Classifications

• • 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
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/14—Macromolecular materials
  • A61L27/20—Polysaccharides
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/54—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic compound
  • A61K47/545—Heterocyclic compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K8/00—Cosmetics or similar toiletry preparations
  • A61K8/18—Cosmetics or similar toiletry preparations characterised by the composition
  • A61K8/30—Cosmetics or similar toiletry preparations characterised by the composition containing organic compounds
  • A61K8/67—Vitamins
  • A61K8/676—Ascorbic acid, i.e. vitamin C
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K8/00—Cosmetics or similar toiletry preparations
  • A61K8/18—Cosmetics or similar toiletry preparations characterised by the composition
  • A61K8/72—Cosmetics or similar toiletry preparations characterised by the composition containing organic macromolecular compounds
  • A61K8/73—Polysaccharides
  • A61K8/735—Mucopolysaccharides, e.g. hyaluronic acid; Derivatives thereof
• • 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
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
  • A61L27/505—Stabilizers
• • 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
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
  • A61L27/54—Biologically active materials, e.g. therapeutic substances
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61Q—SPECIFIC USE OF COSMETICS OR SIMILAR TOILETRY PREPARATIONS
  • A61Q19/00—Preparations for care of the skin
  • A61Q19/08—Anti-ageing preparations
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08B—POLYSACCHARIDES; DERIVATIVES THEREOF
  • C08B37/00—Preparation of polysaccharides not provided for in groups C08B1/00 - C08B35/00; Derivatives thereof
  • C08B37/006—Heteroglycans, i.e. polysaccharides having more than one sugar residue in the main chain in either alternating or less regular sequence; Gellans; Succinoglycans; Arabinogalactans; Tragacanth or gum tragacanth or traganth from Astragalus; Gum Karaya from Sterculia urens; Gum Ghatti from Anogeissus latifolia; Derivatives thereof
  • C08B37/0063—Glycosaminoglycans or mucopolysaccharides, e.g. keratan sulfate; Derivatives thereof, e.g. fucoidan
  • C08B37/0072—Hyaluronic acid, i.e. HA or hyaluronan; Derivatives thereof, e.g. crosslinked hyaluronic acid (hylan) or hyaluronates
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08J—WORKING-UP; GENERAL PROCESSES OF COMPOUNDING; AFTER-TREATMENT NOT COVERED BY SUBCLASSES C08B, C08C, C08F, C08G or C08H
  • C08J3/00—Processes of treating or compounding macromolecular substances
  • C08J3/24—Crosslinking, e.g. vulcanising, of macromolecules
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08L—COMPOSITIONS OF MACROMOLECULAR COMPOUNDS
  • C08L5/00—Compositions of polysaccharides or of their derivatives not provided for in groups C08L1/00 or C08L3/00
  • C08L5/08—Chitin; Chondroitin sulfate; Hyaluronic acid; Derivatives thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2800/00—Properties of cosmetic compositions or active ingredients thereof or formulation aids used therein and process related aspects
  • A61K2800/80—Process related aspects concerning the preparation of the cosmetic composition or the storage or application thereof
  • A61K2800/91—Injection
• • 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
  • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
  • A61L2300/402—Anaestetics, analgesics, e.g. lidocaine
• • 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
  • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
  • A61L2300/428—Vitamins, e.g. tocopherol, riboflavin
• • 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
  • A61L2400/00—Materials characterised by their function or physical properties
  • A61L2400/06—Flowable or injectable implant compositions
• • 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
  • A61L2430/00—Materials or treatment for tissue regeneration
  • A61L2430/34—Materials or treatment for tissue regeneration for soft tissue reconstruction
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08J—WORKING-UP; GENERAL PROCESSES OF COMPOUNDING; AFTER-TREATMENT NOT COVERED BY SUBCLASSES C08B, C08C, C08F, C08G or C08H
  • C08J2305/00—Characterised by the use of polysaccharides or of their derivatives not provided for in groups C08J2301/00 or C08J2303/00
  • C08J2305/08—Chitin; Chondroitin sulfate; Hyaluronic acid; Derivatives thereof
• • C—CHEMISTRY; METALLURGY
  • C08—ORGANIC MACROMOLECULAR COMPOUNDS; THEIR PREPARATION OR CHEMICAL WORKING-UP; COMPOSITIONS BASED THEREON
  • C08J—WORKING-UP; GENERAL PROCESSES OF COMPOUNDING; AFTER-TREATMENT NOT COVERED BY SUBCLASSES C08B, C08C, C08F, C08G or C08H
  • C08J3/00—Processes of treating or compounding macromolecular substances
  • C08J3/02—Making solutions, dispersions, lattices or gels by other methods than by solution, emulsion or suspension polymerisation techniques
  • C08J3/03—Making solutions, dispersions, lattices or gels by other methods than by solution, emulsion or suspension polymerisation techniques in aqueous media
  • C08J3/075—Macromolecular gels

Definitions

• the present invention generally relates to dermal filler compositions, and more specifically relates to injectable dermal filler compositions that are effective for treatment of fine lines in skin.
• Skin aging is a progressive phenomenon, occurs over time and can be affected by lifestyle factors, such as alcohol consumption, tobacco and sun exposure. Aging of the facial skin can be characterized by atrophy, slackening, and fattening. Atrophy corresponds to a massive reduction of the thickness of skin tissue. Slackening of the subcutaneous tissues leads to an excess of skin and ptosis and leads to the appearance of drooping cheeks and eye lids. Fattening refers to an increase in excess weight by swelling of the bottom of the face and neck. These changes are typically associated with dryness, loss of elasticity, and rough texture.
• Hyaluronic acid also known as hyaluronan, is a non-sulfated glycosaminoglycan that is distributed widely throughout the human body in connective, epithelial, and neural tissues.
• Hyalurinic acid is abundant in the different layers of the skin, where it has multiple functions such as, e.g., to ensure good hydration, to assist in the organization of the extracellular matrix, to act as a filler material; and to participate in tissue repair mechanisms.
• the quantity of hyaluronic acid, collagen, elastin, and other matrix polymers present in the skin decreases.
• Injectable dermal fillers have been successfully used in treating the aging skin.
• the fillers can replace lost endogenous matrix polymers, or enhance/facilitate the function of existing matrix polymers, in order to treat these skin conditions.
• Hyaluronic acid-based dermal fillers have become increasingly popular, as hyaluronic acid is a substance naturally found throughout the human body. These fillers are generally well tolerated, nonpermanent, and a fairly low risk treatment for a wide variety of skin conditions.
• Tyndall effect is an adverse event occurring in some patients administered with hyaluronic acid (HA)-based dermal fillers. Tyndall effect is characterized by the appearance of a blue discoloration at the skin site where a dermal filler had been injected, which represents visible hyaluronic acid seen through the translucent epidermis. Clinical reports suggest that filler administration technique and skin properties can influence the manifestation of this adverse event. Fillers with high stiffness and elasticity are successfully used to correct areas on the face like nasolabial folds, cheeks, and chin without any fear of facial discoloration, as the materials are injected in the mid and deep dermis regions.
• HA- based dermal filler gels have been specifically formulated to treat "fine line " wrinkles found around the tear trough, forehead, periobital, glabellar lines, etc.
• Commercially available HA "fine line” gels include Juvederm Refine (G' -67 Pa; G7G” -0.59, HA concentration 18 mg/ml), Belotero Soft (G” -28 Pa; G7G" -1 .1 , HA concentration 20 mg/ml), Emervel Touch (G' -56 Pa; G7G' -0.64, HA concentration 20 mg/ml), Stylage S (G' -192 Pa; G7G' -0.20, HA concentration 16 mg/ml), Teosyal First Lines (G' 59 Pa; G7G' -0.53, HA concentration 20 mg/ml), Restylane Touch (G' -489 Pa; G7G' -0.24, HA concentration 18 mg/ml).
• these gels are formulated to have low elastic moduli, for example, by lightly crosslinking the linear HA chains with a small amount of crosslinker and/or by reducing the final HA concentration of these gels, most of the commercially available "fine line" gels still show Tyndall effect in some patients, especially when when injected superficially, for example, at a depth of less than about one mm.
• Collagen-based gels can be employed in the treatment of superficial wrinkles and does not appear to cause Tyndall effect. Collagen based gels are not highly favored as they have relatively poor duration in the skin and require pre-testing in individuals.
• Radiesse ® calcium hydroxylapatite
• Radiesse ® calcium hydroxylapatite is a subdermal, injectable implant, whose principal component is synthetic calcium hydroxylapatite, not hyaluronic acid. Unlike hyaluronic acid-based dermal fillers, calcium hydroxylapatite is not transparent, and thus avoids the complication of the Tyndall effect. However, if placed too superficially, this filler can be seen as a white substance immediately beneath the skin.
• Radiesse ® Compared to hyaluronic acid based fillers, Radiesse ® requires a larger needle for injection and is not typically recommended for use in the eye area. It would be desirable to provide an injectable hyaluronic acid-based dermal filler that does not exhibit the bluish discoloration attributed to Tyndall effect, even when injected superficially.
• the present invention describes compositions and formulation methods for preparing HA-based dermal fillers that can be administered in the upper dermis without producing any bluish discoloration of the skin, or at least no significant or noticeable bluish discoloration. Further, many of the presently described filler gels of the invention have been found to last significantly longer in vivo than current commercially available gels.
• optically transparent dermal fillers useful for enhancing the appearance of the skin are provided which add volume and fullness, and reduce the appearance of even fine line wrinkles without "tyndalling".
• the present compositions can be introduced into fine lines in the skin, even in regions of thin skin and rather superficially, without causing the negative blue discoloration associated with many conventional optically transparent dermal fillers.
• long lasting, therapeutic dermal filler compositions which generally comprise a biocompatible polymer, for example, crosslinked hyaluronic acid component and an additive combined with the hyaluronic acid component.
• the polymer is a polysaccharide, for example, hyaluronic acid.
• the hyaluronic acid includes a crosslinked component and may further include a non-crosslinked component.
• the additive may comprise a vitamin, for example, vitamin C, for example, a stabilized form of vitamin C, or a vitamin C derivative, for example, L-ascorbic acid 2-glucoside (AA2G), ascobyl 3-aminopropyl phosphate (Vitagen) or sodium ascorbyl phosphate (AA2P).
• the additive is a vitamin derivative which is covalently conjugated to the polymer by a suitable reaction process, for example, etherification, amidization or estherification.
• a dermal filler composition comprising a hyaluronic acid component crosslinked with a crosslinking component, and an additive other than the crosslinking component.
• the hyaluronic acid component may be chemically conjugated to the additive.
• the composition exhibits reduced Tyndall effect when administered into a dermal region of a patient, relative to composition that is substantially identical except without the additive.
• the composition may further comprise other additives, for example, an anesthetic agent, such as lidocaine.
• the additive is a vitamin C derivative, for example, AA2G.
• the additive is Vitagen.
• the hyaluronic acid component is chemically conjugated to the additive with degree of conjugation being between about 3 mol% and about 40 mol, for example, between about 3 mol% and about 10 mol%.
• the composition may be substantially optically transparent.
• the compositions generally have a G' value of between about 40 Pa and about 100 Pa, for example, no greater than about 100 Pa and, for example, no less than about 40 Pa.
• the method comprises the steps of introducing, into skin of a patient, a composition comprising a mixture of a hyaluronic acid component, a crosslinking component crosslinking the hyaluronic acid, and an additive other than the crosslinking component, the composition being substantially optically transparent, and wherein the composition exhibits reduced Tyndall effect relative to composition that is substantially identical except without the additive.
• methods of improving aesthetic appearance of a face comprising the steps of administering, to a dermal region of a patient, a substantially optically transparent dermal filler composition that exhibits no or insignificant Tyndall effect.
• the composition may be made by the steps of providing hyaluronic acid, reacting a crosslinking agent with a vitamin C derivative, adding the reacted crosslinking agent and vitamin C derivative to the hyaluronic acid to form a crosslinked hyaluronic acid composition including covalently conjugated vitamin C; and homogenizing and neutralizing the crosslinked hyaluronic acid composition to obtain an injectable dermal filler composition.
• the vitamin C derivative is AA2G.
• the vitamin C derivative is Vitagen.
• methods of reducing appearance of fine lines in thin skin regions of a patient comprising administering to the patient a dermal filler composition, at a depth of no greater than about 1 mm, a substantially optically transparent hyaluronic acid based dermal filler composition including a vitamin C or a vitamin C derivative.
• the composition is injected at a depth of a depth of no greater than about 0.8 mm, no greater than about 0.6 mm, or no greater than about 0.4 mm.
• a dermal filler composition which is substantially optically transparent, and generally comprises a hyaluronic acid component crosslinked with a crosslinking component, and a vitamin C derivative covalently conjugated to the hyaluronic acid component.
• the composition may have a hyaluronic acid concentration of between about 18 mg/g and about 30 mg/g.
• These compositions may be especially useful and effective in treating fine lines or superficial creases in the skin, for example, even in very thin skin, for example, skin having a thickness of no greater than about 1 mm.
• the compositions of the invention last at least 3 months, at least 6 months or up to a year after being introduced into the skin.
• Figure 1 is a representation of the structure of L-ascorbic acid 2-glucoside (AA2G)
• Figure 2 is a representation of the structure of ascobyl 3-aminopropyl phosphate (Vitagen).
• FIG 3 is a representation of the structure of sodium ascorbyl phosphate (AA2P).
• Figure 4 is a representation of the structure of 1 ,4-butanediol diglycidyl ether (BDDE).
• Figure 5 is a representation of the structure of pentaerythritol glycidal ether (Star- PEG epoxide).
• Figure 6 is a representation of the structure of pentaerythritol (3-aminopropyl) ether (Star-PEG amine).
• Figure 7 is a Table showing conjugation degrees and G' values for various dermal filler compositions in accordance with the invention.
• Figure 8 is a Table showing conjugation degrees, HA concentration and G' values for HA-AA2G(BDDE) dermal filler compositions in accordance with the invention.
• Figure 9 is a graphical representation of observed percent release of AsA from a solution of AA2G in PBS, in terms of time in minutes, for four different a- glucosidase concentrations.
• Figure 10 shows a representation of a release profile of free AsA from conjugated dermal fillers in accordance with the invention (sustained release) (AA2G conversion in mol% versus reaction time).
• Figure 1 1A and 1 1 B show additional release data for various dermal fillers in accordance with the invention.
• Figure 12 shows images of skin after superficial injection of HA based dermal filler gels of the invention and some commercially available gels for fine line application.
• Figure 13 shows visual Tyndall scores of HA based dermal filler gels of the invention and certain commercially available gels for fine line application.
• Figure 14 shows % of blue light remitted from skin of HA based dermal filler gels of the invention and some commercially available gels for fine line application
• Figure 15 shows overall % of gel remaining after 1 week implantation of HA based dermal filler gels of the invention and some commercially available gels for fine line application.
• Figure 16 shows overall % of gel remaining at Week 0 , Week 12, Week 24 and Week 40 of implanted HA based dermal filler gels of the invention and some commercially available gels for fine line application.
