Classifications

• • 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
  • A61K47/02—Inorganic compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/22—Hormones
  • A61K38/28—Insulins
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/12—Carboxylic acids; Salts or anhydrides thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/16—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing nitrogen, e.g. nitro-, nitroso-, azo-compounds, nitriles, cyanates
  • A61K47/18—Amines; Amides; Ureas; Quaternary ammonium compounds; Amino acids; Oligopeptides having up to five amino acids
  • A61K47/183—Amino acids, e.g. glycine, EDTA or aspartame
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
  • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics

Definitions

• the invention is in the general field of injectable rapid acting drug delivery insulin formulations and methods of their use and reduction of pain on injection.
• Glucose is a simple sugar used by all the cells of the body to produce energy and support life. Humans need a minimum level of glucose in their blood at all times to stay alive. The primary manner in which the body produces blood glucose is through the digestion of food. When a person does not get glucose from food digestion, glucose is produced from stores in the tissue and released by the liver. The body's glucose levels are regulated by insulin. Insulin is a peptide hormone that is naturally secreted by the pancreas. Insulin helps glucose enter the body's cells to provide a vital source of energy.
• the pancreas When a healthy individual begins a meal, the pancreas releases a natural spike of insulin called the first-phase insulin release.
• the first-phase insulin release acts as a signal to the liver to stop making glucose while digestion of the meal is taking place. Because the liver is not producing glucose and there is sufficient additional insulin to process the glucose from digestion, the blood glucose levels of healthy individuals remain relatively constant and their blood glucose levels do not become too high.
• Diabetes is a disease characterized by abnormally high levels of blood glucose and inadequate levels of insulin.
• Type 1 diabetes the body produces no insulin.
• Type 2 diabetes although the pancreas does produce insulin, either the body does not produce the insulin at the right time or the body's cells ignore the insulin, a condition known as insulin resistance.
• Type 2 diabetes Even before any other symptoms are present, one of the first effects of Type 2 diabetes is the loss of the meal-induced first-phase insulin release. In the absence of the first-phase insulin release, the liver will not receive its signal to stop making glucose. As a result, the liver will continue to produce glucose at a time when the body begins to produce new glucose through the digestion of the meal. As a result, the blood glucose level of patients with diabetes goes too high after eating, a condition known as hyperglycemia. Hyperglycemia causes glucose to attach unnaturally to certain proteins in the blood, interfering with the proteins' ability to perform their normal function of maintaining the integrity of the small blood vessels. With hyperglycemia occurring after each meal, the tiny blood vessels eventually break down and leak. The long-term adverse effects of hyperglycemia include blindness, loss of kidney function, nerve damage and loss of sensation and poor circulation in the periphery, potentially requiring amputation of the extremities.
• an untreated diabetic's blood glucose becomes so elevated that the pancreas receives a signal to secrete an inordinately large amount of insulin.
• the pancreas can still respond and secretes this large amount of insulin.
• This inordinately large amount of insulin has two detrimental effects. First, it puts an undue extreme demand on an already compromised pancreas, which may lead to its more rapid deterioration and eventually render the pancreas unable to produce insulin. Second, too much insulin after digestion leads to weight gain, which may further exacerbate the disease condition.
• Type 1 diabetes Because patients with Type 1 diabetes produce no insulin, the primary treatment for Type 1 diabetes is daily intensive insulin therapy.
• the treatment of Type 2 diabetes typically starts with management of diet and exercise. Although helpful in the short-run, treatment through diet and exercise alone is not an effective long-term solution for the vast majority of patients with Type 2 diabetes.
• diet and exercise When diet and exercise are no longer sufficient, treatment commences with various non-insulin oral medications. These oral medications act by increasing the amount of insulin produced by the pancreas, by increasing the sensitivity of insulin-sensitive cells, by reducing the glucose output of the liver or by some combination of these mechanisms. These treatments are limited in their ability to manage the disease effectively and generally have significant side effects, such as weight gain and hypertension.
• Insulin therapy has been used for more than 80 years to treat diabetes. This therapy usually involves administering several injections of insulin each day. These injections consist of administering a long-acting basal injection one or two times per day and an injection of a fast-acting insulin at mealtime.
• this treatment regimen is accepted as effective, it has limitations. First, patients generally dislike injecting themselves with insulin due to the inconvenience and pain of needles. As a result, patients tend not to comply adequately with the prescribed treatment regimens and are often improperly medicated. More importantly, even when properly administered, insulin injections do not replicate the natural time-action profile of insulin. In particular, the natural spike of the first-phase insulin release in a person without diabetes results in blood insulin levels rising within several minutes of the entry into the blood of glucose from a meal. By contrast, injected insulin enters the blood slowly, with peak insulin levels occurring within 80 to 100 minutes following the injection of regular human insulin.
• a potential solution is the injection of insulin directly into the vein of diabetic patients immediately before eating a meal.
• patients In studies of intravenous injections of insulin, patients exhibited better control of their blood glucose for 3 to 6 hours following the meal.
• intravenous injection of insulin before each meal is not a practical therapy.
• HUMALOG® insulin lispro
• NOVOLOG® insulin aspart
• APIDRA® insulin glulisine
• hypoglycemia can result in loss of consciousness, coma and even death.
• ADA American Diabetes Association
• insulin-using diabetic patients have on average 1.2 serious hypoglycemic events per year, many of which events require hospital emergency room visits by the patients.
• the rapidity of insulin action is dependent on how quickly it is absorbed.
• regular human insulin is injected subcutaneous ly at 100 IU/ml, the formulation is primarily composed of hexamers (approximately 36kDa) which are not readily absorbed due to their size and charge. Located within the hexamer are two zinc atoms that stabilize the molecule.
