U.S. patent application number 14/513111 was filed with the patent office on 2015-01-29 for methods and compositions for delivering peptides.
The applicant listed for this patent is MannKind Corporation. Invention is credited to Solomon S. Steiner, Joseph W. Sulner, Rodney J. Woods.
Application Number | 20150031609 14/513111 |
Document ID | / |
Family ID | 22495668 |
Filed Date | 2015-01-29 |
United States Patent
Application |
20150031609 |
Kind Code |
A1 |
Steiner; Solomon S. ; et
al. |
January 29, 2015 |
METHODS AND COMPOSITIONS FOR DELIVERING PEPTIDES
Abstract
Methods are provided for purifying peptides and proteins by
incorporating the peptide or protein into a diketopiperazine or
competitive complexing agent to facilitate removal one or more
impurities, from the peptide or protein. Formulations and methods
also are provided for the improved transport of active agents
across biological membranes, resulting for example in a rapid
increase in blood agent concentration. The formulations include
microparticles formed of (i) the active agent, which may be charged
or neutral, and (ii) a transport enhancer that masks the charge of
the agent and/or that forms hydrogen bonds with the target
biological membrane in order to facilitate transport. In one
embodiment, insulin is administered via the pulmonary delivery of
microparticles comprising fumaryl diketopiperazine and insulin in
its biologically active form. This method of delivering insulin
results in a rapid increase in blood insulin concentration that is
comparable to the increase resulting from intravenous delivery.
Inventors: |
Steiner; Solomon S.; (Mount
Kisco, NY) ; Woods; Rodney J.; (New Hampton, NY)
; Sulner; Joseph W.; (Paramus, NJ) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
MannKind Corporation |
Valencia |
CA |
US |
|
|
Family ID: |
22495668 |
Appl. No.: |
14/513111 |
Filed: |
October 13, 2014 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13754698 |
Jan 30, 2013 |
8889099 |
|
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14513111 |
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|
12985197 |
Jan 5, 2011 |
8389470 |
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|
13754698 |
|
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|
12635380 |
Dec 10, 2009 |
7943178 |
|
|
12985197 |
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|
10719734 |
Nov 21, 2003 |
7648960 |
|
|
12635380 |
|
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10224761 |
Aug 20, 2002 |
6652885 |
|
|
10719734 |
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09606468 |
Jun 29, 2000 |
6444226 |
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10224761 |
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60141433 |
Jun 29, 1999 |
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Current U.S.
Class: |
514/5.9 ;
530/303 |
Current CPC
Class: |
A61K 9/0073 20130101;
C07K 1/32 20130101; C07D 241/08 20130101; A61K 9/0075 20130101;
A61K 9/1676 20130101; Y10S 514/866 20130101; A61K 9/0019 20130101;
A61K 9/1617 20130101; A61K 9/14 20130101; A61K 38/28 20130101; C07K
14/62 20130101; B82Y 5/00 20130101; A61K 47/6949 20170801; A61K
47/22 20130101; A61K 9/145 20130101; C07K 14/605 20130101; A61P
3/10 20180101; C07K 1/30 20130101 |
Class at
Publication: |
514/5.9 ;
530/303 |
International
Class: |
A61K 47/22 20060101
A61K047/22; A61K 9/14 20060101 A61K009/14; A61K 9/00 20060101
A61K009/00; A61K 38/28 20060101 A61K038/28 |
Claims
1. A microparticle composition comprising microparticles containing
a diketopiperazine and at least one of a peptide and a protein,
wherein the microparticle composition is prepared by a method
comprising forming at least a portion of the microparticles
containing the diketopiperazine in the absence of at least one of
the peptide and the protein.
2. The composition of claim 1, wherein the microparticles
containing the diketopiperazine comprise fumaryl
diketopiperazine.
3. The composition of claim 1, wherein the peptide or the protein
is an insulin.
4. A method of delivering an insulin to a patient in need thereof,
comprising administering the composition of claim 3 to the
patient.
5. A composition comprising microparticles of a diketopiperazine
and at least one of a peptide and a protein, wherein the
composition comprising microparticles of the diketopiperazine is
prepared by a method comprising forming microparticles of the
diketopiperazine from an aqueous solution that does not include at
least one of the peptide and the protein.
6. The composition of claim 5, wherein the diketopiperazine is
fumaryl diketopiperazine.
7. The composition of claim 5, wherein the peptide or the protein
comprises an insulin.
8. A method of treating diabetes, comprising administering a
composition of claim 7 to a diabetic patient in need of
treatment.
9. Peptide or protein-loaded diketopiperazine microparticles
prepared by a process comprising adding the peptide or protein to a
suspension comprising microparticles of a diketopiperazine.
10. The peptide or protein-loaded microparticles of claim 9,
wherein the microparticles comprise fumaryl diketopiperazine.
11. The peptide or protein-loaded microparticles of claim 9,
wherein the microparticles comprise an insulin.
12. The peptide or protein-loaded microparticles of claim 9,
wherein solvent is removed by lyophilization from the suspension
comprising the peptide or protein and microparticles of the
diketopiperazine.
13. A method of pulmonary delivery of a protein or a peptide to a
mammal in need thereof, the method comprising administering the
peptide or protein-loaded microparticles of claim 9 to the mammal
by inhalation.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 13/754,698 filed Jan. 30, 2013, which is a
continuation of U.S. patent application Ser. No. 12/985,197 filed
Jan. 5, 2011, now U.S. Pat. No. 8,389,470, which is a continuation
of U.S. patent application Ser. No. 12/635,380 filed Dec. 10, 2009,
now U.S. Pat. No. 7,943,178, which is a continuation of U.S. patent
application Ser. No. 10/719,734 filed Nov. 21, 2003, now U.S. Pat.
No. 7,648,960, which is a continuation of U.S. patent application
Ser. No. 10/224,761 filed Aug. 20, 2002, now U.S. Pat. No.
6,652,885, which is a division of U.S. patent application Ser. No.
09/606,468 filed Jun. 29, 2000, now U.S. Pat. No. 6,444,226, which
in turn claims the benefit under 35 U.S.C. 119(e) to provisional
patent application No. 60/141,433 filed Jun. 29, 1999. Each of
these applications and patents are incorporated by reference herein
in their entirety.
BACKGROUND OF THE INVENTION
[0002] The present invention is generally in the field of
pharmaceutical formulations, and more particularly related to
methods and compositions for purifying and stabilizing peptides and
proteins, such as insulin, which are used in pharmaceutical
applications.
