WO2002094283A2 - Use of phospholipids in the treatment of degenerative lung disease such as copd or cystic fibrosis and to enhance delivery of drugs - Google Patents

Use of phospholipids in the treatment of degenerative lung disease such as copd or cystic fibrosis and to enhance delivery of drugs Download PDF

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Publication number
WO2002094283A2
WO2002094283A2 PCT/GB2002/002196 GB0202196W WO02094283A2 WO 2002094283 A2 WO2002094283 A2 WO 2002094283A2 GB 0202196 W GB0202196 W GB 0202196W WO 02094283 A2 WO02094283 A2 WO 02094283A2
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WO
WIPO (PCT)
Prior art keywords
sapl
phosphatidyl
treatment
medicament
lung disease
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PCT/GB2002/002196
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French (fr)
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WO2002094283A3 (en
Inventor
Brian Andrew Hills
Derek Woodcock
John Staniforth
Joy Conway
Jim Thompson
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Britannia Pharmaceuticals Limited
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Priority claimed from GB0112326A external-priority patent/GB0112326D0/en
Priority claimed from GB0112330A external-priority patent/GB0112330D0/en
Application filed by Britannia Pharmaceuticals Limited filed Critical Britannia Pharmaceuticals Limited
Priority to AU2002255181A priority Critical patent/AU2002255181A1/en
Publication of WO2002094283A2 publication Critical patent/WO2002094283A2/en
Publication of WO2002094283A3 publication Critical patent/WO2002094283A3/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/007—Pulmonary tract; Aromatherapy
    • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
    • A61K9/0075—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy for inhalation via a dry powder inhaler [DPI], e.g. comprising micronized drug mixed with lactose carrier particles
    • 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
    • A61K31/66—Phosphorus compounds
    • A61K31/683—Diesters of a phosphorus acid with two hydroxy compounds, e.g. phosphatidylinositols
    • A61K31/685—Diesters of a phosphorus acid with two hydroxy compounds, e.g. phosphatidylinositols one of the hydroxy compounds having nitrogen atoms, e.g. phosphatidylserine, lecithin
    • 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

Definitions

  • This invention relates to pharmaceutical products based on surface active phospholipid (SAPL) for use in the treatment of neutrophil-induced or irreversible degenerative lung disease, especially chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF), and to the use of surface active phospholipid (SAPL) to enhance the delivery of biologically active substances in therapeutic adrnieristration to mammals.
  • SAPL surface active phospholipid
  • SAPL respiratory distress syndrome
  • EP-0 528 034-A (Tokyo Tanabe) describes the use of pulmonary surface active material as an ingredient of an anti-asthmatic, which is in the form of a liquid or suspension for injection or spraying into the patient's air way.
  • WO-00/30654 (Britannia) describes a combination product for treating asthma, comprising a powdered surface active phospholipid composition and an anti-asthma drug.
  • One object of this invention is to provide a method for treatment of neutrophil- induced degenerative lung disease and irreversible degenerative lung disease, especially chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF), by use of a dry powder SAPL administered as a dry powder.
  • COPD chronic obstructive pulmonary disease
  • CF cystic fibrosis
  • asthma is allergen-induced and reversible
  • COPD and CF are neutrophil-induced and irreversible
  • these diseases may be differentiated from asthma by the concept that asthma patients find it difficult to breathe in (due to bronchio-constriction), while COPD patients find it difficult to breathe out (when a COPD patient inhales, the air can still move into the alveoli; but when the patient exhales, the air is often trapped in the lungs by the collapse of the small airways) and CF patients find it difficult to clear their lungs (due to dysfunctional mucociliary clearance).
  • Neutrophil granulocytes are the major acute inflammatory cells, important in host defence but also implicated in tissue injury.
  • neutrophils migrate from the blood into tissues and are activated by proinflammatory mediators.
  • Neutrophil tissue injury is mediated by a combination of neutrophil granule contents, which are released to the exterior, together with generation of oxygen radicals via the NAPDH oxidase system.
  • Neutrophil clearance from tissues permits resolution of inflammation.
  • Chronic obstructive pulmonary disease is a term which includes chronic bronchitis and emphysema.
  • the predominant cause of COPD is cigarette smoking.
  • the chronic bronchitic type patient is characterised by cough and mucous hypersecretion, peripheral airway disease with bronchiolar inflammation, hypertrophy of airway smooth muscle, and fibrosis. These features lead to a persistent limitation to expiratory airflow that shows a progressive deterioration.
  • the presence of self- perpetuating cycles of bronchial inflammation and impairment of mucociliary clearance with bacterial colonisation of retained secretions is a feature of chronic bronchitis.
  • Emphysema is defined as the abnormal, permanent enlargement of the airspaces distal to the terminal bronchioli and destruction of the alveolar walls which again shows progressive deterioration.
  • a rare, genetic, cause of emphysema is alphai-antitrypsin deficiency which would typically present at a younger age than smoking-related emphysema.
  • Cystic fibrosis is the most common inherited disorder in the Caucasian population.
  • the cystic fibrosis transmembrane conductance regulator (CFTR) is an epithelial chloride channel. Absent or defective expression of CFTR in CF patients leads to an abnormal accumulation of secretions in the airways which enhances bacterial colonisation and leads to progressive inflammatory airway changes.
  • Mucociliary clearance is known to be decreased in CF as a result of several factors including dysfunctional/destroyed cilia coupled with altered and increased mucous. This decrease in an effective clearance mechanism results in retained secretions leading to persistence of inflammation and infective exacerbations.
  • a common feature of these types of diseases is the obstructed state of the airways, which are either partially or completely blocked, whether by mucous build-up or anatomical deterioration (or both).
  • the implication of this statement is that even when drugs such as ipratropium, with a place in COPD therapy, are given, there is a real risk that the drug particles will not be sufficiently penetrative based on their severely compromised ballistics in the obstructed airways.
  • This invention provides a therapeutic combination product for use in the prevention and/or treatment of degenerative lung disease comprising (a) a surface active phospholipid (SAPL) composition in finely divided form, the SAPL including a component which enhances spreading of the medicament over a surface at about normal mammalian body temperature; and (b) a drug effective for the treatment of degenerative lung disease; wherein ingredients (a) and (b) are provided in a form for administration together, as a mixture or separately, or sequentially.
  • SAPL surface active phospholipid
  • degenerative lung disease includes in particular chronic obstructive pulmonary disease, smokers lung, chronic bronchitis, and cystic fibrosis.
  • the SAPL ingredient (a) has a number of important effects in the combination product of this invention:
  • the spreading of the SAPL carries drug (b) into lung areas that cannot be reached by ballistic delivery alone; ⁇ the SAPL allows the drug (b) to move through the mucous layers characteristic of the above diseases to reach the underlying lung surfaces; where the combination is for use in the treatment of neutrophil-induced or irreversible degenerative lung disease;
  • the SAPL reduce surface tension of endogenous surfactant to open the airways to allow penetration
  • the SAPL bind to airway epithelium to act as a protective lining with good "nonstick” properties to facilitate clearance of sputum via mucociliary transport;
  • the SAPL improve the rheology of mucous (lower viscosity) to promote clearance.
  • the SAPL (a) is in the form of a powder, that is, it is in solid form.
  • the "dry" surfactant has a high surface activity.
  • SAPL (a) has two components.
  • the first component of the SAPL (a) comprises a phosphatidylcholine (PC), suitably one or more compounds selected from the group consisting of diacyl phosphatidyl cholines.
  • suitable diacyl phosphatidyl cholines (DAPCs) are dioleyl phosphatidyl choline (DOPC); distearyl phosphatidyl choline (DSPC) and dipalmitoyl phosphatidyl choline (DPPC).
  • the first component is DPPC.
  • the second component may comprise one or more compounds selected from the group consisting of phosphatidyl glycerols (PG); phosphatidyl ethanolarnines (PE); phosphatidyl serines (PS); phosphatidyl inositols (PI) and chlorestyl palmitate (CP).
  • Phosphatidyl glycerol is believed to be capable of binding to lung tissue and possibly enhancing the binding of the first component and is, therefore, a preferred second component.
  • PG is also a preferred second component because of its ability to form with the first component a very finely-divided, dry powder dispersion in air.
  • the medicament advantageously comprises a diacyl phosphatidyl choline and a phosphatidyl glycerol.
  • the phosphatidyl glycerol is advantageously a diacyl phosphatidyl glycerol.
  • the acyl groups of the phosphatidyl glycerol which may be the same or different, are advantageously each fatty acid acyl groups which may have from 14 to 22 carbon atoms.
  • the phosphatidyl glycerol component may be a mixture of phosphatidyl glycerols containing different acyl groups.
  • the phosphatidyl glycerol is expediently obtained by synthesis from purified lecithin, and the composition of the acyl substituents is then dependent on the source of the lecithin used as the raw material. It is preferred for at least a proportion of the fatty acid acyl groups of the phosphatidyl glycerol to be unsaturated fatty acid residues, for example, mono-or di-unsaturated C18 or C20 fatty acid residues.
  • Preferred acyl substituents in the phosphatidyl glycerol component are palmitoleoyl, oleoyl, linoleoyl, linolenoyl and arachidonoyl.
  • the medicament preferably comprises dipalmitoyl phosphatidyl choline and phosphatidyl glycerol, with the phosphatidyl moiety of the phosphatidyl glycerol advantageously being obtainable from the phosphatidyl moiety of egg lecithin.
  • the presence of a second component results in a lowering of the melting point of the first component, promoting rapid spreading of the first component over the liquid-air interface as a thin film at body temperature.
