7.	n-SFSFSFSFSFSFSFSF-c (SEQ ID NO: 11)
8.	n-SWSWSWSWSWSWSWSW-c (SEQ ID NO: 12)
9.	n-SPSPSPSPSPSPSPSP-c (SEQ ID NO: 13)
10.	n-TGTGTGTGTGTGTGTG-c (SEQ ID NO: 14)
11.	n-TATATATATATATATA-c (SEQ ID NO: 15)
12.	n-TVTVTVTVTVTVTVTV-c (SEQ ID NO: 16)
13.	n-TLTLTLTLTLTLTLTL-c (SEQ ID NO: 17)
14.	n-TITITITITITITITI-c (SEQ ID NO: 18)
15.	n-TMTMTMTMTMTMTMTM-c (SEQ ID NO: 19)
16.	n-TFTFTFTFTFTFTFTF-c (SEQ ID NO: 20)
17.	n-TWTWTWTWTWTWTWTW-c (SEQ ID NO: 21)
18.	n-TPTPTPTPTPTPTPTP-c (SEQ ID NO: 22)
19.	n-CGCGCGCGCGCGCGCG-c (SEQ ID NO: 23)
20.	n-CACACACACACACACA-c (SEQ ID NO: 24)
21.	n-CVCVCVCVCVCVCVCV-c (SEQ ID NO: 25)
22.	n-CLCLCLCLCLCLCLCL-c (SEQ ID NO: 26)
23.	n-CICICICICICICICI-c (SEQ ID NO: 27)
24.	n-CMCMCMCMCMCMCMCM-c (SEQ ID NO: 28)
25.	n-CFCFCFCFCFCFCFCF-c (SEQ ID NO: 29)
26.	n-CWCWCWCWCWCWCWC-c (SEQ ID NO: 30)
27.	n-CPCPCPCPCPCPCPCP-c (SEQ ID NO: 31)
28.	n-YGYGYGYGYGYGYGYG-c (SEQ ID NO: 32)
29.	n-YAYAYAYAYAYAYAYA-c (SEQ ID NO: 33)
30.	n-YVYVYVYVYVYVYVYV-c (SEQ ID NO: 34)
31.	n-YLYLYLYLYLYLYLYL-c (SEQ ID NO: 35)
32.	n-YIYIYIYIYIYIYIYI-c (SEQ ID NO: 36)
33.	n-YMYMYMYMYMYMYMYM-c (SEQ ID NO: 37)
34.	n-YFYFYFYFYFYFYFYF-c (SEQ ID NO: 38)
35.	n-YWYWYWYWYWYWYWYW-c (SEQ ID NO: 39)
36.	n-YPYPYPYPYPYPYPYP-c (SEQ ID NO: 40)
37.	n-NGNGNGNGNGNGNGNG-c (SEQ ID NO: 41)
38.	n-NANANANANANANANA-c (SEQ ID NO: 42)
39.	n-NVNVNVNVNVNVNVNV-c (SEQ ID NO: 43)
40.	n-NLNLNLNLNLNLNLNL-c (SEQ ID NO: 44)
41.	n-NINININININININI-c (SEQ ID NO: 45)
42.	n-NMNMNMNMNMNMNMNM-c (SEQ ID NO: 46)
43.	n-NFNFNFNFNFNFNFNF-c (SEQ ID NO: 47)
44.	n-NWNWNWNWNWNWNWNW-c (SEQ ID NO: 48)
45.	n-NPNPNPNPNPNPNPNP-c (SEQ ID NO: 49)
46.	n-QGQGQGQGQGQGQGQG-c (SEQ ID NO: 50)
47.	n-QAQAQAQAQAQAQAQA-c (SEQ ID NO: 51)
48.	n-QVQVQVQVQVQVQVQV-c (SEQ ID NO: 52)
49.	n-QLQLQLQLQLQLQLQL-c (SEQ ID NO: 53)
50.	n-QIQIQIQIQIQIQIQI-c (SEQ ID NO: 54)
51.	n-QMQMQMQMQMQMQMQM-c (SEQ ID NO: 55)
52.	n-QFQFQFQFQFQFQFQF-c (SEQ ID NO: 56)
53.	n-QWQWQWQWQWQWQWQW-c (SEQ ID NO: 57)
54.	n-QPQPQPQPQPQPQPQP-c (SEQ ID NO: 58)
55.	n-AEAKAEAKAEAKAEAK-c (SEQ ID NO: 59)
56.	n-RADARADARADARADA-c (SEQ ID NO: 60)
57.	n-RAEARAEARAEARAEA-c (SEQ ID NO: 61)
58.	n-KADAKADAKADAKADA-c (SEQ ID NO: 62)

Other peptides or proteins can be used in combination or alternation with the disclosed self-assembling peptides or compositions. It will be appreciated that the additional peptides can include other self-assembling peptides or proteins. Alternatively, the peptides may be peptides that do not self-assemble. Representative additional peptides, proteins, or chemically modified variants thereof include, but are not limited to the peptides provided in Table 2. Table 2. Additional Peptides

1.
2.	Mpr-Y-F-Q-N-C-P-R (SEQ ID NO: 64)
3.
4.	C-Y-F-Q-N-C-P-R (SEQ ID NO: 66)
5.
6.
7.
8.
9.
10.
11.
12.	Mpr-Y-F-Q-N-C-P-K (SEQ ID NO: 74)
13.
14.	C-Y-F-Q-N-C-P-K (SEQ ID NO: 76)
15.
16.
17.
18.
19.
20.
21.	G-DR-G-D-S-P (SEQ ID NO: 83)
22.	G-DR-G-D-S-P-A-S-S-K (SEQ ID NO: 84)
23.	G-P-R
24.	G-Pen-G-R-G-D-S-P-C-A (SEQ ID NO: 85)
25.	GRADSP (SEQ ID NO: 86)
26.	GRGD-DS-P (SEQ ID NO: 87)
27.	GRGDNP (SEQ ID NO: 88)
28.	GRGDS (SEQ ID NO: 89)
29.	GRGDSP (SEQ ID NO: 90)
30.	GRGDSPC (SEQ ID NO: 91)
31.	GRGDSPK (SEQ ID NO: 92)
32.	GRGDTP (SEQ ID NO: 93)
33.	GRGES (SEQ ID NO: 94)
34.	GRGESP (SEQ ID NO: 95)
35.	GRGETP (SEQ ID NO: 96)
36.	KGDS (SEQ ID NO: 97)
37.	GAVSTA (SEQ ID NO: 98)
38.	WTVPTA (SEQ ID NO: 99)
39.	TDVNGDGRHDL (SEQ ID NO: 100)
40.	REDV (SEQ ID NO: 101)
41.	RGDC (SEQ ID NO: 102)
42.	RGDS (SEQ ID NO: 103)
43.	RGDSPASSKP (SEQ ID NO: 104)
44.	RGDT (SEQ ID NO: 105)
45.	RGDV (SEQ ID NO: 106)
46.	RGES (SEQ ID NO: 107)
47.	SDGR (SEQ ID NO: 108)
48.	SDGRG (SEQ ID NO: 109)
49.	YRGDS (SEQ ID NO: 110)
50.	EGVNDNEEGFFSAR (SEQ ID NO: 111)
51.	YADSGEGDFLAEGGGVR (SEQ ID NO: 112)
52.	Glp-GVNDNEEGFFSARY (SEQ ID NO: 113)

Table 2. Additional Peptides

Pmp = pyridoxamine phosphate Mpr = 3-mercaptopropionyl Deamino-Pen = deamino penicillamine Pen = penicillamine

Other useful self-assembling peptides can be generated, for example, which differ from those exemplified by a single amino acid residue or by multiple amino acid residues (e.g., by inclusion or exclusion of a repeating quartet). For example, one or more cysteine residues may be incorporated into the peptides, and these residues may bond with one another through the formation of disulfide bonds. Structures bonded in this manner may have increased mechanical strength relative to structures made with comparable peptides that do not include cysteine residues and thus are unable to form disulfide bonds.

The amino acid residues in the self-assembling peptides can be naturally occurring or non-naturally occurring amino acid residues. Naturally occurring amino acids can include amino acid residues encoded by the standard genetic code as well as non-standard amino acids (e.g., amino acids having the D-configuration instead of the L-configuration), as well as those amino acids that can be formed by modifications of standard amino acids (e.g. pyrrolysine or selenocysteine). Non-naturally occurring amino acids are not found in nature, but can be incorporated into a peptide chain. Suitable non-naturally occurring amino acids include, but are not limited to, D-alloisoleucine(2R,3S)-2-amino-3-methylpentanoic acid, L-cyclopentyl glycine (S)-2-amino-2-cyclopentyl acetic acid. Other examples of non-naturally occurring amino acids can be found in textbooks or on the worldwide web (e.g., a site is maintained by the California Institute of Technology which displays structures of non-natural amino acids that have been successfully incorporated into functional proteins). Non-natural amino acid residues and amino acid derivatives are described in U.S. Patent Application Publication No. 2004/0204561 to Ellison .

Self-assembling peptides can be chemically synthesized or purified from natural or recombinantly-produced sources by methods well known in the art. For example, peptides can be synthesized using standard f-moc chemistry and purified using high pressure liquid chromatography (HPLC).

Where self-assembling peptides are used, it is thought that their side-chains (or R groups) partition into two faces, a polar face with side chains that have polar groups (e.g., side chains containing -OH, -NH, -CO₂H, or -SH groups) and a nonpolar face with side chains containing non-polar groups (e.g., the side chain of an alanine residue or residues having other hydrophobic groups).

Self-complementary peptides such as EAKA16-I (SEQ ID NO: 114), RADA16-I (SEQ ID NO: 60), RAEA16-I (SEQ ID NO: 61), and KADA16-I (SEQ ID NO: 62) are described in Zhang, S., et al. ((1999) Peptide self-assembly in functional polymer science and engineering. Reactive & Functional Polymers, 41, 91-102). The self-assembling peptides have a length from 8 to 16 amino acid residues and comprise a sequence conforming to one or more of Formulas I-IV:         ((Xaa^neu-Xaa⁺)_x(Xaa^neu-Xaa^-)_y)_n     (I)         ((Xaa^neu-Xaa^-)_x(Xaa^neu-Xaa⁺)_y)_n     (II)         ((Xaa⁺-Xaa^neu)_x(Xaa^--X aa^neu)_y)_n     (III)         ((Xaa^--Xaa^neu)_x(Xaa⁺-X aa^neu)_y)_n     (IV) wherein each Xaa^neu is an amino acid residue selected from alanine, leucine, isoleucine, phenylalanine, or tyrosine; Xaa⁺ is arginine or lysine; Xaa^- is aspartic acid or glutamic acid; x and y are integers having a value of 1, 2, 3, or 4, independently; and n is an integer having a value of 1-4. Peptides with modulus I (i.e., peptides having alternate positively and negatively charged R groups on one side (e.g., the polar face of the β-sheet) are described by each of Formulas I-IV, where x and y are 1. Peptides of modulus II (i.e., peptides having two residues bearing one type of charge (e.g., a positive charge) followed by two residues bearing another type of charge (e.g., a negative charge)) are described by the same formulas where both x and y are 2. Examples of peptides of modulus III (i.e. peptides having three residues bearing one type of charge (e.g., a positive charge) followed by three residues bearing another type of charge (e.g., a negative charge)) include, but are not limited to, RARARADADADA (SEQ ID NO: 118).

If the alanine residues in the peptides are changed to more hydrophobic residues, such as leucine, isoleucine, phenylalanine or tyrosine, the resulting peptides have a greater tendency to self-assemble and form peptide matrices with enhanced strength. Some peptides that have similar amino acids compositions and lengths as the peptides described here form alpha-helices and random-coils rather than beta-sheets and do not form macroscopic structures. Thus, in addition to self-complementarity, other factors are likely to be important for the formation of macroscopic structures, such as the peptide length, the degree of intermolecular interaction, and the ability to form staggered arrays.

Peptide-based structures can be formed of heterogeneous mixtures of peptides (i.e., mixtures containing more than one type of peptide conforming to a given formula or to two or more of the formulas). In some embodiments, each of the types of peptides in the mixture is able to self-assemble alone. In other embodiments, one or more of each type of peptide would not, alone, self-assemble but the combination of heterogeneous peptides may self-assemble (i.e., peptides in the mixture are complementary and structurally compatible with each other). Thus, either a homogeneous mixture of self-complementary and self-compatible peptides of the same sequence or containing the same repeating subunit, or a heterogeneous mixture of different peptides which are complementary and structurally compatible to each other, can be used.

The compositions described herein regardless of the precise form (e.g., whether in a liquid form or molded) and regardless of the overall compositions (e.g., whether combined with another agent, contained within a device, or packaged in a kit) can include a mixture of one or more peptide chains.