• Insulin formulations with a rapid onset of action such as VIAject® are described in U.S. Patent No. 7,279,457, and U.S. Published Applications 2007/0235365, 2008/0085298, 2008/90753, and 2008/0096800, and Steiner, et al, Diabetologia, 51 : 1602-1606 (2008).
• the rapid acting insulin formulations were designed to create insulin formulations that provide an even more rapid pharmacokinetic profile than insulin analogs, thereby avoiding the patient becoming hyperglycemic in the first hour after injection and hypoglycemic two to four hours later.
• VIAJECT® results from the inclusion of two key excipients, a zinc chelator such as disodium EDTA (EDTA) and/or calcium disodium EDTA which rapidly dissociates insulin hexamers into monomers and dimers and a
• dissolution/stabilization agent such as citric acid which stabilizes the dissociated monomers and dimers prior to being absorbed into the blood
• the concentrated insulin formulations were developed with the same concept in mind; however, these formulations have a unique profile combining ultrarapid action with some extended duration of action. They are particularly well suited for insulin resistant individuals who require prandial insulin and basal insulin injections. With this U-400 formulation, the need for two injections is eliminated, since the absorption profile could fulfill both prandial and intermediate acting insulin (i.e. NPH) needs. In addition, these concentrated insulin formulations could be used with insulin pumps for insulin resistant patients. The reduced volume could lead to future design of miniature pumps, or bihormonal pumps such as those being developed for the artificial pancreas.
• compositions and methods for modulating the pharmacokinetics and pharmacodynamics of U- 100, ultra rapid analogs and U-400 ultra-rapid acting injectable insulin formulations with improved injection site tolerability have been developed.
• the formulations contain insulin in combination with a zinc chelator such as ethylenediamine tetraacetic acid (“EDTA”), a dissolution/stabilization agent such as citric acid and/or sodium citrate, one or more magnesium compounds, and, optionally, additional excipients.
• EDTA ethylenediamine tetraacetic acid
• the formulation contains recombinant human insulin, sodium EDTA, a dissolution/stabilization agent such as citric acid and/or sodium citrate, and one or more magnesium compounds, such as magnesium EDTA, Mg(OH) 2 , MgSC ⁇ , or combinations thereof.
• the magnesium compound is MgSC ⁇ .
• the concentration of magnesium compounds is from about 0.1 to about 10 mg/ml, preferably from about 0.1 to about 5 mg/ml, more preferably from about 0.1 to about 2 mg/ml, most preferably from about 0.2 to about 2 mg/ml.
• the formulations contain about 0.2-0.3 mg/ml Mg(OH) 2 (e.g., 0.282), about 1.7-2.0 magnesium EDTA (e.g., 1.89), and/or about 0.4-0.5 magnesium sulfate (e.g., 0.481). Stability is enhanced by optimizing m-cresol and citrate ion concentration. The concentration of the insulin in the formulation varies from 100-500 units/mL.
• the formulations are administered via subcutaneous injection.
• Figure 1 is a three dimensional schematic of insulin showing exposed surface charges and overlaid with molecules ("dissolution and chelating agents") of appropriate size to mask the charge.
• Figures 2 and 3 are graphs of mean insulin concentration (mU/L) as a function of time ( Figure 2, 0-60 minutes; Figure 3, 0-480 minutes) post-dose of the Mg EDTA insulin formulations BIOD 123 and 125 compared to HUMALOG®.
• Figures 4 and 5 are graphs of mean GIR (mg/kg/min) as a function of time (minutes) of the Mg EDTA insulin formulations BIOD 123 and 125 compared to HUMALOG®.
• Figure 6 shows the mean baseline subtracted insulin (solid lines) and glucose (dotted lines) vs. time in diabetic miniature swine. BIOD-530 (black) and Lilly U-500 (grey), ⁇ SEM.
• Figure 9 shows the mean baseline subtracted insulin (solid lines) and glucose (dotted lines) vs. time in diabetic miniature swine following administration of different insulin formulations.
• the insulin formulations disclosed herein are administered immediately prior to a meal or at the end of a meal.
• the formulations are designed to be absorbed into the blood faster than the currently marketed rapid-acting insulin or insulin analogs.
• a zinc chelator is included which disassociates, or separates, the hexameric form of insulin to the monomeric and/or dimeric form of insulin and prevents or minimizes re-association to the hexameric form post injection, thereby promoting rapid absorption into the bloodstream post injection. It has been discovered that a systematic relationship exists between the concentration of zinc chelator, such as disodium EDTA, and the speed of glucose absorption from the blood. Variation in EDTA
• EDTA-citric acid-insulin formulation chelation of extracellular calcium by disodium EDTA.
• Calcium is in the extracellular fluid at a concentration of approximately ImM, and is essential for excitation-contraction coupling, muscle function, neurotransmitter release, and cellular metabolism. Loss of local calcium can cause muscle tetany, which is a disorder marked by intermittent tonic muscular contractions, accompanied by fibrillary tremors, paresthesias and muscular pain. To avoid this interaction, a formulation removing calcium from the extracellular fluid should not be used.
• the substitution of disodium EDTA with the calcium chelated form of EDTA can reduce injection site pain as compared to the same amount of disodium EDTA.
• calcium disodium EDTA slightly delays the rate of absorption in vivo. Therefore, magnesium was used instead of calcium to chelate the excess EDTA.
• the addition of magnesium to the formulation increased injection site tolerability and did not alter the rate of insulin absorption.
• the formulation contains recombinant human insulin, sodium EDTA, a dissolution/stabilization agent such as citric acid and/or sodium citrate, and one or more magnesium compounds, such as magnesium EDTA, Mg(OH)2, MgS0 4 , or combinations thereof.
• the magnesium compound is MgS0 4 .
• the concentration of magnesium compounds is from about 0.1 to about 10 mg/ml, preferably from about 0.1 to about 5 mg/ml, more preferably from about 0.1 to about 2 mg/ml, most preferably from about 0.2 to about 2 mg/ml.
