Field of the invention

[0001] The present invention relates to improved clotting compositions for producing high quality blood serum samples for analyte testing. In particular, the present invention relates to the use of prothrombin activators in combination with stabilizing agents such as colloids for producing high quality blood serum samples for analyte testing, such as for pathology testing and other biological assays. The present invention also relates to associated methods for preparing clotting compositions, tubes, kits and methods of diagnosis, prognosis and monitoring for responsiveness to therapy.

Cross-reference to related applications

[0002] Not applicable.

Statement regarding federally funded research

[0003] Not applicable.

Background to the invention

[0004] Serum is typically produced by allowing a blood sample to clot and then centrifuging the sample to separate the blood clot, including cells, from the serum. Plastic tubes (in place of glass) are now typically used and require procoagulants, also known as clot activators, to enhance the clotting process. Procoagulants use either intrinsic or extrinsic pathways to achieve clot formation.

[0005] Clot formation by the intrinsic pathway is surface-dependent, whereby a greater density of activating surface sites enhances clotting time. Typically, siliceous substances such as glass, silica, kaolin, bentonite and diatomaceous earth are used in plastic tubes to accelerate clot formation through the intrinsic pathway to achieve contact activation. However, clotting via the intrinsic pathway is relatively slow, typically requiring 30 to 60 minutes.

[0006] Clot activation via the extrinsic pathway involves coagulation that is initiated by adding substances that are extrinsic to blood and which involve a biochemical reaction in a concentration- dependent manner. Clot activators that operate via the extrinsic pathway include ellagic acid, thrombin, snake venom components and thromboplastin. Although these clot activators produce rapid clotting in 10 to 20 minutes, the clots that are formed are often gelatinous and do not easily separate from serum.

[0007] Serum is usually preferred over plasma for analyte testing unless urgent results are required, in which case the clotting time for a serum tube is considered too long. Even with existing procoagulants, in most commercial tubes the minimum required clotting time recommended by manufacturers is 30 minutes for blood samples from normal patients, and much longer (typically 60 minutes or longer) for samples from patients taking anti-clotting therapeutic agents such as heparin. For patient samples from emergency situations (emergency departments, intensive care, operating theatres etc.) and samples from catherisation laboratories, the time is too long and therefore plasma, which can be produced much faster, is often preferred over serum.

[0008] Plasma is formed by collecting blood in tubes containing anticoagulants followed by centrifugation which can be performed immediately after collection to separate the cells and thus obtain plasma for analysis. Lithium heparin is the most commonly used anticoagulant in these tubes. Citrate, sodium fluoride/potassium oxalate and EDTA are other anticoagulants that are used in some tubes to produce plasma for estimation of a small number of other analytes.

[0009] The coagulation process in preparing a serum sample consumes fibrinogen and entraps platelets and other cells within a network of fibrin. Upon centrifugation, the serum is separated from the clot, either by a serum separator in the collection device or by aliquoting the serum into a secondary container, to prevent contact with the cells. This separation permits the sample to remain stable for extended periods of time. This stability is particularly important if samples are not analysed immediately, or if re-analysis or additional analyses are required.

[0010] For some serum samples, coagulation remains incomplete after the recommended waiting times. This problem of incomplete clotting, or latent clotting, in samples is especially prevalent in patients on anti-clotting therapy or specimens collected from anticoagulated taps or cannulae. Such blood can take much longer than the manufacturer's recommended waiting time to clot, or in fact may never fully clot in a standard serum tube (e.g. blood from cardiac surgery patients who are fully heparinised).

[0011] If a serum sample is centrifuged before clotting is complete, clotting can continue in the serum, as the remaining fibrinogen is converted to fibrin, leading to clots, microdots or formation of fibrin strings capable of causing analyser or analyte-specific problems. The formation of microdots and fibrinogen strings during sample preparation may also occur in plasma tubes due to the lack of timely inversion of lithium heparin tubes after blood collection. While heparin prevents clot formation, it cannot disintegrate clots upon contact. Hence, clots will remain in the tube regardless of further contact with heparin. Likewise dotting can also occur in other anticoagulated tubes (e.g. EDTA). Lithium heparin plasma tubes can also allow formation of insoluble fibrin as result of the stimulation of platelet factor 4 (PL4) from alpha granules of platelets during platelet aggregation, thereby neutralising heparin.

[0012] Additionally, other patient factors such as disease state and medication can both diminish the efficacy of heparin activity and lead to increased fibrin formation. Over time, heparin activity in stored lithium heparin blood specimens is decreased, mainly due to PL4 activity. The formation of insoluble fibrin is enhanced when plasma is stored at low temperatures.

[0013] Even the smallest clots are capable of producing clinically significant errors and/or cause automatic analysers to clog . Indeed, this problem is becoming more prevalent as the volumes used in new automated analysers are continually reducing over time plus the increasing number of patients on anticoagulants. Clogging of analysers means that laboratory workflow is disrupted, and analysers are subject to down time and require cleaning and may require replacement of affected parts. Thus, for accuracy, samples must be manually checked by eye or using automated detection systems if available to ensure they are free of fibrin strands or clots. If strands or clots of insoluble material are present, the sample requires sub-sampling into a new container and re-centrifugation prior to test analysis. Samples that exhibit repeated latent clotting may need to be transferred to a lithium heparin tube to stop ongoing clotting. These actions take additional time. Further, fibrin strands or clots are not always detected (e.g. they may even occur after analyser sampling), and consequential sampling errors may lead to patient care decisions being made on inaccurate results.

[0014] Specimens obtained in plasma tubes, specifically lithium heparin plasma, may also be contaminated with cells. Lithium heparin gel tubes when centrifuged will always present a small "buffy coat like layer" on top of the gel at the bottom of the plasma. This layer contains fibrin, cells and cell stroma. The rapid gel movement during centrifugation leaves some cells in the plasma The rapid gel and blood cell movement during centrifugation causes the gel to form the barrier between the cells and the plasma and leaves some cells in the plasma. If the plasma specimen is mixed (e.g. during sub-sampling or handling), it will become turbid due to suspension of cell-containing material and fibrin, which decreases the specimen integrity. In addition, platelet aggregates can form which may also contain fibrin and/or white blood cells. These aggregates can be large enough to be visible to the unaided eye and have been termed "white particulate matter" due to their typical white colour, and present similar problems to incomplete clotting discussed above. The presence of cells in the sample can therefore affect analyte concentrations. Certain analytes (e.g. glucose) may be decreased by cell activity and others may be increased by leakage or cell lysis (e.g. lactate dehydrogenase, potassium or phosphate). [0015] Although generally there is no difference in concentration of analytes measured in serum or plasma tubes, there are some exceptions. Plasma tubes that use heparin are not suitable for heparin analysis or cell-based assays. Lithium heparin plasma tubes are not suitable for lithium analysis. Plasma may be unreliable for additional testing or re-testing, due to the presence of cells and insoluble fibrin formation upon prolonged storage at 2-8°C. Further, some serum or plasma tubes may produce inaccurate results of analyte levels due to interaction with procoagulant or anticoagulant agents within the tubes.

[0016] It is also desirable to reduce the sample size needed for testing, especially in critically ill patients, patients receiving blood transfusions, and infants, in order to reduce the volume of blood taken from a patient. It is therefore optimal to be able to run all necessary tests using a sample taken in a single blood collection tube. To achieve this, testing methods have been developed using very small sample volumes (e.g. 2 μΙ_) so that typically one serum or plasma tube is used for at least 21 tests, but can be used for between 50-60 or even 70-80 tests, depending on the volume of sample needed for each test. However, where there is doubt over the accuracy of measuring a particular analyte in a serum or plasma tube, it may be necessary to take both a serum tube and a plasma tube from the patient, and doing so defeats the goal of reducing the volume of blood taken from the patient.

[0017] Thrombin-containing tubes have been developed as faster clotting tubes. Thrombin possesses both procoagulant and proteolytic activity, and thrombin is known to have high specificity for cutting bonds in fibrinogen, activated protein C (APC) and Factor Va. However, it has been found that thrombin-containing tubes cannot be used with all blood samples. Thrombin is known to be rapidly and completely inhibited by the heparin-antithrombin III complex present in heparinised blood samples. For example, it has been reported that BD RST tubes are ineffective in clotting patient samples containing high doses of heparin (see, for example, Dimeski et al., 2010).

[0018] Problems arising from the use of current methodologies for serum and plasma preparation from blood show that improvements are required to achieve timely, reliable analytical results from a wider variety of blood samples generally.

[0019] In response to this need, it was previously shown in International patent application no. PCT/AU2011/001221 , published as WO 2012/037609 (the entire contents of which is incorporated herein by reference), that the use of prothrombin activators isolated from snake venom are able to clot blood samples to produce high quality serum for use in analyte testing procedures.

[0020] It has now been demonstrated that the use of prothrombin activators isolated from snake venom, when formulated as a clotting composition in combination with one or more additional agents such as a colloid, significantly increases the stability of the clotting composition. This increased stability is significant because of the capacity to manufacture, sterilize, transport and store clotting compositions (for example, in the form of a collection tube) without significant loss of clotting activity under conditions that would previously have compromised the efficacy of such compositions. For example, the compositions of the present invention are stable after sterilisation involving irradiation, storage at elevated temperatures and storage for extended periods of time.

Summary of the invention

[0021] In a first aspect of the present invention, there is provided a clotting composition for preparing a serum sample, wherein the clotting composition comprises a prothrombin activator and a stabilizing agent. In some embodiments, the stabilizing agent may be a colloid.

[0022] In a second aspect of the present invention, there is provided a method for preparing the clotting composition of the first aspect, wherein the method comprises providing a prothrombin activator and a stabilizing agent. In some embodiments, the stabilizing agent may be a colloid.

[0023] In a third aspect of the present invention, there is provided a kit for preparing a serum sample, wherein the kit comprises a prothrombin activator and a stabilizing agent. In some embodiments, the stabilizing agent may be a colloid.

[0024] In a fourth aspect of the present invention, there is provided a container comprising a clotting composition for preparing a serum sample, wherein the clotting composition comprises a prothrombin activator and a stabilizing agent. In some embodiments, the stabilizing agent may be a colloid. In particular embodiments, the container is a blood collection tube, the prothrombin activator is OsPa or Ecarin and the colloid is gelofusine or Bovine Serum Albumin.

[0025] In a fifth aspect of the present invention, there is provided a method for preparing a serum sample, wherein the method comprises contacting a blood sample with the clotting composition of the first aspect for a time and under conditions sufficient to cause clotting of the blood sample, and optionally, separating serum from clotted cells, thereby preparing a serum sample. The clotted cells may include red blood cells, white blood cells, platelets and cellular stroma.

[0026] In a sixth aspect of the present invention, there is provided a serum sample produced by the method of the fifth aspect.

[0027] In a seventh aspect of the present invention, there is provided a method for diagnosing a disease or condition in a subject, wherein the method comprises providing a blood sample from the subject, preparing a serum sample from the blood sample in accordance with the fifth aspect of the present invention, and testing the serum sample for the presence or absence of an analyte in the serum sample, or for an indicative level or concentration of an analyte in the serum sample, wherein the presence, absence or indicative level or concentration of the analyte is indicative of the disease or condition in the subject.

[0028] In an eighth aspect of the present invention, there is provided a method for providing a prognosis for a subject, wherein the method comprises providing a blood sample from the subject, preparing a serum sample from the blood sample in accordance with the fifth aspect of the present invention, and testing the serum sample for the presence or absence of an analyte in the serum sample, or for an indicative level or concentration of an analyte in the serum sample, wherein the presence, absence or indicative level or concentration of the analyte is indicative of the prognosis for the subject.

[0029] In a ninth aspect of the present invention, there is provided a method for monitoring the responsiveness of a subject to a therapy, wherein the method comprises providing a blood sample from the subject, preparing a serum sample from the blood sample in accordance with the fifth aspect of the present invention, and testing the serum sample for the presence or absence of an analyte in the serum sample, or for an indicative level or concentration of an analyte in the serum sample, wherein the presence, absence or indicative level or concentration of the analyte is indicative of the responsiveness of the subject to the therapy.

Definitions

[0030] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by those of ordinary skill in the art to which the invention belongs. Although any methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, preferred methods and materials are described. For the purposes of the present invention, the following terms are defined below.

[0031] The articles "a ^" and "an ^" are used herein to refer to one or to more than one (i.e. to at least one) of the grammatical object of the article. By way of example, "an element' means one element or more than one element.

[0032] By "about' is meant a quantity, level, value, number, frequency, percentage, dimension, size, amount, weight or length that varies by as much 15, 10, 9, 8, 7, 6, 5, 4, 3, 2 or 1 % to a reference quantity, level, value, number, frequency, percentage, dimension, size, amount, weight or length.

[0033] The term "biologically active fragment', as applied to fragments of a reference or full-length polynucleotide or polypeptide sequence, refers to a fragment that has at least about 0.1 , 0.5, 1 , 2, 3, , 5, 6, 7, 8, 9, 10, 11, 12. 13, 14, 15, 16, 17, 18, 19, 20, 21 , 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38. 39, 40, 41 , 42, 43, 44, 45, 46, 47, 48, 49, 50, 51. 52, 53, 54, 55, 56, 57, 58, 59. 60, 61 , 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80. 81 , 82, 83, 84, 85, 86, 87, 88, 89, 90, 91 , 92, 93, 94, 95, 96, 97, 98 or 99% of the activity of a reference sequence. Included within the scope of the present invention are biologically active fragments, including those of at least about 18, 19, 20, 21 , 22, 23, 24, 25, 26, 27, 28, 29, 30, 40, 50, 60, 70, 80, 90, 100, 120, 140, 160, 180, 200, 250, 300, 400, 500, 600, 700, 800, 900, 1 ,000, 1 ,500, 2,000 nucleotides or residues in length, which comprise or encode an activity of a reference polynucleotide or polypeptide. Representative biologically active fragments generally participate in an interaction, e.g. an intramolecular or an inter-molecular interaction. An inter-molecular interaction can be a specific binding interaction or an enzymatic interaction (e.g., the interaction can be transient and a covalent bond is formed or broken). Biologically active fragments of a full-length polypeptide include peptides that may comprise amino acid sequences sufficiently similar to or derived from the amino acid sequences of a (putative) full-length polypeptide. Typically, biologically active fragments comprise a domain or motif with at least one activity of a full-length polypeptide. Suitably, the biologically-active fragment has no less than about 1 %, 10%, 25% or 50% of an activity of the full-length polypeptide from which it is derived.

[0034] By "coding sequence" is meant any nucleic acid sequence that contributes to the code for the polypeptide product of a gene. By contrast, the term "non-coding sequence" refers to any nucleic acid sequence that does not contribute to the code for the polypeptide product of a gene.

[0035] Throughout this specification, unless the context requires otherwise, the words "comprise," "comprises" and "comprising" will be understood to imply the inclusion of a stated step or element or group of steps or elements but not the exclusion of any other step or element or group of steps or elements. Thus, use of the term "comprising" and the like indicates that the listed elements are required or mandatory, but that other elements are optional and may or may not be present. By "consisting of is meant including, and limited to, whatever follows the phrase "consisting of. Thus, the phrase "consisting of indicates that the listed elements are required or mandatory, and that no other elements may be present. By "consisting essentially of is meant including any elements listed after the phrase, and limited to other elements that do not interfere with or contribute to the activity or action specified in the disclosure for the listed elements. Thus, the phrase "consisting essentially of indicates that the listed elements are required or mandatory, but that other elements are optional and may or may not be present depending upon whether or not they affect the activity or action of the listed elements.

[0036] The terms "complementary" and "complementary refer to polynucleotides (i.e., a sequence of nucleotides) related by the base-paihng rules. For example, the sequence "A-G-T," is complementary to the sequence "T-C-A. ^" Complementarity may be "partial," in which only some of the nucleic acids' bases are matched according to the base pairing rules. Or, there may be "complete" or "total" complementarity between the nucleic acids. The degree of complementarity between nucleic acid strands has significant effects on the efficiency and strength of hybridisation between nucleic acid strands.

[0037] By "corresponds to" or "corresponding to" is meant (a) a polynucleotide having a nucleotide sequence that is substantially identical or complementary to all or a portion of a reference polynucleotide sequence or encoding an amino acid sequence identical to an amino acid sequence in a peptide or protein; or (b) a peptide or polypeptide having an amino acid sequence that is substantially identical to a sequence of amino acids in a reference peptide or protein.

[0038] The term "derivable" includes, and may be used interchangeably with, the terms "obtainable" and "isolatable". Compositions or other subject matter of the present invention that is "derivable", "obtainable" or "isolatable" from a particular source or process include not only compositions or other matter derived, obtained or isolated from that source or process, but also the same compositions or matter however sourced or produced, for example, through recombinant DNA technology or other genetic engineering methods.

[0039] As used herein, the term "detecting an analyte" means determining the presence, absence, amount, level or concentration of one or more analytes in a sample.

[0040] By "gene" is meant a unit of inheritance that occupies a specific locus on a chromosome and consists of transcriptional and/or translational regulatory sequences and/or a coding region and/or non- translated sequences (i.e., introns, 5' and 3' untranslated sequences).

[0041] "Homolog/ refers to the percentage number of nucleic or amino acids that are identical or constitute conservative substitutions. Homology may be determined using sequence comparison programs such as GAP (Devereux ef a/., 1984) which is incorporated herein by reference. In this way sequences of a similar or substantially different length to those cited herein could be compared by insertion of gaps into the alignment, such gaps being determined, for example, by the comparison algorithm used by GAP.

[0042] The term "host ce/f includes an individual cell or cell culture which can be or has been a recipient of any recombinant vector(s) or isolated polynucleotide of the invention. Host cells include progeny of a single host cell, and the progeny may not necessarily be completely identical (in morphology or in total DNA complement) to the original parent cell due to natural, accidental, or deliberate mutation and/or change. A host cell includes cells transfected or infected in vivo or in vitro with a recombinant vector or a polynucleotide of the invention. A host cell which comprises a recombinant vector of the invention is a recombinant host cell. [0043] "Hybridisation" is used herein to denote the pairing of complementary nucleotide sequences to produce a DNA-DNA hybrid or a DNA-RNA hybrid. Complementary base sequences are those sequences that are related by the base-pairing rules. In DNA, A pairs with T and C pairs with G. In RNA U pairs with A and C pairs with G. In this regard, the terms "match" and "mismatch" as used herein refer to the hybridisation potential of paired nucleotides in complementary nucleic acid strands. Matched nucleotides hybridise efficiently, such as the classical A-T and G-C base pair mentioned above. Mismatches are other combinations of nucleotides that do not hybridise efficiently.

[0044] By "isolated" is meant material that is substantially or essentially free from components that normally accompany it in its native state. For example, an "isolated polynucleotide " as used herein, refers to a polynucleotide, which has been purified from the sequences which flank it in a naturally- occurring state, e.g., a DNA fragment which has been removed from the sequences that are normally adjacent to the fragment. Alternatively, an "isolated peptide" or an "isolated polypeptide" and the like, as used herein, refer to in vitro isolation and/or purification of a peptide or polypeptide molecule from its natural cellular environment, and from association with other components of the cell, i.e. , it is not associated with in vivo substances.

[0045] The terms "derived from" and "derivable" include, and may be used interchangeably with, the terms ^" obtained', "obtainable", ^" isolated' and "isolatable". Compositions or other matter of the present invention that are "derived from", "derivable", ^" obtained ^' , "obtainable", "isolated ^' or "isolatable" from a particular source or process include not only compositions or other matter so derived, obtained or isolated from that source or process, but also the same compositions or matter however sourced or produced. For example, a prothrombin activator derived or derivable from snake venom may include not only a prothrombin activator that is isolated from snake venom, but also the same prothrombin activator expressed from a vector or other expression system through recombinant DNA technology.

[0046] The term "oligonucleotide" as used herein refers to a polymer composed of a multiplicity of nucleotide residues (deoxyribonucleotides or ribonucleotides, or related structural variants or synthetic analogues thereof) linked via phosphodiester bonds (or related structural variants or synthetic analogues thereof). Thus, while the term "oligonucleotide" typically refers to a nucleotide polymer in which the nucleotide residues and linkages between them are naturally occurring, it will be understood that the term also includes within its scope various analogues including, but not restricted to, peptide nucleic acids (PNAs), phosphoramidates, phosphorothioates, methyl phosphonates, 2-O-methyl ribonucleic acids, and the like. The exact size of the molecule can vary depending on the particular application. An oligonucleotide is typically rather short in length, generally from about 10 to 30 nucleotide residues, but the term can refer to molecules of any length, although the term "polynucleotide" or "nucleic acid' is typically used for large oligonucleotides.

[0047] The term "operably linked' as used herein means placing a structural gene under the regulatory control of a promoter, which then controls the transcription and optionally translation of the gene. In the construction of heterologous promoter/structural gene combinations, it is generally preferred to position the genetic sequence or promoter at a distance from the gene transcription start site that is approximately the same as the distance between that genetic sequence or promoter and the gene it controls in its natural setting; i.e. the gene from which the genetic sequence or promoter is derived. As is known in the art, some variation in this distance can be accommodated without loss of function. Similarly, the preferred positioning of a regulatory sequence element with respect to a heterologous gene to be placed under its control is defined by the positioning of the element in its natural setting; i.e., the genes from which it is derived.

[0048] The terms "patient', "subject' and "individual are used interchangeably and refer to patients, subjects and individuals of human or other mammals and includes any one for whom it is desired to detect analyte levels or to diagnose the presence, absence or severity of a disease or condition using the invention. However, it will be understood that "patient' does not imply that symptoms are present. Suitable mammals that fall within the scope of the invention include, but are not restricted to, primates (e.g. humans, chimpanzees) livestock animals (e.g. sheep, cows, horses, donkeys, pigs), laboratory test animals {e.g. rabbits, mice, rats, guinea pigs, hamsters), companion animals (e.g. cats, dogs) and captive wild animals (e.g. foxes, deer, dingoes).

[0049] The term "polynucleotide" or "nucleic acid' as used herein designates mRNA, RNA, cRNA, cDNA or DNA. The term typically refers to polymeric form of nucleotides of at least 10 bases in length, either ribonucleotides or deoxynucleotides or a modified form of either type of nucleotide. The term includes single and double stranded forms of DNA.

[0050] The terms "polynucleotide variant' and "variant' and the like refer to polynucleotides displaying substantial sequence identity with a reference polynucleotide sequence or polynucleotides that hybridise with a reference sequence under stringent conditions that are defined hereinafter. These terms also encompass polynucleotides that are distinguished from a reference polynucleotide by the addition, deletion or substitution of at least one nucleotide. Accordingly, the terms "polynucleotide variant' and "vananf include polynucleotides in which one or more nucleotides have been added or deleted, or replaced with different nucleotides. In this regard, it is well understood in the art that certain alterations inclusive of mutations, additions, deletions and substitutions can be made to a reference polynucleotide whereby the altered polynucleotide retains the biological function or activity of the reference polynucleotide. The terms "polynucleotide variant' and "variant' also include naturally occurring allelic variants.

[0051] "Polypeptide", "peptide" and "protein" are used interchangeably herein to refer to a polymer of amino acid residues and to variants and synthetic analogues of the same. Thus, these terms apply to amino acid polymers in which one or more amino acid residues are synthetic non-naturally occurring amino acids, such as a chemical analogue of a corresponding naturally occurring amino acid, as well as to naturally-occurring amino acid polymers.

[0052] The term "polypeptide variant' refers to polypeptides that are distinguished from a reference polypeptide by the addition, deletion or substitution of at least one amino acid residue. In certain embodiments, a polypeptide variant is distinguished from a reference polypeptide by one or more substitutions, which may be conservative or non-conservative. In certain embodiments, the polypeptide variant comprises conservative substitutions and, in this regard, it is well understood in the art that some amino acids may be changed to others with broadly similar properties without changing the nature of the activity of the polypeptide. Polypeptide variants also encompass polypeptides in which one or more amino acids have been added or deleted, or replaced with different amino acid residues.

[0053] By "primer" is meant an oligonucleotide which, when paired with a strand of DNA, is capable of initiating the synthesis of a primer extension product in the presence of a suitable polymerising agent. The primer is preferably single-stranded for maximum efficiency in amplification but can alternatively be double-stranded. A primer must be sufficiently long to prime the synthesis of extension products in the presence of the polymerization agent. The length of the primer depends on many factors, including application, temperature to be employed, template reaction conditions, other reagents, and source of primers. For example, depending on the complexity of the target sequence, the oligonucleotide primer typically contains 15 to 35 or more nucleotide residues, although it can contain fewer nucleotide residues. Primers can be large polynucleotides, such as from about 200 nucleotide residues to several kilobases or more. Primers can be selected to be "substantially complementary to the sequence on the template to which it is designed to hybridise and serve as a site for the initiation of synthesis. By "substantially complementary", it is meant that the primer is sufficiently complementary to hybridise with a target polynucleotide. Preferably, the primer contains no mismatches with the template to which it is designed to hybridise but this is not essential. For example, non-complementary nucleotide residues can be attached to the 5' end of the primer, with the remainder of the primer sequence being complementary to the template. Alternatively, non-complementary nucleotide residues or a stretch of non- complementary nucleotide residues can be interspersed into a primer, provided that the primer sequence has sufficient complementarity with the sequence of the template to hybridise therewith and thereby form a template for synthesis of the extension product of the primer.

[0054] "Probe" refers to a molecule that binds to a specific sequence or sub- sequence or other moiety of another molecule. Unless otherwise indicated, the term ^" probe" typically refers to a polynucleotide probe that binds to another polynucleotide, often called the "target polynucleotide", through complementary base pairing. Probes can bind target polynucleotides lacking complete sequence complementarity with the probe, depending on the stringency of the hybridisation conditions. Probes can be labelled directly or indirectly.

