U.S. patent application number 14/795825 was filed with the patent office on 2015-11-05 for controlled release auris sensory cell modulator compositions and methods for the treatment of otic disorders.
The applicant listed for this patent is Otonomy, Inc., The Regents of the University of California. Invention is credited to Luis A. Dellamary, Jeffrey P. Harris, Carl Lebel, Jay Lichter, Fabrice Piu, Andrew M. Trammel, Benedikt Vollrath, Qiang Ye.
Application Number | 20150313839 14/795825 |
Document ID | / |
Family ID | 41530500 |
Filed Date | 2015-11-05 |
United States Patent
Application |
20150313839 |
Kind Code |
A1 |
Lichter; Jay ; et
al. |
November 5, 2015 |
CONTROLLED RELEASE AURIS SENSORY CELL MODULATOR COMPOSITIONS AND
METHODS FOR THE TREATMENT OF OTIC DISORDERS
Abstract
Disclosed herein are compositions and methods for the treatment
of otic diseases or conditions with auris sensory cell modulating
agent compositions and formulations administered locally to an
individual afflicted with an otic disease or condition, through
direct application of these compositions and formulations onto or
via perfusion into the targeted auris structure(s).
Inventors: |
Lichter; Jay; (Rancho Santa
Fe, CA) ; Trammel; Andrew M.; (Olathe, KS) ;
Piu; Fabrice; (San Diego, CA) ; Ye; Qiang;
(San Diego, CA) ; Vollrath; Benedikt; (San Diego,
CA) ; Dellamary; Luis A.; (San Marcos, CA) ;
Lebel; Carl; (Malibu, CA) ; Harris; Jeffrey P.;
(La Jolla, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Otonomy, Inc.
The Regents of the University of California |
San Diego
Oakland |
CA
CA |
US
US |
|
|
Family ID: |
41530500 |
Appl. No.: |
14/795825 |
Filed: |
July 9, 2015 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14713944 |
May 15, 2015 |
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14795825 |
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13928157 |
Jun 26, 2013 |
9066855 |
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14713944 |
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12504553 |
Jul 16, 2009 |
8496957 |
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13928157 |
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61082450 |
Jul 21, 2008 |
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61083830 |
Jul 25, 2008 |
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61086094 |
Aug 4, 2008 |
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61094384 |
Sep 4, 2008 |
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61101112 |
Sep 29, 2008 |
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61140033 |
Dec 22, 2008 |
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61160233 |
Mar 13, 2009 |
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61164812 |
Mar 30, 2009 |
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61174421 |
Apr 30, 2009 |
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Current U.S.
Class: |
514/326 ;
514/772.7 |
Current CPC
Class: |
A61K 31/135 20130101;
A61K 31/137 20130101; A61K 47/32 20130101; A61K 47/34 20130101;
A61P 27/16 20180101; A61K 31/517 20130101; A61K 9/0046 20130101;
A61K 47/10 20130101; A61K 31/4535 20130101; A61K 31/47
20130101 |
International
Class: |
A61K 9/00 20060101
A61K009/00; A61K 31/4535 20060101 A61K031/4535; A61K 47/10 20060101
A61K047/10 |
Foreign Application Data
Date |
Code |
Application Number |
Apr 24, 2009 |
GB |
0907070.7 |
Claims
1-22. (canceled)
23. A method of treating a middle or inner ear disorder comprising
intratympanically administering to an individual in need thereof a
controlled release composition comprising a pharmaceutical agent
and a thermosetting polymer; wherein the pharmaceutical agent is
selected from uncoated NMDA receptor antagonists and is suspended
in the composition, and the thermosetting polymer has a gelation
temperature of between about 12.degree. C. to about 20.degree.
C.
24. The method of claim 23, wherein the thermosetting polymer is
polaxamer.
25. The method of claim 24, wherein the poloxamer is poloxamer
407.
26. The method of claim 25, wherein the poloxamer has a
concentration of about 20% w/w.
27. The method of claim 23, wherein the controlled release
composition provides controlled release of the pharmaceutical agent
for an extended period of time of one or more days.
28. The method of claim 23, wherein the pharmaceutical agent is
gacyclidine.
29. The method of claim 23, wherein the controlled release
composition further comprises a phosphate which buffers the pH of
the controlled release composition to a pH range of about
7.0-7.6.
30. The method of claim 23, wherein the controlled release
composition is contained in a syringe.
31. The method of claim 30, wherein a single dose of the controlled
release composition in the syringe is at least 50 .mu.L.
32. The method of claim 23, wherein the controlled release
composition is administered by injecting it into the middle
ear.
33. The method of claim 23, wherein the controlled release
composition is administered by injection or surgical
manipulation.
34. The method of claim 23, wherein the middle or inner ear
disorder is selected from the group consisting of tinnitus, hearing
loss, vertigo, Meniere's disease, infections, and inflammation.
35. The method of claim 23, wherein the inner ear disorder is
tinnitus.
36. A method of treating a middle or inner ear disorder comprising
intratympanically administering to an individual in need thereof a
controlled release composition comprising a pharmaceutical agent
and a thermosetting polymer; wherein the pharmaceutical agent is
selected from uncoated NMDA receptor antagonists and is suspended
in the composition, and the thermosetting polymer has a gelation
temperature of between about 12.degree. C. to about 20.degree. C.,
wherein the thermosetting polymer is poloxamer 407 and has a
concentration of about 20% (w/w), and wherein the pharmaceutical
agent is gacyclidine.
37. The method of claim 36, wherein the controlled release
composition provides controlled release of the pharmaceutical agent
for an extended period of time of one or more days.
38. The method of claim 36, wherein the controlled release
composition further comprises a phosphate which buffers the pH of
the controlled release composition to a pH range of about
7.0-7.6.
39. The method of claim 36, wherein the controlled release
composition is contained in a syringe.
40. The method of claim 39, wherein a single dose of the controlled
release composition in the syringe is at least 50 .mu.L.
41. The method of claim 36, wherein the controlled release
composition is administered by injecting it into the middle
ear.
42. The method of claim 36, wherein the controlled release
composition is administered by injection or surgical
manipulation.
43. The method of claim 36, wherein the middle or inner ear
disorder is selected from the group consisting of tinnitus, hearing
loss, vertigo, Meniere's disease, infections, and inflammation.
44. The method of claim 36, wherein the inner ear disorder is
tinnitus.
Description
CROSS-REFERENCE
[0001] This patent application is a continuation application of
U.S. application Ser. No. 14/713,944, filed May 15, 2015, which is
a continuation application of U.S. application Ser. No. 13/928,157,
filed Jun. 26, 2013, now patented as U.S. Pat. No. 9,066,855, which
is a continuation application of U.S. application Ser. No.
12/504,553, filed Jul. 16, 2009, now patented as U.S. Pat. No.
8,496,957, which claims the benefit of U.S. Provisional Application
Ser. No. 61/082,450 filed Jul. 21, 2008; U.S. Provisional
Application Ser. No. 61/083,830 filed Jul. 25, 2008; U.S.
Provisional Application Ser. No. 61/086,094, filed Aug. 4, 2008;
U.S. Provisional Application Ser. No. 61/094,384 filed Sep. 4,
2008; U.S. Provisional Application Ser. No. 61/101,112 filed Sep.
29, 2008; U.S. Provisional Application Ser. No. 61/140,033 filed
Dec. 22, 2008; U.S. Provisional Application Ser. No. 61/160,233,
filed Mar. 13, 2009; U.S. Provisional Application Ser. No.
61/164,812, filed Mar. 30, 2009; U.S. Provisional Application Ser.
No. 61/174,421 filed Apr. 30, 2009; and UK Patent Application No.
0907070.7, filed Apr. 24, 2009; all of which are incorporated by
reference herein in their entirety.
BACKGROUND OF THE INVENTION
[0002] Vertebrates have a pair of ears, placed symmetrically on
opposite sides of the head. The ear serves as both the sense organ
that detects sound and the organ that maintains balance and body
position. The ear is generally divided into three portions: the
outer ear, auris media (or middle ear) and the auris interna (or
inner ear).
SUMMARY OF THE INVENTION
[0003] Described herein are compositions, formulations,
manufacturing methods, therapeutic methods, uses, kits, and
delivery devices for the controlled release or delivery of at least
one auris sensory cell modulator to at least one structure or
region of the ear. In some embodiments, an auris sensory cell
modulator is an auris sensory cell damage agent. In some
embodiments, an auris sensory cell modulator is an auris sensory
cell death agent. In some embodiments, an auris sensory cell
modulator is an auris sensory cell protection agent (e.g., promotes
survival of auris sensory cells). In some embodiments, an auris
sensory cell modulator is an auris sensory cell growth/regeneration
agent. Disclosed herein are controlled release compositions for
treating or ameliorating hearing loss or reduction resulting from
destroyed, stunted, malfunctioning, damaged, fragile or missing
hairs in the inner ear. In one embodiment, the controlled release
composition comprises a therapeutically-effective amount of at
least one modulator of neuron and/or hair cells of the auris (also
known as "auris sensory cell modulating agent"), a controlled
release auris-acceptable excipient, and an auris-acceptable
vehicle.
[0004] In some embodiments, the target portion of the ear is the
middle ear or auris media. In other embodiments, the target portion
of the ear is the inner ear, or auris interna. In other
embodiments, the target portion of the ear is the middle ear, or
auris media. In still other embodiments, the target portion of the
ear is both the auris media and the auris interna. In some
embodiments, the controlled release formulations further comprise a
rapid or immediate release component for delivering an auris
sensory cell modulating agent to the auris media and/or the auris
interna. All formulations comprise excipients that are auris-media
and/or auris-interna acceptable.
[0005] Described herein are methods for inducing selective auris
sensory cell damage and/or death within the auris media or auris
interna comprising administration of the auris sensory cell
modulating agent controlled release formulations described herein.
Also described herein are methods for inducing auris sensory cell
growth and/or reversal of damage to auris sensory cells (e.g
stunted or malfunctioning auris sensory cells) and/or protection
against further damage to auris sensory cells (e.g stunted or
malfunctioning auris sensory cells) comprising administration of
the auis sensory cell modulating agent compositions described
herein.
[0006] Also disclosed herein are methods for the treatment of otic
disorders comprising administration of auris sensory cell
modulating agent controlled release formulations. In some
embodiments, the auris sensory cell modulating agent is a toxicant
(e.g., gentamicin) and induces cell death. In some embodiments, the
auris sensory cell modulating agent is an otoprotectant, e.g.,
amifostine, an antioxidant, or the like. In some embodiments, the
auris sensory cell modulating agent induces growth of new auris
sensory cells, e.g., an adenovirus expressing Atoh1. In some
embodiments, the auris sensory cell modulating is an agent that
reduces or inhibits auris sensory cell death, e.g., a glutamate
receptor modulator.
[0007] In some embodiments, a glutamate receptor modulator is a
glutatmate receptor antagonist. In some embodiments, a glutamate
receptor antagonist is an NMDA receptor antagonist. In some
embodiments, the agent that modulates the NMDA receptor is an NMDA
receptor antagonist. In some embodiments, an auris sensory cell
modulating agent is a trophic agent (e.g., an agent that promotes
growth of healthy cells and/or tissue). In some embodiments, a
trophic agent is a growth factor. In some embodiments, a growth
factor is brain-derived neurotrophic factor (BDNF), ciliary
neurotrophic factor (CNTF), glial cell-line derived neurotrophic
factor (GDNF), neurotrophin-3, neurotrophin-4, fibroblast growth
factor (FGF), insulin-like growth factor (IGF) or the like and/or
combinations thereof. In some embodiments, the auris sensory cell
modulating agent is an agent that has a protective effect, e.g.,
immune system cells that reduce inflammation and/or infections. In
some embodiments, the immune system cells are macrophages,
microglia, and/or microglia-like cells. In some embodiments, the
auris sensory cell modulating agent is a Na+ channel blocker and
reduces or inhibits auris sensory cell damage and/or death. In some
embodiments, the auris sensory cell modulating agent is an
otoprotectant, e.g., a corticosteroid that reduces, delays or
reverses damage to auris sensory cells. In some embodiments, the
auris sensory cell modulating agent is an ototoxic agent or a
toxicant that causes auris sensory cell death. In some embodiments,
the auris sensory cell modulating agent is a modulator of pRB. In
some embodiments, the auris sensory cell modulating agent is a
modulator of a TH receptor. In some embodiments, the auris sensory
cell modulating agent is an adenovirus expressing a BRN3. In some
embodiments, the auris sensory cell modulating agent is an agonist
of a BRN3. In some embodiments, the auris sensory cell modulating
agent is an antagonist of a BRN3. In some embodiments, the auris
sensory cell modulating agent is a stem cell and/or differentiated
auris sensory cell that promotes growth and/or regeneration of
auris sensory cells.
[0008] In some embodiments, the composition further comprises an
auris sensory cell modulating agent as an immediate release agent
wherein the immediate release auris sensory cell modulating agent
is the same agent as the controlled-release agent, a different
auris sensory cell modulating agent, an additional therapeutic
agent, or a combination thereof.
[0009] In some embodiments, the composition further comprises an
additional therapeutic agent. In some embodiments, the additional
therapeutic agent is an anesthetic, a local acting anesthetic, an
analgesic, an antibiotic, an antiemetic, an antifungal, an
anti-microbial agent, an antiseptic, an antiviral, a
chemotherapeutic agent, a diuretic, a keratolytic agent, an
otoprotectant (e.g., a steroid), an immunosuppressant comprising
but not limited to such agents as calcineurin inhibitors
(cyclosporine, tacrolimus, pimecrolimus), macrolides such as
rapamycin, corticosteroids, or combinations thereof. In some
embodiments, the additional therapeutic agent is an immediate
release agent. In some embodiments, the additional therapeutic
agent is a controlled release agent.
