U.S. patent application number 13/955668 was filed with the patent office on 2014-01-30 for controlled release of n-acetylcysteine (nac) for reduction of systemic and/or vascular inflammation.
This patent application is currently assigned to TIARA PHARMACEUTICALS, INC.. Invention is credited to Yadon ARAD, Liang C. Dong.
Application Number | 20140030323 13/955668 |
Document ID | / |
Family ID | 41265464 |
Filed Date | 2014-01-30 |
United States Patent
Application |
20140030323 |
Kind Code |
A1 |
ARAD; Yadon ; et
al. |
January 30, 2014 |
CONTROLLED RELEASE OF N-ACETYLCYSTEINE (NAC) FOR REDUCTION OF
SYSTEMIC AND/OR VASCULAR INFLAMMATION
Abstract
The present invention provides a controlled-release composition
which provides a therapeutically effective plasma concentration of
N-acetylcysteine over prolonged period of time. The present
invention also includes the use of the controlled-release
composition, either alone or in combination with at least one
additional active agent, for reduction of vascular inflammation
marker and treatment of diseases, conditions, and/or symptoms
associated with systemic and/or vascular inflammation in a patient.
Furthermore, the present invention provides a process of making
granules comprising N-acetylcysteine, or a salt, solvate, prodrug,
and/or analog thereof.
Inventors: |
ARAD; Yadon; (Sunnyvale,
CA) ; Dong; Liang C.; (Sunnyvale, CA) |
Assignee: |
TIARA PHARMACEUTICALS, INC.
Los Altos
CA
|
Family ID: |
41265464 |
Appl. No.: |
13/955668 |
Filed: |
July 31, 2013 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
12595027 |
Jun 16, 2011 |
8524772 |
|
|
PCT/US2009/043435 |
May 11, 2009 |
|
|
|
13955668 |
|
|
|
|
61052120 |
May 9, 2008 |
|
|
|
61143105 |
Jan 7, 2009 |
|
|
|
Current U.S.
Class: |
424/457 ;
424/465; 424/472; 424/484; 424/490; 424/494; 424/495; 424/497;
514/562 |
Current CPC
Class: |
A61K 45/06 20130101;
A61K 31/366 20130101; A61K 9/4808 20130101; A61K 31/198 20130101;
A61K 31/366 20130101; A61K 9/209 20130101; A61K 9/2081 20130101;
A61K 9/5078 20130101; A61P 9/10 20180101; A61K 31/198 20130101;
A61K 9/2077 20130101; A61K 2300/00 20130101; A61K 2300/00
20130101 |
Class at
Publication: |
424/457 ;
514/562; 424/490; 424/484; 424/494; 424/495; 424/497; 424/472;
424/465 |
International
Class: |
A61K 9/48 20060101
A61K009/48; A61K 45/06 20060101 A61K045/06; A61K 31/198 20060101
A61K031/198 |
Claims
1. A composition comprising a sustained release (SR) component,
wherein the SR component comprises a prodrug, or analog of
N-acetylcysteine, or a salt or solvate thereof; wherein the
composition, upon oral administration, provides a therapeutically
effective plasma concentration of N-acetylcysteine over more than
about 2 hours following the administration.
2. The composition of claim 1, further comprising an immediate
release (IR) component, wherein the IR component comprises a
prodrug, or analog of N-acetylcysteine, or a salt or solvate
thereof; wherein the composition, upon oral administration,
provides a therapeutically effective plasma concentration of
N-acetylcysteine over about 30 minutes to about 24 hours following
the administration.
3. The composition of claim 1, wherein the SR and/or IR component
comprises a prodrug or analog of N-acetylcysteine which is less
polar than N-acetylcysteine and is absorbable in the lower
gastrointestinal tract of a mammal.
4. The composition of claim 1, wherein the SR and/or IR component
comprises a prodrug of N-acetylcysteine which has a log P of about
4 or higher.
5. The composition of claim 1, wherein the SR and/or IR component
comprises a prodrug of N-acetylcysteine which contains a
hydrophobic moiety.
6. The composition of claim 1, wherein the SR and/or IR component
comprises a prodrug of N-acetylcysteine selected from the group
consisting of an ester prodrug, an amide prodrug, and an anhydride
prodrug.
7. The composition of claim 1, wherein the analog of
N-acetylcysteine is an amino acid analog.
8. The composition of claim 1, wherein the analog of
N-acetylcysteine is selected from the group consisting of DiNAC;
N-acetylcysteine L-lysine; Carbocisteine; glutathione;
S-nitroso-N-acetylcysteine; S-nitrosothiol-N-acetylcysteine;
S-allyl-cysteine; S-alkyl-cysteine; N-acetyl-5-farnesyl-cysteine;
N-acetyl-L-arginine-NAC; N-acetyl-L-lysine-NAC;
N-acetyl-L-histidine-NAC; N-acetyl-L-ornithine-NAC; thioester of
NAC with salicylic acid;
2'4'-difluoro-4-hydroxy-(1,1'-diphenyl)-3-carboxylic derivatives of
NAC; S-allymercapto-NAC (ASSNaC); N,N-diacetyl-L-cystine;
N-S-diacyl-cysteine; N-acetylcysteine conjugate of phenethyl
isothiocyanate (PEITC-NAC); S-carboxylmethyl-L-cysteine;
derivatives of reacting a reactive derivative of
p-isobutylphenylpropionic acid and NAC; paraisobutyl NAC; esters of
N-acetylcysteine; amides of N-acetylcisteine; anhydrides of
N-acetylcistein; and a combination thereof.
9. The composition of claim 1, wherein the SR component, IR
component, or both, comprise a prodrug or analog of
N-acetyl-D-cysteine, or a salt or solvate thereof.
10. The composition of claim 1, wherein the SR component comprises
a matrix, wherein the matrix comprises: a prodrug, or analog of
N-acetylcysteine, or a salt or solvate thereof; and a release rate
controlling polymer.
11. The composition of claim 2, comprising a layer of the IR
component, and a layer of the SR component, wherein the SR
component comprises a matrix comprising a prodrug, or analog of
N-acetylcysteine, or a salt or solvate thereof; and a release rate
controlling polymer.
12. The composition of claim 10, wherein the rate controlling
polymer is a hydrophilic polymer.
13. The composition of claim 12, wherein the hydrophilic polymer is
selected from the group consisting of polyethylene oxide,
hydroxypropyl cellulose, hydroxypropyl methyl cellulose,
hydroxyethyl cellulose, sodium carboxymethylcellulose, calcium
carboxymethyl cellulose, methyl cellulose, polyacrylic acid,
maltodextrin, pre-gelatinized starch, guar gum, sodium alginate,
polyvinyl alcohol, chitosan, locust bean gum, amylase and a
combination thereof.
14. The composition of claim 1, comprising a release rate
controlling membrane disposed over: a pull layer comprising a
prodrug, or analog of N-acetylcysteine, or a salt or solvate
thereof, and an osmotic push layer; wherein the release rate
controlling membrane has an orifice immediately adjacent to the
pull layer.
15. The composition of claim 14, wherein the pull layer further
comprises a release rate controlling polymer.
16. The composition of claim 2, comprising a release rate
controlling membrane disposed over: a first pull layer comprising
the IR component, a second pull layer comprising the SR component,
and an osmotic push layer; wherein the release rate controlling
membrane has an orifice immediately adjacent to the first pull
layer.
17. The composition of claim 16, wherein the SR component comprises
a matrix comprising: a prodrug, or analog of N-acetylcysteine, or a
salt or solvate thereof; and a release rate controlling
polymer.
18. The composition of claim 15, wherein the release rate
controlling polymer is a hydrophilic polymer.
19. The composition of claim 18, wherein the hydrophilic polymer is
selected from the group consisting of polyethylene oxide,
hydroxypropyl cellulose, hydroxypropyl methyl cellulose,
hydroxyethyl cellulose, sodium carboxymethylcellulose, calcium
carboxymethyl cellulose, methyl cellulose, polyacrylic acid,
maltodextrin, pre-gelatinized starch, guar gum, sodium alginate,
polyvinyl alcohol, chitosan, locust bean gum, amylase and a
combination thereof.
20. The composition of claim 14, wherein the release rate
controlling membrane comprises a water insoluble and non-erodable
polymer.
21. The composition of claim 20, wherein the water insoluble and
non-erodable polymer is selected from the group consisting of a
cellulose ester, a cellulose ether, a cellulose ester-ether, and a
combination thereof.
22. The composition of claim 20, wherein the water insoluble and
non-erodable polymer is selected from the group consisting of
cellulose acylate, cellulose diacylate, cellulose triacylate,
cellulose acetate, cellulose diacetate, cellulose triacetate, a
monocellulose alkanylate, a dicellulose alkanylate, a tricellulose
alkanylate, a monocellulose aroylate, a dicellulose aroylate a
tricellulose aroylate, and a combination thereof.
23. The composition of claim 14, wherein the osmotic push layer
comprises an osmopolymer.
24. The composition of claim 23, wherein the osmopolymer is
selected from the group consisting of
poly(hydroxyalkylmethacrylate) having a molecular weight of from
about 30,000 to about 5,000,000; poly(vinylpyrrolidone) having
molecular weight of from about 10,000 to 360,000 about; anionic and
cationic hydrogels; polyelectrolyte complexes; poly(vinyl alcohol);
a mixture of methyl cellulose, cross-linked agar, and carboxymethyl
cellulose; a copolymer of maleic anhydride with styrene, ethylene,
propylene, butylene or isobutylene; N-vinyl lactams; Carbopol;
acidic carboxy polymers having a molecular weight from about
450,000 to about 4,000,000; a sodium salt of Carbopol; acidic
carboxy polymers and/or the metal salts thereof; polyethylene oxide
polymers having a molecular weight from about 100,000 to about
7,500,000; and combinations thereof.
25. The composition of claim 14, wherein the pull layer comprises
an osmagent.
26. The composition of claim 25, wherein the osmagent is selected
from the group consisting of a magnesium sulfate, magnesium
chloride, sodium chloride, potassium chloride, lithium chloride,
potassium sulfate, sodium sulfate, lithium sulfate, lithium
phosphate, sodium phosphate, potassium phosphate, potassium acid
phosphate, calcium lactate, mannitol, urea, inositol, magnesium
succinate, tartaric acid, carbohydrates such as raffinose, sucrose,
glucose, lactose monohydrate, and a blend of fructose glucose.
27. The composition of claim 1, wherein the SR component comprises
one or more particles, and each of the particles comprises an
active core comprising a prodrug, or analog of N-acetylcysteine, or
a salt or solvate thereof; and a release rate controlling polymer
disposed over the core.
28. The composition of claim 1, wherein the SR component comprises
one or more particles, and each of the particles comprises an inert
core, an active layer comprising a prodrug, or analog of
N-acetylcysteine, or a salt or solvate thereof, and a release rate
controlling polymer disposed over the active layer.
29. The composition of claim 2, wherein the IR component comprises
one or more particles, and the SR component comprises one or more
particles, and each of the particles of the SR component comprises
an active core comprising a prodrug, or analog of N-acetylcysteine,
or a salt or solvate thereof; and a release rate controlling
polymer disposed over the core.
30. The composition of claim 2, wherein the IR component comprises
one or more particles, and the SR component comprises one or more
particles, and each of the particles of the SR component comprises
an inert core, an active layer comprising a prodrug, or analog of
N-acetylcysteine, or a salt or solvate thereof, and a release rate
controlling polymer disposed over the active layer.
31. The composition of claim 27, wherein the release rate
controlling polymer comprises a film-forming, water insoluble
polymer in combination with a film-forming, water soluble
polymer.
32. The composition of claim 31, wherein the film-forming, water
insoluble polymer is selected from the group consisting of
ethylcellulose, cellulose acetate, cellulose propionate (lower,
medium or higher molecular weight), cellulose acetate propionate,
cellulose acetate butyrate, cellulose acetate phthalate, cellulose
triacetate, poly(methyl methacrylate), poly(ethyl methacrylate),
poly(butyl methacrylate), poly(isobutyl methacrylate), poly(hexyl
methacrylate), poly(isodecyl methacrylate), poly(lauryl
methacrylate), poly(phenyl methacrylate), poly(methyl acrylate),
poly(isopropyl acrylate), poly(isobutyl acrylate), poly(octadecyl
acrylate), poly(ethylene), poly(ethylene) low density,
poly(ethylene) high density, poly(propylene), poly(ethylene oxide),
poly(ethylene terephthalate), poly(vinyl isobutyl ether),
poly(vinyl acetate), poly(vinyl chloride), polyurethane, and
combinations thereof.
33. The composition of claim 31, wherein the film-forming, water
soluble polymer is selected from the group consisting of polyvinyl
alcohol, polyvinylpyrrolidone, methyl cellulose, hydroxypropyl
cellulose, hydroxypropylmethyl cellulose and polyethylene glycol,
Pluronic F108, Pluronic F127, Pluronic F68, and combinations
thereof.
34. The composition of claim 29, wherein each of the particles of
the IR component comprises: an inert core, and a coating disposed
over the inert core, wherein the coating comprises a prodrug, or
analog of N-acetylcysteine, or a salt or solvate thereof.
35. A composition comprising a sustained release (SR) component,
wherein the SR component comprises a modified N-acetylcysteine, or
a salt and/or solvate thereof; and a release rate controlling
polymer; wherein the modified N-acetylcysteine is less polar than
N-acetylcysteine.
36. The composition of claim 35, wherein the modified
N-acetylcysteine is a prodrug or analog of N-acetylcysteine, or a
salt and/or solvate thereof.