[0055] The term "recombinant" when used with reference, for example, to a cell, nucleic acid, protein or vector, indicates that the cell, nucleic acid, protein or vector has been modified by the introduction of a heterologous nucleic acid or protein or by the alteration of a native nucleic acid or protein, or that the cell is derived from a cell so modified. Accordingly, "recombinant" cells express genes that are not found within the native (non-recombinant) form of the cell or express native genes that are otherwise abnormally expressed, under expressed or not expressed at all. By the term "recombinant nucleic acid" is meant a nucleic acid, originally formed in vitro, in general, by the manipulation of a nucleic acid, for example, using polymerases and endonucleases, in a form not normally found in nature. In this manner, operable linkage of different sequences is achieved. Thus an isolated nucleic acid, in a linear form, or an expression vector formed in vitro by ligating DNA molecules that are not normally joined, are both considered "recombinant" for the purposes of this invention. It is understood that once a recombinant nucleic acid is made and reintroduced into a host cell or organism, it will replicate non- recombinantly, i.e., using the in vivo cellular machinery of the host cell rather than in vitro manipulations. However, such nucleic acids, once produced recombinantly, although subsequently replicated non-recombinantly, are still considered recombinant for the purposes of the invention. Similarly, a "recombinant protein" is a protein made using recombinant techniques, i.e., through the expression of a recombinant nucleic acid as depicted above.

[0056] The term "reference result" includes a result taken from the same subject at a different time, a result from a normal subject or a group of normal subjects, or a reference standard used in an analytical test.

[0057] By "regulatory element" or "regulatory sequence" is meant nucleic acid sequences (e.g., DNA) necessary for expression of an operably linked coding sequence in a particular host cell. The regulatory sequences that are suitable for prokaryotic cells for example, include a promoter, and optionally a c/ ^' s- acting sequence such as an operator sequence and a ribosome binding site. Control sequences that are suitable for eukaryotic cells include promoters, polyadenylation signals, transcriptional enhancers, translational enhancers, leader or trailing sequences that modulate mRNA stability, as well as targeting sequences that target a product encoded by a transcribed polynucleotide to an intracellular compartment within a cell or to the extracellular environment.

[0058] The term ^" sequence identity as used herein refers to the extent that sequences are identical on a nucleotide-by-nucleotide basis or an amino acid-by-amino acid basis over a window of comparison. Thus, a "percentage of sequence identity" is calculated by comparing two optimally aligned sequences over the window of comparison, determining the number of positions at which the identical nucleic acid base (e.g., A, T, C, G, I) or the identical amino acid residue (e.g., Ala, Pro, Ser, Thr, Gly, Val, Leu, He, Phe, Tyr, Trp, Lys, Arg, His, Asp, Glu, Asn, Gin, Cys and Met) occurs in both sequences to yield the number of matched positions, dividing the number of matched positions by the total number of positions in the window of comparison (i.e., the window size), and multiplying the result by 100 to yield the percentage of sequence identity. For the purposes of the present invention, "sequence identity may be understood to mean the "match percentage" calculated by the DNASIS computer program (Version 2.5 for Windows; available from Hitachi Software Engineering Co., Ltd., South San Francisco, California, USA) using standard defaults as used in the reference material accompanying the software.

[0059] The term "sequence similarity" refers to the percentage number of amino acids that are identical or constitute conservative substitutions as defined in Table 2 infra. Similarity may be determined using sequence comparison programs such as GAP (Devereux ef a/., 1984). In this way, sequences of a similar or substantially different length to those cited herein might be compared by insertion of gaps into the alignment, such gaps being determined, for example, by the comparison algorithm used by GAP.

[0060] Terms used to describe sequence relationships between two or more polynucleotides or polypeptides include "reference sequence", "comparison window", "sequence identity", "percentage of sequence identit ' and "substantial identity. A "reference sequence" is at least 12 but frequently 15 to 18 and often at least 25 monomer units, inclusive of nucleotides and amino acid residues, in length. Because two polynucleotides may each comprise (1 ) a sequence (i.e., only a portion of the complete polynucleotide sequence) that is similar between the two polynucleotides, and (2) a sequence that is divergent between the two polynucleotides, sequence comparisons between two (or more) polynucleotides are typically performed by comparing sequences of the two polynucleotides over a "comparison window" to identify and compare local regions of sequence similarity. A "comparison window refers to a conceptual segment of at least 6 contiguous positions, usually about 50 to about 100, more usually about 100 to about 150 in which a sequence is compared to a reference sequence of the same number of contiguous positions after the two sequences are optimally aligned. The comparison window may comprise additions or deletions (i.e., gaps) of about 20% or less as compared to the reference sequence (which does not comprise additions or deletions) for optimal alignment of the two sequences. Optimal alignment of sequences for aligning a comparison window may be conducted by computerized implementations of algorithms (GAP, BESTFIT, FASTA, and TFASTA in the Wisconsin Genetics Software Package Release 7.0, Genetics Computer Group, 575 Science Drive Madison, Wl, USA) or by inspection and the best alignment (i.e., resulting in the highest percentage homology over the comparison window) generated by any of the various methods selected. Reference also may be made to the BLAST family of programs as for example disclosed by Altschul ef al. , 1997. A detailed discussion of sequence analysis can be found in Unit 19.3 of Ausubel ef al., "Current Protocols in Molecular Biology", John Wiley & Sons Inc, 1994-1998, Chapter 15.

[0061] The phrase "stabilizing agenf as used herein includes any molecule that is capable of contributing to the stability of a clotting composition comprising a prothrombin activator, such as by preserving, increasing, prolonging or otherwise enhancing the ability of a clotting composition to clot blood relative to a given unit of time. Such stabilization may therefore result in a clotting composition that is able to clot blood in less time than it would take to clot blood in the absence of the stabilizing agent. The time taken for the clotting composition, in combination with the stabilizing agent, to clot blood may be less time than it would take to clot blood in the absence of the stabilizing agent due to a range of factors, including, but not limited to, preserving, increasing, prolonging or otherwise enhancing the clotting activity of the clotting composition by the stabilizing agent, especially in circumstances where the clotting activity of the clotting composition would otherwise be compromised, for example, due to exposure of the clotting composition to various environmental conditions, such as during the process of manufacturing the clotting composition, including exposure to heat and sterilizing radiation, as well as the storage time and storage conditions of the clotting composition, including temperature and humidity, and in addition the transportation conditions of the clotting composition, including temperature, humidity and atmospheric pressure.

[0062] "Stringency' as used herein, refers to the temperature and ionic strength conditions, and presence or absence of certain organic solvents, during hybridisation and washing procedures. The higher the stringency, the higher will be the degree of complementarity between immobilized target nucleotide sequences and the labelled probe polynucleotide sequences that remain hybridised to the target after washing. The term "high stringency refers to temperature and ionic conditions under which only nucleotide sequences having a high frequency of complementary bases will hybridise. The stringency required is nucleotide sequence dependent and depends upon the various components present during hybridisation. Generally, stringent conditions are selected to be about 10 to 20°C lower than the thermal melting point (Tm) for the specific sequence at a defined ionic strength and pH. The Tm is the temperature (under defined ionic strength and pH) at which 50% of a target sequence hybridises to a complementary probe.

[0063] The term "transformation" means alteration of the genotype of an organism, for example a bacterium, yeast, mammal, avian, reptile, fish or plant, by the introduction of a foreign or endogenous nucleic acid.

[0064] By "vector" is meant a polynucleotide molecule, preferably a DNA molecule derived, for example, from a plasmid, bacteriophage, yeast or virus, into which a polynucleotide can be inserted or cloned. A vector preferably contains one or more unique restriction sites and can be capable of autonomous replication in a defined host cell including a target cell or tissue or a progenitor cell or tissue thereof, or be integral with the genome of the defined host such that the cloned sequence is reproducible. Accordingly, the vector can be an autonomously replicating vector, i.e., a vector that exists as an extra-chromosomal entity, the replication of which is independent of chromosomal replication, e.g., a linear or closed circular plasmid, an extra-chromosomal element, a mini-chromosome, or an artificial chromosome. The vector can contain any means for assuring self-replication. Alternatively, the vector can be one which, when introduced into the host cell, is integrated into the genome and replicated together with the chromosome(s) into which it has been integrated. A vector system can comprise a single vector or plasmid, two or more vectors or plasmids, which together contain the total DNA to be introduced into the genome of the host cell, or a transposon. The choice of the vector will typically depend on the compatibility of the vector with the host cell into which the vector is to be introduced. In the present case, the vector is preferably a viral or viral-derived vector, which is operably functional in animal and preferably mammalian cells. Such vector may be derived from a poxvirus, an adenovirus or yeast. The vector can also include a selection marker such as an antibiotic resistance gene that can be used for selection of suitable transformants. Examples of such resistance genes are known to those of skill in the art and include the nptll gene that confers resistance to the antibiotics kanamycin and G418 (Geneticin®) and the hph gene which confers resistance to the antibiotic hygromycin B.

[0065] The terms "wild-type" and "naturally occurring" are used interchangeably to refer to a gene or gene product that has the characteristics of that gene or gene product when isolated from a naturally occurring source. A wild type gene or gene product (e.g., a polypeptide) is that which is most frequently observed in a population and is thus arbitrarily designed the "normal" or "wild-type" form of the gene.

[0066] The reference to any prior art in this specification is not, and should not be taken as an acknowledgement or any form of suggestion that prior art forms part of the common general knowledge of the person skilled in the art. [0067] The entire content of all publications, patents, patent applications and other material recited in this specification is incorporated herein by reference.

Brief description of the sequence listing

[0068] SEQ ID NO: 1 is a polypeptide sequence for ecarin from Echis carinatus.

[0069] SEQ ID NO: 2 is a partial polypeptide sequence for basparin from Bothrops asper venom.

[0070] SEQ ID NO: 3 is a partial polypeptide sequence for carinactivase-1 from Echis carinatus venom (prepared as described in Yamada, D., et al.. (1996)) - 62 kDa subunit.

[0071] SEQ ID NO: 4 is a partial polypeptide sequence for multactivase from Echis multisquamatus venom (prepared as described in Yamada, D., et al., (1997)).

[0072] SEQ ID NO: 5 is a nucleotide sequence encoding Factor V-like component of PtPA (or pseutarin C) from Pseudonaja textilis.

[0073] SEQ ID NO: 6 is a nucleotide sequence encoding Factor V-like component of PtPA (or pseutarin C) from Pseudonaja textilis.

[0074] SEQ ID NO: 7 is a polypeptide sequence for Factor V-like component of PtPA (or pseutarin C) from Pseudonaja textilis.

[0075] SEQ ID NO: 8 is a polypeptide sequence for Factor V-like component of PtPA (or pseutarin C) from Pseudonaja textilis.

[0076] SEQ ID NO: 9 is a nucleotide sequence encoding Factor V-like component of OsPA (or oscutarin C) from Oxyuranus scutellatus.

[0077] SEQ ID NO: 10 is a nucleotide sequence encoding Factor V-like component of OsPA (or oscutarin C) from Oxyuranus scutellatus scutellatus.

[0078] SEQ ID NO: 11 is a polypeptide sequence for Factor V-like component of OsPA (or oscutarin C) from Oxyuranus scutellatus scutellatus.

[0079] SEQ ID NO: 12 is a polypeptide sequence for Factor V-like component of OsPA (or oscutarin C) from Oxyuranus scutellatus.

[0080] SEQ ID NO: 13 is a polypeptide sequence for Factor V-like component of OsPA (or oscutarin C) from Oxyuranus scutellatus.

[0081] SEQ ID NO: 14 is a nucleotide sequence encoding Factor V-like component of omicarin C from Oxyuranus microlepidotus. [0082] SEQ ID NO: 15 is a nucleotide sequence encoding factor V from Homo sapiens.

[0083] SEQ ID NO: 16 is a polypeptide sequence for factor V from Homo sapiens.

[0084] SEQ ID NO: 17 is a nucleotide sequence encoding factor V from Bos Taurus.

[0085] SEQ ID NO: 18 is a polypeptide sequence for factor V from Bos Taurus.

[0086] SEQ ID NO: 19 is a nucleotide sequence encoding Factor X-like component of PtPA (or pseutarin C) from Pseudonaja textilis.

[0087] SEQ ID NO: 20 is a nucleotide sequence encoding Factor X-like component of PtPA (or pseutarin C) from Pseudonaja textilis.

[0088] SEQ ID NO: 21 is a nucleotide sequence encoding Factor X-like component of PtPA (or pseutarin C) from Pseudonaja textilis.

[0089] SEQ ID NO: 22 is a nucleotide sequence encoding Factor X-like component of PtPA (or pseutarin C) from Pseudonaja textilis textilis.

[0090] SEQ ID NO: 23 is a nucleotide sequence encoding Factor X-like component of PtPA (or pseutarin C) from Pseudonaja textilis textilis.

[0091] SEQ ID NO: 24 is a nucleotide sequence encoding Factor X-like component of PtPA (or pseutarin C) from Pseudonaja textilis.

[0092] SEQ ID NO: 25 is a nucleotide sequence encoding Factor X-like component of PtPA (or pseutarin C) from Pseudonaja textilis.

[0093] SEQ ID NO: 26 is a polypeptide sequence for Factor X-like component of PtPA (or pseutarin C) from Pseudonaja textilis.

[0094] SEQ ID NO: 27 is a polypeptide sequence for Factor X-like component of PtPA (or pseutarin C) from Pseudonaja textilis.

[0095] SEQ ID NO: 28 is a polypeptide sequence for Factor X-like component of PtPA (or pseutarin C) from Pseudonaja textilis textilis.

[0096] SEQ ID NO: 29 is a polypeptide sequence for Factor X-like component of PtPA (or pseutarin C) from Pseudonaja textilis textilis.

[0097] SEQ ID NO: 30 is a polypeptide sequence for Factor X-like component of PtPA (or pseutarin C) from Pseudonaja textilis.

[0098] SEQ ID NO: 31 is a nucleotide sequence encoding Factor X-like component of OsPA (or oscutarin C) from Oxyuranus scutellatus. [0099] SEQ ID NO: 32 is a polypeptide sequence for Factor X-like component of OsPA (or oscutarin C) from Oxyuranus scutellatus.

[00100] SEQ ID NO: 33 is a nucleotide sequence encoding Factor X-like component of omicarin C from Oxyuranus microlepidotus.

[00101] SEQ ID NO: 34 is a polypeptide sequence for Factor X-like component of omicarin C from Oxyuranus microlepidotus.

[00102] SEQ ID NO: 35 is a nucleotide sequence encoding Factor X-like component of porpharin D from Pseudechis porphyriacus.

[00103] SEQ ID NO: 36 is a polypeptide sequence for Factor X-like component of porpharin D from Pseudechis porphyriacus.

[00104] SEQ ID NO: 37 is a nucleotide sequence encoding Factor X-like component of hopsarin D from Hoplocephalus stephensii.

[00105] SEQ ID NO: 38 is a polypeptide sequence for Factor X-like component of hopsarin D from Hoplocephalus stephensii.

[00106] SEQ ID NO: 39 is a nucleotide sequence encoding Factor X-like component of notecarin D from Notechis scutatus.

[00107] SEQ ID NO: 40 is a polypeptide sequence for Factor X-like component of notecarin D from Notechis scutatus.

[00108] SEQ ID NO: 41 is a nucleotide sequence encoding Factor X-like component of trocarin D from Tropidechis carinatus.

[00109] SEQ ID NO: 42 is a polypeptide sequence for Factor X-like component of trocarin D from Tropidechis carinatus.

[00110] SEQ ID NO: 43 is a nucleotide sequence encoding Factor X-like component of prothrombin activator from Demansia vestigiata.

[00111] SEQ ID NO: 44 is a polypeptide sequence for Factor X-like component of prothrombin activator from Demansia vestigiata.

[00112] SEQ ID NO: 45 is a nucleotide sequence encoding Factor X-like component of prothrombin activator from Demansia vestigiata.

[00113] SEQ ID NO: 46 is a polypeptide sequence for Factor X-like component of prothrombin activator from Demansia vestigiata. [00114] SEQ ID NO: 47 is a nucleotide sequence encoding factor X from Homo sapiens.

[00115] SEQ ID NO: 48 is a polypeptide sequence for factor X from Homo sapiens.

[00116] SEQ ID NO: 49 is a nucleotide sequence encoding factor X from Bos Taurus.

[00117] SEQ ID NO: 50 is a polypeptide sequence for factor X from Bos Taurus.

[00118] SEQ ID NO: 51 is a partial polypeptide sequence for carinactivase-1 from Echis carinatus venom (prepared as described in Yamada, D., et al.. (1996)) - 17 kDa subunit.

[00119] SEQ ID NO: 52 is a partial polypeptide sequence for carinactivase-1 from Echis carinatus venom (prepared as described in Yamada, D., et al.. (1996)) - 14 kDa subunit.

[00120] SEQ ID NO: 53 is a polypeptide sequence for the uncleaved form of wild type ecarin from Echis carinatus venom.

[00121] SEQ ID NO: 54 is a polypeptide sequence for ecarin from Echis carinatus venom, wherein the signal peptide has been removed and a TEV protease site ENLYFQS has been inserted at the boundary between the propeptide and the mature domain.

[00122] SEQ ID NO: 55 is a polypeptide sequence for the mature form of wild type ecarin from Echis carinatus venom.

[00123] SEQ ID NO: 56 is a polypeptide sequence for a mutant form of ecarin from Echis carinatus venom, wherein the signal peptide has been removed and a TEV protease site ENLYFQS has been inserted at the boundary between the propeptide and the mature domain, and a P396S mutation has been introduced.

[00124] SEQ ID NO: 57 is a polypeptide sequence for the mature form of a P396S mutant ecarin from Echis carinatus venom.

Brief description of the figures

[00125] The present invention will now be described, by way of example only, with reference to the following figures.

[00126] Figure 1 shows SDS-PAGE gel patterns of rFv (Lane 2), five OsPA samples (Lanes 3, 4, 5, 6 and 7) separated by different gels and Purified Fxa (Lane 8). Markers are in Lane 1.

[00127] Figure 2 shows Thromboelastograhic traces for the clotting of recalcified whole blood by 31 ng aliquots of each of the ten OsPA preparations. The 10 overlapping traces on the left (fast clotting) represent the ten preparations whereas the labelled ^* Ca traces represent duplicates of clotting by calcium alone.

[00128] Figure 3 shows chromatography of 1.05 gram Oxyuranus scutellatus venom using Superdex ™200 (gel column: 5 cm diameter, 95 cm long) (17 April 2012).

[00129] Figure 4 shows whole blood clotting activity curve of concentrated OsPA fraction purified on Superdex resin.

[00130] Figure 5 shows a diagram representing a graph from the Thrombelastograph® during the clotting of whole blood (from TEG ^? Haemostasis Analyser 5000 Series Manual).

[00131] Figure 6 shows progress curves for the S-2222 assay using pooled OsPA (17/4/12) (A) and standard curve (B).

[00132] Figure 7 shows whole blood clotting activity of freshly diluted OsPA compared with that of desiccator-dried OsPA. DO data are for freshly diluted liquid samples of OsPA added to blood collection tubes; D1 data are for samples dried overnight at room temperature in blood collection tubes in a vacuum desiccator.

[00133] Figure 8 shows whole blood clotting times in blood collection tubes containing freshly diluted OsPA and in similar tubes in which OsPA had been dried using a Genevac.

[00134] Figure 9 shows stability of dried OsPA in Gelofusine at room temperature for 211 days in whole blood clotting time. Left hand series: controls using 1 freshly diluted OsPA in buffer ph 7.4 ; middle series: test samples in which 1 g OsPA was dried in the presence of Gelofusine (20 μΙ); right hand series: clotting times of recalcified blood samples with no OsPA.

[00135] Figure 10 shows line graphs using data from Figure 9. A: all points from zero to 211 days; B: points from zero to 65 days.

[00136] Figure 11. Clotting times (means of duplicates) for the clotting of recalcified citrated whole blood by OsPA in blood collection tubes after storage at room temperature for up to 195 days. Left hand series: controls using 1 g freshly diluted OsPA in 0.1 M Ammonium Acetate buffer pH 6.8; middle series: test samples in which 1 OsPA was dried in the presence of 0.5% w/v bovine serum albumin and 0.5% w/v dextran; right hand series: clotting times of recalcified blood samples with no OsPA.

[00137] Figure 12 shows line graphs of the clotting times for the fresh control and OsPA/BSA/dextran tubes. Data from Figure 11.

[00138] Figure 13 shows clotting times in seconds for recalcified citrated blood after incubation at 50 C. Identifying code for samples: 'B' = BD tube; 7' = pH 7.4; 'F' = freshly diluted OsPA, not dried; R' = dried and kept at room temperature; 'D50' = dried and kept at 50 C; Ό, 1 , 2 or 5' = 0, 1 , 2 or 5 g OsPA. Vertical bars represent storage for zero, one and seven days.

[00139] Figure 14. Clotting times in seconds for recalcified citrated whole blood after incubation at 50°C. Identifying code for samples: 'B' = BD tube; '6' = pH 6.0; 'F' = freshly diluted OsPA, not dried; OR ^' = dried and kept at room temperature; 'D50 ^' = dried and kept at 50°C; Ό, 1 , 2 or 5 ^' = 0, 1 , 2 or 5 g OsPA. Vertical bars represent storage for zero, one and seven days.

[00140] Figure 15 shows clotting times in seconds for recalcified citrated blood after incubation at 50°C. Identifying code for samples: 'G' = Greiner tube; 7' = pH 7.4; = freshly diluted OsPA, not dried; R' = dried and kept at room temperature; ^' D50 ^' = dried and kept at 50°C; Ό, 1' = 0 or 1 g OsPA. Vertical bars represent storage for zero, 1 , 3, 7, 14 and 30 days respectively.

[00141] Figure 16 shows clotting times in seconds for recalcified citrated blood after incubation at 50°C. Identifying code for samples: 'G' = Greiner tube; '6' - pH 6.0; 'F' = freshly diluted OsPA, not dried; R' = dried and kept at room temperature; 'D50' = dried and kept at 50°C; Ό or 1 ' = 0 or 1 ng OsPA. Vertical bars represent storage for zero, 1 , 3, 7, 14 and 30 days respectively.

[00142] Figure 17 shows line graphs of data from Figure 15.

[00143] Figure 18 shows line graphs for data from Figure 16.

[00144] Figure 19A shows clotting times in whole blood clotting assay for the tubes as listed above and for fresh controls and OsPA devoid control. Irradiated tubes were treated with 15 kGy gamma radiation. Each bar represents the mean of two estimates.

[00145] Figure 19B shows clotting times in whole blood clotting assay for the tubes as listed above and for fresh controls and OsPA devoid control. Irradiated tubes were treated with 15kGy gamma radiation. Each bar represents the mean of two estimates (BD and GBO are codes for two different plain blood collection plastic tubes). All tubes apart from controls were formulated with trehalose dissolved in gelofusine.

[00146] Figure 19C shows clotting times for the tubes as listed above and for fresh controls and OsPA devoid control. Irradiated tubes were treated with 15 kGy gamma radiation. Each bar represents the mean of two estimates (BD and GBO are codes for two different plain blood collection plastic tubes). All tubes apart from controls were formulated with trehalose dissolved in gelofusine.

[00147] Figure 20 shows clotting times in whole blood for Ecarin containing tubes and for fresh controls and OsPA devoid control. Irradiated tubes were treated with 25 kGy gamma radiation and stored at Room Temperature for 212 days. All tubes apart from controls were formulated with gelofusine. Figure 21 shows activity of dried OsPA in different sugar and other formulations in plain blood collection plastic tubes at 50°C in clotting recalcified whole blood. [00148] Figure 22 shows activity of dried OsPA in different sugar and other formulations in plain blood collection plastic tubes at Room Temperature in clotting recalcified whole blood.

[00149] Figure 23 shows activity of dried OsPA formulated in gelofusine and lactulose 6 and 10% in plain blood collection tubes at Room Temperature in clotting recalcified whole blood.

[00150] Figure 24 shows activity of dried Ecarin in different sugar and other formulations in plain blood collection plastic tubes at Room Temperature in clotting recalcified whole blood.

Detailed description

[00151] The present inventors have found that the stability of clotting compositions comprising prothrombin activators is significantly increased when formulated in combination with one or more additional agents such as a colloid. This increased stability is significant because of the capacity to manufacture, sterilize, transport and store clotting compositions (for example, in the form of a collection tube) without significant loss of clotting activity under conditions that would previously have compromised the efficacy of such compositions. For example, the compositions of the present invention are stable after sterilisation involving radiation, storage at high temperatures and storage for extended periods of time. Dose response and ranging studies to determine the effective dose of OsPA to use in the clotting tube spray drying procedure were aimed at achieving clotting of whole blood in approximately 5 minutes. It is clearly shown that concentrations of OsPA of 0.1 -1.0 ug in 4 mL of non- anti-coagulated blood will achieve this. The studies illustrate firstly in Example 1 that highly purified Coastal Taipan venom prothrombin activator (OsPA), a Group C prothrombin activator, can be purified from crude Taipan (Os) venom using gel filtration chromatography, for example, on a Superdex 200 column, the activity of which can be determined by clotting in recalcified citrated whole blood or via S- 2222 chromogenic testing designed for detection of Factor Xa, or by S-2238 chromogenic testing designed for the testing of thrombin. Example 1 also details how the pooled OsPA containing fractions can then be concentrated using, for example, an Amicon ultrafiltration unit and prepared as a 50% glycerol solution for long term storage at -20°C. The glyercol stock can then be dialysed and freeze- dried as detailed in Example 1. Ecarin used in the Examples (extracted from Echis Carinatus venom) was purchased commercially and assayed as detailed in Example 1.