• dermal filler compositions are provided, the compositions generally comprising a biocompatible polymer, for example, a polysaccharide such as a crosslinked hyaluronic acid, and a vitamin C derivative covalently conjugated to the polymer.
• the composition is provides sustained release of the vitamin C for skin neocollagenesis as well as other therapeutic or cosmetic benefits.
• the composition When introduced into the skin, for example intradermally, the composition reacts with endogeneous enzymes in the body, and over time, bioactive vitamin C is generated in vivo, via enzymatic cleavages. As vitamin C is released from the composition over a period of weeks or months, its attendant benefits are made available to the body.
• the polymer may be selected from the group of polymers consisting of proteins, peptides and polypeptides, polylysine, collagens, pro-collagens, elastins, and laminins.
• the polymer may be selected from the group of polymers consisting of synthetic polymers with hydroxyl, amine, and carboxyl functional groups: polyvinyl alcohol), polyethylene glycol, polyvinlyl amine, polyallylamine, deacetylated polyacrylamide, polyacrylic acid, and polymethacrylic acid.
• the polymer may be selected from the group of polymers consisting of dentric or branched polymers, including dentric polyols and dentric polyamines.
• the polymer may be selected from the group of polymers consisting of solid surface with hydroxyl, amine, and carboxyl functional groups.
• the polymer may be a polysaccharide, for example, selected from the group of polysaccharides including starch and its derivatives; dextran and its derivatives, cellulose and its derivatives; chitin and chitosan and alginate and its derivatives.
• the polymer is glycosaminoglycan.
• the hydrogel composition disclosed herein can further comprise two or more different glycosaminoglycan polymers.
• glycosaminoglycan is synonymous with "GAG” and "mucopolysaccharide” and refers to long unbranched polysaccharides consisting of a repeating disaccharide units.
• the repeating unit consists of a hexose (six-carbon sugar) or a hexuronic acid, linked to a hexosamine (six-carbon sugar containing nitrogen) and pharmaceutically acceptable salts thereof.
• hexose single-carbon sugar
• hexosamine single-carbon sugar containing nitrogen
• pharmaceutically acceptable salts thereof include, e.g., glucuronic acid, iduronic acid, galactose, galactosamine, glucosamine.
• glycosaminoglycan polymer is useful in the hydrogel compositions disclosed herein with the proviso that the glycosaminoglycan polymer improves a condition of the skin.
• glycosaminoglycans include chondroitin sulfate, dermatan sulfate, keratan sulfate, hyaluronan.
• Non-limiting examples of an acceptable salt of a glycosaminoglycans includes sodium salts, potassium salts, magnesium salts, calcium salts, and combinations thereof.
• Glycosaminoglycan and their resulting polymers useful in the hydrogel compositions and methods disclosed herein are described in, e.g., Piron and Tholin, Polysaccharide Crosslinking, Hydrogel Preparation, Resulting Polysaccharides(s) and Hydrogel(s), uses Thereof, U.S. Patent Publication 2003/0148995; Lebreton, Cross-Linking of Low and High Molecular Weight Polysaccharides Preparation of Injectable Monophase Hydrogels; Lebreton, Viscoelastic Solutions Containing Sodium Hyaluronate and Hydroxypropyl Methyl Cellulose, Preparation and Uses, U.S.
• Patent Publication 2008/0089918 Lebreton, Hyaluronic Acid-Based Gels Including Lidocaine, U.S. Patent Publication 2010/0028438; and Polysaccharides and Hydrogels thus Obtained, U.S. Patent Publication 2006/0194758; and Di Napoli, Composition and Method for Intradermal Soft Tissue Augmentation, International Patent Publication WO 2004/073759, each of which is hereby incorporated by reference in its entirety.
• GAGs useful in the hydrogel compositions and methods disclosed herein are commercially available, such as, e.g., hyaluronan-based dermal fillers JUVEDERM ® , JUVEDERM ® 30, JUVEDERM ® Ultra, JUVEDERM ® Ultra Plus, JUVEDERM ® Ultra XC, and JUVEDERM ® Ultra Plus XC (Allergan Inc, Irvine,
• GalNAc(4S) -D-N-acetylgalactosamine-4-O-sulfate
• GalNAc(6S) -D-N-acetylgalactosamine-6-O-sulfate
• GalNAc(4S,6S) -D-N-acetylgalactosamine-4-O, 6-O-sulfate
• GlcNAc a-D-N-acetylglucosamine
• GlcNS a-D-N-sulfoglucosamine
• GlcNS(6S) g-D-N-sulfoglucosamine-6-O-sulfate
• chondroitin sulfate polymer refers to an unbranched, sulfated polymer of variable length comprising disaccharides of two alternating monosaccharides of D-glucuronic acid (GlcA) and N-acetyl-D-galactosamine (GalNAc) and pharmaceutically acceptable salts thereof.
• a chondroitin sulfate polymer may also include D-glucuronic acid residues that are epimerized into L-iduronic acid (IdoA), in which case the resulting disaccharide is referred to as dermatan sulfate.
• a chondroitin sulfate polymer can have a chain of over 100 individual sugars, each of which can be sulfated in variable positions and quantities. Chondroitin sulfate polymers are an important structural component of cartilage and provide much of its resistance to compression. Any chondroitin sulfate polymer is useful in the compositions disclosed herein with the proviso that the chondroitin sulfate polymer improves a condition of the skin.
• Non-limiting examples of pharmaceutically acceptable salts of chondroitin sulfate include sodium chondroitin sulfate, potassium chondroitin sulfate, magnesium chondroitin sulfate, calcium chondroitin sulfate, and combinations thereof.
• keratan sulfate polymer refers to a polymer of variable length comprising disaccharide units, which themselves include ⁇ -D-galactose and N-acetyl-D-galactosamine (GalNAc) and pharmaceutically acceptable salts thereof. Disaccharides within the repeating region of keratan sulfate may be fucosylated and N-Acetylneuraminic acid caps the end of the chains.
• Any keratan sulfate polymer is useful in the compositions disclosed herein with the proviso that the keratan sulfate polymer improves a condition of the skin.
• Non-limiting examples of pharmaceutically acceptable salts of keratan sulfate include sodium keratan sulfate, potassium keratan sulfate, magnesium keratan sulfate, calcium keratan sulfate, and combinations thereof.
• hyaluronic acid polymer is synonymous with "HA polymer”
• hyaluronic acid polymer and “hyaluronate polymer” refers to an anionic, non-sulfated glycosaminoglycan polymer comprising disaccharide units, which themselves include D-glucuronic acid and D-N-acetylglucosamine monomers, linked together via alternating ⁇ -1 ,4 and ⁇ -1 ,3 glycosidic bonds and pharmaceutically acceptable salts thereof.
• Hyaluronan polymers can be purified from animal and non-animal sources.
• Polymers of hyaluronan can range in size from about 5,000 Da to about 20,000,000 Da. Any hyaluronan polymer is useful in the compositions disclosed herein with the proviso that the hyaluronan improves a condition of the skin.
• Non- limiting examples of pharmaceutically acceptable salts of hyaluronan include sodium hyaluronan, potassium hyaluronan, magnesium hyaluronan, calcium hyaluronan, and combinations thereof.
• a hydrogel composition comprising a crosslinked glycosaminoglycan polymer.
• crosslinked refers to the intermolecular bonds joining the individual polymer molecules, or monomer chains, into a more stable structure like a gel.
• a crosslinked glycosaminoglycan polymer has at least one intermolecular bond joining at least one individual polymer molecule to another one.
• the crosslinking of glycosaminoglycan polymers typically result in the formation of a hydrogel.
• Such hydrogels have high viscosity and require considerable force to extrude through a fine needle.
• Glycosaminoglycan polymers disclosed herein may be crosslinked using dialdehydes and disulfides crosslinking agents including, without limitation, multifunctional PEG-based crosslinking agents, divinyl sulfones, diglycidyl ethers, and bis-epoxides, biscarbodiimide.
• dialdehydes and disulfides crosslinking agents including, without limitation, multifunctional PEG-based crosslinking agents, divinyl sulfones, diglycidyl ethers, and bis-epoxides, biscarbodiimide.
• Non-limiting examples of hyaluronan crosslinking agents include multifunctional PEG-based crosslinking agents like pentaerythhtol tetraglycidyl ether (PETGE), divinyl sulfone (DVS), 1 ,4- butanediol diglycidyl ether (BDDE), 1 ,2-bis(2,3-epoxypropoxy)ethylene (EGDGE), 1 ,2,7,8-diepoxyoctane (DEO), (phenylenebis-(ethyl)-carbodiimide and 1 ,6 hexamethylenebis (ethylcarbodiimide), adipic dihydrazide (ADH), bis(sulfosuccinimidyl)suberate (BS), hexamethylenediamine (HMDA), 1 -(2,3- epoxypropyl)-2,3-epoxycyclohexane, lysine, lysine methylester, or combinations
• cross-linking agents are disclosed in Stroumpoulis and Tezel, Tunably Crosslinked Polysaccharide Compositions, U.S. Patent Application 12/910,466, filed October 22, 2010, which is incorporated by reference in its entirety.
• Non-limiting examples of methods of crosslinking glycosaminoglycan polymers are described in, e.g., Glycosaminoglycan polymers useful in the compositions and methods disclosed herein are described in, e.g., Piron and Tholin, Polysaccharide Crosslinking, Hydrogel Preparation, Resulting Polysaccharides(s) and Hydrogel(s), uses Thereof, U.S.
• Patent Publication 2003/0148995 Lebreton, Cross-Linking of Low and High Molecular Weight Polysaccharides Preparation of Injectable Monophase Hydrogels; Lebreton, Viscoelastic Solutions Containing Sodium Hyaluronate and Hydroxypropyl Methyl Cellulose, Preparation and Uses, U.S. Patent Publication 2008/0089918; Lebreton, Hyaluronic Acid-Based Gels Including Lidocaine, U.S. Patent Publication 2010/0028438; and Polysaccharides and Hydrogels thus Obtained, U.S.
• a hydrogel composition comprising a crosslinked glycosaminoglycan polymer having a degree of crosslinking.
• degree of crosslinking refers to the percentage of glycosaminoglycan polymer monomeric units, such as, e.g., the disaccharide monomer units of hyaluronan that are bound to a cross-linking agent.
• the degree of crosslinking is expressed as the percent weight ratio of the crosslinking agent to glycosaminoglycan.
• the degree of crosslinking in certain advantageous embodiment of the invention is between about 3% and about 12%, for example, between about 5% and about 10%.
• a hydrogel composition comprises a crosslinked glycosaminoglycan polymer, for example, crosslinked hyaluronic acid, wherein the crosslinked glycosaminoglycan polymer is present in the composition at a concentration of, for example, between about 18 mg/g and about 30 mg/g.
• the compositions have a total hyaluronic acid concentration of about 24 mg/g or about 25 mg/g.
• a hydrogel composition comprising hyaluronan polymers of low molecular weight, hyaluronan polymers of high molecular weight, or hyaluronan polymers of both low and high molecular weight.
• high molecular weight when referring to "hyaluronan” refers to hyaluronan polymers having a mean molecular weight of 1 ,000,000 Da or greater.
• Non-limiting examples of a high molecular weight hyaluronan polymers include hyaluronan polymers about 1 ,500,000 Da, about 2,000,000 Da, about 2,500,000 Da, about 3,000,000 Da, about 3,500,000 Da, about 4,000,000 Da, about 4,500,000 Da, and about 5,000,000 Da.
• the term "low molecular weight" when referring to "hyaluronan” refers to hyaluronan polymers having a mean molecular weight of less than 1 ,000,000 Da.
• Non-limiting examples of a low molecular weight hyaluronan polymers include hyaluronan polymers of about 200,000 Da, about 300,000 Da, about 400,000 Da, about 500,000 Da, about 600,000 Da, about 700,000 Da, of about 800,000 Da, and about 900,000 Da.
• a composition comprises crosslinked hyaluronan polymers of low molecular weight.
• a composition comprises crosslinked hyaluronan polymers having a mean molecular weight of, e.g., about 100,000 Da, about 200,000 Da, about 300,000 Da, about 400,000 Da, about 500,000 Da, about 600,000 Da, about 700,000 Da, about 800,000 Da, or about 900,000 Da.
• a composition comprises crosslinked hyaluronan polymers having a mean molecular weight of, e.g., at most 100,000 Da, at most 200,000 Da, at most 300,000 Da, at most 400,000 Da, at most 500,000 Da, at most 600,000 Da, at most 700,000 Da, at most 800,000 Da, at most 900,000 Da, or at most 950,000 Da.
• a composition comprises crosslinked hyaluronan polymers having a mean molecular weight of, e.g., about 100,000 Da to about 500,000 Da, about 200,000 Da to about 500,000 Da, about 300,000 Da to about 500,000 Da, about 400,000 Da to about 500,000 Da, about 500,000 Da to about 950,000 Da, about 600,000 Da to about 950,000 Da, about 700,000 Da to about 950,000 Da, about 800,000 Da to about 950,000 Da, about 300,000 Da to about 600,000 Da, about 300,000 Da to about 700,000 Da, about 300,000 Da to about 800,000 Da, or about 400,000 Da to about 700,000 Da.
• a composition comprises crosslinked hyaluronan polymers of high molecular weight.
• a composition comprises a crosslinked hyaluronan polymers having a mean molecular weight of, e.g., about 1 ,000,000 Da, about 1 ,500,000 Da, about 2,000,000 Da, about 2,500,000 Da, about 3,000,000 Da, about 3,500,000 Da, about 4,000,000 Da, about 4,500,000 Da, or about 5,000,000 Da.
• a composition comprises a crosslinked hyaluronan polymers having a mean molecular weight of, e.g., at least 1 ,000,000 Da, at least 1 ,500,000 Da, at least 2,000,000 Da, at least 2,500,000 Da, at least 3,000,000 Da, at least 3,500,000 Da, at least 4,000,000 Da, at least 4,500,000 Da, or at least 5,000,000 Da.
• a composition comprises a crosslinked hyaluronan polymers having a mean molecular weight of, e.g., about 1 ,000,000 Da to about 5,000,000 Da, about 1 ,500,000 Da to about 5,000,000 Da, about 2,000,000 Da to about 5,000,000 Da, about 2,500,000 Da to about 5,000,000 Da, about 2,000,000 Da to about 3,000,000 Da, about 2,500,000 Da to about 3,000,000 Da.
• a composition comprises a crosslinked hyaluronan polymers where the crosslinked hyaluronan polymers comprise a combination of both high molecular weight hyaluronan polymers and low molecular weight hyaluronan polymers, in various ratios.
• a composition comprises a crosslinked hyaluronan polymers where the crosslinked hyaluronan polymers comprises a combination of both high molecular weight hyaluronan polymers and low molecular weight hyaluronan polymers in a ratio of about 20:1 , about 15:1 , about 10:1 , about 5:1 , about 1 :1 , about 1 :5 about 1 :10, about 1 :15, or about 1 :20.
• aspects of the present specification provide, in part, a hydrogel composition comprising an uncrosslinked glycosaminoglycan polymer.