Self-assembled structures can be formed that have varying degrees of stiffness or elasticity. The structures typically have a low elastic modulus (e.g., a modulus in the range of 0.01-1000 kPa, preferably from 1-10 kPa as measured by standard methods, such as in a standard cone-plate rheometer). Low values may be preferable, as they permit structure deformation as a result of movement, in response to pressure, in the event of cell contraction. More specifically, stiffness can be controlled in a variety of ways, including by changing the length, sequence, and/or concentration of the precursor molecules (e.g., self-assembling peptides). Other methods for increasing stiffness can also be employed. For example, one can attach, to the precursors, biotin molecules or any other molecules that can be subsequently cross-linked or otherwise bonded to one another. The molecules (e.g., biotin) can be included at an N- or C-terminus of a peptide or attached to one or more residues between the termini. Where biotin is used, cross-linking can be achieved by subsequent addition of avidin. Biotin-containing peptides or peptides containing other cross-linkable molecules are representative of cross-linkable peptides. For example, amino acid residues with polymerizable groups, such as vinyl groups may be incorporated and cross-linked by exposure to UV light. The extent of crosslinking can be precisely controlled by applying the radiation for a predetermined length of time to peptides of known sequence and concentration. The extent of crosslinking can be determined by light scattering, gel filtration, or scanning electron microscopy using standard methods. Furthermore, crosslinking can be examined by HPLC or mass spectrometry analysis of the structure after digestion with a protease, such as matrix metalloproteases. Material strength may be determined before and after cross-linking. Regardless of whether cross-linking is achieved by a chemical agent or light energy, the molecules may be cross-linked in the course of creating a mold or when peptide-containing solutions are applied to the body. Further, self-assembling peptide chains can be crosslinked to form a spider web-type pattern to reinforce the material in vivo. The crosslinks serve to reinforce the material providing increased rigidity and strength. For example, the self-assembling material can be applied to a wound, wherein the periphery of the material is functionalized with polymerizable groups. Upon crosslinking, the periphery of the material becomes more rigid, anchoring the material to the wound site, while the interior of material remains flexible to move as the body moves.

The half-life (e.g., the in vivo half-life) of the structures can also be modulated by incorporating protease or peptidase cleavage sites into the precursors that subsequently form a given structure. Proteases or peptidases that occur naturally in vivo or that are introduced (e.g., by a surgeon) can then promote degradation by cleaving their cognate substrates. The half-life can also be modulated by crosslinking (e.g., polymerization) of the material via functional groups within the material. These functional groups may be groups typically found in peptides or additional functional groups added to the peptides. Introducing crosslinks into the material typically increases the degradation time and can provide different cleavage sites/bonds within the material.

B. Components Enhancing or Inducing Formation of Self-assembling Peptide Materials

Prior to self-assembly, the peptides may be contained in (e.g., dissolved in) a solution that is substantially free of ions (e.g., monovalent ions) or that contains a sufficiently low concentration of ions to prevent significant self-assembly (e.g., a concentration of ions less than 10, 5, 1, or 0.1 mM). Self-assembly may be initiated or enhanced at any subsequent time by the addition of an ionic solute or diluent to a peptide solution or by a change in pH. For example, NaCl at a concentration of between approximately 5 mM and 5 M will induce the assembly of macroscopic structures within a short period of time (e.g., within a few minutes). Lower concentrations of NaCl may also induce assembly but at a slower rate. Alternatively, self-assembly may be initiated or enhanced by introducing the peptides (whether dry, in a semi-solid gel, or dissolved in a liquid solution that is substantially free of ions) into a fluid (e.g., a physiological fluid such as blood or gastric juice) or an area (e.g., a body cavity such as the nose or mouth or a cavity exposed by a surgical procedure, injury, trauma, disease, or disorder) comprising such ions. Generally, self-assembly is expected to occur upon contacting the peptides with such a solution in any manner. Assembly time may be decreased in order to allow the material to intermingle with the underlying tissue or vessel before the material assembles.

A wide variety of ions, including anions and cations (whether divalent, monovalent, or trivalent), can be used. For example, one can promote a phase transition by exposure to monovalent cations such as Li⁺, Na⁺, K⁺, and Cs⁺, and the concentration of such ions required to induce or enhance self-assembly is typically at least about 5 mM, preferably at least about 10 mM, more preferably at least about 20 mM, and most preferably about 50 mM. Lower concentrations may also facilitate assembly, though at a slower rate. When desired, self-assembling peptides can be delivered with a hydrophobic material (e.g. pharmaceutically acceptable oil) in a concentration that permits self-assembly, but at a slower rate. When self-assembling peptides are mixed with a hydrophobic agent such as an oil or lipid the assembly of the material forms different structures. The structures typically appear like ice on a layer of oil but in some cases when another material is added, the material will assemble into various other three dimensional structures that may be suitable for drug loading/delivery. The hydrophilic part of the molecule will assemble in such a way as to minimize hydrophobic-hydrophilic interaction, thereby creating a barrier between the two environments. Several experiments have shown that the self-assembling peptides will align on the surface of the oil like ice on water with the hydrophobic part of the molecule toward the surface and the hydrophilic portion of the molecule facing away from the oil, or will form toroidal-like structures with the hydrophobic material contained inside. This type of behavior enables the encapsulation of therapeutics or other molecules of interest for delivery in the body.

Depending on the formulation and desired properties of the macroscopic structure (e.g., the stiffness of the scaffold or the rate of its formation), the concentration of precursors (e.g., self-assembling peptides) can vary from approximately 0.01% w/v (0.1 mg/ml) to approximately 99.99% w/v (999.9 mg/ml), inclusive. For example, the concentration prior to scaffold formation can be between approximately 0.1% (1 mg/ml) and 10% (100 mg/ml), inclusive (e.g., about 0.1%-5%; 0.5%-5%; 1.0%; 1.5%; 2.0%; 2.5%; 3.0%; or 4.0% or more). In some embodiments, the concentration may be less than 0.1%. The precursors (e.g., self-assembling peptides) can be formulated as powders and administered in a resuspended form. In one embodiment, the concentration of the self-assembling peptides in any given formulation can vary and can be between approximately 0.1% (1 mg/ml) and 10% (100 mg/ml), inclusive. For example, the concentration of the self-assembling peptides (e.g., in a liquid formulation) can be approximately 0.1-3.0% (1-30 mg/ml) (e.g., 0.1-1.0%; 1.0-2.0%; 2.0-3.0% or 1.0-3.0%). The concentration of self-assembling peptides can be higher in stock solutions and in solid (e.g., powdered) formulations. In solid preparations, the concentration of self-assembling peptides can approach 100% (e.g., the concentration of self-assembling peptides can be 95, 96, 97, 98, 99% or more (e.g., 99.99%) of the composition). Whether in liquid or solid form, the peptides can be brought to the desired concentration prior to use by addition of a diluent (e.g., deionized water), powder, wetting agent, or a therapeutic, diagnostic or prophylactic agent.

Materials that assemble and/or undergo a phase transition (e.g., a transition from a liquid state to a semi-solid, gel, etc.) when they come in contact with the body are useful in preventing the movement of bodily substances. Self-assembly or phase transition is triggered by components found in a subject's body (e.g., ions) or by physiological pH and is assisted by physiological temperatures. Self-assembly or phase transition can begin when the compositions are exposed to or brought into contact with a subject's body and may be facilitated by the local application of heat to the area where the composition has been (or will be) deposited. The subject, for any indication described herein, can be a human. Based on studies to date, self-assembly occurs rapidly upon contact with internal bodily tissues without the application of additional heat. In one embodiment, the time required for effective assembly and/or phase transition can be 60 seconds or less following contact with a subject's internal tissues or to conditions similar to those found within the body (e.g., in 50, 40, 30, 20, or 10 seconds or less). In some circumstances, such as where the concentration of self-assembling agents in the composition is low or where the movement of the bodily substance is substantial, self-assembly or phase transition may take longer to achieve the desired effect, for example, up to a minute, 5 minutes, 10 minutes, 30 minutes, an hour, or longer. For example, a solution containing a self-assembling peptide applied to sites of blood vessel trans-section in the brain, liver, or muscle provides complete hemostasis within times as short as 10 seconds following application. Ion-containing solutions may be preferred when the compositions are used to protect a subject from contamination, as phase transitions do not occur, or do not readily occur, when non-ionic compositions contact intact skin.

The compositions can form structures that are substantially rigid (e.g., solid or nearly solid) or that assume a definite shape and volume (e.g., structures that conform to the shape and volume of the location to which a liquid composition was administered, whether in vivo or ex vivo). The solidified material may be somewhat deformable or compressible after assembly or phase transition, but will not substantially flow from one area to another, as compositions at a different point along the liquid to solid continuum may do, which may be due, at least in part, to their ability to undergo phase transitions. As a result, the compositions can be used to prevent the movement of a bodily substance in a subject in need thereof. Self-assembly can be achieved in vivo or ex vivo by exposure to conditions within a certain range of physiological values (e.g., conditions appropriate for cell or tissue culture) or non-physiological conditions. "Non-physiological conditions" refers to conditions within the body or at a particular site that deviate from normal physiological conditions at that site. Such conditions may result from trauma, surgery, injury, infection, or a disease, disorder, or condition. For example, a puncture wound in the stomach generally results in a decrease in the pH as stomach acid flows into the wound site. The materials described herein should self assemble under such conditions.

Regardless of the precise nature of the self-assembling agents, upon exposure to conditions such as those described herein, the agents can form membranous two- or three-dimensional structures including a stable macroscopic porous matrix having ordered or unordered interwoven nanofibers (e.g., fibers approximately 10-20 nm in diameter, with a pore size of about 50-100 nm or larger in a linear dimension). Three-dimensional macroscopic matrices can have dimensions large enough to be visible under low magnification (e.g., about 10-fold or less), and the membranous structures can be visible to the naked eye, even if transparent. Although three-dimensional, the structures can be exceedingly thin, including a limited number of layers of molecules (e.g., 2, 3, or more layers of molecules). Typically, each dimension of a given structure will be at least 10 µm in size (e.g., two dimensions of at least 100-1000 µm in size (e.g., 1-10 mm, 10-100 mm, or more)). The relevant dimensions may be expressed as length, width, depth, breadth, height, radius, diameter, or circumference in the case of structures that have a substantially regular shape (e.g., where the structure is a sphere, cylinder, cube, or the like) or an approximation of any of the foregoing where the structures do not have a regular shape.

The self-assembling peptides can form a hydrated material when contacted with water under conditions such as those described herein (e.g., in the presence of a sufficient concentration (e.g., physiological concentrations) of ions (e.g., monovalent cations)). The materials may have a high water content (e.g., approximately 95% or more (e.g., approximately 97%, 98%, 99% or more)), and the compositions can be hydrated but not substantially self-assembled. A given value may be "approximate" in recognition of the fact that measurements can vary depending, for example, on the circumstances under which they are made and the skill of the person taking the measurement. Generally, a first value is approximately equal to a second when the first falls within 10% of the second (whether greater than or lessthan) unless it is otherwise clear from the context that a value is not approximate or where, for example, such value would exceed 100% of a possible value.

The properties and mechanical strength of the structures or scaffolds can be controlled as required through manipulation of the components therein. For example, the stiffness of an assembled gel can be increased by increasing the concentration of self-assembling agents (e.g., peptides) therein. Alternatively, it may be desirable for different parts of the material to have different mechanical properties. For example, it may be advantageous to decrease the stability of all or part of the material by manipulating the amino acid sequence. This may be desirable when the materials are used to fill a void, such that the edges of the material self-assemble to attach to the tissue site while the rest of the material flows out into the void.

The sequences, characteristics, and properties of the peptides and the structures formed by them upon self-assembly are discussed further below.

The compositions can be formulated as concentrated stocks or in dry form, and these can be diluted or dissolved to form compositions (e.g., biocompatible compositions), which are substantially non-toxic to biological cells in vitro or in vivo. For example, the compositions can contain materials in quantities that do not elicit a significant deleterious effect on the recipient's body (e.g., a prohibitively severe immunological or inflammatory reaction, or unacceptable scar tissue formation).

When a solution containing non-assembled peptides is laid down on a biological tissue, the peptides having sufficient proximity to the tissue assemble, causing the solution to gel. Any solution that remains distant from the tissue remains liquid, as the self-assembling peptides have not yet been exposed to conditions that promote their assembly. As the material is disturbed (e.g., by performing a surgical procedure), liquid material appears to gel as it comes into sufficient contact with the body. At times, the compositions can take on characteristics ranging from a liquid to those of a solid, appearing gel- or salve-like or as a slurry.

C. Modification of Self-assembling Materials to Target Specific Tissues.

The self-assembling peptides can be modified to include a targeting agent.

