WO2001037847A2

WO2001037847A2 - Nontoxic vernix compositions and method of producing

Info

Publication number: WO2001037847A2
Application number: PCT/US2000/031059
Authority: WO
Inventors: Steven B. Hoath; William L. Pickens; Martha O. Visscher
Original assignee: Children's Hospital Medical Center
Priority date: 1999-11-22
Filing date: 2000-11-13
Publication date: 2001-05-31
Also published as: WO2001037847A3; EP1231927A2; BR0015549A; DE60036725D1; JP2003514864A; DE60036725T2; ES2291225T3; EP1231927B1; US6333041B1; ATE375163T1; CA2390767A1; AU1600101A

Abstract

A composition containing vernix to provide therapeutic treatment in a human, and a method for using the composition, are disclosed. The composition may contain a natural or synthetic medicament, or may be manipulated to regulate transport properties. The medicament may be, for example, a protectant against ultraviolet radiation or an antioxidant. Various compositions and uses of vernix, both natural and synthetic, are disclosed. The compositions may be used in embodiments such as skin protection, wound healing, and restoration of epidermal barrier function.

Description

NONTOXIC VERNIX COMPOSITIONS AND METHOD OF PRODUCING

Related Applications

This application is a Continuation-ln-Part of United States Patent

Application Serial No. 09/257,008 filed February 25, 1 999, which is a

Continuation-ln-Part of United States Patent Application Serial No. 09/033,209

filed March 2, 1 998, now pending.

Field of the Invention

The invention relates generally to a therapeutic or prophylactic,

natural or synthetic vernix film for enhanced growth and maturation of skin

and other tissue.

Background of the Invention

Skin is one of the largest organs in the body and covers

substantially the entire body surface. Skin is composed of two main layers:

the surface epithelium or epidermis which includes the uppermost stratum

corneum, and the subjacent connective tissue layer or dermis. The skin has

a number of functions such as protecting an organism from injury and

dessication, receiving environmental stimuli, excreting various substances,

regulating body temperature and helping to maintain water balance. Because of its quantitative and qualitative importance, substantially intact and healthy

skin is crucial not only for the well being of an organism but for its very

survival.

The health and integrity of skin may be compromised by wounds,

abrasions, ulcers, burns, infections, irritations, premature birth and other

conditions for which normal skin production and repair processes may be

inadequate. For example, acute conditions such as in patients who are burned

over a large surface area often require immediate skin replacement. Less life-

threatening but chronic skin problems such as decubitus ulcers or irritations

from diaper rash may progress to more severe conditions if left untreated or

if they occur in a neonate or a geriatric patient. Skin treatments encompass

a variety of methods and products. These may range from symptomatic

treatments such as the use of topical anti-inflammatory compounds to the use

of replacement skin. For various physiological, medical, and other reasons,

however, none of these treatments meet the desired goal of utilizing the

body's own healing and repair system to promote its own skin growth and

maturation.

Vernix caseosa (vernix) is a naturally occurring skin protectant.

Vernix is a lipid rich substance composed of sebum, epidermal lipids, and

desquamated epithelial cells that covers the skin of the developing fetus in

utero while the fetus is completely surrounded by amniotic fluid . Vernix

consists of hydrated cells dispersed in a lipid matrix. This lipid matrix

undergoes a transition to a more fluid form at physiological temperatures and

with the application of shear forces, such as those encountered with movement. Vernix is a covering for the skin of the fetus that resembles the

stratum corneum except that it lacks multiple rigid desmosomal connections.

Consequently, vernix exhibits a viscous fluid character which allows vernix to

act as a deformable, viscoelastic, semi-solid which coats the fetal skin surface

before birth. This material detaches in part from the skin prior to birth and is

swallowed by the developing fetus.

The lipid component of vernix has been reported in Stewart et

al ., J. Invest. Dermatol. , 78:291 -295 ( 1 982); Nicolaides, Lipids 6:901 -905

( 1 972); Haahti et al., J. Clin. & Lab. Investigation, 1 3:70-73 ( 1 961 );

Karkkainen et al., J. invest. Dermatol , 44:333-338 ( 1 965); and U.S. Patent

No. 5,631 ,01 2, each of which is incorporated by reference herein in its

entirety. Lipids, defined herein as fats or fat-like substances, include lecithin

and other phospholipids, squalene, waxes, wax esters, sterol esters, diol

esters, triglycerides, free sterols and four classes of fatty acids ranging in

chain length from C₁₂ to C₂₆ (straight chain saturated, straight chain

unsaturated, branched chain saturated, and branched chain unsaturated) .

Because of its anticipated skin maturation and protectant

properties, vernix appears to have promise as a clinically effective therapeutic

agent. Application of vernix to clinical use, however, has been limited by its

physical properties. While vernix in utero is a tractable semi-solid, vernix ex

utero is a nonhomogeneous intractable compound with a consistency

comparable to cheese or hardened cake frosting. Vernix is not completely

soluble in conventional solvents such as absolute ethanol, 95% ethanol, 2-

propanol, and combinations of chloroform and methanol. Thus, controlled and uniform administration of vernix to a surface is difficult. It has been reported

that the surfactant polysorbate 80 (Tween 80) may solubilize vernix, but

Tween 80 is toxic to living cells and therefore cannot be used clinically.

