REAGENTS FOR PERFORMING THE SAME CROSS-REFERENCING

This application claims the benefit of U.S. provisional application serial nos.

62/648,874, filed on Mar 27, 2018, and 62/685,248, filed on Jun 14, 2018, which applications are incorporated by reference herein. BACKGROUND

Tests that detect hemoglobin (Hb) in a stool specimen are commonly used for colorectal cancer screening. The common procedures utilize a sample collection device that contains buffer to stabilize hemoglobin from the time of collection until the detection assay is conducted at the lab. The ability of the buffer to properly stabilize hemoglobin is critical for accurate test results and must stabilize hemoglobin during shipment over a range of environmental conditions. Increasing the ability of the buffer to stabilize hemoglobin would, for example, allow longer shipping durations and provide more flexibility to the patient and test lab for sample processing. SUMMARY

Provided herein, among other things, is a stool resuspension solution that comprises a hemoglobin stabilization reagent. In some embodiments, the hemoglobin stabilization reagent in the solution may be an osmolyte, a polyvalent cation, a sugar or polysaccharide and, optionally, a polyvalent cation, a protoporphyrin, or an HRP stabilization component and, optionally, a polyvalent cation.

The solution finds use in methods that may benefit from stabilizing hemoglobin. In some embodiments, this method may comprise combining the stool sample with the stool resuspension solution to produce a suspension, and maintaining the suspension for a period of time. In some embodiments, this method may comprise shipping the suspension to a remote location. The hemoglobin stabilization reagent in the solution stabilizes the hemoglobin, thereby allowing the hemoglobin in the sample to be more accurately measured after several days in transit.

Compositions, methods and devices that employ the stool resuspension solution are provided. DESCRIPTION OF EXEMPLARY EMBODIMENTS

Before the present invention is described in greater detail, it is to be understood that this invention is not limited to particular embodiments described, as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present invention will be limited only by the appended claims.

Where a range of values is provided, it is understood that each intervening value, to the tenth of the unit of the lower limit unless the context clearly dictates otherwise, between the upper and lower limit of that range and any other stated or intervening value in that stated range, is encompassed within the invention. The upper and lower limits of these smaller ranges may independently be included in the smaller ranges and are also encompassed within the invention, subject to any specifically excluded limit in the stated range. Where the stated range includes one or both of the limits, ranges excluding either or both of those included limits are also included in the invention.

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

All publications and patents cited in this specification are herein incorporated by reference as if each individual publication or patent were specifically and individually indicated to be incorporated by reference and are incorporated herein by reference to disclose and describe the methods and/or materials in connection with which the publications are cited. The citation of any publication is for its disclosure prior to the filing date and should not be construed as an admission that the present invention is not entitled to antedate such publication by virtue of prior invention. Further, the dates of publication provided may be different from the actual publication dates which may need to be independently confirmed.

It must be noted that as used herein and in the appended claims, the singular forms “a”,“an”, and“the” include plural referents unless the context clearly dictates otherwise. It is further noted that the claims may be drafted to exclude any optional element. As such, this statement is intended to serve as antecedent basis for use of such exclusive terminology as “solely,”“only” and the like in connection with the recitation of claim elements, or use of a “negative” limitation. As will be apparent to those of skill in the art upon reading this disclosure, each of the individual embodiments described and illustrated herein has discrete components and features which may be readily separated from or combined with the features of any of the other several embodiments without departing from the scope or spirit of the present invention. Any recited method can be carried out in the order of events recited or in any other order which is logically possible.

A stool resuspension solution comprising one or more hemoglobin stabilization reagents is provided. In some embodiments, the one or more hemoglobin stabilization reagents may be selected from, e.g., an osmolyte, a polyvalent cation, a sugar or

polysaccharide and, optionally, a polyvalent cation, a protoporphyrin and an HRP

stabilization component and, optionally, a polyvalent cation. Examples and concentrations of such reagents in the solution are set forth in the tables shown below and in the appendices.

In some embodiments, the solution may comprise an osmolyte, e.g., betaine. In these embodiments, the osmolyte (e.g., betaine) may be at a concentration in the range of 2 M to 5 M.