[00152] In order to achieve comparable results between experiments, standardised methods were developed. Example 2 details a standardised method of preparation of blood collection tubes with prothrombin activator solution and formulation components, involving a standard surfactant to coat the tube bottom and standardised tube drying methods. Example 3 details the standard irradiation protocols to approximate the sterilisation processes found in commercial blood collection tube manufacture. Blood samples to be used in assessing the blood collection tubes were tested using standard methods as detailed in Example 4 ensuring normal coagulation parameters and hence suitability for use in testing. Tests for clotting performance of the OsPA or other prothrombin activators were conducted using standard methods as detailed in Example 5 including a plasma clotting assay, visual assessment of clotting, Thromboerlastography (TEG) and Chromogenic assays. Standards for stability testing and analyte measurement of resultant serum are also included in Example 5, completing the standard test descriptions.

[00153] Formulations to improve the stability of OsPA in a blood collection tube are disclosed in Example 6, which compares tube drying conditions with and without the use of surfactants and a colloid, BSA. It is shown that the presence of surfactant and BSA colloid when dried with the Genevac, vacuum drying method give an improved clotting activity (reduced time to clot). Data in Example 6 also demonstrates an improvement with the addition of 0.1 % BSA to OsPA without surfactant in tubes, however optimal efficacy is achieved with the addition of a surfactant coating. All subsequent Examples utilise a surfactant coating in the tube. Example 7 continues this experimental program showing a decline in clotting activity from TO when the formulation from Example 6 was stored at 25°C for a period of 85 days. Example 8 builds on Examples 6 and 7 by testing a range of additional agents to enhance formulation stability including the colloids BSA (at a higher concentration) and Dextran. It is shown that BSA (0.5%) and dextran (0.5%), both increase the stability of OsPA at 25°C for 99 days compared to buffer alone, with 1 g OsPA able to clot blood in around 5 min. Example 9 uses the the colloid gelofusine (4% succinylated gelatin) and achieves stability for OsPA after 211 days storage at 25°C (with a 5 min clotting time). Data using fresh blood on tubes with this formulation is also included. Gelofusine was shown to have a greater effect on stability than 0.5% BSA or 0.5% Dextran, but with all colloids conferring greater stability than buffer. Example 10 shows that a combination of 0.5% Dextran and 0.5% BSA gives stability over 195 days at 25°C, and greater stability at 99 days than either colloid alone, as illustrated in Example 8. The gelofusine formulation was successfully stable at 50C for 30 days in Example 1 1 , indicating longer term stability is achievable. Gamma irradiation as used in the sterilisation of commercial tubes was trialed with OsPA tubes in Example 12 using the BSA / Dextran and gelofusine formulations and also a formulation with gelofusine and a non-reducing sugar (trehalose), exposing all samples to a 15kGy dose. It was shown that OsPA formulated with either BSA / Dextran and gelofusine retained activity over baseline after irradiation, t.he protective effect increasing for gelofusine with the addition of trehalose. Another prothrombin activator ecarin, was successfully trialed with the gelofusine and trehalose formulation. Example 13 exposed ecarin formlated with 4% gelofusine to 25kGy of gamma irradiation, demonstrating retention of a significant % of clotting activity. There was no significant difference in clotting activity between tubes which had been irradiated at TO and those which not been irradiated after 212 days storafe at room temperature. Example 14 tested OsPA formulated with gelofusine and a range of sugars and additional agents at room temperature and 50°C and showed that the gelofusine and trehalose / sucrose formulations enabled acceptable clotting times after 10 weeks at 50°C and at room temerpature for over 12m. Although with more limited stability data, lactulose shows promise as another stabilising sugar. Example 15 tested Ecarin formulated with gelofusine and a range of sugars and additional agents at room temperature and showed that the gelofusine and trehalose / sucrose formulations enabled acceptable clotting times after over 12m at room temperature. Example 16 illustrates that there are no effects on analyte testing of the presence of gelofusine in the blood collection tubes.

[00154] In summary, the examples demonstrate the extraction processes for OsPA and the formulations required to achieve commercially acceptable stability (retention of clotting activity) for prothrombin activators such as OsPA or Ecarin in a blood collection tube with exposure to storage time, temperature and irradiation. In this regard, the stability enhancing properties of colloids were clearly demonstrated, in particular, gelofusine or BSA alone or in combination with additional agents.

Prothrombin activators

[00155] The present invention is based in part on the finding that the stability of clotting compositions comprising prothrombin activators is significantly increased when formulated in combination with one or more additional agents such as a colloid.

[00156] In some embodiments, the prothrombin activator is an exogenous prothrombin activator. As used herein, an "exogenous prothrombin activator" means a prothrombin activator obtained from a source other than the blood sample from which the serum sample is to be prepared.

[00157] The prothrombin activators used in the present invention may comprise wild-type or naturally- occurring, recombinant, mutant or genetically engineered forms of prothrombin activators including those obtained, derived or derivable from any suitable organism, including snake, human, bovine and bacterial prothrombin activator.

[00158] In some embodiments of the present invention, the prothrombin activator is a snake prothrombin activator. Suitably, the prothrombin activator is a snake venom prothrombin activator. Snake venom prothrombin activators are generally classified in four groups (A, B, C, and D) depending on their structure, function and requirements for co-factors.

[00159] In particular embodiments, the snake venom prothrombin activator is a group A prothrombin activator. Group A prothrombin activators are metalloproteinases consisting of three domains: a metalloproteinase, a disintegrin, and a Cys-rich domain. The metalloproteinase domain contains the consensus sequence HEXXHXXGXXH, corresponding to the zinc- chelating active site. These prothrombin activators are found at least in several viper venoms, and include ecarin from Echis cannatus venom and basparin from Bothrops asper venom. [00160] In particular embodiments, the snake venom prothrombin activator is a group B prothrombin activator. Group B prothrombin activators are metalloproteinases consisting of two subunits held non- covalently: a metalloproteinase and a C-type lectin-like disulfide-liked dimer. These prothrombin activators are found in several viper venoms, and include carinactivase-1 and carinactivase-2 from Echis carinatus venom and multactivase from Echis multisquamatus venom.

[00161] In particular embodiments, the snake venom prothrombin activator is a group C prothrombin activator. Group C prothrombin activators are serine proteases and resemble the mammalian factor Xa- factor Va complex. Pseutarin C (or PtPA) and oscutarin C (or OsPA) are group C prothrombin activators from the venoms of Pseudonaja textilis and Oxyuranus scutellatus respectively. Omicarin C is the prothrombin activator from Oxyuranus microlepidotus venom.

[00162] In particular embodiments, the snake venom prothrombin activator is a group D prothrombin activator. Group D prothrombin activators are serine proteases and are functionally similar to mammalian factor Xa. Porpharin D (from Pseudechis porphyriacus). notecarin D (from Notechis scutatus scutatus), trocarin D (from Tropidechis carinatus), hopsarin D (from Hopiocephalus stephensi), and notenarin D (from Notechis ater niger) are all group D prothrombin activators.

[00163] A review of snake prothrombin activators is provided in Kini, R. . (2005), and of those specifically from the venom of Australian Elapids (group C and D prothrombin activators) is provided in St. Pierre et al. (2005), the contents of each are herein by reference in their entirety. These two reviews use the classification of snake prothrombin activators into groups A-D as described above. This classification supersedes the previous classification system using groups l-lll (group I encompasses groups A and B; group II is now group D and group III is now group C), and sometimes additional groups IV (snake venom activators that cleave peptide bonds in prothrombin but do not convert the prothrombin to an enzymatically active product - i.e. thrombin or meizothrombin) and V (bacterial prothrombin activators) as described in earlier review articles, including Rosing, J. et al. (1991 ) and Rosing, J. ei al. (1992), the contents of each being incorporated by reference in their entirety. For an explanation on the change to the classification system, see Kini, R, M., er a/. (2001 ), the contents of which are incorporated by reference in its entirety.

[00164] In specific embodiments, the snake prothrombin activator is obtained from the Family Elapidae, illustrative examples of which include species from the genera Demansia, Hopiocephalus. Notechis, Oxyuranus, Pseudechis, Pseudonaja, Rhinoplocephalus, and Tropidechis including but not limited to Demansia vestigiata, Hopiocephalus stephensii, Notechis ater humphreysi, Notechis ater niger, Notechis ater serventyi, Notechis flinkders, Notechis humphreysi, Notechis niger, Notechis occidentalis, Notechis scutatus, Notechis scutatus scutatus, Notechis serventyi, Oxyuranus microlepidotus, Oxyuranus scutellatus. Pseudechis porphyriacus. Pseudonaja affinis, Pseudonaja inframaculata. Pseudonaja nuchalis, Pseudonaja textilis, Rhinoplocephalus nigrescens, and Tropidechis carinatus.

[00165] In specific embodiments, the snake prothrombin activator is obtained from the Family Viperidae, illustrative examples of which include species from the genera Botrhops, Echis and Trimeresurus, including but not limited to Bothrops alternates, Bothrops asper, Bothrops atrox, Bothrops atrox asper. Bothrops brasili. Bothrops castelnaudi, Bothrops columbiensis, Bothrops erythromelas, Bothrops fonsecai, Bothrops itapetiningae, Bothrops jararaca, Bothrops neuwiedi, Bothrops venezuelensis, Echis carinatus, Echis coloratus. Echis multisquamatus, and Trimeresurus okinavensis.

[00166] In specific embodiments, the snake prothrombin activator is obtained from the Family Colubridae, illustrative examples of which include species from the genera Dispholidus, Rhabdophis and Thelotomis, including but not limited to Dispholidus typus. Rhabdophis tigrinus tigrinus, Thelotornis kirtlandii. and Thelotomis capensis.

[00167] In some embodiments the snake prothrombin activator is from or is obtained from snake venom. The purification and characterisation of PtPA from P. textilis snake venom is described in Masci (1986) and Masci et al.. (1988), and OsPA from O. scutellatus venom is described in Speijer et al., (1986), all of which are incorporated by reference in their entirety. The purification and characterisation of ecarin from Echis carinatus venom is described in Morita, T ef al. (1981) and Nishida, S ef al. (1995), of carinactivase from Echis carinatus venom is described in Yamada, D ef al. (1996), of multactivase from Echis multisquamatus is described in Yamada, D. ef al., (1997), and of notecarin from Notechis scutatus is described in Tans, G et al., (1985), each of which are incorporated by reference in their entirety.

[00168] In certain embodiments, the prothrombin activator is a mammalian prothrombin activator. Mammalian prothrombin activators include those derived from human blood and/or tissue and those derived from bovine blood and/or tissue or recombinant versions of these proteins

[00169] In certain embodiments, the prothrombin activator is a bacterial prothrombin activator. Bacterial prothrombin activators include those from Staphylococcus aureus, Peptococcus indolicus, Bacteroides melaninogenicus, and Pseudomonas aeruginosa (Rosing, J. et al. (1991 ).

[00170] As will be appreciated by those skilled in the art, the prothrombin activator may comprise, consist essentially of, or consist of one or more polypeptides. In some embodiments, the prothrombin activator comprises, consists essentially of, or consists of a single polypeptide. In other embodiments, the prothrombin activator comprises, consists essentially of, or consists of more than one polypeptide, including but not limited to complexes of polypeptides. Where the prothrombin activator comprises, consists essentially of, or consists of more than one polypeptide, each polypeptide may be from the organisms from the same or different genera, and/or the same or different species. [00171] In certain embodiments, the prothrombin activator comprises an amino acid sequence selected from those set forth in SEQ ID NOs: 1 , 2, 3, 4, 7. 8, 11 , 12, 13, 16, 18, 26, 27, 28, 29, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, 51 , 52, 53, 54, 55, 56 and 57 or comprises an amino acid sequence encoded by a nucleotide sequence selected from those set forth in SEQ ID NOs: 5, 6, 9, 10, 14, 15, 17, 19. 20, 21 , 22, 23, 24, 25, 31 , 33, 35, 37, 39, 41 , 43, 45, 47, and 49.

[00172] In some embodiments, the prothrombin activator is derived or derivable from snake venom.

[00173] In some embodiments, the prothrombin activator is a serine protease Group C prothrombin activator resembling the mammalian factor Xa-factor Va complex.

[00174] In particular embodiments, the prothrombin activator is selected from the group consisting of Pseutarin C (or PtPA) and oscutarin C (or OsPA) derived or derivable from the venoms of Pseudonaja textilis and Oxyuranus scutellatus, respectively.

[00175] In a preferred embodiment, the prothrombin activator is oscutarin C (or OsPA) derived or derivable from the venom of Oxyuranus scutellatus.

[00176] In a particularly preferred embodiment, the prothrombin activator comprises the amino acid sequence set forth in SEQ ID NOs: 11 , 12, 13 or 32, or comprises an amino acid sequence encoded by a nucleotide sequence selected from those set forth in SEQ ID NOs: 9, 10 or 31.

Chimeric prothrombin activators and fusion polypeptides

[00177] The present invention also contemplates the use of prothrombin activators comprising a chimeric polypeptide. As used herein, a "chimeric polypeptide" includes a first polypeptide component comprising a polypeptide obtained from a first organism linked to a second polypeptide component obtained from a second organism. In some embodiments, the first organism and the second organism are from different genera. In other embodiments, the first organism and the second organism are different species of the same genus. In certain embodiments, the prothrombin activator comprises a chimeric polypeptide that resembles a factor Xa-factor Va complex, wherein the first polypeptide comprises a factor Xa-like polypeptide and the second polypeptide comprises a factor Va-like polypeptide. In certain specific embodiments, the first polypeptide comprises an amino acid sequence selected from those set forth in SEQ ID NOs: 26, 27, 28, 29, 30, 32, 34, 36. 38, 40. 42, 44, 46, 48, and 50, or comprises an amino acid sequence encoded by a nucleotide sequence selected from those set forth in SEQ ID NOs: 19, 20, 21 , 22, 23, 24, 25. 31 , 33, 35, 37, 39, 41 , 43, 45, 47, and 49, and the second polypeptide comprises an amino acid sequence selected from those set forth in SEQ ID NOs: 7, 8, 11 , 12, 13, 16, and 18, or comprises an amino acid sequence encoded by a nucleotide sequence selected from those set forth in SEQ ID NOs: 5, 6, 9, 10, 14, 15, and 17.

[00178] The present invention also contemplates the use of prothrombin activators comprising a fusion polypeptide. As used herein, a "fusion polypeptide" includes a first polypeptide component linked to a second polypeptide component. The first polypeptide component may be obtained from a first organism and the second polypeptide component may be obtained from a second organism. In some embodiments, the first organism and the second organism are from different genera. In other embodiments, the first organism and the second organism are different species of the same genus. The first polypeptide component or the second polypeptide component of the fusion polypeptide can correspond to all or a portion (e.g., a fragment as described herein) of a wild-type or naturally occurring amino acid sequence. The second polypeptide component can be fused to the N-terminus or C- terminus of the first polypeptide component.

Fragments of wild-type or naturally occurring polypeptides

[00179] The prothrombin activator may comprise a fragment of a full-length wild-type or naturally occurring polypeptide, wherein the prothrombin activator exhibits prothrombin activating activity.

[00180] Typically, fragments of a full-length polypeptide may participate in an interaction, for example an intramolecular or an intermolecular interaction. Such fragments include peptides comprising the amino acid sequences shown in SEQ ID NOs: 2, 3, 4, 51 , and 52 and peptides comprising amino acid sequences sufficiently similar to or derived from the amino acid sequences of a (putative) full-length polypeptide, for example, the amino acid sequences shown in SEQ ID NOs: 1 , 7, 8, 11 , 12, 13, 16, 18, 26, 27, 28, 29, 30, 32, 34, 36, 38, 40, 42. 44, 46, 48, 50, 53, 54, 55, 56 and 57, or the amino acid sequences encoded by a nucleotide sequence selected from those set forth in SEQ ID NOs: 5, 6, 9, 10, 14, 15, 17, 19, 20, 21 , 22, 23, 24, 25, 31 , 33, 35, 37, 39, 41 , 43, 45, 47, and 49, which includes less amino acids than a full-length polypeptide, and exhibit one activity of that polypeptide.

Variants of naturally-occurring prothrombin acthivators (polypeptide)

[00181] The present invention also contemplates prothrombin activators comprising polypeptide(s) that is/are variant(s) of the wild-type or naturally-occurring polypeptide(s). Prothrombin activators comprising one or more variant polypeptides encompassed by the present invention are biologically active, that is, they continue to possess prothrombin activating activity.

[00182] Such "variant prothrombin activators include polypeptides derived from the native polypeptide, wherein the polypeptides are derived from the corresponding native polypeptide(s) by deletion (so-called truncation) or addition of one or more amino acids to the N-terminal and/or C-terminal end of the native polypeptide(s); deletion or addition of one or more amino acids at one or more sites in the native polypeptide(s); or substitution of one or more amino acids at one or more sites in the native polypeptide(s). These variant prothrombin activators may result from, for example, genetic polymorphism or human manipulation.

[00183] Further non-limiting examples of variant polypeptides include precursor polypeptide or polypeptide in zymogen form processed forms of a full-length or precursor polypeptide or polypeptide in zymogen form.

[00184] Variants of a wild-type or naturally-occurring polypeptide will have 20, 21 , 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 , 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 , 42, 43, 44, 45, 46, 47, 48, 49, 50, 51 , 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 , 62, 63, 64, 65, 66, 67, 68, 69, 70, 71 , 72, 73, 74, 75, 76, 77, 78, 79, 80, 81 , 82, 83, 84, 85, 86, 87, 88, 89, 90, 91 , 92, 93, 94, 95, 96, 97, 98 or 99% sequence similarity or identity with the amino acid sequence for the wild-type or naturally-occurring polypeptide, including but not limited to the sequences in SEQ ID NOs: 1 , 2, 3, 4, 7, 8, 1 1 , 12, 13, 16, 18, 26, 27, 28, 29, 30, 32, 34, 36. 38, 40, 42, 44, 46, 48, 50, 51 , 52. 53 and 55 or the amino acid sequences encoded by the nucleotide sequences in SEQ ID NOs: 5, 6, 9, 10, 14, 15, 17, 19, 20, 21 , 22, 23, 24, 25, 31 , 33, 35, 37, 39, 41 , 43, 45, 47, and 49, as determined by sequence alignment programs described elsewhere herein using default parameters. A variant of a wild-type or naturally-occurring polypeptide, which falls within the scope of a variant polypeptide, may differ from that polypeptide generally by as much 200, 100, 50 or 20 amino acid residues or suitably by as few as 1-15 amino acid residues, as few as 1 -10. such as 6-10, as few as 5, as few as 4, 3, 2, or even 1 amino acid residue. In some embodiments, a variant polypeptide differs from the corresponding sequences in SEQ ID NOs: 1 , 2, 3, 4, 7, 8, 1 1 , 12, 13, 16, 18, 26, 27, 28. 29, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, 51 , 52, 53 and 55 or the amino acid sequences encoded by the nucleotide sequences in SEQ ID NOs: 5, 6, 9, 10, 14, 15, 17, 19, 20, 21 , 22, 23, 24, 25, 31 , 33, 35, 37, 39, 41 , 43, 45, 47, or 49. by at least 1 but by less than 15, 10 or 5 amino acid residues. In other embodiments, it differs from the corresponding sequences in SEQ ID NOs: 1 , 2, 3, 4, 7, 8, 1 1 , 12, 13, 16, 18, 26, 27, 28, 29, 30, 32, 34, 36, 38, 40, 42. 44, 46, 48, 50, 51 , 52, 53 and 55, or the amino acid sequences encoded by the nucleotide sequences in SEQ ID NOs: 5, 6, 9, 10, 14, 15, 17, 19. 20, 21 , 22, 23, 24, 25, 31 , 33, 35, 37, 39, 41 , 43, 45, 47, or 49, by at least one residue but less than 20%, 15%, 10% or 5% of the residues.

[00185] A polypeptide may be altered in various ways including amino acid substitutions, deletions, truncations, and insertions. Methods for such manipulations are generally known in the art. For example, amino acid sequence variants of a polypeptide can be prepared by mutations in the DNA. Methods for mutagenesis and nucleotide sequence alterations are well known in the art. See, for example, Kunkel (1985), Kunkel ef a/., (1987), US patent 4,873,192, Watson ef a/„ (1987) and the references cited therein. Guidance as to appropriate amino acid substitutions that do not affect biological activity of the protein of interest may be found in the model of Dayhoff ef a/. (1978). Methods for screening gene products of combinatorial libraries made by point mutations or truncation, and for screening cDNA libraries for gene products having a selected property are known in the art. Such methods are adaptable for rapid screening of the gene libraries generated by combinatorial mutagenesis of polypeptides. Recursive ensemble mutagenesis (REM), a technique which enhances the frequency of functional mutants in the libraries, can be used in combination with the screening assays to identify polypeptide variants, see for example Arkin ef a/. (1992) and Delagrave ef a/. (1993). Conservative substitutions, such as exchanging one amino acid with another having similar properties, may be desirable as discussed in more detail below. [00186] Variant polypeptides may contain conservative amino acid substitutions at various locations along their sequence, as compared to a parent (e.g., naturally-occurring or reference) amino acid sequence. A "conservative amino acid substitution" is one in which the amino acid residue is replaced with an amino acid residue having a similar side chain. Families of amino acid residues having similar side chains have been defined in the art, which can be generally sub-classified as follows:

[00187] Acidic: The residue has a negative charge due to loss of H ion at physiological pH and the residue is attracted by aqueous solution so as to seek the surface positions in the conformation of a peptide in which it is contained when the peptide is in aqueous medium at physiological pH. Amino acids having an acidic side chain include glutamic acid and aspartic acid.

[00188] Basic: The residue has a positive charge due to association with H ion at physiological pH or within one or two pH units thereof (e.g. histidine) and the residue is attracted by aqueous solution so as to seek the surface positions in the conformation of a peptide in which it is contained when the peptide is in aqueous medium at physiological pH. Amino acids having a basic side chain include arginine, lysine and histidine.

[00189] Charged: The residues are charged at physiological pH and, therefore, include amino acids having acidic or basic side chains (i.e., glutamic acid, aspartic acid, arginine, lysine and histidine).

[00190] Hydrophobic: The residues are not charged at physiological pH and the residue is repelled by aqueous solution so as to seek the inner positions in the conformation of a peptide in which it is contained when the peptide is in aqueous medium. Amino acids having a hydrophobic side chain include tyrosine, valine, isoleucine, leucine, methionine, phenylalanine and tryptophan.

[00191] Neutral/polar: The residues are not charged at physiological pH, but the residue is not sufficiently repelled by aqueous solutions so that it would seek inner positions in the conformation of a peptide in which it is contained when the peptide is in aqueous medium. Amino acids having a neutral/polar side chain include asparagine, glutamine, cysteine, histidine, serine and threonine.

[00192] This description also characterises certain amino acids as "smalt since their side chains are not sufficiently large, even if polar groups are lacking, to confer hydrophobicity. With the exception of proline, "smalt amino acids are those with four carbons or less when at least one polar group is on the side chain and three carbons or less when not. Amino acids having a small side chain include glycine, serine, alanine and threonine. The gene-encoded secondary amino acid proline is a special case due to its known effects on the secondary conformation of peptide chains. The structure of proline differs from all the other naturally-occurring amino acids in that its side chain is bonded to the nitrogen of the a-amino group, as well as the a-carbon. Several amino acid similarity matrices (e.g. PA 120 matrix and PAM250 matrix as disclosed for example by Dayhoff ef a/. (1978) and by Gonnet ef al. (1992)), however, include proline in the same group as glycine, serine, alanine and threonine. Accordingly, for the purposes of the present invention, proline is classified as a "sma/f amino acid.

[00193] The degree of attraction or repulsion required for classification as polar or nonpolar is arbitrary and, therefore, amino acids specifically contemplated by the invention have been classified as one or the other. Most amino acids not specifically named can be classified on the basis of known behaviour.

[00194] Amino acid residues can be further sub-classified as cyclic or non-cyclic, and aromatic or non- aromatic, self-explanatory classifications with respect to the side-chain substituent groups of the residues, and as small or large. The residue is considered small if it contains a total of four carbon atoms or less, inclusive of the carboxyl carbon, provided an additional polar substituent is present; three or less if not. Small residues are, of course, always non-aromatic. Dependent on their structural properties, amino acid residues may fall in two or more classes. For the naturally-occurring protein amino acids, sub-classification according to this scheme is presented in Table 1.

Table 1 : Amino acid sub-classification

[00195] Conservative amino acid substitution also includes groupings based on side chains. For example, a group of amino acids having aliphatic side chains is glycine, alanine, valine, leucine, and isoleucine; a group of amino acids having aliphatic-hydroxyl side chains is serine and threonine; a group of amino acids having amide-containing side chains is asparagine and glutamine; a group of amino acids having aromatic side chains is phenylalanine, tyrosine, and tryptophan; a group of amino acids having basic side chains is lysine, arginine, and histidine; and a group of amino acids having sulphur-containing side chains is cysteine and methionine. For example, it is reasonable to expect that replacement of a leucine with an isoleucine or valine, an aspartate with a glutamate, a threonine with a serine, or a similar replacement of an amino acid with a structurally related amino acid will not have a major effect on the properties of the resulting variant polypeptide. Whether an amino acid change results in a functional polypeptide can readily be determined by assaying its activity. Conservative substitutions are shown in Table 2 under the heading of exemplary and preferred substitutions. Amino acid substitutions falling within the scope of the invention, are, in general, accomplished by selecting substitutions that do not differ significantly in their effect on maintaining (a) the structure of the peptide backbone in the area of the substitution, (b) the charge or hydrophobicity of the molecule at the target site, or (c) the bulk of the side chain. After the substitutions are introduced, the variants may be screened for biological activity.

Table 2: Exemplary and preferred amino acid substitutions

Val He, Leu, Met, Phe, Ala, Norleu Leu

[00196] Alternatively, similar amino acids for making conservative substitutions can be grouped into three categories based on the identity of the side chains. The first group includes glutamic acid, aspartic acid, arginine, lysine, histidine, which all have charged side chains; the second group includes glycine, serine, threonine, cysteine, tyrosine, glutamine, asparagine; and the third group includes leucine, isoleucine, valine, alanine, proline, phenylalanine, tryptophan, methionine, as described in Zubay, G. (1993).

