US20110201572A1 - Pharmaceutical composition with glycosaminoglycans and use thereof in the treatment of chronic ulcers - Google Patents

Pharmaceutical composition with glycosaminoglycans and use thereof in the treatment of chronic ulcers Download PDF

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US20110201572A1
US20110201572A1 US13/001,895 US200913001895A US2011201572A1 US 20110201572 A1 US20110201572 A1 US 20110201572A1 US 200913001895 A US200913001895 A US 200913001895A US 2011201572 A1 US2011201572 A1 US 2011201572A1
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diabetic
healing
heparin
ulcers
ulcer
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Ivan Lopez-Belmonte Encina
Maria De Los Angeles Canales Mayordomo
Elena Cebadera Miranda
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Laboratorios Farmaceuticos Rovi SA
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Laboratorios Farmaceuticos Rovi SA
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    • 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
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • A61K31/715—Polysaccharides, i.e. having more than five saccharide radicals attached to each other by glycosidic linkages; Derivatives thereof, e.g. ethers, esters
    • A61K31/726—Glycosaminoglycans, i.e. mucopolysaccharides
    • A61K31/727—Heparin; Heparan
    • 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
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • A61K31/715—Polysaccharides, i.e. having more than five saccharide radicals attached to each other by glycosidic linkages; Derivatives thereof, e.g. ethers, esters
    • A61K31/726—Glycosaminoglycans, i.e. mucopolysaccharides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
    • 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
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A61P17/02—Drugs for dermatological disorders for treating wounds, ulcers, burns, scars, keloids, or the like

Definitions

  • the invention relates to a composition of glycosaminoglycans for the treatment of chronic ulcers, specifically diabetic foot ulcers and pressure ulcers. It more particularly relates to compositions of low molecular weight heparins (LMWHs) and very low molecular weight heparins (VLMWHs) in the treatment of chronic ulcers, and more specifically in the manufacture of a medicinal product for the treatment of chronic ulcers.
  • LMWHs low molecular weight heparins
  • VLMWHs very low molecular weight heparins
  • DM Diabetes Mellitus
  • WHO World Health Organization
  • the incidence of DM is increasing in an alarming manner, a prevalence of 2.8% in the world population in 2000 and an increase of this figure to 4.4% in 2030 being estimated.
  • the number of patients with DM was about 171 million in 2000 and it is estimated that this number will increase to 366 million in 2030.
  • This increase in the incidence of DM has been associated, among other factors, with the general aging of the population, as there is a direct relationship between age and the prevalence of the disease.
  • the neurological damage, both of the peripheral and of the autonomic system probably represents the most common complication of DM. It can occur on both types of DM, and its prevalence and severity is related to the years of evolution of the diabetes and with the degree of glycemic control. It is estimated that this complication affects 60% of DM subjects, being the main cause of the onset of ulcers in the feet of diabetic subjects. In this line, the American Diabetes Association in its sixtieth scientific session established that 15% of the patients with DM developed throughout their life a foot ulcer and that foot ulcers are the cause of 6% of the hospitalizations occurring in diabetic subjects.
  • Foot ulceration is a significant complication of diseases such as diabetes with a yearly incidence slightly greater than 2% (Abbott C. A., et al. (2002) The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet. Med. 19(5):377-84). It is estimated that 15% of the patients with diabetes will develop ulcers at some time of their life (Reiber G. E. (1996) The epidemiology of diabetic foot problems. Diabet. Med. 13 Suppl 1:S6-11) and that about 10%-30% of those having ulcers will progress with the amputation of the limb (Lipsky B. A. (2004) Medical treatment of diabetic foot infections. Clin. Infect Dis. 39 Suppl 2:S104-14). Furthermore, this is complicated in the event that there is an ischemia in the lower limb in which the ulcer appears, occurring in most cases due to insufficient blood supply due to a high incidence of thrombosis.
  • the treatment of this type of chronic ulcer is carried out by topical route, for example, the use of dressings in ulcers such as diabetic foot ulcers is common.
  • the new types of dressings studied in controlled clinical trials include the dressings based on semipermeable polymeric membrane, Promogran (collagen matrix), alginate, carboxymethylcellulose, hyaluronan and subatmospheric pressure (Eldor R. et al. (2004) New and experimental approaches to treatment of diabetic foot ulcers: a comprehensive review of emerging treatment strategies. Diabet. Med. 21(11):1161-73). Methods for creating skin substitutes which are placed on the ulcerative lesion have also been developed.
  • Dermagraft® is produced by seeding human dermal fibroblasts on a synthetic scaffold of bioabsorbable material which has proved to be effective in low-grade ulcers with a greater healing proportion in less time (Marston W. A., et al. (2003) Dermagraft Diabetic Foot Ulcer Study Group. The efficacy and safety of Dermagraft® in improving the healing of chronic diabetic foot ulcers: results of a prospective randomized trial. Diabetes Care 26:1701-5).
  • Apligraf® consists of a dermal layer formed from human fibroblasts in a bovine type I collagen matrix and an epidermal later formed from human keratinocytes.
  • this skin substitute has proved to be significantly associated with a greater and faster healing of lesions when it is applied in low-grade and noninfected neuropathic ulcers (Veves A., et al (2001) Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial. Diabetes Care 24:290-5).
  • PDGF Platelet Derived Growth Factor
  • document EP 1499317 discloses a method for treating diabetic complications such as diabetic foot with sodium-hydrogen exchanger type 1 (NHE-1) inhibitors
  • international publication WO 02077155 describes that the keratinocyte growth factor (KGF-2) promotes or accelerates the healing of lesions.
  • heparins are known antithrombotic agents and anti-inflammatory agents which can improve vascular microcirculation.
  • LMWHs low molecular weight heparins
  • LMWH low molecular weight heparin
  • glycosaminoglycans in the treatment of chronic ulcers, specifically diabetic foot ulcers, and particularly the use of some low molecular weight heparins for this purpose, has to date been roughly described for patients having severe circulatory conditions, since these low molecular weight heparins have antithrombotic and anti-coagulating activity, expressed as anti-activated factor X (Xa) effect and anti-factor IIa effect.