In some embodiments, the solution may comprise a sugar, e.g., sucrose or trehalose.

In these embodiments, the sugar (e.g., sucrose or trehalose) may be at a concentration in the range of 0.1 M to 0.5 M. In either case, the solution may optionally contain a polyvalent cation, Mg ²⁺ or Ca ²⁺ _. In these embodiments, the polyvalent cation (e.g., calcium or magnesium ions) may be at a concentration in the range of 5 mM to 25 mM.

In some embodiments, the solution may comprise a polysaccharide, e.g., a substituted or unsubstituted polygalacturonic acid such as a-( 1— 4 J-l i nked D-galacturonic acid. In these embodiments, the polysaccharide (e.g., the substituted or unsubstituted polygalacturonic acid) may be at a concentration in the range of 0.005% to 0.5% (e.g., 0.01% to 0.125%). In these embodiments, the solution may optionally contain a polyvalent cation. In embodiments in which the solution contains a polyvalent cation, the polyvalent cation may be at a

concentration in the range of 5 mM to 25 mM. In some embodiments, the solution may comprise substituted or unsubstituted polygalacturonic acid and a multivalent cation (e.g., a calcium salt or magnesium salt) at a concentration in the range of 5 mM to 25 mM.

In some embodiments, the solution may comprise a protoporphyrin, e.g., a protoporphyrin IX or an analog thereof such as octaethylporphyrin (H ₂ OEP) or

tetraphenylporphyrin (H2TPP), complexed with a metal ion. In these embodiments, the protoporphyrin may be hemin (protoporphyrin IX containing a ferric iron (Fe ³⁺ ) ion with a coordinating chloride ligand) or hematin. In other embodiments, the protoporphyrin may be protoporphyrin IX complexed with a divalent or trivalent cation (e.g., Zn ²⁺ , Cr ³⁺ , or Co ³⁺ , for example). In these embodiments, the protoporhyrin may in the solution at a concentration in the range of 0.1 mM to 100 pM (e.g., 1 pM to 10 pM). In some embodiments, the solution may comprise an HRP stabilization component selected from HRP Conjugate Stabilizer (PN 85R-102; Fitzgerald Industries), HRP Conjugate Stabilizer (PN SZ02; Surmodics) and HRP Conjugate Stabilizer (PN abl7l537; Abeam). Other HRP stabilization components, e.g., , AbGuard (BioRad PN: BUF052; BioRad Laboratories Inc. 2000 Alfred Nobel Dr, Hercules, CA 94547) can potentially be used. If the solution comprises an HRP stabilization component, then the component may be at a concentration in the range of 1% to 20%, e.g.,

5% to 15% or 5% to 20%.

In any embodiment, the solution may comprise a polyvalent cation, e.g., calcium or magnesium ions. In these embodiments, the polyvalent cation may be at a concentration in the range of 5 mM to 25 mM.

In any embodiment, the solution further comprises Tris buffer (e.g., 10 mM to 50 mM Tris, pH 7.5), bovine serum albumen (e.g., 5% to 20% BSA), polysorbate 20 (e.g., 0.05% to 0.2% polysorbate 20), a preservative such as sodium azide (e.g., 0.05% to 0.2% sodium azide), a salt such as sodium chloride (e.g., 50 mM to 250 mM sodium chloride), a chelator such as ethylenediaminetetraacetic acid (e.g., 5 mM to 20 mM ethylenediaminetetraacetic acid), and an antibiotic such as gentamicin (e.g., 5 ug/mL to 50 ug/mL).