• uncrosslinked refers to a lack of intermolecular bonds joining the individual glycosaminoglycan polymer molecules, or monomer chains. As such, an uncrosslinked glycosaminoglycan polymer is not linked to any other glycosaminoglycan polymer by an intermolecular bond.
• a composition comprises an uncrosslinked chondroitin sulfate polymer, an uncrosslinked dermatan sulfate polymer, an uncrosslinked keratan sulfate polymer, an uncrosslinked heparan polymer, an uncrosslinked heparan sulfate polymer, or an uncrosslinked hyaluronan polymer.
• Uncrosslinked glycosaminoglycan polymers are water soluble and generally remain fluid in nature. As such, uncross-linked glycosaminoglycan polymers are often mixed with a glycosaminoglycan polymer-based hydrogel composition as a lubricant to facilitate the extrusion process of the composition through a fine needle.
• a composition comprises an uncrosslinked glycosaminoglycan polymer where the uncrosslinked glycosaminoglycan polymer is present at a concentration of, e.g., about 2 mg/g, about 3 mg/g, about 4 mg/g, about 5 mg/g, about 6 mg/g, about 7 mg/g, about 8 mg/g, about 9 mg/g, about 10 mg/g, about 1 1 mg/g, about 12 mg/g, about 13 mg/g, about 13.5 mg/g, about 14 mg/g, about 15 mg/g, about 16 mg/g, about 17 mg/g, about 18 mg/g, about 19 mg/g, about 20 mg/g, about 40 mg/g, or about 60 mg/g.
• a composition comprises an uncrosslinked glycosaminoglycan where the uncrosslinked glycosaminoglycan is present at a concentration of, e.g., at least 1 mg/g, at least 2 mg/g, at least 3 mg/g, at least 4 mg/g, at least 5 mg/g, at least 10 mg/g, at least 15 mg/g, at least 20 mg/g, at least 25 mg/g at least 35 mg/g, or at least 40 mg/g.
• a composition comprises an uncrosslinked glycosaminoglycan where the uncrosslinked glycosaminoglycan is present at a concentration of, e.g., at most 1 mg/g, at most 2 mg/g, at most 3 mg/g, at most 4 mg/g, at most 5 mg/g, at most 10 mg/g, at most 15 mg/g, at most 20 mg/g, or at most 25 mg/g.
• a composition comprises an uncrosslinked glycosaminoglycan where the uncrosslinked glycosaminoglycan is present at a concentration of, e.g., about 1 mg/g to about 60 mg/g, about 10 mg/g to about 40 mg/g, about 7.5 mg/g to about 19.5 mg/g, about 8.5 mg/g to about 18.5 mg/g, about 9.5 mg/g to about 17.5 mg/g, about 10.5 mg/g to about 16.5 mg/g, about 1 1 .5 mg/g to about 15.5 mg/g, or about 12.5 mg/g to about 14.5 mg/g.
• aspects of the present specification provide, in part, a hydrogel composition that is essentially free of a crosslinked glycosaminoglycan polymer.
• essentially free refers to a composition where only trace amounts of cross-linked matrix polymers can be detected.
• a composition comprises a chondroitin sulfate that is essentially free of a crosslinked chondroitin sulfate polymer, a dermatan sulfate essentially free of a crosslinked dermatan sulfate polymer, a keratan sulfate essentially free of a crosslinked keratan sulfate polymer, a heparan essentially free of a crosslinked heparan polymer, a heparan sulfate essentially free of a crosslinked heparan sulfate polymer, or a hyaluronan sulfate essentially free of a crosslinked hyaluronan polymer.
• aspects of the present specification provide, in part, a hydrogel composition that is entirely free of a crosslinked glycosaminoglycan polymer.
• the term “entirely free” refers to a composition that within the detection range of the instrument or process being used, crosslinked glycosaminoglycan polymers cannot be detected or its presence cannot be confirmed.
• a composition comprises a chondroitin sulfate that is entirely free of a crosslinked chondroitin sulfate polymer, a dermatan sulfate entirely free of a crosslinked dermatan sulfate polymer, a keratan sulfate entirely free of a crosslinked keratan sulfate polymer, a heparan entirely free of a crosslinked heparan polymer, a heparan sulfate entirely free of a crosslinked heparan sulfate polymer, or a hyaluronan sulfate entirely free of a crosslinked hyaluronan polymer.
• a hydrogel composition comprising a ratio of crosslinked glycosaminoglycan polymer and uncrosslinked glycosaminoglycan polymer.
• This ratio of crosslinked and uncrosslinked glycosaminoglycan polymer is also known as the gel:fluid ratio. Any gel :fluid ratio is useful in making the compositions disclosed herein with the proviso that such ratio produces a composition disclosed herein that improves a skin condition as disclosed herein.
• Non-limiting examples of gel:fluid ratios in compositions of the present invention include 100:0, 98:2, 90:10, 75:25, 70:30, 60:40, 50:50, 40:60, 30:70, 25:75, 10:90; 2:98, and 0:100.
• a composition comprises a crosslinked glycosaminoglycan polymer and an uncrosslinked glycosaminoglycan polymer where the gel:fluid ratio is, e.g., about 0:100, about 1 :99, about 2:98, about 3:97, about 4:96, about 5:95, about 6:94, about 7:93, about 8:92, about 9:91 , or about 10:90.
• a composition comprises a crosslinked glycosaminoglycan polymer and an uncrosslinked glycosaminoglycan polymer where the gel:fluid ratio is, e.g., at most 1 :99, at most 2:98, at most 3:97, at most 4:96, at most 5:95, at most 6:94, at most 7:93, at most 8:92, at most 9:91 , or at most 10:90.
• a composition comprises a crosslinked glycosaminoglycan polymer and an uncrosslinked glycosaminoglycan polymer where the gel:fluid ratio is, e.g., about 0:100 to about 3:97, about 0:100 to about 5:95, or about 0:100 to about 10:90.
• a composition comprises a crosslinked glycosaminoglycan polymer and an uncrosslinked glycosaminoglycan polymer where the gel:fluid ratio is, e.g., about 15:85, about 20:80, about 25:75, about 30:70, about 35:65, about 40:60, about 45:55, about 50:50, about 55:45, about 60:40, about 65:35, about 70:30, about 75:25, about 80:20, about 85:15, about 90:10, about 95:5, about 98:2, or about 100:0.
• a composition comprises a crosslinked glycosaminoglycan polymer and an uncrosslinked glycosaminoglycan polymer where the gel:fluid ratio is, e.g., at most 15:85, at most 20:80, at most 25:75, at most 30:70, at most 35:65, at most 40:60, at most 45:55, at most 50:50, at most 55:45, at most 60:40, at most 65:35, at most 70:30, at most 75:25, at most 80:20, at most 85:15, at most 90:10, at most 95:5, at most 98:2, or at most 100:0.
• the gel:fluid ratio is, e.g., at most 15:85, at most 20:80, at most 25:75, at most 30:70, at most 35:65, at most 40:60, at most 45:55, at most 50:50, at most 55:45, at most 60:40, at most 65:35, at most 70:30, at most
• a composition comprises a crosslinked glycosaminoglycan polymer and an uncrosslinked glycosaminoglycan polymer where the gel:fluid ratio is, e.g., about 10:90 to about 70:30, about 15:85 to about 70:30, about 10:90 to about 55:45, about 80:20 to about 95:5, about 90:10 to about 100:0, about 75:25 to about 100:0, or about 60:40 to about 100:0.
• a hydrogel composition disclosed herein may further comprise another agent or combination of agents that provide a beneficial effect when the composition is administered to an individual.
• beneficial agents include, without limitation, an antioxidant, an anti-itch agent, an anti-cellulite agent, an anti-scarring agent, an anti-inflammatory agent, an anesthetic agent, an anti-irritant agent, a vasoconstrictor, a vasodilator, an anti-hemorrhagic agent like a hemostatic agent or anti-fibrinolytic agent, a desquamating agent, a tensioning agent, an anti-acne agent, a pigmentation agent, an anti-pigmentation agent, or a moisturizing agent.
• % in a formulation is defined as weight by weight (i.e., w/w) percentage.
• an anesthetic agent is preferably a local anesthetic agent, i.e., an anesthetic agent that causes a reversible local anesthesia and a loss of nociception, such as, e.g., aminoamide local anesthetics and aminoester local anesthetics.
• the amount of an anesthetic agent included in a composition disclosed herein is an amount effective to mitigate pain experienced by an individual upon administration of the composition. As such, the amount of an anesthetic agent included in a composition disclosed in the present specification is between about 0.1 % to about 5% by weight of the total composition.
• Non-limiting examples of anesthetic agents include lidocaine, ambucaine, amolanone, amylocaine, benoxinate, benzocaine, betoxycaine, biphenamine, bupivacaine, butacaine, butamben, butanilicaine, butethamine, butoxycaine, carticaine, chloroprocaine, cocaethylene, cocaine, cyclomethycaine, dibucaine, dimethysoquin, dimethocaine, diperodon, dycyclonine, ecgonidine, ecgonine, ethyl chloride, etidocaine, beta-eucaine, euprocin, fenalcomine, formocaine, hexylcaine, hydroxytetracaine, isobutyl p-aminobenzoate, leucinocaine mesylate, levoxadrol, lidocaine, mepivacaine, meprylcaine, metabutoxy
• Non-limiting examples of aminoester local anesthetics include procaine, chloroprocaine, cocaine, cyclomethycaine, cimethocaine (larocaine), propoxycaine, procaine (novocaine), proparacaine, tetracaine (amethocaine).
• Non-limiting examples of aminoamide local anesthetics include articaine, bupivacaine, cinchocaine (dibucaine), etidocaine, levobupivacaine, lidocaine (lignocaine), mepivacaine, piperocaine, prilocaine, ropivacaine, and trimecaine.
• a composition disclosed herein may comprise a single anesthetic agent or a plurality of anesthetic agents.
• a composition disclosed herein comprises an anesthetic agent and salts thereof.
• a composition disclosed herein comprises an aminoamide local anesthetic and salts thereof or an aminoester local anesthetic and salts thereof.
• a composition disclosed herein comprises procaine, chloroprocaine, cocaine, cyclomethycaine, cimethocaine, propoxycaine, procaine, proparacaine, tetracaine, or salts thereof, or any combination thereof.
• a composition disclosed herein comprises articaine, bupivacaine, cinchocaine, etidocaine, levobupivacaine, lidocaine, mepivacaine, piperocaine, prilocaine, ropivacaine, trimecaine, or salts thereof, or any combination thereof.
• a composition disclosed herein comprises a lidocaine/prilocaine combination.
• a composition disclosed herein comprises an anesthetic agent in an amount of, e.g., about 0.1 %, about 0.2%, about 0.3%, about 0.4%, about 0.5%, about 0.6%, about 0.7%, about 0.8% about 0.9%, about 1 .0%, about 2.0%, about 3.0%, about 4.0%, about 5.0%, about 6.0%, about 7.0%, about 8.0%, about 9.0%, or about 10% by weight of the total composition.
• a composition disclosed herein comprises an anesthetic agent in an amount of, e.g., at least 0.1 %, at least 0.2%, at least 0.3%, at least 0.4%, at least 0.5%, at least 0.6%, at least 0.7%, at least 0.8% at least 0.9%, at least 1 .0%, at least 2.0%, at least 3.0%, at least 4.0%, at least 5.0%, at least 6.0%, at least 7.0%, at least 8.0%, at least 9.0%, or at least 10% by weight of the total composition.
• a composition disclosed herein comprises an anesthetic agent in an amount of, e.g., at most 0.1 %, at most 0.2%, at most 0.3%, at most 0.4%, at most 0.5%, at most 0.6%, at most 0.7%, at most 0.8% at most 0.9%, at most 1 .0%, at most 2.0%, at most 3.0%, at most 4.0%, at most 5.0%, at most 6.0%, at most 7.0%, at most 8.0%, at most 9.0%, or at most 10% by weight of the total composition.
• a composition disclosed herein comprises an anesthetic agent in an amount of, e.g., about 0.1 % to about 0.5%, about 0.1 % to about 1 .0%, about 0.1 % to about 2.0%, about 0.1 % to about 3.0%, about 0.1 % to about 4.0%, about 0.1 % to about 5.0%, about 0.2% to about 0.9%, about 0.2% to about 1 .0%, about 0.2% to about 2.0%, about 0.5% to about 1 .0%, or about 0.5% to about 2.0% by weight of the total composition.
• composition disclosed herein does not comprise an anesthetic agent.
• an injectable dermal filler which comprises a polymer, for example, a glycosaminoglycan polymer, for example a hyaluronic acid polymer, for example, a hyaluronic acid at least a portion of which is crosslinked, and an additive or beneficial agent combined with the polymer.
• a polymer for example, a glycosaminoglycan polymer, for example a hyaluronic acid polymer, for example, a hyaluronic acid at least a portion of which is crosslinked, and an additive or beneficial agent combined with the polymer.
• the beneficial agent combined with the polymer may comprise a vitamin, for example, vitamin C.
• suitable forms of vitamin C include ascorbic acid and sodium, potassium, and calcium salts of ascorbic acid, fat- soluble esters of ascorbic acid with long-chain fatty acids (ascorbyl palmitate or ascorbyl stearate), magnesium ascorbyl phosphate (MAP), sodium ascorbyl phosphate (SAP), and ascorbic acid 2-glucoside (AA2GTM), sodium ascorbyl phosphate (AA2P), disodium ascorbyl sulfate, and ascobyl 3-aminopropyl phosphate (Vitagen).
• ascorbic acid and sodium, potassium, and calcium salts of ascorbic acid include ascorbic acid and sodium, potassium, and calcium salts of ascorbic acid, fat- soluble esters of ascorbic acid with long-chain fatty acids (ascorbyl palmitate or ascorbyl stearate), magnesium ascorbyl phosphate (MAP),
• the beneficial agent is covalently conjugated to the polymer.
• the beneficial agent may be a vitamin C, or a vitamin C derivative, which is covalently conjugated to the polymer and is present in the compositions in an amount between about 0.04% to about 5.0% by weight of the total composition, for example, between about 0.1 % to about 4.0% by weight of the total composition, for example, between about 0.2% to about 2.0% by weight of the total composition.
• the amount of vitamin C included in a composition disclosed herein is between about 0.3% to about 1 .2% by weight of the total composition.
• the vitamin C covalently conjugated to the polymer includes at least one of ascorbic acid, L-ascorbic acid, L-ascorbic acid 2-sulfate (AA-2S) and L- ascorbic acid 2-phosphate (AA-2P), ascorbic acid 2-O-glucoside (AA-2G), 6-O- acyl-2-O-alpha-D-glucopyranosyl-L-ascorbic acids (6-Acyl-AA-2G), (ascobyl 3- aminopropyl phosphate, Ascorbyl palmitate), derivatives and combinations thereof.
• a composition disclosed herein may comprise a single vitamin C agent or a plurality of vitamin C agents.
• a dermal filler wherein the hyaluronic acid is crosslinked with BDDE.
• the degree of conjugation may be between about 3 mol% and about 10 mol %, to about 15 mol% to about 40 mol%.
• the dermal fillers have a sustained bioavailability.
