US20120107361A1 - Albumin-Free Botulinum Toxin Formulations - Google Patents

Albumin-Free Botulinum Toxin Formulations Download PDF

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US20120107361A1
US20120107361A1 US13/380,131 US201013380131A US2012107361A1 US 20120107361 A1 US20120107361 A1 US 20120107361A1 US 201013380131 A US201013380131 A US 201013380131A US 2012107361 A1 US2012107361 A1 US 2012107361A1
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composition according
botulinum toxin
liquid composition
group
salt
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Stewart A. Thompson
Curtis L. Ruegg
Jacob M. Waugh
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Revance Therapeuticals Inc
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Revance Therapeuticals Inc
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Assigned to REVANCE THERAPEUTICS, INC. reassignment REVANCE THERAPEUTICS, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: RUEGG, CURTIS L., THOMPSON, STEWART A., WAUGH, JACOB M.
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Definitions

  • This invention relates to pharmaceutical formulations containing botulinum toxin.
  • this invention relates to botulinum toxin formulations that are stabilized by non-proteinaceous excipients.
  • Botulinum toxins are neurotoxins produced by Clostridium botulinum bacteria. Botulinum toxins produce paralysis of muscles by preventing synaptic transmission or release of acetylcholine across the neuromuscular junction. The action of botulinum toxins essentially blocks signals that normally would cause muscle spasms or contractions, resulting in paralysis.
  • botulinum neurotoxin serotypes A, B, C, D, E, F and G There are eight naturally occurring serologically related botulinum toxins, seven of which are known to cause paralysis (viz., botulinum neurotoxin serotypes A, B, C, D, E, F and G). Each of these serotypes is distinguished by neutralization with type-specific antibodies. However, the molecular weight of the botulinum toxin protein molecule is about 150 kD for all seven of these active botulinum toxins. As released by the Clostridium botulinum bacteria, the botulinum toxin is present in a complex comprising the 150 kD botulinum toxin protein molecule along with associated non-toxin proteins. The total size of the complex may vary.
  • the botulinum toxin type A complex can be produced by Clostridium botulinum bacteria as 900 kD, 500 kD and 300 kD complexes.
  • Botulinum toxin types B and C complexes are only produced as 700 kD or 500 kD complexes.
  • Botulinum toxin type D complexes are produced as both 300 kD and 500 kD complexes.
  • Botulinum toxin types E and F complexes are only produced as 300 kD complexes.
  • the complexes are believed to contain non-toxin hemaglutinin protein and non-toxin and non-toxic non-hemaglutinin protein.
  • non-toxin proteins which along with the botulinum toxin molecule comprise the relevant neurotoxin complex
  • these two non-toxin proteins are believed to provide stability against denaturation to the botulinum toxin molecule and protection against digestive acids when toxin is ingested.
  • botulinum toxin is the most lethal naturally occurring toxin known to man, it has found extensive use as both a therapeutic and a cosmetic agent.
  • type A botulinum toxin for treatment of movement-associated wrinkles in the glabella area was first demonstrated by Schantz and Scott, in Lewis G E (Ed) Biomedical Aspects of Botulinum , N.Y.: Academic Press, 143-150 (1981).
  • the use of botulinum type A for the treatment of wrinkles was published in 1992 (Schantz and Scott, in Lewis G. E.
  • botulinum toxin may be degraded or denatured by environmental factors, such as heat, alkaline conditions, mechanical shear forces, or contact with reactive surfaces or substances. Furthermore, the difficulty in stabilizing the botulinum toxin in commercial formulations is exacerbated by the extreme toxicity of the toxin, which permits only minute amounts of toxin to be used for therapeutic purposes. If the botulinum toxin formulation is not properly stabilized, the minute amounts of botulinum toxin may undergo unwanted reactions and/or adhere to the inner surfaces of its storage containers, leading to unacceptable loss of botulinum toxin or activity.
  • botulinum toxin formulations are often distributed as lyophilized (i.e. freeze dried) or vacuum-dried powder, in order to prevent degradation and make the botulinum toxin formulation easier to handle and less expensive to transport.
  • a liquid carrier such as water or a saline solution.
  • BOTOX® Allergan, Inc., Irvine, Calif.
  • the BOTOX® formulation is distributed as a vacuum-dried powder stored in individual vials, each of which contains about 100 units (U) of Clostridium botulinum toxin type A complex, 0.5 milligrams of human serum albumin and 0.9 milligrams of sodium chloride. It has been reported that commercial botulinum toxin formulation must be stored at a temperature of ⁇ 10° C. or less to maintain the labeled potency for the one year shelf life.
  • human serum albumin In commercial formulations of botulinum toxin, human serum albumin is often added as a bulk carrier and stabilizer.
  • albumin may stabilize a therapeutic protein (e.g., botulinum toxin) by one or more of the following mechanisms: (1) reducing adhesion of the therapeutic protein to the inner surfaces of storage or dispensing containers, which include glassware, storage vials, and the syringe used to inject the pharmaceutical composition; and (2) reducing denaturation of the therapeutic protein, especially after reconstituting to prepare a solution of the therapeutic protein.
  • Human serum albumin has the added advantage of being minimally immunogenic, which lessens the likelihood that a human patient will develop antibodies against the botulinum toxin formulation.
  • albumin Although human serum albumin has been adopted as a stabilizer in commercial botulinum toxin formulations, there are still significant problems associated with this approach.
  • One serious problem is that albumin is derived from blood and is therefore susceptible to carrying blood borne pathogens or infectious agents.
  • the human serum albumin may carry the Human Immunodeficiency Virus (HIV).