[0010] Disclosed herein are controlled release formulations for
delivering an auris sensory cell modulating agent to the ear. In
some embodiments, the composition is administered so that the
composition is in contact with the crista fenestrae cochleae, the
round window or the tympanic cavity.
[0011] The auris formulations and therapeutic methods described
herein have numerous advantages that overcome the
previously-unrecognized limitations of formulations and therapeutic
methods described in prior art.
[0012] Sterility
[0013] The environment of the inner ear is an isolated environment.
The endolymph and the perilymph are static fluids and are not in
contiguous contact with the circulatory system. The
blood--labyrinth--barrier (BLB), which includes a blood-endolymph
barrier and a blood-perilymph barrier, consists of tight junctions
between specialized epithelial cells in the labyrinth spaces (i.e.,
the vestibular and cochlear spaces). The presence of the BLB limits
delivery of active agents (e.g., auris sensory cell modulating
agents) to the isolated microenvironment of the inner ear. Auris
hair cells are bathed in endolymphatic or perilymphatic fluids and
cochlear recycling of potassium ions is important for hair cell
function. When the inner ear is infected, there is an influx of
leukocytes and/or immunoglobins (e.g. in response to a microbial
infection) into the endolymph and/or the perilymph and the delicate
ionic composition of inner ear fluids is upset by the influx of
leukocytes and/or immunoglobins. In certain instances, a change in
the ionic composition of inner ear fluids results in hearing loss,
loss of balance and/or ossification of auditory structures. In
certain instances, even trace amounts of pyrogens and/or microbes
can trigger infections and related physiological changes in the
isolated microenvironment of the inner ear.
[0014] Due to the susceptibilty of the inner ear to infections,
auris formulations require a level of sterility (e.g., low
bioburden) that has not been recognized hitherto in prior art.
Provided herein are auris formulations that are manufactured with
low bioburden or sterilized with stringent sterilty requirements
and are suitable for administration to the middle and/or inner ear.
In some embodiments, the auris compatible compositions described
herein are substantially free of pyrogens and/or microbes.
[0015] Compatibility with Inner Ear Environment
[0016] Described herein are otic formulations with an ionic balance
that is compatible with the perilymph and/or the endolymph and does
not cause any change in cochlear potential. In specific
embodiments, osmolarity/osmolality of the present formulations is
adjusted, for example, by the use of appropriate salt
concentrations (e.g., concentration of sodium salts) or the use of
tonicity agents which renders the formulations endolymph-compatible
and/or perilymph-compatible (i.e. isotonic with the endolymph
and/or perilymph). In some instances, the endolymph-compatible
and/or perilymph-compatible formulations described herein cause
minimal disturbance to the environment of the inner ear and cause
minimum discomfort (e.g, vertigo) to a mammal (e.g., a human) upon
administration. Further, the formulations comprise polymers that
are biodegradable and/or dispersable, and/or otherwise non-toxic to
the inner ear environment. In some embodiments, the formulations
described herein are free of preservatives and cause minimal
disturbance (e.g., change in pH or osmolarity, irritation) in
auditory structures. In some embodiments, the formulations
described herein comprise antioxidants that are non-irritating
and/or non-toxic to otic structures.
[0017] Dosing Frequency
[0018] The current standard of care for auris formulations requires
multiple administrations of drops or injections (e.g. intratympanic
injections) over several days (e.g., up to two weeks), including
schedules of receiving multiple injections per day. In some
embodiments, auris formulations described herein are controlled
release formulations, and are administered at reduced dosing
frequency compared to the current standard of care. In certain
instances, when an auris formulation is administered via
intratympanic injection, a reduced frequency of administration
alleviates discomfort caused by multiple intratympanic injections
in individuals undergoing treatment for a middle and/or inner ear
disease, disorder or condition. In certain instances, a reduced
frequency of administration of intratympanic injections reduces the
risk of permanent damage (e.g., perforation) to the ear drum. The
formulations described herein provide a constant, sustained,
extended, delayed or pulsatile rate of release of an active agent
into the inner ear environment and thus avoid any variability in
drug exposure in treatment of otic disorders.
[0019] Therapeutic Index
[0020] Auris formulations described herein are administered into
the ear canal, or in the vestibule of the ear. Access to, for
example, the vestibular and cochlear apparatus will occur through
the auris media including the round window membrane, the oval
window/stapes footplate, the annular ligament and through the otic
capsule/temporal bone. Otic administration of the formulations
described herein avoids toxicity associated with systemic
administration (e.g., hepatotoxicity, cardiotoxicity,
gastrointestinal side effects, renal toxicity) of the active
agents. In some instances, localized administration in the ear
allows an active agent to reach a target organ (e.g., inner ear) in
the absence of systemic accumulation of the active agent. In some
instances, local administration to the ear provides a higher
therapeutic index for an active agent that would otherwise have
dose-limiting systemic toxicity.
[0021] Prevention of Drainage into Eustachian Tube
[0022] In some instances, a disadvantage of liquid formulations is
their propensity to drip into the eustachian tube and cause rapid
clearance of the formulation from the inner ear. Provided herein,
in certain embodiments, are auris formulations comprising polymers
that gel at body temperature and remain in contact with the target
auditory surfaces (e.g., the round window) for extended periods of
time. In some embodiments, the formulations further comprise
mucoadhesives that allow the formulations to adhere to otic mucosal
surfaces. In some instances, the auris formulations described
herein avoid attenuation of therapeutic benefit due to drainage or
leakage of active agents via the eustachian tube.
Description of Certain Embodiments
[0023] Described herein are controlled release compositions and
devices for treating otic disorders comprising a
therapeutically-effective amount of an auris sensory cell
modulating agent, a controlled release auris-acceptable excipient
and an auris-acceptable vehicle. In one aspect, the controlled
release auris-acceptable excipient is chosen from an
auris-acceptable polymer, an auris-acceptable viscosity enhancing
agent, an auris-acceptable gel, an auris-acceptable paint, an
auris-acceptable foam, an auris-acceptable microsphere or
microparticle, an auris-acceptable hydrogel, an auris-acceptable in
situ forming spongy material, an auris-acceptable actinic radiation
curable gel, an auris-acceptable liposome, an auris-acceptable
nanocapsule or nanosphere, an auris-acceptable thermoreversible gel
or combinations thereof. In further embodiments, the
auris-acceptable viscosity enhancing agent is a cellulose, a
cellulose ether, alginate, polyvinylpyrrolidone, a gum, a
cellulosic polymer or combinations thereof. In yet another
embodiment, the auris-acceptable viscosity enhancing agent is
present in an amount sufficient to provide a viscosity of between
about 1000 to about 1,000,000 centipoise. In still another aspect,
the auris-acceptable viscosity enhancing agent is present in an
amount sufficient to provide a viscosity of between about 50,000 to
about 1,000,000 centipoise. In some embodiments, the auris sensory
cell modulating agent formulations or compositions are optimal for
osmolality or osmolarity of the target auris structure to ensure
homeostasis is maintained.
[0024] In some embodiments, the compositions are formulated for pH,
and a practical osmolality or osmolarity to ensure that homeostasis
of the target auris structure is maintained. A perilymph-suitable
osmolarity/osmolality is a practical/deliverable
osmolarity/osmolality that maintains the homeostasis of the target
auris structure during administration of the pharmaceutical
formulations described herein.
[0025] For example, the osmolarity of the perilymph is between
about 270-300 mOsm/L, and the compositions described herein are
optionally formulated to provide a practical osmolarity of about
150 to about 1000 mOsm/L. In certain embodiments, the formulations
described herein provide a practical and/or deliverable osmolarity
within about 150 to about 500 mOsm/L at the target site of action
(e.g., the inner ear and/or the perilymph and/or the endolymph). In
certain embodiments, the formulations described herein provide a
practical osmolarity within about 200 to about 400 mOsm/L at the
target site of action (e.g., the inner ear and/or the perilymph
and/or the endolymph). In certain embodiments, the formulations
described herein provide a practical osmolarity within about 250 to
about 320 mOsm/L at the target site of action (e.g., the inner ear
and/or the perilymph and/or the endolymph). In certain embodiments,
the formulations described herein provide a perilymph-suitable
osmolarity within about 150 to about 500 mOsm/L, about 200 to about
400 mOsm/L or about 250 to about 320 mOsm/L at the target site of
action (e.g., the inner ear and/or the perilymph and/or the
endolymph). In certain embodiments, the formulations described
herein provide a perilymph-suitable osmolality within about 150 to
about 500 mOsm/kg, about 200 to about 400 mOsm/kg or about 250 to
about 320 mOsm/kg at the target site of action (e.g., the inner ear
and/or the perilymph and/or the endolymph). Similarly, the pH of
the perilymph is about 7.2-7.4, and the pH of the present
formulations is formulated (e.g., with the use of buffers) to
provide a perilymph-suitable pH of about 5.5 to about 9.0, about
6.0 to about 8.0 or about 7.0 to about 7.6. In certain embodiments,
the pH of the formulations is within about 6.0 to about 7.6. In
certain instances, the pH of the endolymph is about 7.2-7.9, and
the pH of the present formulations is formulated (e.g., with the
use of buffers) to be within about 5.5 to about 9.0, within about
6.5 to about 8.0 or within about 7.0 to about 7.6.
[0026] In some aspects, the controlled-release auris-acceptable
excipient is biodegradable. In some aspects the controlled release
auris-acceptable excipient is bioeliminated (e.g., degraded and/or
eliminated through urine, feces or other routes of elimination). In
another aspect, the controlled release composition further
comprises an auris-acceptable mucoadhesive, an auris-acceptable
penetration enhancer or an auris-acceptable bioadhesive.
[0027] In one aspect, the controlled release auris sensory cell
modulating agent composition is delivered using a drug delivery
device, which is a needle and syringe, a pump, a microinjection
device or combinations thereof. In some embodiments, the auris
sensory cell modulating agent of the controlled release composition
has limited or no systemic release, is toxic when administered
systemically, has poor pK characteristics or combinations thereof.
In some aspects, the auris sensory cell modulating agent is a small
molecule agent. In other aspects, the auris sensory cell modulating
agent is an antibody.
[0028] Also disclosed herein is a method for treating an otic
disorder comprising administering at least once every 3, 4, 5, 6,
7, 8, 9, 10, 11, 12, 13, 14, or 15 days, at least once a week, once
every two weeks, once every three weeks, once every four weeks,
once every five weeks, or once every six weeks; or once a month,
once every two months, once every three months, once every four
months, once every five months, once every six months, once every
seven months, once every eight months, once every nine months, once
every ten months, once every eleven months, or once every twelve
months with the compositions and formulations disclosed herein. In
particular embodiments, the controlled release formulations
described herein provide a sustained dose of auris sensory cell
modulating agent to the inner ear between subsequent doses of the
controlled release formulation. That is, taking one example only,
if new doses of the auris sensory cell modulating agent controlled
release formulation are adminstered via intratympanic injection to
the round window membrane every 10 days, then the controlled
release formulation provides an effective dose of auris sensory
cell modulating agent to the inner ear (e.g., across the round
window membrane) during that 10-day period.
[0029] In one aspect, the composition is administered so that the
composition is in contact with the crista fenestrae cochleae, the
round window membrane or the tympanic cavity. In one aspect the
composition is administered by intratympanic injection.
[0030] Provided herein, in some embodiments, are methods of
selectively inducing auris sensory cell damage comprising
administering to an individual in need thereof an intratympanic
composition or device comprising a therapeutically effective amount
of an ototoxic agent, the composition or device comprising
substantially low degradation products of the ototoxic agent, the
composition or device further comprising two or more
characteristics selected from: [0031] (i) between about 0.1% to
about 10% by weight of the ototoxic agent, or pharmaceutically
acceptable prodrug or salt thereof; [0032] (ii) between about 14%
to about 21% by weight of a polyoxyethylene-polyoxypropylene
triblock copolymer of general formula E106 P70 E106; [0033] (iii)
sterile water, q.s., buffered to provide a pH between about 5.5 and
about 8.0; [0034] (iv) multiparticulate ototoxic agent; [0035] (v)
a gelation temperature between about 19.degree. C. to about
42.degree. C.; [0036] (vi) less than about 50 colony forming units
(cfu) of microbiological agents per gram of formulation; [0037]
(vii) less than about 5 endotoxin units (EU) per kg of body weight
of a subject; [0038] (viii) a mean dissolution time of about 30
hours for the ototoxic agent; and [0039] (ix) an apparent viscosity
of about 100,000 cP to about 500,000 cP.
[0040] In some embodiments of the methods, the ototoxic agent is
released from the composition or device for a period of at least 3
days. In some embodiments of the methods, the ototoxic agent is
released from the composition or device for a period of at least 5
days. In some embodiments of the methods, the ototoxic agent is
essentially in the form of micronized particles.
[0041] Also provided herein are methods of inducing auris sensory
cell growth comprising administering to an individual in need
thereof an intratympanic composition or device comprising a
therapeutically effective amount of a trophic agent, the
composition or device comprising substantially low degradation
products of the trophic agent, the composition or device further
comprising two or more characteristics selected from: [0042] (i)
between about 0.1% to about 10% by weight of the trophic agent, or
pharmaceutically acceptable prodrug or salt thereof; [0043] (ii)
between about 14% to about 21% by weight of a
polyoxyethylene-polyoxypropylene triblock copolymer of general
formula E106 P70 E106; [0044] (iii) sterile water, q.s., buffered
to provide a pH between about 5.5 and about 8.0; [0045] (iv)
multiparticulate trophic agent; [0046] (v) a gelation temperature
between about 19.degree. C. to about 42.degree. C.; [0047] (vi)
less than about 50 colony forming units (cfu) of microbiological
agents per gram of formulation; [0048] (vii) less than about 5
endotoxin units (EU) per kg of body weight of a subject; [0049]
(viii) a mean dissolution time of about 30 hours for the trophic
agent; and [0050] (ix) an apparent viscosity of about 100,000 cP to
about 500,000 cP.