• the formulations contain about 0.2-0.3 mg/ml Mg(OH) 2 (e.g., 0.282), about 1.7-2.0 magnesium EDTA (e.g., 1.89), and/or about 0.4-0.5 magnesium sulfate (e.g., 0.481). Stability is enhanced by optimizing m-cresol and citrate ion concentration.
• the concentration of the insulin in the formulation varies from 100-500 units/mL.
• insulin refers to human or non-human
• Human insulin is the human peptide hormone secreted by the pancreas, whether isolated from a natural source or made by genetically altered microorganisms.
• non-human insulin is the same as human insulin but from an animal source such as pig or cow.
• an insulin analogue is an altered insulin, different from the insulin secreted by the pancreas, but still available to the body for performing the same action as natural insulin.
• the amino acid sequence of insulin can be changed to alter its ADME (absorption, distribution, metabolism, and excretion) characteristics. Examples include insulin lispro, insulin glargine, insulin aspart, insulin glulisine, and insulin detemir.
• the insulin can also be modified chemically, for example, by acetylation.
• human insulin analogues are altered human insulin which is able to perform the same action as human insulin.
• a "chelator” or “chelating agent” refers to a chemical compound that has the ability to form one or more bonds to zinc ions. The bonds are typically ionic or coordination bonds.
• the chelator can be an inorganic or an organic compound.
• a chelate complex is a complex in which the metal ion is bound to two or more atoms of the chelating agent.
• a "solubilizing agent” is a compound that increases the solubility of materials in a solvent, for example, insulin in an aqueous solution.
• solubilizing agents include surfactants such as polysorbates (TWEEN®); solvents such as ethanol; micelle forming compounds, such as oxyethylene monostearate; and pH-modifying agents.
• dissolution/stabilizing agent is an acid or a salt thereof that, when added to insulin and EDTA, enhances the transport and absorption of insulin relative to HC1 and EDTA at the same pH, as measured using the epithelial cell transwell plate assay described in the examples below.
• HC1 is not a dissolution/stabilization agent but may aid in solubilization.
• Citric acid is a dissolution/stabilization agent when measured in this assay.
• inorganic magnesium compound or “inorganic magnesium salt” refers to compounds in which the anion does not contain one or more carbon atoms.
• organic magnesium compound or “organic magnesium salt” refers to compounds in which the anion contains one or more carbon atoms.
• an "excipient” is an inactive substance other than a chelator or dissolution/stabilization agent, used as a carrier for the insulin or used to aid the process by which a product is manufactured. In such cases, the active substance is dissolved or mixed with an excipient.
• a "physiological pH” is between 6.8 and 7.6, preferably between 7 and 7.5, most preferably about 7.4.
• Cmax is the maximum or peak concentration of a drug observed after its administration.
• Tmax is the time at which maximum concentration (Cmax) occurs.
• 1 ⁇ 2 Tmax is the time at which half maximal concentration (1/2 Cmax) of insulin occurs in the blood. This may also be expressed as T50%earlymax.
• Formulations include insulin or an insulin analog, a zinc chelator and a dissolution/stabilizing agent(s), magnesium, and, optionally, one or more other excipients.
• the formulations are suitable for subcutaneous administration and are rapidly absorbed into the subcutaneous tissue.
• At least one of the formulation ingredients is selected to mask charges on the insulin. This is believed to facilitate the transmembrane transport of the insulin and thereby increase both the onset of action and bioavailability for the insulin.
• the ingredients are also selected to form compositions that dissolve rapidly in aqueous medium.
• the insulin is absorbed and transported to the plasma quickly, resulting in a rapid onset of action, preferably beginning within about 5 minutes following administration and peaking at about 15-30 minutes following administration.
• the chelator such as EDTA, chelates the zinc within the insulin, thereby removing the zinc from the insulin molecule.
• the monomeric form has a molecular weight that is less than one-sixth the molecular weight of the hexameric form, thereby markedly increasing both the speed and quantity of insulin absorption.
• the chelator such as EDTA
• dissolution/stabilization agent such as citric acid
• a magnesium salt has been found to not significantly alter the pharmacokinetic profile while at the same time decreasing the injection site pain.
• M-cresol is added for its anti-microbial properties and enhancement of shelf life.
• Insulin or insulin analogs may be used in this formulation.
• the insulin is recombinant human insulin.
• Recombinant human insulin is available from a number of sources.
• the dosages of the insulin depend on its bioavailability and the patient to be treated. Insulin is generally included in a dosage range of 1.5-200 IU, depending on the level of insulin resistance of the individual. Typically, insulin is provided in 100 IU vials, though other presentations of 200, 400 or 500 U/ml are described herein.
• the injectable formulation is a volume of 1 ml containing 100U of insulin. Additional embodiments include higher concentration insulin formulations, the most preferred being U-400.
• Fast acting insulins are intended to respond to the glucose derived from ingestion of carbohydrates during a meal. Fast acting insulins start to work within one to 20 minutes, peaking about one hour later and lasting from three to five hours. Fast acting insulin takes about two hours to fully absorb into the systemic circulation.
• Fast acting insulins include regular recombinant human insulin (such as HUMULI ®, marketed by Eli Lilly, and NOVALIN®, marketed by Novo Nordisk A/S) which are administered in an isotonic solution at pH 7.
• Bovine and porcine insulins which differ in several amino acids to human insulin, but are bioactive in humans, are also fast acting insulins.
• Humulin R U-500 has a very long duration of action and is suitable for basal use only due to its slow release profiles.
• Some diabetes patients use rapid-acting insulin at mealtimes, and long-acting insulin for 'background' continuous insulin.
• This group includes insulins that have been modified or have altered locations of amino acids in order to enhance their rate of absorption.