  • the normal melting temperature of dipalmitoyl phosphatidyl choline which is a preferred first component, is about 40°C, that is, above the normal body temperature.
  • a suitable second component such as a phosphatidyl glycerol
  • the SAPL (a) is in finely divided solid form. It is believed that, as a consequence of the high surface activity of SAPL (a) in that form there results a significant drop in surface tension on contact with the aqueous mucous layer of the lung, permitting improved access to the lung surfaces for the drug (or drugs) (b) to be administered. Thus, the use of the SAPL (a) in combination with a drug (b) is believed to enhance the effectiveness of the drug (b).
  • dosages of an a drug (b) to be administered to a given patient may be reduced, as a consequence of the spreading effect of SAPL (a) in increasing the area of contact of the drug (b) with the lung surfaces, as well as movement of the drug (b) through any mucous layer on the surfaces.
  • SAPL a drug
  • there is an increase in efficacy of the treatment because the spreading action of the SAPL carries the drug (b) into lung areas that cannot be reached by normal ballistic delivery of drug (b) alone.
  • the finely divided powders as used herein have a particle size distribution which is such that at least a major portion by weight of the particles are small enough to enter into a patient's airways and, preferably, deep into the lungs when inhaled.
  • the first and second components preferably each have a particle size distribution which is such that not less than 90%, by weight, of the particles of those components in combination, and more preferably of each of the first and second components, have a particle size of not greater than lO ⁇ m, and especially of not greater than 5 ⁇ m.
  • the median particle size of the combined first and second components, and more preferably of each of the first and second components is not more than lO ⁇ m, and preferably not more than 5 ⁇ m.
  • the median particle size may be less than 3 ⁇ m, for example, about 1.2 ⁇ m. It may be desirable in some circumstances for the particles to have a median particle size of at least 0.5 ⁇ m.
  • the size of the particles may be calculated by laser diffraction, or by any other method by which the aerodynamic diameter of particles can be determined. "Median particle size" as used herein means mass median aerodynamic diameter ( rVLAD).
  • the MMAD may be determined using any suitable method, for example, using a Multi-Stage Liquid I pinger in accordance with the method described in European Pharmacopoeia (supplement 1999) 2.9.18 (Aerodynamic assessment of fine particles). Alternatively, the size distribution of the particles may be characterised by their volume mean diameter (NMD).
  • the NMD is not more than lO ⁇ m, for example not more than 5 ⁇ m, and preferably less than 3 ⁇ m. Finely divided dry powders of this kind can be adsorbed onto the surfaces of lung tissue and are believed, in use, to become bound to the epithelium.
  • a finely divided solid mixture of said first and second components of the medicament (a) may be obtained by size reduction of larger particles by any suitable size reduction method.
  • the first and second components of the medicament (a) may be present in a weight ratio of from 1: 9 to 9: 1.
  • the proportion by weight of the first component exceeds that of the second component.
  • said first component and said second component are present in a weight ratio of from 6: 4 to 8: 2.
  • the mixture spreads rapidly at a temperature of 35°C or above.
  • DPPC can be prepared synthetically by acylation of glycerylphosphorylcholine using the method of Baer & Bachrea -Can. J. of Biochem. Physiol 1959, 37, page 953 and is available commercially from Sigma (London) Ltd.
  • the PG may be prepared from egg phosphatidyl-choline by the methods of Comfurions et al, Biochem. Biophys Acta 1977,488, pages 36 to 42; and Dawson, Biochem J. 1967, 102, pages 205 to 210.
  • the most preferred composition of the invention contains DPPC and a phosphatidyl glycerol derived from egg phosphatidyl choline and having a mixture of C16, C18 (saturated and unsaturated) and C20 (unsaturated) acyl groups.
  • the phospholipid components may be dissolved in a suitable solvent, for example ethanol or chloroform, the solution filtered and vacuum-dried, and the solid product size-reduced as necessary, to obtain particles of the desired size.
  • a suitable solvent for example ethanol or chloroform
  • Drug (b) may be any drug which is effective against degenerative lung disease. Preferred drugs are those already licensed for such treatment, and these may include bronchodilators, anti-inflammatoiies and antibiotics.
  • the drug (b) may comprise one or more effective drugs.
  • effective drugs for use in combination with SAPL include:
  • anti-muscarinics also known as anti-cholinergics: ipratropium (bromide), tiotropium (bromide) etc;
  • beta-2 agonists salbutamol, formoterol, salmeterol etc; 3. combinations of 1 and 2;
  • cromones (sodium) cromoglycate, nedocromil etc.
  • the combination product of this invention may also include anti-infective agents as a prophylactic or treatment for infections arising from or associated with degenerative lung disease.
  • the combination product may typically comprise one or more said drugs in an amount of up to 10 parts, especially up to one part by weight per 100 parts by weight of said first and second components, in combination, of the SAPL (a). It will be appreciated that the drug or drugs should be present in such an amount that each dose delivered by the device contains an effective amount of the drug or drugs.
  • At least ingredient (a) is arranged to be delivered to a patient in the form of at least one individual inhalable dose, the or each individual dose comprising said first and second components of ingredient (a) in a combined amount of at least lOmg.
  • phospholipids have been disclosed previously as adjuvants in certain forms of drug delivery devices, the amounts of phospholipid administered in a dose by those previously disclosed devices have been much smaller than those envisaged according to the present invention.
  • the first and second components are substantially non-toxic, and the upper limit of the dosage of ingredient (a) may therefore in general be selected having regard to convenience taking into account matters such as, for example, the comfort of the patient and/or design parameters of the device.
  • the delivery device used to administer the compositions of this invention will be such that it can deliver doses of up to lOOOmg, advantageously up to 500mg, preferably up to 200mg, and especially up to lOOmg.
  • at least ingredient (a) is arranged for sequential delivery of a multiplicity of inhalable doses.
  • the dry powder can be administered in large doses i.e. 40 mg and above without causing irritation.
  • the products of the invention have the further advantage that the first and second components of the medicament (a) may be of synthetic origin. It has been found undesirable to expose patients to inhaled proteins of animal origin, because such proteins can have a sensitising effect on such patients, and thus the use of synthetic material has considerable advantages over the use of surfactants of animal origin that may contain animal protein.
  • the medicament should not break down in the environment of the lungs.
  • One of the factors which will reduce the life of a lining or coating will be the presence of enzymes, such as phospholipase A capable of digesting DPPC and/or PG.
  • enzymes such as phospholipase A capable of digesting DPPC and/or PG.
  • Such enzymes only attack the laevorotatory (L) form, which constitutes the naturally occurring form. Therefore, the medicament should preferably contain the dextrorotatory (D) form or at least comprise a racemic mixture, which is obtained by synthetic routes.
  • Delivery devices for administering compositions of this invention may employ a propellant such as a halocarbon to form a carrier gas stream and may include a tapered discharge nozzle baffle or a venturi to accelerate particles through a discharge nozzle, and to remove oversized particles.
  • a propellant such as a halocarbon
  • Suitable halocarbons include hydrofluorocarbons, hydrofluorochlorocarbons and fluorochlorocarbons having a low boiling point, such as those marketed under the trade mark "Freon”.
  • the medicament may be packaged with a propellant in a pressurised aerosol container within the inhaler.
  • Other inhalers have an impeller which mixes the powder into an air stream and delivers the powder-laden air into the patient's airways, see, e. g. US Patent 5,577,497.
  • a preferred method and apparatus for administering the medicament involves dispersing the powdered medicament in a propellant gas stream.
  • a pressurised canister of a liquefied gas may be connected to a vial containing the SAPL (a).
  • One suitable form of dispenser for use with the medicaments of this invention for inhalation is described in WO 00/30654, the entire disclosure of which is incorporated herein by reference.
  • increments of the SAPL (a) are ejected from the vial as a cloud of powder and may be inhaled by the user.
  • the drug (b) may be introduced into the gas stream, so that it is administered in admixture with the medicament (a). It is envisaged that, in use, one or two inhalable doses of the medicament (a), each dose containing more than 40 mg, e.g. 50 - 125 mg, may be administered up to three times daily.
  • adrninistration of the drug (b) may occur as and when required by the patient and the timing of administration may thus be independent of the timing of administration of the SAPL (a).
  • An advantage of separate or sequential administration of drug (b) is that initial delivery of SAPL (a) may by its spreading surfactant action open up occluded airways, so as to increase the efficacy of the ballistic delivery of drug (b), as well as transporting drug (b) into otherwise inaccessible areas by its surfactant effect.
  • SAPL (a) may be sufficient to justify its use as a monotherapy, as a preliminary treatment or a treatment between successive doses of the combination product.
  • the non-toxic nature of SAPL means that it can be safely used as interim relief, for example when a patient is prevented from immediate use of drug (b) until elapse of further time, to avoid risk of overdose following on from an earlier dose.
  • SAPL (a) can be administered conjointly and simultaneously with drug (b) by providing that drug (b) is dissolved or dispersed in SAPL (a).
  • SAPL (a) preferably as two components as described above, and drug (b) may be precipitated or spray dried from a common solvent.
  • the invention provides use of (a) a surface active phospholipid (SAPL) composition in finely divided form conjointly with (b) a drug for degenerative lung disease in the manufacture of a medicament or a medicament kit for treatment of degenerative lung disease.
  • SAPL surface active phospholipid
  • Such a medicament kit is a pack with separate dosage forms of SAPL (a) and drug (b), intended for administration in combination therapy.
