WO2012092908A1 - Medical preparation generating iodine, method of preparation thereof and bandage containing said preparation - Google Patents
Medical preparation generating iodine, method of preparation thereof and bandage containing said preparation Download PDFInfo
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- WO2012092908A1 WO2012092908A1 PCT/CZ2012/000002 CZ2012000002W WO2012092908A1 WO 2012092908 A1 WO2012092908 A1 WO 2012092908A1 CZ 2012000002 W CZ2012000002 W CZ 2012000002W WO 2012092908 A1 WO2012092908 A1 WO 2012092908A1
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- WIPO (PCT)
- Prior art keywords
- preparation
- iodine
- sodium
- acid
- iodine source
- Prior art date
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L26/00—Chemical aspects of, or use of materials for, wound dressings or bandages in liquid, gel or powder form
- A61L26/0061—Use of materials characterised by their function or physical properties
- A61L26/0066—Medicaments; Biocides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
- A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
- A61L15/22—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons containing macromolecular materials
- A61L15/28—Polysaccharides or their derivatives
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
- A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
- A61L15/42—Use of materials characterised by their function or physical properties
- A61L15/44—Medicaments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L26/00—Chemical aspects of, or use of materials for, wound dressings or bandages in liquid, gel or powder form
- A61L26/0009—Chemical aspects of, or use of materials for, wound dressings or bandages in liquid, gel or powder form containing macromolecular materials
- A61L26/0023—Polysaccharides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P17/00—Drugs for dermatological disorders
- A61P17/02—Drugs for dermatological disorders for treating wounds, ulcers, burns, scars, keloids, or the like
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
- A61L2300/10—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices containing or releasing inorganic materials
- A61L2300/106—Halogens or compounds thereof, e.g. iodine, chlorite
Definitions
- the invention relates to a preparation for healing of intracorporeal and/or surface wounds and burn injuries based on a physiologically acceptable salt of hyaluronic acid and compounds which are able to generate iodine under the conditions of application. Further, the invention relates to the method of production of the preparation and the bandage for healing of intracorporeal and/or surface wounds containing said preparation.
- a suitable coating should meet several requirements: essecially it should eliminate and/or minimalize adhesion of the bandage to the wound. Furthermore, it should provide for a humid environment which contributes to faster healing. It means to increase the humidity of the dry wounds and conversely to drain excess of moisture from the dripping wounds. At the same time, the coating should reduce the possibility of penetration of the infection and/or to reduce ; the present infection. Moreover, it may contain substances which actively enhance one and or several phases of healing..
- the field of identification of the best the- singlb 'fractibns comprises for example EP G138572 ' frbm 1-984 which defines ⁇ two fractions extracted from the animal material. Specifically,' it is hyalufonan having the ' molecular weight 1 from 50 'to 100 kDa for wound healing since ' thanks to the low viscosity ''thereof it does riot prevent the movement of the cells into the regenerating tissue and in this way it enhances the growth of the tissue. Conversely, the fraction of 500 to 750 kpa has a high viscosity, prevents the
- the patent EP 216453 from 1986 describes the modification of physical and other properties of hyaluronan by esterification.
- the patents US 4582865 from 1984 and US 4636524 from 1985 describe the properties of hyaluronan modified by crosslinking.
- the product is a derivative of hyaluronan which is insoluble in water, it can be used to prepare a biodegradable formation which can be colonized by living cells and used to treat the tissues as it is described for example in PCT application W097/45532 from
- the modification of the pharmacological activity of a medical preparation based on hyaluronan by the fact that it jis'oised in combination with an additional effective substance is broadly described for example in US 4736024 frorn ⁇ '986.
- the product is designated preferably for ophtalmology and' the used pharmacologically effective substances are such as kanamycine, neomycyne, tetr cykcline, chloramferiicol and the mixtures thereof.
- Hyaluronane is seen here as a support, thus more like an adjuvant.
- the product can be in the form of a powder, gel, as well as a solution.
- Patent US 5442053 from 1 92 refers to using a pharmacologically effective substance in combination with defined fractions of hyaluronan for different branches of applications. Thus it presents a combination of the "patents EP 0138572 and US 4736024 which have been mentioned already.
- iodine A part of the suggested technical solution concerning the formation of iodine comes from the known chemical reaction which is used for example also in the documents WO 92/01382 from 1991, EP 1044689 from 1998 and WO 2008/009925 from 2007. It is the oxidation of iodide into iodine, or the reduction of iodate into iodine by means of the suitable agent under suitable conditions. There is hydrogen peroxide, formed by an enzymatic reaction, used as the oxidizing agent in PCT application WO 2008/009925. There is iodate used as the oxidizing agent in the remaining two stated documents which has the advantage that the product resulting from the reduction of the oxidizing agent is also iodine.
- the said patents differ 'fro'rn ' the suggested solution by the composition, the process of production or the application 1 form.
- the PCT application WO 92/01382 also published as US 5128136 describes the preparation' the ! function of which is to prevent dehydration and infection of me 1 wound. It contains the soluble collagen as the main gelling component, which does not influence the wound healing at all, it uses the mixture of citric acid and Na 2 HP0 4 as the buffering agent and it does hot contain hyaluronic acid, nor salts thereof.
- the process of the. prbd iction is based on lyophilisation and it consists in the preparation of three separate components (collagen, iodine and iodate) that can be mixed just before use.
- Iodine functions as the gelling agent in the preparation which forms the gel from the liquid collagen.
- the disadvantage of WO 92/01382 is that it contains collagen which can cause unwanted reactions, such as : iriflammantion.
- a further disadvantage of collagen is the phase conversion from the liqtiid 'irito the solid gel after 1 the application that prevents the penetration of gasses and water steam which is in a certaih small extent beneficial for healing.
- Patent EP 1044689 contains dextrine as the main component in an amount of at least 10 %.
- the production process is based on a hot air dry granulation and the product is n the form of granules, or powder.
- the disadvantage of EP 1044689 is the use of cyclodextrines. Cyclodextrines are body-foreign and it is not possible to 1 exclude undesired reactions of the organism.
- EP 1815877 describes a preparation in the form of a hydrogel that can contain hyaluronan and also iodine ' as an aseptic agent, according to the claims.
- the essential feature is also the fact that the hydfogel of EP 1815877 releases more liquid than it absorbs (Claim 1).
- the preparation can ' contain, besides the substances releasing (i.e. not generating) halogen (preferebly iodine and iodine complexes), liposomes and substances releasing oxygen, or silver and mercury compounds. It is obvious according to the description, claims and examples that iodine is elementar and it is in the form of the PVP-I complex and therefore, no formation of iodine is involved.
- JP 2008266276 uses also the principle of provision of the desinfecting effectivrty by using the ⁇ ⁇ PVP'-I compl xi 'Besides ⁇ the as ⁇ mblirig effeet of PVP, "there is also Used the principle of the formation of the micelles that enhance binding of iodine. Iodide,
- the above mentione 4 ' disadvantages of the' 'current healing, hydrating »and or disinfecting preparations are to the large extent overcome by the preparation for healing of intracorporeal and/or surface wounds generating iodine according to the newly suggested solution.
- the preparation satisfies all of the above mentioned requirements and the subject- matter of the solution consists * in that it contains a ' physiologically acceptable salt of hyaluronic acid having the weight " average molecular 'Weight within the range of 200,000 to 3 3 ⁇ 4 000,000 g/mol and compounds', or a mixture of compounds, which upon contact with water (also with blood or exsudate), or upon mixing or upon exposition to light generate the elementary iodine providing 1 for ' the effective desinfectibn.
- the salt of hyaluronic acid forms a liquid' el or a viscous solutioriy eventually a low viscosity solution (depending on the concentration and the molecular Weight of hyaluronan) that regulates the moisture in the wound, or hr ttie eye (when used as eye-drops), as well as it effectively prevents the bandage adhesion' fo the wound (in case of topical use) ,and at the same time it accelerates all the healing phases.
- 3 ⁇ 43 ⁇ 4e present solution does not contain the elementary iodine and therefore it is possible to store the preparation in the liquid form also in any inert material, such as in the plastic that is elastic and light. If it is in the form of bandage already with or without an auxiliary textile it can be stored in any inert airtight package, such as in a wax paper sack (the package has to prevent passing of the light through it in case it contains a photogenerator).
- the preparation of the invention also has a prolonged effectivity, especially disinfecting effectivity, since iodine is generated continuously during the reaction" aiid it makes up for the losses wheih are due to the free volatilization of iodine after the preparation is applied.
- a further advantage is that it is possible to regulate the amount of the generated iodine and the rate, or the period of iodine generation and to ' adjust the preparation to a particular wound and to the stage of the healing process.
- a further advantage of the preparation of the invention is that it can be in 1 the solid form, as well as hi the liquid form.
- the solid form is preferred in that it is planar Which assures the suitable concentration equally over the whole wound and the concentration of iodine cannot be locally exceeded and at the same time, there cannot be the lack of hyaluronan locally. Therefore, in case of the topical application, the risk that the preparation or the secondary bandage dries and sticks to the wound or that the result of healing is weaker due to the lack of hyaluronan is minimalized.
- the present preparation of the invention compared to the prior art, uses the biotechnologically prepared hyaluronan, without any chemical modification, and in the combination with substances ; such as inorganic salts etc. which do not have the pharmacological effectivness as antibiotics, cytostatics ' , antipyretics and similar drugs, though it is of course possible to add the chemically modified hyaluronan, or the pharmacologically effective substances into the ⁇ preparation of the invention.
- the present preparation of the invention belongs to the field of the preparations using hyaluronan in the combination with another substaiice or a mixture of substances, however, in contrast to the previous solutions none of the "substances contained in the mixture has any pharmacological effectivity by itself or after mixin3 ⁇ 4.
- the effective substance is the reaction product resulting from the reaction of the starting; substances contained in the mixture (conditionned by the suitable environment) and the pharmacological effect is antiseptic.
- hyalurqnan used in the preparation of the invention for example compared to the collagen is that after the application .it does not cause inflammations and no phase conversion from the liquid into the solid dry gel occurs (the viscosity is not dependent on the content of iodine or the sources of iodine but only on the molecular weight and the concentration of hyaluronai and that changes in time according to the absorption / the evaporation of the exudate and the natural disintegration processes).
- the most preferred solid form of the present invention is a spongy lyophilizate, eventually imbedded on a support, or a multilayer bandage with the contact layer made from the permeable polyurethan membrane having the dried surface coating made of the single components generating iodine (it is possible to realize drying via lyophilization, eventually via hot air; the coating can be provided as the 3 ⁇ 4queous solution, eventually as the solution in the mixture of solvents, for example alcohol a id water).
- a further advantage 1 bf the preparation of the -..invention for example compared to the preparations containing pol vMylalcohol is that it does' -hot contain synthetic substances and all siibstances used in the preparation are ⁇ body-natural 6r are changed into harmless products (e.g. iodate into iodine and - water, / iodide into iodiiie by means of the rectioh.
- the substances are biologically decomposable and therefore' it is possible to use the preparation (or some of the forms) also for' int acorporeal applicafioriii' without any risk of inflammations and undesirable reactions.
- the present solution is in the dry- form without enzymes before the application which means lower requirements for the storage.
- the present preparation keeps its effectivity in terms of the iodmS generation also after a [ exposition to temperatures of above 100 °C and also below - 90 °C (selected forms of the preparation are heat-resistant above 121 °C and therefore it is possible to sterilize them in ' an' autoclave).
- the result of the heat stress of the present preparation can only be the change -'of the molecular weight of the used hyalurohan.
- this effect Occurs to a larger extent only after it is exposed for a long time to temperatures of more than 90 °C which does not occur even in the extrerrie conditions of military hospitals or in cases of natural disasters.
- the preparation ' of the invention does not contain free iodine but a mixture of compounds capable of generating iodine. Therefore, it contains a suitable compound or several differeh? compounds -of iodine 3 ⁇ 4s ' *tne ⁇ source ' of iodine and a substance initiating the formation of iodine.
- the preparation for healing of ihtracorporeal and/or surface wounds according; to the invention can have one component, eventually it can contain two parts. As far as the physical state of the preparation is concerned, it can be solid or liquid, or both parts can b ⁇ li uid ⁇ or both parts can be solid, eventually one of them can be liquid and the other one can ; be solid.
- these parts are typically the pairs AB + ⁇ , , ⁇ + B or A+K, or B + ; wherein the component A contains hyaluronan (HA) (but does riot have -to if any of the other ⁇ components contains HA) and one source of iodine (IA), wherein J is preferably the oxidized form of iodine, thus that which has a higher oxidation number (i.e.
- the component B contains HA (but does not have to if any of the other components contains HA) and the second source of iodine ,(I B )j wherein IB is preferably the reduced form of iodine thus that which has the lower oxidation number (i.e.
- the preparatioriv has just one component (BK), it contains the photoactive substance as an initiator K th3 ⁇ 4t; generates iodine from the ⁇ resent source of iodine, or from the mixtures of iodine sources upon , ? exposition to the light of the suitable wave length and intensity.
- the preparation has two components, the following combinations in terms of the chemical composition are possible.
- the part AB contains both sources of iodine, thus IA and IB.
- the part K contains nitiators, for example citric acid or it can be the solid ion exchanger (the acidic form of the cation exchanger)/
- the part AK contains the source of iodine and the ' initiator e.g. citric acid
- the part B contains the source of iodin£3 ⁇ 4
- the agent K or the auxiliary agent that can be in the component A, B or K performs the oxidating or reducing -function directly.
- the 1 ' -coWponent K might Contain ferric chloride or potassium dihydrogen phosphate and hydrogen peroxide, wherein ' the component B would contain iodide.
- the preparation or at least one of the parts A, B, K or AB contains the physiologically acceptable salt of hyaluronic acid, at least one of the part contains the source of iodine and at least of one part contains the iniciating agent.
- the preparation can have more parts, for example A, B and K, however, such asolution does not have practical advantages.
- the physiologically ; acceptable salt of hyaluronic acid is esspecially sodium, potassium, lithium, calcium, magnesium, zinc, cobaltous and manganous salt and/or the mixture thereof.
- the total content of the physiologicall acceptable salt of hyaluronic acid in both parts is within the range of 0,005 to 99,9 wt.%, the total content of all sources of iodine is within the range of 0,001 to 90,0 wt.%, the content of all initiatory agents is within the range of 0,001 to 90,0 wt.% and the content of water is within the range of 0 to 99,9 wt.%.
- the sources of iodine I 'A -ahd 3 ⁇ 4 can be the same or they can differ from each other, U being preferably selected from the group comprising iodates, periodate, periodic acid or a mixture therof and 3 ⁇ 4 being preferably selected from the group comprising iodide, hydroiodic acid or a mixture therof.
- U being preferably selected from the group comprising iodates, periodate, periodic acid or a mixture therof
- 3 ⁇ 4 being preferably selected from the group comprising iodide, hydroiodic acid or a mixture therof.
- the source of iodine U is a compound of iodine having a higher oxidation state than the source 3 ⁇ 4 used in the specific case.
- iodate is used as the source I A
- iodide qari be preferably used as the source 3 ⁇ 4.
- Iodide can be e.g.
- iodate can be for example sodium, potassium or calcium iodate
- the periodate can be for example; sodium or potassium periodate.
- the sources of iodine can be a mixture preferably consisting, of potassium iodide in the amount of 0,001 to 90 % with sodium iodate in the amount of 0,001 to 90 %.
- the use of periodate involves the advantage that even more iodine is generated than in case of iodate (at the same amount of the reactant substance).
- the iniciating agent is acidobasic and/or redox.
- the suitable photoactive agent having oxidizing or reducing effects upon, the light exposition is used.
- the oxidizing agent for example anthraquinone, basic, porphyrin or phtalocyanin dyes, or crystal violet, methylene blue, bengal red.
- crystal violet methylene blue
- bengal red a dye that is not sufficiently photoactive by themselves at the light exposition of the suitable wave length and intensity but that are in a mixture with substances which help the energy transfer from the light.
- these may be for example dyes forming metal complexes, or being imbedded to solid particles (micro- or nano-particles Ti0 2 , ZnO, FeO, Fe 2 0 3 , Fe 3 0 4 , or mixtures thereof).
- the amount of the initiatory agent is selected according to its character and according to the composition of the iodine sources.
- the optimal amount of the initiator usually corresponds to the stechiometric amount that is necessary for the intended reaction to iodine,
- ⁇ r is . ⁇ ⁇ ⁇ . ' . , . : ⁇ ; -.. ⁇ . ⁇ . ⁇ ⁇ ⁇ .. -> : " # ⁇ or that provides for a suitable reaction environment, for example pH of the mixture that is necessary for the generation of iodine, or for the generation with a particular rate in a particular time period.
- a suitable reaction environment for example pH of the mixture that is necessary for the generation of iodine, or for the generation with a particular rate in a particular time period.
- the preparation can have the generation of iodine divided into several intervals having different rates, for example the highest rate in the beginning in order of minutes and then a lower rate in order of tens of hours or days.