[0003] In a normal person, the -cells of the pancreatic islets of
Langerhans produce insulin, required by the body for glucose
metabolism, in response to an increase in blood glucose
concentration. The insulin metabolizes incoming glucose and
temporarily stops the liver's conversion of glycogen and lipids to
glucose thereby allowing the body to support metabolic activity
between meals. The Type I diabetic, however, has a reduced ability
or absolute inability to produce insulin due to -cell destruction
and needs to replace the insulin via daily injections or an insulin
pump. More common than Type I diabetes, though, is Type II
diabetes, which is characterized by insulin resistance and
increasingly impaired pancreatic-cell function. Type II diabetics
may still produce insulin, but they may also require insulin
replacement therapy.
[0004] Type II diabetics typically exhibit a delayed response to
increases in blood glucose levels. While normal persons usually
release insulin within 2-3 minutes following the consumption of
food, Type II diabetics may not secrete endogenous insulin for
several hours after consumption. As a result, endogenous glucose
production continues after consumption (Pfeiffer, Am. J. Med.,
70:579-88 (1981)), and the patient experiences hyperglycemia due to
elevated blood glucose levels.
[0005] Loss of glucose-induced insulin secretion is one of the
earliest disturbances of -cell function (Cerasi et al., Diabetes,
21:224-34 (1972); Polonsky et al., N. Engl. J. Med., 318:1231-39
(1988)), but the causes and degree of -cell dysfunction are unknown
in most cases. While genetic factors play an important role,
(Leahy, Curr. Opin. Endocrinol. Diabetes, 2:300-06 (1995)), some
insulin secretory disturbances seem to be acquired and may be at
least partially reversible through optimal glucose control. Optimal
glucose control via insulin therapy after a meal can lead to a
significant improvement in natural glucose-induced insulin release
by requiring both normal tissue responsiveness to administered
insulin and an abrupt increase in serum insulin concentrations.
Therefore, the challenge presented in the treatment of early stage
Type II diabetics, those who do not have excessive loss of -cell
function, is to restore the release of insulin following meals.
[0006] Most early stage Type II diabetics currently are treated
with oral agents, but with little success. Subcutaneous injections
of insulin are also rarely effective in providing insulin to Type
II diabetics and may actually worsen insulin action because of
delayed, variable, and shallow onset of action. It has been shown,
however, that if insulin is administered intravenously with a meal,
early stage Type II diabetics experience the shutdown of hepatic
glucogenesis and exhibit increased physiological glucose control.
In addition, their free fatty acids levels fall at a faster rate
than without insulin therapy. While possibly effective in treating
Type II diabetes, intravenous administration of insulin, is not a
reasonable solution, as it is not safe or feasible for patients to
intravenously administer insulin at every meal.
[0007] Insulin, a polypeptide with a nominal molecular weight of
6,000 Daltons, traditionally has been produced by processing pig
and cow pancreas to isolate the natural product. More recently,
however, recombinant technology has been used to produce human
insulin in vitro. Natural and recombinant human insulin in aqueous
solution is in a hexameric configuration, that is, six molecules of
recombinant insulin are noncovalently associated in a hexameric
complex when dissolved in water in the presence of zinc ions.
Hexameric insulin is not rapidly absorbed. In order for recombinant
human insulin to be absorbed into a patient's circulation, the
hexameric form must first dissociate into dimeric and/or monomeric
forms before the material can move into the blood stream. The delay
in absorption requires that the recombinant human insulin be
administered approximately one half hour prior to meal time in
order to produce therapeutic insulin blood level, which can be
burdensome to patients who are required to accurately anticipate
the times they will be eating. To overcome this delay, analogs of
recombinant human insulin, such as HUMALOG.TM., have been
developed, which rapidly disassociate into a virtually entirely
monomeric form following subcutaneous administration. Clinical
studies have demonstrated that HUMALOG.TM. is absorbed
quantitatively faster than recombinant human insulin after
subcutaneous administration. See, for example, U.S. Pat. No.
5,547,929 to Anderson Jr., et al.
[0008] In a effort to avoid the disadvantages associated with
delivery by injection and to speed absorption, administration of
monomeric analogs of insulin via the pulmonary route has been
developed. For example, U.S. Pat. No. 5,888,477 to Gonda, et al.
discloses having a patient inhale an aerosolized formulation of
monomeric insulin to deposit particles of insulin on the patient's
lung tissue. However, the monomeric formulation is unstable and
rapidly loses activity, while the rate of uptake remains
unaltered.
[0009] While it would be desirable to produce rapidly absorbable
insulin derived from natural sources, transformation of the
hexameric form into the monomeric form, such as by removing the
zinc from the complex, yields an insulin that is unstable and has
an undesirably short shelf life. It therefore would be desirable to
provide monomeric forms of insulin, while maintaining its stability
in the absence of zinc. It also would be advantageous to provide
diabetic patients with monomeric insulin compositions that are
suitable for pulmonary administration, provide rapid absorption,
and which can be produced in ready-to-use formulations that have a
commercially useful shelf-life.
[0010] These problems with impurities, metal ions that affect
stability or bioavailability, occur with many other proteins and
peptides.
[0011] U.S. Pat. No. 6,071,497 to Steiner, et al. discloses
microparticle drug delivery systems in which the drug is
encapsulated in diketopiperazine microparticles which are stable at
a pH of 6.4 or less and unstable at pH of greater than 6.4, or
which are stable at both acidic and basic pH, but which are
unstable at pH between about 6.4 and 8. The patent does not
describe monomeric insulin compositions that are suitable for
pulmonary administration, provide rapid absorption, and which can
be produced in ready-to-use formulations that have a commercially
useful shelf-life.
[0012] It would therefore be advantageous to develop alternative
insulin delivery compositions for Type II diabetics that provide
more rapid elevation of insulin blood levels and are easily
administered to ensure patient compliance. It also would be
desirable to apply the delivery compositions and methods to other
biologically active agents.
[0013] It is therefore an object of the present invention to
provide improved methods for purifying peptides and proteins,
especially in the preparation of compositions suitable for
pulmonary administration.
[0014] It is another object of the present invention to provide
stable monomeric peptide compositions suitable for pulmonary
delivery.
[0015] It is a further object of the present invention to provide
methods and compositions for the facilitated transport of insulin
and other biologically active agents across biological
membranes.
[0016] It is another object of the present invention to provide
methods and compositions for the improved absorption of insulin or
other biologically active agents in the bloodstream.