  • high surface activity typically means that the equihbrium surface tension, measured as described in the above WO 00/30654, is at least 10% lower than the surface tension before the composition is applied to the water surface.
  • the reduction in surface tension obtainable using certain phospholipid compositions such as those mentioned above in illustration of SAPL (a) may exceed 50%.
  • a component included in admixture with another material is to be understood as enhancing the spreading of the other material if, in carrying out the above method for determination of surface activity using the mixture and, separately, using the other material alone, the time taken for the equilibrium surface tension to be reached is shorter for the mixture, as compared to the material alone.
  • the above method describes determination of surface activity at 37°C. It will be appreciated that, where reference is made herein to enhancing spreading at about normal mammalian body temperature, the method should be carried out at about the normal body temperature of the relevant mammal, where that is not about 37°C.
  • the present invention also provides combination product for use in the prevention or treatment of asthma comprising
  • a medicament comprising a first phospholipid component which is capable of binding to lung tissue and a second component which is capable of enhancing the spreading of said first component over an aqueous medium at 37°C, said medicament being in the form of a finely divided powder;
  • compositions have in particular found to be effective in treatment of horses.
  • SAPL can be administered in powder form as a veterinary treatment, for example via an endotracheal tube or by nasal administration, in large quantities without evidence of irritation. For example, doses of 1500 - 4000 mg have been given to horses to treat airway disease without any adverse reaction.
  • SAPL as a component of a combination therapy for lung disease.
  • drugs applied by ballistic delivery such as sprays
  • ballistic delivery can reach only a small portion of the mucosal membranes intended to be treated or to provide a route for adso ⁇ tion of the drug. This may be due to the obstructed state of route of delivery, such as the airways or the abdominal cavity, which may be partially or completely blocked by mucous build-up or anatomical deterioration (or both).
  • Another major problem in drug delivery is the effective absorption of high molecular weight materials such as proteins and peptides across biological membranes, including mucosal membranes and cell walls. Normally such molecules are not taken up by the body if administered to the abdominal cavity, or by intranasal or pulmonary delivery.
  • SAPLs provide a means for improving the lateral and depthwise dispersion of drugs applied to the mucous layer overlying mucosal membranes or cell walls, thus increasing the effective degree of contact of the drugs with the membranes or cell walls.
  • Another object of this invention is to provide a method for improving delivery of a drug to mucosal mebranes by use of a dry powder SAPL administered as a dry powder in combination with the drug.
  • This invention therefore additionally provides a therapeutic combination product for delivery of drugs into body cavities, in particular to contact mucosal membranes, comprising
  • SAPL surface active phospholipid
  • the SAPL including a component which enhances spreading of the medicament over a surface at about normal mammalian body temperature
  • SAPL ingredient (a) has a number of important effects in the further combination product of this invention:
  • the spreading of the SAPL carries the biological active (c) into areas of the body cavity that cannot be reached by ballistic delivery alone;
  • the SAPL allows the biological active (c) to move through the mucous layers overlying the target surfaces.
  • the SAPL promotes transfer of biological actives (c)across the apical membrane.
  • Biologically active substances for delivery by this invention include proteins (natural and recombinant) and synthetic poly- and oligo-peptides, for example hormones and enzymes and active fragments thereof, and also poly- and oligo-nucleotides, or plasmids or vectors incorporating them, for gene therapy.
  • the SAPL (a) is in the form of a powder, that is, it is in solid form.
  • the "dry" surfactant has a high surface activity.
  • SAPL (a) has two components.
  • the first component of the SAPL (a) comprises a phosphatidylcholine (PC), suitably one or more compounds selected from the group consisting of diacyl phosphatidyl cholines.
  • suitable diacyl phosphatidyl cholines (DAPCs) are dioleyl phosphatidyl choline (DOPC); distearyl phosphatidyl choline (DSPC) and dipalmitoyl phosphatidyl choline (DPPC).
  • DOPC dioleyl phosphatidyl choline
  • DSPC distearyl phosphatidyl choline
  • DPPC dipalmitoyl phosphatidyl choline
  • the first component is DPPC.
  • the second component may comprise one or more compounds selected from the group consisting of phosphatidyl glycerols (PG); phosphatidyl ethanolamines (PE); phosphatidyl serines (PS); phosphatidyl inositols (PI) and chlorestyl palmitate (CP).
  • PG phosphatidyl glycerols
  • PE phosphatidyl ethanolamines
  • PS phosphatidyl serines
  • PI phosphatidyl inositols
  • CP chlorestyl palmitate
  • Phosphatidyl glycerol is believed to be capable of binding mucosal membranes and possibly enhancing the binding of the first component and is, therefore, a preferred second component.
  • PG is also a preferred second component because of its ability to form with the first component a very finely-divided, dry powder dispersion in air.
  • the medicament advantageously comprises a diacyl phosphatidyl choline and a phosphatidyl glycerol.
  • the phosphatidyl glycerol is advantageously a diacyl phosphatidyl glycerol.
  • the acyl groups of the phosphatidyl glycerol which may be the same or different, are advantageously each fatty acid acyl groups which may have from 14 to 22 carbon atoms.
  • the phosphatidyl glycerol component may be a mixture of phosphatidyl glycerols containing different acyl groups.
  • the phosphatidyl glycerol is expediently obtained by synthesis from purified lecithin, and the composition of the acyl substituents is then dependent on the source of the lecithin used as the raw material. It is preferred for at least a proportion of the fatty acid acyl groups of the phosphatidyl glycerol to be unsaturated fatty acid residues, for example, mono-or di-unsaturated CIS or C20 fatty acid residues.
  • Preferred acyl substituents in the phosphatidyl glycerol component are palmitoleoyl, oleoyl, linoleoyl, linolenoyl and arachidonoyl.
  • the medicament preferably comprises dipalmitoyl phosphatidyl choline and phosphatidyl glycerol, with the phosphatidyl moiety of the phosphatidyl glycerol advantageously being obtainable from the phosphatidyl moiety of egg lecithin.
  • the presence of a second component results in a lowering of the melting point of the first component, promoting rapid spreading of the first component over the liquid-air interface as a thin film at body temperature.
  • the normal melting temperature of dipalmitoyl phosphatidyl choline which is a preferred first component, is about 40°C, that is, above the normal body temperature.
  • a suitable second component such as a phosphatidyl glycerol
  • SAPL (a) is in finely divided solid form. It is believed that, as a consequence of the high surface activity of SAPL (a) in that form there results a significant drop in surface tension on contact with the aqueous mucous layer over the surfaces within a body cavity, permitting improved access to the surfaces for the biological active(s) (c) to be administered. Thus, the use of the SAPL (a) in combination with a biological active (c) is believed to enhance the effectiveness of the biological active (c).
  • an a biological active (c) may be administered to a given patient to be reduced, as a consequence of the spreading effect of SAPL (a) in increasing the area of contact of the biological active (c) over the surfaces within a body cavity, as well as movement of the biological active (c) through any overlying mucous layer on the surfaces.
  • the spreading action of the SAPL carries the biological active (c) into regions of the body cavity that cannot be reached by ballistic delivery of biological active (c) alone.
  • the first and second components of the medicament (a) may be present in a weight ratio of from 1: 9 to 9: 1.
  • the proportion by weight of the first component exceeds that of the second component.
  • said first component and said second component are present in a weight ratio of from 6: 4 to 8: 2.
  • At a weight ratio of about 7: 3 the mixture spreads rapidly at a temperature of 35°C or above.
  • DPPC can be prepared synthetically by acylation of glycerylphosphorylcholine using the method of Baer & Bachrea -Can. J. Of Biochem. Physiol 1959, 37, page 953 and is available commercially from Sigma (London) Ltd.
  • the PG may be prepared from egg phosphatidyl-choline by the methods of ComfUrions et al, Biochem. Biophys Acta 1977,488, pages 36 to 42; and Dawson, Biochem J. 1967,102, pages 205 to 210.
  • the most preferred composition of the invention contains DPPC and a phosphatidyl glycerol derived from egg phosphatidyl choline and having a mixture of C16, C18 (saturated and unsaturated) and C20 (unsaturated) acyl groups.
  • the phospholipid components may be dissolved in a suitable solvent, for example ethanol, the solution filtered and vacuum-dried, and the solid product size-reduced to obtain particles of the desired size.
  • a suitable solvent for example ethanol
  • Component (c) may be any substance which has biological activity, for example:
  • Insulin hexameric/dimeric/monomeric forms
  • insulin derivatives e.g. lysine- proline (Lyspro) insulin
  • GHRH Greenth hormone releasing hormone
  • GRF Rowth releasing factor
  • THF TRH Thirotropin releasing hormone
  • IGF Insulin like growth factors
  • CGRP Calcitonin gene related peptide
  • Atrial Natriuretic Peptide Nasopressin and analogues DDAVP, Lypressin
  • Migraine treatment (Dihydroergotamine, Ergometrine, Ergotamine, Pizotizin)
  • G-CSF granulocyte-colony stimulating factor
  • EPO Errythropoietin
  • Antibiotics and antimicrobial agents such as tetracycline hydrochloride, leucomycin, penicillin, penicilhn derivatives and erythromycin, chemotherapeutic agents such as sulphathiazole and nitrofurazone; local anaesthetics such as benzocaine; vasoconstrictors such as phenylephrine hydrochloride, tetrahydrozoline hydrochloride, naphazoline nitrate, oxymetazoline hydrochloride and tramazoline hydrochloride; cardiotonics such as digitalis and digoxin; vasodilators such as nitroglycerin and papaverine hydrochloride; antiseptics such as chlorhexidine hydrochloride, hexylresorcinol, dequalinium chloride and ethacridine; enzymes such as lysozyme chloride, dextranase; bone metabolism controlling agents such as vitamin
  • Steroidal anti-inflammatory agents such as hydrocortisone, prednisone, fluticasone, predonisolone, triamcinolone, triamcinolone acetonide, dexamethasone, betamethasone, beclomethasone, and beclomethasone dipropionate; non-steroidal anti-inflammatory agents such as acetaminophen, aspirin, aminopyrine, phenylbutazone, mefenamic acid, ibuprofen, diclofenac sodium, indomethacin, colchicine, and probenecid; enzymatic anti-inflammatory agents such as chymotrypsin and bromelin seratiopeptidase; anti- stanriinic agents such as diphenhydramine hydrochloride, cWoropheniramine maleate and clemastine.
