Classifications

• • 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
  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
  • A61K31/57—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
  • A61P11/06—Antiasthmatics
• • 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
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/02—Ophthalmic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/08—Antiallergic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• bronchial asthma was regarded as an abnormality of respiratory smooth muscle in which afflicted individuals experience the onset of bronchospasm as a consequence of overactivity of the bronchial smooth muscle. Later, the bronchial mast cell was thought to play a critical role in the stimulation
• Eosinophils are a type of leukocyte containing cytoplasmic granules that stain strongly with acidic dyes. Eosinophils have been associated with bronchial asthma since the early part of this century and they are characteristically found in large numbers in the lung tissue of patients dying of asthma (Ellis et al., J. Med.
• MBP major basic protein
• MBP MBP-induced ciliostasis and epithelial damage.
• This damage consists of desquamation of epithelial cells into the lumen of the respiratory tract, as well as frank disruption of epithelial cells.
• the effects of MBP are dose-related and higher doses cause damage more quickly and to a greater extent than lower doses (Frigas et al., Lab. Invest.. 42. 35 (1980)).
• bronchial asthma an exudate of eosinophils, normal and degenerating bronchial epithelial cells, and clumps of epithelial cells, referred to as Creola bodies, are present in the bronchial lumen.
• Creola bodies In the bronchial mucosa and submucosa, edema, separation and shedding of ciliated cells, and eosinophil infiltration are seen.
• Creola bodies In the bronchial mucosa and submucosa, edema, separation and shedding of ciliated cells, and eosinophil infiltration are seen.
• the effects of the eosinophil granule MBP in vitro are similar to the pathology characteristic of bronchial asthma (Dunnill, J. Clin. Path.. 3, 27 (1960)).
• MBP MBP in sputum samples from 206 patients with various respiratory diseases were measured by radioimmunoassay. In 165 of these patients, MBP was not measurable or the concentrations of MBP were less than 0.1 ⁇ g/ml. In these 165 patients, only one patient carried the diagnosis of asthma. Among 41 patients with sputum concentrations of MBP greater than 0.1 ⁇ g/ml, 28 were diagnosed as having asthma and in the remaining 13 patients, six had obstructive lung disease which is often confused with asthma.
• sputum MBP levels ranged from 0.5 (0.04 x 10 "6 M) to 93 ⁇ g/ml (6.6 x 10 "6 M) (geometric mean 7.1 ⁇ g/ml, 0.51 x 10 "6 M). Further, the levels of sputum MBP in these 15 patients declined during therapy with glucocorticoids (Frigas et al., Mayo Clinic. Proc. 56, 345 (1981)). These results indicated that MBP levels in the toxic range were present in the sputum of patients with asthma, that levels of sputum MBP were highest in acutely ill patients, and that sputum MBP levels decline after steroid therapy.
• MBP directly causes damage to bronchial epithelium was tested utilizing immunofluorescence localization of MBP in lung tissues of patients dying of asthma (Filley et al., Lancet. 2, 11 (1982)). Patients dying of asthma had the classical pathologic features of bronchial asthma, including a thickened basement membrane zone, goblet cell hyperplasia, and peribronchial inflammatory infiltrates with eosinophils in the lamina intestinal. Examination of these same sections by immunofluorescence to localize MBP, revealed MBP deposition onto damaged bronchial epithelium. These results demonstrate that MBP was released from the eosinophil and was present in tissues at the site of damage.
• Bronchial hyperactivity is manifested in patients as a marked irritability of the respiratory tract to nonspecific stimuli including cold air, dust, and, in the laboratory, to inhaled methacholine. Indeed, this hyperactivity is a diagnostic criterion for asthma (N.J. Gross et al., in Allergy. Principles and
• eosinophil proliferation and differentiation are regulated by various cytokines, such as IL-3, IL-5 and GM-CSF.
• cytokines such as IL-3, IL-5 and GM-CSF.
