WO2001068076A2 - D-enantiomer of dfmo and methods of use thereof for treating cancer - Google Patents

Abstract

The present invention concerns a method for preventing and/or treating cancer in a patient comprising administering an effective amount of substantially purified D enantiomer of difluoromethylornithine (D-DFMO) or an analog of D-DFMO to the patient. D-DFMO or an analog thereof is administered at a dose of about 0.05 to about 20.0 gm/M2/day. D-DFMO or an analog thereof may be administered more than once for the treatment and/or prevention of cancer. Methods of administration as well as compositions and formulations of substantially purified D-DFMO and analogs of D-DFMO are described.

Description

DESCRIPTION

D-EN ANTIOMER OF DFMO AND METHODS OF USE THEREFOR

BACKGROUND OF THE INVENTION

The piesent patent application claims pnoπt to co-penαing U S

ιsιonal Patent Application Serial No 60/187.441 filed March 7. 2000 and co-pendmg I S Provisional Patent Application Senal No 60'215.866 filed Julv 1. 2000

1. Field of the Invention

The present invention relates generally to the fields of cancer and biologv More particularh it concerns methods for use of the D-enantiomer of difluoromethvlornithine in cancer therapv

2. Description of Related Art

Difluoromethvlornithine (DFMO) is an irreversible inhibitor ot oimthme decarboxylase (ODC), the kev enzyme in mammalian polyamme biosynthesis (Pasic et al . 1997) The two enantiomers of DFMO have been reported to differ in their ability to inhibit ODC. with the L form being more potent then the D enantiomer (Danz et al . 1987) Although the physiologic functions ot polv amines are not completeh understood, it is clear that their mtracellular concentration is highlv legulated and that normal cell growth, replication differentiation, secretory and repair functions require polyammes (Pegg and McCann. 1982 Oka et al . 1981. Pegg. 1986. Bacnrach. 1973. Williams- shman and Canellakis. 1979 Thet et al . 1984. Luc and Baylin. 1984) Polyammes have been found in high levels in many tumor cells (Pasic et al . 1997) and support sustained cell growth that is essential for the multistep process of cancer development In animal models of colon carcmogenesis. inhibition of ODC b\ DFMO reduces the number and size ot colon adenomas and carcinomas (Me skens and Gerner. 1995 ) Elevated levels of ODC hav e also been reported in transitional cell carcinoma of the bladder and the use of DFMO as a treatment tor bladder cancer patients has been reported (Messing et al 1995)

One ot the unfortunate side effects of DFMO treatment is disruption ot auditor/ function Polyammes hav e been found in the cochlea but their role in hearing is unknown ( Schweitzer et al . 1986) A potential role of polv amines in the cochlea could be to allow interactions with hvdrophobic en ironments, such as those occurring in membranes and thev may regulate the

of inorganic cations (Canellakis et al . 1979) Cochlear function is intimately dependent on the unique electrol tic concentration and positiv e polarization of the endolymph Theretore. changes in the le els ol polv amines could alter the kinetics of electrolytes that underlie the endocochlear potential and consequent!} affect cochlear function (Schweitzer et al . 1986)

Two pes ot ototoxicity are known, a v ertigo-like syndrome and hearing loss (Mevskens and Gerner. 1995 ) As the daily dose of D.L-DFMO increases ( 0 5 g/m2/day to 3 g/m2/day). the magnitude and incidence of threshold shift increases, and the time until onset of the threshold shift decreases (Pasic et al . 1997) Patients w ith normal (threshold less than 30 dB) baseline audiograms demonstrate more hearing loss than those with abnormal (threshold greater than or equal to 30 dB) baseline audiograms at the higher frequency levels (Crogham et al . 1991) Both side effects aie reversible after drug discontinuation (Mevskens and Gerner. 1995). w ith recover} of threshold showing no dependence on the magnitude of the threshold shift or the dose of D.L-DFMO that was administered (Pasic et al . 1997)

Development of chemotherapeutic agents with less ototoxic potential is complicated b} a lack of dosage data in animal models and by uncertainty over which species are susceptible to DFMO ototoxicity The route of DFMO administration most commonly employed has been via ingestion of adulterated drinking water However, accurate quantitation of water intake (and thereby drug dose) has not been carried out W eight loss is a serious consequence of such DFMO exposure ( Mevskens et al . 1995 and it is not clear whether the weight loss results from subjects limiting their intake of contaminated water (possibly due to factors such as taste) or from the toxic effect of the drug itself

The models for DFMO study produce conflicting data In the guinea pig. D.L-DFMO inhibits ODC activit} cochlear tissue and a significant depletion of cochlear polyammes results (Marks et al . 1991 ) \long with this, brainstem audiometn shows that treatment bv water adulterated with 1% D.L-DFMO produces hearing loss accompanied by damage in the hook and first turn with a loss of hair cells in all row s Inner hair cells aie lost at a greater rate than outer hair cells (OHCs) (Salzer et al . 1990 ) W hen the rat is used as the model, the cochlear polyammes are not depleted to a lev el considered critical for disrupting polyamme- dependent processes in other systems Auditorv thresholds evaluated by brainstem evoked potentials remained unchanged in the D.L-DTMO treated rats ( Schweitzer ei al 1986) although onlv a limited dose range was in estigated

There exists a need tor therapeutic compositions and methods of use of those compositions tor the treatment ot cancer that demonstrate lower toxicities and or other side effects

SUMMARY OF THE INVENTION

The present invention concerns a method for preventing and/or treating cancer m a patient comprising administering an effective amount of substantially enriched D enantiomer of difluoromethvlornithine (D-DFMO) or an analog thereof to the patient D-DFMO or an analog thereof is administered at a dose of about 0 05 to about 20 0 gm/M /da} In preferred embodiments. D-DFMO is administered at a dose of about 0 1 to about 2 0 gm M /da} D- DFMO or an analog thereof ma} be administered more than once for the treatment and/or prevention of cancer

The cancer may be bladder cancer, colon cancer, breast cancer, pancreatic cancer, brain cancer, lung cancer, stomach cancer, a blood cancer, skin cancer, testicular cancer, prostate cancer, ovarian cancer, liver cancer, esophageal cancer, and any combination thereof In preferred embodiments, the cancer is colon cancer, and may include familial adenomatous polyposis In other preferred embodiments, the cancer is bladder cancer, and ma} include superficial bladder cancer Preventing and/or treating cancer in a patient by administration of D- DFMO or an analog thereof can involve resection of a solid tumor D-DFMO or an analog thereof may be administered prior to the resection or following the resection

Preventing and/or treating cancer in a patient b} administration of D-DFMO or an analog thereof is accomplished b} a mechanism selected from inducing apoptosis. inhibiting cell div ision, inhibiting metastatic potential, reducing tumor burden, increasing sensitivity to chemotherapv or radiotherapv . killing a cancer cell, inhibiting the growth of a cancer cell. inducing tumor regression and anv combination thereof

Administration of D-DFMO or an analog thereof is b} a route selected from oral, intrav enous, intramuscular, intratumoral. intrapeπtoneal. lntradermal. dermal, nasal, rectal. v aginal, topical buccal. and mtralv mphatic administration in preferred emoodiments DFMO is administered diiectlv to the tumor D-DFMO or an analog thereof mav also be administered svstemicallv administered into the regional v asculature of the tu oi or administered into the region lymph s stem of said tumoi In even more preferred embodiments D-DFMO is administeied orallv

Substantial!} enriched means the D enantiomer comprises at least 60° o b} weight of the difluoromethv lornithine dosage being administered or at least 70% bv weight of the difluoromethvlornithine dosage being administered or at least 80% bv weight of the difluoromethv lornithine dosage being administered or at least 90% bv weight of the difluoromethv lornithine dosage being administered or at least 95% bv weight of the difluorometh lornithine dosage being administered or at least 97 5% bv weight of the difluoromethvlornithine dosage being administered or at least 99% bv weight of the difluoromethv lornithine dosage being administered In preferred embodiments, the D enantiomer comprises at least 99 5% bv weight of the difluoromethvlornithine or analog dosage being administered

The present invention also concerns a pharmaceutical composition, comprising substantially enriched D enantiomer of difluoromethvlornithine (D-DFMO) or an analog thereof together with a pharmaceuticallv acceptable carrier The D-DFMO pharmaceutical composition may be formulated into a unit dose for administration to a patient The pharmaceutical formulation is in a form selected from rapid release timed release, dela ed release, sustained release oral suspension, tablet, capsule, powder troche, suppositorv . hposome. nanoparticle inhalant, nasal solution, opthalmic solution, otic solution, irrigation solution, intravenous admixture, epidermal or transdermai solution, buccal tablet svrup. cream, ointment, lotion, gel emulsion elixer douche, enema, gargle, implant, and aerosol

In preferred embodiments the pharmaceutical composition ot the present invention comprises at least 60% bv weight D-DFMO or an analog thereof of the total DFMO or analog in the composition oi at least 70% bv weight D-DFMO of the total DFMO in the composition, or at least 80% bv weight D-DFMO of the total DFMO in the composition, or at least 90% bv weight D-DFMO of the total DFMO in the composition or at least 95% bv weight D-DFMO of the total DFMO in the composition, or at least 97 5% bv weight D-DFMO of the total DFMO in the composition, or at least 99% by w eight D-DFM of the total DFMO in the composition, or at least 99.5% by weight D-DFMO of the total DFMO in the composition.

BRIEF DESCRIPTION OF THE DRAWINGS

The following drawings form part of the present specification and are included to further demonstrate certain aspects of the present in ention. The invention may be better understood bv reference to one or more of these drawings in combination with the detailed description of specific embodiments presented herein.

FIG. 1 Weight gain of rats treated with D.L-DFMO by gavage daily for 54 days.

Four conditions were chosen to represent the data. *: Control (n=3 ). ■: 200mg/kg D.L-DFMO ( n=3 ). T: 400 mg/kg D.L-DFMO (n=3): A: 600mg/kg D.L-DFMO (n=3 ). ♦: 800mg/kg D.L- DFMO and •: 1.2g/kg D.L-DFMO ( n=2). Vertical bars are standard error ( SE).

FIG. 2A, FIG. 2B, FIG. 2C, FIG. 2D. and FIG. 2E CAP threshold elevation of rats caused by 54 days of D.L-DFMO gavage. Animals are the same as in FIG. 1 . FIG. 2A. *: Control (n=3 ) and ■: 200mg/kg D.L-DFMO ( n=3 ); FIG. 2B. *: Control (n=3 ) and T: 400 mg/kg D.L-DFMO (n=3 ): FIG. 2C. *: Control (n=3) and ▲: 600mg/kg D.L-DFMO (n=3): FIG. 2D. *: Control (n=3) and ♦: 800mg/kg D.L-DFMO: FIG. 2E. *: Control ( n=3 ) and •: 1 .2g/kg D.L-DFMO (n=2 ). Vertical bars are standard error ( SE ).

FIG. 3A. FIG. 3B, FIG. 3C, FIG. 3D. and FIG. 3E Elev ations of 1 μV RMS CM iso-amplitude curve in rats caused by 54 days of D.L-DFMO gavage. Animals are the same as in FIG. 1 . FIG. 3A. *: Control (n=3) and ■: 200mg/kg D.L-DFMO ( n=3 ): FIG. 3B. *: Control < n=3 ) and T: 400 mg/kg D.L-DFMO (n=3): FIG. 3C. *: Control (n=3 ) and A: 600mg/kg D.L- DFMO (n=3): FIG. 3D. *: Control (n=3 ) and ♦: 800mg/kg D.L-DFMO: FIG. 3E. *: Control ( n=3 ) and •: 1.2s/k2 D.L-DFMO (n=2 ). Vertical bars are standard error ( SE).

