US20110306565A1 - Hyaluronic acid containing compositions for treatment of wounds, scars, post-surgical adhesion formation - Google Patents

Hyaluronic acid containing compositions for treatment of wounds, scars, post-surgical adhesion formation Download PDF

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US20110306565A1
US20110306565A1 US13/143,875 US201013143875A US2011306565A1 US 20110306565 A1 US20110306565 A1 US 20110306565A1 US 201013143875 A US201013143875 A US 201013143875A US 2011306565 A1 US2011306565 A1 US 2011306565A1
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pharmaceutical composition
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hyaluronic acid
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Margit Mahlapuu
Mattias Münnich
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Pergamum AB
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/40—Transferrins, e.g. lactoferrins, ovotransferrins
    • 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
    • A61K31/728—Hyaluronic acid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
    • A61K38/08—Peptides having 5 to 11 amino acids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
    • A61K38/10—Peptides having 12 to 20 amino acids
    • 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
    • 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
    • A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
    • A61K47/36—Polysaccharides; Derivatives thereof, e.g. gums, starch, alginate, dextrin, hyaluronic acid, chitosan, inulin, agar or pectin
    • 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
    • A61K9/0014—Skin, i.e. galenical aspects of topical compositions
    • 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
    • A61K9/06—Ointments; Bases therefor; Other semi-solid forms, e.g. creams, sticks, gels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
    • A61L31/14—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L31/16—Biologically active materials, e.g. therapeutic substances
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P41/00—Drugs used in surgical methods, e.g. surgery adjuvants for preventing adhesion or for vitreum substitution
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/20—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices containing or releasing organic materials
    • A61L2300/23—Carbohydrates
    • A61L2300/232—Monosaccharides, disaccharides, polysaccharides, lipopolysaccharides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/20—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices containing or releasing organic materials
    • A61L2300/252—Polypeptides, proteins, e.g. glycoproteins, lipoproteins, cytokines

Definitions

  • the present invention relates to pharmaceutical compositions enhancing the therapeutic effect of biologically active peptides, especially peptides derived from human lactoferrin.
  • the compositions are useful for the treatment and/or prevention of wounds, scars, and post surgical adhesions.
  • Peritoneal adhesions are fibrous tissue connections between abdominal structures following surgical trauma or other types of injury.
  • General abdominal, vascular, gynaecological, urological and orthopaedic surgery may lead to adhesion formation in up to 95% of patients (Ellis et al. 1999. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353, 1476-1480).
  • Post-surgical adhesions are considered the main cause of small bowel obstruction (Menzies et al. 2001. Small bowel obstruction due to postoperative adhesions: treatment patterns and associated costs in 110 hospital admissions.
  • SeprafilmTM composed of sodium hyaluronic acid and carboxymethylcellulose (CMC) forms a viscous gel approximately 24-48 h after placement, which is slowly resorbed within 1 week (Diamond, 1996.
  • Seprafilm membrane Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): a blinded, prospective, randomized, multicenter clinical study. Seprafilm Adhesion Study Group. Fertil Steril 66, 904-910; Beck, 1997. The role of Seprafilm bioresorbable membrane in adhesion prevention. Eur J Surg Suppl, 49-55). SeprafilmTM has been shown to reduce post-surgical adhesion in clinical situation (Vrijland et al. 2002. Fewer intraperitoneal adhesions with use of hyaluronic acid-carboxymethylcellulose membrane: a randomized clinical trial. Ann Surg 235, 193-199.; Beck et al. 2003.
  • SeprafilmTM increases the risk of sequelae associated with anastomosic leak and is not compatible with laparoscopic procedures (diZerega et al. 2002.
  • Interceed composed of oxidized regenerated cellulose, is transformed into a gelatinous mass covering the injured peritoneum and has shown efficacy in adhesion-prevention in several clinical studies (Mais et al. 1995.
  • a limited number of pharmacologically active compounds have been tested in prevention of post-surgical adhesions.
  • the inflammatory component and fibroblast proliferation of the wound healing cascade has been a target of pharmacotherapy by using steroids drugs and cytotoxic drugs, respectively.