37. A method of reducing a vascular inflammatory marker or mediator
in a mammal comprising orally administering to the mammal the
composition of claim 1.
38. The method of claim 37, wherein the vascular inflammatory
marker or mediator is selected from the group consisting of
C-reactive protein (CRP); lipoprotein-associated phospholipase A2
(LP-PLA2); lipoprotein Lp(a); myeloperoxidase (MPO); macrophage
chemotactic protein 1 (MCP-1); interleukins (IL), such as
IL-1,6,8,10; oxidized low-density lipoprotein (oxidized LDL),
adiponectin, matrix metaloproteinases (MMP), such as MMP-9,1,2;
CD40; homocysteine; cardiovascular risk factor (CVRF); plasminogen
activator inhibitor (PAI-1); prostaglandin (PG); tissue polypeptide
antigen (TPA); von Willebrand factor (vWF); platelet aggregation;
fibrinogen; Factor VII; Factor VIII; tissue factor; phosphoglucose
(PGI1); endothelin; metaloproteinases; Lipoxegenase; angiotensin;
and a combination thereof.
39. A method of reducing systemic, organ-specific, and/or vascular
inflammation in a mammal comprising orally administering to the
mammal the composition of claim 1.
40. A method of treating a disease, condition, or symptom
associated with systemic and/or vascular inflammation in a mammal
comprising orally administering to the mammal the composition of
claim 1.
41. The method of claim 40, wherein the disease, condition, or
symptom is related to the circulatory system of the mammal.
42. The method of claim 40, wherein the disease, condition, or
symptom is selected from the group consisting of liver
inflammation; hepatitis; pancreatitis; myocardial hyperthrophy;
pulmonary fibrosis; endotoxic shock; uveitis; dementia; Parkinson's
disease; brain toxicity; kidney damage from radiographic dyes;
cancer drugs toxicity; AIDS; atherosclerosis; arthritis; diabetes;
colitis; multiple sclerosis; acute coronary syndrome; acute
myocardial infarction; chronic obstructive pulmonary disorder
(COPD); and a combination thereof.
43. The method of claim 40, wherein the disease, condition, or
symptom is liver inflammation caused by acetaminophen.
44. A process of making granules comprising a prodrug, or analog of
N-acetylcysteine, or a salt or solvate thereof, comprising the
steps of applying forces to loose solids comprising a prodrug, or
analog of N-acetylcysteine, or a salt or solvate thereof, thereby
obtaining a solid sheet; and reducing the size of the solid sheet,
thereby obtaining granules.
45. The process of claim 44, wherein the process the process does
not utilize a solvent.
46. The process of claim 45, wherein the applying step is carried
out by pressing the loose solids between two counter rotating
rolls.
47. A composition comprising (a) a prodrug, or analog of
N-acetylcysteine, or a salt or solvate thereof; and (b) at least
one additional active agent.
48. The composition of claim 47, wherein the at least one
additional active agent is a statin.
49. The composition of claim 48, wherein the statin is selected
from the group consisting of atorvastatin, cerivastatin,
fluvastatin, lovastatin, mevastatin, pitavastatin, pravastatin,
rosuvastatin, simvastatin, and a combination thereof.
50. A method of treating a disease, condition, or symptom
associated with systemic and/or vascular inflammation in a mammal
comprising co-administering to the mammal (a) N-acetylcysteine, or
a salt, solvate, prodrug, and/or analog thereof; and (b) at least
one additional active agent.
51. The composition of claim 50, wherein the at least one
additional active agent is a statin.
52. The composition of claim 51, wherein the statin is selected
from the group consisting of atorvastatin, cerivastatin,
fluvastatin, lovastatin, mevastatin, pitavastatin, pravastatin,
rosuvastatin, simvastatin, and a combination thereof.
53. The composition of claim 1, wherein the composition, upon oral
administration, provides a therapeutically effective plasma
concentration of N-acetylcysteine over more than about 4 hours
following the administration.
54. The composition of claim 1, wherein the composition, upon oral
administration, provides a therapeutically effective plasma
concentration of N-acetylcysteine over about 2 to about 24 hours
following the administration.
55. The composition of claim 1, wherein the composition is a solid.
Description
CROSS-REFERENCE TO THE RELATED APPLICATIONS
[0001] This application claims priority to U.S. Provisional
Application No. 61/052,120, filed on May 9, 2008 and entitled
"Sustained Controlled Release Prodrug of N-acetylcysteine (NAC) for
Reduction of Vascular Inflammatory Markers, of Systemic and
Vascular Inflammation, and of Atherosclerosis and Acute Coronary
Events", and U.S. Provisional Application No. 61/143,105, filed on
Jan. 7, 2009 and entitled "Sustained Controlled Release Prodrug of
N-acetylcysteine (NAC) for Reduction of Vascular inflammatory
Markers, of Systemic and Vascular Inflammation, and of
Atherosclerosis and Acute Coronary Events", the disclosures of
which are herein incorporated by reference in their entirety for
all purposes.
FIELD OF INVENTION
[0002] The present invention is related to a combination of
modified forms of D-NAC and/or L-NAC including the salts and/or
solvates thereof, together with a controlled-release composition to
provide a therapeutically effective plasma concentration of
N-acetylcysteine over prolonged period of time.
BACKGROUND
[0003] Atherosclerosis is a long-term chronic inflammatory disease
which is associated with increased concentrations of various
inflammatory markers, including the hepatic-origin C-reactive
peptide ("CRP") (Zambon et al., 2006). CRP has been identified not
only as a very sensitive marker and risk factor for
atherosclerosis, but also as a pro-inflammatory mediator which is
involved in endothelial cell dysfunction, oxidant stress, and
intimal hypertrophy, leading to plaque rupture and myocardial
infarction. (Wilson et al., 2006; Mora et al., 2006; Paffen et al.,
2006; Inoue, 2006; de Ferranti, et al., 2007; Gotto et al., 2007;
Bisoendial et al., 2007; and Gonzalez-Gay, et al., 2005)
[0004] Evidence for the direct causal role of CRP in
atherosclerosis includes its ability to induce matrix
metalloproteinase-1 ("MMP-1") expression through the Fc gamma RE
and extra cellular signal-related kinase pathways (shown in U937
cells). MMP-1, in turn, are implicated in plaque instability.
Additionally, CRP is shown to up-regulate interleukin-1,
interleukin-6, and interleukin-8 in human aortic endothelial cells
via nuclear factor-kappa B. CRP also promotes monocyte
chemoattractant protein-1-mediated chemotaxis by up regulating
CC-chemokine receptor 2 expression in human monocytes. CRP is also
shown to attenuate endothelial progenitor cell survival,
differentiation, and function. (Venugopal et al., 2005)
[0005] Other proinflammatory, proatherogenic effects of CRP on
endothelial cells include the following: decreased
endothelial-derived nitric oxide and prostacyclin versus increased
endothelin-1, cell adhesion molecules, monocyte chemoattractant
protein-1 and plasminogen activator inhibitor-1 (leading to higher
likelihood for a blood clot). In monocyte-macrophages, CRP may
induce tissue factor secretion, increase reactive oxygen species
and proinflammatory cytokine release, promote monocyte chemotaxis
and adhesion, and increase oxidized low-density lipoprotein uptake.
Also, CRP has been shown in vascular smooth muscle cells to
increase inducible nitric oxide production (thought to be
detrimental as opposed to endothelial-derived nitric oxide),
increase NFkappa-b and mitogen-activated protein kinase activities,
and, importantly, up regulate angiotensin type-1 receptor resulting
in increased reactive oxygen species and vascular smooth muscle
cell proliferation. (halal et al., 2004; and Chang et al.,
2005)
[0006] N-acetylcysteine (NAC) is an antioxidant and a thiol donor.
Currently, NAC is clinically used for treatment of hepatotoxicity
caused by acetaminophen overdose, for treatment of chronic
bronchitis and other pulmonary diseases complicated by the
production of viscous mucus, and for treatment of reperfusion
injury during cardio bypass surgery. The protective effects of NAC
against inflammatory/oxidative challenges were also demonstrated in
various animal models of brain injury, (Fu et al., 2006; Hicdonmez,
et al., 2006; Jara-Prado et al., 2003; Karageorgos, et al., 2006;
Penugonda et al., 2005; Price et al., 2006; Shea, 2007; and
Tchantchou et al., 2004) liver injury, (Kaya et al., 2008; Liu et
al., 2007; and Alipour et al., 2007) and lung injury (e.g.
LPS-induced, TNF-mediated MPO increase and apoptosis) (Koksel, et
al., 2004; Chuang et al., 2007; and Chen et al., 2007) In vitro,
NAC also inhibited the oxidative modification of LDL. (Van
Antwerpen et al., 2005) In particular, secondary oxidation of LDL
by previously oxidized LDL was markedly inhibited, (Rattan et al.,
1998) an effect not seen with other antioxidants. NAC was also
shown to reduce the ability of lipid loaded macrophages (foam
cells) to degrade vascular matrix. (Galis, et al., 1998)
[0007] Several animal models have actually demonstrated inhibition
of atherosclerosis by NAC. (Fujii et al., 2006; Krieger et al.,
2006; Ivanovski et al., 2005; and Wagberg et al., 2001) Based on
the data cited above, CRP may be a suitable target for therapy to
reduce atherosclerosis. However, currently there is no specific
therapy to lower CRP concentration. Although statin therapy, some
ACE inhibitors and ARBs, anti-inflammatory drugs, and perhaps fish
oils have some benefits, (Prasad et al., 2006; Devarai et al.,
2007; and Nissen, 2005) their benefit is limited, and difficult to
assess because of their other biochemical effects, and many are
associated with undesirable side effects.
[0008] In addition to the cell cultures studies (cited above)
demonstrating the protective effects on NAC against CRP-mediated
inflammation, an immediate release form of NAC has been recently
demonstrated to lower CRP serum concentrations. Intravenous NAC was
administered to patients undergoing abdominal surgery. CRP level
following the surgery fell by 30% as compared to placebo infusion.
(Molnar et al., 2003) Even more impressively, Patients with
exacerbation of chronic obstructive pulmonary disease (COPD)
demonstrated an increase in CRP but orally administered NAC
resulted in decreased CRP (CRP normalized in 52% of patients on 600
mg/day and 90% of patients on 600 mg twice a day). The apparent
greater efficacy of oral NAC vs. intravenous NAC may be related to
the increased liver delivery of NAC via the oral route. (Zuin et
al., 2005) Therefore, NAC is a very appealing therapeutic agent for
achieving a reduction in CRP, thereby reducing inflammation and
oxidative damage, and for the prevention/treatment of
atherosclerosis and possibly other inflammatory and/or oxidative
insults in other diseases such as Parkinson's disease (note its
benefit in MPTP-induced Parkinson's disease and other models).
(Pcnugonda et al., 2005; Aoyama et al., 2007; Shavali et al., 2007;
and Kim-Han et al., 2007)
SUMMARY OF THE INVENTION
[0009] In one embodiment, the present invention provides a
composition comprising a sustained release (SR) component, wherein
the SR component comprises N-acetylcysteine, or a salt, solvate,
prodrug, and/or analog thereof; wherein the composition, upon oral
administration, provides a therapeutically effective plasma
concentration of N-acetylcysteine over about 2 to about 24 hours
following the administration. The prodrug and/or analog decreases
the polarity of NAC to increase its absorption in the lower GI
tract, such as the large intestine, and may further be broken or
decomposed into the original NAC by naturally occurring serum
enzymes, such as serum esterases and amidases.
[0010] In another embodiment, the present invention provides a
composition comprising an immediate release (IR) component, wherein
the IR component comprises N-acetylcysteine, or a salt, solvate,
prodrug, and/or analog thereof; and a sustained release (SR)
component, wherein the SR component comprises N-acetylcysteine, or
a salt, solvate, prodrug, and/or analog thereof; wherein the
composition, upon oral administration, provides a therapeutically
effective plasma concentration of N-acetylcysteine over about 30
minutes to about 24 hours following the administration.
[0011] In another embodiment, the present invention provides a
method of reducing a vascular inflammatory marker or mediator in a
mammal comprising orally administering to the mammal the
composition of the present invention.
[0012] In another embodiment, the present invention provides a
method of reducing systemic inflammation, inflammation of a
particular organ, and/or vascular inflammation in a mammal
comprising orally administering to the mammal the composition of
the present invention.
[0013] In another embodiment, the present invention provides a
method of treating a disease, condition, or symptom associated with
systemic and/or vascular inflammation in a mammal comprising orally
administering to the mammal the composition of the present
invention.
[0014] In another embodiment, the present invention provides a
method of treating a disease, condition, or symptom associated with
systemic and/or vascular inflammation in a mammal comprising
co-administering to the mammal (a) N-acetylcysteine, or a salt,
solvate, prodrug, and/or analog thereof; and (b) at least one
additional active agent.
[0015] In another embodiment, the present invention provides a
composition comprising (a) N-acetylcysteine, or a salt, solvate,
prodrug, and/or analog thereof; and (b) at least one additional
active agent.
[0016] In another embodiment, the present invention provides a
process of making granules comprising N-acetylcysteine, or a salt,
solvate, prodrug, and/or analog thereof, wherein the process does
not utilize a solvent.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] FIG. 1 is a flow diagram which illustrates one specific
embodiment of a bi-modal tablet by providing a schematic
description of how the medication is composed, absorbed and then
de-esterified to achieve high concentrations of the parent compound
in the circulation. The final embodiment is composed of two or more
layers. One layer contains immediate release N-acetyl-L-cysteine or
N-acetyl-D-cysteine and the other layers contain sustained release
formulation of any of compounds C through K (described herein
below). The dosage form may also be covered with enteric coating to
prevent release in the stomach, thus minimizing gastric irritation.