• These cytokines, as well as IFN- ⁇ have been shown to prolong survival of eosinophils in vitro by Valerius et al., J. Immunol.. 145. 2950 (1990), and to augment eosinophil function (Rothenberg et al., J. Clin. Invest. 81 1986 (1988); Fujisawa et al., L Immunol.. 144. 642 (1990); Silberstein et al, J.
• IL-5 primes eosinophils for enhanced locomotor responses to chemotactic agents, such as platelet-activating factor, leukotriene B4, and IL-8 (Sehmi et al, Blood. 79, 2952 (1992)).
• chemotactic agents such as platelet-activating factor, leukotriene B4, and IL-8
• IL-5 is present in the lung following allergen-induced pulmonary late allergic reactions (Sedgwick et al., Am. Rev. Respir. Pis.. 144. 1274 (1991)) and mRNA for IL-5 is expressed in the bronchial epithelium of patients with asthma (Hamid et al., J. Clin. Invest. 87, 1541 (1991)).
• Glucocorticoids are the most useful class of drugs for treating many eosinophil-related disorders, including bronchial asthma (Schleimer et al., Am. Rev. Respir. Pis.. 141. 559 (1990)). They produce eosinopenia in normal persons, decrease circulating eosinophils in patients with eosinophilia, and reduce eosinophil influx at inflammatory sites (Butterfield et al., in
• glucocorticoids are the principal therapy and these patients may require glucocorticoid therapy for long periods of time, e.g., months to years.
• the disease can be characterized as one of chronic glucocorticoid toxicity, in that the toxicity of these steroids can cause severe morbidity and even mortality in the patients.
• cessation of glucocorticoid therapy leads to withdrawal symptoms, such as malaise and muscle pain.
• glucocorticoids are the only effective therapy for severe asthma, and are prescribed long-term despite their toxicity.
• MBP is deposited on respiratory epithelium of the upper airway in association with damage to the epithelium. Therefore, toxic eosinophil granule proteins may cause disease of the upper airway in the same manner as they likely do in the lower airway in the case of bronchial asthma.
• Udell et al. in Am. J. Ophthamol. 92, 824 (1981) reported that MBP is elevated in tears of patients with vernal conjunctivitis, a form of allergic inflammation of the eye, and Trocme et al., in Am. J. Ophthamol. 108. 57 (1989) found that MBP is deposited into inflamed conjunctiva of such patients. Thus, evidence exists that MBP may act as a toxin to the conjunctiva.
• the present invention provides a method for treating a pathology characterized by elevated levels of eosinophils (i.e., an eosinophil-associated pathology) comprising co-administering to a mammal in need of such treatment an amount of a topical anesthetic and an amount of a glucocorticoid, wherein said amounts are effective to counteract at least one of the symptoms of said pathology.
• the mammal be a human, such as a patient afflicted with bronchial asthma.
• co-administer or “co-administration” are defined to encompass administration simultaneously, as in admixture in a single composition, or sequentially, so that they are delivered to, and present at, the target site in vivo, together in therapeutically effective amounts.
• Gleich et al. discloses the use of topical anesthetics to reduce dependence of asthma patients on steroid therapy.
• the present invention is based on Applicant's surprising discovery that lidocaine and dexamethasone act synergistically to inhibit human eosinophil survival in vitro. That is, the administration of a combination of a topical anesthetic and a glucocorticoid requires less of either agent for therapeutic efficacy than would be expected to be required on the basis of an additive effect.
• the treatment of eosinophil-associated diseases with a combination of topical anesthetics and glucocorticoids is more effective than treatment with either agent alone.
• a preferred embodiment of the present method is directed to a therapy for bronchial asthma, eosinophil-associated intranasal inflammation, including nasal polyps, inflammation of the paranasal sinuses and allergic rhinitis, eosinophil- associated cutaneous inflammation, eosinophil-associated disorders of the gastrointestinal tract, such as inflammatory bowel disease, and eosinophil- associated inflammation of the eye, such as vernal and allergic conjunctivitis.