  • steroids drugs and cytotoxic drugs have shown ambiguous efficacy and potentially serious side effects (LeGrand et al. 1995. Comparative efficacy of nonsteroidal anti-inflammatory drugs and anti-thromboxane agents in a rabbit adhesion-prevention model. J Invest Surg 8, 187-194; Li et al. 2004. Synthesis and biological evaluation of a cross-linked hyaluronan-mitomycin C hydrogel. Biomacromolecules 5, 895-902).
  • the object of the present invention is to provide a means which has the ability to prevent the formation of post-operative adhesion formation without having the unwanted side effects of the currently available pharmaceutical compositions, devices and procedures.
  • the present inventors describe the novel approach to prevent formation of intra-abdominal adhesions using biologically active peptides derived from human lactoferrin formulated in a pharmaceutical composition enhancing the therapeutic effect of the peptides.
  • the biologically active peptides exhibit an inhibitory effect on the most important hallmarks of scar formation: reducing risk for infections, prohibiting inflammation and promoting fibrinolysis.
  • the peptides are formulated together with the naturally occurring hydrophilic polymer hyaluronic acid, which provides slow release properties of the drug and contributes to the final results by physical barrier effect.
  • the present invention relates to pharmaceutical compositions enhancing the therapeutic effect of biologically active peptides, especially peptides derived from human lactoferrin.
  • One aspect the present invention provides a pharmaceutical composition for the treatment and/or prevention of wounds, scars, and post surgical adhesions comprising i) one or more biologically active peptides derived from human lactoferrin, and ii) a high molecular weight hyaluronic acid.
  • Another aspect of the present invention provides use of a i) one or more biologically active peptides derived from human lactoferrin, and ii) a high molecular weight hyaluronic acid for the manufacture of a pharmaceutical composition for the treatment and/or prevention of wounds, scars, and post surgical adhesions.
  • Yet another aspect of the present invention provides a method for the treatment, prophylaxis and/or prevention wounds, scars, and post surgical adhesions comprising the administration of a pharmaceutical composition comprising i) one or more biologically active peptides derived from human lactoferrin, and ii) a high molecular weight hyaluronic acid, to a subject in need of such treatment.
  • a biologically active peptide derived from human lactoferrin is meant a biologically active peptide comprising at least one sequence motif which in part or in full is derived from the sequence of human lactoferrin, wherein this sequence motif can comprise one or more amino acid substitutions.
  • biologically active peptides is meant peptides that have one or more activities, such as anti-inflammatory activity, immunomodulatory activity, fibrinolytic activity, anti-angiogenetic activity, and anti-microbial activity such as anti-bacterial activity, anti-viral activity, or anti-fungal activity.
  • Biologically active peptides suitable to be used according to the present invention are described in e.g. PCT/EP2008/064062, PCT/EP2008/065186, WO 00/01730, the corresponding EP 1095061 and U.S. Pat. No. 7,253,143, which hereby are incorporated by reference.
  • the biologically active peptide can be selected from peptides comprising the amino acid sequence
  • amino acid X1 is Gln or Ala
  • amino acid X2 is Trp or Leu
  • amino acid X3 is Gln, Ala, Orn, Nle or Lys
  • amino acid X4 is Arg, Ala or Lys
  • amino acid X5 is Asn, Ala, Orn or Nle
  • amino acid X6 is Met, Ala or Leu
  • amino acid X7 is Arg, Ala or Lys.
  • the biologically active peptide can be selected from peptides according to formula (I) and peptides according to formula (II)
  • R1 is either no amino acid, Lys or a peptide sequence selected from
  • R2 is either no amino acid, Gly or a peptide sequence selected from
  • Gly-Pro-Pro-Val-Ser-Cys-Ile-Lys Gly-Pro-Val-Ser-Cys-Ile, Gly-Pro-Val-Ser-Cys, Gly-Pro-Val-Ser, Gly-Pro-Val, Gly-Pro-Pro, and Gly-Pro.
  • amino acid X8 is Gly, Lys, Glu or Asp; when X8 is Gly then R3 is Ser-(Arg) n -X9 and the bond ⁇ is a peptide bond between the carboxyl group of Gly and the amino group of Ser; when X8 is Lys then R3 is X9-(Arg) n -Ser and the bond ⁇ is an amide bond between the ⁇ -amino group in Lys and the carboxyl group in Ser; and when X8 is Glu or Asp then R3 is Ser-(Arg) n -X9 and the bond ⁇ is an amide bond between the ⁇ -carboxyl group of Glu or the ⁇ -carboxyl group of Asp and the amino group of Ser; amino acid X9 is either no amino acid or Gly; and n is an integer from 1 to 10, preferably an integer from 2 to 6, preferably an integer from 4 to 6, or even more preferably an integer from 3 to 4; and wherein R1 is either no amino acid
  • the biologically active peptide can be selected from the peptides
  • the biologically active peptide is selected from the peptides
  • Peptides comprising two cysteine residues can be in the form of a cyclic peptide structure where the two cysteines form a cysteine bridge.
