Classifications

• • 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
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • 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
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
  • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
  • A61K31/198—Alpha-amino acids, e.g. alanine or edetic acid [EDTA]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/03—Peptides having up to 20 amino acids in an undefined or only partially defined sequence; Derivatives thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/12—Carboxylic acids; Salts or anhydrides thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/16—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing nitrogen, e.g. nitro-, nitroso-, azo-compounds, nitriles, cyanates
  • A61K47/18—Amines; Amides; Ureas; Quaternary ammonium compounds; Amino acids; Oligopeptides having up to five amino acids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/16—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing nitrogen, e.g. nitro-, nitroso-, azo-compounds, nitriles, cyanates
  • A61K47/18—Amines; Amides; Ureas; Quaternary ammonium compounds; Amino acids; Oligopeptides having up to five amino acids
  • A61K47/183—Amino acids, e.g. glycine, EDTA or aspartame
• • 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
  • A61K9/08—Solutions
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
  • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P5/00—Drugs for disorders of the endocrine system
  • A61P5/48—Drugs for disorders of the endocrine system of the pancreatic hormones
  • A61P5/50—Drugs for disorders of the endocrine system of the pancreatic hormones for increasing or potentiating the activity of insulin
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • C07K14/575—Hormones
  • C07K14/62—Insulins
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2121/00—Preparations for use in therapy
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/22—Hormones
  • A61K38/28—Insulins

Definitions

• the invention is in the general field of injectable rapid acting drug delivery insulin formulations. BACKGROUND OF THE INVENTION
• Glucose is a simple sugar used by all the cells of the body to produce energy and support life. Humans need a minimum level of glucose in their blood at all times to stay alive. The primary manner in which the body produces blood glucose is through the digestion of food. When a person is not getting this glucose from food digestion, glucose is produced from stores in the tissue and released by the liver. The body's glucose levels are regulated by insulin. Insulin is a peptide hormone that is naturally secreted by the pancreas. Insulin helps glucose enter the body's cells to provide a vital source of energy.
• the pancreas When a healthy individual begins a meal, the pancreas releases a natural spike of insulin called the first-phase insulin release. In addition to providing sufficient insulin to process the glucose coming into the blood from digestion of the meal, the first-phase insulin release acts as a signal to the liver to stop making glucose while digestion of the meal is taking place. Because the liver is not producing glucose and there is sufficient additional insulin to process the glucose from digestion, the blood glucose levels of healthy individuals remain relatively constant and their blood glucose levels do not become too high. Diabetes is a disease characterized by abnormally high levels of blood glucose and inadequate levels of insulin. There are two major types of diabetes - Type 1 and Type 2. In Type 1 diabetes, the body produces no insulin. In the early stages of Type 2 diabetes, although the pancreas does produce insulin, either the body does not produce the insulin at the right time or the body's cells ignore the insulin, a condition known as insulin resistance.
• Type 2 diabetes Even before any other symptoms are present, one of the first effects of Type 2 diabetes is the loss of the meal-induced first-phase insulin release. In the absence of the first-phase insulin release, the liver will not receive its signal to stop making glucose. As a result, the liver will continue to produce glucose at a time when the body begins to produce new glucose through the digestion of the meal. As a result, the blood glucose level of patients with diabetes goes too high after eating, a condition known as hyperglycemia. Hyperglycemia causes glucose to attach unnaturally to certain proteins in the blood, interfering with the proteins' ability to perform their normal function of maintaining the integrity of the small blood vessels. With hyperglycemia occurring after each meal, the tiny blood vessels eventually break down and leak. The long-term adverse effects of hyperglycemia include blindness, loss of kidney function, nerve damage and loss of sensation and poor circulation in the periphery, potentially requiring amputation of the extremities.
• an untreated diabetic's blood glucose becomes so elevated that the pancreas receives a signal to secrete an inordinately large amount of insulin.
• the pancreas can still respond and secretes this large amount of insulin.
• This inordinately large amount of insulin has two detrimental effects. First, it puts an undue extreme demand on an already compromised pancreas, which may lead to its more rapid deterioration and eventually render the pancreas unable to produce insulin. Second, too much insulin after digestion leads to weight gain, which may further exacerbate the disease condition.
• Type 1 diabetes produces no insulin
• Type 2 diabetes the primary treatment for Type 1 diabetes is daily intensive insulin therapy.
• the treatment of Type 2 diabetes typically starts with management of diet and exercise. Although helpful in the short-run, treatment through diet and exercise alone is not an effective long-term solution for the vast majority of patients with Type 2 diabetes.
• diet and exercise are no longer sufficient, treatment commences with various non-insulin oral medications. These oral medications act by increasing the amount of insulin produced by the pancreas, by increasing the sensitivity of insulin-sensitive cells, by reducing the glucose output of the liver or by some combination of these mechanisms. These treatments are limited in their ability to manage the disease effectively and generally have significant side effects, such as weight gain and hypertension. Because of the limitations of non-insulin treatments, many patients with Type 2 diabetes deteriorate over time and eventually require insulin therapy to support their metabolism. Insulin therapy has been used for more than 80 years to treat diabetes.
• This therapy usually involves administering several injections of insulin each day. These injections consist of administering a long-acting basal injection one or two times per day and an injection of a fast acting insulin at mealtime.
