AND METHODS OF USE

CROSS-REFERENCE TO RELATED APPLICATIONS

This application cl aims the benefit of and priority to U.S. Provisional Application No. 62/960,550 filed January 13, 2020, and U.S. Provisional Application No. 63/063,704 filed August 10, 2020, which are hereby incorporated by reference in their entirety.

REFERENCE TO SEQUENCE LI STI NG The Sequence Listing submitted January 13, 2021, as a text file named CNS_112_ST25.txt,” created on January 4, 2021 , and having a size of 29,163 bytes is hereby incorporated by reference pursuant to 37 C.F.R. § 1.52(e)(5).

FIELD OF THE INVENTION

Theinvention isgenerally directed to compositions of self- assembl i ng pepti des and self-assembl i ng pepti domi meti cs and methods for use i n creati ng t i ssue, and as a bul ki ng agent or a I i f t i n conj uncti on wi th a procedure, which may be surgical, laproscopic or injection.

BACKGROUND OF THE INVENTION Minimally i nvasi ve approaches to medi cal procedures can I essen adverse effects, pain, recovery time, duration of stay and costs, while i mprovi ng outcomes when compared to more i nvasi ve approaches. For example, gastrointestinal tumor and polyp resections previously treated by traditional open surgery are typically now performed laparoscopical ly, and where possible, endoscopically. Improved clinical techniques and advances i n technol ogy that address a wi der array of di seases and i nj uri es have supported the trend toward less invasiveness, but further advances in tools are requi red as many needs of clinici ans remai n unmet. For exampl e, endoscopy can be used to detect, vi sual i ze, exami ne, bi opsy and resect smal I and large lesions in gastrointestinal mucosa Endoscopic resection techniques have gradual I y i mproved and gai ned more i mportance i n the management of resection techniques include, for instance, polypectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (BSD). Such procedures, especi al I y BSD , requi re a hi gh degree of trai ni ng and skill.

Submucosal injection is common duri ng EM R and is i ntegral to BSD. I n order to i mprove the efficiency, operabi I ity and safety of such procedures, a cushion, also known as a lift, is conventionally produced beneath the tissue or lesion that is targeted for resection, dissection or repair in order to elevate and separate it from the underlying tissue. While saline is often used for this purpose, its utility is constrai ned because the resul ti ng cushi on i s easi I y deformed and possesses a limited degree of lift and durabi I i ty. Newer materials, including some that are polymer-based, have short periods of efficacy and must be re-administered if the procedure exceeds thirty minutes to two hours

T o attempt to overcome some of the drawbacks associated with normal sal i ne, several sol uti ons have been devel oped, i ncl udi ng submucosal injection of glucose solution, glycerol, sodium hyaluronate, colloids, hydroxypropyl methyl cellulose, fibrinogen sol uti on, ELEVIEW®, and ORISE™ gel (Castro, R. et al., World J Gastroenterol., 25(7):777-788 (2019)). However, these sol uti ons also possess disadvantages. They can be difficult to prepare or administer, may not be readily available, may be expensive, may damage or hi nder tissue repai r and wound heal i ng, can impair histological assessment, and can be associated with toxicity. Furthermore, they produce cushions that do not last sufficiently long, often requiring multiple cumbersome injecti ons that raise the risk of error and i nj ury. Add! ti onal I y , these approaches do not treat or prevent bl eedi ng, perforation or inflammation, which are common complications of EM Rand ESD, or provide a seal to tissue that has been sutured or clipped. Bleeding can interfere with subsequent procedures, impair the cl ini dan’s field of vision, lead to hematomas and seromas, lead to morbidity or mortality, and make procedures, such as ESD , more ti me consumi ng and i neffi ci ent. Tools that better address these and other probl ems are needed. Therefore, it is an object of the present invention to provide biocompatible, i nj ectabl e com posi ti ons to enabl e better separati on of tissues and visualization of margins, more durable and robust lifts, less need for frequent injecti ons that carry ri sk of undesi red perforati on, and si mul taneous management of adverse effects, such as bleeding, leaking and inflammation during endoscopic, laparoscopic or otherwise minimally invasive, or open surgical procedures in and/or on the body.

SUMMARY OF THE INVENTION Formul ati ons of self-assembl i ng pepti des or pepti domi meti cs, or combi nati ons thereof , referred to herei n jointly as sel f-assembl i ng pepti des uni ess otherwise specified, can be used to create a long-lasting Mft” or means of elevating tissue to be resected, dissected, manipulated or repaired, asa bulking agent, or as a tissue-forming matrix by injection of a solution that forms a solid gel in situ, which isstablefor a prol onged period of time from days to a month, is hemostatic, and may prevent adhesions. Examples demonstrate these formul ati ons and methods of use thereof enabl e better separati on of ti ssues and visualization of margi ns, more durable and robust lifts, less need for frequent i nj ecti ons that carry ri sk of undesi red perforati on, and simultaneous management of adverse effects, such as bleeding, leaking, inflammation and iatrogenic injury during endoscopic, laparoscopic or other minimally invasive, or open surgical procedures in and/or on the body A n exampl e includes a composi ti on contai ni ng sel f-assembl i ng pepti des that i s admi ni stered to form a durabl e submucosal I ift and tunnel with margin visualization, bleeding control, perforation prophylaxis, and/or isolation from vital structures during gastrointestinal EM R and ESD and methods of use thereof. Such compositions are useful at a target site encompassing a lesion that isto be resected, dissected, manipulated or repai red during an endoscopi c, I aparoscopi c or otherwi se minimally invasive, or open surgical procedure. The compositions not only provide an effective lift or bul king agent effective for at least one, two, three or four hours up to two to four weeks but are also hemostati c can be effect! ve as a barrier to liquid or gas, and may reduce formation of adhesions at the site. The composition has a further advantage in that it provides a seal to a surgical wound i n gastroi ntesti nal tissue in combination with, or without, sutures, dips or other devi ces.

Compositions of self-assembling peptides and methods of usein endoscopic procedures and for i njecti on are descri bed. These are provi ded i n an effecti ve amount to form a cushi on or lift at or enabl e tunnel i ng beneath a target site, in an effecti ve amount to create new ti ssue, or as a bul ki ng agent. The composi ti ons are typi cal I y provi ded in the form of a pre-fi lied syri nge, most commonl y havi ng a vol ume of between one and ten ml, , such as 1 , 2, 5, or 10 mL. In some embodi ments the compositions i ncl ude one or more therapeuti c agents, prophyl acti c agents, and/or di agnosti c or i magi ng agents, such as dyes or radiopaque compounds I n preferred embodi ments, the composi ti ons contai n a dye, such as, but not limited to methyl ene bl ue, indi go carmi ne or a food col ori ng, or a radiopaque materi al .

Typically, the composition is administered at or below a target site to form a lift that is positioned and of desired height and/or shape to facilitate resection of a lesion or for the purpose of tunnel i ng through the submucosa below the lesion prior to resection. A typical approximate volume of 1 to 5 mL of composition is used to elevate a polyp, but larger polyps may require at least 10 mL. Even larger lesions or long tunnels may requi re vol umes of 15-20 mL and potenti al I y more. The composi ti on can be used to el evate and isolate a lesion such as polyp or tumor, indudi ng mesenchymal tumors, lymphomas, epithelial tumors, and gastrointestinal stromal tumors, among others. Lesions may also include inflammatory tissue, pseudo- polyps, serrated lesions, adenomas, ulcerations, dysplasias, pre-neoplastic and neoplastic formati ons and congenital abnormalities The duration of the lift provided by the composition of self-assembling peptides may vary. In some embodiments the cushi on or lift lasts for at least 30 minutes such as up to 12 hours or more, but it is important only that the I ift lasts for the duration of the procedure. The formul ati ons can be i nj ected to smooth wrinkles or scars or for other plastic surgery indications. The formul ati ons can also be used to create tissue, for example, to raise the neck of the urethra to prevent bladder leakage.

I n some embodi ments, the sel f-assembl i ng pepti des sel f-assembl e to form a barri er structure that prevents or reduces movement of one or more bodily fluids (e.g., blood, serum, gastrointestinal lumen contents) through the structure. Self-assembly is induced upon contact of the self-assembling peptides with one or more bodily fluids (e.g., blood, serum) present at the target site In some embodi ments, the el f-assembl i ng pepti des may be formulated to beat least partially sel f-assembl ed prior to application to the target site (e.g., tissue). I n some embodi ments, the compositions applied to a target site, for example, before, duri ng, and/or after the procedure (e.g., the resection) are hemostatic and/or may prevent or reduce the movement of one or more bodi ly fluids. In some embodi ments, the hemostatic effect i s prophyl actic. In some embodi ments, the composi ti on reduces ti me to hemostasis at or near the target site and/or lesion, for example, by at least about 10%, at least about 30%, at least about 50%, or at least about 75%, rel ati ve to the ti me of hemostasi sin the absence of the composi ti on.

Studies conducted included use of a self-assembling peptide formulation, such as (RADA ) ₄ sel f-assembl ing peptideformulation, that is typically at least 75weight percent ( %”), 80%, 85% or 90% self-assembling pepti de and the remai nder i nert vehi d e such as steri I e water, which is formulated in a prefilled syringe, either as a dry powder for reconstitution or a sol uti on, and wi th or wi thout a vi sual i zi ng agent such as a dye. When appl i ed, the self -assembl i ng pepti des I ocal I y assembl e into an extracel I ul ar matrix-l i ke scaffol d due to exposure to i ons. The resul ts confi rm that uses of the formul ati ons include 1) creating cushions for EM R; 2) tunnels with better margin visualization in ESD and 3) providing concomitant hemostasis by virtue of forming a contiguous physical -mechanical seal with the wound bed/tissue, in both gastrointestinal as well as tumor models in s/vine. The resul ti ng mi croenvi ronment iscondudve to ti ssue repai r and wound heal i ng and therefore establ i sh that the product can be used as a bul ki ng agent or to create tissue. The self-assembling peptide gel typically persists for at least two to four weeks

DETAI LED DESCRIPTION OF THE I NVENTION I . Definitions

Use of the term Sbout” i s i ntended to descri bevaluesei ther above or bel ow the stated value in a range of approx. +/- 10%; i n other embodi ments the val ues may range in value either above or bel ow the stated value in a range of approximately +/- 5%.

B i ocompati ble” refers to compati bi lity with I ivi ng tissue or a living system by not being toxic, injurious, or physiologically reactive and not causing immunological rqection. A biocompatible material, along with any metabolites or degradation products thereof are generally non-toxic to the red pi ent and do not cause any signifi cant adverse effects to the red pi ent. Biocompatible materials are generally materials which do not elicit a significant or problematic inflammatory or i mmune response when administered to a patient.

Biodegradable” generally refers to a material that will degrade or erode under physi ol ogi c condi ti ons to smal ler units or chemi cal sped es that are capable of being metabolized, eliminated, or excreted by the subject. The degradation time is a function of composition and morphology. Degradation times can be from hours to weeks Degradation can indude disassembly of self-assembled peptide structures. Therefore, in some embodi ments, degradation can indude disassembly of self -assembled structures.

Self-assembl i ng” refers to the spontaneous or i nduced assembly of molecules into defined, stable, non-covalently bonded structures that are held together by i ntermol ecul ar and/or i ntramol ecul ar forces.

Effective amount”, in reference to a therapeutic, prophylactic and/or di agnosti c or i magi ng agent or vehi d e such as a self-assembl i ng pepti de formulation, is a dosage necessary to elicit a desired response. Theeffedive amount of an agent may vary depend! ng on such factors as the desi red biological endpoint the agent to be delivered the nature of the site to which the agent i s del i vered , the nature of the condi ti ons for which the agent i s administered, etc. For example, the effective amount of a composition for hemostasis may be an amount sufficient to promote hemostasis to a greater extent than would occur in the absence of the composition.