• dermal fillers are provided which, when introduced into the skin of a human being, are effective to release ascorbic acid or other vitamin into the human being for at least about 1 months and up to about 20 months or more.
• compositions as disclosed herein are viscoelastic in that the composition has an elastic component (solid-like such as, e.g., crosslinked glycosaminoglycan polymers) and a viscous component (liquid-like such as, e.g., uncrosslinked glycosaminoglycan polymers or a carrier phase) when a force is applied (stress, deformation).
• the rheological attribute that described this property is the complex modulus (G * ), which defines a composition's total resistance to deformation.
• the complex modulus can be defined as the sum of the elastic modulus (G') and the viscous modulus (G").
• Elastic modulus refers to the ability of a hydrogel material to resists deformation, or, conversely, an object's tendency to be non-permanently deformed when a force is applied to it.
• Elastic modulus characterizes the firmness of a composition and is also known as the storage modulus because it describes the storage of energy from the motion of the composition.
• ⁇ stress/strain
• stress is the force causing the deformation divided by the area to which the force is applied
• strain is the ratio of the change caused by the stress to the original state of the object.
• Viscous modulus is also known as the loss modulus because it describes the energy that is lost as viscous dissipation.
• a tan ⁇ is obtained from the dynamic modulus at a frequency of 1 Hz.
• a lower tan ⁇ corresponds to a stiffer, harder, or more elastic composition.
• a hydrogel composition disclosed herein exhibits an elastic modulus.
• a hydrogel composition exhibits an elastic modulus of, e.g., about 25 Pa, about 50 Pa, about 75 Pa, about 100 Pa, about 125 Pa, about 150 Pa, about 175 Pa, about 200 Pa, about 250 Pa, about 300 Pa, about 350 Pa, about 400 Pa, about 450 Pa, about 500 Pa, about 550 Pa, about 600 Pa, about 650 Pa, about 700 Pa, about 750 Pa, about 800 Pa, about 850 Pa, about 900 Pa, about 950 Pa, about 1 ,000 Pa, about 1 ,200 Pa, about 1 ,300 Pa, about 1 ,400 Pa, about 1 ,500 Pa, about 1 ,600 Pa, about 1700 Pa, about 1800 Pa, about 1900 Pa, about 2,000 Pa, about 2,100 Pa, about 2,200 Pa, about 2,300 Pa, about 2,400 Pa, or about 2,500 Pa.
• an elastic modulus of, e.g., about 25 Pa, about 50 Pa, about 75 Pa, about 100 Pa, about 125 Pa, about 150 Pa, about 175 Pa, about 200 Pa,
• a hydrogel composition exhibits an elastic modulus of, e.g., at least 25 Pa, at least 50 Pa, at least 75 Pa, at least 100 Pa, at least 125 Pa, at least 150 Pa, at least 175 Pa, at least 200 Pa, at least 250 Pa, at least 300 Pa, at least 350 Pa, at least 400 Pa, at least 450 Pa, at least 500 Pa, at least 550 Pa, at least 600 Pa, at least 650 Pa, at least 700 Pa, at least 750 Pa, at least 800 Pa, at least 850 Pa, at least 900 Pa, at least 950 Pa, at least 1 ,000 Pa, at least 1 ,200 Pa, at least 1 ,300 Pa, at least 1 ,400 Pa, at least 1 ,500 Pa, at least 1 ,600 Pa, at least 1700 Pa, at least 1800 Pa, at least 1900 Pa, at least 2,000 Pa, at least 2,100 Pa, at least 2,200 Pa, at least 2,300 Pa, at least 2,400 Pa, or at least 2,500 Pa.
• a hydrogel composition exhibits an elastic modulus of, e.g., at most 25 Pa, at most 50 Pa, at most 75 Pa, at most 100 Pa, at most 125 Pa, at most 150 Pa, at most 175 Pa, at most 200 Pa, at most 250 Pa, at most 300 Pa, at most 350 Pa, at most 400 Pa, at most 450 Pa, at most 500 Pa, at most 550 Pa, at most 600 Pa, at most 650 Pa, at most 700 Pa, at most 750 Pa, at most 800 Pa, at most 850 Pa, at most 900 Pa, at most 950 Pa, at most 1 ,000 Pa, at most 1 ,200 Pa, at most 1 ,300 Pa, at most 1 ,400 Pa, at most 1 ,500 Pa, or at most 1 ,600 Pa.
• a hydrogel composition exhibits an elastic modulus of, e.g., about 25 Pa to about 150 Pa, about 25 Pa to about 300 Pa, about 25 Pa to about 500 Pa, about 25 Pa to about 800 Pa, about 125 Pa to about 300 Pa, about 125 Pa to about 500 Pa, about 125 Pa to about 800 Pa, about 500 Pa to about 1 ,600 Pa, about 600 Pa to about 1 ,600 Pa, about 700 Pa to about 1 ,600 Pa, about 800 Pa to about 1 ,600 Pa, about 900 Pa to about 1 ,600 Pa, about 1 ,000 Pa to about 1 ,600 Pa, about 1 ,100 Pa to about 1 ,600 Pa, about 1 ,200 Pa to about 1 ,600 Pa, about 500 Pa to about 2,500 Pa, about 1 ,000 Pa to about 2,500 Pa, about 1 ,500 Pa to about 2,500 Pa, about 2,000 Pa to about 2,500 Pa, about 1 ,300 Pa to about 1 ,600 Pa, about 1 ,400 Pa to about 1 ,700 Pa,
• a hydrogel composition disclosed herein exhibits a viscous modulus.
• a hydrogel composition exhibits a viscous modulus of, e.g., about 10 Pa, about 20 Pa, about 30 Pa, about 40 Pa, about 50 Pa, about 60 Pa, about 70 Pa, about 80 Pa, about 90 Pa, about 100 Pa, about 150 Pa, about 200 Pa, about 250 Pa, about 300 Pa, about 350 Pa, about 400 Pa, about 450 Pa, about 500 Pa, about 550 Pa, about 600 Pa, about 650 Pa, or about 700 Pa.
• a hydrogel composition exhibits a viscous modulus of, e.g., at most 10 Pa, at most 20 Pa, at most 30 Pa, at most 40 Pa, at most 50 Pa, at most 60 Pa, at most 70 Pa, at most 80 Pa, at most 90 Pa, at most 100 Pa, at most 150 Pa, at most 200 Pa, at most 250 Pa, at most 300 Pa, at most 350 Pa, at most 400 Pa, at most 450 Pa, at most 500 Pa, at most 550 Pa, at most 600 Pa, at most 650 Pa, or at most 700 Pa.
• a hydrogel composition exhibits a viscous modulus of, e.g., about 10 Pa to about 30 Pa, about 10 Pa to about 50 Pa, about 10 Pa to about 100 Pa, about 10 Pa to about 150 Pa, about 70 Pa to about 100 Pa, about 50 Pa to about 350 Pa, about 150 Pa to about 450 Pa, about 250 Pa to about 550 Pa, about 350 Pa to about 700 Pa, about 50 Pa to about 150 Pa, about 100 Pa to about 200 Pa, about 150 Pa to about 250 Pa, about 200 Pa to about 300 Pa, about 250 Pa to about 350 Pa, about 300 Pa to about 400 Pa, about 350 Pa to about 450 Pa, about 400 Pa to about 500 Pa, about 450 Pa to about 550 Pa, about 500 Pa to about 600 Pa, about 550 Pa to about 650 Pa, or about 600 Pa to about 700 Pa.
• a viscous modulus of, e.g., about 10 Pa to about 30 Pa, about 10 Pa to about 50 Pa, about 10 Pa to about 100 Pa, about 10 Pa to about 150 Pa, about 70 Pa to about 100 Pa
• a hydrogel composition disclosed herein exhibits a tan ⁇ .
• a hydrogel composition exhibits a tan ⁇ of, e.g., about 0.1 , about 0.2, about 0.3, about 0.4, about 0.5, about 0.6, about 0.7, about 0.8, about 0.9, about 1 .0, about 1 .1 , about 1 .2, about 1 .3, about 1 .4, about 1 .5, about 1 .6, about 1 .7, about 1 .8, about 1 .9, about 2.0, about 2.1 , about 2.2, about 2.3, about 2.4, or about 2.5.
• a hydrogel composition exhibits a tan ⁇ of, e.g., at most 0.1 , at most 0.2, at most 0.3, at most 0.4, at most 0.5, at most 0.6, at most 0.7, at most 0.8, at most 0.9, at most 1 .0, at most 1 .1 , at most 1 .2, at most 1 .3, at most 1 .4, at most 1 .5, at most 1 .6, at most 1 .7, at most 1 .8, at most 1 .9, at most 2.0, at most 2.1 , at most 2.2, at most 2.3, at most 2.4, or at most 2.5.
• a hydrogel composition exhibits a tan ⁇ of, e.g., about 0.1 to about 0.3, about 0.3 to about 0.5, about 0.5 to about 0.8, about 1 .1 to about 1 .4, about 1 .4 to about 1 .7, about 0.3 to about 0.6, about 0.1 to about 0.5, about 0.5 to about 0.9, about 0.1 to about 0.6, about 0.1 to about 1 .0, about 0.5 to about 1 .5, about 1 .0 to about 2.0, or about 1 .5 to about 2.5.
• aspects of the present specification provide, in part, a hydrogel composition disclosed herein having a transparency and/or translucency.
• Optical transparency is the physical property of allowing visible light to pass through a material, whereas translucency (also called translucence or translucidity) only allows light to pass through diffusely. The opposite property is opacity.
• Transparent materials are clear, while translucent ones cannot be seen through clearly.
• the hydrogels disclosed herein are preferably optically transparent or at least translucent.
• a hydrogel composition disclosed herein is optically translucent.
• a hydrogel composition diffusely transmits, e.g., about 75% of the light, about 80% of the light, about 85% of the light, about 90% of the light, about 95% of the light, or about 100% of the light.
• a hydrogel composition diffusely transmits, e.g., at least 75% of the light, at least 80% of the light, at least 85% of the light, at least 90% of the light, or at least 95% of the light.
• a hydrogel composition diffusely transmits, e.g., about 75% to about 100% of the light, about 80% to about 100% of the light, about 85% to about 100% of the light, about 90% to about 100% of the light, or about 95% to about 100% of the light.
• a hydrogel composition disclosed herein is optically transparent and transmits 100% of visible light.
• a hydrogel composition disclosed herein may be further processed by pulverizing the hydrogel into particles and optionally mixed with a carrier phase such as, e.g., water or a saline solution to form an injectable or topical substance like a solution, oil, lotion, gel, ointment, cream, slurry, salve, or paste.
• a carrier phase such as, e.g., water or a saline solution to form an injectable or topical substance like a solution, oil, lotion, gel, ointment, cream, slurry, salve, or paste.
• the disclosed hydrogel compositions may be monophasic or multiphasic compositions.
• a hydrogel may be milled to a particle size from about 10 m to about 1000 ⁇ in diameter, such as about 15 m to about 30 ⁇ , about 50 ⁇ to about 75 ⁇ , about 100 ⁇ to about 150 ⁇ , about 200 ⁇ to about 300 ⁇ , about 450 ⁇ to about 550 ⁇ , about 600 ⁇ to about 700 ⁇ , about 750 ⁇ to about 850 ⁇ , or about 900 ⁇ to about 1 ,000 ⁇ .
• a composition disclosed herein is injectable.
• injectable refers to a material having the properties necessary to administer the composition into a skin region of an individual using an injection device with a fine needle.
• fine needle refers to a needle that is 27 gauge or smaller. Injectability of a composition disclosed herein can be accomplished by sizing the hydrogel particles as discussed above.
• a hydrogel composition disclosed herein is injectable through a fine needle.
• a hydrogel composition disclosed herein is injectable through a needle of, e.g., about 27 gauge, about 30 gauge, or about 32 gauge.
• a hydrogel composition disclosed herein is injectable through a needle of, e.g., 22 gauge or smaller, 27 gauge or smaller, 30 gauge or smaller, or 32 gauge or smaller. In still other aspects of this embodiment, a hydrogel composition disclosed herein is injectable through a needle of, e.g., about 22 gauge to about 35 gauge, 22 gauge to about 34 gauge, 22 gauge to about 33 gauge, 22 gauge to about 32 gauge, about 22 gauge to about 27 gauge, or about 27 gauge to about 32 gauge.
• a hydrogel composition disclosed herein can be injected with an extrusion force of about 60 N, about 55 N, about 50 N, about 45 N, about 40 N, about 35 N, about 30 N, about 25 N, about 20 N, or about 15 N at speeds of 100 mm/min.
• a hydrogel composition disclosed herein can be injected through a 27 gauge needle with an extrusion force of about 60 N or less, about 55 N or less, about 50 N or less, about 45 N or less, about 40 N or less, about 35 N or less, about 30 N or less, about 25 N or less, about 20 N or less, about 15 N or less, about 10 N or less, or about 5 N or less.
• a hydrogel composition disclosed herein can be injected through a 30 gauge needle with an extrusion force of about 60 N or less, about 55 N or less, about 50 N or less, about 45 N or less, about 40 N or less, about 35 N or less, about 30 N or less, about 25 N or less, about 20 N or less, about 15 N or less, about 10 N or less, or about 5 N or less.
• a hydrogel composition disclosed herein can be injected through a 32 gauge needle with an extrusion force of about 60 N or less, about 55 N or less, about 50 N or less, about 45 N or less, about 40 N or less, about 35 N or less, about 30 N or less, about 25 N or less, about 20 N or less, about 15 N or less, about 10 N or less, or about 5 N or less.
• Cohesivity also referred to as cohesion cohesive attraction, cohesive force, or compression force is a physical property of a material, caused by the intermolecular attraction between like-molecules within the material that acts to unite the molecules.
• Cohesivity is expressed in terms of grams-force (gmf). Cohesiveness is affected by, among other factors, the molecular weight ratio of the initial free glycosaminoglycan polymer, the degree of crosslinking of glycosaminoglycan polymers, the amount of residual free glycosaminoglycan polymers following crosslinking, and the pH of the hydrogel composition.
• a composition should be sufficiently cohesive as to remain localized to a site of administration. Additionally, in certain applications, a sufficient cohesiveness is important for a composition to retain its shape, and thus functionality, in the event of mechanical load cycling. As such, in one embodiment, a hydrogel composition disclosed herein exhibits cohesivity, on par with water.
• a hydrogel composition disclosed herein exhibits sufficient cohesivity to remain localized to a site of administration. In still another embodiment, a hydrogel composition disclosed herein exhibits sufficient cohesivity to retain its shape. In a further embodiment, a hydrogel composition disclosed herein exhibits sufficient cohesivity to retain its shape and functionality.
• aspects of the present specification provide, in part, a hydrogel composition disclosed herein that exhibits a physiologically-acceptable osmolarity.
• osmolarity refers to the concentration of osmotically active solutes in solution.
• a physiologically-acceptable osmolarity refers to an osmolarity in accord with, or characteristic of, the normal functioning of a living organism.
• administration of a hydrogel composition as disclosed herein exhibits an osmolarity that has substantially no long term or permanent detrimental effect when administered to a mammal.