[0017] It is a still further object of the present invention to
provide methods and compositions for the improved absorption of
insulin or other biologically active agents in the bloodstream
characterized by ease of administration.
SUMMARY OF THE INVENTION
[0018] Methods are provided for purifying peptides and proteins by
incorporating the peptide or protein into a diketopiperazine or
competitive complexing agent to facilitate removal one or more
impurities, i.e. undesirable components, from the peptide or
protein. In a preferred embodiment, a peptide, such as insulin,
containing one or more impurities, e.g., zinc ions, is entrapped in
diketopiperazine to form a precipitate of
peptide/diketopiperazine/impurity, which is then washed with a
solvent for the impurity to be removed, which is a nonsolvent for
the diketopiperazine and a nonsolvent for the peptide.
Alternatively, the impurity can be removed by using complexing
agents to selectively complex with and displace the impurities, for
example, such as by dialysis.
[0019] Formulations and methods also are provided for the improved
transport of active agents across biological membranes, resulting,
for example, in a rapid increase in blood agent concentration. The
formulations include microparticles formed of (i) the active agent,
which may be charged or neutral, and (ii) a transport enhancer that
masks the charge of the agent and/or that forms hydrogen bonds with
the target biological membrane in order to facilitate transport. In
a preferred embodiment, insulin is administered via pulmonary
delivery of microparticles comprising fumaryl diketopiperazine and
insulin in its biologically active form. The charge on the insulin
molecule is masked by hydrogen bonding it to the diketopiperazine,
thereby enabling the insulin to pass through the target membrane.
This method of delivering insulin results in a rapid increase in
blood insulin concentration that is comparable to the increase
resulting from intravenous delivery.
BRIEF DESCRIPTION OF THE DRAWINGS
[0020] FIG. 1a is a graph of mean blood glucose values over time
(minutes).
[0021] FIG. 1b is a graph of mean C-peptide concentrations during
experiments comparing levels of C-peptide (ng/ml) over time
(minutes) when insulin was administered intravenously,
subcutaneously, and by inhalation.
[0022] FIG. 2a is a graph of glucose infusion rate (mg/kg/min) over
time (minutes) comparing insulin administered intravenously,
subcutaneously, and by inhalation.
[0023] FIG. 2b is a graph of mean insulin concentrations (U/ml)
over time (minutes) comparing insulin administered intravenously,
subcutaneously, and by inhalation.
DETAILED DESCRIPTION OF THE INVENTION
[0024] Encapsulation or entrapment of large polymers, such as
proteins and peptides, in diketopiperazines can be used to remove
impurities or contaminants such as metal ions or other small
molecules. The diketopiperazines also serve both to stabilize and
enhance delivery of the entrapped materials. Formulations also have
been developed for the enhanced transport of active agents across
biological membranes. These formulations include microparticles
formed of (i) the active agent, which may be charged or neutral,
and (ii) a transport enhancer that masks the charge of the agent
and/or that forms hydrogen bonds with the membrane. The
formulations can provide rapid increases in the concentration of
active agent in the blood following administration of the
formulations.
[0025] For example, it was discovered that hexameric insulin can be
delivered to the lung in fumaryl diketopiperazine formulation,
reaching peak blood concentrations within 3-10 minutes. In
contrast, insulin administered by the pulmonary route without
fumaryl diketopiperazine typically takes between 25-60 minutes to
reach peak blood concentrations, while hexameric insulin takes
30-90 minutes to reach peak blood level when administered by
subcutaneous injection. This feat has been successfully replicated
several times and in several species, including humans.
[0026] Removing zinc from insulin typically produces unstable
insulin with an undesirably short shelf life. Purification to
remove zinc, stabilization and enhanced delivery of insulin is
demonstrated by the examples. Formulations of insulin trapped in
fumaryl diketopiperazine were found to be stable and have an
acceptable shelf life. Measurement of the zinc levels demonstrated
that the zinc had been largely removed during the entrapment
process, yielding monomeric insulin in a stable delivery
formulation.
[0027] Rapid absorption of a number of other peptides, including
salmon calcitonin, parathyroid hormone 1-34, octreotide, leuprolide
and RSV peptide, has been observed when the peptide is pulmonarily
delivered in fumaryl diketopiperazine--providing peak blood
concentrations within 3-10 minutes after pulmonary delivery.
[0028] Materials
[0029] A. Agent to be Delivered
[0030] The agent to be delivered is referred to herein as the
active agent, or molecule to be encapsulated or entrapped. It may
or may not be a charged species. Examples of classes of active
agents suitable for use in the compositions and methods described
herein include therapeutic, prophylactic, and diagnostic agents, as
well as dietary supplements, such as vitamins.
[0031] The exact mechanism by which the diketopiperazines form a
complex with the materials to be delivered is not known, but it is
believed that the diketopiperazines form a complex with the
material to be purified. This process is referred to herein
interchangeably as entrapment or encapsulation.
[0032] These materials can be any polymer or large organic
molecules, most preferably peptides and proteins. Generally
speaking, any form of drug can be entrapped. Examples include
synthetic inorganic and organic compounds, proteins and peptides,
polysaccharides and other sugars, lipids, and nucleic acid
sequences having therapeutic, prophylactic or diagnostic
activities. Proteins are defined as consisting of 100 amino acid
residues or more; peptide are less than 100 amino acid residues.
Unless otherwise stated, the term protein refers to both proteins
and peptides. The agents to be incorporated can have a variety of
biological activities, such as vasoactive agents, neuroactive
agents, hormones, anticoagulants, immunomodulating agents,
cytotoxic agents, antibiotics, antivirals, antisense, antigens, and
antibodies. In some instances, the proteins may be antibodies or
antigens which otherwise would have to be administered by injection
to elicit an appropriate response. Representative polymers
including proteins, peptides, polysaccharides, nucleic acid
molecule, and combinations thereof.
[0033] Preferred peptides and proteins include hormones, cytokines
and other immunomodulatory peptides, and antigens/vaccines. In a
preferred embodiment, the active agent is monomeric insulin or a
stabilized form of insulin which has been purified to remove zinc.
In another preferred embodiment, the active agent is glucagon.
[0034] The active agent, or drug, can be an antigen, where the
molecule is intended to elicit a protective immune response,
especially against an agent that preferentially infects the lungs,
such as mycoplasma, bacteria causing pneumonia, and respiratory
synticial virus. In these cases, it may also be useful to
administer the drug in combination with an adjuvant, to increase
the immune response to the antigen.