FIG. 4 Weight gain of guinea pigs treated with D.L-DFMO by ip injection daily for 45 days. 2g/kg D.L-DFMO were terminated early due to toxicity. Data only represents animals that had auditory assessment performed. *: Control ( n=3 ). ■: 500mg/kg D.L-DFMO ( n=5). •: l g/kg D.L-DFMO (n=3 ). and A: 2g kg D.L-DFMO (n=2 ). Vertical bars are standard error ( SE ). FIG. 5A. FIG. 5B, and FIG. 5C CAP threshold elevation of guinea pigs caused bv treatment w ith D.L-DFMO by lp injection daily . Animals are the same as in FIG. 4. FIG. 5A.

*: Control ( n=3 ) and B: 500mg/kg D.L-DFMO (n=5 ): FIG. 5B. *. Control (n=3 ) and •: I g/kg D.L-DFMO (n=3 ): FIG. 5C. *: Control ( n=3 ) and A: 2g/kg D.L-DFMO (n=2). Vertical bars are standard error ( SE).

FIG. 6A. FIG. 6B, and FIG. 6C Elevations of 1 μV RMS CM iso-amplitude curve of guinea pigs caused by treatment with D.L-DFMO by ip injection daily . Animals are the same as in FIG. 4. FIG. 6A. *: Control (n=3) and ■: 500mg/kg D.L-DFMO (n=5 ): FIG. 6B. *^• Control (n=3 ι and •: l g/kg D.L-DFMO (n=3 ): FIG. 6C. *: Control (n=3 ) and A: 2g/kg D.L- DFMO (n=2). Vertical bars are standard error (SE).

FIG. 7A. FIG. 7B, FIG. 7C, FIG. 7D, FIG. 7E, and FIG. 7F Hair cell loss and hearing loss in one animal treated with D.L-DFMO (l g/kg/day for 45 days). Locations are percentage distance from the apex of the basilar membrane. All light micrographs are at same magnification. FIG. 7A. 26%: FIG. 7B. 63%: FIG. 7C. 74%; FIG. 7D. 90%: FIG. 7E. CAP threshold of lg/kg/day D.L-DFMO (■) and average control (n=5. ^~ ); FIG. 7F. l μV CM iso-amplitude curve of l g/kg/day D.L-DFMO (•) and average control (n=5. O).

FIG. 8 Weight gain of guinea pigs treated with lg/kg D.L-DFMO. D-DFMO or

L-DFMO b} ip injection daily for 45 days. All animals survived until auditory testing. *: Control (n=5 ). ■: l g/kg D.L-DFMO (n=5). •: l g/kg D-DFMO (n=5 ). and A: l g/kg L-DFMO (n=5). Vertical bars are standard error (SE).

FIG. 9 CAP threshold elevation of guinea pigs caused by treatment with lg/kg

D.L-DFMO. D-DFMO or L-DFMO by ip injection daily. The animals are the same as in FIG. 8. (A) *: Control (n=5 ) and ■: l g/kg D.L-DFMO (n=5): (B) *: Control (n=5 ) and •: l g/kg D- DFMO (n=5 ): (C) *: Control (n=5 ) and A: l g/kg L-DFMO (n=5 ). Vertical bars are standard error (SE).

FIG. 10A, FIG. 10B, and FIG. 10C Elevations of l μV RMS CM iso-amplitude curve of guinea pigs caused by treatment with l g kg D.L-DFMO. D-DFMO or L-DFMO by ip injection daih . The animals are the same as in FIG. 8. FIG. 10A. *: Control (n=5 ) and ■: lg/kg D.L-DFMO (n=5 ): FIG. 10B. *: Control (n=5 ) and •: l g/kg D-DFMO (n=5): FIG. IOC. *: Control (n=5 ) and A: lg/kg L-DFMO (n=5). Vertical bars are standard error (SE).

FIG. 11 Mean Tumor weight of MCF-7 human breast tumors in nude rats. D-. L-. or D.L-DFMO were administered ad libidum in the animals^" drinking water at the following concentrations: 0.0% controls (•):0.5%> D-DFMO ( J): 0.5% L-DFMO (T); 0.5% D.L-DFMO (V); 3.0% D.L-DFMO (■).

FIG. 12 A dose-response study to compare the relative inhibitory activity of D- and L-DFMO isomers. The indicated doses of DFMO were given only once orally by gavage to a group of female mice. TPA (5nmol) in 0.2 ml acetone was applied to the shaved backs of mice 1 hour post-DFMO treatment. There were three mice per treatment group. Soluble epidermal ODC activity was determined 5 hr after TPA application. Each value is the mean + S.E. of the duplicate determinations of ODC activity from epidermal extract prepared from three mice.

FIG. 13 Mean plasma levels of rats receiving orally 400 mg/kg racemic D.L-

DFMO O), 200 mg/kg D-DFMO (■). or 200 mg/kg L-DFMO (A).

DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

There is a need for effective and less toxic methods for preventing and/or treating cancers. Current treatment protocols, especially those for colon cancers and polyps, includes tumor resection, chemotherapy and radiation therapy. The present invention concerns the development of an effective and safe drug that will improve the prognosis of certain cancers. The present invention provides for therapeutic compositions and methods for use of the D enantiomer of difluoromethvlornithine (D-DFMO) in the prevention and/or treatment of cancer.

I. Difluromethylornithine (DFMO)

D.L-DFMO. also know as eflornithine. has the chemical designation 2-(Difluoromethyl)- DL-ornithine. It is an inhibitor of ornithine decarboxylase. the rate limiting enzyme of the polyamine biosynthetic pathway. As a result of this inhibition of polyamine synthesis, the compound is effective in preventing cancer formation in many organ systems, inhibiting cancer growth, and reducing tumor size. It also has synergistic action with other antineoplastic agents. This drug is relatively non-toxic at low doses of 0.4 gr/M7day to humans while producing inhibition ot putrescine s} nthesιs m tumoi s udies in a lat-tumor model demonstrate that D.L- DFMO infusion can produce a 90% decrease in tumor putrescine lev els without suppressing peripheral platelet counts

Analogs of D-DFMO can also be used in place of D-DFMO tor the prev ention and or the treatment of cancer. The analogs w ill be a D isomer of the form

R'

/

R C COOR"

where R is a Cι-₄ alkyl group or a _{2 4} alkeny l group each of which mav be unsubstituted or substituted with up to 3 substituents selected from NHR'". chlorine, fluorine. OR'", or SR'" wherein R'" is hydrogen or C _.-₄ alkyl. R' is a C₁-₃ alkyl group substituted with up to 3 halogen atoms selected from chlorine and/or fluorine, and R" is hydrogen or a C₁-4 alkyl group Analogs include but are not limited to. α-methylornithine. -ethylornithmε. α-chloromethylormthine. α- fluoromethy lornithine. α-difluoromethylormthine. α-dichloromethy lornithine. σ- chlorofluoromethylornithine. α-tπfluoromethylomithine. u-tπchloromethylornithme. o- dichlorotluoromethylornithme. α-chlorodifluoromethylormthme. α-ethy nylormthme. υ- cy anomethylornithine. α-ethylenic ormthme. α-vinylornithine. α-allenylormthine. σ- hy droxv methylornithme.

methvlornithine. α-ethy ny 1-δ-methy lornithine. α-ethyny 1- - .δ-dιmethylornιthιne. ^s -methy l-acetylenιc ormthine. α-methyldehy droornithine. σ- ethyldehv droornithine. α-chloromethv ldehydioormthine. σ-fluoromethy ldehy droornithine. α- difluoromethyldehydroormthme. α-dichloromethydehy droornithine. σ-chlorofluoromethy 1- dehy drooi nithine. α-tπfluoromethv ldehy droornithine. α-tπchloromethv ldehy droornithine. υ- dichlorolluoromethyldehy dioormthine. α-chlorodifluoromethyldehy droornithine. σ-ethyny l- dehv drooinithme. α-cy anomethv ldehv droornithine α-ethy lenicdehy droornithine. u- i y ldeh ioornithme. σ-allenv ldehv droornithine. -hy dtoxv methv ldeh} droornithine. υ- methoxy methyldehydroormthme. (x-difluoromethy lputrescine. α-fluorometlvy lputrescme. υ- fluoromethv ldehydroputrescine. --meth l-acetv lenicputrescme . α-ethvny l- ' -methy lputrescine. 3-aιmno-3-( methv l )-2-pιpeπdone. '-am o- '-l hvdrox -methv l )-2-pιpeπdone. 3-ammo-3- (fluoromethy l)-2-pιpeπdone 3-ammo-3-( chloromethy l )-2-pιpeπdone. 3-ammo-3-

(difluoromethy l )-2-pιpeπdone. α-methylly sme. α-eth} lly sine. α-chlorometh} llysine. σ- fluoromethy lly sine. α-difluoromethy lly sine. α-dιchloιometh} llysine. α- chloiofluoiomethy llysine. σ-tπfluoromethy lly sine. α-tπchloromefhyllysme. α- dichlorotluorometh lly sine. α-chlorodifluoromethy lly sine. α-ethy nyllysme. α- cy anomethy lly sine. σ-ethylemc ly sine. α-vm llysme. α-alleny lly sine. σ-hydroxymethy llysine. σ-methoxy meth lly sine, α-ethyny l-δ-methy lly sme. α-ethv ny 1-e.^ -dιmethyllysme. δ-methyl- acet} lenιc ly sine. α-meth} lornithine meth} l ester, o-ethy lornithine meth} l ester, α- chlorometh} loιmfhme meth} l ester. α-fluoromefh} lornithine methyl ester. α- difluorometh} lornithine meth} l ester, α-dichlorometh} lornithine meth} l ester, α-chlorofluoro- meth} lornithine methy l ester. o-tπfluorometh loinithme methyl ester. α- tnchloromethy lornithine methy l ester, σ-dichlorofluoromethv lornithine methy l ester, α- chlorodifluoromethylormthine methyl ester. α-ethy ny lornithine methyl ester. α- cyanomethylormthine methv 1 ester, α-ethylemc ornithme methv 1 ester, α-v invlormthme methyl ester, α-allenylornithine methyl ester, σ-hydroxymethylormthme methyl ester, α- methoxymethylornithine methyl ester, α-ethyny l-δ-methylormthine methyl ester, α-ethynyl-δ.δ- dimethylornithine methyl ester, δ-methyl-acetylemc ornithme methyl ester, α-methylormthine ethyl ester, α-ethylormthine ethyl ester, α-chloromethylornithme ethyl ester, α- fluoromethylornithme ethyl ester. α-difluoromethy lornithine ethyl ester. α- dichloromethylormthine ethyl ester. α-chlorofluoromethy lornithine ethyl ester. α- tπfluoromethy lornithine ethyl ester. σ-tπchloromethy lornithine ethyl ester. α- dichlorofluoromethylornithme ethyl ester, σ-chlorodifluoromethy lornithine ethyl ester, α- ethyn loimthine ethyl ester, α-cyanomethylornithme ethy l ester, α-ethylenic ornithme ethyl ester, α-v lnylormthme ethy l ester, α-alleny lornithine ethy l ester, α-hy droxymethylormthine ethy l ester. α-metho\ymethy lornithine ethy l ester, α-ethy nv l- ~ -methv lornithine ethyl ester, α- ethyn l-δ.c-dimeth} lornithine ethy 1 ester, and ^x-meth} l-acet} lenιcornιthιne ethy 1 ester A compound from the above list in which deuterium replaces hv drogen at one or more position is also considered as an analog of DFMO