- the preparation of the invention can contain one or more adjuvants and/or a support.
- Adjuvants can be selected from the group comprising agents for improving the healing effect of the preparation, agents for modifying the viscosity of the preparation and/or the strength of fibers and/or agents for retarding iodine vaporization and/or stabilizers, e.g. stabilizers of iodine sources against the decomposition and/or stabilizers of hyaluronic acid against the decomposition and/or preservative.
- the agent for improving the healing effect of the preparation can be selected from the group comprising sodium alginate, chitosan, glucan, oxycellulose, schizophyllan and biotin;
- benzoic acid selected from the group comprising benzoic acid, salicylic acid or ethylene diamine-tetra- acetic acid, calcium propionate, benzalkonium chloride ⁇ ' stabilized oxychlorine complex, calcium sorban, potassium sorban or tocoferol.
- the preparation of the invention can have different forms.
- the one- component preparation can be , in the form of an ointment or a bandage.
- the two-component preparations can be designed so that both the part A and the part B of the preparation are separated and both parts can be in the form of a liquid or in the form of a gel, but they can also be solid such as a bandage having the sandwich structure. If both components are solutions, or gels, they can haye a different chemical composition and the iodine generation is caused by their mixing.
- the application form or the container can have the different structure.
- it can consist of two cylindrical reservoirs, like syringes having a suitable volume, placed, paralelly side-by-side so that the pistons run together.
- the preparation can be in coaxial cylinders having a different diameter or in two separate parts' of a plastic or metal tube, or in two sacks in a vessel with pressed air or with another propelling medium that forces their content out when the caps of the sacks are opened, through the mixing chamber via a nozzle in the form of an aerosol.
- the extrusion can also be done by interacting of a mechariical force by means of the piston etc. If the cover is in the form of a tube from an elastic rriaterial, in which sacks of the same or another elastic material are placed then at the appplication of the preparation the container is discharged by pressing the content out, thus by the mechariical deformation of the container.
- the container does not need the bleriding chamber since its function can be replaced by cracking of the inrier sacks and blending of the solutions in the whole volume of the tube during the mechanical stressing of the container even before the extrusion.
- the container can be equipped with suitable inner placings, or with outer placings, for example on the container cap. It is possible to perform the mixing also mannually outside of the container after the extrusion of the particular solutions.
- the preparation can be in the form of a solid planar formation on a textile support that is preferably in the form of a multiple layer sandwich.
- the preparation can be in the form of two solid planar formations or two solid planar formations on a textile support adapted for the crisscross placing before or during the application.
- the preparation is in the form of the solid planar formations having the sandwich structure, it is preferred that one of the layers which is closer towards the body consists of a microporous membrane.
- PUR polyurethane
- the membrane has sufficient mechanical properties, it is possible to remove it from the support and use it as the contact layer of the preparation (the layer is in the direct contact with the body).
- the PUR membrane In case it does not have the required mechanical properties, it is ' used including the support on which it was deposited (this support is preferably porous). In case the PUR membrane is not attached to the support with a sufficient force, the cohesion can be increased for example by pressing, wiping, spot or line weld or by .another suitable operation.
- the PUR membrane can also be formed by the so-called coagulation, when the solution of the PUR polymer in the Suitable solvent is used and deposited l pii a suitable support.
- the membrane After removing of the solvent the membrane remains on the support and it is possible to' use it separately or with the support. Besides, it is also possible to use' a mixture of different polymers PUR with the membrane formation from one solution at the same time, or frorti different solutions successively.
- This dan be achieved for example' by first forming the membrane from one polymer via electrospinning and after that an additional membrane is formed from another polymer On this membrane by the coagulatidri metfipd. At the same time, one of the polymers can be more hydrophilic than the other and it can be used in the first, as well as in the second step.
- microporous PUR membfMes are preferred due' 5 to their gas and aqueous vapor permeability, as well as their water permeability and the permeability for aqueous solutions, however, it slows down the riioVement of the macrornoleeular substances. Thanks to this the hyaluronan is maintained loriger on the wound so that' the ' whole preparation has got a higher effectivity, or a longer durability.
- the PUR membrane itself has a low adhesion to the wound so that it minim ⁇ alizes the risk of drying and sticking to the body and this also in case it is used without hyalurpnan or any substance having a similar anti-adhesive effect.
- These properties have been; .proven for the PUR membranes having the trade names Desmopan and Hydromed, however they can be achieved also for other polymers.
- the preparation can be in the form of the textile wherein, the fibre composition corresponds to the composition of the preparation with or without the eontent of at least i ; one adjuvant.
- the preparation can be for example in the -ifbrm of a bandage with the support formed out of several layers of oven or non-woven textiles that are impregnated with the mixture containing the components of the preparation, or they can be provided with a layer of the mixture coating applied on the surface of the support.
- the preparation can also be in the form of a porous planar formations formed from solutions of hyaluronic acid , and additional substances via the lyophilization method, respectively either on the textile . support, or also without, this support.
- the preparation can be formed also as the woven, eventually as the non- woven textile of fibers, the composition of which corresponds to the composition of the preparation, eventually containing even more additional adjuvants.
- the fibers call have the form of nano or microfibers, or they can also have a bigger diameter.
- the structure of the fibers can be either homogenous within the whole volume, or it can be the "core-shell" type or other non-homogenous arrangement.
- the preparation can be formed from the mixture of two. fibers of a different chemical composition.
- the surface distribution of the fibers of the particular chemical composition can be homogenous or also non-homogenous and the preparation Can be formed also on the support.
- the preparation in a solid form, it can be packed with a desiccant selected from the group comprising magnesium sulfate, sodium sulfate, sodium carbonate or silica gel in the suitable permeable cover that is separated from the preparation as such which is then separated from the outside ehviroiiment with an airtight "1' cover having suitable mechanical properties.
- a desiccant selected from the group comprising magnesium sulfate, sodium sulfate, sodium carbonate or silica gel in the suitable permeable cover that is separated from the preparation as such which is then separated from the outside ehviroiiment with an airtight "1' cover having suitable mechanical properties.
- the invention -relates to a method of production of the preparation by dissolving all the components in one solution, or separately by dissolving the components of part A in water and the components of part B in water to form two solutions of a different composition.
- the solution, or solutions can be prepared from sterile raw materials in an aseptic environment and then it is filled into one, or two separated covers. Then either the one-componet form is applied directly, or in case of two components, they are mixed immediately before the application to the wound. Thanks to generating iodine after the application (due to light, by mixing the two parts just before using), the preparation is always fresh, thus containing enough io'dirie;-
- the prepared solution, or the solutions are first filled in a container, or in two separate containers and then sterilized and mixed immidiately before the application to the wo hd.
- the prepared separate solutions or gels are filled into IAVO separate containers, subsequently they are lyophilized or dried with hot air and subsequently they are sterilized separately or together.
- the prepared separate solutions or gels are filled into two separate containers, while a textile is inserted into at least one container, subsequently they are lyophilized or treated 'with hot air and subsequently they are sterilized separately or together.
- Another embodiment of the method of the invention consists in the separate extruding of part A and part B by the: means of a capillary into separate containers containing an anhydrous solvent selected from' 'the group comprising aliphatic alcohols, phenol, glycerol, modified alcohols, ketones, hydrocarbones, esters,; . ethers, amines and heterocyclic compounds that is stirred to fdm trie precipitated fibers. 1 that are subsequently taken out of the containers, are dried separately ! 3 ⁇ 4 25 to 150 °C and subsequently they are formed onto a woven or non-woven textile, or ;a 3 ⁇ 4hree-dimensional formation together or separately and/or they are fixed to the support ficf sterilized.
- an anhydrous solvent selected from' 'the group comprising aliphatic alcohols, phenol, glycerol, modified alcohols, ketones, hydrocarbones, esters,; . ethers, amines and heterocyclic compounds that is stirred
- At least' brie container can also contain an auxiliary support selected from h3 ⁇ 4 group comprising ' 'a textile, a wire screen, a cylinder and other formations whereon the fibers precipitate to fdrhi the two-dimensional or the three- dimensional structures after the . extruding step into , the containers, and subsequently the formed fibers and/or the textiles with " the fibers are sterilized separately or together.
- the parts A and B of the preparation of the invention according to the required physical form for the appllicatidn ⁇ are either kept in the liquid or in the gel state or they are dried. It is possible to perform dfying. either with the addition of a textile auxiliary material or also without the textile material i lri;.
- the drying of the solutions, or gels can proceed also in the gas phase i.e. by means of the extrusion into flowing or static dry gas having a suitable temperature, pressure and vapour pressure of the used liquid or vapour of the components of the liquid mixture.
- the preparation there are various ways ⁇ f application of the preparation, according to the physical form, thereof. If it contains an auxiliary textile it is applied as a bandage to the wound, in case of a dry wound it is wetted in. adyance with the physiological solution, the sterile water or even the usual water, it is po ⁇ sible ⁇ to apply the preparation directly to the dripping wounds. If the preparation does not contain any auxiliary textile ⁇ t. is .suitable to use a secondary dressing in case of a surface wound. ( However, the form without the auxiliary textile is preferably intended for the application inside, the.
- the preparation is applied to the wound either directly and covered with a secondary dressing or it is deposited in a sufficient layer onto such side of the secondary dressing that is subsequenty -applied ' to the wound, of i .the' -bandage is impregnated ith the preparation and subsequantly ap ⁇ Iieditb the wound.
- the invention relates to the use of the preparation for healing surface and or intracorporeal wounds.
- the u -acorporeal wounds that Can be healed by means of the preparation can be for example fistulae, deep wounds and the transplantion of inner organs as well as the skin.
- the preparation is also suitable for eye treatments, i.e. surgeries and transplantions of keras and lens, of as eye-drops (the treatment after surgery or the syndrom of dry eye).
- Fig. 3 and Fig. 4 showjiphptps of me formations sti?ucture of the of the type "A" (the surface form) taken by the electrpn microscope.
- Fig. 5 and Fig. 6 show ph tos of the formations structure of the type "A" (the spheric form) taken by the electron micr seppe.
- Fig. 7 and Fig. 8 shqyv photos the formations structure of the type "B" (the surface form) taken by the electron micrpscope.
- Fig. 9 and Fig. 10 show photos of the formations .structure of the type "B" (the spheric form, the cluster section herein tak n by the electron micrpscope.
- Fig. 11 shows the result's ; f testing the preparation of Example 11 in terms i of the healing effect wherein the meanings of the legend are as follows: " AB+K” is the preparation of Example 11 with the iodine capacity 0.1 %; “Hyiodine” is the preparation of EP 1487506 applied onto the gauze and “untreated” is the wound which was not treated (covered with a dry gauze).
- Fig. 12 shows the generation of iodine in time using a photo-catalyzer in the case of the "FC.KI", wherein the "FC,KI”. is the preparation of Example 13; "FC.nul” is the reference sample of phtalocyanin as such haying the same concentration in pure water; “KI.Nul” is the reference sample of potassium iodide having the same concentration in pure water.
- Fig. 13 shows the res l s ; 3 ⁇ 4)f testing the preparation of Example 17 in terms of the healing effect
- X3C is the bandage wherein the main initiator is citric, acid with the iodine capacity 0.3 %
- X3P is the bandage wherein the main initiator is. the phosphate buffer with the iodine capacity 0.3 %
- X1C is the bandage wherein the main initiator is citric acid with the iodine capacity 0.1 %
- HAI is the preparation of EP 1487506. applied onto the gauze and "untreated” is the wound which was not treated (covered with : dry gauze).
- Fig. 14 shows the concentration changes of iodine in time, the incoming content of iodine is the same for all solutions, namely 0,1 % of iodine, expressed as 100 % herein (compared to Hyiodine).
- the meanings of the legend are as follows: "SH_R” is the system generating iodine by the reaction corresponding to the preparation of Example 2 (KI + NaI0 3 in SH);
- registerH20_R” is the system generating iodine by the reaction which corresponds to the preparation of Example 2 with the difference, that it does not contain hyaluronan (KI + NaIC ⁇ 3 in H 2 0);
- SH E is the system: with the elemental iodine which is analogical to the preparation of EP 1487506 withjtrje difference that it does not contain hyaluronan (I 2 + KI in H 2 0).
- Fig. 15 shows kinetics of the generation of iodine in two extreme cases of the system of analogical sample "I I20 R” (for the legend see above); wherein citric acid is used as the initiator for the system “C”;: the mixture of sodium hydrogen- and dihydrogenphosphate having pH ⁇ 5,6 is used as the initiator for the system "P".
- Fig. 16 shows the effect o f the sterilization with ethylene oxide and the different doses of gamma radiation to the molecular weight of hyaluronan.
- Fig. 17 shows the effect "of the sterilization by means of autoclave to the solution of hyaluronan as such in the pure water* as well as to the solution "AB" of Examples 10 and 11.
- the second solution is prepared by dissolving 0.35 g potassium iodate, 0.1 g citric acid and 1.5 g sodiurri ftyaluronate in 100 ml sterile water for injection which forms solution A. Both solutions are' sterilized and are filled -into two appropriate containers! under sterile conditions. Prior to the application, the containers are unsealed and both solutions are mixed in the ratio of 1 :1. The .mixture is then applied to the wound and covered with a secondary dressing or is applied directly onto the secondary dressing that is then placed on the wound.
- Potassium iodide (0.5 g)v'and sodium hyaluronate (1.5 g) of molecular weight of 1 500 000 g/mol is dissolved in 100 ml of sterile water for injections, which forms the solution B.
- the second solution is prepared separately by dissolving potassium iodate (0.06 g), citric acid (0.1 g) and sodium hyaluronate (1.5 g) in 100 ml of sterile water for injections, which forms the solution A..
- Both . solutions are steriljzed and filled into two .suitable containers under sterile conditions., Prior to the application, the containers are unsealed and both solutions are mixed in the ratio of 1 :1. The mixture is then applied onto the wound and can be subsequently covered with secondary dressing or the mixture is applied directly onto the secondary dressing that is then placed on the wound.
- Potassium iodide (1.75 g) and s di m hyaluronate (1,5 g) of molecular weight of 1 500 000 g/mol is dissolved in 100 ml , of, sterile - water for injections which forms the solution B.
- the second solution- i$ prepared b dissolyjng potassium periodate (0.26, g), citric acid (0.1 g), and sodium hyaluronate (1,5 g) in 100 ml. of t sterile water for injections, which forms the solution A.
- Both .solutions ,are sterilized and -filled into two suitable containers under sterile conditions.
- the containers Prior to the application, the containers are unsealed and both solutions are mixed in the ra ⁇ i i .of A :.1.
- the mixture is applied onto the wound that can be subsequently covered with secondary dressing or the mixture is applied directly onto the secondary dressing that is then plaedd on the wound: ' .
- Potassium iodide (0.45, g ⁇ : and sodium hyaluronate (1.5 g) of molecular weight of 1 500 000 g/mol is dissolved , in ⁇ , ⁇ m of sterile water, for injections, which forms the solution B.
- the second solution- is prepared separately' by dissolving potassium periodate (0.04 g), citric acid (0.1 g) and 'sodium hyaluronate (1.5 g) in 100 ml of sterile water for injections, which forms the.' solution A.
- Both solutions are sterilized and filled into two suitable containers under sterile conditions. Prior to the application, both containers are unsealed and both solutions are* mixed together in the ratib of 1 :1.
- the mixture is applied onto the wound that can be subsequently covered with a secondary dressing or the mixture is applied directly onto the secondary- dressing that is then placed on the wound.
- Potassium iodide (5i4 ; ; mg); sodium hyaluron,ajt t ,(8.5 g) . of molecular weight of 1 500 000 g/mol; disodium hydrogen, phosphate dodecahydrate (0.054 mg) and xanthan (25 mg) are dissolved in 3.4 ml of, sterile water for injection.
- the second solution is prepared separately by dissolving potassium iodate (0.5 mg); citrip acid (8.2 mg); sodium hyaluronate (8.5 mg); xanthan (25 mg) and, sodium dihydrogen phosphate dihydrate (2.2 mg) in 3.4 ml of sterile water for injections.
- the two solutions are poured into two Petri dishes of 3 cm diameter or into containers of a suitable shape with the same bottom area.
- the containers are placed into the liquid nitrogen in' an ultra freezer or conventional freezer and the content is frozen.
- the containers are placed into an instrument which allows for freeze drying under reduced pressure (lyophilizer) where they are left to dry until the formation of slab-like formations having spongy structure (the structure of the pores corresponds to the rate of freezing). Dry slab-like formations re arranged into the required shape, packed separately or together and are sterilized.
- T e ⁇ utilization consists m ; unwrapping and applying onto the wound or into the wound (e.g. fisiiila). If the wound is dry, it is possible to wet the preparation prior to or after the application of the dressing. In. case of body surface application, it is suitable to apply also the s.ec0n3 ⁇ 4afy dressing made - from conventional materials onto the wound.