  • Xa anti-activated factor X
  • they are generally not used for diabetic patients who suffer from diabetic foot ulcer without peripheral arterial occlusive disease, due to the bleeding risk involved in the treatment at greater doses.
  • the antithrombotic activity of fondaparinux is the consequence of the selective inhibition of factor Xa, mediated by antithrombin III (ATIII). Due to its selective binding to ATIII, the fondaparinux enhances 300 times the innate neutralization of factor Xa by ATIII. The neutralization of factor Xa interrupts the blood coagulation cascade and inhibits thrombin formation and thrombus development (see FIG. 1 ).
  • the investigators of the present invention have been able to experimentally determine the beneficial healing effect of the administration of the glycosaminoglycans with less amount of pentasaccharide in any type of ulcer which is considered to be chronic—not only in diabetic foot ulcers—and that said administration is effective by means of three main routes of administration: parenteral, oral and topical route.
  • LMWHs or VLMWHs have been physically and chemically modified to alter the pentasaccharide responsible for the anti-FXa activity in a qualitative and quantitative manner, to demonstrate that in the case of ulcers, specifically diabetic foot ulcers, what is of interest is that in this type of glycosaminoglycans there is a greater proportion of oligosaccharide sequences rich in the monosaccharides selected from the group consisting of: N-sulfo-D-glucosamine and D-glucuronic acid, and in preferred embodiments of the invention, also N-acetyl-D-glucosamine, L-iduronic acid and 2-sulfated L-iduronic acid and not as much of the pentasaccharide responsible for the anti-FXa activity (the presence of high concentrations of the N-sulfo-3O-sulfo-D-glucosamine unit essential for the antithrombotic activity of the pentasaccharide
  • the proportion of pentasaccharide is limited to a maximum of 20% of the characteristic disaccharide of the pentasaccharide (D-glucuronic acid bound to N-sulfo-3-sulfo-D-glucosamine) in the structure of the glycosaminoglycan which, according to the state of the art, is responsible for the anti-FXa activity and which therefore, according to the latter, would be suitable to have a greater proportion.
  • the characteristic disaccharide of the pentasaccharide D-glucuronic acid bound to N-sulfo-3-sulfo-D-glucosamine
  • chronic ulcers are understood as the solutions of continuity with loss of substance in the skin, depending on the origin of the ulcer they can be classified as: pressure ulcers, diabetic ulcer, ischemic (arterial or venous) ulcer, post-burn ulcer, post-radiotherapy ulcers, etc.
  • ischemia can occur due to external pressure on the capillaries (decubitus or pressure ulcers), due to injury by heat (burn), or due to vascular obstruction (diabetes, arteriosclerosis, etc.).
  • vascular obstruction diabetes, arteriosclerosis, etc.
  • the composition object of the present invention works for chronic ulcers even for patients who do not have diabetes and in whom there is an onset of a certain type of chronic ulcer which does not heal easily, such as pressure ulcers, understanding pressure ulcers as those having areas of damage in the skin and underlying tissue caused by the prolonged pressure on a hard plane, not necessarily intense, and independent of the position.
  • decubitus ulcer is currently discarded because it does refer to the pressure, a determining factor in its onset, and because it excludes those which have not appeared in decubitus position.
  • Example 5 it is clearly seen how the administration of the pharmaceutical composition object of the present invention works surprisingly well although the animal is not diabetic.
  • the inventors believe, however, that this hypothesis is supported by the results of their examples, because if the synthetic pentasaccharide (fondaparinux) is used for the treatment of ulcers, and specifically of diabetic foot ulcers, the healing and/or regenerative activity is highly reduced (when it should be the reverse) in the same manner as if the monosaccharides selected from the group consisting of N-sulfo-D-glucosamine and D-glucuronic acid, as well as, in preferred embodiments of the invention, also N-acetyl-D-glucosamine, L-iduronic acid and 2-sulfated L-iduronic acid, are chemically and/or enzymatically modified, the activity of the glycosaminoglycan of the inventors decreases drastically.
  • a main aspect of the present invention is aimed at a composition of glycosaminoglycans containing a proportion of certain monosaccharides and containing a proportion which does not exceed 20% of the characteristic disaccharide of the pentasaccharide, for the treatment of chronic ulcers and particularly of diabetic foot ulcer.
  • the inventors of the present invention have also prepared a relationship between the necessary amount of the aforementioned monosaccharides and the dose of a medicinal product containing a pharmaceutically effective amount of glycosaminoglycan, relating the proportion of monosaccharides (IU) with the plasma half-life of the product, to achieve a disease “treatment” dose and not a prophylaxis dose.
  • the inventors of the present invention have achieved eliminating the prejudices of the state of the art, since they have determined that in the case of certain glycosaminoglycans, such as LMWHs and VLMWHs, the amount of pentasaccharide for the treatment of diabetic foot ulcers (in diabetic patients) is not significant, but rather what is really important is the presence of a proportion of oligosaccharide sequences rich in certain specific monosaccharides.
  • This proportion of certain specific monosaccharides is responsible for the healing of this type of ulcer in diabetic patients, since when this type of glycosaminoglycan is administered by subcutaneous route or by parenteral route, the healing effect is due to the presence of certain oligosaccharide fractions which do not contain the pentasaccharide commonly linked in the state of the art to the anti-factor Xa effect in low molecular weight and very low molecular weight heparins. Furthermore, the inventors of the present invention have determined that provided that the pentasaccharide is slightly (quantitatively and qualitatively) altered in the heparinoid structure, the anti-FXa activity decreases considerably. However, a similar decrease in the healing power is not observed.
  • an important problem in the treatment of diabetic foot ulcers is achieving the effective and efficacious dose of a medicinal product, which achieves ischemic tissue regeneration and prevents the amputation of the diabetic foot and which is furthermore effective not only in prophylaxis but also as therapeutic treatment.
  • Another additional advantage which the treatment of choice must have is that it is not very traumatic for the patient since diabetic foot ulcers are characterized by being extremely painful, therefore the route of administration must not be very traumatic in the proximity of the wound. Therefore, for the purposes of the present invention the preferred routes of administration are the parenteral route, the oral route and the topical route which is non-invasive or is directly applied on the mucosa to be treated.