• the present invention provides a therapy for bronchial asthma and the other hypersensitivity diseases of the respiratory tract, by topical administration, e.g., by inhalation or insufflation of a composition comprising a topical anesthetic, such as lidocaine, bupiracaine, etidocaine, tetracaine and the like, and a glucocorticoid.
• a topical anesthetic such as lidocaine, bupiracaine, etidocaine, tetracaine and the like
• the topical anesthetic in turn is able to inhibit the activity of eosinophil-active cytokines, such as IL-5, and thus, to limit the negative effects of eosinophils on respiratory epithelium or other tissue.
• Topical administration of the composition of the present invention e.g., in nose drops or eye drops, can relieve the symptoms or conditions due to eosinophil-associated inflammation of the nasal passages or of the eye, such as allergic rhinitis or allergic conjunctivitis.
• the present invention also provides the use of a combination of a topical anesthetic and a glucocorticoid to prepare a medicament for treating an eosinophil-associated pathology in a mammal.
• the present invention further provides a pharmaceutical composition
• a pharmaceutical composition comprising a combination of a topical anesthetic and a glucocorticoid in an amount effective to counteract at least one of the symptoms of an eosinophil- associated pathology.
• topical anesthetic or glucocorticoid encompasses the free compounds, as well as the pharmaceutically acceptable salts thereof.
• Figure 1 is a graphical depiction of the time course of eosinophil viability inhibition effect by lidocaine.
• Culture medium was supplemented with recombinant human interleukin 5 (rhIL-5), 10 pg/ml, and the effects on eosinophil viability of lidocaine (0.25 mg/ml)( » ), or medium control (Hybri- Care ® ) (American Type Culture Collection, Rockville, MO) containing gentamicin, 50 ⁇ g/ml and 10% defined calf serum (Hyclone Laboratories, Logan, UT) were tested by comparing viabilities at two and four days.
• rhIL-5 human interleukin 5
• Hybri- Care ® American Type Culture Collection, Rockville, MO
• gentamicin 50 ⁇ g/ml
• 10% defined calf serum Hyclone Laboratories, Logan, UT
• Figure 2 is a graphical depiction of the inhibition of eosinophil survival mediated by cytokines with lidocaine. Purified eosinophils were tested in the eosinophil survival assay for four days and their viability determined by staining with propidium iodide and analysis by FACS.
• Figure 3 is a graphical depiction of the drug regimen of Patient A with respect to inhaled triamcinolone (Panel A), inhaled lidocaine (Panel B) and oral prednisone (Panel C).
• Figure 4 is a graphical depiction of the drug regimen of Patient B with respect to inhaled budesonide (Panel A), inhaled lidocaine (Panel B) and oral prednisone (Panel C).
• Figure 5 is a graphical depiction of the effect of lidocaine and dexamethasone on cytokine-mediated eosinophil survival.
• LC lidocaine
• Pex dexamethasone
• bronchial asthma In addition to the hypersensitivity diseases discussed above, such as bronchial asthma, nasal inflammation and conjunctivitis, many other conditions associated with elevated levels of eosinophil activation and accumulation, some of which are presently treated with glucocorticoids, are amenable to treatment by the present combination therapy.
• Topical Anesthetics Topical anesthetics, all of which are believed to be useful in the present invention, are an art-recognized class of drugs which temporarily interrupt mammalian nerve transmissions.
• N-arylamides comprise the N-(C 7 -C 22 )arylamides of amino-substituted (C 1 .C 5 )carboxylic acids, e.g., N-[(mono or di-(C,- C 4 )alkyl)phenyl] amides of aliphatic (C,.C 5 )carboxylic acids, which acids are preferably substituted with the moiety (R)(R')N- wherein R is H or (C,-C 5 )alkyl and R 1 is (C 1 -C 5 )alkyl.
• a preferred carboxylic acid can have the general formula (R)(R')N(X)CO 2 H where R and R 1 are as defined above and X is a branched- or straight-chain (C,-C 5 )alkylene group such as 1,1-ethylene, 1,2- ethylene, methylene, 2,2-propylene, 1,3-propylene, and the like.