• This treatment regimen is accepted as effective, it has limitations. First, patients generally dislike injecting themselves with insulin due to the inconvenience and pain of needles. As a result, patients tend not to comply adequately with the prescribed treatment regimens and are often improperly medicated.
• insulin injections do not replicate the natural time-action profile of insulin.
• the natural spike of the first-phase insulin release in a person without diabetes results in blood insulin levels rising within several minutes of the entry into the blood of glucose from a meal.
• injected insulin enters the blood slowly, with peak insulin levels occurring within 80 to 100 minutes following the injection of regular human insulin.
• a potential solution is the injection of insulin directly into the vein of diabetic patients immediately before eating a meal.
• patients In studies of intravenous injections of insulin, patients exhibited better control of their blood glucose for 3 to 6 hours following the meal.
• intravenous injection of insulin before each meal is not a practical therapy.
• IL insulin lispro
• IA insulin aspart
• IG insulin glulisine
• peak insulin levels typically occur within 50 to 90 minutes following the injection.
• diabetics using insulin therapy continue to have inadequate levels of insulin present at the initiation of a meal and too much insulin present between meals. This lag in insulin delivery can result in hyperglycemia early after meal onset.
• the excessive insulin between meals may result in an abnormally low level of blood glucose known as hypoglycemia.
• hypoglycemia can result in loss of mental acuity, confusion, increased heart rate, hunger, sweating and faintness. At very low glucose levels, hypoglycemia can result in loss of consciousness, coma and even death. According to the American Diabetes Association, or ADA, insulin-using diabetic patients have on average 1.2 serious hypoglycemic events per year, many of which events require hospital emergency room visits by the patients. Because the time-course of insulin delivery to the blood plays such an important role in overall glucose control, there is significant need for insulin an injectable insulin that reaches the blood more rapidly than the rapid acting insulin analogs.
• the formulations may be for subcutaneous, intradermal or intramuscular administration.
• the formulations are administered via subcutaneous injection.
• the formulations contain insulin in combination with a chelator and dissolution agent, and optionally additional excipients.
• the formulation contains human insulin, a zinc chelator such as EDTA and a dissolution agent such as citric acid or a salt thereof such as sodium citrate. These formulations are rapidly absorbed into the blood stream when administered by subcutaneous injection. Examples demonstrate that one can increase pH to physiological pH and still obtain dissolution and rapid uptake of the insulin.
• the insulin is provided as a dry powder in a sterile vial.
• the insulin is mixed with a diluent containing a pharmaceutically acceptable carrier, such as water, and optionally a zinc chelator such as EDTA and/or a dissolution agent such as citric acid shortly before or at the time of administration.
• a pharmaceutically acceptable carrier such as water
• a zinc chelator such as EDTA
• a dissolution agent such as citric acid
• the insulin usually at a pH of approximately 4, is stored as a frozen mixture, ready for use upon thawing.
• the insulin is provided as an aqueous solution at pH 7, which is stored at 4°C.
• Figure 1 is a three dimensional schematic of insulin showing exposed surface charges and overlaid with molecules ("dissolution and chelating agents") of appropriate size to mask the charge.
• Figure 2 is a schematic diagram of the transwell device 10 used to measure insulin absorption from a donor chamber 12 through 4-5 layers of immortalized oral epithelial cells 14 on a 0.1 micron filter 16 into a receiver chamber 18.
• Figure 3a and 3b are graphs comparing in vitro insulin transport (cumulative insulin in microunits) through oral epithelial cells in the transwell system of Figure 2, with and without 0.45 mg EDT A/ml, as a function ofacid selected as dissolution agent.
• EDTA was constant at 0.45 mg/niL while the acid concentrations were varied as follows: Figure 3a, Aspartic acid (0.47 mg/mL), Glutamic acid (0.74 mg/mL), Succinic acid (0.41 mg/mL), Adipic acid (0.73 mg/mL) and Citric acid (0.29 mg/mL and 0.56 mg/mL), pH range 3.2-3.8.
• Figure 4a and 4b are graphs of in vitro insulin transport (cumulative insulin in microunits) through oral epithelial cells in the transwell system shown in Figure 2, comparing different dissolution agents, with and without 0.56 mg EDTA/mL and acids at the following equimolar (1.5OxIO "3 MoI) concentrations: Aspartic acid (0.20 mg/mL), Glutamic acid (0.22 mg/mL) and citric acid (0.29mg/ml) ( Figure 4a) and Citric acid at 1.80 mg/mL ( Figure 4b). Two time periods (10 and 30 min.) were selected for comparative analysis.
• Figure 5 is a graph of in vitro insulin transport through oral epithelial cells using the transwell system of Figure 2 to compare efficacy of different chelators.
• Figure 5 is a graph of the transport of insulin (1 mg/mL) from a solution containing glutamic acid, citric acid or HCl to which different chelators at the same molar concentration (4.84xlO "3 MoI) were added through oral epithelial cells was measured (cumulative insulin, micromoles).
• the chelators were no chelator (control), EDTA, EGTA 5 DMSA, CDTA, and TSC.
• Figure 6 is a graph of the in vivo pharmacodynamic effect of insulin prepared with citric acid and EDTA (12 U) in human subjects, compared to IL (12 U) and RHI (12 U) 5 measured as mean glucose infusion rate (GIR)/kg.
