Hyaluronic acid fractions having pharmaceutical activity, methods for preparation thereof, and pharmaceutical compositions containing the same.

^ 4) Agent (s): Marc-Roger HIRSCH

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HYALURONIC ACID FRACTIONS HAVING PHARMACEUTICAL ACTIVITY, METHODS FOR THEIR PREPARATION AND PHARMACEUTICAL COMPOSITIONS CONTAINING THEM

The invention relates to fractions, of specific molecular weight of hyaluronic acid (hereinafter referred to as HA) having therapeutic applications and which are non-inflammatory. One of the HA fractions according to the invention is useful for facilitating the healing of wounds, while the second fraction of HA has an intra-ocular application, and can replace endobulbar fluids or be used in intra-articular injection. area for the treatment of damaged bone joints. HA fractions have also been found to be useful as a vehicle for ophthalmic medication, providing formulations compatible with the corneal epithelium and enhancing the activity of ophthalmic medications.

Hyaluronic acid is a naturally occurring heteropolysaccharide consisting of alternating residues of D-glucoronic acid and N-acetyl-D-glucosamine. HA is a linear polymer of high molecular weight, usually around 8 to 13 million, and is found in the lining of cells, the extra-cellular base substance of vertebrate connective tissues, in the synovial fluid of joints, in the endobulbar fluids of the eye, in the tissue of the human umbilical cord and in the crests of roosters.

Previous studies on the use of HA are described in the work of Baïazs, (United States Patent No. 4,141,973) describing a fraction of HA useful for replacing endobulbar fluids as well as others therapeutic applications. This patent is, however, specifically directed to a fraction of HA having an average molecular weight greater than about 750,000 and preferably greater than about 1,200,000. Balazs teaches, specifically, that HA fractions with an average molecular weight of less than 750,000 cannot be used therapeutically because of their inflammatory activity. These HA fractions, of lower molecular weight, are rejected by Balazs. However, this amounts to rejecting about 90% of the total amount of HA available that can be obtained from the tissues, and amounts to using only a small amount (about 10%) of the available HA.

Contrary to the teachings of Balazs, the applicant has discovered that the HA fractions of lower molecular weight have, in fact, a useful pharmaceutical activity. Thus, according to the present invention, about 80% of the HA which can be obtained from various sources is used. In particular, the Applicant has discovered a fraction of HA which is useful for stimulating wound healing, and a second fraction of HA which can be used for intra-ocular injection, and can replace the endobulbar fluids of the eye and can be used in intra-articular injections for the treatment of damaged joints.

FIG. 1 is a curve showing the various fractions of hyaluronic acid which have been identified by the applicant.

As discussed above, previous studies on HA such as, for example, those of the Balazs patent have been directed towards the use of high molecular weight fractions having an average molecular weight greater than 750,000. The Applicant has isolated and characterized two new HA fractions, one having a low molecular weight and the other having an average molecular weight, which are considered to be substantially pure and having no inflammatory activity. These new HA fractions can be obtained from various connective tissues which contain extractable amounts of hyaluronic acid. The specific fractions of the product according to the invention are differentiated and separated according to molecular filtration techniques.

The first isolated fraction was called hyalastine and it has an average molecular weight of about 50,000 to about 100,000. This fraction of hyalastine has been determined to be suitable for therapeutic, veterinary and human use because of its healing activity sores. The second isolated fraction was called hyalectin and it has an average molecular weight of approximately 500,000 to approximately 730,000. This fraction of hyalectin is capable of being used in eye surgery as a substitute for endobulbar fluids and in veterinary and human therapeutics for traumas and degenerative diseases of the joints.

Hyalastine can be administered either by intradermal injection or by topical application for wound healing. Hyalectin, on the other hand, is suitable for intra-ocular and intra-articular injections.

The Applicant has carried out important studies on the various fractions of HA and has, significantly more precisely than before, specifically determined the therapeutically useful fractions of HA and the inflammatory and non-useful fractions of HA. These studies have resulted in 1¹ identification and investigation of two specific characteristics of HA fractions, namely cell mobilizing activity and intrinsic viscosity. The wound healing process in animals is facilitated by cell mobilization and, in particular, the mobilization of fibroblasts. On the other hand, cell mobilization or proliferation activity (i.e. mitosis) should be avoided in cases of surgery inside the eyeball. This is particularly true in operations intended to correct the detachment of the retina where an increased speed of scarring could have harmful effects.

The intrinsic viscosity is also an important parameter to consider in determining the utility of a fraction of HA. A fraction with a high intrinsic viscosity is useful in surgery for the treatment of trauma and degenerative diseases of the joints and in the replacement of endobulbar fluids. On the other hand, high viscosity is an undesirable characteristic of the fractions intended to be used as a medicament to facilitate wound healing. In fact, the fractions to be used in wound healing should be of low viscosity so as to be more easily used in practical application.

It has been found that the fraction of hyalastine identified by the applicant has good cell mobilization or proliferation activity and characteristics of low viscosity. Consequently, hyalastine has the desirable characteristics for a material that promotes wound healing.

The same characteristics make the hyalastine fraction undesirable for treatments comprising intra-ocular or intra-articular injection.

It has also been found that the fraction of hyalectin identified by the applicant has negligible cell mobilization or proliferation activity, while at the same time it has a high viscosity. These characteristics therefore make the hyalectin fraction useful for treatments requiring intra-ocular or intra-articular injections. But, on the other hand, hyalectin cannot be suitable for wound healing treatments because this fraction does not exhibit cell mobilization activity.

When isolating useful fractions of hyaluronic acid, it is also important to obtain those fractions which have no inflammatory activity. The Balazs patent indicated above teaches that in order to obtain fractions of hyaluronic acid without inflammatory activity, only fractions having an average molecular weight of more than 750,000 should be used. Balazs therefore rejects fractions with an average molecular weight of less than 750,000 as not being useful because of their inflammatory activity. Contrary to Balazs' teachings, the Applicant has found that the inflammatory activity attributed by Balazs to fractions having an average molecular weight less than 750,000 was in fact due to impurities having an average molecular weight less than 30,000. Thus, the present invention provides a method which comprises a series of molecular filtration techniques associated with chemical methods allowing the elimination of inflammatory fractions having a molecular weight of less than 30,000.

By the methods according to the invention, it is possible to obtain useful fractions of hyaluronic acid having no inflammatory activity and which, when considered together, constitute a total yield of approximately 80%. total hyaluronic acid available from the specific starting materials. This 80% yield of available hyaluronic acid includes a combined fraction which is a combination of the hyalectin and hyalastine fractions and which has an average molecular weight of about 250,000 to about 350,000. More specifically, the hyalectin fraction is obtained with a yield of approximately 30% of the available HA and the fraction of hyalastine is obtained with a yield of approximately 50% of the available HA from the starting tissues.

This factor represents a significant improvement over the process of the Balazs patent discussed above in that the Applicant has discovered that significantly increased amounts of available hyaluronic acid are pharmaceutically useful. By using only the fraction having an average molecular weight greater than 750,000, the Balazs process only leads to a yield of approximately 10% compared to the original hyaluronic acid obtained from animal organs and it rejects about 90% of the available hyaluronic acid. Thus, according to the present invention, the use of the total hyaluronic extract is greatly increased.