The IR layer is quickly absorbed in the small intestines, thereby
saturating pre-systemic (liver) binding sites. The SR prodrug
containing compound C through K is delivered to the distal
intestines/colon. Due to decreased polarity, there is enhanced
absorption of the SR portion in the distal intestines and colon.
Following absorption, the prodrugs are broken by serum esterases,
converting them back to N-acetyl-L-cysteine or N-acetyl-D-cysteine.
The total process leads to higher systemic blood concentrations of
NAC.
[0018] FIG. 2 is a pictorial illustration of one embodiment of a
controlled release oral dosage form of N-acetylcysteine formulated
to a matrix delivery system. The dosage form is composed of two or
more layers, one layer contains the immediate release forms of
N-acetyl-L-cysteine, N-acetyl-D-cysteine, or both, which are
release fairly quickly in the stomach and small intestines. The
other layers contain any of the sustained-release formulations of
compounds C through K (described herein below) which are released
in a slow sustained fashion to provide persistently leveled blood
concentrations over about 12 to about 24 hours. Additional details
are described in Example 1.
[0019] FIG. 3 is a pictorial illustration of one embodiment of a
controlled release oral dosage form of N-acetylcysteine formulated
to osmotic delivery system. The osmotic delivery system comprises
three layers (immediate-release layer, sustained-release layer and
osmotic push layer), and bound with a rate controlling cover
membrane with one orifice. As fluids moves through the membrane
into the capsule wall, the osmotic push layer expands and pushes
out first the IR layer and then the SR layer through the orifice.
Additional details are described in Example 14.
[0020] FIG. 4 is a pictorial illustration of one embodiment of a
controlled release oral dosage form of N-acetylcysteine formulated
as a multiparticulate delivery system. The dosage form contains
N-acetyl-L-cysteine and/or N-acetyl-D-cysteine in IR particles and
any of compounds C through K (described herein below) in an SR
particles. The tablet disintegrates in the gastric fluid. Following
disintegration, the IR particles dissolve rapidly to release the IR
portion with N-acetyl-L cysteine and/or N-acetyl-D-cysteine. The SR
particles travel to the distal intestines and colon, dissolving
slowly over about 12 to about 24 hours. Additional details are
described in Example 15.
DETAILED DESCRIPTION OF THE INVENTION
[0021] The present invention provides controlled-release
compositions that can achieve sustained systemic blood
concentration of N-acetylcysteine, or a salt, solvate, prodrug,
and/or analog thereof, over a long period of time and thereby
inhibit systemic, organ-specific, and/or vascular inflammation
continuously. The composition may be formulated to provide a
mono-modal or bi-modal release profile. By "mono-modal", it is
meant a composition comprising a sustained-release (SR) component.
The term "sustained-release" denotes the release of the active
agent in a controlled or modified manner over a period of time. By
"bi-modal", it is meant a composition comprising both an
immediate-release (IR) component and a SR component. The bi-modal
composition provides an initial burst of N-acetylcysteine, or a
salt, solvate, prodrug, and/or analog thereof, for a quick build up
of the systemic level of N-acetylcysteine in order to, for
instance, saturate the presystemic metabolizing enzymes, followed
by the sustained release of N-acetylcysteine, or a salt, solvate,
prodrug, and/or analog thereof, for maintaining the therapeutic
level. After the IR component quickly releases N-acetylcysteine, or
a salt, solvate, prodrug, and/or analog thereof, within an hour,
the SR component releases the drug thereafter over a long period of
time, such as over about 1 to about 48 hours, preferably over about
2 hours to 36 hours, and more preferably over about 3 to about 24
hours for maintaining the therapeutic level of NAC. The dosage form
of the composition can be administered as many times as necessary
per day, but preferably twice daily or more preferably once daily.
The IR component may contain from about 10 to 1500 mg of
N-acetylcysteine, or a salt, solvate, prodrug, and/or analog
thereof, for example about 10 mg, about 20 mg, about 30 mg, about
40 mg, about 50 mg, about 75 mg, about 100 mg, about 150 mg, about
200 mg, about 250 mg, about 300 mg, about 350 mg, about 400 mg,
about 450 mg, about 500 mg, about 550 mg, about 600 mg, about 650
mg, about 700 mg, about 750 mg, about 100 mg, about it and 50 mg,
about 900 mg, about 950 mg, about 1000 mg, about 1100 mg, about
1200 mg, about 1300 mg, about 1400 mg, or about 1500 mg of
N-acetylcysteine, or a salt, solvate, prodrug, and/or analog
thereof; while the SR component may contain from about 50 to about
2400 mg of N-acetylcysteine, or a salt, solvate, prodrug, and/or
analog thereof, for example about 50 mg, about 75 mg, about 100 mg,
about 150 mg, about 200 mg, about 250 mg, about 300 mg, about 350
mg, about 400 mg, about 450 mg, about 500 mg, about 550 mg, about
600 mg, about 650 mg, about 700 mg, about 750 mg, about 100 mg,
about it and 50 mg, about 900 mg, about 950 mg, about 1000 mg,
about 1100 mg, about 1200 mg, about 1300 mg, about 1400 mg, or
about 1500 mg, about 1600 mg, about 1700 mg, about 1800 mg, about
1900 mg, about 2000 mg, about 2100 mg, about 2200 mg, about 2300
mg, or about 2400 mg of N-acetylcysteine, or a salt, solvate,
prodrug, and/or analog thereof.
[0022] The composition may be formulated to various delivery
systems including matrix delivery systems, (U.S. Pat. No.
4,871,548), osmotic delivery systems (U.S. Pat. No. 4,612,008), and
mutiparticulate delivery systems (U.S. Pat. No. 4,894,240). Matrix
delivery systems are known to the field of pharmaceutical drug
delivery (U.S. Pat. Nos. 3,870,790; 4,140,755; 4,167,588;
4,226,849; 4,259,314; 4,357,469; 4,369,172; 4,389,393; 4,540,566
and 4,839, 177, the disclosures of which are incorporated herein by
reference in their entirety). The osmotic delivery systems have
been reported in a number of patents (U.S. Pat. Nos. 4,111,202,
4,327,725, 4,612,008, 4765989; 4,783,337, 5,082,668, 6,919,373, the
disclosures of which are incorporated herein by reference in their
entirety). The multiparticulate delivery systems typically involve
hard gelatin capsule or compressed tablets containing film-coated
spheroids or beads, as described, for example, by U.S. Pat. Nos.
2,996,431, 3,492,397, 3,835,221, 4,138,475, 4,415,547, 4,894,240
and 6,419,958, the disclosures of which are incorporated herein by
reference in their entirety. Use of ionic exchange resin for
sustained release of a pharmaceutical agent has also been disclosed
in U.S. Pat. Nos. 2,990,332, 3,138,525, 3,499,960, 3,594,470, and
4,894,239, the disclosures of which are incorporated herein by
reference in their entirety. In addition, the controlled-release of
prodrugs of carbidopa/L-dopa was disclosed in an U.S. Pat. No.
7,101,912 for treatment of Parkinson disease, the disclosures of
which are incorporated herein by reference in their entirety.
[0023] As used herein, the terms "a" and "an" do not denote a
limitation of quantity, but rather denote the presence of at least
one of the referenced item. The term "or" means "and/or". The terms
"comprising", "having", "including", and "containing" are to be
construed as open-ended terms (i.e., meaning "including, but not
limited to") unless otherwise noted. The terms "optional" and
"optionally" means possible/possibly, but not
necessary/necessarily.
N-Acetylcysteine and Modified N-Acetylcysteine
[0024] As used herein, the term "N-acetylcysteine", also known as
2-acetamido-3-sulfanylpropanoic acid or NAC, refers to a compound
having a structure shown in Scheme 1 and includes
N-acetyl-L-cysteine (Compound A), i.e.,
(2R)-2-acetamido-3-sulfanylpropanoic acid; N-acetyl-D-cysteine
(Compound B), i.e., (2R)-2-acetamido-3-sulfanylpropanoic acid); and
a mixture of N-acetyl-L-cysteine and N-acetyl-D-cysteine in any
ratio. Similarly, the term "cysteine" as used herein comprises
L-cysteine, D-cysteine, and a mixture thereof.
[0025] N-acetyl-D-cysteine is more resistant to gastrointestinal
degradation or biological metabolization as compared to
N-acetyl-L-cysteine, thus it may be advantageous to use the D form
N-acetyl-D-cysteine in the present compositions. In one embodiment
of the present composition, the IR and/or SR component(s) comprises
N-acetyl-D-cysteine, or a salt, solvate, prodrug, and/or analog
thereof.
##STR00001##
[0026] "Analog" refers to a compound, the chemical structure and/or
therapeutic effect of which are related to or similar to
N-acetylcysteine. For example, the analog of N-acetylcysteine can
be an amino acid analog, i.e., a compound obtained by coupling
N-acetylcysteine with an amino acid by forming ester, amide, and/or
anhydride bond(s) between the amino acid and N-acetylcysteine. Any
amino acid known to one skilled in the art can be used to make the
amino acid analog. Examples of the analog include, but are not
limited to the dimer of N-acetylcysteine, i.e., DiNAC, which is a
disulfide molecule; N-acetylcysteine L-lysine, i.e., Nacystelyn or
NAL; Carbocisteine; glutathione; S-nitroso-N-acetylcysteine;
S-nitrosothiol-N-acetylcysteine; S-allyl-cysteine;
S-alkyl-cysteine; N-acetyl-5-farnesyl-cysteine;
N-acetyl-L-arginine-NAC; N-acetyl-L-lysine-NAC;
N-acetyl-L-histidine-NAC; N-acetyl-L-ornithine-NAC; thioester of
NAC with salicylic acid;
2'4'-difluoro-4-hydroxy-(1,1'-diphenyl)-3-carboxylic derivatives of
NAC; S-allymercapto-NAC (ASSNaC); N,N-diacetyl-L-cystine;
N-S-diacyl-cysteinc; N-acetylcysteine conjugate of phenethyl
isothiocyanate (PEITC-NAC); S-carboxylmethyl-L-cysteine;
derivatives of reacting a reactive derivative of
p-isobutylphenylpropionic acid and NAC (e.g., an amide);
paraisobutyl NAC; and a combination thereof. The term "analog"
includes the analog and its salts, solvates, and prodrugs.
[0027] "Salts" refers to a derivative of N-acetylcysteine, wherein
N-acetylcysteine is modified by making acid or base addition salts
thereof. The salt includes a salt of N-acetylcysteine, a salt of a
prodrug of N-acetylcysteine, a salt of a solvate of
N-acetylcysteine, and a salt of an analog of N-acetylcysteine.
Examples of pharmaceutically acceptable salts include, but are not
limited to, mineral or organic acid addition salts of basic
residues such as amines; metal ion or organic base addition salts
of acidic residues; and the like, or a combination comprising one
or more of the foregoing salts. Examples of the metal ion include
an alkali metal ion, an alkaline earth ion, and an aluminum ion.
The pharmaceutically acceptable salts include salts and the
quaternary ammonium salts of N-acetylcysteine. For example, acid
salts include those derived from inorganic acids such as
hydrochloric, hydrobromic, sulfuric, sulfamic, phosphoric, nitric
and the like; other acceptable inorganic salts include metal salts
such as sodium salt, potassium salt, cesium salt, and the like; and
alkaline earth metal salts, such as calcium salt, magnesium salt,
and the like, or a combination comprising one or more of the
foregoing salts. Pharmaceutically acceptable organic salts includes
salts prepared from organic acids such as acetic, propionic,
succinic, glycolic, stearic, lactic, malic, tartaric, citric,
ascorbic, pamoic, maleic, hydroxymaleic, phenylacetic, glutamic,
benzoic, salicylic, mesylic, esylic, besylic, sulfanilic,
2-acetoxybenzoic, fumaric, toluenesulfonic, methancsulfonic, ethane
disulfonic, oxalic, isethionic, HOOC--(CH.sub.2).sub.n--COOH where
n is 0-4, bile acids, and the like; organic amine salts such as
triethylamine salt, pyridine salt, picoline salt, ethanolamine
salt, triethanolamine salt, dicyclohexylamine salt,
N,N'-dibenzylethylenediamine salt, and the like; and amino acid
salts such as arginate, asparginate, glutamate, and the like; or a
combination comprising one or more of the foregoing salts. In some
specific embodiments, the salts of N-acetylcysteine include sodium
N-acetylcysteine and calcium N-acetylcysteine.
[0028] "Solvate" means a complex formed by solvation (the
combination of solvent molecules with molecules or ions of
N-acetylcysteine), or an aggregate that consists of a solute ion or
molecule (N-acetylcysteine) with one or more solvent molecules.
When water is the solvent, the corresponding solvate is "hydrate".
The solvate includes a solvate of N-acetylcysteine, a solvate of a
prodrug of N-acetylcysteine, a solvate of a salt of
N-acetylcysteine, and a solvate of an analog of
N-acetylcysteine.