Although there have been isolated reports of vernix directly scraped from a

newborn baby for smearing over wounds (SU Patent No. 1 71 8947A) or in an

artificial lipid composition for use as a cosmetic moisturizer (U.S. Patent No.

5,631 ,01 2), vernix in a therapeutic or prophylactic, natural or synthetic

composition has not yet been reported.

While the barrier function and skin growth and maturational

properties of vernix render it clinically useful to treat a variety of acute and

chronic conditions, its physical properties have heretofore prevented its

controlled administration in a clinical environment for therapeutic or

prophylactic use. A need thus exists for a clinically useful vernix formulation

and for a composition which can provide therapeutic treatment.

Summary of the Invention

The invention is directed to a composition of vernix and a

medicament. The vernix may be natural or synthetic. The medicament may

be, for example, a protectant against ultraviolet (UV) radiation, a vitamin, a

surfactant associated protein, a skin colorant, a nutrient, an antiinfective

compound, or an immunogen.

The invention is also directed to methods for using the

composition. One example is a method for protecting skin from exposure to

UV radiation by applying an effective amount of a vernix/UV protectant

composition in a pharmaceutically acceptable carrier to the skin. The UV protectant may be natural or synthetic, for example, melanin or para-amino

benzoic acid. A second example is a method for altering skin coloration by

applying an effective amount of a vernix/skin colorant composition in a

pharmaceutically acceptable carrier to the skin. A third example is a method

for protecting an epithelial surface from an oxidant by applying an effective

amount of a vernix/antioxidant composition in a pharmaceutically acceptable

carrier to the skin. The antioxidant may be a vitamin such as vitamin E. A

fourth example is a method for providing a nutrient such as glutamine to a

human. An effective amount of a vernix/nutrient composition in a

pharmaceutically acceptable carrier is applied either parenterally or enterally.

The invention is also directed to a synthetic vernix composition

having a lipid fraction in the range of about 5-1 5 % by weight, a protein

fraction in the range of about 5-1 5% by weight, and a medicament. The

medicament may be a protectant against UV radiation, a skin colorant, an

antioxidant, an antiinfective agent, an immunogen, and/or a nutrient.

The invention additionally includes a method of providing a

spreadable composition of vernix and an effective amount of a surfactant

associated protein in a pharmaceutically acceptable carrier to a surface, and

a composition of vernix and surfactant associated protein B (SP-B) in an

amount to enable the composition to be spreadably applied to a surface.

The invention is still further directed to a method of treating an

epithelial surface. A composition containing an effective amount of vernix and

a protein such as a surfactant associated protein, in a pharmaceutically

acceptable carrier, is applied to the surface. The invention additionally includes a method to regulate transport

properties such as hydration in a biological surface. A vernix composition

containing corneocytes is applied to the surface and the orientation of the

corneocytes is altered, for example, by applying a shear stress. Regulation

may include water transport within vernix, water release from vernix,

permeability of one or more substances within vernix, release of one or more

substances from vernix, and/or binding of one or more substances to vernix.

The invention also includes an antioxidant composition comprising

vernix in a pharmaceutically acceptable carrier.

These and other methods and compositions will be apparent in

light of the following figures and detailed description.

Brief Description of the Figures

FIG. 1 A is a photograph of a Western blot analysis demonstrating

surfactant protein-A in vernix.

FIG. 1 B is a photograph of a Western blot analysis demonstrating

surfactant protein-D in vernix.

FIGS. 2A and 2B are photomicrographs showing two orientations

of vernix.

FIG . 3 is a transmission electron photomicrograph of vernix.

FIG. 4A is a chromatograph of a vitamin E standard, and FIG . 4B

is a chromatogram of a vernix extract.

FIG. 5 is a graph showing a drop in yield value of vernix subjected

to repetitive shear stress.

Detailed Description of the Preferred Embodiment A nontoxic vernix film and composition, and methods of

producing and using the film and composition as a therapeutic agent, for

example, for the delivery of selected medicaments such as nutrients or other

bioactive molecules, are described. A therapeutic agent or drug is defined as

one that is used to treat a preexisting or impending condition or to affect a

structure and/or function of the body. The treatment may be prophylactic,

curative, protective, maturation enhancing or combinations of these. In

contrast to a therapeutic agent, a cosmetic agent is defined as one that brings

about an improved appearance but with no mandatory claims to efficacy.