A comparison of the relative yields of the extraction of the various hyaluronic acid fractions is presented below in Table I.

TABLE I

<td>type of hyaluronic acid</td><td>g per 100 g of fresh tissue</td><td> %</td><td>reference</td>

<td>total hyaluronic acid from rooster crests</td><td> 0,08</td><td> 100</td><td>Swann DA 1968</td>

<td>HA (Balazs type)</td><td> 0,08</td><td> 10</td><td>Biochim, Biophys. Acta 156, 17-29 US patent</td>

<td>hyalectin + hamastine</td><td> 0.6</td><td> 80</td><td>n ° 4 141 973 present invention</td>

<td>hyalectin</td><td> 0,2</td><td> 30</td><td>present invention</td>

<td>hyalastine</td><td> 0,4</td><td> 50</td><td>present invention</td>

<td>inflammatory fraction</td><td> 0,16</td><td> 20</td><td>present invention</td>

FIG. 1 represents, graphically, the different fractions of HA that the applicant has identified. The curve, in solid lines, in the shape of a bell in FIG. 1, represents the approximate distribution of the fractions of HA available from a starting tissue. Zone B of FIG. 1 represents the fraction of HA identified by Balazs in United States patent No. 4,143,973 as being useful in pharmacy. Zones A, I and II in FIG. 1 are the fractions identified by the applicant, zone A being the inflammatory fraction having an average molecular weight of less than 30,000; zone I being the fraction of hyalastine and zone II being the fraction of hyalectin. From this curve, it can be seen that the Balazs method rejects the vast majority of extractable HA available by eliminating the HA fractions having an average molecular weight of less than 750,000. The present invention, on the other hand, allows the use in pharmacies of a large proportion of the available HA since the fraction of hyaluronic acid of low molecular weight having an average molecular weight of less than 30,000 causes the inflammatory activity that the previous researchers had found it with various extracts from HA.

The Applicant has discovered that a large percentage of available HA could in fact be used for therapeutic purposes if the separation according to the teachings of the present invention is carried out according to the particular therapeutic application. While the Balazs patent specifically teaches the use of only about 10% of the available HA, the present invention allows the use of about 80% of the available HA, either in the form of the hyalastine fraction for the applications of wound healing, either in the form of the hyalectin fraction for intra-ocular and intra-articular applications, either in the form of a combined fraction of hyalastine and hyalectin which can also be used for wound healing applications.

The chemical and physical characteristics of the fractions identified have also been studied by the applicant and these characteristics are summarized in Table 2.

PREPARATION METHODS

EXAMPLE 1 Process for obtaining a mixture of hyalastine and hyalectin fractions without inflammatory activity.

Rooster crests, either fresh or frozen (3000 g) are minced in a meat grinder and then carefully homogenized in a mechanical homogenizer. The resulting paste is placed in an AISI 316 stainless steel container or in a glass container together with 10 volumes of anhydrous acetone. The total content is then stirred for 6 hours at a speed of 50 g / min and the separation is allowed to continue for 12 hours, then eliminates the acetone by siphoning and rejects it.

This extraction process is repeated until the discharged acetone has reached the correct humidity level (KarlFisher method).

The resulting substance is then centrifuged and dried under vacuum at a suitable temperature for 5 to 8 hours. With this process, approximately 500 to 600 g of dry powder is obtained from the crests of roosters.

300 g of the dry powder are then subjected to an enzymatic digestion process with papain (0.2 g) in an aqueous medium buffered with a Lainpun phosphate in the presence of a suitable quantity of cysteine ​​hydrochloride. This mixture is then stirred for 24 hours at 60 g / min and at a constant temperature of 60 to 65 ° C. The whole mass is cooled to 25 ° C., 60 g of Celite (R) are added and stirring is continued for another hour.

TABLE 2

CHEMICAL AND PHYSICAL CHARACTERISTICS

<td>Fractions</td><td>PM</td><td colspan="2">dynamic viscosity at 20 ° C</td><td>titer in hyaluronic acid in % powder dried</td><td>protein content calculated in bovine albumin</td><td>sulfur sulfide content</td>

<td>hyalastine +</td><td></td><td></td><td></td><td></td><td></td><td></td>

<td>hyalectin</td><td> 250.000-350.000</td><td> 100</td><td>mP.s</td><td></td><td></td><td></td>

<td></td><td></td><td>(conc.</td><td>1% w / v)</td><td> &gt;96%^at</td><td> &lt;0,5%</td><td> &lt;1%</td>

<td>hyalastine</td><td> 50.000-100.000</td><td> 600</td><td>mP.s</td><td></td><td></td><td></td>

<td></td><td></td><td>(conc.</td><td>5% w / v)</td><td> &gt;96%</td><td> &lt;0,5%</td><td> &lt;1%</td>

<td>hyalectin</td><td> 500.000-730.000</td><td> 170</td><td>mP.s</td><td></td><td></td><td></td>

<td></td><td></td><td>(conc.</td><td>1% w / v)</td><td> &gt;96%</td><td> &lt;0,5%</td><td> &lt;1%</td>

the values ​​recorded represent the titer in HA after elimination in water.

For example, a titer of 96% indicates that, after elimination of water, the powder contains 4% of impurities and 96% of hyaluronic acid.

The resulting mixture is filtered until a clear liquid is obtained. This clear liquid then undergoes molecular filtration by means of membranes having a molecular exclusion limit of 30,000 to retain, on the membrane, molecules having a molecular weight greater than 30,000. Five to six volumes are ultra-filtered originally and, at the same time, distilled water is continuously added to the product. The addition of distilled water is suspended and the product is ultra-filtered until it is reduced to one third of its original volume.

The liquid residue is made 0.1 μM by addition of sodium chloride and the temperature is brought to 50 ° C. 45 g of cethylpyridinium chloride are added while the product is stirred at 60 g / min. This mixture is stirred for 60 minutes, and then 50 g of Celite are added with stirring, the temperature of the product is brought back to 25 ° C. and the precipitate formed is collected by centrifugation. The precipitate thus obtained is suspended in a solution of 0.01M of sodium chloride (5 liters) containing 0.05% of cethylpyridinium chloride. It is further stirred for 60 minutes at 50 ° C. The temperature is lowered to 25 ° C and the precipitate is centrifuged.

The washing process is then repeated three times and the precipitate is finally collected in containers containing three liters of a 0.05M solution of sodium chloride containing 0.05% of cethylpyridinium chloride. The mixture is stirred at 60 g / min for 60 minutes and a constant temperature of 25 ° C. is maintained for a period of two hours. The supernatant is removed by centrifugation.

This procedure is then repeated several times with a 0.1M sodium chloride solution containing 0.05% cethylpyridinium chloride. The mixture is centrifuged and what floats is rejected. The precipitate is dispersed in a 0.30M sodium chloride solution containing 0.05% cethylpyridinium chloride (3 liters). The mixture is stirred and both the precipitate and the clear liquid are collected. The extraction is repeated on the precipitate a further three times, each using 0.5 liters of the same aqueous solution.