• Figure 8 is a graph of the in vivo pharmacodynamics of insulin prepared with citric acid and EDTA in 16 diabetic type 2 patients; compared to RHI and IL, plotting blood glucose (mg/dl) over time (minutes). The dosage used in the patient trial was patient specific, adjusted for each patient based on their current insulin therapy.
• Figure 9 A is a graph of the sedimentation coefficients of RHI at concentrations of 0.17, 0.51, 1.68, and 3.62 mg/ml.
• Figure 9B is a graph of the sedimentation coefficients of IL at concentrations of 0.15, 0.56, 1.75, and 3.59 mg/ml.
• Figure 9C is a graph of the sedimentation coefficients of IA at concentrations of 0.16 5 0.56, 1.66, and 3.56 mg/ml.
• Figure 9D is a graph of the sedimentation coefficients of CE 100-4 at concentrations of 0.15, 0.55, 1.72, and 3.48 mg/ml.
• Figure 1OA is a graph of the c(s) distributions normalized to the loading concentration for sedimentation coefficients of RHI at concentrations of 0.18, 0.55, and 1.72 mg/ml.
• Figure 1OB is a graph of the c(s) distributions normalized to the loading concentration for sedimentation coefficients of IL at concentrations of 0.17, 0.57, and 1.82 mg/ml.
• Figure 1OC is a graph of the c(s) distributions normalized to the loading concentration for sedimentation coefficients of IA at concentrations of 0.19, 0.54, and 1.84 mg/ml.
• Figure 1OD is a graph of the c(s) distributions normalized to the loading concentration for sedimentation coefficients of CE 100-4 at concentrations of 0.18, 0,40, and 0.84. mg/ml.
• Figure 11 is a graph of the c(s) distributions normalized to the loading concentration for sedimentation coefficients of control insulin pH 7 at concentrations of 0.18, 0.57, 1.74 and 3.52. mg/ml.
• Figure 12 is a graph of the insulin mean particles size (nm) as a function of dilution for CE 100-4, CE 100-7, and CES 100-7.
• Figure 13 is a graph of the insulin concentration ( ⁇ units/ml) by ELISA over time (minutes) in diabetic miniature swine.
• the insulin formulations of injectable human insulin described herein are administered immediately prior to a meal or at the end of a meal.
• the formulation combines recombinant human insulin with specific ingredients generally regarded as safe by the FDA.
• the formulation is designed to be absorbed into the blood faster than the currently marketed rapid-acting insulin analogs.
• One of the key features of the formulation of insulin is that it allows the insulin to disassociate, or separate, from the six molecule, or hexameric, form of insulin to the monomeric or dimeric form of insulin and deters re-association to the hexameric form.
• this formulation allows for more rapid delivery of insulin into the blood as the human body requires insulin to be in the form of a single molecule before it can be absorbed into the body to produce its desired biological effects.
• Most human insulin that is sold for injection is in the hexameric form. This makes it more difficult for the body to absorb, as the insulin hexamer must first disassociate to form dimers and then monomers.
• insulin refers to human or non-human, recombinant, purified or synthetic insulin or insulin analogues, unless otherwise specified.
• Human insulin is the human peptide hormone secreted by the pancreas, whether isolated from a natural source or made by genetically altered microorganisms.
• non-human insulin is the same as human insulin but from an animal source such as pig or cow.
• an insulin analogue is an altered insulin, different from the insulin secreted by the pancreas, but still available to the body for performing the same action as natural insulin.
• ADME absorption, distribution, metabolism, and excretion
• Examples include insulin lispro, insulin glargine, insulin aspart, insulin glulisine, insulin detemir.
• the insulin can also be modified chemically, for example, by acetylation.
• human insulin analogues are altered human insulin which is able to perform the same biological action as human insulin.
• a "chelator” or “chelating agent” refers to a chemical compound that has the ability to form one or more bonds to zinc ions. The bonds are typically ionic or coordination bonds.
• the chelator can be an inorganic or an organic compound.
• a chelate complex is a complex in which the metal ion is bound to two or more atoms of the chelating agent.
• a "solubilizing agent” is a compound that increases the solubility of materials in a solvent, for example, insulin in an aqueous solution.
• solubilizing agents include surfactants (TWEENS®); solvent, such as ethanol; micelle forming compounds, such as oxyethylene monostearate; and pH-modifying agents.
• a “dissolution agent” is an acid or salt that, when added to insulin and EDTA, enhances the transport and absorption of insulin relative to HCl and EDTA at the same pH, as measured using the epithelial cell transwell plate assay described in the examples below.
• HCl is not a dissolution agent but may be a solubilizing agent.
• Citric acid and sodium citrate are dissolution agents when measured in this assay. It is believed this is achieved at least in part by masking charges on the insulin, some of which are exposed during dissociation from the hexamer.
• an “excipient” is an inactive substance other than a chelator or dissolution agent, used as a carrier for the insulin or used to aid the process by which a product is manufactured. In such cases, the active substance is dissolved or mixed with an excipient.
• a “physiological pH” is between 6.8 and 7.6, preferably between 7 and 7.5, most preferably about 7.4.
• VI AJECTTM is the trademark for a recombinant human insulin formulated with a dissolution agent such as citric acid and a chelator such as EDTA.