Side effects observ ed with D.L-DFMO include effects on hearing at high doses of 4 gr'M7dav that resolve when it is discontinued These effects on hearing are not observed at lower doses of 0 4gr/M7dav when administered for up to one v ear (Mevskens et al . 1994) In addition, a few cases of dizziness/ v ertigo are seen that resolv e when the drug is stopped Thrombocytopenia has been leported predominant!} in studies using high "therapeutic" doses ot D L-DFMO (> 1 Ogmv/dav) and primarily in cancer patients w ho had previously undergone chemotherapy or patients with compromised bone marrow Vlthough the toxicity associated with D L-DFMO therapy is not. in general, as severe as other types of chemotherapy, in limited clinical trials it has been found to promote a dose-related thrombocytopenia Moreover, studies in rats hav e shown that continuous infusion of D.L-DFMO foi 12 days significantly reduces platelet counts compared with controls Other investigations hav e made similar observ ations namely that thrombocytopenia is the major toxic side effect of continuous i v D.L-DFMO therapy These findings suggest that D.L-DFMO may significantly inhibit ODC activity of the bone marrow precursors of megakaryocytes DFMO may inhibit prohferative repair processes such as epithelial wound healing

Although D.L-DFMO can effectively block tumor putrescine biosynthesis, the resultant antitumor effect is cytostasis. not cytotoxicity For example. D.L-DFMO reduces the growth rate of an MCA sarcoma, but does not produce tumor regression This finding is consistent with reports of other investigators who showed that D.L-DFMO is a cytostatic agent. However, studies indicate that a significant role exists for DFMO agents, permitting the future development of combination chemotherapeutic regimens which incorporate DFMO

D.L-DFMO and its use in the treatment of benign prostatic hypertrophy are described in two patents. L S Patents 4.413.141. and 4.330,559 L S Patent 4.413.141 describes D.L- DFMO as being a powerful inhibitor of ODC. both in Mtro and in \ ι\ o Administration of D.L- DFMO causes a decrease in putrescine and spermidine concentrations in cells in which these polyammes are normally actively produced Additionally . D.L-DFMO has been shown to be capable of slowing neoplastic cell proliferation when tested in standard tumor models U S Patent 4 330.559 describes the use of D.L-DFMO and DFMO derivatives for the treatment ot benign prostatic hypertrophy Benign prostatic hypertrophv . like many disease states characterized by rapid cell proliferation, is accompanied bv abnormal elevation of polyamine concentrations The treatment described within this refeience can be administered to a patient either orally, or parenterallv Because D.L-DFMO is an effective inhibitor of ODC. some researchers are attempting to use D.L-DFMO as part of a conjunctive treatment in combination with other therapeutic agents. For instance. U.S. Patent 4.499.072 describes improving the poiyamine-depletion effects of ODC inhibitors ( including D.L-DFMO) by using interferon in combination with the ODC inhibitor. Additionally, it describes the use of both an ODC inhibitor and interferon in conjunction with a known cvtotoxic agent such as methotrexate. U.S. Patent 5.002.879. describe a similar conjunctive therapy in which an ODC inhibitor, preferably D.L-DFMO. is used in combination with lymphokine-activated killer (LAK) cells and interleukin-2.

Alternative strategies to make D.L-DFMO more acceptable to human patients are described in U.S. Patent 4.859.452. Formulations of D.L-DFMO are described which include essential amino acids in combination with either arginine or ornithine to help reduce D.L- DFMO-induced toxicities.

II. D Enantiomer of DFMO

An alternative approach for reducing toxicities associated with DFMO is described in the present invention. As described herein, the D enantiomer of DFMO and analogs thereof, while still being an inhibitor of ODC. has lower toxicity. including ototoxicity. in animal models. The use of the D enantiomer for the treatment of cancer as well as pharmaceutical compositions of D- DFMO will overcome many of the problems associated with the use of D.L-DFMO.

Wagner et al. ( 1987) describes a method for the resolution of the enantiomers of various alpha-substituted ornithine and lysine analogs by high-performance liquid chromatography with chiral eluant and by gas chromatography on Chirasil-Val. A reversed-phase high-performance liquid chromatography method, with L-proline and copper as chiral mobile phase, is described for the enantiomeric resolution of various alpha-substituted ornithine and lysine analogs. Although ornithine gives no separation with the chiral eluant used, excellent resolutions are obtained for various alpha-alkyl-. alpha-halogenomethyl-. alpha-vinyl-, and alpha-ethyny - substituted ornithines. including DFMO. Similar separations are also observed for the dehydroornithine and lysine analogs. Gas chromatography on a chiral stationary phase. Chirasil- Val. allows the resolution of the ornithine and lysine analogs after derivatization into the monofluoroacy derivatives of their corresponding lactams. No resolution, or only a poor resolution, is obtained by GC on Chirasil-λ^'al for the dehydroornithine analogs as their di-N- perfluoroacyl alkyl esters. The chiral eluant HPLC procedure is easily scaled up for the semipreparative resolution ot sev eral ornithme analogs / e alpha-fluoromefhv lornithine. alpha- difluoromethylormthme ( DFMO) alpha-chlorofluoromefhv lornithine and alpha- fluoromethyldehy dioormthine. hich aie known as potent ornithme decarboxv lase inhibitors in

U S Patent 5.217.886 describes a method for the production of (-)-4-dιfluoromethyl- ornithine (L-DFMO) bv reacting a 2-substιtuted-pιpeπdone with the enzyme L-α-E- ammocaprolactam-hydrolase in the presence of a div alent cation followed by purifying the L-

DFMO that is produced The enzv me is obtained from the fungus Cryptococcus laurentii Torav 2001

U S Patent 4.496.588 teaches a method for synthesizing the optical isomers of 2- substituted ormthines The process comprises resolving a racemic 2-pιpeπdone with (-) bmaphthylphosphoric acid Each ot the optical isomers ot the piperidone are then hydrolvzed separately to produce the desired optical isomer of the 2-substιtuted-ornιthme

III. Human Cancers

The present invention also involves the delivery of therapeutic compounds to individuals to reduce or inhibit cancer cells Target cancer cells include cancers of the bladder, lung, brain. prostate, kidney, liver, ovary, breast, skin, stomach, esophagus, head and neck, testicles, colon, cervix, lymphatic system and blood Of particular interest are epithelial cancers of many organs, including those of the colon and polyps which tend to express an activated Ki-ras Also of particular interest is bladder cancer, including superficial bladder cancer

The present invention also involves the dehv erv of therapeutic compounds to individuals exhibiting pre-cancerous symptoms to prevent the onset of cancer Cells of this category include polyps and other precancerous lesions, premahgnancies preneoplastic or other aberrant phenotype indicating probable progiession to a cancerous state

1. Kirsten-Ras dependent cancers

Ras defines a protooncogene product that is found on chromosome 1 1 It is found in normal cells, where it helps to relav signals bv acting as a sw itch ( Lowv and Willumsen. 1993) W hen receptors on the cell surface aie stimulated (bv a hormone, for example). Ras is switched on and tiansduces signals that tell the cell to grow It the cell-surface receptor is not stimulated. Ras is not activated and so the pathwav that lesuits in cell growth is not initiated In about 30% of human cancers. Ras is mutated so that it is permanently switched on. telling the cell to grow regardless ot whether receptors on the cell surface are activated or not Point mutations in the cellular ras gene ( c-ras) also can result in a mutant p21 protein that can transform mammalian cells

Ras is a family of retrovirus-associated DNA sequences originally isolated from Harvey ( H-ras. Ha-ras. rasH) and Kirsten (K-ras. Ki-ras rasK) murme sarcoma viruses Ras genes are widely conserved among animal species and sequences corresponding to both H-ras and K-ras genes have been detected in human, av ian. muπne. and non- vertebrate genomes The closely related N-ras gene has been detected in human neuroblastoma and sarcoma cell lines All genes of the family have a similar exon-mtron structure and each encodes a p21 protein

2. Familial Adenomatous Polyposis, Syndrome, Gene Familial Adenomatous Polyposis (FAP). an inherited polyposis syndrome, is the result of germ-line mutation of the adenomatous polyposis coli (APC) tumor suppressor gene (Su et al . 1992) This autosomal-dominant condition with variable expression is associated with the development of hundreds of colonic adenomas, which uniformly progress to adenocarcinoma by forty years ot age. two decades earlier than the mean age diagnosis for sporadic colon cancer (Bussey. 1990) In prior studies of pre-symptomatic individuals with FAP. increased levels of the polyammes spermidine and spermine. and their diamme precursor putrescine. have been detected in normal -appearing colorectal biopsies when compared to normal family member controls (Giardiello et al . 1997) The acπv itv of ornithme decarboxv lase (ODC). the first and rate-limiting enzyme in mammalian polyamine synthesis, also is elev ated in apparently normal colonic mucosal biopsies from FAP patients (Giardiello et al . 1997. Luk and Baylin. 1984) These findings are of interest as the polyammes are necessary for optimal cell proliferation ( Pegg. 1986) Further, suppression ot ODC activity , using the enzyme-activated irreversible inhibitor DFMO. inhibits colon carcmogenesis in carcinogen-treated rodents ( Kingsnorth et al 1983. Tempero et α/ . 1989)

The \hn (multiple intestinal neoplasm) mouse which shares a mutated APC/apc genotype with FAP. serves as a useful experimental animal model for human FAP patients (Lipkm. 1997) The Mm mouse can dev elop greater than 100 gastrointestinal adenomas/ adenocarcinomas throughout the gastrointestinal tract by 120 dav s ot life leading to GI bleeding, obstruction and death

3. Superficial Bladder Cancer Bladdei tumors aie grouped into sev eral ty pes bv the way they appear under a microscope The three ma types of cancers that affect the bladder are transitional cell carcinoma ( TCC ). squamous cell carcinoma, and adenocarcmoma These same types of cancer can also dev elop in the lining of the kidney ( called the renal pelvis ), the ureters, and the urethra In fact, it is not unusual for patients with bladder cancer to also hav e a similar ty pe of cancer in the lining of the kidneys, ureters, or urethra and is why a complete evaluation of the urinary system is recommended to evaluate these patients

Transitional cell carcinoma (TCC) is by tar the most common form of bladder cancer It accounts tor about 90%) of these cancers TCCs are a cancerous version of the transitional cells that normally line the bladder. Squamous cell carcinomas account for about 8% of bladder cancers Lnder a microscope, the cells look much like cells from skin cancers. Nearly all squamous cell carcinomas are invasive. Adenocarcinomas account for about 1 % to 2% of bladder cancers The cells have a lot in common with gland-forming cells of intestinal cancers Nearly all adenocarcinomas of the bladder are invasive

Transitional cell carcinomas, squamous cell carcinomas and adenocarcinomas all respond differently to surgery, radiation and chemotherapy - thus, treatment approaches may differ. Not all TCCs are the same, they are divided into several sub-types according to whether they are superficial or mv asive. and according to whether their shape is papillary or flat

Superficial TCC has not spread into the mam muscle layer of the bladder (musculaπs propna) The cancer may be entirely limited to the layers of transitional cells closest to the inside of the bladder, or it may have also spread to the thin lay er ot connective tissue (lamina propna) |ust beneath the transitional cells

Invasiv e TCC has spread more deeply and involv es the muscle layer of the bladder and mav have inv aded the fattv la ers outside this muscle laver Papillaiv TCCs grow into the hollow center ot the bladdei They may have a narrow stalk and look like a tmv mushroom Some papillary TCCs grow only towards the center of the bladder Lhese are called superficial noninv asiv e papillary TCd, Others grow toward the center and also grow outward into the muscle lay er of the bladder wall These are called invasiv e papillary TCCs

Flat TCCs do not grow toward the hollow part of the bladder at all Some of these only involve the layer of cells closest to the inside or the hollow part of the bladder These are called noninvasive flat TCCs The medical name for noninvasive flat TCCs is flat carcinoma in situ (CIS) Some flat TCCs invade the deeper layers (away from the hollow part), particularly the muscle layer These are called flat invasive TCCs

IV. Methods of Treating Cancer

In a particular aspect, the present inv ention provides methods for the treatment of v arious malignancies Treatment methods will involve treating an individual with an effective amount of a therapeutic composition containing D-DFMO or an analog thereof An effective amount is described, generally, as that amount sufficient to detectably and repeatedly to ameliorate, reduce, minimize or limit the extent of a disease or its symptoms More rigorous definitions may apply, including elimination, eradication or cure of disease.

