Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0034—Urogenital system, e.g. vagina, uterus, cervix, penis, scrotum, urethra, bladder; Personal lubricants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/517—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with carbocyclic ring systems, e.g. quinazoline, perimidine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/02—Drugs for disorders of the urinary system of urine or of the urinary tract, e.g. urine acidifiers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system

Definitions

• the present invention relates to a composition for the prevention of recurrence of urethral stricture after any other type of conventional treatment such as endoscopic internal urethrotomy, urethral dilatation or chirurchical urethroplasty.
• Narrowing of the urethra is a common pathology characterized by stenosis of the urethral lumen due to the appearance of sclerous tissue, usually following healing of a lesion of the urethra.
• the most common causes are urethral instrumentation and catheterization, external trauma and urethral infections.
• the most common treatments for urethral stricture namely endoscopic internal urethrotomy and urethral dilatation, are effective for the treatment of urethral stricture in the short term.
• Surgical urethroplasty techniques also have a good success rate, reaching 85 to 90% in some series (Barbagli G et al, Journal of Urology, volume 165, p 1918-1919, June 2001, Webster GD et al, Journal of Urology, Vol. 134, p. 892, 1985), but these techniques are often complex and require specific training. There is also a significant rate of recurrence of narrowing of the urethra after this first surgical treatment.
• the quantification of the different collagen subtypes in the fibrous tissue of urethral stricture found a change in the ratio of collagen to the relative proportion of collagen type I and type III.
• the proportion collagen type I and collagen type III The proportion of type I collagen is increased in the tissue of the urethral stricture with a correlated decrease in the proportion of collagen type III.
• These two subtypes of collagen have different mechanical properties and it has been shown that the change in collagen type III / collagen type I ratio results in a change in tissue compliance (Baskin LS et al, British Journal of Urology, volume 150, p 642, 1993).
• Drugs modulating the synthesis of different collagen subtypes may be useful in preventing the onset or recurrence of urethral strictures. More particularly, a specific inhibitor of collagen subtype synthesis may be useful in inhibiting the process leading to stenosis of the urethra.
• R1 is a member of the group consisting of hydrogen, halogen, nitro, benzo, lower alkyl, phenyl and lower alkoxy;
• R2 is a member of the group consisting of hydroxy, acetoxy and lower alkoxy, and R3 is a member of the group consisting of hydrogen and lower alkenoxy carbonyl; n being either 1 or 2; and pharmaceutically acceptable salts thereof.
• Halofuginone is the compound that has been found to be particularly effective for this type of treatment.
• compositions for preventing recurrence of urethral stricture after conventional primary treatment such as internal urethrotomy, urethral dilatation or surgical urethroplasty, including an effective amount from a point of view pharmaceutical composition of a compound in association with a pharmaceutically acceptable carrier, the compound being a member of a group having a formula:
• R1 is a member of the group consisting of hydrogen, halogen, nitro, benzo, lower alkyl, phenyl and lower alkoxy;
• R2 is a member of the group consisting of hydroxy, acetoxy and lower alkoxy, and
• R3 is a member of the group consisting of hydrogen and lower alkenoxycarbonyl; n being either 1 or 2; and pharmaceutically acceptable salts thereof.
• the preferred compound is halofuginone.
• composition for preventing recurrence of urethral stricture after conventional first treatment such as internal urethrotomy, urethral dilatation or surgical urethroplasty, including a step of administering to the patient a pharmaceutically effective amount of a compound having a formula:
• R1 is a member of the group consisting of hydrogen, halogen, nitro, benzo, lower alkyl, phenyl and lower alkoxy;
• R2 is a member of the group consisting of hydroxy, acetoxy and lower alkoxy
• R3 is a member of the group consisting of hydrogen and lower alkenoxy carbonyl; n being either 1 or 2; and pharmaceutically acceptable salts thereof.
• Halofuginone is defined as a compound having a formula:
• composition preferably includes a pharmaceutically acceptable carrier for the compound.
• all of the compounds referred to above may be either the compound itself as described by the formula, and / or pharmaceutically acceptable salts thereof.
• Halofuginone has been shown to be an effective inhibitor of urethral stricture recurrence after internal urethrotomy. Such an effect was not provided by the prior art. Indeed, no other substance was previously described as preventing the recurrence of urethral strictures after internal urethrotomy or urethral dilatation. In addition, the prior art did not teach that recurrence of urethral stricture could be prevented by Halofuginone. Therefore, and as detailed below, Halofuginone can be used as a treatment to prevent recurrence of urethral strictures after first treatment with internal urethrotomy, urethral dilatation or surgical uretroplasty.
• Halofuginone to prevent the appearance of new strictures of the urethra
• the rabbits underwent video urethrocystoscopy and retrograde urethrocystography and were subsequently sacrificed for histological examination.
• the urethra was removed en bloc and fixed in 10% buffered formaldehyde. Histological examination was performed after paraffin embedding and Masson trichrome stain, hematoxylin eosin, and Sirius Red (IMEB, Inc., Chicago Illinois) to evaluate fibrosis. With this last coloration, the collagen is colored red.