[0051] In some embodiments of the methods, the trophic agent is
released from the composition or device for a period of at least 3
days. In some embodiments of the methods, the trophic agent is
released from the composition or device for a period of at least 5
days. In some embodiments of the methods, the trophic agent is
essentially in the form of micronized particles.
[0052] Also provided herein are methods of alleviating damage to
auris sensory cells from an otic intervention comprising
administering to an individual in need thereof an intratympanic
composition or device comprising a therapeutically effective amount
of an otoprotectant, the composition or device comprising
substantially low degradation products of the otoprotectant, the
composition or device further comprising two or more
characteristics selected from: [0053] (i) between about 0.1% to
about 10% by weight of the otoprotectant, or pharmaceutically
acceptable prodrug or salt thereof; [0054] (ii) between about 14%
to about 21% by weight of a polyoxyethylene-polyoxypropylene
triblock copolymer of general formula E106 P70 E106; [0055] (iii)
sterile water, q.s., buffered to provide a pH between about 5.5 and
about 8.0; [0056] (iv) multiparticulate otoprotectant agent; [0057]
(v) a gelation temperature between about 19.degree. C. to about
42.degree. C.; [0058] (vi) less than about 50 colony forming units
(cfu) of microbiological agents per gram of formulation; [0059]
(vii) less than about 5 endotoxin units (EU) per kg of body weight
of a subject; [0060] (viii) a mean dissolution time of about 30
hours for the otoprotectant agent; and [0061] (ix) an apparent
viscosity of about 100,000 cP to about 500,000 cP.
[0062] In some embodiments of the methods, the otoprotectant is
administered before or during an otic intervention. In some
embodiments of the methods, the otoprotectant is administered after
an otic intervention. In some embodiments of the methods, the
otoprotectant is essentially in the form of micronized
particles.
[0063] In some embodiments of the methods described above, the
composition or device comprises: [0064] (i) between about 0.1% to
about 10% by weight of the auris sensory cell modulating agent, or
pharmaceutically acceptable prodrug or salt thereof; [0065] (ii)
between about 14% to about 21% by weight of a
polyoxyethylene-polyoxypropylene triblock copolymer of general
formula E106 P70 E106; [0066] (iii) multiparticulate auris sensory
cell modulating agent; [0067] (iv) a gelation temperature between
about 19.degree. C. to about 42.degree. C.; and [0068] (v) an
apparent viscosity of about 100,000 cP to about 500,000 cP.
[0069] In some embodiments of the methods described above, the
composition or device comprises: [0070] (i) between about 0.1% to
about 10% by weight of the auris sensory cell modulating agent, or
pharmaceutically acceptable prodrug or salt thereof; [0071] (ii)
between about 14% to about 21% by weight of a
polyoxyethylene-polyoxypropylene triblock copolymer of general
formula E106 P70 E106; [0072] (iii) multiparticulate auris sensory
cell modulating agent; [0073] (iv) a gelation temperature between
about 19.degree. C. to about 42.degree. C.; and [0074] (v) a mean
dissolution time of about 30 hours for the auris sensory cell
modulating agent.
[0075] In some embodiments of the methods described above, the
auris sensory cell modulating agent is released from the
composition or device for a period of at least 3 days. In some
embodiments of the methods described above, the auris sensory cell
modulating agent is released from the composition or device for a
period of at least 5 days. In some embodiments of the methods
described above, the auris sensory cell modulating agent is
released from the composition or device for a period of at least 10
days. In some embodiments of the method described above, the auris
sensory cell modulating agent is essentially in the form of
micronized particles.
[0076] In some embodiments of the methods described herein, the
composition is administered across the round window. In some
embodiments, the otic and/or vestibular disorder is ototoxicity,
chemotherapy-induced hearing loss, sensorineural hearing loss,
noise induced hearing loss, excitotoxicity, Meniere's
Disease/Syndrome, endolymphatic hydrops, labyrinthitis, Ramsay
Hunt's Syndrome, vestibular neuronitis, tinnitus or microvascular
compression syndrome.
[0077] Provided herein are pharmaceutical compositions or devices
comprising an amount of an ototoxic agent that is therapeutically
effective for treating an otic disease or condition comprising
substantially low degradation products of the ototoxic agent, the
pharmaceutical composition or device further comprising two or more
characteristics selected from: [0078] (i) between about 0.1% to
about 10% by weight of the ototoxic agent, or pharmaceutically
acceptable prodrug or salt thereof; [0079] (ii) between about 14%
to about 21% by weight of a polyoxyethylene-polyoxypropylene
triblock copolymer of general formula E106 P70 E106; [0080] (iii)
sterile water, q.s., buffered to provide a pH between about 5.5 and
about 8.0; [0081] (iv) multiparticulate ototoxic agent; [0082] (v)
a gelation temperature between about 19.degree. C. to about
42.degree. C.; [0083] (vi) less than about 50 colony forming units
(cfu) of microbiological agents per gram of formulation; [0084]
(vii) less than about 5 endotoxin units (EU) per kg of body weight
of a subject; [0085] (viii) a mean dissolution time of about 30
hours for the ototoxic agent; and [0086] (ix) an apparent viscosity
of about 100,000 cP to about 500,000 cP.
[0087] In some embodiments, the pharmaceutical composition or
device comprises: [0088] (i) between about 0.1% to about 10% by
weight of the ototoxic agent, or pharmaceutically acceptable
prodrug or salt thereof; [0089] (ii) between about 14% to about 21%
by weight of a polyoxyethylene-polyoxypropylene triblock copolymer
of general formula E106 P70 E106; [0090] (iii) multiparticulate
ototoxic agent; [0091] (iv) a gelation temperature between about
19.degree. C. to about 42.degree. C.; [0092] (v) an apparent
viscosity of about 100,000 cP to about 500,000 cP.
[0093] In some embodiments, the pharmaceutical composition or
device comprises: [0094] (i) between about 0.1% to about 10% by
weight of the ototoxic agent, or pharmaceutically acceptable
prodrug or salt thereof; [0095] (ii) between about 14% to about 21%
by weight of a polyoxyethylene-polyoxypropylene triblock copolymer
of general formula E106 P70 E106; [0096] (iii) multiparticulate
ototoxic agent; [0097] (iv) a gelation temperature between about
19.degree. C. to about 42.degree. C.; [0098] (v) an apparent
viscosity of about 100,000 cP to about 500,000 cP.
[0099] In some embodiments, the pharmaceutical composition or
device comprising an ototoxic agent provides a practical osmolarity
between about 200 and 400 mOsm/L. In some embodiments, the
pharmaceutical composition or device comprising an ototoxic agent
provides a practical osmolarity between about 250 and 320
mOsm/L.
[0100] In some embodiments, an ototoxic agent is released from the
composition or device for a period of at least 3 days. In some
embodiments, an ototoxic agent is released from the composition or
device for a period of at least 5 days. In some embodiments, the
pharmaceutical composition or device comprising an ototoxic agent
is an auris-acceptable thermoreversible gel. In some embodiments,
the pharmaceutical composition or device comprises the ototoxic
agent as essentially in the form of micronized particles.
[0101] Provided herein are pharmaceutical compositions or devices
comprising an amount of a trophic agent that is therapeutically
effective for treating an otic disease or condition comprising
substantially low degradation products of the trophic agent, the
pharmaceutical composition or device further comprising two or more
characteristics selected from: [0102] (i) between about 0.1% to
about 10% by weight of the trophic agent, or pharmaceutically
acceptable prodrug or salt thereof; [0103] (ii) between about 14%
to about 21% by weight of a polyoxyethylene-polyoxypropylene
triblock copolymer of general formula E106 P70 E106; [0104] (iii)
sterile water, q.s., buffered to provide a pH between about 5.5 and
about 8.0; [0105] (iv) multiparticulate trophic agent; [0106] (v) a
gelation temperature between about 19.degree. C. to about
42.degree. C.; [0107] (vi) less than about 50 colony forming units
(cfu) of microbiological agents per gram of formulation; [0108]
(vii) less than about 5 endotoxin units (EU) per kg of body weight
of a subject; [0109] (viii) a mean dissolution time of about 30
hours for the trophic agent; and [0110] (ix) an apparent viscosity
of about 100,000 cP to about 500,000 cP.
[0111] In some embodiments, the pharmaceutical composition or
device comprises: [0112] (i) between about 0.1% to about 10% by
weight of the trophic agent, or pharmaceutically acceptable prodrug
or salt thereof; [0113] (ii) between about 14% to about 21% by
weight of a polyoxyethylene-polyoxypropylene triblock copolymer of
general formula E106 P70 E106; [0114] (iii) multiparticulate
trophic agent; [0115] (iv) a gelation temperature between about
19.degree. C. to about 42.degree. C.; [0116] (viii) a mean
dissolution time of about 30 hours for the trophic agent; and
[0117] (ix) an apparent viscosity of about 100,000 cP to about
500,000 cP.
[0118] In some embodiments, the pharmaceutical composition or
device comprising a trophic agent provides a practical osmolarity
between about 200 and 400 mOsm/L. In some embodiments, the
pharmaceutical composition or device comprising a trophic agent
provides a practical osmolarity between about 250 and 320 mOsm/L.
In some embodiments, the trophic agent is released from the
composition or device for a period of at least 3 days. In some
embodiments, the trophic agent is released from the composition or
device for a period of at least 5 days.
[0119] In some embodiments, the pharmaceutical composition or
device comprising a trophic agent is an auris-acceptable
thermoreversible gel. In some embodiments, the pharmaceutical
composition or device comprises the trophic agent as essentially in
the form of micronized particles.
[0120] In some embodiments any composition or device described
above comprises: [0121] (i) between about 0.1% to about 10% by
weight of the auris sensory cell modulating agent, or
pharmaceutically acceptable prodrug or salt thereof; [0122] (ii)
between about 14% to about 21% by weight of a
polyoxyethylene-polyoxypropylene triblock copolymer of general
formula E106 P70 E106; [0123] (iii) multiparticulate auris sensory
cell modulating agent; [0124] (iv) a gelation temperature between
about 19.degree. C. to about 42.degree. C.; and [0125] (v) a mean
dissolution time of about 30 hours for the auris sensory cell
modulating agent.
[0126] In some embodiments, any pharmaceutical composition or
device described above comprises substantially low degradation
products of the auris sensory cell modulating agent.
[0127] In some embodiments a pharmaceutical composition or device
described above provides a practical osmolarity between about 150
and 500 mOsm/L. In some embodiments a pharmaceutical composition or
device described above provides a practical osmolarity between
about 200 and 400 mOsm/L. In some embodiments a pharmaceutical
composition or device described above provides a practical
osmolarity between about 250 and 320 mOsm/L.
[0128] In some embodiments, the auris sensory cell modulating agent
is released from the pharmaceutical composition or device described
above for a period of at least 3 days. In some embodiments, the
auris sensory cell modulating agent is released from the
pharmaceutical composition or device described above for a period
of at least 5 days. In some embodiments, the auris sensory cell
modulating agent is released from the pharmaceutical composition or
device described above for a period of at least 10 days. In some
embodiments, the auris sensory cell modulating agent is released
from the pharmaceutical composition or device described above for a
period of at least 14 days. In some embodiments, the auris sensory
cell modulating agent is released from the pharmaceutical
composition or device described above for a period of at least one
month.
[0129] In some embodiments, a pharmaceutical composition or device
described above comprises auris sensory cell modulating agent as a
neutral compound, a free acid, a free base, a salt or a prodrug. In
some embodiments, a pharmaceutical composition or device described
above comprises auris sensory cell modulating agent as a neutral
compound, a free acid, a free base, a salt or a prodrug, or a
combination thereof. In some embodiments of the pharmaceutical
compositions or devices described herein, the auris sensory cell
modulating agent is administered in the form of an ester
prodrug.
[0130] In some embodiments, a pharmaceutical composition or device
described above is an auris-acceptable thermoreversible gel. In
some embodiments of the pharmaceutical composition or device, the
polyoxyethylene-polyoxypropylene triblock copolymer is
bioeliminated.
[0131] In some embodiments the pharmaceutical composition or device
further comprises a penetration enhancer. In some embodiments, the
pharmaceutical composition or device further comprises a dye.
[0132] In some embodiments, the pharmaceutical composition or
device further comprises the auris sensory cell modulating agent,
or pharmaceutically acceptable salt thereof, prodrug or combination
thereof as an immediate release agent.
[0133] In some embodiments of the pharmaceutical composition or
device the auris sensory cell modulating agent comprises
multiparticulates. In some embodiments of the pharmaceutical
composition or device the auris sensory cell modulating agent is
essentially in the form of micronized particles. In some
embodiments of the pharmaceutical composition or device, the auris
sensory cell modulating agent is in the form of micronized auris
sensory cell modulating agent powder.
[0134] In some embodiments, a pharmaceutical composition or device
described above comprises about 10% of a
polyoxyethylene-polyoxypropylene triblock copolymer of general
formula E106 P70 E106 by weight of the composition. In some
embodiments, a pharmaceutical composition or device described above
comprises about 15% of a polyoxyethylene-polyoxypropylene triblock
copolymer of general formula E106 P70 E106 by weight of the
composition. In some embodiments, a pharmaceutical composition or
device described above comprises about 20% of a
polyoxyethylene-polyoxypropylene triblock copolymer of general
formula E106 P70 E106 by weight of the composition. In some
embodiments, a pharmaceutical composition or device described above
comprises about 25% of a polyoxyethylene-polyoxypropylene triblock
copolymer of general formula E106 P70 E106 by weight of the
composition.