- Potassium iodide (2.2 mg); sodium hyaluronate (8.5 g) of molecular weight of 1 500 000 g/mol; disodium hydrogen phosphate dodecahydrate (0,022 mg) and alginate (40 mg) are dissolved in 3.4 ml of; sterile water for injections.
- the second solution is prepared separately by dissolving potassiuh iiodate (0.22 mg); citric acid (3.3 mg); sodium hyaluronate (8.5 mg); alginate (40 mg) and sodium dihydrogen phosphate dihydrate (0.9 mg) in 3.4 ml of sterile water for injection.
- the solutions are poured into two Petri dishes of 3 cm diameter or alternatively into a containe of a suitable shape with, the same bottom area.
- the containers are placed into the liquid nitrogen in an ultra freezer or conventional freezer and the content is frozen.
- the containers are placed into an instrument which allows for freeze drying under reduced pressure (lyopKili'zier) where they are left to dry until slab-like formations having spongy structure are formed (the structure of pores corresponds to the rate of freezing). Dry slab-like formations are arranged into the required shape, packed separately or together and are sterilized.
- the utilization consists in unwrapping and applying onto the wound or alternatively into the wound (e.gl- fistula). If the wound is dry, it is possible to wet the preparation prior to or after jtne ' application of the dressing. In case of a body surface application, it is suitable to apply ' al So a secondary dressing made from conventional materials onto the wound.
- auxiliary rn.aterial fo ⁇ preparation of the solutions as in Example 5 or 6 is used, with the proviso that an auxiliary rn.aterial of appropriate shape and qualities is added into one or alternatively into both containers with the solutions prior to freezing.
- the suitable auxiliary material can be a square of woven or non- woven fabric of a suitable chemical composition or a long strip of fabric, or alternatively other geometrical shape.
- the auxiliary material for surface wounds include; textiles made of pobyamide, polyethylene, polyester etc.
- supports for wounds inside the body include textiles made of biodegradable, inside the body dissoluble fibers,; that are conventionally used for sutures.
- the support can be shaped into a pocket with the polysaccharide layer inside or outside. Further procedure and applications are similar to those in Examples 5 or 6 with the exception that, when the used support is not biodegradable/degradable within the body, it' can be applied only on the surface wounds.
- the most suitable prepi3 ⁇ 4dti0ri for application inside the organism is the pocket form made of a porous material with j a ' .layer of polysaccharides inside, because the body, fluids permeate the pores of the s p3 ⁇ 4orf '3 ⁇ 4lo ly and thus iodine production and polysaccharides dissolution is also slow. In this a ⁇ /the required time of efficiency is ensured.
- Example 7 An analogous preparation as in the Example 7 is used, with the exception that solutions are spread on the surface or are impregnated into a suitable support, and instead of lyophilization, the standard hot air drying is used, or alternatively microwave or other drying. It is particularly preferred to prepare the solution from isopropanol - water mixture in the ratio of 1 :1 (v/v) with the hyaluronate concentration from 1.5 to 2.5 % by weight for the hot air drying. Hyaluronate is not completely dissolved in this solution, which is the reason why the viscosity is lower than that in an aqueous solution having the same concentration. Another advantage of the use of the 50 % of isopropanol solution is its autosterility.
- the solution can be easily applied using a template of the required shape and thickness.
- the thickness determines the applied amount of the active substance. For majority of applications it is suitable to spread roughly lOO to 200 mg of hyaluronate on the surface of 10 ⁇ 10 cm. This stated range of cdncentratib ⁇ cBrr3 ⁇ 4pohds to the template thidkness of O.S to 2.0 mm.
- the suitable support would be a multilayer bandage with the contact layer of textile made of monofilament fibers (so it .will eliminate fiber release into the wound or ingrowing of the layer into the healing tissue);
- Another layer can be matde of highly porous polyurethane membrane, further absorption layer made of polyester, viscose, or mixture thereof, and the top layer of non- woven polyester.
- Two basic solutions are prepared following the" procedure analogous to Examples 1 and 6, with the exception that they can contain, apart from hyaluronate, another auxiliary substance, e.g. alginate, cellulos iderivates, xanthan or a mixture thereof in an amount of e.g. 1 w. % of the solution weight! n of the solutions is subsequently extruded through a thin capillary into the unhydrous : iso ⁇ pf panol or another suitable liquid in a stirred container to ensure coagulation of fibers ⁇ ' that, kre captured on a suitable structure, e.g.
- the rotating wire cylinder on which the auxiliary pad can be placed for example: textile; alternatively the fibers are spontaneously coagulating' into steric formations inside the container.
- the product was replaced from the solution and dried in the drier at 50 °C. The process of coagulation of fibers is either discontinued or is carried out continually. from the second solution are prepared.
- the fibers can be prepared e.g.: by extrusion through a narrow capillary into unhydrous isopropanol with the rate of 1 ml/min in a stirred container at the room temperature for 2 to 5 min., depending on the desired amount of product. Material is then let to mature for 15 to 30 minutes.
- the fibers have the diameter of 50 nm to 5 ⁇ , the thickness of the layer corresponds to the thickness of microfilaments, or in case the formation is spherical the layer thickness can be up to several millimeters, e.g. 0.5 to 2 mm.
- Potassium iodide (0.26 g); sodium hyaluronate (1.5 g) of molecular weight of 1 500 000 g/mol; potassium iodate (0.026 g) and disodium hydrogen phosphate dodecahydrate (0.0026 g) are dissolved in 89.18 ml of sterile water for injections, which forms the component AB.
- the second solution is prepared separately by dissolving citric acid (0.039 g) and sodium dihydrogen phosphate dihydrate (0.01 g) in 8.92 ml of sterile water for injections, which forms the component K. Both solutions are then filled into suitable containers that are sterilized, e.g. in an autoclave.
- both containers Prior to the application, both containers are unsealed and both solutions are mixed either the whole amounts or in smaller amounts, but always in the ratio of 10:1, in favor of the component AB. If the components are mixed in smaller amounts and the container ensures sterility of separated components, it is possible to use the preparation repeatedly.
- the mixture is applied onto the wound which can be followed by application of a secondary "dressing, or the mixtu e 1 is applied on the secondary dressing and then placed on the woundi
- Potassium iodide (67.2 mg); , sodium iodate (6.5,,. mg ⁇ ; disodium hydrogen phosphate dodecahydrate (0.65 mg) and, podium hyaluronate (400 mg) of average molecular weight of 300 000 g/mol is dissolved in 38 : ml of sterile water. ijbi injections. This solution is divided into ; ,1 .
- ⁇ t is either sodium chloride (8.5 rng); .or sorbit (380 mg), or glucose (388 mg), or disodium hydrogen phosphate dodecahydrate (210 mg) with sodium dihydrogen phosphate dihydrate (55 mg).
- the solutions are sealed into suitable container,! Which preferably enables the dosage in small drops, and then the; solutions are sterilized.
- the flow chambers containing acidic form of ion exchanger are fixed on the output openings of the containers (for example 0.5 ml cation exchanger Abmerlite IR 120 Plus) in the form of. small particles (the diameter of the grain is approximately 0,2 to 1 ,5 mm) and this system is assembled into a form' which enables gradual expelling through the; i0ri';'excharig3 ⁇ 4r. Such preparations are then used as eye drops 1
- the containers for example 0.5 ml cation exchanger Abmerlite IR 120 Plus
- small particles the diameter of the grain is approximately 0,2 to 1 ,5 mm
- One-component form with a photo catalyst bio film inhibitor
- Aluminium ftalocyani3 ⁇ 4(7v8 nig) is dissolved ⁇ ⁇ ! ml of sterile water for injections. 4 ml of this solution are taken ⁇ a3 ⁇ 4d' in these 4 ml - potassium iodide (42 mg); sodium hyaluronate (10 mg) of average .'molecular weight of 1 500 000 g/mol are dissolved and carboxymethylcellulose (180 ' mg) is added resulting in a viscous gel. This gel is then packaged into a container that is lightproof and is sterilized.
- the preparation can be applied either directly on the wound as aft: ointment or is spread in an amount of circa 4 to 8 g on the area of 10 x 10 cm onto one layer of the primary dressing (gauze). It is also possible to seal the prepared gel into a pocket-like areal formation or impregnate bandages therewith and then package it and sterilize. The preparation then forms a pocket made of a porous material or a
- the daily exposure of approximately 50 minutes is performed during the whole healing process.
- the exposure is divided into two or three intervals (2 25 min., or 3 x 16 min.).
- the pocket- like formation or bandage is used ' / it is possible upon the supervision of a doctor to reuse the same dressing for several days until it is decolorized (all the dye is consumed), or the source of iodine is exhausted (this, however; can be continuously refilled).
- Sodium iodate (5.75 mg); disodium hydrogen phosphate dodecahydrate (0.57 mg) and sodium hyaluronate (336 mg) ;,3 ⁇ 43 ⁇ 4th average molecular weight of 1 500 000 g/mol are dissolved in 16.8 ml of sterile water for injections.
- This ⁇ mixture is spread in an amount of 0.8 ml onto squares of porous polyurethane membrane stretched on a suitable pad of a larger area.
- the application of mixture is carried out on separate squares of 4 x 4 cm and there will be free rims of 1 cm in between the squares,
- the membrane together with the pad is placed into a drier and the mixture is dried completely (for example in a hot air dryer with forced circulation at 70 °C).
- the second mixture is prepared by dissolving 57.3 mg of potassium iodide; 86.2 mg of citric -acid; 23 mg of sodium dihydrogen phosphate dihydrate and 255 mg of xanthan in 16.8 nil of sterile water for injections.
- the layer is turned over and on the -other side the same areas are covered with the second mixture, again in the amount of 0.8 ml on the 4 x 4 square.
- The; coating is placed immediately into the dryer and dried (for example 1 in a preheated hot air dryer). Then a suitable pad, optionally more layers of different pads are placed underneath the membrane with the coat, and 5 x 5 cm square bandages are formed by welding together the free rims around the coatings which at the same time leads to the separation of the squares.
- the squares are then individually packaged and sterilized.
- the bandage When used, the bandage is placed with the membrane side on a strongly exuding or bleeding .wound and is fixed by a secondary dressing, or the coating on the membrane is wetted by water 'of a suitable liquid first and then applied onto the wound and fixed by a secondary dressing:
- Bandages of any possible shape or area can be prepared analogously, provided that the stateel amount of the coat on a specific area is complied with.
- Bandage of type cocoP is prepared similarly as in Example 14 in the following way: the first mixture is prepared by. ⁇ dissolving sodium iodate ⁇ ;(17.31 mg); disodium hydrogen phosphate dodecahydrate (1 ,73 tng) and sodium hyaluronate (336 mg) of average molecular weight of 1 500 000 g/mol in 6,8 ml of sterile water for injections.
- the second mixture is then prepared by dissolving potassium ; iodide (172.5 mg); citric acid (86.2 mg); sodium dihydrogen phosphate dihydrate :(8 mg) and xanthan (255 mg) in 16.8 ml of sterile water for injections.
- Bandage of type ' supplementC3 ⁇ 4 is : prepared similarly as bandage anisole", only the amount of sodium dihydrogen phosphate diKydrate is different, which is only 23 mg. The procedure is otherwise identical to the preparation of the bandage of type "P".
- a different amount of . ;..i.JaH2 , P0 4 .2H 2 0, or . Na 2 .H. P.0 4 .12H 2 0, or a different ratio of these compounds while maintaining ' the same amount Of citric acid, or a different ratio of any of phosphates and citric acid influences the rate of iodine production, that is, whether quantitatively all the possible amount is generated immediately after mixing or whether it is created gradually, and also for how long it is generated.
- an exudate has a different pH than blood, which means that for the bleeding wounds more acid is needed,' as well as generally a larger amount of all buffers or acid-base initiators, while on the contrary, a lower amount of acid and of buffer in general is more suitable for exuding wounds, and for dry wounds which are wetted by pure water prior to placing the bindage to the wound, an excess of acid is even undesirable and can slow down the healing process.
- the initial content of hyaluronate For example, in the preparation according to example 1, only 0.15 g of hyaluronate instead of 1.5 g is used and it is supplemented by 2.0 g of xanthan, so that the total amount of polysaccharides is bigger than the original content of hyaluronate (2.15 g of the mixture comp ⁇ ed 3 ⁇ 40 the original 1.5 g). .
- Other substances or mixtures of substances can be used up tp
- Potassium iodide (0.01 g) ; and sodium dihydrogen phosphate dihydrate (0.0001 g) are dissolved in 2 ml of sterile water for injections, which forms the component B.
- the second solution is prepared separately by ..dissolving ferric chloride (0.01 g) and sodium dihydrogen phosphate dihydrate (0.000 l - ); in . 2 ml of sterile water for injections, which forms the component K.
- Both solutions are filled into two suitable containers (PP, PE and the like), the containers here were pockeHike squares 10 ⁇ 10 cm made of soft plastic foil. Pockets are designed in such a way that they- lie on each other by the complete surface thereof and therefore, they share one wall in , this way.
- theie are reduced seams which make the perforation prior to use easy.
- the perforation is also facilitated by a plastic spike welded on the inner side of one of the pockets (the one that is closer to the absorption side).
- the pockets are welded; by ' their rims onto a bandage of 10 * 10 cm formed of one absorption layer with a polyurethan mebrane provided with a hyaluronate coating.
- the coating was prepared by dissolving sodium hyaluronate (0.1 g) of molecular weight of 1 500 000 g/mol in 6.6 ml of . sterile water for injections and by covering evenly the polyurethane membrane therewith and drying at 70 °C.
- the bandage is packed (including the secondary dressing) and is" sterilized.
- the generation of iodine is initiated by mechanically pressing' the bandage, which 5 causes the perforation of the wall between the pockets and mixing of the solutions.
- the ioidine generation is immediately visible thanks to the change of the coiBur::
- the produced iodine ⁇ permeates through the thin wall of the pockets to the absorption i&fe of the bandage and' dioser to the wound, which ensures elimination of microbial contamination from the environment and disinfection of the wound.
- the bandage is then placed onto the wound and fixed by a secondary dressing.
- the bandage is suitable for first aid in the field,' for ; example: disaster ihedicine and military missions.
- This particular form is ideal for acute clean small wounds, o " alternatively for larger and not very contaminated wounds.
- the heavily 1 contaminated wounds 1 require a higher concentration of iodine, which is ensured by increasing the concentrations of the solutions B and K; It is also possible to adjust the production of pockets in such a way that they are not within the whole area Of the bandage, so that a better passage of the exudate is enabled deeper into the layers of the bandage, and therefore, the' bandage is applicable alsd for strongly exuding or bleeding wounds.
- iodofor i.e. an agent that slows, down iodine, votalizat ⁇ h- and/pr stabilizes iodine_, ,schizofilan, chitosan, glucan, or a mixture thereof is used.
- the typerpf ipdofor to be used is adapted according to the application, for example: schizofilan is more suitable for dry wounds (because it is soluble), on the contrary chitosan, glucan, or the complex chitosan-glucan are more suitable for dripping wounds (because it is insoluble 1 , it only forms a solid gel).
- potassium iodide (2,6 g) and "sodium hyaluronate (0,75 g) of the molecular weight of 1 500 000 g ' /mol and schizofilan ' (0,75 g) are dissolved in 100 ml of sterile water for injections, which forms the solution B.
- the second solution is prepared separately by dissolving potassium iodate (0.35 g), citric acid (0.1 g) and sodium hyaluronate (1.5 g) in 100 ml of sterile water for injections, which forms the solution A. Both solutions are sterilized and the further procedure is the same as in Example 1.
- Example 13 An analogous procedure as in Example 13 is used with the exception that a pigment (phtalocyanin) is embedded ori' a suitable solid support; foi example: polyamide textile, or a
- an acid-base agent such as sodium, bicarbonate, triethylamine, etc.
- auxiliary agents e.g. sodium 'chloride type salts.
- the environment for the reaction is either water or another diluent, for example, dimethylsulfoxide (DMSO).
- DMSO dimethylsulfoxide
- polyamide is impregnated by 1 % (weight percent with respect to the weight 1 of the textile) solution of aluminium ⁇ li kiPcyanin in such an amount of DMSO, so that the textile is Completely soaked.
- DMSO is 3 ⁇ 4 ⁇ 'evaporated at 40 °C, then the support is placed into an aqueous solution of 1 % (we3 ⁇ 4g percent with respect to. the weight of the textile) of sodium bicarbonate in such an amount -of Water, so that the ' textile is soaked.
- the solution is then heated for 30 minutes to 60 °C. After the reaction it is necessary to wash the solid support to remove the unbound pigment and waste products of the reaction. That is why the support is washed with water until the fk se,.
- the advantage of the bond to the solid ' support is that a higher concentration of ftalocyanin may be used, and therefore the generation .of iodine is more effective, without any toxic risk for the organism (a high dosage of phtalocyanin could be toxic in case of its release to the body). If the solid support is sufficiently hydf ophilic it maintains the wound moisture.
- the preparation according to this example is ijdeai3 ⁇ 4r ;eliminati of the biofilm on the wound (that is: a short- time application, minutes or tfe s 3 ⁇ 4 minutes of application and exposure to IR lamp).