• Osmolarity is expressed in terms of osmoles of osmotically active solute per liter of solvent (Osmol/L or Osm/L). Osmolarity is distinct from molarity because it measures moles of osmotically active solute particles rather than moles of solute. The distinction arises because some compounds can dissociate in solution, whereas others cannot.
• osmolarity of a hydrogel composition disclosed herein can be measured using a conventional method that measures solutions.
• a hydrogel composition disclosed herein exhibits a physiologically-acceptable osmolarity.
• osmolality refers to the concentration of osmotically active solutes per kilo of solvent in the body.
• a physiologically-acceptable osmolality refers to an osmolality in accord with, or characteristic of, the normal functioning of a living organism. As such, administration of a hydrogel composition disclosed herein exhibits an osmolality that has substantially no long term or permanent detrimental effect when administered to a mammal.
• Osmolality is expressed in terms of osmoles of osmotically active solute per kilogram of solvent (osmol/kg or Osm/kg) and is equal to the sum of the molalities of all the solutes present in that solution.
• the osmolality of a solution can be measured using an osmometer.
• the most commonly used instrument in modern laboratories is a freezing point depression osmometer. This instruments measure the change in freezing point that occurs in a solution with increasing osmolality (freezing point depression osmometer) or the change in vapor pressure that occurs in a solution with increasing osmolality (vapor pressure depression osmometer).
• a hydrogel composition exhibits an osmolarity of, e.g., about 100 mOsm/L, about 150 mOsm/L, about 200 mOsm/L, about 250 mOsm/L, about 300 mOsm/L, about 350 mOsm/L, about 400 mOsm/L, about 450 mOsm/L, or about 500 mOsm/L.
• a hydrogel composition exhibits an osmolarity of, e.g., at least 100 mOsm/L, at least 150 mOsm/L, at least 200 mOsm/L, at least 250 mOsm/L, at least 300 mOsm/L, at least 350 mOsm/L, at least 400 mOsm/L, at least 450 mOsm/L, or at least 500 mOsm/L.
• a hydrogel composition exhibits an osmolarity of, e.g., at most 100 mOsm/L, at most 150 mOsm/L, at most 200 mOsm/L, at most 250 mOsm/L, at most 300 mOsm/L, at most 350 mOsm/L, at most 400 mOsm/L, at most 450 mOsm/L, or at most 500 mOsm/L.
• a hydrogel composition exhibits an osmolarity of, e.g., about 100 mOsm/L to about 500 mOsm/L, about 200 mOsm/L to about 500 mOsm/L, about 200 mOsm/L to about 400 mOsm/L, about 300 mOsm/L to about 400 mOsm/L, about 270 mOsm/L to about 390 mOsm/L, about 225 mOsm/L to about 350 mOsm/L, about 250 mOsm/L to about 325 mOsm/L, about 275 mOsm/L to about 300 mOsm/L, or about 285 mOsm/L to about 290 mOsm/L.
• aspects of the present specification provide, in part, a hydrogel composition disclosed herein that exhibits substantial stability.
• the term “stability” or “stable” when referring to a hydrogel composition disclosed herein refers to a composition that is not prone to degrading, decomposing, or breaking down to any substantial or significant degree while stored before administration to an individual.
• the term “substantial heat stability”, “substantially heat stable”, “autoclave stable”, or “steam sterilization stable” refers to a hydrogel composition disclosed herein that is substantially stable when subjected to a heat treatment as disclosed herein.
• Stability of a hydrogel composition disclosed herein can be determined by subjecting a hydrogel composition to a heat treatment, such as, e.g., steam sterilization at normal pressure or under pressure ⁇ e.g., autoclaving).
• a heat treatment such as, e.g., steam sterilization at normal pressure or under pressure ⁇ e.g., autoclaving.
• the heat treatment is carried out at a temperature of at least about 100 °C for between about one minute and about 10 minutes.
• Substantial stability of a hydrogel composition disclosed herein can be evaluated 1 ) by determining the change in the extrusion force (AF) of a hydrogel composition disclosed herein after sterilization, where the change in extrusion force less 2N is indicative of a substantially stable hydrogel composition as measured by (the extrusion force of a hydrogel composition with the specified additives) minus (the extrusion force of the a hydrogel composition without the added additives); and/or 2) by determining the change in rheological properties of a hydrogel composition disclosed herein after sterilization, where the change in tan ⁇ 1 Hz of less than 0.1 is indicative of a substantially stable hydrogel composition as measured by (tan ⁇ 1 Hz of gel formulation with additives) minus (tan ⁇ 1 Hz of gel formulation without additives).
• AF extrusion force
• a substantially stable hydrogel composition disclosed herein retains one or more of the following characteristics after sterilization: homogeneousness, extrusion force, cohesiveness, hyaluronan concentration, agent(s) concentration, osmolarity, pH, or other rheological characteristics desired by the hydrogel before the heat treatment.
• a hydrogel composition comprising a glycosaminoglycan polymer and the at least one agent disclosed herein is processed using a heat treatment that maintains the desired hydrogel properties disclosed herein.
• a hydrogel composition comprising a glycosaminoglycan polymer and the at least one agent disclosed herein is processed using a heat treatment of, e.g., about 100 °C, about 105 °C, about 1 10 °C, about 1 15 °C, about 120 °C, about 125 °C, or about 130 °C.
• a hydrogel composition comprising a glycosaminoglycan polymer and the at least one agent disclosed herein is processed using a heat treatment of, e.g., at least 100 °C, at least 105 °C, at least 1 10 °C, at least 1 15 °C, at least 120 °C, at least 125 °C, or at least 130 °C.
• a hydrogel composition comprising a glycosaminoglycan polymer and the at least one agent disclosed herein is processed using a heat treatment of, e.g., about 100 °C to about 120 °C, about 100 °C to about 125 °C, about 100 °C to about 130 °C, about 100 °C to about 135 °C, about 1 10 °C to about 120 °C, about 1 10 °C to about 125 °C, about 1 10 °C to about 130 °C, about 1 10 °C to about 135 °C, about 120 °C to about 125 °C, about 120 °C to about 130 °C, about 120 °C to about 135 °C, about 125 °C to about 130 °C, or about 125 °C to about 135 °C.
• a heat treatment of, e.g., about 100 °C to about 120 °C, about 100 °C to about 125 °C, about 100
• Long term stability of a hydrogel composition disclosed herein can be determined by subjecting a hydrogel composition to a heat treatment, such as, e.g., storage in an about 45 °C environment for about 60 days.
• Long term stability of a hydrogel composition disclosed herein can be evaluated 1 ) by assessing the clarity and color of a hydrogel composition after the 45 °C heat treatment, with a clear and uncolored hydrogel composition being indicative of a substantially stable hydrogel composition; 2) by determining the change in the extrusion force (AF) of a hydrogel composition disclosed herein after the 45 °C heat treatment, where the change in extrusion force less 2N is indicative of a substantially stable hydrogel composition as measured by (the extrusion force of a hydrogel composition with the specified additives before the 45 °C heat treatment) minus (the extrusion force of the a hydrogel composition with the specified additives after the 45 °C heat treatment); and/or 3) by determining the change in rheological properties of a hydrogel composition disclosed herein after steriliz
• a hydrogel composition is substantially stable at room temperature for, e.g., about 3 months, about 6 months, about 9 months, about 12 months, about 15 months, about 18 months, about 21 months, about 24 months, about 27 months, about 30 months, about 33 months, or about 36 months.
• a hydrogel composition is substantially stable at room temperature for, e.g., at least 3 months, at least 6 months, at least 9 months, at least 12 months, at least 15 months, at least 18 months, at least 21 months, at least 24 months, at least 27 months, at least 30 months, at least 33 months, or at least 36 months.
• a hydrogel composition is substantially stable at room temperature for, e.g., about 3 months to about 12 months, about 3 months to about 18 months, about 3 months to about 24 months, about 3 months to about 30 months, about 3 months to about 36 months, about 6 months to about 12 months, about 6 months to about 18 months, about 6 months to about 24 months, about 6 months to about 30 months, about 6 months to about 36 months, about 9 months to about 12 months, about 9 months to about 18 months, about 9 months to about 24 months, about 9 months to about 30 months, about 9 months to about 36 months, about 12 months to about 18 months, about 12 months to about 24 months, about 12 months to about 30 months, about 12 months to about 36 months, about 18 months to about 24 months, about 18 months to about 30 months, or about 18 months to about 36 months.
• compositions may optionally include, without limitation, other pharmaceutically acceptable components, including, without limitation, buffers, preservatives, tonicity adjusters, salts, antioxidants, osmolality adjusting agents, emulsifying agents, wetting agents, and the like.
• a pharmaceutically acceptable buffer is a buffer that can be used to prepare a hydrogel composition disclosed herein, provided that the resulting preparation is pharmaceutically acceptable.
• Non-limiting examples of pharmaceutically acceptable buffers include acetate buffers, borate buffers, citrate buffers, neutral buffered salines, phosphate buffers, and phosphate buffered salines.
• Any concentration of a pharmaceutically acceptable buffer can be useful in formulating a pharmaceutical composition disclosed herein, with the proviso that a therapeutically effective amount of the active ingredient is recovered using this effective concentration of buffer.
• concentrations of physiologically-acceptable buffers occur within the range of about 0.1 mM to about 900 mM.
• the pH of pharmaceutically acceptable buffers may be adjusted, provided that the resulting preparation is pharmaceutically acceptable. It is understood that acids or bases can be used to adjust the pH of a pharmaceutical composition as needed.
• Any buffered pH level can be useful in formulating a pharmaceutical composition, with the proviso that a therapeutically effective amount of the matrix polymer active ingredient is recovered using this effective pH level.
• Non-limiting examples of physiologically-acceptable pH occur within the range of about pH 5.0 to about pH 8.5.
• the pH of a hydrogel composition disclosed herein can be about 5.0 to about 8.0, or about 6.5 to about 7.5, about 7.0 to about 7.4, or about 7.1 to about 7.3.
• Pharmaceutically acceptable preservatives include, without limitation, sodium metabisulfite, sodium thiosulfate, acetylcysteine, butylated hydroxyanisole and butylated hydroxytoluene.
• preservatives include, without limitation, benzalkonium chloride, chlorobutanol, thimerosal, phenylmercuric acetate, phenylmercuric nitrate, a stabilized oxy chloro composition, such as, e.g., PURITE ® (Allergan, Inc. Irvine, CA) and chelants, such as, e.g., DTPA or DTPA-bisamide, calcium DTPA, and CaNaDTPA-bisamide.
• compositions useful in a hydrogel composition disclosed herein include, without limitation, salts such as, e.g., sodium chloride and potassium chloride; and glycerin.
• the composition may be provided as a salt and can be formed with many acids, including but not limited to, hydrochloric, sulfuric, acetic, lactic, tartaric, malic, succinic, etc. Salts tend to be more soluble in aqueous or other protonic solvents than are the corresponding free base forms. It is understood that these and other substances known in the art of pharmacology can be included in a pharmaceutical composition disclosed herein.
• the term "treating,” refers to reducing or eliminating in an individual a cosmetic or clinical symptom of a soft tissue condition characterized by a soft tissue imperfection, defect, disease, and/or disorder; or delaying or preventing in an individual the onset of a cosmetic or clinical symptom of a condition characterized by a soft tissue imperfection, defect, disease, and/or disorder.
• the term “treating” can mean reducing a symptom of a condition characterized by a soft tissue defect, disease, and/or disorder by, e.g., at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90% or at least 100%.
• the effectiveness of a hydrogel composition disclosed herein in treating a condition characterized by a soft tissue defect, disease, and/or disorder can be determined by observing one or more cosmetic, clinical symptoms, and/or physiological indicators associated with the condition. An improvement in a soft tissue defect, disease, and/or disorder also can be indicated by a reduced need for a concurrent therapy.
• Those of skill in the art will know the appropriate symptoms or indicators associated with specific soft tissue defect, disease, and/or disorder and will know how to determine if an individual is a candidate for treatment with a compound or composition disclosed herein.
• a hydrogel composition in accordance with the invention is administered to an individual.
• An individual is typically a human being of any age, gender or race.
• any individual who is a candidate for a conventional procedure to treat a soft tissue condition is a candidate for a method disclosed herein.
• a subject experiencing the signs of aging skin is an adult, subjects experiencing premature aging or other skin conditions suitable for treatment (for example, a scar) can also be treated with a hydrogel composition disclosed herein.
• the presently disclosed hydrogel compositions and methods may apply to individuals seeking a small/moderate enlargement, shape change or contour alteration of a body part or region, which may not be technically possible or aesthetically acceptable with existing soft tissue implant technology.
• Preoperative evaluation typically includes routine history and physical examination in addition to thorough informed consent disclosing all relevant risks and benefits of the procedure.
• a soft tissue condition includes, without limitation, a soft tissue imperfection, defect, disease, and/or disorder.
• a soft tissue condition includes breast imperfection, defect, disease and/or disorder, such as, e.g., a breast augmentation, a breast reconstruction, mastopexy, micromastia, thoracic hypoplasia, Tru's syndrome, defects due to implant complications like capsular contraction and/or rupture; a facial imperfection, defect, disease or disorder, such as, e.g., a facial augmentation, a facial reconstruction, a mesotherapy, Parry-Romberg syndrome, lupus erythematosus profundus, dermal divots, scars, sunken checks, thin lips, nasal imperfections or defects, retro-orbital imperfections or defects, a facial fold, line and/or wrinkle like a glabellar line, a nasolabial line, a
• the term "mesotherapy” refers to a non-surgical cosmetic treatment technique of the skin involving intra-epidermal, intra-dermal, and/or subcutaneous injection of an agent administered as small multiple droplets into the epidermis, dermo-epidermal junction, and/or the dermis.
• the amount of a hydrogel composition used with any of the methods as disclosed herein will typically be determined based on the alteration and/or improvement desired, the reduction and/or elimination of a soft tissue condition symptom desired, the clinical and/or cosmetic effect desired by the individual and/or physician, and the body part or region being treated.
• composition administration may be manifested by one or more of the following clinical and/or cosmetic measures: altered and/or improved soft tissue shape, altered and/or improved soft tissue size, altered and/or improved soft tissue contour, altered and/or improved tissue function, tissue ingrowth support and/or new collagen deposition, sustained engraftment of composition, improved patient satisfaction and/or quality of life, and decreased use of implantable foreign material.
• Effectiveness of the compositions and methods in treating a facial soft tissue may be manifested by one or more of the following clinical and/or cosmetic measures: increased size, shape, and/or contour of facial feature like increased size, shape, and/or contour of lip, cheek or eye region; altered size, shape, and/or contour of facial feature like altered size, shape, and/or contour of lip, cheek or eye region shape; reduction or elimination of a wrinkle, fold or line in the skin; resistance to a wrinkle, fold or line in the skin; rehydration of the skin; increased elasticity to the skin; reduction or elimination of skin roughness; increased and/or improved skin tautness; reduction or elimination of stretch lines or marks; increased and/or improved skin tone, shine, brightness and/or radiance; increased and/or improved skin color, reduction or elimination of skin paleness; sustained engraftment of composition; decreased side effects; improved patient satisfaction and/or quality of life.