Vernix compositions may be natural or synthetic. Natural vernix

was obtained from a newborn infant at the time of delivery. Natural vernix

comprises about a 1 0% lipid fraction by weight, about a 1 0% protein fraction

by weight, and about an 80% volatile fraction by weight. The volatile fraction

is primarily water. The rate of evaporation of volatile components is relatively

slow, presumably due to the low rate of water vapor transmission through the

lipid matrix or increased energy requirements for the dissociation of hydrogen

bonds to change water from the liquid to the gaseous state. Vernix is an

odorless material, again indicating the absence of volatile carbon or nitrogen

containing compounds. At least a portion of the lipid and protein fraction are

cellular components, for example, corneocytes. Natural vernix also contains

calcium, tocopherols (vitamin E) of which α-tocopherol is the most potent and

pulmonary surfactant associated proteins (SP) such as SP-A and SP-D.

A synthetic vernix composition may be partially synthetic or

totally synthetic. Synthetic vernix comprises about a 5-1 5% lipid fraction by weight and about a 5-1 5 % protein fraction by weight. In a hydrated state,

there is about a 60-80% water fraction by weight. The water fraction may be

removed to comprise as little as about 1 0% water, however, to prepare a

partially or substantially dehydrated form of vernix. In one embodiment, a

preservative may be added to the formulation. The preservatives that may be

used in skin care formulations include benzoic acid, butylparaben, diazolidinyl

urea, DMDM hydantoin, ethylparaben, imidazolidinyl urea, iodopropynl

butylcarbamate, isobutylparaben, isopropyiparaben, methyldibromo

glutanitrite/phenoxyethanol, methylparaben, propylparaben, and

quatermium-1 5.

As previously described, the lipid fraction of vernix has been

reported to comprise lecithin and other phospholipids, squalene, waxes, wax

esters, sterol esters, diol esters, triglycerides, free sterols and four classes of

fatty acids ranging in chain length from C₁₂ to C₂₆ (straight chain saturated,

straight chain unsaturated, branched chain saturated, and branched chain

unsaturated) . The lipid fraction may contain, with the relative percentages

indicated, squalene (9%), aliphatic waxes (1 2%), sterol esters (33%), diesters

(7%), triglycerides (26%), free sterols (9%), and other lipids (4%) . The fatty

acids within the aliphatic waxes may be branched and the branched fatty acids

may be methylated. The protein fraction consists of epidermally derived

proteins, primarily keratin and filaggrin. The protein fraction also contains

trace amounts in the range of about micromolar to millimolar concentrations

of regulatory proteins such as epidermal growth factor, and trace amounts of

about nanomolar to micromolar concentrations of surfactant associated proteins such as SP-A and surfactant associated protein-B (SP-B) and

surfactant associated protein-D (SP-D) .

In utero, the developing fetus is exposed to an environment that

prepares it for ex utero existence. Natural vernix, a unique embodiment of

fetal skin exposed to the amniotic fluid, covers the developing fetus in the third

trimester of pregnancy, with vernix that is sloughed off being swallowed by

the developing fetus. Following birth, vernix is slowly detached from the skin

of the infant as sebaceous gland secretion diminishes.

Pulmonary surfactant associated proteins also confer useful

benefits on the developing fetus. Pulmonary surfactant is a phospholipid-

protein mixture which reduces the surface tension of the lung and prevents

collapse of the lung during air breathing. Prior to birth, surfactant synthesis

by the lung results in the accumulation of both phospholipids such as lecithin,

and specific surfactant proteins in the amniotic fluid. The most abundant

protein in this mixture is a hydrophilic molecule termed surfactant-associated

protein A (SP-A) , but other surfactant associated proteins such as SP-B and

SP-D are also present.

Pulmonary SP-A and SP-D belong to the collectin group of the

C-type lectin superfamily. Other collectins include mannan-binding lectin,

conglutinin, and collectin-43. SP-A binds phospholipids of pulmonary

surfactant such as dipalmitoylphosphatidylcholine. SP-A, along with

surfactant-associated protein D (SP-D), has antiinfective properties in that

these surfactant associated proteins elicit macrophage phagocytosis, resulting

in the destruction of microorganisms such as viruses, bacteria and fungi. As such, collectins such as SP-A and SP-D play key roles in the innate immune

system of the lung, which is critical for immediate antibody-independent host

defense.

The role of pulmonary surfactant molecules as modulators of the

rheological properties of vernix has been studied. With reference to FIG . 1 , the

presence of SP-A was demonstrated in serial dilutions of human vernix using

Western blotting. Freshly obtained vernix was dispersed in standard

polyacrylamide electrophoresis loading buffer containing sodium dodecyl

sulfate. Serial dilutions of the mixture were subjected to electrophoresis on a

polyacrylamide gel and immunoblotted with a ³²P-labeled polyclonal antibody

directed toward pulmonary SP-A.

The presence of SP-A and SP-D in native vernix, as shown in

FIGS. 1 A and 1 B respectively, demonstrates that a specific protein of

pulmonary origin combines with a barrier substance of cutaneous origin, to

produce in utero a heterogeneous surface coating (i.e., vernix) with new

properties important for barrier protection and host defense. The detachment

of vernix from, and subsequent swallowing by, the fetus would hypothetically

expose the fetal gut to the SP-A/vernix combination. This unique biology

provides support for the use of natural or synthetic vernix as a delivery device

for presenting SP-A or other collectin molecules of pulmonary or

extrapulmonary origin to immature, wounded, or immunocompromised

epithelial surfaces, such as the gut or skin.