Referring to Figure 1, the self assembling material may further contain a tissue specific component to direct the self-assembling peptide to a specific location, cell, tissue, organ, or organelle. Representative targeting agents include, but are not limited to, nuclear localization signals, mitochondria localization signals, antibodies or antigen binding antibody fragments, single chain antibodies, sugar moieties, lipids, glycolipids, dyes, and glycoproteins. The targeting agents can be attached to the self-assembling peptides directly or through a linker. In some embodiments, the targeting agent is releasably attached to the self-assembling peptide for example through a cleavable bond or enzyme cleavage site. For example, cell surface carbohydrates are major components of the outer surface of mammalian cells and are very often characteristic of cell types. It is assumed that cell type-specific carbohydrates are involved in cell-cell interaction. The tissue specific component can therefore, target these cell specific surface carbohydrates. The targeting may be useful for specific locations in the body when the compositions are injected.

Additionally, hydrophobic tails can be added to the self assembling material. Hydrophobic tails can interact with the cell membrane, thus anchoring the self assembling material on to the cell surface. Table 3 shows a list of peptides with hydrophobic tails. Hydrophilic tails can also be added to the peptide, alone or in addition to hydrophobic tails, to facilitate interaction with the ECM of different vessels or tissues, such as the bladder. Table 3: Hydrophobic Tails