  • HAV Human Immunodeficiency Virus
  • Albumin may also carry prions, which are proteinaceous infectious agents that are responsible for causing a neurodegenerative disorder known as Creutzfeldt-Jacob disease. The prions cause misfolding of proteins in the brain, resulting in dementia, memory loss, speech impairment, loss of motor coordination, and death, often within the span of months after the initial onset of symptoms.
  • a non-proteinaceous polymer may be reactive towards the botulinum toxin or may contain reactive impurities that degrade and/or denature the botulinum toxin.
  • some studies have used a poloxamer as a non-proteinaceous stabilizing compound for botulinum toxin.
  • these studies report that reconstituted poloxamer-stabilized botulinum toxin formulations demonstrate low botulinum toxin activity, suggesting that the poloxamer excipient either failed to properly stabilize the botulinum toxin and/or induced unwanted degradation reactions to occur.
  • botulinum toxin formulation that is stabilized, but without a proteinaceous excipient, especially without any animal-protein based excipients. Furthermore, it would be highly desirable to have a non-proteinaceous stabilizing excipient that does not itself react with botulinum toxin.
  • this invention relates to botulinum formulations that are stabilized by non-proteinaceous excipients.
  • this invention relates to botulinum toxin formulations that are stabilized without albumin or other animal protein-derived excipients.
  • Another aspect of the invention is to provide a powder composition by drying the liquid composition described above.
  • This invention also provides a method for stabilizing a botulinum toxin formulation.
  • the method comprises combining a botulinum toxin, a non-reducing disaccharide or a non-reducing trisaccharide, a non-ionic surfactant, and physiologically compatible buffer components capable of maintaining the pH between 4.5 and 6.5 to form a liquid composition.
  • concentration of the non-reducing sugar in the liquid composition is in the range from 10% to 40% (w/v) and the concentration of the non-ionic surfactant is in the range from 0.005% to 0.5% (w/v).
  • the method further comprises drying the liquid composition to produce a stabilized powder composition.
  • Another aspect of the invention is to provide a liquid composition
  • a liquid composition comprising a botulinum toxin, a non-reducing disaccharide or a non-reducing trisaccharide, a non-ionic surfactant, a bulking agent and a physiologically compatible buffer.
  • the concentration of the non-reducing disaccharide compositions is in the range of 0.50 to 3.0% (w/v)
  • the concentration of the bulking agent is in the range of 1.5% to 7.5%
  • the concentration of the non-ionic surfactant is in the range of 0.005% to 0.5% (w/v)
  • the pH of the composition is in the range of 4.5 to 6.5.
  • the amount of non-reducing disaccharide or non-reducing trisaccharide relative to the amount of bulking agent is selected such that the bulking agent does not crystallize when the liquid composition is dried.
  • the invention also expressly contemplates powder formulations prepared by drying such liquid compositions.
  • the invention also provides a method for stabilizing a botulinum toxin formulation comprising combining a botulinum toxin, a non-reducing disaccharide or a non-reducing trisaccharide, a non-ionic surfactant, a bulking agent and a physiologically compatible buffer to form a liquid composition.
  • concentration of the non-reducing disaccharide compositions is in the range of 0.50 to 3.0% (w/v)
  • the concentration of the bulking agent is in the range of 1.5% to 7.5%
  • the concentration of the non-ionic surfactant is in the range of 0.005% to 0.5% (w/v)
  • the pH of the composition is in the range of 4.5 to 6.5.
  • the method further comprises drying the liquid composition to produce a stabilized powder composition.
  • the amount of non-reducing disaccharide or non-reducing trisaccharide relative to the amount of bulking agent is selected such that the bulking agent does not crystallize when the liquid composition is dried.
  • This invention also provides a liquid composition
  • a liquid composition comprising a botulinum toxin, a non-reducing sugar, a non-ionic surfactant, a physiologically compatible buffer, a positively charged peptide and an optional bulking agent.
  • the positively charged peptide has an amino acid sequence selected from the group consisting of RKKRRQRRR-G-(K) 15 -G-RKKRRQRRR, RGRDDRRQRRR-G-(K) 15 -G-RGRDDRRQRRR, and YGRKKRRQRRR-G-(K) 15 -G-YGRKKRRQRRR.
  • the pH of the liquid composition is in the range of 4.5 to 6.5.
  • the invention also expressly contemplates powder formulations prepared by drying such liquid compositions.
  • Yet another aspect of the invention is to provide a method for stabilizing a botulinum toxin formulation
  • a method for stabilizing a botulinum toxin formulation comprising combining a botulinum toxin, a non-reducing sugar, a non-ionic surfactant, a physiologically compatible buffer, a positively charged peptide and an optional bulking agent.
  • the positively charged peptide has an amino acid sequence selected from the group consisting of RKKRRQRRR-G-(K) 15 -G-RKKRRQRRR, RGRDDRRQRRR-G-(K) 15 -G-RGRDDRRQRRR, and YGRKKRRQRRR-G-(K) 15 -G-YGRKKRRQRRR.
  • the pH of the liquid composition is in the range of 4.5 to 6.5.
  • the method further comprises drying the liquid composition to produce a stabilized powder composition.
  • FIG. 1 Recovered botulinum toxin activity as a function of time after storage of a lyophilized botulinum toxin at 40° C.
  • FIG. 2 Recovered botulinum toxin activity as a function of time after storage of a lyophilized botulinum toxin at different temperatures.
  • FIG. 3 Recovered botulinum toxin activity as a function of time after storage of a lyophilized botulinum toxin at different temperatures.
  • This invention relates to botulinum toxin formulations that are stabilized without the addition of proteinaceous excipients derived (i.e., purified) from animal sources, such as albumin.
  • the botulinum formulations of the invention do not suffer from the potential problems associated blood borne pathogens or other types of infectious agents.
