U.S. patent application number 14/254396 was filed with the patent office on 2014-10-30 for preparation and compositions of highly bioavailable zerovalent sulfur and uses thereof.
This patent application is currently assigned to NUEVAS ALTERNATIVAS NATURALES, S.A.P.I. DE C.V.. The applicant listed for this patent is Nuevas Alternativas Naturales, S.A.P.I. DE C.V.. Invention is credited to Gabriel GOJON-ROMANILLOS, Gabriel GOJON-ZORRILLA.
Application Number | 20140322361 14/254396 |
Document ID | / |
Family ID | 47830038 |
Filed Date | 2014-10-30 |
United States Patent
Application |
20140322361 |
Kind Code |
A1 |
GOJON-ROMANILLOS; Gabriel ;
et al. |
October 30, 2014 |
PREPARATION AND COMPOSITIONS OF HIGHLY BIOAVAILABLE ZEROVALENT
SULFUR AND USES THEREOF
Abstract
The present invention features sulfur-rich compositions and
preparations thereof that are safe and effective as hydrogen
sulfide prodrugs of high bioavailability. The invention also
includes methods of treating pathological conditions associated
with oxidative stress using sulfur-rich compositions. The invention
further includes sulfur-rich compositions as antidotes and medical
food for preserving and promoting general health.
Inventors: |
GOJON-ROMANILLOS; Gabriel;
(San Pedro Garza Garcia, MX) ; GOJON-ZORRILLA;
Gabriel; (San Pedro Garza Garcia, MX) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Nuevas Alternativas Naturales, S.A.P.I. DE C.V. |
Monterrey |
|
MX |
|
|
Assignee: |
NUEVAS ALTERNATIVAS NATURALES,
S.A.P.I. DE C.V.
Monterrey
MX
|
Family ID: |
47830038 |
Appl. No.: |
14/254396 |
Filed: |
April 16, 2014 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
13614820 |
Sep 13, 2012 |
8771755 |
|
|
14254396 |
|
|
|
|
61534585 |
Sep 14, 2011 |
|
|
|
Current U.S.
Class: |
424/705 |
Current CPC
Class: |
A61P 37/08 20180101;
A61P 3/06 20180101; A61P 39/00 20180101; A61P 43/00 20180101; A61P
1/04 20180101; A61P 31/04 20180101; A61P 17/04 20180101; A61P 27/16
20180101; A61P 15/00 20180101; A61P 31/14 20180101; A61P 25/18
20180101; A61P 9/06 20180101; A61P 1/16 20180101; A61P 27/02
20180101; A61P 9/12 20180101; A61P 35/00 20180101; A61P 13/12
20180101; A61K 33/06 20130101; A61P 31/00 20180101; Y02A 50/30
20180101; A61P 37/00 20180101; A61P 9/00 20180101; A61P 17/14
20180101; Y02A 50/414 20180101; A61P 31/12 20180101; A61P 21/00
20180101; A61P 27/12 20180101; A61P 3/10 20180101; A61P 29/00
20180101; A61K 45/06 20130101; A61P 3/02 20180101; A61P 25/28
20180101; A61P 9/04 20180101; A61P 19/02 20180101; A61P 11/00
20180101; A61P 17/06 20180101; A61P 9/02 20180101; A61P 17/08
20180101; A61P 7/02 20180101; A61P 31/22 20180101; A61K 33/04
20130101; A61P 11/04 20180101; A61P 39/06 20180101; A61P 7/00
20180101; A61P 31/18 20180101; A61P 9/10 20180101; A61P 17/00
20180101; A61K 33/04 20130101; A61K 33/06 20130101; A61K 2300/00
20130101; A61K 33/06 20130101; A61K 2300/00 20130101 |
Class at
Publication: |
424/705 |
International
Class: |
A61K 33/04 20060101
A61K033/04; A61K 45/06 20060101 A61K045/06 |
Claims
1. A composition comprising 90-99.9% (w/w) elemental alpha sulfur
and 0.01-10% (w/w) highly polar components, and optionally
comprising one or more pharmaceutically acceptable excipients.
2. The composition of claim 1, said composition comprising about
99% (w/w) zerovalent sulfur and about 1% (w/w) highly polar
components, wherein said highly polar components are selected from
sodium sulfate, sodium polythionates, and sodium thiosulfate.
3. The composition of claim 1, wherein said highly polar components
are selected from the group consisting of sodium polythionate,
potassium polythionate, ammonium polythionate, calcium
polythionate, sodium thiosulfate, potassium thiosulfate, ammonium
thiosulfate, calcium thiosulfate, sodium sulfate, potassium
sulfate, ammonium sulfate, sodium bisulfite, potassium bisulfite,
ammonium bisulfite, calcium bisulfite, sodium chloride, potassium
chloride, ammonium chloride, calcium chloride, sodium acetate,
sodium palmitate, potassium palmitate, and ammonium laurate.
4. A composition comprising an elemental alpha sulfur and one or
more highly polar components in a ratio from about 10 to about 150
parts elemental alpha sulfur to 1 part highly polar components
(w/w) for enteral, topical, or parenteral administration.
5. The composition of claim 4, wherein said composition is
formulated for enteral administration and said elemental alpha
sulfur and said highly polar components are present together in an
amount of 400 mg.
6. The composition of claim 5, wherein said composition is a
capsule.
7. The composition of claim 2, wherein said composition is
formulated for topical administration, and said composition
comprises 1-20% zerovalent sulfur content.
8. The composition of claim 7, wherein said composition is a
cream.
9. The composition of claim 8, wherein said cream comprises (i)
5-20% zerovalent sulfur content and (ii) polyethylene glycol or
petroleum jelly.
10. The composition of claim 9, wherein said cream comprises 5-15%
zerovalent sulfur content.
11. The composition of claim 4, further comprising a third
agent.
12. The composition of claim 11, wherein said third agent is a
cardiovascular disease drug, an anti-inflammatory drug, an
anti-neurodegenerative drug, or an anticancer/anti-proliferative
drug.
13. The composition of claim 11, wherein said elemental alpha
sulfur, said highly polar components, and said third agent are
present in an effective amount to treat a condition associated with
oxidative stress.
14. The composition of claim 11, wherein said third agent is a
dietary supplement.
15. The composition of claim 11, wherein said elemental alpha
sulfur, said highly polar components, and said third agent are
present in an effective amount to promote or maintain general
health.
16. A method for preparing the composition of claim 1, said method
comprising: (a) providing a first inorganic compound comprising
sulfur in the .sup.-2 (minus two) oxidation state, (b) reacting
said first inorganic compound with a second compound comprising
sulfur in the .sup.+4 (plus four) oxidation state and optionally an
acid, wherein said reacting produces the composition of claim
1.
17. The method of claim 16, wherein said first inorganic compound
is sodium hydrogen sulfide or sodium sulfide.
18. The method of claim 16, wherein said second inorganic compound
is sodium metabisulfite, sodium bisulfite, or sodium sulfite.
19. The method of claim 16, wherein said acid is concentrated
sulfuric acid.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. application Ser.
No. 13/614,820, filed on Sep. 13, 2012, which claims benefit of
U.S. Provisional Application No. 61/534,585, filed Sep. 14, 2011,
each of which is hereby incorporated by reference.
BACKGROUND OF THE INVENTION
[0002] In general, the invention features zerovalent-sulfur-rich
compositions and methods of preparation, formulation, and
prevention and treatment of pathological conditions associated with
oxidative stress.
[0003] Despite the abundance of medications to lower blood
pressure, reduce cholesterol, and treat cardiovascular conditions,
cardiovascular disease remains the number one killer in the United
States. The incidence of cardiovascular problems is likely to
continue its steady rise as the "Baby Boomer" generation ages and
as obesity and diabetes rates continue to rise. Therefore,
development of better therapies is of utmost importance.
[0004] Hydrogen sulfide (H.sub.2S) is a recognized endogenous
signaling molecule that has been shown to modulate immune and
mitochondrial function, act both directly and indirectly as an
antioxidant, and increase blood flow by a variety of mechanisms. In
addition, hydrogen sulfide is a potent anti-inflammatory agent and
modulator of cell death. This plethora of properties makes hydrogen
sulfide an ideal candidate for the treatment of cardiovascular
disease, cancers, inflammatory disease, diabetes, dyslipidemia,
neurodegenerative disease, AIDS, and other pathological conditions
associated with oxidative stress, an imbalance in redox
homeostasis, and/or immune dysfunction.
[0005] Whereas the main physiological roles of H.sub.2S are in
signaling and cytoprotection in normal (i.e., non-transformed)
cells and tissues, it is now clear that in transformed (i.e.,
malignant) cells, H.sub.2S displays prooxidant and proapoptotic
effects. These effects constitute the basis for developing a novel
therapeutic and/or prophylactic approach to treat conditions
associated with uncontrolled cell growth such as cancer and other
hyperproliferative diseases.
[0006] Hydrogen sulfide is produced endogenously from cysteine by
the enzymes cystathionine beta-synthase, cystathionine gamma-lyase,
and 3-mercaptopyruvate sulfurtransferase. Hydrogen sulfide prodrugs
can provide an exogenous source for hydrogen sulfide in the body,
however, currently used hydrogen sulfide prodrugs contain no more
than 57% bioactive sulfur (sulfur capable of being converted into
hydrogen sulfide in vivo). On the other hand, it has become
increasingly clear that sodium hydrogen sulfide (NaHS, also known
as sodium hydrosulfide), which contains 57% bioactive sulfur,
releases hydrogen sulfide in a sudden and uncontrolled manner when
injected into the body of a mammal, whereas it is highly unlikely
that cells or tissues are ever exposed to H.sub.2S generated in
such manner. Therefore, there is a need to identify hydrogen
sulfide prodrugs that are safe and effective, are active when
orally administered, release H.sub.2S in a controlled and sustained
manner, and have high bioavailability for treatment of
cardiovascular disease, cancer, inflammatory disease, diabetes,
dyslipidemia, neurodegenerative disease, AIDS, and other
pathological conditions associated with oxidative stress, an
imbalance in redox homeostasis, and/or immune dysfunction.
SUMMARY OF THE INVENTION
[0007] The invention features a composition including 90-99.9%
(w/w) elemental alpha sulfur and 0.01-10% (w/w) highly polar
components. In certain embodiments, the composition can optionally
include one or more pharmaceutically acceptable excipients. In
other embodiments, the composition can include about 99% (w/w)
zerovalent sulfur and about 1% (w/w) highly polar components,
wherein the highly polar components are selected from sodium
sulfate, sodium polythionates, and sodium thiosulfate.
[0008] The invention also features a composition including an
elemental alpha sulfur and one or more highly polar components in a
ratio from about 10 to about 150 parts elemental alpha sulfur to 1
part highly polar components (w/w) for enteral, topical, or
parenteral administration. In certain embodiments, the ratio of
elemental alpha sulfur to highly polar components is 15:1, 20:1,
30:1, 35:1, 40:1, 45:1, 50:1, 55:1, 60:1, 70:1, 80:1, 90:1, 100:1,
110:1, 120:1, 130:1, 140:1, or 145:1.
[0009] In some embodiments, a composition of the invention is
formulated for enteral administration and the elemental alpha
sulfur and the highly polar components are present together in an
amount of 400 mg. In one aspect of the embodiment, the composition
is a capsule.
[0010] In other embodiments, a composition of the invention is
formulated for topical administration, and the composition includes
1-20% zerovalent sulfur content. In one aspect of the embodiment,
the composition is a cream. In one aspect, the cream includes (i)
5-20% zerovalent sulfur content and (ii) polyethylene glycol or
petroleum jelly. In another aspect, the cream includes 5-15%
zerovalent sulfur content. In certain embodiments, the cream
includes 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%,
15%, 16%, 17%, 18%, or 19% zerovalent sulfur content.
[0011] For any of the above compositions, the highly polar
components can be selected from the group consisting of sodium
polythionate, potassium polythionate, ammonium polythionate,
calcium polythionate, sodium thiosulfate, potassium thiosulfate,
ammonium thiosulfate, calcium thiosulfate, sodium sulfate,
potassium sulfate, ammonium sulfate, sodium bisulfite, potassium
bisulfite, ammonium bisulfite, calcium bisulfite, sodium chloride,
potassium chloride, ammonium chloride, calcium chloride, sodium
acetate, sodium palmitate, potassium palmitate, and ammonium
laurate.
[0012] In certain embodiments, the compositions of the invention
further include a third agent. In some embodiments, the third agent
is a cardiovascular disease drug, an anti-inflammatory drug, an
anti-neurodegenerative drug, or an anticancer/anti-proliferative
drug. In other embodiments, the third agent is a dietary
supplement. In certain aspects of the invention the elemental alpha
sulfur, the highly polar components, and the third agent are
present in an effective amount to treat a condition associated with
oxidative stress. In other aspects, the elemental alpha sulfur, the
highly polar components, and the third agent are present in an
effective amount to promote or maintain general health.
[0013] The invention also features a method for preparing a
composition including 90-99.9% (w/w) elemental alpha sulfur and
0.01-10% (w/w) highly polar components, the method includes: (a)
providing a first inorganic compound including sulfur in the
.sup.-2 (minus two) oxidation state, (b) reacting the first
inorganic compound with a second compound including sulfur in the
.sup.+4 (plus four) oxidation state and optionally an acid, wherein
the reacting produces a composition including 90-99.9% (w/w)
elemental alpha sulfur and 0.01-10% (w/w) highly polar
components.
[0014] In one embodiment, the first inorganic compound is sodium
hydrogen sulfide or sodium sulfide. In a second embodiment, the
second inorganic compound is sodium metabisulfite, sodium
bisulfite, or sodium sulfite. In a third embodiment, the acid is
concentrated sulfuric acid.
[0015] The invention also features a method of treating a condition
associated with oxidative stress in a subject in need thereof by
administering an effective amount of a composition including
90-99.9% (w/w) elemental alpha sulfur and 0.01-10% (w/w) highly
polar components, and optionally including one or more
pharmaceutically acceptable excipients. In certain aspects, the
composition can also include about 99% (w/w) zerovalent sulfur and
about 1% (w/w) highly polar components, wherein the highly polar
components are selected from sodium sulfate, sodium polythionates,
and sodium thiosulfate.
[0016] In another aspect, the invention also features a method of
treating a condition associated with oxidative stress in a subject
in need thereof by administering an effective amount of a
composition including an elemental alpha sulfur and one or more
highly polar components in a ratio from about 10 to about 150 parts
elemental alpha sulfur to 1 part highly polar components (w/w) for
enteral, topical, or parenteral administration.
[0017] In some embodiments, the condition associated with oxidative
stress is selected from the group consisting of: schizophrenia,
bipolar disorder, fragile X syndrome, sickle cell disease, chronic
fatigue syndrome, osteoarthritis cataract, macular degeneration,
toxic hepatitis, viral hepatitis, cirrhosis, chronic hepatitis,
oxidative stress from dialysis, renal toxicity, kidney failure,
ulcerative colitis, bacterial infection, viral infections, such as
HIV and AIDS, herpes, ear infection, upper respiratory tract
diseases, hypertension, balding and hair loss, male infertility,
over-training syndrome related to athletic performance, athlete's
foot, psoriases, eczema, scleroderma, atopic dermatitis,
polymyositis, rosacea, dermatitis herpetiformis, other
neurodegenerative diseases, other inflammatory disease, and a
cancer.
[0018] In other embodiments, the condition associated with
oxidative stress is a cardiovascular disease. In certain aspects of
the embodiment, the cardiovascular disease is selected from the
group consisting of: arteriosclerosis, coronary heart disease,
ischemia, endothelium dysfunction, in particular those dysfunctions
affecting blood vessel elasticity, restenosis, thrombosis, angina,
high blood pressure, cardiomyopathy, hypertensive heart disease,
heart failure, cor pulmonale, cardiac dysrhythmias, endocarditis,
inflammatory cardiomegaly, myocarditis, myocardial infarction,
valvular heart disease, stroke and cerebrovascular disease, aortic
valve stenosis, congestive heart failure, and peripheral arterial
disease.
[0019] The invention also features a method of increasing hydrogen
sulfide levels in a subject having a sulfur nutritional deficiency
by administering an effective amount of a composition including
90-99.9% (w/w) elemental alpha sulfur and 0.01-10% (w/w) highly
polar components, and optionally including one or more
pharmaceutically acceptable excipients.
[0020] In one aspect, the invention also features a method for
assessing the treatment of a cardiovascular disease by
administering a composition including 90-99.9% (w/w) elemental
alpha sulfur and 0.01-10% (w/w) highly polar components, and
optionally including one or more pharmaceutically acceptable
excipients. The method includes the steps of: determining the level
of hydrogen sulfide in a sample from the subject, adjusting the
dose of the composition in an amount sufficient to treat the
cardiovascular disease, wherein an increase in the level of
hydrogen sulfide or an improvement in a cardiovascular parameter
results in the treatment of the cardiovascular disease. In certain
aspects, the cardiovascular parameter is selected from the group
consisting of end-diastolic volume (EDV), end-systolic volume
(ESV), stroke volume, ejection fraction, heart rate, and cardiac
output.
DEFINITIONS
[0021] By "elemental alpha sulfur" is meant orthorhombic elemental
sulfur having the formula S.sub.8. Elemental alpha sulfur exists as
S.sub.8 (cyclooctasulfur molecules), but can also include S.sub.7
(cycloheptasulfur molecules) and S.sub.6 (cyclohexasulfur
molecules).
[0022] By "elemental beta sulfur" is meant monoclinic elemental
sulfur having the formula S.sub.8 and consisting mainly of
cyclooctasulfur molecules.
[0023] By "highly polar component" is meant a compound whose
molecules contain at least one ionic bond or one highly polar
covalent bond. Highly polar components include, e.g., sodium
polythionates, potassium polythionates, ammonium polythionates,
calcium polythionates, sodium thiosulfate, potassium thiosulfate,
ammonium thiosulfate, calcium thiosulfate, sodium sulfate,
potassium sulfate, ammonium sulfate, sodium bisulfite, potassium
bisulfite, ammonium bisulfite, calcium bisulfite, sodium chloride,
potassium chloride, ammonium chloride, calcium chloride, sodium
acetate, sodium palmitate, potassium palmitate, and/or ammonium
laurate. Highly polar components also include molecules containing
highly polar O--H covalent bonds, e.g., water, alcohols, polyols,
polythionic acids, carboxylic acids, and/or sorbitan monostearate.
Highly polar components further include compounds whose molecules
contain highly polar N--H covalent bonds, for example, primary
amines, amino acids, primary amides, peptides and proteins.
[0024] By "polythionate" is meant an anion or group of the formula
.sup.-O.sub.3S--S.sub.n--SO.sub.3.sup.- (e.g., where n is an
integer from 1 to 60, preferably from 1-20, and more preferably 1,
2, 3, 4, 5, or 6).
[0025] By "zerovalent sulfur" is meant a sulfur atom with an
oxidation state of zero, as calculated according to an agreed-upon
set of rules well known to a person skilled in the art (e.g., each
cyclooctasulfur molecule (S.sub.8) contains eight zerovalent sulfur
atoms, each thiosulfate ion (S.sub.2O.sub.3.sup.-2) contains one
zerovalent sulfur atom, and each polythionate ion contains "n"
zerovalent sulfur atoms. Zerovalent sulfur can be found in sulfane
sulfur compounds.
[0026] By "zerovalent sulfur content" is meant the amount of
zerovalent sulfur present in a composition containing elemental
alpha sulfur and highly polar components, such as, sodium
polythionates, potassium polythionates, ammonium polythionates,
calcium polythionates, sodium thiosulfate, potassium thiosulfate,
ammonium thiosulfate, calcium thiosulfate, sodium sulfate,
potassium sulfate, and ammonium sulfate.
[0027] By "sulfane sulfur" is meant a labile, highly reactive
sulfur atom at a reduced oxidation state with a valence of 0 or -1,
covalently bound to another sulfur atom. Sulfane sulfur compounds
can include, e.g., persulfides, polysulfides, polythionates,
polysulfanes, thiotaurine, thiosulfate, and/or elemental sulfur.
Sulfane sulfur compounds can be formed in the anaerobic cysteine
sulfur metabolism with the participation of enzymes such as
cystathionase, 3-mercaptopyruvate sulfurtransferase, and/or
rhodanese. The last step in enzymatic H.sub.2S-generating pathways
generally involves sulfane sulfur-containing species. Compounds
containing sulfane sulfur can participate in cell regulation
processes through activation or inactivation of enzymes such as,
e.g., oxidoreductase containing an iron or molybdenum atom, e.g.,
xanthine oxidase, aldehyde oxidase, and malate dehydrogenase).
[0028] By "enteral" is meant administration that involves any part
of the gastrointestinal tract. Enteral administration can include:
by mouth in the form of tablets, capsules, or drops, by gastric
feeding tube, duodenal feeding tube, or rectally.
[0029] By "topical" is meant administration that is local or
systemic, particularly epicutaneous, inhalational, eye drops,
and/or ear drops.
[0030] By "parenteral" is meant administering the composition of
the invention by means other than oral intake, particularly by
injection of a form of liquid into the body. Parenteral
administration can include: intravenous, intra-arterial,
intraosseous infusion, intra-muscular, intracerebral,
intracerebroventricular, and subcutaneous administration.