No.																SEQ ID NO
1	G	G	G	G	G	D	G	D	G	D	G	D	G	D	G	D	(126)
2	G	G	G	G	G	E	G	E	G	E	G	E	G	E	G	E	(127)
3	G	G	G	G	G	K	G	K	G	K	G	K	G	K	G	K	(128)
4	G	G	G	G	G	R	G	R	G	R	G	R	G	R	G	R	(129)
5	G	G	G	G	G	H	G	H	G	H	G	H	G	H	G	H	(130)
6	A	A	A	A	A	D	A	D	A	D	A	D	A	D	A	D	(131)
7	A	A	A	A	A	E	A	E	A	E	A	E	A	E	A	E	(132)
8	A	A	A	A	A	K	A	K	A	K	A	K	A	K	A	K	(133)
9	A	A	A	A	A	R	A	R	A	R	A	R	A	R	A	R	(134)
10	A	A	A	A	A	H	A	H	A	H	A	H	A	H	A	H	(135)
11	V	V	V	V	V	D	V	D	V	D	V	D	V	D	V	D	(136)
12	V	V	V	V	V	E	V	E	V	E	V	E	V	E	V	E	(137)
13	V	V	V	V	V	K	V	K	V	K	V	K	V	K	V	K	(138)
14	V	V	V	V	V	R	V	R	V	R	V	R	V	R	V	R	(139)
15	V	V	V	V	V	H	V	H	V	H	V	H	V	H	V	H	(140)
16	L	L	L	L	L	D	L	D	L	D	L	D	L	D	L	D	(141)
17	L	L	L	L	L	E	L	E	L	E	L	E	L	E	L	E	(142)
18	L	L	L	L	L	K	L	K	L	K	L	K	L	K	L	K	(143)
19	L	L	L	L	L	R	L	R	L	R	L	R	L	R	L	R	(144)
20	L	L	L	L	L	H	L	H	L	H	L	H	L	H	L	H	(145)
21	I	I	I	I	I	D	I	D	I	D	I	D	I	D	I	D	(146)
22	I	I	I	I	I	E	I	E	I	E	I	E	I	E	I	E	(147)
23	I	I	I	I	I	K	I	K	I	K	I	K	I	K	I	K	(148)
24	I	I	I	I	I	R	I	R	I	R	I	R	I	R	I	R	(149)
25	I	I	I	I	I	H	I	H	I	H	I	H	I	H	I	H	(150)
26	M	M	M	M	M	D	M	D	M	D	M	D	M	D	M	D	(151)
27	M	M	M	M	M	E	M	E	M	E	M	E	M	E	M	E	(152)
28	M	M	M	M	M	K	M	K	M	K	M	K	M	K	M	K	(153)
29	M	M	M	M	M	R	M	R	M	R	M	R	M	R	M	R	(154)
30	M	M	M	M	M	H	M	H	M	H	M	H	M	H	M	H	(155)
31	F	F	F	F	F	D	F	D	F	D	F	D	F	D	F	D	(156)
32	F	F	F	F	F	E	F	E	F	E	F	E	F	E	F	E	(157)
33	F	F	F	F	F	K	F	K	F	K	F	K	F	K	F	K	(158)
34	F	F	F	F	F	R	F	R	F	R	F	R	F	R	F	R	(159)
35	F	F	F	F	F	H	F	H	F	H	F	H	F	H	F	H	(160)
36	W	W	W	W	W	D	W	D	W	D	W	D	W	D	W	D	(161)
37	W	W	W	W	W	E	W	E	W	E	W	E	W	E	W	E	(162)
38	W	W	W	W	W	K	W	K	W	K	W	K	W	K	W	K	(163)
39	W	W	W	W	W	R	W	R	W	R	W	R	W	R	W	R	(164)
40	W	W	W	W	W	H	W	H	W	H	W	H	W	H	W	H	(165)
41	P	P	P	P	P	D	P	D	P	D	P	D	P	D	P	D	(166)
42	P	P	P	P	P	E	P	E	P	E	P	E	P	E	P	E	(167)
43	P	P	P	P	P	K	P	K	P	K	P	K	P	K	P	K	(168)
44	P	P	P	P	P	R	P	R	P	R	P	R	P	R	P	R	(169)
45	P	P	P	P	P	H	P	H	P	H	P	H	P	H	P	H	(170)
46	A	A	A	A	A	R	A	D	A	R	A	D	A	R	A	D	(171)
47	A	A	A	A	A	R	A	R	A	D	A	D	A	R	A	R	(172)
48	A	A	A	A	A	E	A	K	A	E	A	K	A	E	A	K	(173)
49	A	A	A	A	A	E	A	E	A	K	A	K	A	E	A	E	(174)
50	A	A	A	A	A	R	A	E	A	R	A	E	A	R	A	E	(175)
51	A	A	A	A	A	R	A	R	A	E	A	E	A	R	A	E	(176)
52	A	A	A	A	A	K	A	D	A	K	A	D	A	K	A	D	(177)
53	A	A	A	A	A	E	A	H	A	E	A	H	A	E	A	H	(178)
54	A	A	A	A	A	E	A	E	A	H	A	H	A	E	A	E	(179)
55	A	A	A	A	A	R	A	R	A	R	A	R	A	R	A	R	(180)
56	A	A	A	A	A	R	A	R	A	R	A	R	A	D	A	D	(181)
57	A	A	A	A	A	R	A	R	A	R	A	D	A	D	A	D	(182)
58	A	A	A	A	A	H	A	D	A	H	A	D	A	H	A	D	(183)
59	A	A	A	A	A	H	A	H	A	H	A	H	A	H	A	H	(184)
60	A	A	A	A	A	H	A	D	A	D	A	H	A	D	A	D	(185)
61	A	A	A	A	A	H	A	E	A	E	A	H	A	E	A	E	(186)
62	G	G	G	G	G	R	G	D	G	R	G	D	G	R	G	D	(187)
63	G	G	G	G	G	R	G	R	G	D	G	D	G	R	G	R	(188)
64	G	G	G	G	G	E	G	K	G	E	G	K	G	E	G	K	(189)
65	G	G	G	G	G	E	G	E	G	K	G	K	G	E	G	E	(190)
66	G	G	G	G	G	R	G	E	G	R	G	E	G	R	G	E	(191)
67	G	G	G	G	G	R	G	R	G	E	G	E	G	R	G	E	(192)
68	G	G	G	G	G	K	G	D	G	K	G	D	G	K	G	D	(193)
69	G	G	G	G	G	E	G	H	G	E	G	H	G	E	G	H	(194)
70	G	G	G	G	G	E	G	E	G	H	G	H	G	E	G	E	(195)
71	G	G	G	G	G	R	G	R	G	R	G	R	G	R	G	R	(196)
72	G	G	G	G	G	R	G	R	G	R	G	R	G	D	G	D	(197)
73	G	G	G	G	G	R	G	R	G	R	G	D	G	D	G	D	(198)
74	G	G	G	G	G	H	G	D	G	H	G	D	G	H	G	D	(199)
75	G	G	G	G	G	H	G	H	G	H	G	H	G	H	G	H	(200)
76	G	G	G	G	G	H	G	D	G	D	G	H	G	D	G	D	(201)
77	G	G	G	G	G	H	G	E	G	E	G	H	G	E	G	E	(202)
78	V	V	V	V	V	R	V	D	V	R	V	D	V	R	V	D	(203)
79	V	V	V	V	V	R	V	R	V	D	V	D	V	R	V	R	(204)
80	V	V	V	V	V	E	V	K	V	E	V	K	V	E	V	K	(205)
81	V	V	V	V	V	E	V	E	V	K	V	K	V	E	V	E	(206)
82	V	V	V	V	V	R	V	E	V	R	V	E	V	R	V	E	(207)
83	V	V	V	V	V	R	V	R	V	E	V	E	V	R	V	E	(208)
84	V	V	V	V	V	K	V	D	V	K	V	D	V	K	V	D	(209)
85	V	V	V	V	V	E	V	H	V	E	V	H	V	E	V	H	(210)
86	V	V	V	V	V	E	V	E	V	H	V	H	V	E	V	E	(211)
87	V	V	V	V	V	R	V	R	V	R	V	R	V	R	V	R	(212)
88	V	V	V	V	V	R	V	R	V	R	V	R	V	D	V	D	(213)
89	V	V	V	V	V	R	V	R	V	R	V	D	V	D	V	D	(214)
90	V	V	V	V	V	H	V	D	V	H	V	D	V	H	V	D	(215)
91	V	V	V	V	V	H	V	H	V	H	V	H	V	H	V	H	(216)
92	V	V	V	V	V	H	V	D	V	D	V	H	V	D	V	D	(217)
93	V	V	V	V	V	H	V	E	V	E	V	H	V	E	V	E	(218)
94	L	L	L	L	L	R	L	D	L	R	L	D	L	R	L	D	(219)
95	L	L	L	L	L	R	L	R	L	D	L	D	L	R	L	R	(220)
96	L	L	L	L	L	E	L	K	L	E	L	K	L	E	L	K	(221)
97	L	L	L	L	L	E	L	E	L	K	L	K	L	E	L	E	(222)
98	L	L	L	L	L	R	L	E	L	R	L	E	L	R	L	E	(223)
99	L	L	L	L	L	R	L	R	L	E	L	E	L	R	L	E	(224)
100	L	L	L	L	L	K	L	D	L	K	L	D	L	K	L	D	(225)
101	L	L	L	L	L	E	L	H	L	E	L	H	L	E	L	H	(226)
102	L	L	L	L	L	E	L	E	L	H	L	H	L	E	L	E	(227)
103	L	L	L	L	L	R	L	R	L	R	L	R	L	R	L	R	(228)
104	L	L	L	L	L	R	L	R	L	R	L	R	L	D	L	D	(229)
105	L	L	L	L	L	R	L	R	L	R	L	D	L	D	L	D	(230)
106	L	L	L	L	L	H	L	D	L	H	L	D	L	H	L	D	(231)
107	L	L	L	L	L	H	L	H	L	H	L	H	L	H	L	H	(232)
108	L	L	L	L	L	H	L	D	L	D	L	H	L	D	L	D	(233)
109	L	L	L	L	L	H	L	E	L	E	L	H	L	E	L	E	(234)
110	I	I	I	I	I	R	I	D	I	R	I	D	I	R	I	D	(235)
111	I	I	I	I	I	R	I	R	I	D	I	D	I	R	I	R	(236)
112	I	I	I	I	I	E	I	K	I	E	I	K	I	E	I	K	(237)
113	I	I	I	I	I	E	I	E	I	K	I	K	I	E	I	E	(238)
114	I	I	I	I	I	R	I	E	I	R	I	E	I	R	I	E	(239)
115	I	I	I	I	I	R	I	R	I	E	I	E	I	R	I	E	(240)
116	I	I	I	I	I	K	I	D	I	K	I	D	I	K	I	D	(241)
117	I	I	I	I	I	E	I	H	I	E	I	H	I	E	I	H	(242)
118	I	I	I	I	I	E	I	E	I	H	I	H	I	E	I	E	(243)
119	I	I	I	I	I	R	I	R	I	R	I	R	I	R	I	R	(244)
120	I	I	I	I	I	R	I	R	I	R	I	R	I	D	I	D	(245)
121	I	I	I	I	I	R	I	R	I	R	I	D	I	D	I	D	(246)
122	I	I	I	I	I	H	I	D	I	H	I	D	I	H	I	D	(247)
123	I	I	I	I	I	H	I	H	I	H	I	H	I	H	I	H	(248)
124	I	I	I	I	I	H	I	D	I	D	I	H	I	D	I	D	(249)
125	I	I	I	I	I	H	I	E	I	E	I	H	I	E	I	E	(250)
126	M	M	M	M	M	R	M	D	M	R	M	D	M	R	M	D	(251)
127	M	M	M	M	M	R	M	R	M	D	M	D	M	R	M	R	(252)
128	M	M	M	M	M	E	M	K	M	E	M	K	M	E	M	K	(253)
129	M	M	M	M	M	E	M	E	M	K	M	K	M	E	M	E	(254)
130	M	M	M	M	M	R	M	E	M	R	M	E	M	R	M	E	(255)
131	M	M	M	M	M	R	M	R	M	E	M	E	M	R	M	E	(256)
132	M	M	M	M	M	K	M	D	M	K	M	D	M	K	M	D	(257)
133	M	M	M	M	M	E	M	H	M	E	M	H	M	E	M	H	(258)
134	M	M	M	M	M	E	M	E	M	H	M	H	M	E	M	E	(259)
135	M	M	M	M	M	R	M	R	M	R	M	R	M	R	M	R	(260)
136	M	M	M	M	M	R	M	R	M	R	M	R	M	D	M	D	(261)
137	M	M	M	M	M	R	M	R	M	R	M	D	M	D	M	D	(262)
138	M	M	M	M	M	H	M	D	M	H	M	D	M	H	M	D	(263)
139	M	M	M	M	M	H	M	H	M	H	M	H	M	H	M	H	(264)
140	M	M	M	M	M	H	M	D	M	D	M	H	M	D	M	D	(265)
141	M	M	M	M	M	H	M	E	M	E	M	H	M	E	M	E	(266)
142	F	F	F	F	F	R	F	D	F	R	F	D	F	R	F	D	(267)
143	F	F	F	F	F	R	F	R	F	D	F	D	F	R	F	R	(268)
144	F	F	F	F	F	E	F	K	F	E	F	K	F	E	F	K	(269)
145	F	F	F	F	F	E	F	E	F	K	F	K	F	E	F	E	(270)
146	F	F	F	F	F	R	F	E	F	R	F	E	F	R	F	E	(271)
147	F	F	F	F	F	R	F	R	F	E	F	E	F	R	F	E	(272)
148	F	F	F	F	F	K	F	D	F	K	F	D	F	K	F	D	(273)
149	F	F	F	F	F	E	F	H	F	E	F	H	F	E	F	H	(274)
150	F	F	F	F	F	E	F	E	F	H	F	H	F	E	F	E	(275)
151	F	F	F	F	F	R	F	R	F	R	F	R	F	R	F	R	(276)
152	F	F	F	F	F	R	F	R	F	R	F	R	F	D	F	D	(277)
153	F	F	F	F	F	R	F	R	F	R	F	D	F	D	F	D	(278)
154	F	F	F	F	F	H	F	D	F	H	F	D	F	H	F	D	(279)
155	F	F	F	F	F	H	F	H	F	H	F	H	F	H	F	H	(280)
156	F	F	F	F	F	H	F	D	F	D	F	H	F	D	F	D	(281)
157	F	F	F	F	F	H	F	E	F	E	F	H	F	E	F	E	(282)
158	W	W	W	W	W	R	W	D	W	R	W	D	W	R	W	D	(283)
159	W	W	W	W	W	R	W	R	W	D	W	D	W	R	W	R	(284)
160	W	W	W	W	W	E	W	K	W	E	W	K	W	E	W	K	(285)
161	W	W	W	W	W	E	W	E	W	K	W	K	W	E	W	E	(286)
162	W	W	W	W	W	R	W	E	W	R	W	E	W	R	W	E	(287)
163	W	W	W	W	W	R	W	R	W	E	W	E	W	R	W	E	(288)
164	W	W	W	W	W	K	W	D	W	K	W	D	W	K	W	D	(289)
165	W	W	W	W	W	E	W	H	W	E	W	H	W	E	W	H	(290)
166	W	W	W	W	W	E	W	E	W	H	W	H	W	E	W	E	(291)
167	W	W	W	W	W	R	W	R	W	R	W	R	W	R	W	R	(292)
168	W	W	W	W	W	R	W	R	W	R	W	R	W	D	W	D	(293)
169	W	W	W	W	W	R	W	R	W	R	W	D	W	D	W	D	(294)
170	W	W	W	W	W	H	W	D	W	H	W	D	W	H	W	D	(295)
171	W	W	W	W	W	H	W	H	W	H	W	H	W	H	W	H	(296)
172	W	W	W	W	W	H	W	D	W	D	W	H	W	D	W	D	(297)
173	W	W	W	W	W	H	W	E	W	E	W	H	W	E	W	E	(298)
174	P	P	P	P	P	R	P	D	P	R	P	D	P	R	P	D	(299)
175	P	P	P	P	P	R	P	R	P	D	P	D	P	R	P	R	(300)
176	P	P	P	P	P	E	P	K	P	E	P	K	P	E	P	K	(301)
177	P	P	P	P	P	E	P	E	P	K	P	K	P	E	P	E	(302)
178	P	P	P	P	P	R	P	E	P	R	P	E	P	R	P	E	(303)
179	P	P	P	P	P	R	P	R	P	E	P	E	P	R	P	E	(304)
180	P	P	P	P	P	K	P	D	P	K	P	D	P	K	P	D	(305)
181	P	P	P	P	P	E	P	H	P	E	P	H	P	E	P	H	(306)
182	P	P	P	P	P	E	P	E	P	H	P	H	P	E	P	E	(307)
183	P	P	P	P	P	R	P	R	P	R	P	R	P	R	P	R	(308)
184	P	P	P	P	P	R	P	R	P	R	P	R	P	D	P	D	(309)
185	P	P	P	P	P	R	P	R	P	R	P	D	P	D	P	D	(310)
186	P	P	P	P	P	H	P	D	P	H	P	D	P	H	P	D	(311)
187	P	P	P	P	P	H	P	H	P	H	P	H	P	H	P	H	(312)
188	P	P	P	P	P	H	P	D	P	D	P	H	P	D	P	D	(313)
189	P	P	P	P	P	H	P	E	P	E	P	H	P	E	P	E	(314)
190	S	S	S	S	S	R	S	D	S	R	S	D	S	R	S	D	(315)
191	S	S	S	S	S	R	S	R	S	D	S	D	S	R	S	R	(316)
192	S	S	S	S	S	E	S	K	S	E	S	K	S	E	S	K	(317)
193	S	S	S	S	S	E	S	E	S	K	S	K	S	E	S	E	(318)
194	S	S	S	S	S	R	S	E	S	R	S	E	S	R	S	E	(319)
195	S	S	S	S	S	R	S	R	S	E	S	E	S	R	S	E	(320)
196	S	S	S	S	S	K	S	D	S	K	S	D	S	K	S	D	(321)
197	S	S	S	S	S	E	S	H	S	E	S	H	S	E	S	H	(322)
198	S	S	S	S	S	E	S	E	S	H	S	H	S	E	S	E	(323)
199	S	S	S	S	S	R	S	R	S	R	S	R	S	R	S	R	(324)
200	S	S	S	S	S	R	S	R	S	R	S	R	S	D	S	D	(325)
201	S	S	S	S	S	R	S	R	S	R	S	D	S	D	S	D	(326)
202	S	S	S	S	S	H	S	D	S	H	S	D	S	H	S	D	(327)
203	S	S	S	S	S	H	S	H	S	H	S	H	S	H	S	H	(328)
204	S	S	S	S	S	H	S	D	S	D	S	H	S	D	S	D	(329)
205	S	S	S	S	S	H	S	E	S	E	S	H	S	E	S	E	(330)
206	T	T	T	T	T	R	T	D	T	R	T	D	T	R	T	D	(331)
207	T	T	T	T	T	R	T	R	T	D	T	D	T	R	T	R	(332)
208	T	T	T	T	T	E	T	K	T	E	T	K	T	E	T	K	(333)
209	T	T	T	T	T	E	T	E	T	K	T	K	T	E	T	E	(334)
210	T	T	T	T	T	R	T	E	T	R	T	E	T	R	T	E	(335)
211	T	T	T	T	T	R	T	R	T	E	T	E	T	R	T	E	(336)
212	T	T	T	T	T	K	T	D	T	K	T	D	T	K	T	D	(337)
213	T	T	T	T	T	E	T	H	T	E	T	H	T	E	T	H	(338)
214	T	T	T	T	T	E	T	E	T	H	T	H	T	E	T	E	(339)
215	T	T	T	T	T	R	T	R	T	R	T	R	T	R	T	R	(340)
216	T	T	T	T	T	R	T	R	T	R	T	R	T	D	T	D	(341)
217	T	T	T	T	T	R	T	R	T	R	T	D	T	D	T	D	(342)
218	T	T	T	T	T	H	T	D	T	H	T	D	T	H	T	D	(343)
219	T	T	T	T	T	H	T	H	T	H	T	H	T	H	T	H	(344)
220	T	T	T	T	T	H	T	D	T	D	T	H	T	D	T	D	(345)
221	T	T	T	T	T	H	T	E	T	E	T	H	T	E	T	E	(346)
222	C	C	C	C	C	R	C	D	C	R	C	D	C	R	C	D	(347)
223	C	C	C	C	C	R	C	R	C	D	C	D	C	R	C	R	(348)
224	C	C	C	C	C	E	C	K	C	E	C	K	C	E	C	K	(349)
225	C	C	C	C	C	E	C	E	C	K	C	K	C	E	C	E	(350)
226	C	C	C	C	C	R	C	E	C	R	C	E	C	R	C	E	(351)
227	C	C	C	C	C	R	C	R	C	E	C	E	C	R	C	E	(352)
228	C	C	C	C	C	K	C	D	C	K	C	D	C	K	C	D	(353)
229	C	C	C	C	C	E	C	H	C	E	C	H	C	E	C	H	(354)
230	C	C	C	C	C	E	C	E	C	H	C	H	C	E	C	E	(355)
231	C	C	C	C	C	R	C	R	C	R	C	R	C	R	C	R	(356)
232	C	C	C	C	C	R	C	R	C	R	C	R	C	D	C	D	(357)
233	C	C	C	C	C	R	C	R	C	R	C	D	C	D	C	D	(358)
234	C	C	C	C	C	H	C	D	C	H	C	D	C	H	C	D	(359)
235	C	C	C	C	C	H	C	H	C	H	C	H	C	H	C	H	(360)
236	C	C	C	C	C	H	C	D	C	D	C	H	C	D	C	D	(361)
237	C	C	C	C	C	H	C	E	C	E	C	H	C	E	C	E	(362)
238	Y	Y	Y	Y	Y	R	Y	D	Y	R	Y	D	Y	R	Y	D	(363)
239	Y	Y	Y	Y	Y	R	Y	R	Y	D	Y	D	Y	R	Y	R	(364)
240	Y	Y	Y	Y	Y	E	Y	K	Y	E	Y	K	Y	E	Y	K	(365)
241	Y	Y	Y	Y	Y	E	Y	E	Y	K	Y	K	Y	E	Y	E	(366)
242	Y	Y	Y	Y	Y	R	Y	E	Y	R	Y	E	Y	R	Y	E	(367)
243	Y	Y	Y	Y	Y	R	Y	R	Y	E	Y	E	Y	R	Y	E	(368)
244	Y	Y	Y	Y	Y	K	Y	D	Y	K	Y	D	Y	K	Y	D	(410)
245	Y	Y	Y	Y	Y	E	Y	H	Y	E	Y	H	Y	E	Y	H	(369)
246	Y	Y	Y	Y	Y	E	Y	E	Y	H	Y	H	Y	E	Y	E	(370)
247	Y	Y	Y	Y	Y	R	Y	R	Y	R	Y	R	Y	R	Y	R	(371)
248	Y	Y	Y	Y	Y	R	Y	R	Y	R	Y	R	Y	D	Y	D	(372)
249	Y	Y	Y	Y	Y	R	Y	R	Y	R	Y	D	Y	D	Y	D	(373)
250	Y	Y	Y	Y	Y	H	Y	D	Y	H	Y	D	Y	H	Y	D	(374)
251	Y	Y	Y	Y	Y	H	Y	H	Y	H	Y	H	Y	H	Y	H	(375)
252	Y	Y	Y	Y	Y	H	Y	D	Y	D	Y	H	Y	D	Y	D	(376)
253	Y	Y	Y	Y	Y	H	Y	E	Y	E	Y	H	Y	E	Y	E	(377)
254	N	N	N	N	N	R	N	D	N	R	N	D	N	R	N	D	(378)
255	N	N	N	N	N	R	N	R	N	D	N	D	N	R	N	R	(379)
256	N	N	N	N	N	E	N	K	N	E	N	K	N	E	N	K	(380)
257	N	N	N	N	N	E	N	E	N	K	N	K	N	E	N	E	(381)
258	N	N	N	N	N	R	N	E	N	R	N	E	N	R	N	E	(382)
259	N	N	N	N	N	R	N	R	N	E	N	E	N	R	N	E	(383)
260	N	N	N	N	N	K	N	D	N	K	N	D	N	K	N	D	(384)
261	N	N	N	N	N	E	N	H	N	E	N	H	N	E	N	H	(385)
262	N	N	N	N	N	E	N	E	N	H	N	H	N	E	N	E	(386)
263	N	N	N	N	N	R	N	R	N	R	N	R	N	R	N	R	(387)
264	N	N	N	N	N	R	N	R	N	R	N	R	N	D	N	D	(388)
265	N	N	N	N	N	R	N	R	N	R	N	D	N	D	N	D	(389)
266	N	N	N	N	N	H	N	D	N	H	N	D	N	H	N	D	(390)
267	N	N	N	N	N	H	N	H	N	H	N	H	N	H	N	H	(391)
268	N	N	N	N	N	H	N	D	N	D	N	H	N	D	N	D	(392)
269	N	N	N	N	N	H	N	E	N	E	N	H	N	E	N	E	(393)
270	Q	Q	Q	Q	Q	R	Q	D	Q	R	Q	D	Q	R	Q	D	(394)
271	Q	Q	Q	Q	Q	R	Q	R	Q	D	Q	D	Q	R	Q	R	(395)
272	Q	Q	Q	Q	Q	E	Q	K	Q	E	Q	K	Q	E	Q	K	(396)
273	Q	Q	Q	Q	Q	E	Q	E	Q	K	Q	K	Q	E	Q	E	(397)
274	Q	Q	Q	Q	Q	R	Q	E	Q	R	Q	E	Q	R	Q	E	(398)
275	Q	Q	Q	Q	Q	R	Q	R	Q	E	Q	E	Q	R	Q	E	(399)
276	Q	Q	Q	Q	Q	K	Q	D	Q	K	Q	D	Q	K	Q	D	(400)
277	Q	Q	Q	Q	Q	E	Q	H	Q	E	Q	H	Q	E	Q	H	(401)
278	Q	Q	Q	Q	Q	E	Q	E	Q	H	Q	H	Q	E	Q	E	(402)
279	Q	Q	Q	Q	Q	R	Q	R	Q	R	Q	R	Q	R	Q	R	(403)
280	Q	Q	Q	Q	Q	R	Q	R	Q	R	Q	R	Q	D	Q	D	(404)
281	Q	Q	Q	Q	Q	R	Q	R	Q	R	Q	D	Q	D	Q	D	(405)
282	Q	Q	Q	Q	Q	H	Q	D	Q	H	Q	D	Q	H	Q	D	(406)
283	Q	Q	Q	Q	Q	H	Q	H	Q	H	Q	H	Q	H	Q	H	(407)
284	Q	Q	Q	Q	Q	H	Q	D	Q	D	Q	H	Q	D	Q	D	(408)
285	Q	Q	Q	Q	Q	H	Q	E	Q	E	Q	H	Q	E	Q	E	(409)