• N-arylamides are the N-[(mono- or di- (C,-C 4 ) alkyl) phenyljamides of 5- or 6-membered-heterocycloaliphatic carboxylic acids, which acids comprise one or two [(C,-C 4 )alkyl- substituted]N atoms, i.e., N- butylpiperidine-2-carboxylic acid.
• the aminoalkylbenzoates include esters between benzoic acids and alcohols of the general formula (R 4 )(R 5 )N(X)OH, wherein X is as defined above, R 4 is H or (C,-C 4 )-alkyl, R 5 is (C,- C 4 )alkyl or R 4 and R 5 taken together with N are a 5- or 6-membered heterocycloaliphatic ring, optionally substituted by (C,- C 3 )alkyl or comprising an additional ring O- or N-atom.
• the benzoic acid moiety can be the moiety (R 2 )(R 3 ) ArCO 2 H wherein Ar is an aromatic -C 6 H 3 - radical "phenylene” and (phenylene) and each R 2 and R 3 is H, halo, preferably Cl, (R 5 )(H)N-, H 2 N- or (C,-C 5 ) alkoxy.
• Useful topical anesthetics include lidocaine ((2-diethylamino)-N-(2,6- dimethylphenyl)-acetamide) (see Lofgren et al. (U.S. Patent No. 2,441,498), May & Baker (British Patent No. 706409) and Macfariane & Co. (British Patent No. 758,224)); bupivacaine (l-butyl-N-(2,6-dimethylphenyl)-2- piperidinecarboxyamide) (see Thuresson et al., (U.S. Patent No. 2,955,111) and Sterling Orug (British Patent Nos.
• mepivacaine (2- piperidinecarboxyamide, N-(2,6-dimethylphenyl)-l-methyl), chloroprocaine (4- amino-2-chlorobenzoic acid 2-(diethylamino)ethyl ester); procaine (4- aminobenzoic acid 2-(diethylamino)ethyl ester); etidocaine (N-(2,6- dimethylphenyl)-2-(ethylpropylamino)butanamide; see, Astra (German Patent No.
• tetracaine (4-(butylamino)benzoic acid 2-(dimethylaminoethyl ester; see Shupe (U.S. Patent No. 3,272,700)); benoxinate (4-amino-3- butoxybenzoic acid 2-(diethylamino)ethyl ester (U.K. Patent No. 654,484)) proparacaine (3-amino-4-propoxybenzoic acid 2-(diethylamino) ethyl ester); dibucaine (3-butoxy-N-[2-(diethylamino)ethyl]-4-quinolinecarboxyamide; Miescher (U.S. Patent No.
• Preferred salts include the amine addition salts of inorganic and organic acids, e.g., the hydrochloride, hydrobromide, sulfate, oxalate, fumarate, citrate, malate, propionate and phosphate salts.
• the hydrochloride and sulfate salts are preferred for use in the present invention.
• adrenal cortical steroids Over 50 steroids have been shown to be present in the adrenal cortex. Only seven of these, however, have been shown to exert a significant biological effect related to adrenal cortical function. However, the adrenal cortex also produces androgenic steroids. All of the adrenal cortical steroids, except the androgens, contain 21 carbon atoms, an , ⁇ - unsaturated ketone in ring A, and an ⁇ -ketol chain attached to ring P. They differ in extent of oxygenation or hydroxylation at carbons 11, 17, or 19.
• the cortical steroids are classified as either mineralcorticoid or glucocorticoid, respectively.
• mineralcorticoid a grouping of cortical steroids in man correlates well with their glucocorticoid activity.
• the undesirable side effects sodium retention, edema
• Mineralcorticoid activity a grouping of cortical steroids in man correlates well with their glucocorticoid activity.
• Interest in glucocorticoids primarily focuses on their anti-inflammatory and immunosuppressant effects.
• glucocorticoids are also of immense value in treating diseases that result from undesirable immune reactions. These diseases range from conditions that are predominantly the consequence of humoral immunity, such as idiopathic thrombocytopenia, to those that are mediated by cellular immune mechanisms, such as the rejection of transplanted organs.