  • FIG. 1 depicts the mechanism of action of the synthetic pentasaccharide (fondaparinux).
  • FIG. 2A depicts the region of the anomeric signals (H1-C1 correlations) of the 13 C- 1 H HSQC spectrum of fondaparinux (pentasaccharide responsible for the interaction with antithrombin III) recorded at 298K in deuterated water (D 2 O).
  • fondaparinux pentasaccharide responsible for the interaction with antithrombin III
  • D 2 O deuterated water
  • FIG. 2B depicts the region of the anomeric signals (H1-C1 correlations) of the 13 C- 1 H HSQC spectrum of the low molecular weight heparin bemiparin, recorded at 298K in deuterated water (D 2 O).
  • the spectrum is much more complex than that obtained for fondaparinux (see FIG. 2A ), due to the presence of new monosaccharide units which were not present in fondaparinux (I, non-sulfated L-iduronic acid; ANAc, N-acetyl-D-glucosamine) and to the alteration of the proportion of the existing units, as is the case of the 2-sulfated L-iduronic acid ring, I2S, which is present in a greater proportion.
  • I non-sulfated L-iduronic acid
  • I2S 2-sulfated L-iduronic acid ring
  • the H1-C1 correlation peak of the characteristic G-(ANS,3S) unit of the pentasaccharide has been highlighted with a circle.
  • the intensity of this signal has decreased in comparison with the fondaparinux sample due to the increase of the proportion of D-glucuronic acid bound to N-sulfo-D-glucosamine G-(ANS), the latter being the major glucuronic ring.
  • FIG. 2C depicts the region of the anomeric signals (H1-C1 correlations) of the 13 C- 1 H HSQC spectrum of the very low molecular weight heparin RO14 ckw2 — 13 — 11L, recorded at 298K in deuterated water (D 2 O). The spectrum is much more complex than that obtained for fondaparinux (see FIG.
  • the intensity of this signal has decreased in comparison with the fondaparinux sample due to the increase of the proportion of D-glucuronic acid bound to N-sulfo-D-glucosamine G-(ANS), the latter being the major glucuronic ring.
  • FIG. 2D depicts the region of the anomeric signals (H1-C1 correlations) of the 13 C— 1 H HSQC spectrum of the low molecular weight heparin enoxaparin, recorded at 298K in deuterated water (D 2 O).
  • the spectrum is much more complex than that obtained for fondaparinux (see FIG. 2A ), due to the presence of new monosaccharide units which were not present in fondaparinux (I, non-sulfated L-iduronic acid; ANAc, N-acetyl-D-glucosamine) and to the alteration of the proportion of the existing units, as is the case of the 2-sulfated L-iduronic acid ring, I2S, which is present in a greater proportion.
  • I non-sulfated L-iduronic acid
  • I2S 2-sulfated L-iduronic acid ring
  • the H1-C1 correlation peak of the characteristic G-(ANS,3S) unit of the pentasaccharide has been highlighted with a circle.
  • the intensity of this signal has decreased in comparison with the fondaparinux sample due to the increase of the proportion of D-glucuronic acid bound to N-sulfo-D-glucosamine G-(ANS), the latter being the major glucuronic ring.
  • FIG. 2E depicts the region of the anomeric signals (H1-C1 correlations) of the 13 C- 1 H HSQC spectrum of the low molecular weight heparin tinzaparin, recorded at 298K in deuterated water (D 2 O).
  • the spectrum is much more complex than that obtained for fondaparinux (see FIG. 2A ), due to the presence of new monosaccharide units which were not present in fondaparinux (I, non-sulfated L-iduronic acid; ANAc, N-acetyl-D-glucosamine) and to the alteration of the proportion of the existing units, as is the case of the 2-sulfated L-iduronic acid ring, I2S, which is present in a greater proportion.
  • I non-sulfated L-iduronic acid
  • I2S 2-sulfated L-iduronic acid ring
  • the H1-C1 correlation peak of the characteristic G-(ANS,3S) unit of the pentasaccharide has been highlighted with a circle.
  • the intensity of this signal has decreased in comparison with the fondaparinux sample due to increase of the proportion of D-glucuronic acid bound to N-sulfo-D-glucosamine G-(ANS), the latter being the major glucuronic ring.
  • FIG. 2F depicts the region of the anomeric signals (H1-C1 correlations) of the 13 C- 1 H HSQC spectrum of the very low molecular weight heparin RO14-H13-96-5, recorded at 298K in deuterated water (D 2 O). The spectrum is much more complex than that obtained for fondaparinux (see FIG.
  • the intensity of this signal has decreased in comparison with the fondaparinux sample due to the increase of the proportion of D-glucuronic acid bound to N-sulfo-D-glucosamine G-(ANS), the latter being the major glucuronic ring.
  • FIG. 2G depicts the region of the anomeric signals (H1-C1 correlations) of the 13 C- 1 H HSQC spectrum of the low molecular weight heparin BEMI — 99 — 4, recorded at 298K in deuterated water (D 2 O).
  • the spectrum is very different from that obtained for fondaparinux (see FIG. 2A ), due to the presence of new monosaccharide units which were not present in fondaparinux (I, non-sulfated L-iduronic acid; ANAc, N-acetyl-D-glucosamine) and to the disappearance of some of the characteristic signals such as ANS,3S and G-(ANS,3S).
  • FIG. 2H depicts the region of the anomeric signals (H1-C1 correlations) of the 13 C- 1 H HSQC spectrum of heparin sodium, recorded at 298K in deuterated water (D 2 O).
  • the spectrum is much more complex than that obtained for fondaparinux (see FIG. 1 ), due to the presence of new monosaccharide units which were not present in fondaparinux (I, non-sulfated L-iduronic acid; ANAc, N-acetyl-D-glucosamine) and to the alteration of the proportion of the existing units, as is the case of the 2-sulfated L-iduronic acid ring, I2S, which is present in a greater proportion.
  • I non-sulfated L-iduronic acid
  • I2S 2-sulfated L-iduronic acid ring
  • the H1-C1 correlation peak of the characteristic G-(ANS,3S) unit of the pentasaccharide has been highlighted with a circle.