• Viaject 25 U/mL contains 25 U/mL regular recombinant human insulin, 1.8 mg/mL Citric acid, 1.8 mg/mL disodium EDTA, 0.82% NaCI (isotonicity) and 3 mg/mL m-cresol. It is provided as an aqueous solution which is stored frozen, or in a two part kit consisting of dry powder insulin and diluent, at least one of which contains citric acid and EDTA. The pH of both reconstituted mixture and frozen solution is approximately pH 4.
• Viaject lOOU/mL contains 100 U/mL regular recombinant human insulin, 1.8 mg/mL citric acid, 1.8 mg/mL disodium EDTA, 22 mg/mL glycerin, 3 mg/mL m-cresol. This is also provided either as a frozen aqueous solution or two part kit consisting of dry powdered insulin and diluent. The pH of both of the reconstituted mixture and frozen solution is approximately 4.
• Viaject 100 U/mL contains 100 U/mL regular recombinant human insulin, 1.8 mg/mL citric acid, 1.8 mg/mL disodium EDTA, 22 mg/mL glycerin, 3 mg/mL m-cresol. This is provided as an aqueous solution having a pH of about 7.4, which can be stored at 4°C.
• VIAject with acid salts is made by adding 1.8 mg/mL of both EDTA and trisodium citrate to water, then adding 100U/mL insulin, reducing pH to 6, then raising pH to 7.4.
• Formulations include insulin, a chelator and a dissolution agent(s) and, optionally, one or more other excipients.
• the formulations are suitable for subcutaneous administration and are rapidly absorbed into the fatty subcutaneous tissue.
• At least one of the formulation ingredients is selected to mask charges on the active agent. This may facilitate the transmembrane transport of the insulin and thereby increase both the onset of action and bioavailability for the insulin.
• the ingredients are also selected to form compositions that dissolve rapidly in aqueous medium. Preferably the insulin is absorbed and transported to the plasma quickly, resulting in a rapid onset of action (preferably beginning within about 5 minutes following administration and peaking at about 15-30 minutes following administration).
• the chelator such as EDTA, chelates the zinc in the insulin, removing the zinc from the insulin solution. This causes the insulin to take on its dimeric and monomelic form and retards reassembly into the hexamer state. Studies described in the examples indicate that the overall size of the dissociating hexamer is larger than the zinc complexed insulin hexamer, which then forms smaller units. Since the hexamers, dimers and monomers exist in a concentration-driven equilibrium, as the monomers are absorbed, more monomers are created. Thus, as insulin monomers are absorbed through the subcutaneous tissue, additional dimers dissemble to form more monomers.
• the completely dissociated monomeric form has a molecular weight that is less than one-sixth the molecular weight of the hexameric form, thereby markedly increasing both the speed and quantity of insulin absorption.
• the chelator such as EDTA
• dissolution agent such as citric acid
• the insulin can be recombinant or purified from a natural source.
• the insulin can be human or non-human. Human is preferred. In the most preferred embodiment, the insulin is human recombinant insulin. Recombinant human insulin is available from a number of sources.
• the insulin may also be an insulin analogue which may be based on the amino acid sequence of human insulin but having one or more amino acids differences, or a chemically modified insulin or insulin analog.
• the dosages of the insulin depend on its bioavailability and the patient to be treated. Insulin is generally included in a dosage range of 1.5- 100 IU, preferably 3-50 IU per human dose. Typically, insulin is provided in 100 IU vials.
• Those acids which are effective as dissolution agents include acetic acid, ascorbic acid, citric acid, glutamic, aspart ⁇ c, succinic, fumaric, maleic, and adipic, relative to hydrochloric acid, as measured in the transwell assay described in the examples below.
• the active agent is insulin
• a preferred dissolution agent is citric acid.
• Hydrochloric acid and sodium hydroxide are preferred agents for pH adjustment.
• HCl may be used in combination with any of the formulations, but is not a dissolution agent.
• Salts of the acids include sodium acetate, ascorbate, citrate, glutamate, aspartate, succinate, fumarate, maleate, and adipate.
• Salts of organic acids can be prepared using a variety of bases including, but not limited to, metal hydroxides, metal oxides, metal carbonates and bicarbonates, metal amines, as well as ammonium bases, such as ammonium chloride, ammonium carbonate, etc.
• Suitable metals include monovalent and polyvalent metal ions. Exemplary metals ions include the Group I metals, such as lithium, sodium, and potassium; Group II metals, such as barium, magnesium, calcium, and strontium; and metalloids such as aluminum.
• Polyvalent metal ions may be desirable for organic acids containing more than carboxylic acid group since these ions can simultaneously complex to more than one carboxylic acid group.
• the range of dissolution agent corresponds to an effective amount of citric acid in combination with insulin and EDTA of between 9.37 x 10 "4 M to 9.37 x 10 "2 M citric acid.
• Chelators In the preferred embodiment, a zinc chelator is mixed with the insulin. The chelator may be ionic or non-ionic.
• Suitable chelators include ethylenediam ⁇ netetraacetic acid (EDTA), EGTA, alginic acid, alpha lipoic acid, d ⁇ mercaptosuccinic acid (DMSA), CDTA (1,2- diaminocyclohexanetetraacetic acid), trisodium citrate (TSC). Hydrochloric acid is used in conjunction with TSC to adjust the pH, and in the process gives rise to the formation of citric acid, which is a dissolution agent.