However, little attention has been paid to vernix as a

physiologically relevant surface active material . The presence of surfactant associated proteins such as SP-B in natural vernix, and the addition of SP-B

and/or its derivatives to a synthetic vernix composition, permits control of the

rheological properties of the composition. This is advantageous in a number

of environments, such as when applying the composition to a natural or

synthetic surface such as intact skin (e.g., as a barrier), compromised skin

(e.g ., as a wound treatment) or a synthetic surface (e.g., applied to a

membrane, a film, a fabric, a wound dressing, an adhesive product, an ostomy

care product, a hospital pad, an incontinent pad, an absorbent pad, an

examination pad, a diaper and/or a feminine hygiene product.

Natural or synthetic vernix may be advantageously used as a

vehicle for delivery of other substances due to its combined hydrophilic/

hydrophobic character. Examples of substances to be delivered include, but

are not limited to, required or supplemental nutrients, immunological

molecules, therapeutic agents, etc. The properties of vernix that allow its use

as a vehicle include selective sequestration of the active moieties in a

hydrophobic domain such as the lipid matrix, or in a hydrophilic domain such

as corneocytes. Regulation of the high water content of vernix and binding or

release of water soluble moieties are putatively associated with the cellular

component, while binding or release of phospholipid-binding moieties and/or

hydrophobic molecules would be a function of interaction with the lipid matrix.

A lipid formulation that lacks the cellular component is not vernix, but a

composition containing both the cellular and lipid components of vernix,

whether both components are natural, both are synthetic, or one component

is natural and the other component is synthetic, may be used. The cellular component of vernix, either of biologic or synthetic

origin, may serve several functions. One function may be as an aid in the

moisture delivery and/or moisture retention aspects of the disclosed

composition. The high water content of vernix has been localized to the

cellular component. Cells, for example skin epithelial cells in general and

corneocytes in particular, may serve as vehicles for the slow release of water

which supplies moisture to an appropriate tissue such as skin. Corneocytes,

which are terminally differentiated skin cells, may be harvested from

keratinocyte culture systems and may be incorporated into synthetic lipid

formulations. The corneocytes may be bioengineered to perform a particular

function or to provide a particular gene or gene product, as described in co-

pending Application Serial No. 09/257,008 which is expressly incorporated by

reference herein in its entirety.

Corneocytes are flattened discs measuring approximately 1 0-40

microns in diameter and 1 -2 microns in thickness. In vivo, these cellular discs

are embedded in a lipid matrix of presumptive sebaceous origin (e.g., see

FIG. 3) . The overall form of vernix, therefore, can be modeled as described for

flake-filled membranes. The permeability properties of flake filled membranes

have been investigated using inorganic flakes of mica, with value for use in

transport across human skin as described by Falla et al. (Journal of Membrane

Science 1 1 9, 1 996, 1 29-1 38), which is expressly incorporated by reference

herein in its entirety. The orientation of the flakes is a primary determinant of

the permeability of such membranes and depends on several factors. The

factor providing the chief contribution to the increased resistance in flake-filled barrier membranes is the resistance to diffusion of the tortuous path around

the flakes (a "wiggle") . Other less important factors are the resistance to

diffusion of the slits or gaps between adjacent flakes in the same horizontal

plane (the "slit resistance"), and the constriction of the solute to pass into and

out of the narrow slits ("necking"). Falla et al. mentioned the close parallel

between the geometries used in simulating flake-filled membranes and human

skin, remarking that the outermost layer of the skin (stratum corneum) consists

of about twenty layers of keratin-rich cells embedded in a lipid bilayer matrix,

with the impermeable keratin cells analogous to flakes and the lipid matrix

corresponding to the continuum. Thus, the presence of the keratin-rich cells

reduces the diffusion of materials through the lipid by three hundred times,

with two thirds of this reduction due to wiggles and one third results from

necking, with almost nothing from the slits between the flakes.

Vernix may be compared to mica-filled membranes but with the

flakes constituted by biological units; i.e., corneocytes. Vernix is analogous

to stratum corneum, but there are no desmosomal attachments between cells

in vernix. These structural differences between vernix and stratum corneum

confer novel properties upon vernix insofar as the application of exogenous

directional stresses allow orientation of the corneocytes within vernix but not

within the stratum corneum. Examples of such orientation are shown in

FIGS. 2A and 2B. FIG. 2A shows freshly harvested vernix under low

magnification (30x). Vernix is comprised of a large amount of sebaceous-

derived wax esters and has the appearance and feel of a lipid material.

FIG. 2B shows the same vernix sample flattened between two glass slides and viewed by phase contrast microscopy (500x magnification). Flattening of the

vernix results in an oriented array of corneocytes lying parallel to the visual

axis. There is dense packing of fetal corneocytes surrounded by a presumptive

lipid matrix. Of particular note is the observation that vernix is primarily a

cellular moiety. FIG. 3 is a transmission electron photomicrograph (21 ,000x

magnification) of a flattened vernix sample. The large number of fetal

corneocytes are shown as flattened light grey structures surrounded by the

darker staining lipid matrix.