[0035] Any genes that would be useful in replacing or supplementing
a desired function, or achieving a desired effect such as the
inhibition of tumor growth, could be introduced using the matrices
described herein. As used herein, a "gene" is an isolated nucleic
acid molecule of greater than thirty nucleotides, preferably one
hundred nucleotides or more, in length. Examples of genes which
replace or supplement function include the genes encoding missing
enzymes such as adenosine deaminase (ADA) which has been used in
clinical trials to treat ADA deficiency and cofactors such as
insulin and coagulation factor VIII. Genes which effect regulation
can also be administered, alone or in combination with a gene
supplementing or replacing a specific function. For example, a gene
encoding a protein which suppresses expression of a particular
protein-encoding gene, or vice versa, which induces expresses of a
protein-encoding gene, can be administered in the matrix. Examples
of genes which are useful in stimulation of the immune response
include viral antigens and tumor antigens, as well as cytokines
(tumor necrosis factor) and inducers of cytokines (endotoxin), and
various pharmacological agents.
[0036] Other nucleic acid sequences that can be utilized include
antisense molecules which bind to complementary DNA to inhibit
transcription, ribozyme molecules, and external guide sequences
used to target cleavage by RNAase P.
[0037] As used herein, vectors are agents that transport the gene
into targeted cells and include a promoter yielding expression of
the gene in the cells into which it is delivered. Promoters can be
general promoters, yielding expression in a variety of mammalian
cells, or cell specific, or even nuclear versus cytoplasmic
specific. These are known to those skilled in the art and can be
constructed using standard molecular biology protocols. Vectors
increasing penetration, such as lipids, liposomes, lipid conjugate
forming molecules, surfactants, and other membrane permeability
enhancing agents are commercially available and can be delivered
with the nucleic acid.
[0038] Imaging agents including metals, radioactive isotopes,
radioopaque agents, fluorescent dyes, and radiolucent agents also
can be incorporated. Examples of radioisotopes and radioopaque
agents include gallium, technetium, indium, strontium, iodine,
barium, and phosphorus.
[0039] Impurities which can be removed from the active agent
composition include metal ions such as zinc, and other di- or
multi-valent ions, and small inorganic molecules and solvent
residuals.
[0040] B. Diketopiperazines
[0041] Diketopiperazines useful in the present compositions and
methods are described, for example, in U.S. Pat. No. 6,071,497,
which is incorporated herein in its entirety.
[0042] (i). General Formula
[0043] The diketopiperazines or their substitution analogs are
rigid planar rings with at least six ring atoms containing
heteroatoms and unbonded electron pairs. One or both of the
nitrogens can be replaced with oxygen to create the substitution
analogs diketomorpholine and diketodioxane, respectively. Although
it is possible to replace a nitrogen with a sulfur atom, this does
not yield a stable structure.
[0044] The general formulae for diketopiperazine and its analogs
are shown below.
##STR00001##
[0045] Wherein n is between 0 and 7, Q is, independently, a
C.sub.1-20 straight, branched or cyclic alkyl, aralkyl, alkaryl,
alkenyl, alkynyl, heteroalkyl, heterocyclic, alkyl-heterocyclic, or
heterocyclic-alkyl; T is --C(O)O, --OC(O), --C(O)NH, --NH, --NQ,
--OQO, --O, --NHC(O), --OP(O), --P(O)O, --OP(O).sub.2,
--P(O).sub.2O, --OS(O).sub.2, or --S(O).sub.3; U is an acid group,
such as a carboxylic acid, phosphoric acid, phosphonic acid and
sulfonic acid, or a basic group, such as primary, secondary and
tertiary amines, quaternary ammonium salts, guanidine, aniline,
heterocyclic derivatives, such as pyridine and morpholine, or a
zwitterionic C.sub.1-20 chain containing at least one acidic group
and at least one basic group, for example, those described above,
wherein the side chains can be further functionalized with an
alkene or alkyne group at any position, one or more of the carbons
on the side chain can be replaced with an oxygen, for example, to
provide short polyethylene glycol chains, one or more of the
carbons can be functionalized with an acidic or basic group, as
described above, and wherein the ring atoms X at positions 1 and 4
are either O or N.
[0046] As used herein, "side chains" are defined as Q-T-Q-U or Q-U,
wherein Q, T, and U are defined above.
[0047] Examples of acidic side chains include, but are not limited,
to cis and trans --CH.dbd.CH--CO.sub.2H,
--CH(CH.sub.3).dbd.CH(CH.sub.3)--CO.sub.2H,
--(CH.sub.2).sub.3--CO.sub.2H, --CH.sub.2CH(CH.sub.3)--CO.sub.2H,
--CH(CH.sub.2CO.sub.2H).dbd.CH.sub.2, -(tetrafluoro)benzoic acid,
-benzoic acid and --CH(NHC(O)CF.sub.3)--CHS--CO.sub.2H.
[0048] Examples of basic side chains include, but are not limited
to, -aniline, -phenyl-C(NH)NH.sub.2, -phenyl-C(NH)NH(alkyl),
-phenyl-C(NH)N(alkyl).sub.2 and
(CH.sub.2).sub.4NHC(O)CH(NH.sub.2)CH(NH.sub.2)CO.sub.2H.
[0049] Examples of zwitterionic side chains include, but are not
limited to, --CH(NH.sub.2)--CH.sub.2--CO.sub.2H and
--NH(CH.sub.2).sub.1-20CO.sub.2H.
[0050] The term aralkyl refers to an aryl group with an alkyl
substituent.
[0051] The term heterocyclic-alkyl refers to a heterocyclic group
with an alkyl substituent.
[0052] The term alkaryl refers to an alkyl group that has an aryl
substituent.
[0053] The term alkyl-heterocyclic refers to an alkyl group that
has a heterocyclic substituent.
[0054] The term alkene, as referred to herein, and unless otherwise
specified, refers to an alkene group of C.sub.2 to C.sub.10, and
specifically includes vinyl and allyl.
[0055] The term alkyne, as referred to herein, and unless otherwise
specified, refers to an alkyne group of C.sub.2 to C.sub.10. As
used herein, "diketopiperazines" includes diketopiperazines and
derivatives and modifications thereof falling within the scope of
the above-general formula.
[0056] Fumaryl diketopiperazine is most preferred for pulmonary
applications.