• insulin lispro Lysine-Proline insulin, sold by Eli Lilly as HUMALOG®
• insulin glulisine sold by Sanofi-Aventis as APIDRA®
• insulin aspart sold by Novo Nordisk as NOVOLOG®
• Intermediate-acting insulin has a longer lifespan than short-acting insulin but it is slower to start working and takes longer to reach its maximum strength. Intermediate-acting insulin usually starts working within 2-4 hours after injection, peaks somewhere between 4-14 hours and remains effective up to 24 hours. Types of intermediate-acting insulin include NPH (Neutral Protamine Hagedorn) and LENTE insulin. NPH insulin contains protamine which slows down the speed of absorption so that the insulin takes longer to reach the bloodstream but has a longer peak and lifespan. Intermediate acting insulins may be combined with rapid acting insulins at neutral H, to reduce the total number of injections per day.
• Blends of immediate acting insulin and intermediate acting insulin are commercially available to fulfill the need for prandial and basal use in a single injection. These insulin blends may be regular recombinant insulin based (HUMULIN® 70/30 (70% human insulin isophane and 30% human insulin, Eli Lilly) or analog based, such HUMALOG®Mix75/25 (75% insulin lispro protamine suspension and 25% insulin lispro solution) (Eli Lilly) and are 100 U-ml. These blends use a protamine insulin suspension (HUMULIN® or HUMALOG® based) to extend the duration of action insulin action with HUMULIN®R (regular human insulin) or HUMALOG®R to cover the prandial needs.
• HUMULIN® 70/30 70% human insulin isophane and 30% human insulin, Eli Lilly
• analog HUMALOG®Mix75/25 75% insulin lispro protamine suspension and 25% insulin lispro solution
• HUMULIN®R regular human insulin
• insulin glargine marketed under the tradename LANTUS®, Sanofi Aventis
• insulin detemir marketed under the tradename LANTUS®, Sanofi Aventis
• LANTUS® Novo Nordisk A/S
• the extended duration of action of LANTUS® is normally induced by the pH elevation from 4 to 7 post subcutaneous injection. This changes the solubility of the insulin glargine, creating a microprecipitate. This microprecipate slowly dissolves in the subcutaneous tissue, sustaining its glucose lowering effect for up to 24 hours. It differs from human insulin by having a glycine instead of asparagine at position 21 and two arginines added to the carboxy -terminus of the beta- chain.
• Certain polyacids appear to mask charges on the insulin, enhancing uptake and transport, as shown in Figure 1.
• Those acids which are effective as dissolution/stabilization agents include acetic acid, ascorbic acid, citric acid, glutamic acid, aspartic acid, succinic acid, fumaric acid, maleic acid, adipic acid, and salts thereof, relative to hydrochloric acid, which is not a charge masking agent.
• the effective acids are all diacids or polyacids.
• the active agent is insulin
• a preferred dissolution/stabilization agent is citric acid and/or sodium citrate.
• Hydrochloric acid may be used for pH adjustment, in combination with any of the formulations, but is not a dissolution/stabilization agent.
• the acid may be added directly or in the form of a salt, which dissociates in aqueous solution.
• Salts of the acids include sodium acetate, ascorbate, citrate, glutamate, aspartate, succinate, fumarate, maleate, and adipate.
• Salts of organic acids can be prepared using a variety of bases including, but not limited to, metal hydroxides, metal oxides, metal carbonates and bicarbonates, metal amines, as well as ammonium bases, such as ammonium chloride, ammonium carbonate, etc.
• Suitable metals include monovalent and polyvalent metal ions.
• Exemplary metals ions include the Group I metals, such as lithium, sodium, and potassium; Group II metals, such as barium, magnesium, calcium, and strontium; and metalloids such as aluminum.
• Group I metals such as lithium, sodium, and potassium
• Group II metals such as barium, magnesium, calcium, and strontium
• metalloids such as aluminum.
• Polyvalent metal ions may be desirable for organic acids containing more than carboxylic acid group since these ions can
• the range of dissolution/stabilization agent corresponds to an effective amount of citric acid in combination with insulin and disodium EDTA.
• a range of 9.37 x 10 "4 M to 9.37 x 10 "2 M citric acid corresponds with a weight/volume of about 0.18 mg/ml to about 18 mg/ml if the citric acid is anhydrous citric acid with a molar mass of approximately 192 gram/mole.
• the amount of anhydrous citric acid ranges from about 50% of 1.8 mg/ml (0.9 mg/ml) to about 500% of 1.8 mg/ml (9 mg/ml), more preferably from about 75% of 1.8 mg/ml (1.35 mg/ml) to about 300% of 1.8 mg/ml (5.4 mg/ml).
• the amount of anhydrous citric acid can be about 1.8 mg/ml, or about 2.7 mg/ml, or about 3.6 mg/ml, or about 5.4 mg/ml.
• the amount of citric acid is 2.7 mg/ml of the injectable formulation.
• the weight/volume may be adjusted, if for example, citric acid monohydrate or trisodium citrate or another citric acid is used instead of anhydrous citric acid.
• the preferred dissolution/stabilization agent when the insulin formulation has a pH in the physiological pH range is sodium citrate.
• the formulation contains a mixture of disodium EDTA and citric acid.
• the ratio of citric acid to disodium EDTA is in the range of 300: 100, for example, 100: 120, 100: 100, 200: 100, 150: 100, 300:200, and 500: 100.
• a zinc chelator is mixed with the insulin.
• the chelator may be ionic or non-ionic.
• Chelators include ethylenediaminetetraacetic acid (EDTA), EGTA, alginic acid, alpha lipoic acid, dimercaptosuccinic acid (DMSA), CDTA (1,2- diaminocyclohexanetetraacetic acid), and trisodium citrate (TSC).