[0031] By "cardiovascular disease drug" is meant a class of agents
or substances that are used to treat diseases that affect the
cardiovascular system, particularly cardiac disease, vascular
disease of the brain and kidney, and peripheral arterial
disease.
[0032] By "anti-inflammatory drug" is meant an agent or substance
that act by reducing inflammation.
[0033] By "anticancer/anti-proliferative drug" is meant an agent,
substance, and/or mixture of substances that reduces, prevents,
and/or interferes with the uncontrolled growth of cells, its
initiation, promotion, progression, and/or spread to other
organs.
[0034] By "anti-neurodegenerative drug" is meant an agent,
substance, and/or mixture of substances that restores and/or
improves neuron function by acting directly on neurons or
indirectly on pathways associated with neuronal function (e.g.,
axonal transport pathways, protein misfolding pathways, protein
degradation pathways, and programmed cell death pathways).
[0035] By "dietary supplement" is meant an agent, substance, and/or
mixture of substances that is a food supplement or nutritional
supplement intended to supplement the diet and provide nutrients,
such as vitamins, minerals, fiber, fatty acids, or amino acids that
may be missing or may not be consumed in sufficient quantities in a
person's diet.
[0036] By "promote or maintain general health" is meant to aid in
accomplishing a state of human health that is characterized by
homeostatic balance with the stable condition of properties such as
temperature, pH, electrolytes, and/or metabolites.
[0037] By "inorganic" is meant a compound that is not an organic
compound.
[0038] By "oxidation state" is meant a measure of the degree of
oxidation of an atom in a molecule of a substance defined as the
charge an atom might be imagined to have when electrons are counted
according to an agreed-upon set of rules well known to a person
skilled in the art.
[0039] By "acid" is meant an Arrhenius acid, a Bronsted-Lowry acid,
and/or a Lewis acid. An Arrhenius acid is a substance that
increases the concentration of the hydronium ion when dissolved in
water. A Bronsted-Lowry acid is a species that donates a proton to
a Bronsted-Lowry base. A Lewis acid is a species that accepts a
pair of electrons from another species.
[0040] By "conditions associated with oxidative stress" is meant a
condition characterized by or originated from imbalance between the
systemic manifestation of reactive oxygen species and a biological
system's ability to readily detoxify the reactive intermediates
and/or to repair the resulting damage.
[0041] By "hydrogen sulfide" is meant a compound having the formula
H.sub.2S that is produced in small amounts by many cells of the
mammalian body and has a number of biological signaling functions
(e.g., a relaxant of smooth muscle, a vasodilator, increases
response of NMDA receptor, facilitates long term potentiation, and
involvement in memory formation).
[0042] By "increasing hydrogen sulfide levels" is meant increasing
in the level of hydrogen sulfide produced in the mammalian body
(e.g., from cysteine by the enzymes cystathionine beta-synthase and
cystathionine gamma-lyase) by at least about 5%, 10%, 20%, 30%,
40%, 50%, 60%, 70%, 80%, 90%, or 100% as compared to a control
reference sample. Levels of hydrogen sulfide can be determined
using any useful methods known in the art.
[0043] By "sulfur nutritional deficiency" is meant a condition
characterized by an imbalance in enzyme activity, hormone levels,
and immune system function due to a lack of sufficient amounts of
sulfur in a regular diet. Symptoms of sulfur nutritional deficiency
include, for example, impaired hepatic and renal function, fragile
nails, shedding of hair, itchy skin or scalp, eczema, acne, diaper
rash, migraine headaches, flatulence, indigestion, vomiting,
diarrhea, hemorrhoids, impotence, painful and irregular
menstruation, frequent episodes of infections of bacterial or viral
origin, sore throat, toothache, nosebleeds, measles, joint pain,
hay fever, fever, bed wetting, and/or breastfeeding problems.
[0044] By "improvement in cardiovascular parameter" is meant a
change in a cardiovascular parameter (e.g., end-diastolic volume
(EDV), end-systolic volume (ESV), stroke volume, ejection fraction,
heart rate, and cardiac output) to normal ranges (e.g., an
end-diastolic volume (EDV) from about 65-240 mL, an end-systolic
volume (ESV) from about 16-143 mL, a stroke volume from about
55-100 mL, an ejection fraction from about 55-70%, a heart rate
from about 60-100 bpm, and/or cardiac output of about 4.0-8.0
L/min).
[0045] By "treating" is meant subjecting a patient to a management
regimen for the purpose of combating a disease or disorder and
obtaining beneficial or desired results, such as clinical results.
Beneficial or desired results can include, but are not limited to,
improvement in quality of life, alleviation or amelioration of one
or more symptoms or conditions; diminishment of extent of disease,
disorder, or condition; stabilization (i.e., not worsening) of a
state of disease, disorder, or condition; prevention of spread of
disease, disorder, or condition; delay or slowing the progress of
the disease, disorder, or condition; amelioration or palliation of
the disease, disorder, or condition; and remission (whether partial
or total), whether detectable or undetectable.
[0046] By "subject" is meant a mammal (e.g., a human or a
non-human).
[0047] By "effective amount" of an agent is meant the amount of the
agent sufficient to effect beneficial or desired result (e.g.,
treatment of cardiovascular diseases, cancers (e.g., malignant cell
hyperproliferation), inflammatory diseases, diabetes, dyslipidemia,
neurodegenerative diseases, AIDS, and other pathological conditions
associated with oxidative stress, an imbalance in redox
homeostasis, and/or immune dysfunction), and, as such, an amount of
the composition sufficient to achieve an increase in in vivo
hydrogen sulfide and/or sulfane sulfur levels, as compared to the
level of hydrogen sulfide and/or sulfane sulfur without
administration of the composition.
[0048] By "composition" is meant a system comprising a substance
described herein, optionally formulated with an acceptable
excipient, and manufactured or sold with the approval of a
governmental regulatory agency as part of a therapeutic regimen for
the treatment of disease in a mammal or to promote and maintain
general health. Pharmaceutical compositions can be formulated, for
example, for oral administration in unit dosage form (e.g., a
tablet, capsule, caplet, gel cap, or syrup); for topical
administration (e.g., as a cream, gel, lotion, or ointment); for
intravenous administration (e.g., as a sterile solution or
colloidal dispersion free of particulate emboli and in a solvent
system suitable for intravenous use); or in any other formulation
described herein.
[0049] By "acceptable excipient" is meant any ingredient other than
the substance described herein (for example, a vehicle capable of
suspending or dissolving the active substance and/or substances,
e.g., petroleum jelly and polyethylene glycol) and having the
properties of being nontoxic and non-inflammatory in a patient.
Excipients may include, for example: antiadherents, antioxidants,
binders, coatings, compression aids, disintegrants, dyes (colors),
emollients, emulsifiers, fillers (diluents), film formers or
coatings, flavors, fragrances, glidants (flow enhancers),
lubricants, preservatives, printing inks, sorbents, suspending or
dispersing agents, colloid stabilizers, sweeteners, and water.
Exemplary excipients include, but are not limited to: butylated
hydroxytoluene (BHT), calcium carbonate, calcium phosphate
(dibasic), calcium stearate, croscarmellose, crosslinked polyvinyl
pyrrolidone, citric acid, crospovidone, ethylcellulose, gelatin,
hydroxypropyl cellulose, hydroxypropyl methylcellulose, lactose,
magnesium stearate, maltitol, mannitol, methylcellulose, methyl
paraben, microcrystalline cellulose, polyethylene glycol, polyvinyl
pyrrolidone, povidone, pregelatinized starch, propyl paraben,
shellac, silicon dioxide, sodium carboxymethyl cellulose, sodium
starch glycolate, sorbitol, starch (corn), stearic acid, sucrose,
talc, titanium dioxide, and xylitol. Excipients may also include
diluents (e.g., saline and aqueous buffer solutions), aqueous
carriers, and nonaqueous carriers, for example, water, ethanol,
polyols (such as glycerol, propylene glycol, polyethylene glycol,
and the like), and suitable mixtures thereof, vegetable oils, such
as olive oil, and injectable organic esters, such as ethyl
oleate.
[0050] As used herein, the term "about" means.+-.10% of the recited
value.
[0051] Provided in Table 1 is a list of abbreviations and meanings
of terminology described herein.
TABLE-US-00001 TABLE 1 Abbreviation Meaning 3-MST
3-mercaptopyruvate sulfutransferase ACS6 H.sub.2S-donating
derivative of sildenafil ADEM acute disseminated encephalomyelitis
Akt Protein Kinase B Ak-P.sup.Ser473 phosphorylated Akt at serine
residue 473 Akt-P.sup.Thr308 phosphorylated Akt at threonine
residue 308 ALS amyotrophic lateral sclerosis BHT butylated
hydroxytoluene CBS cystathionine beta synthase CO carbon monoxide
CRISPs cysteine-rich-secretory proteins CS-CSE Tg cardiac specific
CSE transgenic mice CSE cystathionine gamma lyase CSE KO CSE
deficient DADS diallyl disulfide DATS diallyl trisulfide DBTS
dibenzyl trisulfide ED erectile dysfunction EDV end-diastolic
volume eNOS endothelial nitric oxide synthase eNOS-P.sup.Ser1177
eNOS at serine residue 1177 ESV end-systolic volume FEG
phenylalanine-glutamine-glycine feG D-isomeric form GSH glutathione
H.sub.2S hydrogen sulfide HO-1 heme oxygenase 1 IJM circulating
sulfane sulfur levels ImSAIDs immune selective anti-inflammatory
derivatives I/R ischemia/reperfusion IVSd intraventricular septal
end-diastolic dimension j.JM 02/sec/mg mitochondrial respiratory
function LV left ventricular LVEDD left ventricular end-diastolic
diameter LVEF left ventricular ejection fraction LVESD left
ventricular end-systolic diameter MFR mobile forms recovered NaHS
sodium hydrogen sulfide NO nitric oxide NO.sub.2.sup.- nitrite
NO.sub.3.sup.- nitrate NOX NADPH oxidase Nox4 NADPH oxidase 4
NSAIDs non-steroidal anti-inflammatory drugs PDE5 phosphodiesterase
type 5 RCR respiratory control ratio RCR respiratory control ratio
ROS reactive oxygen species S.sub.2O.sub.3.sup.-2 thiosulfate ion
S.sub.8 cyclooctasulfur molecule SG-1002 highly bioavailable
zerovalent-sulfur rich composition TAC transverse aortic
constriction TBZ 4-hydroxythiobenzamide VEGF vascular endothelial
growth factor WT wild-type
BRIEF DESCRIPTION OF THE FIGURES
[0052] FIGS. 1A-1H are data showing that heart failure reduces
sulfide levels in humans and mice. FIGS. 1A-1D show representative
gas chromatograph peaks and summary data of circulating free
hydrogen sulfide (H.sub.2S) and sulfane sulfur levels in normal
controls and heart failure patients. FIGS. 1E-1F show circulating
levels of free H.sub.2S and sulfane sulfur after 6 weeks of
pressure overload-induced heart failure (TAC) in groups of mice
maintained on a standard chow (TAC+Vehicle) or maintained on a chow
containing the H.sub.2S donor SG-1002 (TAC+SG-1002, 20 mg/kg/day).
FIGS. 1G-1H show myocardial levels of free H.sub.2S and sulfane
sulfur in the experimental groups. Results are expressed as
mean.+-.SEM. Numbers in bars represent the sample size. **p<0.01
and ***p<0.001 vs. Sham.
[0053] FIGS. 2A-2F are data showing that deficiency of
cystathionine gamma lyase (CSE) exacerbates cardiac dysfunction
following TAC. FIG. 2A is representative heart pictures of
wild-type (WT+TAC) mice, CSE deficient (CSE KO+TAC) mice, and CSE
KO mice treated with SG-1002 (CSE KO+TAC+SG-1002) at 12 weeks of
TAC. FIG. 2B shows the ratio of heart weight/tibia length ratio and
lung weight/tibia length at 12 weeks following TAC. FIG. 2C shows
intraventricular septal end-diastolic dimension (IVSd in mm). FIG.
2D shows LV end-diastolic diameter (LVEDD in mm), FIG. 2E shows LV
end-systolic diameter (LVESD in mm), and FIG. 2F shows LV ejection
fraction (%) following TAC. Wall thickness increased similarly in
all groups at 1 week up to 12 weeks following TAC. CSE KO mice
exhibited dilatation and dysfunction starting at 6 weeks of TAC. WT
and CSE KO mice treated with SG-1002 exhibited no significant
change in LV dimensions and exhibited preserved cardiac function.
Results are expressed as mean.+-.SEM. .sup..dagger.p<0.05,
.sup..dagger-dbl.p<0.01 and p<0.001 vs. WT. *p<0.05 and
***p<0.001 vs. Baseline.
[0054] FIGS. 3A-3F are data showing cardiac specific overexpression
of CSE attenuates cardiac dilatation and cardiac dysfunction
following TAC. FIG. 3A is representative photomicrographs of
wild-type (WT+TAC) and cardiac specific CSE transgenic mice (CS-CSE
Tg+TAC) at 12 weeks of TAC. FIG. 3B shows myocardial weights
(mg/cm) and lung weights (mg/cm) expressed as ratio of tibia length
at 12 weeks of TAC. FIG. 3C shows IVSd (mm), FIG. 3D shows LVEDD
(mm), FIG. 3E shows LVESD (mm), and FIG. 3F shows LV ejection
fraction (%) following TAC. Wall thickness increased similarly in
WT and CSE Tg mice from 1 week to 12 weeks of TAC. CSE Tg mice
experienced significantly less dilatation and cardiac dysfunction
compared to WT mice. Results are expressed as mean.+-.SEM.
**p<0.01 and ***p<0.001 vs. Baseline.
[0055] FIGS. 4A-4H are data showing exogenous H.sub.2S therapy
prevents cardiac dilatation and dysfunction following TAC. FIG. 4A
is representative heart pictures of Sham, Vehicle (TAC+Vehicle),
and SG-1002 (TAC+SG-1002) treated mice at 12 weeks of TAC. FIG. 4B
shows the ratio of heart weight/tibia lengths. FIG. 4C shows the
ratio of lung weight/tibia lengths. FIG. 4D shows circulating BNP
levels (ng/mL) at 6 and 12 weeks of TAC. FIG. 4E shows IVSd (mm),
FIG. 4F shows LVEDD (mm), FIG. 4G shows LVESD (mm), and FIG. 4H
shows ejection fraction (%) following TAC. Wall thickness increased
similarly in both groups following TAC. However, SG-1002 diet
prevented cardiac dilatation and dysfunction starting at 6 weeks of
TAC. Results are expressed as mean.+-.SEM. *p<0.05, **p<0.01,
and ***p<0.001 vs. Baseline.
[0056] FIGS. 5A-5C are data showing H.sub.2S attenuates the
intermuscular and perivascular fibrosis following TAC. FIG. 5A is
representative photomicrographs of Masson's Trichrome and
Picrosirius Red stained heart sections depicting intermuscular and
perivascular fibrosis in hearts from Sham, TAC+Vehicle, and
TAC+SG-1002 treated mice at 6 weeks of TAC. FIG. 5B is a summary of
fibrosis area as % of the LV as calculated from Masson's Trichrome
sections. FIG. 5C is a summary of fibrosis area as % of the LV
calculated from the Picrosirius Red sections. Results are expressed
as mean.+-.SEM. **p<0.01, and ***p<0.001 vs. Sham.
[0057] FIGS. 6A-6H are data showing H.sub.2S upregulates Akt
phosphorylation, VEGF expression, and activates the eNOS-NO pathway
following TAC. FIG. 6A is representative immunoblots of total Akt,
Akt-P.sup.Ser473, and Akt-P.sup.Thr308. FIG. 6B is densitometric
analysis of the expression of total Akt. FIG. 6C is densitometric
analysis of Akt-P.sup.Ser473 and Akt-P.sup.Thr308 in hearts from
Sham, TAC+Vehicle, and TAC+SG-1002 at 6 weeks of TAC. FIG. 6D is
representative immunoblots and densitometric analysis of cardiac
VEGF expression at 6 weeks of TAC. FIGS. 6E-6F are representative
immunoblots and densitometric analysis of the expression of total
eNOS and eNOS-P.sup.Ser1177 in hearts from Sham, TAC+Vehicle, and
TAC+SG-1002 at 6 weeks of TAC. FIGS. 6G-6H show nitrite and nitrate
levels in the hearts of the experimental groups at 6 weeks of TAC.
Results are expressed as mean.+-.SEM.
[0058] FIGS. 7A-7F are data showing H2S preserves mitochondrial
respiratory function and attenuates oxidative stress following TAC.
FIG. 7A shows mitochondrial respiratory function (j.JM 02/sec/mg)
in State 3 and State 4 in hearts from Sham, TAC+Vehicle, and
TAC+SG-1002 at 6 weeks of TAC. FIG. 7B shows the respiratory
control ratio (RCR) from the hearts of the experimental groups at 6
weeks of TAC. FIGS. 7C-7D show plasma and heart 8-isoprostane
levels at 6 weeks of TAC. FIG. 7E is representative immunoblots and
densitometric analysis of NADPH oxidase 4 (Nox4) in hearts of the
experimental groups at 6 weeks of TAC. FIG. 7F is representative
immunoblots and densitometric analysis of heme oxygenase 1 (HO-1)
in hearts of the experimental groups at 6 weeks of TAC Results are
expressed as mean.+-.SEM. *p<0.05 and ***p<0.001 vs.
Sham.
[0059] FIGS. 8A-8D. FIG. 8A is representative immunoblots of
cystathionine gamma lyase (CSE), cystathionine beta synthase (CBS),
and 3-mercaptopyruvate sulfutransferase (3-MST) in the hearts of
Sham, TAC+Vehicle, and TAC+SG-1002 treated mice at 6 weeks of TAC.
FIGS. 8B-8D show densitometric analysis of CSE, CBS, and 3-MST in
Sham, TAC+Vehicle, and TAC+SG-1002 groups at 6 weeks following TAC.
Results are expressed as mean.+-.SEM. Numbers in bars represent the
sample size.
[0060] FIGS. 9A-9D. FIG. 9A shows circulating free hydrogen sulfide
(H.sub.2S) and FIG. 9B shows circulating sulfane sulfur levels
(IJM) in wild-type (WT) control, CSE deficient (CSE KO) and CSE KO
mice fed a diet containing the H.sub.2S donor SG-1002, FIG. 9C
shows free H.sub.2S and FIG. 9D shows sulfane sulfur levels
(nmol/mg wet weight) in the hearts of WT, CSE KO and CSE KO+SG-1002
mice. Results are expressed as mean.+-.SEM. *p<0.05, **p<0.01
vs. WT.
[0061] FIGS. 10A-10C. FIG. 10A shows Kaplan-Meier survival curves
for TAC+WT mice, TAC+CSE KO mice and CSE KO mice fed a SG-1002 diet
(TAC+CSE KO+SG-1002) during the 12 week TAC protocol. FIG. 10B
shows Kaplan-Meier survival curves for TAC+WT and cardiac-specific
CSE transgenic mice (TAC+CS-CSE Tg) following 12 weeks of TAC. FIG.
10C shows Kaplan-Meier survival curves for mice fed a control diet
(TAC+Vehicle) and mice fed a SG-1002 diet (TAC+SG-1002) following
12 weeks of TAC.
[0062] FIG. 11 is representative immunoblots of cystathionine beta
synthase (CBS), and 3-mercaptopyruvate sulfutransferase (3-MST)
from the hearts of Wild-type and CS-CSE transgenic mice.
[0063] FIGS. 12A-12D. FIG. 12A shows the intraventricular septum
end-diastolic dimension (IVSd, mm), FIG. 12B shows the LV
end-diastolic diameter (LVEDD, mm), FIG. 12C shows the LV
end-systolic diameter (LVESD, mm), and FIG. 12D shows the LV
ejection fraction (%) from treated with SG-1002 for 6 weeks
following TAC (SG-1002), mice treated with SG-1002 for 1 week
following TAC and then SG-1002 was withdrawn for 5 weeks and mice
treated with SG-1002 for 3 weeks following TAC and SG-1002 was
withdrawn for 3 weeks. Results are expressed as mean.+-.SEM.
*p<0.05, ***p<0.001 vs. Baseline.
[0064] FIGS. 13A-13D. FIG. 13A shows serum levels (pg/mL) of VEGF-A
in TAC+Vehicle, and TAC+SG-1002 treated mice at 6 weeks following
TAC. FIG. 13B is representative immunoblots for myocardial nNOS and
iNOS from the hearts of Sham, TAC+Vehicle, and TAC+SG-1002 treated
mice at 6 weeks of TAC. FIG. 13C shows a densitometric analysis of
nNOS protein relative to fibrillarin in Sham, TAC+Vehicle, and
TAC+SG-1002 hearts. FIG. 13D shows a bar graph of densitometric
analysis of myocardial iNOS protein relative to fibrillarin in
Sham, TAC+Vehicle, and TAC+SG-1002 mice following 6 weeks of TAC.
Results are expressed as mean.+-.SEM. *p<0.05, **p<0.01 vs.
Sham.