- Two-parts type A + B having ; thel ' 6dihe capacity 0.65 and 0.1 %
- Figure 1 shows that the preparations generating iodine from the source .according to Examples 1 and 2 have at a longer application a better healing effect than the ⁇ preparation Hyiodine with elementary iodine. They are especially suitable for chronic wounds.
- Preparation was produced according to Example 9. 2 ml of the solutions A and B were used and coagulation was carried but by means of a syringe into a stirred beaker of 50 ml volume containing 30 ml of airihydroiis isopropanol. Based on the stirring intensity, 1 either areai formations (membranes) or globular clumps of fibers were formed. Generally, the intensity of stirring for the areal formations is low, thai is 5 to 50 rpm; the intensity of stirring for the globular forms is generally high, that is 250 to 1000 rpm. Based on trie Reynolds criteria, laminar area of flow is suitable for areal formations when stirring, whereas for globular formations the turbulent area is preferable.
- Figure 11 shows that the preparation generating iodine from the source ⁇ according to example. ! 1 has a better healing effect then Hyiodine with elementary iodine ⁇ at a longer application . Therefore, it is especially preferable for chronic wounds.
- One part preparation with the ion exchanger was prepared according to the Example 12 without isotonisation and for several isotonising agents and was tested in terms of the iodine generation after passing through the catalyst which was the acid form of ion exchanger Amberlite IR 120 Na.
- Table 1 shows the results ' of evaluation of the effectiveness of iodine generation.
- characters in front of the underline mean the composition of the solution, the characters behind the underline stand for the way of initialization of iodine generation; Specifically, "Nul” stands for the comparative example without initiation of iodine s gfetieiation; serviceKat” stands for initiation by catalyst and consequentKys” stands for the comparative example of initiation by chloride acid, which is a method that should lead to a quantitative; reaction of iodine production devisAbs 287nm (-)” is the value of absorbance of the solution at 28*7 Jim; whilc(I 2 ) (mol/1)” is the calculated molar concentration of iodine and thereforec(I 2 ) (% theoretical)” Is the theoretical yield when compared with the initiation by a strong mineral acid.
- Table 1 shows that all of the stated combinations are applicable, because they ensure production of iodine within the ' desired extent (in this case specifically 0.05 % of I 2 ).
- Iodine generation was 'evaluated in terms of the sufficient initial rate and the duration of the reaction in the following way.
- Solutions B and lK were prepared according to Example 21 and mixed. Concurrently- ⁇ comparative solutions of individual components were prepared, with the same concentration as c he concentration after -.mixing of the preparation. Jodine generation was evaluated 5 minutes- after mixing of the solutions spectrophotometrically at 287 nm. The difference of absotbance of comparative solutions and the mixture after a sixfold dilution is 0,978 which corresponds to approximately 0,064 % iodine concentration in the original mixture. The solutions were kept in a glass phial covered with a plastic lid so the iodine content decreased by , aporization.
- the preparation is suitable for acute treatment in ;the field followed by the transport of the patient to a clinical treatment, preferably within 2$ ' h3 ⁇ 43 ⁇ 4s.. :
- Figure 14 presents changes in the iodine! concentration over time, the input content of iodine is the same m ' all solutions, 0.1 % : of iodine, here expressed as 100 % (compared to Hyiodine). It is cleat that the iodine generation supplements the iodine loss due to vaporization and in this way thfe disinfection efficiency of the preparation generating iodine is prolonged.
- the effect of the prolonged efficiency is mainly due to the appropriate kinetics qf iodine generation in a ; Viscous environment, the suitable viscosity is provided by hyaluronate. Similar results 0a be obtained not only with hyaluronate but also using other native, modified or synthetic polymers (such as: xanthan or cellulose derivates).
- the initiating agetit is important (in this case the acid component to adjust an environment which is suitable forlthe reaction).
- Figure 15 demonstrates the ; kinetics of the production in two extreme cases of the system of the analogous sample ' ,H20_R" (for description see Figure 14).
- Figure 15 shows that, when citric acid is used the generation of iodine is initiated immediately after mixing and practically in a quantitative amount. On the contrary, . when phosphate buffer is used the generation is gradual.
- the desired kinetics of iodine _ ; generation in the preparation of the presented invention is achieved by using a combination of more substances, for example citric acid and phosphate buffer.
- One possibility is the composition mentioned in Example 20, but generally, every type of wound and preparation form possesses its optimal combination, which applies especially for solid-bandages (e.g. Examples 14 and 15).
- Figure 16 demonstrates, jthe impact of sterilization by ethylene oxide and various dosages of gamma rays on the molecular weight of hyaluronate. Both methods are applicable, but at the expense of a certa3 ⁇ 4.decrease (degradation) of the molecular weight.
- Figure 16 demonstrates that if the sterilization, should not have, any .important impact on the molecular weight of hyaluronate it is necessary to carry it out.iby gamma rays in a dose lower than approximately 0.1 kGy. In case i3 ⁇ 4igher dose then 0.5 KGy is needed for sterilization and in case the nature of the preparation allows it, it is more suitable to sterilize by means of ethylene oxide.
- Figure 17 demonstrates the impact of the sterilization by autoclave first on the solution of hyaluronate in water and second ,on the solution structuriAB" according to Examples 10 and 11. It is clear that the properly selected composition of solution structuriAB" decreases the degradation of hyaluronate. This is yet another advantage compared to the method of sterilization in the production of Hyiodine (preparation according to EP 1487506).
- Figure 17 demonstrates the advantage of the preparation; according to Examples 10 and 11 compared to the method of sterilization used in the production; of the preparation according to EP 1487506.
- a suitable solution composition diminisKe3 ⁇ 4
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Abstract
The invention relates to the preparation for healing of intracorporeal and/or surface wounds and burn injuries based on the physiologically acceptable salt of hyaluronic acid and compounds which are able to generate iodine in the presence of water and the initiating agent, wherein the preparation either contains one component or contains more components. The preparation comrpises the physiologically acceptable salt of hyaluronic acid, the source or the sources of iodine, the initiating agent and optionally one, or more adjuvants including for example auxiliary textiles. The preparation can be in the form of a liquid composition, gel, in a solid form or in a combination of these forms. Further, the invention relates to the method of production of the preparation consisting in the dissolution of the components in water to form one solution or gel or two separate solutions or gels that can be dried subsequently alone or on a support, or they can be extruded through a capillary into a solvent resulting in the precipitation of fibres. The invention also relates to a bandage containing the preparation:
Description
Medical preparation generating iodine, method of preparation thereof and bandage containing said preparation
Field of the Art
The invention relates to a preparation for healing of intracorporeal and/or surface wounds and burn injuries based on a physiologically acceptable salt of hyaluronic acid and compounds which are able to generate iodine under the conditions of application. Further, the invention relates to the method of production of the preparation and the bandage for healing of intracorporeal and/or surface wounds containing said preparation.
Prior Art
Healing of wounds and burn injuries, esspecially having large area, is a complicated process that can be accelerated by coatings ensuring suitable conditions for healing and/or containing active substances. A suitable coating should meet several requirements: essecially it should eliminate and/or minimalize adhesion of the bandage to the wound. Furthermore, it should provide for a humid environment which contributes to faster healing. It means to increase the humidity of the dry wounds and conversely to drain excess of moisture from the dripping wounds. At the same time, the coating should reduce the possibility of penetration of the infection and/or to reduce ; the present infection. Moreover, it may contain substances which actively enhance one and or several phases of healing..
Nowadays, there are lots of preparations which, however, usually satisfy only one or two of the above mentioned requiremets. For example, it is possible to solve prevention of bandage adhesion to the wound by permanent moistening of the bandage by sterile water or by means of hydrophobizatiori of ' the bandage by various greasy substances. Furthermore, various natural or synthetic gelling substances are used that are able to regulate the rrioisture. Elimination of infection is solved by applying disinfecting preparations before the application of the bandage. Similarly it is; possible to apply preparations containing substances which accelerate healing.
Each of the above mentioned processes has its- disadvantages and limitations. The permanent moistering of the wdu¾■prevents the adhesibhrbf the bandage, but however, the moisture content is usually too hig i arid therefore lorig-terrn use causes wound maceration. Similarly, the hydrophobization of the bandage surface blocks the draining of the excess moisture which causes similar problems as permanent moistening. Moreover, hydrophobization also prevents the access of oxygen to the wound. The gelling substances
effectively regulate the moisture, however the problem is their releasing into the wound and the necessity of wound washing during the re-bandages since mostly they are not substances biodegradable into harmless products. Generally, it is "unpleasant that the above mentioned combination of different preparations involves higher requirements to the duration of the treatment and material consumption and increases the risk of decreasing the effectivity or even making harm to the patient by using the preparations containing the substances which can interact with each other to unwanted products.
Lots of substances in different forms have been tested and used to enhance wound healing which reflects the prior aft in the particular time periods. In the past times, only raw natural substances had been used, later followed by purified substances, separately or in mixtures.
A substance which forms an important component ¾ν lots of recent preparations for
of the free acid arid the salt which are also referred to as i hyamr Aari: The hyalufohafi¾ais been mentioned in the technical literature already since 1934:'* Pre iousl ,' the hyaluroriahe was obtained by means bf Extraction from the animal oufces for example frofn 'cb'ckcofribs. Therefore, the product contained except of the hji¾ ur0riarie also other components that1 caused inflammations and other unwanted effects in th^; pharfnacblbgical applications. One of the first advanced processes bf extraction, the 'p odUc of which did not have1 ^^ ^y un anted effects, is described for example in US patent 41 1973 from 1979. The dbcumerit' discloses a test demonstrating that the prepared product does not have' any unwanted effects iri contrast to the other products coming from the older extracting processes. Also the use of the extracted hyaluronan in most of the branches in which it has be¾ri used up tb the present Bay s i s mentioned in the document, i.e. eye arid general surgery," ort opedics1 arid wound "healing': Different fractions of mbiecular weights are not distinguished there;'
: 'Further research was aimeci at the identificatiori' whidh of the fractibfts of hyaluridriarie are the rriost suitable for the respective ^hafmacologicai applicatibns and also at the research of · hyalufonane modification'' iri order' to ' modify the': Vbpbrties thereof. This bricerried esspecially the deceleratibn: i f ' it's" 'degradation after %e application thereof arid the modification of the physical properties thereof, such as1 sblubllity,r's welling, elasticity etc. i - iThe field of identification of the best
the- singlb 'fractibns comprises for example EP G138572'frbm 1-984 which defines ι two fractions extracted from the animal material. Specifically,' it is hyalufonan having the 'molecular weight1 from 50 'to 100 kDa for wound healing since' thanks to the low viscosity ''thereof it does riot prevent the
movement of the cells into the regenerating tissue and in this way it enhances the growth of the tissue. Conversely, the fraction of 500 to 750 kpa has a high viscosity, prevents the
. . . . .... . . ■·'!·:¥ ift)
movement of the cells and therefore, is useful to limit the undesirable coalescence at eye surgery or to support the treatment of joints.
For example the patent EP 216453 from 1986 describes the modification of physical and other properties of hyaluronan by esterification. For example also the patents US 4582865 from 1984 and US 4636524 from 1985 describe the properties of hyaluronan modified by crosslinking. In case the product is a derivative of hyaluronan which is insoluble in water, it can be used to prepare a biodegradable formation which can be colonized by living cells and used to treat the tissues as it is described for example in PCT application W097/45532 from
1997.
The modification of the pharmacological activity of a medical preparation based on hyaluronan by the fact that it jis'oised in combination with an additional effective substance is broadly described for example in US 4736024 frorn ί'986. The product is designated preferably for ophtalmology and' the used pharmacologically effective substances are such as kanamycine, neomycyne, tetr cykcline, chloramferiicol and the mixtures thereof. Hyaluronane is seen here as a support, thus more like an adjuvant. The product can be in the form of a powder, gel, as well as a solution.
Patent US 5442053 from 1 92 refers to using a pharmacologically effective substance in combination with defined fractions of hyaluronan for different branches of applications. Thus it presents a combination of the "patents EP 0138572 and US 4736024 which have been mentioned already.
Furthermore, the use of a -liquid, or jellylike foriti is known which corresponds to the principle of the existing patent EP 1487506 "Preparation for wound healing and prevention of bandage adhesion to the wound" concerning the preparation "Hyiodine" the practical use of which has already proved a high efficiency in complicated wound healing. The disadvantage of the praparation Hyiodine is ma it is packaged standardly in a glass vial which is a fragile container having a high weight, ^'further disadvantage of the liquide preparation Hyiodine is that the patients, having a frequent tendency to economise, apply less than the recommended amount of the preparation and* consequently the result of healing is not favourable or the bandage sticks to the wound and it -is': harmed even more during the re-bandage. This risk does not appear in case of the solid 'forms "Of the preparation of the invention since it is impregnated with a sufficient amount of the active substances and the patient can not fault anything even he he/she has the tendency to economise.
All of the above mentioned patents are outside the range of the submitted invention since they use either hyalurorian etftf acted from the animal material or the chemicaly modified one, eventually in the combination with an additional pharmacologically effective substance.
A part of the suggested technical solution concerning the formation of iodine comes from the known chemical reaction which is used for example also in the documents WO 92/01382 from 1991, EP 1044689 from 1998 and WO 2008/009925 from 2007. It is the oxidation of iodide into iodine, or the reduction of iodate into iodine by means of the suitable agent under suitable conditions. There is hydrogen peroxide, formed by an enzymatic reaction, used as the oxidizing agent in PCT application WO 2008/009925. There is iodate used as the oxidizing agent in the remaining two stated documents which has the advantage that the product resulting from the reduction of the oxidizing agent is also iodine.
The said patents differ 'fro'rn' the suggested solution by the composition, the process of production or the application1 form. Specifically, the PCT application WO 92/01382 (also published as US 5128136) describes the preparation' the! function of which is to prevent dehydration and infection of me1 wound. It contains the soluble collagen as the main gelling component, which does not influence the wound healing at all, it uses the mixture of citric acid and Na2HP04 as the buffering agent and it does hot contain hyaluronic acid, nor salts thereof. The process of the. prbd iction is based on lyophilisation and it consists in the preparation of three separate components (collagen, iodine and iodate) that can be mixed just before use. Iodine functions as the gelling agent in the preparation which forms the gel from the liquid collagen. The disadvantage of WO 92/01382 is that it contains collagen which can cause unwanted reactions, such as: iriflammantion. A further disadvantage of collagen is the phase conversion from the liqtiid 'irito the solid gel after1 the application that prevents the penetration of gasses and water steam which is in a certaih small extent beneficial for healing.
Patent EP 1044689 contains dextrine as the main component in an amount of at least 10 %. The production process is based on a hot air dry granulation and the product is n the form of granules, or powder.1 The disadvantage of EP 1044689 is the use of cyclodextrines. Cyclodextrines are body-foreign and it is not possible to1 exclude undesired reactions of the organism.
The patent application' WO"2008/009925 contaihs^polyvinylalcohol as the main gelling substance and the product is in the form of hydrated- rr^drogel which has the form of two separatly packaged layers. It kbes ¾5t contain hyaluroriic 'aicid, nor salts thereof, nor iodate. It is possible to use the product only for the surface treatment. Iodine is formed by enzymatic reaction and the presence of enzymes limits the conditions of preparation storage (at
temperatures higher than 55 PC" the denaturation of proteins occurs which implies a drastic decrease of the enzyme effectivity).
The document EP 1815877 describes a preparation in the form of a hydrogel that can contain hyaluronan and also iodine' as an aseptic agent, according to the claims. The essential feature is also the fact that the hydfogel of EP 1815877 releases more liquid than it absorbs (Claim 1). The preparation can' contain, besides the substances releasing (i.e. not generating) halogen (preferebly iodine and iodine complexes), liposomes and substances releasing oxygen, or silver and mercury compounds. It is obvious according to the description, claims and examples that iodine is elementar and it is in the form of the PVP-I complex and therefore, no formation of iodine is involved.
The document JP 2008266276 uses also the principle of provision of the desinfecting effectivrty by using the ^^ PVP'-I compl xi 'Besides^ the as^mblirig effeet of PVP, "there is also Used the principle of the formation of the micelles that enhance binding of iodine. Iodide,
components are kept separatel Until the moment of the application.
However, according1 'to the newly suggested solution th iodine formirig components can be mixed. It is described in detail ii the following parts'of the document.