[0057] (ii). Synthesis
[0058] Diketopiperazines can be formed by cyclodimerization of
amino acid ester derivatives, as described by Katchalski, et al.,
J. Amer. Chem. Soc. 68:879-80 (1946), by cyclization of dipeptide
ester derivatives, or by thermal dehydration of amino acid
derivatives in high-boiling solvents, as described by Kopple, et
al., J. Org. Chem. 32(2):862-64 (1968), the teachings of which are
incorporated herein. 2,5-diketo-3,6-di(aminobutyl)piperazine
(Katchalski et al. refer to this as lysine anhydride) was prepared
via cyclodimerization of N-epsilon-P-L-lysine in molten phenol,
similar to the Kopple method in J. Org. Chem., followed by removal
of the blocking (P)-groups with 4.3 M HBr in acetic acid. This
route is preferred because it uses a commercially available
starting material, it involves reaction conditions that are
reported to preserve stereochemistry of the starting materials in
the product and all steps can be easily scaled up for
manufacture.
[0059] Diketomorpholine and diketooxetane derivatives can be
prepared by stepwise cyclization in a manner similar to that
disclosed in Katchalski, et al., J. Amer. Chem. Soc. 68:879-80
(1946).
[0060] Diketopiperazines can be radiolabelled. Means for attaching
radiolabels are known to those skilled in the art. Radiolabelled
diketopiperazines can be prepared, for example, by reacting tritium
gas with those compounds listed above that contain a double or
triple bond. A carbon-14 radiolabelled carbon can be incorporated
into the side chain by using .sup.14C labeled precursors which are
readily available. These radiolabelled diketopiperazines can be
detected in vivo after the resulting microparticles are
administered to a subject.
[0061] (a) Synthesis of Symmetrical
[0062] Diketopiperazine Derivatives
[0063] The diketopiperazine derivatives are symmetrical when both
side chains are identical. The side chains can contain acidic
groups, basic groups, or combinations thereof.
[0064] One example of a symmetrical diketopiperazine derivative is
2,5-diketo-3,6-di(4-succinylaminobutyl)piperazine.
2,5-diketo-3,6-di(aminobutyl) piperazine is exhaustively
succinylated with succinic anhydride in mildly alkaline aqueous
solution to yield a product which is readily soluble in weakly
alkaline aqueous solution, but which is quite insoluble in acidic
aqueous solutions. When concentrated solutions of the compound in
weakly alkaline media are rapidly acidified under appropriate
conditions, the material separates from the solution as
microparticles.
[0065] Other preferred compounds can be obtained by replacing the
succinyl group(s) in the above compound with glutaryl, maleyl or
fumaryl groups.
[0066] (b) Synthesis of Asymmetrical
[0067] Diketopiperazine Derivatives
[0068] One method for preparing unsymmetrical diketopiperazine
derivatives is to protect functional groups on the side chain,
selectively deprotect one of the side chains, react the deprotected
functional group to form a first side chain, deprotect the second
functional group, and react the deprotected functional group to
form a second side chain.
[0069] Diketopiperazine derivatives with protected acidic side
chains, such as cyclo-Lys(P)Lys(P), wherein P is a
benzyloxycarbonyl group, or other protecting group known to those
skilled in the art, can be selectively deprotected. The protecting
groups can be selectively cleaved by using limiting reagents, such
as HBr in the case of the benzyloxycarbonyl group, or fluoride ion
in the case of silicon protecting groups, and by using controlled
time intervals. In this manner, reaction mixtures which contain
unprotected, monoprotected and di-protected diketopiperazine
derivatives can be obtained. These compounds have different
solubilities in various solvents and pH ranges, and can be
separated by selective precipitation and removal. An appropriate
solvent, for example, ether, can then be added to such reaction
mixtures to precipitate all of these materials together. This can
stop the deprotection reaction before completion by removing the
diketopiperazines from the reactants used to deprotect the
protecting groups. By stirring the mixed precipitate with water,
both the partially and completely reacted species can be dissolved
as salts in the aqueous medium. The unreacted starting material can
be removed by centrifugation or filtration. By adjusting the pH of
the aqueous solution to a weakly alkaline condition, the asymmetric
monoprotected product containing a single protecting group
precipitates from the solution, leaving the completely deprotected
material in solution.
[0070] In the case of diketopiperazine derivatives with basic side
chains, the basic groups can also be selectively deprotected. As
described above, the deprotection step can be stopped before
completion, for example, by adding a suitable solvent to the
reaction. By carefully adjusting the solution pH, the deprotected
derivative can be removed by filtration, leaving the partially and
totally deprotected derivatives in solution. By adjusting the pH of
the solution to a slightly acidic condition, the monoprotected
derivative precipitates out of solution and can be isolated.
[0071] Zwitterionic diketopiperazine derivatives can also be
selectively deprotected, as described above. In the last step,
adjusting the pH to a slightly acidic condition precipitates the
monoprotected compound with a free acidic group. Adjusting the pH
to a slightly basic condition precipitates the monoprotected
compound with a free basic group.
[0072] Limited removal of protecting groups by other mechanisms,
including but not limited to cleaving protecting groups that are
cleaved by hydrogenation by using a limited amount of hydrogen gas
in the presence of palladium catalysts. The resulting product is
also an asymmetric partially deprotected diketopiperazine
derivative. These derivatives can be isolated essentially as
described above.
[0073] The monoprotected diketopiperazine is reacted to produce a
diketopiperazine with one sidechain and protecting group. Removal
of protecting groups and coupling with other side chains yields
unsymmetrically substituted diketopiperazines with a mix of acidic,
basic, and zwitterionic sidechains.
[0074] Other materials that exhibit this response to pH can be
obtained by functionalizing the amide ring nitrogens of the
diketopiperazine ring.
[0075] C. Transport Enhancers
[0076] In a preferred embodiment, the active agent is complexed
with a transport enhancer which is degradable and capable of
forming hydrogen bonds with the target biological membrane in order
to facilitate transport of the agent across the membrane. The
transport enhancer also is capable of forming hydrogen bonds with
the active agent, if charged, in order to mask the charge and
facilitate transport of the agent across the membrane. A preferred
transport enhancer is diketopiperazine.
[0077] The transport enhancer preferably is biodegradable and may
provide linear, pulsed or bulk release of the active agent. The
transport enhancer may be a natural or synthetic polymer and may be
modified through substitutions or additions of chemical groups,
including alkyl), alkylene, hydroxylations, oxidations, and other
modifications routinely made by those skilled in the art.
[0078] A preferred transport enhancer is fumaryl diketopiperazine.