• EDTA ethylenediaminetetraacetic acid
• EGTA alginic acid
• alpha lipoic acid dimercaptosuccinic acid
• CDTA 1,2- diaminocyclohexanetetraacetic acid
• TSC trisodium citrate
• Hydrochloric acid is used in conjunction with TSC to adjust the pH, and in the process gives rise to the formation of citric acid, which is a
• the chelator captures the zinc from the insulin, thereby favoring the monomeric or dimeric form of the insulin over the hexameric form and facilitating absorption of the insulin into the tissues surrounding the site of administration (e.g. mucosa, or fatty tissue).
• the chelator hydrogen may bond to the insulin, thereby aiding the charge masking of the insulin monomers and facilitating transmembrane transport of the insulin monomers.
• the chelator is EDTA.
• the formulation contains insulin, disodium EDTA, calcium chloride, and a dissolution/stabilization agent such as citric acid or sodium citrate.
• a range of 2.42 x 10 "4 M to 9.68 x 10 "2 M EDTA corresponds to a weight/volume of about 0.07 mg/ml to about 28 mg/ml if the EDTA is Ethylenediaminetetraacetic acid with a molar mass of approximately 292 grams/mole. Reduction of the concentration of EDTA can slow the rate of insulin absorption and delay the glucose response to the insulin injection. Further increases in this concentration provide negligible gains in absorption rate.
• the amount of EDTA ranges from about 5% of 1.8 mg/ml (0.09 mg/ml) to about 500% of 1.8 mg/ml (9 mg/ml), more preferably about 15% of 1.8 mg/ml (0.27 mg/ml) to about 200% of 1.8 mg/ml (3.6 mg/ml).
• the amount of EDTA can be 0.1 mg/ml, 0.25 mg/ml, 1.0 mg/ml, 1.8 mg/ml, 2.0 mg/ml, or 2.4 mg/ml of EDTA.
• the chelator is disodium EDTA, preferably, in an amount equal to or less than 2.0 mg/ml. Further increases in this
• the EDTA is a combination of disodium EDTA and calcium disodium EDTA.
• the EDTA is about 0.27- 0.3 mg/ml of disodium EDTA in combination with about 1.8-2.0 mg/ml of calcium disodium EDTA.
• the EDTA is between about 1.8-2.0 mg/ml of calcium disodium EDTA or disodium EDTA and CaCl 2 .
• the formulations contain one or more pharmaceutically acceptable magnesium compounds.
• EDTA can cause irritation at the injection site due to the complexation of endogenous calcium at the site of administration. While the inclusion of calcium EDTA can ameliorate this irritation, the addition of calcium EDTA to the formulation slows down the insulin absorption. In order to minimize or prevent injection site irritation and not change the rate of subcutaneous absorption, one or more magnesium compounds are incorporated into the formulation.
• the magnesium compounds can be an inorganic and/or organic magnesium salt.
• Suitable magnesium inorganic salts include, but are not limited to, magnesium hydroxide (Mg(OH) 2 ), magnesium sulfate Mg(S0 4 ), magnesium halides, such as magnesium chloride (MgCl 2 ), magnesium bromide (MgBr 2 ), and magnesium iodide (Mgl 2 ); magnesium
• magnesium organic salts include, but are not limited to, magnesium EDTA, magnesium lactate, amino acid chelates, such as magnesium aspartate; magnesium acetate, magnesium carbonate
• magnesium citrate magnesium citrate
• magnesium gluconate magnesium citrate
• the one or more magnesium compounds is magnesium EDTA, Mg(OH)2, MgS0 4 , or combinations thereof. In one embodiment, the one or more magnesium compounds is MgS0 4 .
• the concentration of the one or more magnesium compounds is from about 0.1 to about 10 mg/ml, preferably from about 0.1 to about 5 mg/ml, more preferably from about 0.1 to about 2 mg/ml, most preferably from about 0.2 to about 2 mg/ml.
• the formulations contains about 0.2-0.3 mg/ml Mg(OH) 2 (e.g., 0.282), about 1.7-2.0 magnesium EDTA (e.g., 1.89), and/or about 0.4-0.5 magnesium sulfate (e.g., 0.481).
• compositions may be formulated in a conventional manner using one or more physiologically acceptable carriers comprising excipients and auxiliaries which facilitate processing of the active compounds into preparations which can be used pharmaceutically.
• solubilizing agents are included with the insulin to promote rapid dissolution in aqueous media.
• Suitable solubilizing agents include wetting agents such as polysorbates, glycerin and poloxamers, non-ionic and ionic surfactants, food acids and bases (e.g. sodium bicarbonate), and alcohols, and buffer salts for pH control.
• the pH is adjusted using hydrochloric acid (HQ) or sodium hydroxide (NaOH).
• the pH of the injectable formulation is typically between about 6.8-7.8, preferably about 7.1
• Stabilizers are used to inhibit or retard drug decomposition reactions which include, by way of example, oxidative reactions. A number of stabilizers may be used.
• Suitable stabilizers include buffers; such as citrates, phosphates and acetates; polysaccharides, such as cellulose and cellulose derivatives, sulfated polysaccharides complex and simple alcohols, such as glycerol (or glycerin, or glycerine); bacteriostatic agents such as phenol, benzyl alchohol, meta-cresol (m-cresol), 2-phenoxyethanol and
• isotonic agents such as sodium chloride, glycerol (or glycerin, or glycerine), cyclic amino acids, amino acids and glucose;
• lecithins such as example natural lecithins (e.g. egg yolk lecithin or soya bean lecithin) and synthetic or semisynthetic lecithins (e.g.
• dimyristoylphosphatidylcholine dimyristoylphosphatidylcholine, dipalmitoylphosphatidylcholine or distearoyl-phosphatidylcholine; phosphatidic acids;
• phosphatidylethanolamines such as distearoyl- phosphatidylserine, dipalmitoylphosphatidylserine and
• diarachidoylphospahtidylserine phosphatidylglycerols
• phosphatidylinositols phosphatidylinositols; cardiolipins; sphingomyelins.