Finally, the residual precipitate is removed and the clear liquids are collected in a single container. The temperature of the liquid is increased to 50 ° C while stirring. The liquid is then brought to 0.23M with sodium chloride. 1 g of cethylpyridinium chloride chloride is added and stirring is continued for 12 hours. The mixture is cooled to 25 ° C and it is then filtered first through packings of this Celite ^ and then through a filter (1P).

The resulting mixture then undergoes additional molecular ultrafiltration through membranes having a molecular exclusion limit of 30,000, ultrafiltrating 3 original volumes with the addition of a 0.33M sodium chloride solution. The addition of the sodium chloride solution is stopped and the volume of liquid is reduced to a quarter of its original volume.

The solution thus concentrated is precipitated with stirring (60 g / min) at a temperature of 25 ° C with three volumes of ethanol (95%). The precipitate is collected by centrifugation and what floats is rejected. The precipitate is dissolved in one liter of 0.1M sodium chloride solution and the precipitation process is repeated with three volumes of 95% ethanol.

The precipitate is collected and washed, first with 75% ethanol (three times), then absolute ethanol (three times) and third with absolute acetone (three times).

The product thus obtained (fraction of hyalastine + hyalectin) has an average molecular weight of between 250,000 and 350,000.

The yield of hyaluronic acid is equal to 0.6% of the original tii.'iu frai ·.

EXAMPLE 2 - Method for obtaining the hyalastine fraction from the mixture obtained by the method described in Example 1.

The mixture obtained by the method described in Example 1 is dissolved in distilled water free of pyrogen in proportion to 10 mg of product per ml of water. The solution thus obtained undergoes molecular ultrafiltration through a membrane having a molecular exclusion limit of 200,000 with a concentration technique and without the addition of water to the membrane. During the filtration process through membranes with an exclusion limit of 200,000, molecules with a molecular weight above 200,000 do not pass while smaller molecules pass through the membrane at the same time with water. . During the filtration process, no water is added to the compartment located above the membrane; therefore, the volume in this compartment decreases and at the same time there is an increase in the concentration of molecules with a molecular weight greater than 200,000. Ultrafiltration is then carried out until the volume on the membrane is reduced to 10% of the initial volume. Two volumes of pyrogen-free bi-distilled water are added and the solution is again ultrafiltered until the volume is reduced to one third. The operation is repeated two more times.

The solution which passes through the membrane is brought to 1.0 M with sodium chloride and it is then precipitated with four volumes of 95% ethanol. The precipitate is washed three times with 75% ethanol and is then dried under vacuum.

The product thus obtained (hyalastine fraction) has an average molecular weight of between 50,000 and 100,000.

The yield of hyaluronic acid is equal to 0.4% of the original fresh tissue.

EXAMPLE 3 - Method for obtaining the hyalectin fraction.

The concentrated solution, collected in a container from the ultrafiltration membrane having a molecular exclusion limit of 200,000 described in Example 2, is diluted with water until a solution containing 5 mg / ml of hyaluronic acid as determined by a quantitative analysis based on a test of glycuronic acid.

The solution is brought to 0.1 μM in sodium chloride and it is then precipitated with 4 volumes of 95% ethanol. The precipitate is washed three times with 75% ethanol and it is then dried under vacuum.

The product thus obtained (fraction of hyalectin) has an average molecular weight of between 500,000 and 730,000. This corresponds to a fraction of specific hyaluronic acid having a defined molecular chain length of approximately 250,000 to 350,000 saccharide units with a high degree of purity.

The yield of hyaluronic acid is equal to 0.2% of the original fresh tissue.

EVALUATION OF BIOLOGICAL AND PHARMACOLOGICAL ACTIVITY

1.- Biological activity of cellular mobilization of hyaluronic acid fractions

The method consisting in determining the activity of detachment of fibroblasts in a culture is used as a method for evaluating the activity of mobilization of cells of the HA fractions.

BALB 3T3 mouse cells are cultured on a medium of

Dulbecco modified Eagle with 10% calf serum, penicillin (250 units / ml) and streptomycin (0.25 mg / ml), and they are incubated in 5% humidified COg, 95% air at 37 ° C. For experimental purposes, cells are conventionally inoculated into plastic tissue culture dishes with a diameter of 60 mm (6 x $ 10 cells / box). &gt;

Conjugated monolayers of 3T3 cells are decanted and fresh medium containing 2.0 mg / ml of different HA fractions is added. At fixed intervals, the detachment of the cells is observed both under the microscope and by counting the mobilized cells in a Coulter counter.

Detachment tests

To measure the kinetics of the detachment, cells are inoculated into plastic boxes and allowed to grow. for 24 hours. After this time, the culture medium is decanted and fresh medium containing 2.0 mg / ml of HA is added. Every 24 hours, two dishes, one from test culture and one from control culture, are decanted and both the cells in the supernatant and the bound cells are counted in a Coulter counter. Table 3 gives the results obtained with tests using the fractions obtained in the examples of preparation 1 to 3 above.

TABLE 3

Results of mobilization studies

<td>Fraction</td><td>Concentration (mg / ml)</td><td>Number of cells detached by comparison with controls</td><td>% efficiency (compared to controls)</td>

<td>witness</td><td></td><td>2 x 10⁶</td><td></td>

<td>hyalectin + hyalas</td><td>tine 2</td><td>3.5 x 10⁶</td><td> 75</td>

<td>hyalectin</td><td> 2</td><td>2.1 x 10⁶</td><td> 5</td>

<td>hyalastine</td><td> 2</td><td>5 x 10⁶</td><td> 150</td>

The data indicated in Table 3 show that the fraction of hyalastine manifests a high cell mobilization activity which makes this fraction useful for wound healing applications. This activity of mobilizing hyalastine cells stimulates the migration and proliferation of new cells when a pharmaceutical preparation of the fraction is applied to an area of ​​damaged tissue.

'

The hyalectin fraction exhibits very limited cell mobilization activity and is therefore not useful for wound healing. However, hyalectin, because of its high average molecular weight and inherent viscosity, is useful for ocular and intra-articular injections, and the appreciable lack of cell mobilization activity is an important characteristic of the fraction of hyalectin which makes it especially useful for intra-ocular and intra-articular injections.

2.- Biological inflammatory activity of hyaluronic acid fractions

For this evaluation, the invasive cell count method is used after intra-ocular administration in rabbits.

Method

Five (5) New Zealand or California rabbits weighing approximately 2 kg, with vision considered to be perfect, are used for this test. The outside of the rabbit eye is checked for inflammatory processes at the macroscopic level and the inside of the eye is checked with an ophthalmoscope. If the fundus is clearly visible and normal, the test can take place.

The selected animals undergo local anesthesia by instillation of a few drops of a sterile anesthetic suitable for ophthalmology, a few drops of atropine in ophthalmological solution are also instilled.

