Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
  • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
  • A61K31/198—Alpha-amino acids, e.g. alanine or edetic acid [EDTA]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/194—Carboxylic acids, e.g. valproic acid having two or more carboxyl groups, e.g. succinic, maleic or phthalic acid
• • 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
  • A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
  • A61K47/36—Polysaccharides; Derivatives thereof, e.g. gums, starch, alginate, dextrin, hyaluronic acid, chitosan, inulin, agar or pectin
  • A61K47/38—Cellulose; Derivatives thereof
• • 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
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
  • A61K9/4808—Preparations in capsules, e.g. of gelatin, of chocolate characterised by the form of the capsule or the structure of the filling; Capsules containing small tablets; Capsules with outer layer for immediate drug release
• • 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
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
  • A61K9/4841—Filling excipients; Inactive ingredients
  • A61K9/4858—Organic compounds
• • 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
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
  • A61K9/4841—Filling excipients; Inactive ingredients
  • A61K9/4866—Organic macromolecular compounds
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/04—Drugs for disorders of the urinary system for urolithiasis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/12—Drugs for disorders of the urinary system of the kidneys
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

• the present invention relates generally to the field of nephrology or urology, and more specifically to compositions and methods designed to treat, mitigate or prevent kidney stone disease, bladder stone disease, and ureter stone disease, and to methods of preparing such compositions.
• kidney stone disease or nephrolithiasis (as well as from related bladder and ureter stone diseases), which is a condition characterized by the appearance of stone-like matter (i.e., renal calculi, also known as nephroliths) that are formed and deposited in the patient's kidneys, bladder or ureter, respectively.
• stone-like matter i.e., renal calculi, also known as nephroliths
• Typical renal calculi include those principally composed of calcium oxalate or phosphate, cystine (the stones formed as a result of a particular kind of nephrolithiasis, cystinuria), xanthine, uric acid and struvite.
• the symptoms include strong intermittent or constant pain (i.e., renal colic), hematuria, nausea, vomiting, and urinary urgency. In severe cases, nephrolithiasis can cause permanent kidney damage and even death.
• Figure 1 demonstrates schematically a cross-section of the side view of an article of manufacture according to one embodiment of the invention.
• Figure 2 demonstrates schematically a cross-section of the side view of an article of manufacture according to another embodiment of the invention.
• a pharmaceutical composition for treating, mitigating or preventing nephrolithiasis comprising a therapeutically effective quantity of at least one pharmaceutically acceptable reducing agent capable of undergoing thiol-disulfide exchange with cystine to form a mixed disulfide, and a therapeutically effective quantity of at least one urine alkanizing agent selected from the group consisting of alkali metal salts of citric acid and alkaline-earth metal salts of citric acid.
• a method for treating, mitigating or preventing kidney stone disease, bladder stone disease or ureter stone disease comprising administering to a patient in need thereof an above-mentioned pharmaceutical composition in the form of a pill, a powder, a tablet or a troche.
• a pharmaceutical article of manufacture comprising a first element that comprises the first component that includes at least one pharmaceutically acceptable reducing agent capable of undergoing thiol-disulfide exchange with cystine to form a mixed disulfide, and a second element that comprises the second component that includes at least one urine alkanizing agent selected from the group consisting of alkali metal salts of citric acid, alkaline-earth metal salts of citric acid, and sodium bicarbonate, wherein the first element is completely ensconced within the second element.
• the first element can be a solid structure optionally coated with a pharmaceutically suitable coating, or can comprise an optionally acid resistant first solid shell defining a first space therein, the first space containing the first component.
• the second element can be a solid structure optionally coated with a pharmaceutically suitable coating, or can comprise an optionally acid resistant second solid shell, and the first element and the second element define the second space
• a method for treating, mitigating or preventing kidney stone disease, bladder stone disease or ureter stone disease comprising administering to a patient in need thereof an above-mentioned pharmaceutical article of manufacture in the form of a pill, a capsule, a tablet or a troche.