[0065] FIG. 14 is a schematic diagram highlighting the proposed
mechanism by which cystathionine gamma lyase (CSE) or exogenous
hydrogen sulfide protects the heart following transverse aortic
constriction (TAC). Our data suggest (CSE) or hydrogen sulfide
donor therapy with SG-1002 activates vascular endothelial growth
factor (VEGF) and subsequently phosphorylates Akt. Akt activation
results in phosphorylation and activation of eNOS. Following eNOS
activation nitric oxide (NO) bioavailability and nitrite levels are
increased. These molecular signals result in reduced myocardial
oxidative stress and injury, improvements in mitochondrial
respiration, and decreased cardiac fibrosis. Ultimately, these
cytoprotective actions prevent the transition from compensated to
decompensated heart failure and left ventricular (LV) ejection
fraction is preserved.
DETAILED DESCRIPTION
[0066] We have discovered an extraordinarily safe and effective
hydrogen sulfide prodrug of high bioavailability. The highly
bioavailable zerovalent-sulfur-rich compositions of the invention
contain at least 96% bioactive zerovalent sulfur that readily
undergoes bioconversion into hydrogen sulfide.
[0067] Other currently used hydrogen sulfide precursors contain no
more than 57% bioactive sulfur. Table 2 shows the percentage
bioactive sulfur contained in several prior art hydrogen sulfide
prodrugs and Table 3 shows the effects of hydrogen sulfide in
various cancer pathways. We describe herein the preparation and
characterization of the highly bioavailable zerovalent sulfur-rich
composition and methods of administering the composition to treat
and/or prevent cardiovascular disease, cancers, inflammatory
disease, diabetes, dyslipidemia, neurodegenerative disease, AIDS,
and other pathological conditions associated with oxidative stress,
an imbalance in redox homeostasis, and/or immune dysfunction.
TABLE-US-00002 TABLE 2 % Bioactive Hydrogen Sulfide Prodrug sulfur
(w/w) NaHS (anhydrous) 57 Diallyl trisulfide (DATS) 53.9 Diallyl
disulfide (DADS) 45.1 Na.sub.2S (anhydrous) 41
4-hydroxythiobenzamide (TBZ) 20.9 Sulforaphane (an isothiocyanate,
from broccoli) 18 Anethole trithione (a dithiolethione) 13.3
Dibenzyl trisulfide (DBTS) 11.5 ATB 346 (a naproxen-TBZ conjugate)
8.8 GYY 4137 (a morpholinium 8.5 arylmorpholinophosphinodithionate)
ACS 83 (a levodopa-dithiolethione conjugate) 7.1 ACS 15* (also
known as ATB 337) 6.3 (a diclofenac-dithiolethione conjugate) ATB
343 (an idomethacin-dithiolethione conjugate) 5.6 ACS 67 (a
latanoprost-dithiolethione conjugate 5.3 ACS 6 (a
sildenafil-dithiolethione conjugate) 3.5
TABLE-US-00003 TABLE 3 Affected stage (s)* Effect Mediator (s) 1 2
3 4 1 Increased immunocompetence GSH (.uparw.), Taurine (.uparw.) 2
Abolishment of chronic GSH (.uparw.), CAMs in
inflammation/resolution of acute Leukocytes (.dwnarw.), NF-kB
(.dwnarw.) inflammation 3 Inhibition of procarcinogen None (?)
activation by oxidases (Cyp-450, etc) 4 Carcinogen detoxification
Nrf2 (.uparw.), GSH (.uparw.), SO.sub.4.sup.-2 (.uparw.) 5
Epigenetic silencing of SAM (.uparw.) protooncogenes 6 Epigenetic
reactivation of tumor HDAC (.dwnarw.) suppressor genes 7 DNA
protection/repair GSH (.uparw.), Trx (.uparw.) 8 Inhibition of
Nf-kB and TNF- GSH (.uparw.) alpha nuclear translocation 9 Cell
cycle arrest Checkpoint kinase I 10 Prooxidant/proapoptotic Sulfane
sulfer (.uparw.) "redlining" ROS (.uparw.) 11 Antiangiogenesis (at
"high levels" ? of H.sub.2S) 12 Antimetastatic effect E-Cadherin
(.uparw.) 13 Antiosteolytic effect Nf-kB (.dwnarw.) *1 =
Initiation, 2 = Promotion, 3 = Progression, 4 = Metastasis
Sulfur-Rich Compositions
Preparations of Highly Bioavailable Zerovalent Sulfur-Rich
Compositions
[0068] In one embodiment, the highly bioavailable
zerovalent-sulfur-rich compositions are obtained by Procedure I
outlined below to prepare a 2.7 kg lot of a composition comprising
highly bioavailable zerovalent sulfur. The starting materials are
listed in Table 4 and suitable equipment is listed in Table 5.
TABLE-US-00004 TABLE 4 % Purity Weight Volume Material (w/w) (kg)
(L) Anhydrous sodium metabisulfite 99.4 4.890
(Na.sub.2S.sub.2O.sub.5) Sodium hydrogen sulfide, HYDRATED* 70
7.090 (Sodium sulfhydrate, HYDRATED) Concentrated sulfuric acid 98
6.408 3.483 Distilled water 100 67.25 67.25 High-purity ice 100
30.0 Anhydrous ethyl alcohol .gtoreq.99.5 5.68 7.2 (FREE FROM
DENATURING ADDITIVES) *contains approximately 30% water and 70%
NaHS
TABLE-US-00005 TABLE 5 Equipment Preferred specifications 200 L
main reaction vessel plastic or glass-lined 80 L auxiliary reaction
vessel plastic or glass-lined 40 L vessel plastic or stainless
steel 19 L vessel plastic or stainless steel 10 L vessel Plastic or
stainless steel Large trays Stainless steel or glass High-torque
motor-stirrer Should be capable of continuously assembly (220 v, 3
HP) with varying speed between 0 and 1725 rpm. a frequency
converter-speed The speed scale shown in the display control (ABB,
model ACS 150) should go from 0 to 50. The dimensions of the 304
stainless steel propeller-type stirrer shaft should be 80 cm long
and 1 inch in diameter. Low-torque stirrer -- pH meter or pH
measuring -- sticks Thermometer (-5-110.degree. C.) -- Measuring
cylinders -- Scales -- 4 L-Kitasato flask -- Buchner funnel 185 mm
internal diameter Two additional funnels Graduated At least 2
full-face safety -- masks fitted with cartridges designed to absorb
acid fumes Vacuum pump or water ejection -- vacuum system
Procedure I
[0069] Add portionwise and under brisk stirring, 4.890 kg of
Na.sub.2S.sub.2O.sub.5 to 20 L of distilled water contained in the
200 L-main reaction vessel fitted with the high-torque stirrer (7-8
shown in display). The addition is desirably made over 3-5 minutes
and an effort should be made to keep the powder from forming lumps.
Dissolve 7.090 kg of NaHS.xH.sub.2O in 15 L of distilled water
contained in the 80 L auxiliary reaction vessel fitted with the
low-torque stirrer. Filter the NaHS solution through 3 pieces of
Whatman #1 filter paper under reduced pressure using a
Kitasato-Buchner assembly. Collect the filtrates in a 19 L vessel.
It should be noted that only a very small amount of impurities is
usually retained on the filter papers.
[0070] Next, rinse the 80 L auxiliary reaction vessel and transfer
the filtered NaHS solution from the 19 L vessel to the 80 L
auxiliary reaction vessel. Add 30 L of distilled water to the 80 L
auxiliary reaction vessel that contains the filtered NaHS solution.
Pour 1.458 kg of concentrated sulfuric acid (98%) into a stirred
mixture of 2.25 kg ice and 2.25 kg distilled water contained in a
10 L vessel. The next two steps should take place simultaneously
and should last 40 minutes. Pour, at once, 600 ml of
Na.sub.2S.sub.2O.sub.5 solution into the auxiliary reaction vessel,
which contains the stirred NaHS solution, and start adding (from an
addition funnel) the dilute sulfuric acid solution (5.958 kg) into
the same vessel with good stirring. Stirring should create a vortex
that goes all the way down to the propeller. Wearing a full-face
mask (fitted with an acid-absorbing cartridge), add 2.5 kg of ice
to the main reaction vessel containing the Na.sub.2S.sub.2O.sub.5
solution. Start pouring concentrated sulfuric acid (4.95 kg) in
small portions and under brisk stirring. Alternate acid additions
with ice additions so as to prevent the solution from heating up.
Measure the temperature of the solutions in both reaction vessels.
The temperature of the solution in the 200 L main reaction vessel
(Na.sub.2S.sub.2O.sub.5 plus H.sub.2SO.sub.4) should be about
0.degree. C. and the solution in the 80 L auxiliary reaction vessel
(NaHS plus a bit of Na.sub.2S.sub.2O.sub.5 plus H.sub.2SO.sub.4)
should be between 30-35.degree. C. Charge 5 kg ice into the 200 L
reaction vessel (Na.sub.2S.sub.2O.sub.5 plus H.sub.2SO.sub.4) and
then run into it the solution contained in the 80 L auxiliary
reaction vessel (NaHS plus a bit of Na.sub.2S.sub.2O.sub.5 plus
H.sub.2SO.sub.4) under brisk stirring (24.5-25 on speed scale shown
in display). This operation should take about 10 minutes and
stirring should create a vortex that goes all the way down to the
propeller. Upon mixing the 2 solutions, the reaction mixture should
go from colorless to canary yellow, fluidity increases, there is
some frothing, and a yellowish precipitate separates. Measure the
final temperature of the reaction mixture as well as its pH. The
temperature should be between 25-30.degree. C. and the pH should be
close to 3. Continue stirring briskly for 90 minutes. Stirring
should create a vortex that goes all the way down to the
propeller.
[0071] Allow the reaction mixture to stand undisturbed during 24
hours at room temperature. At the end of this stage the yellowish
precipitate should lie at the bottom of the vessel in the form of a
relatively compact mass. Without perturbing the precipitate,
transfer as much as possible of the liquid phase to a different
vessel by decantation or siphoning. Transfer the material remaining
in the reaction vessel (about 20 L) to a 40 L plastic or glass
container and stir during 1 hour to obtain a homogeneous slurry.
Filter the slurry through a #1 Whatman filter paper using a
Buchner-Kitasato assembly. Wash the filter cake with 1 L of
distilled water or until the filtrate shows no acidity. Washing
should be done before the filter cake develops cracks in order to
prevent channeling. Immediately after washing keep applying vacuum
during 10 more minutes. Over-drying will lead to a highly compact
filter cake and will bring about great difficulties in subsequent
steps. Use of a rubber or plastic filter dam (or similar device) is
recommended. Transfer the relatively dry filter cake to a 10 L
plastic container and add 7 L of pure anhydrous ethanol. Stir until
all the solid is suspended and keep stirring 1 hour. If the
suspension is too thick add more anhydrous ethanol. Filter the
suspension through a #1 Whatman filter paper, wash the filter cake
with 200 ml of anhydrous ethanol, place the rubber dam on top and
keep applying vacuum for no longer than 10 minutes. Over-drying
will lead to a highly compact filter cake and will bring about
great difficulties in subsequent steps. Transfer the filter cake to
large glass or stainless steel trays for room-temperature air
drying. Allow to dry for about 4 days or until constant weight and
absence of ethanol odor. The dry product is a material that
consists of easily friable lumps and an impalpable powder.
Disaggregate the lumps and sift to make sure that the material goes
through a 325 standard sieve.
[0072] Procedure I yields a product (SG-1002) containing about 99%
zerovalent sulfur and about 1% highly polar components (e.g.,
sodium sulfate and traces of sodium polythionates and sodium thio
sulfate).
[0073] In some embodiments, variations of Procedure I may be used
to obtain similar materials. Such procedures include but are not
limited to the following:
Procedure II
[0074] Use sodium sulfide instead of sodium hydrogen sulfide and
adjust the amounts of reactants according to rules well known to
those skilled in the art, such as increasing the amount of acid,
following the process detailed in Procedure I.
Procedure III
[0075] Use sodium sulfite instead of sodium metabisulfite and
adjust the amount of reactants according to rules well known to
those skilled in the art, following the process detailed in
Procedure I.
Procedure IV
[0076] Use sodium sulfide instead of sodium hydrogen sulfide and
sodium sulfite instead of sodium metabisulfite and adjust the
amount of reactants according to rules well known to those skilled
in the art, following the process detailed in Procedure I.
Procedure V
[0077] Use concentrated hydrochloric acid instead of concentrated
sulfuric acid with mole-per-mole replacement and following the
process detailed in Procedure I.
Procedure VI
[0078] Use concentrated hydrochloric acid instead of concentrated
sulfuric acid with mole-per-mole replacement and following the
process detailed in Procedure II.
Procedure VII
[0079] Use concentrated hydrochloric acid instead of concentrated
sulfuric acid with mole-per-mole replacement and following the
process detailed in Procedure III.
Procedure VIII
[0080] Use concentrated hydrochloric acid instead of concentrated
sulfuric acid with mole-per-mole replacement and following the
process detailed in Procedure IV.
Procedure IX
[0081] Use potassium salts instead of sodium salts and adjust the
amount of reagents according to rules well known to those skilled
in the art, and following the process detailed in Procedure I.
[0082] In some embodiments, the reactants used in the procedure can
include any compound comprising sulfur in the minus two oxidation
state and another compound comprising sulfur in the plus four
oxidation state, and optionally an acid and/or catalyst(s).
[0083] In other embodiments, vacuum-aided filtration may be
replaced by pressure-aided filtration and/or centrifugation. In
other embodiments, closed reactors may be used, a heat-exchange
cooling system may be substituted for ice addition, spray drying
may substitute air drying, and one and/or more steps (e.g., washing
with alcohol) may be omitted. It should be understood that
embodiments involving a larger or smaller scale of operation are
also within the scope of the present invention.
Characterization of Highly Bioavailable Zerovalent-Sulfur-Rich
Compositions
[0084] The standard yield of dry, sifted product is 2.7 kg of an
impalpable, odorless, fluffy, light yellow, microcrystalline powder
with the following properties: [0085] Melting range: the mean
melting temperature is between about 117.degree. C. and about
121.degree. C..+-.2-3.degree. C. (e.g., melting occurs between
118-120.degree. C., 116-119.degree. C., or between 119-120.degree.
C.). [0086] Zerovalent sulfur content (w/w): 90-99.9% (e.g., 91%,
92%, 93.5%, 94%, 96%, 96.5%, 97.1%, 97.5%, 98%, 98.6%, 98.9%, or
99.5%) [0087] Elemental alpha sulfur content (w/w): 90-99.9% (e.g.,
91%, 92%, 93.5%, 94%, 96%, 97.1%, 97.5%, 98%, 98.6%, 98.9%, or
99.5%) [0088] Highly polar components (w/w): 0.01-10% (e.g., 0.02%,
0.1%, 0.25%, 0.5%, 0.8%, 1%, 1.5%, 2%, 3%, 4%, 5%, 5.5%, 6%, 7%,
8%, 9%, 9.5%, or 9.9%) [0089] Solubility in water at 25.degree. C.:
0% [0090] Solubility in carbon disulfide: 87-97% [0091] Apparent
density (tapped): .about.0.6 g/ml [0092] Median particle size
distribution: between about 26 and about 33 micrometers (e.g.,
26.5, 27, 27.3, 28, 28.5, 29, 29.5, 30, 31.3, 32, 32.5, or 32.9)
[0093] Sodium content: .about.0.03% [0094] Oxygen content (by
difference): .about.0.12%
[0095] The composition obtained by adhering to Procedure I consists
of microcrystals rich in zerovalent sulfur; its solubility in
carbon disulfide is lower than that of alpha-sulfur (rhombic
sulfur) and contains measurable amounts of sodium and oxygen. X-ray
diffraction patterns of the composition are consistent with that of
alpha sulfur.
[0096] The methods used to obtain the data described herein include
the following. The solubility of the composition in carbon
disulfide was obtained by adding 6 mL of carbon disulfide to 0.500
g of the final product and determining the weight of the residue.
Zerovalent sulfur content was measured by sulfitolysis not
correcting for the fact that sulfitolysis converts all sulfur atoms
in S.sub.8 into thiosulfate but only (n-1) sulfur atoms in
Na.sup.+-O.sub.3S--S.sub.n--SO.sub.3.sup.-Na.sup.+. Sodium content
was determined by Galbraith Laboratories, USA (GLI procedure
ME-70). Particle size distribution was measured using a Partica
LA-950 laser diffraction particle size analyzer from Horiba
Instruments.
[0097] Without being limited by any hypothesis, it is likely that
the high bioavailability of the above material is associated with
the hydrophilic nature of the crystal surfaces, which in turn may
be related to the presence of highly polar groups such as
.sup.-SO.sub.3Na and/or .dbd.SO.sub.3Na.sub.2. These groups might
be those present in polythionate molecules
(Na.sup.+-O.sub.3S--S.sub.n SO.sub.3.sup.-Na.sup.+, e.g., where
n=1, 2, or 3), thiosulfates, or sulfates. Highly polar groups such
as .sup.-SO.sub.3Na may be associated with molecules of water of
hydration and may, under some circumstances, undergo cationic
exchange, yielding, e.g., .sup.-SO.sub.3H groups. Further, the
hydrophilicity of the surface of this unique microcrystalline
material is in stark contrast with the hydrophobic nature of the
surface of crystals of pure alpha- or beta-elemental sulfur. Pure
alpha- or beta-elemental sulfur in contrast, is completely soluble
in carbon disulfide. Also without being limited by any hypothesis
or theory, it is likely that the low bioavailability of ordinary
alpha sulfur is directly related to the hydrophobic nature of its
surface.
[0098] In some embodiments, the composition can be micro- or
nanosized, comprising particles rich in alpha sulfur but always
modified so as to possess hydrophilic surfaces. Similar
compositions also within the scope of the present invention can be
obtained by any chemical, electrochemical, mechanochemical,
sonochemical, photochemical, microwave-assisted, biochemical and/or
biotechnological processes known in the art. Compositions
comprising elemental beta sulfur and surface modifying polar groups
further constitute embodiments of the present invention. As
established, elemental alpha sulfur is converted into beta sulfur
when heated and vice versa.
Determination of Zerovalent Sulfur Content in the Highly
Bioavailable Zerovalent Sulfur-Rich Compositions
[0099] In one aspect, the zerovalent sulfur content of the
composition of the invention can be determined using the method
described herein to measure the percentage (w/w) of zerovalent
sulfur in alpha sulfur, sodium thiosulfate, and sodium
polythionates. The sulfitolysis method for determining zerovalent
sulfur content described herein does not correct for the fact that
sulfitolysis of polythionate molecules stops at the trithionate as
shown in equation (ii), therefore, one of the zerovalent sulfur
atoms present in each polythionate molecule escapes sulfitolysis
and is not converted into thiosulfate (equation (ii)). However,
since the sodium content of the composition disclosed herein is
small, the error introduced in the calculation of % zerovalent
sulfur is correspondingly small. A detailed analysis of
sulfitolysis is described in Koh et al., Anal. Sci. 6:3-14,
1990.
[0100] The sulfitolysis reactions equation (i) and (ii) proceed as
in the volumetric method for quantitative determination of
elemental sulfur in aromatic hydrocarbons reported by Morris et
al., Anal. Chem. 20:1037-1039, 1948. The sulfitolysis method
described herein is improved compared to the method of Morris et
al. in several ways, including the use of n-hexadecyl pyridinium
chloride as a sulfitolysis catalyst.
S.sub.8+8SO.sub.3.sup.2-.fwdarw.8S.sub.2O.sub.3.sup.2- Equation
(i)
.sup.-O.sub.3S--S.sub.n--SO.sub.3.sup.-+(n-1)SO.sub.3.sup.2-.fwdarw.(n-1-
)S.sub.2O.sub.3.sup.2-+.sup.-O.sub.3S--S--SO.sub.3.sup.- Equation
(ii)
[0101] The reagent solutions and methods of preparation of the
solutions are shown in Table 6.
TABLE-US-00006 TABLE 6 Reagent Solution Preparation of Solution
Sodium sulfite (15% w/w) Weigh 150 grams of anhydrous chemically
aqueous solution pure sodium sulfite and dissolved in 850 mL
distilled water. Formaldehyde aqueous -- solution (37%) 6N HCl
Measure 250 mL of concentrated hydro- chloric acid (approximately
12N) and dilute to 500 mL with distilled water. KI (10% w/w in
water) Weigh 50 grams chemically pure KI and dissolve in 450 mL
distilled water. 0.200N KIO.sub.3 Weigh 7.134 grams of high purity
anhydrous KIO.sub.3 dissolve in 100 mL distilled water and dilute
to 1 L with distilled water. Hexadecylpyridinium Weigh 1 gram solid
monohydrate and chloride monohydrate dissolve in 99 mL distilled
water. (1% w/w) solution in water Soluble starch (5 g/L, Weigh 1
gram soluble starch, add 10 mg aqueous solution) red mercuric
iodide, add cold water to form a paste, then add 200 mL boiling
water and boil for 1 or 2 minutes while stirring. Allow the
solution to cool to room temperature.
[0102] To determine the zerovalent sulfur content, weigh 0.160
g.+-.10 mg of the composition into a 250 mL Erlenmeyer flask. Add
to the flask 100 mL of 15% Na.sub.2SO.sub.3 solution. Place the
flask in a water bath and apply heat until the water boils. Then
add 0.5 mL of 1% hexadecylpyridinium chloride monohydrate solution
and continue heating until the solid disappears completely. Allow
the contents in the flask to cool down to room temperature and
place a magnetic stirring bar inside. While stirring, add 15 mL
formaldehyde solution, 25 mL 6N solution, 10 mL of 10% KI solution,
and 1 mL of 0.5% soluble starch indicating solution. The resulting
solution should be colorless. Titrate the contents in the flask
with 0.2N KIO.sub.3 solution using a 25 mL burette. As the
titration starts, the contents of the flask become amber-colored,
but the color disappears quickly. As the equivalence point is
approached be very careful not to overstep. The final point is
reached when a drop of titrating solution produces no color
change.