  • non-steroidal anti-inflammatory agents such as acetaminophen, aspirin, aminopyrine, phenylbutazone, mefenamic
  • dry powder SAPL may be used as a vehicle to deliver to the respiratory tract drugs such as antibiotics, pulmonary vasodilators), elastase inhibitors, bronchodilators , steroids and proteins. These drugs are currently delivered orally or by injection.
  • the combination product may comprise one or more said drugs in an amount of up to 10 parts, especially up to one part by weight per hundred parts by weight of said first and second components, in combination, of the SAPL (a). It will be appreciated that the drug or drugs should be present in such an amount that each dose delivered by the device contains an effective amount of the biologically active substances (c). ,
  • the products of the invention have the further advantage that the first and second components of the medicament (a) may be of synthetic origin. It has been found undesirable to expose patients to inhaled proteins of animal origin, because such proteins can have a sensitising effect on such patients, and thus the use of synthetic material has considerable advantages over the use of surfactants of animal origin that may contain animal protein.
  • the medicament should not break down within the body cavity.
  • One of the factors which will reduce the life of a lining or coating will be the presence of enzymes, such as phospholipase A, capable of digesting DPPC and or PG. Such enzymes only attack the laevorotatory (L) form, which constitutes the naturally occurring form. Therefore, the medicament should preferably contain the dextrorotatory (D) form or at least comprise a racemic mixture, which is obtained by synthetic routes.
  • Conventional delivery systems for powder compositions may be used with the delivery system of this invention, to administer the SAPL powder or both the SAPL (a) and the active substance (c) into a patient's body cavities, such as Eustachian tubes, nasal passages, airways or the abdominal cavity.
  • the powdered components are delivered in a stream of a carrier gas. This may be a simple air puffer when the body cavity is open during surgery.
  • delivery devices for adrninistering compositions of this invention may employ a propellant such as a halocarbon to form a carrier gas stream and may include a tapered discharge nozzle baffle or a venturi to accelerate particles through a discharge nozzle, and to remove oversized particles.
  • Suitable halocarbons include hydrofluorocarbons, hydrofluorochlorocarbons and fluorochlorocarbons having a low boiling point, such as those marketed under the trade mark "Freon".
  • the medicament may be packaged with a propellant in a pressurised aerosol container within an inhaler.
  • Other delivery devices have an impeller which mixes the powder into an air stream and delivers the powder-laden air into the patient's body cavities, see, e. • £g3.- US Patent No. 5,577,497.
  • a preferred,method and apparatus for administering the medicament involves dispersing the powdered medicament in a propellant gas stream.
  • a pressurised canister of a liquefied gas may be connected to a vial containing the SAPL (a).
  • increments of the SAPL (a) are ejected from the vial as a cloud of powder and may be directed to coat the relevant mucosal surfaces or for inhalation nasally or orally.
  • the biological active (c) may be introduced into the gas stream, so that it is administered in admixture with the medicament (a).
  • each dose containing at least 50mg of the SAPL (a) may be administered up to three times daily.
  • the delivery device used to administer the compositions of this invention will be such that it can dehver doses of up to lOOOmg, advantageously up to 500mg, preferably up to 200mg, and especially up to lOOmg.
  • biological active (c) is to be administered separately or sequentially with the SAPL (a)
  • administration of the biological active (c) may occur as and when required by the patient and the timing of administration may thus be independent of the timing of administration of the SAPL (a).
  • An advantage of separate or sequential administration of drug (c) is that initial delivery of SAPL (a) may by its spreading surfactant action open up occluded passages, so as to increase the efficacy of ballistic delivery of drug (c), as well as transporting drug (c) into otherwise inaccessible areas by its surfactant effect.
  • SAPL (a) can be administered conjointly and simultaneously with biological active (c) by providing that biological active (c) is dissolved or dispersed in SAPL (a).
  • biological active (c) may be precipitated or spray dried from a common solvent.
  • the invention provides use of (a) a surface active phospholipid (SAPL) composition in finely divided form and (c) a biologically active substance in the manufacture of a medicament for combined therapy with simultaneous, separate or sequential administration by ballistic delivery to a patient's body cavity.
  • the medicament may be a medicament kit i.e. a pack with separate dosage forms of SAPL (a) and biological active (c), intended for administration in combination therapy.
  • the particle size of the SAPL and or the whole composition is not critical; the controlling factor is the particle size that can be easily delivered to the cavity by the delivery means selected.
  • particle sizes of 0.5 - 1000 microns, preferably 10 - 500 microns, more preferably 25 -100 microns may used, for example in nasal administration.
  • the particle size is in the range of 0.5 to lOO ⁇ m.
  • Particles which are more readily conveyed in a gas stream typically have a particle size of 0.5 to 20 ⁇ m, more suitably 0.5 to lO ⁇ m.
  • Example 1 neutrophil reduction
  • a 650 kg horse was dosed via an endotracheal tube to deliever 1500 mg of a dry powder SAPL compostion, consisting of DPPC and PG in the ratio 7:3 by wt., directly to the carina of the brochi.
  • a known volume of buffered saline was aspirated into the trachea and then sucked out. The tracheal washings were sent away for analysis, with the results reported below.
  • the data indicates that a horse with generally high inflammatory scores at baseline showed a marked reduction in neutrophils post-dosing.

Abstract

Surface active phospholipid (SAPL) is administered as a dry powder for the treatment of neutrophil-induced or irreversible degenerative lung disease, especially chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). The SAPL powder is also used in combination therapy to enhance the delivery of biologically active substances to airways to treat COPD and CF, and to enhance the delivery of other actives via mucosal membranes.

Description

USE OF PHOSPHOLIPIDS IN THE TREATMENT OF DEGENERATIVE LUNG DISEASE AND TO ENHANCE DELIVERY OF DRUGS
This invention relates to pharmaceutical products based on surface active phospholipid (SAPL) for use in the treatment of neutrophil-induced or irreversible degenerative lung disease, especially chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF), and to the use of surface active phospholipid (SAPL) to enhance the delivery of biologically active substances in therapeutic adrniriistration to mammals.
SAPL is used clinically for the treatment of respiratory distress syndrome (RDS) in neonates. In this role, it has been assumed that the SAPL functions by reducing the high surface tension forces at the air-water interface within the alveoli, thereby reducing the pressure needed to expand the lungs, see Bangham et al., Colloids & Surfaces, 10 (1984), 337 to 341.
EP-0 528 034-A (Tokyo Tanabe) describes the use of pulmonary surface active material as an ingredient of an anti-asthmatic, which is in the form of a liquid or suspension for injection or spraying into the patient's air way.
WO-00/30654 (Britannia) describes a combination product for treating asthma, comprising a powdered surface active phospholipid composition and an anti-asthma drug.
One object of this invention is to provide a method for treatment of neutrophil- induced degenerative lung disease and irreversible degenerative lung disease, especially chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF), by use of a dry powder SAPL administered as a dry powder..
Asthma and COPD have several common symptoms, but asthma is allergen-induced and reversible, while COPD and CF are neutrophil-induced and irreversible In simplistic terms these diseases may be differentiated from asthma by the concept that asthma patients find it difficult to breathe in (due to bronchio-constriction), while COPD patients find it difficult to breathe out (when a COPD patient inhales, the air can still move into the alveoli; but when the patient exhales, the air is often trapped in the lungs by the collapse of the small airways) and CF patients find it difficult to clear their lungs (due to dysfunctional mucociliary clearance). Neutrophil granulocytes are the major acute inflammatory cells, important in host defence but also implicated in tissue injury. In an inflammatory response, neutrophils migrate from the blood into tissues and are activated by proinflammatory mediators. Neutrophil tissue injury is mediated by a combination of neutrophil granule contents, which are released to the exterior, together with generation of oxygen radicals via the NAPDH oxidase system. Neutrophil clearance from tissues permits resolution of inflammation.
Chronic obstructive pulmonary disease (COPD) is a term which includes chronic bronchitis and emphysema. The predominant cause of COPD is cigarette smoking. The chronic bronchitic type patient is characterised by cough and mucous hypersecretion, peripheral airway disease with bronchiolar inflammation, hypertrophy of airway smooth muscle, and fibrosis. These features lead to a persistent limitation to expiratory airflow that shows a progressive deterioration. The presence of self- perpetuating cycles of bronchial inflammation and impairment of mucociliary clearance with bacterial colonisation of retained secretions is a feature of chronic bronchitis. Emphysema is defined as the abnormal, permanent enlargement of the airspaces distal to the terminal bronchioli and destruction of the alveolar walls which again shows progressive deterioration. A rare, genetic, cause of emphysema is alphai-antitrypsin deficiency which would typically present at a younger age than smoking-related emphysema.