• “About” as used herein means that a number referred to as “about” comprises the recited number plus or minus 1-10% of that recited number. For example, “about” 100 degrees can mean 95-105 degrees or as few as 99-101 degrees depending on the context. Whenever it appears herein, a numerical range such as “1 to 20” refers to each integer in the given range; i.e., meaning only 1, only 2, only 3, etc., up to and including only 20. [0017]
• pharmaceutical composition is defined as a chemical or biological compound or substance, or a mixture or combination of two or more such compounds or substances, intended for use in the medical diagnosis, cure, treatment,
• kidney stone disease and “nephrolithiasis” refer to a urological or nephrological disease or condition manifesting itself by having renal calculi (nephroliths) formed and deposited in the patient's kidneys.
• blade stone disease and “ureter stone disease” refer to urological diseases or conditions manifesting themselves by having stone-like matter (cystoliths) formed and deposited in the patient's urinary bladder or ureter, respectively.
• cystineuria refers to a kidney, bladder and/or ureter stone disease that is characterized by the formation of cystine stones in the kidneys, ureter, and bladder (i.e., the calculi formed as a result of precipitation of cystine out of urine).
• alkanizing agent refers to a chemical compound or a drug that is administered to a patient having diseases or medical disorders associated with low pH of bodily fluids (e.g., blood), in order to increase the pH.
• reducing agent refers to an electron-donor compound, i.e., a compound that donates an electron to another chemical species in a redox chemical reaction.
• thiol and “thiol moiety” refer to an organic compound that is a sulfur- containing analog of an alcohol, i.e., a compound containing the group— SH.
• thiol-disulfide exchange refers to a chemical reaction described generally as follows:
• amino acid and “amino acid moiety” refer to an organic compound having both a carboxyl (-COOH) and an amino (-NH 2 ) group.
• amino acid and “amino acid moiety” refer to an organic compound having both a carboxyl (-COOH) and an amino (-NH 2 ) group.
• glycine refers to aminoacetic acid having the structure NH2-CH2- COOH.
• cysttine refers to 2-amino-3-(2-amino-2-carboxy- ethyl)disulfanylpropanoic acid (i.e., an amino acid having the structure HOOC-CH(NH 2 )- CH2-S-S-CH 2 -CH( -i2)-COOH).
• citrate refers to salts of citric acid (2-hydroxy-l,2,3-propanetricarboxylic acid).
• alkali metal refers to the following elements of Group I of the Periodic Table: potassium, sodium, and lithium.
• alkaline-earth metal refers to the following elements of Group II of the Periodic Table: magnesium, calcium, and barium.
• homogeneous mixture refers to a combination of several separate substances forming a blend which visibly manifests itself as a single phase, where the individual components of the blend have the same proportions throughout a given volume creating a consistent mixture.
• tablette and “pill” refer to a generally spherical (for pills) or disk-shaped (for tablets) compressed solid articles containing a medicament to be taken orally.
• capsule refers to a small, soluble container containing a dose of medicine, to be swallowed whole.
• doctore refers to a small tablet or lozenge (i.e., a medicated candy intended to be dissolved in the mouth), typically in a form of a disk, a ball or rhombic in cross-section, comprising medication and processed into a paste and dried.
• binder refers to a pharmaceutical preparation in a solid dosage form comprised of a large number of finely divided solid particles of drugs or mixture of drugs and having the size of particles generally in the range of between about 0.1 ⁇ and about 1 ⁇ .
• terapéuticaally effective amount is defined as the amount of the compound or pharmaceutical composition that will elicit the biological or medical response of a tissue, system, animal or human, that is being sought by the researcher, medical doctor or other clinician.
• pharmaceutically acceptable is defined as a carrier, whether diluent or excipient, that is compatible with the other ingredients of the formulation and not deleterious to the recipient thereof.
• administration of a composition or “administering a composition” is defined to include an act of providing a compound of the invention or pharmaceutical composition to the subject in need of treatment.
• compositions for treating, mitigating or preventing kidney stone disease, bladder stone disease or ureter stone disease.