The test is carried out under sterile conditions. The eyeball is brought out by applying pressure until it is possible to inject, through the sclera about 5 to 6 mm from the edge of the cornea, in the center of the vitreous humor, 100 μl of the solution using a 26G needle. The other eye is taken as a witness. Two drops of antibiotic solution are instilled into the treated eye and the animals are then placed alone in cages.

After 50 to 60 hours, the test can continue. The eyes are checked in the same way as above for the selection of animals. The animals are sacrificed with an intravenous injection of pentothal. Next, the aqueous humor is first collected (about 0.2 ml) using an insulin syringe with a 26G needle. The eyeballs are then enucleated, stripped of all foreign matter, washed in saline, dried on paper, incised and opened in petri dishes; the main part of the vitreous humor is separated and collected with a sterile syringe (approximately 0.7 ml). The vitreous humor is placed in small polyethylene test tubes and 50 μΐ of hyaluronidase (100 U NF / ml) are added. The mixture is then kept at a temperature of 37 ° C for about 3 hours to make the solution less viscous.

A leukocyte count is carried out under a phase contrast microscope (120 X) in a Burker chamber. A series of counts is carried out on each sample, the average values ​​are calculated and the result is expressed in number of leukocytes per mm³.

The test is considered positive when:

1. - the eyes examined show no sign of damage, and

2. - the average number of leukocytes from at least four of the five eyes treated does not exceed 200 per mm³ and the average number of leukocytes from each control eye does not exceed 50 per mm³.

Table 4 shows the results obtained from this evaluation using the HA fractions obtained in Preparation Examples 1 to 3 discussed above.

TABLE 4

Results of inflammatory activity studies

<td>Fraction</td><td>Number of invasive cells</td>

<td>. witness</td><td> 25</td>

<td>. hyalastine + hyalectin</td><td> 32</td>

<td>. hyalastine</td><td> 20</td>

<td>. hyalectin</td><td> 22</td>

<td>. inflammatory fraction (mean PM</td><td></td>

<td>30,000)</td><td> 150</td>

<td>. total hyaluronic acid from</td><td></td>

<td>of roosters (RF. Swann DA</td><td></td>

<td>1968, BB; A. 156, 17-29)</td><td> 120</td>

The results indicated in Table 4 indicate that the fractions of hyalastine and hyalectin do not show any inflammatory activity greater than that of the control and the combined fraction of hyalastine and hyalectin only shows a negligible increase in inflammatory activity compared to witness. Therefore, the fractions of hyalastine and hyalectin are pharmaceutically useful without manifesting undesirable inflammatory side effects. These results also confirm the discovery by the Applicant that it is the fraction of HA having a low average molecular weight of less than 30,000 which is responsible for the inflammatory activity of the preparations of HA. Hyaluronic acid from rooster crests prepared according to the method described in the literature by Swann (Swann

DA, 1968, BBA 156, 17-29) exhibits remarkable inflammatory activity.

It has thus been demonstrated that the fraction of hyalastine having an average molecular weight of approximately 50,000 to 100,000 exhibits a high cell mobilization activity and that it is therefore useful in wound healing applications without manifesting unwanted inflammatory reactions. The hyalectin fraction having an average molecular weight of about 500,000 to 730,000 has been shown to be useful for making ocular and intraocular injections because of its high molecular weight and inherent viscosity and because, at the same time time, it does not stimulate cell mobilization activity or inflammatory reactions which are undesirable side effects to be avoided in these pharmaceutical applications.

More specifically, we have found that the hyalastine fraction is useful as a wound healing preparation because of the following characteristics:

1. the preparation promotes a remarkably shortened healing time compared to conventional therapies, the sanitation of the affected area being rapid, regularization of the edges of the ulcers, vigorous development of granulation tissue, activation of cell migration of macrophages and fibroplasts and early epithelization.

2. the preparation promotes accelerated preparation for reconstructive surgery in more severe cases.

3. absence of keloid formation or retraction scar with final reshaping of scar tissue providing good aesthetic and functional results.

The preparation of hyalastine has been found to be useful for the treatment of various wounds, including pressure sores (bedsores), trophic ulcers, burns, sores, atones, post-traumatic ulcers, varicose ulcers and post-phlebitic ulcers following various venous tasks, radiological necrosis *, skin lesions, skin grafts and skin lesions due to herpes simplex. For these wound healing treatments, the preparation of hyalastine or its sodium salt can be administered by different. niéIIiijcIcl such ', that lampou &lt;le &lt;jar »ifèim ·, |&gt; ιι1 vriï'.al ion or ampoule ·, pou» intradermal injection. For topical applications in the form of a cream or gas pad, hyalastine is preferably combined with an emulsifying agent which absorbs exudate from the exposed area while providing excellent diffusion of hyaluronic acid and a water dispersible excipient such that the wound dressing is easily removed.

The hyalectin fraction has been found particularly useful for the treatment of horses, particularly racehorses suffering from disorders and joint diseases caused by acute or chronic trauma, infections or repeated injections of intra-articular corticosteroid. Specific disorders that can be treated with hyalectin are, for example, osteoarthritis with or without inflammatory signs, acute or chronic synoritis, degenerative processes in joint cartilage and dry joint disease. The most common symptoms of these disorders are, generally, pain, damaged function of the joint, and decreased flexion of the joint. It has been found that the hyalectin fraction according to the invention promotes a significant reduction in the healing time for these affected horses_zcompared to conventional therapies, promoting early and lasting improvement in the functioning of joints and reducing pain and infirmity. These clinically advantageous effects are believed to be favored by a normalization of the visco-elasticity of the synovial fluid and by the activation of tissue repair processes in joint cartilage.

In addition, all of the above advantageous effects are favored by the hyalectin fraction in the absence of toxic, local and / or systemic effects. Repeated administration of hyalectin does not show any signs of an allergic reaction or any harmful or lasting effect.

Pharmaceutical preparations

The above description has shown that the hyalastine fractions ₁₆ 255309 9 and hyalectin had good activity in pharmaceutical applications. examples slllvaiils lit- .mil ilnimt's qiir pnin ilin i lin pltipuial luiib phü I liiat-uu LI .u.icpl Ihlrv d'tHic: υιιιμ I nyüo | n »m nm:

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A.- Wound healing preparations

Example 1: ampoules for intradermal injection:

each bulb contains:

. sodium salt of hyalasline. 4 mg. sodium chloride ........... 16mg. water for injection, qs ... 2 ml

Example 2: ampoules for intradermal injection:

each bulb contains:

. potassium salt of hyalastine 5 mg. sodium chloride .......... 8mg. water for injection, qs .... 1 ml

Example 3: spray bottle for topical application each bottle contains:

. sodium salt of hyalastine .. 20 mg. sodium chloride ........... 80mg. water for injection, qs ... 10 ml

Example 4: spray bottle for topical application each bottle contains:

. potassium salt of hyalastine 30 mg. mannitol ..................... 100mg. water for injection, qs ... 10 ml

Example 5: cream for topical application each tube of cream contains:

. potassium salt of hyalastine 25 mg. polyethylene glycol monostearate 400 ...... 1000mg. cetiole (decyl ester of