• the immunosuppressive and antiinflammatory actions of the glucocorticoids are inextricably linked because they both result in large part from inhibition of specific function of leukocytes.
• Glucocorticoids useful in the practice of the present invention include, but are not limited to, beclomethasone dipropionate, betamethasone, betamethasone acetate, betamethasone sodium phosphate, betamethasone valerate, budesonide, cortisol, cortisol acetate, cortisol cypionate, cortisol sodium phosphate, cortisol sodium succinate, cortisone acetate, dexamethasone, flumethasone pivalate, fluocinolone acetonide, fluocinonide, fluorometholone, flurandrenolide, fluticasone, meprednisone, methylprednisolone, methylprednisolone acetate, methylprednisolone sodium succinate, paramethasone acetate
• the glucocorticoid is beclomethasone, betamethasone, budesonide, cortisol, cortisone, dexamethasone, flumethasone, fluocinolone, fluocinonide, fluorometholone, flurandrenolide, fluticasone, meprednisone, methylprednisolone, prednisolone, triamcinolone, amcinonide, desonide, desoximetasone, or a pharmaceutically acceptable salt thereof.
• the glucocorticoid is betamethasone, cortisol, cortisone, dexamethasone, meprednisone, methylprednisolone, or prednisolone or a pharmaceutically acceptable salt thereof.
• the glucocorticoid is dexamethasone or a pharmaceutically acceptable salt thereof.
• dexamethasone salts useful in the practice of the present method include the tert-butylacetate, the 21- phosphate, 21 -phosphate disodium salt, the tetrahydrophthalate, the 21-palmitate, the 17,21 -dipropionate, the 21-isonicotinate, and the 21-diethyl-amino-acetate salts of dexamethasone.
• the topical anesthetic or anesthetics and the glucocorticoid or glucocorticoids are co-administered so that they are both present at the active site ( vivo) in therapeutically effective amounts.
• the active ingredients may be combined either in the pure form or in combination with one or more pharmaceutically acceptable carriers in a single composition.
• the active ingredients can be formulated as discrete compositions and administered concurrently, i.e., via a double lumen catheter, as encapsulated coated microparticles, via an inhaler with double outlets, or via like dosage forms.
• the active ingredients may also be administered sequentially, i.e., via the use of two discrete inhalers, injections, tablets or the like, administered so that the active ingredients both reach therapeutic levels together at the target site.
• the active ingredients may be administered as a single composition suitable for oral or parenteral (including intramuscular, subcutaneous and intravenous) administration.
• forms suitable for parenteral administration also include forms suitable for administration by inhalation or insufflation or for nasal, or topical (including buccal, rectal, vaginal and sublingual) administration.
• the active ingredients may, where appropriate, be conveniently presented in discrete unit dosage forms and may be prepared by any ofthe methods well known in the art of pharmacy. Such methods include the step of bringing into association the active compound with liquid carriers, solid matrices, semi-solid carriers, finely divided solid carriers or combinations thereof, and then, if necessary, shaping the product into the desired delivery system.
• compositions suitable for oral administration may be presented as discrete unit dosage forms such as hard or soft gelatin capsules, cachets or tablets each containing a predetermined amount ofthe active ingredients; as a powder or as granules; as a solution, a suspension or as an emulsion; or in a chewable base such as a synthetic resin for ingestion ofthe active ingredients from a chewing gum.
• the active ingredients may also be presented as a bolus, electuary or paste.
• Tablets and capsules for oral administration may contain conventional excipients such as binding agents, fillers, lubricants, disintegrants, or wetting agents.
• the tablets may be coated according to methods well known in the art, i.e., with enteric coatings.
• Oral liquid preparations may be in the form of, for example, aqueous or oily suspensions, solutions, emulsions, syrups or elixirs, or may be presented as a dry product for constitution with water or other suitable vehicle before use.
• Such liquid preparations may contain conventional additives such as suspending agents, emulsifying agents, non-aqueous vehicles (which may include edible oils), or preservatives.