• the compositions of the present invention comprise a therapeutically effective quantity of at least one pharmaceutically acceptable reducing agent capable of undergoing thiol-disulfide exchange with cystine to form a mixed disulfide, and a therapeutically effective quantity of at least one urine alkanizing agent selected from the group consisting of alkali metal salts of citric acid, alkaline-earth metal salts of citric acid, and sodium bicarbonate.
• compositions of the invention are so formulated that the at least one reducing agent mentioned above and the at least one urine alkanizing agent also mentioned above form a homogeneous mixture, as the latter is defined herein.
• the reducing agent comprises a thiol moiety and an amino acid moiety and may be, e.g., N-(2-mercaptopropionyl) glycine having the chemical formula:
• Tiopronin is capable of binding cystine by thiol-disulfide exchange, to form a mixed disulfide of tiopronin-cysteine.
• (2S)-2-amino-3-methyl-3-sulfanylbutanoic acid having the formula: also known as D-penicilamine or under the trade name CUPRIMINE ® (Valeant
• Penicilamine may be used as the sole reducing agent in the composition or in a combination with tiopronin, if desired.
• captopril l-(3-mercapto-2-methyl-l-oxopropyl)-L-proline
• CAPOTEN® Bristol-Myers Squibb
• compositions of the invention are to be formulated as pills, tablets, capsules or troches for oral administration.
• the concentration of the reducing agent(s) described above, in the compositions may be between about 25.0 mass % and about 50.0 mass % of the total mass of the pill, tablet, capsule, troche or powder.
• the mass quantity of the reducing agent(s) may be between about 100 mg and about 1,000 mg, such as between about 150 mg and about 500 mg, for example about 200 mg.
• a urine alkanizing agent such as potassium citrate, sodium citrate, magnesium citrate, sodium bicarbonate or combinations thereof may be used.
• the concentration of the urine alkanizing agent(s) described above in the compositions may be between about 25.0 mass % and about 70.0 mass % of the total mass of the pill, tablet, capsule, troche or powder, for example, about 60.0 mass %.
• the mass quantity of the urine alkanizing agent(s) may be between about 100 mg and about 800 mg, such as between about 200 mg and about 800 mg, for example about 500 mg.
• the pharmaceutical composition may further optionally include one or several pharmaceutically acceptable excipient(s).
• an excipient that can be used may be one or several filler(s) to be selected by those having ordinary skill in the art, such as microcrystalline cellulose and/or hydroxypropyl
• Methocell ® E4M which is a component allowing delayed release, can be used for preparing the formulations in the form of AR (i.e., acid-resistant) capsules to protect from gastric acid and delay dissolution.
• AR i.e., acid-resistant
• formulations may be optionally compounded as delayed release compositions.
• the concentration of such excipient(s), if used, in the compositions may between about 20.0 mass % and about 25.0 mass % of the total mass of the pill, tablet, capsule, troche or powder.
• the mass quantity of the urine alkanizing agent(s) may be between about 100 mg and about 400 mg.
• one or both of the reducing agent(s) and urine alkanizing agent(s) may be utilized without the use of encapsulating shells; instead uncoated or coated tablets, pills or troches may be employed. If the coated tablets, pills or troches are used, those having ordinary skill in the art will select the most appropriate coatings, as is known in the art. Acid-resistant and/or delayed release coatings may be so used, if desired.
• a one-batch formulation method may be used, where the components of the pharmaceutical formulation can be combined in single container; the components may be added to the container simultaneously or consecutively.
• a quantity of reducing agent(s) and a quantity of urine alkanizing agent(s) may be placed into a mixing container (e.g., a mortar) followed by dry mixing with a pestle.
• the resulting product may then be adapted for oral administration, for example formulated and shaped as pill, tablet, capsule, troche or powder according to methods known to those having ordinary skill in the art.
• the medication prepared as described above may then be prescribed and given to a patient for treating, mitigating or preventing kidney stone disease, bladder stone disease or ureter stone disease.
• kidney, bladder or ureter stone disease that may be treated, one kind of treatment that is particularly envisioned according to embodiments of the present invention is the treatment, mitigation or prevention of cystinuria.