• compositions and methods for sphincter support may be manifested by one or more of the following clinical measures: decreased frequency of incontinence, sustained engraftment, improved patient satisfaction and/or quality of life, and decreased use of implantable foreign filler.
• the amount of a hydrogel composition administered is, e.g., about 0.01 g, about 0.05 g, about 0.1 g, about 0.5 g, about 1 g, about 5 g, about 10 g, about 20 g, about 30 g, about 40 g, about 50 g, about 60 g, about 70 g, about 80 g, about 90 g, about 100 g, about 150 g, or about 200 g.
• the amount of a hydrogel composition administered is, e.g., about 0.01 g to about 0.1 g, about 0.1 g to about 1 g, about 1 g to about 10 g, about 10 g to about 100 g, or about 50 g to about 200 g.
• the amount of a hydrogel composition administered is, e.g., about 0.01 mL, about 0.05 mL, about 0.1 mL, about 0.5 mL, about 1 mL, about 5 mL, about 10 mL, about 20 mL, about 30 mL, about 40 mL, about 50 mL, about 60 mL, about 70 g, about 80 mL, about 90 mL, about 100 mL, about 150 mL, or about 200 mL.
• the amount of a hydrogel composition administered is, e.g., about 0.01 mL to about 0.1 mL, about 0.1 mL to about 1 mL, about 1 mL to about 10 mL, about 10 mL to about 100 mL, or about 50 mL to about 200 mL.
• administration of a hydrogel composition disclosed herein can treat a soft tissue condition for, e.g., about 6 months, about 7 months, about 8 months, about 9 months, about 10 months, about 1 1 months, about 12 months, about 13 months, about 14 months, about 15 months, about 18 months, or about 24 months.
• administration of a hydrogel composition disclosed herein can treat a soft tissue condition for, e.g., at least 6 months, at least 7 months, at least 8 months, at least 9 months, at least 10 months, at least 1 1 months, at least 12 months, at least 13 months, at least 14 months, at least 15 months, at least 18 months, or at least 24 months.
• administration of a hydrogel composition disclosed herein can treat a soft tissue condition for, e.g., about 6 months to about 12 months, about 6 months to about 15 months, about 6 months to about 18 months, about 6 months to about 21 months, about 6 months to about 24 months, about 9 months to about 12 months, about 9 months to about 15 months, about 9 months to about 18 months, about 9 months to about 21 months, about 6 months to about 24 months, about 12 months to about 15 months, about 12 months to about 18 months, about 12 months to about 21 months, about 12 months to about 24 months, about 15 months to about 18 months, about 15 months to about 21 months, about 15 months to about 24 months, about 18 months to about 21 months, about 18 months to about 24 months, or about 21 months to about 24 months.
• administering means any delivery mechanism that provides a composition disclosed herein to an individual that potentially results in a clinically, therapeutically, or experimentally beneficial result.
• the actual delivery mechanism used to administer a composition to an individual can be determined by a person of ordinary skill in the art by taking into account factors, including, without limitation, the type of skin condition, the location of the skin condition, the cause of the skin condition, the severity of the skin condition, the degree of relief desired, the duration of relief desired, the particular composition used, the rate of excretion of the particular composition used, the pharmacodynamics of the particular composition used, the nature of the other compounds included in the particular composition used, the particular route of administration, the particular characteristics, history and risk factors of the individual, such as, e.g., age, weight, general health and the like, or any combination thereof.
• a composition disclosed herein is administered to a skin region of an individual by injection.
• a composition disclosed herein may be administered by any means known to persons of ordinary skill in the art including, without limitation, syringe with needle, a pistol (for example, a hydropneumatic-compression pistol), catheter, topically, or by direct surgical implantation.
• the hydrogel composition disclosed herein can be administered into a skin region such as, e.g., a dermal region or a hypodermal region.
• a hydrogel composition disclosed herein can be injected utilizing needles with a diameter of about 0.26 mm to about 0.4 mm and a length ranging from about 4 mm to about 14 mm.
• the needles can be 21 to 32 G and have a length of about 4 mm to about 70 mm.
• the needle is a single-use needle.
• the needle can be combined with a syringe, catheter, and/or a pistol.
• a composition disclosed herein can be administered once, or over a plurality of times. Ultimately, the timing used will follow quality care standards.
• a hydrogel composition disclosed herein can be administered once or over several sessions with the sessions spaced apart by a few days, or weeks.
• an individual can be administered a hydrogel composition disclosed herein every 1 , 2, 3, 4, 5, 6, or 7 days or every 1 , 2, 3, or 4 weeks.
• the administration a hydrogel composition disclosed herein to an individual can be on a monthly or bi-monthly basis or administered every 3, 6, 9, or 12 months.
• the term "dermal region” refers to the region of skin comprising the epidermal-dermal junction and the dermis including the superficial dermis (papillary region) and the deep dermis (reticular region).
• the skin is composed of three primary layers: the epidermis, which provides waterproofing and serves as a barrier to infection; the dermis, which serves as a location for the appendages of skin; and the hypodermis (subcutaneous adipose layer).
• the epidermis contains no blood vessels, and is nourished by diffusion from the dermis.
• the main type of cells which make up the epidermis are keratinocytes, melanocytes, Langerhans cells and Merkels cells.
• the dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain.
• the dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptor/nerve endings that provide the sense of touch and heat. It contains the hair follicles, sweat glands, sebaceous glands, apocrine glands, lymphatic vessels and blood vessels.
• the blood vessels in the dermis provide nourishment and waste removal from its own cells as well as from the Stratum basale of the epidermis.
• the dermis is structurally divided into two areas: a superficial area adjacent to the epidermis, called the papillary region, and a deep thicker area known as the reticular region.
• the papillary region is composed of loose areolar connective tissue. It is named for its fingerlike projections called papillae that extend toward the epidermis.
• the papillae provide the dermis with a "bumpy" surface that interdigitates with the epidermis, strengthening the connection between the two layers of skin.
• the reticular region lies deep in the papillary region and is usually much thicker. It is composed of dense irregular connective tissue, and receives its name from the dense concentration of collagenous, elastic, and reticular fibers that weave throughout it. These protein fibers give the dermis its properties of strength, extensibility, and elasticity. Also located within the reticular region are the roots of the hair, sebaceous glands, sweat glands, receptors, nails, and blood vessels. Tattoo ink is held in the dermis. Stretch marks from pregnancy are also located in the dermis.
• the hypodermis lies below the dermis. Its purpose is to attach the dermal region of the skin to underlying bone and muscle as well as supplying it with blood vessels and nerves. It consists of loose connective tissue and elastin.
• the main cell types are fibroblasts, macrophages and adipocytes (the hypodermis contains 50% of body fat). Fat serves as padding and insulation for the body.
• a hydrogel composition disclosed herein is administered to a skin region of an individual by injection into a dermal region or a hypodermal region.
• a hydrogel composition disclosed herein is administered to a dermal region of an individual by injection into, e.g., an epidermal-dermal junction region, a papillary region, a reticular region, or any combination thereof.
• compositions are especially useful and effective in reducing appearance of fine lines, for example, in thin skin regions, of a patient.
• methods for fine line treatment comprising the steps of administering to the patient a dermal filler composition as described elsewhere herein, at a depth of no greater than about 1 mm.
• a method of treating a skin condition comprises the step of administering to an individual suffering from a skin condition a hydrogel composition disclosed herein, wherein the administration of the composition improves the skin condition, thereby treating the skin condition.
• a skin condition is a method of treating skin dehydration comprises the step of administering to an individual suffering from skin dehydration a hydrogel composition disclosed herein, wherein the administration of the composition rehydrates the skin, thereby treating skin dehydration.
• a method of treating a lack of skin elasticity comprises the step of administering to an individual suffering from a lack of skin elasticity a hydrogel composition disclosed herein, wherein the administration of the composition increases the elasticity of the skin, thereby treating a lack of skin elasticity.
• a method of treating skin roughness comprises the step of administering to an individual suffering from skin roughness a hydrogel composition disclosed herein, wherein the administration of the composition decreases skin roughness, thereby treating skin roughness.
• a method of treating a lack of skin tautness comprises the step of administering to an individual suffering from a lack of skin tautness a hydrogel composition disclosed herein, wherein the administration of the composition makes the skin tauter, thereby treating a lack of skin tautness.
• a method of treating a skin stretch line or mark comprises the step of administering to an individual suffering from a skin stretch line or mark a hydrogel composition disclosed herein, wherein the administration of the composition reduces or eliminates the skin stretch line or mark, thereby treating a skin stretch line or mark.
• a method of treating skin paleness comprises the step of administering to an individual suffering from skin paleness a hydrogel composition disclosed herein, wherein the administration of the composition increases skin tone or radiance, thereby treating skin paleness.
• a method of treating skin wrinkles comprises the step of administering to an individual suffering from skin wrinkles a hydrogel composition disclosed herein, wherein the administration of the composition reduces or eliminates skin wrinkles, thereby treating skin wrinkles.
• a method of treating skin wrinkles comprises the step of administering to an individual a hydrogel composition disclosed herein, wherein the administration of the composition makes the skin resistant to skin wrinkles, thereby treating skin wrinkles.
• the dermal fillers have a sustained bioavailability.
• dermal fillers are provided which, when introduced into the skin of a human being, (for example, intradermally or subdermally into a human being for the correction of soft tissue defects of voids in the face), release ascorbic acid (or other vitamin) into the human being for at least about 1 months and up to about 20 months or more.
• ascorbic acid or other vitamin
• an estimation on conjugated degree is made. This estimation was based on the formulation of AA2G conjugation to HA via etherification. The formulation is stable under physiological conditions but start to release of Ascorbic acid (AsA) by a-glucosidase which is attached to the cell membrane.
• a gel with conjugation degree of 5 mol% approximately could release active Vitamin C in a period of at least up to 1 month, for example, between 3 ⁇ 5 months; a gel with 10 mol % conjugation degree could release active Vitamin C in a period up to 6-8 months; a gel with 15 mol% conjugation degree could release active Vitamin C in a period up to 10- months; 30 mol% up to one and half years.
• a dermal filler comprising hyaluronic acid crosslinked with a Star-PEG epoxide and having a vitamin C derivative (for example, one of AA2G (Ascorbic acid 2-Glucoside), Vitagen (3- aminopropyl-L-ascorbyl phosphate) and SAP (sodium ascorbyl phosphate) conjugated to the hyaluronic acid with a degree of conjugation of between about 3 mol% and about 40 mol%.
• a vitamin C derivative for example, one of AA2G (Ascorbic acid 2-Glucoside), Vitagen (3- aminopropyl-L-ascorbyl phosphate) and SAP (sodium ascorbyl phosphate) conjugated to the hyaluronic acid with a degree of conjugation of between about 3 mol% and about 40 mol%.
• Methods of making this dermal filler include reacting pentaerythritol glycidal ether (Star-PEG epoxide) with ascorbic acid 2-Glucoside (AA2G) at a ratio, reaction temperature and reaction time suitable for achieving a composition containing AA2G capped by 4-arm epoxides (AA2G-4 arm epoxides), unreacted 4-arm epoxides and free AA2G.
• the 4 arm epoxide capped AA2G (AA2G-4 arm epoxides) is conjugated to hyaluronic acid via the epoxyl group.
• the unreacted 4 arm epoxides serves as a crosslinker to crosslink hyaluronic acid and as a conjugation agent to further conjugate AA2G.
• a dermal filler comprising hyaluronic acid crosslinked with BDDE and having a vitamin C derivative (for example, one of AA2G (Ascorbic acid 2-Glucoside), Vitagen (3-aminopropyl-L- ascorbyl phosphate) and SAP (sodium ascorbyl phosphate) conjugated to the hyaluronic acid with a degree of conjugation of between about 3 mol% and about 10 mol%.
• a vitamin C derivative for example, one of AA2G (Ascorbic acid 2-Glucoside), Vitagen (3-aminopropyl-L- ascorbyl phosphate) and SAP (sodium ascorbyl phosphate) conjugated to the hyaluronic acid with a degree of conjugation of between about 3 mol% and about 10 mol%.
• Methods of making this dermal filler include reacting BDDE with ascorbic acid 2- Glucoside (AA2G) at a ratio, reaction temperature and reaction time suitable for achieve a composition containing AA2G capped by BDDE (AA2G-BDDE), unreacted BDDE and free AA2G.
• the BDDE capped AA2G (AA2G-BDDE) is conjugated to hyaluronic acid via the epoxyl group.
• the unreacted BDDE serves as a crosslinker to crosslink hyaluronic acid and as a conjugation agent to further conjugate AA2G.
• Figure 9 is a Table showing the effect of a-glucosidase concentration on AsA release from AA2G -PBS solution.
• the conversion of AA2G to AsA depends on the concentration of a-glycosidase.
• AA2G converted AsA almost completely in 15 minutes when a-glycosidase concentration is 6.3 unit per gram gel.
• a- glycosidase concentration is 4.7 units per gram gel, It took 30 minutes to completely convert AA2G to AsA. Further decease a-glycosidase concentration resulted in slow conversion of AA2G to AsA.
• Figure 10 shows a representation of a release profile of free AsA from conjugated dermal fillers in accordance with the invention (sustained release) (AA2G conversion in mol% versus reaction time). AA2G completely converted to AsA in AA2G/HA mix in 40 minutes. AA2H/HA conjugates showed a time dependence of AA2G conversion to AsA.
• Figure 1 1A and 1 1 B show additional release data for various dermal fillers in accordance with the invention. More specifically, conversion of AA2G to AsA in HA-AA2G gels is dependent on ⁇ -glycosidase concentration. High a-glycosidase concentration resulted in a fast conversion of AA2G to AsA. For a given a- glycosidase concentration, different formulations showed different profiles of AA2G to AsA.
• dermal fillers are provided which are especially effective in treating and eliminating the appearance of fine lines, for example, relatively superficial, creases in the skin, for example, but not limited to, fine lines near the eyes, the tear trough region, forehead, periorbital, glabellar lines, etc.
• Tyndall effect The appearance of a blue discoloration at the skin site where a dermal filler had been injected, (Tyndall effect) is a significant adverse event experienced by some dermal filler patients. Tyndall effect is more common in patients treated for superficial fine line wrinkles.
• Embodiments of the present invention have been developed which provide long lasting, translucent fillers which can be injected superficially to treat fine lines and wrinkles, even in regions of relatively thin skin, without any resulting blue discoloration from Tyndall effect.
• Fine lines or superficial wrinkles are generally understood to be those wrinkles or creases in skin that are typically found in regions of the face( forehead, lateral canthus, vermillion border/perioral lines) where the skin is thinnest, that is, the skin has a dermis thickness of less than 1 mm.
• the average dermal thickness is about 0.95 mm for normal skin and about 0.81 mm for wrinkled skin.
• Dermis around the lateral canthus is even thinner (e.g. about 0.61 mm for normal skin and about 0.41 mm for wrinkled skin).
• the average outer diameter of a 30 or 32 gauge needle needle that are typically used for fine line gel application) is about 0.30 and about 0.24 mm.