A composition comprising: (a) a stool sample and (b) the stool resuspension solution, as described above, is also provided. The stool sample may be suspended in the solution. Some components of the stool may be dissolved in the solution, where other, insoluble components, may be suspended but not dissolved in the solution. In some embodiments, the stool sample may contain hemoglobin which may be dissolved in the solution. In these embodiments, the presence of the hemoglobin stabilization reagent may increase the amount of hemoglobin in the sample after it has been subjected to a real or simulated shipping stress, as described below, as compared to an otherwise identical control sample that has not been subjected to the stress, e.g., a“To” sample. In some embodiments, use of the hemoglobin stabilization reagent may increase the amount of hemoglobin in the sample by at least 10%, at least 20 or at least 30%, relative to a control stool sample that has been suspended in an otherwise identical solution that does not contain the hemoglobin stabilization reagent. The amount of hemoglobin in the sample may be determined by enzyme-linked immunosorbent assay (ELISA) although several other methods are known (see, generally, Haug et al, Am J. Gastroenterology 105: 682-690; Ahlquist et al, Ann Intern Med 1984;101:297-302; Ahlquist et al, JAMA 1993 269:1262-1267; Young et al Dig Dis Sci. 2015 60: 609-622; and

Harewood et al Mayo Clin. Proc. 2002 77: 23-28).

Also provided is a method of stabilizing stool hemoglobin. In some embodiments, this method may comprise combining the stool sample with the stool resuspension solution as described above, i.e., a solution comprising one or more hemoglobin stabilization reagents selected from: an osmolyte, a polyvalent cation, a sugar or polysaccharide and, optionally, a polyvalent cation; a protoporphyrin; and an HRP stabilization component and, optionally, a polyvalent cation, to produce a suspension; and maintaining the suspension for a period of time. Details of the identities of the reagents that can be in the solution as well as their concentrations are described above, below and in the accompanying appendices. In some embodiments, the method may comprise obtaining the stool sample from a larger mass of stool by scraping or scooping, e.g., using a stool sampling implement.

In some embodiments, the method may comprise shipping the sample to a remote location, e.g., to another town, city, state or country, for testing. In these embodiments, the sample may be waiting to be shipped, en route, or waiting to be tested at a remote location for several days, e.g., 3, 4, 5, 6, or 7 days, thereby subjecting the sample to stresses that potentially reduce the amount of hemoglobin in the sample.

Also provided is a method that comprises receiving a composition that comprises: (a) a stool sample and (b) a stool resuspension solution comprising one or more hemoglobin stabilization reagents selected from, e.g., an osmolyte, a polyvalent cation, a sugar or polysaccharide and, optionally, a polyvalent cation, a protoporphyrin, and an HRP stabilization component and, optionally, a polyvalent cation. Examples and concentrations of such reagents in the solution are set forth above, below and in the accompanying appendices. In certain embodiments, this method may further comprise performing an assay on the sample after it has been received. For example, the concentration of hemoglobin in the solution may be measured, methods for performing which are described above. In addition, the amount of one or more colorectal cancer tumor markers in the sample may be tested after it has been received (see, generally, Lech et al, World J Gastroenterol. 2016 22: 1745-1755 and Scheruders et al, Curr. Treat. Options Gastroenterol. 2016 14: 152-162). These embodiments may further comprise forwarding test results to a remote location by, e.g., fax or e-mail, etc., or via the internet via a portal, so that the results can be obtained by a medical practitioner (e.g., an MD or a nurse, etc.), in advance of providing a diagnosis to the patient from which the stool sample was obtained. Also provided is a sample collection device that comprises: (a) a sample collection container having an open end; (b) a stool resuspension solution that is within the container, where the solution comprises one or more hemoglobin stabilization reagents selected from: an osmolyte, a polyvalent cation, a sugar or polysaccharide and, optionally, a polyvalent cation, a protoporphyrin, and an HRP stabilization component and, optionally, a polyvalent cation, as described herein; and (c) a stool sampling rod comprising a distal beveled tip for scooping and/or scraping a sample of stool. In this device, the distal end of the sampling rod is dimensioned to be inserted into the sample collection container and the proximal end of the sampling rod is adapted to connect with the open end of the sample collection container, thereby sealing distal end of the sampling rod within the device. In some embodiments, the sample collection container and sampling rod may connect via a screw fit. With the exception of the hemoglobin stabilization reagent, details, options and the design of an example of such a sample collection device can be found in US9211112, for example. In some embodiments, the device may comprise a) a body comprising a sample collection chamber bounded on a distal end by a penetrable seal affixed to a recessed sealing surface of the distal end of the body and bounded on a proximal end by a septum comprising an aperture, said penetrable seal being penetrable by a pipette tip or needle; b) a flexible sampling rod comprising a proximal portion and a distal portion, said sampling rod adapted to fit through and seal said aperture when said distal portion is in said sample collection chamber, wherein said distal portion comprises: i) an asymmetrical beveled tip at a distal end, said beveled tip having an apex at the circumference of the flexible sampling rod and configured to bend the flexible sampling rod away from collisions and/or to deflect collisions with an inserted pipette tip or needle; and ii) a plurality of stacked coaxial frusta of cones to form a plurality of metering ridges; and c) the stool resuspension solution described above in the sample collection chamber, as described in US9211112.