Titration reaction
IO.sub.3.sup.-+5I.sup.-+6H.sup.++6S.sub.2O.sub.3.sup.2-.fwdarw.6I.sup.-+3-
S.sub.4O.sub.6.sup.2-+3H.sub.2O Equation (iii)
% zerovalent sulfur*=(V.sub.KIO3
(mL).times.N.sub.KIO3.times.32.07.times.100)/(1000.times.sample
weight (g)) Formula (iv)
* susceptible of undergoing sulfitolysis
Conditions and Disorders
[0103] The highly bioavailable zerovalent-sulfur-rich compositions
described herein can be used to treat a cardiovascular disease,
hyperproliferative diseases (e.g., cancer), an inflammatory
disease, diabetes, dyslipidemia, a neurodegenerative disease, AIDS,
and other pathological conditions associated with oxidative stress,
an imbalance in redox homeostasis, and/or immune dysfunction.
[0104] In one aspect, compositions of the invention are
administered to a subject already suffering from a cardiovascular
disease, an inflammatory disease, a neurodegenerative disease,
AIDS, and a pathological condition associated with oxidative stress
and/or an imbalance in redox homeostasis, or cancer. In another
aspect, compositions of the invention may also be administered to a
subject at risk for developing a cardiovascular disease,
hyperproliferative diseases (e.g., cancer), an inflammatory
disease, diabetes, dyslipidemia, a neurodegenerative disease, AIDS,
and other pathological condition associated with oxidative stress,
an imbalance in redox homeostasis, and/or immune dysfunction.
Cardiovascular Diseases
[0105] The compositions of the invention are also useful in
treating cardiovascular diseases. As used herein cardiovascular
diseases included, but are not limited to, arteriosclerosis,
coronary heart disease, ischemia, endothelium dysfunction, in
particular those dysfunctions affecting blood vessel elasticity,
restenosis, thrombosis, angina, high blood pressure,
cardiomyopathy, hypertensive heart disease, heart failure, cor
pulmonale, cardiac dysrhythmias, endocarditis, inflammatory
cardiomegaly, myocarditis, myocardial infarction, valvular heart
disease, stroke and cerebrovascular disease, aortic valve stenosis,
congestive heart failure, and peripheral arterial disease. In one
aspect, the invention includes methods of administering the highly
bioavailable zerovalent-sulfur-rich compositions for chronic
treatment. In another aspect, the invention also includes methods
of administering the highly bioavailable zerovalent-sulfur-rich
compositions for acute treatment.
[0106] In preferred embodiments, the highly bioavailable
zerovalent-sulfur-rich compositions of the invention will restore
and/or improve cardiovascular parameters to normal ranges in a
subject diagnosed with or at risk of a cardiovascular disease.
Normal ranges of cardiovascular parameters include but are not
limited to, an end-diastolic volume (EDV) from about 65-240 mL, an
end-systolic volume (ESV) from about 16-143 mL, a stroke volume
from about 55-100 mL, an ejection fraction from about 55-70%, a
heart rate from about 60-100 bpm, and/or cardiac output of about
4.0-8.0 L/min.
Inflammatory Diseases
[0107] Highly bioavailable zerovalent-sulfur-rich compositions of
the invention may also be used to treat inflammatory diseases.
Examples of inflammatory diseases include, but are not limited to
acne vulgaris, asthma, autoimmune diseases (e.g., acute
disseminated encephalomyelitis (ADEM), Addison's disease,
agammaglbulinemia, alopecia areata, amyotrophic lateral sclerosis,
ankylosing spondylitis, antiphospholipid syndrome, antisynthetase
syndrome, atopic allergy, atopic dermatitis, autoimmune aplastic
anemia, autoimmune cardiomyopathy, autoimmune enteropathy,
autoimmunehemolytic anemia, autoimmune hepatitis, autoimmune inner
ear disease, autoimmune lymphoproliferative syndrome, autoimmune
peripheral neuropathy, autoimmune pancreatitis, autoimmune
polyendocrine syndrome, autoimmune progesterone dermatitis,
autoimmune thrombocytopenic purpura, autoimmune urticaria,
autoimmune uveitis, Balo concentric sclerosis, Behcet's disease,
Berger's disease, Bickerstaff's encephalitis, Blau syndrome,
bullous pemphigoid, Castleman's disease, celiac disease, Chagas
disease, chronic inflammatory demyelinating polyneuropathy, chronic
recurrent multifocal osteomyelitis, chronic obstructive pulmonary
disease, Churg-Strauss syndrome, cicatricial pemphigoid, Cogan
syndrome, cold agglutinin disease, complement component 2
deficiency, contact dermatitis, cranial arteritis, CREST syndrome,
Crohn's disease, Cushing's syndrome, cutaneous leukocytoclastic
vasculitis, Dego's disease, Dercum's disease, dermatitis
herpetiformis, dermatomyositis, diabetes mellitus type 1, diffuse
cutaneous systemic sclerosis, Dressler's syndrome, drug-induced
lupus, discoid lupus erythematosus, eczema, endometriosis,
enthesitis-related arthritis, eosinophilic fasciitis, eosinophilic
gastroenteritis, epidermolysis bullosa acquisita, erythema nodosum,
erythroblastosis fetalis, essential mixed cryoglobulinemia, Evan's
syndrome, fibrodysplasia ossificans progressive, fibrosing
alveolitis, gastritis, gastrointestinal pemphigoid, giant cell
arteritis, glomerulonephritis, Goodpasture's syndrome, Grave's
disease, Guillain-Barre syndrome, Hashimoto's encephalopathy,
Hashimoto's thyroiditis, Henoch-Schonlein purpura, herpes
gestationis, hidradenitis suppurativa, Hughes-Stovin syndrome,
hypogammaglobulinemia, idiopathic inflammatory demyelinating
diseases, idiopathic pulmonary fibrosis, idiopathic
thrombocytopenic purpura, IgA nephropathy, inclusion body myositis,
chronic inflammatory demyelinating polyneuropathy, interstitial
cystitis, juvenile idiopathic arthritis, Kawasaki's disease,
Lambert-Eaton myasthenic syndrome, leukocytoclastic vasculitis,
lichen planus, lichen sclerosus, linear IgA disease, lupus
erythematosus, Majeed syndrome, Meniere's disease, microscopic
polyangiitis, mixed connective tissue disease, morphea,
Mucha-Habermann disease, myasthenia gravis, myositis, narcolepsy,
neuromyelitis optica, neuromyotonia, ocular cicatricial pemphigoid,
opsoclonus myoclonus syndrome, Ord's thyroiditis, palindromic
rheumatism, PANDAS, paraneoplastic cerebellar degeneration,
paroxysmal nocturnal hemoglobinuria, Parry Romberg syndrome,
Parsonage-Turner syndrome, pars planitis, pemphigus vulgaris,
pernicious anaemia, perivenous encephalomyelitis, POEMS syndrome,
polyarteritis nodosa, polymyalgia rheumatic, polymyositis, primary
biliary cirrhosis, primary sclerosing cholangitis, progressive
inflammatory neuropathy, psoriatic arthritis, pyoderma gangrenosum,
pure red cell aplasia, Rasmussen's encephalitis, raynaud
phenomenon, relapsing polychondritis, Reiter's syndrome, restless
leg syndrome, retroperitoneal fibrosis, rheumatic fever, Schnitzler
syndrome, scleritis, scleroderma, serum sickness, Sjogren's
syndrome, spondyloarthropathy, stiff person syndrome, subacute
bacterial endocarditis, Susac's syndrome, Sweet's syndrome,
sympathetic ophthalmia, Takayasu's arteritis, temporal arteritis,
thrombocytopenia, Tolosa-Hunt syndrome, transverse myelitis,
ulcerative colitis, undifferentiated connective tissue disease,
undifferentiated spondyloarthropathy, vitiligo, and Wegener's
granulomatosis), celiac disease, chronic prostatitis,
glomerulonephritis, hypersensitivities, inflammatory bowel
diseases, pelvic inflammatory disease, reperfusion injury,
rheumatoid arthritis, sarcoidosis, transplant rejection,
vasculitis, interstitial cystitis, and osteoarthritis.
Neurodegenerative Diseases
[0108] Highly bioavailable zerovalent-sulfur-rich compositions of
the invention may also be used to treat neurodegenerative diseases.
Neurodegenerative diseases are any diseases that are characterized
by the progressive loss of structure or function of neurons,
including death of neurons. Neurodegenerative diseases may be
caused by genetic mutations (e.g., CAG nucleotide triplet
mutation), protein misfolding (e.g., aggregation of
alpha-synuclein, hyperphosphorylated tau protein, and aggregation
of beta amyloid), misregulation in protein degradation pathways
(e.g., ubiquitin-proteasome pathway and autophagy-lysosome
pathways), membrane damage, mitochondrial dysfunction, defects in
axonal transport, and misregulation of programmed cell death
pathways (e.g., apoptosis, autophagic, and cytoplasmic). Examples
of neurodegenerative diseases include, but are not limited to
Alzheimer's disease, Parkinson's disease, Huntington's disease,
amyotrophic lateral sclerosis (ALS), Creutzfeldt-Jakob disease,
primary progressive aphasia, progressive supranuclear palsy,
spinocerebellar ataxia type 3, frontotemporal dementia, dementia
with Lewy bodies, corticobasal degeneration, prion disorders,
multiple system atrophy, hereditary spastic paraparesis,
Friedreich's ataxia, and amyloidoses.
Other Pathological Conditions Associated with Oxidative Stress
and/or an Imbalance in Redox Homeostasis
[0109] Highly bioavailable zerovalent-sulfur-rich compositions of
the invention may be useful in treating other conditions associated
with oxidative stress including but not limited to autism,
schizophrenia, bipolar disorder, fragile X syndrome, sickle cell
disease, chronic fatigue syndrome, osteoarthritis cataract, macular
degeneration, toxic hepatitis, viral hepatitis, cirrhosis, chronic
hepatitis, oxidative stress from dialysis, renal toxicity, kidney
failure, ulcerative colitis, bacterial infection, viral infections,
such as HIV and AIDS, herpes, ear infection, upper respiratory
tract diseases, hypertension, balding and hair loss, over-training
syndrome related to athletic performance, eczema, scleroderma,
atopic dermatitis, polymyositis, and dermatitis herpetiformis.
[0110] In preferred embodiments, the compositions of the invention
can be formulated for topical administration and/or enteral
administration to treat conditions such as psoriasis, athlete's
foot, and/or rosacea. In some embodiments, the highly bioavailable
zerovalent-sulfur-rich compositions of the invention may be useful
in healing wounds by influencing the stages of wound healing
including but not limited to hemostasis, inflammatory,
proliferative, and remodeling. In another embodiment, the highly
bioavailable zerovalent-sulfur-rich compositions of the invention
also enhance athletic performance by increasing one or more of the
factors of: endurance, energy, strength, visual acuity, and/or
coordination.
[0111] In another preferred embodiment, the compositions of the
invention can be formulated for enteral administration to treat
male infertility. Oxidative stress plays a major role in the
etiology of sperm dysfunction via induction of peroxidative damage
to the plasma membrane. Furthermore, oxidative stress affects the
integrity of the sperm nuclear and mitochondrial genomes, leading
to DNA strand breaks, aberrant recombination, and/or defective
packing, as well as chromatin cross-linking. The observation of
correlations between reactive oxygen species (ROS) generation by
washed human sperm suspensions and their fertilizing capacity is
consistent with the clinical significance of oxidative damage to
human spermatozoa; this significance is bolstered by the
demonstration of loss of functional competence and high rates of
DNA damage of human spermatozoa directly or indirectly exposed to
hydrogen peroxide. When the source of ROS is intracellular, many of
the classical antioxidants that are effective against extracellular
oxidative stress (e.g., NAC and hypotaurine) prove useless.
[0112] The high susceptibility toward irreversible oxidative damage
of mammalian sperm cells may be attributed to: (i) the particularly
high content of polyunsaturated fatty acids, plasmalogens, and
sphingomyelins of their membranes, (ii) the lack of adequate repair
mechanisms for oxidative damage, derived from a dearth of cytosolic
antioxidant enzymes associated with the loss of most of their
cytoplasm upon spermiation, (iii) the fact that mature
post-epididymal sperm cells possess highly condensed nuclear
chromatin (due to the replacement of histones by protamine, with
increased disulfide bond formation); this compactness contributes
to silencing the paternal chromosomes, which are unable to engage
in transcriptional activation by ROS, (iv) the fact that sperm
cells are particularly rich in highly active mitochondria, because
they need a constant supply of energy to support their motility.
Spermatozoa were the first cells found to generate significant
levels of ROS and these characteristics increase the probability of
mitochondrial membrane damage by leaked ROS, (v) the fact that
native cysteine-rich-secretory proteins (CRISPs) contain unusually
high numbers of thiolic (unoxidized) cysteine residues, which
renders them especially sensitive to inactivation by oxidants.
[0113] H.sub.2S may be used by cells to synthesize L-cysteine,
which can then serve as a building block in protein synthesis, as
described in Predmore et al., Antioxid Redox Signal. 17:119-140,
2012. Sulfur-deficient diets, however, are common and may lead to
cysteine deficiency-especially in males and consequently to
deficits in the biosynthesis of important cysteine-rich proteins
such as CRISPs. The CRISPs are found only in vertebrates, within
the male reproductive tract. CRISPs have been implicated in many
aspects of spermatogenesis, as well as in the actual process of
fertilization as reported in Koppers et al., Asian J. Androl.
13:111-117, 2011, and down-regulation of CRISP-2 mRNA by a factor
of 4.3 in asthenospermic patients was recently reported in Jing et
al., Natl. J. Androl. 17:203-207, 2011.
[0114] Srilatha et al., J. Sex. Med., 4:1304-1311, 2007, have
described some pioneering studies that provide evidence for the
endogenous formation of hydrogen sulfide and its proerectile
relaxant effect on the corpus cavernosum of mammals, as well as on
the effects of hydrogen sulfide in female sexual function. The
first set of results was corroborated by an international team that
included Louis J. Ignarro who won the Nobel Prize in 1998 for his
work on demonstrating the signaling properties of nitric oxide.
There is also evidence that oxidative stress is implicated in
erectile dysfunction in diabetic rodents as described in Bivalacqua
et al., J. Sex. Med. 2:187-197, 2005 and interventions based on
administration of tetrahydrobiopterin and up-regulation of
antioxidant enzymes may be useful as described in Deng et al.,
Methods Mol Biol. 610:213-227, 2010 and Minhas et al., Expert Opin
Pharmacother. 3:889-897, 2002. Moreover, recent work discusses the
effects of endogenous and exogenous H.sub.2S on the physiological
control of penile tone and the possibility of developing new
therapies for erectile dysfunction (ED) that target this
pathway.
[0115] Sparatore et al., Expert Rev. Clin. Pharmacol. 4:109-121,
2011 developed an H.sub.2S-donating derivative of sildenafil (ACS6)
with possible clinical indications in ED, benign prostatic
hypertrophy and low urinary tract symptoms. The H.sub.2S released
by ACS6 inhibits both phosphodiesterase type 5 (PDES) and NADPH
oxidase (NOX) expression activity, hence this mechanism may
constitute the basis of a new and effective approach to the
treatment of patients suffering from ED, benign prostatic
hypertrophy and lower urinary tract symptoms. In fact, studies
performed by Shukla et al., BJU Int. 103:1522-1529, 2009 showed
that ACS6 and sildenafil citrate relaxed cavernosal smooth muscle
equipotently and ACS6 inhibited superoxide formation and expression
of p47.sup.phox (a subunit of NOX) more than sildenafil citrate. It
was concluded that ACS6 not only promotes erection, but also
affords effective protection from oxidative stress through
up-regulation of glutathione (GSH) synthesis.
[0116] Furthermore, in an investigation of the effect of NaHS on
pregnant rat uterine contractility in vitro, Sidhu et al.,
Pharmacol Toxicol. 88:198-203, 2001 found that this "hydrogen
donor" produced significant dose-dependent decreases in uterine
spontaneous contractility.
[0117] Showell et al., Cochrane Database Syst Rev. 1:CD007411, 2011
assessed the effects of oral antioxidants on men with documented
sperm DNA damage and/or with impaired semen parameters on the basis
of clinical trials wherein the participants were randomly assigned
to antioxidant versus placebo, an alternative antioxidant, or no
treatment. The outcomes considered were: 1) life birth rate per
couple randomized, 2) pregnancy rate per couple, 3) miscarriage
rate per couple, or spontaneous abortion, 4) stillbirth rate per
couple, 5) level of sperm DNA damage after treatment, 6) sperm
concentration, 7) sperm motility, and 7) adverse effects. The 44
trials analyzed in this review involved 2876 couples, carried out
over an average duration of treatment of 4.1 months, and included
the following antioxidants: vitamin B, vitamin C, vitamin E,
selenium, magnesium, zinc, zinc plus vitamin E, zinc plus vitamin E
plus vitamin C, combined antioxidants plus minerals (e.g., vitamin
C, vitamin E, zinc, selenium, folic acid, lycopene, and garlic
oil), L-acetylcarnitine, L-carnitine, L-acetyl carnitine plus
L-carnitine, pentoxifylline, ethyl cysteine, N-acetylcysteine, and
docosahexenoic acid. The study concluded that antioxidant
supplementation in sub-fertile males may improve the outcomes of
live birth and pregnancy rate for sub-fertile couples undergoing
treatment (ART cycles). Further head-to-head comparisons are
necessary to identify the superiority of one antioxidant over
another. These results indicate that there is currently only
limited scientifically acceptable evidence that antioxidant
supplementation improves outcomes for sub-fertile couples or the
available forms of treatment have mostly produced only marginally
satisfactory responses, even in the best of proper trials and that
many drugs are being used without any rationale. According to
Cavallini et al, Asian J. Androl. 8:143-157, 2006, no drug can be
defined as unquestionably effective for the treatment of male
idiopathic oligoasthenoteratozoospermia.
[0118] The highly bioavailable zerovalent-sulfur-rich composition
of the invention was used in a clinical trial conducted by Mexican
researchers (see Example 8) and the results were highly encouraging
for several reasons including: a treatment duration of only 2.5
months versus an average of 4.1 months for all trials described in
Showell et al., Cochrane Database Syst Rev. 1:CD007411, 2011, and a
single-component formulation instead of an un-optimized
miscellaneous mixture of 7-10 or more presumably active
ingredients.
[0119] Oxidative stress is associated with an increase in the
production of oxidizing species (e.g., superoxide, peroxides, free
radicals) and/or a significant decrease in effectiveness and/or
levels of antioxidant defenses, such as glutathione. The highly
bioavailable zerovalent-sulfur-rich compositions of the invention
when administered will desirably act to restore the cysteine and
glutathione levels thus restoring the redox homeostasis in the
body.
Diabetes
[0120] Compositions of the invention may also be useful for
treating diabetes and its complications. Diabetes can be any
metabolic disease in which a person has high blood sugar, either
because the body does not produce enough insulin, or because cells
do not respond to the insulin that is produced. Non-limiting
examples of diabetes includes, type 1 diabetes mellitus, type 2
diabetes mellitus, gestational diabetes, congenital diabetes,
cystic fibrosis-related diabetes, steroid diabetes, latent
autoimmune diabetes of adults, and monogenic diabetes.
Complications associated with diabetes include but are not limited
to hypoglycemia, diabetic ketoacidosis, nonketotic hyperosmolar
coma, cardiovascular disease, chronic renal failure, diabetic
nephropathy, diabetic neuropathy, diabetes-related foot problems
(e.g., diabetic foot ulcers), and diabetic retinopathy.
Cancers
[0121] Other conditions that may be treated using highly
bioavailable zerovalent-sulfur-rich compositions of the invention
include cancers. Cancers are generally characterized by unregulated
cell growth, formation of malignant tumors, and invasion to nearby
parts of the body. Cancers may also spread to more distant parts of
the body through the lymphatic system or bloodstream. Cancers may
be a result of gene damage due to tobacco use, certain infections,
radiation, lack of physical activity, obesity, and/or environmental
pollutants. Cancers may also be a result of existing genetic faults
within cells to cause diseases due to genetic heredity. Screenings
may be used to detect cancers before any noticeable symptoms appear
and treatment may be given to those who are at higher risks of
developing cancers (e.g., people with a family history of cancers).
Examples of screening techniques for cancer include but are not
limited to physical examination, blood or urine tests, medical
imaging, and/or genetic testing. Non-limiting examples of cancers
include: bladder cancer, breast cancer, colon and rectal cancer,
endometrial cancer, kidney or renal cell cancer, leukemia, lung
cancer, melanoma, Non-Hodgkin lymphoma, pancreatic cancer, prostate
cancer, ovarian cancer, stomach cancer, wasting disease, and
thyroid cancer.