Oleic acid) ............. 500mg. SX strip (cetylstearic alcohol + lauryl sulfate 9/1) 150 mg. glycerol ..... 200mg. sorbitol ................._______ 150 mg. Na dehydroacetate ......... 10mg. p-oxymethylbenzoate .......... 7.5mg

<td></td><td>. p-oxypropylbenzoate .......... 5 mg . redistilled water, qs ...... 10 g</td>

<td>Example 6:</td><td>cream for topical application each tube of cream contains:. sodium salt of hyalastine .. 30 mg . paraffin jelly ........... 3 mg . polyethylene monostearate- glycol 400 ................... 1000 mg . cetiole (decyl ester of oleic acid) ............. 500 mg . lanette SX (cetyl alcohol- stearic + lauryl sulfate 9/1) 150 mg . glycerol ......... 200 mg . sorbitol ..................... 150 mg . dehydroacetate of Na ......... 10 mg . p-oxymethylbenzoate .......... 7.5 mg . p-oxypropylbenzoate .......... 5 mg . redistilled water, qs ...... 10 g</td>

<td>Example 7:</td><td>gas pad containing medication for topical application, each gas pad measuring 10 x 10 cm, contains: . sodium salt of hyalastine .. 3 mg . glycerol ..................... 1 g . polyethylene glycol ........... 2g . redistilled water, qs ...... 3 g</td>

<td>Example 8:</td><td>drug-loaded gas pad for topical application, each gas pad measuring 10 x 10 cm, contains: . potassium salt of hyalastine 6 mg . paraffin jelly ........... 0.5 mg . glycerol ..................... 1 g . polyethylene glycol ........... 2g . redistilled water, qs ...... 3 g</td>

<td>Example 9:</td><td>dry powder for application in wound healing - each gram of dry powder contains: . sodium salt of hyalastine .. 10 mg . mannitol ..................... 0.75 g</td>

. wisteria ...................... 0.24g

B.- Preparations for intraocular use

Example 10: 1 ml vials each vial contains:

. sodium salt of hyalectin. 10 mg. sodium chloride 8 mg. monobasic sodium phosphate 2HgO ..................... 0.25mg. dibasic sodium phosphate ÎPH ^ O ............... 3 mg. water for injection, qs ... 1 ml

Example 11: 5 ml flasks each flask contains:

. potassium salt of hyalectin 60 mg. mannitol ............ 50 mg. monobasic sodium phosphate 2H2O ..................... 1.25 mg. dibasic sodium phosphate 12H2O 15 mg. water for injection, qs ... 5 ml

Example 12: pre-filled syringes each syringe contains:

. sodium salt of hyalectin. 40 mg. sodium chloride 16 mg. monobasic sodium phosphate 2H2O ..................... 0.8 mg. dibasic sodium phosphate .................... 8.16 mg. water for injection, qs ... 2 ml

C.- Preparations for intra-articular use

Example 13: 2 ml flasks each flask contains:

. hysieçtine sodium salt. 40 mg. sodium chloride ........... 16mg. water for injection, qs ... 2 ml

Example 14: 4 ml flasks each flask contains:

. potassium salt of hyalectin 60 mg. mannitol ................ 35 mg. wisteria. 10 mg. water for injection, qs ... 4 ml

Example 15: pre-filled syringes each syringe contains:

. sodium salt of hyalectin. 25 mg. sodium chloride ........ 12 mg. mannitol ............. 10 mg. monobasic sodium phosphate ΣΗ ^ Ο ..................... 0.5 mg. 12H dibasic sodium phosphate₂0 6 mg. water for injection, qs ... 2 ml

Although the above preparations have been described by way of examples, it will be understood that other pharmaceutical formulations can be prepared by combining the fractions of hyalastine and hyalectin discovered by the applicant or their potassium or sodium salts with other pharmaceutically acceptable vehicles, diluents or excipients and, at various doses, depending on the particular use of the formulation.

For wound healing uses, the preparations of hyalastine fractions are applied to the affected areas of the skin in one of the dosage forms discussed above, i.e. in the form of a cream, spray, gas, dry powder or intradermal injection. For intraarticular uses, the hyalectin preparations are generally administered at a dose of 2 ml per joint, either from a prepared vial or from a pre-filled syringe as described above.

In a further study, the capacity and effectiveness of hyaluronic acid as a vehicle for various molecules, in particular as a vehicle for ophthalmic drugs, was observed, ensuring perfect tolerability and compatibility (i.e. sensitization phenomenon) with the corneal epithelium. Hyaluronic acid is considered to be of particular interest as an ophthalmic vehicle. As discussed above, HA is an aminoglycan glycose present in various connective tissues and biological fluids (such as synovial fluid and, in particular, vitreous humor) where due to its physical and chemical nature and its viscous characteristics. - striking elastic, it plays a structural and biological role of fundamental importance.

Thus, a study was conducted to examine the use of HA fraction having different molecular weights, in particular the fractions of hyalastine and hyalectin and a mixture of these for the preparation of various pharmaceutical forms such as eye drops, gels, creams , inserts or dry powders. Therefore, ophthalmic drugs of different types are being studied in order to obtain a broad understanding of the potential use of this biological polymer in these different fractions as a vehicle.

The experiments described below aim to determine whether formulations containing hyaluronic acid as an excipient are capable of improving the biological availability of the drugs carried or of producing a cynergic effect in combination with the drugs carried, in particular with the drugs having a ophthalmic activity or utility. These potential capacities of HA as a vehicle are studied in the rabbit eye with four ophthalmic drugs having different types and actions, in particular pilocarpine nitrate, triamcinolone, epidermal growth factor (EGF) and an antibiotic such than streptomycin and gentamicin. All of these drugs are known to have anti-inflammatory and anti-microbial myotic anti-inflammatory efficacy. In addition, the evaluation of the activity of the antibiotic streptomycin carried by hyaluronic acid is very important, because it is one of the antibiotics most widely used in ocular infections.

The experimental models studied and the experiments carried out are as follows:

1) myotic activity of pilocarpine nitrate carried by hyaluronic acid in the eye of the rabbit;

2) anti-inflammatory activity of triamcinolone conveyed by hyaluronic acid in the model of inflammation induced by textran in the eye of the rabbit;

3) healing activity of the epidermal growth factor (EGF) conveyed by hyaluronic acid in a model of epithelial lesion of rabbit cornea;

4) antimicrobial activity of streptomycin carried by hyaluronic acid against Bacillus substilus 6633 on agar-agar plates.

I.- Myotic activity of pilocarpine nitrate carried by hyaluronic acid

Materials

The following materials are used as pilocarpine excipients for the various pilocarpine nitrate formulations:

sodium salt of hyaluronic acid, fraction of hyalastine (pm approximately 100,000) at a concentration of 10 mg / ml and 20 mg / ml;

sodium salt of hyaluronic acid, fraction of hyalectin (pm 500,000 to 730,000) at a concentration of 10 mg / ml and 20 Mg / ml;

5% polyvinyl alcohol as a comparative ophthalmic excipient. Various 2% formulations (eye drops or gel) of pilocarpine nitrate are prepared! ” and conveyed by adding the two different fractions of sodium salts of HA at a concentration of 10 and 20 ml / ml. The following solutions are prepared:

Formulation 1 - saline solution with pilocarpine nitrate (PiNO₃) (2%), used as a reference.