• EDTA ethylenediam ⁇ netetraacetic acid
• DMSA d ⁇ mercaptosuccinic acid
• CDTA 1,2- diaminocyclohexanetetraacetic acid
• TSC trisodium citrate
• Hydrochloric acid is used in conjunction with TSC to adjust the pH, and in the process gives rise to the formation of citric acid, which is a dissolution agent.
• the chelator is EDTA.
• the chelator captures the zinc from the insulin, thereby favoring the dimeric form of the insulin over the hexameric form and facilitating absorption of the insulin by the tissues surrounding the site of administration (e.g. mucosa, or fatty tissue), hi addition, the chelator hydrogen may bond to the active agent, thereby aiding the charge masking of the insulin monomers and facilitating transmembrane transport of the insulin monomers.
• the range of chelator corresponds to an effective amount of EDTA in combination with insulin and citric acid of between 2.42 x 10 "4 M to 9.68 x 10 "2 M EDTA.
• compositions may be formulated in a conventional manner using one or more physiologically acceptable carriers comprising excipients and auxiliaries which facilitate processing of the active compounds into preparations which can be used pharmaceutically.
• physiologically acceptable carriers comprising excipients and auxiliaries which facilitate processing of the active compounds into preparations which can be used pharmaceutically.
• Formulation of drugs is discussed in, for example, Hoover, John E., Remington's Pharmaceutical Sciences, Mack Publishing Co., Easton, Pennsylvania (1975), and Liberman, H. A. and Lachman, L., Eds.,
• solubilizing agents are included with the insulin agent to promote rapid dissolution in aqueous media.
• Suitable solubilizing agents include wetting agents such as polysorbates, glycerin and poloxamers, non-ionic and ionic surfactants, food acids and bases (e.g. sodium bicarbonate), and alcohols, and buffer salts for pH control.
• Stabilizers are used to inhibit or retard drug decomposition reactions which include, by way of example, oxidative reactions.
• a number of stabilizers may be used. Suitable stabilizers include polysaccharides, such as cellulose and cellulose derivatives, and simple alcohols, such as glycerol; bacteriostatic agents such as phenol, m-cresol and methylparaben; isotonic agents, such as sodium chloride, glycerol, and glucose; lecithins, such as example natural lecithins (e.g. egg yolk lecithin or soya bean lecithin) and synthetic or semisynthetic lecithins (e.g.
• the stabilizer may be a combination of glycerol, bacteriostatic agents and isotonic agents.
• the injectable formulation contains insulin, a chelator, and a dissolution agent.
• the injectable formulation contains insulin, EDTA, Citric acid, saline and/or glycerin.
• the subcutaneous injectable formulation is produced by mixing saline and glycerin, citric acid and EDTA to form a solution and sterilizing the solution (referred to as the "diluent").
• the insulin is separately added to sterile water to form a solution, filtered, and a designated amount is placed into each of a number of separate sterile injection bottles.
• the insulin solution is lyophilized to form a powder and should be stored separately from the diluent to retain its stability. Prior to administration, the diluent is added to the insulin injection bottle. After the predetermined amount of insulin is subcutaneously injected into the patient, the remaining insulin solution may be stored, preferably by refrigeration.
• the insulin is combined with the diluent, pH 4, sterile filtered into multi-use injection vials or cartridges and frozen prior to use.
• the insulin is prepared as an aqueous solution, at pH 7.0, in vials or cartridges and kept at 4°C.
• the formulations may be administered by subcutaneous or intramuscular injection.
• the formulation is designed to be rapidly absorbed and transported to the plasma for systemic delivery.
• Formulations containing insulin as the active agent may be administered to a type 1 or type 2 diabetic patient before or during a meal. Due to the rapid absorption, the compositions can shut off the conversion of glycogen to glucose in the liver, thereby preventing hyperglycemia, the main cause of complications from diabetes and the first symptom of type 2 diabetes.
• Currently available, standard, subcutaneous injections of human insulin must be administered about one half to one hour prior to eating to provide a less than desired effect, because the insulin is absorbed too slowly to shut off the production of glucose in the liver. Additionally, if given early enough in the progression of the disease, the subcutaneous insulin compositions may be able to slow or stop the progression of type 2 diabetes.
• the advantage of the low pH formulation is that it can be mixed with BYETTA® (exenatide), SYMLIN® (pramlintide acetate), and LANTUS® (long acting insulin analog), none of which can be mixed with other types of commercially available insulins due to immiscibility and precipitation.
• the advantage of the higher pH insulin is that it is more stable during storage than the insulins at lower pH.
• the present invention will be further understood by reference to the following non-limiting examples. The following insulins were used in the examples.
• HUMULIN® is recombinant human insulin. Each mililiter contains 100 units regular recombinant human insulin, 0.22% m-cresol, 1.4- 1.8% glycerin, pH 7. This is available commercially from several sources.
• HUMALOG® from Eli Lilly (IL) insulin lispro injection is a recombinant human insulin analog that is a Lys(B28), Pro(B29) human insulin analog, created when the amino acids at positions 28 and 29 on the insulin B-chain are reversed.