Minimally Invasive” and Minimally Invasively” refers to a procedure in which access to the tissue, organ, or body is made with tools or techni ques that minimizeor limit the requi red si ze and/or number of incisions. Examples include, but are not limited to, arthroscopic, hysteroscopic, laparoscopic, percutaneous, endoscopic, and natural orifice transl umi nal endoscopi c procedures.

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

T real”, treatment” and freati ng” refer to the reducti on or amelioration of the progression, severity and/or duration of one or more symptoms of an injury, disease or disorder, delay of the onset of a disease or disorder, or the amel i orati on of one or more consequences, indicati ons or symptoms (preferably, one or more di scerni bl e symptoms) of an injury, disease or di sorder, resul ti ng from the admi ni strati on of one or more therapies (e.g., one or more therapeutic agents such as a compound as described). The terms freat”, treatment”, and freati ng” also encompass the reducti on of the risk of devel opi ng a di sease or di sorder, and the del ay or i nhi bi ti on of the recurrence of a di sease or di sorder.

Smal I Molecule” refers to a mol ecul e havi ng a rel atively I ow molecular weight, such as less than about 1000 or 1,500 g/mol. Typically, smal I molecules are not pepti des or nucleic adds.

Surgery” and Surgical”, uni ess otherwise specified, refer to treating i nj uri es, di seases, deformiti es and/or undesi rabl e features of, in, or on the body by the physical removal , repai r, or readjustment of organs and/or tissues, often involving cutting into the body, regardless of whether performed as a minimally invasive or traditional open procedure.

II. Formulations

The compositions typically contain one or more self-assembling peptides in an effective amount to form a cushion or lift at a target site. In some embodiments, mixtures of self-assembling peptides may be used.

The compositions are formulated for administration into one or more internal structures by injection. Typically, the assembly of the self assembling peptides is initiated upon contact with physiological fluids. Therefore, in some embodiments, compositions of substantially non- assembled self-assembling peptides are induced to assemble in vivo upon administration into a target site in the body (e.g., upon contact with blood, serum, pus, or other bodily fluids, extracellular fluid or interstitial fluid).

A. Self-Assembling Peptides and Peptidomimetics (SAP)

The compositions include one or more self-assembling peptides and/or peptidomimetics (i.e., peptides having a sequence of amino acid residues that are capable of self-assembly). Suitable peptides and peptidomimetics are described in U.S. Patent Nos. 9,415,084 and 9,789,157. The preferred self-assembling peptides are manufactured by Arch Biosurgery.

The term “peptide” includes “polypeptide,” “oligopeptide,” and “protein,” and refers to a chain of at least two α-amino acid residues linked together by covalent bonds (peptide bonds). The D-enantiomer (“D-a-amino acid”) of residues may also be used. When D-a-amino acid residues (Xaa) are included within a sequence, they are annotated as “Xaa ^D ”.

Peptides can be represented as amino acid residue sequences. Those sequences are written left to right in the direction from the amino (“N-”) to the carboxyl (“-C”) terminus. In accordance with standard nomenclature, amino acid residue sequences are denominated by either a three letter or a single letter.

“Variant” refers to a polypeptide that differs from a reference polypeptide but retains essential properties. A typical variant of a polypepti de differs in amino acid sequence from another, reference polypepti de. Generally, differences are limited so that the sequences of the reference pol ypepti de and the vari ant are cl osel y similar overal I and, i n many regions, identical . A variant and reference polypeptide may differ in amino acid sequence by one or more modifications (e.g., substitutions, additions, and/or deletions). A substituted or inserted amino acid residue may or may not be one encoded by the genetic code. A variant of a polypeptide may be natural I y occurri ng such as an allelic vari ant, or it may be a vari ant that i s not known to occur naturally.

Modifications and changes can be made i n the structure of the pol ypepti des and still obtai n a mol ecul e havi ng si mi I ar character! sties as the polypeptide (e.gr., a conservative ami no acid substitution). For example, certai n amino acids can be substituted for other amino adds in a sequence without appredable loss of activity. Because it i s the interact! vecapadty and nature of a pol ypepti de that defi nes that pol ypepti de’ s bi ol ogi cal functi onal activity, certain ami no acid sequence substitutions can be made in a pol ypepti de sequence and neverthel ess obtai n a pol ypepti dewith like properties.

I n maki ng such changes, the hydropathic i ndex of ami no aci ds can be consi dered. The i mportance of the hydropathi c amino acid i ndex i n conferring interactive biologic function on a polypeptide is generally understood in the art. It is known that certain amino acids can be substituted for other ami no aci ds havi ng a si mi I ar hydropathi c i ndex or score and sti 11 result in a pol ypepti dewith similar biological activity.

Substi tuti on of I ike ami no acids can also be made on the basi s of hydrophi I i ci ty , particularly where the biological functional equivalent polypeptide or peptide thereby created is intended for use in immunological embodiments Amino acid substitutions are generally based on the relative similarity of the ami no acid side-chain substituents, for example, their hydrophobi ci ty, hydrophi I i city, charge, and si ze. I n some embodi merits the sel f-assembl i ng pepti des have a sequence of ami no aci d resi dues conformi ng to one or more of the fol I owi ng formul as:

((X aa ^neu -Xaa ⁺ )x(X aa ^neu -Xaa-)y)n (I)

5 ((X aa ^neu -Xaa-) _x (X aa ^neu -Xaa ⁺ ) _y ) _n (II) ((Xaa ⁺ -X aa ^neu )x(Xaa ^" -Xaa ^neu )y)n (II I) ((Xaa--X aa ^neu )x(Xaa ⁺ -Xaa ^neu )y)n (iv) Xaa ^neu ((X aa ^neu -Xaa ⁺ ) _x (X aa ^neu -Xaa-)y)n (V) Xaa ^neu ((X aa ^neu -Xaa-)x(X aa ^neu -Xaa ⁺ ) _y )n (VI)

10 ((Xaa ⁺ -X aa ^neu )x(Xaa--Xaa ^neu )y) _n X aa ^neu (VI I) ((Xaa--X aa ^neu )x(Xaa ⁺ -Xaa ^neu )y)n X aa ^neu (VI M) ((X aa ^neu -Xaa+X aa ^neu -Xaa- ) _y ) _n Xa ^neu (IX) ((X aa ^neu -Xaa-)x(X aa ^neu -Xaa ⁺ ) _y ) _n X ^neu (X) - Xaa ^neu ((Xaa ⁺ -Xaa ^neu )x(Xaa--Xaa ^neu ) _y )n (XI)

15 Xaa ^neu ((Xaa--X aa ^neu (Xaa ⁺ -X aa ^neu )n (XI I) where each Xaa ^neu represents an ami no aci d resi due havi ng a neutral charge; Xaa ⁺ represents an amino acid residue having a positive charge; Xaa- represents an ami no acid residue havi ng a negative charge; x and y are i ntegers havi ng a value of 1, 2, 3, or 4, i ndependentl y ; and n i s an i nteger havi ng a value of 1-5. In preferred embodi ments, the one or more SAP are or include RAD A RAD A RAD A RAD A (RADA16 or (RADA) ₄ ; SEQ ID NO:1).

I n a preferred embodi ment, most of the sel f-assembl i ng peptides i n the composi ti on are of the same si ze and have the same ami no acid sequence. For example, 75% or more, such as 80%, 85%, 90%, 95%, or 99% of the self-assembling pepti des are of the same size and have the same ami no acid sequence. The concentration of sel f-assembl ing pepti des typically is between about 0.1% weight/vol ume (w/v) and about 6% w/v, inclusive, preferably between about 0.1% w/v and about 4% w/v, i nclusive, more preferably between about 1 % w/v and about 3% w/v, i ncl usi ve. I n certai n embodi ments, the concentration of ions in the formulation, prior to administration, is less than 10 mM , preferably I ess than 5 mM, and more preferably between 5 nM and 5 mM The sel f-assembl i ng pepti des can vary i n I ength so I ong as they retai n the ability to sel f-assembl e to an extent useful for one or more of the desi red purposes. Typically, peptides which sel f-assembl e have from about 4 to about 64 residues, more preferably from about 8 to about 36 residues, most preferabl y from about 8 to about 16 resi dues I n preferred embodi ments, the peptide has from about 8 to about 12 residues or about 12 to about 16 residues or about 16 to about 20 residues

The self-assembling peptides can have an amphiphil ic nature (e.g., the peptides can contai n, but do not requi re, approxi mat el y equal numbers of hydrophobi c and hyd rophi lie amino acid resi dues) and are compl ementary and structural I y compati bl e. Compl ementary” means havi ng the capabi I i ty of formi ng ionic or hydrogen bondi ng i nteracti ons between hydrophi I i c resi dues from adjacent peptides in a structure. Each hydrophilic residue in a pepti de either hydrogen bonds or ionically pairs with a hydrophi lie residue on an adjacent pepti ds or isex posed to solvent. Pairing may also involve van der Waal s forces

The si de chai ns (or R groups) of self-assembl i ng peptides can partition into two faces a polar face with positively and/or negatively charged ionic side chai ns (e.g., side chai ns containing -OH, -NH, -CO2H, or - SH groups) , and a nonpol ar face with side chai ns that are consi dered neutral or uncharged at physiological pH {e.g., the side chain of an alanine resi due or residues having other hydrophobic groups). The positively charged and negati vel y charged ami no acid resi dues on the polar face of one pepti de can form complementary ionic pairs with oppositely charged residues of another pepti de. These pepti des are referred to as ionic, sel f -compl ementary pepti des

If the ionic resi dues al ternate wi th one posi t i vel y and one negati vel y charged residue on the polar face (- + - + - + - +), the peptides may be descri bed as " modul us l;" if the ionic resi dues al ternate with two posi lively and two negatively charged residues (- - + + - - + +) on the polar face, the peptides are descri bed as "modul us II;" if the ionic resi dues alternate with three positively and three negatively charged residues (+ + + — + + + — ) on the polar face the peptides are describe as "modulus I I I;" if the ionic residues alternate with four positively and four negatively charged residues (+ + + + - — + + + + - — ) on the polar face, they are descri bed as " modul us IV." For exampl e, a pepti de havi ng four repeati ng units of the sequence EAKA (SEQ ID NO: 77) may be designated EAKA16-I, and a peptide having four repeating units of the sequence RADA (SEQ ID NO: 57) may be designated RADA16-I . Peptides havi ng other sequences may be descri bed by the same convention.

Hydrophilic residues typically contain a polar functional group or a functional group that is charged at physiological conditions Exemplary charged or pol ar functi onal groups i ncl ude, but are not limited to, carboxyl i c acid groups, amino groups, sulfate groups, hydroxyl groups, halogen groups, nitro groups, phosphate groups, efc. Hydrophobic residues are those residues that contain non-pol ar functional groups Exemplary non-pol ar functional groups include, but are not limited to, alkyl groups, alkene groups, alkyne groups, and phenyl groups

I n one embodiment, the hydrophilic residue has the formula -NH-CH(X)-COO-, wherein X has the formula (CH2) _y Z, wherein y = 0-8, preferably 1-6, more preferably 1-4, and most preferably 1-3, and Z is a polar or charged functional group including, but not limited to, a carboxylic acid group, an ami no group, a sulfate group, a hydroxyl group, a halogen group, a nitro group, a phosphate group, or afunctional group containing a quaternary ami ne. The al kyl chai n can be i n a I i near, branched, or cycl i c arrangement. X may al so contai n one or more heteroatoms withi n the al kyl chai n and/or X may be substituted with one or more additional substituents In a preferred embodi ment, Z i s a carboxyl ic acid group or an ami no group. I n one embodiment, the hydrophobic residue has the formula -NH-CH(X)-COO-, wherein X has the formul a (CH2) _y Z, wherein y = 0-8, preferably 1-6, more preferably 1-4, and more preferably 1-3, and Z is a non-pol ar functional group including, but not limited to, an alkyl group, an alkene group, an al kyne group, or a phenyl group. The al kyl , al kene, or al kyne chai n can be i n a I i near, branched, or cyd i c arrangement. X may al so contai n one or more heteroatoms withi n the al kyl chai n and/or X may be substituted with one or more additional substituents In a preferred embodiment, X is an alkyl group, such as a methyl group.