EMBODIMENTS

Embodiment 1. A composition comprising: (a) a stool sample; and (b) a stool resuspension solution comprising one or more hemoglobin stabilization reagents selected from: a protoporphyrin; a polyvalent cation; a sugar or polysaccharide and, optionally, a polyvalent cation; an osmolyte; and an HRP stabilization component and, optionally, a polyvalent cation.

Embodiment 2. The composition of embodiment 1, wherein the stool sample contains hemoglobin. Embodiment 3. The composition of embodiment 1, wherein the solution comprises betaine.

Embodiment 4. The composition of embodiment 2, wherein the betaine is at a concentration in the range of 2 M to 5 M.

Embodiment 5. The composition of embodiment 1, wherein the solution comprises sucrose or trehalose, and, optionally, a polyvalent cation.

Embodiment 6. The composition of embodiment 5, wherein the sucrose or trehalose is at a concentration in the range of 0.1 M to 0.5 M and the solution, optionally comprises, a polyvalent cation.

Embodiment 7. The composition of embodiment 1, wherein the solution comprises substituted or unsubstituted polygalacturonic acid and, optionally, a polyvalent cation.

Embodiment 8. The composition of embodiment 1 or 7, wherein the solution comprises a-(l-4)-linked D-galacturonic acid and, optionally, a polyvalent cation.

Embodiment 9. The composition of embodiment 7, wherein the substituted or unsubstituted polygalacturonic acid is at a concentration in the range of 0.005% to 0.5%.

Embodiment 10. The composition of embodiment 1, wherein the solution comprises substituted or unsubstituted polygalacturonic acid and a multivalent cation (e.g., a calcium salt or magnesium salt) at a concentration in the range of 5 mM to 25 mM.

Embodiment 11. The composition of embodiment 1, wherein the solution comprises a protoporphyrin.

Embodiment 12. The composition of embodiment 11, wherein the protoporphyrin is hemin or hematin.

Embodiment 13. The composition of embodiment 11, wherein the protoporphyrin comprises protoporphyrin IX complexed with a divalent or trivalent cation (e.g., Zn ²⁺ , Cr ³⁺ or Co ³⁺ ).

Embodiment 14. The composition of any of embodiments 11-13, wherein the protoporphyrin is at a concentration in the range of 0.1 mM to 100 pM (e.g., 1 pM to 10 pM).

Embodiment 15. The composition of embodiment 1, wherein the solution comprises an HRP stabilization component selected from HRP Conjugate Stabilizer (PN 85R-102; Fitzgerald Industries), HRP Conjugate Stabilizer (PN SZ02; Surmodics) and HRP Conjugate Stabilizer (PN abl7l537; Abeam)

Embodiment 16. The composition of embodiment 15, wherein the HRP stabilization component is at a concentration in the range of 1% to 20%. Embodiment 17. The composition of any prior embodiment, wherein the solution comprises one or more cations selected from iron, cobalt, chromium, zinc, calcium or magnesium ions.

Embodiment 18. The composition of embodiment 17, wherein the cations are at a concentration in the range of 5 mM to 25 mM.

Embodiment 19. The composition of any prior embodiment, wherein the stool sample is suspended in the solution.