  • This invention also provides methods for preparing botulinum toxin formulations without the addition of animal-derived proteinaceous excipients.
  • the formulations do not contain any proteinaceous excipients at all.
  • proteinaceous excipients not derived from animal sources e.g., recombinant albumin or recombinant gelatin
  • proteinaceous excipients not derived from animal sources e.g., recombinant albumin or recombinant gelatin
  • the term “stabilize” and variations thereof refers to the retention of biological activity of the botulinum toxin in the formulation over a specified time period as measured by a 20-mouse LD 50 assay (See L B Pearce, R E Borodic, Tox. Appl. Pharmacol, v128, p69, 1994 and ICCVAM/NICEATM/ECVAM, Scientific Workshop on Alternate Methods to Refine, Reduce and Replace the Mouse LD50 Assay for Botulinum Toxin Testing, 14 Nov. 2006).
  • the duration of the specified time period may be chosen to be consistent with the duration of the botulinum toxin product manufacturing processes. For instance, the duration of the specified time period may be chosen to be sufficient to stabilize the botulinum toxin as it is subjected to one or more processing steps.
  • the specified time will be on the order of weeks, months or even years, such as the case when the non-toxin formulation components are selected to permit long-term stabilization of the botulinum toxin formulation for storage.
  • the specified time is at least two weeks, at least one month, at least three months, at least six months, at least nine months, at least one year, at least 18 months or at least two years.
  • the specified time is coincident with the time for botulinum toxin to retain a desired amount of bioactivity using the formulations of the invention, which time includes, for example, the duration of the activities stated above.
  • the components used to stabilize the formulation may be selected to permit stabilization at low temperatures (e.g., ⁇ 5 to ⁇ 10° C.) or at ambient temperature, as described herein.
  • the botulinum toxin formulations of the invention are provided in solid form.
  • the formulations may be lyophilized or vacuum-dried to produce a solid formulation.
  • the activity that is observed upon reconstitution is said to be the activity upon initial recovery.
  • the activity upon initial recovery is greater than 99% and can even be 100%.
  • the specified time over which stability is measured is greater than 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, or 24 months at given storage temperature.
  • the activity that is observed upon reconstitution is said to be the activity upon long term storage.
  • the botulinum toxin formulations are stored in liquid form, rather than solid form.
  • the liquid botulinum toxin formulations according to the invention retain at least 60%, 70%, 80%, or 90% of the botulinum toxin activity for up to 8 hours at room temperature.
  • liquid botulinum toxin formulations according to the invention retain 100% of the botulinum toxin activity for up to 8 hours at room temperature.
  • the excipients in the botulinum formulations of the invention advantageously reduce or eliminate mechanisms by which the botulinum toxin is lost during manufacturing and storage. Without wishing to be limited by theory, it is believed that the non-proteinaceous excipients of the invention reduce or eliminate unwanted adhesion of the botulinum toxin to the vessels used for manufacturing, storage, or delivery of the formulation. Non-limiting examples of such vessels includes those made with glass, polystyrene, polypropylene, and other polymers.
  • non-proteinaceous excipients of the invention reduce or to prevent unwanted reactions between the botulinum toxin and objects or substances encountered by the botulinum toxin during manufacturing, storage, or delivery.
  • the non-proteinaceous excipients are inert to the other components of the formulation.
  • the botulinum toxin formulations are prepared in a powder form for ease of handling, transport, or storage.
  • the powder form may be prepared by any method known in the art. Non-limiting examples of such methods include lyophilization, vacuum-drying, drum-drying and spray drying, with lyophilization and vacuum-drying being particularly preferred.
  • botulinum toxin as used herein is meant to refer to any of the known types of botulinum toxin, whether produced by the bacterium or by recombinant techniques, as well as any such types that may be subsequently discovered including engineered variants or fusion proteins.
  • botulinum neurotoxins seven immunologically distinct botulinum neurotoxins have been characterized, namely botulinum neurotoxin serotypes A, B, C, D, E, F and G, each of which is distinguished by neutralization with type-specific antibodies.
  • the botulinum toxin serotypes are available from Sigma-Aldrich and from Metabiologics, Inc. (Madison, Wis.), as well as from other sources.
  • the different serotypes of botulinum toxin vary in the animal species that they affect and in the severity and duration of the paralysis they evoke.
  • the botulinum toxin used in the compositions of this invention can alternatively be a botulinum toxin derivative, that is, a compound that has botulinum toxin activity but contains one or more chemical or functional alterations on any part or on any chain relative to naturally occurring or recombinant native botulinum toxins.
  • the botulinum toxin may be a modified neurotoxin (e.g., a neurotoxin which has at least one of its amino acids deleted, modified or replaced, as compared to a native, or a recombinantly produced neurotoxin or a derivative or fragment thereof).
  • the botulinum toxin may be one that has been modified in a way that, for instance, enhances its properties or decreases undesirable side effects, but that still retains the desired botulinum toxin activity.
  • the botulinum toxin may be any of the botulinum toxin complexes produced by the bacterium, as described above.
  • the botulinum toxin may be a toxin prepared using recombinant or synthetic chemical techniques (e.g. a recombinant peptide, a fusion protein, or a hybrid neurotoxin, as prepared from subunits or domains of different botulinum toxin serotypes (see U.S. Pat. No. 6,444,209, for instance)).
  • the botulinum toxin may also be a portion of the overall molecule that has been shown to possess the necessary botulinum toxin activity, and in such case may be used per se or as part of a combination or conjugate molecule, for instance a fusion protein. Additionally, the botulinum toxin may be in the form of a botulinum toxin precursor, which may itself be non-toxic, for instance a nontoxic zinc protease that becomes toxic on proteolytic cleavage.