Other hydrophilic residues that form hydrogen bonds including, but not limited to, asparagi ne and gl utami ne, may be i ncorporated i nto the pepti des. I f the al ani ne resi dues i n the pepti des are changed to more hydrophobic residues, such as leucine, isoleucine, phenyl alanine or tyrosine, the resulti ng peptides have a greater tendency to self-assembl e and form peptide matrices with enhanced strength.

I n one embodi ment, the self-assembl i ng pepti des have a sequence of amino acid residues conformi ng to one or more of Formul as I -X 11 : ((Xaa ^neu -Xaa ⁺ )x(Xaa ^neu -Xaa-)y) _n (I) ((Xaa ^neu -Xaa-)x(Xaa ^neu -Xaa ⁺ ) _y )n (II) ((Xaa ⁺ -X aa ^neu )x(Xaa--Xaa ^neu )y)n (III) ((Xaa--X aa ^neu )x(Xaa ⁺ -Xaa ^neu )y)n (IV) Xaa ^neu ((X aa ^neu -Xaa ⁺ )x(X aa ^neu -Xaa-)y) _n (V) Xaa ^neu ((X aa ^neu -Xaa-) _x (Xaa ^neu -Xaa ⁺ )y)n (VI) ((Xaa ⁺ -X aa ^neu )x(Xaa--X aa ^neu )y) _n X aa ^neu (VI I) ((Xaa--X aa ^neu )x(Xaa ⁺ -Xaa ^neu )y)n X aa ^neu (VI M) ((Xaa ^neu -Xaa ⁺ )x(Xaa ^neu -Xaa-)y)n X aa ^neu (IX) ((Xaa ^neu -Xaa-)x(Xaa ^neu -Xaa ⁺ )y)n Xaa ^naj (X) Xaa ^neu ((Xaa ⁺ -Xaa ^neu )x(Xaa--Xaa ^neu )y) _n (XI) Xaa ^neu ((Xaa--Xaa ^neu )x(Xaa ⁺ -X aa ^neu ) _y )n (XI I) wherei n each X aa ^neu represents an amino acid residue havi ng a neutral charge; Xaa ⁺ represents an amino acid residue having a positive charge; Xaar represents an ami no acid resi due havi ng a negative charge; x and y are i ntegers havi ng a value of 1, 2, 3, or 4, i ndependentl y ; and n i s an i nteger having a value of 1-5. The charge (e.g., neutral, positive or negative) can be the charge at physiological conditions (e.g., pH).

Useful pepti des can al so incl ude one or more ami no aci d resi dues havi ng a neutral charge between one or more sets of resi dues conform! ng to any one of Formulas l-IV. For example, in some embodiments, peptides i ncl ude sequences conform! ng to Formul as 111 and IV li nked with a single ami no acid residue havi ng a neutral charge, or I i nked wi th two ami no aci d resi dues havi ng a neutral charge, or I i nked wi th three ami no aci d resi dues havi ng a neutral charge.

Peptides with modulus I (i.e., peptideshaving alternate positively and negatively charged R groups on one side ( e.g ., the polar face of the β-sheet) are described by each of Formulas l-IV, wherex and y are 1. Examples of peptides of modulus I include, but are not limited to, RADA (SEQ ID NO: 57) and RAD A RAD A RAD A RAD A (SEQ ID NO: 1). Examples of peptides of modulus ll (i.e., peptides having two resi dues bearing one type of charge (e.g., a positive charge) followed by two resi dues bearing another type of charge (e.g., a neutral charge)) are described by the same formulas where both x and y are 2. Exampl es of pepti des of modul us 111 (i.e., pepti des havi ng three resi dues beari ng one type of charge ( e.g. , a posi ti ve charge) f ol I owed by three residues beari ng another type of charge (e.g. , a negative charge)) include, but are not limited to, RARARADADADA (SEQ I D NO: 93). Examples of pepti des of modul us IV (i.e, peptides having four residues beari ng one type of charge (e.g. , a posi ti ve charge) f ol I owed by four resi dues beari ng another type of charge (eg., a negative charge)) i ncl ude, but are not limited to, RA RARARADADADA DA (SEQ I D NO: 94).

I n some embodi ments, the self-assembl i ng peptides i ncl ude two or more repeating units of the sequence RADA (SEQ ID NO: 57), two or more repeating units of the sequence EAK A (SEQ ID NO: 77), or combinations thereof.

I n some embodi ments, SAP i ncl ude one or more segments of positively or negatively charged residues (under physiological conditions). For exampl e, these segments can i nd ude a sequence of posi ti vel y or negatively charged residues, for example, about 2 to about 50 amino acid residues, typically about 3 to about 30 residues, more typically about 10 to about 20 amino acid residues. In some embodi ments, about half of the residues of a self-assembling peptides can be positively charged and about half of the residues can be negatively charged. For example, self-assembling peptides can have the foil owing sequence RRRRDDDD (SEQ ID NO: 95) or GGGGSSSS (SEQ ID NO: 96). In some embodiments, self-assembling pepti des contai n sequences in which at I east one hydrophobi c resi due alternates with at least one hydrophilic residue (under physiological condi ti ons). For exampl e, the sequence of a representati ve self-assembl i ng peptide can be one or more units of GQGQ (SEQ I D NO: 97), GGQQGG

(SEQ I D NO: 98), GQQGQQG (SEQ I D NO: 99), GGQGGQGG (SEQ I D NO: 100), etc.

Other exemplary peptides that can be used are described in U.S. Patent Nos, 5,670,483; 5,955,343; 6,548,630; 6,800,481; 7,098,028; 9,327,010; and 9,364,513 to Zhang, ef a/.; U.S. Patent Nos. 9,162,005;

9,415,084; and 9,339,476 to Ellis-Behnke, et a/.; Holmes, et a!., Proc. Natl. Acad. Sci. USA, 97:6728-6733 (2000); Zheng, et al., Proc. Natl. Acad. Sci. US A, 90:3334-3338 (1993); Zhang, ef al., Biomaterials, 16:1385-1393 (1995); Caplan ef al., Biomaterials 23:219-227 (2002); Leon, et al., J. Biomater. Sci. Polym. Ed, 9:297-312 (1998); and Caplan, et al., Biomacromolecules 1:627-631 (2000).

The composi ti ons can i ncl ude a mixture of one or more pepti des. Peptide-based structures can be formed of heterogeneous mixtures of peptides (/.a, mixtures containing more than one type of peptide conforming to a gi ven formul a or to two or more of the formul as). In some embodi ments, each type of peptide i n the mixture can self-assembl e with the same type of pepti de. I n other embodi ments, one or more of each type of pepti de woul d not self-assembl e alone, but the combination of heterogeneous pepti des may self-assembl e (/.a, peptides in the mixture are complementary and structural I y compati blewith each other) . Thus, either a homogeneous mixture of self-complementary and self-compatible pepti des of the same sequence or contai ni ng the same repeat! ng subunit, or a heterogeneous mixture of different peptides, which are complementary and structurally compati ble to each other, can be used.

One or more short amino acid sequences that assists in self-assembly (referred to as assembl y assist sequences) can be added to a homogeneous or heterogeneous mixture of ami no aci d sequences that al one do not self- assembl e. The assembl y assist sequences contai n ami no aci ds that are compl ementary wi th the ami no aci ds i n the sequences in the mi xture. The assembly assist sequences may contain any number of ami no acids. Preferably, the assembly assist sequences contain at least four amino acids. The assembly assist sequences may contain a flexible linker (e.g., PEG, N- succinimidyl 3-(2- py ri dy I di thi o) propionate) between the ami no aci ds that assist in self-assembly. For example, the assembly assist sequence may contain a pair, a triad, or a quartet of assembly assisting amino acids at the termini of the sequence which are connected via a flexible linker. Suitable assembly assist sequences include, but are not limited to, RADA (SEQ ID NO: 57) and EAKA (SEQ ID NO: 77).

Self -assembl i ng peptides structures can have varyi ng degrees of stiffness or elasticity. The structures typically have a low elastic modulus (e.g. , a modul us i n the range of between about 0.01 and about 1 ,000 kPa, preferably between about 1 and about 100 kPa, more preferably between about 1 and about 10 kPa as measured by standard methods, such as i n a standard cone-plate rheometer. Low values may be preferable, as they permit structure deformation as a result of movement, i n response to pressure Stiffness can be control led in a vari ety of ways, indudi ng by changi ng the I ength, sequence, and/or concentrati on of the self-assembl i ng pepti de precursors. Other methods for increasing stiffness can also be employed. For exampl e, one or more cystei ne resi dues may be i ncorporated i nto the peptides, and these residues may bond with one another through the formation of disulfide bonds Structures bonded i n this manner may have i ncreased mechani cal strength rel ati ve to structures made wi th comparabl e pepti des that do not i ncl ude cystei ne resi dues and thus are unabl e to form disulfide bonds As another example, one can attach to theself-assembling peptides precursors, either biotin or other molecules that can be subsequently cross-l i nked or otherwi se bonded to one another. One or more physi cal , mechani cal , and/or chemi cal crossl i nkers can be i ncorporated. The crossl i nks can serve to reinforce the material or to provide increased rigidity, strength and/or half-life (e.g., in vivo half-life). Modified (i.e., functionalized) or unmodified polyethylene glycol (PEG) can be used.

Crossl i nkers such as biotin can be i ncl uded at an N- or C-termi nus of a pepti de or attached to one or more residues between the termi ni . Other sui tabl e cross-1 i nkers i ncl udi ng, for exampl e, ami no aci d resi dues wi th polymerizable groups such as vinyl groups, may be incorporated and cross- linked by exposure to UV light. The extent of crossl i nki ng can be preci sel y controlled by apply! ng the radi ati on for a predetermi ned I ength of ti ma The extent of crosslinking can be determined by light scattering, gel filtration, scanni ng el ectron mi croscopy, or other methods wel I known i n the art.

Crossl i nki ng can be assessed by H PL C or mass spectrometry anal ysi s of the structure after di gesti on wi th a protease, such as a matrix metal I oprotease.

M ateri al strength may be determi ned before and/or after cross-l i nki ng.

Factors influencing the physical properties of sel f-assem bled peptide structures i ncl ude, but are not limited to, pepti de sequence, pepti de I ength, presence of bound agents, the amount of peptide (e.g., concentration, mass and volume), pepti deform (e.g., powder, solution, or gel) and assembly-state at application time

The structures formed from self-assembling peptides made by any process can be character! zed usi ng vari ous bi ophysi cal and opti cal techniques, such as circular dichroism (CD), dynamic light scattering,

Fourier transform infrared (FTIR), atomic force (tension) microscopy (ATM), scanning electron microscopy (SEM), and transmission electron microscopy (T EM). For example, biophysical methods can be used to determi ne the degree of beta-sheet secondary structure in the pepti de structure. Filament and pore size, fiber diameter, length, elasticity, and volume fraction can be determi ned using quantitative image analysis of scanning and/or transmission electron micrographs The structures can also be ©rami ned using several standard mechanical testing techniques to measure the extent of swel I i ng, the effect of pH and ion concentration on structure formation, the level of hydration under various conditions the tensi I e strength as wel I as the manner i n whi ch vari ous characteri sti cs change over the period of ti me requi red for the structures to form and degrade

Typically, the self -assembling peptides are biocompatible, non-toxic, fully or partially biodegradable, and do not cause local or systemic inflammation. Preferably, breakdown products of theself-assembling peptides do not cause secondary toxicity and are suitable for growth and repai r of the surroundi ng tissues.