[0135] In some embodiments, a pharmaceutical composition or device
described above comprises about 0.01% of an auris sensory cell
modulating agent, or pharmaceutically acceptable prodrug or salt
thereof, by weight of the composition. In some embodiments, a
pharmaceutical composition or device described above comprises
about 0.05% of an auris sensory cell modulating agent, or
pharmaceutically acceptable prodrug or salt thereof, by weight of
the composition. In some embodiments, a pharmaceutical composition
or device described above comprises about 0.1% of an auris sensory
cell modulating agent, or pharmaceutically acceptable prodrug or
salt thereof, by weight of the composition. In some embodiments, a
pharmaceutical composition or device described above comprises
about 1% of an auris sensory cell modulating agent, or
pharmaceutically acceptable prodrug or salt thereof, by weight of
the composition. In some embodiments, a pharmaceutical composition
or device described above comprises about 2.5% of an auris sensory
cell modulating agent, or pharmaceutically acceptable prodrug or
salt thereof, by weight of the composition. In some embodiments, a
pharmaceutical composition or device described above comprises
about 5% of an auris sensory cell modulating agent, or
pharmaceutically acceptable prodrug or salt thereof, by weight of
the composition. In some embodiments, a pharmaceutical composition
or device described above comprises about 10% of an auris sensory
cell modulating agent, or pharmaceutically acceptable prodrug or
salt thereof, by weight of the composition. In some embodiments, a
pharmaceutical composition or device described above comprises
about 20% of an auris sensory cell modulating agent, or
pharmaceutically acceptable prodrug or salt thereof, by weight of
the composition. In some embodiments, a pharmaceutical composition
or device described above comprises about 30% of an auris sensory
cell modulating agent, or pharmaceutically acceptable prodrug or
salt thereof, by weight of the composition. In some embodiments, a
pharmaceutical composition or device described above comprises
about 40% of an auris sensory cell modulating agent, or
pharmaceutically acceptable prodrug or salt thereof, by weight of
the composition. In some embodiments, a pharmaceutical composition
or device described above comprises up to about 50% of an auris
sensory cell modulating agent, or pharmaceutically acceptable
prodrug or salt thereof, by weight of the composition.
[0136] In some embodiments, a pharmaceutical composition or device
described above has a pH between about 5.5 to about 8.0. In some
embodiments, a pharmaceutical composition or device described above
has a pH between about 6.0 to about 8.0. In some embodiments, a
pharmaceutical composition or device described above has a pH
between about 6.0 to about 7.6. In some embodiments, a
pharmaceutical composition or device described above has a pH
between about 7.0 to about 7.6.
[0137] In some embodiments, a pharmaceutical composition or device
described above contains less than 100 colony forming units (cfu)
of microbiological agents per gram of formulation. In some
embodiments, a pharmaceutical composition or device described above
contains less than 50 colony forming units (cfu) of microbiological
agents per gram of formulation. In some embodiments, a
pharmaceutical composition or device described above contains less
than 10 colony forming units (cfu) of microbiological agents per
gram of formulation.
[0138] In some embodiments, a pharmaceutical composition or device
described above contains less than 5 endotoxin units (EU) per kg of
body weight of a subject. In some embodiments, a pharmaceutical
composition or device described above contains less than 4
endotoxin units (EU) per kg of body weight of a subject.
[0139] In some embodiments a pharmaceutical composition or device
described above provides a gelation temperature between about
between about 19.degree. C. to about 42.degree. C. In some
embodiments a pharmaceutical composition or device described above
provides a gelation temperature between about between about
19.degree. C. to about 37.degree. C. In some embodiments a
pharmaceutical composition or device described above provides a
gelation temperature between about between about 19.degree. C. to
about 30.degree. C.
[0140] In some embodiments, the pharmaceutical composition or
device is an auris-acceptable thermoreversible gel. In some
embodiments, the polyoxyethylene-polyoxypropylene triblock
copolymer is biodegradable and/or bioeliminated (e.g., the
copolymer is eliminated from the body by a biodegradation process,
e.g., elimination in the urine, the feces or the like). In some
embodiments, a pharmaceutical composition or device described
herein further comprises a mucoadhesive. In some embodiments, a
pharmaceutical composition or device described herein further
comprises a penetration enhancer. In some embodiments, a
pharmaceutical composition or device described herein further
comprises a thickening agent. In some embodiments, a pharmaceutical
composition or device described herein further comprises a dye.
[0141] In some embodiments, a pharmaceutical composition or device
described herein further comprises a drug delivery device selected
from a needle and syringe, a pump, a microinjection device, a wick,
an in situ forming spongy material or combinations thereof
[0142] In some embodiments, a pharmaceutical composition or device
described herein is a pharmaceutical composition or device wherein
the auris sensory cell modulating agent, or pharmaceutically
acceptable salt thereof, has limited or no systemic release,
systemic toxicity, poor PK characteristics, or combinations
thereof. In some embodiments pharmaceutical compositions or devices
described herein comprise one or more auris sensory cell modulating
agent, or pharmaceutically acceptable salt thereof, prodrug or
combination thereof as an immediate release agent.
[0143] In some embodiments, pharmaceutical compositions or devices
described herein are pharmaceutical compositions or devices wherein
the pH of the pharmaceutical composition or device is a
perilymph-suitable pH between about 6.0 to about 7.6.
[0144] In some embodiments of the pharmaceutical compositions or
devices described herein, the ratio of a
polyoxyethylene-polyoxypropylene triblock copolymer of general
formula E106 P70 E106 to a thickening agent is from about 40:1 to
about 5:1. In some embodiments, the thickening agent is
carboxymethyl cellulose, hydroxypropyl cellulose or hydroxypropyl
methylcellulose.
[0145] In some embodiments, the otic and/or vestibular disorder is
ototoxicity, chemotherapy-induced hearing loss, sensorineural
hearing loss, noise induced hearing loss, excitotoxicity, Meniere's
Disease/Syndrome, endolymphatic hydrops, labyrinthitis, Ramsay
Hunt's Syndrome, vestibular neuronitis, tinnitus or microvascular
compression syndrome.
BRIEF DESCRIPTION OF FIGURES
[0146] FIG. 1. illustrates a comparison of non-sustained release
and sustained release formulations.
[0147] FIG. 2 illustrates the effect of concentration on the
viscosity of aqueous solutions of Blanose refined CMC.
[0148] FIG. 3 illustrates the effect of concentration on the
viscosity of aqueous solutions of Methocel.
[0149] FIG. 4 illustrates the anatomy of the ear
[0150] FIG. 5 shows predicted tunable release characteristics from
four compositions
DETAILED DESCRIPTION OF THE INVENTION
[0151] Provided herein are controlled release compositions for
treating or ameliorating hearing loss or reduction resulting from
destroyed, stunted, malfunctioning, damaged, fragile or missing
hairs in the inner ear. In one embodiment, the controlled release
composition comprises a therapeutically-effective amount of at
least one modulator of growth and/or regeneration of auris sensory
cells (e.g., neuron and/or hair cells of the auris), a controlled
release auris-acceptable excipient, and an auris-acceptable
vehicle. In one embodiment, the controlled release composition
comprises a therapeutically-effective amount of at least one
modulator of auris sensory cell damage, a controlled release
auris-acceptable excipient, and an auris-acceptable vehicle. In one
embodiment, the controlled release composition comprises a
therapeutically-effective amount of at least one agent that
protects neuron and/or hair cells of the auris from damage or
reduces, reverses or delays damage to auris sensory cells, a
controlled release auris-acceptable excipient, and an
auris-acceptable vehicle.
[0152] Further disclosed herein are controlled release auris
sensory cell modulating agent compositions and formulations to
treat ototoxicity, excitotoxicity, sensorineural hearing loss,
noise induced hearing loss, Meniere's Disease/Syndrome,
endolymphatic hydrops, labyrinthitis, Ramsay Hunt's Syndrome,
vestibular neuronitis, tinnitus and microvascular compression
syndrome.
[0153] A few therapeutic products are available for the treatment
of ototoxicity, excitotoxicity, sensorineural hearing loss, noise
induced hearing loss, Meniere's Disease/Syndrome, endolymphatic
hydrops, labyrinthitis, Ramsay Hunt's Syndrome, vestibular
neuronitis, tinnitus and microvascular compression syndrome;
however, systemic routes via oral, intravenous or intramuscular
routes are currently used to deliver these therapeutic agents.
[0154] Systemic drug administration may create a potential
inequality in drug concentration with higher circulating levels in
the serum, and lower levels in the target auris interna organ
structures. As a result, fairly large amounts of drug are required
to overcome this inequality in order to deliver sufficient,
therapeutically effective quantities to the inner ear. Further,
bioavailability is often decreased due to metabolism of the drug by
the liver. In addition, systemic drug administration may increase
the likelihood of systemic toxicities and adverse side effects as a
result of the high serum amounts required to effectuate sufficient
local delivery to the target site. Systemic toxicities may also
occur as a result of liver breakdown and processing of the
therapeutic agents, forming toxic metabolites that effectively
erase any benefit attained from the administered therapeutic (e.g.
metabolites of carbamazepine can cause hepatic injuries and death
in some patients).
[0155] To overcome the toxic and attendant undesired side effects
of systemic delivery of auris sensory cell modulating agents (which
are generally understood to be toxic to cells), disclosed herein
are methods and compositions for local delivery of auris sensory
cell modulating agents to auris media and/or auris interna
structures. Access to, for example, the vestibular and cochlear
apparatus will occur through the auris media or auris interna,
including the round window membrane, the oval window/stapes
footplate, the annular ligament and through the otic
capsule/temporal bone. In further or alternative embodiments, the
auris controlled-release formulations are capable of being
administered on or near the round window membrane via intratympanic
injection. In other embodiments, the auris controlled release
formulations are administered on or near the round window or the
crista fenestrae cochleae through entry via a post-auricular
incision and surgical manipulation into or near the round window or
the crista fenestrae cochleae area. Alternatively, the auris
controlled release formulation is applied via syringe and needle,
wherein the needle is inserted through the tympanic membrane and
guided to the area of the round window or crista fenestrae
cochleae.
[0156] In addition, localized treatment of the auris interna also
affords the use of previously undesired therapeutic agents,
including agents with poor pK profiles, poor uptake, low systemic
release, and/or toxicity issues.
[0157] Because of the localized targeting of the auris sensory cell
modulating agent formulations and compositions, as well as the
biological blood barrier present in the auris interna, the risk of
adverse effects will be reduced as a result of treatment with
previously characterized toxic or ineffective auris sensory cell
modulating agent. Accordingly, also contemplated within the scope
of the embodiments herein is the use of auris sensory cell
modulating agents in the treatment of ototoxicity, excitotoxicity,
sensorineural hearing loss, noise induced hearing loss, Meniere's
Disease/Syndrome, endolymphatic hydrops, labyrinthitis, Ramsay
Hunt's Syndrome, vestibular neuronitis, tinnitus and microvascular
compression syndrome, including therapeutic agents that have been
previously rejected by practitioners because of adverse effects or
ineffectiveness of the auris sensory cell modulating agent(s).
[0158] Also included within the embodiments disclosed herein is the
use of additional auris media and/or auris interna-acceptable
agents in combination with the auris sensory cell modulating agent
formulations and compositions disclosed herein. When used, such
agents assist in the treatment of hearing or equilibrium loss or
dysfunction resulting from an autoimmune disorder, including
vertigo, tinnitus, hearing loss, balance disorders, infections,
inflammatory response or combinations thereof. Accordingly, agents
that ameliorate or reduce the effects of vertigo, tinnitus, hearing
loss, balance disorders, infections, inflammatory response or
combinations thereof are also contemplated to be used in
combination with the auris sensory cell modulating agent(s)
described herein.
[0159] In some embodiments, the composition further comprises an
auris sensory cell modulating agent as an immediate release agent
wherein the immediate release auris sensory cell modulating agent
is the same agent as the controlled-release agent, a different
auris sensory cell modulating agent, an additional therapeutic
agent, or a combination thereof. In some embodiments, the
composition further comprises an additional therapeutic agent. In
some embodiments, the additional therapeutic agent is an
anesthetic, a local acting anesthetic, an analgesic, an antibiotic,
an antiemetic, an antifungal, an anti-microbial agent, an
antiseptic, an antiviral, a chemotherapeutic agent, a diuretic, a
keratolytic agent, an otoprotectant, an immunosuppressant
comprising but not limited to such agents as calcineurin inhibitors
(cyclosporine, tacrolimus, pimecrolimus), macrolides such as
rapamycin, corticosteroids or combinations thereof. In some
embodiments, the additional therapeutic agent is an immediate
release agent. In some embodiments, the additional therapeutic
agent is a controlled release agent.
[0160] Accordingly, provided herein are controlled release auris
sensory cell modulating agent formulations and compositions to
locally treat auris media and/or auris interna structures, thereby
avoiding side effects as a result of systemic administration of the
auris sensory cell modulating agents. The locally applied auris
sensory cell modulating agent formulations and compositions are
compatible with auris media and/or auris interna structures, and
are administered either directly to the desired auris media and/or
auris interna structure, e.g. the cochlear region or the tympanic
cavity, or administered to a structure in direct communication with
areas of the auris interna, including but not limited to the round
window membrane, the crista fenestrae cochleae or the oval window
membrane. By specifically targeting the auris media or auris
interna structures, adverse side effects as a result of systemic
treatment are avoided. Moreover, by providing a controlled release
auris sensory cell modulating agent formulation or composition to
treat otic disorders, a constant and/or extended source of auris
sensory cell modulating agent is provided to the individual or
patient suffering from an otic disorder, reducing or eliminating
the variability of treatment.
[0161] Intratympanic injection of therapeutic agents is the
technique of injecting a therapeutic agent behind the tympanic
membrane into the auris media and/or auris interna. Despite early
success with this technique (Schuknecht, Laryngoscope (1956) 66,
859-870) some challenges do remain. For example, access to the
round window membrane, the site of drug absorption into the auris
interna, can be challenging.