Formulation 2 - PiNO ^ solution (2%) conveyed in 5% polyvinyl alcohol (used as reference).

Formulation 3 - PiNO ^ solution of the fraction of

Formulation 4 - PiNO solution₃of the fraction of

Formulation 5 - PiN0 solution₃of the fraction of

Formulation 6 - PiNO solution₃of the fraction of

<td>(2%) conveyed in</td><td>salt</td><td>of</td><td>sodium</td>

<td>hyalastine (10 mg / ml).</td><td></td><td></td><td></td>

<td>(2%) conveyed in</td><td>salt</td><td>of</td><td>sodium</td>

<td>hyalastine (20 mg / ml).</td><td></td><td></td><td></td>

<td>(2%) conveyed in</td><td>salt</td><td>of</td><td>sodium</td>

<td>hyalastine (10 mg / ml).</td><td></td><td></td><td></td>

<td>(2%) conveyed in</td><td>salt</td><td>of</td><td>sodium</td>

hyalastine (20 mg / ml).

Method

New Zealand albino rabbits are used (weight 2 to 2.5 kg). The formulation to be tested is instilled into an eye with a micro-syringe (10 1); the other eye serves as a witness. In all cases, the diameter of the pupil is measured at suitable time intervals. Each solution is tested on at least 8 rabbits. Each eye is not treated more than three times and a rest period of at least one week is observed between each treatment.

Measured parameters

Pupil diameters are measured at various intervals to determine the curve of myotic activity over time. The following activity parameters are then calculated from the miosis / time curve:

I = maximum difference in pupil diameter between the max treated eye and the reference. Peak time = time required to reach I_.

llldA

Duration = time required to restore basic conditions. Plateau = period of absolute myotic activity.

AUC = area under miosis / time curve.

Results

The results of the tests are shown in Table 5. It can be seen from the data of the various parameters measured from the time curve of myotic activity for all the solutions tested that the addition of hyaluronic acid to a 2% pilocarpine S nitrate solution leads to an increase in the myotic activity of the drug. In fact, the biological availability of the drug can be up to 2.7 times greater than that of the aqueous solution containing 2% pilocarpine nitrate (formulation 1).

It should also be noted that there is a significant statistical increase in activity when the hyalectin fraction and the hyaluronic acid fraction are both used at 10 and 20 mg / ml as vehicles (formulations 5 and 6), at unlike the pilocarpine nitrate solution carried by polyvinyl alcohol (formulation 2).

The use of hyaluronic acid as a vehicle is particularly interesting because the myotic activity of pilocarpine nitrate lasts longer when it is transported with this substance. That is, for formulations containing hyaluronic acid, the time required to restore the pupil diameter to basic conditions is up to 190 minutes (formulation 6) compared to the 110 minutes required to pilocarpine with saline alone (formulation 1).

II.- Anti-inflammatory activity of triamcinolone carried by hyaluronic acid

Materials

The following materials are used:

a sodium salt fraction of hyaluronic acid-hyalectin, pm between 500,000 and 730,000. 10 mq / ml dan '; a saline coliitinn: triamcinolone solution (10% in saline solution).

Method

The experiments are carried out on male New Zealand rabbits (average weight 1.6 kg). After an adaptation period of five days, intraocular inflammation is induced in rabbits by intraocular injection of dextran (10%, 0.1 ml). Administration is carried out in both eyes, under local anesthesia with Novesina 4%, inserting the needle of the 4 mm syringe into the anterior chamber at a distance of 2 mm from the periphery of the cornea. The test is carried out on ten animals.

TABLE 5

Biological activity of ophthalmic formulations containing pilocarpine-nitrate carried by hyaluronic acid³

<td>Formulation</td><td>vehicle</td><td>1, mm max (at LF 95%)</td><td>peak time (in minutes)</td><td>duration (in minutes)</td><td>tray (in minutes)</td><td>AUC, cm²(± LF 95%)</td><td>AUC relative</td>

<td> 1</td><td>saline solution</td><td> 1,93 + 0,35</td><td> 20</td><td> 110</td><td> -</td><td> 117 ± 28</td><td> 1</td>

<td> 2</td><td>polyviny- alcohol</td><td></td><td></td><td></td><td></td><td></td><td></td>

<td></td><td>5%</td><td> 2,33 ± 0,28</td><td> 20</td><td> 140</td><td> -</td><td> 192 ± 32</td><td> 1,64</td>

<td> 3</td><td>hyalastine (10 mg / ml)</td><td> 2,50 ± 0,42</td><td> 20</td><td> 120</td><td> -</td><td> 240 ± 40</td><td> 2,05</td>

<td> 4</td><td>hyalastine (20mg / ml)</td><td> 2,58 ± 0,38</td><td> 30</td><td> 150</td><td> -</td><td> 208 ± 41</td><td> 1,78</td>

<td> 5</td><td>hyalectin (10 mg / ml)</td><td> 2,50 ± 0,38</td><td> 15</td><td> 170</td><td> -</td><td> 242 ± 48</td><td> 2,06</td>

<td> 6</td><td>hyalectin (20mg / ml)</td><td> 2,10 ± 0,38</td><td> 20</td><td> 190</td><td> 45</td><td> 320 ±45</td><td> 2,73</td>

the values ​​indicated represent the average value of eight tests.

Treatment

A treatment is carried out on each animal, both in the right eye and in the left eye by instillation of three drops, three times a day for six days in all of the following:

- a triamcinolone solution (10% in saline) in the left eye (LE);

- a sodium salt solution of hyaluronic acid, hyalectin fraction, (10 mg / ml) + triamcinolone (10%) in the right eye (RE);

Settings

The anti-inflammatory effect on the phlogistic reaction induced by dextran is evaluated by observing the eye with a slit lamp at the following intervals: 0, 1 hour, 3 hours, 24 hours, 48 ​​hours, 3 days, 4 days, 5 days and 6 days.

At these intervals, examination of the eye leads to the following observations:

- the state of the cornea and conjunctiva to detect the possible presence of hypermia, edema and in particular observation of the iris which is normally sensitive to the phlogistic process after intra-ocular injection of inflammatory agents;

- Tyndall effect in which the presence of a more nn less opacity^r. intense (nubecula) is indicative of the presence of corpuscular elements (inflammatory) in the anterior chamber.

The result of the observations is expressed in terms of subjective ratings (from 0 to 3) linked to the progressiveness of the effect observed. Results

It can be seen from the results reported in Table 6 that the administration of triamcinolone has an anti-inflammatory effect on the iris and causes the disappearance of the opacity (Tyndall effect) in the anterior chamber. The inflammatory process which is evident from the first to the third hour until the fourth day gradually decreases until substantially normal conditions are restored with perfect clarity of the eye on the sixth day. On the other hand, the administration of the sodium salt of hyaluronic acid, hyalectin fraction, at the same time as triamcinolone reduces the intra-ocular inflammation observed at the time discussed above compared to the administration of triamcinolone alone. That is to say that the phlogistic process in the iris and the opacity in the anterior chamber seem to have decreased at the 24th hour, with a progressive reduction until the 48th hour and with a total absence of inflammatory reaction. from the 4th day.