An example ot a preferred cancer for treatment with a therapeutic composition containing enriched D-DFMO or an analog thereof is bladdei cancer, and in particular early stage oi superficial bladder cancer Early stage bladder cancer can be almost always treated without removing the bladder Treatment options include transurethral resection (TUR) alone, or TUR followed by fulguration (burning), intravesical immunotherapy . or intravesical chemotherapy

Partial cy stectomy is rarely done for Stage 0 bladder cancer Even more rarely is radical cy stectomy done to treat this stage This operation is considered only when there are many superficial cancers or when a superficial cancer continues to grow or is later identified in se eral more areas ithin the bladder despite other treatments

The prognosis for people with Stage 0a bladder cancer is excellent These noninv asiv e papillary cancers are nearly always cured by appropriate treatment and long-term follow-up care Although these patients are likely to dev elop one or more superficial cancels elsewhere in then urinarv svstem these new cancers aie rarelv deeplv invasiv e and life threatening The 5-vear survival rate for Stage 0a cancel is better than 95%

The prognosis for Stage 0 is bladder cancer (also known as carcinoma m situ or flat noninv asiv e cancer is not quite as favorable because they have a greater risk of eventuallv dev eloping into a cancer with muscle inv asion The 5-v ear surv ival late is about 85%

Intravesical chemotherapv means that a medication is placed directlv into the bladder lather than being giv en bv mouth or injected into a v ein When given directlv into the bladder. these medications reach cancer cells near the bladder lining but do not reach cancer cells which are in the kidnevs. ureters, and urethra, cancer cells which may have invaded deeply into the bladder wall, or cancer cells that have spread to other organs For this reason, this treatment is used only for superficial (Stage 0) or mimmallv inv asive (Stage I) bladder cancers This treatment uses drugs that kill activ elv growing cancer cells Mam of the same drugs aie given sv stemicallv (by mouth or into a vein) to treat more advanced stages of bladder cancer Thiotepa. mitomvcin. and doxorubicin hv drochloπde are the drugs used most often for intravesical chemotherapy One of the main advantages of intravesical chemotherapy is that the medication does not spread throughout the bodv This limits the unwanted side effects to other organs that can occur with systemic chemotherapy

D-DFMO or an analog thereof mav be administered at a dose of about 0 05 to about 20 0 gm/M7dav . due to lower anticipated toxicitv associated with the D enantiomer Preferred doses ot D-DFMO or an analog be administered are from about 0 1 to about 15 0 gm/M dav or from about 0 1 to 12 gm/M^"7dav or from about 0 1 to 10 gm/M²/day. or trom about 0 1 to 8 gm M7dav. or from about 0 1 to 6 gm/MVdav. or from about 0 1 to 4 gm/M^" dav or trom about 0 1 to 2 gm/M²/day . or trom about 0 1 to 1 gm M7dav . or from about 0 1 to 0 5 gm λL/day

To kill cells, inhibit cell growth, inhibit metastasis, decrease tumor size and otherwise rev erse or reduce the malignant phenotype ot tumor cells, using the methods ana compositions of the present invention one would generallv contact a target" cell with the therapeutic composition This mav be combined with compositions comprising other agents etfecti e in the treatment of cancer These compositions would be provided in a combined amount effecti e to kill or inhibit proliferation of the cell This process may involve contacting the cells with D- DFMO or an analog thereof and the agent! s ) or factor! s ) at the same time This mav be achiev ed by contacting the cell with a single composition or pharmacological formulation that includes both agents, or by contacting the cell with two distinct compositions or formulations, at the same time, wherein one composition includes D-DFMO or an analog thereof and the other includes the second agent.

Alternatively, the D-DFMO therapy may precede or follow the other agent treatment bv intervals ranging from minutes to weeks. In embodiments where the other agent and D-DFMO or an analog of D-DFMO are applied separately to the cell, one would generally ensure that a significant period of time did not expire between the time of each delivery, such that the agent and D-DFMO would still be able to exert an advantageously combined effect on the cell. In such instances, it is contemplated that one would contact the cell with both modalities within about 12-24 h of each other and. more preferably, within about 6-12 h of each other, with a delay- time of only about 12 h being most preferred. In some situations, it may be desirable to extend the time period for treatment significantly, however, w here several d (2. 3. 4. 5. 6 or 7) to several vvk (1. 2. 3. 4. 5. 6. 7 or 8) lapse between the respective administrations.

Administration of the therapeutic D-DFMO or an analog thereof composition of the present invention to a patient will follow general protocols for the administration of chemotherapeutics. taking into account the toxicity. if any. of D-DFMO or the analog of D- DFMO. It is expected that the treatment cycles would be repeated as necessary. It also is contemplated that various standard therapies, as well as surgical intervention, may be applied in combination with the described therapy.

Where clinical application of a D-DFMO therapy is contemplated, it will be necessary to prepare the complex as a pharmaceutical composition appropriate for the intended application. Generally this will entail preparing a pharmaceutical composition that is essentially free of pyrogens. as well as any other impurities that could be harmful to humans or animals. One also will generally desire to employ appropriate salts and buffers to render the complex stable and allow for complex uptake by target cells.

Aqueous compositions of the present invention comprise an effective amount of the compound, dissolved or dispersed in a pharmaceutically acceptable carrier or aqueous medium. Such compositions can also be referred to as inocula. The phrases "pharmaceutically or pharmacologically acceptable^"" refer to molecular entities and compositions that do not produce an adverse allergic or other untoward reaction wnen administered to an animal. 01 a human, as appropriate Vs used herein, "pharmaceuticallv acceptable carrier^"" includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotomc and absorption delaying agents and the like The use ot such media and agents tor pharmaceutical active substances is well known m the art Except insofar as an} conventional media or agent is incompatible with the active ingredient, its use in the therapeutic compositions is contemplated Supplementary active ingredients also can be incorporated into the compositions

The compositions of the present inv ention mav include classic pharmaceutical preparations Dispersions also can be prepared in glycerol. liquid polyethylene glycols. and mixtures thereof and in oils Under ordinary conditions of storage and use. these preparations contain a preservative to prevent the growth of microorganisms

Depending on the particular cancer to be treated, administration of therapeutic compositions according to the present invention will be \ ιa any common route so long as the target tissue is av ailable \ ιa that route This includes oral, nasal, buccal. lectal. v aginal or topical Topical administration would be particularly advantageous for treatment of skm cancers Alternatively, administration will be by orthotopic. intradermal. subcutaneous, intramuscular, lntrapeπtoneal or intravenous inaction Such compositions would normally be administered as pharmaceutically acceptable compositions that include physiologically acceptable carriers, buffers or other excipients

In certain embodiments, ex vivo therapies also are contemplated Ex vno therapies involve the removal, from a patient, of target cells The cells are treated outside the patient^'s body and then returned One example of ex vv. o therapy would involve a ariation of autologous bone marrow transplant (ABMT) Many times. ABMT fails because some cancer cells are present in the withdrawn bone marrow, and return of the bone marrow to the treated patient results in repopulation of the patient with cancer cells In one embodiment, howev er, the withdrawn bone marrow cells could be treated while outside the patient with an viral particle that targets and kills the cancer cells Once the bone marrow cells are ^"purged.^"" they can be reintroduced into the patient

The treatments mav include various "unit doses I mt dose is defined as containing a predetermined-quantity ot the therapeutic composition calculated to produce the desired responses in association with its administration, i.e.. the appropriate route and treatment regimen. The quantity to be administered, and the paπicular route and formulation, are within the skill of those in the clinical aπs. Also of import is the subject to be treated, in paπicular. the state of the subject and the protection desired. A unit dose need not be administered as a single injection but may comprise continuous infusion over a set period of time.

One of the preferred embodiments of the present invention involves the use of therapeutic compositions of D-DFMO or an analog thereof with specific target cancer cells. Target cancer cells include cancers of the lung, brain, prostate, kidney, liver, ovary, breast, skin, stomach, esophagus, head and neck, testicles, colon, cervix, lymphatic system and blood. Of paπicular interest are non-small cell lung carcinomas including squamous cell carcinomas, adenocarcinomas and large cell undifferentiated carcinomas.

According to the present invention, one may treat the cancer by directly injection a tumor with the D-DFMO or analog composition. Alternatively, the tumor may be infused or perfused with the composition using any suitable delivery vehicle. Local or regional administration, with respect to the tumor, also is contemplated. Finally, systemic administration may be performed. Continuous administration also may be applied where appropriate, for example, where a tumor is excised and the tumor bed is treated to eliminate residual, microscopic disease. Delivery via syringe or catherization is prefeπed. Such continuous perfusion may take place for a period from about 1 -2 hours, to about 2-6 hours, to about 6-12 hours, to about 12-24 hours, to about 1-2 days, to about 1 -2 vvk or longer following the initiation of treatment. Generally, the dose of the therapeutic composition via continuous perfusion will be equivalent to that given by a single or multiple injections, adjusted over a period of time during which the perfusion occurs.

For tumors of > 4 cm. the volume to be administered will be about 4- 10 ml (preferably 10 ml), while for tumors of < 4 cm. a volume of about 1 -3 ml will be used (preferably 3 ml ).

Multiple injections delivered as single dose comprise about 0.1 to about 0.5 ml v olumes. The viral particles ma}' advantageously be contacted by administering multiple injections to the tumor, spaced at approximately 1 cm intervals.