[0162] However, intra-tympanic injections create several
unrecognized problems not addressed by currently available
treatment regimens, such as changing the osmolarity and pH of the
perilymph and endolymph, and introducing pathogens and endotoxins
that directly or indirectly damage inner ear structures. One of the
reasons the art may not have recognized these problems is that
there are no approved intra-tympanic compositions: the inner ear
provides sui generis formulation challenges. Thus, compositions
developed for other parts of the body have little to no relevance
for an intra-tympanic composition.
[0163] There is no guidance in the prior art regarding requirements
(e.g., level of sterility, pH, osmolarity) for otic formulations
that are suitable for administration to humans. There is wide
anatomical disparity between the ears of animals across species. A
consequence of the inter-species differences in auditory structures
is that animal models of inner ear disease are often unreliable as
a tool for testing therapeutics that are being developed for
clinical approval.
[0164] Provided herein are otic formulations that meet stringent
criteria for pH, osmolarity, ionic balance, sterility, endotoxin
and/or pyrogen levels. The auris compositions described herein are
compatible with the microenvironment of the inner ear (e.g., the
perilymph) and are suitable for administration to humans. In some
embodiments, the formulations described herein comprise dyes and
aid visualization of the administered compositions obviating the
need for invasive procedures (e.g., removal of perilymph) during
preclinical and/or clinical development of intratympanic
therapeutics.
[0165] Provided herein are controlled release auris sensory cell
modulating agent formulations and compositions to locally treat
targeted auris structures, thereby avoiding side effects as a
result of systemic administration of the auris sensory cell
modulating agent formulations and compositions. The locally applied
auris sensory cell modulating agent formulations and compositions
and devices are compatible with the targeted auris structures, and
administered either directly to the desired targeted auris
structure, e.g. the cochlear region, the tympanic cavity or the
external ear, or administered to a structure in direct
communication with areas of the auris interna, including but not
limited to the round window membrane, the crista fenestrae cochleae
or the oval window membrane. By specifically targeting an auris
structure, adverse side effects as a result of systemic treatment
are avoided. Moreover, clinical studies have shown the benefit of
having long term exposure of drug to the perilymph of the cochlea,
for example with improved clinical efficacy of sudden hearing loss
when the therapeutic agent is given on multiple occasions. Thus, by
providing a controlled release auris sensory cell modulating agent
formulation or composition to treat otic disorders, a constant,
and/or extended source of auris sensory cell modulating agent is
provided to the individual or patient suffering from an otic
disorder, reducing or eliminating variabilities in treatment.
Accordingly, one embodiment disclosed herein is to provide a
composition that enables at least one auris sensory cell modulating
agent to be released in therapeutically effective doses either at
variable or constant rates such as to ensure a continuous release
of the at least one agent. In some embodiments, the auris sensory
cell modulating agents disclosed herein are administered as an
immediate release formulation or composition. In other embodiments,
the auris sensory cell modulating agents are administered as a
sustained release formulation, released either continuously,
variably or in a pulsatile manner, or variants thereof. In still
other embodiments, auris sensory cell modulating agent formulation
is administered as both an immediate release and sustained release
formulation, released either continuously, variably or in a
pulsatile manner, or variants thereof. The release is optionally
dependent on environmental or physiological conditions, for
example, the external ionic environment (see, e.g. Oros.RTM.
release system, Johnson & Johnson).
[0166] In addition, the auris-acceptable controlled-release auris
sensory cell modulating agent formulations and treatments described
herein are provided to the target ear region of the individual in
need, including the inner ear, and the individual in need is
additionally administered an oral dose of auris sensory cell
modulating agent. In some embodiments, the oral dose of auris
sensory cell modulating agent is administered prior to
administration of the auris-acceptable controlled-release auris
sensory cell modulating agent formulation, and then the oral dose
is tapered off over the period of time that the auris-acceptable
controlled-release auris sensory cell modulating agent formulation
is provided. Alternatively, the oral dose of auris sensory cell
modulating agent is administered during administration of the
auris-acceptable controlled-release auris sensory cell modulating
agent formulation, and then the oral dose is tapered off over the
period of time that the auris-acceptable controlled-release auris
sensory cell modulating agent formulation is provided.
Alternatively, the oral dose of auris sensory cell modulating agent
is administered after administration of the auris-acceptable
controlled-release auris sensory cell modulating agent formulation
has been initiated, and then the oral dose is tapered off over the
period of time that the auris-acceptable controlled-release auris
sensory cell modulating agent formulation is provided.
[0167] In addition, the auris sensory cell modulating agent
pharmaceutical compositions or formulations or devices included
herein also include carriers, adjuvants, such as preserving,
stabilizing, wetting or emulsifying agents, solution promoters,
salts for regulating the osmotic pressure, and/or buffers. Such
carriers, adjuvants, and other excipients will be compatible with
the environment in the targeted auris structure(s). Accordingly,
specifically contemplated are carriers, adjuvants and excipients
that lack ototoxicity or are minimally ototoxic in order to allow
effective treatment of the otic disorders contemplated herein with
minimal side effects in the targeted regions or areas. To prevent
ototoxicity, auris sensory cell modulating agent pharmaceutical
compositions or formulations or devices disclosed herein are
optionally targeted to distinct regions of the targeted auris
structures, including but not limited to the tympanic cavity,
vestibular bony and membranous labyrinths, cochlear bony and
membranous labyrinths and other anatomical or physiological
structures located within the auris interna.
Certain Definitions
[0168] The term "auris-acceptable" with respect to a formulation,
composition or ingredient, as used herein, includes having no
persistent detrimental effect on the auris interna (or inner ear)
of the subject being treated. By "auris-pharmaceutically
acceptable," as used herein, refers to a material, such as a
carrier or diluent, which does not abrogate the biological activity
or properties of the compound in reference to the auris interna (or
inner ear), and is relatively or is reduced in toxicity to the
auris interna (or inner ear), i.e., the material is administered to
an individual without causing undesirable biological effects or
interacting in a deleterious manner with any of the components of
the composition in which it is contained.
[0169] As used herein, amelioration or lessening of the symptoms of
a particular otic disease, disorder or condition by administration
of a particular compound or pharmaceutical composition refers to
any decrease of severity, delay in onset, slowing of progression,
or shortening of duration, whether permanent or temporary, lasting
or transient that is attributed to or associated with
administration of the compound or composition.
[0170] "Antioxidants" are auris-pharmaceutically acceptable
antioxidants, and include, for example, butylated hydroxytoluene
(BHT), sodium ascorbate, ascorbic acid, sodium metabisulfite and
tocopherol. In certain embodiments, antioxidants enhance chemical
stability where required. Antioxidants are also used to counteract
the ototoxic effects of certain therapeutic agents, including
agents that are used in combination with the auris sensory cell
modulating agents disclosed herein.
[0171] "Auris interne" refers to the inner ear, including the
cochlea and the vestibular labyrinth, and the round window that
connects the cochlea with the middle ear.
[0172] "Auris-interna bioavailability" refers to the percentage of
the administered dose of compounds disclosed herein that becomes
available in the inner ear of the animal or human being
studied.
[0173] "Auris media" refers to the middle ear, including the
tympanic cavity, auditory ossicles and oval window, which connects
the middle ear with the inner ear.
[0174] "Balance disorder" refers to a disorder, illness, or
condition which causes a subject to feel unsteady, or to have a
sensation of movement. Included in this definition are dizziness,
vertigo, disequilibrium, and pre-syncope. Diseases which are
classified as balance disorders include, but are not limited to,
Ramsay Hunt's Syndrome, Meniere's Disease, mal de debarquement,
benign paroxysmal positional vertigo, and labyrinthitis.
[0175] "Blood plasma concentration" refers to the concentration of
compounds provided herein in the plasma component of blood of a
subject.
[0176] "Carrier materials" are excipients that are compatible with
the auris sensory cell modulating agent, the auris interna and the
release profile properties of the auris-acceptable pharmaceutical
formulations. Such carrier materials include, e.g., binders,
suspending agents, disintegration agents, filling agents,
surfactants, solubilizers, stabilizers, lubricants, wetting agents,
diluents, and the like. "Auris-pharmaceutically compatible carrier
materials" include, but are not limited to, acacia, gelatin,
colloidal silicon dioxide, calcium glycerophosphate, calcium
lactate, maltodextrin, glycerine, magnesium silicate,
polyvinylpyrrolidone (PVP), cholesterol, cholesterol esters, sodium
caseinate, soy lecithin, taurocholic acid, phosphatidylcholine,
sodium chloride, tricalcium phosphate, dipotassium phosphate,
cellulose and cellulose conjugates, sugars sodium stearoyl
lactylate, carrageenan, monoglyceride, diglyceride, pregelatinized
starch, and the like.
[0177] The term "diluent" refers to chemical compounds that are
used to dilute the auris sensory cell modulating agent prior to
delivery and which are compatible with the auris interna.
[0178] "Dispersing agents," and/or "viscosity modulating agents"
are materials that control the diffusion and homogeneity of the
auris sensory cell modulating agent through liquid media. Examples
of diffusion facilitators/dispersing agents include but are not
limited to hydrophilic polymers, electrolytes, Tween.RTM. 60 or 80,
PEG, polyvinylpyrrolidone (PVP; commercially known as
Plasdone.RTM.), and the carbohydrate-based dispersing agents such
as, for example, hydroxypropyl celluloses (e.g., HPC, HPC-SL, and
HPC-L), hydroxypropyl methylcelluloses (e.g., HPMC K100, HPMC K4M,
HPMC K15M, and HPMC K100M), carboxymethylcellulose sodium,
methylcellulose, hydroxyethylcellulose, hydroxypropylcellulose,
hydroxypropylmethylcellulose phthalate,
hydroxypropylmethylcellulose acetate stearate (HPMCAS),
noncrystalline cellulose, magnesium aluminum silicate,
triethanolamine, polyvinyl alcohol (PVA), vinyl pyrrolidone/vinyl
acetate copolymer (S630), 4-(1,1,3,3-tetramethylbutyl)-phenol
polymer with ethylene oxide and formaldehyde (also known as
tyloxapol), poloxamers (e.g., Pluronics F68.RTM., F88.RTM., and
F108.RTM., which are block copolymers of ethylene oxide and
propylene oxide); and poloxamines (e.g., Tetronic 908.RTM., also
known as Poloxamine 908.RTM., which is a tetrafunctional block
copolymer derived from sequential addition of propylene oxide and
ethylene oxide to ethylenediamine (BASF Corporation, Parsippany,
N.J.)), polyvinylpyrrolidone K12, polyvinylpyrrolidone K17,
polyvinylpyrrolidone K25, or polyvinylpyrrolidone K30,
polyvinylpyrrolidone/vinyl acetate copolymer (S-630), polyethylene
glycol, e.g., the polyethylene glycol has a molecular weight of
about 300 to about 6000, or about 3350 to about 4000, or about 7000
to about 5400, sodium carboxymethylcellulose, methylcellulose,
polysorbate-80, sodium alginate, gums, such as, e.g., gum
tragacanth and gum acacia, guar gum, xanthans, including xanthan
gum, sugars, cellulosics, such as, sodium carboxymethylcellulose,
methylcellulose, sodium carboxymethylcellulose, polysorbate-80,
sodium alginate, polyethoxylated sorbitan monolaurate,
polyethoxylated sorbitan monolaurate, povidone, carbomers,
polyvinyl alcohol (PVA), alginates, chitosans and combinations
thereof. Plasticizers such as cellulose or triethyl cellulose are
also be used as dispersing agents. Dispersing agents useful in
liposomal dispersions and self-emulsifying dispersions of the auris
sensory cell modulating agents disclosed herein are dimyristoyl
phosphatidyl choline, natural phosphatidyl choline from eggs,
natural phosphatidyl glycerol from eggs, cholesterol and isopropyl
myristate.
[0179] "Drug absorption" or "absorption" refers to the process of
movement of the auris sensory cell modulating agents from the
localized site of administration, by way of example only, the round
window membrane of the inner ear, and across a barrier (the round
window membranes, as described below) into the auris interna or
inner ear structures. The terms "co-administration" or the like, as
used herein, are meant to encompass administration of the auris
sensory cell modulating agents to a single patient, and are
intended to include treatment regimens in which the auris sensory
cell modulating agents are administered by the same or different
route of administration or at the same or different time.
[0180] The terms "effective amount" or "therapeutically effective
amount," as used herein, refer to a sufficient amount of the auris
sensory cell modulating agent being administered that would be
expected to relieve to some extent one or more of the symptoms of
the disease or condition being treated. For example, the result of
administration of the auris sensory cell modulating agent disclosed
herein is reduction and/or alleviation of the signs, symptoms, or
causes of tinnitus or balance disorders. For example, an "effective
amount" for therapeutic uses is the amount of auris sensory cell
modulating agent, including a formulation as disclosed herein
required to provide a decrease or amelioration in disease symptoms
without undue adverse side effects. The term "therapeutically
effective amount" includes, for example, a prophylactically
effective amount. An "effective amount" of a modulator of neuron
and/or hair cells of the auris composition disclosed herein is an
amount effective to achieve a desired pharmacologic effect or
therapeutic improvement without undue adverse side effects. It is
understood that "an effective amount" or "a therapeutically
effective amount" varies, in some embodiments, from subject to
subject, due to variation in metabolism of the compound
administered, age, weight, general condition of the subject, the
condition being treated, the severity of the condition being
treated, and the judgment of the prescribing physician. It is also
understood that "an effective amount" in an extended-release dosing
format may differ from "an effective amount" in an immediate
release dosign format based upon pharmacokinetic and
pharmacodynamic considerations.