Exemplary Self- Assembling Sequences The foil owing table provides a non-limiting list of self-assembling sequences that may be used i n accordance with the present di scl osure.

T able 1. Representative Self-Assembl i ng Peptide Sequences

SEQ ID

Sequence (N → C) NO:

Self-assembling peptides can be generated which differ from those expl icitly exempl ified in Table 1 by a si ngle ami no aci d resi due or by multi pie ami no acid resi dues (e.g., by i ncl usi on or ex cl usi on of a repeati ng quartet, or 1, 2, 3, 4, 5 or more residues). The si ngl e or mu I ti pi e ami no aci d residues may be i ncl uded or excl uded at the N- and/or C- termi ni of the pepti des. The si ngl e or multi pi e ami no aci d resi dues may be neutral or charged (i .e., positive or negative) at physiological pH.

Peptide modifications

The peptides may be modified i n various ways. I n some embodiments, the modification(s) may render the peptides more stable (e.g., resistant to degradation in vivo). Useful modifications include, without limitation, chemical modification, N terminus modification, C terminus modification, peptide bond modification, backbone modifications, residue modification, D-amino acids, or non- natural amino acids or others. An i ndi vi dual pepti de may contai n one or more modi f i cati ons.

Incorporation of artificial or non-natural amino acids are contemplated, Non-natural I y occurring amino acids are not found or have not been found in nature, but they can by synthesized and incorporated into a pepti de chai n. Non-natural ami no aci ds are known to those ski I led in the art of chemical synthesis and peptide chemistry. Non-limiting examples of suitable non-natural amino acids (each one in L- or D-configuration) are azi doal ani ne, azi dohomoal ani ne, 2-ami no-5-hexynoi c aci d, norl eud ne, azidonorleucine, L-a-aminobutyric add, 3-(l -naphthyl )-al ani ne, 3-(2- naphthyl )-al ani ne, p-ethynyl -phenyl al ani ne, m-ethynyl -phenyl al ani ne, p- ethynyl- phenylalanine, p-bromophenyl alanine, p-idiophenyl alanine, p- azidophenyl alanine, and 3-(6- chloroi ndolyl) alanin.

I n some embodiments, peptide bonds (-CO-NH-) withi n the peptide may be substituted, for example, by N-methylated bonds (-N(CH3)-CO-), ester bonds (-C(R)H-C-0-0-C(R)-N-), ketomethylen bonds (-CO-CH2-), CC- aza bonds (-NH-N(R)-CO-), wherein R is any alkyl, e.g., methyl, carba bonds (-CH2-NH-), hydroxyethylene bonds (-CH(OH)-CH2-), thioamide bonds (-CS-NH-), olefinic double bonds (-CH=CH-), retro amide bonds (- NH- CO-), peptide derivatives (-N(R)-CH2-CO-), wherein R isthe"normd" side chain, naturally presented on the carbon atom. These modifications can occur at any of the bonds al ong the pepti de chai n and even at several (e.g. , 2, 3, 4 or more) at the same ti me.

One or more of the amino add residues i n a SAP can be altered or derivati zed by the addition of one or more chemical entities induding, but not I i mi ted to, acyl groups, carbohydrate groups, phosphate groups, farnesyl groups, isofarnesyl groups, fatty acid groups, or a linker which allows for conjugation or functionalization of the peptide. For example, either or both ends of a given peptide can be modifi ed. The carboxyl and/or ami no groups of the carboxyl- and amino-terminal residues, respectively can be protected or not protected. The charge at a terminus can also be modified. For example, a group or radical such as an acyl group (RCO-, where R isan organic group (e.g., an acetyl group (CH3CO-)) can be present at the N-termi nus of a peptide to neutralize an §xtra" positive charge that may otherwise be present (e.gr., a charge not resulting from the side chain of the N-termi nal amino add). Similarly, a group such as an amine group (RNH-, where R isan organi c group (eg. , an ami no group -N hh)) can be used to neutralize an Sxtra” negative charge that may otherwi se be present at the C-termi nus (e.g. , a charge not result! ng from the si de chai n of the C-termi nal amino add resi due) . Where an amine is used, the C-termi nus bears an ami de (-CON HR). The neutralization of charges on aterminusmay f aci I itate self- assembly. One of ordinary skill in the art will be able to select other suitable groups I n some embodi merits, the pepti des contai n one or more of the following modifications: glycosylation, amidation, acetylation, acylation, alkylation, alkenyl ati on, alkynylation, phosphorylation, sulphorization, hydroxyl ati on, hydrogenation, cyclization, ADP-ribosylation, anchor formation, coval ent attachment of a lipid or lipid deri vati ve, methyl ati on, myristylation, pegylation, prenyl ati on, esterification, biotinylation, coupling of farnesyl or ubiquiti nation, a linker which allows for conjugation or functionalization of the peptide, or a combination thereof.

The term Pepti domimetic”, refers to non-natural peptide-like mol ecul es that mi mi c pepti de structure. Typically, a pepti domi meti c has the activity of the peptide upon which it is structurally based. For ©cample, pepti domi meti cs typically retain the ability to produce the same bi ol ogi cal effect as and can interact with the biological target of the parent peptide. Such pepti domi meti cs include chemically modified peptides, peptide-like mol ecul es contai ni ng non-natural I y occurri ng ami no aci ds, and peptoi ds and have an activity such as that from which the pepti domi metic is derived (see, for example, Goodman and Ro, Pepti domi meti cs for Drug Design, in "Burger's Medicinal Chemistry and Drug Discovery" Vol. 1 (ed. M. E. Wolff; John Wiley & Sons 1995), pages 803-861). Pepti domi meti cs may be used to ci rcumvent some of the probl ems associ ated with a natural pepti de: e.g. stability against proteolysis and poor bioavailability (Vagner J., et al. Curr. Opin. Chem. Biol., 12(3): 292-296 (2008)). Self-assembling pepti domi meti cs are mol ecul es that are structural ly similar to pepti des havi ng a segment of residues having a positive charge under physiological condi ti ons j oi ned to a segment of resi dues havi ng a negati ve charge under phydological conditions

The sel f-assem bling pepti domi meti cs have general features anal ogous to sel f-assembl i ng pepti des, such as amphi phi I i city. Exampl es of pepti domi meti cs that can be used are described in Moore et al., Chem. Rev. 101(12), 3893-4012 (2001), and in WO 2007/142757.

The pepti domi meti cs can be classified into four categories: a- peptides β-peptides γ-peptides and δ-peptides Self-assembling pepti domi meti cs i ncl udi ng combi nati ons of more than one of a-ami no aci ds, β-ami no aci ds, γ-ami no aci ds, and δ-ami no acids can also be used. For example, self -assembling pepti domi meti cs can include alpha-ami no and beta-ami no acid residues (i.e., alpha-beta peptides), alpha-amino and delta- amino acid residues (i.e., alpha- delta peptides), and alpha-amino and gamma-amino acid residues (i.e., alpha-gamma peptides). In an exemplary embodi ment, a self-assembl i ng pepti domi metic i nd udes both al pha ami no aci ds (annotated as Xaa) and beta ami no aci ds (annotated as Xaa ^B ). Exemplary self-assembling pepti domi metic sequences include EA ^B KA ^B EA ^B KA ^B EA ^B KA ^B EA ^B KA ^B (SEQ ID NO: 101), EA ^B KA ^B EA ^B KA ^B (SEQ I D NO: 102), RA ^B DA ^B RA ^B DA ^B RA ^B DA ^B RA ^B DA ^B (SEQ I D NO:

103), and RA ^B DA ^B RA ^B DA ^B (SEQ ID NO: 104).

The alpha ami no acids can bed assi cal or non-classical alpha amino acids {i.e., L-form or D-form, or combi nati ons thereof). Examples of a- pepti de pepti domi meti cs that can be used i ncl ude, but are not I i mi ted to,

Ν,Ν'- linked oligoureas, oligopyrroli nones, oxazolidi n-2-ones, azati desand azapeptides.

Examples of β-peptides include, but are not limited to, β-peptide fol darners, β-aminoxy adds, sulfur-containing β-peptide analogues, and hydrazi no peptides,

Exam pies of γ- pepti des i ncl ude, but are not limited to, γ-pepti de fol darners, oligoureas, oligocarbamates, and phosphodi esters.

Examples of δ-peptides include, but are not limited to, alkene-based δ-amino adds and carbopeptoids, such as pyranose-based carbopeptoids and furanose-based carbopeptoids.

B. Therapeutic, Prophylactic and Diagniostic or I maging agents

Therapeutic, prophylactic, and diagnostic agents or imaging agents such as dyes or radi opaque agents can be i ncorporated i nto the composi ti ons before or duri ng admini strati on. One or more agents can be added/ mi xed simultaneously or sequentially with self -assembling peptides. The agent(s) can be covalently or non-covalently coupled to the self-assembl ing materials either di recti y or vi a an i ntermedi ate mol ecul e. Exempl ary agents i ncl ude, but are not limited to, anti -angiogenesis agents, anti -infective agents (e.g., an antibiotic, antibacterial, antiviral, or antifungal agent), immunomodulatory agents such as anti -inf I ammatory agents (e.g. , non-steroi dal , steroi dal ) , vasoconstri ctors, anal gesi cs, anestheti cs, anti oxi dants, cytoki nes, cel I s and combi nati ons thereof . The composi ti ons can contai n one or more addi ti onal agents in any amount that i s effect! ve for a desi red purpose. For example, an agent (e.g., an anesthetic agent) can be present in the composition in an amount of about 0.1 %, about 0.2%, about 0.3%, about 0.4%, about 0.5%, about 0.6%, about 0.7%, about 0.8% about 0.9%, about 1.0%, about 2.0%, about 3.0%, about 4.0%, about 5.0%, about 6.0%, about 7.0%, about 8.0%, about 9.0%, or about 10% by weight of the total composition.

I n one preferred embodi ment, an i magi ng agent is added. The compositions can contai n one or more dyes or agents such as bari urn which are radi opaque. Dyes are wi del y used i n composi ti ons for endoscopi c procedures. In particular, in compositions for EM R and/or ESD procedures, dyes functi on to make the margi ns of the target lesion, the submucosa, and the physi ol ogi cal structures underl yi ng the mucosa, more visible to the endoscopist such that target lesion can be more easily removed with less risk of damagi ng the submucosal I ayer or external muscul ar wall.

Useful dyes include vital dyes (or absorptive dyes), non-vital dyes (or contrast dyes), and reactive dyes. Vital (or absorptive) dyes, such asLugol's solution and methylene blue, identify specific epithelial cell types by preferential absorption or diffusion across the cel I membrane; non-vital (or contrast) dyes, such as i ndi go carmi ne, seep through mucosal crevi ces and highlight surface topography and mucosal irregularities; reactive dyes, such as congo red and phenol red, undergo chemical reactions with specific cellular constituents, resulting in a color change akin to a pH indicator. Thus, the composi ti ons can contai n one or more dyes such as, but not limited to, L ugol 's sol uti on, methyl ene bl ue, tol ui di ne bl ue, crystal violet, indigo carmine, Congo red, phenol red and food coloring. In preferred embodi ments the composi ti ons contai n methyl ene bl ue or i ndi go carmi ne I n some embodi merits, the dye i s present i n an amount whi ch ranges from about 0.0001% to about 0.2% by weight with respect to the weight of the composition, preferably from about 0.0002% to about 0.05% by weight with respect to the weight of the composition, and more preferably from about 0.0005% to about 0.01% by weight with respect to the weight of the composition.