• compositions of the invention comprise a hyaluronic acid component crosslinked with a crosslinking component, an additive other than the crosslinking component;, the composition exhibiting reduced Tyndall effect when administered into a dermal region of a patient, relative to composition that is substantially identical except without the additive.
• the composition may be substantially optically transparent.
• the additive is a vitamin C derivative, for example, AA2G which may be chemically conjugated to the hyaluronic acid as described elsewhere herein.
• the crosslinking component is BDDE and the degree of conjugation is between about 3 mol% and about 10 mol%, or up to 15 mol% or greater.
• the composition further comprises an anesthetic agent, for example, lidocaine in an amount suitable for providing comfort to the patient upon injection.
• compositions such as described herein.
• the compositions comprise a mixture of a hyaluronic acid component, a crosslinking component crosslinking the hyaluronic acid, and an additive other than the crosslinking component, the composition being substantially optically transparent; and wherein the dermal filler composition exhibits reduced Tyndall effect relative to composition that is substantially identical except without the additive.
• the composition comprises a hyaluronic acid component crosslinked with di - or multiamine crosslinker using EDC chemistry.
• the crosslinker may be HMDA.
• the composition has a G' of up to about 70 Pa, G7G' between about 0.65 and about 0.75, extrusion force of about 24 N or less, and a final HA concentration of between about 24 mg/g and about 25 mg/g.
• the conjugation degree is between about 3 mol% and about 10 mol%, or up to about 15 mol%, or up to about 40 mol%.
• These compositions may have a G' from at least about 30 Pa, more preferably at least about 40 Pa, to about 100 Pa, G7G" between about 0.30 and about 0.50, extrusion force of about 27 N or less and a final HA concentration of between about 24 mg/g and about 25 mg/g.
• degree of conjugation is defined as molar percentage of conjugant, e.g., AA2G, to the repeating unit of hyaluronic acid (e.g., HA dimer).
• 10 mol% conjugation degree means every 100 HA repeat units contain 10 conjugated AA2G.
• Degree of conjugation can be calculated using the method illustrated in Example 2 below, or other methods known to those of skill in the art.
• LMW HA low molecular weight hyaluronic acid
• the weight of HA after dialysis the starting weight of HA x (actual weight before dialysis / theoretical weight)
• the AA2G conjugation degree in the gel as described in Example 1 is 14.7 mol%.
• Example 4 An oscillatory parallel plate rheometer (Anton Paar, Physica MCR 301 ) was used to measure the properties of the gel obtained in Example 1 .
• the diameter of plate used was 25 mm.
• the gap between the plates was set at 1 mm.
• a frequency sweep at a constant strain was run first, before the strain sweep at a fixed frequency.
• the G' (storage modulus) was obtained from the strain sweep curve at 1 % strain. The value is 1450 Pa for the gel.
• Example 4 AA2G conjugation to crosslinked HA Gels using BDDE as a crosslinker, with tunable conjugation degree and gel rheological properties
• the HA-AA2G gel was formed.
• the gel was cut into pieces, and the HCI-PBS solution was added to it.
• the gel was allowed to neutralize and swell overnight on an orbital shaker.
• the gel was sized through a -60 ⁇ screen and mixed -20 times by passing back and forth between 2 syringes.
• the gel was put in a 15,000 MWCO RC dialysis bag and dialyzed in PBS, pH7.4 buffer. The dialysis went on for -164.5 hours, with frequent change of PBS buffer.
• the gel was put in a syringe and stored in a 4 °C refrigerator.
• the conjugation degree is 13%.
• Gel storage modulus (G) is 803 Pa.
• Example 5 AA2G conjugation to crosslinked HA Gels using BDDE as a crosslinker, conjugation degree is 5.3 %, G' is ⁇ 300 Pa.
• 400.3 mg of LMW HA was hydrated in 3002.0 mg of 1 % NaOH in a syringe for ⁇ 30min.
• 800.5 mg of AA2G was put in a vial, followed by 264.3 mg of BDDE and 1 100.0 mg of 10% NaOH.
• the above solution pH >12
• the mixed paste was put in a vial and in the 50 °C water bath for -2.5 hours. 104.2 mg of 12M HCI was added to 8.5128 g PBS, pH7.4. After -2.5 hours, the HA-AA2G gel was formed, and the HCI-PBS solution was added to it. The gel was allowed to neutralize and swell over the weekend (-55 hours) on an orbital shaker. The gel was sized through a -60 ⁇ screen and mixed -20 times by passing back and forth between 2 syringes. The gel was put in a 15,000 MWCO RC dialysis bag and dialyzed in PBS, pH7.4 buffer. The dialysis went on for -1 14 hours, with frequent change of PBS buffer.
• Example 6 AA2G conjugation to crosslinked HA Gels using star-PEG epoxide as a crosslinker, conjugation degree is 29.4 %, G' is ⁇ 235 Pa.
• LMW HA 200.4 mg was hydrated in 2000 mg of 1 % NaOH in a syringe for ⁇ 30min. 400 mg of AA2G was put in a vial, followed by 312.7 mg of star-PEG epoxide and 1026.5 mg of 10% NaOH. The above solution was allowed to react in a 50 °C water bath for ⁇ 20min, before adding to the hydrated HA. After the addition, the mixture was mixed -20 times by passing back and forth between 2 syringes. The mixed paste was put in a vial and in the 50 °C water bath for -2.5 hours. 187.4 mg of 12M HCI was added to 3.034 g PBS, pH7.4.
• the HA-AA2G gel was formed, and the HCI-PBS solution was added to it.
• the gel was allowed to neutralize and swell over the weekend (-68 hours) on an orbital shaker.
• the gel was sized through a -60 ⁇ screen and mixed -20 times by passing back and forth between 2 syringes.
• the gel was put in a 15,000 MWCO RC dialysis bag and dialyzed in PBS, pH 7.4 buffer. The dialysis went on for -95 hours, with frequent change of PBS buffer.
• the gel was put in a syringe and stored in a 4 °C refrigerator.
• the conjugation degree and gel rheological properties are measured in a procedure as described in Examples 2 and 3.
• the conjugation degree is 29.4%.
• Gel storage modulus is - 235 Pa.
• Example 7 AA2G conjugation to crosslinked HA Gels using star-PEG epoxide as a crosslinker, conjugation degree is 27.8 %, G' is - 363 Pa.
• LMW HA 200.3 mg was hydrated in 2000 mg of 1 % NaOH in a syringe for ⁇ 30min.
• 400.2 mg of AA2G was put in a vial, followed by 313.4 mg of star-PEG epoxide and 1022.6 mg of 10% NaOH.
• the above solution was added to the hydrated HA.
• the mixture was mixed -20 times by passing back and forth between 2 syringes.
• the mixed paste was put in a vial and in the 50 °C water bath for -2.5 hours. 196.5 mg of 12M HCI was added to 3.016 g PBS, pH7.4. After -2.5 hours, the HA-AA2G gel was formed, and the HCI-PBS solution was added to it.
• the gel was allowed to neutralize and swell overnight (-24 hours) on an orbital shaker.
• the gel was sized through a -60 ⁇ screen and mixed -20 times by passing back and forth between 2 syringes.
• the gel was put in a 15,000 MWCO RC dialysis bag and dialyzed in PBS, pH7.4 buffer. The dialysis went on for -98.5 hours, with frequent change of PBS buffer. After the dialysis, the gel was put in a syringe and stored in a 4 °C refrigerator.
• the conjugation degree and gel rheological properties are measured in a procedure as described in Examples 2 and 3.
• the conjugation degree is 27.8%.
• Gel storage modulus is - 363 Pa.
• Example 8 AA2G conjugation to crosslinked HMW HA Gels using BDDE as a crosslinker, conjugation degree is about 10 mol %, G' is about 240 Pa.
• HMW HA 400.3 mg was hydrated in 2501 .3 mg of 4 wt% NaOH in a syringe for ⁇ 30min. 1200 mg of AA2G was put in a vial, followed by 304.7 mg of BDDE and 1 178.6 mg of 16 wt% NaOH.
• the above solution (pH >12) was allowed to react in a 50 °C water bath for ⁇ 20min and transferred to a 20 cc syringe, before adding to the hydrated HA. After the addition, the mixture was mixed -20 times by passing back and forth between 2 syringes. The mixed paste was put in a 20 cc vial and in the 50 °C water bath for -2.5 hours.
• the HA-AA2G gel was formed. Then 226.6 mg of 12M HCI was added to 8492.2 mg 10X PBS, pH7.4 to get HCI-PBS solution and the HCI-PBS solution was added to neutralize and swell the gel. The gel was allowed to neutralize and swell over 48 hrs on an orbital shaker. The gel was sized through a -60 ⁇ screen and mixed -20 times by passing back and forth between 2 syringes. The gel was put in a 20,000 MWCO CE dialysis bag and dialyzed in PBS, pH7.4 buffer. The dialysis went on for -1 14 hours, with frequent change of PBS buffer.
• the conjugation degree and gel rheological properties are measured in a procedure as described in Examples, 2 and 3.
• the conjugation degree is 10 mol%.
• Gel storage modulus is about 240 Pa.
• Example 9 Vitagen conjugation to crosslinked LMW HA Gels using BDDE as a crosslinker, conjugation degree is 15 mol %, G' is about 365 Pa.
• LMW HA 398.2 mg was hydrated in 1753.24 mg of 1 wt% NaOH in a syringe for - 40min.
• BDDE 31 1 .7 mg was added to swollen HA and continue let HA swell for another 80 min. The swollen HA BDDE mixture was pre-reacted at 50 C for 20 min.
• Vitagen 801 .9 mg was separately dissolved in 1459.7 mg of 10 wt% NaOH and mixed with HA which was pre-reacted with BDDE. The mixture was continued to react at 50 °C for another 2.5 hrs. After -2.5 hours, the HA-Vitagen gel was formed. Then 195 mg of 12M HCI was added to 9004.0 mg of 10X PBS, pH7.4 to get HCI-PBS solution and the HCI-PBS solution was added to neutralize and swell the gel. The gel was allowed to neutralize and swell over 48 hrs on an orbital shaker. The gel was sized through a -60 ⁇ screen and mixed -20 times by passing back and forth between 2 syringes.
• the gel was put in a 20,000 MWCO CE dialysis bag and dialyzed in PBS, pH7.4 buffer. The dialysis went on for -120 hours, with frequent change of PBS buffer. After the dialysis, the gel was put in a syringe and stored in a 4 °C refrigerator. The gel rheological properties were measured in a procedure as described in Example 3. The conjugation degree was determined to be about 15 mol% using a similar method as the AA2G determination as described in Example 2. Gel storage modulus is about 365 Pa.
• Example 10 Vitagen conjugation to linear HA via amidization chemistry 200.3 mg of HMW HA was hydrated in 10 ml of water in 60 cc syringe. 500 mg of Vitagen was dissolved in 0.5 ml of water and solution was neutralized to pH 4.8. 197.7 mg of EDC and 149 mg of NHS were dissolved separately in 6 ml of water. The above solutions (solutions and EDC/NHS solutions) are added to another 60 cc syringe containing 23.5 ml of water. The two syringes are mixed 20 times by passing back and forth between 2 syringes. The mixtures was stored in one syringe and soaked in 37°C bath for 4 hrs. The solutions was finally dialyzed against PBS pH7.4 buffer until no noticeable Vitagen was observed. The conjugation degree was determined by a similar method as described Example 3. The conjugation degree is about 10 mol%.
• Example 11 AA2P Conjugations to crosslinked HA gels 200.4 mg of LMW HA is hydrated in 1000 mg of MES 5.2 buffer in a syringe for ⁇ 30min. 292 mg of AA2P is put in a vial, followed by 300 mg of star-PEG amine added. The above solution is allowed to react at room temperature overnight. The gel was hydrated with PBS buffer and dialyzed against PBS buffer to remove unreacted AA2P. The finally gel was characterized as described in Examples 2 and 3 to determine the conjugation degree and gel rheological properties. The conjugation degree is about 20 mol%.
• the storage modulus (G') is about 500 Pa.
• a suitable amount of free HA gel may be added to the gel to improve of modify gel cohesivity and/or injectability.
• free HA fibers are swollen in a phosphate buffer solution, in order to obtain a homogeneous viscoelastic gel ("free" HA gel).
• This uncrosslinked gel is added, before the dialysis step, to the HA BDDE crosslinked gel obtained in Example 1 (for example, to obtain a composition having between about 1 % to about 5%, w/w free HA).
• the resulting gel is then filled into Ready-to- Fill sterile syringes and autoclaved at sufficient temperatures and pressures for sterilization for at least about 1 minute.
• the final HA AA2G product is packaged and distributed to physicians to use as a dermal filler for superficial injection to improve the appearance of fine lines in the periorbital or other facial region.
• Example 12 The procedure of Example 12 is followed, but after the dialysis step and before the addition of free HA gel, lidocaine chlorhydrate (lidocaine HCI) is added to the mixture.
• the (lidocaine HCI) in powder form may first be solubilized in WFI and filtered through a 0.2 ⁇ filter.
• Dilute NaOH solution is added to the cohesive HA/AA2G gel in order to reach a slightly basic pH (for example, a pH of between about 7.5 and about 8).
• the lidocaine HCI solution is then added to the slightly basic gel to reach a final desired concentration, for example, a concentration of about 0.3% (w/w).
• the resulting pH of the HA AA2G/lidocaine mixture is then about 7 and the HA concentration is about 24 mg/g.
• Mechanical mixing is performed in order to obtain a proper homogeneity in a standard reactor equipped with an appropriate blender mechanism.
• additives such as retinoic acid (AKA, tretinoin), adapalence and alpha-lipoic acid contain carboxyl functional group (-COOH). These additives are conjugated to HA hydrogels via esterifications using EDC chemistry.
• AKA retinoic acid
• tretinoin adapalence
• alpha-lipoic acid contain carboxyl functional group (-COOH).
• HMW HA is hydrated in 10 ml of pH 4.8 MES buffer in 60 cc syringe.
• 200 mg of retinoic acid is dissolved in 5 ml of water- acetone mixture (water/acetone volume ratio 1 :3).
• the above two syringes are mixed via a syringe connector for about 20 times.
• 197.7 mg of EDC and 149 mg of NHS are dissolved separately in 6 ml of water in a separate syringe.
• the syringe containing EDC and NHS is connected the syringe containing with HA and retinoic acid to allow reactants to mix at least for 20 times by passing back and forth between 2 syringes.
• the mixtures are stored in one syringe and soaked in 37°C bath for 4 hrs.
• the gels are dialyzed against isopropanol to remove unconjugated Retinoic acid, and then dialyzed against PBS buffer under aseptic conditions.
• the gels are packaged into sterilized syringes and stored at 4 °C.
• Additives such as retinol (AKA, tretinoin), catalase, dimethylaminoethanol and g- Tocopherol contain hydroxyl functional group (-OH). These additives are conjugated to HA hydrogels via esterifications using EDC chemistry.
• a typical example for the conjugations is described as follows:
• HMW HA 200 mg is hydrated in 10 ml of pH 4.8 2-(N-morpholino) ethanesulfonic acid (MES) buffer in 60 cc syringe.