[0181] The terms "enhance" or "enhancing" refers to an increase or
prolongation of either the potency or duration of a desired effect
of auris sensory cell modulating agent, or a diminution of any
adverse symptomatology that is consequent upon the administration
of the therapeutic agent. Thus, in regard to enhancing the effect
of the auris sensory cell modulating agents disclosed herein, the
term "enhancing" refers to the ability to increase or prolong,
either in potency or duration, the effect of other therapeutic
agents that are used in combination with the auris sensory cell
modulating agent disclosed herein. An "enhancing-effective amount,"
as used herein, refers to an amount of auris sensory cell
modulating agent or other therapeutic agent which is adequate to
enhance the effect of another therapeutic agent or auris sensory
cell modulating agent of the target auris structure in a desired
system. When used in a patient, amounts effective for this use will
depend on the severity and course of the disease, disorder or
condition, previous therapy, the patient's health status and
response to the drugs, and the judgment of the treating
physician.
[0182] The term "inhibiting" includes preventing, slowing, or
reversing the development of a condition, for example, or
advancement of a condition in a patient necessitating
treatment.
[0183] The terms "kit" and "article of manufacture" are used as
synonyms.
[0184] "Pharmacodynamics" refers to the factors which determine the
biologic response observed relative to the concentration of drug at
the desired site within the auris media and/or auris interna.
[0185] "Pharmacokinetics" refers to the factors which determine the
attainment and maintenance of the appropriate concentration of drug
at the desired site within the auris media and/or auris
interna.
[0186] "Modulator of neuron and/or hair cells of the auris" and
"auris sensory cell modulating agent" are synonyms. They include
agents that promote the growth and/or regeneration of neurons
and/or the hair cells of the auris, and agents that destroy neurons
and/or hair cells of the auris. In some embodiments, an auris
sensory cell modulating agent provides therapeutic benefit (e.g.,
alleviation of hearing loss) by promoting the growth and/or
regeneration of auris sensory cells (e.g., neurons and/or the hair
cells) of the auris. In some embodiments, an auris sensory cell
modulating agent (e.g., a toxicant) provides therapeutic benefit
(e.g., alleviation of vertigo) by destroying or damaging auris
sensory cells (e.g., neurons and/or hair cells of the auris). In
some embodiments, an auris sensory cell modulating agent provides
therapeutic benefit (e.g., alleviation of tinnitus due to acoustic
trauma) by treating and/or reversing damage to auris sensory cells
(e.g., dysfunction of neurons and/or hair cells of the auris) or
reducing or delaying further damage (e.g., cell death) to auris
sensory cells (e.g., by exerting an otoprotectant effect or a
trophic effect).
[0187] The term "trophic agent" means an agent that promotes the
survival, growth and/or regeneration of auris sensory cells (e.g.,
neurons and/or the hair cells of the auris). In some embodiments, a
trophic agent reduces or inhibits oxidative damage and/or
osteoneogenesis and/or degeneration of auris sensory cells. In some
embodiments, a trophic agent maintains healthy auris sensory cells
(e.g., after a surgical implant of a medical device). In some
embodiments, a trophic agent upregulates activity of antioxidant
enzymes (e.g., during administration of ototoxic agents). In some
embodiments, a trophic agent is an immunosuppresant (e.g., an
immunosuppresant used during otic surgery). In some embodiments, a
trophic agent is a growth factor (e.g., a growth factor used after
an implantation procedure to promote growth of auris cells).
[0188] The term "glutamate receptor antagonist" means a compound
that interferes with or inhibits the activity of a glutamate
receptor. In some embodiments, the receptor is an AMPA receptor, or
NMDA receptor. In some embodiments, a glutamate receptor antagonist
binds to a glutamate receptor but said binding does not produce a
physiological response. Glutamate receptor antagonists include
partial agonists, inverse agonists, neutral or competitive
antagonists, non-competitive antagonists, allosteric antagonists,
and/or orthosteric antagonists.
[0189] The term "glutamate receptor agonist" means a compound that
binds to a glutamate receptor and activates the receptor. The term
further includes a compound that facilitates the binding of a
native ligand. In some embodiments, the receptor is an mGlu
receptor. Glutamate receptor agonists include partial antagonists,
allosteric agonists, and/or orthosteric agonists.
[0190] In prophylactic applications, compositions comprising the
auris sensory cell modulating agents described herein are
administered to a patient susceptible to or otherwise at risk of a
particular disease, disorder or condition. For example, such
conditions include and are not limited to ototoxicity,
excitotoxicity, sensorineural hearing loss, noise induced hearing
loss, Meniere's Disease/Syndrome, endolymphatic hydrops,
labyrinthitis, Ramsay Hunt's Syndrome, vestibular neuronitis,
tinnitus and microvascular compression syndrome. Such an amount is
defined to be a "prophylactically effective amount or dose." In
this use, the precise amounts also depend on the patient's state of
health, weight, and the like.
[0191] As used herein, a "pharmaceutical device" includes any
composition described herein that, upon adminstration to an ear,
provides a reservoir for extended release of an active agent
described herein.
[0192] The term "substantially low degradation products" means less
than 5% by weight of the active agent are degradation products of
the active agent. In further embodiments, the term means less than
3% by weight of the active agent are degradation products of the
active agent. In yet further embodiments, the term means less than
2% by weight of the active agent are degradation products of the
active agent. In further embodiments, the term means less than 1%
by weight of the active agent are degradation products of the
active agent. In some embodiments, any individual impurity (e.g.,
metal impurity, degradation products of active agent and/or
excipients, or the like) present in a formulation described herein
is less than 5%, less than 2%, or less than 1% by weight of the
active agent. In some embodiments the formulation does not contain
precipitate during storage or change in color after manufacturing
and storage.
[0193] As used herein "essentially in the form of micronized
powder" includes, by way of example only, greater than 70% by
weight of the active agent is in the form of micronized particles
of the active agent. In further embodiments, the term means greater
than 80% by weight of the active agent is in the form of micronized
particles of the active agent. In yet further embodiments, the term
means greater than 90% by weight of the active agent is in the form
of micronized particles of the active agent.
[0194] The term "otic intervention" means an external insult or
trauma to one or more auris structures and includes implants, otic
surgery, injections, cannulations, or the like. Implants include
auris-interna or auris-media medical devices, examples of which
include cochlear implants, hearing sparing devices,
hearing-improvement devices, short electrodes, micro-prostheses or
piston-like prostheses; needles; stem cell transplants; drug
delivery devices; any cell-based therapeutic; or the like. Otic
surgery includes middle ear surgery, inner ear surgery,
tympanostomy, cochleostomy, labyrinthotomy, mastoidectomy,
stapedectomy, stapedotomy, endolymphatic sacculotomy or the like.
Injections include intratympanic injections, intracochlear
injections, injections across the round window membrane or the
like. Cannulations include intratympanic, intracochlear,
endolymphatic, perilymphatic or vestibular cannulations or the
like.
[0195] A "prodrug" refers to an auris sensory cell modulating agent
that is converted into the parent drug in vivo. In certain
embodiments, a prodrug is enzymatically metabolized by one or more
steps or processes to the biologically, pharmaceutically or
therapeutically active form of the compound. To produce a prodrug,
a pharmaceutically active compound is modified such that the active
compound will be regenerated upon in vivo administration. In one
embodiment, the prodrug is designed to alter the metabolic
stability or the transport characteristics of a drug, to mask side
effects or toxicity, or to alter other characteristics or
properties of a drug. Compounds provided herein, in some
embodiments, are derivatized into suitable prodrugs.
[0196] "Solubilizers" refer to auris-acceptable compounds such as
triacetin, triethylcitrate, ethyl oleate, ethyl caprylate, sodium
lauryl sulfate, sodium doccusate, vitamin E TPGS,
dimethylacetamide, N-methylpyrrolidone, N-hydroxyethylpyrrolidone,
polyvinylpyrrolidone, hydroxypropylmethyl cellulose, hydroxypropyl
cyclodextrins, ethanol, n-butanol, isopropyl alcohol, cholesterol,
bile salts, polyethylene glycol 200-600, glycofurol, transcutol,
propylene glycol, and dimethyl isosorbide and the like that assist
or increase the solubility of the auris sensory cell modulating
agents disclosed herein.
[0197] "Stabilizers" refers to compounds such as any antioxidation
agents, buffers, acids, preservatives and the like that are
compatible with the environment of the auris interna. Stabilizers
include but are not limited to agents that will do any of (1)
improve the compatibility of excipients with a container, or a
delivery system, including a syringe or a glass bottle, (2) improve
the stability of a component of the composition, or (3) improve
formulation stability.
[0198] "Steady state," as used herein, is when the amount of drug
administered to the auris interna is equal to the amount of drug
eliminated within one dosing interval resulting in a plateau or
constant levels of drug exposure within the targeted structure.
[0199] As used herein, the term "subject" is used to mean an
animal, preferably a mammal, including a human or non-human. The
terms patient and subject may be used interchangeably.
[0200] "Surfactants" refer to compounds that are auris-acceptable,
such as sodium lauryl sulfate, sodium docusate, Tween 60 or 80,
triacetin, vitamin E TPGS, sorbitan monooleate, polyoxyethylene
sorbitan monooleate, polysorbates, polaxomers, bile salts, glyceryl
monostearate, copolymers of ethylene oxide and propylene oxide,
e.g., Pluronic.RTM. (BASF), and the like. Some other surfactants
include polyoxyethylene fatty acid glycerides and vegetable oils,
e.g., polyoxyethylene (60) hydrogenated castor oil; and
polyoxyethylene alkylethers and alkylphenyl ethers, e.g., octoxynol
10, octoxynol 40. In some embodiments, surfactants are included to
enhance physical stability or for other purposes.
[0201] The terms "treat," "treating" or "treatment," as used
herein, include alleviating, abating or ameliorating a disease or
condition, for example tinnitus, symptoms, preventing additional
symptoms, ameliorating or preventing the underlying metabolic
causes of symptoms, inhibiting the disease or condition, e.g.,
arresting the development of the disease or condition, relieving
the disease or condition, causing regression of the disease or
condition, relieving a condition caused by the disease or
condition, or stopping the symptoms of the disease or condition
either prophylactically and/or therapeutically.
[0202] Other objects, features, and advantages of the methods and
compositions described herein will become apparent from the
following detailed description. It should be understood, however,
that the detailed description and the specific examples, while
indicating specific embodiments, are given by way of illustration
only.
Anatomy of the Ear
[0203] As shown in FIG. 4, the outer ear is the external portion of
the organ and is composed of the pinna (auricle), the auditory
canal (external auditory meatus) and the outward facing portion of
the tympanic membrane, also known as the ear drum. The pinna, which
is the fleshy part of the external ear that is visible on the side
of the head, collects sound waves and directs them toward the
auditory canal. Thus, the function of the outer ear, in part, is to
collect and direct sound waves towards the tympanic membrane and
the middle ear.
[0204] The middle ear is an air-filled cavity, called the tympanic
cavity, behind the tympanic membrane. The tympanic membrane, also
known as the ear drum, is a thin membrane that separates the
external ear from the middle ear. The middle ear lies within the
temporal bone, and includes within this space the three ear bones
(auditory ossicles): the malleus, the incus and the stapes. The
auditory ossicles are linked together via tiny ligaments, which
form a bridge across the space of the tympanic cavity. The malleus,
which is attached to the tympanic membrane at one end, is linked to
the incus at its anterior end, which in turn is linked to the
stapes. The stapes is attached to the oval window, one of two
windows located within the tympanic cavity. A fibrous tissue layer,
known as the annular ligament connects the stapes to the oval
window. Sound waves from the outer ear first cause the tympanic
membrane to vibrate. The vibration is transmitted across to the
cochlea through the auditory ossicles and oval window, which
transfers the motion to the fluids in the auris interna. Thus, the
auditory ossicles are arranged to provide a mechanical linkage
between the tympanic membrane and the oval window of the
fluid-filled auris interna, where sound is transformed and
transduced to the auris interna for further processing. Stiffness,
rigidity or loss of movement of the auditory ossicles, tympanic
membrane or oval window leads to hearing loss, e.g. otosclerosis,
or rigidity of the stapes bone.
[0205] The tympanic cavity also connects to the throat via the
eustachian tube. The eustachian tube provides the ability to
equalize the pressure between the outside air and the middle ear
cavity. The round window, a component of the auris interna but
which is also accessible within the tympanic cavity, opens into the
cochlea of the auris interna. The round window is covered by round
window membrane, which consists of three layers: an external or
mucous layer, an intermediate or fibrous layer, and an internal
membrane, which communicates directly with the cochlear fluid. The
round window, therefore, has direct communication with the auris
interna via the internal membrane.
[0206] Movements in the oval and round window are interconnected,
i.e. as the stapes bone transmits movement from the tympanic
membrane to the oval window to move inward against the auris
interna fluid, the round window (round window membrane) is
correspondingly pushed out and away from the cochlear fluid. This
movement of the round window allows movement of fluid within the
cochlea, which leads in turn to movement of the cochlear inner hair
cells, allowing hearing signals to be transduced. Stiffness and
rigidity in round window membrane leads to hearing loss because of
the lack of ability of movement in the cochlear fluid. Recent
studies have focused on implanting mechanical transducers onto the
round window, which bypasses the normal conductive pathway through
the oval window and provides amplified input into the cochlear
chamber.
[0207] Auditory signal transduction takes place in the auris
interna. The fluid-filled auris interna, or inner ear, consists of
two major components: the cochlear and the vestibular apparatus.
The auris interna is located in part within the osseous or bony
labyrinth, an intricate series of passages in the temporal bone of
the skull. The vestibular apparatus is the organ of balance and
consists of the three semi-circular canals and the vestibule. The
three semi-circular canals are arranged relative to each other such
that movement of the head along the three orthogonal planes in
space can be detected by the movement of the fluid and subsequent
signal processing by the sensory organs of the semi-circular
canals, called the crista ampullaris. The crista ampullaris
contains hair cells and supporting cells, and is covered by a
dome-shaped gelatinous mass called the cupula. The hairs of the
hair cells are embedded in the cupula. The semi-circular canals
detect dynamic equilibrium, the equilibrium of rotational or
angular movements.