[00197] Thus, a predicted non-essential amino acid residue in a polypeptide is typically replaced with another amino acid residue from the same side chain family. Alternatively, mutations can be introduced randomly along all or part of a polypeptide gene coding sequence, such as by saturation mutagenesis, and the resultant mutants can be screened for an activity of the parent polypeptide to identify mutants which retain that activity. Following mutagenesis of the coding sequences, the encoded peptide can be expressed recombinantly and the activity of the peptide can be determined. A "non-essentiaf amino acid residue is a residue that can be altered from the wild-type sequence of a polypeptide without abolishing or substantially altering one or more of its activities. Suitably, the alteration does not substantially alter one of these activities, for example, the activity is at least 20, 21 , 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 , 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 , 42, 43, 44, 45, 46, 47, 48, 49, 50, 51 , 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 , 62, 63, 64, 65, 66, 67, 68, 69, 70, 71 , 72, 73, 74, 75, 76, 77, 78, 79, 80, 81 , 82, 83, 84, 85, 86, 87, 88, 89, 90, 91 , 92, 93, 94, 95, 96, 97, 98 or 99% of wild-type. An "essentia amino acid residue is a residue that, when altered from the wild-type sequence of a reference polypeptide, results in abolition of an activity of the parent molecule such that less than 20% of the wild-type activity is present.

[00198] Accordingly, the present invention also contemplates variants of the naturally-occurring polypeptide sequences or their biologically-active fragments, wherein the variants are distinguished from the naturally-occurring sequence by the addition, deletion, or substitution of one or more amino acid residues. In general, variants will display at least about 20, 21 , 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 , 32, 33, 34, 35, 36. 37, 38, 39, 40, 41 , 42, 43, 44, 45, 46, 47, 48, 49. 50, 51 , 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 , 62, 63, 64, 65, 66, 67, 68, 69, 70, 71 , 72, 73, 74, 75, 76, 77, 78, 79, 80, 81 , 82, 83, 84, 85, 86. 87, 88, 89, 90, 91 , 92, 93, 94, 95, 96, 97, 98 or 99% similarity to a parent or reference polypeptide sequence as, for example, set forth in SEQ ID NO: 1 , 2, 3, 4, 7, 8, 1 1 , 12, 13, 16, 18, 26, 27, 28, 29, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, 51 , 52, 53. 54, 55, 56 and 57 or the parent or reference polypeptide sequence as, for example, encoded by the nucleotide sequence set forth in SEQ ID NO: 5, 6, 9, 10, 14, 15, 17, 19, 20,

21 , 22, 23, 24, 25, 31 , 33, 35, 37, 39, 41 , 43, 45, 47, or 49. Desirably, variants will have at least 20, 21 ,

22, 23, 24, 25, 26, 27, 28, 29, 30, 31 , 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 , 42, 43, 44, 45, 46, 47, 48, 49, 50, 51 , 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 , 62, 63, 64, 65, 66, 67, 68, 69, 70, 71. 72, 73, 74, 75, 76, 77, 78, 79, 80, 81 , 82, 83, 84, 85, 86, 87, 88, 89, 90, 91 , 92, 93, 94, 95, 96, 97, 98 or 99% sequence identity to a parent polypeptide sequence as, for example, set forth in SEQ ID NO: 1 , 2, 3, 4, 7, 8, 11 , 12, 13, 16, 18, 26, 27, 28, 29. 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, 51 , 52, 53, 54. 55, 56 and 57 or the parent polypeptide sequence as, for example, encoded by the nucleotide sequence set forth in SEQ ID NO: 5, 6. 9, 10, 14, 15, 17, 19, 20, 21 , 22, 23, 24, 25, 31 , 33, 35, 37. 39. 41 , 43, 45, 47, or 49. Moreover, sequences differing from the native or parent sequences by the addition, deletion, or substitution of 1 , 2, 3, 4, 5, 6, 7. 8, 9, 10, 11 , 12, 13, 14, 15, 16, 17, 18, 19, 20, 30, 40, 50, 60, 70, 80, 90, 100 or more amino acids but which retain the properties of the parent polypeptide are contemplated. Polypeptides also include polypeptides that are encoded by polynucleotides that hybridise under stringency conditions as defined herein, especially high stringency conditions, to parent-coding polynucleotide sequences, or the non-coding strand thereof, as described below. Illustrative parent polynucleotide sequences are set forth in SEQ ID NO: 5, 6, 9, 10, 14, 15, 17, 19, 20, 21 , 22, 23, 24, 25, 31 , 33, 35, 37, 39, 41, 43, 45, 47 and 49.

[00199] In some embodiments, variant polypeptides differ from a reference sequence by at least one but by less than 50, 40, 30, 20, 15, 10, 8, 6, 5, , 3 or 2 amino acid residue(s). In other embodiments, variant polypeptides differ from the corresponding sequences of SEQ ID NO: 1 , 2, 3, 4, 7, 8, 11 , 12, 13, 16, 18, 26, 27, 28, 29, 30, 32, 34, 36, 38, 40, 42, 44. 46, 48, 50, 51 , 52, 53. 54, 55, 56 and 57. or the amino acid sequences encoded by the nucleotide sequences of SEQ ID NO: 5, 6, 9, 10, 14, 15, 17, 19, 20, 21 , 22,

23, 24, 25, 31 , 33, 35, 37, 39, 41 , 43, 45, 47, or 49, by at least 1% but less than 20%, 15%, 10% or 5% of the residues. (If this comparison requires alignment, the sequences should be aligned for maximum similarity. "Looped" out sequences from deletions or insertions, or mismatches, are considered differences). The differences are, suitably, differences or changes at a non-essential residue or a conservative substitution.

[00200] Variants of a protein can be identified by screening combinatorial libraries of mutants, e.g., truncation mutants, of a protein. Libraries or fragments e.g., N terminal, C terminal, or internal fragments, of a protein coding sequence can be used to generate a variegated population of fragments for screening and subsequent selection of variants of a protein.

[00201] Methods for screening gene products of combinatorial libraries made by point mutation or truncation, and for screening cDNA libranes for gene products having a selected property are known in the art. Such methods are adaptable for rapid screening of the gene libraries generated by combinatorial mutagenesis of proteins.

[00202] Some variants of the snake prothrombin activator ecarin are described in US patent no. 6,413,737, the entire contents of which are incorporated herein by reference.

Variants of naturally-occurring prothrombin activators (nucleotide)

[00203] The present invention also contemplates prothrombin activators comprising polypeptide(s) that is/are encoded by variant(s) of the wild-type or naturally-occurring polynucleotide(s) encoding the wild- type or naturally-occurring polynucleotide(s).

[00204] Variants of a wild-type or naturally-occurring polynucleotides will have at least at least 20, 21 , 22, 23, 24, 25, 26. 27, 28, 29, 30, 31 , 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 , 42, 43, 44, 45, 46, 47, 48, 49, 50, 51 , 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 , 62, 63, 64, 65, 66, 67, 68, 69, 70, 71 , 72. 73, 74, 75, 76. 77, 78, 79, 80, 81 , 82, 83, 84, 85, 86, 87, 88, 89, 90, 91 , 92, 93, 94, 95, 96, 97, 98 or 99% (and all partial integer percentages in between) sequence similarity or identity with the nucleotide sequence for the wild-type or naturally-occurring polynucleotide, including but not limited to the sequences encoded by the sequences of SEQ ID NOs: 1 , 2, 3, 4, 7, 8, 11 , 12, 13, 16, 18, 26, 27, 28, 29, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, 51 , 52, 53, 54, 55, 56 and 57 or the sequences of SEQ ID NOs: 5, 6, 9, 10, 14, 15, 17, 19, 20, 21 , 22, 23, 24, 25, 31 , 33, 35, 37, 39, 41 , 43, 45, 47, and 49, or a complement thereof, as determined by sequence alignment programs described elsewhere herein using default parameters.

[00205] Exemplary nucleotide sequences that encode the polypeptides encompass full-length genes as well as portions of the full-length or substantially full-length nucleotide sequences of the genes or their transcripts or DNA copies of these transcripts. Portions of a nucleotide sequence may encode polypeptide portions or segments that retain the biological activity of the native polypeptide. A portion of a nucleotide sequence that encodes a biologically active fragment of a polypeptide may encode at least about 20, 21 , 22, 23. 24, 25, 30, 40, 50, 60, 70, 80, 90. 100, 120, 150, 300 or 400 contiguous amino acid residues, or almost up to the total number of amino acids present in a full-length polypeptide.

[00206] Also contemplated are variants of the nucleotide sequences. Nucleic acid variants can be naturally-occurring, such as allelic variants (same locus), homologs (different locus), and orthologs (different organism) or can be non naturally-occurring. Naturally- occurring variants such as these can be identified with the use of well-known molecular biology techniques, as, for example, with polymerase chain reaction (PCR) and hybridisation techniques as known in the art. Non-naturally occurring variants can be made by mutagenesis techniques, including those applied to polynucleotides, cells, or organisms. The variants can contain nucleotide substitutions, deletions, inversions and insertions. Variation can occur in either or both the coding and non-coding regions. The variations can produce both conservative and non-conservative amino acid substitutions (as compared in the encoded product). For nucleotide sequences, conservative variants include those sequences that, because of the degeneracy of the genetic code, encode the amino acid sequence of a reference polypeptide. Variant nucleotide sequences also include synthetically derived nucleotide sequences, such as those generated, for example, by using site-directed mutagenesis but which still encode a polypeptide. Generally, variants of a particular nucleotide sequence will have at least about at least 20, 21 , 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 , 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46. 47, 48, 49, 50, 51 , 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 , 62, 63, 64, 65, 66, 67, 68, 69, 70, 71 , 72, 73, 74, 75. 76, 77, 78, 79, 80, 81 , 82, 83, 84, 85, 86, 87, 88, 89, 90, 91 , 92, 93, 94, 95, 96, 97, 98 or 99% sequence identity to that particular nucleotide sequence as determined by sequence alignment programs described elsewhere herein using default parameters.

[00207] Nucleotide sequences can be used to isolate corresponding sequences and alleles from other organisms, particularly other snakes. Methods are readily available in the art for the hybridisation of nucleic acid sequences. Coding sequences from other organisms may be isolated according to well known techniques based on their sequence identity with the coding sequences set forth herein. In these techniques all or part of the known coding sequence is used as a probe which selectively hybridises to other coding sequences present in a population of cloned genomic DNA fragments or cDNA fragments (i.e. , genomic or cDNA libraries) from a chosen organism (e.g., a snake). Accordingly, the present invention also contemplates polynucleotides that hybridise to reference nucleotide sequences, or to their complements, under stringency conditions described below. As used herein, the term "hybridises under low stringency, medium stringency, high stringency, or very high stringency conditions" describes conditions for hybridisation and washing.

[00208] Guidance for performing hybridisation reactions can be found in Ausubel et al., (1992), sections 6.3.1 -6.3.6. Aqueous and non-aqueous methods are described in that reference and either can be used. Reference herein to low stringency conditions include and encompass from at least about 1 % v/v to at least about 15% v/v formamide and from at least about 1 M to at least about 2 M salt for hybridisation at 42°C, and at least about 1 M to at least about 2 M salt for washing at 42°C. Low stringency conditions also may include 1 % Bovine Serum Albumin (BSA), 1 mM EDTA, 0.5 M NaHP04 (pH 7.2), 7% SDS for hybridisation at 65°C, and (i) 2 x SSC, 0.1 % SDS; or (ii) 0.5% BSA, 1 mM EDTA. 40 mM NaHP04 (pH 7.2), 5% SDS for washing at room temperature. One embodiment of low stringency conditions includes hybridisation in 6 x sodium chloride/sodium citrate (SSC) at about 45°C, followed by two washes in 0.2 x SSC, 0.1 % SDS at least at 50°C (the temperature of the washes can be increased to 55°C for low stringency conditions). Medium stringency conditions include and encompass from at least about 16% v/v to at least about 30% v/v formamide and from at least about 0.5 M to at least about 0.9 M salt for hybridisation at 42°C, and at least about 0.1 M to at least about 0.2 M salt for washing at 55°C. Medium stringency conditions also may include 1 % Bovine Serum Albumin (BSA), 1 mM EDTA, 0.5 M NaHP04 (pH 7.2), 7% SDS for hybridisation at 65°C, and (i) 2 x SSC, 0.1% SDS; or (ii) 0.5% BSA, 1 mM EDTA, 40 mM NaHP04 (pH 7.2), 5% SDS for washing at 60-65°C. One embodiment of medium stringency conditions includes hybridising in 6 x SSC at about 45°C, followed by one or more washes in 0.2 x SSC, 0.1 % SDS at 60°C. High stringency conditions include and encompass from at least about 31 % v/v to at least about 50% v/v formamide and from about 0.01 M to about 0.15 M salt for hybridisation at 42°C, and about 0.01 M to about 0.02 M salt for washing at 55°C. High stringency conditions also may include 1% BSA, 1 mM EDTA, 0.5 M NaHP04 (pH 7.2). 7% SDS for hybridisation at 65°C, and (i) 0.2 x SSC, 0.1 % SDS; or (ii) 0.5% BSA, 1 mM EDTA, 40 mM NaHP04 (pH 7.2), 1 % SDS for washing at a temperature in excess of 65°C. One embodiment of high stringency conditions includes hybridising in 6 x SSC at about 45°C, followed by one or more washes in 0.2 x SSC, 0.1 % SDS at 65°C.

[00209] In certain embodiments, a polypeptide is encoded by a polynucleotide that hybridises to a disclosed nucleotide sequence under low, medium, high, or very high stringency conditions. One embodiment of very high stringency conditions includes hybridising 0.5 M sodium phosphate, 7% SDS at 65°C, followed by one or more washes at 0.2 x SSC, 1% SDS at 65°C.

[00210] Other stringency conditions are well known in the art and a skilled addressee will recognise that various factors can be manipulated to optimise the specificity of the hybridisation. Optimisation of the stringency of the final washes can serve to ensure a high degree of hybridisation. For detailed examples, see Ausubel et al. , (1992) at pages 2.10.1 to 2.10.16 and Sambrook, J. er a/. (2001 ) at sections 1.101 to 1.104.

[00211] While stringent washes are typically carried out at temperatures from about 42°C to 68°C, one skilled in the art will appreciate that other temperatures may be suitable for stringent conditions. Maximum hybridisation rate typically occurs at about 20°C to 25°C below the Tm for formation of a DNA-DNA hybrid. It is well known in the art that the Tm is the melting temperature, or temperature at which two complementary polynucleotide sequences dissociate. Methods for estimating Tm are well known in the art (see Ausubel ef a/., supra at page 2.10.8). In general, the Tm of a perfectly matched duplex of DNA may be predicted as an approximation by the formula:

Tm = 81.5 + 16.6 (Iog10 M) + 0.41 (%G+C) - 0.63 (% formamide) - (600/length) wherein: M is the concentration of Na ⁺ , preferably in the range of 0.01 molar to 0.4 molar; %G+C is the sum of guanine and cytosine bases as a percentage of the total number of bases, within the range between 30% and 75% G+C; % formamide is the percent formamide concentration by volume; length is the number of base pairs in the DNA duplex. The Tm of a duplex DNA decreases by approximately 1°C with every increase of 1 % in the number of randomly mismatched base pairs. Washing is generally carried out at Tm - 15°C for high stringency, or Tm - 30°C for moderate stringency.

[00212] In one example of a hybridisation procedure, a membrane (e.g., a nitrocellulose membrane or a nylon membrane) containing immobilized DNA is hybridised overnight at 42°C in a hybridisation buffer (50% deionized formamide, 5 x SSC, 5 x Denhardt's solution (0.1 % ficoll. 0.1% polyvinylpyrollidone and 0.1 % bovine serum albumin), 0.1 % SDS and 200 mg/mL denatured salmon sperm DNA) containing labelled probe. The membrane is then subjected to two sequential medium stringency washes (i.e., 2 x SSC, 0.1 % SDS for 15 min at 45°C, followed by 2 x SSC, 0.1 % SDS for 15 min at 50°C), followed by two sequential higher stringency washes (i.e., 0.2 x SSC, 0.1% SDS for 12 min at 55°C followed by 0.2 x SSC and 0.1 % SDS solution for 12 min at 65-68°C.

Preparing prothrombin activators

[00213] Prothrombin activators may be prepared by any suitable procedure known to those of skill in the art. For example, the prothrombin activators may be produced by any convenient method such as by purifying or isolating the polypeptide from naturally-occurring reservoirs, including but not limited to snake venom, blood and blood-derived products {e.g. serum). Alternatively, the prothrombin activators used in the present invention may produced through recombinant DNA technology, or other forms of genetic engineering, including for example, using bacterial, insect, yeast, mammalian or other expression systems.

[00214] Methods of purification include affinity chromatography, including lectin {e.g. wheat germ agglutinin) affinity chromatography, anion/cation exchange chromotography or any other separation technique, for example, Hex-His tag isolation techniques. The identity and purity of derived prothrombin activator can be determined for example by SDS-polyacrylamide electrophoresis or chromatographically such as by high performance liquid chromatography (HPLC). For example, the purification and characterisation of pseutarin C (also abbreviated to PtPA) from P. textilis snake venom is described in Masci (1986) and Masci er a/. (1988), and oscutarin C (OsPA) from O. scutellatus venom is described in Speijer ei al. (1986), both of which are incorporated by reference in their entirety. The purification of ecarin from E. carinatus venom is described in Morita, T et al. (1981 ), the contents of which is also incorporated by reference in its entirety.

[00215] Alternatively, the prothrombin activators may be produced from venom gland cells in culture using methods known in the art, including for example the method described in Yamanouye, N., ef al. (2007), which describes the primary culture of secretory cells from the venom gland of Bothrops jararaca for in vitro venom production, the contents of which is incorporated by reference in its entirety.

[00216] Alternatively, the prothrombin activators may be synthesised by chemical synthesis, e.g. using solution synthesis or solid phase synthesis as described, for example, in Chapter 9 of Atherton and Shephard (1989) and in Roberge et al. (1995).

[00217] Alternatively, the prothrombin activators may be prepared by recombinant techniques. For example, the prothrombin activators used in the invention may be prepared by a procedure including the steps of: (a) preparing a construct comprising a polynucleotide sequence that encodes a polypeptide and that is operably linked to a regulatory element; (b) introducing the construct into a host cell; (c) culturing the host cell to express the polypeptide; (d) isolating the polypeptide from the host cell. If the prothrombin activator comprises a complex or two polypeptides, then the prothrombin activator may be prepared by a procedure including the steps of: (a) preparing a construct comprising a polynucleotide sequence that encodes a first polypeptide and that is operably linked to a regulatory element; (b) introducing the construct into a host cell; (c) culturing the host cell to express the first polypeptide; (d) isolating the polypeptide from the host cell; repeating steps (a) to (d) for a second polypeptide; and linking the first polypeptide and the second polypeptide. The above procedures are equally applicable to preparing prothrombin activators that are fragments, variants, mutant forms or chimeric forms of wild type prothrombin activators. In illustrative examples, the nucleotide sequence that encodes a polypeptide encodes at least a biologically active portion of the sequences set forth in SEQ ID NO: 5, 6, 9, 10, 14, 15, 17, 19, 20, 21 , 22, 23, 24. 25, 31 , 33, 35, 37, 39, 41 , 43, 45, 47, 49, or a variant thereof.

[00218] Recombinant prothrombin activators can be conveniently prepared using standard protocols as described for example in Sambrook, J. et ai. (2001 ), in particular Chapters 16 and 17 and Ausubel ef al. (1992), in particular Chapters 10 and 16. For example, the recombinant production of snake factor V and snake factor X, which can be used to produce group C and group D prothrombin activators, is described in Filippovic, I. ef al (2005) and Bos. . H. A. ef al (2009), each of which is incorporated herein in its entirety. An illustrative process for the recombinant production of ecarin and variants of ecarin is provided in Yonemura, H. et al. (2004) and in US patent 6.413,737, the entire contents of each of which are incorporated herein by reference.

Colloids

[00219] The present invention includes in one aspect the formulation of a clotting composition comprising a prothrombin activator and a stabilizing agent such as a colloid. [00220] Colloids represent one of the three primary types of mixtures, with the other two being solutions and suspensions. A colloid typically has particles ranging between 1 and 1000 nanometers in diameter, with the particles able to remain evenly distributed throughout the colloid. Accordingly, a colloid involves one substance being evenly dispersed in another. Colloidal dispersions therefore remain dispersed and do not settle to the bottom of a container. The substance being dispersed is in the dispersed phase, while the substance in which it is dispersed is in the continuous phase.

[00221] If the dimensions of the substance in the dispersed phase are smaller than 1 nanometer, then the mixture is called a solution. If the dimensions of the substance in the dispersed phase are larger than 1000 nanometers, then the mixture is called a suspension.

[00222] A common method for classifying colloids is based on the phase of the dispersed substance and what phase it is dispersed in. Using this classification, types of colloids include sols, emulsions, foams and aerosols, where a sol is a colloidal suspension with solid particles in a liquid, an emulsion is one liquid dispersed in another, a foam is where gas particles are trapped in a liquid or solid, and an aerosol contains small particles of liquid or solid dispersed in a gas. When the dispersion medium is water, the collodial system may be referred to as a hydrocolloid. Table 3 exemplifies different types of colloids.

Table 3: Exemplary colloids

Dispersion Medium Dispersed Phase Type of Colloid Example

Solid Solid Solid sol Ruby glass

Solid Liquid Solid emulsion/gel Pearl, cheese

Solid Gas Solid foam Lava, pumice

Liquid Solid Sol Paints, cell fluids

Liquid Liquid Emulsion Milk, oil in water

Liquid Gas Foam Soap suds, whipped cream

Gas Solid Aerosol Smoke

Gas Liquid Aerosol Fog. mist

[00223] Colloids are frequently used in fluid resuscitation for critical or intensive care patients. Fluid volume deficit in a patient may be the result of excessive fluid loss, insufficient fluid intake or a combination of the two, including for example blood loss, vomiting, diarrhoea and dehydration. Colloids are most typically used as plasma volume expanders in the treatment of circulatory shock. Colloids have large molecules that do not readily cross capillary walls and are retained in the blood vessels. Vascular volume can therefore be restored, circulatory haemodynamics can be stabilized and tissue perfusion can be maintained when severe haemorrhaging occurs. Common examples of colloids include the plasma substitutes Gelofusine® and Haemaccel® which consist of a modified fluid gelatin, and which promote osmotic diuresis. These colloids have a half-life of several hours, provide long-term volume replacement and are generally iso-oncotic with blood, which they typically replace on a volume- for-volume basis. Other types of colloids used in fluid resuscitation include dextran-based colloids, starch-based colloids such as Voluven® and Volulyte®, and albumin-based colloids such as human albumin. Polyvinylpyrrolidone (PVP) and other synthetic polymers are also classified as colloids

[00224] Gelatin-based colloids have been used as plasma substitutes for almost 100 years. They are most useful as volume substitutes, with a volume effect of approximately 80%. However, they have an increased risk for anaphylactic or anaphylactoid reactions. The gelatin-based colloid Gelofusine® is 4% w/v succinylated gelatine in saline. It is generally prepared by hydrolysis and succinylation of bovine collagen, with 40g/L gelatine, 154mmol/L sodium, 120mmol/l chloride, an average Mw of 30,000, an average Mn of 22,600, a pH of 7.4+/-0.3, a relative viscosity at 37°C of 1.9, an isolelectric point of pH 4.5+/-0.3, a colloid osmotic pressure of 453mm H2O, a gel point of 0°C, an osmolarity of 274 mOsm/L and a half life of about 4 hours. Other commercially available gelatin-based colloids include Geloplasma® (a succinylated gelatin) and Isoplex® (a urea-linked modified fluid gelatin).

[00225] Starch-based colloids comprise a hydroxyethyl starch solution and have been used since the mid-1960s. Commercially available versions such as Plasmatersil ® are used as volume expanders that advantageously resist biological degradation by a-amlyase through the use of high molecular weight hetastarch and chemical substitution. Other starch-based colloids such as Elo-HAES® use smaller but heavily substituted hydroxyethyl hexastarches. In addition, even smaller and less substituted hydroxyethyl starches such as HAES-Steril® pentastarch or Voluven® tetrastarch appear to have improved safety and a virtual 100% volume substitution effect that can be maintained for up to 6 hours.

[00226] Albumin-based colloids have several advantages including an absence of risk for disease transmission resulting from the manufacturing process, an absence of volume restrictions, low allergenicity, an absence of significant nephrotoxicity and an absence of intrinsic coagulopathy. However, albumin-based colloids are significantly more expensive than crystalloids, starch-based colloids and gelatin-based colloids for volume replacement. Bovine Serum Albumin is used in laboratory applications such as protein concentration standard and a nutrient in cell and microbial culture and isinexpensive.

[00227] In addition to colloids, crystalloids may also be used in fluid resuscitation. Crystalloids are balanced salt solutions that freely cross capillary walls. They are made up of water and electrolytes and are designed to remain in the intravascular compartment for a shorter time than colloids. Common examples include normal saline and sodium lactate preparations such as Hartmann ^' s and Ringer- Lactate solutions. Crystalloids are useful for maintaining fluid balance such as during the time after an operation when a patient is not able to drink or to replace intravascular volume after sudden blood loss.

[00228] The present invention demonstrates that the stability of a clotting composition comprising a prothrombin activator is significantly improved when a stabilizing agent such as a colloid is added to the composition. In some embodiments of the present invention, the colloid is selected from the group comprising or consisting of a gelatin-based colloid, a starch-based colloid, an albumin-based colloid or a dextran-based colloid.