The sequences described in Table 3 are generally linear sequences. However, the materials can be in the form of non-linear sequences containing hydrophobic or hydrophilic tails, which interact with the ECM. In one embodiment, the sequence is in the form of a "rake", wherein the tines of the rake are the hydrophilic and/or hydrophobic sequences which interact with the ECM to anchor the material to the tissue or vessel. The handle of rake contains a sequence that self-assembles.

D. Therapeutic, Prophylactic and Diagnostic Agents

The self-assembling peptide formulations may contain one or more therapeutic, prophylactic or diagnostic agents. The agents can be peptides or proteins, polysaccharides or saccharides, nucleic acids or nucleotides, proteoglycans, lipids, carbohydrates, or small molecules, typically organic compounds having multiple carbon-carbon bonds. Small molecules have relatively low molecular weights (e.g., less than about 1500 g/mol) and are not peptides or nucleic acids. The agent(s) may be naturally occurring or prepared via chemical synthesis. For example, a protein having a sequence that has not been found in nature (e.g., one that does not occur in a publicly available database of sequences) or that has a known sequence modified in an unnatural way by a human hand (e.g., a sequence modified by altering a post-translational process such as glycosylation) is a synthetic molecule. Nucleic acid molecules encoding such proteins (e.g., an oligonucleotide, optionally contained within an expression vector) can be incorporated into the compositions described herein. For example, a composition can include a plurality of self-assembling peptides and cells that express, or that are engineered to express, a protein (by virtue of containing a nucleic acid sequence that encodes the protein).

The one or more therapeutic, prophylactic or diagnostic agents can be added in combination or alternation with the self-assembling peptides. In certain embodiments, the one or more therapeutic, prophylactic or diagnostic agents can be covalently linked to the self-assembling peptides, for example, via a thio-linkage or other suitable linkages.

In one embodiment, these agents may be anti-inflammatories, vasoactive agents, coloring agents, anti-infectives, anesthetics, growth factors, and/or cells. Representative vasoconstrictors, any of which can be formulated with one or more self-assembling peptides (e.g., in a biocompatible composition in liquid, powder or gel form) include, but are not limited to, epinephrine and phenylephrine.

Representative anesthetic agents include, but are not limited to, benzocaine, bupivacaine, butamben picrate, chloroprocaine, cocaine, curare, dibucaine, dyclonine, etidocaine, lidocaine, mepivacaine, pramoxine, prilocaine, procaine, propoxycaine, ropivacaine, tetracaine, or combinations thereof. Local application of the anesthetic agent may be all that is required in some situations, for example, for a burn or other wound to the skin, including decubitus ulcers, or for minimally invasive surgeries. Combining local anesthetics with the self-assembling peptides, whether combined by virtue of being present in the same formulation or by virtue of co-administration, can help contain the anesthetic within the body and reduce the amount entering the circulation.

Vasoconstrictors such as phenylephrine can be included to prolong the effect of local anesthesia (e.g., 0.1-0.5% phenylephrine). Analgesic agents other than a local anesthetic agent, such as steroids, non-steroidal anti-inflammatory agents like indomethacin, platelet activating factor (PAF) inhibitors such as lexipafant, CV 3988, and/or PAF receptor inhibitors such as SRI 63-441.

An anti-infective or antimicrobial agent (e.g., an antibiotic, antibacterial, antiviral, or antifungal agent) can be included for either systemic or local administration. Examples include β-lactam antibiotics such as penicillins and cephalosporins and other inhibitors of cell wall synthesis such as vancomycin, chloramphenicol, tetracyclines, macrolides, clindamycin, streptogramins, aminoglycosides, spectinomycin, sulfonamides, trimethoprim, quinolones, amphotericin B, flucytosine, azoles such as ketoconazole, itraconazole, fluconazole, clotrimazole, and miconazole, griseofulvin, terbinafine, and nystatin. The antimicrobial can also be a broad spectrum agent. For example, a second, third, or fourth generation cephalosporin can be used. These agents may be active against a wide range of bacteria including both gram positive and gram negative species. One of ordinary skill in the art will be able to select appropriate antimicrobial agents by considering factors such as the patient's history (e.g., any history of an allergic reaction to such agents), the location to which the peptides are to be applied, the type of infectious agent likely to be present, and so forth.

Suitable coloring agents include commercially available food colorings, natural and synthetic dyes, and fluorescent molecules. Preferably, the coloring agent is nontoxic or is included at such low concentrations as to minimize any undesirable effect (e.g., a toxic effect). The use of a coloring agent allows for improved visualization of an area that is covered by a structure or scaffold and can facilitate removal, if such removal is desired. The coloring agent can be one that changes color when it comes into contact with a contaminated area (e.g., a color change may be triggered by the contamination itself (e.g., by the blood or bacteria present at a wound site)). For example, a metabolic product of a bacterium may trigger a color change. Conditions such as pH or redox state induced by contaminants may also be detected. Exemplary coloring agents include, but are not limited to, azo red, azo yellow, arsenazo III, chlorophosphonazo III, antipyrylazo III, murexide, Eriochrome Black T and Eriochrome Blue SE for Mg²⁺, oxyacetazo I, carboxyazo III, tropolone, methylthymol blue, and Mordant Black 32. AlamarBlue, a redox indicator, and phenol red can also be used in the compositions and methods described herein.

One or more growth factors can also be included in the compositions to accelerate one or more aspects of healing (e.g., angiogenesis, cell migration, process extension, and cell proliferation). The one or more growth factors can be incorporated into the self-assembling material or may be co-administered with the self-assembling composition. Examples of growth factors include, but are not limited to, vascular endothelial growth factor (VEGF), a transforming growth factor (TGF) such as transforming growth factor β, a platelet derived growth factor (PDGF), an epidermal growth factor (EGF), a nerve growth factor (NGF), an insulin-like growth factor (e.g., insulin-like growth factor I), a glial growth factor (GGF), a fibroblast growth factor (FGF), etc. It will be appreciated that in many cases these terms refer to a variety of different molecular species. For example, several transforming growth factor β species are known in the art. One of ordinary skill in the art will be guided in the selection of an appropriate growth factor by considering, for example, the site at which the composition is to be administered. For example, an EGF can be included in compositions applied to the skin; an NGF and/or GGF can be included in compositions applied to nerves or the nervous system; and so forth.

The growth factor or another agent can be a chemotactic substance, which has the ability, in vivo or in cell culture, to recruit cells to a site at which the substance is present. The cells recruited may have the potential to contribute to the formation of new tissue or to repair existing, damaged tissue (e.g., by contributing structurally and/or functionally to the tissue (e.g., by providing growth factors or contributing to a desirable immune response)). Certain chemotactic substances can also function as proliferation agents (e.g., neurotropic factors such as NGF or BDNF).

Other suitable active agents include cyanoacrylates, oxidized cellulose, fibrin sealants, collagen gel, thrombin powder, microporous polysaccharide powders, clotting factors (e.g., Factor V, Factor VIII, fibrinogen, or prothrombin) and zeolite powders.

It will be understood that therapeutic molecules are generally administered in an effective amount in order to achieve a clinically significant result, and effective dosages and concentrations are known in the art. These dosages and concentrations can guide the selection of dosages and concentrations in the present context. Bioactive molecules can be provided at a variety of suitable concentrations and in suitable amounts (e.g., in the microgram or milligram range, or greater). For guidance, one can consult texts such as Goodman and Gilman's The Pharmacological Basis of Therapeutics, 10th Ed., and Katzung, Basic and Clinical Pharmacology .

Where cells are delivered to a patient (e.g., to promote tissue healing), autologous cells can be used. In one embodiment, the cells could be hematopoietic cells from the patient, dispersed in the material and implanted. In another embodiment, the cells can be cord blood cells.

E. Excipients, Carriers, and Devices

The formulation can include a pharmaceutically acceptable carrier. The formulations may also include other therapeutic, prophylactic or diagnostic agents.

In one embodiment, the formulation is suspended or dissolved in a solvent, most preferably aqueous, and applied as an injection.

One or more of the compositions described herein can be assembled in kits, together with instructions for use. The kit may also include one or more of a syringe (e.g., a barrel syringe or a bulb syringe), a needle, a pipette, gauze, sponges, or cotton, swabs, a bandage, a nosebleed plug, a disinfectant, surgical thread, scissors, a scalpel, a sterile fluid, a spray canister, including those in which a liquid solution is sprayed through a simple hand pump, a sterile container, or disposable gloves. In one embodiment, the kit contains an applicator which can selectively dispense several compositions which are specific for different tissues. For example, the device can contain several chambers, each of which contained a self-assembling peptide composition which is specific for a tissue. The composition can be dispensed directly onto the site of administration or can be mixed in a mixing chamber within the device prior to administration. In one embodiment, an applicator can be used to administer compositions to blood vessels.

II. Methods of Use A. Extracellular Matrix (ECM) and Tight Junction

Extracellular matrix (ECM) is any material part of a tissue that is not part of any cell. Extracellular matrix is the defining feature of connective tissue. The ECM's main components are various glycoproteins, proteoglycans and hyaluronic acid. In most animals, the most abundant glycoproteins in the ECM are collagens. ECM also contains many other components: proteins such as fibrin, elastin, fibronectins, laminins, and nidogens, and minerals such as hydroxylapatite, or fluids such as blood plasma or serum with secreted free flowing antigens. In addition it sequesters a wide range of cellular growth factors, and acts as a local depot for them. Changes in physiological conditions can trigger protease activities that cause local release of such depots. This allows the rapid and local activation of cellular functions, without de novo synthesis. Given this diversity, ECM can serve many functions, such as providing support and anchorage for cells, providing a way of separating the tissues, and regulating intercellular communication. The ECM regulates a cell's dynamic behavior.