  • one preferred biologically active peptide is the peptide
  • CysM acetamidomethyl-cysteine
  • the carboxy terminal end of the peptide has been capped, i.e. the free COOH at the carboxy terminal end has been transformed, e.g. by amidation into CONH 2 . (indicated as —NH 2 )
  • the amino terminal end of the peptide has been capped, i.e. the free NH 2 group at the amino terminal has been transformed, e.g. by acetylation into the amide CH 3 CONH— (indicated as Ac—).
  • both the carboxy-terminal and the amino-terminal ends of the peptide have been capped.
  • a peptide according to the invention is described as being capped at the carboxy terminal end and/or amino terminal end, it is also possible according to the invention to use the corresponding uncapped peptide.
  • a peptide according to the invention is described as being uncapped at the carboxy terminal end and/or amino terminal end, it is also possible according to the invention to use the corresponding capped peptide.
  • the advantage of the capped versions is that N- and C-terminal amino acids of these peptides are neutral and uncharged and thus has changed electrostatic properties. Assuming that the receptors bind the corresponding sequences of human lactoferrin where there are no N- and C terminal charges, the capped peptides should bind better as they in this respect resemble the native protein more than uncapped peptides.
  • the biologically active peptide is present in the pharmaceutical composition at a concentration between 0.1 mg/ml and 100 mg/ml, most preferably between 0.5 mg/ml and 25 mg/ml.
  • the biologically active peptide can be present in the form of a pharmaceutical acceptable salt.
  • the high molecular weight hyaluronic acid has a molecular weight higher than 300,000 Da, most preferably higher than 800,000 Da.
  • the high molecular weight hyaluronic acid is present in the pharmaceutical composition at a concentration between 0.1 and 10% (w/w), most preferably between 0.5 and 2.5% (w/w).
  • the high molecular weight hyaluronic acid can be present in the form of a pharmaceutical acceptable salt.
  • compositions according to the invention can be used to prevent the formation of post surgical scars, adhesions, keloids in connection with surgical procedures on various tissues such as skin, muscles, tendons, nervous tissue, blood vessels, and at different locations of the body such as eyes, ears, vocal cord, hand, spinal cord, intra-abdominal cavity, intra-thoracic cavity, intra-cranial cavity, oral cavity, gynaecological procedures, endometrios, phimosis.
  • the present inventors have unexpectedly found that the biological effect of the peptides derived from human lactoferrin can be significantly enhanced if the peptides are administered in a pharmaceutical composition comprising the peptide together with a high molecular weight hyaluronic acid.
  • This enhancement can not be explained only by a possible effect of the hyaluronic acid as such, but is due to an unexpected synergistic effect.
  • FIG. 1 The behaviours of PXL01 loaded sodium hyaluronate gels at 37° C.
  • the concentration of PXL01 is 6 mg/ml in 1.5% sodium hyaluronate solution.
  • the cumulative drug released was expressed as the % drug released at time t.
  • the data are shown as mean ⁇ SDV of three independent product preparations with the moving average trendline added.
  • FIG. 2 PXL01 prevents adhesion formation in rat model of abdominal surgery.
  • A The incidence of adhesion formation between the injury sites of abdominal wall and cecum, presented as a percentage of animals developing wall to wall adhesion connecting these injuries in each group.
  • B The cumulative scoring scale showing the total number of adhesions found in the abdominal cavity presented as mean ⁇ SEM.
  • C The adhesion scores according to the Nair scale presented as mean ⁇ SEM (scoring criteria listed in Examples).
  • D Percentage of animals without any adhesion formation in the abdominal cavity in each group.
  • E Weight change during the 6 survival days after surgery presented as percentage of initial weight.
  • the peptide PXL01 (SEQ ID NO:56) was used in the experiments.