Embodiment 20. The composition of any prior embodiment, wherein the solution further comprises Tris buffer, bovine serum albumen, polysorbate 20, sodium azide, sodium chloride, ethylenediaminetetraacetic acid, and gentamicin.

Embodiment 21. A method of stabilizing hemoglobin in a stool sample, comprising: combining the stool sample with a stool resuspension solution comprising one or more hemoglobin stabilization reagents selected from: a protoporphyrin; a polyvalent cation; a sugar or polysaccharide and, optionally, a polyvalent cation; an osmolyte; and an HRP stabilization component and, optionally, a polyvalent cation; to produce a suspension; and maintaining the suspension for a period of time.

Embodiment 22. The method of embodiment 17, wherein the method comprises shipping the suspension to a remote location.

Embodiment 23. A method of analyzing a stool sample, comprising: (a) receiving, from a remote location, a composition comprising: (i) a stool sample; and (ii) a stool resuspension solution comprising one or more hemoglobin stabilization reagents selected from: a protoporphyrin; a polyvalent cation; a sugar or polysaccharide and, optionally, a polyvalent cation; an osmolyte; and an HRP stabilization component and, optionally, a polyvalent cation, wherein the stool sample is suspended in the solution; and (b) measuring the amount of hemoglobin in the composition.

Embodiment 24. The method of embodiment 19, further comprising measuring the amount of one or more colorectal cancer tumor markers in the sample.

Embodiment 25. A sample collection device comprising: a sample collection container having an open end; a stool resuspension solution that is within the container, comprising one or more hemoglobin stabilization reagents selected from: a protoporphyrin; a polyvalent cation; a sugar or polysaccharide and, optionally, a polyvalent cation; an osmolyte; and an HRP stabilization component and, optionally, a polyvalent cation; and a stool sampling rod comprising a distal beveled tip for scooping and/or scraping a sample of stool, wherein the distal end of the sampling rod is dimensioned to be inserted into the sample collection container and the proximal end of the sampling rod is adapted to connect with the open end of the sample collection container, thereby sealing distal end of the sampling rod within the device.

Embodiment 26. The sample collection device of embodiment 25, wherein the sample collection container and sampling rod connect via a screw fit.

Embodiment 27. A method of stabilizing hemoglobin in a stool sample, comprising: combining the stool sample with a stool resuspension solution comprising protoporphyrin IX complexed with a multivalent cation to produce a suspension; and maintaining the suspension for a period of time.

Embodiment 28. The method of embodiment 27, wherein the method comprises shipping the suspension to a remote location.

Embodiment 29. A method of analyzing a stool sample, comprising: (a) receiving, from a remote location, a composition comprising: (i.) a stool sample; and (ii.) a stool resuspension solution comprising protoporphyrin IX complexed with a multivalent cation, wherein the stool sample is suspended in the solution; and (b) measuring the amount of hemoglobin in the composition.

Embodiment 30. The method of any of embodiments 27-29, further comprising measuring the amount of one or more colorectal cancer tumor markers in the sample.

Embodiment 31. The method of any of embodiments 27-30, wherein the multivalent cation is Cr ³⁺ or Co ³⁺ .

Embodiment 32. The method of any of embodiments 27-31, wherein the solution has a pH in the range of pH 6.5 to pH 7.4.

Embodiment 33. The method of any of embodiments 27-32, wherein the multivalent cation is Cr ³⁺ and the pH of the solution is in the range of pH 6.9 to pH 7.4.

Embodiment 34. The method of any of embodiments 27-32, wherein the multivalent cation is Co ³⁺ and the pH of the solution is in the range of pH 6.5 to pH 7.0.

Embodiment 35. The method of any of embodiments 27-34, wherein the

protoporphyrin IX is at a concentration in the range of 0.5 uM to 10 uM.

Embodiment 36. A sample collection device comprising: a sample collection container having an open end; a stool resuspension solution comprising protoporphyrin IX complexed with a multivalent cation; and a stool sampling rod comprising a distal beveled tip for scooping and/or scraping a sample of stool, wherein the distal end of the sampling rod is dimensioned to be inserted into the sample collection container and the proximal end of the sampling rod is adapted to connect with the open end of the sample collection container, thereby sealing distal end of the sampling rod within the device.