A novel application of this controlled cellular orientation concept

is the slow release of substances from vernix or across vernix under the

influence of repetitive shear stress. Repetitive shear stress would be exerted,

for example, with directional massage or application of force to vernix.

Application of shear force to a molecule such as a cell causes the molecular

segments to align in the direction of shear. Viscous drag forces cause

molecular segments to become stretched along their horizontal axes and

compressed along their vertical axes. At low shear stresses, molecular

segments are able to compress and stretch to dissipate energy, and

considerable kinetic energy is converted into heat. Thus, the viscosity is high.

At higher shear stresses, molecular segments become effectively rigid and do

not transform as much kinetic energy into heat. Thus, the apparent viscosity

decreases. At low shear stresses, thermal motion overcomes any tendency

toward molecular alignment, but as the shear rate increases the molecules

begin to disentangle and align, hence the resistance to flow past one cell to

another is reduced. Under high shear stresses, the elements (cells) become almost totally disentangled and aligned. Thus, a steady state condition is

reached where a minimum flow resistance occurs. Repetition of high shear

stress would tend to further orient the molecular or cellular elements.

The rheological behavior of substances is explained in, e.g.,

Rheology, chapter 1 7 (p. 453-476 of Physical Pharmacy, Physical Chemical

Principles in the Pharmaceutical Sciences, Alfred Martin, Lea & Febiger, 4^th

Edition, 1 993), which is expressly incorporated by reference herein in its

entirety. The rheological (flow) behavior of vernix can be explained by the

dynamics of entangling and disentangling of cellular elements. A sample of

vernix was spread onto a plate of a Dynamic Stress Rheometer SR-5000^®

(cone and plate set, plate diameter 40 mm) (Rheometric Scientific, Inc.,

Piscataway, NJ), with the plate adjusted to 25 °C. The vernix sample was

sufficient to cover the plate after the cone was lowered, leaving a gap of

0.046 mm between the cone and plate. A preshear stress of 500 dyne/cm²

was applied before a steady stress sweep between 500-1 0,000 dyne/cm² was

applied. The rheometer measured the shear strain and viscosity corresponding

to the shear stress applied. The same vernix sample was subjected to a

repetitive shear stress, with a one minute interval between five repetitions.

A stress-strain curve was plotted, as shown in FIG . 5. The drop

in yield value, defined as the minimum amount of shear stress that must be

applied for a material to begin flowing, was calculated. The fall in the yield

value during repetitive stresses (r² = 0.80) shown in FIG. 5 is consistent with

progressive alignment of cellular elements (analogous to mica flakes), with

consequent lowering of the viscosity of the vernix sample. Control of orientation of the cellular elements in vernix may have

direct effects on several processes, given the mathematics of flake-filled

membrane transport processes and the high water content of cells such as

corneocytes. These transport properties, such as hydration-related processes,

include water transport within vernix, water release from vernix, the

permeability of substances within vernix, the release of substances from

vernix, and the binding of substances to vernix. The effects may relate

directly to the moisturizing properties of vernix and its ability to control water

gradients across surfaces to which it is applied.

Substances within vernix or substances interacting with vernix

may have anticipated therapeutic uses. An example of one nutritive use is

supplementation with vernix containing glutamine. Glutamine is a water

soluble, nonessential amino acid that is produced by the human body. Under

specific circumstances, the availability of glutamine may be limited, in which

case it becomes an essential amino acid. Glutamine is known, for example,

to be an important nutrient for rapidly dividing cells such as cells from the

immune system and the gut. One of the important functions of the gut is to

prevent migration of bacteria and/or toxins from the gut lumen into the

systemic circulation. A lack of glutamine may result in deterioration of this

intestinal barrier. In the small intestine, glutamine is considered conditionally

essential. Supplementation of glutamine to certain patients with immature or

compromised small intestinal function could be essential.

In a report of the amino acid composition of a vernix hydrolysate

(Baker et al., Indian Journal of Pediatrics 1 995; 62:237), over one fifth (22.7 ± 2.5%) of the free amino acids were glutamine. The authors noted the

importance of this amino acid in lymphoblasts synthesizing immunoglobulin,

and recommended that vernix be left intact on the newborn skin surface

instead of following the usual practice of discarding the material as detritus.

Since vernix detaches in part from the skin prior to birth and is swallowed by

the developing fetus, the detachment process may be aided by the presence

of surfactant material of pulmonary origin that is present in the amniotic fluid.

In light of this information and given reports of the high glutamine content of

vernix, there is likely a novel nutritive role for vernix. Thus, natural or

synthetic vernix may provide a prototypical delivery device for glutamine and

other endogenous or exogenous molecules beneficial to patients having

immature, wounded or immunocompromised epithelial surfaces. Such patient

populations would include, for example, premature infants, burn patients and

patients with immunocompromised immune systems secondary to infection or

cancer.