Tight junctions, or zonula occludens, are the closely associated areas of two cells whose membranes join together forming a virtually impermeable barrier to fluid. It is a type of junctional complex. They are formed by claudin and occludin proteins, joining the cytoskeletons of the adjacent cell. Tight junctions perform three vital functions: (1) holding cells together; (2) blocking the movement of integral membrane proteins between the apical and basolateral surfaces of the cell, allowing the specialized functions of each surface (for example receptor-mediated endocytosis at the apical surface and exocytosis at the basolateral surface) to be preserved, and thereby preserving transcellular transport; and (3) preventing the passage of molecules and ions through the space between cells, so materials must actually enter the cells (by diffusion or active transport) in order to pass through the tissue. This pathway provides control over what substances are allowed through. (e.g. Tight junctions play the control role in maintaining the blood-brain barrier.)

Disorders associated with leakage of tight junctions, include sepsis and neurodegeneration. Sepsis is the systemic response to severe infection in critically ill patients. Sepsis, sepsis syndrome, and septic shock represent the increasingly severe stages of the same disease. Severe sepsis and septic shock occur in persons with preexisting illness or trauma. If sepsis is not diagnosed and treated early, it can become self-perpetuating, and elderly persons, in particular, are at a greater risk of death from sepsis. Sepsis is associated with a profound intravascular fluid deficit due to vasodilatation, venous pooling and capillary leakage. Fluid therapy is aimed at restoration of intravascular volume status, hemodynamic stability and organ perfusion.

Circulatory stability following fluid resuscitation is usually achieved in the septic patient at the expense of tissue edema formation that may significantly influence vital organ function. The type of fluid therapy, crystalloid or colloid, in sepsis with capillary leakage remains an area of intensive and controversial discussion.

The self-assembling peptide formulations can be administered via injection. The self-assembling peptide formulations can be injected using a syringe or other suitable delivery means. The self-assembling peptide formulations can be delivered directly to the tissue using a syringe or other mechanical delivery means e.g. tubing or catheter.

Neurodegenerative disorders, such as Alzheimer's and Parkinson's disease, degrade the central nervous system, resulting in senile dementia and motor dysfunction. Currently there are preventative and therapeutic measures for Alzheimer's disease but no cure. The blood-brain barrier is essential for normal neuronal activity and loss of key features such as tight junctions may lead to neuronal impairment. The microvessel endothelial cells that form the barrier send regulatory signals to cells within the brain, providing vital instructions both during normal brain development and later in adult life. Close connections between the endothelial and surrounding cells (including differentiated glia and neurons as well as uncommitted neural precursor cells) facilitate regulatory interchange between the various cells.

B. Diabetic Retinopathy

Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which can eventually lead to blindness. Diabetic retinopathy is the result of microvascular retinal changes. Hyperglycemia-induced pericyte death and thickening of the basement membrane lead to incompetence of the vascular walls. These damages change the formation of the blood-retinal barrier and also make the retinal blood vessels become more permeable.

Small blood vessels - such as those in the eye - are especially vulnerable to poor blood sugar control. An overaccumulation of glucose and/or fructose damages the tiny blood vessels in the retina. During the initial stage, called nonproliferative diabetic retinopathy (NPDR), most patients do not notice any changes in their vision.

As the disease progresses, severe nonproliferative diabetic retinopathy enters an advanced, or proliferative, stage. The lack of oxygen in the retina causes fragile, new, blood vessels to grow along the retina and in the clear, gel-like vitreous humour that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina. Fibrovascular proliferation can also cause tractional retinal detachment. The new blood vessels can also grow into the angle of the anterior chamber of the eye and cause neovascular glaucoma. Nonproliferative diabetic retinopathy shows up as cotton wool spots, or microvascular abnormalities or as superficial retinal hemorrhages. Even so, the advanced proliferative diabetic retinopathy (PDR) can remain asymptomatic for a very long time, and so should be monitored closely with regular checkups.

In diabetic neuropathy, the structural ECM at the edges of the blood vessel retreat into the cell and as a result the blood vessel leaks. Self-assembling materials may be used to replace or supplement the tight junction of the blood vessels in diabetic neuropathy, as well as vessels in the brain that are also leaking due to the retraction of the tight junctions between cells. In one embodiment, the self-assembling material is injected into the blood stream. It is believed that the compositions described herein can bridge the gap between the retreating structural ECM by interacting with the sugars on the glycoproteins in the ECM or integrating into the damaged membranes around the site of injury.

Figure 2 shows an enlarged portion of a blood vessel that is leaking fluid. When the self assembling material is administered to the site of leakage, self assembling material assembles around the disrupted structural protein. The self-assembling material, when fully assembled, actually pulls the adjacent cells to each other.

C. Reinforcing Vessel Walls

The compositions described herein may also be used to strengthen and/or repair vessels walls, such as in patients suffering from varicose veins. The materials can also be used to reinforce vessel walls in other organs or tissues such as the eye or intestine as well as the organ walls themselves. Templates can be added to the self-assembling material which allow for the coupling of the self-assembling material to the sugars of the extracellular matrix (ECM) of blood vessels for a given tissue. The material spans the entire site of injury upon coupling to the ECM and may be able to bring the blood vessel walls back together to stop leaks. The chemical composition of the templates to be added to the self-assembling material depends on the composition of ECM of the blood vessels of the tissue to be treated. ECM for blood vessels in the brain is different from ECM in the other organs, such as the liver, eyes, heart, etc. One of ordinary skill in the art will be able to determine the appropriate template based on the tissue to be treated. For example, excess ADADADs can be added to the ends of the self-assembling materials. The ADADAD fragments should be complementary with the ECM sugars of various types of cells. However, templates can be designed that are specific for one type of tissue. Further, hydrophobic templates, such as segments of hydrophobic amino acid residues, can be added to the ends of the self-assembling materials which would allow the materials to integrate into the ECM. The self-assembling nanofiber scaffold is biocompatible and the degradation products, L-amino acids in the case of peptides, can be used by cells as building blocks for cell growth and repair.

D. Burns

Proper fluid management is critical to the survival of the victim of a major thermal injury. In the 1940's, hypovolemic shock or shock-induced renal failure was the leading cause of death after burn injury. Today, with the current knowledge of the massive fluid shifts and vascular changes that occur during burn shock, mortality related to burn-induced volume loss has decreased considerably. Although a vigorous approach to fluid therapy has ensued in the last 20 years and fewer deaths are occurring in the first 24-48 hours post-burn, the fact remains that approximately 50% of the deaths occur within the first 10 days following burn injury from a multitude of causes, one of the most significant being inadequate fluid resuscitation therapy. Knowledge of fluid management following burn shock resuscitation is also important and is often over-looked in burn education.

Burn shock is both hypovolemic shock and cellular shock, and is characterized by specific hemodynamic changes including decreased cardiac output, extracellular fluid, plasma volume and oliguria. As in the treatment of other forms of shock, the primary goal is to restore and preserve tissue perfusion in order to avoid ischemia. However, in burn shock, resuscitation is complicated by obligatory burn edema, and the voluminous transvascular fluid shifts which result from a major burn are unique to thermal trauma. Although the exact pathophysiology of the postburn vascular changes and fluid shifts is unknown, one major component of burn shock is the increase in total body capillary permeability. Direct thermal injury results in marked changes in the microcirculation. Most of the changes occur locally at the burn site, when maximal edema formation occurs at about 8-12 hours post-injury in smaller bums and 12-24 hours post-injury in major thermal injuries. The rate of progression of tissue edema is dependent upon the adequacy of resuscitation.

Fluid resuscitation is aimed at supporting the patient throughout the initial 24-hour to 48-hour period of hypovolemia. The primary goal of therapy is to replace the fluid sequestered as a result of thermal injury. The critical concept in burn shock is that massive fluid shifts can occur even though total body water remains unchanged. What actually changes is the volume of each fluid compartment, intracellular and interstitial volumes increasing at the expense of plasma volume and blood volume.

It is quite clear that the edema process is accentuated by the resuscitation fluid. The magnitude of edema will be affected by the amount and type of fluid administered. The National Institutes of Health consensus summary on fluid resuscitation in 1978 was not in agreement in regard to a specific formula; however, there was consensus in regard to two major issues - the guidelines used during the resuscitation process and the type of fluid used. In regard to the guidelines, the consensus was to give the least amount of fluid necessary to maintain adequate organ perfusion. The volume infused should be continually titrated so as to avoid both under-resuscitation and over-resuscitation. As for the optimum type of fluid, there is no question that replacement of the extracellular salt lost into the burned tissue and into the cell is essential for successful resuscitation.

One of the acute features of cutaneous thermal injury is the swelling of the involved tissue. This swelling is caused by a fluid shift from circulating plasma. Along with the evolution of intravenous fluid therapy in trauma and surgery, the implementation of such therapy to burn victims has improved survival. Edema generation aggravated by fluid therapy may, however, represent a source of increased morbidity. It is well documented that fluid is lost from the circulation into burned tissue because of a moderate increase in capillary permeability to fluid and macromolecules and a modest increase in hydrostatic pressure inside the perfusing microvessels. Recently it was discovered that a very negative interstitial pressure develops in thermally injured skin. This pressure constitutes a strong "suction" adding markedly to the edema generating effect of increased capillary permeability and pressure.

E. Prevent Movement of Fluids

As the compositions described here can be used to inhibit movement of a bodily substance in a subject, including movement within or from the epidermis, the compositions can be employed in the context of performing surgery and may be described as new methods for performing surgery or generating a surgical field. The methods, whether performed in the context of surgery or not, can include a step of identifying a subject in need of treatment and a step of providing a nanoscale structured material, or a precursor thereof, at or in the vicinity of a site where unwanted movement has occurred or is expected to occur. The amount of the composition administered and the concentration of self-assembling peptides therein can be sufficient to inhibit the unwanted movement of a bodily substance. For example, one can identify a patient who is about to undergo a surgical procedure and provide a biocompatible composition comprising self-assembling peptides and a vasoconstrictor, a coloring agent, or a local anesthetic agent to a site at which an incision or other invasive maneuver will be made or has been made. The bodily substance that is affected may be a fluid such as blood or a blood product, serous exudate (an inflammation-associated exudate composed largely of plasma, which typically appears as a clear or amber-colored fluid), pus, gastric juice, urine, bile, cerebrospinal fluid (CSF), pancreatic juice, and the like. The bodily substance may be viscous, sludge-like or semi-solid but will generally exhibit an ability to flow or move.

Treatment and prevention of bleeding

Any individual who has an increased risk of suffering undesirable bleeding, which may or may not be excessive or immediately life-threatening, can be treated with the compositions described herein. These individuals include those with blood clotting disorders such as hemophilia, patients who are receiving anticoagulant therapy, patients who suffer recurrent nosebleeds, and individuals undergoing surgery, particularly major surgery or procedures that involve accessing an artery. Without limitation, the surgery or procedure can be an operation on the nervous system, eye, ear, nose, mouth, pharynx, respiratory system, cardiovascular system, digestive system, urinary system, musculoskeletal system, integumentary (skin) system, or reproductive system. As noted, the compositions can also be applied to tissues exclusive of those that define the central nervous system (i.e., the brain and spinal cord). Specific examples of surgeries and procedures in which the compositions can be used include arteriography, angiocardiography, cardiac catheterization, repair of obstetric laceration, removal of coronary artery obstruction, insertion of stent, Caesarean section, hysterectomy, reduction of fracture, coronary artery bypass graft, cholecystectomy, organ transplant, total joint (e.g., knee, hip, ankle, shoulder) replacement, appendectomy, excision or destruction of intervertebral disk, partial excision of the large intestine, mastectomy, or prostatectomy. The surgical procedure can involve the intentional or unintentional transection of a blood vessel or causing the release of a bodily substance other than blood.

Accident victims, individuals engaged in combat, and women giving birth are also at risk of experiencing significant blood loss. Spontaneous hemorrhage, aneurysm rupture, esophageal varices, gastric ulcers, ulcers of the upper portion of the intestine (e.g., duodenal ulcers) are also medical conditions in which considerable bleeding can occur, and these individuals can also be treated as described here.

The precise source of the bleeding can vary and can be from any blood vessel in the arterial or venous system (e.g., an artery, arteriole, capillary or capillary bed, venule, or vein). The size of the vessel may range from large (e.g., the compositions can inhibit bleeding from the aorta, the iliac or femoral artery, or a portal vein) to small (e.g., a capillary), and the vessel may be located anywhere in the body (e.g., in a solid organ such as liver, the stomach, intestine, skin, muscle, bone, the lungs, or the reproductive system).