Cystic fibrosis (CF) is the most common inherited disorder in the Caucasian population. The cystic fibrosis transmembrane conductance regulator (CFTR) is an epithelial chloride channel. Absent or defective expression of CFTR in CF patients leads to an abnormal accumulation of secretions in the airways which enhances bacterial colonisation and leads to progressive inflammatory airway changes. Mucociliary clearance is known to be decreased in CF as a result of several factors including dysfunctional/destroyed cilia coupled with altered and increased mucous. This decrease in an effective clearance mechanism results in retained secretions leading to persistence of inflammation and infective exacerbations.
A common feature of these types of diseases is the obstructed state of the airways, which are either partially or completely blocked, whether by mucous build-up or anatomical deterioration (or both). The implication of this statement is that even when drugs such as ipratropium, with a place in COPD therapy, are given, there is a real risk that the drug particles will not be sufficiently penetrative based on their severely compromised ballistics in the obstructed airways.
This invention provides a therapeutic combination product for use in the prevention and/or treatment of degenerative lung disease comprising (a) a surface active phospholipid (SAPL) composition in finely divided form, the SAPL including a component which enhances spreading of the medicament over a surface at about normal mammalian body temperature; and (b) a drug effective for the treatment of degenerative lung disease; wherein ingredients (a) and (b) are provided in a form for administration together, as a mixture or separately, or sequentially.
In this invention, degenerative lung disease includes in particular chronic obstructive pulmonary disease, smokers lung, chronic bronchitis, and cystic fibrosis.
The SAPL ingredient (a) has a number of important effects in the combination product of this invention:
♦ the SAPL spreads rapidly over the surfaces of the lungs and air passages;
♦ the spreading of the SAPL carries drug (b) into lung areas that cannot be reached by ballistic delivery alone; ♦ the SAPL allows the drug (b) to move through the mucous layers characteristic of the above diseases to reach the underlying lung surfaces; where the combination is for use in the treatment of neutrophil-induced or irreversible degenerative lung disease;
♦ the SAPL reduce surface tension of endogenous surfactant to open the airways to allow penetration;
♦ the SAPL bind to airway epithelium to act as a protective lining with good "nonstick" properties to facilitate clearance of sputum via mucociliary transport;
♦ the SAPL improve the rheology of mucous (lower viscosity) to promote clearance.
It is an important feature of the present invention that the SAPL (a) is in the form of a powder, that is, it is in solid form. The "dry" surfactant has a high surface activity. Preferably, SAPL (a) has two components. Suitably the first component of the SAPL (a) comprises a phosphatidylcholine (PC), suitably one or more compounds selected from the group consisting of diacyl phosphatidyl cholines. Examples of suitable diacyl phosphatidyl cholines (DAPCs), are dioleyl phosphatidyl choline (DOPC); distearyl phosphatidyl choline (DSPC) and dipalmitoyl phosphatidyl choline (DPPC). Each of those compounds appears to be capable of forming a thin film or coating on surfaces of the lungs. Most preferably, the first component is DPPC. The second component may comprise one or more compounds selected from the group consisting of phosphatidyl glycerols (PG); phosphatidyl ethanolarnines (PE); phosphatidyl serines (PS); phosphatidyl inositols (PI) and chlorestyl palmitate (CP).
Phosphatidyl glycerol (PG) is believed to be capable of binding to lung tissue and possibly enhancing the binding of the first component and is, therefore, a preferred second component. PG is also a preferred second component because of its ability to form with the first component a very finely-divided, dry powder dispersion in air.
The medicament advantageously comprises a diacyl phosphatidyl choline and a phosphatidyl glycerol. The phosphatidyl glycerol is advantageously a diacyl phosphatidyl glycerol. The acyl groups of the phosphatidyl glycerol, which may be the same or different, are advantageously each fatty acid acyl groups which may have from 14 to 22 carbon atoms. In practice, the phosphatidyl glycerol component may be a mixture of phosphatidyl glycerols containing different acyl groups. The phosphatidyl glycerol is expediently obtained by synthesis from purified lecithin, and the composition of the acyl substituents is then dependent on the source of the lecithin used as the raw material. It is preferred for at least a proportion of the fatty acid acyl groups of the phosphatidyl glycerol to be unsaturated fatty acid residues, for example, mono-or di-unsaturated C18 or C20 fatty acid residues.
Preferred acyl substituents in the phosphatidyl glycerol component are palmitoleoyl, oleoyl, linoleoyl, linolenoyl and arachidonoyl. The medicament preferably comprises dipalmitoyl phosphatidyl choline and phosphatidyl glycerol, with the phosphatidyl moiety of the phosphatidyl glycerol advantageously being obtainable from the phosphatidyl moiety of egg lecithin.
It is believed that, on contact of a first component of the medicament (a) with the mucous within the lungs, the presence of a second component results in a lowering of the melting point of the first component, promoting rapid spreading of the first component over the liquid-air interface as a thin film at body temperature. For example, the normal melting temperature of dipalmitoyl phosphatidyl choline, which is a preferred first component, is about 40°C, that is, above the normal body temperature. When used in combination with a suitable second component, such as a phosphatidyl glycerol, however, the melting point of the dipalmitoyl phosphatidyl choline can in effect be reduced to below the normal body temperature.
Second, once the surface active medicament is in situ over the surfaces of the lungs and air passages, a component of the composition is thought to migrate across the mucous layer enabling a thin hydrophobic lining or coating to be adsorbed onto the tissue surface.
The SAPL (a) is in finely divided solid form. It is believed that, as a consequence of the high surface activity of SAPL (a) in that form there results a significant drop in surface tension on contact with the aqueous mucous layer of the lung, permitting improved access to the lung surfaces for the drug (or drugs) (b) to be administered. Thus, the use of the SAPL (a) in combination with a drug (b) is believed to enhance the effectiveness of the drug (b).
Thus, in some circumstances it may be possible for dosages of an a drug (b) to be administered to a given patient to be reduced, as a consequence of the spreading effect of SAPL (a) in increasing the area of contact of the drug (b) with the lung surfaces, as well as movement of the drug (b) through any mucous layer on the surfaces. Further, there is an increase in efficacy of the treatment, because the spreading action of the SAPL carries the drug (b) into lung areas that cannot be reached by normal ballistic delivery of drug (b) alone.
The finely divided powders as used herein have a particle size distribution which is such that at least a major portion by weight of the particles are small enough to enter into a patient's airways and, preferably, deep into the lungs when inhaled. In practice, the first and second components preferably each have a particle size distribution which is such that not less than 90%, by weight, of the particles of those components in combination, and more preferably of each of the first and second components, have a particle size of not greater than lOμm, and especially of not greater than 5μm. Advantageously, the median particle size of the combined first and second components, and more preferably of each of the first and second components is not more than lOμm, and preferably not more than 5μm. The median particle size may be less than 3μm, for example, about 1.2μm. It may be desirable in some circumstances for the particles to have a median particle size of at least 0.5μm. The size of the particles may be calculated by laser diffraction, or by any other method by which the aerodynamic diameter of particles can be determined. "Median particle size" as used herein means mass median aerodynamic diameter ( rVLAD). The MMAD may be determined using any suitable method, for example, using a Multi-Stage Liquid I pinger in accordance with the method described in European Pharmacopoeia (supplement 1999) 2.9.18 (Aerodynamic assessment of fine particles). Alternatively, the size distribution of the particles may be characterised by their volume mean diameter (NMD). Advantageously, the NMD is not more than lOμm, for example not more than 5μm, and preferably less than 3μm. Finely divided dry powders of this kind can be adsorbed onto the surfaces of lung tissue and are believed, in use, to become bound to the epithelium.
A finely divided solid mixture of said first and second components of the medicament (a) may be obtained by size reduction of larger particles by any suitable size reduction method. The first and second components of the medicament (a) may be present in a weight ratio of from 1: 9 to 9: 1.
Advantageously, the proportion by weight of the first component exceeds that of the second component. Preferably, said first component and said second component are present in a weight ratio of from 6: 4 to 8: 2. At a weight ratio of about 7: 3, the mixture spreads rapidly at a temperature of 35°C or above.
DPPC can be prepared synthetically by acylation of glycerylphosphorylcholine using the method of Baer & Bachrea -Can. J. of Biochem. Physiol 1959, 37, page 953 and is available commercially from Sigma (London) Ltd. The PG may be prepared from egg phosphatidyl-choline by the methods of Comfurions et al, Biochem. Biophys Acta 1977,488, pages 36 to 42; and Dawson, Biochem J. 1967, 102, pages 205 to 210.
When PG is co-precipitated with DPPC from a common solvent such as chloroform or ethanol, the mixture of PG and DPPC forms a fine powder. When inhaled, this powder spreads rapidly over the surfaces of the airways and lungs. The most preferred composition of the invention contains DPPC and a phosphatidyl glycerol derived from egg phosphatidyl choline and having a mixture of C16, C18 (saturated and unsaturated) and C20 (unsaturated) acyl groups. To obtain a mixture in which the particle size is suitable for inhalation, the phospholipid components may be dissolved in a suitable solvent, for example ethanol or chloroform, the solution filtered and vacuum-dried, and the solid product size-reduced as necessary, to obtain particles of the desired size. During size-reduction, care should be taken to protect the mixture from moisture, oxygen, direct heat, electrostatic charge and microbial contamination. Drug (b) may be any drug which is effective against degenerative lung disease. Preferred drugs are those already licensed for such treatment, and these may include bronchodilators, anti-inflammatoiies and antibiotics. The drug (b) may comprise one or more effective drugs.