[00229] In some embodiments, the gelatin-based colloid is selected from the group comprising or consisting of a succinylated gelatin colloid or a urea-linked modified fluid gelatin colloid. In particular embodiments, the succinylated gelatin colloid is selected from the group comprising or consisting of Gelofusine® or Geloplasma®. In alternative particular embodiments, the urea-linked modified fluid gelatin colloid is Haemaccel®. In preferred embodiments, the succinylated gelatin colloid is Gelofusine®.

[00230] In some embodiments, the albumin-based colloid is selected from the group comprising or consisting human or bovine albumins produced by Cohn cold-ethanol treatment or chromatographic methods. In particular embodiments, the albumin-based colloid is Human Serum Albumin or Bovine Serum Albumin. In preferred embodiments, the albumin-based colloid is Bovine Serum Albumin.

[00231] In some embodiments, the starch-based colloid is selected from the group comprising or consisting of a hetastarch-based colloid, a hexastarch-based colloid, a pentastarch-based colloid or a tetrastarch-based colloid. In particular embodiments, the hetastarch-based colloid is Plasmerteril®. In alternative particular embodiments, the hexastarch-based colloid is Elo-HAES®. In alternative particular embodiments, the pentastarch-based colloid is HAES-Steril ®. In alternative particular embodiments, the tetrastarch-based colloid is selected from the group consisting of Voluven®, Valvuven® and Volulyte®.

Compositions

[00232] The present invention provides clotting compositions comprising a prothrombin activator and a stabilizing agent such as a colloid.

[00233] In some embodiments, the ratio of prothrombin activator to colloid (w/w) is 1 :1 , 1 :2, 1 :3, 1 :4, 1 :5. 1 :10, 1 :20, 1 :30, 1 :40, 1 :50, 1 :60, 1 :70, 1 :80, 1 :90, 1 :100, 1 :110, 1 :120, 1 :130, 1 :140, 1 :150, 1 :160, 1:170, 1180, 1:190, 1:200, 1210, 1:220, 1230, 1240, 1250, 1260, 1:270, 1280, 1290, 1300.1310,

1:320, 1 330, 1:340,1:350, 1 360, 1:370, 1 380, 1 390,1 400, 1 410, 1:420, 1 430,1 440, 1 450, 1 460,

1:470, 1 480, 1:490, 1:500, 1 510, 1:520, 1 530, 1 540,1 550, 1 560, 1:570, 1 580, 1 590, 1 600.1 610,

1:620, 1 630, 1:640, 1:650, 1 660, 1:670, 1 680.1 690, 1 700, 1 710, 1:720, 1 730,1 740, 1 750, 1 760,

1:770, 1 780, 1:790, 1:800, 1 810, 1:820, 1 830, 1 840, 1 850, 1 860, 1:870, 1 880, 1 890, 1 900, 1 910,

1:920, 1:930. 1:940, 1:950, 1:960, 1:970, 1:980, 1:990, 1:1000, 1:1100, 1:1200, 1:1300, 1:1400, 1:1500, 1:1600, 1:1700, 1:1800, 1:1900, 1:2000, 1:3000, 1:400, 1:5000, 1:6000, 1:7000, 1:8000, 1:9000, or 1:10000 or more, or any integer or partial integer in between the integers stated. In particular embodiments, the ratio of prothrombin activator to colloid (w/w) is between 1 : 100 to 1 :800.

[00234] The quantity of the composition should be sufficient to effectively clot a blood sample and to produce a serum sample by separating the serum from the clotted cells. In some embodiments, the time taken to clot the blood sample is less than 1,2, 3,4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17,18, 19, 20, 21, 22, 23, 24.25, 26, 27, 28, 29 or 30 minutes. In particular embodiments, the time taken to clot the blood sample is less than 2, 3, 4, 5, 6, 7, 8, 9 or 10 minutes. In a preferred embodiment, , the time taken to clot the blood sample is less than 2, 3, 4 or 5 minutes.

[00235] In some embodiments, the compositions of the present invention are able to achieve clotting in an advantageously quick time after storage or transport at temperatures of less than -20, -21 , -22, -23, - 24, -25, -26, -27, -28. -29, -30, -31, -32, -33. -34. -35, -36, -37, -38, -39, 40, 41, 42, 43, 44, 45, 46, - 47, 48, 49, -50, -51, -52, -53, -54, -55, -56, -57, -58, -59, -60, -61, -62, -63, -64, -65. -66, -67, -68, -69, - 70, -71,-72, -73, -74, -75, -76, -77, -78, -79, -80, -81, -82, -83. -84, -85, -86, -87, -88. -89, -90, -91,-92, -93, - 94, -95, -96, -97, -98 or -99 degrees Celsius or more than 20, 21, 22, 23, 24, 25, 26, 27, 28.29, 30, 31, 32, 33, 34, 35.36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98 or 99 degrees Celsius. In a preferred embodiment, the compositions of the present invention are able to achieve clotting in an advantageously quick time after storage or transport at room temperature or at temperatures of 20, 21 , 22, 23, 24 or 25 degrees Celsius or more. In another preferred embodiment, the compositions of the present invention are able to achieve clotting in an advantageously quick time after storage at elevated temperatures of 50 degrees Celsius or more.

[00236] In some embodiments, the compositions of the present invention are able to achieve clotting in an advantageously quick time after storage for a period of time of more than 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43.44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72.73, 74, 75, 76.77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91 , 92, 93, 94, 95. 96, 97, 98, 99, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310, 320, 330, 340, 350, 360, 370, 380, 390, 400, 410, 420, 430, 440, 450, 460, 470, 480, 490, 500. 510, 520, 530, 540, 550, 560, 570, 580, 590, 600, 610, 620, 630, 640, 650, 660, 670, 680, 690, 700. 710, 720, 730, 740, 750, 760, 770, 780, 790, 800, 810, 820, 830, 840, 850, 860, 870, 880, 890, 900. 910, 920, 930, 940, 950, 960, 970, 980, 990, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800, 1900, 2000 or 3000 or more days, or any number of day in between the integers stated. In some embodiments, the compositions of the present invention are able to achieve clotting in an advantageously quick time after storage for a period of time of more than 200 days.

[00237] In some embodiments, the compositions of the present invention are able to achieve clotting in an advantageously quick time after sterilization of the compositions by irradiation. In some embodiments, the sterilisation is via electron-beam or ethylene oxide exposure. In particular embodiments, the irradiation is gamma irradiation and the amount of irradiation the compositions are subjected to is 1 , 2, 3, 4, 5, 6, 7, 8, 9, 10, 1 1 , 12, 13, 14, 15, 16, 17, 18, 19, 20, 20, 21 , 22, 23, 24, 25, 26, 27, 28, 29. 30, 31 , 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 , 42, 43, 44, 45, 46, 47, 48, 49 or 50 kGy. In a preferred embodiment, the irradiation is gamma irradiation and the amount of irradiation the compositions are subjected to is in a range of about 15kGy to about 25kGy. In a most preferred embodiment, the irradiation is gamma irradiation and the amount of irradiation the compositions are subjected to is about 15kGy.

[00238] In some embodiments, the composition may be spray dried or otherwise adhered to an internal surface of a container suitable for collecting the blood of a subject. In other embodiments, the composition may be provided in an isolated form, suitable for addition to a blood sample previously taken from a subject. In yet other embodiments, the composition may be provided in a reaction container, to which a blood sample previously taken from a subject is added. In further embodiments, composition may be provided in an aqueous form, for example, in a container such as a blood clotting tube, to which a blood sample is added.

[00239] The amount of prothrombin activator used in the compositions of the present invention will depend upon a variety of factors including the subject being tested and the severity of any associated conditions; for example, the activity of the prothrombin activator and/or colloid, the age, body weight, general health, sex and diet of the patient, and any drugs being used by the subject, together with other related factors well known in the art, such as whether or not the subject is already being prescribed anticoagulants such as heparin or warfarin. One skilled in the art would therefore be able, by routine experimentation, to determine an effective amount of the prothrombin activator which would be required to clot a blood sample and provide a serum sample for analyte testing. The amount of prothrombin activator may be determined to ensure adequate blood clotting in a particular patient group, such as patients with normal blood to achieve rapid clotting, or to ensure adequate blood clotting from a wider patient group including, for example, patients on anticoagulant therapy.

[00240] In particular embodiments, the composition may be used as part of a stat tube, for example, for use in troponins, or in combination with cardiac procedures and/or catheterisation, or in combination with haemodialysis. In other embodiments, the composition may be used as part of a standard blood collection tube.

[00241] In some embodiments, the amount of prothrombin activator used in the compositions of the present invention is 0.00, 0.05, 0.1 , 0.2, 0.3, 0.4, 0.5, 0.6. 0.7, 0.8, 0.9. 1 , 1.1 , 1.2, 1.3, 1.4, 1.5, 1.6, 17. 1.8, 1.9, 2, 2.1 , 2.2. 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9 or 3ng of prothrombin activator. In other embodiments, the amount of prothrombin activator used in the compositions of the present invention is 0.1. 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1.0, 1.1. 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1 , 2.2, 2.3, 2.4, 2.5. 2.6, 2.7, 2.8, 2.9, 3, 3.1 , 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9. 4, 4.1 , 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9. 5, 5.1 , 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 6, 6.1 , 6.2, 6.3, 6.4, 6.5. 6.6, 6.7, 6.8, 6.9, 7, 7.1 , 7.2, 7.3, 7.4, 7.5, 7.6, 7.7, 7.8, 7.9, 8, 8.1 , 8.2, 8.3, 8.4, 8.5, 8.6, 8.7, 8.8, 8.9, 9, 9.1 , 9.2, 9.3, 9.4, 9.5, 9.6, 9.7. 9.8, 9.9 or 10j.ig of prothrombin activator.

[00242] In other embodiments, the clotting composition is measured in units by means of an assay based on a peptide p-nitoanilide substrate or thrombin substrate. In particular embodiments, OsPA comprises 0.001 -0.2 units, as measured in the hydrolysis of the chromogenic substrate S-2222 or S2238 in a standard assay.

[00243] Surfactants may also be used as part of the clotting composition in order to provide a physical barrier between blood components and the wall of a container containing the composition, such a blood collection tube. The presence of a surfactant does not affect the coagulation mechanism.

[00244] The composition may therefore also incorporate any suitable surfactant such as an anionic, cationic or non-ionic surfactant such as sorbitan esters or polyoxyethylene derivatives thereof. Suitable surfactants may also include sodium dodecyl sulphate (SDS), ammonium lauryl sulphate, sodium laureth sulphate, and sodium myreth sulphate. Surfactants are commonly used to decrease non-specific adsorption, and require careful selection and optimization. Surfactants can also improve blood flow, distribute clot activators, and prevent proteins, RBCs. and platelets from adsorbing to tube walls. Suspending agents such as natural gums, cellulose derivatives or inorganic materials such as silicaceous silicas, and other ingredients such as lanolin, may also be included. [00245] In a preferred embodiment, the surfactant is a hydrophilic surfactant. In another embodiment, the surfactant may be a hydrophobic surfactant. Both hydrophilic and hydrophobic surfactants can have similar effectiveness in reducing interactions between blood proteins and blood cells, and the walls of containers such as blood collection tubes. In a preferred embodiment, the surfactant may be a hydrophilic polysilane polymers, such as Dow Coming 7-9245. .

[00246] Compositions may be prepared according to methods which are known to those of ordinary skill in the art and may include additional carriers, excipients or diluents. Carriers, excipients and diluents must be "acceptable" in terms of being compatible with the other ingredients of the composition, and not deleterious to formation of a serum sample that possesses certain advantageous features such as decreased fibrinogen concentration, fewer microdots, fewer cells, will be able to be stored for longer periods of time if required and will result in more reproducible analyte results. Such carriers, excipients and diluents may be used for further enhancing the integrity and half-life of the compositions of the present invention.

[00247] Carriers such as polyvinylpyrrolidone (PVP), carboxymethyl cellulose, polyvinyl alcohol, and polyethylene oxide may also be used to allow addition of clotting compositions to tubes. Such carriers allow rapid clot activator suspension into blood so that the carriers dissolve into both serum and clots as the clotting is initiated. PVP and water-soluble surfactants can also release clot activators into blood specimens to reduce the need for mixing.

[00248] Further examples of acceptable carriers or diluents are demineralised or distilled water; saline solution; vegetable based oils such as peanut oil, safflower oil, olive oil, cottonseed oil, maize oil, sesame oils, arachis oil or coconut oil; silicone oils, including polysiloxanes, such as methyl polysiloxane, phenyl polysiloxane and methylphenyl polysolpoxane; volatile silicones; mineral oils such as liquid paraffin, soft paraffin or squalane; cellulose derivatives such as methyl cellulose, ethyl cellulose, carboxymethylcellulose, sodium carboxymethylcellulose or hydroxypropylmethylcellulose; lower alkanols, for example ethanol or iso-propanol; lower aralkanols; lower polyalkylene glycols or lower alkylene glycols, for example polyethylene glycol, polypropylene glycol, ethylene glycol, propylene glycol, 1 ,3-butylene glycol or glycerin; fatty acid esters such as isopropyl palmitate, isopropyl myristate or ethyl oleate; polyvinylpyrolidone; agar; gum tragacanth or gum acacia, and petroleum jelly.

[00249] Additional carriers that may be included in the compositions of the present invention include non-reducing sugars such as sucrose and reducing sugars such as lactulose. Such carriers, as well as sugar alcohols such as mannitol, xylitol, glycerol and sorbitol, are also useful for inclusion in the compositions of the present invention as they can act as antioxidants and potential stabilisers. [00250] In some embodiments, the clotting composition may comprise snake venom, including but not limited to crude snake venom. In some other embodiments, the clotting composition may comprise a preparation of prothrombin activator prepared by partial or full purification of snake venom. Such preparations may be prepared by any suitable method known in the art, including chromatographic and gel filtration methods, including those described herein, and elsewhere. In some other embodiments, the clotting composition may comprise a purified prothrombin activator or an isolated prothrombin activator. Purified and isolated prothrombin activators may be prepared by any suitable method known in the art, including those described herein, and elsewhere. In yet other embodiments, the prothrombin acticvator may be recombinantly produced, wherein the prothrombin activator is derivable from snake venom.

[00251] The ability of the compositions as herein defined to activate prothrombin to thrombin may be initiated by or improved with the addition of co-factors, including but not limited to calcium, phospholipid(s) and polypeptides comprising FVa activity, as well as other clotting agents or coagulants. In one embodiment, the clotting composition is initially produced devoid of co-factors, or where the co-factors are provided separately to the clotting composition, for example, where the clotting composition and the co-factors are distributed in separate locations on the inner surface of a container such as a blood collection tube. Upon the tube being filled or partially filled with a patient ^' s blood, the co-factors then come into contact with the blood and initiate or improve the clotting reaction with the prothrombin activator.

[00252] Clotting agents or coagulants are classified as either intrinsic clotting agents or extrinsic clotting agents according to the blood cascade stimulated (see for example US patent no. 6,686,204). Suitable clotting agents include, but are not limited to, diatomaceous earth, microparticles or particles of inorganic silicates, microsilica, glass microparticles, ellagic acid, thrombin, heparinase, thromboplastin, batroxobin, hydroyapitite, kaolin, kaolin particles, prothrombin (including microparticulated prothrombin), fibrinogen, and depolymerised collagen.

[00253] In some embodiments, the composition comprises a reversible prothrombin activator, which may remain inhibited by an additional agent until activation of the clotting process is desired. Such additional agents may include protease inhibitors such as benzamidine hydrochloride, aminobenzamidin dihydrochloride, antipain dihydrochloride, aprotinin, EGTA or leupeptin hemisulphate, all of which are commercially available, for example, from Carl Roth GmbH & Co KG, or from Sigma- Aldrich Co. LLC.

[00254] In some embodiments, the composition comprises a prothrombin activator, a colloid and a surfactant. In a particular embodiment, the composition comprises a prothrombin activator derived from or derivable from snake venom, a gelatin-or albumin based colloid and a surfactant. In preferred embodiments, the composition comprises a group C prothrombin activator derived from or derivable from snake venom or a recombinant version of same, a gelatin-or albumin based colloid and a hydrophilic surfactant. In a particularly preferred embodiment, the composition comprises the Group C prothrombin activator oscutarin C (OsPa) derived from or derivable from the venom of Oxyuranus scutellatus, the gelatin-based colloid Gelofusine®, being 4% w/v succinylated gelatine in saline and containing 40g/L gelatine, 154mmol/L sodium, 120mmol/l chloride, and a hydrophilic surfactant.

Containers

[00255] The present invention contemplates any suitable container for preparing a suitable serum sample. Many suitable containers are well known in the art, including those described in US patent no. 4,227,620; US patent no. 4,256,120; US patent no. 6,416,717; US patent no. 6,592,613; US patent no. 6.686,204; US patent no. 7,488,287; US patent no. 7,699,828; European patent no. 0 628 816; and commercially available containers including those used in the Examples of the present specification.

[00256] In some embodiments, the containers used in accordance with the present invention are tubes, including glass or plastic tubes. Suitable plastics include polyvinyl chloride, polypropylene, polyethylene terephthalate, and polystyrene.

[00257] The containers may be evacuated and the end sealed with an appropriate puncturable septum or cap. This allows for a double-ended needle to be used where one end is inserted into a patient's vein and the other end of the needle then punctures the septum or cap covering the end of the tube so that the vacuum in the tube draws the blood sample through the needle into the tube.

[00258] The containers may be of any suitable size. In some embodiments, the containers are designed to hold a blood sample of between 50 μί and 10 mL. Suitably, the containers are designed to hold at least 50 μΙ_, 70 μΙ_, 100 μί, 150 μί, 200 μί, 250 μί, 300 μΙ_, 350μί., 400 μί, 450 μί, 500 μί, 1 mL, 2 mL, 3 mL, 4 mL, 5 mL, 8 mL, or 10 mL of blood sample. In a particular embodiment, the containers hold a 4 mL blood sample providing a final concentration of prothrombin activator in the 4 mL blood sample of 25 ng/mL to 2.5 μg/mL.

[00259] In some embodiments, the containers contain a clotting composition comprising, consisting essentially of, or consisting of a prothrombin activator and an additional agent such as a colloid.

[00260] In some embodiments, the clotting composition may be contained within the container before the blood sample is added to the container. In some embodiments, the clotting composition may be added to the container after the blood sample is added to the container. Where the clotting composition is contained within the container before the blood sample is added, it may have been added to the container by any suitable method known in the art. In some embodiments, the clotting composition is dissolved into a suitable solvent and is then added to the container and dried onto the inner surface of the container. The solvent may be a neutral buffer. The clotting composition in solution may be dried onto the inner surface of the container by spray-drying, by freeze-drying, by heat-drying or by any other suitable method known in the art. In some embodiments, the clotting composition is dried on to an inner surface of a container such as a blood collection tube using a blast of warm air heated to 60°C-70°C. In some other embodiments, the clotting composition is dissolved into a suitable solvent and added to the container without drying so that the container contains an aqueous solution comprising the clotting composition. The solvent may be a neutral buffer. In further embodiments, the clotting composition is contacted onto the inner surface of a container such a blood collection tube by atomisation or aerosolisation.

[00261] In some embodiments, beads are coated with the clotting composition and these beads are added to the container. The beads may be glass beads or synthetic resinous beads, including polystyrene and propylene beads. The beads may have a spherical shape. In some embodiments, the mean diameter of the beads is between 0.1 mm and 1 mm.

[00262] In a particular embodiment, the prothrombin activator is rapidly dried onto an inner surface of a container using a mild vacuum at 37°C, for example, by using a Gene-Vac machine. In a particular embodiment, the proithrombin activator is rapidly dried by a jet of heated air at 50°C or greater directly into a container such as a blood collection tube.

[00263] In some embodiments, the container provides for separation of the serum from the clotted cells after clotting has occurred. In some embodiments, the container comprises or contains a serum separator gel that provides a barrier between the clotted cells and the serum sample. In some embodiments, the container is a suitable shape and a suitable material to permit centrifugation to separate or assist in maintaining separation of the clotted cells and the serum sample. In some embodiments, the serum sample is removed from the clotted cells, or the clotted cells are removed from the serum sample. For example, such embodiments are compatible with the use of commercially available Serum Separation Tubes and Plasma Separator Tubes.

[00264] In some embodiments, the container may comprise one or more further components. The other components may include, for example, one or more co-factors, one or more surfactants, and/or one or more clotting agents in addition to the clotting composition.

[00265] In a preferred embodiment, the containers are Greiner Bio-One White Top or Red Top tubes, or Becton Dickinson venous blood collection tubes. Such preferred collection tubes are made of polyethylene terephthalate and may have no additives at all, or may be coated with a surfactant, and contain silica as the clot activator, a gel separator and a rubber stopper coated with silicone.

Serum samples

[00266] As discussed above, the present invention is predicated in part on the discovery that prothrombin activators, when formulated in combination with an additional agent such as a colloid, result in a clotting composition having enhanced stability, thereby preserving clotting activity and improving the quality of serum samples for use in immunoassays or analyte detection, which may be in a laboratory, at point of care or at a clinical or research situation. A serum sample that is suitable for detecting analytes is one of suitable quality as discussed herein, and/or one that is prepared within a suitable time as discussed herein.

[00267] An important factor in the preparation of a serum sample suitable for detecting analytes is the extent to which the clotting process removes fibrinogen from the serum. Serum containing residual fibrinogen or partially degraded fibrinogen, or fibrin as a result of incomplete clotting can lead to analytical accuracy problems because of the formation of precipitates (microdots or strings), latent clotting post-centrifugation and on storage of the serum. Hence, complete or substantially complete clotting is pivotal in ensuring highest quality serum and accurate test results.

[00268] Accordingly, some embodiments of the present invention provide the use of a clotting composition comprising, consisting essentially of, or consisting of a prothrombin activator and a colloid in the preparation of a serum for detecting an analyte, where the serum comprises < 30 g/mL of fibrinogen or fibrinogen/fibrin related products. In more specific embodiments, the serum comprises≤ 25 Mg/mL, < 20 pg/mL, ≤ 15 pg/mL, < 10 pg/mL, < 8 pg/mL, or < 6 pg/mL of fibrinogen or fibrinogen/fibrin related products.

[00269] In some embodiments, the serum comprises < 30%,≤ 20%, < 10%, < 9%, <8%, < 7%,≤ 6%, < 5%, < 4%,≤ 3%, < 2%, < 1 %, < 0.5%, < 0.2%, < 0.1 % of fibrinogen or fibrinogen/fibrin related products present in the original sample from which the serum was produced.

[00270] Levels of fibrinogen and/or fibrinogen/fibrin related products can be detected by any suitable method known in the art, including a sandwich immunoassay using antibodies from MP Biomedicals and standard fibrinogen preparations purchased from NIBSC, Potters Bar, Hertsfordshire, London, UK.

[00271] Another important factor in the preparation of a serum sample suitable for detecting analytes is the activity or number of cells or cellular debris that remain in the serum after clotting. The presence of cells can have two effects during storage and analysis of serum or plasma. Firstly, cells may lyse, releasing cellular contents (e.g. potassium, lactate dehydrogenase) into the serum or plasma. This can lead to significant differences between measurements made immediately after centrifugation and measurements after a period of storage. Secondly, cells continue to be metabolically active and may use up significant amounts of nutrients (e.g. glucose) and release metabolic products {e.g. lactate) on storage. Changes can even be observed in the samples of many tubes when the samples are stored for the usual recommended 30 minute clotting time when the samples are from healthy participants. The degree of cellular contamination is therefore an important quality criterion for serum samples and an important advantage of using serum over plasma.

[00272] Accordingly, in some embodiments, the serum sample comprises less than 50%, 40%, 30%, 20%, 10%, 5%, or 1 % of cells in the blood sample from which it has been prepared.

[00273] In some embodiments, the serum sample comprises a change of lactate dehydrogenase activity or phosphate concentration (typically measured in U/L and mmol/L respectively) of < 25%, < 20%, < 15% or < 10% over a period of 24 hours, 12 hours, 8 hours, 6 hours, 5 hours, 4 hours, 3 hours, 2 hours, 1 hour or 30 minutes. In some embodiments, the serum sample comprises a change of glucose concentration or potassium concentration (both typically measured in mmol/L) of < 5%, < 4%, < 3%, < 2%, < 1 %, < 0.5%, or < 0.1 % over a period of 24 hours, 12 hours, 8 hours, 6 hours, 5 hours, 4 hours, 3 hours, 2 hours, 1 hour or 30 minutes (for example, from the time of preparing the serum sample). Methods for measuring lactate dehydrogenase activity are well known in the art, see, for example, Dimeski, G., et al. (2004), the contents of which is incorporated by reference in its entirety.

[00274] The haemoglobin concentration of a serum sample can also be used to determine whether the serum sample is suitable for detecting analytes. Accordingly, in some embodiments, the serum sample comprises a haemoglobin concentration of < 150 mg/L, < 100 mg/L, < 90 mg/L, < 80 mg/L, < 70 mg/L, < 60 mg/L, < 50 mg/L, < 40 mg/L, < 30 mg/L, < 20 mg/L, or < 10 mg/L.

[00275] As a sample for testing, serum is usually preferred over plasma unless urgent results are required and thus the clotting time for a serum tube is considered too long. Another downside to prolonged clotting time is that it can lead to clinically significant analyte concentration changes due to cellular activity in the blood sample, this problem being most pronounced in leukocytosis (Dimeski and Bird 2009).

[00276] Thus in some embodiments, the present invention provides a method of producing a serum sample for detecting an analyte of interest, the method comprising contacting a blood sample with a clotting composition comprising, consisting essentially of, or consisting of a prothrombin activator and a colloid as defined herein, where the serum sample is prepared within 25, 20, 15, 10, 8, 6, 5, 4, 3, 2, 1 , or 0.5 minutes from contact with the clotting composition.