• Table 1 shows this effect of Halofuginone in preventing the occurrence of narrowing of the urethra after this lesion of the urethra.
• Table 1 Effect of Halofuginone in preventing the occurrence of narrowing of the urethra after urethral injury.
• All live rabbits underwent endoscopic internal urethrotomy under visual control using a cold slide and a 0.028 inch endoscopic guide. A single deep incision at 12 hours was performed in all rabbits.
• the rabbits were subsequently randomized into two groups: a study group receiving Malofuginone and a control group without Halofuginone for 10 weeks from the date of urethrotomy.
• the study group received a diet containing 10 mg / kg Halofuginone while the control group received a normal diet without Halofuginone.
• the rabbits were subsequently monitored and an evaluation for narrowing of the urethra was performed if certain signs appeared: decrease in diuresis by 24 h, anorexia, deterioration of the general state with a bladder eyeball on palpation. In the absence of these signs, the evaluation for a narrowing of the urethra was performed systematically 10 weeks after urethrotomy. This evaluation was performed using video-urethrocystoscopy and retrograde urethrocystography. The rabbits were subsequently sacrificed for histological study. The urethra was removed en bloc and fixed in 10% buffered formaldehyde.
• Table 2 presents the results.
• 3 of the 48 rabbits died;
• the number of rabbits in the study group and in the control group was 22 and 23 rabbits, respectively.
• the two groups were comparable for shrinkage obtained after electrocoagulation in terms of urethral lumen reduction and stenosis length.
• Two rabbits died immediately after endoscopic internal urethrotomy by urethral perforation.
• 3 rabbits per group died from unrelated causes at follow-up.
• 18 and 19 evaluable rabbits remained respectively at the end of the experiment.
• Figure 1 shows a photomicrograph of a section of the urethra at the site of the urethral stricture in a control rabbit receiving a diet without Halofuginone showing severe fibrosis.
• A Hematoxylin and Eosin.
• B Collagen type 1 fibers stained red with Sirius Red staining.
• Figure 2 shows retrograde urethrocystography in a rabbit from the study group receiving Halofuginone.
• A Prior to internal urethrotomy, there was significant narrowing of the bulbar urethra.
• B 1 At 10 weeks, the bulbar urethra is of normal caliber and there has been no recurrence of narrowing.
• Figure 3 shows a photomicrograph of a section of the urethra at the site of prior internal urethrotomy in a rabbit from the study group receiving Halofuginone showing minimal fibrosis
• A Hematoxylin and Eosin.
• B Collagen type 1 fibers stained red with Sirius Red staining.
• Halofuginone can be administered to a subject in a variety of ways, which are well known in the art.
• subject refers to a human or a lower animal to which Halofuginone has been administered.
• administration may be topical (including the trans-urethral route), orally or parenterally.
• Topical administration formulas may include, but are not limited to, lotions, gels, creams, suppositories, drops, liquids, powders or sprays.
• compositions for oral administration include powders or granules, aqueous suspensions or solutions or in non-aqueous media, sachets, capsules or tablets. Thickeners, diluents, flavoring agents, dispersants, emulsifiers or binders may be desirable.
• Parenteral formulations may include, but are not limited to, sterile aqueous solutions which may also contain buffers, diluents and other suitable additives.
• the dosage depends on the severity of the symptoms and the subject's response to Halofuginone. Those of ordinary skill in the art can easily determine optimal dosages, dosing methodologies, and repeat rates. Example 4
• Halofuginone has been shown to be effective in preventing recurrence of urethral stricture after initial treatment with internal urethrotomy.
• the application includes the step of administering Halofuginone, in a pharmaceutically acceptable carrier as described in Example 3 above, to a subject to be treated.
• Halofuginone is administered according to an effective assay methodology in a subject immediately after the first treatment of urethral stricture by internal urethrotomy, urethral dilation or surgical urethroplasty for a period of time sufficient to be most effective and to prevent recurrence of narrowing of the urethra.
• Halofuginone is synthesized according to good manufacturing practice. Examples of the methods for synthesizing halofuginone and related derivatives of quinazolinones are given in US Pat. No. 3,338,909. Thereafter, Halofuginone is placed in a suitable pharmaceutical carrier, as described in Example 3 below. above, again in accordance with good pharmaceutical manufacturing practice. While the invention is described with respect to a limited number of embodiments, it should be noted that several variations, modifications, and other applications of the present invention may be made.

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• 2007
  • 2007-10-23 FR FR0707387A patent/FR2922451A1/fr active Pending
• 2008
  • 2008-10-23 US US12/739,324 patent/US20100305144A1/en not_active Abandoned
  • 2008-10-23 WO PCT/IB2008/003375 patent/WO2009053842A2/fr active Application Filing
  • 2008-10-23 CN CN2008801131027A patent/CN101917998A/zh active Pending
  • 2008-10-23 RU RU2010120687/15A patent/RU2010120687A/ru unknown
  • 2008-10-23 EP EP08841527A patent/EP2240180A2/de not_active Withdrawn
  • 2008-10-23 AU AU2008315685A patent/AU2008315685A1/en not_active Abandoned
• 2014
  • 2014-02-13 RU RU2014105453/15A patent/RU2014105453A/ru not_active Application Discontinuation
  • 2014-03-24 US US14/222,941 patent/US20140288102A1/en not_active Abandoned

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