• Each milliliter of IL injection contains insulin lispro 100 units, 16 mg glycerin, 1.88 mg dibasic sodium phosphate, 3.15 mg metacresol, zinc oxide content adjusted to provide 0.0197 mg zinc ion, trace amounts of phenol, and water for injection.
• Insulin lispro has a pH of 7.0 to 7.8, Hydrochloric acid 10% and/or sodium hydroxide 10% may be added to adjust pH.
• One unit of IL has the same glucose-lowering effect as one unit of Regular human insulin, but its effect is more rapid and of shorter duration.
• NOVOLOG® is a recombinant insulin analog available from Novo Nordisk AJS.
• the analog contains a single substitution of the amino acid proline by aspartic acid in position B28, and is produced by recombinant yeast. It is provided in a sterile, aqueous solution containing 100 Units insulin aspart/ml, 16 mg/ml glycerin, 1.50 mg phenol/ml, 1.72 metacresol/ml, 19.6 mg zinc/ml, 1.25 mg disodium hydrogen phosphate dihydrate/ml, 0.58 mg sodium chloride/ml, having a pH of 7.2 to 7.6, adjusted with 10% HCl or NaOH.
• VIAJECTTM is a recombinant human insulin formulated with citric acid and EDTA.
• Viaject 25 U/mL contains 25 U/mL regular recombinant human insulin, 1.8 mg/mL Citric acid, 1.8 mg/mL disodium EDTA, 0.82% NaCl (isotonicity) and 3 mg/mL m-cresol. It is provided as an aqueous solution which is stored frozen, or in a two part kit consisting of dry powder insulin and diluent, at least one of which contains citric acid and EDTA. The pH of both reconstituted mixture and frozen solution is approximately pH 4. The reconstituted powder is what was used in the examples.
• Viaject WOU/mL contains 100 U/mL regular recombinant human insulin, 1.8 mg/mL citric acid, 1.8 mg/mL disodium EDTA, 22 mg/mL glycerin, 3 mg/mL m-cresol. This is also provided either as a frozen aqueous solution or two part kit consisting of dry powdered insulin and diluent. The pH of both of the reconstituted mixture and frozen solution is approximately 4. Only the frozen aqueous solution was used in the analytical centrifuge data and malvern.
• Viaject 100 U/mL contains 100 U/mL regular recombinant human insulin, 1.8 mg/mL citric acid, 1.8 mg/mL disodium EDTA, 22 mg/raL glycerin, 3 mg/mL m-cresol. This is provided as an aqueous solution having a pH of about 7.4, which can be stored at 4°C. This was used in the swine study.
• VIAject with acid salts (CSE 100-7) is made with 1.8 mg/mL of both EDTA and trisod ⁇ um citrate in water, with 100U/mL insulin and glycerin ( 22 mg/mL). . The final pH is adjusted to 7.4 with sodium hydroxide. This was used in the final example for malvern information.
• Example 1 In Vitro Comparison of Uptake and Transport of Insulin using Epithelial Cell Transwell Assay as a Function of Dissolution Agent.
• Oral epithelial cells were grown on transwell inserts for two weeks until multiple (4-5 layer) cell layers had formed, as shown in Figure 2.
• the transport studies were conducted by adding the appropriate solutions to the donor well and removing samples from the receiver well after 10 minutes. Solutions consisted of water, +/- EDTA (0.45 mg/ml), NaCl (0.85% w/v), 1 mg/ml insulin and a sufficient amount of acid to maintain the pH at 3.8. Insulin amounts in the receiver wells were assayed using ELISA. Results
• Example 1 The materials and methods of Example 1 were used with different concentrations of reagents. In the study, equimolar concentrations of acid and chelator were added. Solutions consisted of water, +/- EDTA (0.56 mg/mL),, NaCl (0.85% w/v), 1 mg/mL insulin and an acid: Aspartic acid (0.20 mg/mL), Glutamic acid (0.22 mg/mL) or citric acid (0.20 mg/ml). Citric acid was tested at a higher concentration of 1.8 mg/mL with and without chelator. This data is shown at two time periods, 10 and 30 minutes, post dosing of cell donor chambers. Results The results obtained with Aspartic acid (0.20 mg/mL), Glutamic acid
• Oral epithelial cells were grown on transwell inserts for two weeks until multiple (4-5 layer) cell layers had formed.
• the transport studies were conducted by adding the appropriate solutions to the donor well and removing samples from the receiver well after 10, 20 and 30 minutes.
• the solutions were prepared immediately before the transwell experiments in the following way: Citric acid at 1.8 mg/ml was dissolved in 0.85% w/v saline and then one ofthe following chelators was added to this solution at the concentration shown: EDTA at 1.80 mg/ml, EGTA at 1.84 mg/ml, DMSA at 0.88 mg/ml and TSC at 1.42 mg/ml. Because CDTA was used in its liquid form, citric acid was added directly to the CDTA.
• the concentration of chelator was constant at 4.84x10 " moles. Insulin was then added at 1 mg/ml and the pH was re-adjusted to 3.8 if necessary. A control set of samples using only HCl for pH adjustment are included for comparison. Transwell experiments were done by adding 0.2 ml of each solution to the donor wells.
• Insulin amounts in the receiver wells were assayed using ELISA. Results
• a graph of 30 minute insulin data is shown in Figure 5. There was significantly more insulin delivered through the cells when citric or glutamic acid was used, except as compared to results obtained with TSC (trisodium citrate). In the case of TSC, HCl was used for pH adjustment. The adjustment of pH generated citric acid, explaining these results.