Blood samples

[00277] As discussed herein, there is a desire to provide a clotting composition that is suitable for producing a serum sample from most, if not all, blood samples, or a container comprising a clotting composition that will clot most, if not all blood samples, in a suitable time; that is, in a period of time that allows for analyte testing to be conducted consistent with the clinical needs of a patient.

[00278] Examples of different types of blood sample for which testing may be desired include fresh blood from healthy individuals, citrated blood, blood with EDTA added, blood from patients on anti-clotting therapy such as heparin, warfarin, citrate, oral anticoagulants of the Factor Xa inhibitor (eg rivoroxaban), or direct thrombin inhibitor (eg dabigatran) classes, patients taking anti-thrombotic agents including aspirin, thrombocytopenic patients (patients with low platelet counts), and patients with prolonged PTT.

[00279] In some embodiments, the blood sample is a whole blood sample. In some other embodiments, the blood sample is a serum sample derived from a whole blood sample. Exemplary serum samples in this instance include serum samples where a better quality serum sample is desired, including those where the amount of fibrinogen or fibrinogen/fibrin related products and/or the amount of cells or cellular material in the serum sample and/or the amount of haemoglobin is considered too high for the serum sample to be a sample suitable to detect analytes. For example, the serum sample may exhibit microdots or latent clotting. In some other embodiments, the blood sample is a plasma sample derived from a whole blood sample. For example, the plasma sample may exhibit microdots or insoluble fibrin formation, or latent clotting.

Detecting analytes

[00280] In some embodiments the present invention further provides methods of detecting an analyte, the method comprising analysing a serum sample prepared by the method of the present invention for the presence or amount of the analyte of interest.

[00281] In specific embodiments, the serum sample prepared by the method of the present invention is suitable for more than one analyte test, so that the serum sample can be used to detect more than one analyte. As discussed herein, often a clinician will desire more than one analyte test to be performed on a blood sample from a patient, and it is not uncommon for one serum sample to be used for at least 20 tests, or even more, sometimes between 50-60 or even 70-80 tests. It will be appreciated by those skilled in the art that in specific embodiments the present invention provide for the production of a serum sample where the serum sample is of sufficient volume and quality to enable all desired analyte tests to be performed on the one serum sample. The advantage of this is that both the volume of blood to be taken from the subject and the time taken to perform the analyte tests are reduced.

[00282] Illustrative analyte tests are described below. Methods for performing these analyte tests may be performed in a number of ways and are well known in the art. [00283] Troponin: This test measures the levels of Troponin T and/or Troponin I in a serum or plasma sample, in which high levels can be indicative of acute myocardial infarction.

[00284] Sodium (Na ^* ): This test measures the amount of sodium in a serum or plasma sample. Sodium plays an important role in salt and water balance in the body. Low sodium levels may indicate too much water intake, heart failure, kidney failure, or loss of sodium from the body due to diarrhoea or vomiting. High sodium levels may indicate excessive salt intake or insufficient water intake.

[00285] Potassium (K ^* ): This test measures the amount of potassium in a serum or plasma sample. Levels of potassium that are too high (hyperkalaemia) may be the result of kidney disease, diabetes, ketoacidosis or drugs that decrease the amount of potassium excreted from the body. Levels of potassium that are too low (hypokalaemia) may be caused by dehydration, for example from diarrhoea or vomiting, or excessive sweating. Levels of potassium may also be low as a result of taking drugs that cause the kidneys to lose potassium, for example diuretics. Potassium levels are often monitored in those patients that take diuretics or heart medications, those with high blood pressure or kidney disease, critical acidosis and alkalosis conditions, and those receiving kidney dialysis or intravenous therapy on a drip.

[00286] Chloride (CI ): This test measures the amount of chloride in serum or plasma. Chloride is typically measured to assess whether there is an electrolyte imbalance in the patient. Low chloride and normal sodium and elevated bicarbonate can be indicative of vomiting or loss of gastric fluid.

[00287] Bicarbonate (HCO3 ): This test measures the amount of three forms of carbon dioxide (bicarbonate, carbonic acid, and dissolved carbon dioxide) in serum or plasma. A bicarbonate/carbonic acid buffer is the most important in plasma, being very effective in regulation of body pH. This test is often performed in determining metabolic acid/base status. Buffer concentration is regulated by the kidneys. A high level may be observed in response to loss of chloride (vomiting), diuretic therapy, mineralocorticoid excess or glucocorticoid excess (e.g. Cushing's disease). . A low level may be caused by production of organic acids as seen in diabetic ketoacidosis, reduced excretion of acids in renal failure, excessive loss of bicarbonate (renal disease), diarrhoea and poisons such as methanol abuse.

[00288] Glucose: This test measures the amount of glucose in serum or plasma. Glucose levels are often tested in those patients exhibiting symptoms of high blood glucose (hyperglycaemia) or hypoglycaemia, those who are pregnant, those who have diabetes.

[00289] Urea: This test measures the amount of urea in serum or plasma. This test can help evaluate kidney function and monitor the effectiveness of dialysis. [00290] Creatinine: This test measures the amount of creatinine in serum or plasma. This test is pivotal in helping to evaluate kidney function and monitor treatment of kidney disease.

[00291] Urate: This test measures the amount of urate (or uric acid) in serum or plasma. High levels of uric acid may be a sign of gout. Uric acid levels are also monitored in patients that are undergoing chemotherapy or radiotherapy to detect tumour lysis syndromes.

[00292] Total protein (TP): This test measures the total amount of protein in serum or plasma. Although the results of a total protein test will not indicate a specific disease, a high or low protein level often indicates that additional tests are required to determine if there is a problem. Total protein tests are often used to screen for certain liver disorders, kidney disorders, multiple myeloma and hydration status.

[00293] Albumin (Alb): This test measures the amount of albumin in serum or plasma. Albumin levels are often measured to screen for liver or kidney disease, or to evaluate nutritional status, especially in hospitalised patients.

[00294] Total bilirubin: This test measures the amount of bilirubin in serum or plasma. Bilirubin levels are measured to screen for and monitor liver disorders, such as jaundice, or liver diseases, such as cirrhosis. Bilirubin levels are also measured in babies to help detect certain rare genetic disorders and to avoid brain damage in those babies with jaundice.

[00295] Alkaline phosphatise (ALP): This test measures the amount of alkaline phosphatase in serum or plasma. This test is typically performed to screen for or monitor treatment of a liver or bone disorders.

[00296] Gamma-glutamyl transferase (GGT): This test measures the amount of gamma-glutamyl transferase in serum or plasma. This test is used to screen for liver disease and alcohol abuse. It can also be used to determine if a raised level of ALP is due to liver or bone disease.

[00297] Alanine aminotransferase (ALT): This test measures the amount of alanine aminotransferase in serum or plasma. This test is used to screen for liver disease.

[00298] Aspartate aminotransferase (AST): This test measures the amount of aspartate aminotransferase in serum or plasma. This test is used to detect liver damage, muscular damage, and other conditions as the enzyme is present in many organs and tissue cells.

[00299] Lactate dehydrogenase (LDH): This test measures the amount of lactate dehydrogenase in serum or plasma. This test is typically used to identify the cause and location of tissue damage in the body, tissue ischemia, and to monitor its progress. [00300] Creatine kinase (CK): This test measures the amount of creatine kinase in serum or plasma. Creatine kinase is measured in patients with chest pain or muscle pain or weakness to determine if they have had a heart attack and if other muscles in the body have been damaged.

[00301] Total calcium (TCa): This test measures the amount of calcium in serum or plasma. Calcium levels are often measured in patients with kidney, bone or nerve disease, or when symptoms of significantly increased or decreased calcium are present.

[00302] Phosphate: This test measures the amount of phosphate in serum or plasma. Phosphate levels may be measured as a follow-up to a test result of abnormal calcium levels. Phosphate levels may also be measured in patients with kidney disorders, uncontrolled diabetes, or where the patient is taking calcium or phosphate supplements.

[00303] Magnesium (Mg ^2* ): This test measures the amount of magnesium in serum or plasma. This test may be performed if the patient has symptoms of too much or too little magnesium, including weakness, irritability, cardiac arrhythmia, nausea or diarrhoea. Magnesium levels may also be measured if abnormal calcium or potassium levels have been detected.

[00304] Lipase: This test measures the amount of lipase in serum or plasma. This test is typically used to diagnose pancreatitis or other pancreatic diseases.

[00305] Cholesterol: This test measures the amount of cholesterol in serum or plasma. Cholesterol levels are measured to screen for risk of developing heart disease.

[00306] Triglycerides: This test measures the amount of triglycerides in serum or plasma. As for cholesterol levels, this test is typically used to screen for risk of developing heart disease.

[00307] High-density lipoprotein (HDL): This test measures the amount of HDL cholesterol in serum or plasma. This test is typically used to determine the risk of developing heart disease.

[00308] Iron (Fe ^2* ): This test measures the amount of iron in serum or plasma. Iron is measured to check if a patient has low or high iron levels. Low iron levels can cause anaemia, and is usually due to long-term or heavy bleeding, pregnancy or rapid growth (in children). High iron levels can be due to a genetic condition or extensive blood transfusions.

[00309] Transferrin: This test measures the amount of transferrin in serum or plasma. Transferrin is a plasma protein that transports iron through the blood to the liver, spleen and bone marrow. Thus the blood transferrin level is tested to determine the cause of anaemia, to examine iron metabolism (for example, in iron deficiency anaemia) and to determine the iron- carrying capacity of the blood. [00310] C reactive protein (CRP): This test measures the amount of C reactive protein in serum or plasma. This test is used to identify the presence of inflammation, to determine its severity, and to monitor response to treatment.

[00311] Cortisol: This test measures the amount of Cortisol in serum or plasma. Cortisol levels are measured to help diagnose Cushing's syndrome or Addison's disease.

[00312] Free thyroxine: This test measures the amount of free thyroxine in serum or plasma. The test is typically used to diagnose hypothyroidism or hyperthyroidism.

[00313] Thyroid stimulating hormone (TSH): This test measures the amount of thyroid stimulating hormone in serum or plasma. The test is typically used to screen for, diagnose and monitor thyroid disorders.

[00314] Ferritin: This test is used to measure ferritin in serum or plasma. Low ferritin levels are indicative of iron deficiency. Elevated levels are indicative of iron overload such as in haematochromatosis.

[00315] Haemolytic index: The haemolytic index test measures the degree of red cell lysis. Haemolysis is the most common interference encountered in a biochemistry laboratory. The test is predominantly used to detect in vitro haemolysis and sample suitability for reporting of certain or all analytes, and in detection of haemolytic anaemias (hereditary spherocytosis, spontaneous haemolysis, RBC enzyme deficiency). Haemolysis or haemolytic index (concentration of free haemoglobin in serum or plasma) is currently estimated by all general chemistry analysers. The value is then used as a guide in determining which analytes and at what haemolysis level may be affected or not reported (Dimeski et al. 2005).

[00316] Icteric index: The icteric index test returns a value indicating the relative level of bilirubin in a test sample by a purely spectrophotometric method. It is used in determining sample suitability for reporting of certain analytes and cross checking accuracy of bilirubin results in rare cases of interference with the total bilirubin photometric estimation methods. The icteric index has been shown to be of value in detecting cancer paraproteins interference (precipitation and false high total bilirubin) with Roche Total Bilirubin method (Sheppard ef a/., 2005), where the icteric index has stayed unaffected. Bilirubin can interfere with some creatinine assays at high concentration (e.g. >200 μΜ/L) as discussed in Dimeski et al., 2008.

[00317] Lipemia index: The lipemia index has been employed to predict possible interference with assays due to lipaemia (Dimeski 2009). [00318] In addition to the above analyte tests, other assays may be performed using a serum or plasma sample by different analytical techniques such as immunoassays, including competitive, noncompetitive, reverse or sandwich enzyme-linked immunoassays.

Methods of diagnosis, prognosis and monitoring responsiveness to therapy

[00319] The present invention provides methods for diagnosing a disease or condition in a subject, wherein the methods comprise providing a blood sample from the subject, preparing a serum sample from the blood sample by contacting the blood sample with a clotting composition of the present invention, and testing the serum sample for the presence or absence of an analyte in the serum sample, or for an indicative level or concentration of an analyte in the serum sample, wherein the presence, absence or indicative level or concentration of the analyte is indicative of the disease or condition in the subject.

[00320] The present invention also provides methods for providing a prognosis for a subject, wherein the methods comprise providing a blood sample from the subject, preparing a serum sample from the blood sample by contacting the blood sample with a clotting composition of the present invention, and testing the serum sample for the presence or absence of an analyte in the serum sample, or for an indicative level or concentration of an analyte in the serum sample, wherein the presence, absence or indicative level or concentration of the analyte is indicative of the prognosis for the subject.

[00321] The present invention moreover provides methods for monitoring the responsiveness of a subject to a therapy, wherein the methods comprise providing a blood sample from the subject, preparing a serum sample from the blood sample by contacting the blood sample with a clotting composition of the present invention, and testing the serum sample for the presence or absence of an analyte in the serum sample, or for an indicative level or concentration of an analyte in the serum sample, wherein the presence, absence or indicative level or concentration of the analyte is indicative of the responsiveness of the subject to the therapy.

[00322] In some embodiments, the methods of the present invention involve comparing the result of the analyte test to a reference interval or cut off limit in order to obtain the diagnosis.

[00323] The disease or condition may be any disease or condition that is susceptible to diagnosis, prognosis or responsiveness to therapy, using a serum sample, including but not limited to, the diseases or conditions outlined above with reference to different analyte tests.

[00324] In some embodiments, the methods may comprise diagnosing the presence or absence of a disease or condition not previously presented by the subject. In other embodiments, the methods may comprise diagnosing the presence, absence or severity of a disease or condition that the subject has previously presented. The methods may comprise reference to a result obtained from the subject at an earlier time. Alternatively, the reference result may be a standard analytical reference.

[00325] In some embodiments, the methods are performed in a testing facility such as a pathology laboratory. In some other embodiments, the methods are "point-of-care" methods. As used herein, a "point-of-care method" means that the method is performed at or near the site of patient care. Point-of- care methods are increasingly popular in hospital and other environments where there is a need to obtain results rapidly. This is often accomplished through the use of transportable, portable, and handheld instruments and test kits.

[00326] The advantages of point of care testing include the ability to obtain rapid analytical results at the bedside in hospitals, especially in emergency situations and the ability to obtain analytical results at home, in doctors ^' surgeries, remote areas, etc (e.g., using small volumes of arterial, venous or capillary blood).

[00327] Devices for point-of-care methods currently available on the market include the i-Stat (Abbott Diagnostics), the Retro-STATUS HIV/CD4 350 rapid test device (Millenium Biotechnology, Inc.), and the Triage PLGF test (Alere International).

Kits

[00328] The present invention provides kits for preparing a serum sample, wherein the kit comprises a prothrombin activator and a colloid.

[00329] Kits of the present invention facilitate the employment of the methods of the present invention. Typically, kits for carrying out a method of the invention contain all the necessary reagents and means to carry out the method. For example, in one embodiment, the kit may comprise a clotting composition of the present invention and, optionally, means to perform analyte detection such as devices for point of care methods as defined herein.

[00330] Typically, the kits described herein will also comprise one or more containers. In the context of the present invention, a compartmentalised kit includes any kit in which compounds or compositions are contained in separate containers, and may include small glass containers, plastic containers or strips of plastic or paper. Such containers may allow the efficient transfer of compounds or compositions from one compartment to another compartment whilst avoiding cross-contamination of samples, and the addition of agents or solutions of each container from one compartment to another in a quantitative fashion. In a preferred embodiment, the one or more containers comprising the kit is a blood collection tube.

[00331] Typically, a kit of the present invention will also include instructions for using the kit components to conduct the appropriate methods.

[00332] Methods and kits of the present invention are equally applicable to any animal, including humans, for example including non-human primate, equine, bovine, ovine, caprine, leporine, avian, feline and canine species. Accordingly, for application to different species, a single kit of the invention may be applicable, or alternatively different kits, for example containing compounds or compositions specific for each individual species, may be required.

[00333] Methods and kits of the present invention find application in any circumstance in which it is desirable to produce a serum sample.

Research tools

[00334] The present invention also contemplates the use of research tools that employ serum samples produced in accordance with the present invention. These methods generally comprise providing a serum sample prepared according to the methods broadly described above; and employing the serum sample in a research tool study, including but not limited to a genomics, proteomics, metabolomics, systems biology, molecular imaging or assay study.

[00335] Suitable research tools are well known in the art and include those described in Scaros, O. et a/., 2005, the entire contents of which are incorporated by reference. Genomics includes pharmacogenomics which studies the correlation between genetics and gene expression patterns with response to therapeutics. Proteomics permits the analysis of the abundance and distribution of proteins in a system. Metabolomics, or biochemical profiling, is the study of metabolites in a system. Systems biology looks at the entire biological system as a functional unit, producing models of behaviour that can potentially predict how that system will respond to stimulus. Molecular imaging technologies have the ability to demonstrate both the level of a specific molecular target and the functional state of that target in vivo, and can be used for diagnostic methods.

[00336] The person skilled in the art will understand and appreciate that different features disclosed herein may be combined to form combinations of features that are within the scope of the present invention.

[00337] The present invention will now be further described with reference to the following examples, which are illustrative only and non-limiting. Examples

[00338] A requirement for using prothrombin activators in clotting compositions is that the activity of the prothrombin activator remains stable over time, and under variable conditions such as exposure to heat and/or sterilizing irradiation. For example, if a prothrombin activator is to be used in a clotting composition in combination with a container such as a blood collection tube, the clotting activity of the prothrombin activator must be retained during storage of the prothrombin activator after purification or recombinant production and before tube production.

[00339] In addition, commercially available blood collection tubes are typically made in very large numbers on a production line, where the product may be a plastic tube containing additives such as a procoagulant, a surfactant and a spacer gel. The contents of the tubes are typically dried, sealed under vacuum and sterilized. Where the procoagulant is a prothrombin activator, the prothrombin activator must therefore be capable of retaining activity after the processes of drying, sealing under vacuum and sterilizing (for example, using irradiation). Stability should typically be demonstrated across a wide range of temperatures as disclosed herein. In particular embodiments, stability at room temperature should allow for a shelf life of at least 6 months, preferably greater than 12 months, and more preferably greater than 18 months.

Example 1 - Prothrombin Activators: Isolation and Characterisation

[00340] In mammals, the prothrombin-activator complex in vivo typically consists of a serine protease, Factor Xa, and a protein cofactor, Factor Va, complexed on a phospholipid membrane in the presence of calcium ions (Jackson and Suttie, 1977). Factor Xa alone activates prothrombin, but inefficiently. In the presence of Factor Va, calcium ions and phospholipid, prothrombin activation is enhanced by several orders of magnitude..

[00341] It is well known that the venoms of many snakes cause rapid coagulation of blood. The first report of a prothrombin activator complex in snake venom was by Speijer et al (1986), who reported the discovery of a prothrombin activator complex from Oxyuranus scutellatus (Coastal Taipan) venom with at least four polypeptide chains, two of which appeared to represent a Factor Va-like component and two, joined by a disulfide bond, that represented a Factor Xa-like component. [00342] The methodology used in the present study for purification of the prothrombin activator is essentiallythat previously described by Masci et al 1988 and Masci ei al 2000. Briefly, 10 grams of venom (purchased from Venom Supplies Pty Ltd, South Australia) was purified in 1 gram batches using a single step column chromatography process involving redissolved venom on a suitable gel filtration resin (e.g. Sephacryl S300, Superdex 200). The activity of the concentrated OsPA containing fraction was then determined in recalcified citrated whole blood and recalcified citrated plasma clotting assays as well as by using the spectrophotometric substrate designed for Factor Xa, S-2222.

Example 1.1 - Purification of Prothrombin Activators

[00343] Sephacryl S-300, Superdex 200, Toyopearl H55S and Toyopearl H65Sresins were purchased from GE Healthcare Sydney and Toyo, Japan. A slurry of each resin was diluted by 150% with column buffer, 0.05 M tris-HCI, pH 7.4, containing 0.1 M NaCI and 0.01 % sodium azide. Glass columns (either 5.0 x 95 cm; or 2.5 x 95 cm) were packed with each resin at 4°C in a cold room. Columns were equilibrated overnight at flow rate 1 ml/min and absorbance at 280 nm was monitored until stable at zero (minimum of 10 column volumes of buffer between runs).

[00344] Coastal Taipan (Oxyuranus scutellatus, Os) venom (Venom Supplies Pty Ltd, South Australia) was purchased in 2 x 5 gram lots and the commercial supplier, Venom Supplies confirmed both 5 gram lots were from the same batch of venom milkings. Approximately 1.0-1.5 grams lots of Os venom were reconstituted in 45 mL of column buffer in a 37°C water bath until completely dissolved. This took approximately 30 minutes. A 1/50 dilution of the Os venom solution was made and A280 measured and recorded for total protein concentration. From the stock solution, 2 x 1.0 mL aliquots, 1 x 0.5 mL in 50% glycerol and a 1/50 dilution were stored at -20°C. The remaining 40-42 mL of Os venom solution was then loaded onto an equilibrated gel filtration column. Chromatography was developed over 24 hours at 0.8-1.0 mL/min flow rate. Fractions were collected using an LKB Redirac fraction collection on time-base mode collecting 8-10 mL fractions. Absorbance at 280nm (A280) of the eluent was monitored continuously using an Alex dual UV (A280 nm) channel monitoring system and a dual pen recorder set full scale range on 2.48 and 1.24 absorbance units.

[00345] Fractions containing OsPA clotting activity were identified by assay using the recalcified citrated plasma clotting assay and the S-2222 chromogenic hydrolytic activity assay, as described below. Fractions with high specific clotting activity were pooled and concentrated as described below.

Example 1.2 - Concentration and Storage of OsPA

[00346] Fractions from Superdex 200, Sephacryl S300 and Toyopearl H55S and Toyopearl H65S chromatographies which contained plasma clotting and S-2222 hydrolytic activity were pooled (designated "pooled OsPA fractions") for characterization. Protein concentration was determined by measuring absorbance at 280 nm of the pooled OsPA fractions and using an absorption coefficient of 1.0 for 1 mg /mL solution to calculate the protein concentration in mg/mL.

[00347] Concentration of the pooled OsPA fractions was carried out using a pressurized Amicon cell Model 402 using a YM 10 membrane (mol cut off 10,000 Da) to a concentration of 2-4 mg/mL. In the initial experiments, the loss of protein in the concentration step was 20-25%. In later experiments, 5% glycerol was added to pooled OsPA containing fractions prior to concentrating with the aim of reducing losses due to protein binding. When 5% glycerol was used the loss of protein in the concentrating step was 0-5%. High purity glycerol was then added to the concentrated OsPA solution to achieve 50% glycerol concentration. The OsPA/glycerol solution was gently mixed to avoid frothing until solution was homogeneous and then stored in a dark glass bottle covered in Alfoil at -20°C. Protein concentration of the OsPA/glycerol solution was determined using a 1/10 dilution and measuring absorbance at 280 nm. OsPA Batch 17-Apr-2012 is used for all experiments.

[00348] Table 4 shows characterisation data for 10 different preparations demonstrating that the different isolation methods yield functionally similar preparations that are suitable and all capable of producing high quality serum as can be inferred from chromogenic substrate S-2222.

Table 4. Characterisation data for prothrombin activator preparations

(1-4 and 7) (1-10) (1 -4)

[00349] Table 4 provides quantitative information on the ten OsPA preparations described above in terms of elution profiles and SDS PAGE banding patterns. In summary, (1 ) the yield of protein in the OsPA preparations using Sephacryl or Superdex was 126 ± 17 mg per gram of dry venom, (2) the plasma clotting activity of one gram of venom was (1.031 ± 0.194)x10 ⁶ units, (3) the plasma clotting activity in four Sephacryl or Superdex preparations was 526,417 ± 44433 units, giving a yield of approximately 52% of the total plasma clotting activity of the venom sample loaded onto the column, and (4) the two Toyopearl 65S runs gave higher recoveries of activity (60% and 75%) with very little purification between the prothrombin activator fraction and taipoxin fraction.

[00350] Figure 1 shows the banding patterns obtained using samples from six preparations of OsPA, including one stored since 1989. In all cases, there is a very consistent banding pattern in the high molecular weight region. The only clear difference is the presence of a greater amount of low molecular weight material in the Toyopearl preparation. This is consistent with the much poorer resolution of venom fractions achieved using Toyopearl chromatography.

[00351] Clotting of whole blood by samples of each of these ten preparations (being the concentrated OsPA fractions stored in 50% glycerol, derived from each preparation) was studied by thromboelastography. Traces are shown in Figure 2 and parameters for each trace are shown in Table 5.

Table 5: Thromboelastographic Data for 10 OsPA Preparations

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60 '4.» 14.4 xo

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Sii -r< -\ OK 10 12 I.U.I J 50 6K 1 10." 125

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Inxoptarl d m 1 5X2.2 161.5 f~.t> 50 65.5 •*.5 ro

(HW65-M

jrl 140612 .4 261.1 "" I 50 6 10.5 120 tllW 65-M

[00352] All OsPA preparations caused rapid and complete clotting as shown by R, K and angle values (speed) and MA values (clot strength).

[00353] Based on results achieved, the OsPA preparation designated 17/4/2012 was used in all dosage and stability experiments. The Superdex 200 chromatography elution profile for this preparation is shown in Figure 3 and the SDS PAGE banding pattern in Figure 1. Comparison of the elution profile and banding pattern of this preparation shows that it is a typical preparation. As shown in Table 1 , the pooled fractions making up this preparation contained 159 mg, equivalent to 151 mg per gram of venom. The specific activity in the plasma clotting assay was 3534 U/mg and the total activity recovered was 534,987 U per gram of dry venom, a yield of 59%. These numbers are in general agreement with mean values achieved in several preparations as listed in Table 1. The specific activity of 3534 U/mg shows that 1 g of OsPA, as used in many of the dosage and stability experiments, contained 3.5 plasma clotting units. Parameters for clotting of whole blood by this preparation are in Table 5.