  • the intensity of this signal has decreased in comparison with the fondaparinux sample due to the increase of the proportion of D-glucuronic acid bound to N-sulfo-D-glucosamine G-(ANS), the latter being the major glucuronic ring.
  • FIG. 2I depicts the region of the anomeric signals (H1-C1 correlations) of the 13 C- 1 H HSQC spectrum of the low molecular weight heparin BEMI — 99 — 2, recorded at 298K in deuterated water (D 2 O). The spectrum is very different from that obtained for fondaparinux (see FIG.
  • FIG. 2J depicts the region of the anomeric signals (H1-C1 correlations) of the 13 C- 1 H HSQC spectrum of heparin calcium, recorded at 298K in deuterated water (D 2 O).
  • the spectrum is much more complex than that obtained for fondaparinux (see FIG. 1 ), due to the presence of new monosaccharide units which were not present in fondaparinux (I, non-sulfated L-iduronic acid; ANAc, N-acetyl-D-glucosamine) and to the alteration of the proportion of the existing units, as is the case of the 2-sulfated L-iduronic acid ring, I2S, which is present in a greater proportion.
  • I non-sulfated L-iduronic acid
  • I2S 2-sulfated L-iduronic acid ring
  • the H1-C1 correlation peak of the characteristic G-(ANS,3S) unit of the pentasaccharide has been highlighted with a circle.
  • the intensity of this signal has decreased in comparison with the fondaparinux sample due to the increase of the proportion of D-glucuronic acid bound to N-sulfo-D-glucosamine G-(ANS), the latter being the major glucuronic ring.
  • FIG. 2K depicts the region of the anomeric signals (H1-C1 correlations) of the 13 C- 1 H HSQC spectrum of the low molecular weight heparin BP06408-66/27-A, recorded at 298K in deuterated water (D 2 O).
  • the spectrum is very different from that obtained for fondaparinux (see FIG. 2A ), due to the presence of new monosaccharide units which were not present in fondaparinux (I, non-sulfated L-iduronic acid; ANAc, N-acetyl-D-glucosamine) and to the decrease of the signals corresponding to ANS,3S and G-(ANS,3S).
  • the decrease of the signal of the pentasaccharide, G-(ANS,3S) shows that this type of low molecular weight heparin has a low concentration of the structural motif responsible for the interaction with the antithrombin III.
  • FIG. 2L depicts the region of the anomeric signals (H1-C1 correlations) of the 13 C- 1 H HSQC spectrum of the low molecular weight heparin BP06408-66/28-A, recorded at 298K in deuterated water (D 2 O).
  • the spectrum is very different from that obtained for fondaparinux (see FIG. 2A ), due to the presence of new monosaccharide units which were not present in fondaparinux (I, non-sulfated L-iduronic acid; ANAc, N-acetyl-D-glucosamine) and the disappearance of the signals corresponding to ANS,3S and G-(ANS,3S).
  • the disappearance of the signal of the pentasaccharide, G(ANS,3S) shows that this type of low molecular weight heparin does not have detectable amounts of the structural motif responsible for the interaction with antithrombin III.
  • FIG. 3 shows the percentage of ulcerated area reduction in the mice of Example 2 when bemiparin is administered with a ratio between the half-life and the dose of 1:950, when bemiparin is administered with a ratio between the half-life and the dose of 1:472 and when fondaparinux is administered at equivalent treatment doses, i.e., 5 mg/ml, since it has a plasma half-life of 17 hours in healthy individuals, therefore in wistar rats it is 0.22 mg per rat.
  • FIG. 4 shows the evolution of the diabetic control mice of Example 4 with respect to the mice treated with bemiparin sodium.
  • the wound area has been depicted to the right of each animal.
  • FIG. 5 shows the evolution of the percentage of healing of the wound over time in the mice of Example 4.
  • FIG. 6 shows microphotographs of the wound sections of the mice of Example 4 after the staining with hematoxylin-eosin.
  • a diabetic control B diabetic animal treated with fondaparinux sodium, C diabetic animal treated with bemiparin sodium.
  • FIG. 7 depicts the percentage of ulcerated area reduction of the mice of Example 5 when a control composition by topical route, a topical composition of bemiparin sodium and a topical composition of fondaparinux sodium, a topical composition of non-fractionated heparin are administered to them.
  • FIG. 8 shows the evolution of the non-diabetic control mice of Example 5 with respect to the mice treated with heparin calcium. The wound area has been depicted to the right of each animal.
  • FIG. 9 shows the evolution of the percentage of healing of the wound over time in the mice of Example 5.
  • FIG. 10 shows microphotographs of the wound sections of the mice of Example 5 after the staining with hematoxylin-eosin.
  • FIG. 11 depicts the percentage of ulcerated area reduction in diabetic wistar rat when a control solution by oral route, an oral 100 mg/kg bemiparin sodium suspension and a 10 mg/kg fondaparinux sodium suspension are administered to it.
  • the problem to be solved by the present invention is, therefore, to provide a pharmaceutical composition solving the problems of the prior art.
  • a pharmaceutical composition of glycosaminoglycans by subcutaneous or parenteral route, oral route and/or topical route, particularly LMWHs and VLMWHs, for the treatment of chronic ulcers such as diabetic foot ulcers containing the following proportion of the following monosaccharides (in which all the percentages are over the total percentage of monosaccharides of the composition):
  • the proportion of the disaccharide unit D-glucuronic acid bound to N-sulfo-3-sulfo-D-glucosamine is not greater than 25%, and preferably not greater than 20%, achieves solving the indicated problem, since it achieves tissue regeneration, preventing the amputation of the limb, and is effective as therapeutic treatment and not only in prophylaxis.
  • Another aspect of the invention also relates to the use of a composition of glycosaminoglycans by subcutaneous or parenteral route, oral route and/or topical route, particularly LMWHs and VLMWHs, containing a characteristic proportion of at least the monosaccharides selected from the group N-sulfo-D-glucosamine, N-acetyl-D-glucosamine, L-iduronic acid, 2-sulfated L-iduronic acid and D-glucuronic acid in the manufacture of an alternative medicinal product for the treatment of chronic ulcers such as pressure ulcers and diabetic foot ulcers.