In the conjunctiva and the cornea, there is noticeably noticeable reaction after intraocular injection of dextran.

Thus, the administration of triamcinolone, together with the hyaluronic acid fraction leads to improved activity of the drug, which is demonstrated by the faster healing of the rabbit eye.

TABLE 6

Effect of the combination of hyaluronic acid and triamcinolone on the intraocular inflammation induced by dextran

Observation interval

<td></td><td> 0</td><td>1 hr</td><td>3 hrs</td><td>24h</td><td>48 h</td><td>3 d</td><td> 4</td><td>j</td><td>5 d</td><td> 6</td><td>j</td>

<td></td><td></td><td></td><td colspan="3">rated rating³</td><td></td><td></td><td></td><td></td><td></td><td></td>

<td></td><td>THE RE</td><td>THE RE</td><td>THE RE</td><td>THE RE</td><td>THE RE</td><td>THE RE</td><td>THE</td><td>RE</td><td>THE RE</td><td>THE</td><td>RE</td>

<td colspan="2">: onjunctive 0.0 0.0</td><td> 0,2 0,0</td><td> 0,0 0,0</td><td> 0,0 0,0</td><td> 0,0 0,0</td><td> 0,0 0,0</td><td colspan="2"> 0,0 0,0</td><td> 0,0 0,0</td><td colspan="2"> 0,0 0,0</td>

<td>lomea</td><td> 0,0 0,0</td><td> 1,0 0,2</td><td> 0,0 0,7</td><td> 0,1 0,0</td><td> 0,0 0,0</td><td> 0,0 0,0</td><td> 0,0</td><td> 0,0</td><td> 0,0 0,0</td><td> 0,0</td><td> 0,0</td>

<td>Cyndall</td><td> 0,0 0,0</td><td> 1,0 1,2</td><td> 3,0 3,0</td><td> 3,0 2,1</td><td> 3,0 1,2</td><td> 3,0 0,2</td><td> 2,2</td><td> 0,0</td><td> 1,2 0,0</td><td> 0,4</td><td> 0,0</td>

<td>Iris</td><td> 0,0 0,0</td><td> 0,5 0,7</td><td> 2,7 2,7</td><td> 3,0 2,5</td><td> 3,0 1,2</td><td> 3,0 0,4</td><td> 2,4</td><td> 0,0</td><td> 1,5 0,0</td><td> 0,5</td><td> 0,0</td>

<td>THE "eye</td><td colspan="2">left treated with</td><td colspan="2">triamcinolone</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td>

<td>RE - eye</td><td colspan="2">right treated with</td><td colspan="4">triamcinolone and hyalectin.</td><td></td><td></td><td></td><td></td><td></td>

each value is the average of seven observations on a total of seven animals and it is expressed in terms of subjective rating between 0 and 3, in relation to the progressiveness of the effect observed.

III.- Healing activity of EGF carried in hyaluronic acid

Materials

The following materials are used:

Formulation Λ · EGF (lacteui de (ro i ·, ·, ηιιι e e epidermique) di'.sou ·. Dan ·, saline solution (0.5 mg / 5 ml).

Formulation B - sodium salt of hyaluronic acid, hyalastine fraction (pm approximately 100,000) dissolved in a saline solution (10 mg / ml).

Methods

The experiments are carried out on male albino rabbits from New Zealand (average weight 1.8 kg). The animals, after an adaptation period of approximately 5 days, undergo epithelial lesion of the cornea under the conditions of local anesthesia with Novesina (4%). The lesion consists of a monocular scarification of a circular zone of the optical zone carried out by a concave glass cylinder (3 mm) having a cutting edge.

Treatment

The animals are subdivided into groups, each group consisting of five animals and they are subjected to pharmacological treatment by instillation in the conjunctiva of the following:

<td>Groups</td><td>Treatment</td>

<td>group 1 (witness) group 2 group 3</td><td>saline solution EGF solution (formulation A) sodium salt solution of hyaluronic acid, hyalastine fraction + EGF solution - combination of lurmuldtion A * lonnulolion B in a 1/1 ratio, to obtain a formulation C</td>

The treatment is carried out on the right eye (RE) by instillation in the conjunctiva of two drops every eight hours for three administration in total.

Settings

The scarring of the corneal epithelium is evaluated by observation of the eye and by photographic documentation with a slit lamp at various intervals after scarification: 0, 8 hours, 16 hours, 24 hours, 32 hours, 40 hours and 48 hours.

Results

Ophthalmological examination 1, as indicated in table 7, reveals that for the controls (group 1) complete healing is obtained (5 animals out of 5) 48 hours after the lesion. In the animals treated with EGF (group 2), the healing process is already apparent 24 hours after scarification with considerable efficiency (4 animals out of 5). In animals treated with formulation C comprising the sodium salt of hyaluronic acid, hyalastine fraction + EGF (group 3), the healing process is complete in all animals (5 out of 5) already 16 hours after scarification.

These results show that the use of the hyalastine fraction of hyaluronic acid as a vehicle for EGF accelerates the healing process by promoting faster efficient healing of corneal lesions.

TABLE 7

Healing of lesions of the corneal epithelium

<td rowspan="2"> 15</td><td rowspan="2">Group</td><td rowspan="2">Treatment</td><td colspan="4">Hours after scarification</td>

<td> 0</td><td> 8</td><td> 16</td><td> 24 48</td>

<td></td><td> 1</td><td>saline</td><td> - +’</td><td> +</td><td> +</td><td> + -</td>

<td></td><td></td><td></td><td> +</td><td> +</td><td> +</td><td> +</td>

<td> 20</td><td></td><td></td><td> +</td><td> +</td><td> +</td><td> + -</td>

<td></td><td></td><td></td><td> +</td><td> +</td><td> +</td><td> + -</td>

<td></td><td></td><td> -</td><td> +</td><td> +</td><td> +</td><td> +</td>

<td></td><td> 2</td><td>EGF</td><td></td><td></td><td></td><td></td>

<td></td><td></td><td>(formulation A)</td><td> +</td><td> +</td><td> +</td><td> -</td>

<td> 25</td><td></td><td></td><td> +</td><td> +</td><td> +</td><td> -</td>

<td></td><td></td><td></td><td> +</td><td> +</td><td> + '</td><td> -</td>

<td></td><td></td><td></td><td> +</td><td> +</td><td> +</td><td> +</td>

<td></td><td></td><td></td><td> +</td><td> +</td><td> +</td><td> -</td>

<td></td><td> 3</td><td>hyaluronic acid +</td><td></td><td></td><td></td><td></td>

<td> 30</td><td></td><td>EGF (formulation C)</td><td> +</td><td> +</td><td> -</td><td> - -</td>

<td></td><td></td><td></td><td> +</td><td> +</td><td> -</td><td> - -</td>

<td></td><td></td><td></td><td> +</td><td> +</td><td> -</td><td> -</td>

<td></td><td></td><td></td><td> +</td><td> +</td><td> -</td><td> - - -</td>

<td> 35</td><td>+ = eye</td><td>not healed.</td><td></td><td></td><td></td><td></td>

<td></td><td>- = eye</td><td>healed.</td><td></td><td></td><td></td><td></td>

IV.- Antimicrobial activity of gentamicin carried by hyaluronic acid

Materials

The following materials are used:

- gentamicin dissolved without saline solution (50 mg / ml);

- sodium salt of hyaluronic acid, hyalectin fraction (2 mg / ml). Meihudeb

Septic phlogosis is caused in each eye of 11 rabbits by intra-ocular injection of a titrated suspension of pneudomonas aerugi10 nosa (0.1 ml). In rabbits with septic phlogosis, hyaluronic acid, hyalectin fraction is administered in combination with gentamicin by instillation in the right eye and gentamicin in a vehicle consisting of a buffered saline solution is administered in the left eye. Treatment (three drops every six hours) begins immediately after injection of the infective agent and is continued until the infection subsides. The eyes are observed daily under a slit lamp.