Transplants
[0122] The zerovalent-sulfur-rich composition of the invention are
expected to be effective in treating ischemia-reperfusion injury
from reconstructive and transplantation procedures. Water
dispersions of fine particles of the zerovalent-sulfur-rich
composition can be used to treat flaps of tissue from plastic or
reconstructive surgery and solid organs from transplants in order
to prevent/minimize ischemia-reperfusion injury and to protect the
mitochondria during the operative procedures. Exemplary tissues and
organs to be treated using the composition of the invention have
active metabolism and increased mitochondrial function and are
susceptible to reperfusion injury after brief periods of ischemia
and include but are not limited to; skeletal muscle, the heart, the
liver, large intestine, small intestine, the brain, the skin, the
limbs (e.g., arms, legs, feet, hands).
Pharmaceutical Compositions and Treatment Methods
[0123] The present invention also relates to pharmaceutical
compositions that contain the highly bioavailable zerovalent
sulfur-rich compositions or a combination of one of the highly
bioavailable zerovalent sulfur-rich compositions described herein
and a second therapeutic agent (e.g., an antiplatelet drug, a
.beta. blocker, an angiotensin-converting-enzyme (ACE) inhibitor or
angiotensin-receptor blocker (ARB), a statin, fibrates, biguanides,
blood pressure lowering agents, cytokines, cholesterol lowering
agents, erectile dysfunction drugs, anti-inflammatory drugs,
anti-thrombosis drugs, anticancer drugs, anti-diabetic drugs,
and/or dietary supplements).
[0124] A composition of the present invention can be administered
by a variety of methods known in the art. As will be appreciated by
the skilled artisan, the route and/or mode of administration will
vary depending upon the desired results. The pharmaceutical
compositions can be formulated for parenteral, intranasal, topical,
oral, or local administration, such as by a transdermal means, for
prophylactic and/or therapeutic treatment. The pharmaceutical
compositions can be administered parenterally (e.g., by
intravenous, intramuscular, or subcutaneous injection), or by oral
ingestion, or by topical application or intraarticular injection at
areas affected by the vascular or cancer condition. Additional
routes of administration include intravascular, intra-arterial,
intratumor, intraperitoneal, intraventricular, intraepidural, as
well as nasal, ophthalmic, intrascleral, intraorbital, rectal,
topical, or aerosol inhalation administration. Sustained release
administration is also specifically included in the invention, by
such means as depot injections or erodible implants or components.
Thus, the invention provides compositions for parenteral
administration that comprise the above mentioned agents dissolved,
colloidally dispersed, or suspended in an acceptable carrier,
preferably an aqueous carrier, e.g., water, buffered water, saline,
PBS, and the like. The compositions may contain pharmaceutically
acceptable auxiliary substances as required to approximate
physiological conditions, such as pH adjusting and buffering
agents, tonicity adjusting agents, wetting agents, detergents and
the like.
[0125] The therapeutic composition may be in the form of a
solution, colloidal dispersion, a suspension, an emulsion, an
infusion device, or a delivery device for implantation or it may be
presented as a dry powder to be used as such or to be reconstituted
with water or another suitable vehicle before use. The composition
can be in the form of a tablet, capsule (e.g., hard gelatin capsule
and soft gelatin capsule), liquid, or sustained release tablet for
oral administration; or a liquid for intravenous, intrathecal,
subcutaneous or parenteral administration; or a cream or ointment
for topical administration, or a polymer or other sustained release
vehicle for local administration.
[0126] Methods well known in the art for making formulations are
found, for example, in "Remington: The Science and Practice of
Pharmacy" (20th ed., ed. A. R. Gennaro A R., 2000, Lippincott
Williams & Wilkins, Philadelphia, Pa.). Formulations for
parenteral administration may, for example, contain excipients,
sterile water, saline, polyalkylene glycols such as polyethylene
glycol, oils of vegetable origin, or hydrogenated napthalenes.
Biocompatible, biodegradable lactide polymer, lactide/glycolide
copolymer, or polyoxyethylene-polyoxypropylene copolymers may be
used to control the release of the substances. Nanoparticulate
formulations (e.g., biodegradable nanoparticles, solid lipid
nanoparticles, liposomes) may be used to control the
biodistribution of the substances. Other potentially useful
delivery systems include ethylene-vinyl acetate copolymer
particles, osmotic pumps, intrathecal pumps, implantable infusion
systems, and liposomes. The concentration of the substance in the
formulation varies depending upon a number of factors, including
the dosage of the drug to be administered, and the route of
administration.
[0127] To administer a composition of the invention by certain
routes of administration, it may be necessary to coat the
composition with, or co-administer the composition with a material
to prevent its inactivation. For example, the composition may be
administered to a subject in an appropriate carrier, for example,
liposomes, or a diluent. Pharmaceutically acceptable diluents
include saline and aqueous buffer solutions. Liposomes include
water-in-oil-in-water CGF emulsions as well as conventional
liposomes (Strejan et al., J. Neuroimmunol. 7:27-41, 1984).
Pharmaceutically acceptable carriers include sterile aqueous
solutions or dispersions and sterile powders for the extemporaneous
preparation of sterile injectable colloidal solutions or
dispersion. The use of such media and agents for pharmaceutically
active substances is known in the art and is included in the
invention except where any conventional media or agent is
incompatible with the active substance. Supplementary active
substances can also be incorporated into the compositions.
[0128] Therapeutic compositions typically must be sterile and
stable under the conditions of manufacture and storage. The
composition can be formulated as a suspension, microemulsion,
liposome, or other ordered structure suitable to high drug
concentration. The carrier can be a solvent or dispersion medium
containing, for example, water, ethanol, petroleum jelly (e.g.,
Vaseline.RTM.), polyol (e.g., glycerol, propylene glycol, and
liquid polyethylene glycol, and the like), and suitable mixtures
thereof, formulated at different percentages (e.g., 5, 10, 15, 20,
25, 30, 35, 40, 45, or 50% by weight in a dispersion medium
described herein). The proper fluidity can be maintained, for
example, by the use of a coating such as lecithin, by the
maintenance of the required particle size in the case of dispersion
and by the use of surfactants. In many cases, it will be preferable
to include isotonic agents, for example, sugars, polyalcohols such
as mannitol, sorbitol, or sodium chloride in the composition.
Prolonged absorption of the injectable compositions can be brought
about by including in the composition an agent that delays
absorption, for example, monostearate salts and gelatin. Colloidal
dispersions may be stabilized through addition of agents well known
in the art.
[0129] The compositions of the invention may be sterilized by
conventional sterilization techniques, or may be sterile filtered.
The resulting aqueous dispersions may be packaged for use as is, or
lyophilized, the lyophilized preparation being combined with a
sterile aqueous carrier prior to administration. The pH of the
preparations typically will be between 3 and 11, more preferably
between 5 and 9 or between 6 and 8, and most preferably between 7
and 8, such as 7 to 7.5. The resulting compositions in solid or
semisolid form may be packaged in multiple single dose units, each
containing a fixed amount of the composition, such as in a sealed
package of tablets or capsules. The composition in solid form can
also be packaged in a container for a flexible quantity, such as in
a squeezable tube designed for a topically applicable cream or
ointment.
[0130] Preferred formulations of the invention include but are not
limited to: preparation of hard gelatin capsules containing 100-400
mg of a highly bioavailable zerovalent-sulfur-rich composition of
the invention, preparation of a suspension of about 5-20% (5.5%,
6%, 6.5%, 7%, 8%, 10%, 15%, 17%, or 19%) of highly bioavailable
zerovalent-sulfur-rich composition of the invention and petroleum
jelly (e.g., Vaseline.RTM.) or polyethylene glycol, or a colloidal
dispersion of about 5-20% (5.5%, 6%, 6.5%, 7%, 8%, 10%, 15%, 17%,
or 19%) of highly bioavailable zerovalent-sulfur-rich composition
of the invention in water or oil.
[0131] Sterile injectable colloidal suspensions can be prepared by
incorporating the active compound in the required amount in an
appropriate solvent with one or a combination of ingredients
enumerated above, as required, optionally followed by sterilization
microfiltration. Generally, dispersions are prepared by
incorporating the active compound into a sterile vehicle that
contains a basic dispersion medium and the required other
ingredients from those enumerated above. Dosage regimens are
adjusted to provide the optimum desired response (e.g., a
therapeutic or prophylactic response). For example, a single bolus
may be administered, several divided doses may be administered over
time or the dose may be proportionally reduced or increased as
indicated by the exigencies of the therapeutic or prophylactic
situation. For example, the compositions of the invention may be
administered once or twice weekly by subcutaneous injection or once
or twice monthly by subcutaneous injection.
[0132] It is especially advantageous to formulate parenteral
compositions in dosage unit form for ease of administration and
uniformity of dosage. Dosage unit form as used herein refers to
physically discrete units suited as unitary dosages for the
subjects to be treated; each unit contains a predetermined quantity
of active compound calculated to produce the desired therapeutic or
prophylactic effect, optionally in association with the required
pharmaceutical carrier. The specifications for the dosage unit
forms of the invention are dictated by and directly dependent on
(a) the unique characteristics of the active substance and the
particular therapeutic or prophylactic effect to be achieved, and
(b) the limitations inherent in the art of compounding such an
active substance for the treatment of sensitivity in
individuals.
[0133] When the substances of the present invention are
administered as pharmaceuticals, to humans and animals, they can be
given alone or as a pharmaceutical composition containing, for
example, 1 to 100% (more preferably, 10 to 100%, such as 90 to
100%) of active ingredient, optionally in combination with one more
pharmaceutically acceptable carriers or excipients.
[0134] The compositions containing an effective amount can be
administered for prophylactic or therapeutic treatments. In
prophylactic applications, compositions can be administered to a
patient with a clinically determined predisposition or increased
susceptibility to development of cardiovascular diseases,
hyperproliferative diseases (e.g., cancer), inflammatory diseases,
diabetes, dyslipidemia, neurodegenerative diseases, AIDS, and other
pathological conditions associated with oxidative stress, an
imbalance in redox homeostasis, and/or immune dysfunction.
Compositions of the invention can be administered to the patient
(e.g., a human) in an amount sufficient to delay, reduce, or
preferably prevent the onset of the clinical disease. In
therapeutic applications, compositions are administered to a
patient (e.g., a human) already suffering from a cardiovascular
disease, hyperproliferative diseases (e.g., cancer), an
inflammatory disease, diabetes, dyslipidemia, a neurodegenerative
disease, AIDS, and other pathological conditions associated with
oxidative stress, an imbalance in redox homeostasis, and/or immune
dysfunction, in an amount sufficient to cure or at least partially
arrest the symptoms of the condition and its complications. An
amount adequate to accomplish this purpose is defined as a
"therapeutically effective dose," an amount of a compound
sufficient to substantially improve some symptom associated with a
disease or a medical condition. For example, in the treatment of a
cardiovascular disease, hyperproliferative diseases (e.g., cancer),
an inflammatory disease, diabetes, dyslipidemia, a
neurodegenerative disease, AIDS, and other pathological conditions
associated with oxidative stress, an imbalance in redox
homeostasis, and/or immune dysfunction, an agent or substance which
decreases, prevents, delays, suppresses, or arrests any symptom of
the disease or condition would be therapeutically effective. A
therapeutically effective amount of an agent or substance is not
required to cure a disease or condition but will provide a
treatment for a disease or condition such that the onset of the
disease or condition is delayed, hindered, or prevented, or the
disease or condition symptoms are ameliorated, or the term of the
disease or condition is changed or, for example, is less severe or
recovery is accelerated in an individual.
[0135] The compositions and formulations of the present invention
may be used in combination with either conventional methods of
treatment or therapy or may be used separately from conventional
methods of treatment or therapy. When the substances and
formulations of this invention are administered in combination
therapies with other agents, they may be administered sequentially
or concurrently to an individual. Alternatively, pharmaceutical
compositions according to the present invention include a
combination of a substance or formulation of the present invention
optionally in association with a pharmaceutically acceptable
excipient, as described herein, and another therapeutic or
prophylactic agent known in the art.
[0136] The formulated agents can be packaged together as a kit.
Non-limiting examples include kits that contain, e.g., two pills, a
pill and a powder, a suppository and a liquid in a vial, two
topical creams, etc. The kit can include optional components that
aid in the administration of the unit dose to patients, such as
vials for reconstituting powder forms, syringes for injection,
customized IV delivery systems, inhalers, etc. Additionally, the
unit dose kit can contain instructions for preparation and
administration of the compositions. The kit may be manufactured as
a single use unit dose for one patient, multiple uses for a
particular patient (at a constant dose or in which the individual
compounds may vary in potency as therapy progresses); or the kit
may contain multiple doses suitable for administration to multiple
patients ("bulk packaging"). The kit components may be assembled in
cartons, blister packs, bottles, tubes, and the like.
Dosage
[0137] The pharmaceutical compositions of the present invention are
formulated into pharmaceutically acceptable dosage forms by
conventional methods known to those of skill in the art. Actual
dosage levels of the active ingredients in the pharmaceutical
compositions of the present invention may be varied so as to obtain
an amount of the active ingredient which is effective to achieve
the desired therapeutic response for a particular patient,
composition, and mode of administration, without being toxic to the
patient. The selected dosage level will depend upon a variety of
pharmacokinetic factors including the activity of the particular
compositions of the present invention employed, the route of
administration, the time of administration, the rate of absorption
of the particular agent being employed, the duration of the
treatment, other drugs, substances, and/or materials used in
combination with the particular compositions employed, the age,
sex, weight, condition, general health and prior medical history of
the patient being treated, and like factors well known in the
medical arts. A physician or veterinarian having ordinary skill in
the art can readily determine and prescribe the effective amount of
the pharmaceutical composition required. For example, the physician
or veterinarian can start doses of the substances of the invention
employed in the pharmaceutical composition at levels lower than
that required in order to achieve the desired therapeutic effect
and gradually increase the dosage until the desired effect is
achieved. In general, a suitable daily dose of a composition of the
invention will be that amount of the substance which is the lowest
dose effective to produce a therapeutic effect. Such an effective
dose will generally depend upon the factors described above.
Preferably, the effective daily dose of a therapeutic composition
may be administered as two, three, four, five, six or more
sub-doses administered separately at appropriate intervals
throughout the day, optionally, in unit dosage forms.
[0138] Preferred therapeutic dosage levels are between about 800 mg
to about 1600 mg (e.g., 800, 850, 900, 1000, 1050, 1100, 1200,
1300, 1400, 1450, 1500, 1550, and 1600 mg) of active
zerovalent-sulfur-rich composition per day administered orally to
adults of average weight afflicted with most of the symptoms,
syndromes and pathological conditions described herein, Preferred
prophylactic dosage levels are between about 100 mg to about 1200
mg (e.g., 110, 140, 200, 250, 300, 350, 400, 460, 700, 750, 800,
900, 1000, 1100, and 1150 mg). In cancer, AIDS, and some chronic or
refractory pathologies, the preferred oral dosage levels are 2400
mg per day or higher (e.g., 2450, 2500, 3000, 3500, 4000, 8000 mg,
1 g) for an adult of average weight. For children afflicted with
cancer, the dose may be titrated (e.g., the dose may be escalated
gradually until signs of gastrointestinal toxicity appear, such as
diarrhea or nausea). In preferred embodiments, the highly
bioavailable zerovalent-sulfur-rich compositions of the invention
are extremely safe for oral administration and most patients can
tolerate higher dosages as treatment progresses.
[0139] In other embodiments, the highly bioavailable
zerovalent-sulfur-rich compositions of the invention are safe for
topical administration. Acceptable dosage forms for topical
administration can be formulated as creams, lotions, pastes, gels,
and/or ointments containing the highly bioavailable
zerovalent-sulfur-rich compositions.
[0140] Final dosage forms suitable for administration to human
subjects may comprise one of the highly bioavailable
zerovalent-sulfur-rich compositions as pharmacologically-active
agent or further comprise other active agents such as alpha-lipoic
acid, carnitine, carnitine tartrate, carnitine fumarate, coenzyme
Q10, selenium, alpha-ketoglutaric acid, potassium
alpha-ketoglutarate, diethyl alpha-ketoglutarate, oxaloacetic acid,
sodium oxaloacetate, diethyl oxaloacetate,
2-oxo-3-(ethoxycarbonyl)-pentanodioc acid diethyl ester, L-cystine,
paracetamol, a sulfa drug, an NSAID, a corticosteroid, taurine, a
vitamin, a prebiotic, another anticancer drug, including but not
limited to another mitocan (e.g., a drug targeting the
mitochondrial electron transport chain), alkylating agents (e.g.
procarbazine, dacarbazine, altretamine, cisplatin), methotrexate,
purine antagonists (e.g., mercaptopurine, thioguanine, cladribine,
pentostatin), pyrimidine antagonists (e.g., fluorouracil,
cytarabine, azacitidine), plant alkaloids (e.g., vinblastine,
etoposide, topotecan), hormonal agents (e.g., tamoxifen,
flutamide), antibiotics (e.g., doxorubicin, daunorubicin,
mitomycin, bleomycin), and mitocans (e.g., sodium dichloroacetate
and 3-bromopyruvic acid).
Medical Food
[0141] The present invention also relates to highly bioavailable
zerovalent-sulfur-rich compositions as medical food for daily
intake and for maintaining and promoting general health. Evidence
indicates that daily ingestion by an adult of average weight of
about 800 mg of the highly bioavailable zerovalent sulfur-rich
composition described herein during extended periods is safe and
beneficial to health because it brings about a marked reduction in
the frequency and severity of digestive and respiratory infections
(e.g., of viral and bacterial origin) and allergic episodes. Daily
intake of the composition of the invention is also associated with
a greatly reduced probability of being afflicted by cancer, AIDS, a
neurodegenerative condition, stroke, diabetes and its
complications, cardiovascular disease, and confers protection from
cardiovascular, cerebrovascular, gastric, and hepatic damage caused
by xenobiotics including, drugs such as paracetamol,
corticosteroids, NSAIDs and antiretrovirals, toxins and poisons
(e.g., cyanide, thallium, methanol). Daily intake of the
composition of the invention can also result in faster growth of
hair and nails, firmer skin, a prebiotic-like effect, and a sense
of general wellness.
[0142] In one aspect, highly bioavailable zerovalent-sulfur-rich
compositions of the invention are used as a paravitamin to provide
a supplemental source of cysteine and its derivatives. Cysteine and
its derivatives (e.g., glutathione, taurine, taurine conjugates
with bile acids, hydrogen sulfide, and sulfate ions) play a role
similar to that of vitamins. Like antioxidative vitamins, cysteine
and its derivatives play a role in the oxidant/antioxidant balance
and indirectly in the regulation of metabolic processes. Cysteine
supplementation on top of the normal diet can have various
beneficial effects, for example, cysteine supplementation can lead
to an increase in muscle function, immune function, plasma albumin
concentration and a decrease in TNF-.alpha. concentration.
Supplementation can also restore the body's reservoirs of cysteine
and glutathione levels which are driving forces behind multiple
ageing-related processes.
[0143] In another aspect, the paravitamins are medical foods
providing a minimum amount of calories and maximum amount of a
bioavailable form of sulfur intended for humans not receiving
enough sulfur in their diets. Studies from a preliminary clinical
trial showed that in 120 men and women participants given the
highly bioavailable zerovalent-sulfur-rich composition as a
paravitamin, most participants noticed faster growth of hair and
nails. Furthermore, evidence obtained from in vivo experiments
showed that in mammals, hydrogen sulfide, sulfane sulfur, and
glutathione levels are increased in blood and tissues upon
administration of the highly-bioavailable sulfur-rich compositions
as paravitamins.
[0144] In preferred embodiments, the highly bioavailable
zerovalent-sulfur-rich composition is rapidly and efficiently
converted into hydrogen sulfide in the body, which in turn is
largely transformed into L-cysteine. L-cysteine may be used as a
building block in the synthesis of peptides enzymes, and other
proteins and small sulfur-containing biomolecules (e.g., keratin
which constitutes 14% of hair and nails, e.g., glutathione, a
tripeptide needed for regulating and potentiating immune function
and for cellular protection from oxidants, electrophiles, e.g.,
taurine, which is essential for cardiovascular function,
development, and function of skeletal muscle, the retina, the
central nervous system, it is a major constituent of bile; has many
fundamental biological roles such as conjugation of bile acids,
antioxidant, osmoregulation, membrane stabilization, and modulation
of calcium signaling, e.g., sulfate, which is necessary for the
synthesis of cartilage and for detoxification of many drugs
including but not limited to corticosteroids and
acetaminophen).
[0145] In another embodiment, the zerovalent sulfur-rich
composition is transformed and stored as sulfane sulfur. Sulfane
sulfur is conveniently used by the body as highly versatile
precursor of hydrogen sulfide which readily releases hydrogen
sulfide whenever and wherever this species is needed to activate
protective genes, block inflammation, and protect cells from
free-radical damage.
[0146] In yet another preferred embodiment, the maximum human life
span may be increased beyond the previous limit by providing
compositions of the invention as paravitamins, glutathione levels
will be restored to a normal level in the cells of the immune
system thereby normalizing the function of the immune system and
restoring health and well-being.
Antidotes
[0147] The present invention also relates to highly bioavailable
zerovalent-sulfur-rich compositions as antidotes for various
poisons and drug overdose. The composition of the invention can be
used as an antidote for cyanide poisoning. Cyanide poisoning can
occur from inhalation and/or ingestion of poisonous cyanide
compounds (e.g., hydrogen cyanide gas, potassium cyanide, and
sodium cyanide), constant exposure to pesticides and insecticides
containing poisonous cyanide compounds, tobacco smoke, inhalation
of smoke from building fires and foods including almonds, apricot
kernel, cassava, yucca, manioc, and apple seeds. Signs of cyanide
poisoning can include but are not limited to permanent paralysis,
nervous lesions, hypothyroidism, miscarriages, weakness, mild liver
damage, and mild kidney damage.