• Example 4 Preclinical evaluation of chelators in a citric acid based insulin formulation in swine. Materials and Methods
• Diabetic swine were injected subcutaneously with one of four formulations of insulin.
• Three formulations contained a chelator (EDTA, EGTA or TSC) and fourth control contained only regular human insulin RHI, no chelator.
• Citric acid (1.8 mg/ml) was used as the acid in all the chelator formulations, and NaCl and m-cresol were added for isotonicity and formulation sterility in all cases.
• the chelators were all at the same molar concentration of 4.84x10 "3 moles. Swine were fasted overnight, and subcutaneously administered a dose of 0.125 U/kg human insulin containing EDTA (n-3) or 0.08 U/kg human insulin containing EGTA or TSC (n-2).
• BG of 9 patients (5 males and 4 females; age 40 ⁇ 10 yrs, BMI 24.0 ⁇ 2.0 kg/m 2 ) were stabilized by means of a glucose clamp (target BG 120 mg/dl) prior to meal ingestion.
• the glucose infusion was turned off prior to the standard meal and insulin dosing.
• VIAjectTM CE25-4
• ILor RHI ILor RHI
• Table 2 The results shown in Table 2 as the mean plus or minus standard deviation compare insulin Tmax after subcutaneous injection to type 2 diabetic patients after a meal, regular human insulin, insulin plus citric acid and EDTA (CE) and Hspro.
• Table 3 compare blood glucose for the same test subjects.
• Table 2 Comparison of Insulin Tmax(min) *p ⁇ .001, paired t-test
• Table 3 Comparison of Insulin Pharmacokinetics Blood Glucose
• the total number of hypoglycemic events (hours requiring glucose infusion) 3 to 8 hours post injection were 13 with RHI, 11 with IL and 4 with the CE 25-4 formulation.
• the mean total amount of glucose infused to prevent hypoglycemia during this time was six times higher for RHI and twice as much for IL than with CE 25-4.
• the areas above and below the normal glycemic target zone (BG AUC above 140 and below 80mg/dL) summed for all patients per group was 81,895 for RHI 5 57,423 for IL and 38,740 mg/dL*min for CE 25-4.
• the mean blood glucose levels are shown in Figure 8.
• CE 25-4 was the fastest in reversing the rise in blood glucose following the standard meal. Patients treated with CE 25-4 experienced reduced post prandial glucose excursions. In contrast, RHI had the highest glucose excursion, which is consistent with its slower absorption rate. Variability of the glucose levels (mean difference between maximal and minimal values) was significantly less for CE 25-4 than IL, demonstrating the better glycemic control of CE 25-4 in these patients with Type 1 diabetes.
• Example 7 Characterization of Size of Insulins by Light Scattering: CE 100-4 has a very rapid onset of action in patients. To understand the basis for the rapid absorption profile, in vitro experiments were performed with CE 100-4 in comparison to other commercially available recombinant human insulins and rapid acting analogs of insulin.
• a dilution series was performed from 1 :2 to 1 : 16 in buffer having similar pH and buffering capacity of extracellular fluid (ECF, 0.7 rnN MgCl 2 , 1.2 mM CaCl 2 , 0.2 mM KCl, 0.5 mM Na 2 SO 4 , 104 niM NaCl, 28.3 mM NaHCO 3 ).
• ECF extracellular fluid
• the mean size was determined for all dilutions with each of the commercially available insulins and CE 100-4, to understand the monomer/dimer/hexamer size distribution for each formulation. Insulins
• CE 100-4 initially appears larger than the other insulins studied, possibly due to citric acid and EDTA being weakly attracted to the surface, which may serve to further increase the rate of absorption from subcutaneous sites by masking the surface charge. Charge can be an impediment to absorption. Shortly after subcutaneous administration, as the injected material is diluted by ECF, CE 100-4 has a smaller mean size than rapid acting insulin analogs and RHI at identical dilutions.
• Example 8 Analytical Ultracentrifugation of insulin Materials and Methods
• the second set of samples was prepared substituting ECF buffer instead of diluent.
• ECF buffer instead of diluent.
• the most concentrated sample was diluted first with ECF 1:2. Further dilutions were then done with ECF, In the case of CE 100-4, the initial dilution with ECF was 1 :4 to assure that the isoelectric point was crossed to eliminate any precipitated matter.
• DcDt is a model independent, sedimentation coefficient distribution g(s*) which uses the time derivative of the concentration profile. If there is no shift to higher values of S with an increase in concentration, it is strong evidence that there are no reversible reactions occurring (i.e. monomer, dimer hexamer). If the size and shape change on dilution (shifting from hexamer to dimer to monomer), it is not possible to determine an estimate of the molecular weight, but useful information can be obtained from the Sedfit program on the sedimentation coefficient S(w).
• this program produces a direct boundary model for the individual data sets using a model based numerical solution to the Lamm equation. 3 It plots the continuous sedimentation coefficient c(s) versus sedimentation coefficient (s) to produce curves that describe relative sizes of the sedimenting species. Dilution of each insulin with insulin-specific diluent:
• RHI was submitted for analysis by sedimentation velocity ultracentrif ⁇ igation.