The time normally required for blood clotting can be prolonged when plasma levels of clotting factors and/or platelets are low or in cases in which an individual has received an anticoagulant (e.g., warfarin or heparin). Bleeding frequently persists for considerably longer than the average clotting time when there is more than minimal damage to blood vessel integrity. Based on the studies, it is expected that the compositions will cause hemostasis in a period of time that is less than, and in at least some cases much less than, the average blood clotting time. Although the compositions are not limited to those that achieve hemostasis in any given time (and uses such as protecting an area from contamination or promoting tissue healing are independent of this function), the compositions may confer a benefit to a bleeding subject in as little as five seconds following application. Other compositions can exert an effect in about 10, 15, or 20 seconds following application. The effective period can be characterized in a manner other than absolute time. For example, compositions may reduce the time required to achieve hemostasis by between 25% and 50%; between 50% and 75%; or between 75% and 100% relative to the time required when iced saline is applied. The time required to achieve hemostasis can be reduced by approximately 2-, 3-, 4-, or 5-fold relative to the time required when iced saline is applied.

The peptide concentration may be selected with reference to variables such as the caliber of the vessel, the extent to which it has been injured, and the force with which blood is exiting (or would exit upon injury). Higher peptide concentrations will be desirable to promote hemostasis from a major vessel (e.g., the aorta, brachiocephalic, carotid, subclavian, celiac, superior mesenteric, renal, iliac, femoral, or popliteal arteries). Useful concentrations can range from between approximately 0.1-10% (e.g., 1-10%; 0.5-5%; 1-4%; 0.1-2%; 0.1-3%; 0.1-4%; 0.1-5%; and 1-8% (e.g., about 1, 1.5, 2, 2.5, 3, 4, 5, 6, or 7%). Any subrange, or any specific value within any of the aforesaid ranges, can be used. Any of the aforementioned concentrations may also be used for the other indications described herein.

As noted, bleeding can be due to any of a large number of different causes and can be internal or external. The compositions can be applied regardless of the cause or the nature of the cause (e.g. whether caused by a disease process or intentional or accidental trauma). The compositions can be used to achieve hemostasis in a confined space (e.g., inside a hollow organ) or at or near the body's surface. In that event, the compositions may be serving multiple functions; they may not only promote hemostasis, but also protect the wounded tissue from contaminants and promote tissue healing.

Many medical procedures involve vascular puncture, which can be followed by significant bleeding.

More generally, compositions comprising nanostructured materials or precursors thereof (e.g., self-assembling peptides) can be used for sealing any passage through tissue. Sealing the passage can result in hemostasis. The passage can also be a fistula (i.e., an abnormal connection between two organs or body structures or between an organ or structure and the external world).

As the compositions contain biocompatible and biodegradable material, they can be left in place, thereby avoiding the need for removal at the end of the procedure and avoiding the need for a subsequent operation for this purpose. Biodegradable materials can be broken down physically and/or chemically within cells or within the body of a subject (e.g., by hydrolysis under physiological conditions or by natural biological processes such as the action of enzymes present within cells or within the body) to form smaller chemical species which can be metabolized and, optionally, reused, and/or excreted or otherwise disposed of. Preferably, the biodegradable compounds are biocompatible.

Gastrointestinal bleeding, which can occur as a consequence of ulcers or angiodysplasia, is a relatively common and serious condition that can be fatal if left untreated. Bleeding esophageal varices, and bleeding gastric or duodenal ulcers can be particularly severe. A number of endoscopic therapeutic approaches have been developed to achieve hemostasis, such as the injection of sclerosing agents, the attachment of mechanical hemostatic devices, and contact electrocautery techniques. Bleeding in the distal portion of the large intestine, rectum, or anus (e.g., hemorrhoids) can also be treated in this manner.

Rupture of an aneurysm can represent a catastrophic event with rapidly fatal consequences. Ruptured aortic aneurysms can rapidly result in exsanguination despite prompt medical attention. Ruptured intracranial aneurysms frequently have devastating consequences. The compositions and methods of the invention can be used to treat bleeding from a ruptured aneurysm in an essentially similar manner to the way in which they are used to treat bleeding due to other causes. Given the often severe consequences of aneurysm rupture, surgical repair is often attempted. Once any bleeding is under better control, the aneurysm may then be repaired using any suitable technique. Presence of the peptide structure within the aneurysm sac reduces the chance of leakage or rupture prior to or during these other procedures. The scaffold can be left in place.

Inhibiting movement or leakage of cerebrospinal fluid (CSF)

The dura mater is the tough, outermost, fibrous membrane that covers the brain and spinal cord, and lines the inner surface of the skull. Leakage of CSF is a significant complication following injury, surgery, or other procedures in which the dura mater is penetrated, including inadvertent penetration in the course of administering an anesthetic to the epidural space. Such leakage can lead to serious sequelae, such as severe headaches, infection, and meningitis.

Inhibiting leakage of contents of the gastrointestinal tract

Gastric contents, which contain digestive secretions of the stomach glands consisting chiefly of hydrochloric acid, mucin, and enzymes such as pepsin and lipase, can cause injury and/or infection if released into the peritoneal cavity. Release of intestinal contents into the peritoneal cavity represents a frequent event during surgery on the intestine and can also occur in cases of intestinal perforation or a ruptured appendix. The site of movement can be a site of gastric or intestinal damage caused by a disease process or a surgical incision.

One can similarly inhibit movement of the contents of other internal organs (e.g., organs in the biliary or urinary systems). For example, one can inhibit movement of bile, pancreatic juice (i.e., secretions of the exocrine portion of the pancreas that contain digestive enzymes), or urine and/or decontaminate or clean an area into which bile, pancreatic juice, or urine have been released by application and subsequent removal of the compositions to the site. The methods thus have broad application to surgeries for repairing or otherwise treating intestinal, biliary, and/or urinary system defects.

Wound healing

Studies also indicate that the compositions have the ability to enhance healing, particularly of an epithelial layer or muscle, and can therefore be administered to treat a site of tissue damage. The compositions appear to both increase the rate of tissue repair and inhibit formation of scar tissue.

Unless defined otherwise, all technical and scientific terms used herein have the same meanings as commonly understood by one of skill in the art to which the disclosed invention belongs.

Transmission Electrode Microscopy sample preparation.

In the brain and liver of anesthetized adult rats 1% or 2% of NHS-1 was injected immediately after making a cut and the treatment site was sampled. Samples were fixed in a mixture of 2% para-formaldehyde and 2.5% glutaraldehyde in 0.1M PB for 4 hours. The samples were washed in 0.1M PB buffer 10 min x 3 at 4 °C and embedded in 2% agar. Agar blocks were post fixed in 1% osmium tetroxide for 2 hrs at 4°C and then washed in buffer for 10 min x3 at 4°C. The sample blocks were dehydrated in ethanol, infiltrated and embedded in pure epon with Lynx EM tissue processor. Ultra-thin 70 nm sections were cut (Reichert-Jung ultra cut) and collected on #200 mesh grids. Sections and grids were stained with uranyl acetate and lead citrate and examined under Philip EM208S transmission electron microscope.

Preparation of the self-assembling solutions.

The NHS-1 solution was prepared using RADA16-I (SEQ ID NO: 60) synthetic dry powder (obtained from the Massachusetts Institute of Technology Center for Cancer Research Biopolymers Lab, Cambridge, MA; the Zhang lab and 3-DMatrix, Cambridge, MA) dissolved in an Eppendorf tube. The 1% NHS-1 solution was prepared by dissolving 10mg of RADA16-I (SEQ ID NO: 60) powder in 1 ml of autoclaved Milli-Q water (Millipore corp. Billerica, MA), sonicated for up to five minutes and filtered. This was repeated with 20 mg/ml, 30mg/ml, and 40mg/ml to produce 2 %, 3% and 4% concentrations. NHS-2 and TM-3 dry powders (made by the Massachusetts Institute of Technology Center for Cancer Research Biopolymers Lab, Cambridge, MA) were prepared using the same method. The time of preparation did not affect the action of the solution. Some material that was prepared (obtained from Zhang lab), and stored in solution at room temperature, for three years prior to use, was also tested and shown to perform as well as the newly mixed material.

The following Examples illustrate the self-assembling nature of the peptides and their ability to cause hemostasis, but do not necessarily involve administration to the blood.

Example 1: Hemostasis in a Brain Injury Methods and Materials

Adult Syrian hamsters were anesthetized with an intraperitoneal injection of sodium pentobarbital (50 mg/kg) and adult rats were anesthetized with an intraperitoneal injection of ketamine (50 mg/kg). The experimental procedures adhered strictly to the protocol approved by the Department of Health and endorsed by the Committee on the Use of Laboratory Animals for Teaching and Research of the University of Hong Kong and the Massachusetts Institute of Technology Committee on Animal Care.

The animals were fitted in a head holder. The left lateral part of the cortex was exposed. Each animal received a transection of a blood vessel leading to the superior sagittal sinus (Figure 4a). With the aid of a sterile glass micropipette, 20 µl of 1% NHS-1 solution was applied to the site of injury or iced saline in the control cases. The animals were allowed to survive for up to six months.

Results

Initial experiments in the brain included removing the overlying skull and performing a complete transection of a branch of the superior sagittal sinus in the brain of rats (n=15) and hamsters (n=15) (Figure 3A). The areas were treated with 20 µl of 1% solution of RADA16-I (SEQ ID NO: 60) (NHS-1) self-assembling solution or with iced saline.

In the NHS-1 treated groups hemostasis was achieved in less than 10 seconds in both hamsters and rats (Figure 4a-d). Control group hamsters (n=5) and rats (n=5) irrigated with saline, bled for more than 3 minutes (Figure 3A). Student t test for two independent samples in both hamsters and rats showed highly significant differences (p<0.0001).

Example 2: Hemostasis in a Spinal Cord Injury Methods and Materials

Under an operating microscope, the second thoracic spinal cord segment (T2) was identified before performing a dorsal laminectomy in anesthetized adult rats. After opening the dura mater, a right hemisection was performed using a ceramic knife. Immediately after the cord hemisection 20 µl of 1% solution of RADA16-I (SEQ ID NO: 60) (NHS-1) was applied to the area of the cut for bleeding control. The controls received a saline treatment. The animals were allowed to survive for up to 8 weeks as part of another experiment.

Results

The spinal environment and the brain environment were investigated for similarities or differences. Secondary damage caused by surgery can be reduced by quickly bringing bleeding under control. After laminectomy and removal of the dura, the spinal cord was hemisected at T2, from the dorsal to ventral aspect and treated (N=5) with 20 µl of 1% NHS-1. Hemostasis was achieved in 7.6 seconds. In the saline controls (n=5) it took on average 163 seconds to stop bleeding (Figure 3a). Comparison of the treated group and the saline controls using the Student t test for two independent samples showed a highly significant difference (p<0.0001).

Example 3: Hemostasis in a High Pressure Femoral Artery Wound Methods and Materials

Rats were placed on their backs and the hind limb was extended to expose the medial aspect of the thigh (Figure 4b). The skin was removed and the overlying muscles were cut to expose the femoral artery and sciatic nerve. The femoral artery was cut to produce a high pressure bleeder. With a 27 gauge needle, 200 µl of 1% RADA16-I (SEQ ID NO: 60) (NHS-1) solution was applied over the site of injury. In two cases powder was applied to the injury site which also worked. (Data not shown and was not included in the analysis). Controls were treated with a combination of saline and pressure with a gauge. All animals were sacrificed four hours after the experiment.

Results

The femoral artery of 14 adult rats was surgically exposed, transected and then treated with 200 µl of 1% solution of NHS-1 or iced saline and packing. The treated cases (n=10) took about 10 seconds to achieve hemostasis (Figure 3a). The controls (n=4) continued to bleed more than 6 minutes. The difference in times to achieve complete hemostasis was highly significant (Student t test p<0.0001).

Example 4: Hemostasis in Highly Vascularized Liver Wounds Methods and Materials

Rats were anesthetized and placed on their back and the abdomen was opened exposing the liver (Figure 4c). The left lobe of the liver was cut using a scalpel in the rostral to caudal direction separating the two halves of the lobe in the sagittal cut. With a 27 gauge needle, 100 µl of 1% or 2%, of RADA16-I (SEQ ID NO: 60) (NHS-1), RADA-12 (NHS-2), or EAK-16 (TM-3) solution was applied to the site of injury. Livers of the controls were treated with saline or cauterized. Cauterization was performed using a thermal cautery device and was applied to entire surface of the injury. In another group of adult rats the same procedure was followed for the liver, which was cut transversely (Figure 4d). With a 27 gauge needle, 400 µl of 1%, 2%, 3%, or 4% of NHS-1, or TM-3 solution was applied to the site of injury.

TM-3 is a stiffer gel: 1% TM-3 is similar in stiffness to 3% NHS-1. Three different concentration levels, 1%, 2%, and 3% were tried and it was found that TM-3 was not effective at any concentration; the assembled material fractured and the TM-3 treated animals continued to bleed regardless of the concentration used. There was actually no significant difference between TM-3 and the controls (Figure 3d) in achieving hemostasis.