  • botulinum toxin complex or “toxin complex” as used herein refers to the approximately 150 kD botulinum toxin protein molecule (belonging to any one of botulinum toxin serotypes A-G), along with associated endogenous non-toxin proteins (i.e., hemagglutinin protein and non-toxin non-hemagglutinin protein produced by Clostridium botulinum bacteria). Note, however, that the botulinum toxin complex need not be derived from Clostridium botulinum bacteria as one unitary toxin complex.
  • botulinum toxin or modified botulinum toxin may be recombinantly prepared first and then subsequently combined with the non-toxin proteins.
  • Recombinant botulinum toxin can also be purchased (e.g., from List Biological Laboratories, Campbell, Calif.) and then combined with non-toxin proteins.
  • This invention also contemplates “reduced botulinum toxin complexes,” in which the botulinum toxin complexes have reduced amounts of non-toxin protein compared to the amounts naturally found in botulinum toxin complexes produced by Clostridium botulinum bacteria.
  • reduced botulinum toxin complexes are prepared using any conventional protein separation method to extract a fraction of the hemagglutinin protein or non-toxin non-hemagglutinin protein from botulinum toxin complexes derived from Clostridium botulinum bacteria.
  • reduced botulinum toxin complexes may be produced by dissociating botulinum toxin complexes through exposure to red blood cells at a pH of 7.3 (e.g., see EP 1514556 Al, hereby incorporated by reference). HPLC, dialysis, columns, centrifugation, and other methods for extracting proteins from proteins can be used.
  • the reduced botulinum toxin complexes are to be produced by combining synthetically produced botulinum toxin with non-toxin proteins, one may simply add less hemagglutinin or non-toxin non-hemagglutinin protein to the mixture than what would be present for naturally occurring botulinum toxin complexes.
  • any of the non-toxin proteins e.g., hemagglutinin protein or non-toxin non-hemagglutinin protein or both
  • the non-toxin proteins may be reduced independently by any amount.
  • one or more non-toxin proteins are reduced by at least about 0.5%, 1%, 3%, 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90% compared to the amounts normally found in botulinum toxin complexes.
  • substantially all of the non-toxin protein e.g., >95% of the hemagglutinin protein and non-toxin non-hemagglutinin protein
  • substantially all of the non-toxin protein e.g., >95% of the hemagglutinin protein and non-toxin non-hemagglutinin protein
  • botulinum toxin complexes derived from Clostridium botulinum bacteria is removed from the botulinum toxin complex.
  • only the pure botulinum toxin molecule, without any hemagglutinin protein and non-toxin non-hemagglutinin protein is used.
  • this invention also contemplates reducing each of the endogenous non-toxin proteins by different amounts, as well as reducing at least one of the endogenous non-toxin proteins, but not the others.
  • This invention also contemplates the general use of combinations and mixtures of botulinum toxins, although due to their differing nature and properties, mixtures of botulinum toxin serotypes are not generally administered at this time in the health-care or cosmetic industries.
  • the botulinum toxin formulations of the invention comprise a non-ionic surfactant.
  • this invention contemplates the use of any non-ionic surfactant that has the ability to stabilize botulinum toxin and that is suitable for pharmaceutical use.
  • the non-ionic surfactant is a polysorbate, non-limiting examples of which include polysorbate 20, polysorbate 40, polysorbate 60, and polysorbate 80.
  • the non-ionic surfactant is a sorbitan ester, non-limiting examples of which include Span 20, Span 60, Span 65, and Span 80.
  • the invention also contemplates the use of poloxamers, non-limiting examples of which include poloxamer 181, poloxamer 188, and poloxamer 407.
  • the invention also contemplates using Triton X-100 or NP-40 as the non-ionic surfactants.
  • the invention contemplates embodiments in which combinations of different non-ionic surfactants are used in conjunction.
  • the non-ionic surfactant is selected from the group consisting of polysorbates, poloxamers, and sorbitans, with polysorbates and sorbitans being particularly preferred.
  • the concentration of the non-ionic surfactant is in the range of 0.005% to 0.5%, or in the range of 0.01% to 0.2%, or in the range of 0.02% to 0.1% or in the range of 0.05 to 0.08%.
  • This invention also contemplates formulations where the concentration of the non-ionic surfactant is 0.01%, 0.02%, 0.03%, 0.04%, 0.05%, 0.06%, 0.07%, 0.08%, 0.09%, 0.10%, 0.11%, 0.12%, 0.13%, 0.14%, or 0.15%.
  • the botulinum toxin formulations of the invention comprise a non-reducing sugar.
  • the non-reducing sugar has a glass transition temperature above 55° C., 57° C. or 60° C. Without wishing to be bound by theory, it is believed that such glass transition temperatures are sufficiently high to suppress undesirable molecular motions that cause the botulinum toxin to denature.
  • the non-reducing sugar is a disaccharide, non-limiting examples of which include trehalose and sucrose.
  • the non-reducing sugar is a trisaccharide, a non-limiting example of which is raffinose.
  • the concentration of the non-reducing sugar in the botulinum toxin formulations of the invention are in the range of 10% to 40% (w/v), preferably 10% to 25% (w/v), more preferably 15% to 20% (w/v). In some preferred embodiments, the concentration of the non-reducing sugar is 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19% or 20% (w/v).
  • the non-reducing sugar is trehalose
  • preferably the hydrated form of trehalose i.e., trehalose-dihydrate
  • use of the anhydrous form of trehalose is contemplated as well.