Studies using 1%- 3% (RADA)4 (SEQ ID NO: 1) solutions mixed with dextran sulfate solution (0.5 and 1%), formed space occupying gels, which could be tailored for AVMs, internal casts, lifts, etc.

C. Excipients

The formul ati ons may be rehydrated or mixed wi th exci pi ents suitable for administration onto or into the body. A preferred excipient is sterile water.

Other sui tabl e exd pi ents can be sel ected based upon the desi red assembl y-state of the sel f-assembl i ng pepti des precursor materi al & For example, when the sel f-assembl ing pepti des formul ati ons are in the form of a solution, a suitable excipient may contain a concentration of ions below the threshold required to initiate assembly, or may be mixed with ions to initiate assembl y pri or to or at t he ti me of admi ni strati on. Sui tabl e buffers are wel I known by those ski 11 ed i n the art and i nd ude acetate, borate, carbonate, citrate, and phosphate buffers Formulations may also contai n one or more toni ci ty agents to adj ust the i sotoni c range of the formul ati on . Sui tabl e tonicity agents are wel I known i n the art and i ncl ude glyceri n, mannitol , sorbitol, sodium chloride, and other electrolytes.

Other additives to the formul ati on may indude pH modifying agents or preservatives to prevent bacterial contamination. Suitable preservatives are known in the art.

D. Dosage Unit Formsand Kits

I n some embodi ments, formul ati ons of sel f-assembl i ng pepti des are dried or dehydrated to remove fluid, typically using lyophilization.

Kits induding self-assembling peptides may also contain diluents, self-assembling pepti des with and without dye needles and/or syringes or other means for administration, and instructions for use. The kit may also include one or more of a pipette, gauze sponges, cotton, swabs, disinfectant, scissore a scalpel, a sterile fluid, and disposable gloves.

I n some embodi ments, the sel f-assembl i ng pepti des formul ati ons i n the kit are pre-packaged i n a concentrated stock powder or solution, with i nstructi ons for diluti ng to the desi red concentrati on immediately prior to application. When kits include dried sel f-assembl ing peptides, they can be packaged with a desiccant. Components of the kit may be packaged individually and be sterile. The kits are generally provided in acontainer, e.g., a plastic, cardboard, or metal container suitable for commercial sale.

I n some embodi ments, the ki t i ncl udes any of the sel f-assembl i ng peptides, formulations, a suitable means for administration (e.g., an endoscopic injection needle, a syringe), and instruct! ons for use thereof. The kit components may be packaged i n pri mary packagi ng such as ampul es, vials, bottl es, pre-fi lied syri nges, pre-fi I led injection needl es, pre-fi 11 ed catheters and the I i ke.

I n some embodi ments, the sel f-assembl i ng pepti de formul ati on is packaged in 1, 2, 5, or 10 ml. pre-fi I led syringes. Suitable endoscopic injection needl es may have a di ameter of the needl e rangi ng from 12 gauge to 35 gauge, from 15 gauge to 30 gauge, and from 17 gauge to 28 gauge. I n some embodi ments, suitable endoscopic injection needles have a length ranging from 100 cm to 300 cm, from 120 cm to 260 cm, and from 140 cm to 250 cm. In some embodi ments, sui tabl e endoscopi c injecti on needl es have an outer diameter ranging from 1.0 mm to 4.0 mm, preferably from 1.5 mm to 3.0 mm, more preferably from 1.8 mm to 2.5 mm.

The self-assembling pepti des formul ati on can be provided as a dry powder in a single dosage unit, typi cally in combi nati on with steri I e di I uent to mix at the time of administration. Exemplary volumes for application of sol uti ons of self-assembl i ng pepti des to the body i ncl ude an amount between about 10 μΙ and about 100 mL, more typically between 0.1 and 1 mL, 1 to 5 mL, or 1 to 10 mL. A kit containing self-assembling peptides formulated with and without dye allows the clinician to inject the dyed self-assembling, then, if desired, administer non-dyed self-assembling peptides to avoid obscuring the field of view. III . M ethods of maki ng self-assembling peptide formulations

Formulations of self-assembling peptides can be prepared using techniques known in the art or purchased, as described above. In some embodi ments, the sel f-assembl i ng pepti de formul ati ons are steri I i zed to remove undesi rabl e contami nants and/or mi croorgani sms. I n some embodi ments, f i I trati on i s used to remove contami nants or mi croorgani sms such as bacteria, cells, protozoa, viruses» fungi , and combi nations thereof. In some embodi ments, f i I trati on i s used to remove aggregated or ol i gomeri zed proteins

Assembly of the self-assembling pepti descan be initiated or enhanced before or duri ng upon admi ni strati on by the addi ti on of an i oni c sol ute or di I uent to a sol uti on of sel f-assembl i ng peptides or by a change i n pH. For example, NaCI at a concentration of at least 5 mM can i nduce the assembly of macroscopic structures within a short period of time, within a few seconds to minutes. Lower concentrations of NaCI may also induce assembly but at a slower rate. More preferably, self-assembly isinitiated or enhanced by i ntroduci ng the SAP i nto a tissue where it contacts a physiological fluid such as blood, lymph, or tissue secretions.

A wide variety of ions, including anions and cations (whether divalent, monovalent, or tri valent), can be used to induce self-assembly. For example, one can promote a self-assembly by exposure to monovalent cations such as Li ⁺ , Na ⁺ , K ⁺ , Cs+ and Ca ⁺ The concentration of such ions required to induce or enhance self-assembly is typically at least 5 nM to 5 mM . Lower concentrations also facilitate assembly, although at a reduced rate.

Alternatively, some of the self -assembling peptides do not require ions to self-assemble but may sel f-assembl e due to solvent, hydrophobic, and/or side chain interactions and hydrogen bonding The resulting material characteristics, the time required for assembly, and the di mensi ons of the macroscopi c structure that forms are governed by the concentrati on and amount of sol uti on that i s appl i ed, and the concentration of ions used to induce assembly of the structure. Theself- assembl i ng pepti des can achi eve a gel -like or substanti ally solid form upon self-assembly.

Self-assembly or phase transit! on is triggered by components found in a subject's body {e.g., ions) or by physiological pH. Self-assembly or phase transit! on can begin when the compositions are exposed to or brought into contact with a subject's body (e.g., at the mucosa). Self-assembly can occur rapidly upon contact with bodily fluids The time required for effective assembly and/or phase transit! on can occur in 60 seconds or less(e.g., in 50, 40, 30, 20, or 10 seconds or less) following contact with a subject's tissue, or to conditions similar to those found withi n the body. Solutionscontai ning sel f-assembl i ng pepti des can form a self -assembl ed fluid-i mpermeabl e structure u pon contact with physi ological fluidswithin ti mes as short as 10 seconds foil owing application. In some circumstances, such as when condi ti ons are sub-opti mal or non-physi ological, or when the concentrati on of self-assembling peptide precursors is low, self-assembly or phase transi ti on may take I onger to achi eve, for exampl e, up to a mi nute, 5 minutes, 10 minutes, 30 minutes, an hour, or longer.

The compositions can form structures that are substanti ally rigid (e.g., solid or nearly solid) or that assume a definite shape and volume (e.g., structures that conform to the shape and vol ume of the I ocati on to which a liquid composition was administered, whether in vivo or ex vivo).

IV. Methods of Use

Formul ations contai ni ng sel f-assembl i ng peptides and/or self- assembl i ng pepti domi metics, referred to herei n jointly as sel f-assembl i ng peptides uni ess otherwise specified, can be administered by injection during endoscopi c, I aparoscopi c or otherwi se minimally i nvasi ve, or open surgical procedures i n and/or on the body, i nd udi ng the central nervous, gastrointestinal, genitourinary, integumentary, pulmonary, renal, reproductive, and/or vascular systems, to achieve any of the foil owing: a. separati on or del i neati on of ti ssues and/or org ans; I i fti ng, separating, or tunneling beneath or besides tissues, lesions, or medical apparati , such as wi res, durabl e equi pment , and closure devi ces, preferabl y with sufficient durability (duration) to minimize frequency of injections required to obtain the lift; and preferably with sufficient density for desired separati on i n the presence of pressure appl i ed duri ng the procedure or natural elastic forces; b. visual i zati on or access to ti ssue or margi ns du ri ng a procedure; c. creati on of an i nternal cast or structure that provi des support around and/or between tissues or organs to, for instance, enable them to be stabi I ized, protected, recover, and/or heal , such as after a central nervous system i nfarcti on or before, duri ng or after orthopedi c or geni touri nary procedures; or as bul ki ng agent; d . creati on of new ti ssue; and e. to smooth wrinkles, scars or other plastic surgery i ndicati ons.

In the process, the formulation may help to prevent iatrogenic injury; and to concomi tantl y prevent or stop bl eedi ng, I eaki ng, i nfl ammati on, perforation or contamination of tissues, organs and related compartments during any of the above procedures. The formulation is useful prior to excision of adenomas, earl y-stage cancers or gastrointestinal mucosal lesions as well as for endoscopic management of gastrointestinal bleeding, a. Separation or Delineation of Tissues and/or Organs The formulation provi des a lift that lasts for at least hours, possesses excellent visualization characteristics, and has hemostatic and sealant activity either prophylactically or in response to bleeding and leaking.

Self-assembling peptides can be administered at any desired target site, such as a region where a minimally invasive procedure is performed. The target site may be a submucosal layer. I n some embodi ments, the procedure i s a gastroi ntesti nal endoscopy performed i n the esophagus stomach, small intestine, cecum, colon, and/or rectum and may be a polypectomy, an EMR or an BSD. In another embodiment, the procedure is performed for the treatment of esophageal varices whereby the formulations, applied topically or i nj ected, are used or as an adj unct to other methods to slow or stop blood flow, visualize and ligate the targeted blood vessels, or treat or lessen the risk of potential perforation. The formulation can be administered through an endoscope, laparoscope, catheter, needle, nebulizer or other device. The formulation can be administered during endoscopic, minimally invasive, or open surgical procedures Individuals to be treated include subjects with inflammatory tissue, polyps, adenomas, ulcerations, one or more dysplasias, pre-neoplastic and neoplastic formations, vascular malformations, congenital defects, and/or tumors at or near the target site.

The formulations and uses thereof enable I ess invasive, endoscopic approaches to gastroi ntesti nal procedures (e.g. , to remove I esi ons), i mproved separati on of I ayers of the gastroi ntesti nal tract for better vi sual i zati on and treatment, and concomitant management of bleeding and sealing of leaks by topical application or local injection. Typically, I ayers of the gastroi ntesti nal tract include mucosa (innermost), submucosa, muscularis propria, and adventitia (outermost). Mucosal and submucosal layers can also be subdivi ded i nto I ayers.

The examples confirm that the formulations are useful for 1) creating cushions for endoscopic mucosal resections (EM R); 2) establishing tunnels with better margin visualization in endoscopic submucosal dissections (ESD); and 3) providing hemostasisby virtue of forming a contiguous physi cal -mechani cal seal wi th the wound bed/ti ssue The result! ng microenvironment is conducive for tissue repair and wound healing. The same benefits are found in removal of tumors and associated tissue repairs The formulation may be administered by injection or expression either percutaneousl y, endoscopically, laparoscopically or otherwise minimally invasively, or during open surgery through a needle or catheter i nto a tissue to, for i nstance, create a reservoi r of self-assembl i ng pepti des. The formul ation is i nj ected i nto the ti ssue at the si te where a lift or tunnel or separati on of ti ssues or structures i s desi red. The formul ati ons can be appl i ed to any such regions or sites. Exemplary regions or sites include the mucosa, liver, lung, gallbladder, intestines, stomach, colon, rectum, anus, muscle, kidney, artery, vein, brain, spinal cord, peripheral nervous system, eye (i ncl udi ng reti na), and genitouri nary system (i ncl udi ng bl adder, ureters, uterus, fallopian tubes, and prostate).