• solvent or co- solvent systems ethanol, PEG-300, glycerin, propylene glycol
• solubilizing agents such as polysorbates 20/80;poloxamer 188 and sorbitol.
• the stabilizer may be a combination of glycerol, bacteriostatic agents and isotonic agents.
• the most preferred formulations include glycerin and m-cresol. The range for glycerin is about 1-35 mg/ml, preferably about 10-25 mg/ml, most preferably about 19.5-22.5 mg/ml.
• the range for m-cresol is about 0.75-6 mg/ml, preferably about 1.8-3.2 mg/ml, most preferably about 2 or 3 mg/ml.
• Calcium chloride can be added to the formulation to "neutralize" any free EDTA and sodium citrate and/or citric acid is added to stabilize the dissociated monomer. Calcium chloride is more typically added to the formulation when the chelator is disodium EDTA. It is added in matched approximately equimolar concentration to the disodium EDTA. For example, if the disodium EDTA is 5mM, then 5mM calcium chloride should be used. The effective range is 80-120% of disodium EDTA. A further possible candidate for this is magnesium, added in similar quantities.
• the range for calcium chloride is about 0.1-10 mM, preferably more preferably about 2.5-7.5 mM, most preferably about 5 mM.
• commercial preparations of insulin and insulin analogs preparations can be used as the insulin of the formulations disclosed herein. Therefore, the final formulation can include additional excipients commonly found in the commercial preparations of insulin and insulin analogs, including, but not limited to, zinc, zinc chloride, phenol, sodium phosphate, zinc oxide, disodium hydrogen phosphate, sodium chloride, tromethamine, and polysorbate 20. These may also be removed from these commercially available preparations prior to adding the chelator and dissociating/stabilizing agents described herein.
• Calcium-EDTA-citric acid formulations contain: 100 U/ml of insulin, 1.8 mg/ml of calcium disodium EDTA, 2.7 mg/ml of citric acid, 20.08 mg/ml of glycerin, and 3.0 mg/ml of m-cresol ("BIOD-105 or 100 U/ml of insulin or an insulin analog, 1.8 mg/ml of disodium EDTA, 2.7 mg/ml of citric acid, 18.1 mg/ml of glycerin, 2.0 mg/ml of m-cresol, and 5 mM of calcium chloride ("BIOD-107").
• Insulin formulations containing one or more magnesium compounds were prepared as described in Table 1.
• the injectable formulation contains insulin, disodium and/or calcium disodium EDTA, citric acid, saline or glycerin, m-Cresol and chloride magnesium salt.
• the subcutaneous injectable formulation is produced by combining water, disodium EDTA, magnesium salt such as MgS0 4; citric acid, glycerin, m-Cresol and insulin by sterile filtration into multi-use injection vials or cartridges.
• the EDTA is added to the formulation(s) prior to the citric acid.
• sodium citrate is added instead of citric acid.
• citric acid is added to the formulation(s) prior to the EDTA.
• the components of the formulation are added to water: citric acid, EDTA, glycerin, m-Cresol, magnesium salt and insulin. Glycerol and m-Cresol are added as a solution while citric acid, EDTA and magnesium salt may be added as powder, crystalline or pre-dissolved in water
• the subcutaneous injectable formulation is produced by mixing water, citric acid, EDTA, glycerin and m-Cresol to form a solution (referred to as the "diluent") which is filtered and sterilized.
• the insulin is separately added to water, sterile filtered and a designated amount is added to a number of separate sterile injection bottles which is then lyophilized to form a powder.
• the lyophilized powder is stored separately from the diluent to retain its stability. Prior to administration, the diluent is added to the insulin injection bottle to dissolve the insulin and create the final reconstituted product.
• the insulin is in solution and the excipients are lyophilized, spray dried and are added to the insulin prior to injection.
• the excipients are made as a concentrated liquid and introduced to the liquid insulin prior to injection. After the predetermined amount of insulin is subcutaneously injected into the patient, the remaining insulin solution may be stored, preferably with refrigeration.
• the insulin is prepared as an aqueous solution at about pH 7.0, in vials or cartridges and kept at 4°C. IV.
• the formulations may be injected subcutaneously or intramuscularly.
• the formulation is designed to be rapidly absorbed and transported to the plasma for systemic delivery.
• Formulations containing insulin as the active agent may be administered to type 1 or type 2 diabetic patients before or during a meal. Due to the rapid absorption, the compositions can shut off the conversion of glycogen to glucose in the liver, thereby preventing hyperglycemia, the main cause of complications from diabetes and the first symptom of type 2 diabetes.
• Currently available, standard, subcutaneous injections of human insulin must be administered about one half to one hour prior to eating to provide a less than desired effect, because the insulin is absorbed too slowly to shut off the production of glucose in the liver.
• These new ultrarapid acting formulations may be taken closer to the meal.
• a potential benefit to this formulation with enhanced pharmacokinetics may be a decrease in the incidence or severity of obesity that is a frequent complication of insulin treatment.
• Example 1 Effect of Calcium disodium EDTA Concentration on Injection Site Discomfort in Humans
• Each milliliter of VIAJECT® 7 contains: 3.7 mg (100 IU) of recombinant human insulin, 1.8 mg of citric acid, 1.8 mg of disodium EDTA, 22.07 mg of glycerin, 3.0 mg of m-Cresol as a preservative, and sodium hydroxide and/or hydrochloric acid to adjust the pH to approximately 7.
• BIOD 102 contains: 3.7 mg (100 IU) of
• recombinant human insulin 1.8 mg of citric acid, 2.4 mg of calcium disodium EDTA, 15.0 mg of glycerin, 3.0 mg of m-cresol as a preservative, and sodium hydroxide and/or hydrochloric acid to adjust the pH to approximately 7.1.