  • one aspect of this invention is the recognition that the choice of non-reducing sugar may be used to tailor the stability of the botulinum toxin formulation as a function of temperature. For instance, when the botulinum toxin formulation is subjected to conditions without refrigeration it is advantageous to use trehalose as the non-reducing sugar, because trehalose confers stability to the botulinum toxin at ambient temperatures. Thus, trehalose-containing formulations of the invention may be advantageously processed at ambient temperatures during various manufacturing processes without appreciable loss of botulinum toxin activity. In situations where the botulinum toxin formulation will be refrigerated (e.g., during long term storage lasting months or even years), one may choose sucrose as the non-reducing sugar.
  • sucrose and trehalose are added to the botulinum toxin formulation.
  • the specific ratio of components of the sugar mixture will depend upon the effect to be achieved and can be determined by routine experimentation.
  • non-reducing sugars such as disaccharides
  • trehalose may be used during initial processing and/or purification at higher temperatures (e.g., ambient temperature), followed by removal and replacement of the trehalose with sucrose.
  • the removal and substitution of one non-reducing sugar, such as a disaccharide, for another may be accomplished by, for example, dialysis, chromatography, or other methods known in the art.
  • non-reducing sugar (or sugars) specified herein may, for certain embodiments, act as the primary bulking agent for solid botulinum toxin formulations.
  • the non-reducing sugars when added in the amounts specified herein, can form a stable and mechanically robust cake upon lyophilization or vacuum-drying of the botulinum toxin formulation.
  • the non-reducing sugars in such formulations form an amorphous solid in which the hydroxyl groups on the non-reducing sugar randomly orient the non-reducing sugar to maximize hydrogen bonding, which stabilizes the botulinum toxin and imparts mechanical robustness to the solid cake.
  • the non-reducing sugars described herein are used as the sole bulking agent for the botulinum toxin formulations.
  • a non-reducing sugar acts as the primary bulking agent, but small amounts of secondary bulking agents are added to the botulinum toxin formulation.
  • the secondary bulking agents are not particularly limited, and may be any bulking agent that does not have an unacceptably adverse affect on the stability of the botulinum toxin formulation. When using secondary bulking agents that have a tendency to crystallize, it is preferable to add them in sufficiently low concentrations, so that they are unable to crystallize. Without wishing to be limited by theory, it is believed that crystallization of such secondary bulking agents would have an adverse affect on the stability of the solid cake obtained after lyophilization or vacuum-drying.
  • a further aspect of the invention is the unexpected result that non-reducing sugars, at the concentrations described herein, may be used not only to stabilize lyophilized botulinum toxin formulations, but also botulinum toxin formulations in the solution phase.
  • the botulinum toxin formulation comprises a buffer.
  • any physiologically compatible buffer capable of maintaining the pH in the range of 4.5 to 6.5, more preferably in the range of 5 to 6, and most preferably about 5.5, is suitable for the botulinum toxin formulations of the invention.
  • buffers include those involving salts of citric acid, acetic acid, succinnic acid, tartaric acid, maleic acid, and histidine.
  • suitable buffer concentrations include buffer concentrations in the range of 0.400% to 0.600%; 0.450% to 0.575%, or 0.500% to 0.565%.
  • the invention also contemplates botulinum toxin formulations comprising a mixture of buffer salts, non-limiting examples of which include citrate/acetate, citrate/histidine, citrate/tartrate, maleate/histidine, or succinate/histidine.
  • the buffer is phosphate buffer.
  • the botulinum toxin formulations comprise a bulking agent (in addition to the non-reducing sugar(s)) which makes it easier to handle lyophilized forms of the botulinum toxin formulations.
  • the bulking agents crystallize under lyophilization conditions and do not mix well with the other excipients when in the solid state.
  • the bulking agent remains amorphous under lyophilization conditions, even if it is known to have a tendency to crystallize during freezing (e.g., mannitol or glycine).
  • the amount of non-reducing sugar relative to bulking agent is adjusted to suppress the crystallization of the bulking agent.
  • the ratio of non-reducing sugar to bulking agent may be greater than 0.33 to 1; 0.5 to 1, 0.75 to 1; 1:1; 2:1, 3:1, or 4:1.
  • Non-limiting examples of bulking agents contemplated by the invention include sorbitol, mannitol, glycine, arginine, and histidine.
  • the concentration of the bulking agent may be in the range of 1% to 10%, 2% to 6%, 3% to 5% or 4% to 4.5% (w/v).
  • the concentration of the non-reducing sugar may be reduced from the 10% to 40% (w/v) range to a range of 0.5% to 3.0% (w/v).
  • the ratio of the non-reducing sugar to the bulking agent is in the range of 0.07 to 2.0, preferably in the range of 0.4 to 0.6.
  • the formulation may comprise mannitol as the bulking agent and trehalose dihydrate as the non-reducing sugar, with mannitol present in a concentration range of 1.5% to 7.5% (w/v) and trehalose dihydrate present in a concentration range of 0.5% to 3.0% (w/v).
  • the bulking agent is not sodium chloride.
  • the botulinum toxin formulations of the invention can be administered via any conventional route of administration.
  • the botulinum toxin formulations are administered by intramuscular or subcutaneous injection into to the subject.
  • the botulinum toxin formulations are administered topically.
  • the formulations may include a positively charged carrier having positively charged efficiency groups, as described herein, in order to facilitate the penetration of the botulinum toxin into the issues of interest. It should be noted, however, that the positively charged carrier is not required for stabilization and that the invention contemplates embodiments in which the formulations do not comprise such a positively charged carrier.
  • the botulinum toxin formulations of the invention may also be administered via a drug delivery device, a non-limiting example of which is a skin patch.