• MES 2-(N-morpholino) ethanesulfonic acid
• 200 mg of retinol acid is dissolved in 5 ml of water-acetone mixture (water/acetone volume ratio 1 :3).
• the above two syringes are mixed via a syringe connector for about 20 times.
• 197.7 mg of EDC and 149 mg of NHS are dissolved separately in 6 ml of water in a separate syringe.
• the syringe containing EDC and NHS is connected the syringe containing with HA and retinol to allow reactants to mix at least for 20 times by passing back and forth between 2 syringes.
• the mixtures are stored in one syringe and soaked in 37°C bath for 4 hrs.
• the gels are dialyzed against isopropanol to remove unconjugated retinol, and then dialyzed against PBS buffer under aseptic conditions.
• the gels are packaged into sterilized syringes and stored at 4 °C.
• Step one A crosslinked HA gel, for example, a commercial HA-based dermal filler, for example, JUVEDERM ® , Allergan, Irvine CA, or Restylane ® Medicis Aesthetics, Inc. is treated with EDC/NHS to activate the carboxyl group of HA.
• a commercial HA-based dermal filler for example, JUVEDERM ® , Allergan, Irvine CA, or Restylane ® Medicis Aesthetics, Inc. is treated with EDC/NHS to activate the carboxyl group of HA.
• Step 2 the activated HA hydrogel is treated with additives containing hydroxyl groups.
• Additives containing hydroxyl groups are retinol, catalase, dimethylaminoethanol and g-Tocopherol hydroxyl functional group (-OH).
• a typical examples for the conjugation of additives to crosslinked HA gels is as follows:
• Juvederm gel 2 gm of Juvederm gel is mixed with 200 gm of EDC and 150 mg of NHS at room temperature. Then 200mg of retinol in 3 ml of acetone-water mixture is added. The above mixture is reacted at 37 °C for 4 hrs. The gels are dialyzed against isopropanol to remove unconjugated Retinol, and then dialyzed against PBS buffer under aseptic conditions. The gels are packaged into sterilized syringes and stored at 4 °C.
• Additives such as epidermal growth factor (EGF), transforming growth factor (TGF) and peptides contain functional amine groups may be conjugated to HA to form beneficial dermal fillers. These additives are conjugated to HA via amidization chemistry.
• a typical example for conjugating is described as follows:
• HMW HA 200.3 mg is hydrated in 10 ml of MES pH 5.4 buffer water. 20 mg of EGF in 100 mg of MES solution is added. To above mixture, 197.7 mg of EDC and 149 mg are added. The resulting reaction mixture is allowed to react at 37 °C for 4 hrs. After the reaction completes, the gel is further dialyzed against isopropanol and then dialyzed against PBS buffer under aseptic conditions. The gels are packaged into sterilized syringes and stored at 4 °C.
• the present invention further provides methods of enhancing viability of grafted adipose tissue.
• the methods may generally comprise the steps of introducing a composition into the skin of a patient adjacent grafted adipose tissue, the composition being a composition as described elsewhere herein.
• the composition may comprise hyaluronic acid and a vitamin C derivative covalently conjugated to the hyaluronic acid, wherein a degree of conjugation is between about 3 mol% and about 40 mol%.
• methods for treating skin include the steps of introducing, into skin, a composition comprising adipose tissue, hyaluronic acid and a vitamin C conjugated to the hyaluronic acid.
• hASCs human adipose tissue derived stem cells
• hASCs were cultured on tissue culture plastic for 4 days in complete MesenPro medium (Invitrogen, Carlsbad, CA) supplemented with or without vitamin C (ascorbic acid) or its derivatives (Vitagen or AA2G) in free form. Proliferation was assessed by MTT assay as described by the manufacturer (ATCC, Manassas, VA).
• crosslinking HA with BDDE in the presence of either AA2G or Vitagen greatly changes the properties of the gels, with gels having high crosslinked densities, high HA concentrations, low viscosities and low extrusion forces, relative to commercial HA gels crosslinked with BDDE. Since AA2G or Vitagen is present during crosslinking, the present gels formed have these ascorbic acid derivatives coupled to the HA chains as both pendent groups, and as crosslinkers bridging HA chains, either alone, or via BDDE.
• the microscopic structure of the gel is greatly changed, resulting in gels that have very low extrusion force, even through needles as fine as 30 gauge.
• the gels have between about 3 mol % to about 10 mol%, or up to about 15 mol%, of vitamin C conjugated to HA.
• active Vitamin C may trigger skin collagenesis and may act as a radical scavenger to inhibit gel degradation.
• Formulation of a HA/AA2G gel with reduced Tyndall effect A mixture of 400.1 mg of LMW HA and 402.3 mg AA2G in a syringe, was hydrated for 60 min after adding 1764.0 mg of a 5 wt% NaOH solution. In a separate vial was added 800.8 mg of AA2G, followed by 1401 .1 mg of an 9.1 wt% NaOH solution, and 252.6 mg of BDDE. The resulting solution (pH >12) was allowed to react in a 50 °C water bath for -20 min, before it was transferred to the hydrated HA. After the addition, the mixture was mixed -20 times by passing it back and forth two syringes.
• the paste was then transferred in a vial before it was placed in a 50 °C water bath for -2.5 hours.
• a solution containing 197.0 mg of 12 M HCI and 9.18 g 10X PBS, pH 7.4 was added to neutralize the base, and swell the gel for 72 h on an orbital shaker.
• the gel was sized by forcing it through a -60 ⁇ pore size mesh.
• the sized gel was mixed -20 times by passing it back and forth two syringes before it was transferred into a cellulose ester dialysis bag, MWCO ⁇ 20 kDa and dialyzed against PBS, pH 7.4 buffer for 5 days changing the buffer twice daily.
• the gel was dispensed into 1 ml COC syringes, centrifuge at 5000 RPM for 5 min to remove air bubbles, and sterilized with moist steam.
• the gel had final HA concentration of 25 mg/g, an AA2G mol% calculated as described in Example 2 of about 10 mol%, and a G' of about 80 Pa.
• Other gels were made in a similar manner with G' values of about 60 Pa to about 80 Pa.
• lidocaine was added to produce a HA/AA2G with lidocaine gel having 0.3% ww lidocaine.
• a solution of lidocaine was prepared by dissolving lidocaine HCI in PBS buffer pH -7.4. An aliquot of the lidocaine solution was added to the gel in Example 19 after dialysis but before sterilization. The gel was then thoroughly mixed to obtain a homogenized mixture with a 0.3% w/w lidocaine concentration.
• Formulation of a HA/Vitaqen gel with reduced Tyndall effect 401 .0 mg of LMW HA was hydrated in 2355.0 mg of 1 wt% NaOH solution in a syringe for ⁇ 45min. 303.8 mg BDDE of was added to the hydrated HA and mix 10 times by syringe-to-syringe mixing. The mixture was pre-reacted in a 50 °C water bath for 15 min. 800.1 mg of Vitagen was separately dissolved in 950.6 mg of 15 wt% NaOH, followed by 510.1 Milli-Q water. The Vitagen solution was mixed with the pre-heated hydrated HA BDDE mixture 30 times back and forth using syringe- to-syringe mixing.
• the mixture was placed back in the 50 °C water bath and the reaction proceeded for another 2 h after which a solution containing 148.1 mg of 12M HCI and 8523.1 mg of 10X PBS, pH7.4 was added to the cross
• the HCI-PBS solution was added to neutralize and swell the gel.
• the gel was allowed to neutralize and swell over 48 hrs on an orbital shaker.
• the gel was sized through a -60 ⁇ screen and mixed -20 times by passing back and forth between 2 syringes.
• the gel was put in a 20,000 MWCO CE dialysis bag and dialyzed in PBS, pH7.4 buffer. The dialysis went on for -197 hours, with frequent change of PBS buffer.
• the gel was transferred into 1 ml COC syringes, centrifuge at 5000RPM for 5 min, and sterilized with moist steam.
• the final HA concentration of the gel was 24 mg/g.
• Example 21 the gel is made via EDC chemistry using crosslinker is hexamethylene diamine (HMDA), and in Example 20, 3-[3-(3-amino propoxy)-2,2-bis(3-amino-propoxymethyl)- propoxy]-propylamine (4 arm amine-4 AA).
• Crosslinking is carried out under mild conditions, e.g. room temperature, and for example, at pH 5.4. The reactions conditions could be tuned to prepare highly reticulate gels with optimal gel properties, excellent injectability and high final HA concentrations ( ⁇ 24 mg/g).
• HMDA solution was prepared by dissolving 260.9 mg HMDA.HCI in 2010.5 mg of 100 mM MES buffer pH 5.2, and adding 2 ⁇ of 1 M NaOH to bring pH to 5.2.
• EDC solution was prepared by dissolving 254.2 mg of EDC in 1 188.4 mg 100 mM MES buffer pH 5.2, and in a separate vial, 44.3 mg of NHS was dissolved in 1341 .8 mg of 100 mM MES buffer pH 5.2.
• ⁇ 1 h, 790 ⁇ of the HMDA solution was added to the hydrated HA.
• the mixture was homogenized by 10 times syringe-to-syringe mixing.
• 490 ⁇ EDC and 490 ⁇ NHS solutions were then added to the homogenized paste and again mix 10 times by syringe-to-syringe mixing.
• the mixture was then transferred to a vial and crosslinked at room temperature for 5 h. before the addition of 17.9 ml of 1 X PBS buffer pH 7.4.
• the gel was allowed to swell for 3 days on a roller before it was force through a 60 ⁇ pore size mesh.
• the sized gel was placed in a cellulose ester membrane dialysis tubing MWCO 20 KDa and dialyzed against 1 X PBS for 4 days changing the buffer twice a day.
• the gel was dispensed in 1 ml COC syringes, centrifuge at 5000 RPM for 5 min, and sterilized with moist steam.
• the final HA concentration of the gel was 25 mg/g.
• the mixture was homogenized by 10 times syringe-to-syringe mixing. 277 ⁇ EDC and 273 ⁇ NHS solutions were then added to the homogenized paste and again mix 10 times by syringe-to-syringe mixing. The mixture was then transferred to a vial and crosslinked at room temperature for 5 h. before the addition of 6.4 ml of 10X PBS buffer pH 7.4. The gel was allowed to swell for 3 days on a roller before it was force through a 60 ⁇ pore size mesh. The sized gel was placed in a cellulose ester membrane dialysis tubing MWCO 20 KDa and dialyzed against 1 X PBS for 4 days changing the buffer twice a day. The gel was dispensed in 1 ml COC syringes, centrifuge at 5000 RPM for 5 min, and sterilized with moist steam. The gel had a final HA concentration of 23 mg/g.
• An Oscillatory parallel plate rheometer Anton Paar Physica MCR 301 , was used to measure the rheological properties of the gels.
• a plate diameter of 25 mm was used at a gap height of 1 mm. Measurements were done at a constant temperature of 25 °C.
• Each measurement consisted of a frequency sweep from 1 to 10 Hz at a constant strain of 2% and a logarithmic increase of frequency followed by a strain sweep from 1 to 300% at a constant frequency of 5 Hz with a logarithmic increase in strain.
• the storage modulus (G') and the viscose modulus (G") were obtained from the strain sweep at 1 % strain.
• the force required to extrude the gels through a 30 gauge needle was measured using an Instron 5564 and a Bluehill 2 software.
• the gels were extruded from a 1 ml COC syringe through a 30G1 ⁇ 2 TSK needle.
• the plunger was pushed at a speed of 100 mm/min for 1 1 .35 mm, and the extrusion force was recorded.
• In Vitro cytotoxicity tests of the gels were performed by NAMSA according to the Agarose Overlay Method of ISO 10993-5: biological Evaluation of Medical Devices - Part 5: Tests for In Vitro Cytotoxicity.
• Triplicate wells were dosed with 0.1 ml of test articles placed on a filtered disc, as well as 0.9% NaCI solution, 1 cm length of high density polyethylene as a negative control, and 1 x 1 cm 2 portion of latex as a positive control. Each was placed on an agarose surface directly overlaying a monolayer of L929 mouse fibroblast cells. After incubating at 37 °C in 5% CO 2 for 24 h. the cultures were examined macroscopically and microscopically for any abnormal cell morphology and cell lysis.
• test articles were scored from 0 - 4 based on the zone of lysis in the proximity of the samples. Test materials from examples 1 , 3, and 4 scored 0 as test articles showed no evidence of causing any cell lysis or toxicity. Quantitative Analysis of Tvndall effect
• compositions of the invention as used in the treatment of periorbital lines
• a 40 year old thin woman presents with fine wrinkles in the periorbital region and requests dermal filler treatment.
• the physician introduces 0.6 ml of a HA-based gel in accordance with the invention (such as that described in Example 19) superficially into the fine lines beneath each of her eyes and in the tear trough region using linear threading technique. Although the gel is introduced superficially, no blue discoloration is observed and the patient is satisfied with the results.
• compositions of the present invention for example, those of
• Examples 19 and 21 have reduced or insignificant Tyndall effect, and substantially longer duration in the body relative to certain HA-based commercial gels, for example, Juvederm Refine/Surgiderm 18 and Belotero Soft.
• certain HA-based commercial gels for example, Juvederm Refine/Surgiderm 18 and Belotero Soft.
• Example 19 of the present invention had not only a Tyndall score at least as favorable as this commercial gel, but advantageously exhibited substantially higher in vivo duration.
• Additives such as Vitamin A, Vitamin B, Vitamin C, Vitamin D, Vitamin E and derivatives thereof, alone and in combination, are conjugated to crosslinked hyaluronic acid gels in a manner so as to produce a variety of substantially optically transparent, injectable HA-based gels.
• the HA component is at least 90% by weight, for example, is substantially entirely low molecular weight HA, or about 100% low molecular weight HA, as defined elsewhere herein.
• These additives are conjugated to HA hydrogels using any suitable means.
• the conjugated gels are sized and processed to produce an injectable, pH neutral, cohesive composition having a HA concentration of at least about 20 mg/g, for example, about 23, about 24 mg/g, about 25 mg/g, up to about 30 mg/g, and suitable for injection through a fine gauge needle.
• the gels have a G' value of at least about 50 PA, about 60 Pa, about 70 Pa, about 80 Pa up to, and no greater than about 100 Pa.
• the gels are packaged and sterilized using autoclave, UV light or other suitable means.
• Each of the gels is useful for superficial injection, for example, injection into skin at a depth of no greater than about 1 .0mm, in a wrinkle of patients, for example, the periorbital region, nasolabial fold region, tear trough region, neck region, or any other facial region that would benefit from dermal filling.
• a wrinkle of patients for example, the periorbital region, nasolabial fold region, tear trough region, neck region, or any other facial region that would benefit from dermal filling.
• each numerical parameter should at least be construed in light of the number of reported significant digits and by applying ordinary rounding techniques. Notwithstanding that the numerical ranges and parameters setting forth the broad scope of the invention are approximations, the numerical values set forth in the specific examples are reported as precisely as possible. Any numerical value, however, inherently contains certain errors necessarily resulting from the standard deviation found in their respective testing measurements.

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