[00354] Results for the assay of venom and the 17/4/2012 OsPA preparation against the Factor Xa selective substrate S-2222 are shown in Table 6. Table 6. S-2222 assay data for the 17/4/2012 OsPA preparation

Example 1.3 - Elution profiles after gel chromatography

[00355] Solutions containing approximately 1-1.5 g of O. scutellatus venom (prepared by dissolving freeze dried venom) were subjected to gel filtration chromatography as follows: on Sephacryl 300 (once); on Superdex 200 (6 times), on Toyopearl HW55-S (once) and on Toyopearl HW65-S (twice). Figure 3 shows the elution profile of O. scutellatus venom using Superdex™ 200 (gel column: 5 cm diameter, 95 cm long).

Example 1.4 - SDS-Page

[00356] NuView Precast Mini Gels (#NB10-420, 4-20%) SDS PAGE gels with Tris-Glycine non- reducing sample buffer (#BG-145) ( NuSep), and a reducing sample buffer with 5% β - mercaptoethanol were prepared. After a five minute incubation, a 40 pL aliquot from each sample was transferred into the equivalent volume of reducing sample buffer. The samples were then incubated for 10 minutes at 100 °C in a heating block. Aliquots of 25 μί of each sample and 12 L of the pre-stained molecular weight marker (#SM0671 Page Ruler Prestained Protein Ladder, Fermentas, Hanover. MD, USA) were loaded on the gels. Gels were run at 100 V using a Mini-Protein II Cell PAGE apparatus (Bio-Rad) until the dye-front reached the bottom of the gel. The gels were stained with Coomassie Brilliant BlueG (#B-0770, Sigma) (0.25% w/v Coomassie Brilliant Blue G, 45% methanol, 10% acetic acid), and excess stain was removed by de-staining solution (45% methanol, 45% water and 10% acetic acid).

Example 1.5 ^■ Storage of OsPA freeze-dried as a freeze-dried powder

[00357] In addition to the storage of purified OsPA in 50% glycerol, OsPA can be produced as a freeze-dried protein which can then be stored at -20C. This can be achieved by conversion from the 50% glycerol OsPA stock solution or directly from the OsPA concentrate directly from the column. [00358] Dialysis tubing (23 mm width, 12kDa cut off) of 30cm length was soaked in distilled water containing 1 mM EDTA and 0.2% sodium azide for 1 -2 hours. Tubing was then washed with distilled water 10 times then each piece was filled with 80 ml 10% BSA in H20 containing 0.2% sodium azide and stored in distilled water at 4 °C for 8 weeks. The tubing is ensured to be always submerged. Before use, the BSA solution was removed and the tubding washed inside with 100 volumes of distilled water.

[00359] Add OsPA glycerol stock (2.0 mg/mL in 50% glycerol-0.05 M Tris HCL Ph7.4) into each tubing, then add 10% BSA at a final concentration of 1 % and 10% sodium azide to final concentration 0.2% and tie off tube. The OsPA in dialysis tubing was dialysed in 0.02 M hepes buffer pH 7.4 (dialysis buffer) at 250-300 times dialysate volume at 4 °C overnight with continuous slow magnetic stirring to giving an approximate final glycerol concentration of 10-15 mM. This raito ensrues that the final concentration of glycerol in the blood (4 mL) in a collection tube with OsPA is less than 0.1 mM.

[00360] After equilibrium was achieved (i.e. 24 hours at 4 °C), the dialyzed OsPA was carefully removed from the tubing. The OsPA was divided into dark glass bottles pretreated and dried with surfactant (2.41 g/L) with 10 mg of OsPA per bottle. The recovered OsPA/BSA suspension was shell- frozen using dry ice in preparation for freeze drying. Freeze drying was undertaken using a Christ freeze dryer as per Example 2 with setting 0.08 m Torr and -60C for 24 hours.

[00361] After freeze drying, a sample bottle of the OsPA was reconstituted with 5 mL of Gelofusine to give an OsPA concentration 1.0-2.0 mg/mL A standard concentration curve of undiaiyzed OsPA at 0.125, 0.25, 0.50, 0.75, 1.0, 1.5, 2.0 and 3.0 g was established for determining the recovery of dialyzed and freeze-dried OsPA. Four different dilutions of both dialyzed and freeze-dried OsPAs was used for recalcified whole blood clotting assay. The recovery of the OsPA at the two steps was calculated wth results showing that approximately 100% of OsPA was recovered from the dialysis and freezer-drying steps.

[00362] The freeze dried OsPA has been successfully stored with retention of activity for 6 months at - 20C.

[00363] Note that the OsPA used in the Examples is from 50% glycerol stocks.

Example 1.6 Characterisation of Ecarin

[00364] Ecarin isolated from Echis carinatus venom was sourced from Sigma Aldrich Catalogue Number EC0504 in a vial of 45-55 Units as a freeze-dried powder. The protein content was determined by Lowry protein assay (BioRAD DC protein Assay Catalogue number 500-01116) as 110-110mg / vial. The ecarin was stored at -20C. [00365] Ecarin from Echis carinatus venom is the primary reagent in the ecarin clotting time (ECT) test, which is used to monitor anticoagulation and thrombin inhibition. One unit is defined as the amount required to activate prothrombin to produce one unit of amidolytic activity at pH 8.4 at 37 °C. One amidolytic unit will hydrolyze 1.0 pmole of N-p-tosyl-Gly-Pro-Arg-p-nitroanilide per min at pH 8.4 at 37 °C . Ecarin activity is determined using the chromotographic Assays as per Example 5.

Example 2 - Tube Preparation

[00366] The tubes used in the present study were either plastic Greiner White Top plain tubes (Code #456001. Greiner Bio-One GmbH, Austria ) or plastic Becton Dickinson Red Top tube plain (Code# 3276916, Becton, Dickinson and Company, Franklin Lakes, USA).

[00367] Example 6 illustrates that the presence of a surfactant in the tube formulation is of benefit for optimal release from the tube wall and hence activity of the prothrombin activator. Although in this example, the addition of a colloid carrier (in this case 0.1 % BSA) to the tubes with no surfactant demonstrates a benefit compared to the tubes with no BSA and no surfactant, activity is optimal in all cases with the addition of a surfactant. Hence, tubes for the examples have been produced with the addition of a surfactant.

[00368] To prepare tubes, 20μΙ of surfactant solution was added to the tube as a liquid formulation, followed by vortexing for 10 seconds to ensure bottom of tube was coated. This process mimicked the commercial spraying process typically employed by tube manufacturers. Tubes were then dried in a vaccum dessicator overnight or using a GeneVac centrifuge drier. 20μΙ_ of prothrombin activator was then dissolved in buffer or other formulation (as per Example 1 ) and added to the tube, followed by drying by centrifugal vacuum drying using a Genevac Z-22 for 30 minutes at 0.1 T vacuum at 29-30°C. Tubes were then re-capped with the original lid and cling wrapped to protect from dust and moisture and stored at room temperature until required.

[00369] Alternatively, tube samples were air-dried overnight without the lid at a controlled ambient temperature. Tubes were then re-capped with the original lid and cling wrapped to protect from dust and moisture and stored at room temperature until required.

[00370] Freeze-drying was conducted using a Christ freeze-dryer. Samples were dried at 0.01 T vacuum at -60°C for 1 hour. Tubes were then re-capped with the original lid and cling wrapped to protect from dust and moisture and stored at room temperature until required.

Example 3 - Irradiation

[00371] Irradiation of prepared tubes was undertaken to ensure the sterility of the final product. Irradiation can be accomplished by either exposure to gamma radiation or electon beam (E-beam) technology. In the present study, irradiation was undertaken by a commercial facility utilising a Gammacel 220 system (GC220) utilising gamma irradiation.

[00372] Blood collection tubes containing prepared clotting compositions were placed in a calibration rig (GC220), and then into the GC220 irradiation chamber and subject to gamma irradiation (Cobalt -60). Based on the known dose rate in this calibration rig, the product was then irradiated for a time expected to ensure the required dose was achieved. Results are expressed as target dose (kGv); actual dose; (kGv) and irradiation time.

[00373] Measurement traceability and uncertainty were validated as follows. Dosimeters were calibrated in a cobalt-60 radiation field, in which the dose rate was determined from reference dosimeter measurements made under similar conditions. The reference dosimeter measurements are traceable to the Australian standard for absorbed dose. This irradiation was performed based on the reference dose rate determined in the calibrated radiation field.

[00374] The overall uncertainty associated with the reference dose rate includes both the uncertainty of calibration of the batch of dosimeters and the uncertainty due to variation within the batch, and was calculated to be 2.0%. This expanded uncertainty was based on the standard uncertainty multiplied by a coverage factor of two, providing a level of confidence of approximately 95%. The uncertainty evaluation was carried out in accordance with the ISO Guide to the Expression of Uncertainty in Measurement. Quality management systems were compliant with the following licences and standards: TGA Licence No. 1 182; ISO 13485:2003 (excluding design and development) of ISO 9001 :2008. The quality management system also adhered to the principles of the following standards and guidelines: RSO 11137 International best practice for dosimetry (ISO 17025 and ISO/ASTM standards for dosimetry for radiation processing).

Example 4 - Standardised Methods for Assessing Blood Samples

[00375] Citrated whole blood collected for all examples was taken from both healthy individuals and patients who were undertaking oral anticoagulant therapies, with written consent. The coagulation parameters used were: prothrombin time (PT), activated partial thromboplastin time (aPTT) and plasma fibrinogen concentration.

[00376] Platelet numbers were also measured on a Sysmex XE-5000 haematology analysers (Sysmex, Kobe Japan): [00377] Normal coagulation parameters are: PT: 10-12 seconds; aPTT: 30-35 seconds; fibrinogen plasma concentration 1.5-2.5 g/L and platelet count 150-450 x 10 ⁹ per mL of blood.

[00378] Patients undertaking oral warfarin therapy were monitored using International Normalized ratio (INR). The INR was determined by plotting the ratio of PT of patients on anticoagulation therapies versus healthy individuals. INR for effective warfarin therapy is 2.0-3.0.

[00379] Citrated whole blood from healthy individuals was either pooled at approximately n=50 or used on an individual basis. Healthy individuals donated -500 mL of blood which were checked for recalcified whole blood clotting time, PT, aPTT, fibrinogen concentration and platelet count.

[00380] Whole blood recalcification time was measured in every example and data recorded for each batch of citrated whole blood. Normal whole blood recalcification time is between 15- 20 minutes. Pooled or single samples with normal clotting profile or anticoagulated patients were suitable for use in blood clotting testing.

[00381] Fresh blood was used in some examples, taking single or multiple samples directly from volunteers with no citration / recalcification. The samples were tested for normal clotting profile by the use of a control tube in parallel to the tubes being tested. In some studies, blood from the same volunteer was also citrated and tested in parallel including TEG measurements as per Example 5.,.

Example 5 - Clotting Composition Performance Assessment

Example 5.1 - Plasma clotting assay

[00382] A recalcified citrated plasma clotting assay was performed using a Hyland-Clotek instrument as described by Austen et al (1975). Freshly pooled citrated plasma from normal volunteers was used for each group of experiments. The assay volume was 250 μί. Citrated normal human plasma (100 μί.) was added to a glass clotting tube (1 mL) with 100 μί. of 0.2 M Hepes buffer and 0.1 M NaCI (pH 7.4). Samples were placed in the 37 °C heating block of a Hyland-Clotek plasma clotting machine, and after at least 1 min, 25 μΐ of 0.2 M CaC (to a final concentration 20 mM) was added (when required), immediately followed by 20 μί. of a solution containing OsPA activity, at which point the timer was started.

[00383] The concentrations of OsPA, based on protein concentration and a molecular weight for the Factor V-Factor Xa complex of 250,000, ranged between 0.01 p and 1.9 μΜ. Citrated plasma typically contains 20 m citrate (as trisodium citrate) and after dilution, the citrate concentration in the reaction mixture was 8 mM, giving a net calcium concentration (molar excess over citrate) in the reaction mixture of 12 mM. Clotting time was recorded in seconds. Each assay was carried out in duplicate.

[00384] Figure 4 shows standard curves, plotting clotting time against amount of protein from the April 17, 2012 OsPA fraction.

Example 5.2 - Visual assessment of clotting

[00385] Pooled citrated normal blood having a PT = 10-12 seconds; an aPTT = 35-40 seconds; fibrinogen concentration = 1.5-4.0 g/L and platelet count of 150-400 x 10 ⁹ /ml. was placed in a plastic bottle in a biohazard hood. Greiner white top tubes or BD plain red top tubes containing vacuum dried hydrophilic surfactant (20 μΙ_ of 2.41 g/L surfactant in RO water) were used. In addition, either OsPA or ecarin, with or without Gelofusine (20 μΙ_), was added to the tubes. The OsPA or ecarin was added either as a wet solution or as a Genevac/vacuum desiccator dried composition, to which 50 μΐ of 1 M calcium chloride was added. 3.95 mL of citrated blood was then dispensed using a Gilson P5000 pipette into the tubes and the timer was started. The tubes were immediately recapped and then gently tilted by inversion. Duplicate test blood samples were carried out by two investigators. Blood containing tubes were continually inverted until an initial clot lump was observed, at which point the time was recorded as "start clotting time". When a solid clot was observed on inversion, the time was recorded as "completed clotting time".

Example 5.3 - Thromboelastography (TEG) Assay

[00386] The operating procedures for the thrombelastograph (TEG) machine and parameters generated from each assay are provided in the TEG® Haemostasis Analyser 5000 series (Haemscope Corporation, IL, USA) Operating Manual and accompanying software.

[00387] Each reaction mix was made up directly into a purpose-made disposable cup (Cat no. 621 1 , Haemscope Corporation) and consisted of a maximum volume of 360 μΙ_. Whole citrated blood was a component of all of the assays and was kept at a constant volume of 320 μί.

[00388] Other components were added in the following order: 1. OsPA dilutions, 2. Calcium when present (final concentration 20 mM = 3.6 μί of 2 M solution), and 3. Citrated whole blood (320 μί), giving an excess of calcium over citrate of about 10 mM depending on the haematocrit of the pool of 10 blood samples. [00389] Figure 5 shows a diagram of a trace from a thrombelastography experiment. Each test was monitored until the maximum amplitude (MA) value was established. Graphs were generated by the TEG companion software. The TEG® analyzer measures the shear elasticity of a clot as it forms or lyses. The relevant parameters calculated by the companion software were: R - Reaction time. The time from the start of a sample run until the first detectable clot formation. This is the point at which most traditional plasma clotting assays reach their end point, measured in seconds; Angle - a. Measurement of the rapidity of fibrin build-up and cross-linking (clot strengthening); MA - Maximum amplitude. Maximum stiffness or strength (maximum shear modulus) of the developed clot. ; A - Amplitude. The width of the trace at any point and is equal to MA until MA is established; G - The shear elastic modulus strength (SEMS). This value can be calculated from the maximum amplitude value using the relationship G = 5000 ^* MA/(100-MA).

[00390] The amplitude of the Thrombelastograph profile at 5 second intervals was recorded and retrieved using the lysis Tracker' function in the TEG software. These data were then used to calculate the kinetic parameters of clot formation and lysis. The parameters for each sample were recorded and averaged for replicates. Standard error was determined by first calculating the standard deviation then dividing this value by the square root of the replicate number.

Example 5.4 - Chromogenic / S-2222 Assay

[00391] S-2222 is a peptide-based chromogenic substrate which releases p-nitroaniline on hydrolysis, which can be measured at 405 nm. S-2222 was designed to be specific for hydrolysis by Factor Xa.

[00392] Using a spectromphotometer, the assay mixture in the cell had a total volume of 1 mL, made up of: (1 ) 900 μΐ_ Hepes buffer, pH 7.4; (2) 50 μΙ_ S-2222 (3 mM solution in water), giving an initial substrate concentration of 150 μΜ; and 50 μί prothrombin activator, such as OsPA. This was diluted to a final working concentration of 10 nM. The molar extinction coefficient A405 for p-nitroaniline is 9600 M \ , with the spectrophotometer providing the rate of increase in A405 in absorbance units/sec.

[00393] Figure 6 shows progress curves for the release of p-nitroaniline at different concentrations of OsPA (using the OsPA fraction designated 17/04/2012). The progress curves are linear. A repiot of rate against amount of OsPA was linear and constituted the standard curve for this assay. From the rate, and the amount of prothrombin activator in the assay, a specific activity of prothrombin activator can be calculated, as Units/mL of protein where 1 Unit (U) is the amount of protein required to hydrolyse 1 micromole of S-2222 per minute in the standard assay. Example 5.5 ^■ Chromogenic / S-2238 Two Stage Assay

[00394] Another chromogenic assay which can be used is the S-2238, a peptide-based chromogenic substrate which releases p-nitroaniline on hydrolysis, which is measured at 405 nm. S-2238 was designed to be specific for hydrolysis by thrombin (Factor I la). The assay depends on sampling timed aliquots from a first stage assay mixture (Prothrombin and Activator) into a second stage assay mixture containing S-2238 to measure the thrombin produced in the first stage.

[00395] The assay is performed in a 96 well microtitre plate and absorbances read on a Plate reader. The first stage assay mixture had a total volume of 100 uL, made up of: (1 ) 25 μί Hepes buffer, pH 7.4, 5m CaCI2, 0.1 % BSA; (2) 25 uL activator (0.25 ug OsPA/mL); (3) and 50 uL prothrombin (2 uM) to start the reaction.

[00396] At 5 min intervals 10 uL of the first stage assay mixture are added to 90 uL 0.2 mM S2238 in an adjacent well of the microplate and the absorbance monitored for 2 minutes. The effective extinction coefficient A405 for p-nitroaniline under these conditions was determined as 2271 M ', using p- nitroaniline standards. This factor is used to convert the rate of increase in absorbance units/s to umol S2238 hydrolysed per second.

[00397] Linear progress curves were produced the slopes of which give the rate of S2238 hydrolysis in Stage 1. These are converted to thrombin concentrations using the Michaelis-Menten equation substituted with literature values for kcat and Km (Sonder SA and Fenton JW, Clin.Chem. 1986, 32 (6), 934-937A). A replot of these thrombin concentrations against sampling time was also linear, the slope of which gives the concentration of prothrombin activator in the Stage 2 assay as Units/mL, where 1 Unit (U) is the amount of activator required to hydrolyse 1 micromole of prothrombin per minute in the standard assay (eg) (9.98e-6 umol/min). Linearity of the rate of thrombin production against OsPA concentration was also demonstrated, the slope of which gives the specific activity of the prothrombin activator as Units/mg of protein (eg) (5.0e-3 units/mg).

Example 5.6 - Stability Testing

[00398] In order to determine the stability of formulations under usage conditions, the samples were stored at the following conditions: (1 ) for refrigerated stability testing: 4°C in a refrigerated environment (thermostat controlled cold room); (2) for room temperature stability testing, defined as 25°C (23.5 - 26.5°C) samples were stored at ambient temperature; (3) for accelerated stability testing: 50°C in a thermostat controlled oven (49-51°C).

Example 5.7 - Analyte Measurement

[00399] The following panel of analytes was measured in serum prepared as described herein . The equipment used was a Beckman DxC800 general chemistry analyser and Beckman Dxl800 immunoassay analyser (Beckman Coulter, Brea, CA, USA):

Cholestrerol mmol/L

HDL Cholestrol mmol/L

Haemolytic Index 1 =0-50 mg/dL

Example 6. Stability of clotting compositions relative to drying conditions and surfactant

Example 6.1 - Introduction

[00400] This experiment aimed to investigate the effects of drying conditions and the use of surfactants on clotting time. In this example, samples of freshly diluted prothrombin activator (OsPA, either 0.25ng or g) were placed in Greiner White Top plain (Code #456001) blood collection tubes (+/- hydrophilic surfactant (20μ of 2.41 g/L in water); +/- 0.1% BSA) in HEPES buffer. These tubes were prepared as per Example 2, then tested with 4mL of blood from a pool of 50 healthy donors or individual patients as per Example 4 and subjected to the visual clotting assay and TEG analysis as per Example 5. The tubes were dried either by vacuum dessicator or Genevac as per Example 2 prior to blood clotting experiments. All steps were carried out at room temperature.

Example 6.2 - Results and discussion

[00401] The results in Figure 7 show whole blood clotting activity of freshly diluted OsPA compared with that of vacuum dessicator-dried OsPA. DO data are for freshly diluted liquid samples of OsPA added to blood collection tubes. D1 data are for samples dried overnight at room temperature in blood collection tubes in a vacuum desiccator as per Example 2. Upon comparison of the dark columns (DO), the effect of including a surfactant and BSA on fresh samples can be seen. For the control blood samples (no OsPA). adding surfactant and/or BSA to the tube prior to the blood had no significant effect on the clotting time as measured using the Standard Clotting Assays as per Example 5. For the samples containing 0.25 pg OsPA, the presence of surfactant reduced the clotting time from 330 to 132 seconds; with 1 pg OsPA, the values were 180 and 72.5 seconds respectively. BSA alone also reduced the clotting times substantially (but not as much as the surfactant) but the effect of BSA and surfactant was not additive. Without wishing to be bound by theory, the likely explanation for the effects of the surfactant is that it prevents binding of OsPA to the tube surface in such a way that it is unavailable to function.

[00402] Comparing the checkered and dark columns in Figure 7 (DO and D1) for each set of conditions shows the effect of drying in a vacuum desicator as undertaken per Example 2 compared to a freshly diluted OspA sample. There was generally a loss of clotting activity caused by the drying process. For example, using 1 g OsPA, drying increased the clotting time from 180 to 255 seconds in the absence of surfactant and from 72.5 to 127.5 sec in the presence of surfactant. The presence of surfactant and BSA separately or together led to lower clotting times on drying but losses remained substantial. In all cases, tubes with surfactant clotted faster than tubes with no surfactant. For example, a wet sample of 1 pg OspA without surfactant clotted in 180 seconds, and with the addition of a surfactant in 72 seconds. The same tube with the OsPA dissolved in a 0.1 % BSA and no added surfactant clotted in 97 seconds. This pattern is repeated across the wet and dried samples and shows that although colloids such as BSA may improve activity if the prothrombin activator in a tube environment, the addition of a surfactant is optimal.

[00403] The results in Figure 8 involved use of a Genevac vacuum drier as per Example 2 which achieved faster drying of the OsPA sample than the vacuum dessicator used in Figure 7. The drying time was 30 min for a total volume of 50 μί. as per Example 2. Figure 8 shows that dried samples had the same clotting times as the corresponding fresh samples. HEPES controls were also included. This experiment demonstrates that drying in a Genevac gave 100% retention of clotting activity. Accordingly, Genevac drying was used in the majority of subsequent experiments to prepare blood collection tubes containing dried OsPA.

[00404] Figure 8 also shows that samples maintained activity, as evidenced by clotting time, after storage at room temperature for 8 days.

Example 7 - Stability of clotting compositions relative to storage time

Example 7.1 - Introduction

[00405] This experiment aimed to investigate the effects of storage time on clotting time. Samples of freshly diluted prothrombin activator (OsPA, either 0.25ng or 1 μ$) were placed in Greiner White Top plain (Code #456001 ) blood collection tubes (+/- hydrophilic surfactant (20μί. of 2.41g/l in water); +/- 0.1 % BSA) in HEPES buffer. The tubes were then dried using a Genevac vacuum drier as Per Example 2 and stored at room temperature in a dry environment as per Example 2 for up to 85 days. Whole blood clotting assays were performed as per Example 5 weekly using citrated, pooled blood collected as per Example 4. After storage, the tubes were used for blood clotting assay via the visual clotting and TEG analyses (see Example 5). All steps were carried out at room temperature. Controls using freshly diluted OsPA in liquid form were performed each week, as well as controls using Hepes buffer only.

Example 7.2 - Results [00406] Table 7 shows a loss of clotting activity by Day 85 for both 0.25 ^ig and 1 ng OsPA samples. Loss of activity occurs sometime between Day 15 and Day 22.

Table 7. Clotting of recalcified citrated whole blood in dry OsPA-containing blood collection tubes plotting times in seconds)

Example 7.3 - Conclusion

[00407] From Table 7, it can be seen that control tubes using freshly prepared liquid OsPA consistently gave the expected clotting times throughout the 85 days of the experiment (see rows 1 , 2, 5 and 6). For the dried samples, clotting times remained stable for the first three measurements (Days 1 , 8 and 15). However, there was a marked increase in clotting time at the 22 day time point and this loss of clotting activity continued through until Day 85 (see Rows 3, 4, 5 and 6). This example therefore demonstrated a gradual loss of OsPA activity when formulated with surfactant only over time when the OsPA containing blood collection tubes were stored at room temperature. Example 8 - Stability of clotting compositions relative to storage time and other additives

Example 8.1 - Introduction

[00408] This experiment aimed to investigate the effects on clotting time of ten reagents known to stabilize proteins under some conditions. Samples of freshly diluted prothrombin activator (OsPA, either 0.25ng or 1 ug +/- ammonium-acetate pH 6.8) were placed in Greiner White Top plain (Code #456001 ) blood collection tubes (+/- hydrophilic surfactant (20μΙ of 2.41 g/L in water) +/- 0.5% BSA; and other potential stabilizing agents: +/- 0.1 % PEG; +/- 0.5% Prionex®; +/- 1 mM Glycine/Arginine; +/- 534nm Textilinin; +/- 1 mM trisodium citrate; +/- 0.5% mannitol; +/- 0.5% sorbitol: +/- 0.5% dextran; +/- 0.5% gelatin) in HEPES buffer. The tubes were prepared as per Example 2, being dried using a Genevac® and stored at room temperature in a dry environment for up to 99 days. Whole blood clotting assays were performed weekly using citrated, pooled blood prepared as per Example 4. After storage, the tubes were used for blood clotting assay using the visual clotting method as per Example 5. All steps were carried out at room temperature. Controls using freshly diluted OsPA in liquid form were performed each week, as well as controls using Hepes buffer only.