In ceπain embodiments, the tumor being treated may not. at least initially, be resectable. Treatments with therapeutic D-DFMO or analog compositions may increase the resectability of the tumor due to shrinkage at the margins or by elimination of ceπain paπicularly invasive poπions Following treatments, resection mav be possible Vdditional u eatments subsequent to resection will serv e to eliminate micioscopic residual disease at the tumoi site

Cancer therapies also include a v aπetv of combination therapies w ith both chemical and radiation based ueatments Combination chemotherapies include, tor example cisplatin (CDDP). carboplatm procarbazme. mechlorethamine. cv clophosphamide. camptothecin. lfosfamide. melphalan chlorambucil. bisulfan. nitrosurea. dactmomv cin. daunorubicm. doxorubicin. bleomycin plicomvcin. mιtom} cm etoposide (VP16) tamoxifen taxol transplatinum. 5-fluorouracil. v mcristin. v mblastin and methotrexate or anv analog or derivative 10 v aπant thereof

Other factors that cause DNA damage and hav e been used extensiv ely include what are commonh known as /-ra} s. X-rays, and/or the directed delivery ot radioisotopes to tumor cells Other forms of DNA damaging factors are also contemplated such as microwav es and UV -

15 irradiation It is most likely that all of these tactors effect a broad range of damage on DNA. on the precursors of DNA. on the replication and repair of DNA. and on the assembly and maintenance of chromosomes Dosage ranges for X-rays range from daily doses of 50 to 200 roentgens for prolonged periods of time (3 to 4 wk). to single doses of 2000 to 6000 roentgens Dosage ranges for radioisotopes vary widely . and depend on the half-life of the isotope, the 0 strength and type of radiation emitted, and the uptake bv the neoplastic cells

Various combinations mav be emploved. tor instance where D-DFMO or analog composition is ""A^" and the radio- or chemotherapeutic agent is "B^"

5 A/B/A B'A/B B/B/A A/A/B A B/B B/A/A VB/B/B B'VB/B

B/B/B/A B'B/A/B A/A/B/B A B/ A B A/B/B/A B/B/A/

B/A/B/A B A/A/B A/ A/A/B B A A A A/B/A/ A A/ A/B/A

?0

The terms contacted^"" and ' exposed w hen applied to a cell, are used herein to describe the process bv which a therapeutic composition and a chemotherapeutic or radiotherapeutic agent are delivered to a target cell or are placed in direct juxtaposition with the target cell To achieve cell killing or stasis, both agents are delivered to a ceil in a combined amount effective to kill the cell or prevent it from dividing

V . Pharmaceutical Compositions Aqueous compositions of the present invention comprise an effectiv e amount of D-

DFMO or an analog thereof, dissolved or dispersed in a pharmaceutically acceptable carrier or aqueous medium The phrases "pharmaceutically or pharmacologically acceptable" refer to molecular entities and compositions that do not produce an adverse, allergic or other untoward reaction when administered to an animal, or a human, as appropriate

As used herein, "pharmaceutically acceptable carrier" includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, lsotomc and absorption delaying agents and the like The use of such media and agents for pharmaceutical active substances is well known in the an Except insofar as any conventional media or agent is incompatible with the active ingredient, its use in the therapeutic compositions is contemplated Supplementary active ingredients can also be incorporated into the compositions. For human administration, preparations should meet sterility, pyrogemcity . general safety and purity standards as required by FDA Office of Biologies standards

The biological material should be extensively dialyzed to remov e undesired small molecular weight molecules and/or lyophihzed for more ready formulation into a desired vehicle, where appropriate The active compounds will then generally be formulated for parenteral administration, e g , formulated for injection via the intravenous, intramuscular, subcutaneous, mtralesional, or even mtrapeπtoneal routes The preparation of an aqueous composition that contains an headpin agent as an active component or ingredient will be known to those of skill in the an in light of the present disclosure Typically, such compositions can be prepared as lnjectables, either as liquid solutions or suspensions, solid forms suitable for using to prepare solutions or suspensions upon the addition of a liquid prior to injection can also be prepared, and the preparations can also be emulsified

The pharmaceutical forms suitable for mjectable use include sterile aqueous solutions or dispersions, formulations including sesame oil. peanut oil or aqueous propylene glycol. and sterile powders for the extemporaneous preparation of sterile mjectable solutions or dispersions In all cases the form must be sterile and must be fluid to the extent that easy syπngability exists It must be stable under the conditions ot manutacture and storage and must be preserved against the contaminating action of microorganisms, such as bacteria and fungi

Solutions of the active compounds as tree base or pharmacologicallv acceptable salts can be prepared in water suitably mixed with a surfactant, such as hydroxypropylcellulose Dispersions can also be prepared in glycerol. liquid polyethylene gly cols. and mixtures thereof and in oils L nder ordinary conditions of storage and use these preparations contain a preservative to prev ent the growth of microorganisms

D-DFMO or analog of the present invention can be formulated into a composition in a neutral or salt form Pharmaceutically acceptable salts, include the acid addition salts (formed with the free amino groups of the protein) and which are formed with inorganic acids such as. for example, hydrochloric or phosphoric acids, or such organic acids as acetic, oxalic, tartaπc mandehc. and the like Salts formed with the tree carboxv i groups can also be derived from inorganic bases such as. for example, sodium, potassium ammonium, calcium, or ferric hydroxides, and such organic bases as isopropy lamme. tπmethylamine. histidine. procaine and the like

The carrier can also be a solvent or dispersion medium containing, for example, water. ethanol. polyol (for example, glycerol. propylene glycol. and liquid polyethylene glycol. and the like), suitable mixtures thereof, and vegetable oils The proper fluidity can be maintained, for example, bv the use of a coating, such as lecithin, by the maintenance of the required panicle size in the case of dispersion and by the use of surfactants The prevention of the action of microorganisms can be brought about by v arious antibacterial and antifungal agents, for example, parabens chlorobutanol. phenol, sorbic acid, thimerosal. and the like In many cases, it will be preferable to include lsotomc agents, for example, sugars or sodium chloride Prolonged absorption of the mjectable compositions can be brought about by the use in the compositions of agents delaying absorption, for example, aluminum monostearate and gelatin

Sterile mjectable solutions are prepared bv incorporating the activ e compounds in the required amount in the appropriate solvent with various ot the other ingredients enumerated above, as required, followed by filtered sterilization Generally , dispersions are prepared by incorporating the v arious sterilized active ingredients into a sterile ehicle which contains the basic dispersion medium and the required other ingredients trom those enumerated above In the case ot sterile powders for the preparation of sterile iniectable solutions, the preferred methods or preparation are acuum-drying and treeze-dr ing techniques which vield a powder of the activ e ingredient plus anv additional desired ingredient trom a piev iouslv sterile-filtered solution thereof The preparation of moie. or highly , concentrated solutions for direct injection is also contemplated where the use ot DMSO as solvent is env isioned to result in extremely rapid penetration, dehv eimg high concentrations of the activ e agents to a small area

Lpon formulation, solutions w ill be administered in a manner compatible with the dosage formulation and in such amount as is therapeuticallv effectiv e The formulations are easilv administered in a variety of dosage forms, such as the type ot mjectable solutions described above, but drug release capsules and the like can also be employed

For parenteral administration in an aqueous solution, tor example, the solution should be suitablv buffered if necessary and the liquid diluent fust rendered lsotomc with sufficient saline or glucose These particular aqueous solutions are especially suitable for intravenous, intramuscular, subcutaneous and mtrapeπtoneal administration In this connection, sterile aqueous media which can be employed will be known to those of skill m the art in light of the present disclosure For example, one dosage could be dissolved in 1 ml of isotonic NaCl solution and either added to 1000 ml of hypodermoclysis fluid or injected at the proposed site of infusion, (see for example. "Remington's Pharmaceutical Sciences" 15th Edition, pages 1035- 1038 and 1570-1580) Some variation in dosage will necessarily occur depending on the condition of the subject being treated The person responsible for administration will, in any event, determine the appropriate dose tor the individual subject

In addition to the compounds formulated tor parenteral administration, such as intravenous or intramuscular injection, other pharmaceutically acceptable forms include, e g tablets or other solids for oral administration, hposomal formulations, time release capsules, and anv other form currently used, including cremes

One also mav use nasal solutions or sprays, aerosols or inhalants the present invention

Nasal solutions are usuallv aqueous solutions designed to be administered to the nasal passages in drops or sprav s Nasal solutions are prepared so that thev are similar in many respects to nasal secretions, so that normal ciliary action is maintained Thus, the aqueous nasal solutions usually are isotonic and slightly buffered to maintain a pH of 5 5 to 6 5 In addition, antimicrobial preservatives, similar to those used in ophthalmic preparations, and appropriate drug stabilizers, if required, mav be included in the iormulation λ arious commercial nasal preparations are known and include, toi example, antibiotics and antihistammes and are used foi asthma prophylaxis

" Additional formulations which are suitable for other modes of administration include v aginal suppositones and pessaries rectal pessarv or suppository mav also be used Suppositones are solid dosage forms ot various weights and shapes usually medicated, for insertion into the lectum. vagina or the urethra After insertion, suppositories soften, melt or dissolv e in the cavity fluids In general, for suppositones traditional binders and carriers mav include, for '⁾ example, polyalkylene glycols or tπglyceπdes. such suppositories may be formed from mixtures containing the active ingredient in the range of 0 5% to 10%. preferably l%-2%

Oral formulations include such normally employed excipients as. for example, pharmaceutical grades ot mannitol. lactose starch, magnesium stearate. sodium saccharine. 5 cellulose, magnesium carbonate and the like These compositions take the form of solutions, suspensions, tablets, pills, capsules, sustained release formulations or powders In certain defined embodiments oral pharmaceutical compositions will comprise an inert diluent or assimilable edible carrier, or they may be enclosed in hard or soft shell gelatin capsule, or they may be compressed into tablets, or they may be incorporated directly with the food of the diet 0 For oral therapeutic administration the activ e compounds may be incorporated with excipients and used in the form of mgestible tablets, buccal tables, tioches. capsules, elixirs, suspensions, syrups, wafers, and the like Such compositions and preparations should contain at least 0 1% of activ e compound The percentage of the compositions and preparations mav ot course, be varied and mav conveniently be between about 2 to about 75% of the weight of the unit, or preferablv between 25-60%o The amount ot activ e compounds in such therapeuticallv useful compositions is such that a suitable dosage will be obtained

The tablets, tioches. pills capsules and the like may also contain the following a binder as gum tragacanth. acacia, cornstarch. or gelatin, excipients. such as dicalcium phosphate, a 0 disintegrating agent, such as corn starch, potato starch, algimc acid and the like, a lubricant, such as magnesium stearate. and a sweetening agent, such as sucrose, lactose or saccharin may be added or a flav oring agent, such as peppermint oil of wintergreen. or cherrv flav oring When the dosage unit form is a capsule it may contain, in addition to materials of the abov e ty pe. a liquid carnei V arious other materials mav be present as coatings oi to other ise modify the physical form of the dosage unit. For instance, tablets, pills, or capsules may be coated with shellac, sugar or both. A syrup of elixir may contain the active compounds sucrose as a sweetening agent methyl and propylparabens as preservatives, a dye and flavoring, such as cherry or orange flavor.

In ceπain embodiments, the use of liposomes and/or nanopaπicles is contemplated for the formulation and administration of D-DFMO or an analog thereof. The formation and use of liposomes is generally known to those of skill in the an. and is also described below.

Nanocapsules can generally entrap compounds in a stable and reproducible way. To avoid side effects due to intracellular polymeric overloading, such ultrafine particles (sized around 0.1 μm) should be designed using polymers able to be degraded in vivo. Biodegradable polyalkyl-cyanoacrylate nanopaπicles that meet these requirements are contemplated for use in the present invention, and such panicles may be are easily made.

Liposomes are formed from phospholipids that are dispersed in an aqueous medium and spontaneously form multilamellar concentric bilayer vesicles (also termed multilamellar vesicles

(MLVs). MLVs generally have diameters of from 25 nm to 4 μm. Sonication of MLVs results in the formation of small unilamellar vesicles (SUVs) with diameters in the range of 200 to 500 A. containing an aqueous solution in the core.

The following information may also be utilized in generating liposomal formulations.

Phospholipids can form a variety of structures other than liposomes when dispersed in water. depending on the molar ratio of lipid to water. At low ratios the liposome is the preferred structure. The physical characteristics of liposomes depend on pH. ionic strength and the presence of divalent cations. Liposomes can show low permeability to ionic and polar substances, but at elevated temperatures undergo a phase transition which markedly alters their permeability. The phase transition involves a change from a closely packed, ordered structure. known as the gel state, to a loosely packed, less-ordered structure, known as the fluid state. This occurs at a characteristic phase-transition temperature and results in an increase in permeability to ions, sugars and drugs.

Liposomes interact with cells via four different mechanisms: Endocytosis by phagocytic cells of the reticuloendothelial system such as macrophages and neutrophils: adsorption to the cell surface, either by nonspecific weak hv drophobic or electrostatic forces, or by specific interactions with cell-surface components, fusion with the plasma cell membrane by insertion of the lipid bi layer of the liposome into the plasma membrane, with simultaneous release of liposomal contents into the cytoplasm, and by transfer of liposomal Iipids to cellular or subcellular membranes, or vice versa, w ithout any association of the liposome contents Varying the liposome formulation can alter which mechanism is operativ e, although more than one may operate at the same time.