A vernix composition may also function as a delivery or

therapeutic vehicle for essential factors such as lipophilic vitamins (vitamins A,

D, E, and K) . Natural vernix contains the antioxidant vitamin E, as shown in

FIGS. 4A and 4B. A sample of vernix was obtained from a newborn, and the

hydrophobic components were extracted into chloroform. The chloroform was

then evaporated and the residue was resuspended in 95 % ethanol and

centrifuged at 2000 x g for 1 0 min. The supernatant was filtered through a

0.22 μm filter and injected onto an HPLC C-1 8 packed column. Substances were eluted using an isocratic gradient of 95 % ethanol and fractions were

monitored at an absorbance of 280 nm.

FIG . 4A is an HPLC absorbance chromatogram of a vitamin E

standard that was recovered from the column using the previously described

method. The retention time was about 4.4 min. FIG . 4B shows the extracted

vernix composition. The chromatogram demonstrates a peak having a

retention time of about 4.4 min, corresponding to the retention time of the

vitamin E standard shown in FIG . 4A.

It is known (e.g., Devlin, Textbook of Biochemistry, Fourth Ed.,

Wiley-Liss, New York 1 997) that vitamin E is lipophilic and accumulates in

circulating lipoproteins, cellular membranes, and fat deposits. It reacts very

rapidly with molecular oxygen and free radicals to scavenge for these

compounds, protecting unsaturated fatty acids (especially those in cellular

membranes) from peroxidation reactions. Vitamin E appears to play a role in

cellular respiration, either by stabilizing coenzyme Q or by helping transfer

electrons to coenzyme Q. It also appears to enhance heme synthesis by

increasing the levels of γ-aminolevulinic acid (ALA) synthetase and ALA

dehydratase. Most of these vitamin E effects are thought to be an indirect

effect of its antioxidant potential, rather than its actual participation as a

coenzyme in any biochemical reactions.

Premature infants fed on formulas low in vitamin E sometimes

develop a form of hemolytic anemia that can be corrected by vitamin E

supplementation. Adults suffering from fat malabsorption show a decreased

red blood cell survival time. Hence, vitamin E supplementation may be necessary with premature infants and in cases of fat malabsorption. In

addition, studies have suggested that supplementation with at least

100 mg/day of vitamin E may decrease the risk of heart disease. This is well

above the current recommended daily allowance and is far greater than can be

obtained from even a very well balanced diet. These findings have rekindled

the debate as to whether dietary recommendations should consider optimal

levels of nutrients rather than the levels needed to prevent deficiency diseases.

As a fat-soluble vitamin, E has the potential for toxicity. However, it does

appear to be the least toxic of the fat-soluble vitamins, and no instances of

toxicity have been reported at doses of 1 600 mg/day or less.

Newborn infants are at special nutritional risk. In the first place,

this is a period of very rapid growth, and needs for many nutrients are high.

Some micronutrients, such as vitamin E, do not cross the placental membrane

well and tissue stores are low in the newborn infant. The gastrointestinal tract

may not be fully developed, leading to malabsorption problems (particularly

with respect to the fat-soluble vitamins) . The gastrointestinal tract is also

sterile at birth and the intestinal flora that normally provide significant amounts

of certain vitamins take several days to become established. If the infant is

born prematurely, the nutritional risk is slightly greater, since the

gastrointestinal tract will be less well developed and the tissue stores will be

less. If infants must be maintained on oxygen, supplemental vitamin E may be

beneficial.

A natural or synthetic vernix formulation may assist in providing

vitamin E to individuals requiring supplementation as described above, or to those with an increased risk of oxidative exposure, for example, environmental

workers in which additional protection against oxidation would be desirable.

In both of these cases, delivery of nutrients or therapeutic agents such as

vitamin E directly to epithelial surfaces such as skin or gut may be

advantageous.

Vernix may also be used to protect skin against damage caused

by exposure to ultraviolet (UV) light. As epidermal cells mature, they produce

the keratin filament-aggregating protein known as filaggrin. Filaggrin

subsequently undergoes proteolysis within the corneocyte to form natural

moisturizing factor (NMF) . NMF is a mixture of amino acids such as urocanic

acid and pyrollidone carboxylic acid which function as natural humectants to

bind water and plasticize the stratum corneum. Urocanic acid absorbs

ultraviolet (UV) radiation, and additionally possesses immunomodulatory

properties. Filaggrin proteolysis within the corneocytes of vernix would result

in the liberation of NMF with production of urocanic acid .

Melanin, a naturally occurring material found in skin, is also able

to absorb and scatter UV radiation. Incorporation of one or more medicaments

such as melanin or other compounds into a natural or synthetic vernix to form

a composition would confer UV-protective properties on the composition.