[0148] The composition of the invention can be used as an antidote
for drug overdoses including but not limited to acetaminophen
overdose and sulfa drug overdose (e.g., sulfamethoxazole,
fulfisomidine, dichlorophenamide, acetazolamide, bumetanide,
chlorthalidone, clopamide, furosemide, hydrochlorothiazide,
mefruside, metolazone, xipamide, acetazolamide, ethoxzolamide,
sultiame, zonisamide, mafenide, sumatriptan, fulfasalazine,
tipranavir, and probenecid).
Combination Therapies
[0149] Pharmaceutical compositions of the invention can be
administered in combination therapy, i.e., combined with other
agents (e.g., an antiplatelet drug, a .beta. blocker, an ACE
inhibitor or ARB, a statin, fibrates, biguanides, blood pressure
lowering agents, cytokines, cholesterol lowering agents, erectile
dysfunction drugs, anti-inflammatory drugs, anti-thrombosis drugs,
anticancer drugs, anti-diabetic drugs, and/or dietary supplements)
depending on the condition to be treated.
Prevention Drugs for Cardiovascular Diseases
[0150] Compositions of the invention can be administered in
combination with one or more drugs that are used as secondary
prevention drugs for cardiovascular diseases. Examples of
preventative drugs include, but are not limited to, .beta. blockers
(e.g., nonselective agents, e.g., alprenolol, carteolol,
oxprenolol, sotalol, timolol, e.g., .beta..sub.1-selective agents,
e.g., acebutolol, betaxolol, celiprolol, metoprolol, e.g.,
.beta..sub.2-selective agents, e.g., butaxamine, e.g.,
.beta..sub.3-selective agents, e.g., SR 59230A), statins (e.g.,
atorvastatin, cerivastatin, fluvastatin, lovastatin, mevastatin,
pravastatin, simvastatin, and rosuvastatin), fibrates (e.g.,
bezafibrate, ciprofibrate, clofibrate, gemfibrozil, and
fenofibrate), biguanides (e.g., metformin, phenformin, buformin,
and proguanil), and/or ACE inhibitors (e.g., sulfhydryl-containing
agents, e.g., captopril, zofenopril, e.g., dicarboxylate-containing
agents, e.g., enalapril, ramipril, quinapril, perindopril,
imidapril, e.g., phosphate-containing agents, e.g.,
fosinopril).
Drugs for Treatment of Erectile Dysfunction
[0151] The highly bioavailable zerovalent-sulfur-rich composition
of the invention can be administered in combination with one or
more drugs for treatment of erectile dysfunction. Examples of drugs
for treatment of erectile dysfunction include, but are not limited
to: sildenafil, tadalafil, vardenafil, alprostadil, avanafil, and
yohimbine.
Anti-Neurodegenerative Drugs
[0152] The highly bioavailable zerovalent-sulfur-rich composition
of the invention can be administered in combination with one or
more anti-neurodegenerative drugs. Examples of
anti-neurodegenerative drugs include, but are not limited to,
acetylcholinesterase inhibitors (e.g., donepezil, galantamine, and
rivastigmine), anti-glutamate agent (e.g., amantadine, GABA-ergic,
valproic acid), reserpine, tetrabenazine, typical/atypical
neuroleptics, tricyclic antidepressants, SSRIs, carbamazepine,
baclofen, tizanidine, and lamotrigine.
Anti-Inflammatory Drugs
[0153] The highly bioavailable zerovalent-sulfur-rich composition
of the invention can be administered in combination with one or
more anti-inflammatory drugs. Examples of anti-inflammatory drugs
include, but are not limited to, steroids (e.g., glucocorticoids,
e.g., corticosteroids), non-steroidal anti-inflammatory drugs
(NSAIDs) (e.g., aspirin, diflunisal, salsalate, ibuprofen,
naproxen, fenoprofen, ketoprofen, flurbiprofen, sulindac, etodolac,
ketorolac, nabumetone, piroxicam, meloxicam, tenoxicam, mefenamic
acid, flufenamic acid, tolfenamic acid, celecoxib, rofecoxib,
parecoxib, etoricoxib, firocoxib, nimesulide, and licofelone),
immune selective anti-inflammatory derivatives (ImSAIDs) (e.g.,
phenylalanine-glutamine-glycine (FEG) and its D-isomeric form
(feG)), and/or herbs (e.g., Harpagophytum, hyssop, ginger,
turmeric, Arnica montana, and willow bark)
Dietary Supplements
[0154] The composition of the invention can be administered in
combination with one or more dietary supplements to promote and/or
maintain general health. Examples of dietary supplements include,
but are not limited to, a vitamin (e.g., Vitamin A, Vitamin
B.sub.1, B.sub.2, B.sub.3, B.sub.5, B.sub.6, B.sub.7, B.sub.9,
B.sub.12, Vitamin C, Vitamin D, Vitamin E, and Vitamin K), a
mineral (e.g., potassium, chlorine, sodium, calcium, magnesium,
phosphorus, zinc, iron, manganese, copper, iodine, selenium, and
molybdenum), an herb or botanical (e.g., St. John's-wort, kava,
Shilajit, and Chinese herbal medicines), an amino acid (e.g.,
glycine, serine, methionine, cysteine, aspartic acid, glutamic
acid, glutamine, tryptophan, and phenylalanine), and a concentrate,
constituent, extract, and/or a combination of any of the above
Anticancer/Anti-Proliferative Drugs
[0155] The highly bioavailable zerovalent-sulfur-rich composition
can be formulated or administered in combination with one or more
anticancer drugs. Examples of anticancer agents include, but are
not limited to: chemotherapeutic agents (e.g., arsenic trioxide,
cisplatin, carboplatin, chlorambucil, melphalan, nedaplatin,
oxaliplatin, triplatin tetranitrate, satraplatin, imatinib,
nilotinib, dasatinib, and radicicol), immunomodulatory agents
(e.g., methotrexate, leflunomide, cyclophosphamide, cyclosporine A,
minocycline, azathioprine, antibiotics (e.g., tacrolimus),
methylprednisolone, corticosteroids, steroids, mycophenolate
mofetil, rapamycin, mizoribine, deoxyspergualin, brequinar, T cell
receptor modulators, and cytokine receptor modulators),
antiangiogenic agents (e.g., bevacizumab, suramin, and
etrathiomolybdate), mitotic inhibitors (e.g., paclitaxel,
vinorelbine, docetaxel, abazitaxel, ixabepilone, larotaxel,
ortataxel, tesetaxel, vinblastine, vincristine, vinflunine, and
vindesine), nucleoside analogs (e.g., gemcitabine, azacitidine,
capecitabine, carmofur, cladribine, clofarabine, cytarabine,
decitabine, floxuridine, fludarabine, fluorouracil, mercaptopurine,
pentostatin, tegafur, and thioguanine), DNA intercalating agents
(e.g., doxorubicin, actinomycin, bleomycin, mitomycin, and
plicamycin), topoisomerase inhibitors (e.g., irinotecan,
aclarubicin, amrubicin, belotecan, camptothecin, daunorubicin,
epirubicin, etoposide, idarubicin, mitoxantrone, pirarubicin,
pixantrone, rubitecan, teniposide, topotecan, valrubicin, and
zorubicin), folate antimetabolites (e.g., pemetrexed, aminopterin,
methotrexate, pralatrexate, and raltitrexed), mitocans (e.g.,
sodium dichloroacetate and 3-bromopyruvic acid), and other
targeting agents (e.g., agents that target particular enzymes or
proteins involved in cancer or agents that target particular organs
or types of cancers), and combinations thereof.
EXAMPLES
[0156] The highly bioavailable zerovalent sulfur-rich compositions
of the invention and their uses will now be illustrated by means of
the following non-limiting examples. These examples are set forth
merely for illustrative purposes and many other variations may be
used.
Experimental Methods
[0157] Human Blood Samples from Heart Failure Patients
[0158] Serum samples were obtained from a cardiac tissue and blood
biorepository at the University of Louisville. All procedures were
approved by the Institutional Review Board of the University of
Louisville. The samples procured after informed consent from
patients with advanced heart failure undergoing LV assist device
placement. Additional serum samples from control patients were
obtained from a commercial vendor (Innovative Research).
Experimental Animals
[0159] CSE deficient (KO) mice (C57/Sv129 background) and cardiac
restricted (.alpha.MHC) CSE Tg mice (C57BL/6J background) were
developed as described in Levy et al., The New England Journal of
Medicine. 322:1561-1566, 1990; Heineke et al., Nature reviews.
Molecular Cell Biology. 7:589-600, 2006. Male C57BL/6J mice 8-10
weeks of age were purchased from The Jackson Laboratory (Bar
Harbor, Me.). All experimental protocols were approved by the
Institute for Animal Care and Use Committee at Emory University
School of Medicine and conformed to the Guide for the Care and Use
of Laboratory Animals, published by the National Institutes of
Health (NIH Publication No. 86-23, revised 1996), and with federal
and state regulations.
Transverse Aortic Constriction (TAC) Protocol
[0160] To create pressure overload, the TAC procedure was performed
in 10-14 week old mice. Mice were anesthetized with Ketamine (100
mg/kg) and Xylazine (8 mg/kg) and the core body temperature was
maintained in normal range (36-37.degree. C.). Mice were then
orally intubated and placed on a rodent ventilator to maintain
respiration during the surgical procedure. The second intercostal
muscle was incised to visualize the aortic arch. Following
identification and dissection of the aortic arch, 7-0 silk suture
was placed around the aortic arch between the brachlocephalic trunk
and the left carotid artery and ligated around a 27 G blunt needle.
The needle was immediately removed after ligation. The chest was
surgically closed and mice were put in a recovery chamber with 100%
oxygen along with a surgical warming pad to maintain core body
temperature within normal limits. At the end of the experimental
protocol (i.e., 6 or 12 weeks following TAC surgery) mice were
euthanized and heart, lung and blood samples were collected.
Hydrogen Sulfide Donor
[0161] A zerovalent-sulfur-rich composition (SG-1002, containing
about 99% zerovalent sulfur, melting between 119 and 120.degree.
C.) was administered in the diet to mice to achieve dosages of 20
mg/kg/day in C57BL/6J mice or 40 mg/kg/day in CSE KO mice at one
week prior to TAC procedure and was continued up to 12 weeks
following TAC. In addition, some C57BL/6J mice receiving SG-1002
diet were placed on the control diet at 1 week or 3 weeks following
TAC.
Echocardiography
[0162] At 2 days prior to TAC procedure, baseline transthoracic
echocardiogram was performed using 30-MHz probe on a Vevo 2100
(Visualsonics) under anesthesia with isoflurane (0.25 to 0.50%)
supplemented with 100% O.sub.2. Following TAC procedure,
echocardiography was also performed in the same manner for up to 12
weeks. To determine cardiac structure and function,
intraventricular septal end diastolic dimension (IVSd), LV end
diastolic dimension (LVEDD), LV end systolic dimension (LVESD), and
LV ejection fraction (LVEF) were analyzed from M-mode images.
Measurement of Hydrogen Sulfide and Sulfane Sulfur
[0163] Hydrogen sulfide and sulfane sulfur levels were measured in
heart and blood according to methods known in the art. For heart
tissue, the amount of H.sub.2S is reported as nmol/mg wet weight.
For the blood, the amount of H.sub.2S is reported as .mu.m.
Western Blot Analysis
[0164] Western blot analysis was performed as described in Li et
al., Annu. Rev. Pharmacol. Toxicol. 51:169-187, 2011. Equal amounts
of protein were loaded into lanes of polyacrylamide-SDS gels. The
gels were electrophoresed, followed by transfer of the protein to a
PVDF membrane. The membrane was then blocked and probed with
primary antibodies overnight at 4.degree. C. Immunoblots were next
processed with secondary antibodies (anti-rabbit, anti-chicken, or
anti-mouse, Cell Signaling) for 1 hour at room temperature.
Immunoblots were then probed with an ECL+Plus chemiluminescence
reagent kit (GE Healthcare) to visualize signal, followed by
exposure to X-ray film (Denville Scientific). The film was scanned
to make a digital copy and densitometric analysis was performed to
calculate relative intensity with ImageJ software from the National
Institutes of Health (version 1.40 g) using the Rodbard function.
The membranes were incubated with the phospho-specific antibody
first. Membranes were then stripped and incubated with the
total-specific antibody. Results are presented as the ratio of the
expression of phosphorylated protein to total protein. All
experiments were performed in triplicate. For each membrane the
relative intensity of each band was normalized to the value of the
weakest band (smallest intensity). The values for each individual
sample were averaged to obtain one value for each sample. The
values for each group were then averaged and subsequently
normalized to the mean of the control group (Sham)
Myocardial Measurement of NO Metabolites
[0165] Nitrite (NO.sub.2.sup.-) and nitrate (NO.sub.3.sup.-)
analysis of cardiac tissue was determined by ion chromatography
(ENO20 Analyzer, Eicom) as previously described in Li et al., Annu.
Rev. Pharmacol. Toxicol. 51:169-187, 2011.
Serum Measurements of VEGF and BNP
[0166] Serum levels of VEGF (VEGF ELISA kit, R&D Systems) and
brain natriuretic peptide (BNP) (BNP EIA kit, Phoenix
Pharmaceuticals, Inc.) were determined by ELISA at 6 and/or 12
weeks following TAC.
Cardiac Mitochondrial Respiration Assay
[0167] The myocardial mitochondria were isolated and mitochondrial
respiratory capacity was assessed using methods known in the art.
Mice were euthanized by cervical dislocation, and hearts were
quickly excised and placed in ice-cold isolation buffer (300 mM
sucrose, 20 mM Tris, 2 mM EGTA, 1 mM ATP, 5 mM MgCl.sub.2, and 1%
fat free BSA). Hearts were finely chopped and homogenized with a
Tissue Tearor (Biospec Products, Bartlesville, Okla.) on low to
medium speed for .about.10 s. Homogenates were centrifuged for 3
min at 2,500 rpm. The supernatant was collected and centrifuged for
5 min at 9,000 rpm. The supernatant was discarded, and the pellet
was resuspended in isolation buffer and centrifuged for 5 min at
10,000 rpm and repeated two additional times. The final pellet was
suspended in 100 .mu.L isolation buffer. Protein concentration was
determined by a Lowry protein assay kit (Bio-Rad Laboratories,
Hercules, Calif.). The O.sub.2 consumption of isolated mitochondria
(500 .mu.g/mL) was monitored using a Clark-type oxygen electrode
(Hansatech Instruments, Amesbury, Mass.). Mitochondria were
incubated in respiration buffer (100 mM KCl, 25 mM sucrose, 5 mM
KH.sub.2PO.sub.4, 1 mM MgCl.sub.2, 1 mM EGTA, 10 mM HEPES, 10 mM
glutamate, and 2.5 mM malate), and the respiratory capacity was
assessed by measuring state 3 (i.e., ADP-dependent) and state 4
(i.e., ADP-independent) respiration. The respiratory control ratio
(RCR) was calculated as the ratio of state 3 and state 4
respiration rates.
8-Isoprostane Assay
[0168] Concentrations of 8-isoprostane in the plasma and heart were
determined by 8-isoprostane EIA kit according to manufacture
instruction (Cayman Chemicals, Michigan).
Histology
[0169] For histological analysis, hearts were collected at the
indicated times, fixed in 10% buffered formalin, and embedded in
paraffin. Serial 5 .mu.m heart sections from each group were
stained with Masson's trichrome and Picrosirius Red (to detect
fibrosis). Digital images of the slides were then captured and
analyzed using ImageJ. For each heart, we analyzed multiple
sections taken from the mid-ventricle and then averaged these
numbers to obtain a single % fibrosis/LV measurement for each
animal.
Statistical Analysis
[0170] All data are expressed as mean.+-.SEM. Statistical
significance was evaluated using unpaired Student's t test for
comparison between 2 means and ANOVA (1-way or 2-way) for
comparison among 3 or more means using Prism 5 (Graph Pad Software
Inc). For the ANOVA, if a significant result was found, the Tukey
(1-way ANOVA) or Bonferroni (2-way ANOVA) test was used as the
posthoc analysis. For all data, a value of p<0.05 denotes
statistical significance.
Clinical Studies and Statistical Analysis
[0171] A prospective, randomized, double blind study evaluated and
approved by the Ethics Committee of the Universidad Autonoma de
Nuevo Leon University Hospital (Monterrey, Mexico) with
registration number BR09-001 was conducted. The study included
patients who attended the Reproductive Biology Clinic of the
University Hospital from July 2009 to September 2010 who desired to
be pregnant and met the inclusion criteria. Patients between 20 and
45 years of age with a diagnosis of idiopathic
oligoasthenozoospermia wishing to participate in the study after
signing informed consent were included. The diagnosis of
oligoasthenozoospermia was reached by performing two semen analyses
on different dates with an interval of three weeks in between. To
make the diagnosis, the results of the semen analyses needed to
report less than 25% type A sperm motility or less than 50% type
A+B sperm motility as detailed in the World Health Organization
Laboratory Manual for the Examination of Human Semen and
Semen-Cervical Mucus Interaction, 4.sup.th ed. New York: Cambridge
University Press, 1999. Type A Motility comprised rapid
progression; type B motility comprised medium progression; type C
mobility comprised slow or clumsy progression; and type D mobility
comprised immotile. Oligozoospermia was defined as a concentration
of less than 20 million sperm per milliliter, according to the
criteria of the World Health Organization. Oligoasthenozoospermia
was defined as the presence of oligozoospermia and
asthenozoospermia in the same patient. In each semen analysis,
morphology was manually assessed using Kruger strict criteria.
[0172] Infertile patients with normal findings on semen analysis,
patients who were chronic smokers or those who had been taking
antioxidants in the last 6 months prior to study entry were
excluded. Patients with chronic degenerative diseases such as
diabetes or high blood pressure or with hormonal abnormalities were
also excluded. All study subjects who did not comply with
medication given as prescribed, who discontinued the drug or were
hypersensitive to it were eliminated.
[0173] A complete medical history and physical examination was
obtained for all patients. All study participants underwent a
second semen analysis to confirm the diagnosis after a sexual
abstinence of 3 to 5 days. This semen analysis was considered
baseline (sample 1). On a second visit this new semen analysis was
reviewed to confirm oligoasthenozoospermia and one of the 3
substances to be taken was randomly prescribed for 75 days. The
substances given were 1.5 g of hydrogen sulfide prodrug as an
antioxidant, 50 mg of resveratrol as an antioxidant, and 1.5 g of
microcrystalline cellulose as a placebo.
[0174] Randomization of the substance given to each patient was
performed by placing in a drawer at random all the containers
having exactly the same color, size, and shape with the three
separate substances (hydrogen sulfide prodrug, resveratrol, and
placebo) without any kind of reference as to the content. Each
container had a label with a serial number. The attending physician
and the patient were unaware of the contents of the container. A
third researcher had a log and database for each label and the
contents of the container. Each patient was asked to take a
container at random and the container number was recorded in the
patient's medical record. At the end of the study, before
statistical analysis, we obtained the relationship between the
numbers on the labels and the contents, grouping patients according
to the substance. Each patient was given a treatment adherence form
(a patient log) in order to count the days of medication and record
adverse events, if these occurred, including the type and
frequency.
[0175] The patients were scheduled one month after starting
treatment (third visit) in order to document adverse effects and
adherence to treatment. If the patient did not attend the event
data were collected by phone.
[0176] In the next scheduled consultation (fourth visit), carried
out 75 days after starting treatment; adherence was verified and
adverse effects were reported. For this visit, the patients
presented with 3 to 5 days of sexual abstinence for post-treatment
semen analysis (sample 2). Sperm concentration and motility were
evaluated, and carried out entirely with an automated IVOS
(Integrated Visual Optical System) device and manually confirmed by
lab technicians, who were blinded to the treatment group that each
patient in. The morphology of each semen analysis was manually
assessed, according to Kruger criteria.
[0177] Traditional descriptive data, such as measures of central
tendency (means, median and mode) and in the case of quantitative
variables, measures of dispersion (variance, standard deviation and
coefficient of variation) were studied for each variable, together
with the frequencies observed in qualitative variables.
[0178] The study subjects were divided according to the group
assigned and the statistical variables mentioned were analyzed. The
results of each variable by group using hypothesis tests for means
(x.sup.2) and proportions, according to each type of variable
(quantitative and qualitative, respectively) at a confidence
interval of 95%, with a statistically significant p<0.05, were
also compared and evaluated.
Example 1
Sulfide Levels are Declined after Heart Failure in Patients and
Mice
[0179] Previous studies suggest that both exogenous and
endogenously derived H.sub.2S exhibit potent cytoprotective effects
in models of acute myocardial I/R and ischemia-induced heart
failure. However, the role of endogenous H.sub.2S in pressure
overload-induced heart failure has not been fully elucidated. In
the current study, a number of novel findings regarding the role of
CSE-derived H.sub.2S on the severity of heart failure following TAC
have been identified and important insights into the mechanism by
which oral H.sub.2S therapy attenuates TAC-induced heart failure
are provided.