The formul ati ons can be applied to provide a cushion or lift (e.g., for an endoscopic resection procedure), to prevent or reduce fluid passage (e.g., to promote hemostasis), and/or to function as a barrier.

The formul ati ons can be used wi thi n the gastroi ntesti nal , pul monary genitourinary, renal, and reproductive systems, which have mucosal surfaces.

The formul ati ons can be used for mucosal resection techniques including, but not limited to, EMR, ESD, laparoscopic mucosal resection, uteroscopic mucosal resection, transurethral resection of bladder tumor, and laser mucosectomy. The formul ati ons are particularly useful in endoscopic procedures. Typically, the formul ati ons is administered at a target site (e.g., a submucosal layer) to form a cushion or I ift.

The sel f-assem bl i ng pepti des are suitable for use i n endoscopi c resection procedures in the upper and lower gastrointestinal tract, such as the esophagus, stomach, smal I i ntesti ne, colon, si gmoi d col on, and rectum, and as a submucosal i nj ectabl e agent duri ng the removal of pol yps, adenomas, earl y-stage cancers and other pathological lesions by EMR, ESD or polypectomy. The formul ati ons can be i njected i nto the submucosal I ayer (e.g., by an endoscopic injection needle). When injected, the formul ati ons create a I i ft in situ by el evati ng the gastroi ntesti nal mucosa from the submucosal layer, allowing performance of a resection procedure (e.g.,

EMR, ESD or polypectomy). In some embodiments, theself-assembling pepti des sel f -assembl e and/or undergo a phase transit! on upon contact with a bodily fluid in the submucosal layer. The I ift may be fluid, semi-fluid, or gel- like. The li ft may withstand the appl i cati on of pressure duri ng resecti on (e.g. , not dissipate, diffuse or deform). The formul ati ons can be appl i ed to regi ons or sites indudi ng mucosa and/or surrounding tissues in a subject (e.g., a human). The formul ati ons can be applied to or beneath mucosa intended to be lifted by the formul ati on. Exempl ary regi ons or sites i ncl ude submucosa, mucosa, or epi thel i urn. For exampl e, the formul ati ons can be appl led to the mucosa or submucosal I ayer of digestive organs such as the esophagus, stomach, duodenum, bile duct, small intestine, large intestine, colon, and rectum, the mucosa of respiratory organs such as the I ung, and the mucosa of genitouri nary organs such as the urinary bladder, urethra, vagina, and uterus Preferably, the formul ati ons are applied to the mucosa of the upper digestive tract (from the esophagus to the stomach or duodenum) and the mucosa of the I ower di gestive tract (the smal I i ntesti ne, jejunum, ileum lower than the duodenum), and I arge i ntesti ne (colon, rectum).

The formul ati ons can be appl i ed to regi ons or si tes that contai n one or more I esi ons Examples of rel evant I esi ons are i nf I ammatory ti ssue, pol yps, pseudo- polyps, serrated lesions, adenomas, ulcerations, dysplasias, preneoplastic and neoplastic formati ons, congenital abnormalities, and tumors (including mesenchymal tumors, lymphomas, epithelial tumors, gastrointestinal stromal tumors, among others). Typically, the formul ati ons areadmini stered i nto the submucosal I ayer beneath or besi de a lesion to providea lift. The lift is formed such that it is spati al I y posi ti oned and i s of optimal height and/or shape to facilitate resection of a lesion (e.g., polyp or tumor) at or near the target site. The lesion can range in size or vol ume from about 1 mm to about 20 mm and often more. Larger lesions, such as gastroi ntesti nal stromal tumors, can commonly range in size from about 5 cm to about 8 cm, and can occasionally reach sizes of at least 35 cm.

I n some embodi ments, the sel f-assembl i ng pepti des are useful for the removal of mucosal lesions, polyps, pseudo-polyps, flat polyps, adenomas, serrated lesions, dysplasias, Barrett's dysplasia, pre- neoplastic formations, neopl astic formations and/or tumors duri ng Surgi cal procedures.

Polypectomy is a procedure used to remove polyps (an abnormal collection of ti ssue that extends i nto the hoi I ow space) A pol ypectomy can be performed on any area of the body that devel ops polyps, such as in the uterus, nose, cervix, colon, or stomach. Polypectomy can be performed through open surgery, but more commonly, it is performed minimally invasively.

EM R and BSD are exampl esof minimally i nvasive surgery and are the pri mary surgi cal options for resecti on of lesi ons such as di gesti ve system pol yps and mal i gnanci es. EM R i s an endoscopi c techni que devel oped for removal of sessile or flat neoplasms confined to the superficial layers (mucosa and submucosa) of the gastrointestinal tract. EMR istypically used for removal of lesi ons I ess than 2 cm in size or piecemeal removal of larger I esi ons. EM R al so pi ays an i important role in the assessment of resected sped mens for accurate pathol ogi cal stagi ng. V ari ous EM R techni ques have been described, and four methods involving snare resection are commonly used: inject and cut; inject, lift, and cut; cap-assisted EMR (EMRC); and EMR with ligation (EMRL). The inject and cut technique, also known as submucosal injection polypectomy, has become more widely used because of its simplicity. The diseased mucosa is lifted from the muscular layer by creating a submucosal fluid cushion, and then captured, strangulated, and resected with, for example, an electrosurgical snare.

BSD was devel oped for wi de areas and removi ng I esi ons deemed to large to be safely addressed by EMR. Lesi ons are dissected directly along the submucosal layer using an electrosurgical knife, allowing for en bloc resection of large lesions. ESD is associated with more perforation and bleeding complications than conventional EMR, and requires, therefore, a greater degree of endoscopi c skill and ex peri ence.

Submucosal injection is essential in most EMR procedures, and it is integral to ESD. Injection lifts the I esi on and separates it from the muscular layer, thereby reducing thermal injury and the risk of perforation and bleeding, while making larger en bloc resecti ons techni cal feasible. Self- assembl i ng pepti des can be used for submucosal injection to provi de a lift to faci I i tate the procedure. The el evati on of the mucosal surface al I ows for easier resection of the mucosal lesion even if the lesion isflat and thus not protruding into the lumen. Self-assembling peptides (e.g., in theform of a f I ui d or gel ) can provi de I i f t that remai ns i n the submucosal I ayer I ong enough to avoid the need for multiple injections, improve outcomes, reduce adverse events, and mi ni mize damage to ti ssue sped mens i n order to al I ow for accurate pathol ogic stagi ng. The I ift generated by self-assembl i ng pepti des can I ast I ong enough to al I ow the endoscopi c procedure to be performed with few or no re-injections, lasting for at least 15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4 hours or longer, uni ike with other formulations, such as normal saline, which may require repeat injections every coupl e of mi nutes.

For exampl e, a sol uti on of self-assembl i ng pepti des can be i nj ected i n the submucosal layer. Upon contact with a bodily fluid, the self-assembling pepti des sel f-assembl e i nto a gel or gel -I i ke structure that provi des mechanical support as a cushion or lift to facilitate resection of a lesion. Additionally, and/or alternatively, the self-assembl ed structure can prevent or reduce the movement or flow a bodily fluid such as blood. This combination of lift, hemostaticand sealant properties of the self-assembl ing peptides f ormul ati ons i s advantageous for EM R and BSD .

For Separation of Tissuesfrom Vital Structures or Implants

Sel f-assembl i ng pepti des can be admi ni stered for the purpose of separating non-vital tissuesfrom vital structures, including, for example, cranial nerves, biliary ducts, coronary arteries and other critical blood vessel s, and sensi ti ve organs or ti ssues thereby I esseni ng the ri sk for iatrogenic i nj ury. Disruption of these can be potential ly catastrophic to the patient.

Sel f-assembl i ng pepti des can be admi ni stered for the purpose of separating tissues and organs from medical implants and devices, such as i mpl antabl e cardi overt er def i bri 11 ators and pacemakers (e.g. procedures within or near the pocket), electrodes, stents, breast implants, ocular i mpl ants, among others, i n order to mi ni mi ze damagi ng the devi ce or ti ssue to whi ch i t i s i mpl anted. For Management of Anti-retropulsion Migration during Lithotripsy

Sel f-assembl i ng pepti descan be admi ni stered by ureteroscopy to a site of renal stones to prevent antiretropulsion migration during lithotripsy, as well as to manage bleeding that may occur i n surroundi ng ti ssue as a result of the procedure. This may be of particular benefit in patients for whom the procedure may be ri ski er or otherwise contrai ndicated due to underl yi ng bl eedi ng probl ems, such as those due to quali tati ve pi atel et abnormalities.

For Control of Leakage of Fluid and/or Bleeding

Sel f-assembl i ng pepti de formul ati ons can be admi ni stered to prevent rupture of structures. Self-assembling peptides are administered near structures that are at risk of rupturing, resulting in fluid loss, such as from a maj or artery or the central nervous system, or potenti al contami nati on of surrounding tissues, such as with a bowel perforation. In the instances, the formulation allows for better delineation, visualization, and separation of the structures.

Sel f-assembl i ng pepti des may be admi ni stered to stop or prevent acute or del ayed onset bl eedi ng that i s common i n procedures requi ring a I ift, tunneling, tissue delineation, or better visualization, whereby the formulation i s appl i ed at, on or adj acent to the si te of bl eedi ng. Exampl es i ncl ude gastrointestinal, prostate, and central nervous system procedures.

The same method can be used to stop or prevent acute or del ayed onset leakage of serum, gastrointestinal fluid, cerebrospinal fluid or other bodi ly fluids by appl yi ng the formul ati on topi cally or by injection i nto the ti ssue at or near the injection si te.

Sel f-assembl i ng peptides can also be used to provi de a seal to a surgical or non-surgical wound alone or in combination with sutures, clips or other devi ces, at the ti me of creati ng I i ft, tunnel s or bul ki ng adj acent to the tissue being treated.

Bleeding is a known complication of EM R and ESD. I ntraprocedural ESD bleeding can develop during submucosal injection, incision, or dissection Submucosal vasculature is abundant in the gastrointestinal tract and, therefore, intraprocedural bleeding occurs commonly. Although about 50% to 70% of bleeding is observed within 2 days of BSD, bleeding can devel op as I ate as 2 weeks after the procedure. Late post-procedural BSD bleeding is a concern because of the challenges associated with providing prompt care after pati ent di scharge.

Sel f-assembl i ng pepti des can be appl ied to a region or site of i nterest before, during, and/or after an endoscopic procedure. In some embodiments, the formulations reduce time of hemostasis by at least about 10%, 20%,

30%, 40%, 50%, 60%, 70%, 80%, 90%, or more relative to the time of hemostasi sin the absence of the formul ati on. The formul ati ons may reduce the ti me requi red to achieve hemostasi s by between 25% and 50%; between 50% and 75%; or between 75% and 100% rel ati ve to the time in the absence of the formul ati on. The ti me requi red to achi eve hemostasi scan be reduced by approxi matel y 2-, 3-, 4-, or 5-fol d rel ati ve to the time in the absence of the formul ati on. In some embodiments, administration of the formul ati ons prevents or reduces occurrences of intraprocedural and postprocedural bleeding (e.g., from an endoscopic procedure).

For Management of Complicated Skin Wounds

Sel f-assembl ing peptides can be used during debridement of compl i cated ski n wounds, such as burns or chronic wounds. The formul ati ons can provide separati on from critical structures and manage bleeding.