  • botulinum toxin formulations When the botulinum toxin formulations are to be administered topically, it is advantageous to include in the formulations a positively charged carrier with positively charged branching groups, as described herein, to promote transdermal penetration of the botulinum toxin (see also U.S. patent application Ser. Nos. 09/910,432; 11/073,307; 11/072,026; and 10/793,138, each of which is incorporated by reference in its entirety). Without the use of the positively charged carrier or some other means of enhancing transdermal transport, the transdermal flux of topically applied botulinum toxin would be expected to be quite low.
  • the invention also contemplates the use of other methods of enhancing transdermal transport, besides the use of a positively charge carrier as described herein, with the botulinum toxin formulations of the invention.
  • Non-limiting examples of such methods include transdermal delivery of the botulinum toxin formulations using liposomes, iontophoresis, micelles, and the like.
  • botulinum toxin formulations when the botulinum toxin formulations are to be administered topically, it is often advantageous to mix them with gelling agents and/or viscosity-modifying agents to increase the viscosity of the formulation, order make the application of the botulinum toxin easier and more accurate. Additionally, if a positively charged carrier is used, these agents help to prevent the aqueous botulinum toxin/carrier formulation from drying out, which tends to cause a decrease in the activity of the botulinum toxin. Particularly preferred agents are those that are uncharged and do not interfere with the botulinum toxin activity or the efficiency of the toxin-carrier complexes in crossing skin.
  • the gelling agents may be certain cellulose-based gelling agents, such as hydroxypropylcellulose (HPC) for example.
  • HPC hydroxypropylcellulose
  • the botulinum toxin/carrier complex is formulated in a composition having 2-4% HPC.
  • the viscosity of a solution containing a botulinum toxin/carrier complex may be altered by adding polyethylene glycol (PEG).
  • PEG polyethylene glycol
  • the botulinum toxin/carrier solution is combined with pre-mixed viscous agents, such as Cetaphil® moisturizer.
  • the viscosity modifying agent is a poloxamer, non-limiting examples of which include poloxamer 188 and poloxamer 407.
  • the viscosity-modifying agent may also be a polyacrylic acid, a polyamide, or a vegetable gum (e.g., guar gum).
  • botulinum toxin formulations as described herein may be mixed with excipients to form emulsions (including microemulsions), suspensions, creams, lotions, gels, powders, or other typical solid or liquid compositions used for application to skin and other tissues where the compositions may be used.
  • compositions may also contain other ingredients typically used in such products, such as antimicrobials, moisturizers and hydration agents, penetration agents, preservatives, emulsifiers, natural or synthetic oils, solvents, surfactants, detergents, emollients, antioxidants, fragrances, fillers, thickeners, waxes, odor absorbers, dyestuffs, coloring agents, powders, and optionally anesthetics, anti-itch additives, botanical extracts, conditioning agents, darkening or lightening agents, glitter, humectants, mica, minerals, polyphenols, silicones or derivatives thereof, sunblocks, vitamins, and phytomedicinals.
  • other ingredients typically used in such products such as antimicrobials, moisturizers and hydration agents, penetration agents, preservatives, emulsifiers, natural or synthetic oils, solvents, surfactants, detergents, emollients, antioxidants, fragrances, fillers, thickeners, waxes, odor absorbers, dyes
  • kits for preparing and/or administering the botulinum toxin formulations of the invention comprises the botulinum toxin, as well as such additional excipients that are needed to produce a stabilized formulation according to the invention.
  • the kit may also comprise a premix that may in turn be used to produce such a formulation.
  • the kit comprises a botulinum toxin formulation according to the invention that has been lyophilized and a device for delivering the formulation, a non-limiting example of which is a syringe.
  • the invention provides formulations that deliver a “therapeutic amount” of botulinum to the subject during treatment.
  • therapeutic amount refers to an amount of botulinum toxin that is sufficient to produce the desired effect (e.g., relaxation of muscles, treatment of wrinkles, treatment of pain, or reduction of activity of an overactive gland, such as a sweat gland).
  • the “therapeutic amount” of botulinum toxin is implicitly understood to be a safe amount that does not cause unwanted paralysis or other undesired or harmful side effects.
  • a therapeutic amount may be in the range of 10 U to 150 U or 1,000 U to 2,500 U. In other preferred embodiments, the therapeutic amount ranges from 400 U to 800 U and 1,000 U to 50,000 U, preferably from 2,000-35,000 U, more preferably from 3,000 U-30,000 U, and even more preferably from 4,000 U to 25,000 U. In certain embodiments, the therapeutic amount ranges from 4,000 U to 8,000 U, 9,000 U to 19,000 U, or 20,000 U to 40,000 U.
  • compositions of the invention are applied so as to cause a desired effect, which may be a cosmetic or a therapeutic effect. Desired effects include the relaxation of certain muscles with the aim of, for instance, decreasing the appearance of fine lines and/or wrinkles, especially in the face, or adjusting facial appearance in other ways such as widening the eyes, lifting the corners of the mouth, or smoothing lines that fan out from the upper lip, or the general relief of muscular tension. The last-mentioned effect, general relief of muscular tension, can be effected in the face or elsewhere.
  • the compositions of the invention may contain an appropriate effective amount of the botulinum toxin for application as a single-dose treatment, or may be more concentrated, either for dilution at the place of administration or for use in multiple applications.
  • the stabilized botulinum toxin complexes or stabilized reduced botulinum toxin complexes can be administered to a subject for treating conditions such as undesirable facial muscle or other muscular spasms, hyperhidrosis, acne, or conditions elsewhere in the body in which relief of muscular ache or spasms is desired.
  • the botulinum toxin is administered delivery to muscles or to other skin-associated structures.