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

Example 1 Methods for In Vivo Studies of DFMO

Animals and Reagents

Twenty-four Long Evans pigmented rats (250-275g) were acquired from Harlan Sprague

Dawley (Indianapolis. IN) and thirty-six pigmented guinea pigs obtained from Kuiper Rabbit

Ranch (Gary. IN) at an initial weight of 200-250g and housed in University of Oklahoma Health Sciences Center animal facility. Subjects were housed under a 12.12 hr light dark cycle with free access to food and water with a room temperature controlled at 21 °C.

D,L-DFMO Dose Response in rats

Twenty -four animals were randomly placed into 8 groups of three subjects each. Treatment groups were as follows: 0. 200. 400. and 600mg/kg/day D.L-DFMO by gavage daily

(5days/week) for 4 and 8 weeks. Four additional animals were randomly placed into 2 subsequent groups. 400 and 600mg/kg/day by gavage twice a day (5days/week) for 8 weeks.

For the weekend. D.L-DFMO (volume determined by weight estimation) was left in the drinking water (30 ml/ day /animal) Weight measurements were taken daily ( 5days/week) w ith assessment of auditory function performed at the conclusion ot dosing

D,L-DFMO Dose Response in guinea pigs Thirtv-one juvenile pigmented guinea pigs were randomly assigned to treatment groups receiving dailv (7days/vveek) ip injection with 0 5g/kg D.L-DFMO (n=5). l g/kg/day D.L-DFMO (n=5). 2g kg/day D.L-DFMO (n=2 ). 3g/kg/day D.L-DFMO (n=4). and salme vehicle (n=5) The variation in number of animals is due to the pronounced mortahtv rate, which led to the decision to discontinue addition ot animals to the higher exposure groups Auditory thresholds were assessed m the 0 5g/kg and l g/kg/day subjects at day 45 of dosmg while the 2g/kg/day subjects were evaluated at 22 days of dosing Thus, subjects in the l g/kg/day and 2g/kg/day doses of DX-DFMO received approximately identical total D.L-DFMO doses per kg body weight Daily weight measurements determined the injection volume Assessment of auditory function occurred at the conclusion of dosing

DFMO Enantiomers versus Racemate in guinea pigs

Twenty subjects were randomly assigned to treatment groups (n=5) that received lg/kg/day D-DFMO. l g/kg/day L-DFMO. lg/kg/day D.L-DFMO or saline Injections, determined by daily weight measurements, were made ip daily for 45 days Assessment of auditory function occurred at the conclusion of dosing with all animals surviving the trial period

CAP and CM recording and analysis

At the end of the treatment cycle (24 hours after last drug dosage), the rats were anesthetized with xylazme ( 13 mg/kg. i m ) and ketamine (87 mg/kg. l m ) and guinea pigs were anesthetized with xylazine ( 5 mg/kg. l m ). ketamine (30 mg/kg, I m ). and urethane ( 160mg/kg. i p ) The round window was surgically exposed using a ventro-lateral approach and a silv er wire electrode was carefully placed on the round window under a surgery microscope tor recording compound action potential (CAP) and cochlear microphonic (CM) A silv er chloride electrode was placed in the neck muscle as the reference The CAP and CM signals were amplified with a Grass A C preamplifier (Model PI 5) The ga was 1000 The band-pass frequencv for CAP was 0 1 -1 0 kHz and 0 1 -50 kHz for CM The CAP signals were observ ed using a digital oscilloscope (Nicolet Instrument Co . 2090-IIIA) The CM signals were sent to a SR530 Lock-in amplifier (Stanford Research Systems. Inc ) and then to a PC computer for automatic determination ot the 1 uV RMS amplitude The sound lev el of test frequencies that evoked a just detectable C AP was determined and this value was used to estimate the threshold at the frequency The sound lev els that ev oked 1 uV RMS CM at each test frequencies was determined by the computer program and the 1 uV RMS CM iso-amplitude curve was evaluated CAP-threshold shifts vveie calculated as the difference between each C AP-threshold for each treated subject and the mean control v alue (from subjects exposed to vehicle alone) at the same frequency CM iso-amplitude curve elev ation was obtained in a similar way

Pure tones tor eliciting C AP and CM were generated with the SR530 Lock-in amplifier (Stanford Research Sy stems. Inc , Sunnyvale. CA) The signals were attenuated by a programmable attenuator and then amplified by a high voltage amplifier and delivered to a high frequency sound source (made from an ACO 1/2" microphone. 7013) placed within a speculum that fit into the exposed external auditory meatus The frequencies of the tones were 2. 4. 6. 8. 12. 16. 20. 24. 30. 35 and 40 kHz Continuous tones were used for eliciting CM Tone bursts were used to elicit the CAP The duration of the tone bursts was 10 msec with a rise/fall time ot 1 0 msec, and a repetition rate of 9 7/sec Sound levels at all testing frequencies were calibrated with a probe microphone located near the eardrum

Repeated measures ANOVA (NCSS software) was used to evaluate the overall significance between different drug exposures and test frequencies and their interactions Frequency was evaluated as a within subject variable and treatment group was a between subject variable Post hoc analysis was performed by Fisher^'s Least Square Difference

Histology

Surface preparations of the Organ of Corti were ev aluated in a limited number ot subjects The animals were decapitated while deeply anesthetized after CAP and CM recording Cochleae were removed immediately Both the round and ov al windows were opened and the apex of the cochlea was drilled open to facilitate perfusion The cochleae were perfused with SDH (succmate dehydrogenase ) incubativ e solution (0 05 M sodium succinate. 0 05 M phosphate buffer and 0 05%o TetraNitro Blue Tetrazohum) and immersed in the solution for one h (37°C) Then the cochleae were fixed with 10% formalin for at least 2 da}s After fixation, the cochleae were decalcified in 10% EDTA solution (EthyleneDiamine Tetraacetic Acid) tor 3 days or longer as needed Cochlea microdissection was accomplished under a light microscope

Example 2 Dose Response

and Ototoxicity in rats treated with D.L-DFMO

D.L-DFMO exposure in rats with doses between 200 mg/kg/ day and 1 2 g/kg/day does not produce any significant weight change or auditory dysfunction when intubation exposures of up to eight weeks aie used FIG 1 shows the weight gain in grams for all treatment groups averaged over five-day interv als Compared to the weight gam of the controls, doses between 200mg/kg/day and 600mg/kg dav do not cause any weight loss The two highest doses appear to reduce weight gain, although the number of subjects used in these groups was small When subjected to statistical analy sis these data did not meet the significance criteria (F_{[22 44j}=l 56. p=0 103)

The effects of multiple doses of D.L-DFMO treatments on CAP threshold and CM amplitude are represented in FIG 2 and FIG 3. respectively D.L-DFMO has no effect on either of the measures CAP threshold levels and the l μV RMS iso-amplitude CM curve varied by less than 5dB from vehicle treated control subjects, shifts of this magnitude are within the error associated with measurement and have no biological significance (F_{[2 4}j=l 24. p=0 381 )

Example 3 Dose Response Toxicity and Ototoxicity in guinea pigs treated with D,L-DFMO

In contrast to the data observed in rats, substantial general toxicity and ototoxicity were observed when guinea pigs were treated with doses of D.L-DFMO between 500mg/kg/day and 3g/kg/day All 3g/kg/day subjects died within the first six davs of treatment and two of the five lg/kg/day subjects did not surv i e the full 6 week dosmg regimen With the loss of the 3g/kg/day group, two 2g/kg/day subjects were added By day 22. the 2g/kg/day animals had gained virtually no weight so the animals^" auditory function was evaluated at this time FIG 4 shows the rate of weight gain of the animals for which auditory assessment was made Weight gain was effectively blocked tor the 2g/kg/day subjects while the l g/kg/day subjects appear to diverge from the controls during the last 10 days of the dosing period The 500mg/kg/day D.L- DFMO animals showed no apparent signs of systemic toxicity, their growth rate actually surpassed that of the controls Analysis revealed that neither the 500mg/kg/day nor l g kg/day subjects were significantlv different from the control (F<1 0)

A dose dependent elev ation in auditory thresholds was observ ed in the D.L-DFMO treated guinea pigs. Due to the general toxicity . auditory assessments was actually performed on five 500mg/kg/day D.L-DFMO. three l g kg/day D.L-DFMO. two 2 g kg/ day D.L-DFMO. and three control subjects (two subjects vveie dropped, one αue to anaesthetic overdose and another due to pregnancv ) FIG 5 shows the loss oi CAP sensitiv uv tor each D.L-DFMO dose group Subjects leceiv mg 500mg'kg/day ot the drug showed a C \P threshold elevation a eraging 9dB and the loss was relatively flat across tiequency The limited number of 2g kg/day and l g/kg/day animals showed a shift in threshold that was most apparent in the high fiequencv test range The 2g'kg/day group revealed an av erage loss across all frequencies of 14 dB while the l g/kg/day subjects had a 10 dB av erage shift When onlv the frequencies between 20 and 40 kHz were ev aluated, the average loss of auditoiy sensitiv nv tor the 2g/kg/day subjects was 30 dB. compared to onlv 17 dB for the l g kg/day subjects and 7 1 dB for the 500mg/kg/day subjects Repeated measures ANO\ A corrected for unequal n determined a significant difference in CAP between the tour dose groups receiving 2g/kg/dav D.L-DFMO. l g kg/day/day D.L-DFMO. 500mg/kg/day D.L-DFMO. and saline ( between treatment. F_{[3 9]}=4 06. p=0 044 between frequency . Fμo i9_0] ⁼25 98,p<0 001. treatment-frequency interaction.

F[3o i₉u_] ⁼10 89. <-0 001 ) Post hoc analy sis showed that ail three drug treatments were significantly different from the control ψ *0 05)

Interestingly, in contrast to the disruption in CAP sensitiv πy . none of the treatments had an effect on CM sensitivity (see FIG 6) The CM is generated mainly by the outer hair cells, especially those at the base of the cochlea (close to the recording electrode), to an acoustic stimulation The CM was not effected by any of the doses of D.L-DFMO suggesting that the effect seen in the CAP did not occur secondarily based on OHC dysfunction None of the treatments produced changes in the CM curve that met statistical significance from the control (F<1 0)

Hair cell damage was examined histologically in a guinea pig with severe CAP threshold elevation caused by D.L-DFMO ( l g/kg/day tor 45 day s ), but with no change in CM sensitivity This subject^'s CAP threshold loss relativ e to control increased with stimulus frequency , with the highest elevation of 55dB at 40kHz (FIG 7E) CAP thresholds to low frequencv were not obtained because of interference by CM Locations along the smlace of the basilar membrane were identified by percent distance from apex, and can be related to the physiological data because sound is encoded in a tonotopic fashion ith the highest tiequencies represented in the most basal portion ot the cochlea Both inner hair cells (IHCs ) and outer hair cells (OHCs) within the most apical 40% of the basilai membrane showed normal SDH (succinate dehydrogenase) staining For example. FIG 7 A is an image of the hair cells located at 26% of the basilar membrane The remaining 60%o. FIG 7B. of the basilar membrane showed hair cell damage At 74%. FIG 7C. the loss of OHCs and IHCs occurs Interestingly, at some places very close to the base where all IHCs were gone, many OHCs were still surviving (FIG 7D. 90%) That CM sensitivity was normal (FIG 7T) indicates normal function in the surviving OHCs in the basal turn close to the round window

Example 4 L-DFMO and D-DFMO Toxicity and Ototoxicity in guinea pigs

Data comparing the enantiomers of DFMO and the racemate are shown m FIG 8 FIG 9 AND FIG 10 It was found that D-DFMO does not produce any significant hearing impairment in the guinea pig whereas the L-enantiomer of DFMO generates a threshold shift that surpassed that of the D.L-DFMO treatment The weight data suggest that the enantiomers do not produce significant general toxicity