Summary of the invention
The above mentione 4 ' disadvantages of the' 'current healing, hydrating »and or disinfecting preparations are to the large extent overcome by the preparation for healing of intracorporeal and/or surface wounds generating iodine according to the newly suggested solution. The preparation satisfies all of the above mentioned requirements and the subject- matter of the solution consists* in that it contains a 'physiologically acceptable salt of hyaluronic acid having the weight "average molecular 'Weight within the range of 200,000 to 3¾000,000 g/mol and compounds', or a mixture of compounds, which upon contact with water (also with blood or exsudate), or upon mixing or upon exposition to light generate the elementary iodine providing 1 for ' the effective desinfectibn. At the same time, the salt of
hyaluronic acid forms a liquid' el or a viscous solutioriy eventually a low viscosity solution (depending on the concentration and the molecular Weight of hyaluronan) that regulates the moisture in the wound, or hr ttie eye (when used as eye-drops), as well as it effectively prevents the bandage adhesion' fo the wound (in case of topical use) ,and at the same time it accelerates all the healing phases. "
One of the advantages of the preparation according to the invention is that it facilitates packaging, storing and application of the preparation. ¾¾e present solution does not contain the elementary iodine and therefore it is possible to store the preparation in the liquid form also in any inert material, such as in the plastic that is elastic and light. If it is in the form of bandage already with or without an auxiliary textile it can be stored in any inert airtight package, such as in a wax paper sack (the package has to prevent passing of the light through it in case it contains a photogenerator). Moreover, the preparation of the invention also has a prolonged effectivity, especially disinfecting effectivity, since iodine is generated continuously during the reaction" aiid it makes up for the losses wheih are due to the free volatilization of iodine after the preparation is applied.
A further advantage is that it is possible to regulate the amount of the generated iodine and the rate, or the period of iodine generation and to' adjust the preparation to a particular wound and to the stage of the healing process. A further advantage of the preparation of the invention is that it can be in1 the solid form, as well as hi the liquid form. The solid form is preferred in that it is planar Which assures the suitable concentration equally over the whole wound and the concentration of iodine cannot be locally exceeded and at the same time, there cannot be the lack of hyaluronan locally. Therefore, in case of the topical application, the risk that the preparation or the secondary bandage dries and sticks to the wound or that the result of healing is weaker due to the lack of hyaluronan is minimalized.
Moreover, the present preparation of the invention, compared to the prior art, uses the biotechnologically prepared hyaluronan, without any chemical modification, and in the combination with substances ; such as inorganic salts etc. which do not have the pharmacological effectivness as antibiotics, cytostatics', antipyretics and similar drugs, though it is of course possible to add the chemically modified hyaluronan, or the pharmacologically effective substances into the · preparation of the invention. Furthermore, the present preparation of the invention belongs to the field of the preparations using hyaluronan in the combination with another substaiice or a mixture of substances, however, in contrast to the previous solutions none of the "substances contained in the mixture has any pharmacological effectivity by itself or after mixin¾. 'The effective substance is the reaction product resulting
from the reaction of the starting; substances contained in the mixture (conditionned by the suitable environment) and the pharmacological effect is antiseptic.
The advantage of hyalurqnan used in the preparation of the invention for example compared to the collagen is that after the application .it does not cause inflammations and no phase conversion from the liquid into the solid dry gel occurs (the viscosity is not dependent on the content of iodine or the sources of iodine but only on the molecular weight and the concentration of hyaluronai and that changes in time according to the absorption / the evaporation of the exudate and the natural disintegration processes). In this aspect, the most preferred solid form of the present invention is a spongy lyophilizate, eventually imbedded on a support, or a multilayer bandage with the contact layer made from the permeable polyurethan membrane having the dried surface coating made of the single components generating iodine (it is possible to realize drying via lyophilization, eventually via hot air; the coating can be provided as the ¾queous solution, eventually as the solution in the mixture of solvents, for example alcohol a id water).
A further advantage1 bf the preparation of the -..invention for example compared to the preparations containing pol vMylalcohol is that it does' -hot contain synthetic substances and all siibstances used in the preparation are ^ body-natural 6r are changed into harmless products (e.g. iodate into iodine and - water, / iodide into iodiiie by means of the rectioh. Thus, the substances are biologically decomposable and therefore' it is possible to use the preparation (or some of the forms) also for' int acorporeal applicafioriii' without any risk of inflammations and undesirable reactions.
Moreover, the present solution is in the dry- form without enzymes before the application which means lower requirements for the storage. The present preparation keeps its effectivity in terms of the iodmS generation also after a [ exposition to temperatures of above 100 °C and also below - 90 °C (selected forms of the preparation are heat-resistant above 121 °C and therefore it is possible to sterilize them in 'an' autoclave). The result of the heat stress of the present preparation can only be the change -'of the molecular weight of the used hyalurohan. However, this effect Occurs to a larger extent only after it is exposed for a long time to temperatures of more than 90 °C which does not occur even in the extrerrie conditions of military hospitals or in cases of natural disasters.
Furthermore, the preparation ' of the invention does not contain free iodine but a mixture of compounds capable of generating iodine. Therefore, it contains a suitable compound or several differeh? compounds -of iodine ¾s'*tne · source' of iodine and a substance initiating the formation of iodine. 'Specifically, the preparation for healing of ihtracorporeal
and/or surface wounds according; to the invention can have one component, eventually it can contain two parts. As far as the physical state of the preparation is concerned, it can be solid or liquid, or both parts can b^ li uid^ or both parts can be solid, eventually one of them can be liquid and the other one can ; be solid. In case the preparation contains two parts, these parts are typically the pairs AB + Κ, ,ΑΚ + B or A+K, or B + ; wherein the component A contains hyaluronan (HA) (but does riot have -to if any of the other ^components contains HA) and one source of iodine (IA), wherein J is preferably the oxidized form of iodine, thus that which has a higher oxidation number (i.e. positive) than the elemental iodine (having zero); the component B contains HA (but does not have to if any of the other components contains HA) and the second source of iodine ,(IB)j wherein IB is preferably the reduced form of iodine thus that which has the lower oxidation number (i.e. negative), than the elemental iodine (having zero); the component K coritkinsV-tfjc initiator of iodme;¾&ieratiori and it can contain also HA if HA is not contained in any Wtne Other components;' ;AB is a mixture of the iodine source IA atad IB and HA (it does not ¾¾ve to contain HA if 'any of the other components contains HA).
In case the preparatioriv has just one component (BK), it contains the photoactive substance as an initiator K th¾t; generates iodine from the^resent source of iodine, or from the mixtures of iodine sources upon , ? exposition to the light of the suitable wave length and intensity. In case the preparation" has two components, the following combinations in terms of the chemical composition are possible. The part AB contains both sources of iodine, thus IA and IB. The part K contains nitiators, for example citric acid or it can be the solid ion exchanger (the acidic form of the cation exchanger)/ In' ease of the combination AK and B then the part AK contains the source of iodine and the'initiator e.g. citric acid, and the part B contains the source of iodin£¾ In case the combinatibn A and K is used, the source of iodine is used only in one coMponeht. The same applies to the combination B and K. In these cases then the agent K or the auxiliary agent that can be in the component A, B or K performs the oxidating or reducing -function directly. Specifically, for example in case of the combination B and K, the1 ' -coWponent K might Contain ferric chloride or potassium dihydrogen phosphate and hydrogen peroxide, wherein ' the component B would contain iodide.
Independently of the combination, the preparation, or at least one of the parts A, B, K or AB contains the physiologically acceptable salt of hyaluronic acid, at least one of the part contains the source of iodine and at least of one part contains the iniciating agent. Of
course the preparation can have more parts, for example A, B and K, however, such asolution does not have practical advantages.
The physiologically ; acceptable salt of hyaluronic acid is esspecially sodium, potassium, lithium, calcium, magnesium, zinc, cobaltous and manganous salt and/or the mixture thereof. The total content of the physiologicall acceptable salt of hyaluronic acid in both parts is within the range of 0,005 to 99,9 wt.%, the total content of all sources of iodine is within the range of 0,001 to 90,0 wt.%, the content of all initiatory agents is within the range of 0,001 to 90,0 wt.% and the content of water is within the range of 0 to 99,9 wt.%.
The sources of iodine I'A -ahd ¾ can be the same or they can differ from each other, U being preferably selected from the group comprising iodates, periodate, periodic acid or a mixture therof and ¾ being preferably selected from the group comprising iodide, hydroiodic acid or a mixture therof. Typic y,- the source of iodine U is a compound of iodine having a higher oxidation state than the source ¾ used in the specific case. For example, if iodate is used as the source IA, iodide qari be preferably used as the source ¾. Iodide can be e.g. sodium, potassium, ammonium;' aluminous, silver or mercuric iodide, preferably sodium or potassium iodide is used; iodate !can be for example sodium, potassium or calcium iodate; and the periodate can be for example; sodium or potassium periodate. The sources of iodine can be a mixture preferably consisting, of potassium iodide in the amount of 0,001 to 90 % with sodium iodate in the amount of 0,001 to 90 %. The use of periodate involves the advantage that even more iodine is generated than in case of iodate (at the same amount of the reactant substance).
Furthemore, it is prefeffd¾ that the iniciating agent is acidobasic and/or redox. The
exchanger, catex).
Finally, for the one-component preparation the suitable photoactive agent having oxidizing or reducing effects upon, the light exposition is used. It is possible to use as the oxidizing agent for example anthraquinone, basic, porphyrin or phtalocyanin dyes, or crystal violet, methylene blue, bengal red. Besides these dyes, it is also possible to use other different substances that are not sufficiently photoactive by themselves at the light exposition of the suitable wave length and intensity but that are in a mixture with substances which help the energy transfer from the light. Specifically, these may be for example dyes forming metal complexes, or being imbedded to solid particles (micro- or nano-particles Ti02, ZnO, FeO, Fe203, Fe304, or mixtures thereof).
The amount of the initiatory agent is selected according to its character and according to the composition of the iodine sources. The optimal amount of the initiator usually corresponds to the stechiometric amount that is necessary for the intended reaction to iodine,
: . ■ ■. . - .■ · V : : .< r is . · · · . '. , . : · ; -..· .·. < ■ ■ .. -> : " # ■ or that provides for a suitable reaction environment, for example pH of the mixture that is necessary for the generation of iodine, or for the generation with a particular rate in a particular time period. For , the most of applications it is preferred to maintain the concentration of iodine at the level of 0,1 %, except of the eye-drops where it is preferred not tp exceed 0,05 %. The preparation can have the generation of iodine divided into several intervals having different rates, for example the highest rate in the beginning in order of minutes and then a lower rate in order of tens of hours or days.
Furthermore, the preparation of the invention can contain one or more adjuvants and/or a support. Adjuvants can be selected from the group comprising agents for improving the healing effect of the preparation, agents for modifying the viscosity of the preparation and/or the strength of fibers and/or agents for retarding iodine vaporization and/or stabilizers, e.g. stabilizers of iodine sources against the decomposition and/or stabilizers of hyaluronic acid against the decomposition and/or preservative. The agent for improving the healing effect of the preparation can be selected from the group comprising sodium alginate, chitosan, glucan, oxycellulose, schizophyllan and biotin; the agent for modifying the viscosity of the preparation and/or the strength of fibers can be selected from the group comprising agar, urea, xanthan gum, gum arabic, guar gum, carob gum, tragant, a simple saccharide such as glucose or fructose, fibrinogen, thrombin, seaweed, gelatine, sorbitol, cellulose and its derivatives, oxycellulose, schizofyllan, polyethylenglycol and the mixtures thereof; and the agents for retarding of iodine vaporizatioii thereby prolonging the' disinfecting effects of iodine and/or the stabilizers of the iodine sd rces can be selected from the group comprising cysteine,
selected from the group comprising benzoic acid, salicylic acid or ethylene diamine-tetra- acetic acid, calcium propionate, benzalkonium chloride^' stabilized oxychlorine complex, calcium sorban, potassium sorban or tocoferol.
The preparation of the invention can have different forms. For example the one- component preparation can be , in the form of an ointment or a bandage. The two-component preparations can be designed so that both the part A and the part B of the preparation are separated and both parts can be in the form of a liquid or in the form of a gel, but they can also be solid such as a bandage having the sandwich structure. If both components are solutions, or gels, they can haye a different chemical composition and the iodine generation is caused by their mixing. In this case the application form or the container can have the different structure. For example it can consist of two cylindrical reservoirs, like syringes having a suitable volume, placed, paralelly side-by-side so that the pistons run together.
■ : > ''■'■■ ' ''V■ i d ' ' 1 ;
Opening of both reservoirs leadsanto the blender that provides for the proper mixing of both
1 : , ί. x - components. Optionally, the preparation can be in coaxial cylinders having a different diameter or in two separate parts' of a plastic or metal tube, or in two sacks in a vessel with pressed air or with another propelling medium that forces their content out when the caps of the sacks are opened, through the mixing chamber via a nozzle in the form of an aerosol. The extrusion can also be done by interacting of a mechariical force by means of the piston etc. If the cover is in the form of a tube from an elastic rriaterial, in which sacks of the same or another elastic material are placed then at the appplication of the preparation the container is discharged by pressing the content out, thus by the mechariical deformation of the container. At the same time the container does not need the bleriding chamber since its function can be replaced by cracking of the inrier sacks and blending of the solutions in the whole volume of the tube during the mechanical stressing of the container even before the extrusion. For an easier perforation of the inner" sacks, the container can be equipped with suitable inner placings, or with outer placings, for example on the container cap. It is possible to perform the mixing also mannually outside of the container after the extrusion of the particular solutions.
According to another embodiement of the invention, the preparation can be in the form of a solid planar formation on a textile support that is preferably in the form of a multiple layer sandwich. Optionally, the preparation can be in the form of two solid planar formations or two solid planar formations on a textile support adapted for the crisscross placing before or during the application. If the preparation is in the form of the solid planar formations having the sandwich structure, it is preferred that one of the layers which is closer towards the body consists of a microporous membrane. Preferably it is possible to use a membrane formed by the method of electrospinning from polyurethane (PUR), which is deposited on a suitable support (e.g. woven or non-woven textile). In case the membrane has sufficient mechanical properties, it is possible to remove it from the support and use it as the contact layer of the preparation (the layer is in the direct contact with the body). In case it does not have the required mechanical properties, it is 'used including the support on which it was deposited (this support is preferably porous). In case the PUR membrane is not attached to the support with a suficient force, the cohesion can be increased for example by pressing, wiping, spot or line weld or by .another suitable operation. Optionally, it is possible to; use as the contact layer the support of thfrrhembrane of PUR (Woven or non-woven textile) and then the membane forms the second layer of the preparation: The PUR membrane can also be formed by the so-called coagulation, when the solution of the PUR polymer in the Suitable solvent is used and deposited lpii a suitable support. After removing of the solvent the membrane remains on the support and it is possible to' use it separately or with the support. Besides, it is also possible to use' a mixture of different polymers PUR with the membrane formation from one solution at the same time, or frorti different solutions successively. This dan be achieved for example' by first forming the membrane from one polymer via electrospinning and after that an additional membrane is formed from another polymer On this membrane by the coagulatidri metfipd. At the same time, one of the polymers can be more hydrophilic than the other and it can be used in the first, as well as in the second step. By this method it is possible to obtain membranes having suitable mechanical properties as well as different porosity and different transport rate for aqueous solutions, aqueous vapor and gases. The microporous PUR membfMes are preferred due' 5 to their gas and aqueous vapor permeability, as well as their water permeability and the permeability for aqueous solutions, however, it slows down the riioVement of the macrornoleeular substances. Thanks to this the hyaluronan is maintained loriger on the wound so that' the ' whole preparation has got a higher effectivity, or a longer durability. Besides, also the PUR membrane itself has a low adhesion to the wound so that it minim^alizes the risk of drying and sticking to the body and this also in
case it is used without hyalurpnan or any substance having a similar anti-adhesive effect. These properties have been; .proven for the PUR membranes having the trade names Desmopan and Hydromed, however they can be achieved also for other polymers.
According to an additional embodiment of the ihyeiition, the preparation can be in the form of the textile wherein, the fibre composition corresponds to the composition of the preparation with or without the eontent of at least i ; one adjuvant. According to another embodiment, the preparation can be for example in the -ifbrm of a bandage with the support formed out of several layers of oven or non-woven textiles that are impregnated with the mixture containing the components of the preparation, or they can be provided with a layer of the mixture coating applied on the surface of the support.
The preparation can also be in the form of a porous planar formations formed from solutions of hyaluronic acid , and additional substances via the lyophilization method, respectively either on the textile .support, or also without, this support. The preparation can be formed also as the woven, eventually as the non- woven textile of fibers, the composition of which corresponds to the composition of the preparation, eventually containing even more additional adjuvants. The fibers call have the form of nano or microfibers, or they can also have a bigger diameter. At the same time, the structure of the fibers can be either homogenous within the whole volume, or it can be the "core-shell" type or other non-homogenous arrangement. In case the fibers have a homogenous composition, the preparation can be formed from the mixture of two. fibers of a different chemical composition. At the same time, the surface distribution of the fibers of the particular chemical composition can be homogenous or also non-homogenous and the preparation Can be formed also on the support.
In case the preparation is in a solid form, it can be packed with a desiccant selected from the group comprising magnesium sulfate, sodium sulfate, sodium carbonate or silica gel in the suitable permeable cover that is separated from the preparation as such which is then
separated from the outside ehviroiiment with an airtight"1' cover having suitable mechanical properties.