• the active ingredients may also be formulated for parenteral administration (e.g., by injection, for example, bolus injection or continuous infusion) and may be presented in unit dose form in ampules, pre-filled syringes, small volume infusion containers or in multi-dose containers with an added preservative.
• the active ingredients may take such forms as suspensions, solutions, or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilizing and/or dispersing agents.
• the active ingredients may be in powder form, obtained by aseptic isolation of sterile solid or by lyophilization from solution, for constitution with a suitable vehicle, e.g., sterile, pyrogen-free water, before use.
• the active ingredients may be formulated as ointments, creams or lotions, or as the active ingredients of a transdermal patch.
• Suitable transdermal delivery systems are disclosed, for example, in A. Fisher et al. (U.S. Patent No. 4,788,603), or R. Bawa et al. (U.S. Patent Nos. 4,931,279; 4,668,506 and 4,713,224).
• Ointments and creams may, for example, be formulated with an aqueous or oily base with the addition of suitable thickening and/or gelling agents.
• Lotions may be formulated with an aqueous or oily base and will in general also contain one or more emulsifying agents, stabilizing agents, dispersing agents, suspending agents, thickening agents, or coloring agents.
• the active ingredients can also be delivered via iontophoresis, e.g., as disclosed in U.S. Patent Nos. 4,140,122; 4,383,529; or 4,051,842.
• the above-described formulations can be adapted to give sustained release ofthe active ingredients employed, e.g., by combination with certain hydrophilic polymer matrices, e.g., comprising natural gels, synthetic polymer gels or mixtures thereof.
• compositions suitable for rectal administration wherein the carrier is a solid are most preferably presented as unit dose suppositories.
• Suitable carriers include cocoa butter and other materials commonly used in the art, and the suppositories may be conveniently formed by admixture ofthe active compounds with the softened or melted carrier(s) followed by chilling and shaping in molds.
• compositions suitable for vaginal administration may be presented as pessaries, tampons, creams, gels, pastes, foams or sprays containing, in addition to the active ingredients, such carriers as are known in the art to be appropriate.
• the active ingredients may also be formulated so as to be suitable for administration by inhalation or insufflation or for nasal, intraocular or other topical (including buccal and sub-lingual) administration.
• the active ingredients are conveniently delivered from an insufflator, nebulizer or a pressurized pack or other convenient means of delivering an aerosol spray.
• Pressurized packs may comprise a suitable propellant such as dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or other suitable gas.
• the dosage unit may be determined by providing a valve to deliver a metered amount.
• the active ingredients may take the form of a dry powder composition, for example, a powder mix ofthe active ingredients and a suitable powder base such as lactose or starch.
• the powder composition may be presented in unit dosage form in, for example, capsules or cartridges or, e.g., gelatin or blister packs from which the powder may be administered with the aid of an inhalator, insufflator or a metered-dose inhaler.
• the active ingredients may also be administered via nose drops, a liquid spray, such as via a plastic bottle atomizer or metered-dose inhaler.
• a liquid spray such as via a plastic bottle atomizer or metered-dose inhaler.
• atomizers are the Mistometer® (Wintrop) and the Medihaler® (Riker).
• Props such as eye drops or nose drops, may be formulated with an aqueous or non-aqueous base also comprising one or more dispersing agents, solubilizing agents or suspending agents.
• Liquid sprays are conveniently delivered from pressurized packs. Props can be delivered via a simple eye dropper-capped bottle, or via a plastic bottle adapted to deliver liquid contents dropwise, via a specially shaped closure.
• the active ingredients may further be formulated for topical administration in the mouth or throat.
• the active ingredients may be formulated as a lozenge further comprising a flavored base, usually sucrose and acacia or tragacanth; pastilles comprising the composition in an inert base such as gelatin and glycerin or sucrose and acacia; and mouthwashes comprising the composition ofthe present invention in a suitable liquid carrier.
• formulations and compositions described herein may also contain other ingredients such as antimicrobial agents, or preservatives.
• the active ingredients may also be used in combination with other therapeutic agents, for example, bronchodilators.