FIG 8 shows the growth of the animals Although the treated animals appeared to grow at a slower rate than the controls, statistical analysis of the data for the entire trial period showed no significant difference (F_[3

44) The weight gain between the enantiomers and racemate did not differ from each other

FIG 9 shows the CAP threshold shifts for the enantiomer. racemate and controls Both

L-DFMO (filled triangle) and the D,L-DFMO (filled square) generated an average threshold shift of 25±2dB When the D-enantiomer (FIG 9. filled circle) was measured for auditory function, a CAP threshold average shift of 2 dB was found over all frequencies with a slight elevation at 40kHz Repeated measures ANOVA determined a significant difference in CAP between the four dose groups receiving l g'kg/day D.L-DFMO. l g/kg/day/day D-DFMO. lg/kg/day L- DFMO. and saline (between treatment, F_[3 i_9j=7 41 p=0 002. between frequency . Fjio 99.p<0 001 , treatment-frequency interaction. F_|3o

90 p<0 001 ) When subjected to Fisher^'s LSD. the L-DFMO (p<0 005) and D.L-DFMO (p<0 005) were found to be significantly different from the control over all test frequencies, but the D-enantiomer was not

In contrast to the significant effect on CAP thresholds L-DFMO did not generate change of CM sensiti ity (FIG 10. filled triangle) The slight elev ation at 35 and 40kHz is due to one animal showing as much as a 40 dB loss at these two frequencies D-DFMO also did not alter the CM None oi the ueatments ef fects on CM were significant horn the control (F_[ , ι_6j=0 92 p=0 45)

Discussion When ti eating animals w ith an enzvme inhibitor, one w ould expect the results to be a dose dependent cui e w ith some saturation point For ototoxicity to be eliminated as a side effect of D.L-DFMO chemotherapy it is necessarv to determine an ototoxic dose response tor this drug Previous studies had given the drug in drinking water w hich made for a difficult determination ot actual diug intake Therefore, direct deliv ery of the drug is needed to elicit an accurate ototoxic dose response Both the rat and guinea pig are utilized in this process

The rat model generated no significant weight loss (toxicity ) and no significant threshold shifts (ototoxicit ) ov er the audiometπc range The results imply that D.L-DFMO treatment in rats does not produce the ototoxic side effects previously reported in human cancer patients Schweitzer et al ( 1986) found that treating rats with 1 % DFMO in the drinking water (approximately 300mg/kg assuming a daily intake of 30ml water) not only resulted in normal brainstem evoked potentials, but the levels of polyammes were not depleted to a level considered disrupting in other sy stems The inventors extended this data by exposing the animals, by intubation, to much greater doses, up to 4 times, and still found no effect on auditory thresholds If the levels of polv amines do plav a role in auditory function, the metabolism of the rat is such that D.L-DFMO does not inhibit polyamine synthesis to a critical lev el and therefore the rat cannot be used as a reliable model for determination of D.L-DFMO ototoxicity

In contrast. D.L-DFMO treatment in the guinea pig generates significant auditory dysfunction (ototoxicity ) Again, determination of actual drug intake from prev ious studies was difficult and therefore all drug administration in the current study was by ip injection Within the first six days of the study D.L-DFMO showed substantial toxicity at 3g kg/ day with 100% of the animals dying The remaining treatment groups did not produce significant toxicitv (mortalitv or weight loss ) within the trial period Necropsies were carried out on one animal that died during the course of treatment and on the subjects that surviv ed until the end ot the experiment The reports support the conclusion that repeated injection was not responsible for the subject s death or for depression in weight gam The C \P thiesholds showed that D L-DFMO pi oαuces a significant and reproducible shift in the guinea pig \s expected, the av erage threshold shift acioss test fiequencies is dose dependent The ability of the 2g kg/dav D L-DFMO to generate a gieatei auditorv impairment in a shorter period of time implies that the amount ot diug giv en and not the duration ot the treatment ultimatelv determines the ototoxicitv

CM is generated mainlv bv the outer hair cells in the basal turn of the cochlea and is a sensitive measurement for detecting impairment follow ing manv ototoxic drugs including the ammoglycosioe ana cisplatin but D.L-DFMO did not generate a change in the CM ISO- amplitude cur e Histology rev ealed that the majoπtv of outer hair cells at the verv basal turn were intact accounting for the null effect on CM The basal inner hair cells however, showed extensive damage with a majoπtv missing The middle ot the cochlea showed both damage and loss ot outer and inner hair cells \t the apex neither outer nor inner hair cells were damaged or missing Therefore D.L-DFMO mav hav e some preference ior hair cells located at the basal turns of the cochlea

The generation of the dose response data allowed for comparison of D L-DFMO and its enantiomers Since the inventors found a reproducible D L-DFMO induced threshold shift in the guinea pig. the characterization of the enantiomers was continued in the guinea pig Due to the lethality of the high doses l g/kg/day was chosen for comparison of the enantiomers with the racemate

The enantiomers did not show significant toxicitv ( determined bv weight gam) The D- form of DFMO was found to hav e no significant effects on either the compound action potential or cochlear microphomc E aluation of auditorv function round that the L- form of DFMO produced significant disruption ot normal cochlear potentials The research described abov e mav hav e implications tor the dev elopment ot chemotherapeutic strategies inv olving a single enantiomer of DFMO

Example 5

Comparison of D-. L-. and DL-Difluoromethv lornithine. Effects on Ornithine Decarboxv lase (ODC) Activ ity Materials and Methods Recombinant murine ODC was expressed in E coli and purified for the studies. A microassav is used to measure ODC activity and inhibition by DFMO. Specifically. 20 ul of recombinant murine ODC at a concentration of 0.6 mg/ml was preincubated with serial dilutions (0 to 80 uM of D-. L-. or D-L-DFMO ) in a 1.5 ml Eppendorf tube for 30 minutes at room temperature. The enzymatic reaction was initiated in the Eppendorf tube by the addition of 27.5 ul of Brij 35 ODC assay mixture (final concentrations: 40 mM Tris HC1 pH 7.5. 8 niM DTT. 0.64 mM pyridoxal phosphate (PLP). 0.80 mM EDTA. 0.04% Brij 35 and 0.2 uCi (¹⁴C) L- ornithine). 40 ul of the CO? trapping agent (ethanoiarnine/3-methoxyethanol. 2: 1) was placed at the bottom of a 20 ml glass sere-cap liquid scintillation vial and the open Eppendorf tube containing the sample was placed in the vial away from the trapping agent. The scintillation vial was immediately capped with a septum cap and the vials were incubated in a 37° shaking water bath for 1 hour. The vials were then removed from the water bath and 100 ul of 2M citric acid was added through the septum into the open Eppendorf tube to stop the ODC reaction. The scintillation vials were incubated for an additional 2 hours at 37° to quench the reaction. The tubes were removed from the vials and 6 ml of scintillation fluid was added. The vials were counted on a Beckman LS-6500 scintillation counter for 1 minute. K, inhibition values were obtained by a least-squares fit of the data.

Results In three separate studies using concentrations from 0.6 uM to 80 uM D-. L-. and D.L-

DFMO. the effective concentration level of each which inhibits 50% of the ODC activity (K,) was determined. The effective concentration levels are as follows: D-DFMO 24.1 uM L-DFMO 6.4 uM D.L-DFMO 8.1 uM

Both enantiomers, as well as the racemic mixture, were inhibitory. The K, of D-DFMO was four fold lower than the L-form and 3 fold lower than the mixture.

Example 6 Induction of Apoptosis in Cell Lines by D-, L-, and D.L-DFMO

The ability of D-. L-. and D.L-DFMO to induce apoptosis was examined in six human cell lines: MCF-7 (breast cancer. ATCC #HTB22). LNCaP (prostate cancer. ATCC #CRL1740). PC-3 (prostate cancer. ATCC #CRL1435). HT-29 (colon cancer. ATCC #HTB38). HSK 612 (normal karatinocytes. purchased from InCell. Inc.) and 506SM (normal colon submucosal mesenchv mal cells, purchased trom InCell. Inc ) Fach ol the three forms ot DFMO were tested at two concentrations ( 1 and l OuM) Adπamycin and calcium chloiide were used as positiv e controls Apoptosis was assaved using a multi-well plate DNA fragmentation assay according to the Cellulai DNA Fiagmentation ELISA kit (Boehnnger Mannheim Biochemicals. Cat =1585- 045 ) and Hoechst staining

All three forms of DFMO caused apoptosis but not cytotoxicitv in the cancer cell lines There was no overall major difference between the forms of DFMO at the concentrations examined Apoptosis was more pronounced for all the DFMO solutions than for the adπamycm positive control (which was cvtotoxic as well as apoptotic)

Example 7 In Vivo Ev luation of the Enantiomers of DFMO in the MCF-7 Human Breast Cancer

Xenograft Model Nude mice were implanted with the estrogen-dependent human breast tumor line. MCF-7

(ATCC ?τHTB22) D-. L-, or D.L-DFMO were administered ad hbidum in the animals^' drinking water as 0 5% w/v solutions, with eight animals per group One additional group of eight animals were administered D.L-DFMO as a 3 0% solution The experiment was terminated on Day 90 (when control tumors had reached a size of 400 mg ) Mice were weighed twice weekly. and tumor measurements were taken by calipers twice weekly , starting at time of DFMO administration (Day 1 ) Tumor measurements were converted to mg tumor weight by the formula. L^" \ W/2

For the group receiving D.L-DFMO. seven of eight animals experienced mean partial tumor shrinkage of 60 4%. with a tumor growth inhibition of 99 2%> in the eighth animal For the group receiving L-DFMO. seven of eight animals experienced a mean partial tumor shrinkage of 50 0%. with a tumor growth inhibition of 5 5% in the eighth animal For the group receiving D-DFMO four of eight animals experienced a mean partial tumoi shrinkage of 62 6% two of eight animals had a tumor inhibition ot 84 7% and the remaining two animals experienced toxic death The averaged results of each group compared to controls, including the 3 0% D.L-DFMO group, are shown in FIG 1 1 Differences in antitumor activ ity seen in the groups are not considered significant

Example 8 Effects of Enantiomers of DFMO on Ornithine Decarboxvlase In Vitro Activity

Two in vitro s stems vveie examined for the effects ot D- L-. or D.L-DFMO to inhibit ornithme decarboxv lase (ODC ) The first utilized ODC sy nthesized in a cell free system from a mouse ODC cDN A L-DFMO was found to be a moie potent ODC inhibitor at low inhibitor substrate tatios than D-DFMO The D isomer was estimated to be 10 fold less potent than the L-foim in this system w hile the racemic D.L-DFMO was intermediate in potency The L-form appeared to be acting in a non-competitiv e manner (as would be expected for an irreversible inhibitor) whereas the D-form appears to be acting in a competitive manner

The second system looked at inhibition of endogenous ODC in HCT-1 16 colon cancer- derived cells Again, the L-form was more potent than the D-form in reducing mtracellular polyamine lev els, the end product of ODC activity All forms of DFMO suppressed putrescine levels, another end product of ODC. below the limit of detection Polyamine levels recovered more quicklv m the cells treated with D-DFMO than in cells treated with L-DFMO

Example 9 Comparison of In Vivo Inhibition of ODC by D-, L-, and D,L-DFMO The ability of svstemicallv administered D-. L-. and D.L-DFMO to inhibit phorbol ester induced ODC in mouse skin All forms of DFMO given at 100 mg (either in a single dose or split doses) completely inhibited ODC activity 5 mg doses of all forms given daily for five days nearly completely inhibited ODC activity, with no difference between the isomers As shown in FIG 12. a single dose of D-DFMO versus L-DFMO show ed a dose-dependent inhibition ot ODC. again ith no difference seen between the two isomers

Example 10

Analysis of D,L-DFMO in Biological Fluids

Rats were given single doses of D-. L-. or D.L-DFMO and plasma lev els determined o er time (FIG 13 ) Rats given 400 mg/kg of D.L-DFMO achiev ed a maximum plasma level of 109 ug/ml between one and two hours after administration Rats receiving either D-DFMO or 1 - DFMO at 200 mg/kg achieved plasma levels of 102 ug/ml and 45 ug ml respectively over the same time course The lower blood lev els seen with L-DFMO may be due to a lower bioav ailabihtv for this form, more rapid excretion, or more rapid binding to tissues or proteins All of the compositions and/or methods disclosed and claimed herein can be made and executed without undue experimentation in light of the present disclosure While the compositions and methods of this invention have been described in terms of preferred embodiments, it will be apparent to those of skill in the art that variations may be applied to the compositions and/or methods and in the steps or in the sequence of steps of the method described herein without departing from the concept, spirit and scope of the invention More specifically . it will be apparent that certain agents which are both chemically and physiologically related may be substituted for the agents described herein while the same or similar results would be achieved All such similar substitutes and modifications apparent to those skilled in the art are deemed to be within the spirit, scope and concept of the invention as defined by the appended claims

REFERENCES

The following references, to the extent that they provide exemplary procedural or other details supplementary to those set forth herein, are specifically incorporated herein by reference.