Moreover, the invention; -relates to a method of production of the preparation by dissolving all the components in one solution, or separately by dissolving the components of part A in water and the components of part B in water to form two solutions of a different composition. The solution, or solutions can be prepared from sterile raw materials in an aseptic environment and then it is filled into one, or two separated covers. Then either the one-componet form is applied directly, or in case of two components, they are mixed immediately before the application to the wound. Thanks to generating iodine after the application (due to light, by mixing the two parts just before using), the preparation is always fresh, thus containing enough io'dirie;-
According to another embodiment, the prepared solution, or the solutions are first filled in a container, or in two separate containers and then sterilized and mixed immidiately before the application to the wo hd. According to another embodiment, the prepared separate solutions or gels are filled into IAVO separate containers, subsequently they are lyophilized or dried with hot air and subsequently they are sterilized separately or together. According to another embodiment of the invention, the prepared separate solutions or gels are filled into two separate containers, while a textile is inserted into at least one container, subsequently they are lyophilized or treated 'with hot air and subsequently they are sterilized separately or together.
Another embodiment of the method of the invention consists in the separate extruding of part A and part B by the: means of a capillary into separate containers containing an anhydrous solvent selected from' 'the group comprising aliphatic alcohols, phenol, glycerol, modified alcohols, ketones, hydrocarbones, esters,; . ethers, amines and heterocyclic compounds that is stirred to fdm trie precipitated fibers.1 that are subsequently taken out of the containers, are dried separately !¾ 25 to 150 °C and subsequently they are formed onto a woven or non-woven textile, or ;a ¾hree-dimensional formation together or separately and/or they are fixed to the support ficf sterilized. At least' brie container can also contain an auxiliary support selected from h¾ group comprising' 'a textile, a wire screen, a cylinder and other formations whereon the fibers precipitate to fdrhi the two-dimensional or the three- dimensional structures after the . extruding step into , the containers, and subsequently the formed fibers and/or the textiles with "the fibers are sterilized separately or together.
Thus the parts A and B of the preparation of the invention according to the required physical form for the appllicatidn^are either kept in the liquid or in the gel state or they are dried. It is possible to perform dfying. either with the addition of a textile auxiliary material or also without the textile material i lri;. both cases it is possible: to use the lyophilization, wherein esspecialy in case of the preparation without the textile material it is suitable to have the solution to be dried in a container of a suitable geometrical shape. It is possible to use the classical method of drying by means of heat and dried air which is suitable in case of the preparation with the auxiliary textile. With regard to the thermal resistence of salts of hyaluronic acid, it is suitable to dry at the temperature lower than 80 °C.
The drying of the solutions, or gels can proceed also in the gas phase i.e. by means of the extrusion into flowing or static dry gas having a suitable temperature, pressure and vapour pressure of the used liquid or vapour of the components of the liquid mixture.
There are various ways ^f application of the preparation, according to the physical form, thereof. If it contains an auxiliary textile it is applied as a bandage to the wound, in case of a dry wound it is wetted in. adyance with the physiological solution, the sterile water or even the usual water, it is po^sible^ to apply the preparation directly to the dripping wounds. If the preparation does not contain any auxiliary textile^ t. is .suitable to use a secondary dressing in case of a surface wound.( However, the form without the auxiliary textile is preferably intended for the application inside, the. body of the patient, where it is left to slowly decompose resulting in substances that are utilizable in the body or that can be eliminated from the body without any risk of harm to any individual organ or to the body as a whole. In case of the liquid or gel form, the preparation is applied to the wound either directly and covered with a secondary dressing or it is deposited in a sufficient layer onto such side of the secondary dressing that is subsequenty -applied' to the wound, of i .the' -bandage is impregnated ith the preparation and subsequantly ap^Iieditb the wound.
Moreover, the invention relates to the use of the preparation for healing surface and or intracorporeal wounds. The u -acorporeal wounds that Can be healed by means of the preparation can be for example fistulae, deep wounds and the transplantion of inner organs as well as the skin. The preparation is also suitable for eye treatments, i.e. surgeries and transplantions of keras and lens, of as eye-drops (the treatment after surgery or the syndrom of dry eye).
Brief Descri tion of the Drawings
1487506 applied onto the gauze ari "Control" is the untreated wound (covered with a dry gauze).
Fig. 3 and Fig. 4 showjiphptps of me formations sti?ucture of the of the type "A" (the surface form) taken by the electrpn microscope.
Fig. 5 and Fig. 6 show ph tos of the formations structure of the type "A" (the spheric form) taken by the electron micr seppe.
Fig. 7 and Fig. 8 shqyv photos the formations structure of the type "B" (the surface form) taken by the electron micrpscope.
Fig. 9 and Fig. 10 show photos of the formations .structure of the type "B" (the spheric form, the cluster section herein tak n by the electron micrpscope.
Fig. 11 shows the result's ; f testing the preparation of Example 11 in terms i of the healing effect wherein the meanings of the legend are as follows: " AB+K" is the preparation of Example 11 with the iodine capacity 0.1 %; "Hyiodine" is the preparation of EP 1487506 applied onto the gauze and "untreated" is the wound which was not treated (covered with a dry gauze).
Fig. 12 shows the generation of iodine in time using a photo-catalyzer in the case of the "FC.KI", wherein the "FC,KI". is the preparation of Example 13; "FC.nul" is the reference sample of phtalocyanin as such haying the same concentration in pure water; "KI.Nul" is the reference sample of potassium iodide having the same concentration in pure water.
Fig. 13 shows the res l s ;¾)f testing the preparation of Example 17 in terms of the healing effect wherein the meanings of the legend arenas follows: "X3C" is the bandage
wherein the main initiator is citric, acid with the iodine capacity 0.3 %; " X3P" is the bandage wherein the main initiator is. the phosphate buffer with the iodine capacity 0.3 %; "X1C" is the bandage wherein the main initiator is citric acid with the iodine capacity 0.1 %; "HAI" is the preparation of EP 1487506. applied onto the gauze and "untreated" is the wound which was not treated (covered with : dry gauze).
Fig. 14 shows the concentration changes of iodine in time, the incoming content of iodine is the same for all solutions, namely 0,1 % of iodine, expressed as 100 % herein (compared to Hyiodine). The meanings of the legend are as follows: "SH_R" is the system generating iodine by the reaction corresponding to the preparation of Example 2 (KI + NaI03 in SH);„H20_R" is the system generating iodine by the reaction which corresponds to the preparation of Example 2 with the difference, that it does not contain hyaluronan (KI + NaIC<3 in H20); "SH E" is the system: with the elemental iodine which is analogical to the preparation of EP 1487506 withjtrje difference that it does not contain hyaluronan (I2 + KI in H20).
Fig. 15 shows kinetics of the generation of iodine in two extreme cases of the system of analogical sample "I I20 R" (for the legend see above); wherein citric acid is used as the initiator for the system "C";: the mixture of sodium hydrogen- and dihydrogenphosphate having pH ~ 5,6 is used as the initiator for the system "P".
Fig. 16 shows the effect o f the sterilization with ethylene oxide and the different doses of gamma radiation to the molecular weight of hyaluronan.
Fig. 17 shows the effect "of the sterilization by means of autoclave to the solution of hyaluronan as such in the pure water* as well as to the solution "AB" of Examples 10 and 11.
Examples of the Invention
Example 1
Two parts type AK + B having .the. iodine capacity of 0,65 % from iodate
Potassium iodide (2.6 ^)--. and sodium hyalurpnate; (1.5 g) of molecular weight of 1 500 000 g/mol was dissolved ih lOO ml sterile water for injection which forms the solution B. Separately the second solution is prepared by dissolving 0.35 g potassium iodate, 0.1 g citric acid and 1.5 g sodiurri ftyaluronate in 100 ml sterile water for injection which forms solution A. Both solutions are' sterilized and are filled -into two appropriate containers! under sterile conditions. Prior to the application, the containers are unsealed and both solutions are
mixed in the ratio of 1 :1. The .mixture is then applied to the wound and covered with a secondary dressing or is applied directly onto the secondary dressing that is then placed on the wound.
Example 2
Two parts type AK + B having the iodine capacity of Q.1 % from iodate
Potassium iodide (0.5 g)v'and sodium hyaluronate (1.5 g) of molecular weight of 1 500 000 g/mol is dissolved in 100 ml of sterile water for injections, which forms the solution B. The second solution is prepared separately by dissolving potassium iodate (0.06 g), citric acid (0.1 g) and sodium hyaluronate (1.5 g) in 100 ml of sterile water for injections, which forms the solution A.. Both . solutions are steriljzed and filled into two .suitable containers under sterile conditions., Prior to the application, the containers are unsealed and both solutions are mixed in the ratio of 1 :1. The mixture is then applied onto the wound and can be subsequently covered with secondary dressing or the mixture is applied directly onto the secondary dressing that is then placed on the wound.
Example 3
Two parts type AK + B having t ie iodine capacity of 0.65 % from periodate
Potassium iodide (1.75 g) and s di m hyaluronate (1,5 g) of molecular weight of 1 500 000 g/mol is dissolved in 100 ml , of, sterile - water for injections which forms the solution B. Separately, the second solution- i$ prepared b dissolyjng potassium periodate (0.26, g), citric acid (0.1 g), and sodium hyaluronate (1,5 g) in 100 ml. of t sterile water for injections, which forms the solution A. Both .solutions ,are: sterilized and -filled into two suitable containers under sterile conditions. Prior to the application, the containers are unsealed and both solutions are mixed in the ra^i i .of A :.1. The mixture is applied onto the wound that can be subsequently covered with secondary dressing or the mixture is applied directly onto the secondary dressing that is then plaedd on the wound: ' .
Example 4
Two parts type AK + B having the iodine capacity 0.1 % from periodate
Potassium iodide (0.45, g} :and sodium hyaluronate (1.5 g) of molecular weight of 1 500 000 g/mol is dissolved , in Τ,ΟΟ m of sterile water, for injections, which forms the
solution B. The second solution- is prepared separately' by dissolving potassium periodate (0.04 g), citric acid (0.1 g) and 'sodium hyaluronate (1.5 g) in 100 ml of sterile water for injections, which forms the.' solution A. Both solutions are sterilized and filled into two suitable containers under sterile conditions. Prior to the application, both containers are unsealed and both solutions are* mixed together in the ratib of 1 :1. The mixture is applied onto the wound that can be subsequently covered with a secondary dressing or the mixture is applied directly onto the secondary- dressing that is then placed on the wound.
Example 5
Spongy form of AK + B having the iodine capacity of 0, 1 %, mixture with xanthan
Potassium iodide (5i4;; mg); sodium hyaluron,ajt t,(8.5 g) . of molecular weight of 1 500 000 g/mol; disodium hydrogen, phosphate dodecahydrate (0.054 mg) and xanthan (25 mg) are dissolved in 3.4 ml of, sterile water for injection. The second solution is prepared separately by dissolving potassium iodate (0.5 mg); citrip acid (8.2 mg); sodium hyaluronate (8.5 mg); xanthan (25 mg) and, sodium dihydrogen phosphate dihydrate (2.2 mg) in 3.4 ml of sterile water for injections. The two solutions are poured into two Petri dishes of 3 cm diameter or into containers of a suitable shape with the same bottom area. The containers are placed into the liquid nitrogen in' an ultra freezer or conventional freezer and the content is frozen. Then the containers are placed into an instrument which allows for freeze drying under reduced pressure (lyophilizer) where they are left to dry until the formation of slab-like formations having spongy structure (the structure of the pores corresponds to the rate of freezing). Dry slab-like formations re arranged into the required shape, packed separately or together and are sterilized. T e^utilization consists m; unwrapping and applying onto the wound or into the wound (e.g. fisiiila). If the wound is dry, it is possible to wet the preparation prior to or after the application of the dressing. In. case of body surface application, it is suitable to apply also the s.ec0n¾afy dressing made - from conventional materials onto the wound.
Example 6
Spongy form of AK + B having the iodine capacity 0.04 %, mixture with alginate
Potassium iodide (2.2 mg); sodium hyaluronate (8.5 g) of molecular weight of 1 500 000 g/mol; disodium hydrogen phosphate dodecahydrate (0,022 mg) and alginate (40 mg) are dissolved in 3.4 ml of; sterile water for injections. The second solution is prepared
separately by dissolving potassiuh iiodate (0.22 mg); citric acid (3.3 mg); sodium hyaluronate (8.5 mg); alginate (40 mg) and sodium dihydrogen phosphate dihydrate (0.9 mg) in 3.4 ml of sterile water for injection. The solutions are poured into two Petri dishes of 3 cm diameter or alternatively into a containe of a suitable shape with, the same bottom area. The containers are placed into the liquid nitrogen in an ultra freezer or conventional freezer and the content is frozen. Then the containers are placed into an instrument which allows for freeze drying under reduced pressure (lyopKili'zier) where they are left to dry until slab-like formations having spongy structure are formed (the structure of pores corresponds to the rate of freezing). Dry slab-like formations are arranged into the required shape, packed separately or together and are sterilized. The utilization consists in unwrapping and applying onto the wound or alternatively into the wound (e.gl- fistula). If the wound is dry, it is possible to wet the preparation prior to or after jtne' application of the dressing. In case of a body surface application, it is suitable to apply 'al So a secondary dressing made from conventional materials onto the wound.
Example 7
Spongy form of AK + B on a solid support, freeze dried
An analogous procedure: fo^ preparation of the solutions as in Example 5 or 6 is used, with the proviso that an auxiliary rn.aterial of appropriate shape and qualities is added into one or alternatively into both containers with the solutions prior to freezing. The suitable auxiliary material can be a square of woven or non- woven fabric of a suitable chemical composition or a long strip of fabric, or alternatively other geometrical shape. Examples of the auxiliary material for surface wounds include; textiles made of pobyamide, polyethylene, polyester etc. Examples of the supports for wounds inside the body include textiles made of biodegradable, inside the body dissoluble fibers,; that are conventionally used for sutures. They can be used directly after drying or as one of the layers of the bandage, -or alternatively the support can be shaped into a pocket with the polysaccharide layer inside or outside. Further procedure and applications are similar to those in Examples 5 or 6 with the exception that, when the used support is not biodegradable/degradable within the body, it' can be applied only on the surface wounds. The most suitable prepi¾dti0ri for application inside the organism is the pocket form made of a porous material with j a '.layer of polysaccharides inside, because the body, fluids permeate the pores of the s p¾orf '¾lo ly and thus iodine production and polysaccharides dissolution is also slow. In this a^ /the required time of efficiency is ensured.
Example 8
Spongy form of AK + B on a soliff support, hot air dried
An analogous preparation as in the Example 7 is used, with the exception that solutions are spread on the surface or are impregnated into a suitable support, and instead of lyophilization, the standard hot air drying is used, or alternatively microwave or other drying. It is particularly preferred to prepare the solution from isopropanol - water mixture in the ratio of 1 :1 (v/v) with the hyaluronate concentration from 1.5 to 2.5 % by weight for the hot air drying. Hyaluronate is not completely dissolved in this solution, which is the reason why the viscosity is lower than that in an aqueous solution having the same concentration. Another advantage of the use of the 50 % of isopropanol solution is its autosterility. The solution can be easily applied using a template of the required shape and thickness. The thickness determines the applied amount of the active substance. For majority of applications it is suitable to spread roughly lOO to 200 mg of hyaluronate on the surface of 10 χ 10 cm. This stated range of cdncentratib^ cBrr¾pohds to the template thidkness of O.S to 2.0 mm.
The suitable support would be a multilayer bandage with the contact layer of textile made of monofilament fibers (so it .will eliminate fiber release into the wound or ingrowing of the layer into the healing tissue); Another layer can be matde of highly porous polyurethane membrane, further absorption layer made of polyester, viscose, or mixture thereof, and the top layer of non- woven polyester.
Example 9
Filamentary form of AB + K .separate, or on a solid support
; Two basic solutions are prepared following the" procedure analogous to Examples 1 and 6, with the exception that they can contain, apart from hyaluronate, another auxiliary substance, e.g. alginate, cellulos iderivates, xanthan or a mixture thereof in an amount of e.g. 1 w. % of the solution weight! n of the solutions is subsequently extruded through a thin capillary into the unhydrous : iso^pf panol or another suitable liquid in a stirred container to ensure coagulation of fibers ί ' that, kre captured on a suitable structure, e.g. rotating wire cylinder on which the auxiliary pad can be placed, for example: textile; alternatively the fibers are spontaneously coagulating' into steric formations inside the container. After the agglomerate of fibers of the desired size was formed or the surface of the cylinder was covered by an appropriate layer of fibers, the product was replaced from the solution and
dried in the drier at 50 °C. The process of coagulation of fibers is either discontinued or is carried out continually. from the second solution are prepared. A method
of gradual deposition can be; used, when the product from one coagulation bath is dried and put into the second coagulation bath, so the layer then, contains both types of fibers. This process can be repeated several; iirries so as to obtain the desired amount of fibers. The fibers, actually fibers clusters, can: be . subsequently used for healing either without or with an auxiliary pad. When applying . this; method of fiber production, it is necessary to keep the amount of water in isoproparioi or in another suitable liquid as low as possible. This can be achieved either by a batch process of production Or continual water removal by its condensation inside the flow system, which is constantly refilled with the necessary amount of the non-aqueous liquid, so the sufficiently low content of water is ensured.