Results

Treatment with the gentamicin combination hyaluro20ic acid leads to a more rapid disappearance of the septic infection compared to the case of administration of the antibiotic alone. This conclusion appears from the data presented in Table 8. TABLE 8

Effects of gentamicin conveyed by hyaluronic acid, hyalectin fraction on intraocular spectral phlogosis

<td rowspan="2">Treatment</td><td colspan="3">days from</td><td>start</td><td colspan="3">phlogosis</td>

<td> 1</td><td> 2</td><td> 3</td><td> 4</td><td> 5</td><td> 6</td><td> 7</td>

<td>gentamicin + saline buffer vehicle</td><td> 0,0</td><td> 0,0</td><td> 0,0</td><td> 0,0</td><td> 0,0</td><td> 36,3</td><td> 100</td>

<td>gentamicin + hyaluronic acid fraction hyalectin</td><td> 0,0</td><td> 0,0</td><td> 9,0+</td><td> 27,2+</td><td> 72,7+</td><td> 100</td><td> 100</td>

The values ​​are expressed as a percentage (number of eyes cured of phlogosis compared to the number of eyes treated).

+ = significant difference compared to the buffer vehicle (less than 0.05, Fisher's exact T-test).

Additional samples, although this list is not exhaustive, of ophthalmic drugs which can be transported with HA fractions according to the present invention, are the following: antibiotics ................... chloromphenicol. hormones ........................

. anesthetics (local) ..........

. antiviral .......................

. anti-inflammatory .............

. vasopressors and vasoconstrictors

CONCLUSIONS neomycin aureomycin myxin and polymyxin bacitrincine mycetins nandrolone and nandrolone sulphate henoxinate and its hydrochloride i odocéoxyuridi ne i odocéoxycyti di ne dexamethasone and its phosphate synephrine and neosynph

On the basis of the results obtained from the experiments discussed above, it can be concluded that solutions of hyaluronic arid soils, (both in the hyalastine and hyalectin fractions) can be used as vehicles for ophthalmic drugs and s 'prove to be effective as such for various types of drugs with different biological actions. For example, drugs including anti-glaucoma agents such as pilocarpine nitrate, anti-allergic and anti-inflammatory agents such as triamcinolone, agents that promote tissue healing and cell proliferation, agents that promote wound healing eye tissues such as EGF and antibiotics such as streptomycin and gentamicin, the anti-inflammatory myotic activities of which are indicated, Healing and anti-microbial agents can all be effectively administered using HA as a vehicle.

The formulations of ophthalmic drugs carried in fractions of hyaluronic acid having various molecular weights are perfectly tolerated by the host and compatible with the corneal epithelium without giving rise, however, to phenomena of sensitization.

It is also possible, from the data, to observe that this biological product, hyaluronic acid, is an effective vehicle capable of improving the biological availability in vivo of the drugs transported, and of reinforcing the pharmacological activity of these drugs. . The use of hyaluronic acid fractions as a vehicle for drugs has particularly good results:

- an increase in the myotic activity of pilocarpine nitrate, while prolonging the time of activity of the drug;

- an increase in anti-inflammatory activity of the triamclu nu lune daiib l * lui lanniial. iuii InLi a- ocuulaiie Induced by dextran, with a regression of the phlogistic process in shorter times than those obtained with triamcinolone alone;

- increase in the protective action of epidermal growth factor (EGF) on superficial lesions of the cornea with obvious cynergism and reduction in healing times compared with the recovery time observed with EGF alone; and

- increase in in vivo biological activity of antibiotics such as gentamicin.

The results obtained by using this biological polymer, hyaluronic acid, as a vehicle for drugs with such diverse effects, allows the extrapolation of its potential as a vehicle for many other ophthalmic drugs.

Various examples of various formulations of ophthalmic drugs which may be in the form of powders, eye drops, gels, creams or inserts are indicated below, in which hyaluronic acid in the form of these various hyalastine and hyalectin fractions is the only excipient used:

Example 1

Eye drops that can be used as artificial tears containing:

. sodium salt of hyaluronic acid, hyalectin fraction .............. 10 mg. saline solution buffered with phosphate at pH, 6 .................... 10 ml

Example 2

Eye drops that can be used as artificial tears containing:

. sodium salt of hyaluronic acid, hyalectin fraction ................. 20mg. saline solution buffered with phosphate at pH 6 .............. 10mg

Example 3

A gel containing EGF in which 100 g contain:

. sodium salt of hyaluronic acid, hyalastine fraction 55 mg. sodium salt of hyaluronic acid, hyalectin fraction ................. 30 mg .EGF 0.5 g. bi-distilled water .............; ...... 25.5 g

Example 4

An insert of 100 mg with pilocarpine nitrate containing:. sodium salt of hyaluronic acid, hyalastine fraction ....... 100 mg. pilocarpine nitrate .............. 2 mg

Example 5

A powder for topical application containing streptomycin.

100 g of powder contain:

. sodium salt of hyaluronic acid, hyalastine fraction ................. 70 mg. sodium salt of hyaluronic acid, hyalectin fraction ............ 28.5 mg. streptomycin ......... 1.5g

Although the above preparations have been given by way of example, it will be appreciated that the pharmaceutical formulations can be prepared by combining the hyaluronic fractions, in particular the hyalectin or hyalastin fractions or the combined hyalectin / hyalastin fraction or their sodium salts or potassium with other active drugs with varying doses depending on the particular use of the formulation.

Hyaluronic acid, in particular in the substantially pure fractions of hyalectin and hyalastine has therefore been shown to be an effective vehicle or excipient usable in combination with various drug drugs having an ophthalmic utility or activity. Pharmaceutical compositions containing the HA fractions as drug carriers are particularly useful because the HA fractions exhibit a high level of tolerability for the eye and high compatibility with the corneal epithelium.

The use of HA fractions further provides a means of effectively improving the in vivo biological activity of ophthalmic drugs. The use of the particular hyalectin and hyalastin fractions of HA is, moreover, useful and important because these fractions, when administered into the eye do not manifest undesirable inflammatory side reactions.