[0029] "Prodrug" refers to a precursor of N-acetylcysteine wherein
the precursor itself may or may not be pharmaceutically active but,
upon administration, will be converted, either metabolically, for
example hydrolyzed or oxidized, or otherwise, into
N-acetylcysteine. For example, after being absorbed, the prodrug
can be converted to the active compound (N-acetylcysteine) by
naturally occurring serum enzyme. Typical examples of prodrugs
include compounds that have biologically labile protecting groups
on a functional moiety of N-acetylcystcinc, such as the thiol
and/or the carboxylic acid. Prodrugs include compounds that can be
oxidized, reduced, aminated, deaminated, hydroxylated,
dehydroxylated, hydrolyzed, dehydrolyzed, alkylated, dealkylated,
acylated, deacylated, phosphorylated, dephosphorylated to produce
the active compound. For example, the prodrug includes an ester, an
amide, an anhydride, or a thioether form of N-acetylcysteine.
[0030] In one embodiment of the present composition, the IR and/or
SR component(s) comprises a prodrug of N-acetylcysteine.
Preferably, the prodrug is less polar than N-acetylcysteine and is
absorbable in the lower gastrointestinal (GI) tract of a mammal.
The decreased polarity can improve absorption in the lower GI
tract. The lower GI tract includes, but is not limited to the small
intestine (duodenum, jejunum, and ileum) and large intestine
(cecum, colon, and rectum). The polarity of the prodrug may be
measured by any method known to one skilled in the art. In one
embodiment, the polarity of the prodrug is measured by a partition
coefficient, such as log P, which can be calculated or experimental
and refers to the logarithm of the ratio of the concentration of
the un-ionized solute, i.e., the prodrug of N-acetylcysteine, in
the solvents, such as octanol-water. In one embodiment of the
present invention, the prodrug has a log P value of 3.5, 3.6, 3.7,
3.8, 3.9, 4.0, 4.1, 4.2, 4.3, 4.4, 4.5, or higher.
[0031] In one embodiment of the present invention, the prodrug
comprises a hydrophobic moiety. The hydrophobic moiety can be any
organic radical which imparts non-polarity to the prodrug. For
example, the hydrophobic moiety can be a hydrocarbon radical
optionally substituted by one or more functional groups containing
one or more heteroatoms. In one specific embodiment, the prodrug is
an ester, amide, or anhydride of N-acetylcysteine having structures
as shown in Scheme 2.
##STR00002##
[0032] wherein:
[0033] R.sup.1 and R.sup.3 are independently alkyl, substituted
alkyl, alkenyl, substituted alkenyl, aryl, substituted aryl,
heteroaryl, or substituted heteroaryl; and
[0034] each R.sup.2 are independently hydrogen, alkyl, substituted
alkyl, alkenyl, substituted alkenyl, aryl, substituted aryl,
heteroaryl, or substituted heteroaryl.
[0035] In one embodiment, the anhydride of NAC is an anhydride of
two NAC, i.e., an anhydride dimer of NAC as shown below:
##STR00003##
[0036] The term "alkyl", by itself or as part of other
substituents, refers to a saturated straight, branched, or cyclic,
primary, secondary, or tertiary hydrocarbon, including but not
limited to groups with C.sub.1 to C.sub.10. The term "alkyl"
includes "lower alkyl". The term "lower alkyl" refers to a
saturated straight, branched, or cyclic, primary, secondary, or
tertiary hydrocarbon, including groups with C.sub.1 to C.sub.4, and
if appropriate a cyclic alkyl group (for example cyclopropyl). The
term "alkyl" also includes "cycloalkyl", "heteroalkyl",
"heterocycloalkyl", "arylalkyl", and "heterarylalkyl" as defined
herein below.
[0037] Illustrative examples of alkyl groups are methyl, ethyl,
propyl, isopropyl, cyclopropyl, butyl, sec-butyl, isobutyl,
tert-butyl, cyclobutyl, 1-methylbutyl, 1,1-dimethylpropyl, pentyl,
cyclopentyl, isopentyl, neopentyl, cyclopentyl, hexyl, isohexyl,
and cyclohexyl. Unless otherwise specified, the alkyl group can be
unsubstituted or substituted with one or more moieties selected
from the group consisting of alkyl, halo, haloalkyl, hydroxyl,
carboxyl, acyl, acyloxy, amino, amido, carboxyl derivatives,
alkylamino, dialkylamino, acylamino, alkoxy, aryloxy, nitro, cyano,
thiol, imine, sulfonic acid, sulfate, sulfonyl, sulfanyl, sulfinyl,
sulfamonyl, ester, carboxylic acid, amide, phosphonyl, phosphinyl,
phosphoryl, phosphine, thioester, thioether, acid halide,
anhydride, oxime, hydrozine, carbamate, phosphonic acid, phosphate,
phosphonate, or any other viable functional group that does not
inhibit the pharmacological activity of this compound, either
unprotected, or protected as necessary, as known to those skilled
in the art, for example, as taught in Greene, et al., Protective
Groups in Organic Synthesis, John Wiley and Sons, Second Edition,
1991.
[0038] The terms "alkenyl", by itself or as part of other
substituents, refer to alkyl moieties, including both substituted
and unsubstituted forms wherein at least one saturated C--C bond is
replaced by a double bond. Thus, C.sub.2-6 alkenyl may be vinyl,
allyl, 1-propenyl, 2-propenyl, 1-butenyl, 2-butenyl, 3-butenyl,
1-pentenyl, 2-pentenyl, 3-pentenyl, 4-pentenyl, 1-hexenyl,
2-hexenyl, 3-hexenyl, 4-hexenyl, or 5-hexenyl.
[0039] "Alkyl" or "alkenyl" includes both straight chain and
branched groups. However, reference to an individual radical such
as "propyl" embraces only that straight-chain radical, whereas a
branched chain isomer such as "isopropyl" is specifically termed
such.
[0040] The term "aryl", by themselves or as part of other
substituents, as used herein and unless otherwise specified refers
to any stable monocyclic, bicyclic, or tricyclic carbon ring of up
to 8 members in each ring, wherein at least one ring is aromatic as
defined by the Huckel 4n+2 rule, and especially phenyl, biphenyl,
or naphthyl. The term includes both substituted and unsubstituted
moieties. The aryl group can be substituted with any described
moiety, including but not limited to one or more moieties selected
from the group consisting of halogen (fluoro, chloro, bromo or
iodo), hydroxyl, amino, azido, alkylamino, acylamino, alkoxy,
aryloxy, nitro, cyano, sulfonic acid, sulfate, phosphonic acid,
phosphate, or phosphonate, either protected or unprotected as
necessary, as known to those skilled in the art, for example, as
taught in Greene et al., Protective Groups in Organic Synthesis,
John Wiley & Sons, 3.sup.1d Ed., 1999.
[0041] The term "alkaryl" or "alkylaryl" refers to an alkyl group
with an aryl substituent or an alkyl group linked to the molecule
through an aryl group as defined herein. The term "aralkyl" or
"arylalkyl" refers to an aryl group substituted with an alkyl
substituent or linked to the molecule through an alkyl group as
defined above.
[0042] The term "cycloalkyl", by themselves or as part of other
substituents, includes a ring of C.sub.3-8, including but not
limited to cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl,
cycloheptyl and cyclooctyl.
[0043] The term "heteroalkyl", by themselves or as part of other
substituents, refer to an alkyl group in which one or more of the
carbon atoms (and optionally any associated hydrogen atoms), are
each, independently of one another, replaced with the same or
different heteroatoms or heteroatomic groups. The heteroatoms or
heteroatomic groups may be placed at any interior position of the
alkyl group.
[0044] The term "heteratom" includes an atom other than carbon or
hydrogen in the structure of a heterocyclic compound, nonlimiting
examples of which are nitrogen, oxygen, sulfur, phosphorus or
boron.
[0045] The term "cycloheteroalkyl" by itself or as part of another
substituent, refers to a cyclic alkyl radical in which one or more
carbon atoms (and optionally any associated hydrogen atoms) are
independently replaced with the same or different heteroatom.
[0046] The term "heterocycle", "heterocyclyl", or "heterocyclic" as
used herein includes non-aromatic ring systems having four to
fourteen members, preferably five to ten, in which one or more ring
carbons, preferably one to four, are each replaced by a heteroatom.
Heterocycle includes, but is not limited to, cycloheteroalkyl.
Examples of heterocyclic rings include 3-1H-benzimidazol-2-one,
(1-substituted)-2-oxo-benzimidazol-3-yl, 2-tetrahydro-furanyl,
3-tetrahydrofuranyl, 2-tetrahydropyranyl, 3-tetrahydropyranyl,
4-tetra-hydropyranyl, [1,3]-dioxalanyl, [1,3]-dithiolanyl,
[1,3]-dioxanyl, 2-tetra-hydro-thiophenyl, 3-tetrahydrothiophenyl,
2-morpholinyl, 3-morpholinyl, 4-morpholinyl, 2-thiomorpholinyl,
3-thiomorpholinyl, 4-thiomorpholinyl, 1-pyrrolidinyl,
2-pyrrolidinyl, 3-pyrrolidinyl, 1-piperazinyl, 2-piperazinyl,
1-piperidinyl, 2-piperidinyl, 3-piperidinyl, 4-piperidinyl,
4-thiazolidinyl, diazolonyl, N-substituted diazolonyl,
1-phthalimidinyl, benzoxanyl, benzopyrrolidinyl, benzopiperidinyl,
benzoxolanyl, benzothiolanyl, and benzothianyl. Also included
within the scope of the term "heterocyclyl" or "heterocyclic", as
it is used herein, is a group in which a non-aromatic
heteroatom-containing ring is fused to one or more aromatic or
non-aromatic rings, such as in an indolinyl, chromanyl,
phenanthridinyl, or tetrahydroquinolinyl, where the radical or
point of attachment is on the non-aromatic heteroatom-containing
ring. The term "heterocycle", "heterocyclyl", or "heterocyclic"
whether saturated or partially unsaturated, also refers to rings
that are optionally substituted.
[0047] The term "heteroaryl", used alone or as part of a larger
moiety as in "heteroaralkyl" or "heteroarylalkoxy", refers to
heteroaromatic ring groups having five to fourteen members.
Examples of heteroaryl rings include 2-furanyl, 3-furanyl,
3-furazanyl, N-imidazolyl, 2-imidazolyl, 4-imidazolyl,
5-imidazolyl, 3-isoxazolyl, 4-isoxazolyl, 5-isoxazolyl,
2-oxadiazolyl, 5-oxadiazolyl, 2-oxazolyl, 4-oxazolyl, 5-oxazolyl,
1-pyrrolyl, 2-pyrrolyl, 3-pyrrolyl, 1-pyrazolyl, 2-pyrazolyl,
3-pyrazolyl, 2-pyridyl, 3-pyridyl, 4-pyridyl, 2-pyrimidyl,
4-pyrimidyl, 5-pyrimidyl, 3-pyridazinyl, 2-thiazolyl, 4-thiazolyl,
5-thiazolyl, 5-tetrazolyl, 2-triazolyl, 5-triazolyl, 2-thienyl,
3-thienyl, carbazolyl, benzimidazolyl, benzothienyl, benzofuranyl,
indolyl, quinolinyl, benzotriazolyl, benzothiazolyl, benzooxazolyl,
benzimidazolyl, isoquinolinyl, indazolyl, isoindolyl, acridinyl,
and benzoisoxazolyl. Also included within the scope of the term
"heteroaryl", as it is used herein, is a group in which a
heteroatomic ring is fused to one or more aromatic or nonaromatic
rings where the radical or point of attachment is on the
heteroaromatic ring. Examples include tetrahydroquinolinyl,
tetrahydroisoquino-linyl, and pyrido[3,4-d]pyrimidinyl. The term
"heteroaryl" also refers to rings that are optionally substituted.
The term "heteroaryl" may be used interchangeably with the term
"heteroaryl ring" or the term "heteroaromatic".
[0048] Certain specific compounds of the present invention are
defined as follows: [0049] N-acetyl-L cysteine is Compound A;
[0050] N-acetyl-D-cysteine is Compound B; [0051] The ester prodrugs
of N-acetyl-L-cysteine are Compounds C, where the prodrugs have the
general structure as shown in Scheme 2, wherein the R.sup.1 group
can be methyl (C1), ethyl (C2), propyl (C3), butyl (C4), pentyl
(C5), or hexyl (C6) group; [0052] The ester prodrugs of
N-acetyl-D-cysteine are Compounds D, where the prodrugs have the
general structure as shown in Scheme 2, wherein the R.sup.1 group
can be methyl (D1), ethyl (D2), propyl (D3), butyl (D4), pentyl
(D5), or hexyl (D6) group; [0053] The amide prodrugs of
N-acetyl-L-cysteine are Compounds E, where the prodrug has the
general chemical structure as shown in Scheme 2, wherein one of
R.sup.2 is hydrogen, and the other R.sup.2 independently can be
methyl (E1), ethyl (E2), propyl (E3) butyl (E4), pentyl (E5) or
hexyl (E6); [0054] The amide prodrugs of N-acetyl-D-cysteine are
Compounds F, where the prodrug has the general chemical structure
as shown in Scheme 2, wherein one of R.sup.2 is hydrogen, and the
other R.sup.2 independently can be methyl (F1), ethyl (F2), propyl
(F3) butyl (F4), pentyl (F5) or hexyl (F6); [0055] The anhydride
prodrugs of N-acetyl-L-cysteine is Compound G, where the prodrug
has the general chemical structure as shown in Scheme [0056] The
anhydride prodrug of N-acetyl-D-cysteine is Compound H where the
prodrugs have the chemical structure as shown in Scheme 2; [0057]
The dimer of N-acetylcysteine, DiNAC is Compound I; [0058]
N-acetylcysteine L-lysinate (Nacystelyn) is Compound J; and [0059]
Carbocisteine is Compound K.