Example 8.2 - Results

[00409] Table 8 shows a loss of clotting activity by Day 85 for the 1 pg OsPA samples. Loss of activity occurs some time between Day 15 and Day 22.

Table 8. Clotting of recalcified citrated whole blood in dry OsPA-containing blood collection tubes

Table 8 shows the results of the experiment covering storage for up to 99 days (over 3 months) at room temperature. Figures shown are the number of seconds required for clot formation. BSA and dextran separately stabilized the blood clotting activity of OsPA compared with buffer alone. For example, after 99 day storage, the clotting time for the OsPA/BSA and OsPA /dextran tubes was 380 and 310 seconds, respectively, compared with the fresh control (95 seconds), OsPA only (510 seconds) and the the control without OsPA (710 seconds). This result demonstrated the ability of 1 \ig of OsPA to clot 4 mL of recalcified citrated whole blood in approximately 5 minutes after storage at room temperature for three months, with either dextran or BSA. Other reagents which gave some degree of stabilization were sorbitol, Prionex®, gelatin and mannitol.

Example 9 - Stability of clotting compositions relative to storage time, temperature and addition of the colloid Gelofusine Example 9.1 - Introduction

[00410] In seeking to further improve the stability of the clotting activity of dried prothrombin activators such as OsPa, the plasma extender Gelofusine was tested. The colloid Gelofusine (B. Braun) is a sterile solution of succinylated gelatin (4% w/v) in isotonic saline and is low cost and readily available.

[00411] This experiment aimed to investigate the effects of a protein colloid as a stabilizer to preserve clotting time function over time. Tubes were prepared as per Example 2. wherein the colloid was rolled onto the inside surface of the tube. Samples of freshly diluted prothrombin activator (OsPA, ^ig +/- ammonium-acetate pH 6.8) in 20μΙ_ Gelofusine pH 7.4 were placed in Greiner White Top plain (Code #456001) blood collection tubes (+/- hydrophilic surfactant (20μί of 2.41g/L in water). The tubes were then dried using a Genevac® as per Example 2 and stored at room temperature for up to 211 days (Figure 9 and 10). Whole blood prepared as per Example 4 was used in whole blood clotting assays and assessed in this example by the Visual Clotting Assessment method as per Example 5. After storage and at each time point, blood samples (citrated, pooled) were aliquoted into the tubes with a final volume of 4mL, and the tube containing the sample subjected to the standard whole blood clotting assay as per Example 5. All steps were carried out at room temperature. Controls using freshly diluted OsPA in liquid form were performed at each time point in addition to appropriate controls that were devoid of OsPA.

[00412] In addition, 12 tubes were tested using fresh blood as per Example 4 with Visual Clotting Assessment conducted as per Example 5. The tubes were prepared as per Example 2, with samples of freshly diluted prothrombin activator (OsPA, 1 ng in 20μί Gelofusine pH7.4) placed in Becton Dickinson plain (Code #3276916) blood collection tubes + hydrophilic surfactant (20μΙ_ of 2.41g/L in water). The tubes were then dried using a Genevac® as per Example 2. The visual clotting time at TO was 158.9 +/- 95 seconds, comparable to the experiments with citrated blood in BD plain tubes. Example 9.2 - Results and discussion

[00413] Results are shown in Figures 9 (histogram) and 10 (line graphs). After seven months (211 days) at room temperature, the clotting time using 1 OsPA of 4 mL blood was 265 seconds, compared with 84 seconds for the fresh control and 950 seconds for recalcified citrated blood sample control with no additions. Excellent stability was observed up to 121 days but then there was a loss of activity between 121 and 157-day measurements. The slope of the 'dried OsPA ^' line graph is 1.0 seconds/day if all time points are considered and 0.79 seconds/day if points from day 1 to day 121 only are considered.

[00414] The rates of loss of clotting activity in Example 10 and the present example were then compared. The initial rates of activity loss were 1.67 seconds per day in Example 10 (presence of BSA and dextran) and 0.79 seconds per day in Example 9 (presence of Gelofusine as an exemplary colloid). If all data points in each trial are considered, the corresponding rates were 1.29 in Example 11 and 1.0 in Example 10. These datatherefore show that the colloids dextran, BSA and Gelofusine are effective in stabilising OsPA, with Gelofusine appearing to have the greatest effect out of the samples tested. Example 10 - Stability of clotting compositions relative to storage time, temperature and addition of BSA and dextran

Example 10.1 - Introduction

[00415] This experiment aimed to investigate the effects of BSA and Dextran combined as a stabiliser to preserve clotting function over time (Figures 11 and 12). Tubes were prepared as per Example 2. Samples of freshly diluted prothrombin activator (OsPA, 1 ^ig in 20 L ammonium-acetate solution containing +/- 0.5% dextran, +/- 0.5% BSA pH 6.8) were placed in Greiner White Top plain (Code #456001 ) blood collection tubes (+/- hydrophilic surfactant (20μ of 2.41g/l in water) The tubes were then dried using a Genevac® as per Example 2 and stored at room temperature for up to 195 days as per Example 5. Whole blood prepared as per Example 4 was used in whole blood clotting assays, assessed in this example by the Visual Clotting Assessment method as per Example 5. After storage and at each time point, blood samples (citrated, pooled) were aliquoted into the tubes, final volume of 4ml and the tube containing the sample subjected to the standard whole blood clotting assay as per Example 5. All steps were carried out at room temperature. Controls using freshly diluted OsPA in liquid form were performed at each time point in addition to appropriate controls that were devoid of OsPA.

Example 10.2 - Results and discussion

[00416] Figure 1 1 shows the results of the experiment covering storage for up to 195 days (about 6.5 months) at room temperature as a histogram, and Figure 12 shows the corresponding line graphs. Comparing these results with those in Table 8 shows that BSA and dextran together gave greater stabilization than either material alone. After 6.5 months storage, the clotting time for the OsPA/BSA/dextran tubes was 247 seconds compared with the fresh control (83 seconds) and the control without OsPA (957 seconds). The slope of the line graph in Figure 12 including all time points is 1.29 seconds per day (increase in clotting time per day). If the last four time points are excluded, the slope is 1.67 seconds per day (R2 = 0.87).

Example 11 - Stability of clotting compositions relative to temperature and addition of the colloid Gelofusine

Example 11.1 - Introduction

[00417] The aim of this study was to determine the stability of the whole blood clotting activity of OsPA dried in Gelofusine when stored at 50°C. Forced degradation at higher than the normal storage temperature has often been used to obtain stability data more rapidly than by storing samples for a defined period at the elevated storage temperature. The rate of loss of activity at the higher temperature can then be extrapolated to the normal storage temperature, for example, by using the Arrhenius equation.

[00418] As well as testing stability when OsPA was dried in Gelofusine at pH 7.4, the effect of adjusting the Gelofusine pH to 6.0 was also determined. The reason for studying the effect of a lower pH was to investigate the possibility that the Factor Xa component of OsPA is able to catalyse the proteolysis of OsPA with concomitant loss of activity. The catalytic activity of OsPA is lower at pH 6.0 than at pH 7.4. [00419] Tubes were prepared as per Example 2. Two sets of samples were prepared, one set with Greiner White Top plain (Code #456001 ) blood collection tubes and one with BD red top plain blood collection tubes (Code #3276916)., For each set of samples, freshly diluted prothrombin activator (OsPA, either 1 μς, 2μς or 5μς,) were placed in the tubes +/- hydrophilic surfactant (20μΙ_ of 2.41 g/L in water) +/- 50 μΙ of 4% w/v Gelofusine; and buffered to either pH 7.4 or pH 6.0. The tubes were then dried using a Genevac® as per Example 2 and stored at room temperature for up to 21 1 days as per Example 2. Whole blood prepared as per Example 4 was used in whole blood clotting assays, assessed in this example by the Visual Clotting Assessment method as per Example 5. After storage and at each time point, blood samples (citrated, pooled) were aliquoted into the tubes, final volume of 4ml and the tube containing the sample subjected to the standard whole blood clotting assay as per Example 5. All steps were carried out at room temperature. Controls using freshly diluted OsPA in liquid form were performed at each time point in addition to appropriate controls that were devoid of OsPA.

Example 11.2 - Results and discussion

[00420] Figures 13 and 14 show the results of the 50°C stability trial with BD tubes. Figures 15-18 show results with Greiner tubes.

[00421] Based on these results, the corresponding experiment in Greiner tubes was modified so as to use a single amount of OsPA (1 ng). Results in Figures 15 (pH 7.4) and 18 (pH 6.0) showed that the OsPA was much more stable in the Greiner tubes than in the BD tubes (compare Figures 13 and 15 and Figures 14 and 16). Accordingly, the experiment was continued for 30 days rather than the 7 day cut off for the BD experiment.

[00422] After 30 days, the clotting time for the 50°C tube was 153.5 seconds compared with 1 17.5 seconds for the tube kept at room temperature and 83.5 seconds for the fresh control (Figure 16). Comparison of the Figure 15 and 16 data also shows that adjusting the pH to 6 had a small beneficial effect (cf. Figures 13 and 14).

[00423] The results in Figure 13 show that maintaining the OsPA-containing BD tubes at 50°C led to a progressive loss of activity, such that a high percentage of the original activity had been lost by 7 days. Similar results were obtained using 1 , 2 or 5 pg OsPA except that a higher percentage of the original activity was lost in the 5 ς tubes than in the 2 ς tubes which in turn lost more activity than the 1 tubes. This result is consistent with earlier suggestions that the proteolytic activity of OsPA may result in self-degradation, which would occur faster at higher concentrations. Another possible reason for this concentration dependence of activity loss is that the amount of Gelofusine per tube was the same in all tubes whereas the OsPA amount changed from 1 A higher Gelofusine to OsPA ratio may give better protection. Figure 14 shows that similar results were obtained when the pH of the Gelofusine was adjusted from 7.4 to 6.0 prior to addition of OsPA and drying. However, comparison of the clotting times after 1 and 7 days storage at 50°C suggests that there was slightly slower loss of activity at pH 6 than at pH 7.4. This also fits the "proteolytic loss of activity" hypothesis.

[00424] The results clearly show that the loss of activity was greater in the BD than in the Greiner tubes. One possible reason is that the surfactant used may not have been suited to the type of plastic in the BD tubes. It should be noted that the rate of loss of activity in the Greiner tubes at 50°C was not much greater than the rate of loss in the corresponding experiment at room temperature. This may be due to excess moisture in the film at the lower temperature. It should be noted that commercially produced blood collection tubes are sealed under vacuum, which may limit the amount of moisture within the surface film.

[00425] The clotting times in Figures 15 and 16 were plotted as line graphs in an attempt to determine the rate of loss of activity at 50°C. per Figures 17 and 18, respectively. The slope of the line of best fit for the 50°C data in Figure 17 was an increase in clotting time of 1.86 seconds per day of storage. The corresponding slope for the room temperature storage in Example 9 was 0.79 seconds per day (based on the initial rate).

Example 12 - Stability of clotting compositions relative to irradiation

Example 12.1 - Introduction

[00426] Irradiation is routinely used in the commercial production of standard blood collection tubes as a means of sterilization. This experiment aimed to investigate the effect on OsPA of gamma irradiation at an industrially relevant dose of 15kGy. The experiment was conducted in two parts: Part 1 : OsPA with gelofusine, Part 2: OsPA and snake-venom derived ecarin with gelofusine and trehalose.

[00427] In Part 1 , tubes were prepared as per Example 2. Freshly diluted prothrombin activator (OsPA, either l ^ig, or 5μ9,) was placed in Greiner White top blood collection tubes (Code# 456001 ) + hydrophilic surfactant (20μΙ_ of 2.41 g/L in water) and either 50 \sl of 4% w/v Gelofusine; Hepes buffer pH7.4, or Hepes buffer pH 7.4 + 0.5% Dextran + 0.5% BSA. The tubes were then dried using a vacuum dessicator as per Example 2 and stored at room temperature while irradiation was done as per Example 3. Eight tubes were manufactured with each formulation, being four tubes for irradiation as per Example 3 and four tubes to be stored at room temperature as per Example 2. [00428] Tubes to be irradiated were sent to the irradiation facility on Day 1 after preparation. After irradiation with 15 kGy, the tubes were returned and assayed on Day 8. Irradiation was conducted as per Example 3 at the Gammacell 220 irradiation facility (ANSTO, Building 23, New lllawarra Road, Lucas Heights, NSW 2234, Australia) at 1.92kGy/h for 7.88 hours at 23.4°C for 7.88 hours, delivering a total dose of 15.1 kGy.

[00429] For Part 2, tubes were prepared as per Example 2 including coating with hydrophilic surfactant. Prothrombin activator (OsPA or ecarin),was prepared by diluring concentrated solutions into Gelofusine containing 6% or 10% trehalose. Twenty μί aliquots containing either ^{^} \ μ$, or 5μρ,οί OsPA or 2 IU of ecarin, were placed in Greiner White top plain tubes (Code number 456001 ) and BD Red top no additive tubes (Code number 366408). The tubes were then dried using a Genevac as per Example 2 and stored at room temperature while irradiation was done as per Example 3. Thirty-two OsPA- containing tubes and eight ecarin-containing tubes were manufactured, being twenty tubes for irradiation as per Example 3 and twenty tubes to be stored at room temperature as per Example 2.

[00430] Tubes to be irradiated were again sent to the irradiation facility on Day 1 after preparation. After irradiation on Day 8 with 15 kGy, the tubes were returned and assayed on Day 20. Irradiation was conducted as per Example 3 at the Gammacell 220 irradiation facility (ANSTO, Building 23, New lllawarra Road, Lucas Heights, NSW 2234, Australia) at 1.92kGy/h for 7.88 hours at 23.4°C for 7.88 hours, delivering a total dose of 15.1 kGy.

[00431] Whole blood prepared as per Example 4 was used in whole blood clotting assays, assessed in this example by the Visual Clotting Assessment method as per Example 5. All steps were carried out at room temperature. Controls using freshly diluted OsPA in liquid form were performed in addition to appropriate controls that were devoid of OsPA. All tubes with clotted blood were centrifuged after 35 minutes. Serum from individual tubes was imaged and collected for biochemical analyte testing. Example 12.2 - Part 1 Results and discussion

[00432] The results in Figure 19 show that irradiation with 15 kGy led to a loss of most of the clotting activity in all samples with 1 μ OsPA. Gelofusine gave significant protection of the clotting activity, that is, tubes retained -20% activity of non-irradiated tubes whereas in the Hepes buffer alone, nearly all of the activity was lost. Both Dextran and BSA in the Hepes buffer and Gelofusine gave protection of the clotting activity, Gelofusine doing so to a greater extent. There was also some loss of activity in the tubes which had been dried and stored at room temperature but not irradiated (Figure 19A), consistent with earlier experiments which showed loss of activity when samples were dried by vacuum dessicator. This did not significantly affect the results in the Gelfusine tubes or in the tubes containing Hepes with BSA and dextran. However, with Hepes alone, the tubes containing 1 pg OsPA lost most activity without irradiation, confirming earlier tests.

[00433] The concentration dependence of clotting times shown in Figure 4 allows an estimation to be made of how much of the clotting activity had been lost due to irradiation. For example, the clotting time of the irradiated tubes containing 5 g OsPA was 134 seconds (Figure 19a). The clotting time in a tube containing 0.3 μg OsPA was 137 seconds (Figure 4). Therefore the activity of the 5 μg OsPA after irradiation was approximately the same as the activity of 0.3 μg of fresh OsPA. Similarly, 1 μg of irradiated OsPA in Gelofusine gave a clotting time of 733 seconds compared with 744 seconds for 0.05 μg of fresh OsPA.

Example 12.3 - Part 2 Results and discussion

[00434] Figure 19B shows the results of the trials with OsPA tubes formulated with Gelofusine and 6% or 10% trehalose. The results show that irradiation with 15 kGy led to some loss of the clotting activity in all samples at day 12 after irradiation. However, Gelofusine containing 6% and 10% trehalose gave significant protection of the clotting activity of OsPA compared with the results shown in Figure 19A.. Furthermore, the clotting time of 1 μg OsPA dried in Gelofusine with 10% trehalose was about 5 min after irradiation.

[00435] The results in Figure 19C show that irradiation with 15 kGy did not affect the clotting activity of ecarin at 2 IU dried in Gelofusine containing 10% trehalose.

Example 13 - Stability of clotting compositions relative to irradiation II

[00436] This experiment aimed to investigate the effect on OsPA of gamma irradiation at an industrially relevant dose of 25kGy with tubes formulated with Ecarin. The experiment was conducted in two parts: Part 1 : Ecarin with gelofusine, Part 2: Stability at room temperature of irradiated tubes.

[00437] In Part 1 , tubes were prepared as per Example 2. Freshly diluted Ecarin 2U was placed in Greiner White top blood collection tubes (Code# 456001 ) + hydrophilic surfactant (20μί. of 2.41 g/L in water) and 20 μί. of 4% w/v Gelofusine. The tubes were then dried using a Genevac as per Example 2 and stored at room temperature while irradiation was done as per Example 3.

[00438] Tubes to be irradiated were sent to the irradiation facility on Day 1 after preparation. After irradiation with 25 kGy, the tubes were returned and assayed on Day 7. Irradiation was conducted as per Example 3 at the Gammacell 220 irradiation facility (ANSTO, Building 23, New lllawarra Road, Lucas Heights, NSW 2234, Australia) [00439] For Part 2, tubes with and without irradiation treatment were stored at room temperature as per Example 2.

[00440] Whole blood prepared as per Example 4 was used in whole blood clotting assays, assessed in this example by the Visual Clotting Assessment method as per Example 5. All steps were carried out at room temperature. Controls using freshly diluted OsPA in liquid form were performed in addition to appropriate controls that were devoid of OsPA. All tubes with clotted blood were centrifuged after 35 minutes.

Example 13.1 -Results and discussion

[00441] The results in Figure 20 show that irradiation with 25 kGy led to a minor loss of clotting activity at Day 7 in samples with 2U Ecarin (123 seconds) compared to dried and not irradiated (119 seconds). After 212 days at room temperature, there was again a minor difference between tubes which has been irradiated compared to those tubes which had not been irradiated (264 seconds compard to 254 seconds). This example illustrates that the prothrombin activator Ecarin in an appropriate formulation exhibits stability in the presence of irradiation and after subsequent long term storage at room termperature.

Example 14 - Stability of clotting compositions relative to storage time, temperature and other additives II

Example 14.1 - Introduction

[00442] Experiments were carried out to determine if the stability of OsPA when stored or transported at room temperature and at elevated temperatures such as at 50°C could be enhanced by the use of sugars and other additives. Tubes were prepared as per Example 2. Freshly diluted OsPA 1 μς was placed in Greiner White top plain blood collection tubes (Code #456001 ) (+ hydrophilic surfactant (20μΙ_ of 2.41 g/L in water) +/- 20 μΙ_ of 4% w/v Gelofusine, and containing 10% of trehalose, mannose, sucrose and sorbitol, 1 mM benzamidine and 0.1 m EDTA. In part 1 , the tubes were then dried using a vaccum dessicator as per Example 2 and stored at 50°C for up to 71 days (see Figure 21). In part 2, the tubes were then dried using a vaccum dessicator as per Example 2 and stored at room temperature for up to 392 days (see Figure 22). In part 3, additional tubes were prepared as per Example 2 using OsPA g placed in BD red top plain blood collection tubes (Code #3276916) (+ hydrophilic surfactant (20μί of 2.41 g/L in water) + 20 μί. of 4% w/v Gelofusine, and containing 6 or 10% of lactulose. In part 3, the tubes were then dried using a Genevac vacuum drier as per Example 2 and stored at room temperature for 22 days (see Figure 23).

[00443] Whole blood prepared as per Example 4 was used in whole blood clotting assays, and assessed by the Visual Clotting Assessment method as per Example 5. After storage, blood samples (citrated, pooled) were aliquoted into tubes, with a final volume of 4mL. Tubes containing the samples were then subjected to the standard whole blood clotting assay as per Example 5. All steps were carried out at room temperature. Controls using freshly diluted OsPA were performed at each time point in addition to appropriate controls that were devoid of prothrombin activator.

Example 14.2 - Part 1 - Results and discussion.

[00444] Figure 21 shows a time course in which major loss of activity with OsPA was found at 7 days in all samples when the samples were dried in a vacuum-dessicator. Subsequent storage at 50°C gave no further loss of activity. Indeed, some samples showed partial recovery of activity. It is possible that the initial loss of activity may have been due to incomplete drying of samples, such that the presence of moisture was the cause of the initial loss of activity. The trehalose-containing sample had a clotting time of 367 seconds after 10 weeks at 50°C and the other sugars around 580-600 seconds after the same period.. This is very encouraging assuming that the initial loss of activity can be prevented, and suggests that agents such as colloids with stabilising additives can effectively stabilize the activity of prothrombin activators when stored at elevated temperatures over extended periods of time.

Example 14.3 - Part 2 - Results and discussion.

[00445] Figure 22 illustrates that although the drying process leads to a decrease in activity at TO, subsequent storage at room temperature for 392 days showed retention of activity within 425 seconds in samples formulated with Trehalose and sucrose. Formulations with other additives appeared to have a negative effect on clotting activity. This is also very encouraging assuming that the initial loss of activity can be prevented, and suggests that agents such as colloids with stabilising additives can effectively stabilize the activity of prothrombin activators when stored at commercially relevant temperatures over extended periods of time.

[00446] Example 14.4 Part 3 - Results and Discussion

[00447] Figure 23 illustrates that lactulose when formulated with gelofusine appears to have a protective effect from the drying process at TO. Although only stored for 22 days at Room Temperature, the results show an improvement in clotting time with 10% lactulose, indicating that there may be a stabilising effect on OsPA over extended periods of time.

Example 15: Stability of clotting compositions relative to storage time, temperature and other additives III

Example 15.1 - Introduction

[00448] Experiments were carried out to determine if the stability of Ecarin when stored or transported at room temperature could be enhanced by the use of sugars and other additives. Tubes were prepared as per Example 2. Freshly diluted Ecarin 1 U was placed in Greiner White top plain blood collection tubes (Code #456001 ) (+ hydrophilic surfactant (20μΙ_ of 2.41g/L in water) +/- 20 μί. of 4% w/v Gelofusine, and containing 10% of trehalose, mannose, sucrose and sorbitol, 1 mM benzamidine and 0.1 m EDTA. The tubes were then dried using a vaccum dessicator as per Example 2 and stored at room temperature for up to 392 days (see Figure 23)

[00449] .Recalcified, citrated whole blood prepared as per Example 4 was used in whole blood clotting assays, and assessed by the Visual Clotting Assessment method as per Example 5. After storage, blood samples (citrated, pooled) were aliquoted into tubes, with a final volume of 4mL. Tubes containing the samples were then subjected to the standard whole blood clotting assay as per Example 5. All steps were carried out at room temperature. Controls using freshly diluted OsPA were performed at each time point in addition to appropriate controls that were devoid of prothrombin activator.

Example 15.2 - Results and discussion.

[00450] Figure 24 illustrates that although the drying process leads to a decrease in activity at TO, subsequent storage at room temperature for 392 days showed retention of activity within 350 seconds in samples formulated with Trehalose and Sucrose. Formulations with other additives appeared to have a negative effect on clotting activity although not as much as in Example 13 when OspA was used as the active.. This is also very encouraging assuming that the initial loss of activity can be prevented, and suggests that agents such as colloids with stabilising additives can effectively stabilize the activity of prothrombin activators when stored at commercially relevant temperatures over extended periods of time. Example 16 - Effect of Gelofusine on Analyte Detection

Example 16.1 - Introduction

[00451] This study aimed to determine whether or not the addition of gelofusine to blood collection tubes had any clinically significant effect on the ability to detect range of biochemical analytes.

[00452] The following tube samples were prepared according to Example 2 in the following tubes: Greiner White top plain tube (Code number 456001 , Greiner Red top serum tube (Code number 456092), BD Red top plain tube (Code number #3276916) and BD no additive tube (Code number 366408): (1 ) Greiner plain tube with OsPA in Hepes buffer + hydrophilic surfactant A, (2) Greiner plain tube with OsPA + gelofusine + hydrophilic surfactant A, (3) BD plain tube with OsPA in Hepes buffer + hydrophobic surfactant; (4) BD plain tube with OsPA + gelofusine + hydrophobic surfactant, (5) Greiner serum tube. (6) Greiner serum tube +gelofusine, (7) Greiner serum tube + OsPA in Hepes buffer, (8) Greiner serum tube + OsPA +gelofusine, (9) BD serum tube, (10) BD serum tube + gelofusine, (11 ) BD serum tube + OsPA in Hepes buffer, and (12) BD serum tube + OsPA +gelofusine.

[00453] Each of these tube samples was then used to detect a range of analytes as shown in Table 9. Analytes were tested as per Example 5.

Example 16.2 - Results and discussion

[00454] Results are shown in Table 9. OsPA added on top of the comemrcial serum tubes (both Greiner tubes 7 and 8 and BD tubes 11 and 12) maintained normalanalyte detection. The addition of gelofusine had no clinical impact on any of the measured analytes. The addition of gelofusine to blood collection tubes therefore appears to have no impact on the ability to detect analytes.

Table 9 - Detection of analytes using Gelofusine in blood collection tubes

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40. EP 0 628 816

41. US 4,227,620

42. US 4,256,120

43. US 4,873,192

44. US 6,187,553

45. US 6,413,737

46. US 6,416,717

47. US 6,592,613

48. US 6,686,204

49. US 7,488,287

50. US 7,699,828

51. US 8,586,323