In another group of anesthetized adult rats, the liver was exposed and a 4 mm punch biopsy from the ventral aspect through the liver to the dorsal surface of the left liver lobe was made. The resulting core was removed from the liver and one of three treatments was applied. In one treatment, 200 µl of a 3% NHS-1 solution was applied to the site of injury. In one control saline was applied to the site of injury. In a second control, the injury surface was cauterized. The superficial material was then wiped clear of the injury site. The abdominal incision was closed and the animals were allowed to survive for up to eight weeks.

In anesthetized adult nude mice using aseptic precautions, a 4mm punch was used to create three wounds on each side of the back of the animal. On one side of the animal the wounds created were treated with 1% NHS-1 solution and the wounds on the opposite side were left untreated for a control. The punch biopsies were made through the full thickness of the skin. If the wound did not bleed for ten seconds the punch would be excluded from the data analyzed. All procedures were videotaped and the analysis was done by reviewing the tapes. The animals were allowed to survive for up to two months. If animals involved in any of the above experiments appeared to experience any discomfort they were euthanized.

Results

Three different liver cuts using a group of 76 rats were performed 1) A sagittal (rostral caudal) cut to explore NHS in an irregular-shaped laceration wound; 2) a transverse (lateral medial) cut involving the transection of a major branch of the hepatic portal vein to intensify bleeding; and 3) 4 mm punches through the liver lobe to observe the material in uniform wounds. In the first liver experiment a sagittal cut in the left lobe (n=8) was made and upon treatment of 100 µl of 1% NHS-1 solution bleeding ceased in less than 10 seconds. In one set of controls (n=3) bleeding stopped at 90 seconds (Figure 3a) following cauterization of the wound; in the saline treated control animals (n=3) bleeding continued for more than 5 minutes. Comparison of the cauterized group and the saline treated controls shows a significant difference using the Tukey test with a 99% confidence interval.

In the second experiment a major branch of the portal vein was severed while making a transverse cut in the left lobe to test NHS-1 in a high flow rate environment. Four concentrations of NHS-1 were tested (n=12) along with (n=4) control animals. 400 µl of 4% concentration NHS-1 was applied and bleeding stopped in 11 seconds. The test was successfully duplicated with 400 µl of both 3% and 2% NHS-1 solution; bleeding ceased in 10 and 10.3 seconds, respectively (Figure 3d). When 400 µl of 1% NHS-1 was applied, bleeding continued for more than 60 seconds (Figure 3d). The controls, however, bled for over 6 minutes. The dose response shows that treatment results using 3% and 4% NHS-1 are nearly the same as with the 2% concentration. Furthermore, in the 2%, 3% and 4% concentration treatment cases complete hemostasis was maintained after removing the excess assembled NHS-1 material. It was found that the higher blood pressure/flow rate transverse liver cut required a concentration of 2% NHS-1 or higher to bring about complete hemostasis in less than 15 seconds. A significant difference was found between the NHS-1 treated and control groups using ANOVA. When each treatment group was compared to the control group those differences were also significant. There was no significant difference when the various NHS-1 concentrations were compared, except for the 1% NHS-1 solution treatment group.

In the third experiment using adult rats (n=45) 4mm holes were punched through the left lateral lobe and then the area was treated with 3% NHS-1, saline or heat cautery to bring about hemostasis (Figure 3b). In the experimental group (n=15) a solution of 3% NHS-1 was applied after injury and hemostasis was achieved in about 10 seconds, while the saline controls (n=15) took 3.5 minutes to stop bleeding. In the heat cautery control group (n=15) cessation of bleeding took more than 60 seconds, inclusive of applying heat to cauterize the inside surface of the punch. NHS-1 treated animals were allowed to survive for up to 6 months with no detrimental effect on the tissues. Using ANOVA there was a significant difference between the 3% NHS-1 treatment and the controls (p<0.0001). In addition, the Tukey test showed that each group was significantly different from the other with a 99% confidence interval.

Example 5: Hemostasis in skin punch biopsies

Six 4 mm punch biopsies were made on the back of anesthetized adult nude mice (n=23) for a total of 138 punches into the skin. Three punches were treated with 1% NHS-1 solution and the other three were left untreated, except for dabbing with cotton every 15 seconds until bleeding stopped. Punched wounds that bled for less than 10 seconds were excluded from the experiment. A solution of 1% NHS-1 was applied ten seconds after injury (n=23) and hemostasis took less than 10 seconds; the controls (n=23) continued to bleed for over 60 seconds (Figure 3c). The bleeding times were averaged for each side of the animal and the Student t test for paired samples showed a significant difference between the treatment and control side of the animal (p<0.0001).

Example 6: Comparison of Three Different Materials

To learn more about the hemostatic properties and mechanism of action of NHS-1 (RADA-16) (SEQ ID NO: 60), both the sagittal and transverse liver experiments were repeated, comparing them with two additional materials that are known to self-assemble and spontaneously form nanofibers: 1) RADA-12 (NHS-2), a sequence variation of NHS-1 and 2) EAK-16 (TM-3), a different sequence in the same family of self-assembling peptides used to determine if the material's length and stiffness altered its hemostatic effectiveness in bleeding models.

Making a sagittal liver cut in adult rats (n=9) 100 µl of 2% NHS-2 solution was applied to the wound and bleeding stopped in less than 10 seconds. In the cautery controls (n=3) bleeding continued for more than 90 seconds (p<0.0001). Repeating the experiment in adult rats (n=8) using 100 µl of 2% TM-3 the material assembled but did not achieve hemostasis; the animals continued to bleed until the experiment was terminated after more than 3 minutes.

The increased blood flow from the portal vein after making a transverse liver cut allowed the performance of another dose response experiment where various concentrations of NHS-1 (1% to 4%) and TM-3 (1% to 3%) could be compared with controls (Figure 3d). All concentrations of NHS-1 were effective; however the higher blood pressure and flow rate after the transverse liver cut required a concentration of 2% or higher of NHS-1 to stop bleeding in less than 15 seconds.

Example 7: Interface of NHS-1 and tissues

Still looking for mechanism clues as well as further understanding of the relationship of the NHS-1 blood/tissue interface in both the brain and liver, the treated tissues were examined under the transmission electron microscope (TEM), to determine how the red blood cells (RBCs), platelets, tissue and the ECM interact with the material.

A 1% NHS-1 solution was applied to a liver wound and the tissue was immediately harvested. In the electron micrograph the hepatocyte and RBC looks to be intact with the assembled NHS-1 at the interface. When applied shortly after injury, the material appeared to stop the movement of blood from the vessels without detrimental effects to the liver's RBCs; there was also no evidence of lysing. Furthermore, there was no evidence of platelet aggregation at the blood/NHS-1 interface when samples were taken at various time points after treatment.

A very tight interaction between NHS-1 and the neural tissue was found in the brain. No RBCs and no evidence of platelet aggregation were observed in the assembled NHS-1. The RBCs that were present appeared intact at the edges of the assembled NHS-1 with no evidence of lysing. Furthermore, no evidence of thrombi was observed in the brain, lung, or liver of the NHS-1 and NHS-2 treated animals.

NHS-1 and NHS-2 are synthetic, biodegradable and do not contain any blood products, collagens or biological contaminants that may be present in human or animal-derived hemostatic agents, like fibrin glue. They can be applied directly onto, or into, a wound without the worry of the material expanding, reducing the problem of secondary tissue damage as well as the problems caused by constricted blood flow. In our brain studies evidence of the production of prion-like substances or fibril tangles in animals that had the material implanted in their brain for up to six months, was investigated. None was found. Furthermore, the breakdown products of NHS-1 are amino acids which may be used as tissue building blocks for the repair of the injury. Independent third-party testing of the material found no pyrogenicity, which has been found with some other hemostatic agents, and no systemic coagulation or other safety issues in animals. These data demonstrate that hemostasis can be achieved in less than 15 seconds in multiple tissues as well as a variety of different wounds.

The NHS-1 and NHS-2 solutions easily filled in and conformed to the irregular shapes of the wounds before assembling, as shown in the electron micrographs. This tight contact is believed to play a role in the hemostatic action because of the size of the self-assembling peptide units. The micrographs also showed that the material does not cause the RBCs to lyse appearing to protect them from normal degradation when exposed to the air.

The observed hemostasis cannot be explained by gelation kinetics. One would think that a stiffer gel would be more effective for higher pressure bleeders; however the opposite was found to be true. TM-3, which is from the same family of peptides as NHS-1 and NHS-2, and is the stiffest of the three self-assembling peptides tested, did not arrest bleeding; it fractured at the tissue interface and within the resultant gel. TM-3 may have fractured due to 1) the pulsations of the liver and 2) the inability of the material to flex with the tissue as blood pumped through the organ. This is similar to the fracturing of an artery when grown in a laminar flow environment and then transplanted to a pulsed environment. The cells line up along the direction of flow, unlike the natural helical coil 36-39 seen in a pulsed environment, which allows for expansion and contraction, without splitting, as blood moves though the artery. Conversely, NHS-1 and NHS-2 were able to flex with the tissue.

Finally, NHS-2, the least stiff of the three materials, appeared to perform the same as NHS-1 most likely due to their similar structure and modulus.

With this discovery the speed of hemostasis will fundamentally change how much blood is needed during surgery of the future. As much as 50% of surgical time can be spent packing wounds to reduce or control bleeding. The NHS solutions may represent a step change in technology and could revolutionize bleeding control during surgery and trauma; however they need to be clinically tested for use in humans.

Claims (17)

1. A formulation comprising an effective amount of self-assembling peptides to form a barrier structure to prevent or limit the movement of bodily fluids; wherein the self-assembling peptides have a length of from 8 to 16 amino acid residues and comprise a sequence conforming to one or more of Formula I-IV:         ((Xaa^neu-Xaa⁺)_x(Xaa^neu-Xaa-)_y)_n     (I)         ((Xaa^neu-Xaa-)_x(Xaa^neu-Xaa⁺)_y)_n     (II)         ((Xaa⁺-Xaa^neu)_x(Xaa^--Xaa^neu)_y)_n     (III)         ((Xaa^--Xaa^neu)_x(Xaa⁺-Xaa^neu)_y)_n     (IV)

   wherein each Xaa^neu is an amino acid residue selected from alanine, leucine, isoleucine, phenylalanine, or tyrosine; Xaa⁺ is arginine or lysine; Xaa^- is aspartic acid or glutamic acid; x and y are integers having a value of 1, 2, 3 or 4, independently; and n is an integer having a value of 1-4;

   for use in a method for treatment of disorders involving leaky or damaged tight junctions or weak, diseased, or injured extracellular matrix comprising administering the formulation as a liquid into the bloodstream of a subject in need thereof.
2. The formulation for use of claim 1, wherein the amount of self-assembling peptides effective to prevent or limit the movement of bodily fluids is between 1% weight to volume and 4% weight to volume.
3. The formulation for use of claim 1 or 2, further comprising a pharmaceutically acceptable carrier for administration in the body.
4. The formulation for use of any of claims 1-3, wherein the self-assembling peptides comprise a sequence of amino acid residues conforming to Formula III or Formula IV.
5. The formulation for use of any of claims 1-3, wherein Xaa^neu represents alanine or leucine.
6. The formulation for use of any of claims 1-5, wherein the self-assembling peptides comprise amino acid sequence RADARADARADARADA (SEQ ID No. 60).
7. The formulation for use of any of claims 1-6, wherein the self-assembling peptides further comprise a tissue specific component.
8. The formulation for use of claim 7, wherein the tissue specific component comprises an oligosaccharide.
9. The formulation for use of claim 8, wherein the oligosaccharide comprises naturally occurring sugar molecules.
10. The formulation for use of claim 7, wherein the tissue specific component comprises a hydrophobic peptide, a hydrophilic peptide, or combinations thereof.
11. The formulation for use of claim 10, wherein the hydrophobic peptide comprises 5 identical naturally occurring amino acid residues.
12. The formulation for use of claim 1 or 2, wherein one or more of the self-assembling peptides comprise one or more protease or peptidase cleavage sites.
13. The formulation for use of any one of claims 1 to 12 in the treatment of sepsis or diabetic retinopathy.
14. The formulation for use of any one of claims 1 to 12 in the treatment and support of blood vessel walls, veins, or arteries.
15. The formulation for use of any one of claims 1 to 14, further comprising a therapeutic, prophylactic, or diagnostic agent.
16. The formulation for use of claim 15, wherein the therapeutic agent or prophylactic agent is selected from the group consisting of a vasoconstrictor, an anesthetic agent, an antimicrobial agent, collagen, an anti-inflammatory agent, a growth factor, or a nutrient.
17. The formulation for use of claim 15, wherein the diagnostic agent is a coloring agent.