• each article comprises a first element, comprising the first component that includes at least one pharmaceutically acceptable reducing agent capable of undergoing thiol-disulfide exchange with cystine to form a mixed disulfide.
• the article further provides a second element, comprising the second component that includes at least one urine alkanizing agent selected from the group consisting of alkali metal salts of citric acid, alkaline-earth metal salts of citric acid, and sodium bicarbonate.
• the first element is incorporated into the second element, so that the former is completely ensconced within the latter.
• Figure 1 shows a cross-section of the side view of an article 100
• capsule-in-capsule having an inner capsule 1 incorporated into a large outer capsule 2.
• the space 3 inside capsule 1 is filled with a quantity of one or several reducing agent(s) capable of undergoing thiol-disulfide exchange with cystine to form a mixed disulfide, as described above.
• the space 4 between capsules 1 and 2 is filled with one or several urine alkanizing agent(s) also described above (e.g., alkali metal salts of citric acid, alkaline-earth metal salts of citric acid, sodium bicarbonate).
• the longer diameter of the larger capsule 2 can be between about 20 mm and about 22 mm, such as between about 15 mm and about 20 mm, for example, about 20 mm, and the shorter diameter of the larger capsule 2 can be between about 8 mm and about 12 mm, for example, about 10 mm.
• the dimensions of the smaller inner capsule 1 may be generally at about 50% of the corresponding dimensions of the outer capsule 2.
• the article 200 includes a larger capsule 5 incorporating a smaller tablet 6 made of one or several reducing agent(s) described above.
• the rest of the capsule 5 is filled with one or several urine alkanizing agent(s) also described above.
• Another illustrative, non-limiting example can be an article having a larger tablet made of one or several urine alkanizing agent(s) incorporating a smaller tablet made of one or several reducing agent(s).
• kits are provided.
• the kit includes a sealed container approved for the storage of pharmaceutical compositions, and the above- described pharmaceutical composition.
• An instruction for the use of the composition and the information about the composition are to be included in the kit.
• a pharmaceutical composition can be prepared as described below. The following components were used in the amounts and concentrations specified:
• Tiopronin, potassium citrate, and Methocell ® E4M powders can be mixed using a mortar and pestle method by using the principles of trituration and geometric dilution known to those having the skill in the art of preparing pharmaceutical compositions. To wit, potassium citrate, and Methocell ® E4M powders can be mixed into tiopronin powder in small portions until a completely homogenous mixture has been obtained.
• the resulting product can be encapsulated into AR Caps ® Clear, Size 0 or 1, the capsules can be put into an airtight container, and the container can be labeled accordingly.

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• Health & Medical Sciences (AREA)
• Chemical & Material Sciences (AREA)
• Veterinary Medicine (AREA)
• Life Sciences & Earth Sciences (AREA)
• Public Health (AREA)
• General Health & Medical Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• Medicinal Chemistry (AREA)
• Pharmacology & Pharmacy (AREA)
• Epidemiology (AREA)
• Bioinformatics & Cheminformatics (AREA)
• Engineering & Computer Science (AREA)
• Organic Chemistry (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Urology & Nephrology (AREA)
• General Chemical & Material Sciences (AREA)
• Chemical Kinetics & Catalysis (AREA)
• Inorganic Chemistry (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
• Medicinal Preparation (AREA)
• Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)

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• 2016
  • 2016-12-19 JP JP2018532419A patent/JP2019504024A/ja active Pending
  • 2016-12-19 EP EP16879926.0A patent/EP3393469A4/en not_active Withdrawn
  • 2016-12-19 US US15/383,211 patent/US20170172960A1/en not_active Abandoned
  • 2016-12-19 CA CA3009332A patent/CA3009332A1/en not_active Abandoned
  • 2016-12-19 WO PCT/US2016/067466 patent/WO2017112574A1/en not_active Ceased
  • 2016-12-19 KR KR1020187020408A patent/KR20180095647A/ko not_active Withdrawn
  • 2016-12-19 AU AU2016378399A patent/AU2016378399A1/en not_active Abandoned

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