Embodiment 37. The sample collection device of embodiment 36, wherein the sample collection container and sampling rod connect via a screw fit.

Embodiment 38. The sample collection device of embodiment 36 or 37, wherein the multivalent cation is Cr ³⁺ or Co ³⁺ .

Embodiment 39. The sample collection device of any of embodiments 36-38, wherein the solution has a pH in the range of pH 6.5 to pH 7.4.

Embodiment 40. The sample collection device of any of embodiments 36-39, wherein the multivalent cation is Cr ³⁺ and the pH of the solution is in the range of pH 6.9 to pH 7.4.

Embodiment 41. The sample collection device of any of embodiments 36-39, wherein the multivalent cation is Co ³⁺ and the pH of the solution is in the range of pH 6.5 to pH 7.0.

Embodiment 42. The sample collection device of any of embodiments 16-21, wherein the protoporphyrin IX is at a concentration in the range of 0.5 uM to 10 uM.

Although the foregoing invention has been described in some detail by way of illustration and example for purposes of clarity of understanding, it is readily apparent to those of ordinary skill in the art in light of the teachings of this invention that certain changes and modifications may be made thereto without departing from the spirit or scope of the appended claims.

EXAMPLE 1

SIMULATED SHIPPING STRESS

To assess the stability of hemoglobin in stool samples, samples were exposed to simulated shipping stress conditions using a thermal cycler. Table 1 shows the time and temperature profile for a 3-Day (72 hour) shipping simulation. An ELISA based detection method is used to determine the hemoglobin concentrations of samples before and after exposure to the shipping simulation.

Hemoglobin stability is calculated as a % recovery of hemoglobin after the samples have been exposed to the shipping simulation.

An accelerated shipping simulation profile was created to mimic the 3-Day shipping simulation but in a shortened amount of time. Table 2 shows the time and temperature profile for an accelerated shipping simulation. Samples exposed to the accelerated shipping simulation exhibit similar levels of Hb stability as when exposed to the 3-Day shipping simulation.

To assess the stability of hemoglobin in stool samples beyond 3 days, a 7-Day shipping simulation was created. Table 3 shows the time and temperature profile for a 7-Day shipping simulation.

As an additional challenge, a shipping simulation meant to represent a“worst case” scenario was created using extreme temperatures. Table 4 show the time and temperature profile for a 3-Day extreme temperature shipping simulation.

ASSAY RESULTS

The performance of the existing buffer formulation (shown below) was tested. The average percent hemoglobin recovery across all samples was determined for days 3, 5, and 7 of the 7-Day shipping simulation. These results are shown below.

Results are listed in the table below. The desired % Hb Recovery at 7 days is minimally 70%. As such, the existing buffer formulation does not achieve the desired level of stability beyond 3 days (72 hours).

In an effort to improve hemoglobin stability, several classes of compounds (see Appendix A) were evaluated as additives to the base buffer formulation (also referred to herein as the existing buffer formulation) described above.

These compounds were tested at various concentrations and in combination. A list of the compounds tested using the accelerated shipping simulation and the results of these assays are found in Appendix B. A list of the compounds tested using the 3-day shipping simulation and their results are found in Appendix C. A list of the combinations of compounds that were tested is shown in Appendix D.

Of the compounds evaluated, several were identified that show potential in enhancing the stability of hemoglobin as additives to the existing buffer formulation. These compounds are listed in the table below:

The compounds demonstrating the most potential for enhancing Hb stability from the accelerated shipping and other simulations were tested on three stool samples in several different shipping simulations. These results are shown below.