Specifically, the fibers can be prepared e.g.: by extrusion through a narrow capillary into unhydrous isopropanol with the rate of 1 ml/min in a stirred container at the room temperature for 2 to 5 min., depending on the desired amount of product. Material is then let to mature for 15 to 30 minutes. The fibers have the diameter of 50 nm to 5 μπι, the thickness of the layer corresponds to the thickness of microfilaments, or in case the formation is spherical the layer thickness can be up to several millimeters, e.g. 0.5 to 2 mm.
Example 10
Two parts type A + B (10:l),haying the iodine capacity, of 0.65 % from iodate
Potassium iodide (1.652 g); sodium hyaluronate (1.5 g) of molecular weight of
smaller amounts and the container ensures sterility of the separated components, it is possible to use the preparation repeatedly. ; The mixture is applied onto the wound which can be followed by application of a secondary dressing, or the mixture is applied on the secondary dressing and then placed on the Wound.
Example 11
Two parts type AK + B (10:1)' having the iodine capacity of 0.1 % from iodate
Potassium iodide (0.26 g); sodium hyaluronate (1.5 g) of molecular weight of 1 500 000 g/mol; potassium iodate (0.026 g) and disodium hydrogen phosphate dodecahydrate (0.0026 g) are dissolved in 89.18 ml of sterile water for injections, which forms the component AB. The second solution is prepared separately by dissolving citric acid (0.039 g) and sodium dihydrogen phosphate dihydrate (0.01 g) in 8.92 ml of sterile water for injections, which forms the component K. Both solutions are then filled into suitable containers that are sterilized, e.g. in an autoclave. Prior to the application, both containers are unsealed and both solutions are mixed either the whole amounts or in smaller amounts, but always in the ratio of 10:1, in favor of the component AB. If the components are mixed in smaller amounts and the container ensures sterility of separated components, it is possible to use the preparation repeatedly. The mixture is applied onto the wound which can be followed by application of a secondary "dressing, or the mixtu e1 is applied on the secondary dressing and then placed on the woundi
Example 12
One-component/one part form with ion exchanger (eye drops)
Potassium iodide (67.2 mg); , sodium iodate (6.5,,. mg^; disodium hydrogen phosphate dodecahydrate (0.65 mg) and, podium hyaluronate (400 mg) of average molecular weight of 300 000 g/mol is dissolved in 38: ml of sterile water. ijbi injections. This solution is divided into ; ,1.0 ml portions to whic^an agent for adjusting th^ isotonic property is added (it is possible to add slightly more,1 th(e drops can be isotonic^ but also slightly hypertonic), {t is either sodium chloride (8.5 rng); .or sorbit (380 mg), or glucose (388 mg), or disodium hydrogen phosphate dodecahydrate (210 mg) with sodium dihydrogen phosphate dihydrate (55 mg). The solutions are sealed into suitable container,! Which preferably enables the dosage in small drops, and then the; solutions are sterilized. The flow chambers containing acidic form of ion exchanger are fixed on the output openings of the containers (for example 0.5 ml cation exchanger Abmerlite IR 120 Plus) in the form of. small particles (the diameter of the grain is approximately 0,2 to 1 ,5 mm) and this system is assembled into a form' which enables gradual expelling through the; i0ri';'excharig¾r. Such preparations are then used as eye drops 1
Example 13
One-component form with a photo catalyst (bio film inhibitor)
Aluminium ftalocyani¾(7v8 nig) is dissolved ί ΐΟΟ! ml of sterile water for injections. 4 ml of this solution are taken^ a¾d' in these 4 ml - potassium iodide (42 mg); sodium hyaluronate (10 mg) of average .'molecular weight of 1 500 000 g/mol are dissolved and carboxymethylcellulose (180 ' mg) is added resulting in a viscous gel. This gel is then packaged into a container that is lightproof and is sterilized. The preparation can be applied either directly on the wound as aft: ointment or is spread in an amount of circa 4 to 8 g on the area of 10 x 10 cm onto one layer of the primary dressing (gauze). It is also possible to seal the prepared gel into a pocket-like areal formation or impregnate bandages therewith and then package it and sterilize. The preparation then forms a pocket made of a porous material or a
desired amount of iodine is 'maintained in the following way: the daily exposure of approximately 50 minutes is performed during the whole healing process. Preferably, the exposure is divided into two or three intervals (2 25 min., or 3 x 16 min.). When the pocket- like formation or bandage is used'/ it is possible upon the supervision of a doctor to reuse the same dressing for several days until it is decolorized (all the dye is consumed), or the source of iodine is exhausted (this, however; can be continuously refilled).
Example 14
Bandage for surface / flesh wounds with iodine capacity of 0.1 % from iodate
Sodium iodate (5.75 mg); disodium hydrogen phosphate dodecahydrate (0.57 mg) and sodium hyaluronate (336 mg) ;,¾¾th average molecular weight of 1 500 000 g/mol are dissolved in 16.8 ml of sterile water for injections. This^mixture is spread in an amount of 0.8 ml onto squares of porous polyurethane membrane stretched on a suitable pad of a larger area.
The application of mixture is carried out on separate squares of 4 x 4 cm and there will be free rims of 1 cm in between the squares, The membrane together with the pad is placed into a drier and the mixture is dried completely (for example in a hot air dryer with forced circulation at 70 °C). Consequently; the second mixture is prepared by dissolving 57.3 mg of potassium iodide; 86.2 mg of citric -acid; 23 mg of sodium dihydrogen phosphate dihydrate and 255 mg of xanthan in 16.8 nil of sterile water for injections. The membrane with the dry
' ■ · 1:..·' · ■
layer is turned over and on the -other side the same areas are covered with the second mixture, again in the amount of 0.8 ml on the 4 x 4 square. The; coating is placed immediately into the dryer and dried (for example1 in a preheated hot air dryer). Then a suitable pad, optionally more layers of different pads are placed underneath the membrane with the coat, and 5 x 5 cm square bandages are formed by welding together the free rims around the coatings which at the same time leads to the separation of the squares. The squares are then individually packaged and sterilized. When used, the bandage is placed with the membrane side on a strongly exuding or bleeding .wound and is fixed by a secondary dressing, or the coating on the membrane is wetted by water 'of a suitable liquid first and then applied onto the wound and fixed by a secondary dressing: Bandages of any possible shape or area can be prepared analogously, provided that the stateel amount of the coat on a specific area is complied with.
Example 15
Bandage for surface / flesh wounds having iodine capacity of 0.3 % from iodate
Bandage of type„P" is prepared similarly as in Example 14 in the following way: the first mixture is prepared by. ^dissolving sodium iodate^ ;(17.31 mg); disodium hydrogen phosphate dodecahydrate (1 ,73 tng) and sodium hyaluronate (336 mg) of average molecular weight of 1 500 000 g/mol in 6,8 ml of sterile water for injections. The second mixture is then prepared by dissolving potassium ; iodide (172.5 mg); citric acid (86.2 mg); sodium dihydrogen phosphate dihydrate :(8 mg) and xanthan (255 mg) in 16.8 ml of sterile water for injections. Bandage of type '„C¾is: prepared similarly as bandage„P", only the amount of sodium dihydrogen phosphate diKydrate is different, which is only 23 mg. The procedure is otherwise identical to the preparation of the bandage of type "P".
A different amount of . ;..i.JaH2,P04.2H20, or . Na2.H. P.04.12H20, or a different ratio of these compounds while maintaining' the same amount Of citric acid, or a different ratio of any of phosphates and citric acid influences the rate of iodine production, that is, whether quantitatively all the possible amount is generated immediately after mixing or whether it is
created gradually, and also for how long it is generated. Moreover, the variation of the amount is necessary based on the type of the wound: an exudate has a different pH than blood, which means that for the bleeding wounds more acid is needed,' as well as generally a larger amount of all buffers or acid-base initiators, while on the contrary, a lower amount of acid and of buffer in general is more suitable for exuding wounds, and for dry wounds which are wetted by pure water prior to placing the bindage to the wound, an excess of acid is even undesirable and can slow down the healing process.
Example 16
Replacement of a part of hyaluronate by cellulose derivates
, , An analogous procedure a n Examples 1, 2 10, 11, 12, 13, .14 or 15 is used with the difference that 75 % of, hyaluronate is re la ed by a: physiologically . acceptable derivative of cellulose of pharmaceutical purity. Acpepjtable , derivatives f are , for example carbpxymethylcellulose sodiunv.sa.lt, methylcel^lose^^ydroxyethyl cellulose, hydroxyethyl methyl cellulose, hydroxy-prol l; ςεΐΐμΐοββ and hydroxypropyl methyl cellulose (e.g.„ the company Aqualon has a pharmaceutical qpality productjon.thereof).
Example 17
Replacement of a part of hyaluronate by xanthan
: An analogous procedure as.in Examples 1, 2,i 3; 4, 9, 10, 11, 12, 13, 14 or 15 is used with the difference that 75 % of hyaluronate (SH) is replaced by xanthan.
the initial content of hyaluronate. For example, in the preparation according to example 1, only 0.15 g of hyaluronate instead of 1.5 g is used and it is supplemented by 2.0 g of xanthan, so that the total amount of polysaccharides is bigger than the original content of hyaluronate
(2.15 g of the mixture comp^ed ¾0 the original 1.5 g).. Other substances or mixtures of substances can be used up tp| .the concentrations which ^correspond to saturated solutions thereof. The purpose of this modification is to attain the maximum hypertonic environment which is favorable for certain , phases of healing of special types of wounds, mainly the chronic ones.
Example 19
Replacement of citric acid by phosphate buffer
An analogous procedure as in Examples 1, 2, 3 or 4 (liquid forms consisting of two
Use of a mixture of citric acid and phosphate buffer
An analogous procedure as in Examples 1, 2, 3 or 4 (liquid forms consisting of two parts) is used with the difference; that the mixture of NaH2P04 x 2 ¾0 (0.5 g) and Na2HP04 x 12 H20 (0.04 g) is dissolved m a solution containing citric acid. In the case of Examples 5, 6, 7, 8, 9, 14 and 15 (solid forms) it is possible to , use a greater amount of the mixture, specifically 10 mg instead of J . mg. The reason for this , is the buffering capacity of blood, or of serum or of exudate, if the generation of the necessary amount is to be ensured even when wetting with blood (disaster medicine and military field treatment).
Example 21
Bandage with a catalyst (iron ions, two parts type B + )
Potassium iodide (0.01 g); and sodium dihydrogen phosphate dihydrate (0.0001 g) are dissolved in 2 ml of sterile water for injections, which forms the component B. The second solution is prepared separately by ..dissolving ferric chloride (0.01 g) and sodium dihydrogen phosphate dihydrate (0.000 l - ); in . 2 ml of sterile water for injections, which forms the
component K. Both solutions are filled into two suitable containers (PP, PE and the like), the containers here were pockeHike squares 10 χ 10 cm made of soft plastic foil. Pockets are designed in such a way that they- lie on each other by the complete surface thereof and therefore, they share one wall in , this way. In this wall theie are reduced seams which make the perforation prior to use easy. .Moreover, the perforation is also facilitated by a plastic spike welded on the inner side of one of the pockets (the one that is closer to the absorption side). The pockets are welded; by 'their rims onto a bandage of 10 * 10 cm formed of one absorption layer with a polyurethan mebrane provided with a hyaluronate coating. The coating was prepared by dissolving sodium hyaluronate (0.1 g) of molecular weight of 1 500 000 g/mol in 6.6 ml of . sterile water for injections and by covering evenly the polyurethane membrane therewith and drying at 70 °C. Then the bandage is packed (including the secondary dressing) and is" sterilized. Prior to the application, the generation of iodine is initiated by mechanically pressing' the bandage, which5 causes the perforation of the wall between the pockets and mixing of the solutions. The ioidine generation is immediately visible thanks to the change of the coiBur:: The produced iodine^ permeates through the thin wall of the pockets to the absorption i&fe of the bandage and' dioser to the wound, which ensures elimination of microbial contamination from the environment and disinfection of the wound. The bandage is then placed onto the wound and fixed by a secondary dressing. The bandage is suitable for first aid in the field,' for; example: disaster ihedicine and military missions. This particular form is ideal for acute clean small wounds, o " alternatively for larger and not very contaminated wounds. The heavily1 contaminated wounds1 require a higher concentration of iodine, which is ensured by increasing the concentrations of the solutions B and K; It is also possible to adjust the production of pockets in such a way that they are not within the whole area Of the bandage, so that a better passage of the exudate is enabled deeper into the layers of the bandage, and therefore, the' bandage is applicable alsd for strongly exuding or bleeding wounds.
Example 22
Replacement of a part of the hyaluronate by iodofor
An analogous procedure as. in Examples 1, 8, If , 15, 16, or 17 is used with the difference that not more than , 75 % of hyaluronatej is replaced by the physiologically acceptable iodofor which is ; harmaceutically pure. As: ^ suitable iodofor, i.e. an agent that slows, down iodine, votalizat^ h- and/pr stabilizes iodine_, ,schizofilan, chitosan, glucan, or a
mixture thereof is used. The typerpf ipdofor to be used is adapted according to the application, for example: schizofilan is more suitable for dry wounds (because it is soluble), on the contrary chitosan, glucan, or the complex chitosan-glucan are more suitable for dripping wounds (because it is insoluble1, it only forms a solid gel).
For example: potassium iodide (2,6 g) and "sodium hyaluronate (0,75 g) of the molecular weight of 1 500 000 g'/mol and schizofilan ' (0,75 g) are dissolved in 100 ml of sterile water for injections, which forms the solution B. The second solution is prepared separately by dissolving potassium iodate (0.35 g), citric acid (0.1 g) and sodium hyaluronate (1.5 g) in 100 ml of sterile water for injections, which forms the solution A. Both solutions are sterilized and the further procedure is the same as in Example 1.
Example 23
Utilization of photoinitiator on ajSolid support
An analogous procedure as in Example 13 is used with the exception that a pigment (phtalocyanin) is embedded ori' a suitable solid support; foi example: polyamide textile, or a
an acid-base agent (soda, bicarbonate, triethylamine, etc.), optionally in the presence of auxiliary agents (e.g. sodium 'chloride type salts). The environment for the reaction is either water or another diluent, for example, dimethylsulfoxide (DMSO). In case DMSO is used, it is preferred to carry out the reaction in the following was: first the solid support is impregnated by the solution 6fp¾nieht, DMSO is then evaporated at 40 °C and then the solid support is placed into a suitable sbfution with an alkaline agent, which is further heated. For example: polyamide is impregnated by 1 % (weight percent with respect to the weight1 of the textile) solution of aluminium^^li kiPcyanin in such an amount of DMSO, so that the textile is Completely soaked. DMSO is ¾ · 'evaporated at 40 °C, then the support is placed into an aqueous solution of 1 % (we¾g percent with respect to. the weight of the textile) of sodium bicarbonate in such an amount -of Water, so that the' textile is soaked. The solution is then heated for 30 minutes to 60 °C. After the reaction it is necessary to wash the solid support to remove the unbound pigment and waste products of the reaction. That is why the support is
washed with water until the fk se,. water has a sufficiently low conductivity and is clear (the waste salts and the unbound ^ ment are washed out). Then the support is dried and impregnated by 0.1 % hyaluronate solution (weight percent with respect to the weight of the textile) and potassium iodide , of ^ % (weight percent with respect to the weight of the textile) and is again dried. It is not always -necessary to carry out the complete drying, for dry wounds applications it is more suitable to leave a residual amount of moisture inside the textile so that it corresponds either to 10 % of the hyaluronate weight , or to 50 % of the textile weight. The advantage of the bond to the solid' support is that a higher concentration of ftalocyanin may be used, and therefore the generation .of iodine is more effective, without any toxic risk for the organism (a high dosage of phtalocyanin could be toxic in case of its release to the body). If the solid support is sufficiently hydf ophilic it maintains the wound moisture. The preparation according to this example is ijdeai¾r ;eliminati of the biofilm on the wound (that is: a short- time application, minutes or tfe s ¾ minutes of application and exposure to IR lamp).
Example 24
Example of use of the preparation (iodine generation, preclinical evaluation)
Utilized wound model, brief description.
In all cases a model of Excision wound in healthy rats (ZDF males) was used for the evaluation of healing effects.; The ; ounds of 2 x 2 cm were created and the healing was evaluated by the rate of the wound contraction.
Preparations according to Exatn¾les 1 and 2
Two-parts type A + B having;thel'6dihe capacity 0.65 and 0.1 %
The results of the evaluation of the preparations according to Examples 1 and 2 in terms of the healing effect are summarize in Figure 1.. Figure 1 shows that the preparations generating iodine from the source .according to Examples 1 and 2 have at a longer application a better healing effect than the ^preparation Hyiodine with elementary iodine. They are especially suitable for chronic wounds.