• a suitable unit dose of topical anesthetic for counteracting respiratory tract symptomatology will deliver from about 0.05 to about 10-15 mg/kg, e.g., from about 0.10 to about 5.0 mg/kg of body weight per day.
• a suitable unit dose of glucocorticoid will deliver from about 0.050 to about 10-15 mg/kg, e.g., from about 0.10 to about 5.0 mg/kg of body weight per day.
• the desired dose may conveniently be presented in a single dose or as divided doses administered at appropriate intervals, for example, as two, three, four or more sub-doses per day.
• the sub-dose itself may be further divided, e.g., into a number of discrete, loosely spaced administrations such as multiple inhalations from an insufflator or by application of a plurality of drops into the eye or nose.
• the invention will be further described by reference to the following detailed Examples.
• Eosinophils were purified from human peripheral blood, as previously described by Fujisawa et al., J. Immunol.. 144. 642 (1990). Briefly, heparinized (10 U/ml) venous blood was obtained from normal volunteers or patients with mild asthma or hay fever and sedimented with 6% dextran in 0.9% NaCl (Gentian 70) (Travenol Laboratories, Oeerfield, IL) at 5:1 (v/v) ratio for 45 minutes at 37°C.
• Gentian 70 Travenol Laboratories, Oeerfield, IL
• the buffer coat was collected and washed twice in Pipes buffer (25 mM piperazine-N,N ' -bis[2-ethanesulfonic acid], 110 mM NaCl, 5 mM KCL, 25 mM NaOH, 5.4 mM glucose, pH 7.4) with 50 U/ml PNase (Sigma Chemical Co., St. Louis, MO).
• the cells were suspended in 2.4 ml of Percoll (Sigma), density 1.070 g/ml, with 5% heat-inactivated defined calf serum (PCS) (Hyclone Laboratories, Logan, UT) and overlayered on a discontinuous Percoll gradient consisting ofthe following densities (g/ml): 1.080, 1.085, 1.090, 1.100, and 1.120.
• the osmolarity of Percoll ranged from 290 to 315 mOsm kg and the pH was 7.4.
• Cells were centrifuged through the gradient at 1,500 g in a JA-20 fixed angle rotor on a Beckman J2-21 centrifuge at 4°C for 45 minutes.
• Eosinophil-Survival Assay Eosinophils were cultured at 37°C and 5% CO 2 in 200 ⁇ l Hydri-Care® medium containing gentamicin and 10% PCS in 90-well, flat-bottom tissue culture plates at a cell concentration of 2.5 x lOVml or 1.25 X 10 5 cells/ml . No difference in viability was observed at these two cell concentrations. Viability was determined at day 4 for all experiments unless otherwise specified. A Neubauer hemacytometer (CA. Hausser & Son; Philadelphia, PA) and fluorescence microscopy were used to count live cells, stained green with fluorescein diacetate (Rotman et al., PNAS USA.
• Anesthetics were dissolved in 0.15 M NaCl, stored at -20°C, and diluted in medium just before use; thus, 0.15 M NaCl was used as a control for each experiment.
• IC 50 is the concentration of anesthetic that produces 50% inhibition of viability.
• Example 1(C) To determine whether or not other topical anesthetics, particularly those ofthe carboxamide (lidocaine) class or benzoate class, also can inhibit eosinophil viability in vitro, the assay of Example 1(C) was carried out. Eosinophils were cultured in the presence of 100 pg/ml II-5 and 1 mM/ml, 0.1 mM/ml and 0.01 mM/ml of lidocaine and nine other topical anesthetics, and viability in the presence ofthe anesthetic was compared to viability in medium with and without IL-5. The results of this study are summarized on Table 1, below.
• eosinophils are cultured in the absence and the presence of a survival stimulating factor, such as interleukin (IL)-5.
• IL interleukin
• Table 1 eosinophil viability was enhanced over culture medium by addition of 10 or 100 pg/ml of IL-5.
• the survival of eosinophils in the absence of any survival-enhancing factor was 22% (78% ofthe eosinophils were dead) at four days.