  • the administration may be made, for example, to the face, legs, shoulders, back (including lower back), axilla, palms, feet, neck, groin, dorsa of the hands or feet, elbows, upper arms, knees, upper legs, buttocks, torso, pelvis, or any other part of the body where administration of the botulinum toxin is desired.
  • the botulinum toxin formulations of the invention comprise a positively charged carrier with positively charged efficiency groups.
  • the positively charged carrier is present in an amount sufficient to facilitate penetration of the botulinum toxin into the tissues of interest.
  • the term “positively charged” means that the carrier has a positive charge under at least some solution-phase conditions, more preferably under at least some physiologically compatible conditions. More specifically, “positively charged” means that the group in question contains functionalities that are charged under all pH conditions, for instance, a quaternary amine, or contains a functionality which can acquire positive charge under certain solution-phase conditions, such as pH changes in the case of primary amines.
  • the positively-charged carrier comprises a positively charged backbone, which is typically a chain of atoms, either with groups in the chain carrying a positive charge at physiological pH, or with groups carrying a positive charge attached to side chains extending from the backbone.
  • the positively charged backbone itself will not have a defined enzymatic or therapeutic biologic activity.
  • the linear backbone is a hydrocarbon backbone which is, in some embodiments, interrupted by heteroatoms selected from nitrogen, oxygen, sulfur, silicon and phosphorus. The majority of backbone chain atoms are usually carbon.
  • the backbone will often be a polymer of repeating units (e.g., amino acids, poly(ethyleneoxy), poly(propyleneamine), polyalkyleneimine, and the like) but can be a heteropolymer.
  • the positively charged backbone is a polypropyleneamine wherein a number of the amine nitrogen atoms are present as ammonium groups (tetra-substituted) carrying a positive charge.
  • the positively charged backbone is a nonpeptidyl polymer, which may be a hetero- or homo-polymer such as a polyalkyleneimine, for example a polyethyleneimine or polypropyleneimine, having a molecular weight of from about 100 to about 2,500,000 D, preferably from about 250 to about 1,800,000 D, and most preferably from about 1000 to about 1,400,000 D.
  • the backbone has attached a plurality of side-chain moieties that include positively charged groups (e.g., ammonium groups, pyridinium groups, phosphonium groups, sulfonium groups, guanidinium groups, or amidinium groups).
  • the sidechain moieties in this group of embodiments can be placed at spacings along the backbone that are consistent in separations or variable. Additionally, the length of the sidechains can be similar or dissimilar.
  • the sidechains can be linear or branched hydrocarbon chains having from one to twenty carbon atoms and terminating at the distal end (away from the backbone) in one of the above-noted positively charged groups.
  • the association between the carrier and the botulinum toxin is by non-covalent interaction, non-limiting examples of which include ionic interactions, hydrogen bonding, van der Waals forces, or combinations thereof.
  • the positively charged backbone is a polypeptide having multiple positively charged sidechain groups (e.g., lysine, arginine, ornithine, homoarginine, and the like).
  • the polypeptide has a molecular weight of from about 100 to about 1,500,000 D, more preferably from about 250 to about 1,200,000 D, most preferably from about 1000 to about 1,000,000 D.
  • the sidechains can have either the D- or L-form (R or S configuration) at the center of attachment.
  • the polypeptide has a molecular weight from about 500 to about 5000 D, more preferably from 1000 to about 4000 D, more preferably from 2000 to about 3000 D. In other embodiments, the polypeptide has a molecular weight of at least about 10,000.
  • the backbone portion is a polylysine and efficiency groups, as discussed herein, are attached to the polylysine.
  • the polylysine may have a molecular weight of from about 100 to about 1,500,000 D, preferably from about 250 to about 1,200,000 D, and most preferably from about 1000 to about 3000 D.
  • the positively charged carrier with positively charged efficiency groups is a peptide with the amino acid sequence RKKRRQRRR-G-(K) 15 -G-RKKRRQRRR, RGRDDRRQRRR-G-(K) 15 -G-RGRDDRRQRRR, or YGRKKRRQRRR-G-(K) 15 -G-YGRKKRRQRRR.
  • polylysines such as, for example, polylysine having MW>70,000 D, polylysine having MW of 70,000 to 150,000 D, polylysine having MW 150,000 to 300,000 D and polylysine having MW>300,000 D.
  • the selection of an appropriate polylysine will depend on the remaining components of the composition and will be sufficient to provide an overall net positive charge to the composition and provide a length that is preferably from one to four times the combined length of the negatively charged components.
  • a variety of other backbones can be used employing, for example, steric or electronic mimics of polypeptides wherein the amide linkages of the peptide are replaced with surrogates such as ester linkages, thioamides (—CSNH—), reversed thioamide (—NHCS—), aminomethylene (—NHCH 2 —) or the reversed methyleneamino (—CH 2 NH—) groups, keto-methylene (—COCH 2 —) groups, phosphinate (—PO 2 RCH 2 —), phosphonamidate and phosphonamidate ester (—PO 2 RNH—), reverse peptide (—NHCO—), trans-alkene (—CR ⁇ CH—), fluoroalkene (—CF ⁇ CH—), dimethylene (—CH 2 CH 2 —), thioether (—CH 2 S—), hydroxyethylene (—CH(OH)CH 2 —), methyleneoxy (—CH 2 O—), tetrazole (CN 4 ), sulf
  • sidechain groups can be appended that carry a positively charged group.
  • the sulfonamide-linked backbones (—SO 2 NH— and —NHSO 2 —) can have sidechain groups attached to the nitrogen atoms.
  • the hydroxyethylene (—CH(OH)CH 2 —) linkage can bear a sidechain group attached to the hydroxy substituent.
  • linkage chemistries to provide positively charged sidechain groups using standard synthetic methods.