Other diketopiperazines which may be useful as a transport enhancer
are described above.
[0079] Like most proteins and peptides, insulin is a charged
molecule, which impedes its ability to cross charged biological
membranes. It has been found that when insulin hydrogen bonds to
fumaryl diketopiperazine, the charge of the peptide is masked,
thereby facilitating or enhancing the passage of insulin across the
membranes, such as mucosal membranes, and into the blood.
[0080] II. Methods
[0081] A. Encapsulation
[0082] In one embodiment, active agent is encapsulated within
microparticles by dissolving a diketopiperazine with acidic side
chains in bicarbonate or other basic solution, adding the active
agent in solution or suspension, and then precipitating the
microparticle by adding acid, such as 1 M citric acid.
[0083] In another embodiment, active agent is encapsulated within
microparticles by dissolving a diketopiperazine with basic side
chains in an acidic solution, such as 1 M citric acid, adding the
active agent in solution or suspension, and then precipitating the
microparticle by adding bicarbonate or another basic solution.
[0084] In still another embodiment, active agent is encapsulated
within microparticles by dissolving a diketopiperazine with both
acidic and basic side chains in an acidic or basic solution, adding
the active agent in solution or suspension to be encapsulated, then
precipitating the microparticle by neutralizing the solution.
[0085] The microparticles can be stored in the dried state and
suspended for administration to a patient. In the first embodiment,
the reconstituted microparticles maintain their stability in an
acidic medium and dissociate as the medium approaches physiological
pH in the range of between 6 and 14. In the second embodiment,
suspended microparticles maintain their stability in a basic medium
and dissociate at a pH of between 0 and 6. In the third embodiment,
the reconstituted microparticles maintain their stability in an
acidic or basic medium and dissociate as the medium approaches
physiological pH in the range of pH between 6 and 8.
[0086] The impurities typically are removed when the microparticles
are precipitated. However, impurities also can be removed by
washing the particles to dissolve the impurities. A preferred wash
solution is water or an aqueous buffer. Solvents other than water
also can be used to wash the microspheres or precipitate the
diketopiperazines, in order to remove impurities that are not water
soluble. Any solvent in which neither the cargo nor the fumaryl
diketopiperazine is soluble are suitable. Examples include acetic
acid, ethanol, and toluene.
[0087] In an alternative embodiment, microparticles of
diketopiperazine are prepared and provided in a suspension,
typically an aqueous suspension, to which a solution of the active
agent then is added. The suspension is then lyophilized or freeze
dried to yield diketopiperazine microparticles having a coating of
active agent. In a preferred embodiment, the active agent is
insulin in a hexameric form. Zinc ions can then be removed by
washing the microparticles with an appropriate solvent.
[0088] As used herein, the term "entrapped" with reference to an
active agent in/with a diketopiperazine includes coating of the
active agent onto microparticles of the diketopiperazine.
[0089] The diketopiperazine microparticles have been found to have
a higher affinity for insulin than does zinc. Insulin has been
found to be stabilized within an ordered lattice array of fumaryl
diketopiperazine. In this state, in the sufficient absence of zinc
ions, the insulin is predominately dimeric and monomeric, as
opposed to it hexameric state. The insulin therefore more readily
dissociates to its monomeric state, which is the state in which
insulin exerts its biological activity.
[0090] Other complexing agents may be substituted for the
diketopiperazine. Other representative complexing agents include
serum albumin and other proteins, alginic acid, antibodies,
cyclodextrins, phospholipids, and lecithin. For example, insulin
contaminated with zinc can be complexed with bovine serum albumin.
The complex can be dialyzed in tubing with a molecular weight
cut-off below 1,000 Daltons to separate and remove the zinc. Once
sufficient amounts of zinc have been dialyzed away, as evidenced by
its presence in the dialysate, the dispersion is transferred to
dialysis tubing with a molecular weight cut-off below 10,000
Daltons. Only monomeric insulin will pass through the tubing into
the dialysate, leaving any remaining hexameric zinc complexed
insulin behind. The purified insulin can be captured from the
dialysate.
[0091] These materials may not, however, provide sufficient
stabilization of unstable or labile drugs.
[0092] B. Administration
[0093] The compositions of active agent described herein can be
administered to patients in need of the active agent. The
compositions preferably are administered in the form of
microparticles, which can be in a dry powder form for pulmonary
administration or suspended in an appropriate pharmaceutical
carrier, such as saline.
[0094] The microparticles preferably are stored in dry or
lyophilized form until immediately before administration. The
microparticles then can be administered directly as a dry powder,
such as by inhalation using, for example, dry powder inhalers known
in the art. Alternatively, the microparticles can be suspended in a
sufficient volume of pharmaceutical carrier, for example, as an
aqueous solution for administration as an aerosol.
[0095] The microparticles also can be administered via oral,
subcutaneous, and intraveneous routes.
[0096] The compositions can be administered to any targeted
biological membrane, preferably a mucosal membrane of a patient. In
a preferred embodiment, the patient is a human suffering from Type
II diabetes. In a preferred embodiment, the composition delivers
insulin in biologically active form to the patient, which provides
a spike of serum insulin concentration which simulates the normal
response to eating.
[0097] In a preferred embodiment, hexameric insulin is entrapped in
fumaryl diketopiperazine to form a solid precipitate of monomeric
insulin in the fumaryl diketopiperazine, which then is washed with
aqueous solution to remove the free zinc. This formulation
demonstrates blood uptake following pulmonary administration at a
rate 2.5 times the rate of insulin uptake following subcutaneous
injection, with peak blood levels occurring at between 7.5 and 10
minutes after administration.
[0098] The range of loading of the drug to be delivered is
typically between about 0.01% and 90%, depending on the form and
size of the drug to be delivered and the target tissue. In a
preferred embodiment using diketopiperazines, the preferred range
is from 0.1% to 50% loading by weight of drug. The appropriate
dosage can be determined, for example, by the amount of
incorporated/encapsulated agent, the rate of its release from the
microparticles, and, in a preferred embodiment, the patient's blood
glucose level.