Examples of UV-protectant compounds include para-amino benzoic acid,

avobenzone(parsol 1 789), benzophenone-3, octylmethoxycinnamate, octyl

salicylate, oxybenzone, titanium dioxide, phenylbenzimidazole sulfonic acid,

and/or homosalate. The concentration of melanin could be adjusted to

optimize the UV-protectant effect of the composition. As one example, individuals who have suffered burns may require increased protection from

exposure to UV radiation. Vernix compositions for use on burn patients may

incorporate a higher concentration of melanin than compositions for use on

other patients. As another example, individuals who are particularly sensitive

to the effects of UV radiation, such as those with fair skin, may require

enhanced protection from such exposure. As previously described, protection

from UV radiation may also be enhanced by the inclusion of urocanic acid, one

of the naturally-occurring breakdown products of filaggrin.

A native or synthetic vernix composition may also be used to

control or alter pigmentation of the skin. There is considerable variation in the

coloration of vernix, with vernix collected from infants of color often being

darker than vernix obtained from lighter skinned infants. The variations most

likely are due to differing amounts and/or forms of the pigment melanin, which

is formed by enzymatic oxidation of the amino acid tyrosine found in vernix.

The pigment-altering formulation could be used, for example, in the treatment

of pigment cell pathology such as vitiligo, a skin disease characterized by the

occurrence of whitish nonpigmented areas surrounded by hyperpigmented

borders. The formulation could also be used as a skin complexion-altering

preparation, either directly (e.g., tanning) or indirectly (e.g., added to topically

applied barrier compositions to provide a non-greasy material that easily blends

with natural skin) .

To alter skin pigmentation, melanin is incorporated into a natural

or synthetic vernix formulation. Melanin may be added in the form of either

meianosomes, aggregates of melanosomes (melanosome complexes), free melanin, or small melanin granules (melanin dust) within a lipid matrix to

produce a coloring agent. Alternatively, melanin may be incorporated directly

into the cellular component of vernix by in vitro cell co-cultures of

keratinocytes and melanocytes. For example, keratinocyte extracellular matrix-

mediated regulation of normal human melanocyte functions has been reported

(Pigment Cell Res. February 1 995, 8( 1 ): 1 0-1 8, which is expressly incorporated

by reference herein in its entirety) .

In summary, the above-described inventive compositions and

methods meet a current need for a versatile biocompatible substance for

interacting with multiple epithelial systems. The inventive compositions and

methods are based on novel biological mechanisms which occur in the human

fetus, and which do not exist in the adult organism. Reapplication of these

fetal mechanisms make available new potential biological delivery and

regulatory systems.

A nontoxic vernix composition and film and methods of producing

and using the composition and film are thus disclosed. In addition, a vernix

dispersion and methods of producing and using the dispersion are disclosed.

The compositions and methods of the invention may be used for skin cell

maturation, for skin protection and coloration, for nutritive purposes, and for

wound healing and/or repair. Other variations or embodiments of the invention

will also be apparent to one of ordinary skill in the art from the above

description and example. For example, a vernix composition may be

formulated into a cream, such as a first aid cream, a cream for treating poison

ivy or other forms of contact dermatitis, or a diaper rash cream. Thus, the forgoing embodiments are not to be construed as limiting the scope of this

invention.

What is claimed is:

Claims

1 . A composition comprising vernix and a medicament.

2. The composition of claim 1 wherein the vernix is selected from

the group consisting of natural vernix and synthetic vernix.

3. The composition of claim 1 wherein the medicament is a

protectant against ultraviolet radiation.

4. The composition of claim 3 wherein the protectant is selected

from the group consisting of melanin, melanosomes, melanosome complexes,

melanin dust, urocanic acid, para-amino benzoic acid, avobenzone(parsol

1 789), benzophenone-3, octylmethoxycinnamate, octyl salicylate, oxybenzone,

titanium dioxide, phenylbenzimidazole sulfonic acid, homosalate and

combinations thereof.

5. The composition of claim 1 wherein the medicament is a vitamin.

6. The composition of claim 5 wherein the vitamin is selected from

the group consisting of A, D, E, K and combinations thereof.

7. The composition of claim 1 wherein the medicament is a

surfactant associated protein (SP) .

8. The composition of claim 7 wherein the surfactant associated

protein is selected from the group consisting of SP-A, SP-B, SP-D and

combinations thereof.

9. The composition of claim 1 wherein the medicament is a skin

colorant.

1 0. The composition of claim 9 wherein the skin colorant is selected

from the group consisting of melanin, melanosomes, melanosome complexes,

melanin dust and combinations thereof.

1 1 . The composition of claim 1 wherein the medicament is a nutrient.

1 2. The composition of claim 1 1 wherein the nutrient is glutamine.

1 3. The composition of claim 1 wherein the medicament is an

antiinfective compound.

1 4. The composition of claim 1 3 wherein the compound is a collectin.

1 5. The composition of claim 1 wherein the medicament is a

compound to enhance immunocompetency.

1 6. The composition of claim 1 5 wherein the compound is a collectin.

1 7. A method for protecting skin from exposure to ultraviolet (UV)

radiation comprising applying an effective amount of a composition comprising

vernix and a UV protectant in a pharmaceutically acceptable carrier to the skin.