[0208] When the head turns rapidly, the semicircular canals move
with the head, but endolymph fluid located in the membranous
semi-circular canals tends to remain stationary. The endolymph
fluid pushes against the cupula, which tilts to one side. As the
cupula tilts, it bends some of the hairs on the hair cells of the
crista ampullaris, which triggers a sensory impulse. Because each
semicircular canal is located in a different plane, the
corresponding crista ampullaris of each semi-circular canal
responds differently to the same movement of the head. This creates
a mosaic of impulses that are transmitted to the central nervous
system on the vestibular branch of the vestibulocochlear nerve. The
central nervous system interprets this information and initiates
the appropriate responses to maintain balance. Of importance in the
central nervous system is the cerebellum, which mediates the sense
of balance and equilibrium.
[0209] The vestibule is the central portion of the auris interna
and contains mechanoreceptors bearing hair cells that ascertain
static equilibrium, or the position of the head relative to
gravity. Static equilibrium plays a role when the head is
motionless or moving in a straight line. The membranous labyrinth
in the vestibule is divided into two sac-like structures, the
utricle and the saccule. Each structure in turn contains a small
structure called a macula, which is responsible for maintenance of
static equilibrium. The macula consists of sensory hair cells,
which are embedded in a gelatinous mass (similar to the cupula)
that covers the macula. Grains of calcium carbonate, called
otoliths, are embedded on the surface of the gelatinous layer.
[0210] When the head is in an upright position, the hairs are
straight along the macula. When the head tilts, the gelatinous mass
and otoliths tilts correspondingly, bending some of the hairs on
the hair cells of the macula. This bending action initiates a
signal impulse to the central nervous system, which travels via the
vestibular branch of the vestibulocochlear nerve, which in turn
relays motor impulses to the appropriate muscles to maintain
balance.
[0211] The cochlea is the portion of the auris interna related to
hearing. The cochlea is a tapered tube-like structure which is
coiled into a shape resembling a snail. The inside of the cochlea
is divided into three regions, which is further defined by the
position of the vestibular membrane and the basilar membrane. The
portion above the vestibular membrane is the scala vestibuli, which
extends from the oval window to the apex of the cochlea and
contains perilymph fluid, an aqueous liquid low in potassium and
high in sodium content. The basilar membrane defines the scala
tympani region, which extends from the apex of the cochlea to the
round window and also contains perilymph. The basilar membrane
contains thousands of stiff fibers, which gradually increase in
length from the round window to the apex of the cochlea. The fibers
of the basement membrane vibrate when activated by sound. In
between the scala vestibuli and the scala tympani is the cochlear
duct, which ends as a closed sac at the apex of the cochlea. The
cochlear duct contains endolymph fluid, which is similar to
cerebrospinal fluid and is high in potassium.
[0212] The organ of Corti, the sensory organ for hearing, is
located on the basilar membrane and extends upward into the
cochlear duct. The organ of Corti contains hair cells, which have
hairlike projections that extend from their free surface, and
contacts a gelatinous surface called the tectorial membrane.
Although hair cells have no axons, they are surrounded by sensory
nerve fibers that form the cochlear branch of the vestibulocochlear
nerve (cranial nerve VIII).
[0213] As discussed, the oval window, also known as the elliptical
window communicates with the stapes to relay sound waves that
vibrate from the tympanic membrane. Vibrations transferred to the
oval window increases pressure inside the fluid-filled cochlea via
the perilymph and scala vestibuli/scala tympani, which in turn
causes the round window membrane to expand in response. The
concerted inward pressing of the oval window/outward expansion of
the round window allows for the movement of fluid within the
cochlea without a change of intra-cochlear pressure. However, as
vibrations travel through the perilymph in the scala vestibuli,
they create corresponding oscillations in the vestibular membrane.
These corresponding oscillations travel through the endolymph of
the cochlear duct, and transfer to the basilar membrane. When the
basilar membrane oscillates, or moves up and down, the organ of
Corti moves along with it. The hair cell receptors in the Organ of
Corti then move against the tectorial membrane, causing a
mechanical deformation in the tectorial membrane. This mechanical
deformation initiates the nerve impulse which travels via the
vestibulocochlear nerve to the central nervous system, mechanically
transmitting the sound wave received into signals that are
subsequently processed by the central nervous system.
Diseases
[0214] Otic disorders produce symptoms which include but are not
limited to hearing loss, nystagmus, vertigo, tinnitus,
inflammation, infection and congestion. The otic disorders which
are treated with the compositions disclosed herein are numerous and
include ototoxicity, excitotoxicity, sensorineural hearing loss,
noise induced hearing loss, Meniere's Disease/Syndrome,
endolymphatic hydrops, labyrinthitis, Ramsay Hunt's Syndrome,
vestibular neuronitis, tinnitus and microvascular compression
syndrome.
Excitotoxicity
[0215] Excitotoxicity refers to the death or damaging of neurons
and/or otic hair cells by glutamate and/or similar substances.
[0216] Glutamate is the most abundant excitatory neurotransmitter
in the central nervous system. Pre-synaptic neurons release
glutamate upon stimulation. It flows across the synapse, binds to
receptors located on post-synaptic neurons, and activates these
neurons. The glutamate receptors include the NMDA, AMPA, and
kainate receptors. Glutamate transporters are tasked with removing
extracellular glutamate from the synapse. Certain events (e.g.
ischemia or stroke) can damage the transporters. This results in
excess glutamate accumulating in the synapse. Excess glutamate in
synapses results in the over-activation of the glutamate
receptors.
[0217] The AMPA receptor is activated by the binding of both
glutamate and AMPA. Activation of certain isoforms of the AMPA
receptor results in the opening of ion channels located in the
plasma membrane of the neuron. When the channels open, Na+ and Ca2+
ions flow into the neuron and K+ ions flow out of the neuron.
[0218] The NMDA receptor is activated by the binding of both
glutamate and NMDA. Activation of the NMDA receptor, results in the
opening of ion channels located in the plasma membrane of the
neuron. However, these channels are blocked by Mg2+ ions.
Activation of the AMPA receptor results in the expulsion of Mg2+
ions from the ion channels into the synapse. When the ion channels
open, and the Mg2+ ions evacuate the ion channels, Na+ and Ca2+
ions flow into the neuron, and K+ ions flow out of the neuron.
[0219] Excitotoxicity occurs when the NMDA receptor and AMPA
receptors are over-activated by the binding of excessive amounts of
ligands, for example, abnormal amounts of glutamate. The
over-activation of these receptors causes excessive opening of the
ion channels under their control. This allows abnormally high
levels of Ca2+ and Na+ to enter the neuron. The influx of these
levels of Ca2+ and Na+ into the neuron causes the neuron to fire
more often, resulting in a rapid buildup of free radicals and
inflammatory compounds within the cell. The free radicals
eventually damage the mitochondria, depleting the cell's energy
stores. Furthermore, excess levels of Ca2+ and Na+ ions activate
excess levels of enzymes including, but not limited to,
phospholipases, endonucleases, and proteases. The over-activation
of these enzymes results in damage to the cytoskeleton, plasma
membrane, mitochondria, and DNA of the sensory neuron. In some
embodiments, an auris sensory cell modulating agent is a glutamate
receptor antagonist that reduces or inhibits excessive neuronal
firing and/or neuronal cell death. Disclosed herein, in certain
embodiments, is a pharmaceutical composition for use in the
treatment of a disease of the ear characterized by the dysfunction
of an NMDA receptor.
Tinnitus
[0220] As used herein, "tinnitus" refers to a disorder
characterized by the perception of sound in the absence of any
external stimuli. In certain instances, tinnitus occurs in one or
both ears, continuously or sporadically, and is most often
described as a ringing sound. It is most often used as a diagnostic
symptom for other diseases. There are two types of tinnitus:
objective and subjective. The former is a sound created in the body
which is audible to anyone. The latter is audible only to the
affected individual. Studies estimate that over 50 million
Americans experience some form of tinnitus. Of those 50 million,
about 12 million experience severe tinnitus.
[0221] There are several treatments for tinnitus. Lidocaine,
administered by IV, reduces or eliminates the noise associated with
tinnitus in about 60-80% of sufferers. Selective neurotransmitter
reuptake inhibitors, such as nortriptyline, sertraline, and
paroxetine, have also demonstrated efficacy against tinnitus.
Benzodiazepines are also prescribed to treat tinnitus. In some
embodiments, an auris sensory cell modulating agent reduces or
inhibits auris sensory cell damage and/or death associated with
tinnitus.
Sensorineural Hearing Loss
[0222] Sensorineural hearing loss is a type of hearing loss which
results from defects (congenital and acquired) in the
vestibulocochlear nerve (also known as cranial nerve VIII), or
sensory cells of the inner ear. The majority of defects of the
inner ear are defects of otic hair cells.
[0223] Aplasia of the cochlea, chromosomal defects, and congenital
cholesteatoma are examples of congenital defects which can result
in sensorineural hearing loss. By way of non-limiting example,
inflammatory diseases (e.g. suppurative labyrinthitis, meningitis,
mumps, measles, viral syphilis, and autoimmune disorders),
Meniere's Disease, exposure to ototoxic drugs (e.g.
aminoglycosides, loop diuretics, antimetabolites, salicylates, and
cisplatin), physical trauma, presbyacusis, and acoustic trauma
(prolonged exposure to sound in excess of 90 dB) can all result in
acquired sensorineural hearing loss.
[0224] If the defect resulting in sensorineural hearing loss is a
defect in the auditory pathways, the sensorineural hearing loss is
called central hearing loss. If the defect resulting in
sensorineural hearing loss is a defect in the auditory pathways,
the sensorineural hearing loss is called cortical deafness. In some
embodiments, an auris sensory cell modulating agent is a trophic
agent (e.g., BDNF, GDNF) that promotes growth of auris sensory
cells and reduces or reverses sensorineural hearing loss.
Noise Induced Hearing Loss
[0225] Noise induced hearing loss (NIHL) is caused upon exposure to
sounds that are too loud or loud sounds that last an extended
period of time. Long or repeated or impulse exposure to sounds at
or above 85 decibels can cause hearing loss. Hearing loss may also
occur from prolonged exposure to loud noises, such as loud music,
heavy equipment or machinery, airplanes, gunfire or other
human-based noises. NIHL causes damage to the hair cells and/or the
auditory nerve. The hair cells are small sensory cells that convert
sound energy into electrical signals that travel to the brain.
Impulse sound can result in immediate hearing loss that may be
permanent. This kind of hearing loss may be accompanied by
tinnitus--a ringing, buzzing, or roaring in the ears or head--which
may subside over time. Hearing loss and tinnitus may be experienced
in one or both ears, and tinnitus may continue constantly or
occasionally throughout a lifetime. Continuous exposure to loud
noise also damages the structure of hair cells, resulting in
permanent hearing loss and tinnitus, although the process occurs
more gradually than for impulse noise.
[0226] In some embodiments, an otoprotectant can reverse, reduce or
ameliorate NIHL. Examples of otoprotectants that treat or prevent
NIHL include, but are not limited to, otoprotectants described
herein.
Ototoxicity
[0227] Ototoxicity refers to hearing loss caused by a toxin. The
hearing loss may be due to trauma to otic hair cells, the cochlea,
and/or the cranial nerve VII. Multiple drugs are known to be
ototoxic. Often ototoxicity is dose-dependent. It may be permanent
or reversible upon withdrawal of the drug.
[0228] Known ototoxic drugs include, but are not limited to, the
aminoglycoside class of antibiotics (e.g. gentamicin, and
amikacin), some members of the macrolide class of antibiotics (e.g
erythromycin), some members of the glycopeptide class of
antibiotics (e.g. vancomycin), salicylic acid, nicotine, some
chemotherapeutic agents (e.g. actinomycin, bleomycin, cisplatin,
carboplatin and vincristine), and some members of the loop diuretic
family of drugs (e.g. furosemide), 6-hydroxy dopamine (6-OH DPAT),
6,7-dinitroquinoxaline-2,3-dione (DNQX) or the like.
[0229] Cisplatin and the aminoglycoside class of antibiotics induce
the production of reactive oxygen species ("ROS"). ROS can damage
cells directly by damaging DNA, polypeptides, and/or lipids.
Antioxidants prevent damage of ROS by preventing their formation or
scavenging free radicals before they can damage the cell. Both
cisplatin and the aminoglycoside class of antibiotics are also
thought to damage the ear by binding melanin in the stria
vascularis of the inner ear.
[0230] Salicylic acid is classified as ototoxic as it inhibits the
function of the polypeptide prestin. Prestin mediates outer otic
hair cell motility by controlling the exchange of chloride and
carbonate across the plasma membrane of outer otic hair cells. It
is only found in the outer otic hair cells, not the inner otic hair
cells. Accordingly, disclosed herein is the use of controlled
release auris-compositions comprising otoprotectants (e.g.
antioxidants) to prevent, ameliorate or lessen ototoxic effects of
chemotherapy, including but not limited to cisplatin treatment,
aminoglycoside or salicylic acid administration, or other ototoxic
agents.
Endolymphatic Hydrops
[0231] Endolymphatic hydrops refers to an increase in the hydraulic
pressure within the endolymphatic system of the inner ear. The
endolymph and perilymph are separated by thin membranes which
contain multiple nerves. Fluctuation in pressure stresses the
membranes and the nerves they house. If the pressure is great
enough, disruptions may form in these membranes. This results in a
mixing of the fluids which can lead to a depolarization blockade
and transient loss of function. Changes in the rate of vestibular
nerve firing often leads to vertigo. Further, the organ of Corti
may also be affected. Distortions of the basilar membrane and the
inner and outer hair cells can lead to hearing loss and/or
tinnitus.
[0232] Causes include metabolic disturbances, hormonal imbalances,
autoimmune disease, and viral, bacterial, or fungal infections.