They can further be applied between a wound bed and either a skin graft, cellular or tissue based product, or ski n equival ent i n order to provi de separati on for a period of time that may be from 1 -5 mi nutes, up to one hour, up to 1 day, up to 7 days, or I onger, i n order to provide ti me for the wound bed to adequatel y heal , become less i nfl aimed, or achi eve hemostasi s as may be requi red before di reel contact with the appl i ed product isall owed. I n such cases, the sel f-assembl i ng pepti des resorb over ti me.

For use During Tumor Resection

Self-assembling pepti des can be used for the separati on and isolation of a tumor or malignant tissue from underlying surrounding or nearby tissue i n order to i mprove resecti on and provide d ear margi ns for demarcati on. Self-assembling peptides can also help manage bleeding and mitigate hematogenous spread of metastatic ti ssue. Exampl es of tumors i nd ude, but are not limited to, glioblastoma and acoustic astrocytoma in the brain; breast and prostate cancer; gastroi ntesti nal tumors; mel anoma and spi ndl e tumors, i ncl udi ng dermatofi brosarcoma, in the skin; hemangi oma; hepatocel I ul ar carcinoma, adenoma, and focal nodular hyperplasia in the liver; and renal cell carcinoma.

This approach may be particularly beneficial in Mohs Surgery during which a tumor or lesion is removed from a location in which there is a need to obtain or rely on smaller than normal margins, typically because of a nearby vital structure or risk for disfigurement.

For use During Resection of Arteriovenous Malformations

Self-assembling pepti des can be used for the separation, delineation, visualization, isolation and resection of arteriovenous malformations (AVMs) and prevention or treatment of related bleeding. AVMsare abnormal tangl es of bl ood vessel s connecti ng arteri es and vei ns that can disrupt circulation of blood and oxygen. AVMsare prone to weakeni ng and rupture. They may occur throughout the body, but are particularly common i n the brai n, where a rupture can result i n hemorrhage and stroke or brai n damage. b. visualization or access to tissue or margins during a procedure

I ncorporation of a dye or radiopaque agent ( imagi ng agent”) i nto the sel f-assembl i ng pepti de formul ati on enhances one’ s ability to i denti fy where the formul ati on has been i nj ected and to del i neate the structures separated by the lift, such as the mucosa, the submucosal layer and the external muscular wal I , thereby I oweri ng the risk of causi ng damage. The i magi ng agent can also help distinguish the cushion cavity from the mucosal basement. The i magi ng agent can be added to the sel f-assembl i ng pepti des formul ati on, identify! ng the area of submucosal i njection and disti nguishi ng between the muscle layer and the submucosal layer Thisalso facilitatesidentification of the lateral and deep margins of the target lesion before and during the resecti on process, T he i magi ng agent can also helpto eval uate the presence of residual lesions at the end of endoscopic resection and improve recognition of muscularis propria injury, which indicates intraprocedural perforation. c. For use as an Internal Cast or to Provide Structural Support Self-assembling peptides can be used to create an internal cast or structure that provides support around and/or between ti ssues or organs to, for i nstance, enable them to be stabi lized, protected, recover, and/or heal , such as after a central nervous system i nfarcti on or before, duri ng or after orthopedi c or geni touri nary procedures. I n parti cul ar, they can be used to stabi I i ze brai n parenchyma, i ncl udi ng by filling a potenti al voi d after hematoma evacuati on, as well as to stabi I i ze smal I , fractured and unstabl e carti I age or bony structures in lieu of i nserti ng permanent i mpl ants.

Theself-assembling peptides may also be injected as a bulking agent, where the gel is used i n procedures i nstead of al ternati ves such as al gi nate sol uti ons whi ch are cross-l i ned with calci urn i ons. I nj ectabl e bul ki ng agents are space-f i lling substances used to i ncrease ti ssue bul k.

I nj ectabl e bul king agents can be used endoscopi cal ly in the treatment of both uri nary i nconti nence and vesi coureteral refl ux. The advantages i n treati ng uri nary i nconti nence and vesi coureteral reflux wi th thi s minimally i nvasi ve approach i nd ude the si mpl i city of a quick outpati ent proced ure and the low morbidity assodated with it. The ideal substance for the endoscopic treatment of reflux and incontinence should be injectable, non-anti genic, non-mi gratory, vol ume stabi e, and safe for human use.

When used to treat stress uri nary i nconti nence (SU I), bulking agents are i nj ected peri urethral I y to i ncrease the tissue bul k and thereby increase resistance to the outflow of urine. Alternatively, the bulking agents are i nj ected transurethral I y by advanci ng a sped al I y desi gned i nj ecti on needl e through the operati ve port of a 0-degree cytoscope i nto the mucosa of the urethra j ust bel ow the i nternal urethral sphi ncter. The bulking agent is then injected at the 4 or 8 o'clock position until the urethral I umen i s vi si bl y occl uded, and the procedure i s repeated on the opposi te si de.

The use of i nj ectabl e bul ki ng agents to augment urethral ti ssue function isnow common practice because they facilitate minimally invasive del i very of the bul ki ng agent and provi de the advantage of I ow cost and I ow patient morbidity. The procedure can be performed in an outpatient setti ng with the patient under local anesthesia d. Creation of New Ti ssue Extracellular matrix (ECM) bioscaffolds prepared from decel I ul ari zed ti ssues have been used to f aci I i tate construct! ve and f uncti onal ti ssue remodel i ng i n a vari ety of cl i ni cal appl i cati ons. The di scovery that these ECM materials could be solubilized and subsequently manipulated to form hydrogels expanded their potential in vitro and in vivo utility; i.e. as cul ture substrates comparabl e to col I agen or M atri gel , and as i nj ectabl e materi al s that f i 11 i rregul arl y-shaped defects. The mechani sms by whi ch

ECM hydrogel s di rect cel I behavi or and i nf I uence remodel i ng outcomes are only partially understood, but likely include structural and biological signals retai ned from the native source tissue. The ECM consi sts of the structural and functional molecules secreted by the resident cel Is of each tissue, hence the 3D organi zati on and bi ochemi cal composi ti on of the ECM is disti nctive for each tissue type.

M i mi cki ng aspects of the structure and composi ti on of the ECM usi ng self -assembled peptides provides an alternative to these materials as a means of creating new tissue at sites of injection. e. Smoothing of wrinkles, scars or other plastic surgical indications

Dermal f i llers are gel -I i ke substances that are i nj ected beneath the ski n to restore I ost vol ume, smooth I i nes and soften creases, or enhance f aci al contours The f i 11 ers are used to smooth out I i nes around nose and mouth (a k.a. mari onette I i nes, smi I e I i nes, and parentheses) , enhance and restore vol ume to sunken cheeks or tempi es, di mi ni sh verti cal I i p I i nes pi ump and enhance the lips, smooth out a chi n crease, and i mprove symmetry among facial features.

The self-assembl ed pepti de gel s can also be admi ni stered to smooth out scar tissue, whether due to i nj ury, surgery or burns.

Effective A mounts

I n general , the requi red amount of self-assembl i ng pepti des and formulations thereof varies depending on several factors including, for i nstance, the sped fic sel f-assembl i ng pepti des empl oyed, the di mensi on of the treated area, the desi red size of the planned cushion or lift at the target site, and the procedure duration. Other factors that may affect the sped f i c dosage i nd ude age, body wei ght, general health status, sex, ti me of admi ni strati on, and severi ty and course of an underl y i ng di sease or condi ti on. The admi ni stered dosage, vol ume or concentrati on may vary depend! ng upon the form of the self-assembl i ng peptides (for exampl e, in a pepti de sol uti on, hydrogel ) and the route of admi ni strati on. In certai n embodiments, the self-assembl ing peptide formulation is administered in a single dose. In other embodiments, the self-assembl ing peptide formulation i s admi ni stered i n two or more doses.

An effective amount, whether in reference to self- assembling peptides and/or other agents present i n the formulati ons, means the amount necessary to elicit a desi red response or effect. For exampl e, i n some embodi ments the sel f-assembl i ng pepti des formul ation is admi ni stered i n an amount to form a desi red cushion or lift at a target site (e.g., in submucosal layer beneath a lesion).

I n another exampl e, an effective amount can be an amount of a self- assembl ing pepti des formul ation that accelerates hemostasis, such as an amount sufficient to decrease blood loss between the onset and cessation of bleeding by at least 25% relative to comparable blood loss in the absence of the formul ation. An effective amount of a formul ation for accelerating hemostasi s may also be an amount suffi ci ent to decrease the ti me to cessati on of visible bleeding by at I east 25% rel ati ve to comparabl e time in the absence of the formul ati on The effective amount may vary depend! ng on the desi red size of the result! ng cushi on or I ift and/or the degree of bl eedi ng. The amount may vary, for example, from a few microliters to several milliliters or more, e.g., tens or hundreds of milliliters. In some embodiments, the effective amount may i ncl ude vol umes of from about 0.1 mi 11 i liters ( mL) to about 100 mL of a self- assembl i ng pepti des sol uti on. In certai n embodi ments, the effecti ve amount may be about 0.5 mL, 1.0 mL, 1.5 mL, 2.0 mL, or 3.0 mL of aself- assembl i ng pepti des sol uti on. In certai n embodi ments, the effecti ve amount may be approximately 0.1 mL to about 5 mL per 1 cm ² of target area

Useful concentrations of self-assembling peptides in the formulations can range from between approximately 0.1-10% (e.g., 0.1-2%; 0.1-3%; 0.1- 4%; 0.1-5%; 0.5-5%; 1-3%; 1-4%; 1-6%; 1-8%, and 1-10%) expressed in weight/vol ume or vol ume/vol ume. Any subrange, or any specif i c val ue within any of the aforesaid ranges, can be used. The effective amounts may include self-assembling pepti des concentrations in solution of about 1% w/v.

I n other embodi ments, the effecti ve amounts may i ncl ude self-assembl i ng pepti des concentrations of about 1.5%, 2%, 2.5%, 3%, 3.5%, or 4% w/v.

M ethods of admi ni strati on

The sel f-assembl i ng pepti des and formul ati ons can be admi ni stered via any means whi ch i s effecti ve to deliver an effecti ve amount to asite in need thereof. In some embodi ments, the formul ati ons are delivered directly to the target site/surface using mechanical delivery means, e.g., dropping and/or spraying.

Delivery devices that may be used include a syringe, pipette, tube, endoscope, I aparoscope, catheter, syri nge catheter, or other needl e- based devi ce. I n preferred embodi ments, the formul ati ons are admi ni stered to the target site through an endoscope, laparoscope, or catheter. The use of a catheter may provide for selective administration of the formul ati on to provide for a more accurate delivery to the target site. Administration of the formul ati on may al I ow for enhanced and more targeted del i very of the sel f- assembling pepti des sol uti on, such that formation of a cushion or lift is successful and positioned in the desi red location in an accurate manner I n some embodi merits, the sel f-assembl i ng pepti des formul ation is admi ni stered to a target site through i nj ecti on by means of an endoscopi c injection needle. For ©(ample, in some embodiments, an effective amount of a sel f-assembl i ng peptides formulation is admi ni stered by means of an endoscopi c i nj ecti on needl e i nserted through the worki ng channel of the endoscope. The endoscopic injection needle can be positioned to facilitate deposition of the formul ation immediately under the superficial mucosal layer or a lesion, or to deposit the formul ation (e.g., a liquid) into the submucosal layer.

All references cited herei n are i ncorporated by reference in their entirety. The present description will be further understood by reference to the followi ng non- 1 i mi ti ng exampl es.

EXAM PLES

Example 1: Self-assembling peptidesform submucosal cushions and promote hemostasis in endoscopic resection procedures in a porcine model.