1 8. The method of claim 1 7 wherein the UV protectant is selected

from the group consisting of melanin, melanosomes, melanosome complexes,

melanin dust, urocanic acid, para-amino benzoic acid, avobenzone(parsol

1 789), benzophenone-3, octylmethoxycinnamate, octyl salicylate, oxybenzone,

titanium dioxide, phenylbenzimidazole sulfonic acid, homosalate and

combinations thereof.

1 9. A method for altering skin coloration comprising applying an

effective amount of a composition comprising vernix and a skin colorant in a

pharmaceutically acceptable carrier to the skin.

20. The method of claim 1 9 wherein the colorant is selected from the

group consisting of melanin, melanosomes, melanosome complexes, melanin

dust and combinations thereof.

21 . A method for protecting an epithelial surface from an oxidant

comprising applying an effective amount of a composition comprising vernix

and an antioxidant in a pharmaceutically acceptable carrier to the surface.

22. The method of claim 21 wherein the antioxidant is a vitamin.

23. The method of claim 22 wherein the vitamin is selected from the

group consisting of A, D, E, K and combinations thereof.

24. A method for providing a nutrient comprising providing an

effective amount of a composition comprising vernix and the nutrient in a

pharmaceutically acceptable carrier.

25. The method of claim 24 wherein the nutrient is glutamine.

26. The method of claim 24 wherein the nutrient is provided enterally

or parenterally.

27. The method of claim 24 wherein the nutrient is provided topically.

28. A synthetic vernix composition having a lipid fraction in the range

of about 5-1 5% by weight and a protein fraction in the range of about 5-1 5%

by weight and further comprising a medicament.

29. The composition of claim 28 wherein the medicament is selected

from the group consisting of a protectant against ultraviolet (UV) radiation, a

skin colorant, an antioxidant, an antiinfective, an immunogen, a nutrient and

combinations thereof.

30. The composition of claim 29 wherein the UV protectant is

selected from the group consisting of melanin, melanosomes, melanosome

complexes, melanin dust, urocanic acid, para-amino benzoic acid,

avobenzone(parsol 1 789), benzophenone-3, octylmethoxycinnamate, octyl

salicylate, oxybenzone, titanium dioxide, phenylbenzimidazole sulfonic acid,

homosalate and combinations thereof.

31 . The composition of claim 28 wherein the antioxidant is a vitamin.

32. The composition of claim 31 wherein the vitamin is selected from

the group consisting of A, D, E, K and combinations thereof.

33. The composition of claim 29 wherein the antiinfective is a

surfactant associated protein.

34. The composition of claim 33 wherein the surfactant associated

protein is selected from the group consisting of surfactant associated protein

A (SP-A), SP-B, SP-D and combinations thereof.

35. The composition of claim 29 wherein the skin colorant is selected

from the group consisting of melanin, melanosomes, melanosome complexes,

melanin dust and combinations thereof.

36. The composition of claim 29 wherein the nutrient is glutamine.

37. The composition of claim 29 wherein the antiinfective compound

is a collectin.

38. A method of providing a spreadable composition comprising

vernix and an effective amount of a surfactant associated protein in a

pharmaceutically acceptable carrier to a surface.

39. The method of claim 38 wherein the surfactant associated protein

is surfactant associated protein-B.

40. A composition comprising vernix and surfactant associated

protein B (SP-B) in an amount to spreadably apply said composition to a

surface.

41 . The composition of claim 40 further comprising a collectin.

42. The composition of claim 40 wherein the surface is selected from

the group consisting of a membrane, a film, a fabric, a wound dressing, an

adhesive product, an ostomy care product, a hospital pad, an incontinent pad,

an absorbent pad, an examination pad, a diaper, a feminine hygiene product

and combinations thereof.

43. A method of treating an epithelial surface by applying a

composition comprising an effective amount of vernix and a protein of

pulmonary origin in a pharmaceutically acceptable carrier to the surface.

44. The method of claim 43 wherein said protein is a surfactant

associated protein.

45. The method of claim 43 wherein said surface is a wound.

46. The method of claim 43 wherein said surface is

immunocompromised.

47. The method of claim 43 wherein said surface is an immature

organ selected from the group consisting of gut, skin and combinations

thereof.

48. The method of claim 43 wherein said treatment restores a

compromised epidermal barrier function.

49. The method of claim 43 wherein said composition is applied

directly to said surface.

50. A method to regulate transport in a biological surface comprising

applying a vernix composition containing corneocytes to said surface for

orientating the corneocytes in the composition.

51 . The method of claim 50 wherein transport regulation is selected

from the group consisting of water transport within vernix, water release from

vernix, permeability of at least one substance within vernix, release of at least

one substance from vernix, binding of at least one substance to vernix and

combinations thereof.

52. The method of claim 50 wherein transport regulation is by

applying a stress to said composition.

53. An antioxidant composition comprising vernix in a

pharmaceutically acceptable carrier.

54. The composition of claim 53 further comprising vitamin E.