In a 3-Day (72 hour) shipping simulation the potential additives demonstrate improved stability over the existing formulation (Hb Collection Buffer). See the following table:

The HRP (horse radish peroxidase) stabilizers tested and shown in the tables are: HRP Conjugate Stabilizer (PN 85R-102), Fitzgerald Industries International, 30 Sudbury Road, Suite 1A North, Acton, MA, 01720 USA

HRP Conjugate Stabilizer (PN SZ02), Surmodics, Inc., 9924 West 74th Street, Eden Prairie, MN 55344 USA

HRP Conjugate Stabilizer (PN abl7l537), Abeam, 1 Kendall Square, Cambridge, MA 02139 USA

In a 7-Day shipping simulation the potential additives demonstrate improved stability over the existing formulation (Hb Collection Buffer). See the following Table:

In a 3-Day extreme temperature shipping simulation the potential additives demonstrate improved stability over the existing formulation (Hb Collection Buffer). Additives containing HRP stabilization buffer and Calcium Chloride or Magnesium Sulfate also demonstrate improved Hb stability compared to the Polymedco buffer. See following Table:

In an accelerated shipping simulation, the additive polygalacturonic acid (with calcium chloride) is demonstrating improved Hb stability over the existing formulation (Hb Collection Buffer) at different concentrations. See the following table:

Another class of compounds called protoporphyrins was tested and can enhance the stability of hemoglobin when added to the existing buffer formulation. The protoporphyrins tested are shown in the table below. Note that in some test cases the pH was altered as solubility of protoporphyrins is known to be sensitive to pH.

In a 3-Day (72 hour) shipping simulation the existing formulation with added protoporphyrin provided improved stability over the existing formulation without any protoporphyrin). These results are shown in the table below.

In a 7-day shipping simulation the existing formulation with added protoporphyrin provided improved stability over the existing formulation without any protoporphyrin. These results are shown in the table below.

Adding protoporphyrins to the existing formulation (Hb Collection Buffer) also improves Hb stability in 3-Day extreme temperature shipping simulation. In addition, additives containing protoporphyrin cobalt (Co) or protoporphyrin chromium (Cr) demonstrate improved Hb stability compared to the Polymedco buffer. See the table below:

FURTHER TESTING OF PROTOPORPHYRIN

Protoporphyrin IX was tested at various concentrations and pHs using the 7-Day Modified Shipping Simulation conditions listed below as well as other conditions.

The following table shows that buffers containing Cobalt(III) PPIX (Protoporphyrin IX) at concentrations of 3-6 mM at an adjusted pH range of 6.4-7.0 provide increased Hb stability in the 7-Day Modified Shipping Simulation.

The following table shows that buffers containing Cobalt(III) PPIX (Protoporphyrin IX) at concentrations of 2.5-10 mM at an adjusted pH of 6.8 provide increased Hb stability in the 3 and 7 day Shipping Simulations.

The following table shows that buffers containing Chromium(III) PPIX

(Protoporphyrin IX) at concentrations of 0.5-10 pM at an adjusted pH of 7.1 provide increased Hb stability in the 3 and 7 day Shipping Simulations.

The following table shows that buffers containing Cobalt(III) PPIX (Protoporphyrin IX) at concentrations of 2.5-10 mM at an adjusted pH range of 6.2-7.4 provide increased Hb stability in the 35C 16 hour challenge.

The following table shows that buffers containing Chromium(III) PPIX

(Protoporphyrin IX) at concentrations of 1.25-5 pM at an adjusted pH range of 6.2-7.4 provide increased Hb stability in the 35C 16 hour challenge.

Accordingly, the preceding merely illustrates the principles of the invention. It will be appreciated that those skilled in the art will be able to devise various arrangements which, although not explicitly described or shown herein, embody the principles of the invention and are included within its spirit and scope. Furthermore, all examples and conditional language recited herein are principally intended to aid the reader in understanding the principles of the invention and the concepts contributed by the inventors to furthering the art and are to be construed as being without limitation to such specifically recited examples and conditions. Moreover, all statements herein reciting principles, aspects, and embodiments of the invention as well as specific examples thereof, are intended to encompass both structural and functional equivalents thereof. Additionally, it is intended that such equivalents include both currently known equivalents and equivalents developed in the future, i.e., any elements developed that perform the same function, regardless of structure. The scope of the present invention, therefore, is not intended to be limited to the exemplary embodiments shown and described herein. Rather, the scope and spirit of the present invention is embodied by the appended claims. APPENDIX A

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