[0060] In another embodiment, the present invention provides a
sustained-release composition comprising a modified
N-acetylcysteine, or a salt and/or solvate thereof; and a
release-rate controlling polymer. The modified N-acetylcysteine, or
a salt and/or solvate thereof, is less polar than N-acetylcysteine,
and thereby is more absorbable in the lower GI tract than
N-acetylcysteine is. By "modified N-acetylcysteine", it is meant a
compound that is structurally related to and chemically derivable
from N-acetylcysteine. For example, the modified N-acetylcysteine
can be made from N-acetylcysteine by adding one or more hydrophobic
moieties to N-acetylcystein. Examples of the modified
N-acetylcystein include, but are not limited to the prodrugs and
analogs of N-acetylcystein as described herein.
[0061] The sustained-release composition may be formulated to
various delivery systems including matrix delivery system, osmotic
delivery system, or multiparticulates delivery system. For example,
the release rate controlling polymer may be mixed with the modified
N-acetylcysteine, or a salt and/or solvate thereof, to form a
matrix; or alternatively, the release rate controlling polymer is
disposed over the modified N-acetylcysteine, or a salt and/or
solvate thereof, to form a coating. The release rate controlling
polymer is the same as described hereinabove. The release of the
active agent by the sustained-release composition is extended for
longer than it would be in an immediate-release composition, e.g.,
at least over several hours. The sustained-release composition may
further optionally comprise one or more pharmaceutically acceptable
excipient as described herein.
[0062] The modified N-acetylcystein of the present invention can be
prepared by any method known to one skilled in the art. For
example, methods for preparing esters, amides, and anhydrides from
a carboxylic acid are well known in the field of organic chemistry.
Thus, the ester, amide, and anhydride prodrugs of NAC can be
prepared according to these known methods. Specific methods and
procedures can be found in Francis A. Carey and Richard J.
Sundberg, "Advanced Organic Chemistry, Part B: Reactions and
Synthesis", fifth edition, Springer Science+Business Media, LLC,
2007.
Controlled Release Compositions
[0063] In one embodiment, the present invention provides a
composition comprising a sustained release (SR) component. The SR
component comprises N-acetylcysteine, or a salt, solvate, prodrug,
and/or analog thereof. In one embodiment, the composition is
mono-modal and provides a sustained release profile. Upon oral
administration, the composition provides a therapeutically
effective plasma concentration of N-acetylcysteine over about 2 to
about 24 hours following the administration. In another embodiment,
the composition can provide a therapeutically effective plasma
concentration of N-acetylcysteine about 2.5 hours after the
administration. In another embodiment, the composition can provide
a therapeutically effective plasma concentration of
N-acetylcysteine about 3 hours after the administration. In another
embodiment, the composition provides a therapeutically effective
plasma concentration of N-acetylcysteine until about 20 hours
following the administration. In another embodiment, the
composition provides a therapeutically effective plasma
concentration of N-acetylcysteine until about 16 hours after the
administration. In another embodiment, the composition provides a
therapeutically effective plasma concentration of N-acetylcysteine
until about 12 hours after the administration. In another
embodiment, the composition provides a therapeutically effective
plasma concentration of N-acetylcysteine until about 8 hours after
the administration.
[0064] In one embodiment of the composition comprising a SR
component, the SR component comprises N-acetylcysteine, or a salt
and/or solvate thereof. Preferably, the SR component or the
composition does not contain a rheology modifying polymer. For
example, the rheology modifying polymer can be a granulated,
rhenology modifying, release-controlling, slightly cross-linked
polymer of acrylic acid, methacrylic acid, or an analog thereof.
Examples of the rheology modifying polymer are described in details
in U.S. Pat. No. 6,623,754, the disclosures of which are herein
incorporated by reference in its entirety. In another embodiment of
the composition comprising a SR component, the SR component
comprises N-acetylcysteine, or a prodrug and/or analog thereof,
wherein the SR component or the composition may or may not further
comprise a rhenology modifying polymer. In another embodiment, the
present invention provides a composition comprising an immediate
release (IR) component and a sustained release (SR) component. The
IR component comprises N-acetylcysteine, or a salt, solvate,
prodrug, and/or analog thereof; and the SR component comprises
N-acetylcysteine, or a salt, solvate, prodrug, and/or analog
thereof. The composition provides a bi-modal release profile. That
is, upon oral administration, the IR component readily release
N-acetylcysteine, or a salt, solvate, prodrug, and/or analog
thereof and thereby provides a therapeutically effective plasma
concentration of N-acetylcysteine, for instance, within about 20 to
about 40 minutes and maintains the therapeutically effective plasma
concentration of N-acetylcysteine for about 2 to 4 hours. In one
embodiment, the IR component provides a therapeutically effective
plasma concentration of N-acetylcysteine over about 30 minutes to
about 3 hours. As N-acetylcysteine released by the IR component is
absorbed and metabolized, the SR component starts to release
N-acetylcysteine and provides a sustained release profile as
described above. That is, the SR component can provides a
therapeutically effective plasma concentration of N-acetylcysteine
for about 8, 12, 16, 20, up to, or more than 24 hours. Thus, the
bi-modal composition, upon administration provides a
therapeutically effective plasma concentration of N-acetylcysteine
over, for instances, about 20 minutes to about 24 hours following
the administration. In another embodiment, the composition provides
a therapeutically effective plasma concentration of
N-acetylcysteine over about 30 minutes to about 24 hours following
the administration. In another embodiment, the composition provides
a therapeutically effective plasma concentration of
N-acetylcysteine over about 40 minutes to about 24 hours following
the administration.
[0065] "Therapeutically effective", as used herein, means the
amount of N-acetylcysteine, when administered to a patient for
treating a disease, condition, and/or symptom, is sufficient to
effect such treatment for the disease, condition, and/or symptom.
The therapeutically effective amount, such as the plasma
concentration, will vary depending on the compound, the disease and
its severity and the age, weight, etc., of the patient to be
treated. As used herein, the terms "mammal" and "patient" are used
interchangeably and refer to a human or domestic animal (including
both farm animals and companion animals).
[0066] Various mono- or bi-modal delivery systems comprising the
composition of the present invention may be formulated to provide a
release profile as described herein. For example, the present
composition can be formulated as a matrix, osmotic, and/or
multiparticulate delivery system. Each of the delivery systems can
be mono- or bi-modal. The composition may be provided in any dosage
form suitable for sustained release of a drug. A "dosage form"
means a unit of administration of N-acetylcysteine, or a salt,
solvate, prodrug, and/or analog thereof. Examples of dosage forms
include tablets, mini-tablets, capsules, microcapsules, injections,
suspensions, liquids, emulsions, creams, ointments, suppositories,
inhalable forms, transdermal forms, and the like. Preferred dosage
form of the present invention is oral dosage form. An "oral dosage
form" means a unit dosage form for oral administration.
[0067] In one embodiment, the composition comprises an SR
component, wherein the SR component comprises a matrix. The matrix
comprises N-acetylcysteine, or a salt, solvate, prodrug, and/or
analog thereof; and a release rate controlling polymer. The matrix
optionally further comprises one or more pharmaceutically
acceptable excipients. As used herein, the term "matrix" denotes a
homogeneous solid mixture composed of evenly dispersed ingredients
throughout. The composition, in a whole or a portion, may be in
form of a matrix. For example, the composition may be composed of a
matrix core and a coating over the matrix core; or alternatively,
the composition may be composed of two matrices as two portions of
the composition. In one embodiment, the matrix as described herein
is further coated with an enteric coating.
[0068] By "release rate controlling polymer", it is meant any
polymer which can control the release of N-acetylcysteine, or a
salt, solvate, prodrug, and/or analog thereof, from the composition
in such a way to obtain the desired release profile as described
herein. In one embodiment, the release rate controlling polymer is
a hydrophilic polymer. The term "hydrophilic polymer" refers to a
polymer having a strong affinity for water and tending to dissolve
in, mix with, or be wetted by water. Examples of the hydrophilic
polymer include, but are not limited to polyethylene oxide,
hydroxypropyl cellulose, hydroxypropyl methyl cellulose,
hydroxyethyl cellulose, sodium carboxymethylcellulose, calcium
carboxymethyl cellulose, methyl cellulose, polyacrylic acid,
maltodextrin, pre-gelatinized starch, guar gum, sodium alginate,
polyvinyl alcohol, chitosan, locust bean gum, amylase, any other
water-swelling polymer, and a combination thereof.
[0069] In another embodiment, the composition comprises both an IR
and SR components, wherein the SR component comprises a matrix as
described herein. The IR component comprises N-acetylcysteine, or a
salt, solvate, prodrug, and/or analog thereof, optionally in a
matrix form. The IR component optionally further comprises one or
more pharmaceutically acceptable excipients.
[0070] In one embodiment, the composition is formulated to an
osmotic delivery system. For example, the composition comprises a
release rate controlling membrane disposed over a pull layer and an
osmotic push layer, wherein the pull layer comprises
N-acetylcysteine, or a salt, solvate, prodrug, and/or analog
thereof, and the release rate controlling membrane has an orifice
immediately adjacent to the pull layer. The pull layer further
optionally comprises a release rate controlling polymer and/or a
pharmaceutically acceptable excipient. The release rate controlling
membrane is a semipermeable wall that surrounds the pull layer and
the osmotic push layer. The wall is permeable to the passage of
fluid and has an orifice which allows passage of N-acetylcysteine,
or a salt, solvate, prodrug, and/or analog thereof, from inside of
the wall to outside. Upon being exposed to biological or other
fluids, the semipermeable wall allows permeation of the fluids
through the wall causing expansion of the osmotic push layer, and
consequently the osmotic push layer pushes the pull layer through
the orifice. The release rate of N-acetylcysteine, or a salt,
solvate, prodrug, and/or analog thereof, is determined by the
permeability of the wall and the osmotic pressure gradient across
the wall.
[0071] There may be one or more pull layers and/or one or more
osmotic push layers encapsulated by the release rate controlling
membrane. In one embodiment, the release rate controlling membrane
encapsulates one pull layer and one osmotic push layer, wherein the
pull layer comprises N-acetylcysteine, or a salt, solvate, prodrug,
and/or analog thereof, and optionally a release rate controlling
polymer. That is, the pull layer may comprise either the IR
component or the SR component. In another embodiment, the release
rate controlling membrane encapsulates a first pull layer
comprising the IR component, a second pull layer comprising the SR
component, and an osmotic push layer; wherein the release rate
controlling membrane has an orifice immediately adjacent to the
first pull layer. Both the IR and SR components comprise
N-acetylcysteine, or a salt, solvate, prodrug, and/or analog
thereof, and further optionally independently comprise a
pharmaceutically acceptable excipient. In one embodiment, the SR
component comprises a matrix which contains N-acetylcysteine, or a
salt, solvate, prodrug, and/or analog thereof; and a release rate
controlling polymer. The release rate controlling polymer in the
osmotic delivery system is the same as described above.
[0072] The release rate controlling membrane can be made of any
material that is non-erodable, nontoxic, and insoluble in fluids,
and can form a semipermeable wall as described herein. Examples of
materials for forming the wall include, but are not limited to
cellulose esters, cellulose ethers, cellulose ester-ethers, and
combinations thereof. Additional examples include cellulose
acylate, cellulose diacylate, cellulose triacylate, cellulose
acetate, cellulose diacetate, cellulose triacetate, mono-, di- and
tricellulose alkanylates, mono-, di- and tricellulose aroylates,
and the like. Exemplary polymers include cellulose acetate having a
D.S. up to 1 and acetyl content up to 21%; cellulose acetate having
an acetyl content of 32 to 39.8%: cellulose diacetate having a D.S.
of 1 of 2 and an acetyl content of 21 to 35%; cellulose triacetate
having a D.S. of 2 to 3 and an acetyl content of to 44.8%; and the
like. More specific cellulosic polymers include cellulose
propionate having a D.S. of 1.8 and a propionyl content of 39.2 to
45% and a hydroxyl content of 2.8 to 5.4%; cellulose
acetate-butyrate having a D.S. of 1.8, and acetyl content of 13 to
15% and a butyryl content of 34 to 39%; cellulose acetate butyrate
having an acetyl content of 2 to 29%, a butyryl content of 17 to
53% and a hydroxyl content of 0.5 to 4.7%; cellulose triacylates
having a D.S. of 2.9 to 3 such as cellulose trivalerate, cellulose
trilaurate, cellulose tripalmitate, cellulose trisuccinate, and
cellulose trioclanoate; cellulose diacylates having a D.S. of 2.2
to 2.6 such as cellulose disuccinate, cellulose dipalmitate,
cellulose dioclanoate, cellulose dipentale, and the like.
[0073] In one embodiment, the osmotic push layer comprises an
osmopolymer. The osmopolymers are typically hydrophilic polymers
and interact with water and aqueous biological fluids and swell or
expand to push a drug composition through the orifice. The
osmopolymers exhibit the ability to swell in water and retain a
significant portion of the imbibed water within the polymer
structure. The osmopolymers may swell or expand to a very high
degree. The osmopolymers can be noncross-linked or cross-linked.
The swellable, hydrophilic polymers may be lightly cross-linked,
such as cross-links being formed by covalent or ionic bonds. The
osmopolymers can be of plant, animal or synthetic origin.