• BIOD 103 contains: 3.7 mg (100 IU) of recombinant human insulin, 1.8 mg of citric acid, 0.25 mg of disodium EDTA, 2.0 mg of calcium disodium EDTA, 15.0 mg of glycerin, 3.0 mg of m-cresol as a preservative, and sodium hydroxide and/or hydrochloric acid to adjust the pH to approximately 7.1.
• Each solution was injected subcutaneously into a human volunteer and the volunteer was asked to rate the pain associated with the injection.
• VIAJECT® 7 1.8 mg of disodium EDTA
• BIOD 102 2.4 mg of calcium disodium EDTA
• BIOD 103 0.25 mg of disodium EDTA, 2.0 mg of calcium disodium EDTA
• Example 2 Study of the rate of insulin absorption of formulations BIOD 105 and BIOD 107 in miniature diabetic swine.
• the aim of this study was to evaluate the pharmacokinetic (PK) and pharmacodynamic (PD) properties of modified insulin formulations predicted to be associated with improved toleration.
• PK pharmacokinetic
• PD pharmacodynamic
• the addition of calcium EDTA to an insulin formulation (containing disodium EDTA) was shown in Example 1 to reduce the site reaction to the injection when compared to an insulin formulation containing disodium EDTA, without added calcium EDTA); however, the rapid action of the formulation was somewhat delayed from this substitution. Therefore, new insulin formulations were developed to regain the loss in timing (rapid action), and to improve stability.
• the pharmacodynamic response was calculated from the time post dose required to drop the blood glucose level 20 points from baseline and the time for blood glucose to increase 20 points from nadir. The time between these parameters is defined as duration of action. Absorption rate was calculated as the slope of line drawn from the initial increase in insulin concentration post injection (up to 30 min. post dose).
• Table 4 Comparison of the initial rate of absorption of formulations BIOD 105 and BIOD 107 to the original formulation VJ7.
• Time to 20 pt recovery time post dose for blood glucose to increase 20 point post nadir Duration is the time between time to 20 pt drop and time to 20 pt recovery.
• Example 3 Insulin formulations containing magnesium salts.
• HUMLAOG® pharmacodynamics and injection site discomfort obtained with insulin formulations containing disodium EDTA was assessed, compared to HUMLAOG®.
• HUMLAOG® contains: insulin lispro 100 units, 16 mg glycerin, 1.88 mg dibasic sodium phosphate, 3.15 mg
• Metacresol zinc oxide content adjusted to provide 0.0197 mg zinc ion, trace amounts of phenol, and water for Injection.
• Insulin lispro has a pH of 7.0 to 7.8. The pH is adjusted by addition of aqueous solutions of hydrochloric acid 10% and/or sodium hydroxide 10%..
• Insulin formulations were prepared as described above in Table 1.
• BIOD 123 The pharmacokinetics (Mean ⁇ SE) for BIOD 123, BIOD 125, and HUMLAOG® are shown in Table 7.
• BIOD- 123 contains disodium EDTA and MgS0 4; while BIOD-125 contains disodium EDTA (1.98 mg/ml); citric acid (2.7 mg/ml); glycerin (18 mg/ml); m-cresol (3 mg/ml); CaCi 2 (3.38 mg/ml); tween (1.53 mg/ml) and no magnesium compounds.
• AUCinsO-30 the 0-30 min area under the curve for insulin
• AUCinsO-45 the 0-45 min area under the curve for insulin
• AUCinsO-60 the 0-60 min area under the curve for insulin
• AUCinsO-120 the 0-120 min area under the curve for insulin
• AUCinsO- 480 the 0-480 min area under the curve for insulin
• AUCins 120-480 the 120-480 min area under the curve for insulin.
• GIR is the glucose infusion rate (mg/kg/min), or amount of glucose required to clamp a subject within a normoglycemic range, typically 80-120 mg/dL following an insulin injection.
• the GIRmax is the maximal glucose infusion rate, which occurs at TGIRmax.
• the Half maximal rate occurs before the peak (GIRearly50%) and after the peak (GIRlate50%), at
• TGIR50%early and TGIR50%late Areas under the GIR curve are estimated for the entire study duration GIRAUCO-480 (mg/kg) and segments of time between the beginning and end of the study, 0-30, 0-60, 0-120, 0-180, and 180-480 minutes.
• Graphic representation of the mean concentration vs. time profiles from time 0-60 min and 0-480 min are shown in Figures 2 and 3, respectively.
• Figure 4 and 5 are graphs of mean GIR (mg/kg/min) as a function of time (minutes) of the insulin formulations BIOD 123 and 125 compared to Humalog.
• BIOD-125 which contains disodium EDTA, CaCl 2 and no magnesium compounds
• BIOD-123 which contains disodium EDTA and MgS0 4
• Table 1 1 shows Injection Site Discomfort Results - Safety Population (LS means) and severity of injection site discomfort.
• BIOD-123 3.6 ⁇ 2.
• BIOD-125 6.8 ⁇ 2.9
• Humalog 1.8 ⁇ 1.1
• Table 12 shows the injection site discomfort relate to usual meal time insulin injection.
• BIOD-123 As shown above, the formulation containing a magnesium compound (BIOD-123, MgS04), showed significantly less injection site discomfort than the corresponding compound without MgS0 4 (BIOD-125). The duration of discomfort for BIOD-123 was significantly less than for BIOD-125 (Table 13).
• Example 4 Human study with BIOD-250 and BIOD-238 demonstrating reduced injection site pain and ultra-rapid action.
• BIOD-238 and BIOD-250 were combinations of Biodel's proprietary excipients with the marketed formulation of
• BIOD-250 The composition of BIOD-250 is shown in Table 1. BIOD- 238 has similar composition except it does not have magnesium, and has less EDTA (0.225 mg/ml).