More specifically, effective drugs for use in combination with SAPL include:
1. anti-muscarinics (also known as anti-cholinergics): ipratropium (bromide), tiotropium (bromide) etc;
2. beta-2 agonists: salbutamol, formoterol, salmeterol etc; 3. combinations of 1 and 2;
4. combinations of 2 and steroids;
5. cromones: (sodium) cromoglycate, nedocromil etc.
When the primary drug (b) is not already an antibiotic, the combination product of this invention may also include anti-infective agents as a prophylactic or treatment for infections arising from or associated with degenerative lung disease.
The combination product may typically comprise one or more said drugs in an amount of up to 10 parts, especially up to one part by weight per 100 parts by weight of said first and second components, in combination, of the SAPL (a). It will be appreciated that the drug or drugs should be present in such an amount that each dose delivered by the device contains an effective amount of the drug or drugs.
Advantageously, at least ingredient (a) is arranged to be delivered to a patient in the form of at least one individual inhalable dose, the or each individual dose comprising said first and second components of ingredient (a) in a combined amount of at least lOmg. Whereas phospholipids have been disclosed previously as adjuvants in certain forms of drug delivery devices, the amounts of phospholipid administered in a dose by those previously disclosed devices have been much smaller than those envisaged according to the present invention. In fact, it is preferred in accordance with the present invention for each individual dose to comprise at least 25mg, and more especially at least 40mg of said first and second components. The first and second components are substantially non-toxic, and the upper limit of the dosage of ingredient (a) may therefore in general be selected having regard to convenience taking into account matters such as, for example, the comfort of the patient and/or design parameters of the device. In general, however, the delivery device used to administer the compositions of this invention will be such that it can deliver doses of up to lOOOmg, advantageously up to 500mg, preferably up to 200mg, and especially up to lOOmg. Preferably, at least ingredient (a) is arranged for sequential delivery of a multiplicity of inhalable doses.
It is a great advantage of the SAPL medicament used in the present invention that the dry powder can be administered in large doses i.e. 40 mg and above without causing irritation.
The products of the invention have the further advantage that the first and second components of the medicament (a) may be of synthetic origin. It has been found undesirable to expose patients to inhaled proteins of animal origin, because such proteins can have a sensitising effect on such patients, and thus the use of synthetic material has considerable advantages over the use of surfactants of animal origin that may contain animal protein.
Because it is desirable in the present invention to achieve a relatively long term adsorption of the SAPL (a) on the lung surfaces, it is highly desirable that the medicament (or any active components) should not break down in the environment of the lungs. One of the factors which will reduce the life of a lining or coating will be the presence of enzymes, such as phospholipase A capable of digesting DPPC and/or PG. Such enzymes only attack the laevorotatory (L) form, which constitutes the naturally occurring form. Therefore, the medicament should preferably contain the dextrorotatory (D) form or at least comprise a racemic mixture, which is obtained by synthetic routes.
Delivery devices for administering compositions of this invention may employ a propellant such as a halocarbon to form a carrier gas stream and may include a tapered discharge nozzle baffle or a venturi to accelerate particles through a discharge nozzle, and to remove oversized particles. Suitable halocarbons include hydrofluorocarbons, hydrofluorochlorocarbons and fluorochlorocarbons having a low boiling point, such as those marketed under the trade mark "Freon". The medicament may be packaged with a propellant in a pressurised aerosol container within the inhaler. Other inhalers have an impeller which mixes the powder into an air stream and delivers the powder-laden air into the patient's airways, see, e. g. US Patent 5,577,497.
A preferred method and apparatus for administering the medicament involves dispersing the powdered medicament in a propellant gas stream. For example, a pressurised canister of a liquefied gas may be connected to a vial containing the SAPL (a). One suitable form of dispenser for use with the medicaments of this invention for inhalation is described in WO 00/30654, the entire disclosure of which is incorporated herein by reference. By releasing controlled amounts of gas from the canister into the vial, increments of the SAPL (a) are ejected from the vial as a cloud of powder and may be inhaled by the user. The drug (b) may be introduced into the gas stream, so that it is administered in admixture with the medicament (a). It is envisaged that, in use, one or two inhalable doses of the medicament (a), each dose containing more than 40 mg, e.g. 50 - 125 mg, may be administered up to three times daily.
Where the drug (b) is to be administered separately or sequentially with the SAPL (a) adrninistration of the drug (b) may occur as and when required by the patient and the timing of administration may thus be independent of the timing of administration of the SAPL (a). An advantage of separate or sequential administration of drug (b) is that initial delivery of SAPL (a) may by its spreading surfactant action open up occluded airways, so as to increase the efficacy of the ballistic delivery of drug (b), as well as transporting drug (b) into otherwise inaccessible areas by its surfactant effect.
In fact, the occlusion-clearing effect of SAPL (a) may be sufficient to justify its use as a monotherapy, as a preliminary treatment or a treatment between successive doses of the combination product. The non-toxic nature of SAPL means that it can be safely used as interim relief, for example when a patient is prevented from immediate use of drug (b) until elapse of further time, to avoid risk of overdose following on from an earlier dose.
Such a monotherapy approach using SAPL alone for the treatment of degenerative lung disease forms a further aspect of this invention.
In addition, testing of SAPL on horses suffering from respiratory problems has shown that administration of SAPL reduces the neutrophil count of bronchial lavages, showing both a reduction in inflammation and a reduction of a source of iriflammation. This further supports the benefit of using SAPL as a monotherapy in the treatment of neutrophil-induced degenerative lung disease.
As an alternative to SAPL monotherapy, SAPL (a) can be administered conjointly and simultaneously with drug (b) by providing that drug (b) is dissolved or dispersed in SAPL (a). For example, SAPL (a), preferably as two components as described above, and drug (b) may be precipitated or spray dried from a common solvent.
Furthermore, the invention provides use of (a) a surface active phospholipid (SAPL) composition in finely divided form conjointly with (b) a drug for degenerative lung disease in the manufacture of a medicament or a medicament kit for treatment of degenerative lung disease. Such a medicament kit is a pack with separate dosage forms of SAPL (a) and drug (b), intended for administration in combination therapy.
The term "high surface activity" as used herein with reference to any composition for use in accordance with the invention typically means that the equihbrium surface tension, measured as described in the above WO 00/30654, is at least 10% lower than the surface tension before the composition is applied to the water surface. In practice, the reduction in surface tension obtainable using certain phospholipid compositions such as those mentioned above in illustration of SAPL (a) may exceed 50%.
A component included in admixture with another material is to be understood as enhancing the spreading of the other material if, in carrying out the above method for determination of surface activity using the mixture and, separately, using the other material alone, the time taken for the equilibrium surface tension to be reached is shorter for the mixture, as compared to the material alone.
The above method describes determination of surface activity at 37°C. It will be appreciated that, where reference is made herein to enhancing spreading at about normal mammalian body temperature, the method should be carried out at about the normal body temperature of the relevant mammal, where that is not about 37°C.
Accordingly, the present invention also provides combination product for use in the prevention or treatment of asthma comprising
(a) a medicament comprising a first phospholipid component which is capable of binding to lung tissue and a second component which is capable of enhancing the spreading of said first component over an aqueous medium at 37°C, said medicament being in the form of a finely divided powder; and
(b) a drug effective for the treatment of degenerative lung disease; the ingredients (a) and (b) being arranged for administration in combination or separately, simultaneously or sequentially. While the present invention has been described with particular reference to the treatment of human patients, the monotherapy or combination product of the present invention may also be employed in the treatment of degenerative lung conditions in other mammals. The above described compositions have in particular found to be effective in treatment of horses. Studies have shown that SAPL can be administered in powder form as a veterinary treatment, for example via an endotracheal tube or by nasal administration, in large quantities without evidence of irritation. For example, doses of 1500 - 4000 mg have been given to horses to treat airway disease without any adverse reaction.
The above description indicates the advantageous use of SAPL as a component of a combination therapy for lung disease. In fact, it is a common feature of many diseases that drugs applied by ballistic delivery, such as sprays, can reach only a small portion of the mucosal membranes intended to be treated or to provide a route for adsoφtion of the drug. This may be due to the obstructed state of route of delivery, such as the airways or the abdominal cavity, which may be partially or completely blocked by mucous build-up or anatomical deterioration (or both). There is a risk that drug particles will not be sufficiently penetrative within a body cavity, based on the severely compromised ballistics in obstructed pathways.
Another major problem in drug delivery is the effective absorption of high molecular weight materials such as proteins and peptides across biological membranes, including mucosal membranes and cell walls. Normally such molecules are not taken up by the body if administered to the abdominal cavity, or by intranasal or pulmonary delivery.
Accordingly a further aspect of this invention is based on the recognition that SAPLs provide a means for improving the lateral and depthwise dispersion of drugs applied to the mucous layer overlying mucosal membranes or cell walls, thus increasing the effective degree of contact of the drugs with the membranes or cell walls.
Therefore another object of this invention is to provide a method for improving delivery of a drug to mucosal mebranes by use of a dry powder SAPL administered as a dry powder in combination with the drug.
This invention therefore additionally provides a therapeutic combination product for delivery of drugs into body cavities, in particular to contact mucosal membranes, comprising
(a) a surface active phospholipid (SAPL) composition in powder form, the SAPL including a component which enhances spreading of the medicament over a surface at about normal mammalian body temperature; and (c) a biologically active substance other than an antiasthmatic disclosed in WO- 00/30654 wherein ingredients (a) and (c) are provided in a form for administration together, as a mixture or separately, or sequentially.