Hydrophilic polymers suitable for the present purpose include, but
are not limited to poly(hydroxyalkylmethacrylate) having a
molecular weight of from 30,000 to 5,000,000;
poly(vinylpyrrolidone) having molecular weight of from 10,000 to
360,000; anionic and cationic hydrogels; polyelectrolyte complexes,
poly(vinyl alcohol) having a low acetate residual, cross-linked
with glyoxal, formaldehyde, or glutaraldehyde and having a degree
of polymerization from 200 to 30,000; a mixture of methyl
cellulose, cross-linked agar and carboxymethyl cellulose; a water
insoluble, water swellable copolymer reduced by forming a
dispersion of finely divided copolymer of maleic anhydride with
styrene, ethylene, propylene, butylene or isobutylene cross-linked
with from 0.00001 to about 0.5 moles of polyunsaturated
cross-linking agent per mole of maleic anhydride in the copolymer;
water swellable polymers of N-vinyl lactams, and the like. Other
osmopolymers include hydrogel polymers, such as Carbopol (acrylic
acid-based polymers crosslinked with polyalkylene polyethers) and
the sodium salt thereof; acidic carboxy polymers generally having a
molecular weight of 450,000 to 4,000,000 and their metal salts;
Polyox; polyethylene oxide polymers having a molecular weight of
100,000 to 7,500,000.
[0074] In one embodiment, the pull layer further comprises an
osmagent, also known as osmotically effective solutes. The osmagent
can be any compound, inorganic or organic, that exhibit an osmotic
pressure gradient across an external fluid across the semipermeable
wall. In one embodiment, the osmagent is a solid. Examples of the
osmagent include, but are not limited to a salt, oxide,
carbohydrate, acid, ester, magnesium sulfate, magnesium chloride,
sodium chloride, potassium chloride, lithium chloride, potassium
sulfate, sodium sulfate, lithium sulfate, lithium phosphate, sodium
phosphate, potassium phosphate, potassium acid phosphate, calcium
lactate, mannitol, urea, inositol, magnesium succinate, tartaric
acid, carbohydrates such as raffinose, sucrose, glucose, lactose
monohydrate, and a blend of fructose glucose.
[0075] In one embodiment, the composition of the present invention
is formulated to a multiparticulate delivery system. Certain
examples of the multiparticulate delivery system and the
manufacturing thereof are described in detail in Lu, Int. J.
Pharm., 1994, 112, pages 117-124, the content of which is herein
incorporated by reference in its entirety. In one embodiment, the
SR component of the composition comprises one or more particles and
each of the particles comprises an active core comprising
N-acetylcysteine, or a salt, solvate, prodrug, and/or analog
thereof; and a release rate controlling polymer disposed over the
core. In another embodiment, the SR component of the composition
comprises one or more particles and each of the particles comprises
an inert core, an active layer comprising N-acetylcysteine, or a
salt, solvate, prodrug, and/or analog thereof disposed over the
inert core, and a release rate controlling polymer disposed over
the active layer. In one embodiment, the present composition
comprises both the IR and SR components and each of the IR and SR
components comprises one or more particles. In one embodiment, the
IR component comprises an inert core, and a cotaing disposed over
the inert core, wherein the coating comprises N-acetylcysteine, or
a salt, solvate, prodrug, and/or derivatives thereof. In yet
another embodiment, the composition comprises one or more particles
and each of the particles comprises the IR and SR components,
wherein the IR component forms a layer encapsulating the SR
component and optionally there are one or more additional layers
between the IR component and the SR component. Any of the active
core, the inert core, the active layer, the coating, or the coating
formed by the release rate controlling polymer disposed over the
active layer may optionally further comprise a pharmaceutically
acceptable excipient.
[0076] The term "particle" denotes a small discrete mass of solid,
semi-solid, or liquid matter that remains individually dispersed in
the composition. The particles can be in any shape including
spherical, round, elliptical, square, rectangular, triangular,
polygonal, or irregular shape. Depending on the shape, the process
of preparation, and the intended use of the particle, it may be
referred to as pellet, seed, bead, spheroid, or granule. For
example, a granule is a particle obtained through a granulation
process; a bead is a round-shaped particle.
[0077] In one embodiment of the multiparticulate delivery system,
the release rate controlling polymer comprises a film-forming,
water insoluble polymer in combination with a film-forming, water
soluble polymer. The ratio between the water insoluble polymer and
the water soluble polymer can be adjusted depending on the intended
drug release profile. In one embodiment, the release rate
controlling polymer comprises a major proportion of a
pharmaceutically acceptable film-forming, water insoluble polymer,
and a minor proportion of a pharmaceutically acceptable
film-forming, water soluble polymer. A coating can be formed by
disposing the release rate controlling polymer over the core or the
active layer, and the thickness of the coating can be adjusted to
permit the release of N-acetylcysteine, or a salt, solvate,
prodrug, and/or derivatives thereof with an intended profile.
[0078] Examples of the film-forming, water insoluble polymer
include, but are not limited to ethylcellulose, cellulose acetate,
cellulose propionate (lower, medium or higher molecular weight),
cellulose acetate propionate, cellulose acetate butyrate, cellulose
acetate phthalate, cellulose triacetate, poly(methyl methacrylate),
poly(ethyl methacrylate), poly(butyl methacrylate), poly(isobutyl
methacrylate), poly(hexyl methacrylate), poly(isodecyl
methacrylate), poly(lauryl methacrylate), poly(phenyl
methacrylate), poly(methyl acrylate), poly(isopropyl acrylatc),
poly(isobutyl acrylate), poly(octadecyl acrylate), poly(ethylene),
poly(ethylene) low density, poly(ethylene) high density,
poly(propylene), poly(ethylene oxide), poly(ethylene
terephthalate), poly(vinyl isobutyl ether), poly(vinyl acetate),
poly(vinyl chloride) or polyurethane, or any other water insoluble
polymer, or mixtures thereof.
[0079] Examples of the film-forming, water soluble polymer include,
but are not limited to polyvinyl alcohol, polyvinylpyrrolidone,
methyl cellulose, hydroxypropyl cellulose, hydroxypropylmethyl
cellulose and polyethylene glycol, Pluronic F108, Pluronic F127,
Pluronic F68 or mixtures thereof.
[0080] "Pharmaceutically acceptable" refers to being suitable for
use in contact with the tissues of humans and animals without undue
toxicity, irritation, allergic response, and the like, commensurate
with a reasonable benefit/risk ratio, and effective for their
intended use within the scope of sound medical judgment.
"Excipient" denotes a diluent, adjuvant, vehicle or carrier with
which N-acetylcysteine, or a salt, solvate, prodrug, and/or analog
thereof, is administered. Examples of the pharmaceutically
acceptable excipient include, are not limited to a filler (or
diluent), a binder, a disintegrant, a lubricant, or a combination
thereof.
[0081] Fillers may be one or more compounds which are capable of
providing compactability and good flow. Examples of fillers include
microcrystalline cellulose, starch, lactose, sucrose, glucose,
mannitol, maltodextrin, sorbitol, dextrose, silicic acid, dibasic
calcium phosphate, or a combination comprising at least one of the
foregoing fillers. Exemplary lactose forms include lactose
monohydrate, NF (Fast Flo), lactose spray-dried monohydrate, and
lactose anhydrous. Exemplary microcrystalline celluloses (MCC)
include, for example, AVICEL.RTM. PH101 and AVICEL.RTM. PH102,
which are commercially available from FMC Biopolymer, Philadelphia,
Pa.
[0082] Binders may be used to impart cohesive qualities to a
formulation, for example, a tablet formulation, and thus ensure
that the tablet remains intact after compaction. Examples of
binders include starches (for example, Starch 1500.RTM. or
pregelatinized starch), alignates, gelatin, carboxymethylcellulose,
sugars (for example, sucrose, glucose, dextrose, and maltodextrin),
polyethylene glycol, waxes, natural and synthetic gums,
polyvinylpyrrolidone, and cellulosic polymers (for example,
microcrystalline cellulose, hydroxypropyl cellulose, hydroxypropyl
methylcellulose, methyl cellulose, and hydroxyethyl cellulose) and
combinations comprising one or more of the foregoing binders.
[0083] Disintegrants are used to facilitate disintegration or
"breakup" of a composition, for example, a tablet, after
administration. Examples of disintegrants include sodium starch
glycolate, sodium croscarmellose (cross-linked carboxy methyl
cellulose), crosslinked polyvinylpyrrolidone (PVP-XL), anhydrous
calcium hydrogen phosphate, agar-agar, potato or tapioca starch,
alginic acid, or a combination comprising one or more of the
foregoing disintegrants.
[0084] A lubricant may be added to the composition for a minimum
period of time to obtain good dispersal. Examples of lubricants
include magnesium stearate, calcium stearate, zinc stearate,
stearic acid, talc, glyceryl behenate, polyethylene glycol,
polyethylene glycol, polyethylene oxide, sodium lauryl sulfate,
magnesium lauryl sulfate, sodium oleate, sodium stearyl fumarate,
DL-leucine, colloidal silica, or a combination comprising one or
more of the foregoing lubricants.
[0085] If desired, the composition may optionally comprise small
amounts of nontoxic auxiliary substances such as wetting or
emulsifying agents, or pH buffering agents, for example, sodium
acetate, sorbitan monolaurate, triethanolamine sodium acetate,
triethanolamine oleate, sodium lauryl sulfate, dioctyl sodium
sulfosuccinate, and polyoxyethylene sorbitan fatty acid esters.
[0086] The ratio among the active ingredient (N-acetylcysteine, or
a salt, solvate, prodrug, and/or analog thereof), the release rate
controlling polymer, osmopolymer, osmagent, and other
pharmaceutically acceptable excipients can be adjusted according to
the intended release profile and therapeutic objective. In one
embodiment, the present composition comprises from about 10 to
about 90 wt. % of the active ingredient, with the range from about
20 to about 80 wt. % more preferred, and with the range from about
30 to about 70 wt. % most preferred. In one specific embodiment,
the composition comprises about 60 wt. % of the active ingredient.
In other embodiments, the composition comprises about 10 wt. %,
about 20 wt. %, about 30 wt. %, about 40 wt. %, about 50 wt. %,
about 60 wt. %, about 70 wt. %, about 80 wt. %, or about 90 wt. %
of the active ingredient, inclusive of all ranges and subranges
therebetween.
Therapeutic Usage
[0087] The present invention also provides a method of reducing a
vascular inflammatory marker or mediator in a mammal. The method
comprises orally administering to the mammal the composition of the
present invention. "Vascular inflammatory marker or mediator" means
a biological substance that relates to or that is used to identify
vascular inflammatory. Examples of the vascular inflammatory marker
or mediator include, but are not limited to C-reactive protein
(CRP); lipoprotein-associated phospholipase A2 (LP-PLA2);
lipoprotein Lp(a); myeloperoxidase (MPO); macrophage chemotactic
protein 1 (MCP-1); interleukins (IL), such as IL-1,6,8,10; oxidized
low-density lipoprotein (oxidized LDL), adiponectin, matrix
metaloproteinases (MMP), such as MMP-9,1,2; CD40; homocysteine;
cardiovascular risk factor (CVRF); plasminogen activator inhibitor
(PAI-1); prostaglandin (PG); tissue polypeptide antigen (TPA); von
Willebrand factor (vWF); platelet aggregation; fibrinogen; Factor
VII; Factor VIII; tissue factor; phosphoglucose (PGI1); endothelin;
metaloproteinases; Lipoxegenase; angiotensin; and a combination
thereof.
[0088] In one embodiment, the present invention provides a method
of reducing systemic, organ-specific, and/or vascular inflammation
in a mammal. The method comprises orally administering to the
mammal the composition of the present invention.
[0089] In one embodiment, the present invention provides a method
of treating a disease, condition, or symptom associated with
systemic and/or vascular inflammation in a mammal. The term
"treating", as used herein, means preventing, relieving,
ameliorating, and/or curing an illness including a disease,
condition, and/or symptom as well as reducing the frequency of
occurrence of adverse health event (e.g., acute coronary events).
The term "associated with systemic and/or vascular inflammation"
denotes a disease, condition, and/or symptom that accompanies or is
connected with systemic and/or vascular inflammation. Such a
disease, condition, and/or symptom may directly or indirectly cause
or be caused by systemic and/or vascular inflammation. The method
comprises orally administering to the mammal the composition or the
present invention. In one embodiment, the disease, condition, or
symptom is related to the circulatory system of the mammal.
Examples of the disease, condition, or symptom include, but are not
limited to liver inflammation; pancreatitis; myocardial
hyperthrophy; pulmonary fibrosis, such as pulmonary fibrosis
related to radiation damage; endotoxic shock; uveitis; dementia
including Alzheimer's dementia and AIDS dementia; Parkinson's
disease; brain toxicity; kidney damage from radiographic dyes;
cancer drugs toxicity, such as the toxicity of methotrexate (MTX);
AIDS; atherosclerosis, arthritis, diabetes, colitis, multiple
sclerosis, acute coronary syndrome, and acute myocardial
infarction. The liver inflammation may be related to or caused by a
disease, such as acute or chronic hepatitis, ischemic hepatitis,
viral hepatitis, autoimmune discasees, metabolic diseases (e.g.,
Wilson's disease), non-alcoholic stcatohcpatitis, primary biliary
cirrhosis, and primary sclerosing cholangitis; a body condition,
such as pregancy; and/or the use of certain substance, such as
alcohol, toxins, and drugs including acetaminophen (TYLENOL),
amoxycillin, antituberculosis drugs, minocycline, ibuprofen, and
other drugs having liver toxicity. In one specific embodiment, the
method comprises orally administering to the mammal the composition
of the present invention for treating liver inflammation caused by
acetaminophen.