[0099] One preferred application is in the treatment of
hyperinsulinemia. In a preferred embodiment, microparticles of the
composition wherein the active agent is glucagon can be
administered by continuous subcutaneous infusion. Glucagon is an
extremely unstable peptide, but can be stabilized in particles of
diketopiperazine, for example. The stabilized
glucagon/diketopiperazine microparticles can be made by adding
glucagon to a solution of diketopiperazine which hydrogen bonds to
the glucagon and when the solution is acidified, such as by adding
a food acid, both the diketopiperazine and the glucagon
self-assemble to form uniform microspheres having a mean particle
size of, for example, about 2 m. In this process, approximately 95%
of the glucagon is pulled out of solution and is evenly distributed
within the diketopiperazine microparticle. These particles can
readily be suspended and infused subcutaneously with a standard
infusion pump. Then the glucagon/diketopiperazine particles are
contacted with the near neutral pH environment of the subcutaneous
fluid, where they dissolve, thereby releasing glucagon in its
pharmacologically active state.
[0100] The compositions and methods described herein are further
described by the following non-limiting examples.
Example 1
Removal of Zinc from U.S.P. Injectable Insulin
[0101] Insulin trapped in fumaryl diketopiperazine was analyzed to
assess whether zinc was removed during the entrapment process. The
insulin used as the starting material met U.S.P. standards for
injectable insulin, and according to the certificate of analysis,
the insulin contained a considerable quantity of zinc: 0.41%. This
insulin was then entrapped in fumaryl diketopiperazine to form a
solid fumaryl diketopiperazine/insulin mixture, as described
above.
[0102] Following entrapment of the insulin in fumaryl
diketopiperazine, the amount of zinc theoretically should be
present in the same proportion as it existed in the neat insulin.
Using the certificate of analysis value, it was calculated that one
should expect to find 697 parts per million (ppm) of zinc per gram
in the solid yield of fumaryl diketopiperazine/insulin.
Surprisingly, the quantity of zinc present the solid fumaryl
diketopiperazine/insulin was measured to be only 6 ppm. The
"missing" zinc was presumably eliminated with the water used to
wash the insulin/fumaryl diketopiperazine precipitate.
Example 2
Bioavailability of Insulin in Diketopiperazine Pulmonary
Formulation
[0103] Subjects and Methods
[0104] The study was reviewed and approved by the ethical review
committee of the Heinrich-Heine-University, Dusseldorf, and
conducted according to local regulations, the Declaration of
Helsinki and the rules of Good Clinical Practice.
[0105] The study was conducted with 5 healthy male volunteers.
Inclusion criteria were good health, as judged by physical
examination, age: 18 to 40 years, body mass index: 18 to 26
kg/m.sup.2, capability to reach peak inspiratory flow of I/sec
measured by a computer assisted spirometry and a FEV.sub.1 equal to
or greater than 80% of predicted normal (FEV.sub.1=forced
expiratory volume in one second). Exclusion criteria were Diabetes
mellitus type 1 or 2, prevalence of human insulin antibodies,
history of hypersensitivity to the study medication or to drugs
with similar chemical structures, history or severe or multiple
allergies, treatment with any other investigational drug in the
last 3 months before study entry, progressive fatal disease,
history of drug or alcohol abuse, current drug therapy with other
drugs, history significant cardiovascular, respiratory,
gastrointestinal, hepatic, renal, neurological, psychiatric and/or
hematological disease, ongoing respiratory tract infection or
subjects defined as being smokers with evidence or history of
tobacco or nicotine use.
[0106] Conduct of the Study
[0107] On the morning of the study days, the subjects came to the
hospital (fasting, except for water, from midnight onward) at 7:30
a.m. The subjects were restricted from excessive physical
activities and an intake of alcohol for 24 hours before each
treatment day. They were randomly assigned to one of the three
treatment arms. The subjects received a constant intravenous
regular human insulin infusion, which was kept at 0.15 mU
min.sup.-1 kg.sup.-1 so that serum insulin concentrations were
established at 10-15 U/ml during a period of 2 hours before time
point 0. This low-dose infusion was continued throughout the test
to suppress endogenous insulin secretion. Blood glucose was kept
constant at a level of 90 mg/dl throughout the glucose clamp by a
glucose controlled infusion system (BIOSTATOR.TM.). The glucose
clamp algorithm was based on the actual measured blood glucose
concentration and the grade of variability in the minutes before to
calculate the glucose infusion rates for keeping the blood glucose
concentration constant. The insulin application (5 U i.v. or 10 U
s.c. injection or three deep breaths inhalation per capsule (2
capsules with 50 U each) applied with a commercial inhalation
device (Boehringer Ingelheim)) had to be finished immediately
before time point 0. The duration of the clamp experiment was 6
hours from time point 0. Glucose infusion rates, blood glucose,
serum-insulin and C-peptide were measured.
[0108] Bioefficacy and Bioavailability
[0109] To determine bioefficacy, the areas under the curve of the
glucose infusion rates were calculated for the first 3 hours
(AUC.sub.0-180) after the administration and for the overall
observation period of six hours after the administration
(AUC.sub.0-360) and were correlated to the amount of insulin
applied. To determine bioavailability, the areas under the curve of
the insulin concentrations were calculated for the first 3 hours
(AUC.sub.0-180) after the administration and for the overall
observation period of six hours after the administration
(AUC.sub.0-360) and correlated to the amount of insulin
applied.
[0110] In this clamp study, inhalation of 100 U of
TECHNOSPHERE.TM./Insulin was well tolerated and was demonstrated to
have a substantial blood glucose lowering effect with a relative
bioavailability of 25.8% for the first three hours as calculated
from the achieved serum insulin concentrations. TECHNOSPHERES.TM.
are microparticles (also referred to herein as microspheres) formed
of diketopiperazine that of self-assembles into an ordered lattice
array at particular pHs, typically a low pH. They typically are
produced to have a mean diameter between about 1 and about 5 m.
[0111] Results
[0112] The pharmacokinetic results are illustrated in FIGS. 1 and 2
and in Table 1.
[0113] Efficacy Results
[0114] Inhalation of 100 U of TECHNOSPHERE.TM./Insulin (inhalation
of 100 U) revealed a peak of insulin concentration after 13 min
(intravenous (i.v.) (5U): 5 min, subcutaneous (s.c.) (10 U): 121
min) and a return of the insulin levels to baseline after 180 min
(i.v.: 60 min, s.c. 360 min). Biological action as measured by
glucose infusion rate peaked after 39 min (i.v. 14 min, s.c.: 163
min) and lasted for more than 360 min (i.v.: 240 min, s.c.: >360
min). Absolute bioavailability (comparison to i.v. application) was
14.6.+-.5.1% for the first 3 hours and 15.5.+-.5.6% for the first 6
hours. Relative bioavailability (comparison to s.c. application)
was 25.8.+-.11.7% for the first 3 hours and 16.4.+-.7.9% for the
first 6 hours.