  • LMWHs and VLMWHs containing a characteristic proportion of at least the monosaccharides selected from the group N-sulfo-D-glucosamine, N-acetyl-D-glucosamine, L-iduronic acid, 2-sulfated L-iduronic acid and D-glucuronic acid
  • the solution is based on the fact that the inventors have identified that, contrary to the general belief, it is possible to administer to a patient suffering from diabetic foot ulcer a treatment consisting of a dose of low molecular weight heparin (LMWH) classified as venous thromboembolic disease treatment dose without there being a greater bleeding risk, and better results than if it is administered at lower concentrations such as the usual concentrations for prophylaxis being surprisingly obtained, due to the presence of a certain proportion of certain monosaccharides in the glycosaminoglycans.
  • LMWH low molecular weight heparin
  • the present invention provides a pharmaceutical composition for the treatment of diabetic foot ulcer using the usual treatment doses for venous thromboembolic disease, understanding treatment doses as those in which the ratio between the plasma half-life and the dose in IU of the LMWH is between 1:800 and 1:5,000, i.e., those containing a larger amount of specific monosaccharides.
  • a pharmaceutical composition of glycosaminoglycans by subcutaneous or parenteral route, oral route and/or topical route, particularly LMWHs and VLMWHs, for the treatment of diabetic foot ulcer containing the following proportion of the following monosaccharides:
  • a pharmaceutical composition of glycosaminoglycans by subcutaneous or parenteral route, oral route and/or topical route, particularly LMWHs and VLMWHs, for the treatment of diabetic foot ulcer containing the following proportion of the following monosaccharides:
  • a pharmaceutical composition of glycosaminoglycans by subcutaneous or parenteral route, oral route and/or topical route, particularly LMWHs and VLMWHs, for the treatment of diabetic foot ulcer containing the following proportion of the following monosaccharides:
  • the present invention is aimed at a pharmaceutical composition of glycosaminoglycans by subcutaneous or parenteral route, oral route and/or topical route, particularly LMWHs and VLMWHs, for the treatment of chronic ulcers such as diabetic foot ulcers, containing a proportion of the disaccharide unit D-glucuronic acid bound to N-sulfo-3-sulfo-D-glucosamine (A NS,3S ) less than 20%, even more preferably less than 10% and most preferably less than 5% of the total saccharide composition.
  • a NS,3S N-sulfo-3-sulfo-D-glucosamine
  • One of the merits of this invention is not only having eliminated a prejudice of the state of the art, but also achieving an effective correlation between the proportion of the aforementioned monosaccharides with the dose of medicinal product containing the aforementioned pharmaceutical composition necessary for treating the diabetic foot ulcer as well as for favoring tissue healing and regeneration in the patients according to the plasma half-life of these glycosaminoglycans.
  • an additional aspect of the invention is aimed at the use of glycosaminoglycans, particularly low molecular weight heparins, in the manufacture of a medicinal product for the treatment of diabetic foot ulcer which is characterized in that the ration between the plasma half-life and the dose in IU of the LMWH is between 1:800 and 1:5,000, i.e., it is characterized in that a composition containing a larger amount of the monosaccharides selected from the group consisting of N-sulfo-D-glucosamine, N-acetyl-D-glucosamine and D-glucuronic acid, and in preferred embodiments of the invention also L-iduronic acid and 2-sulfated L-iduronic acid, and a proportion of the disaccharide unit D-glucuronic acid bound to N-sulfo-3-sulfo-D-glucosamine less than 20% of the total saccharide composition, for the treatment of diabetic foot ulcer, more preferably less than 10% and
  • the invention is aimed at the use of a low molecular weight heparin in the manufacture of a medicinal product for the treatment of diabetic foot ulcer in which the LMWH is a heparin with an average molecular weight less than 6,000 daltons.
  • the invention is aimed at the use of a low molecular weight heparin in the manufacture of a medicinal product for the treatment of diabetic foot ulcer characterized in that the plasma half-life is between 5.2 and 5.4 and the daily average dose is 5,000 IU, which ensures having a specific proportion of the monosaccharides selected from the group consisting of N-sulfo-D-glucosamine and D-glucuronic acid, and in preferred embodiments of the invention also N-acetyl-D-glucosamine, L-iduronic acid and 2-sulfated L-iduronic acid, and the disaccharide unit G-glucuronic acid bound to N-sulfo-3-sulfo-D-glucosamine less than 20% of the total saccharide composition, more preferably less than 10% and most preferably less than 5%
  • the invention is aimed at the use of a low molecular weight heparin in the manufacture of a medicinal product for the treatment of diabetic foot ulcer characterized in that the plasma half-life is between 4.0 and 4.4 and the daily average dose is 7,600 IU, which ensures having a specific proportion of the monosaccharides selected from the group consisting of N-sulfo-D-glucosamine, N-acetyl-D-glucosamine, L-iduronic acid, 2-sulfated L-iduronic acid and D-glucuronic acid.
  • the invention is aimed at the use of a low molecular weight heparin in the manufacture of a medicinal product for the treatment of diabetic foot ulcer characterized in that the plasma half-life is between 2.3 and 2.8 and the daily average dose is 10,000 IU, which ensures having a specific proportion of the monosaccharides selected from the group consisting of N-sulfo-D-glucosamine and D-glucuronic acid, and in preferred embodiments of the invention also N-acetyl-D-glucosamine, L-iduronic acid and 2-sulfated L-iduronic acid.
  • the inventors of the present invention consider, however, that the results of the examples support their hypothesis, since if the synthetic pentasaccharide (fondaparinux) is used for the treatment of diabetic foot ulcer, the healing and/or regenerative activity is highly reduced (when it should be the reverse) in the same manner as if the monosaccharides selected from the group consisting of N-sulfo-D-glucosamine, N-acetyl-D-glucosamine, L-iduronic acid, 2-sulfated L-iduronic acid and D-glucuronic acid are chemically and/or enzymatically modified, the activity of the composition of glycosaminoglycan decreases drastically.