• the survival of eosinophils was increased to 78% by 100 pg/ml of IL-5.
• Glucocorticoids are believed to be effective to manage bronchial asthma due to their ability to interfere with the cytokine-indicated accumulation and activation of inflammatory cells, including eosinophils. Examples 1-2 indicate that lidocaine and other topical anesthetics are able to mimic the bioactivity of glucocorticoids. Therefore, lidocaine was evaluated for its ability to replace glucocorticoids in the therapy of bronchial asthma.
• A .
• Patient A Patient A
• Patient A is a woman (age 43) presenting with chronic, severe, glucocorticoid-dependent bronchial asthma.
• lidocaine inhalation 2% aqueous lidocaine, 2 ml per nebulization, four times a day
• a deVilbiss nebulizer Model #561 OP
• Nebulization of this concentration of lidocaine has not caused side effects other than transient numbness ofthe oral cavity and ofthe upper regions ofthe pharynx and larynx, and this was well tolerated.
• Patient A was begun on lidocaine inhalation in early September 1992, at a time when she was receiving 40 mg of prednisone orally a day, as well as 20 puffs of asthmacort (triamcinolone). Over the preceding four months, the patient had received virtually continuous prednisone therapy. The lowest dose administered was 5 mg daily for a period of a few days in the middle of June 1992. After that reduction in therapy, the patient required a prompt increase in the quantity of glucocorticoids to 40 mg daily and then a taper was done such that she received 40 mg on one day and gradually decreasing doses of prednisone on the alternate day.
• the patient eventually reached a dose of 20 mg prednisone on one day and no prednisone on the following day, but this regimen was followed by a severe flare of asthma, such that for a period of time in July, she required therapy with 80 mg of prednisone a day.
• lidocaine therapy in late September was associated with a reduction in the patient' s nocturnal cough and with relief of the patient' s breathlessness.
• the prior prednisone therapy while keeping the asthma under control, did not completely relieve the symptoms, whereas lidocaine therapy was associated with a feeling of well being and virtually complete relief of symptoms.
• the patient's prednisone was reduced gradually, such that by Oecember 1992, the patient was receiving 5 mg every other day, a dose which she had not been able to achieve other than briefly in June 1992.
• an exacerbation of asthma occurred following a respiratory tract infection, which was treated by addition to the patient's therapy of one administration of 80 mg of prednisone.
• Patient B is a woman (age 34), who was begun on lidocaine therapy around the middle of September 1992, as described in section A, above. As shown by Figure 4, she has been able to reduce prednisone therapy from an average of 50 mg daily to a dose of 5 mg daily in early Oecember 1992. This reduction has not been associated with any untoward effects other than those which one anticipates from reduction of glucocorticoids in any patient who has been receiving glucocorticoids for long periods of time. (Glucocorticoid withdrawal causes a characteristic syndrome associated with malaise and muscle aching; both patients A and B have experienced these symptoms).
• Example 4 The Effects of Lidocaine and Dexamethasone on Isolated Human Eosinophils The effects of lidocaine and dexamethasone on isolated human eosinophils was determined utilizing an in vitro assay of eosinophil survival. In the below described experiment, all drugs were purchased from Sigma. Human recombinant IL-5 was generously provided by Shering-Plough Corporation. Lidocaine was resuspended in Hybri-Care media with 10% alpha calf serum and made fresh for each use.
• Dexamethasone was resuspended in DMSO, and dilutions ofthe dexamethasone stock solution were made in Hybri-Care® medium supplemented with 10%) alpha calf serum.
• A. Eosinophil Isolation Human eosinophils were isolated by layering over Percoll and separation from remaining neutrophils by negative selection using anti-CD 16 magnetic beads and MACS column isolation, as previously described by Ide et al., J. Immunol. Methods. 168. 187 (1994). The isolated eosinophils were >97% pure.
• the percentage of surviving eosinophils is defined as the number of PI -negative eosinophils over the total number of eosinophils gated and analyzed.

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