Preparations according to Example 7
Spongy formations with apacl with the iodine capacity of 0.1 a 0.04 %
The results of the evaluation of ftlie preparation according to Example 7 in terms of the healing effect are summarized in Figure 2;. ' Figure 2 shows that the preparations generating iodine from the sources according to Exarnple 7 have a worse healing effect than the preparation Hyoidine with elementary iodine,- yet they are beneficial for healing, at least after some time. The advantages compared tb';Hyiodine are easy storage, easy application and durability. Moreover, they have much lower; production costs than Hyiodine, and therefore, they are suitable for small wounds.
Preparation according to Example 9
Filamentary form
Preparation was produced according to Example 9. 2 ml of the solutions A and B were used and coagulation was carried but by means of a syringe into a stirred beaker of 50 ml volume containing 30 ml of airihydroiis isopropanol. Based on the stirring intensity, 1 either areai formations (membranes) or globular clumps of fibers were formed. Generally, the intensity of stirring for the areal formations is low, thai is 5 to 50 rpm; the intensity of stirring for the globular forms is generally high, that is 250 to 1000 rpm. Based on trie Reynolds criteria, laminar area of flow is suitable for areal formations when stirring, whereas for globular formations the turbulent area is preferable.
The structure of forn^tipns is documented by photos of electron microscope - see figs. 3-10.
After drying, the generation^ of iodine was checked by adding a drop of DEMI water (250 μΐ) to equal amounts of, trie mixture of fibers A. and -B. The change of colour due to the iodine generation was obse v d:. t_(¾e; presence of. ioah¾¾ was proved by a adding drop of 250 μΐ of starch paste that create^, a blue colour. Concurreritly, the prepared solutions of only type A or type B fibers did neither generate iodine individually, nor the blue colour.
Preparation according to Example 11
Two-type form of AB + K (1 :10) having the iodine capacity of 0,1 %
The results of the evaluation ; of the preparation according to Example 11 in terms of the healing effect are summarized in Figure 11. Figure 11 shows that the preparation generating iodine from the source^ according to example. ! 1 has a better healing effect then
Hyiodine with elementary iodine^at a longer application . Therefore, it is especially preferable for chronic wounds.
Preparation according to Exampl£¾2
One part type with the ion exchanger
One part preparation with the ion exchanger was prepared according to the Example 12 without isotonisation and for several isotonising agents and was tested in terms of the iodine generation after passing through the catalyst which was the acid form of ion exchanger Amberlite IR 120 Na.
Table 1 shows the results' of evaluation of the effectiveness of iodine generation. The symbols utilized in the tabic , havc.thc following meaning:; characters in front of the underline mean the composition of the solution, the characters behind the underline stand for the way of initialization of iodine generation; Specifically, "Nul" stands for the comparative example without initiation of iodine s gfetieiation;„Kat" stands for initiation by catalyst and„Kys" stands for the comparative example of initiation by chloride acid, which is a method that should lead to a quantitative; reaction of iodine production„Abs287nm (-)" is the value of absorbance of the solution at 28*7 Jim;„c(I2) (mol/1)" is the calculated molar concentration of iodine and„c(I2) (% theoretical)" Is the theoretical yield when compared with the initiation by a strong mineral acid.
Gl Kat 0.367 Glucose ■8.88E-05 107
Gl Kys 0.329 Glucose 8.3ΪΕ-05 100
Table 1 shows that all of the stated combinations are applicable, because they ensure production of iodine within the ' desired extent (in this case specifically 0.05 % of I2). The found variations of the amount:;b¾iodine are partially ^diie to the influence of the isotonising agents.
Preparation according to Example .13
One part type with a photo catalyst
The preparation with aluminium phthalocyanm , as the photo catalyst was prepared according to Example 13 as a g li he gel was placed Int -a glass phial (4 ml of the gel into a phial of 10 ml volume), sealed with a plastic cover and placed under the infrared lamp with a bulb 100 W in the distance of 35 cm from the bulb. The course of absorbance changes at 287 nm was monitored in sixty minutes intervals - see fig. 12. Figure 12 shows the generation of iodine with the use of a photOr&atalyst in case of the sample„FC.KI". the catalyst alone is subject to a slow degradation after exposure, this is shown as the curve„FC.Nul". The iodide solution doesn't show any measurable changes, the iodide absorbance at the given wavelength is almost zero and is within the level of the device fault.
Preparation according to Example 17
Bandage with a polyurethane Membrane and replacement1 of 75 % hyaluronate by xanthan
even upon a short-time application. On the contrary,, the type„X3C" is more suitable for chronic wounds.
Preparation according to Example ¾1
Bandage with a catalyst (iron;iiqnsyiwo-parts type B + K). ,
Iodine generation was 'evaluated in terms of the sufficient initial rate and the duration of the reaction in the following way. : Solutions B and lK were prepared according to Example 21 and mixed. Concurrently- < comparative solutions of individual components were prepared, with the same concentration as c he concentration after -.mixing of the preparation. Jodine generation was evaluated 5 minutes- after mixing of the solutions spectrophotometrically at 287 nm. The difference of absotbance of comparative solutions and the mixture after a sixfold dilution is 0,978 which corresponds to approximately 0,064 % iodine concentration in the original mixture. The solutions were kept in a glass phial covered with a plastic lid so the iodine content decreased by , aporization. Still, 24 hours later the iodine content was similar to that of the preparation 5 minutes after mixing the solutions. Therefore, the preparation is suitable for acute treatment in ;the field followed by the transport of the patient to a clinical treatment, preferably within 2$'h¾¾s..:
Mutual comparison of individual ex-amples of preparaiiofi embodiments
Preparations according to Examples 11, 13 and 20
Comparison of kinetics of vo,la¾lizatipn and iodine generation
One of the most important contributions of the solution of the presented invention is that iodine loss by vaporization is reduced, i.e. a higher; iodine concentration is ensured for a longer period of time. A study comparing several systems is shown for a better explanation (see Figure 14). Figure 14 presents changes in the iodine! concentration over time, the input content of iodine is the same m' all solutions, 0.1 % : of iodine, here expressed as 100 % (compared to Hyiodine). It is cleat that the iodine generation supplements the iodine loss due to vaporization and in this way thfe disinfection efficiency of the preparation generating iodine is prolonged. The effect of the prolonged efficiency is mainly due to the appropriate kinetics qf iodine generation in a ; Viscous environment, the suitable viscosity is provided by hyaluronate. Similar results 0a be obtained not only with hyaluronate but also using other native, modified or synthetic polymers (such as: xanthan or cellulose derivates).
From the viewpoint of the iodine generation in the preparation according to the presented invention, especiall in systems similar to preparations according to Examples 1, 2,
3, 4, 10 and 11, the initiating agetit is important (in this case the acid component to adjust an environment which is suitable forlthe reaction).
Figure 15 demonstrates the ; kinetics of the production in two extreme cases of the system of the analogous sample ' ,H20_R" (for description see Figure 14). Figure 15 shows that, when citric acid is used the generation of iodine is initiated immediately after mixing and practically in a quantitative amount. On the contrary, . when phosphate buffer is used the generation is gradual. The desired kinetics of iodine _; generation in the preparation of the presented invention is achieved by using a combination of more substances, for example citric acid and phosphate buffer. One possibility is the composition mentioned in Example 20, but generally, every type of wound and preparation form possesses its optimal combination, which applies especially for solid-bandages (e.g. Examples 14 and 15).
Preparation according to example, 11, 13 and 20
Comparison in terms of the sterilization
Another important difference, of the presented! solution is the method of sterilization. This concerns the use of more¾ possible modes, including: ^toclave, but also the possibility to sterilize the finished product. '.Tjhis considerably facilitates the production because it is not necessary to work under strict aseptic conditions.
Figure 16 demonstrates, jthe impact of sterilization by ethylene oxide and various dosages of gamma rays on the molecular weight of hyaluronate. Both methods are applicable, but at the expense of a certa¾.decrease (degradation) of the molecular weight. Figure 16 demonstrates that if the sterilization, should not have, any .important impact on the molecular weight of hyaluronate it is necessary to carry it out.iby gamma rays in a dose lower than approximately 0.1 kGy. In case i¾igher dose then 0.5 KGy is needed for sterilization and in case the nature of the preparation allows it, it is more suitable to sterilize by means of ethylene oxide.
Figure 17 demonstrates the impact of the sterilization by autoclave first on the solution of hyaluronate in water and second ,on the solution„AB" according to Examples 10 and 11. It is clear that the properly selected composition of solution„AB" decreases the degradation of hyaluronate. This is yet another advantage compared to the method of sterilization in the production of Hyiodine (preparation according to EP 1487506). Figure 17 demonstrates the advantage of the preparation; according to Examples 10 and 11 compared to the method of
sterilization used in the production; of the preparation according to EP 1487506. A suitable solution composition diminisKe¾|he degree of hyaluro tate degradation.
Claims
1. A preparation for healing of intracorporeal and/or surface wounds containing a physiologically acceptable salt of hyaluronic acid, characterized by that it further contains at least one iodine source U and/or IB and an initiating agent K, wherein the iodine source IA and the iodine source IB are the same or different and they are selected from the group comprising iodates, periodates, periodic acid, iodides, hydroiodic acid and the mixtures thereof; and the iodine source and/or ¾ is able to generate elementary iodine by the interaction with the initiating agent at suitable conditions; and wherein the initiating agent is selected from the group comprising hydrogen phosphates, dihydrogen phosphates, ferric salts, inorganic and organic acids or salts thereof, photocatalysts and an ion exchanger, optionally mixtures of said substances.
3. The preparation of Claims ,!, or 2, characterized , by that it comprises of two separate components AK and B, wherein ;at least one of the , components AK and B contains the physiologically acceptable salt of hyaluronic acid and. wherein the component AK contains the iodine source IA and the initiating agent K, and .the , component B contains the iodine source ¾.
4. The preparation of Claim characterized in that the iodine source U is sodium or potassium iodate or periodate, the iodine source IB is sodium or potassium iodide and the initiating agent K is citric acid.
5. The preparation of Claims l ;:or 2, characterized by1 that it comprises of two separate components AB and K, whereiti at least one of the components AB and K contains the physiologically acceptable salt , of ' hyaluronic acid and, wherein the component AB contains the iodine source U and the .iodine source IB and the component K contains the initiating agent.
6. The preparation of Claim 5,- characterized in that the iodine source L\ is sodium or potassium iodate, the iodine source ¾ is sodium or potassium iodide and the initiating agent K is an ion exchanger or citric, acid and sodium dihydrogenphosphate dihydrate.
7. The preparation of Claim 1 or 2, characterized by that it comprises of two separate components B and K, wherein at least one of the components B and K contains the physiologically acceptable salt; of hyaluronic acid and wherein the component B contains the iodine source ¾ and the component K contains the initiating agent.
8. The preparation of Claim 7, characterized in that the iodine source ¾ is sodium or potassium iodide and the initiating agent K is ferric chloride.
9. The preparation of Claim 1 or .2, characterized by that it comprises of one component BK containing the physiologically acceptable salt of hyaluronic acid and the iodine source IB and the initiating agent.
10. The preparation of Claim 9, characterized in that the iodine source ¾ is sodium or potassium iodide and the initiafing'iagent K is aluminium^htalocyanin.
11. The preparation of Claims 9 or 10, characterized in ithat the initiating agent K is fixed on a solid support.
12. The preparation of Claim 11 ^characterized in that the solid support is a solid material containing suitable functional: groups and it is selected from the group comprising a synthetic polymer including polyamide, polyester or polyethylene, or a natural or modified polymer including cellulose, carboxyrnethylcellulose and other derivatives of cellulose, or polysaccharides chitosan, glucan, hyaluronan and derivatives thereof, and mixtures thereof.
13. The preparation of any of the previous Claims, characterized in that the physiologically acceptable salt of hyaluronic lac'id has the weight average molecular weight within the range of 10,000 to 3,000,000 g mol ÷ahd'- tis' selected from the* group comprising sodium, potassium, lithium, calcium, magnesium,! zinc- cobaltous and manganous salt or a mixture thereof. ,
14. The preparation of any of jthe previous Claims, characterized in that it further contains one or more adjuvants selected frprn the group comprising agents for improving the healing effect of the preparation, agents !for modifying the iscosity of the preparation and/or the strength of fibres, agents for^etardjng the iodine vaporization, stabilizers, preservatives and a pad.
15. The preparation of Claim' 14, characterized in that the agent for improving the healing effect of the preparation can be; selected from the group comprising sodium alginate, chitosan, glucan, oxycellulose, schizophyjlan and biotin; the agent for modifying the viscosity of the preparation and/or the strength of fibres can be selected, from the group comprising agar, urea, glucose, fructose, saccharose,: xanthan gum, arabic gum, guar gum, carob gum, tragant, fibrinogen, thrombin, seaweed ' 1 gelatine, sorbitol, cellulose and derivatives thereof, oxycellulose, schizofyllan, polyethylenglycol and mixtures thereof; the agents for retarding the iodine vaporization and/i)r¾br the stabilization of* iodine can be selected from the group comprising schizofyllan, chit safiv glucan or a mixture- thereof, cysteine, starch, dextrines, maltodextrines, cyclodextrines.> and other derivatives or hydrolyzates of starch; and the preservative is selected from .'the1 ¾roup comprising benzoic acid, salicylic acid or ethylene diamine-tetra-acetic acid, benzalkonium chloride, oxychlorine complex, calcium propionate, calcium sorban, potassium sorban or tocoferol.
16. The preparation of any of the previous Claims, characterized in that the total content of the physiologically acceptable .salt of hyaluronic acid in all components is within the range of 0.005 to 99.9 wt.%, the total content of all iodine sources U and IB is within the range of 0.001 to 90.0 wt.%, the content "of all initiating agents K is within the range of 0,001 to 90.0 Wt.% and the total content of all other adjuvants is within the range of 0.0 to 99.5 % and the content of water is within the range oif 0 to 99.9 wt.%.
17. The preparation of any pfjhe previous Claims, characterized in that the total content of the physiologically acceptable .salt- pf hyaluronic acid-in all, components is within the range of 0.5 to 25 wt.%, the total content of all iodine sources IA and IB is within the range of 0.05 to 5 wt.%, the content of all initiating agents K is within the range of 0,01 to 15 wt.%.
18. The preparation of any of. the previous Claims, ..characterized in that the iodide is sodium, potassium, ammonium, aluminium, silver or, mercuric iodide, the iodate is spdium, potassium or calcium iodate,; and, jhe periodate is sodium, potassium periodate.
19. The preparation of any of the previous Claims, cha¾pacterized in that the initiating agent is selected from the group' comprising sodium hydrogen phosphate, sodium dihydrogen phosphates, ferric chloride,' ferric sulphate, ferric citrate, ammonium-ferric citrate, ferric oxide, hydrogen peroxide5j f spdium peroxoborate, . ammonium peroxodisulfate, sodium peroxodisulfate, potassium peroxodisulfate, citric acid,, malic acid and ascorbic acid, the ion exchanger in the acidic form .releasing H+, an ion exchanger releasing Fe3+, an agent capable to oxidizing Fe2+ to Fe3+, such as a dye forming a singlet oxygen such as phtalocyanin, porphyrin, bengal red, crystal violet, optionally mixtures of said substances.
20. The preparation of any of the previous Claims, characterized in that it is in the form of a liquid composition, gel or in a solid form or in a combination of these forms.
21. A method of production df the, preparation of any of the previous Claims, characterized in that the physiologically acceptable salt of hyaluronic: acid, the iodine source U and/or ¾, the initiating agent and optionally 'one or more adjuvants are dissolved in water, optionally in a mixture of water and alcohol, to form one solution or. gel or two separate solutions or gels.
22. The method of production, of( the preparation according to Claim 21, characterized in that the formed solution or jthee el or the two separate solutions or gels are dried with or without the addition of an auxiliary textile material.
23. The method of production , of the preparation of Claim 21, characterized in that the two formed separate solutions or gels . are extruded separately into an anhydrous solvent with or without any auxiliary textile, where they precipitate and subsequently are dried together or separately.
24. The method of production , of the preparation according to Claim 22, characterized in that the anhydrous solvent is, selected from the group .comprising aliphatic alcohols, phenol, glycol, glycerol, modified alcohols, ketones, hydrocarbones, esters, ethers, amines and heterocyclic compounds.
25. The method of production of the preparation according to Claim 22 or 23, characterized in that the drying is performed byimeans of lyophilisation or by means of hot air or in the gas phase.
26. A single-layer or multiple layer bandage impregnated with the preparation of any of Claims 1 - 20 or containing a pocket-like formation comprising the preparation of any of Claims 1 - 20 or formed from the .preparation of any Claims 1 - 20 by the method of Claims 22 or 23.
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Also Published As
Publication number | Publication date |
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CZ303548B6 (en) | 2012-11-28 |
AR084791A1 (en) | 2013-06-26 |
CZ20113A3 (en) | 2012-07-18 |
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