  • glycosaminoglycans such as low molecular weight heparins
  • the ratio between the plasma half-life of each LMWH and the dose in IU of the LMWH is between 1:800 and 1:5,000 provide the indicated advantages of the invention.
  • the experiments conducted were generally the following: preparation and quantification and identification of fractions of the glycosaminoglycan fractions by means of NMR and administration in previously diabetized wistar rats and in genetically modified mice to assess the healing of said ulcers.
  • the inventors of the present invention have analyzed commercial samples and their own research samples, to determine the monosaccharide proportions of those monosaccharides responsible for the healing of diabetic foot ulcer as well as the different saccharide fractions present in the pentasaccharide.
  • the average content of monosaccharides in the glycosaminoglycan (GAG) samples has been determined by means of the Nuclear Magnetic Resonance (NMR) technique, using quantitative 13 C- 1 H HSQC (heteronuclear single quantum coherence) two-dimensional experiments, according to the method described by Marco Guerrini et al.
  • NMR Nuclear Magnetic Resonance
  • HSQC heterouclear single quantum coherence
  • the amount of the unit of D-glucuronic acid bound to N-sulfo-3-sulfo-D-glucosamine G(ANS,3S) present in GAGs obtained from natural heparin can be directly related to the anti-Xa activity thereof, as described by M. Guerrini et al.
  • This disaccharide belongs to the pentasaccharide responsible for the interaction with antithrombin III and is only detected in the active sequences.
  • the correlation signal of the anomeric carbon of this type of glucuronic acid with the directly bound hydrogen appears in a characteristic and overlap-free region in the HSQC spectrum and can therefore be used to quantify the proportion of the pentasaccharide in the GAG.
  • FIGS. 2A to 2L The 13 C- 1 H HSQC spectra of fondaparinux and of different GAGs are shown in attached FIGS. 2A to 2L , in which the 1 H— 13 C correlation signal of the anomeric proton corresponding to the unit of glucuronic acid of the pentasaccharide has been highlighted with a circle.
  • the GAGs studied have new monosaccharide units, such as non-sulfated iduronic acid rings (I) or N-acetylated glucosamines (ANAc).
  • I non-sulfated iduronic acid rings
  • ANAc N-acetylated glucosamines
  • the proportion of the unit of 2-sulfated iduronic acid is much greater than in the pentasaccharide. Therefore, the samples analyzed contain mostly oligosaccharide chains different from fondaparinux.
  • Sweetened water 350 mg/dL was administered to all the rats for three days and glucose measurements were performed with a glucometer every day to verify that the rats were indeed diabetized. For this reason, before the administration and at time 4 days after the administration of streptozocin, a drop of blood was extracted from the rat tail vein for the subsequent quantification of glycemia and to see whether they were diabetic before starting the ulceration assay.
  • Control group 2 rats Group 1: High dose of heparin (217 IU) 3 rats Group 2: Low dose of heparin (108 IU) 3 rats
  • the selection of the rats included in each group was performed randomly.
  • the ulcers were treated with water and cleaned for 9 days after the ulceration.
  • bemiparin The administrations of bemiparin were performed by means of a bemiparin solution by subcutaneous route (100 ⁇ L) for the treatment of the ulcers.
  • the diameter of the ulcer was quantified by means of tracing the ulcer onto a transparency to see the progress of the healing.
  • Table 2 shows the calculation of the percentage of area reduction of day 9 with respect to day 1:
  • Sweetened water 350 mg/dL was administered to all the rats for three days and glucose measurements were performed with a glucometer every day to verify that the rats were indeed diabetized. For this reason, before the administration and at time 4 days after the administration of streptozocin, a drop of blood was extracted from the rat tail vein for the subsequent quantification of glycemia and see whether they were diabetic before starting the ulceration assay.
  • the selection of the rats included in each group was performed randomly.
  • the ulcers were treated with water and cleaned for 9 days after the ulceration.
  • the diameter of the ulcer was quantified by means of tracing the ulcer onto a transparency to see the progress of the healing.
  • Table 4 shows the calculation of the percentage of area reduction of day 9 with respect to day 1:
  • Diabetes was induced in 6 of all the rats and 4 of them were left as a non-diabetic control, to test the result of the healing of chronic ulcers not caused by diabetes.
  • Sweetened water 350 mg/dL was administered to the rats for three days and glucose measurements were performed with a glucometer every day to verify that the rats were indeed diabetized. For this reason, before the administration and at time 4 days after the administration of streptozocin, a drop of blood was extracted from the rat tail vein for the subsequent quantification of glycemia and see whether they were diabetic before starting the ulceration assay.
  • Non-diabetic control group 2 rats Diabetic control group 2 rats
  • Group 1 Non-diabetic Bemiparin (217 IU/rat) 2 rats
  • Group 2 Diabetic Bemi 99_2 (2.2 mg/rat) 2 rats
  • Group 3 Diabetic fondaparinux (0.22 mg/rat) 2 rats
  • the selection of the rats included in each group was performed randomly.
  • the ulcers were treated with water and cleaned for 9 days after the ulceration. A corresponding solution was administered to each group by SC route (100 ⁇ L) for the treatment of the ulcers. The diameter of the ulcer was quantified by means of tracing the ulcer onto a transparency to see the progress of the healing.
  • Table 6 shows the calculation of the percentage of healing of day 9 with respect to day 1:
  • the healing is similar to the diabetized rats. In other words, no difference is observed between the healing of the diabetic controls and the non-diabetic controls.
  • non-diabetic bemiparin 217 IU/rat
  • the rats of Group 1 it is observed that the healing is substantially reduced by 71.82% compared to its non-diabetic control, therefore it is concluded that in the case of chronic ulcers of non-diabetic patients (such as pressure ulcers) the administration of an oligosaccharide composition with a higher percentage of the monosaccharides:
  • the objective of this study is to evaluate the healing activity of the assay products: fondaparinux sodium and bemiparin after their administration by oral route in the diabetic rat wound model.
  • Both treatments were administered by oral route at an administration volume of 10 mL/kg.
  • a dose of 10 mg/kg was administered and in the case of bemiparin, 100 mg/kg were administered.