Bachrach. ""Function of naturally occurring polyamines.^"" Academic Press. 1973.

Busse} . ""Historical developments in familial adenomatous polyposis.^" lnr Lemuel Herrera (ed).

Familial Adenomatous Polyposis. pp. 1 -22. Alan R. Liss. Inc. New York. 1990. Canellakis. Viceps-Madore. Kyriakidis. Heller. ^"The regulation and function of ornithine decarboxylase and of the polyamines.^"' In. Current Topics in Cellular Regulation.

Academic Press. 15: 155-202. 1979. Croghan. Aickin. Mevskens. ""Dose-Related α-Difluoromethylornithine Ototoxicity.^" Am. J

Clin. Oncol. 14(4):331-335. 1991. Danzin. Ducep. Schirlin. W^,ragner. ^'"Absence of stereospecificity in the suicide inhibition of ornithine decarboxylase.^"' Biochemistry of Vitamin B 333-336. 1987.

Giardiello. Hamilton. Hylind. Yang. Tamez. Casero. ^"'Ornithine decarboxylase and polyamines in familial adenomatous polyposis.^" Cancer Res.. (57): 199-201 , 1997. Kingsnorth. King. Diekema. McCann. Ross. Malt. "Inhibition of ornithine decarboxylase with 2- difluoromethylornifhine: reduced incidence of dimethylhydrazine-induced colon tumors in mice.^"' Cancer Res.. (43V.2545-2549. 1983.

Lipkin. "New rodent models for studies of chemopreventive agents.'^" J Cell Biochem Sitppl (28-

29): 144-7. 1997. Lowy . Willumsen. "" Function and regulation of τas.^'Αnnu Rev Biochem (62):851 -91. 1993. Luc and Baylin. "'Inhibition of intestinal epithelial DNA synthesis and adaptive hyperplasia after jejunectomy in the rat by suppression of polyamines biosynthesis.^" J. Clin. Invest.

74:698-704. 1984. Marks. Mattox. Casero. "The effects of DFMO on polyamine metabolism in the inner ear.^""

Hear Res. 53(2):230-236. 1991. Messing. Verma. Storer. Sansiman. Bram. ^"Ornithine decarboxylase (ODC) activity in normal and malignant urothelium- Implications for prevention and treatment of bladder cancer

(BCV Proc. Amer. Urological Assoc 153. Supplement 523A. Abstract #1 177. 1995. Mevskens. Jr. and Gerner. ""Development of difluoromethvlornithine as a chemoprevention agent for the management of colon cancer.^"" Cell. Bio.. 22: 126- 131. 1995. Mevskens. Jr.. Emerson. Pelot. Meshkinpour. Shassetz. Einsphar. Alberts. Gerner. "Dose de- escalation chemoprevention trial of α-difluoromethylornithine in patients with colon polyp.^'" ,/ Natl. Cancer Inst. 86(151: 1 122- 1 130. 1994. Oka. Perry. Takemoto. Sakai. Terada. Inoue. ^"The multiple regulatory roles of polyamine in the hormonal induction of mammary giand development.^" In: Advances Polvamine

Research. 3 :309-320. 1981 Pasic. Heisev. Love. "α-Difluoromethylomithine ototoxicity: chemoprevention clinical trial results." Arch. Otolaryngol Head eck Surg. 123(12): 1281 -1286. 1997. Pegg. "Recent advances in the biochemistry of polyamines in eukaryotes.^" Biochem. J. 234. 249- 262. 1986.

Pegg. and McCann. "Polyamine metabolism and function.^" Am. J. Physiol. 243 : 212-221. 1982. Salzer. Mattox. Browned. "'Cochlear damage and increased threshold in α- difluoromethylornithine (DFMO) treated guinea pigs.^" Hear. Res. 46: 101 -1 12. 1990. Schweitzer. Cassedav. Sjoerdsma. McCann. Baπolome. "Identification of polyamines in the cochlea of the rat and their potential role in hearing.^" Brain Research Bulletin. 16:215-

218. 1986. Su. Kinzler. Vogelstein. Preisinger. Moser. Luongo, Gould. Dove. "Multiple intestinal neoplasia caused by a mutation in the murine homolog of the APC gene.^" Science. (256):668-670.

1992. Tempero. Nishioka. Knott. Zetterman. "Chemoprevention of mouse colon tumors with difluromethylornithine during and after carcinogen treatment.^" Cancer Res.. (49):5793-

5797. 1989. Thet. Parra. Shelburne. "Repair of oxygen-induced lung injury in adult rats: The role of ornithine decarboxylase and polyamines. ^" Am. Rev. Respir. Dis. 129. 174-181. 1984. Wagner. Gaget. Heintzelmann. Wolf "Resolution of the enantiomers of various alpha-substituted ornithine and lysine analogs by high-performance liquid chromatography with chiral eluant and by gas chromatography on Chirasil-Val.^" Anal Biochem 164( 1 ): 102-16. 1987. Williams-Ashman, and Canellakis. ^"Polyamines in mammalian biology and medicine.^"

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Claims

1. A method for preventing and/or treating cancer in a patient comprising administering an effective amount of substantially enriched D enantiomer of difluoromethvlornithine ( D- DFMO) or an analog thereof to said patient.

2. The method of claim 1 , wherein D-DFMO or an analog thereof is administered at a dose of about 0.05 to about 20.0 gm/M²/day.

3. The method of claim 2. wherein D-DFMO or an analog thereof is administered at a dose of about 0.1 to about 2.0 gm/M²/day.

4. The method of claim 1. wherein the cancer being administered to is selected from bladder cancer, colon cancer, breast cancer, pancreatic cancer, brain cancer, lung cancer, stomach cancer, a blood cancer, skin cancer, testicular cancer, prostate cancer, ovarian cancer, liver cancer, esophageal cancer, and any combination thereof.

5. The method of claim 1, wherein the cancer is colon cancer.

6. The method of claim 5. wherein the colon cancer is familial adenomatous polyposis.

7. The method of claim 1. wherein the cancer is bladder cancer.

8. The method of claim 7. wherein the bladder cancer is superficial bladder cancer.

9. The method of claim 1. wherein said preventing and/or treating cancer is accomplished by a mechanism selected from inducing apoptosis. inhibiting cell division, inhibiting metastatic potential, reducing tumor burden, increasing sensitivity to chemotherapy or radiotherapy, killing a cancer cell, inhibiting the growth of a cancer cell, inducing tumor regression and any combination thereof.

10. The method of claim 1. wherein D-DFMO or an analog thereof is administered at least a second time. The method ot claim 1. further comprising resection ot a solid tumor

The method of claim 1 1. wherein D-DFMO or an analog thereof is administered prior to said resection

The method of claim 1 1. wherein DFMO or an analog thereof is administered after said resection

The method of claim 1. wherein administration route is selected from oral, intravenous. intramuscular, mtratumoral. lntrapeπtoneal. intradermal. dermal, nasal, rectal, vaginal. topical, buccal. and intralymphatic administration

The method of claim 1. wherein DFMO or an analog thereof is administered directly to a tumor

The method of claim 1. wherein D-DFMO or an analog thereof is administered systemically

The method of claim 1. wherein D-DFMO or an analog thereof is administered into the regional vasculature of a tumor

The method of claim 1. wherein D-DFMO or an analog thereof is administered into the region lymph system of a tumor

The method of claim 1. wherein D-DFMO or an analog thereof is administered orally

The method of claim 1. wherein the D enantiomer comprises at least 60%) by weight of the difluoromethvlornithine or analog dosage being administered

The method ot claim 1 wherein the D enantiomer comprises at least 70% by weight of the difluoromethvlornithine oi analog dosage being administered

The method of claim 1 wherein the D enantiomer comprises at least 80% by weight of the difluoromethvlornithine or analog dosage being administered The method oi claim 1 w herein the D enantiomer comprises at least 90%o by weight of the difluoromethv lornithine or analog dosage being administered

The method of claim 1 wherein the D enantiomer comprises at least 95% by weight ot the difluoromethv lornithine or analog dosage being administered

The method of claim 1. wherein the D enantiomer comprises at least 97 5% by weight of the difluoromethvlornithine or analog dosage being administered

The method of claim 1 wherein the D enantiomer comprises at least 99% by weight of the difluoromethvlornithine or analog dosage being administered

The method of claim 1 wherein the D enantiomer comprises at least 99 5% bv weight of the difluoromethvlornithine or analog dosage being administered

A pharmaceutical composition, comprising substantially enriched D enantiomer of difluoromethvlornithine (D-DFMO) or analog thereof together with a pharmaceutically acceptable carrier

The pharmaceutical composition ot claim 28 formulated into a unit dose for administration to a patient

The pharmaceutical composition of claim 28 formulated in a form selected from rapid release, timed release, delaved release, sustained release, oral suspension, tablet, capsule, powder, troche, suppository, liposome. nanoparticle. inhalant, nasal solution, ophthalmic solution, otic solution lmgation solution intravenous admixture epidermal or transdermal solution, buccal tablet svrup cream ointment, lotion, gel. emulsion, elixer douche, enema, gargle implant, and aerosol

The pharmaceutical composition of claim 28 wherein the D enantiomer comprises at least 60%) by weight of the total difluoromethv lornithine or analog The pharmaceutical composition ot claim 28 wherein the D enantiomer comprises at least 10% by weight of the total difluoromethvlornithine or analog

The pharmaceutical composition of claim 28 wherein the D enantiomer comprises at least 80% by weight of the total difluoromethvlornithine or analog

The pharmaceutical composition of claim 28. wherein the D enantiomer comprises at least 90% by weight of the total difluoromethylornithine or analog

The pharmaceutical composition of claim 28. wherein the D enantiomer comprises at least 95%o by weight of the total difluoromethvlornithine or analog

The pharmaceutical composition of claim 28. wherein the D enantiomer comprises at least 97 5% by weight of the total difluoromethvlornithine or analog

The pharmaceutical composition of claim 28. wherein the D enantiomer comprises at least 99%o by weight of the total difluoromethylornithine or analog

The pharmaceutical composition of claim 28. wherein the D enantiomer comprises at least 99 5% by weight of the total difluoromethvlornithine or analog