As mentioned above in connection with COPD, it is believed that SAPL ingredient (a) has a number of important effects in the further combination product of this invention:
■ the SAPL spreads rapidly over the target surface of the body cavity;
■ the spreading of the SAPL carries the biological active (c) into areas of the body cavity that cannot be reached by ballistic delivery alone;
■ the SAPL allows the biological active (c) to move through the mucous layers overlying the target surfaces.
■ the SAPL promotes transfer of biological actives (c)across the apical membrane.
Biologically active substances for delivery by this invention include proteins (natural and recombinant) and synthetic poly- and oligo-peptides, for example hormones and enzymes and active fragments thereof, and also poly- and oligo-nucleotides, or plasmids or vectors incorporating them, for gene therapy.
It is an important feature of the present invention that the SAPL (a) is in the form of a powder, that is, it is in solid form. The "dry" surfactant has a high surface activity. Preferably, SAPL (a) has two components. Suitably the first component of the SAPL (a) comprises a phosphatidylcholine (PC), suitably one or more compounds selected from the group consisting of diacyl phosphatidyl cholines. Examples of suitable diacyl phosphatidyl cholines (DAPCs), are dioleyl phosphatidyl choline (DOPC); distearyl phosphatidyl choline (DSPC) and dipalmitoyl phosphatidyl choline (DPPC). Each of those compounds appears to be capable of forming a thin film or coating on surfaces of body cavities. Most preferably, the first component is DPPC.
The second component may comprise one or more compounds selected from the group consisting of phosphatidyl glycerols (PG); phosphatidyl ethanolamines (PE); phosphatidyl serines (PS); phosphatidyl inositols (PI) and chlorestyl palmitate (CP).
Phosphatidyl glycerol (PG) is believed to be capable of binding mucosal membranes and possibly enhancing the binding of the first component and is, therefore, a preferred second component. PG is also a preferred second component because of its ability to form with the first component a very finely-divided, dry powder dispersion in air.
The medicament advantageously comprises a diacyl phosphatidyl choline and a phosphatidyl glycerol. The phosphatidyl glycerol is advantageously a diacyl phosphatidyl glycerol. The acyl groups of the phosphatidyl glycerol, which may be the same or different, are advantageously each fatty acid acyl groups which may have from 14 to 22 carbon atoms. In practice, the phosphatidyl glycerol component may be a mixture of phosphatidyl glycerols containing different acyl groups. The phosphatidyl glycerol is expediently obtained by synthesis from purified lecithin, and the composition of the acyl substituents is then dependent on the source of the lecithin used as the raw material. It is preferred for at least a proportion of the fatty acid acyl groups of the phosphatidyl glycerol to be unsaturated fatty acid residues, for example, mono-or di-unsaturated CIS or C20 fatty acid residues.
Preferred acyl substituents in the phosphatidyl glycerol component are palmitoleoyl, oleoyl, linoleoyl, linolenoyl and arachidonoyl. The medicament preferably comprises dipalmitoyl phosphatidyl choline and phosphatidyl glycerol, with the phosphatidyl moiety of the phosphatidyl glycerol advantageously being obtainable from the phosphatidyl moiety of egg lecithin.
It is believed that, on contact of a first component of the medicament (a) with the mucous coating of a surface within a body cavity, the presence of a second component results in a lowering of the melting point of the first component, promoting rapid spreading of the first component over the liquid-air interface as a thin film at body temperature. For example, the normal melting temperature of dipalmitoyl phosphatidyl choline, which is a preferred first component, is about 40°C, that is, above the normal body temperature. When used in combination with a suitable second component, such as a phosphatidyl glycerol, however, the melting point of the dipalmitoyl phosphatidyl choline can in effect be reduced to below the normal body temperature.
Second, 'once the surface active medicament is in situ over the surfaces within a body cavity, a component of the composition is thought to migrate across the mucous layer enabling a thin hydrophobic lining or coating to be adsorbed onto the tissue surface. The SAPL (a) is in finely divided solid form. It is believed that, as a consequence of the high surface activity of SAPL (a) in that form there results a significant drop in surface tension on contact with the aqueous mucous layer over the surfaces within a body cavity, permitting improved access to the surfaces for the biological active(s) (c) to be administered. Thus, the use of the SAPL (a) in combination with a biological active (c) is believed to enhance the effectiveness of the biological active (c).
Thus, in some circumstances it may be possible for dosages of an a biological active (c) to be administered to a given patient to be reduced, as a consequence of the spreading effect of SAPL (a) in increasing the area of contact of the biological active (c) over the surfaces within a body cavity, as well as movement of the biological active (c) through any overlying mucous layer on the surfaces. Further, there is an increase in efficacy of the treatment, because the spreading action of the SAPL carries the biological active (c) into regions of the body cavity that cannot be reached by ballistic delivery of biological active (c) alone.
Suitably the first and second components of the medicament (a) may be present in a weight ratio of from 1: 9 to 9: 1. Advantageously, the proportion by weight of the first component exceeds that of the second component. Preferably, said first component and said second component are present in a weight ratio of from 6: 4 to 8: 2. At a weight ratio of about 7: 3, the mixture spreads rapidly at a temperature of 35°C or above.
DPPC can be prepared synthetically by acylation of glycerylphosphorylcholine using the method of Baer & Bachrea -Can. J. Of Biochem. Physiol 1959, 37, page 953 and is available commercially from Sigma (London) Ltd. The PG may be prepared from egg phosphatidyl-choline by the methods of ComfUrions et al, Biochem. Biophys Acta 1977,488, pages 36 to 42; and Dawson, Biochem J. 1967,102, pages 205 to 210.
When co-precipitated with DPPC from a common solvent such as chloroform, PG forms with DPPC a fine powder which spreads rapidly over the mucosal surfaces. The most preferred composition of the invention contains DPPC and a phosphatidyl glycerol derived from egg phosphatidyl choline and having a mixture of C16, C18 (saturated and unsaturated) and C20 (unsaturated) acyl groups. To obtain a mixture in which the particle size is suitable for use in this aspect of the invention, the phospholipid components may be dissolved in a suitable solvent, for example ethanol, the solution filtered and vacuum-dried, and the solid product size-reduced to obtain particles of the desired size. During size-reduction, care should be taken to protect the mixture from moisture, oxygen, direct heat, electrostatic charge and microbial contamination.
Component (c) may be any substance which has biological activity, for example:
Insulin (hexameric/dimeric/monomeric forms) and insulin derivatives, e.g. lysine- proline (Lyspro) insulin
Glucagon
Growth Hormone (Somatotropin) Polypeptides or their derivatives (preferably with a molecular weight from 1000 to
300,000)
Calcitonins and synthetic modifications thereof
Enkephalins
Interferons (especially Alpha-2 Interferon for treatment of common colds) LHRH and analogues (Nafarelin, Buserelin, Zolidex)
GHRH (Growth hormone releasing hormone)
Secretin
Parathyroid hormone
Leuprolide calcitonin
Nifedipine
Bradykin antagonists
GRF (Growth releasing factor)
THF TRH (Thyrotropin releasing hormone)
ACTH analogues
IGF (Insulin like growth factors)
CGRP (Calcitonin gene related peptide)
Atrial Natriuretic Peptide Nasopressin and analogues (DDAVP, Lypressin)
Antibiotics
Metoclopramide
Migraine treatment (Dihydroergotamine, Ergometrine, Ergotamine, Pizotizin)
Nasal Vaccines (Particularly AIDS vaccines) FACTOR Nm
G-CSF (granulocyte-colony stimulating factor)
EPO (Erythropoietin) Antibiotics and antimicrobial agents such as tetracycline hydrochloride, leucomycin, penicillin, penicilhn derivatives and erythromycin, chemotherapeutic agents such as sulphathiazole and nitrofurazone; local anaesthetics such as benzocaine; vasoconstrictors such as phenylephrine hydrochloride, tetrahydrozoline hydrochloride, naphazoline nitrate, oxymetazoline hydrochloride and tramazoline hydrochloride; cardiotonics such as digitalis and digoxin; vasodilators such as nitroglycerin and papaverine hydrochloride; antiseptics such as chlorhexidine hydrochloride, hexylresorcinol, dequalinium chloride and ethacridine; enzymes such as lysozyme chloride, dextranase; bone metabolism controlling agents such as vitamin D3 and active vitamin D3 ; sex hormones; hypotensives; sedatives; and anti-tumour agents.
Steroidal anti-inflammatory agents such as hydrocortisone, prednisone, fluticasone, predonisolone, triamcinolone, triamcinolone acetonide, dexamethasone, betamethasone, beclomethasone, and beclomethasone dipropionate; non-steroidal anti-inflammatory agents such as acetaminophen, aspirin, aminopyrine, phenylbutazone, mefenamic acid, ibuprofen, diclofenac sodium, indomethacin, colchicine, and probenecid; enzymatic anti-inflammatory agents such as chymotrypsin and bromelin seratiopeptidase; anti- stanriinic agents such as diphenhydramine hydrochloride, cWoropheniramine maleate and clemastine.
In the context of pulmonary disoders, dry powder SAPL may be used as a vehicle to deliver to the respiratory tract drugs such as antibiotics, pulmonary vasodilators), elastase inhibitors, bronchodilators , steroids and proteins. These drugs are currently delivered orally or by injection.