  • the control group only received the carrier used to prepare the assay product.
  • the carrier for the preparation of the assay product is a 1.5% (w/v) bicarbonate solution in water for injections. It was verified that the pH of the formulations prepared was above 8.00.
  • diabetes mellitus was induced in all the animals. To that end, they received a single intraperitoneal injection of streptozotocin (60 mg/kg, 10 mL/kg). After 72 hours, the establishment of the diabetes was verified by analyzing the blood glucose levels. To that end, animals were anesthetized with isoflurane and 0.8 mL of blood were extracted from the retroorbicular plexus. The animals had to have values of glucose greater than 15 mmol/L. A week after the induction of the diabetes, the wound was made.
  • the animals were anesthetized (ketamine+xylazine, 90+10 mg/kg, i.m.). Their back was shaved and cleaned with disinfectant (povidone-iodine) and the area where the wound would be made was marked by means of a template to homogenize its position in all the animals.
  • disinfectant povidone-iodine
  • the wound was made by means of a circular incision with a diameter of approximately 1.5 cm, the skin of the mid-dorsal area being removed. 1 mL/animal of physiological serum was administered by i.p. route after the intervention. For the 7 days after the intervention. Analgesia (paracetamol, 1 mg/mL) was provided in drinking water for the 7 days after the intervention.
  • the assigned treatments were administered to the animals.
  • the follow-up of the animals was performed, the evolution of the wounds being macroscopically assessed twice a week, by means of digital photography of the wound.
  • the body weight of the animals was also recorded twice a week.
  • the wound area was calculated as the percentage of reduction thereof to evaluate the degree of curing thereof, by means of the standardized formula:
  • the measurement performed immediately after the intervention or incision was used as the baseline area.
  • the animals were previously homogeneously distributed, according to the body weight, into the following treatment groups, with at least 5 animals per group:
  • the follow-up of the animals was performed, the evolution of the wounds being macroscopically assessed twice a week, by means of digital photography of the wound.
  • the body weight of the animals was also recorded twice a week.
  • the animals were sacrificed on day 15 of the study and the area of the skin where the wound was caused was stored in formol to perform a histopathological evaluation (hematoxylin-eosin staining).
  • Each section was given a histological score was given in the grade I to grade V range, where I means uncured wound and V means completely epithelialized wound. The score is based on the degree of cell invasion, the formation of granulation tissue, vascularization and epithelialization.
  • scab is essential in the healing process of the wound, since it fulfills the objective of limiting the loss of transdermal water and of acting as a barrier against bacteria and external pathogens, preventing the infection of the wound.
  • the rats in which scab has been formed on previous days show in the histopathological analysis of the scar, that the pattern of the dermis is closer to normality, compared with the wounds of the animals in which scab has not been formed or is smaller.
  • the healing area is greater and therefore the measurement is not conclusive compared to the animals in which scab has not been formed. Therefore, the formation of scab is a good indicator of the natural healing process, which in this particular case is only macroscopically observed in the group treated with bemiparin.
  • the animals were previously homogeneously distributed, according to the body weight, into the following treatment groups:
  • the follow-up of the animals was performed, the evolution of the wounds being macroscopically assessed twice a week, by means of digital photography of the wound.
  • the body weight of the animals was also recorded twice a week.
  • FIG. 11 shows the evolution of the diabetized control rats with respect to the diabetized rats treated with bemiparin sodium and fondaparinux. This graph shows how the rats treated with bemiparin heal much better than those treated with fondaparinux. In relation to the areas of the ulcers, when all the products are compared it is observed how the glycosaminoglycans which have a higher proportion of monosaccharides of the regular region have a beneficial effect on the healing of the wounds.
  • the animals were sacrificed on day 15 of the study and the area of the skin where the wound was caused was stored in formol to perform a histopathological evaluation (hematoxylin-eosin staining).
  • Each section was given a histological score in the grade I to grade V range, where I means uncured wound and V means completely epithelialized wound. The score is based on the degree of cell invasion, the formation of granulation tissue, vascularization and epithelialization.
  • a more evolved granulation tissue, intense neovascularization, with a higher healing level is observed in the group treated with bemiparin sodium, in addition to a greater homogeneity in the results obtained in all the animals.
  • the hyperglycemic animals treated with bemiparin sodium have shown healing levels that are even greater than those of the normoglycemic control group.
  • the C57BL/KsJ-db/db diabetic mouse has been used as a type II diabetes model having an altered healing, unlike the mouse with diabetes induced by streptozotocin used in the previous examples, which is a type I diabetes model (Michaels, J., et al, db/db mice exhibit severe wound-healing impairments compared with other murine diabetic strains in a silicone-splinted excisional wound model. Wound Repair Regen, 2007. 15(5): p. 665-70).
  • the genetically diabetic mouse develops resistance to insulin and hyperglycemia similar to those observed in adult diabetes.
  • the total thickness wounds made in the back of these animals takes longer in forming the granulation tissue and in closing than the same wounds caused in non-diabetic animals.
  • the animals were anesthetized (ketamine+xylazine, 100+10 mg/kg, i.m.). The back of the animal was shaved, the area was cleaned with disinfectant and the location of the wound was marked by means of a template to make its position the same in all the animals.
  • the wound was made by means of a circular incision with a diameter of approximately 1.5 cm, the skin of the mid-dorsal area being removed. A semipermeable dressing was subsequently placed on the wound. 1 mL/animal of physiological serum was administered by i.p. route after the intervention.
  • Analgesia (paracetamol, 1 mg/mL) was administered in drinking water for the 7 days after the intervention.
  • the wound area was calculated as the percentage of reduction thereof to evaluate the degree of curing thereof, by means of the standardized formula:
  • the measurement performed immediately after the intervention or incision was used as the baseline area. On the following day and for a total of 14 days, the assigned treatments were administered to the animals.
  • the animals were previously homogeneously distributed, according to the body weight, into the following treatment groups:
  • Diabetic control Diabetic animal treated with fondaparinux sodium 1 mg/kg Diabetic animal treated with bemiparin sodium 1000 IU Xa/kg Diabetic animal treated with heparin calcium 600 IU Xa/kg Diabetic animal treated with BP06408-66/28-A 10 mg/kg Diabetic animal treated with RO-14 1000 IU Xa/kg
  • the follow-up of the animals was performed up to a period of 21 days (average time necessary for the healing of the wounds in this animal model).