[0180] Circulating sulfide levels (free H.sub.2S and sulfane
sulfur) in 20 heart failure patients and 24 aged-matched controls
were examined. The detailed description of these patients is given
in Table 7. As shown by the representative gas chromatograph peaks
and summarized data in FIGS. 1A and 1C, free H.sub.2S levels were
significantly lower in the heart failure patients as compared to
the controls (p=0.049), whereas sulfane sulfur levels trended to be
lower in the heart failure patients FIGS. 1B and D; p=0.054). Next,
the effects of TAC-induced heart failure on the myocardial
expression of the three known H.sub.2S-producing enzymes were
examined, as well as the levels of circulating and myocardial
sulfide levels at 6 weeks of TAC. The analysis revealed that the
expression of CBS was unaltered (FIGS. 8A and 8B). However, CSE
expression was upregulated in the vehicle mice compared to the sham
(FIGS. 8A and 8C; p<0.001), whereas 3-MST expression was
significantly downregulated compared to Sham levels (FIGS. 8A and
8D; p<0.01). Interestingly, free H.sub.2S and sulfane sulfur
levels were significantly lower in the blood (p<0.01) and heart
(p<0.001) of TAC+Vehicle mice when compared to Sham-operated
mice (FIGS. 1E-1H).
TABLE-US-00007 TABLE 7 Control Heart Failure Number 24 20 Age
(average years) 51 .+-. 10 53 .+-. 13 Gender Mates (%) 16 (67%) 18
(90%) Females (%) 8 (33%) 2 (10%) NYHA Classification III(%) -- 5
(25%) IIIb(%) -- 2 (10%) IV(%) -- 13 (65%)
Example 2
CSE Deficiency Exacerbates Cardiac Dysfunction Following TAC
[0181] To investigate the role of endogenous H.sub.2S in pressure
overload, we performed TAC surgery in CSE KO mice and evaluated
cardiac structure and function using echocardiography were
performed. Initially, it was confirmed that CSE KO mice exhibited
lower free H.sub.2S and sulfane sulfur levels in the blood and
heart compared to WT mice (FIGS. 9A-9D; p<0.05). CSE KO mice
exhibited significantly greater cardiac enlargement and pulmonary
edema at 12 weeks following TAC compared to WT mice (FIGS. 2A-2B).
Both groups showed similar degrees of increased IVSd thickness from
1 week to 12 weeks following TAC (FIG. 2C). However, CSE KO mice
exhibited significant LV cavity dilatation, as seen by increases in
both LVEDD and LVESD, and exhibited exacerbated cardiac dysfunction
from 3 weeks to 12 weeks following TAC compared to WT mice (FIGS.
2D-2F). Despite the increased cardiac structure and functional
changes in the CSE KO mice, no difference in the mortality was
observed after TAC when compared to the WT mice (FIG. 10A).
Example 3
Myocardial Overexpression of CSE Attenuates Cardiac Dysfunction
without Preventing Cardiac Hypertrophy Following TAC
[0182] Overexpression of CSE has been shown to increase H.sub.2S
production in the heart without alteration in CBS expression. In
the present studies, no alteration in cardiac CBS expressions in
CS-CSE Tg mice were observed, but CS-CSE Tg mice exhibited less
3-MST expression compared to WT mice (FIG. 11). It was examined
whether overexpression of CSE specifically within the cardiac
myocyte would attenuate cardiac hypertrophy and/or dysfunction
following TAC using CS-CSE Tg mice. CS-CSE Tg mice exhibited
significantly less cardiac enlargement and pulmonary edema, as
assessed by the ratio of heart and lung weights to tibia length
(mg/cm) when compared to WT controls (FIGS. 3A-3B). Furthermore,
echocardiography analysis revealed that while CS-CSE Tg mice
exhibited no difference in IVSd thickness when compared to WT mice,
they did exhibit less cardiac dilatation and dysfunction from 6
weeks to 12 weeks following TAC (FIGS. 3C-3F). Again, no difference
in mortality was observed between the two groups (FIG. 10B).
[0183] Together, this data indicates that endogenous H.sub.2S
generated enzymatically by CSE plays an important role in the
maintenance of cardiac function following pressure overload-induced
hypertrophy independently of the regulation of cardiac myocyte
hypertrophy.
Example 4
Administration of Exogenous H.sub.2S Prevents Cardiac Enlargement,
Preserves LV Function, and Reduces Fibrosis Following TAC
[0184] Next, the effects of administration of oral H.sub.2S therapy
on pressure overload-induced cardiac hypertrophy and dysfunction
(FIGS. 4A-4H) were examined in wild-type C57BL/6J mice. For these
experiments we administered SG-1002 (20 mg/kg/day) in the chow.
Initial studies found that SG-1002 treatment partially restored
free H.sub.2S and significantly restored sulfane sulfur levels in
the blood (FIGS. 1E-1F; p<0.05 vs. TAC+Vehicle) and heart (FIGS.
1G-1H; p<0.05 vs. TAC+Vehicle). Gross morphologic analysis at 12
weeks following TAC, revealed that hearts from vehicle mice
enlarged to a greater extent compared to SG-1002 treated mice (FIG.
4A). This was confirmed by heart weight/tibia length ratios, which
found that the hearts of both vehicle and SG-1002 treated mice,
were significantly increased compared to Sham mice at 6 and 12
weeks following TAC (FIG. 4B; p<0.001). However, SG-1002 treated
mice showed significantly less of an increase compared to vehicle
mice (FIG. 4B; p<0.001). In addition, SG-1002 treated mice
displayed significantly less pulmonary edema when compared to
vehicle mice at both time points (FIG. 4C). Moreover, circulating
BNP levels as an indication of heart failure severity following TAC
were evaluated. BNP levels increased significantly (p<0.01) in
vehicle mice at 6 and 12 weeks compared to sham mice, but SG-1002
treatment significantly inhibited BNP (p<0.01 vs. TAC+Vehicle)
levels following TAC (FIG. 4D). Echocardiography analysis (FIG. 4F)
revealed that SG-1002 treatment did not alter the increase in IVSd
thickness following TAC (FIG. 4E), but did prevent cardiac
dilatation (FIGS. 4F-4G; p<0.01 vs. TAC+Vehicle) and cardiac
contractile dysfunction (FIG. 4H; p<0.001 vs. TAC+Vehicle) from
6 weeks to 12 weeks following TAC. Histological analysis of
Masson's Trichrome and Picrosirius Red stained sections at 12 weeks
following TAC revealed extensive areas of intermuscular and
perivascular fibrosis in hearts from TAC+Vehicle mice (FIGS. 5A-5C;
p<0.01 vs. sham). Although fibrosis was evident in the sections
taken from TAC+SG-1002 heart, it was significantly less when
compared to the TAC+Vehicle hearts (p<0.001 for Masson's
Trichrome and p<0.01 for Picrosirius Red). Finally, SG-1002
treated mice exhibited a better, but not statistically significant
improved survival rate compared to vehicle mice (80% vs. 61%,
p=0.23) (FIG. 10C).
[0185] Further analysis revealed that the administration of SG-1002
to CSE KO mice slightly, but not significantly, increased free
H.sub.2S levels in the blood and heart, whereas administration of
SG-1002 did significantly increase sulfane sulfur levels in both
the blood (p<0.001) and the heart (p<0.05) as compared to CSE
KO mice fed a control diet (FIGS. 9A-9D). The administration of
SG-1002 also completely diminished LV cavity dilatation in CSE KO
mice when compared to CSE KO mice fed a control diet (FIGS. 2D-2E;
p<0.05). Interestingly, SG-1002 treated CSE KO mice maintained
cardiac ejection fraction following TAC as compared to not only
control diet-fed CSE KO mice but also WT mice at 12 weeks following
TAC (FIG. 2F; p<0.001 vs. CSE KO+TAC and p<0.05 vs. WT+TAC).
However, no difference in mortality was observed between the CSE KO
groups (FIG. 10A).
[0186] Together, the results up to this point indicate that
endogenous H.sub.2S bioavailability is markedly attenuated in heart
failure following pressure overload even though CSE and CBS
expression levels are maintained or upregulated. Moreover,
augmentation of H.sub.2S levels by genetic or pharmacological
approaches prevents the transition from compensated to
decompensated cardiac hypertrophy.
Example 5
Withdrawal of SG-1002 Leads to Development of Cardiac Dilatation
and Dysfunction
[0187] Experiments were then conducted to determine how withdrawal
of SG-1002 from the chow would affect the development of cardiac
dilatation and dysfunction after TAC. For these experiments,
SG-1002 was administered in the chow for 1 week and then subjected
different groups of mice to 6 weeks of TAC: (1) Mice received
SG-1002 in the chow for 6 weeks following TAC, (2) Mice received
SG-1002 in the chow for 1 week following TAC and then received
normal chow for 5 weeks; (3) Mice received SG-1002 in the chow for
3 weeks following TAC and then received normal chow for 3 weeks.
Echocardiography analysis revealed that all three groups of mice
displayed similar degrees of increased IVSd thickness, as well as
similar LVEDD diameters from 1 week to 6 weeks following TAC (FIGS.
12A-12B). Withdrawal of SG-1002 after 1 week of TAC resulted in a
larger increase in L VESD and a larger decrease in ejection
fraction at 6 weeks of TAC when compared to the non-withdrawal
group (FIGS. 12C-12D; p<0.01 vs. SG-1002). Withdrawing SG-1002
at 3 weeks of TAC resulted in a non-significant increase in both of
these parameters at 6 weeks of TAC when compared to the
non-withdrawal group. These data indicate that the withdrawal of
SG-1002 early following the onset of pressure-overload does not
prevent the development of cardiac dilatation and dysfunction,
suggesting that the benefits of SG-1002 are achieved when the diet
is maintained throughout the follow-up period.
Example 6
H.sub.2S Therapy Augments VEGF-Akt-eNOS-Nitric Oxide Signaling
Following TAC
[0188] The serine/threonine kinase Akt regulates cardiac growth,
myocardial angiogenesis, and survival in cardiac myocytes. SG-1002
treatment was examined to see whether activation Akt
phosphorylation was activated in the heart following TAC.
Representative Western blots for Akt phosphorylation status in the
heart at 6 weeks following TAC are shown in FIG. 6A. SG-1002
treatment did not alter total Akt expression in the heart (FIG. 6B)
but did significantly increase the expression of phosphorylated Akt
at threonine residue 308 (Akt-P.sup.Thr308) (p<0.001) and serine
residue 473 (Akt-P.sup.Ser473) when compared to vehicle mice (FIG.
6e; p<0.001). Next, SG-1002 treatment was examined to determine
if VEGF, a potent angiogenic and cytoprotective cytokine in the
myocardium was upregulated. At 6 weeks following TAC, SG-1002
treated mice showed significantly greater VEGF protein expression
levels in the heart (FIG. 6D; p<0.01 vs. Sham and p<0.05 vs.
TAC+Vehicle), but not in the systemic circulation (FIG. 13A).
[0189] Nitric oxide (NO) generated from endothelial nitric oxide
synthase (eNOS) is known to promote vascular and myocardial cell
cytoprotection during ischemic conditions. To investigate the
potential involvement of eNOS in SG-1002 induced cardioprotection
following TAC, the expression and the phosphorylation status of
eNOS at serine residue 1177 (eNOS-P.sup.Ser1177) were assessed by
Western blot analysis in the hearts of Sham, vehicle, and SG-1002
treated mice.
[0190] There were no differences in total eNOS expression in the
heart among all groups (FIGS. 6 E-6F). However, the eNOS activation
site (eNOS-P.sup.Ser1177) exhibited significantly greater
phosphorylation following SG-1002 when compared to Sham and
TAC+Vehicle mice (FIGS. 6E-6F; p<0.01). Furthermore, SG-1002
treatment increased cardiac NOx (nitrite and nitrate) levels,
following TAC compared to Sham mice (FIG. 6 G-H; p<0.05), which
is indicative of increased NO bioavailability following H.sub.2S
therapy. Myocardial expression of both nNOS and iNOS in mice
subjected to TAC that received either vehicle or SG-1002 (FIGS.
13B-13D) was also investigated. nNOS expression in the both vehicle
and SG-1002 treated mice trended to be higher than the Sham, but
did not reach statistical significance. Interestingly, iNOS
expression in the TAC+Vehicle group was upregulated compared to the
Sham group (p<0.01), but SG-1002 mice diminished this
upregulation (p<0.01 vs. TAC+Vehicle).
Example 7
H.sub.2S Therapy Attenuates Mitochondrial Respiratory Dysfunction
and Oxidative Stress Following TAC
[0191] Mitochondrial energetic failure is considered one of the
central pathological mechanisms in heart failure resulting from
cardiac hypertrophy. Therefore, respiratory function of isolated
mitochondria obtained from mouse hearts at 6 weeks following TAC
was investigated. A significant decrease in State 3 respiration
rates (FIG. 7A; p<0.01) and RCR (FIG. 7B; p<0.001) was
observed in the TAC+Vehicle mice compared to the Sham mice.
However, SG-1002 treatment preserved mitochondrial respiratory
function when compared to TAC+Vehicle mice (p<0.05 for State 3
and p<0.01 for RCR). No difference in State 4 respiration was
observed among any of the study groups (FIG. 7A).
[0192] Mitochondrial dysfunction leads to impaired ATP production
and increased reactive oxygen species (ROS) generation that can
result in increased apoptosis. Therefore, 8-isoprostane levels were
examined as a marker of antioxidant deficiency and oxidative stress
in both the plasma and heart at 6 weeks following TAC. Both the
TAC+Vehicle and TAC+SG-1002 treated mice exhibited higher plasma
levels of 8-isoprostane compared to sham mice (FIG. 7C; p<0.05).
However, TAC+Vehicle mice exhibited significantly higher
8-isoprostane levels in the heart compared to sham mice
(p<0.001), whereas the administration of SG-1002 attenuated the
TAC-induced increase in 8-isoprostane levels (FIG. 7D; p<0.05
vs. TAC+Vehicle). Next, cardiac Nox4 expression was assessed as
another marker of oxidative stress. At 6 weeks following TAC,
myocardial NADPH oxidase 4 (Nox4) expression was significantly
upregulated in the TAC+Vehicle mice compared to Sham mice (FIG. 7E;
p<0.01). However, SG-1002 treatment significantly inhibited the
upregulation of Nox4 (p<0.01 vs. TAC+Vehicle). Additional
analysis revealed that SG-1002 treatment resulted in an
upregulation in the expression of the antioxidant heme oxygenase 1
(HO1) in the heart following TAC (FIG. 7F; p<0.01 vs. Sham and
TAC+Vehicle).
[0193] The examples described in examples 1-7 provide several lines
of evidence to support the idea that sulfide levels may be an
important predictor of heart failure severity. First, in agreement
with previous clinical studies, further evidence is provided
showing that circulating levels of sulfide are lower in heart
failure patients. Second, data is provided showing that this is
mirrored in an experimental model of pressure overload-induced
heart failure, as evidenced by the finding that both myocardial and
circulating levels of free H.sub.2S and sulfane sulfur are
significantly reduced after TAC. Third, it is demonstrated that a
deficiency in endogenously produced H.sub.2S results in an
exacerbation of cardiac dysfunction following TAC, whereas genetic
overexpression of CSE significantly preserved left ventricular
function. Finally, chronic administration of a nH.sub.2S donor
provides protection against the adverse remodeling associated with
TAC by increasing circulating and cardiac sulfide levels. While the
mechanisms responsible for the heart failure-induced decline in
sulfide levels are currently not known, this finding strongly
suggests that a deficiency of H.sub.2S may contribute to the
pathophysiology and progression of heart failure. These findings
also suggest that increasing the bioavailability of H.sub.2S with
oral H.sub.2S donor therapy significantly preserves cardiac
function in the setting of heart failure.
[0194] One of the main findings of the current study is that
administration of SG-1002 significantly preserved cardiac function
following TAC. Given that H.sub.2S is a physiological gas that
freely diffuses into multiple intracellular compartments
independently of specific receptors, it can be postulated that
H.sub.2S targets multiple pathological cascades simultaneously. One
potential target is VEGF, which is among the most potent angiogenic
and cytoprotective cytokines. Givvimani et al., J. Appl. Physiol.
110:1093-1100, 2011 previously reported that sodium hydrogen
sulfide (NaHS) in the drinking water augmented angiogenesis via
increasing VEGF expression and inhibition of antiangiogenic factors
(angiostatin and endostatin). Short-term Akt activation in
inducible transgenic mice induces physiological hypertrophy with
maintained vascular density, whereas deficiency in Akt results in
exacerbated cardiac dysfunction due to lack of exercise-induced
cardiac hypertrophy. In this study, SG-1002 treatment was
demonstrated to activate a VEGF-Akt-eNOS-NO signaling pathway at 6
weeks following the induction of TAC (a time point when cardiac
hypertrophy and left ventricular dysfunction are significant).
[0195] An increase in oxidative stress and/or a deficiency in the
endogenous antioxidant reserve can also cause contractile
dysfunction. The cardioprotective effects of H.sub.2S against
myocardial I/R are mediated by antioxidant signaling. In addition,
H.sub.2S directly scavenges reactive oxygen species (ROS) in vitro.
Therefore, endogenous H.sub.2S may directly and/or indirectly
contribute to modulation of oxidative stress in the setting of
pressure overload-induced hypertrophy. Here, it was demonstrated
that H.sub.2S attenuates the TAC-induced increase in oxidative
stress, as evidenced by the finding that SG-1002 decreases cardiac
8-isoprostane levels. In terms of mechanism, it was determined that
SG-1002 attenuates the TAC-induced upregulation of Nox4, a member
of the NADPH oxidase family that is a major source of ROS-related
cardiac dysfunction in the setting of pressure overload. It was
also determined that SG-1002 upregulated the expression of HO-1 and
preserved mitochondrial respiratory function. Since, mitochondrial
respiratory dysfunction in the heart leads to metabolic remodeling,
deficit cardiac energetics, and increased oxidative stress, the
preserved mitochondrial respiratory function observed in the
current study could be an additional mechanism to explain the
inhibition of oxidative stress by H.sub.2S following TAC.
[0196] It has been generally thought that H.sub.2S and NO exert
their biological effects via independent signaling pathways. Recent
experimental evidence suggests that there is crosstalk between the
H.sub.2S and NO signaling pathways, which could provide synergistic
and additional regulatory effects. For example, H.sub.2S
upregulates NO production in endothelial cells through the
activation of eNOS in an Akt-dependent manner. Likewise, NO has
been shown to enhance the production of H.sub.2S from vascular
tissue and more recently, Coletta et al., Proc. Natl. Acad. Sci.
USA. 109:9161-9166, 2012, demonstrated that NO and H.sub.2S are
mutually required for the control of vascular function. Therefore,
another major finding of the current study is the evidence that
exogenous H.sub.2S therapy very potently activates eNOS and
increases NO bioavailability within the myocardium. This is
important for two reasons: (1) it further corroborates the evidence
that there is crosstalk between the H.sub.2S and NO systems and (2)
provides evidence for the first time that H.sub.2S increases the
bioavailability of NO in an in vivo model of disease. Consequently
the activation of eNOS by SG-1002 may serve as an important
mechanism for the observed protective effects against TAC. In terms
of its effects on hypertrophy, NO produced from eNOS has been shown
to have antihypertrophic effects in the heart as evidenced by the
findings that eNOS KO mice have hypertension and cardiac
hypertrophy and exhibit exacerbated cardiac dysfunction due to
pressure overload induced hypertrophy compared to WT mice.
Moreover, cardiac specific overexpression of eNOS prevents
isoproterenol induced cardiac hypertrophy. However, in sharp
contrast, Takimoto et al., J. Clin. Invest. 115:1221-1231, 2011
suggested that pressure overload results in eNOS-uncoupling
resulting in increased myocardial oxidant production and
exacerbated cardiac function. In spite of this, physicians have
been successfully using drugs which are able to activate eNOS,
(i.e. ACE-1, ARB, and (3-blockers) in the treatment of heart
failure. Therefore, controversy still remains in regards to the
utility and effectiveness of NO-based therapies in the treatment of
heart failure, which warrants further investigation to resolve
these issues. Additionally, both NO and H.sub.2S are known to
increase HO-1 levels, an enzyme that produces carbon monoxide (CO).
This suggests that the activation of one of the endogenously
produced gases can lead to the activation of the other two. Under
these conditions, the three gases have the ability to synergize to
produce antiapoptotic, antioxidant, anti-inflammatory, and
antihypertrophic effects, which ultimately can lead to
cardioprotection.
[0197] The findings of the current study indicate that preserving
sulfide levels during the development of pressure overload-induced
heart failure preserves cardiac function and prevents the
transition from compensated to decompensated cardiac hypertrophy.
Furthermore, the current study indicates that administration of a
novel oral H.sub.2S donor facilitates these protective effects by
activating a VEGF-Akt-eNOS-NO signaling pathway significantly
increasing NO bioavailability (FIG. 14). This cardioprotective
signaling cascade ultimately results in the inhibition of oxidative
stress, attenuated cardiac fibrosis, preservation of mitochondrial
respiration, and preserved left ventricular function. The study
suggests that endogenously produced H.sub.2S plays an important
role in the preservation of cardiac function in heart failure and
that oral H.sub.2S therapy may be a therapeutic option for the
treatment of LV dysfunction in the setting of pressure
overload-induced hypertrophy.