TABLE-US-00001 TABLE 1 Pharmacokinetic Parameters Intravenous
Subcutaneous Administration Inhaled Administration Parameter
Calculated on Glucose Infusion Rate T50%* 9 min 13 min 60 min Tmax
14 min 39 min 163 min T-50%** 82 min 240 min 240 min T to baseline
240 min >360 min >360 min Parameter Calculated on Insulin
Levels T50%* 2 min 2.5 min 27 min Tmax 5 min 13 min 121 min T-50%**
6 min 35 min 250 min T to baseline 60 min 180 min 360 min *time
from baseline to half-maximal values **time from baseline to
half-maximal after passing Tmax
[0115] Safety Results
[0116] TECHNOSPHERE.TM./Insulin was shown to be safe in all
patients. One patient was coughing during the inhalation without
any further symptoms or signs of deterioration of the breathing
system.
[0117] Conclusions
[0118] Inhalation of 100 U of TECHNOSPHERE.TM./Insulin was well
tolerated and was demonstrated to have a substantial blood glucose
lowering effect with a relative bioavailability of 25.8% for the
first 3 hours as calculated from the achieved serum insulin
concentrations.
SUMMARY
[0119] In this study, the inhalation of TECHNOSPHERE.TM./Insulin
(the formulation of example 1) was demonstrated in healthy human
subjects to have a time-action profile with a rapid peak of insulin
concentration (Tmax: 13 min) and rapid onset of action (Tmax: 39
min) and a sustained action over more than 6 hours. The total
metabolic effect measured after inhalation of 100 U of
TECHNOSPHERE.TM./Insulin was larger than after subcutaneous
injection of 10 U of insulin. The relative bioefficacy of
TECHNOSPHERE.TM./Insulin was calculated to be 19.0%, while the
relative bioavailability was determined to be 25.8% in the first
three hours.
[0120] The data also show that inhalation of
TECHNOSPHERE.TM./Insulin resulted in a much more rapid onset of
action than s.c. insulin injection that was close to the onset of
action of i.v. insulin injection, while duration of action of
TECHNOSPHERE.TM./Insulin was comparable to that of s.c. insulin
injection.
[0121] The drug was well tolerated and no serious adverse events
were reported during the entire trial.
Example 3
Removal of Impurity from Proprietary Peptide
[0122] A proprietary peptide containing an impurity was trapped in
fumaryl diketopiperazine, forming a peptide/fumaryl
diketopiperazine precipitate. The precipitate was washed with water
to remove the impurity. The peptide is rather unstable and trapping
it in fumaryl diketopiperazine markedly improves its stability;
both as a dry powder and in aqueous suspension for injection.
Example 4
Stabilized Glucagon Formulations
[0123] Formulation
[0124] Glucagon was formulated under sterile conditions, into a
stabilized complex by precipitation in acidic solution with fumaryl
diketopiperazine
(3,6bis[N-fumaryl-N-(n-butyl)amino]-2,5-diketopiperazine). The
complex was washed and lyophilized, yielding a sterile dry powder
formulation of diketopiperazine/glucagon (hereinafter referred to
as "TG") containing from 1.2 to 8.2% glucagon by weight, depending
upon the formulation parameters desired (allowing physicians to
increase dose yet keep the volume constant). The TG powder was
suspended in an appropriate media suitable for subcutaneous
delivery in a MiniMed 507C infusion pump.
[0125] Stability Protocol
[0126] Glucagon and TG were suspended in infusion media and
incubated at 40.degree. C. in a water bath for varying amounts of
time up to 150 hours.
[0127] Glucagon HPLC Analysis
[0128] An adaptation of USP method for glucagon analysis was
employed. A Waters Symmetry Shield RP8 column (5 m, 3.9.times.150
mm) and guard RP8 column (5 m, 3.9.times.20 mm) were used at a flow
rate of 1 mL/min. and a detection wavelength of 214 nm. The
gradient method consisted of mobile phase A: 9.8 g NaH2PO.sub.4
(0.0816 M) and 170 mg L-cysteine (1.4 mM) per liter HPLC grade
water, adjusted pH to 2.6 with phosphoric acid; and B:
acetonitrile. Glucagon solutions were diluted as needed with water
and injected. TG samples were prepared by adding 1/10.sup.th volume
1 M Tris pH 10.0 to sample to solubilize the fumaryl
diketopiperazine.
[0129] Rat Study Protocol
[0130] Sprague Dawley rates 200-250 g were fasted overnight and
given subcutaneous injection of glucagon or TG (0.75 mg/kg) in an
appropriate media that had been held at 25.degree. C. for 0, 24, or
48 hours. Blood samples were taken at -10, -5, 0, 5, 10, 15, 20,
30, 45, and 60 minutes post dose and analyzed for blood glucose
(HemCue B-glucose analyzer, Hemocue AB, Angelholm Sweden). Mean
baseline was determined (pre-dose measurements) and was subtracted
from the subsequent data and plotted vs. time. This was done to
assure that the TG formulation, which appeared to not degrade
significantly, showed appropriate pharmacological activity.
[0131] Results
[0132] Following 40.degree. C. incubation, HPLC analysis showed an
increase in breakdown products in the glucagon preparation. By
contrast, TG has only one minor degradation peak (RT=6) which
correlated with the slightly less active oxidative form of
glucagon. Glucagon without diketopiperazine (i.e. without
TECHNOSPHERES.TM.) had many degradation peaks, some of which
contributed to an enhanced effect and others that reduced the
potency of glucagon.
[0133] The TG sterile lyophilized powder was shipped frozen to a
hospital, where it was re-suspended in sterile media. The material
re-suspended well and each vial was continuously infused over a 72
hour period.
[0134] Conclusion
[0135] Standard preparations of glucagon are not suitable for
regulation of blood glucose by continuous subcutaneous infusion.
Administration of such preparations containing variable amounts of
the deamidated and hydrolysed forms resulted in highly variable
blood glucose levels. Suspensions of TECHNOSPHERES.TM./glucagon,
which is stabilized, does not aggregate and contains clinically
irrelevant amounts of breakdown products. As such TG can be and has
been used as a therapy for hyperinsulinemia, providing consistent,
elevated glucose levels when administered subcutaneously over
time.
[0136] Modifications and variations of the present invention will
be obvious to those of skill in the art from the foregoing detailed
description. Such modifications and variations are intended to come
within the scope of the following claims.
* * * * *