Manufacturing Process
[0090] It has been known that NAC may degrade via hydrolysis during
the manufacturing process, especially in a granulation process
employing an aqueous solution. U.S. Pat. No. 6,623,754 describes a
direct compression process to avoid NAC hydrolysis. However, this
process limits the selection of excipients and requires large size
drug particles. Therefore, the present invention provides an
alternative process to manufacture the controlled-release
composition comprising N-acetylcysteine, or a salt, solvate,
prodrug, and/or analog thereof, with minimal NAC degradation. The
process does not utilize a solvent, particularly water. In one
embodiment, the process for making granules comprising
N-acetylcysteine, or a salt, solvate, prodrug, and/or analog
thereof, comprises the steps of applying forces to loose solids
comprising N-acetylcysteine, or a salt, solvate, prodrug, and/or
analog thereof, thereby obtaining a solid sheet; and reducing the
size of the solid sheet, thereby obtaining granules. By "loose
solids", it is meant solids that are not pressed, compacted, or
otherwise processed to have a fixed shape to some extent. In one
embodiment, the applying step is carried out by pressing the loose
solids between two counter rotating rolls. The granules further
optionally comprise one or more pharmaceutically acceptable
excipients. In one embodiment of the process, a roller compactor
forces powdery and fine crystalline excipients and NAC or it
prodrug between two counter rotating rolls and presses them into a
solid compact or sheet, so called flakes. Then, these flakes are
reduced to desired particle size for further process such as
compression to tablets. Since this granulation method does not
involve any solvents, especially water, the potential for drug
degradation is eliminated.
Combination Therapy
[0091] In one embodiment, a composition or formulation comprising
N-acetylcysteine, or a salt, solvate, prodrug, and/or analog
thereof, may be used in combination with at least one additional
active agent. The additional active agent can be any compound,
agent, molecule, composition, or medication that have biological
activity or therapeutic effect. For example, the additional active
agent may enhance the therapeutic effect of or generate synergistic
effect with N-acetylcysteine, or a salt, solvate, prodrug, and/or
analog thereof. Alternatively, the toxicity or side effect of the
additional active agent may be reduced by N-acetylcysteine, or a
salt, solvate, prodrug, and/or analog thereof. The additional
active agent can be a small-molecule drug, biologics, herbal
composition, or a treatment method, such as radiotherapy. In one
embodiment, the additional active agent is a drug for treating
cadiovascular and/or metabolism diseases. Preferably, the
additional active agent is a statin. Examples of the statins
include, but are not limited to atorvastatin, cerivastatin,
fluvastatin, lovastatin, mevastatin, pitavastatin, pravastatin,
rosuvastatin, simvastatin, and a combination thereof.
[0092] In one embodiment, the present invention provides a method
of treating a disease, condition, or symptom associated with
systemic and/or vascular inflammation in a mammal comprising
co-administering to the mammal (a) N-acetylcysteine, or a salt,
solvate, prodrug, and/or analog thereof; and (b) at least one
additional active agent. The term "co-administration" or
"coadministration" refers to administration of the above-mentioned
components (a) and (b) together in a coordinated fashion. For
example, the co-administration can be simultaneous administration,
i.e., administration of (a) and (b) at the same time; sequential
administration, i.e., administration of (a) and (b) in succession
within a short period of time, such as within a couple of hours;
separate administration, i.e., administration of (a) and (b) that
is not simultaneous or sequential, but is according to a
predetermined dosing regimen or schedule; or a combination thereof.
Furthermore, the co-administration includes the administration of a
single dosage form containing both (a) and (b); and two separate
dosage forms containing (a) and (b), respectively.
[0093] The dosing amount of (a) and (b) needs to be a
therapeutically effective amount and may vary for each patient
depending on the individual patient's condition. The term
"therapeutically effective amount", as used herein, denotes an
amount that can produce one or more intended biological effects in
a patient, such as preventing, ameliorating, relieving, improving,
or remedying the disease, condition, and/or symptoms.
[0094] In one embodiment, the present invention provides a
composition comprising (a) N-acetylcysteine, or a salt, solvate,
prodrug, and/or analog thereof; and (b) at least one additional
active agent. The component (a) may include a sustained release
component comprising N-acetylcysteine, or a salt, solvate, prodrug,
and/or analog thereof; and a release rate controlling polymer as
described herein. The sustained release component can be formulated
to any delivery system as described herein. The component (a) may
further optionally include an immediate release component
comprising N-acetylcysteine, or a salt, solvate, prodrug, and/or
analog thereof. Furthermore, the composition may optionally contain
one or more pharmaceutically acceptable excipient as described
herein.
[0095] In one embodiment, the present invention provides a
combination package comprising (a) at least one individual dose of
N-acetylcysteine, or a salt, solvate, prodrug, and/or analog
thereof; and (b) at least one individual dose of an additional
active agent. The combination package may further optionally
comprise an instruction document providing a protocol for
co-administering (a) and (b). Each of the individual dose may be
formulated to a pharmaceutical composition or a dosage form
thereof. Component (b) may be included in either or both the SR or
IR forms, layers, etc. or may be formulated as a separate dosage
form, within or external to the NAC component.
[0096] In one embodiment, the present invention provides a method
of distributing a therapeutic agent comprising distributing to a
patient a predetermined amount of a first pharmaceutical
composition comprising N-acetylcysteine, or a salt, solvate,
prodrug, and/or analog thereof, in combination with a predetermined
amount of a second pharmaceutical composition comprising at least
one additional active agent. In one embodiment, the present
invention provides a method of distributing a therapeutic agent
comprising distributing to a patient a predetermined amount of a
first pharmaceutical composition comprising at least one active
agent, in combination with a predetermined amount of a second
pharmaceutical composition comprising N-acetylcysteine, or a salt,
solvate, prodrug, and/or analog thereof.
[0097] In one embodiment, the present invention provides a method
of distributing a chemotherapeutic agent comprising distributing to
a patient a predetermined amount of a first pharmaceutical
composition comprising N-acetylcysteine, or a salt, solvate,
prodrug, and/or analog thereof, in combination with an instruction
of administering the first pharmaceutical composition with a
predetermined amount of a second pharmaceutical composition
comprising at least one additional active agent. In another
embodiment, the present invention provides a method of distributing
a chemotherapeutic agent comprising distributing to a patient a
predetermined amount of a first pharmaceutical composition
comprising at least one active agent, in combination with an
instruction of administering the first pharmaceutical composition
with a predetermined amount of a second pharmaceutical composition
comprising N-acetylcysteine, or a salt, solvate, prodrug, and/or
analog thereof.
EXAMPLES
[0098] The following examples are provided for illustrative
purposes only. These examples should not be considered as limiting
the invention in any way.
Example 1
[0099] FIG. 2 shows the configuration of the bi-layer matrix
delivery system. The dosage form is composed of two layers, one
being an immediate release layer and the other the sustained
release layer. The immediate release layer (IR) comprises 84% of
N-acetyl-L-cysteine, 5% of hydroxypropylmethylcellose E5, 5% of
croscarmellose sodium, 5% of sodium bicarbonate and 1% of magnesium
stearate, and the sustained release layer (SR) comprises 60% of
N-acetyl-L-cysteine, 15% of a mixture of Carbomer 71G and Carbomer
934P, 24% of sodium bicarbonate and 1% of magnesium stearate. The
system can be prepared as described below.
[0100] First, all these components are sieved individually through
a 40-mesh screen. The sieved IR ingredients except Mg stearate are
dry-blended in a V-blender for 10 minutes. The resultant dry blend
is roller compacted using a roller compactor with a 1.25-mm screen.
Then, the resultant IR layer granules are blended with 1% Mg
stearate in the V-blender. Next, the SR granules are prepared using
the same way as the IR granules. Finally, the 238 mg of the IR
granules and 666.7 mg of the SR granules are compressed in to a
bi-layer tablet on a bi-layer tablet press with 0.75''.times.0.35''
oval tooling. Each of the bi-layer tablets comprises 600 mg of NAC
in total, 200 mg in the IR layer and 400 mg in the SR layer. By
adjusting the weight ratio of Carbomer 71G to Carbomer 934P in the
SR layer, various release durations from 4 hr to 24 hrs can be
achieved. The release duration here is referred to as the period of
time during which 90% of NAC are released from the matrix
tablet.
Example 2
[0101] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. However, the
tablet in this example comprises N-acetyl-D-cysteine instead of
N-acetyl-L-cysteine.
Example 3
[0102] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. However, the
IR component of the tablet in this example comprises the racemate
or any mixtures of N-acetyl-D-cysteine and N-acetyl-L-cysteine.
Example 4
[0103] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. However, the
SR component of tablet in this example comprises an ester prodrug
of N-acetyl-L-cysteine. The prodrug has the general chemical
structure as shown in Scheme 2 (compounds C), wherein R can be
methyl, ethyl, propyl, butyl, pentyl or hexyl.
Example 5
[0104] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. However, the
SR component of the tablet in this example comprises an ester
prodrug of N-acetyl-D-cysteine. The prodrug has the general
chemical structure as shown in Scheme 2 (compounds D), wherein R
can be methyl, ethyl, propyl butyl, pentyl or hexyl.
Example 6
[0105] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. However, the
SR component of the tablet in this example comprises an amide
prodrug of N-acetyl-L-cysteine. The prodrug has the chemical
structure as shown in Scheme 2 (compounds E), wherein each R.sup.2
is independently as described herein.
Example 7
[0106] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. However, the
SR component of the tablet in this example comprises an amide
prodrug of N-acetyl-D-cysteine. The prodrug has the chemical
structure as shown in Scheme 2 (compounds F), wherein each R.sup.2
is independently as described herein.
Example 8
[0107] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. However, the
SR component of the tablet in this example comprises an anhydride
prodrug of N-acetyl-L-cysteine. The prodrug has the chemical
structure as shown in Scheme 2 (compounds G), wherein R.sup.3 is as
described herein.
Example 9
[0108] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. However, the
SR component of the tablet in this example comprises an anhydride
prodrug of N-acetyl-D-cysteine. The prodrug has the chemical
structure as shown in Scheme 2 (compounds H), wherein R.sup.3 is as
described herein.
Example 10
[0109] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. However, the
SR component of the tablet in this example comprises either (a) the
dimer of N-acetylcysteine, DiNAC (compound I), (b) N-acetylcysteine
L-lysinate (Nacystclyn, Compound J), or (c) Carbocisteine.
(compound K).
Example 11
[0110] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. The tablet in
this example has the following composition in the SR layer.
TABLE-US-00001 Component Weight % NAC 60 HPMC E5 and HPMC K100M 39
Mg Stearate 1
Example 12
[0111] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. The tablet in
this example has the following composition in the SR layer.
TABLE-US-00002 Component Weight % Any of Compounds A through K 60
Na bicarbonate 0-34 Chitosan 5-39 Mg Stearate 1
Example 13
[0112] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. The tablet in
this example has the following composition in the SR layer.
TABLE-US-00003 Component Weight % Any of Compounds A through K 60
Na bicarbonate 0-34 Crosslinked high amylose starch 5-39 Mg
Stearate 1
Example 14
[0113] The procedure for preparing the matrix tablet in this
example is identical to that described in Example 1. The tablet in
this example has the following composition in the SR layer.
TABLE-US-00004 Component Weight % NAC 60 Na bicarbonate 0-34 Polyox
coagulant 5-39 Mg Stearate 1
Example 15
[0114] FIG. 3 schematically shows the configuration of an osmotic
delivery system for controlled release of NAC to the
gastrointestinal tract of a human. An embodiment of this delivery
system comprises the first immediate release drug layer, the second
sustained release drug layer and the third osmotic push layer, and
the rate-controlling membrane enrobing the three layers.
[0115] The delivery system is manufactured as follows: first, the
immediate release NAC layer and the sustained release NAC layer
granules are separately prepared by a roller compaction process as
described in Example 1. Next, the osmotic push layer is prepared by
a fluid-bed granulation process. Then, the first IR drug layer
granules, the second SR drug layer granules and the osmotic push
layer granules are compressed together to from a tri-layer table,
using a 17/64'' tooling. A rate-controlling membrane composition is
coated around the tri-layer tablet and a 155 mil orifice for drug
release is formed by cutting through the membrane. The tables below
list the amount of each component comprised in the osmotic delivery
system.
TABLE-US-00005 First IR Drug Layer Component Amount (mg) NAC About
10-1500, usually 200 Croscarmellose sodium About 23.8 HPMC E5 About
11.9 Mg Stearate About 2.3
TABLE-US-00006 Second SR Drug layer Compounds A to K, up to 2400,
usually 400 HPMC K100M About 22.5 HPMC E5 About 22.5 Mg Stearate
About 4.5
TABLE-US-00007 Third Osmotic Push Layer
Sodium-Carboxylmethylcellulose About 159 Sodium Chloride About 75
HPMC E5 About 12.5 Mg stearate About 1.3 Ferric Oxide About 2.5
TABLE-US-00008 Rate-limiting Membrane Cellulose acetate (39.8%
acetate content) About 76.5 Pluronic F68 About 13.5
Example 16
[0116] FIG. 4 schematically shows the configuration of a delivery
tablet for controlled release of NAC to the gastrointestinal tract
in a human. The preferred embodiment of this tablet comprises IR
particulates and SR spheres of NAC. The tablet will disintegrate in
a gastric fluid, with the IR particulates dissolving rapidly and
the SR spheres releasing NAC slowly.