• BIOD-238 and BIOD-250 proved to be consistent with the target product profile for analog-based ultra-rapid- acting insulin.
• VAS Visual Analog Scale
• Example 5 The PK and PD of rapid acting concentrated insulin formulation compared to commercial U-500 formulation in diabetic miniature swine.
• the aim of the present study was to evaluate the pharmacokinetic (PK) and pharmacodynamic (PD) properties of a new U-400 concentrated insulin formulation designed for prandial use.
• composition of the formulation BIOD-530 was: 3.6 mg/ml EDTA, 1.8 mg/ml trisodium citrate, 2 mg/ml m-cresol, 16 mg/ml glycerin, 12.12 mg/ml insulin (400 U/mL).
• the data shows the concentrated insulin formulation has a rapid action profile compared to the Lilly U-500 commercial formulation.
• the rapidity of the BIOD-530 formulation may be sufficient for prandial use.
• Example 6 Comparison of HUMALOG® (U-100) to BIOD-530 and BIOD-531 in diabetic miniature swine.
• the aim of the present study was to evaluate the pharmacokinetic (PK) and pharmacodynamic (PD) properties of a U-400 concentrated insulin formulation with Magnesium (BIOD-531) (TABLE 1) and a formulation without Magnesium (BIOD-530) (see Example 4) compared to
• HUMALOG® a rapid acting U-100 analog insulin for prandial use.
• BIOD-530 The composition of the formulation BIOD-530 was: 3.6 mg/ml EDTA, 1.8 mg/ml trisodium citrate, 2 mg/ml m-cresol, 16 mg/ml glycerin, 12.12 mg/ml insulin (400 U/mL).
• BIOD-53 l was the same composition as BIOD-530 with 4mm Mg S0 4 added, intended to improve injection site tolerability.
• BIOD-530 9 diabetic miniature swine were injected in the morning with 0.25 U/kg of BIOD-530, BIOD-531 or
• HUMALOG® instead of their daily insulin.
• Animals were fed 500 g of swine diet directly after dosing and plasma samples were collected at -30, - 20, -10, 0, 5, 10, 15, 20, 30, 45, 60, 75, 90, 120, 150, 180, 240, 300, 360, 420 and 480 min post dose using a Becton Dickinson K 2 EDTA vacutainer.
• Frozen plasmas were assayed for insulin content (iso insulin kit, Mercodia) and analyzed for glucose concentration (YSI 3200 analyzer, YSI Life sciences, USA).
• Example 7 Reduction of Disodium EDTA and loss of rapid absorption in diabetic miniature swine.
• BIOD-532 had 2.7 mg/ml disodium EDTA and BIOD-533 had 1.8 mg/ml disodium EDTA. The rest of the components remained the same composition as BIOD-530 (See Example 4).
• BIOD-530 9 diabetic miniature swine were injected in the morning with 0.25 U/kg of BIOD-530, BIOD-532 or BIOD- 533 instead of their daily insulin.
• Animals were fed 500 g of swine diet directly after dosing and plasma samples were collected at -30, -20, -10, 0, 5, 10, 15, 20, 30, 45, 60, 75, 90, 120, 150, 180, 240, 300, 360, 420 and 480 min post dose using a Becton Dickinson K 2 EDTA vacutainer.
• Frozen plasmas were assayed for insulin content (iso insulin kit, Mercodia) and analyzed for glucose concentration (YSI 3200 analyzer, YSI Life sciences, USA).
• Example 8 A Novel Concentrated Recombinant Human Insulin Formulation with Improved Ultra-Rapid Prandial and Similar Basal Absorption as Insulin Lispro Protamine Mixes
• Formulations of U- 100 recombinant human insulin (RHI) and insulin lispro (IL) containing EDTA and citrate show increased rates of absorption after subcutaneous (sc) injection in man compared to commercial formulations of RHI and IL.
• BIOD-530 and BIOD-531 are similar EDTA/citrate formulations with RHI concentrations of 400 U/ml.
• BIOD-530 had a significantly faster onset and similar duration of action to RHI U-500 which provides both prandial and basal coverage in type 2 diabetes patients requiring larger injection volumes.
• BIOD-531 was developed with MgS0 4 to mitigate EDTA related injection site discomfort.
• the aim of this study was to compare pharmacokinetic (PK) and pharmacodynamic (PD) profiles in diabetic miniature swine of BIOD-531 with U-100 formulations of mixtures of IL-Protamine (ILP) and IL 50/50 (ILP/IL 50/50) and 75/25 (ILP/IL 75/25) which also provide both prandial and basal coverage in patients with diabetes.
• PK pharmacokinetic
• PD pharmacodynamic
• Test formulations consisted of ILP/IL 75/25, ILP/IL 50/50 and BIOD-531. On the morning of each crossover study, miniature diabetic swine were given a sc dose (0.25 U/kg) of test formulation followed by a meal. Study 1 and Study 2 compared BIOD-531 with ILP/IL 75/25 and ILP/IL 50/50, respectively. Blood glucose and plasma insulin were sampled from -30 to 480 min post dose. Plasma insulin was measured by an ELISA method and glucose concentration determined by YSI. Time to half maximal concentration (T5o% ea ri y ) was calculated for each swine and averaged for each test article. Results of each study compared BIOD-531 to ILP/IL 75/25 or 50/50 mixtures using Students t-test.
• BIOD-531 (32-43%), ILP/IL 75/25 (45%) and ILP/IL 50/50 (35%).
• the glucose concentrations of all three formulations remained suppressed up to 480 min while insulin and glucose concentrations returned towards baseline levels around 240 min following IL administration.
• BIOD-531 has a rapid onset of action comparable to IL and a similar basal control profile to ILP/IL pre-mixed insulins. BIOD-531 has the potential to deliver improved prandial and comparable basal coverage as pre-mixed insulins with lower injection volumes.

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