  • the assessment was performed by means of digital photography of the wound and subsequent image analysis.
  • FIG. 4 shows the evolution of the diabetic control mice with respect to the mice treated with bemiparin sodium. The wound area has been depicted to the right of each animal.
  • FIG. 5 shows the evolution of the percentage of healing of the wound over time.
  • the untreated diabetic animals are the ones showing a slower curing rate, since they do not reach 90% healing on day 21, followed by the animals treated with fondaparinux which did not reach complete curing either, which reach 96% on day 21.
  • the animals treated with bemiparin reach complete curing at time 21 days and have healing values of 98% from day 18.
  • the animals were sacrificed on day 21 of the study and the area of the skin where the wound was caused was stored in formol to perform a histopathological evaluation (hematoxylin-eosin staining).
  • Each section was given a histological score in the grade 1 to grade V range, where I means uncured wound and V means completely epithelialized wound. The score is based on the degree of cell invasion, the formation of granulation tissue, vascularization and epithelialization.
  • topical formulations were prepared for the direct administration on the ulcers, the carriers of which formulations are formed by Carbopol, Phenonip®, Span 80, Glycerol and water.
  • the ulceration and measurement of the area were performed as detailed in the subcutaneous administration assays. On the day after the incision and for a total of 14 days, the assigned treatments, 0.15 ml/animal by topical route in the back of the animal, above the wound, were administered to the animals.
  • the animals were previously homogeneously distributed, according to the body weight, into the following treatment groups:
  • Diabetic control Diabetic animal treated with bemiparin 1000 IU/kg Diabetic animal treated with fondaparinux 1000 IU/kg Diabetic animal treated with heparin calcium 1000 IU/kg
  • FIG. 7 shows the overall values of the evolution of the percentage of wound reduction of the treatment groups compared to the control group. As observed in the graph, the best of the wounds was observed with bemiparin, a value of area reduction greater than 60% being obtained at the end of the treatment.
  • the animals were sacrificed on the day after the last administration (day 15) and the area where the wound was made was extracted. The rear portion of the area containing the wound was stored in formol for its histological processing (hematoxylin-eosin staining).
  • the histopathological scores obtained for the different groups are shown in the table below.
  • the three treated groups generally obtain a better histological score than the control group, at least two points above the latter.
  • the difference between them is in the greater presence of inflammatory cells, as occurs in the case of the control group, compared to the greater presence of fibroblasts and collagen fiber deposition, as is the case of the treated groups.
  • the skin samples belonging to the groups treated with bemiparin and NFH have a somewhat more evolved cicatricial repair rate, with a more evolved granulation tissue, greater presence of fibroblasts and dermal neovascularization.
  • the group treated with NFH is different in histological score, being comprised within grade IV, which indicates a higher quality in the healing with respect to the other groups.
  • the granulation tissue formed is thicker and is dominated by fibroblasts, with extensive collagen fiber deposition.
  • the epithelium covers the wound partially or completely.
  • Bemiparin has a greater healing rate, whereas in the case of NFH the healing is slower but with higher quality in the tissue formed.
  • the C57BL/KS.Cg-m Lepr db +/+ m mouse is the non-diabetic analog of the mouse used in the previous example.
  • the animals were anesthetized (ketamine+xylazine, 100+10 mg/kg, i.m.). The back of the animal was shaved, the area was cleaned with disinfectant and the location of the wound was marked by means of a template to make its position the same in all the animals.
  • the wound was made by means of a circular incision with a diameter of approximately 1.5 cm, the skin of the mid-dorsal area being removed. A semipermeable dressing was subsequently placed on the wound. 1 mL/animal of physiological serum was administered by i.p. route after the intervention.
  • Analgesia (paracetamol, 1 mg/mL) was administered in drinking water for the 7 days after the intervention.
  • the wound area was calculated as the percentage of reduction thereof to evaluate the degree of curing thereof, by means of the standardized formula:
  • the measurement performed immediately after the intervention or incision was used as the baseline area. On the following day and for a total of 14 days, the assigned treatments were administered to the animals.
  • the animals were previously homogeneously distributed, according to the body weight, into the following treatment groups:
  • Non-diabetic control Non-diabetic animal treated with bemiparin Na 1000 IU Xa/kg
  • the follow-up of the animals was performed up to a period of 21 days.
  • the assessment was performed by means of digital photography of the wound and subsequent image analysis.
  • FIG. 8 shows the evolution of the non-diabetic control mice with respect to the mice treated with heparin calcium. The wound area has been depicted to the right of each animal.
  • FIG. 9 shows the evolution of the percentage of healing of the wound over time.
  • the untreated non-diabetic animals reach values of wound reduction greater than 90% after day 14.
  • the treatment with bemiparin sodium does not improve the healing rate.
  • the animals treated with heparin calcium do improve with respect to the control, reaching 90% healing on day 11.
  • the animals were sacrificed on day 21 of the study and the area of the skin where the wound was caused was stored in formol to perform a histopathological evaluation (hematoxylin-eosin staining).
  • Each section was given a histological score in the grade 1 to grade V range, where I means uncured wound and V means completely epithelialized wound. The score is based on the degree of cell invasion, the formation of granulation tissue, vascularization and epithelialization.
  • the score obtained with the sample of the investigational product BP06408-66/28A which hardly has the presence of the pentasaccharide in its structure, is especially good with a complete cell structure and a very high degree of epithelialization, which again demonstrates that a higher factor Xa inhibitory activity is not necessary for the treatment of chronic ulcers, since it is not correlated with a better effect on healing.
  • FIG. 10 shows microphotographs of the sections of the wounds after the staining with hematoxylin-eosin: A non-diabetic control. B non-diabetic animal treated with bemiparin sodium, C non-diabetic animal treated with heparin calcium. The results obtained were the following:
  • the glycosaminoglycans object of the present invention can be used for treating other chronic ulcers different from diabetic foot ulcers.

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