• the estimated stock concentration was 3.745 mg/ml.
• the diluent was as described above.
• the diluent density and viscosity were calculated to be 1.00231 g/ml and 0.01041 poise at 20 0 C, respectively, using Se ⁇ nterp.
• Figure 9 A shows a plot of the c(s) distributions normalized to the loading concentration of RHITM.
• the data shown for the normalized c(s) plot is consistent with the g(s*) data from the DcDt+. There is a marked shift to lower values of S in the sedimentation with an increase in concentration.
• Figure 9B is a plot of the weight average sedimentation coefficients for each concentration.
• the protein dissociates upon dilution.
• Figure 9C shows a plot of the c(s) distributions normalized to the loading concentration.
• the data shown for the normalized c(s) plot is consistent with the g(s*) data from DcDt+.
• the c(s) curves at low concentrations show a contribution of a smaller species (monomer) which decreases as the concentration is increased. There is also a slight shift to lower values of S in the sedimentation with an increase in concentration.. .
• FIG. 9D shows a plot of the c ⁇ s) distribution normalized in the loading concentration.
• the c(s) plot is consistent with the g(s*) data from DcDt+ in that there is a marked shift towards lower S values upon dilution.
• the c(s) plots from the higher concentrations clearly show that CE 100-4 may be larger than a hexamer.
• the value obtained for the weight average sedimentation coefficient for each loading concentration, corrected to standard conditions, is given in the table below.
• the diluent density and viscosity were calculated to be 1.00273 g/ml and 0.01043 poise at 2O 0 C, respectively, using Sednterp.
• Sedfit version 11.7I 5
• Figure 1OA shows a plot of the c(s) distributions normalized to the loading concentration.
• the data shown for the normalized c(s) plot is consistent with the g(s*) data from DcDt+.
• the c(s) plots are nearly coincidental but there is a small shift to lower values of S in the sedimentation with an increase in concentration.
• Figure 1OB shows a plot of the c(s) distributions normalized to the loading concentration.
• the data shown for the normalized c(s) plot is consistent with the g(s*) data from DcDt+.
• the c(s) curves at low concentration show a significant contribution of a smaller species (perhaps dimer) which decreases as the concentration is increased.
• Insulin aspart Methods described above.
• Figure 1OC shows a plot of c(s) distributions normalized to the loading concentration.
• the data shown for the normalized c(s) plot is consistent with the g(s*) data from DcDt+.
• the c(s) curves at low concentrations show a small amount of a smaller species (monomer/dimer) which decreases as the concentration is increased. There is also a slight shift to lower values of S in the sedimentation with an increase in concentration.
• the graph clearly shows that the protein is slightly dissociating upon dilution.
• the estimated stock concentration was 0.936 mg/ml after diluting one volume of the solution with three volumes of the supplied ECF.
• Figure 1OD shows a plot of the c(s) distributions normalized to the loading concentration.
• the c(s) plot is consistent with the g(s*) data from DcDt+ in that there is a marked shift towards lower S values upon dilution.
• the c(s) plot from the highest concentration clearly shows that CE 100-4 may be larger than a hexamer.
• the diluent density and viscosity were calculated to be 0.99823 g/ml and 0.01002 poise at 20 0 C, respectively, using Sednterp. Internal Control IC pH7
• the c(s) distribution plots are sharpened, relative to other analysis methods, because the broadening effects of diffusion are removed by use of an average value for the frictional coefficient.
• Figure 11 shows a plot of the c(s) distributions normalized to the loading concentration. The c(s) plot is consistent with the g(s*) data from DcDt+ in that there is a marked shift towards lower S values upon dilution.
• Insulin was diluted with 0.01N HCl as described above.
• IA and IL start in the hexamer size range and has a small population of nionomer/dinier forms after dilution to 1 :16 in ECF. A higher proportion of monomeric/dimeric particles with CE 100-4 is consistent with its more rapid absorption profile.
• Example 10 Determination of Effect on Insulin Size by Addition of sodium citrate and EOTA to insulin, pH 7.4
• Disodium EDTA (1.8 mg/mL) and trisodium citrate (1.8 mg/mL) were dissolved in water with glycerin (22mg/mL). Insulin was added to the solution at a concentration of 3.8 mg/mL. Sodium Hydroxide was added dropwise to elevate the pH to 7.4. The undiluted material was then analyzed on the Malvern for mean particle size, and then diluted with extracellular fluid buffer (ECF) and sized at each point along the dilution series.
• ECF extracellular fluid buffer
• FIG. 12 is a graph of the insulin mean particles size (nm) as a function of dilution for CE 100-7 pH 7.5, and CSE 100-7 containing sodium citrate instead of citric acid, pH 7.4.
• Insulin was prepared by mixing Insulin (3.8 mg/ml), disodium EDTA (1.8 mg/mL), Citric Acid (1.8 mg/mL), glycerin and ni-cresol (3mg/mL) and adjusting the pH to 4 with HCl. The pH ofthe solution was then raised to pH 7 by addition of NaOH. This briefly brought the formulation through the isoelectric point of the insulin creating a cloudy mixture that clarified when the final pH of 7.4 was reached.
• the CE 100-7 was given as a prandial insulin to swine before a meal, Six male diabetic miniature swine (30-50 kg) were first administered

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