M ateri al s and M ethods

Solutions of (RADA) ₄ (RADARADARADARADA; SEQ ID NO: 1) i n water were prepared. Concentrati ons of (RADA) ₄ (SEQ I D NO: 1 ) were between from 1% and 3%w/v. Methylene blue or indigo carmine dye (0.1 to 0.4%) was added to the sol uti on i n some ex peri ments, and ex cl uded from the sol uti on in other experi ments.

Rgs were randomly assigned to control or experimental groups. Animals were anesthetized. Multi pie (> 20) endoscopic procedures (EM D and ESD) were performed in different areas of the stomach of pigs, including the pyl orus, and the esophagus, i ncl udi ng the sphi ncter. I n some experiments, polyps had previously been created by applying bands to the mucosa

The (RADA) ₄ (SEQ I D NO: 1) sol uti ons (experi mental ani mals) or saline or EL EV I EW™ (control ani mal s) were admi ni stered i nto the submucosal space through 2.2 mm channel diameter, 230 cm long catheters that have either 25 gauge needle ti ps or spray ti ps on the end to form a cushi on. I n some ex peri ments, catheters havi ng different diameters were used as well as multi pie internal channels. The products were delivered from a prefilled syringe or mixed from a kit prior to delivery.

Results

Ex peri ments were performed to i nvesti gate the use of SAP in gastroi ntesti nal tract endoscopic procedures. The cushion formi ng ability of the different (RADA) ₄ (SEQ ID NO: 1) formulations was evaluated using several procedures i n pigs The porcine model was used because it isa widely accepted model of the human gastrointestinal mucosa

M ul ti pi e procedures were performed, indudi ng endoscopi c mucosal resections, endoscopic submucosal dissections and hemostasis of postpolypectomy beds (RADA) ₄ (SEQ ID NO: 1) was easily delivered through a 25G endoscopic injection needle and provided a durable submucosal lift in the gastric antrum that lasted beyond 2 hours. When del ivered with the visualizing agent prior to tissue dissection, (RADA) ₄ (SEQ I D NO: 1) allowed for easy visualization with both snare and electrosurgical knives, and no visible bleeding was observed following pol yp removal . 11 was al so shown to provide hemostasis in actively bleeding lesions when applied with or wi thout the vi sual i zi ng agent, ei ther topi cal I y to a bl eedi ng si te or when injected i nto the nearby mucosa. Furthermore, (RADA) ₄ (SEQ I D NO: 1) was found to be useful i n conj unction with clips asa potenti al sealant when appl ied followi ng appl i cati on of cl i ps to a post-pol ypectomy si te for the purpose of mitigating leaks and potentially enabling healing.

Submucosal injection of (RADA) ₄ (SEQ ID NO: 1) solutions created cushi ons. With good vi si bi I i ty, mucosal ti ssue above the cushi on was easi I y removed with snares. I n other cases, the ti ssue was di ssected whilea submucosal tunnel was created and elongated with simultaneously appl i cati on of the formul ati on; ti ssue represent! ng the roof of the tunnel was removed. I n other cases, a long cushion was created, and a submucosal tunnel was dissected subsequently. Tissue representing the roof of the tunnel was removed. I n some procedures, mi ni mal to no bl eedi ng i n most I esi ons was observed indicati ng that the sel f-assembl i ng pepti de sol uti on was prophyl acti cal I y hemostatic. In afew lesions that bled, or in cases where bleeding was created intentionally, direct application of the (RADA)4 (SEQ ID NO: 1) solution, either topically or by injection, into the mucosa near the bleeding site stopped bleeding promptly, typically within seconds During the procedures, the (RADA)4 (SEQ ID NO: 1) solutions were easily used as an adj unct to dips to achieve hemostasis and prevent leaks i n I arge wounds The(RADA)4 (SEQ ID NO: 1) solutions produced cushions that were of significant height that provided adequate lift/cushion. After formation of the mucosal lift/cushion, polyps were easily removed. It was easier to control the degree of lift provided by the (RADA )4 (SEQ ID NO: 1) solution versus saline, which is traditionally used. (RADA)4 (SEQ I D NO: 1) cushions remai ned i ntact where I ocal ly inj ected wi thout evi dence of dissi pati ng or traveling away. The(RADA)4 (SEQ ID NO: 1) cushions were highly durable (the duration of submucosal elevation could be measured in hours), while also possessi ng prophyl acti c hemostati c and seal ant properti ea The durabi I ity of the (RADA)4 (SEQ I D NO: 1 ) cushions was pronounced, lasting longer than ELEVIEW™ and saline control a The(RADA)4 (SEQ ID NO: 1) cushi ons perm! tied safe and eff i ci ent performance of EM R as a si ngl e injection without need for subsequent injections, even hours later.

The (RADA)4 (SEQ ID NO: 1) cushions could be easily dissected through and tissue could be resected/dissected using a range of devices, i ncl udi ng hot and col d snares and knives (indudi ng hot/energi zed or col d) knivea

Excel I ent ability to tunnel through the ( RADA )4 (SEQ ID NO: 1) cushi ons was observed, even for long distancea up to centimeters in length. Easy injection of the (RADA )4 (SEQ ID NO: 1) compositions into the lumen and di ssecti on i nto tunnel s through the I ayers as desi red was performed wi th excellent visibility and over prolonged periods of time. When (RADA)4 (SEQ ID NO: 1) cushions were created, the dinici an/endoscopist could easi ly find the tunnel openi ng whenever the equi pment was removed and rei nserted. This was observed over extended peri ods of ti me, typi cal I y more than an hour The(RADA)4 (SEQ ID NO: 1) solutions with dye or without dye were appl i ed as desi red. Thi s was determi ned by whether or not contrast was preferred in the given situation. In some topi cal application situations, contrast can obscure the vi sual field. This was not the case i n any procedures requiring injection.

Collectively, these results show that self-assembl i ng peptides can be used to create cushions or lifts duri ng endoscopic procedures. Self- assembl i ng pepti des cushi ons/l ifts in the submucosal I ayer faci I i tate easy removal of polyps and other lesions The self-assembl ing peptides cushions/lifts show high duration, obviating the need for multiple injections. The cushi ons/l ifts are expected to be resorbed over ti me. The self-assembl i ng pepti des cushions limit or prevent bleeding (i.e, prophylactically), but the sel f-assembl i ng pepti des formul ati ons can also be appl i ed topi cal I y or by i nj ecti on to stop bl eedi ng duri ng and/or after the procedure. Example 2: Tumor resections using SAPS

The formul ati ons were tested to confi rm thei r useful ness for the separation and the isolation of tumor and tumor tissue from the underlying and surroundi ng ti ssue that contai ns the tumor. Thi s creates a resecti on pathway and a clear margin for demarcation during resection. In addition, it stops bleeding and flow of any ti ssue out of the tumor to contai n metastases.

M ateri al s and M ethods

Prostrate tumors were subcutaneousl y impl anted i n nude mi ce.

Formulations of (EARA) ₄ (SEQ ID NO: 89), (RADA) ₄ (SEQ ID NO: 1), and other sequences, were i nj ected to I ift and separate the tumor from the surroundi ng tissue duri ng resection.

Results

The SAP formul ati ons were effect! ve to hoi d I oose t umors together so that when they were resected, nothing was I eft behind. Thisalso helped to i nsure good margi ns were obtai ned. In addi ti on to bl eedi ng control , there i s also metastati c control . The margi ns are cl earl y vi si bl e as wel I . Example 3: Rheology and injection force assessment of self-assembling peptides formulations

M ateri al s and M ethods

AC5-G solution preparation

(RADA)4 peptide (SEQ I D NO: 1) from Arch Biosurgery (also referred to asAC5) was used. 1.5%, 2.0% and 3% solutions of (RADA)4 (SEQ ID NO: 1) were prepared using an aqueous solution of 0.004% Methylene Blue (MB) NF grade in SpeedMixer™ cups The cups were then transferred to the Speed-M ixer™ and run at 3,000 rpm for 5 mi nutes. The sol uti ons were exami ned for uni f ormi ty and ai r bubbl es. T he sol uti ons were then quickly transferred into BD syringes and filtered through a 0.2u FES syri nge f i I ter. The f i I tered sol uti ons were f i 11 ed i n Schott 5cc T opRac COC Syringes.

Injection Force Measurements

A calibrated Mark-10 force gauge and motorized stand (travel speed was 1 ,5”/mi n) were used to measure the i njection force of sol uti ons from 5cc syri nge connected to 240cm x 23G BSC I nterj ect catheter needl e.

Rheol ogy Assessment

Peptide sol uti on: A TA instruments DHR-2 rheometer with a parallel pi ate conf i gurati on was set up. Each test sol uti on was vortexed for 5 mi nutes and then 130 microlitersof solution was placed on the Peltier plate previ ousl y equi I i brated 25°C. The 20 mm steel paral I el pi ate geometry was I owered to a gap of 325 mi crometer contact! ng the pepti de sol uti on on the Pel ti er pi ate Ti me sweep data was col I ected under strai n control I ed conditions: Frequency 1 Hz, Strain 0.1%, Time 10 minutes, delay time 10 seconds.

Peptide sol uti on mixed with human sera: A TA instruments DHR-2 rheometer wi th a paral I el pi ate conf i gurati on was set up. Each test sol uti on was vortexed for 5 mi nutes. Fi rst, 65 mi crol iters of human sera was added to the center of the Pel ti er pi ate (precool ed to 5°C) and then 65 mi crol i ters of pepti de sol uti on was added. Both sol uti on were mi xed together briefly wi th a pi pette ti p The 20 mm steel paral I el plate geometry was I owered to a gap of 325 micrometer contacting the peptide sol ution on the Peltier plate. The test was started wi thi n one mi nute of mi xi ng the pepti dewith human sera.

Ti me sweep data was col I ected under torque control I ed condi ti ons Frequency 1 Hz, Torque: 20 pN.m, Temperature: 37°C ( heating from 5°C as fast as possi ble during the experi ment) , Time 30 mi nutes, delay time 10 seconds.

Results

Tabl e 2 shows the resul ts from the i nj ecti on force experi ments. T able 2. 1 nj ecti on force measurements

The i nj ecti on force resul ts show that as concentrati on of the sel f- assembling peptide increases, it generates viscosity/ rheol ogi cal property such that it will requi re a I arger force to inject the sol uti on through a needl e catheter into tissue. It isbelieved that if water were to be injected in this experiment instead, the value for injection force would be I ess than 10 N (data not shown).

Tables S and 4 show the results from the rheol ogy assessments T able 3. Rheol ogy measurements for pepti de sol uti ons T able 4. Rheol ogy measurements for pepti de sol uti ons mi xed wi th human sera

The rheological results show that the G’ (storage modulus, which is an indi cator of the elastic behavi or/mechani cal property) val ue i ncreases with concentration. When G’>G”, this indi cates that the sol uti on is more likeagel than a vi scous sol uti on. The G’ val ues were I ower in the absence of sera (T able 3) as compared to the presence of sera (T able 4). The ex peri ments in which the pepti de sol uti ons were mixed with sera show that i ) AC5-G self assembles and the mechanical strength of the resulting gel is dependent on the concentration of the peptide, and i i ) the addition of methyl ene blue did not affect the self-assembl i ng property of the sol uti on (similar trends were observed for the ACS pepti de sol uti ons wi th or wi thout methylene blue).

Overal I , it is contemplated that the rheology and i njection force experi ments descri bed above can i nform the sel ecti on of the concentrati on for a self -assembling peptide formulation. For example, in some embodi ments a formul ati on that requi res a I ower i nj ecti on force but reasonable G’ value post mixing with serum is useful asa lift solution and hemostat.