  • the positively charged carrier comprises positively charged efficiency groups.
  • efficiency groups include -(gly) n1 -(arg) 2 , in which the subscript n1 is an integer of from 0 to 20 more preferably 0 to 8, still more preferably 2 to 5, and the subscript n2 is independently an odd integer of from about 5 to about 25, more preferably from about 7 to about 17, and most preferably from about 7 to about 13, HIV-TAT or fragments thereof, or Antennapedia PTD or a fragment thereof.
  • the side-chain or branching groups have the general formula -(gly) n1 -(arg) n2 as described above.
  • branching or efficiency groups are HIV-TAT fragments that have the formula (gly) p -RGRDDRRQRRR-(gly) q , (gly) p -YGRKKRRQRRR-(gly) q , or (gly) p -RKKRRQRRR-(gly) q , wherein the subscripts p and q are each independently an integer of from 0 to 20 and the fragment is attached to the carrier molecule via either the C-terminus or the N-terminus of the fragment.
  • the side branching groups can have either the D- or L-form (R or S configuration) at the center of attachment.
  • An exemplary botulinum toxin formulation of the invention was prepared by combining appropriate amounts of trehalose dihydrate, polysorbate-20, histidine, and histidine HCl to produce a 2 ⁇ formulation stock solution that contained 36% trehalose dihydrate, 0.05% polysorbate-20, and 1.126% histidine at a pH of 5.5.
  • the solution was cooled to 4° C.
  • Botulinum toxin API was pelleted by centrifugation from an ammonium sulfate stock suspension.
  • the toxin pellet was dissolved in 0.56% histidine buffer pH 5.5 with 0.05% polysorbate-20. This solution was further diluted with the histidine/polysorbate-20 solution to give a toxin stock solution of 1.074 ⁇ g/mL solution.
  • a stock solution of the carrier peptide RKKRRQRRR-G-(K) 15 -G-RKKRRQRRR was prepared by dissolving sufficient peptide into water to produce a solution of 6.0 mg/mL peptide.
  • Toxin stock solution, peptide stock solution, 0.56% histidine buffer, and 2 ⁇ formulation stock solution were combined to produce a formulation bulk drug product consisting of 18% trehalose dihydrate, 0.025% polysorbate-20, 0.56% histidine buffer, 55 ng/mL toxin and 150 ⁇ g/mL carrier peptide.
  • This example provides a lyophilization procedure for a botulinum toxin formulation according to the invention.
  • 200 ⁇ L aliquots of the formulation bulk drug product described in Example 1 was transferred to each of fifty-five 2-mL glass vials.
  • Grey butyl rubber lyophilization stoppers were loosely placed on top of the glass vials. The vials were placed into the lyophilizer and lyophilization initiated.
  • the lyophilization process comprised three main stages: (1) a freezing stage; (2) a primary drying stage; and (3) a secondary drying stage. Each of these three main stages contained one or more individual process steps, which were performed at the temperatures and pressures as indicated below.
  • the primary drying time required to complete primary drying varied depending upon the number of vials and the fill volume in the vials.
  • FIG. 3 shows the results of stability studies in which vials of the botulinum toxin formulation with sucrose at 11 ng/vial were prepared using the protocol described above for the trehalose-containing formulations, stored at 4° C. and 25° C. and tested at the indicated time points to determine the biological activity of the botulinum toxin for a duration of up to 18 months.
  • the activity was measured using the LD 50 mouse assay as described above and the activities are reported in FIG. 3 as equivalent units of botulinum toxin per vial.
  • the observed activity was 2299 units of botulinum toxin per vial.
  • the botulinum toxin formulation was prepared by combining appropriate amounts of trehalose dihydrate, mannitol, polysorbate-20, histidine, and histidine HCl to produce a formulation stock solution that contained 3% trehalose dihydrate, 7.5% mannitol, 0.05% polysorbate-20, and 0.563% histidine at a pH of 5.5.
  • the solution was cooled to 4° C.
  • Botulinum toxin API was pelleted by centrifugation from an ammonium sulfate stock suspension. The toxin pellet was dissolved in the formulation stock solution. The concentration of this solution was 117 ⁇ g/mL.
  • This solution was further diluted with the same solution to a final toxin stock solution concentration of 11.7 ⁇ g/mL.
  • a sufficient amount of a carrier peptide having the amino acid sequence RKKRRQRRR-G-(K) 15 -G-RKKRRQRRR was dissolved in water to prepare a 20 mg/mL carrier peptide stock solution.
  • These solutions were combined to create a formulation bulk drug product with a final composition of 3% trehalose dihydrate, 7.5% mannitol, 0.05% polysorbate-20, and 0.563% histidine pH of 5.5, 75 ⁇ g/mL carrier peptide, and 5.5 ng/mL toxin,
  • the lyophilization process comprised three main stages: (1) a freezing stage; (2) a primary drying stage; and (3) a secondary drying stage.
  • Each of these three main stages contained one or more individual process steps, which were performed at the temperatures and pressures as indicated below:

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US20100330123A1 (en) 2010-12-30
KR20200141546A (ko) 2020-12-18
IL268980A (en) 2019-10-31
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MX366344B (es) 2019-07-05
EP2445521A4 (en) 2015-08-26
CO6491076A2 (es) 2012-07-31
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CN102869373B (zh) 2017-05-10
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US20190290740A1 (en) 2019-09-26
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BRPI1015938A2 (pt) 2016-09-27
US9340587B2 (en) 2016-05-17
KR20210141783A (ko) 2021-11-23
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US20160256532A1 (en) 2016-09-08
US11911449B2 (en) 2024-02-27
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AU2010265888A1 (en) 2012-01-19

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