[0117] The delivery system is manufactured as follows: first, the
active NAC cores are prepared. NAC and Na bicarbonate are sieved
through a 40-mesh screen and blended well to obtain a homogeneous
powder mixture. The powder mixture is applied to non-pareil sugar
spheres (preferred particle size of 420-500 .mu.m) using a Freund
CF granulator. A 10% solution of FIPMC E5 in ethanol is used as a
binding agent for this drug powder layering process. Then, the
active cores are coated with a rate-controlling membrane
composition. The uncoated active core also serves as the IR
spheres. Finally, the IR spheres and the coated spheres are
dry-blended with a disintegrant and compressed into a tablet using
0.75''.times.0.35'' oval tooling. The tables below list the
composition of this multiparticulate tablet.
TABLE-US-00009 IR sphere Component WT % NAC or compounds A-K, or
analogs About 59.5 Na Bicarbonate About 3.5 Non-Pareil About 30.0
HPMC About 7.0
TABLE-US-00010 SR sphere Component Wt % NAC About 47.6 Na
Bicarbonate About 2.8 Non-Pareil About 24 HPMC' About 5.6 Sreelcase
solid About 20
TABLE-US-00011 Multiparticulate Tablet Component Wt % IR spheres
About 27.1 SR spheres About 67.9 Crosscarmellose Na About 5.0
Example 17
Preparation of a Controlled Release Oral Dosage Form of a NAC
Prodrug
[0118] The controlled release system is composed of a drug core and
a release rate-controlling membrane. The drug core comprises 70% of
the N-acetyl-L-cysteine prodrug, 19.0% of Puronic F127, 10% of
Povidone K29 and 1% of magnesium stearate. The membrane is composed
of cellulose ether (ethyl cellulose or cellulose acetate) and a
water flux enhancer (Povidone K90, PEG 400, or Pluronic F68). The
system can be prepared as described below.
[0119] First, all these components are sieved individually through
a 40-mesh screen. The sieved ingredients except Mg stearate are
dry-blended in a V-blender for 10 mins. The resultant dry blend is
roller compacted using a roller compactor with a 1.25-mm screen.
Then, the resultant granules are blended with 1% Mg stearate in the
V-blender. Next, 857.1 mg of the granules are compressed in to a
tablet. Each tablet comprises 600 mg of the NAC prodrug. By
adjusting either the weight ratio of the cellulose ether to the
flux enhancer in the membrane or the membrane thickness, various
release durations f' rom 3 hr to 24 hrs can be achieved. The
release duration here is referred to as the period of time during
which 90% of NAC are released from the delivery system.
[0120] All publications, patents, and patent applications
referenced herein (including the references listed herein below)
are incorporated by reference in their entireties to the same
extent as if each individual publication, patent, or patent
application was specifically and individually indicated to be
incorporated by reference in its entirety.
REFERENCES
[0121] 1. Zambon A, Gervois P, Pauletto P, Fruchart J C, Staels B.
Modulation of hepatic inflammatory risk markers of cardiovascular
diseases by PPAR-alpha activators: clinical and experimental
evidence. Arterioscler Thromb Vasc Biol. May 2006; 26(5):977-986.
[0122] 2. Wilson A M, Ryan M C, Boyle A J. The novel role of
C-reactive protein in cardiovascular disease: risk marker or
pathogen. Int J. Cardiol. Jan. 26, 2006; 106(3):291-297. [0123] 3.
Mora S, Ridker P M. Justification for the Use of Statins in Primary
Prevention: an Intervention Trial Evaluating Rosuvastatin
(JUPITER)--can C-reactive protein be used to target statin therapy
in primary prevention? Am J. Cardiol. Jan. 16, 2006;
97(2A):33A-41A. [0124] 4. Paffen E, DeMaat M P. C-reactive protein
in atherosclerosis: A causal factor? Cardiovasc Res. Jul. 1, 2006;
71(1):30-39. [0125] 5. Inoue N. Vascular C-reactive protein in the
pathogenesis of coronary artery disease: role of vascular
inflammation and oxidative stress. Cardiovasc Heinatol Disord Drug
Targets. December 2006; 6(4):227-231. [0126] 6. de Ferranti S D,
Rifai N. C-reactive protein: a nontraditional serum marker of
cardiovascular risk. Cardiovasc Pathol. January-February 2007;
16(1):14-21. [0127] 7. Gotto A M, Jr. Role of C-reactive protein in
coronary risk reduction: focus on primary prevention. Am J Cardiol.
Mar. 1, 2007; 99(5):718-725. [0128] 8. Bisoendial R J, Kastelein J
J, Stroes E S. C-reactive protein and atherogenesis: from fatty
streak to clinical event. Atherosclerosis. December 2007;
195(2):e10-18. [0129] 9. Gonzalez-Gay M A, Gonzalez-Juanatey C,
Pineiro A, Garcia-Porrua C, Testa A, Llorca J. High-grade
C-reactive protein elevation correlates with accelerated
atherogenesis in patients with rheumatoid arthritis. J Rheumatol.
July 2005; 32(7):1219-1223. [0130] 10. Venugopal S K, Devaraj S,
Jialal I. Effect of C-reactive protein on vascular cells: evidence
for a proinflammatory, proatherogenic role. Curr Opin Nephrol
Hypertens. January 2005; 14(1):33-37. [0131] 11. Jialal I, Devaraj
S, Venugopal S K. C-reactive protein: risk marker or mediator in
atherothrombosis? Hypertension. July 2004; 44(1):6-11. [0132] 12.
Chang J W, Kim C S, Kim S B, Park S K, Park J S, Lee S K.
C-reactive protein induces NF-kappaB activation through
intracellular calcium and ROS in human mesangial cells. Nephron Exp
Nephrol. 2005; 101(4):e165-172. [0133] 13. Fu A L, Dong Z H, Sun M
J. Protective effect of N-acetyl-L-cysteine on amyloid
beta-peptide-induced learning and memory deficits in mice. Brain
Res. Sep. 13, 2006; 1109(1):201-206. [0134] 14. Hicdonmez T, Kanter
M, Tiryaki M, Parsak T, Cobanoglu S, Neuroprotective effects of
N-acetylcysteine on experimental closed head trauma in rats.
Neurochem Res. April 2006; 31(4):473-481. [0135] 15. Jara-Prado A,
Ortega-Vazquez A, Martinez-Ruano L, Rios, Santamaria A.
Homocysteine-induced brain lipid peroxidation: effects of NMDA
receptor blockade, antioxidant treatment, and nitric oxide synthase
inhibition. Neurotox Res. 2003; 5(4):237-243. [0136] 16.
Karageorgos N, Patsoukis N, Chroni E, Konstantinou D,
Assimakopoulos S F, Georgiou C. Effect of N-acetylcysteine,
allopurinol and vitamin E on jaundice-induced brain oxidative
stress in rats. Brain Res. Sep. 21, 2006; 1111(1):203-212. [0137]
17. Penugonda 5, Marc 5, Goldstein G, Banks W A, Ercal N. Effects
of N-acetylcysteine amide (NACA), a novel thiol antioxidant against
glutamate-induced cytotoxicity in neuronal cell line PC12. Brain
Res. Sep. 21, 2005; 1056(2):132-138. [0138] 18. Price T O, Uras F,
Banks W A, Ercal N. A novel antioxidant N-acetylcysteine amide
prevents gp120- and Tat-induced oxidative stress in brain
endothelial cells. Exp Neurol. September 2006; 201(1):193-202.
[0139] 19. Shea T B. Effects of dietary supplementation with
N-acetyl cysteine, acetyl-L-carnitine and S-adenosyl methionine on
cognitive performance and aggression in normal mice and mice
expressing human ApoE4. Neuromolecular Med. 2007; 9(3):264-269.
[0140] 20. Tchantchou F, Graves M, Ortiz D, Rogers E, Shea TB.
Dietary supplementation with 3-deaza adenosine, N-acetyl cysteine,
and 5-adenosyl methionine provide neuroprotection against multiple
consequences of vitamin deficiency and oxidative challenge:
relevance to age-related neurodegeneration. Neuromolecular Med.
2004; 6(2-3):93-103. [0141] Kaya H, Koc A, Sogut S, et al. The
protective effect of N-acetylcysteine against cyclosporine
A-induced hepatotoxicity in rats. J Appl Toxicol. January-February
2008; 28(1):15-20. [0142] 22. Liu Y, Zhang H, Zhang L, et al.
Antioxidant N-acetylcysteine attenuates the acute liver injury
caused by X-ray in mice. Eur J Pharmacol. Dec. 1, 2007;
575(1-3):142-148. [0143] 23. Alipour M, Omri A, Smith M G, Suntres
Z E. Prophylactic effect of liposomal N-acetylcysteine against
LPS-induced liver injuries. J Endotoxin Res. 2007; 13(5):297-304.
[0144] 24. Koksel O, Cinel I, Tamer L, et al. N-acetylcysteine
inhibits peroxynitrite-mediated damage in oleic acid-induced lung
injury. Pulm Pharmacol Ther. 2004; 17(5):263-270. [0145] 25. Chuang
I C, Liu D D, Kao S J, Chen H I. N-acetylcysteine attenuates the
acute lung injury caused by phorbol myristate acetate in isolated
rat lungs. Pulm Pharmacol Ther. 2007; 20(6):726-733. [0146] 26.
Chen C M, Yin M C, Hsu C C, Liu T C. Antioxidative and
anti-inflammatory effects of four cysteine-containing agents in
striatum of MPTP-treated mice. Nutrition. July-August 2007;
23(7-8):589-597. [0147] 27. Van Antwerpen P, Boudjeltia K Z, Babar
S, et al. Thiol-containing molecules interact with the
myeloperoxidase/H2O2/chloride system to inhibit LDL oxidation.
Biochem Biophys Res Commun. Nov. 11, 2005; 337(1):82-88. [0148] 28.
Rattan A K, Arad Y. Temporal and kinetic determinants of the
inhibition of LDL oxidation by N-acetylcysteine (NAC).
Atherosclerosis. June 1998; 138(2):319-327. [0149] 29. Galis Z S,
Asanuma K, Godin D, Meng X. N-acetyl-cysteine decreases the
matrix-degrading capacity of macrophage-derived foam cells: new
target for antioxidant therapy? Circulation. Jun. 23, 1998;
97(24):2445-2453. [0150] 30. Fujii H, Li S H, Szmitko P E, Fcdak P
W, Verma S. C-reactive protein alters antioxidant defenses and
promotes apoptosis in endothelial progenitor cells. Arterioscler
Thromb Vase Biol. November 2006; 26(11):2476-2482. [0151] 31.
Krieger M H, Santos K F, Shishido S M, et al. Antiatherogenic
effects of S-nitroso-N-acetylcysteine in hypercholesterolemic LDL
receptor knockout mice. Nitric Oxide. February 2006; 14(1):12-20.
[0152] 32. Ivanovski O, Szumilak D, Nguyen-Khoa T, et al. The
antioxidant N-acetylcysteine prevents accelerated atherosclerosis
in uremic apolipoprotein E knockout mice. Kidney Int. June 2005;
67(6):2288-2294. [0153] 33. Wagberg M, Jansson A H, Westerlund C,
et al. N,N'-diacetyl-L-cystine (DiNAC), the disulphide dimer of
N-acetylcysteine, inhibits atherosclerosis in WHHL rabbits:
evidence for immunomodulatory agents as a new approach to prevent
atherosclerosis. J Pharmacol Exp Ther. October 2001; 299(1):76-82.
[0154] 34. Prasad K. C-reactive protein (CRP)-lowering agents.
Cardiovasc Drug Rev. Spring 2006; 24(1):33-50. [0155] 35. Devaraj
S, Rogers J, Jialal I. Statins and biomarkers of inflammation. Curr
Atherascler Rep. January 2007; 9(1):33-41. [0156] 36. Nissen S E.
Effect of intensive lipid lowering on progression of coronary
atherosclerosis: evidence for an early benefit from the Reversal of
Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) trial. Am
J. Cardiol. Sep. 5, 2005; 96(5A):61F-68F. [0157] 37. Molnar Z,
Szakmany T, Koszegi T. Prophylactic N-acetylcysteine decreases
serum CRP but not PCT levels and microalbuminuria following major
abdominal surgery. A prospective, randomised, double-blinded,
placebo-controlled clinical trial. Intensive Care Med. May 2003;
29(5):749-755. [0158] 38. Zuin R, Palamidese A, Negrin R, Catozzo
L, Scarda A, Balbinot M. High-dose N-acetylcysteinc in patients
with exacerbations of chronic obstructive pulmonary disease. Clin
Drug Investig. 2005; 25(6):401-408. [0159] 39. Aoyama K, Matsumura
N, Watabe M, Nakaki T. Oxidative stress on EAAC1 is involved in
MPTP-induced glutathione depletion and motor dysfunction. Eur J.
Neurosci. Dec. 14, 2007. [0160] 40. Shavali S, Sens D A.
Synergistic Neurotoxic Effects of Arsenic and Dopamine in Human
Dopaminergic Neuroblastoma SH-SY5Y Cells. Toxicol Sci. Dec. 13,
2007. [0161] 41. Kim-Han J S, O'Malley K L. Cell stress induced by
the parkinsonian mimetic, 6-hydroxydopamine, is concurrent with
oxidation of the chaperone, ERp57, and aggresome formation.
Antioxid Redox Signal. December 2007; 9(12):2255-2264. [0162] 42.
U.S. Pat. No. 4,612,008 [0163] 43. U.S. Pat. No. 4,894,240 [0164]
44. U.S. Pat. No. 4,871,548 [0165] 45. Sjodin K, Nilsson E,
Hallberg A, Tunek A. Metabolism of N-acetyl-L-cysteine. Some
structural requirements for the deacetylation and consequences for
the oral bioavailability, Biochem Pharmacol. 1989 Nov. 15;
38(22):3981-5
* * * * *