  • PXL01 dissolved in sodium chloride solution was added to 2.5% sodium hyaluronate solution at a volume ratio of 2/5 PXL01 solution and 3/5 sodium hyaluronate solution, to obtain 1.5 or 6 mg/ml PXL01 in 1.5% sodium hyaluronate.
  • the solutions were homogenized by drawing the mixtures several times through 2.1 mm diameter needles.
  • PXL01 concentration and homogeneity in sodium hyaluronate were determined by high performance liquid chromatography with UV detector (Agilent model 1100) at 220 nm.
  • the analytical column used was a Vydac 218TP (C18, 5 ⁇ m, 250 ⁇ 4.6 mm).
  • the mobile phases used (0.1% TFA in water containing 1% acetonitrile (solvent A) and 0.1% TFA in acetonitrile (solvent B)) were run at a gradient with a flow rate of 1.0 ml/min. Diluted PXL01 standards were applied to create calibration curves.
  • Samples were prepared by adding hyaluronidase solution (Hyaluronidase from Streptomyces hyalurolyticus , Sigma-Aldrich, St Louis, Mo.) with an enzyme activity of 500 units/ml to sample solutions. The mixtures were agitated for 2 h at room temperature and samples were diluted as needed with TFA in water, followed by additional mixing. The samples were centrifuged at 7000 rpm for 5 min before injection to the column.
  • hyaluronidase solution Hyaluronidase from Streptomyces hyalurolyticus , Sigma-Aldrich, St Louis, Mo.
  • 0.25 ml of the formulated product was placed into the well of the tissue culture plate (24-Flat Well Tissue Culture Plate, Techno Plastic Products AG), resulting in a thin film of approximately 1.3 mm.
  • the plates were placed into thermostat (37° C.) for 1 h to allow the product to reach the temperature of 37° C.
  • 0.5 ml of the release medium (PBS, pH 7.4) re-equilibrated at 37° C. was carefully layered over the surface of the gel and the tissue culture plates were transferred into a thermostatic shaker (60 rpm, 37° C.). At predetermined time intervals, 10 microl aliquots of the aqueous solution were withdrawn from the release media.
  • the concentration of PXL01 released was monitored at wavelength of 230 nm using a spectrophotometric measurement. Because the measurement of absorbance at 230 nm could detect the peptide as well as dissolved sodium hyaluronate in the release medium, a control release medium was used which has the same amount of sodium hyaluronate without any PXL01 as that of sodium hyaluronate with the drug.
  • mice Female Sprague-Dawley rats (200-250 g, Charles River Laboratories, Sulzfeldt, Germany) were kept in a 12 hours light-dark cycle and were cared for in accordance with regulations for the protection of laboratory animals. The study was performed after prior approval from the local ethical committee.
  • Cecum abrasion and excision of the abdominal wall were performed to induce de novo adhesions as described previously (Harris et al. 1995. Analysis of the kinetics of peritoneal adhesion formation in the rat and evaluation of potential antiadhesive agents. Surgery 117, 663-669). Briefly, the rats were anaesthetized with isoflurane (Isoba®vet, Shering-Plough Animal Health, Farum, Denmark) and buprenorfin (48 microg/kg, Temgesic, Shering-Plough, Brussels, Belgium) was given as post-operative pain reliever.
  • isoflurane Isoba®vet, Shering-Plough Animal Health, Farum, Denmark
  • buprenorfin 48 microg/kg, Temgesic, Shering-Plough, Brussels, Belgium
  • a 5-cm-long midline incision of the abdomen was performed and a rectangle full thickness injury (5 mm ⁇ 25 mm) was made on the peritoneal wall through both the parietal peritoneum and the muscular fascia. Also, an area of the serous membrane on the both sides of the cecum, approximately 10 mm ⁇ 15 mm, was gently rubbed using cotton gauze until petechial hemorrhages appeared. The rats were randomized to untreated control group or treated groups. Excessive blood from the injury was removed and the test substance was applied over the abraded areas using a syringe.
  • the laparotomy wound was closed with a continuous suture and the skin was closed with metal clips (Appose ULC35W, TycoHealthcare Group LP, Norwalk, Conn., US).
  • the animals were killed 6 days after surgery with an overdose of pentobarbital sodium (Pentobarbital vet, APL, Sweden).
  • the abdomen was opened and the adhesions were scored by an evaluator blinded to the treatment.
  • the incidence of adhesions between abdominal incision and the abraded cecum was quantified as a percentage of animals developing wall to wall adhesions connecting these injuries, in each group.