Example 8
Treatment with a Highly Bioavailable Zerovalent Sulfur-Rich
Composition (SG-1002, Containing about 99% Zerovalent Sulfur)
Increases Sperm Concentration and Sperm Motility in Infertile
Men
[0198] Between July 2009 and September 2010, a total of 435 men, of
which 125 (28.73%) had oligoasthenozoospermia were evaluated at the
University Center for Reproductive Medicine. Seventy-two patients
who agreed to enter the study were recruited; of these 18 were
eliminated for various reasons (five did not present a combination
of oligozoospermia and asthenozoospermia in the second semen
analysis before treatment, eight had a chronic degenerative
disease, three were chronic smokers, and two had taken antioxidants
two months before the study). Fifty-four patients were included in
the study who started treatment. Three dropped out (one mentioned
"strange" smelling sweat, one referred nausea and flatulence during
the first three days of ingestion of the hard gelatin capsules,
each containing 400 mg of SG-1002 (5 capsules per day) and one
argued that there were too many capsules to take per day). When the
patients were seen at the end of the 75 days of treatment, four did
not attend despite insisting by telephone.
[0199] Information from 47 patients who complied with the protocol
was analyzed. Mean age of the patients was 34.23 years, with 32
years being the most frequent. Patients were divided into three
groups (hydrogen sulfide prodrug, resveratrol and placebo),
maintaining a similar relationship between groups. Sixteen patients
were included in the resveratrol group, 16 in the hydrogen sulfide
prodrug group, and 15 in the placebo group. Two evaluations were
made, a baseline sample and after treatment. In each of the two
evaluations, variables such as concentration, motility, and
morphology in fresh semen and post-capacitation were analyzed. The
baseline characteristics of the three groups were similar. The
average age of patients in each group was 34.6 years for hydrogen
sulfide prodrug group, 35 years for the resveratrol group, and
33.07 years for the placebo group.
[0200] Mean sperm baseline concentration was 10.84 million per
milliliter, with 0.5 million per milliliter being the lowest
concentration and 19.9 million per milliliter, the highest
concentration. The mean concentration in the first sample was
11.02, 10.9 and 10.64 million per milliliter for the hydrogen
sulfide prodrug, resveratrol, and placebo groups, respectively. As
for sperm motility recorded at baseline, A+B type motility had a
mean of 13.43%, 14.43%, and 8.33% for the hydrogen sulfide prodrug,
resveratrol and placebo groups, respectively. The morphology
recorded in sample 1 was also similar in the three groups: 31.6%
for the hydrogen sulfide prodrug group, 32.06% for the resveratrol
group, and 30.06% for the placebo group with no statistically
significant difference. The mobile forms recovered (MFR) obtained
post-sperm capacitation were 0.579, 0.40 and 0.371 million for the
hydrogen sulfide prodrug, resveratrol and placebo group,
respectively (Table 8).
TABLE-US-00008 TABLE 8 Characteristics of the first sample in the
three groups Hydrogen sulfide Characteristic prodrug Resveratrol
Placebo Sperm concentration 11.02 .times. 10.sup.6 10.9 .times.
10.sup.6 10.64 .times. 10.sup.6a,b Motility A + B (%) 13.43 14.43
8.33.sup.a,b Normal morphology 31.6 32.06 30.06.sup.a,b (%) MFR
0.579 .times. 10.sup.6 0.40 .times. 10.sup.6 0.371 .times.
10.sup.6a,b Note: statistical analysis was performed using x.sup.2
MFR: Mobile Forms Recovery, post sperm capacitation .sup.ano
statistically significant differences were found between placebo
and hydrogen sulfide prodrug .sup.bno statistically significant
differences were found between placebo and resveratrol
[0201] The data obtained from the first samples of the placebo
group were compared with data obtained from the hydrogen sulfide
prodrug. No statistically significant differences were found
between the placebo group and the hydrogen sulfide prodrug group.
Samples that were collected after treatment showed different data
among the groups. The sperm concentration for the hydrogen sulfide
prodrug group was 17.01 vs. 11.18 million for the placebo group
(p=0.038). A+B motility for the hydrogen sulfide prodrug group was
20.06% vs. 10.06% in the placebo group (p=0.037). The morphology
obtained was 36.3% for the hydrogen sulfide prodrug group compared
to the placebo group with 30.4% (p=0.088). The MFR
post-capacitation for the hydrogen sulfide prodrug group was
1.62.times.10.sup.6 vs. 0.338.times.10.sup.6 in the placebo group
(p=0.035) (Table 9).
TABLE-US-00009 TABLE 9 Characteristics of the 2.sup.nd sample
(post-treatment) between the hydrogen sulfide prodrug and placebo
group Hydrogen sulfide Characteristic prodrug Placebo P Sperm
concentration 17.01 .times. 10.sup.6 11.18 .times. 10.sup.6 0.038
Motility A + B (%) 20.06 10.06 0.037 Normal morphology (%) 36.3
30.4 0.088 MFR 1.62 .times. 10.sup.6 0.338 .times. 10.sup.6 0.035
Note: statistical analysis was performed using x.sup.2 MFR: Mobile
Forms Recovery, post sperm capacitation
[0202] The results of this study provide support for using therapy
with antioxidants such as SG1002 (i.e., agents that act not only as
free radical/reactive oxygen species scavengers but also as
indirect antioxidants that induce genes to generate other
small-molecule antioxidants, antioxidant enzymes and enzymes that
regulate lipid metabolism) as a valid method for improving
spermatogenesis in carefully selected patients. This is the first
prospective, controlled, randomized, double blind clinical trial
that shows that hydrogen sulfide prodrug therapy improves some
seminal parameters.
[0203] An increase in sperm concentration was observed in the
hydrogen sulfide prodrug group, this was the only group with a
statistically significant increase. These findings demonstrate and
confirm the data obtained in other studies where antioxidant
therapy appears to be effective in the management of patients with
oligoasthenozoospermia.
[0204] In summary, this study demonstrates that hydrogen sulfide
prodrugs such as SG1002 are well tolerated by the human body,
without developing significant adverse effects at the doses used
and can increase the sperm count, motility, normal morphology, and
MFR post-capacitation.
Example 9
Treatment with a Highly Bioavailable Zerovalent Sulfur-Rich
Composition (SG-1002) in Patients with Osteosarcoma
[0205] Two trials were conducted on patients diagnosed with
different forms of osteosarcoma. In one study, the patient was 11
years old. The baseline condition was characterized as osteoblastic
osteosarcoma of the left distal femur, presented with a
pathological fracture and important tumor-related swelling and loss
of function of the adjacent joint. The patient's physical
examination was remarkable for the presence of a soft tissue mass
and redness at the site of the primary tumor. No evidence of lung
metastasis was recorded. The patient received four cycles of
chemotherapy with cisplatin, doxorubicin, ifosfamide, and etoposide
with no apparent clinical response. Chemotherapy was stopped before
treatment with the highly bioavailable zerovalent sulfur-rich
composition. The treatment regimen consisted of administration of
nine hard gelatin capsules (each containing 400 mg SG-1002) per day
of the highly bioavailable zerovalent sulfur-rich composition for
12 weeks. By the end of the second week, the patient began to feel
better, the pain subsided and the inflammation also began to
decline. The X-ray showed reduction of the limb soft tissue
surrounding the tumor. At the end of the fourth week, inflammation
of the extremity had fallen dramatically to almost disappearance.
There was no pain and the X-ray radiograph showed signs of growth
of the cortical bone. At the end of the eighth week, the
inflammation had completely disappeared. The mood of the patient
was excellent. There was no pain and the X-ray radiograph showed
greater cohesion bone. At the end of the twelfth week, the X-ray
radiograph clearly showed greater cohesion bone. The bone was
consolidated with angulation, product of the original pathological
fracture.
[0206] In the second study, the patient was 13 years old. The
baseline condition was characterized as telangiectasis osteosarcoma
of the left proximal humerus presented with a pathological fracture
and important tumor-related swelling and loss of function of the
left shoulder. His physical examination was remarkable for the
presence of a soft tissue mass and redness at the site of the
primary tumor. At the time of diagnosis, there was evidence of
bilateral lung metastases. Conventional X-rays showed a cystic,
lucent lesion with a soft tissue mass with periosteal reaction. The
patient received six cycles of chemotherapy with cisplatin,
doxorubicin, high dose methotrexate, ifosfamide, and etoposide with
modest clinical response. At the end of the sixth cycle
chemotherapy was stopped. The treatment regimen consisted of
administration of 9 capsules per day of the highly bioavailable
zerovalent sulfur-rich composition for 12 weeks. By the end of the
third week, the patient began to feel better, the pain subsided and
the inflammation also began to decline. By the end of the fourth
week, the X-ray radiograph showed reduction of the limb soft tissue
surrounding the tumor. The CAT scan showed no improvement of the
pulmonary metastases although metastases no longer progressed. At
the end of the eighth week, the limb inflammation had decreased,
although still noticeable. The patient had no pain and the X-ray
radiograph showed that the tumor had not progressed. At the end of
the twelfth week, the soft tissue swelling persisted. The mood of
the patient was excellent. There was no pain and the X-ray
radiograph showed no progression of the cancer in the bone. The CAT
scan showed no new pulmonary metastases.
Example 10
Treatment with a Highly Bioavailable Zerovalent Sulfur-Rich
Composition (SG-1002) in Patients with Conditions Associated with
Hydrocephalus
[0207] Three trials were conducted on patients showing signs of
hydrocephalus. In the first trial, the patient was 3 years old. Her
baseline condition was characterized by non specific signs of
hydrocephalus. An MRI showed a mass in the posterior fossa. Surgery
was planned and an incomplete resection was performed. Pathology
results showed an infratentorial atypical tertoid/rabdoid tumor
with leptomeningeal dissemination. She was treated at that time
with various cycles of chemotherapy with very modest response.
Chemotherapy was suspended and the patient was placed on palliative
care. A treatment regimen consisting of administration of 6 hard
gelatin capsules (each containing 400 mg SG-1002) per day of the
highly bioavailable zerovalent sulfur-rich composition was started
for a period of 12 weeks. The patient began to show signs of
improvement at the end of the second week. The sleepiness improved
and by the end of the eighth week the patient was fully conscious
and without clinical evidence of headache, vomiting or
irritability. The patient had an important neurological recovery
and at the end of the twelfth week, the patient was able to stand
and walk a few steps. The radiological evidence of the tumor
disappeared and the patient could walk unaided and eat normally in
the next few weeks.
[0208] In the second trial, the patient was 2 years old. She was
presented with insidious, non localizing signs of increased
intracranial pressure with hydrocephalus. MRI showed an
intraventricular mass in the lateral ventricle. Surgery was
planned, a CSF shunt was placed, and an incomplete resection was
performed. Pathology results showed an anaplastic tumor consistent
with choroid plexus carcinoma. She was treated at that time with
various cycles of chemotherapy, with very modest response. The
parents decided at that time not to give their child further
treatment. A treatment regimen consisting of administration of 3
hard gelatin capsules (each containing 400 mg SG-1002) per day of
the highly bioavailable zerovalent sulfur-rich composition was then
initiated for a period of 12 weeks. The patient began to show signs
of improvement at the end of the second week. The sleepiness was
improved and by the end of the eighth week the patient was fully
conscious and without clinical evidence of headache, vomiting, or
irritability. The patient had an important neurological recovery at
the end of the twelfth week and the patient was able to stand and
walk a few steps. The radiological evidence of the residual tumor
decreased but did not disappear.
[0209] The third trial was conducted on a patient who was 5 years
old. She presented with non specific signs of increased
intracranial pressure with hydrocephalus, vomiting, headaches,
somnolence, and upward gaze palsy. MRI showed an enlarged pineal
heterogeneous mass with calcifications. Surgery was planned, a CSF
shunt was placed, and an incomplete resection was performed.
Pathology results were consistent with pinealoblastoma. She was
treated at that time with various cycles of medulloblastoma type
chemotherapy with initial good response but months later showed
evidence of relapse. The parents of the patient decided at that
time not to give their child further treatment. A treatment regimen
consisting of administration of 6 hard gelatin capsules (each
containing 400 mg SG-1002) per day of the highly bioavailable
zerovalent sulfur-rich composition was then initiated for a period
of 12 weeks. The patient began to show improvement by the third
week. The sleepiness was improved and at the end of the twelfth
week the patient was fully conscious and without clinical evidence
of headache, vomiting, or irritability. Radiological evidence of
the residual tumor decreased but did not disappear.
Example 11
Treatment of a Patient with Ependymoma with the Highly Bioavailable
Zerovalent-Sulfur-Rich Composition (SG-1002)
[0210] A trial was conducted on a 6 year old patient diagnosed with
supratentorial ependymoma. She was presented in bad clinical
condition with signs of increased intracranial pressure with
hydrocephalus, vomiting, headaches, somnolence and papilledema. MRI
showed a locally invasive tumor infiltrating adjacent to the brain
at the thalamic region. Pathology review slides were consistent
with a diagnosis of ependymoma. She was treated at that time with
incomplete surgery and different cycles of chemotherapy. No
radiotherapy was accepted and the parents decided not to give their
child further treatment. She began a treatment regimen of
administration of six hard gelatin capsules (each containing 400 mg
SG-1002) per day of the highly bioavailable zerovalent-sulfur-rich
composition for 12 weeks. The patient showed improvement by the
third week. The somnolence improved gradually and by the end of the
twelfth week the patient had improved considerably with large
decrease in headache, vomiting, and irritability. The radiological
evidence of residual tumor decreased and the clinical condition
improved markedly.
Example 12
Treatment of a Patient with Macrocephaly with the Highly
Bioavailable Zerovalent-Sulfur-Rich Composition (SG-1002)
[0211] An 18 month old patient with evidence of macrocephaly and
lethargy alternating with irritability was treated with the highly
bioavailable sulfur-rich composition. MRI prior to treatment showed
hydrocephalus and a tumor mass localized in the posterior fossa.
Surgery was planned, a CSF shunt was placed and a partial resection
was performed. Pathology results were consistent with ependymoma.
Her signs of intracraneal pressure improved because of the shunt
and her hemiparesis was almost resolved. No further treatment was
accepted by the parents. Four months later a MRI showed that the
tumor size was increasing and the patient started complaining again
of headaches, somnolence, and progressive hemiparesis. Treatment
regimen consisted of administration of six hard gelatin capsules
(each containing 400 mg SG-1002) per day of the highly bioavailable
zerovalent-sulfur-rich composition for 12 weeks. The patient showed
a slight improvement by the third week. Headache and drowsiness
improved but did not disappear. By the end of the twelfth week the
patient felt better, had occasional headache, no vomiting, and the
hemiparesis did not progress. The radiological evidence of residual
tumor after 14.sup.th weeks showed that there was no increase in
the size compared to the last study.
Example 13
Treatment of a Patient with Hemiparesis with the Highly
Bioavailable Zerovalent-Sulfur-Rich Composition (SG-1002)
[0212] A 5 year old patient presented initially with progressive
signs of hemiparesis at the age of three was treated with the
highly bioavailable zerovalent-sulfur-rich composition of the
invention for 12 weeks with administration of six hard gelatin
capsules (each containing 400 mg SG-1002) per day. The patient's
baseline condition consisted of non specific signs of increased
intracranial pressure with morning vomiting, headaches, and
somnolence. MRI showed a supratentorial tumor mass with signs of
hemorrhage and calcifications. Surgery was planned, a CSF shunt was
placed, and a partial resection was performed. Pathology results
were consistent with anaplastic ependymoma. Her signs of
intracraneal pressure improved because of the shunt and her
hemiparesis was almost resolved. She started chemotherapy and
received 12 cycles with almost complete resolution of her signs and
symptoms. MRI showed improvement with no macroscopic evidence of
tumor. Four months later a MRI showed regional tumor invasion and
the patient started complaining again of headaches, somnolence, and
progressive hemiparesis. No further treatment was accepted by the
parents. Upon administration of the highly bioavailable sulfur-rich
composition, the patient showed slight improvement by the third
week. Headache and drowsiness improved. By the end of the twelfth
week the patient felt better, had no vomiting, and the hemiparesis
did not progress. Radiological evidence of the residual tumor after
14 weeks showed no increase in the size compared to the last
study.
Example 14
Treatment of a Patient with Medulloblastoma with the Highly
Bioavailable Zerovalent-Sulfur-Rich Composition (SG-1002)
[0213] A trial was conducted on a 14 year old patient with
recurrent medulloblastoma and pelvic dissemination of his original
tumor through CSF shunt. He presented initially with abdominal
pain, swelling of the extremities, and urinary symptoms as well as
headaches, morning nauseas, and ataxia. He started chemotherapy
with modest results. Treatment of the highly bioavailable
zerovalent-sulfur-rich composition was initiated for 12 weeks by
administration of nine hard gelatin capsules (each containing 400
mg SG-1002) per day. The patient showed improvement by the third
week. The waist circumference decreased and the urinary symptoms
disappeared. Headache and ataxia improved, but did not disappear.
By the end of the twelfth week the patient felt better, the
abdominal/pelvic tumor had decreased significantly. The headache
and ataxia was greatly improved. The radiological evidence of the
medulloblastoma recurrent in the posterior fossa did not increase
in size compared to previous studies.
Example 15
Treatment of a Patient with Squamous Cell Carcinoma with the Highly
Bioavailable Zerovalent-Sulfur-Rich Composition (SG-1002)
[0214] A trial was conducted on a 57 year old patient with rectal
bleeding and pain due to recurrent squamous cell carcinoma of the
anal canal treated with surgery, chemotherapy, and radiation
therapy. His condition recurred three months after his last
radiation treatment and he refused further treatment. The patient
was put on a treatment regimen of nine hard gelatin capsules (each
containing 400 mg SG-1002) per day of the highly bioavailable
zerovalent-sulfur-rich composition of the invention. The patient
showed improvement in pain in 4 or 5 days after the start of the
treatment regimen. By the third week, the pain was gone and the
rectal bleeding had subsided. The patient decided to restart a
program of salvage chemotherapy along with the treatment regimen of
the highly bioavailable sulfur-rich composition.
Example 16
Treatment of a Patient with Leukemia with the Highly Bioavailable
Zerovalent-Sulfur-Rich Composition (SG-1002)
[0215] A trial was conducted on a 13 year old patient diagnosed
with pre-B-calla (+) acute lymphoblastic leukemia. She was in first
remission and was taking medication according to protocol BFM 85.
After 6 months of treatment she started taking hydrogen sulfide
precursor capsules and said she felt much better and was capable of
doing exercise with better tolerance. She was running, hiking
during weekends, and attending school regularly. Her treatment
regimen consisted of administration of six hard gelatin capsules
(each containing 400 mg SG-1002) per day. The patient was able to
compare how she felt before and after the intake of the precursor
of hydrogen sulfide. Her physical and intellectual capacity
improved. Now she can tolerate extreme exercises, such as walking
cross-country and running a 5-10 km marathon. Her mood has also
improved.
Example 17
Treatment of a Patient Diagnosed with Heart Failure with the Highly
Bioavailable Zerovalent-Sulfur-Rich Composition (SG-1002)
[0216] A trial was conducted on a 47 year old patient diagnosed
with heart failure at the age of 46 after having increasing
shortness of breath after moderate activities or exercise and chest
pain. After a couple of months of ignoring his symptoms he had a
heart attack. He already has a coronary angioplasty. The patient
did not smoke but has a family history of diabetes and high
cholesterol levels. His ejection fraction was less than 40%. He
started a treatment regimen of six hard gelatin capsules (each
containing 400 mg SG-1002) per day of the highly bioavailable
zerovalent-sulfur-rich composition. The treatment regimen lasted
for four months. By the end of the second week the patient began to
feel better, blood sugar levels regularized even though the patient
continued use of glibenclamide every 12 hours. The breathlessness
improved by the third week. By the eighth week sugar levels were
stable and the use of glibenclamide was reduced to one tablet per
day without impact. Shortness of breath with exercise decreased
just as chest pain. At the end of the fourth month a ventricular
ejection fraction study came above 40% and the patient felt better
and had better tolerance for exercise.
Example 18
Treatment of a Patient with Type 2 Diabetes with the Highly
Bioavailable Zerovalent-Sulfur-Rich Composition (SG-1002)
[0217] A trial was conducted on a 44 year old obese male patient
with type 2 diabetes. He was diagnosed with type 2 diabetes since
he was 30 years old. Since then he has been taking glibenclamide
with regular sugar control. At the age of 41 he started noticing
regular coughing, shortness of breath, and orthopnea. He had a
heart attack at the age of 42 and his ejection fraction after that
was less than 40%. He started a treatment regimen of six hard
gelatin capsules (each containing 400 mg SG-1002) per day of the
highly bioavailable zerovalent-sulfur-rich composition. The
treatment regimen lasted for three months. By the third week the
patient began to feel better, blood sugar levels regularized even
though the patient continued to use glibenclamide. Lack of air
began to improve by the end of the seventh week. At the end of the
third month the patient only took glibenclamide in the mornings but
his glycaemia was practically normal.
Other Embodiments
[0218] While the invention has been described in connection with
specific embodiments thereof, it will be understood that it is
capable of further modifications and this application is intended
to cover any variations, uses, or adaptations of the invention
following, in general, the principles of the invention and
including such departures from the present disclosure come within
known or customary practice within the art to which the invention
pertains and may be applied to the essential features hereinbefore
set forth.
[0219] All publications, patents and patent applications are herein
incorporated by reference in their entirety 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.
* * * * *