The combination product may comprise one or more said drugs in an amount of up to 10 parts, especially up to one part by weight per hundred parts by weight of said first and second components, in combination, of the SAPL (a). It will be appreciated that the drug or drugs should be present in such an amount that each dose delivered by the device contains an effective amount of the biologically active substances (c). ,
The products of the invention have the further advantage that the first and second components of the medicament (a) may be of synthetic origin. It has been found undesirable to expose patients to inhaled proteins of animal origin, because such proteins can have a sensitising effect on such patients, and thus the use of synthetic material has considerable advantages over the use of surfactants of animal origin that may contain animal protein.
Because it is desirable hi most cases in the present invention to achieve a relatively long term adsorption of the SAPL (a) on the lung surfaces, it is highly desirable that the medicament (or any active components) should not break down within the body cavity. One of the factors which will reduce the life of a lining or coating will be the presence of enzymes, such as phospholipase A, capable of digesting DPPC and or PG. Such enzymes only attack the laevorotatory (L) form, which constitutes the naturally occurring form. Therefore, the medicament should preferably contain the dextrorotatory (D) form or at least comprise a racemic mixture, which is obtained by synthetic routes.
Conventional delivery systems for powder compositions may be used with the delivery system of this invention, to administer the SAPL powder or both the SAPL (a) and the active substance (c) into a patient's body cavities, such as Eustachian tubes, nasal passages, airways or the abdominal cavity. Typically the powdered components are delivered in a stream of a carrier gas. This may be a simple air puffer when the body cavity is open during surgery. In non-surgical situations, such as delivery to the airways, delivery devices for adrninistering compositions of this invention may employ a propellant such as a halocarbon to form a carrier gas stream and may include a tapered discharge nozzle baffle or a venturi to accelerate particles through a discharge nozzle, and to remove oversized particles. Suitable halocarbons include hydrofluorocarbons, hydrofluorochlorocarbons and fluorochlorocarbons having a low boiling point, such as those marketed under the trade mark "Freon". The medicament may be packaged with a propellant in a pressurised aerosol container within an inhaler. Other delivery devices have an impeller which mixes the powder into an air stream and delivers the powder-laden air into the patient's body cavities, see, e. •£g3.- US Patent No. 5,577,497.
A preferred,method and apparatus for administering the medicament, involves dispersing the powdered medicament in a propellant gas stream. For example, a pressurised canister of a liquefied gas may be connected to a vial containing the SAPL (a). By releasing controlled amounts of gas from the canister into the vial, increments of the SAPL (a) are ejected from the vial as a cloud of powder and may be directed to coat the relevant mucosal surfaces or for inhalation nasally or orally. The biological active (c) may be introduced into the gas stream, so that it is administered in admixture with the medicament (a). It is envisaged that, in use, one or two doses of the combination product, each dose containing at least 50mg of the SAPL (a), may be administered up to three times daily. In general, however, the delivery device used to administer the compositions of this invention will be such that it can dehver doses of up to lOOOmg, advantageously up to 500mg, preferably up to 200mg, and especially up to lOOmg.
Where the biological active (c) is to be administered separately or sequentially with the SAPL (a) administration of the biological active (c) may occur as and when required by the patient and the timing of administration may thus be independent of the timing of administration of the SAPL (a). An advantage of separate or sequential administration of drug (c) is that initial delivery of SAPL (a) may by its spreading surfactant action open up occluded passages, so as to increase the efficacy of ballistic delivery of drug (c), as well as transporting drug (c) into otherwise inaccessible areas by its surfactant effect.
Alternatively, SAPL (a) can be administered conjointly and simultaneously with biological active (c) by providing that biological active (c) is dissolved or dispersed in SAPL (a). For example, SAPL (a), preferably as two components as described above, and biological active (c) may be precipitated or spray dried from a common solvent.
Furthermore, the invention provides use of (a) a surface active phospholipid (SAPL) composition in finely divided form and (c) a biologically active substance in the manufacture of a medicament for combined therapy with simultaneous, separate or sequential administration by ballistic delivery to a patient's body cavity. The medicament may be a medicament kit i.e. a pack with separate dosage forms of SAPL (a) and biological active (c), intended for administration in combination therapy.
When the composition is being delivered directly into a body cavity, the particle size of the SAPL and or the whole composition, is not critical; the controlling factor is the particle size that can be easily delivered to the cavity by the delivery means selected. Depending on the circumstances, particle sizes of 0.5 - 1000 microns, preferably 10 - 500 microns, more preferably 25 -100 microns may used, for example in nasal administration. Generally the particle size is in the range of 0.5 to lOOμm. Particles which are more readily conveyed in a gas stream typically have a particle size of 0.5 to 20μm, more suitably 0.5 to lOμm.
The effects used in the present invention are illustrated in the following Examples; Example 1 - neutrophil reduction
A 650 kg horse was dosed via an endotracheal tube to deliever 1500 mg of a dry powder SAPL compostion, consisting of DPPC and PG in the ratio 7:3 by wt., directly to the carina of the brochi. A known volume of buffered saline was aspirated into the trachea and then sucked out. The tracheal washings were sent away for analysis, with the results reported below.
Date 18.12.01 Baseline Tracheal Wash Data Pre Treatment — = non detected, + = mild, ++++ = severe Macroscopic appearance Microscopic appearance
Mucus ++*+• Neutropbils +++ Cloudy trace DegNeutrophils +
Blood + Macropahges +
Siderophages +
Epithelium ++
General Inflammation score (0-12) 7
Date Nucleated Cells / 1 Cell Type Neutrophils Mononuclear Eosionphils Epithelium 19.01.02 0.3 x 10y ~ ~ TZ ZT (24 hours post treatment)
26.01.02 1.2 x lO9 ++ ++ + +
(Pre treatment)
26.01.02 0.8 x 108 +
(24 hours post treatment)
22.02.02 centrifuged deposit smear cell density 28% 24% — 48% (Pre treatment) HIGH
25.02.02 centrifuged deposit smear cell density 32% 27% 3% 38%
(Post treatment) LOW
The data indicates that a horse with generally high inflammatory scores at baseline showed a marked reduction in neutrophils post-dosing.
Example 2 - lack of irritability
In a randomized, single-blind, cross-over study seven, mild, allergic asthmatic subjects (18-60 yr) were enrolled. The active treatment involved 2 doses of 400mgs of pumactant (respirable dose lOOmg as a dry powder SAPL inhalation, consisting of dipalmitoylphosphatidylcholine and unsaturated phosphatidyl glycerol 7:3 by wt) given at 8 and 0.5 hrs prior to allergen challenge. The placebo treatment involved exactly the same procedure but empty vials were used instead. The 2 treatment days were separated by >3 weeks. The surfactant treatment abolished the EAR (early asthmatic response) in all 7 subjects. The surfactant was well tolerated with no adverse events.
This data indicates that the SAPL powder can be administered at high doses, without any irritability issues for the patient

Claims

1. Use of an SAPL for the preparation of a medicament for the treatment of neutrophil-induced or irreversible degenerative lung disease in a mammal.
2. Use of an SAPL for the preparation of a medicament for use in combination therapy with a bronchodilator, anti-inflammatory and/or antibiotic for the treatment of degenerative lung disease in a mammal.
3. Use according to claim 2, in which the medicament is a combination product.
4. Use according to claim 3 or 4, in which the degenerative lung disease is selected from chronic obstructive pulmonary disease, smokers lung, chronic bronchitis, and cystic fibrosis.
5. Use according to any one of claims 1 to 4, in which the SAPL comprises a phosphatidyl cholines (PC).
6. Use according to any one of claims 1 to 4, in which the SAPL is one or more diacyl phosphatidyl cholines.
7. Use according to claim 6, in which the SAPL is selected from dioleyl phosphatidyl choline (DOPC); distearyl phosphatidyl choline (DSPC) and dipalmitoyl phosphatidyl choline (DPPC).
8. Use according to claim 5, 6 or 7 in which the SAPL further includes one or more compounds selected from the group consisting of phosphatidyl glycerols (PG); phosphatidyl ethanolamines (PE); phosphatidyl serines (PS); phosphatidyl inositols (PI) and chlorestyl palmitate (CP).
9. Use according to any one of claims 1 to 5, in which the SAPL comprises a diacyl phosphatidyl choline and phosphatidyl glycerol.
10. Use according to any one of claims 1 to 5, in which the SAPL comprises dipalmitoyl phosphatidyl choline and phosphatidyl glycerol.
11. A therapeutic combination product for enhancing the administration of a biologically active substance to a mammal comprising
(a) a surface active phospholipid (SAPL) composition in finely divided form, the SAPL including a component which enhances spreading of the medicament over a surface at about normal mammalian body temperature; and
(c) a biologically active substance; wherein ingredients (a) and (c) are provided in a form for administration together (as a mixture or separately) or sequentially.
12. A combination product according to claim 11, in which drug (c) is a bronchodilator, anti-inflammatory or antibiotic for use in the prevention or treatment of neutrophil-derived or irreversible degenerative lung disease.
13. A combination product according to claim 11 or 12, in which SAPL (a) has a particle size suitable for inhalation.
14. A combination product according to claim 11 or 12, in which SAPL (a) has a particle size suitable for nasal administration.
15. A combination product according to claim 11, in which SAPL (a) has a particle size suitable for delivery into the abdominal cavity.
PCT/GB2002/002196 2001-05-21 2002-05-21 Use of phospholipids in the treatment of degenerative lung disease such as copd or cystic fibrosis and to enhance delivery of drugs WO2002094283A2 (en)

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