  • mice Female Sprague Dawley rats (200-250 g, Charles River Laboratories, Sulzfeldt, Germany) were kept at a 12 hours light-dark cycle and were cared for in accordance with regulations for the protection of laboratory animals. The study was conducted after prior approval from the local ethical committee. Anaesthesia was induced with isoflurane (Isoba®vet, Shering-Plough Animal Health, Farum, Denmark) and the rats received buprenorfin (48 microg/kg; Temgesic, Shering-Plough, Brussels) intramuscularly for post-operative pain relieve and Bimotrim (80 mg/kg; Bimeda, UK), subcutaneously before the surgery.
  • isoflurane Isoba®vet, Shering-Plough Animal Health, Farum, Denmark
  • buprenorfin 48 microg/kg; Temgesic, Shering-Plough, Brussels
  • Bimotrim 80 mg/kg; Bimeda, UK
  • the abdominal wall was shaved and a midline laparatomy of approximately 3 cm was performed.
  • the colon was exposed and transected 2 cm distal of cecum.
  • a seromuscular end-to-end anastomosis was performed with 8 interrupted sutures using 6/0 monocryl (Y432H, Ethicon Inc, St-Stevens Woluwe, Belgium) thread.
  • a macaroon was placed in colon at anastomosis as stent during suturing.
  • the abdomen was closed with a continuous suture (4-0 monocryl, Y3100H, Ethicon Inc.) in the muscular layer and with staplers in the skin. 2 ml isotonic saline was administered subcutaneously to prevent dehydration.
  • the intestinal segment was placed immediately under isotonic sodium chloride, stained saline was infused through the tube into the intestinal segment, and the intraluminar pressure was monitored using a Grass recorder (Grass Instruments Co, Quincy, Ohio, USA). The maximum pressure prior to anastomotic burst was recorded as the burst pressure. The appearance of stained saline around the anastomosis indicated the time point for the burst. The evaluator was blinded to the treatment each animal received.
  • Sodium hyaluronate was chosen as carrier to achieve controlled release of PXL01.
  • PXL01 appears readily soluble and sufficiently stable in sodium hyaluronate, also the PXL01-containing sodium hyaluronate hydrogel is bioadhesive and easy to apply to the surgical area using a syringe.
  • PXL01 was applied in 1.5% high molecular weight sodium hyaluronate formulation, the formation of abdominal adhesions was significantly reduced, compared with the control group. There was a 4-fold reduction according to the cumulative adhesion scoring scale ( FIG. 2B ) and more than 3-fold reduction of the adhesion score according to Nair ( FIG. 2C ).
  • FIGS. 2A-D The ability of PXL01 to prevent adhesions was limited in water solution ( FIGS. 2A-D ), possibly due to the fact that the peptide is rapidly eliminated from the peritoneum.
  • the peptide was highly effective formulated in sodium hyaluronate ( FIGS. 2A-D ), causing significant reduction of adhesions according to different grading scales encompassing both the adhesions formed between the two injured surfaces as well as in the abdominal areas remote form the site of application.
  • Sodium hyaluronate a natural component of extracellular matrix, is catabolized locally or carried to lymph notes or the general circulation, from where it is cleared by the endothelial cells of the liver (Fraser et al. 1988.
  • the present inventors describe an unexpected observation that the biological effect of the lactoferrin-derived peptides on prevention of post-surgical adhesion formation can be significantly enhanced if the peptides are administered in a pharmaceutical composition comprising the peptide together with a high molecular weight hyaluronic acid.
  • the effect is significantly synergistic as compared to the effect of the peptide and the effect of hyaluronic acid given independently.
  • carrier systems based on microparticles have been shown to induce adhesions or cause inflammation (Hockel et al. 1987. supra; Kohane et al. 2006. supra).
  • the peptide-loaded sodium hyaluronate gel is easy to handle and administrate and is compatible with laparatomy or laparoscopy. Taken together, the product is expected to give comprehensive adhesion prevention regime preventing not only the adhesions which form at sites of operative procedures, but also de novo adhesions that form to sites not directly involved in surgery due to unintentional tissue injury during surgical manipulation, without causing any adverse effects on healing.

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PCT/EP2010/050284 WO2010081800A2 (en) 2009-01-13 2010-01-12 New pharmaceutical compositions

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