Symptoms include hearing loss, vertigo, tinnitus, and aural
fullness. Nystagmus may also be present. Treatment includes
systemic administration of benzodiazepine, diuretics (to decrease
the fluid pressure), corticosteroids, and/or anti-bacterial,
anti-viral, or anti-fungal agents.
Labyrinthitis
[0233] Labyrinthitis is an inflammation of the labyrinths of the
ear which contain the vestibular system of the inner ear. Causes
include bacterial, viral, and fungal infections. It may also be
caused by a head injury or allergies. Symptoms of labyrinthitis
include difficulty maintaining balance, dizziness, vertigo,
tinnitus, and hearing loss. Recovery may take one to six weeks;
however, chronic symptoms may be present for years.
[0234] There are several treatments for labyrinthitis.
Prochlorperazine is often prescribed as an antiemetic.
Serotonin-reuptake inhibitors have been shown to stimulate new
neural growth within the inner ear. Additionally, treatment with
antibiotics is prescribed if the cause is a bacterial infection,
and treatment with corticosteroids and antivirals is recommended if
the condition is caused by a viral infection.
Meniere's Disease
[0235] Meniere's Disease is an idiopathic condition characterized
by sudden attacks of vertigo, nausea and vomiting that may last for
3 to 24 hours, and may subside gradually. Progressive hearing loss,
tinnitus and a sensation of pressure in the ears accompanies the
disease through time. The cause of Meniere's disease is likely
related to an imbalance of inner ear fluid homeostasis, including
an increase in production or a decrease in reabsorption of inner
ear fluid.
[0236] Studies of the vasopressin (VP)-mediated aquaporin 2 (AQP2)
system in the inner ear suggest a role for VP in inducing endolymph
production, thereby increasing pressure in the vestibular and
cochlear structures. VP levels were found to be upregulated in
endolymphatic hydrops (Meniere's Disease) cases, and chronic
administration of VP in guinea pigs was found to induce
endolymphatic hydrops. Treatment with VP antagonists, including
infusion of OPC-31260 (a competitive antagonist of V2-R) into the
scala tympani resulted in a marked reduction of Meniere's disease
symptoms. Other VP antagonists include WAY-140288, CL-385004,
tolvaptan, conivaptan, SR 121463A and VPA 985. (Sanghi et al. Eur.
Heart J. (2005) 26:538-543; Palm et al. Nephrol. Dial Transplant
(1999) 14:2559-2562).
[0237] Other studies suggest a role for estrogen-related receptor
.beta./NR3B2 (ERR/Nr3b2) in regulating endolymph production, and
therefore pressure in the vestibular/cochlear apparatus. Knock-out
studies in mice demonstrate the role of the polypeptide product of
the Nr3b2 gene in regulating endolymph fluid production. Nr3b2
expression has been localized in the endolymph-secreting strial
marginal cells and vestibular dark cells of the cochlea and
vestibular apparatus, respectively. Moreover, conditional knockout
of the Nr3b2 gene results in deafness and diminished endolymphatic
fluid volume. Treatment with antagonists to ERR/Nr3b2 may assist in
reducing endolymphatic volume, and thus alter pressure in the auris
interna structures.
[0238] Other treatments may be aimed at dealing with the immediate
symptoms and prevention of recurrence. Low-sodium diets, avoidance
of caffeine, alcohol, and tobacco have been advocated. Medications
that may temporarily relieve vertigo attacks include antihistamines
(including meclizine and other antihistamines), and central nervous
system agents, including barbiturates and/or benzodiazepines,
including lorazepam or diazepam. Other examples of drugs that may
be useful in relieving symptoms include muscarinic antagonists,
including scopolamine. Nausea and vomiting may be relieved by
suppositories containing antipsychotic agents, including the
phenothiazine agent prochlorperazine.
[0239] Surgical procedures that have been used to relieve symptoms
include the destruction of vestibular and/or cochlear function to
relieve vertigo symptoms. These procedures aim to either reduce
fluid pressure in the inner ear and/or to destroy inner ear balance
function. An endolymphatic shunt procedure, which relieves fluid
pressure, may be placed in the inner ear to relieve symptoms of
vestibular dysfunction. Other treatments include gentamicin
application, which when injected into the eardrum destroys sensory
hair cell function, thereby eradicating inner ear balance function.
Severing of the vestibular nerve may also be employed, which while
preserving hearing, may control vertigo. In some embodiments, an
auris sensory cell modulator promotes growth of hair cells and
allows a subject to regain inner ear balance function.
Meniere's Syndrome
[0240] Meniere's Syndrome, which displays similar symptoms as
Meniere's disease, is attributed as a secondary affliction to
another disease process, e.g. thyroid disease or inner ear
inflammation due to syphilis infection. Meniere's syndrome, thus,
are secondary effects to various process that interfere with normal
production or resorption of endolymph, including endocrine
abnormalities, electrolyte imbalance, autoimmune dysfunction,
medications, infections (e.g. parasitic infections) or
hyperlipidemia. Treatment of patients afflicted with Meniere's
Syndrome is similar to Meniere's Disease.
Ramsay Hunt's Syndrome (Herpes Zoster Infection)
[0241] Ramsay Hunt's Syndrome is caused by a herpes zoster
infection of the auditory nerve. The infection may cause severe ear
pain, hearing loss, vertigo, as well as blisters on the outer ear,
in the ear canal, as well as on the skin of the face or neck
supplied by the nerves. Facial muscles may also become paralyzed if
the facial nerves are compressed by the swelling. Hearing loss may
be temporary or permanent, with vertigo symptoms usually lasting
from several days to weeks.
[0242] Treatment of Ramsay Hunt's syndrome includes administration
of antiviral agents, including acyclovir. Other antiviral agents
include famciclovir and valacyclovir. Combination of antiviral and
corticosteroid therapy may also be employed to ameliorate herpes
zoster infection. Analgesics or narcotics may also be administered
to relieve the pain, and diazepam or other central nervous system
agents to suppress vertigo. Capsaicin, lidocaine patches and nerve
blocks are optionally used. Surgery may also be performed on
compressed facial nerves to relieve facial paralysis.
Microvascular Compression Syndrome
[0243] Microvascular compression syndrome (MCS), also called
"vascular compression" or "neurovascular compression", is a
disorder characterized by vertigo and tinnitus. It is caused by the
irritation of Cranial Nerve VII by a blood vessel. Other symptoms
found in subjects with MCS include, but are not limited to, severe
motion intolerance, and neuralgic like "quick spins". MCS is
treated with carbamazepine, TRILEPTAL.RTM., and baclofen. It can
also be surgically treated.
Vestibular Neuronitis
[0244] Vestibular neuronitis, or vestibular neuropathy, is an
acute, sustained dysfunction of the peripheral vestibular system.
It is theorized that vestibular neuronitis is caused by a
disruption of afferent neuronal input from one or both of the
vestibular apparatuses. Sources of this disruption include viral
infection and acute localized ischemia of the vestibular nerve
and/or labyrinth.
[0245] The most significant finding when diagnosing vestibular
neuronitis is spontaneous, unidirectional, horizontal nystagmus. It
is often accompanied by nausea, vomiting, and vertigo. It is,
however, generally not accompanied by hearing loss or other
auditory symptoms.
[0246] There are several treatments for vestibular neuronitis.
H1-receptor antagonists, such as dimenhydrinate, diphenhydramine,
meclizine, and promethazine, diminish vestibular stimulation and
depress labyrinthine function through anticholinergic effects.
Benzodiazepines, such as diazepam and lorazepam, are also used to
inhibit vestibular responses due to their effects on the GABAA
receptor. Anticholinergics, for example scopolamine, are also
prescribed. They function by suppressing conduction in the
vestibular cerebellar pathways. Finally, corticosteroids (i.e.
prednisone) are prescribed to ameliorate the inflammation of the
vestibular nerve and associated apparatus.
Pharmaceutical Agents
[0247] Provided herein are auris sensory cell modulating agent
compositions or formulations that modulate the degeneration of
auris sensory cells (e.g., neurons and/or hair cells of the auris).
In some embodiments, auris sensory cell modulating agent
compositions or formulations described herein reduce or delay or
reverse the degeneration of auris sensory cells (e.g., neurons
and/or hair cells of the auris).. Also disclosed herein are
controlled release compositions for treating or ameliorating
hearing loss or reduction resulting from destroyed, stunted,
malfunctioning, damaged, fragile or missing hairs in the inner ear.
Additionally provided herein are auris sensory cell modulating
agent compositions or formulations that promote the growth and/or
regeneration of auris sensory cells (e.g., neurons and/or hair
cells of the auris). In some embodiments, auris sensory cell
modulating agent compositions or formulations destroy auris sensory
cells (e.g., neurons and/or hair cells of the auris). In some
embodiments, auris sensory cell modulating agents are
otoprotectants and reduce, reverse or delay damage to auris sensory
cells (e.g., neurons and/or hair cells of the auris).
[0248] Otic and vestibular disorders have causes and symptoms that
are responsive to the pharmaceutical agents disclosed herein, or
other pharmaceutical agents. Auris sensory cell modulating agents
which are not disclosed herein but which ameliorate or eradicate
otic disorders are expressly included and intended within the scope
of the embodiments presented.
[0249] Moreover, pharmaceutical agents which have been previously
shown to be toxic, harmful or non-effective during systemic or
localized application in other organ systems, for example through
toxic metabolites formed after hepatic processing, toxicity of the
drug in particular organs, tissues or systems, through high levels
needed to achieve efficacy, through the inability to be released
through systemic pathways or through poor pK characteristics, are
useful in some embodiments herein. Accordingly, pharmaceutical
agents which have limited or no systemic release, systemic
toxicity, poor pK characteristics or combinations thereof are
contemplated within the scope of the embodiments disclosed
herein.
[0250] The auris sensory cell modulating agent formulations
disclosed herein are optionally targeted directly to otic
structures where treatment is needed; for example, one embodiment
contemplated is the direct application of the auris sensory cell
modulating agent formulations disclosed herein onto the round
window membrane or the crista fenestrae cochlea of the auris
interna, allowing direct access and treatment of the auris interna,
or inner ear components. In other embodiments, the auris sensory
cell modulating agent formulation disclosed herein is applied
directly to the oval window. In yet other embodiments, direct
access is obtained through microinjection directly into the auris
interna, for example, through cochlear microperfusion. Such
embodiments also optionally comprise a drug delivery device,
wherein the drug delivery device delivers the auris sensory cell
modulating agent formulations through use of a needle and syringe,
a pump, a microinjection device, an auris-acceptable in situ
forming spongy material or any combination thereof
[0251] Some pharmaceutical agents, either alone or in combination,
are ototoxic. For example, some chemotherapeutic agents, including
actinomycin, bleomycin, cisplatin, carboplatin and vincristine; and
antibiotics, including erythromycin, gentamicin, streptomycin,
dihydrostreptomycin, tobramycin, netilmicin, amikacin, neomycin,
kanamycin, etiomycin, vancomycin, metronidizole, capreomycin, are
mildly to very toxic, and affect the vestibular and cochlear
structures differentially. However, in some instances, the
combination of an ototoxic drug, for example cisplatin, gentamicin,
in combination with an otoprotectant is lessens the ototoxic
effects of the drug. Moreover, the localized application of the
potentially ototoxic drug also lessens the toxic effects that would
otherwise occur through systemic application through the use of
lower amounts with maintained efficacy, or the use of targeted
amounts for a shorter period of time.
[0252] In some embodiments, the auris sensory cell modulating agent
formulations disclosed herein further comprise otoprotectants that
reduce, inhibit or ameliorate the ototoxicity of agents such as
chemotherapeutic agents and/or antibiotics as described herein, or
reduce, inhibit or ameliorate the effects of other environmental
factors, including excessive noise and the like. Examples of
otoprotectants include, and are not limited to, otoprotectants
described herein, thiols and/or thiol derivatives and/or
pharmaceutically acceptable salts, or derivatives (e.g. prodrugs)
thereof
[0253] Otoprotectants allow for the administration of ototoxic
agents and/or antibiotics at doses that are higher than maximal
toxic doses; the ototoxic agents and/or antibiotics would otherwise
be administered at lower doses due to ototoxicity. An
otoprotectant, when optionally administered by itself, also allows
for the amelioration, reduction or elimination of the effect of
environmental factors that contribute to loss of hearing and
attendant effects, including but not limited to noise-induced
hearing loss and tinnitus.
[0254] The amount of otoprotectant in any formulation described
herein on a mole:mole basis in relation to the ototoxic
chemotherapeutic agent (e.g. cis platin) and/or an ototoxic
antibiotic (e.g. gentamicin) is in the range of from about 5:1 to
about 200:1, from about 5:1 to about 100:1, or from about 5:1 to
about 20:1. The amount of otoprotectant in any formulation
described herein on a molar basis in relation to the ototoxic
chemotherapeutic agent (e.g. cis platin) and/or an ototoxic
antibiotic (e.g. gentamicin) is about 50:1, about 20:1 or about
10:1. Any auris sensory cell modulating agent formulation described
herein comprises from about 10 mg/ml to about 50 mg/ml, from about
20 mg/ml to about 30 mg/ml, or from 10 mg/mL to about 25 mg/ml of
otoprotectant.
[0255] Moreover, some pharmaceutical excipients, diluents or
carriers are potentially ototoxic. For example, benzalkonium
chloride, a common preservative, is ototoxic and therefore
potentially harmful if introduced into the vestibular or cochlear
structures. In formulating a controlled release auris sensory cell
modulating agent formulation, it is advised to avoid or combine the
appropriate excipients, diluents or carriers to lessen or eliminate
potential ototoxic components from the formulation, or to decrease
the amount of such excipients, diluents or carriers. Optionally, a
controlled release auris sensory cell modulating agent formulation
includes otoprotective agents, such as antioxidants, alpha lipoic
acid, calcium, fosfomycin or iron chelators, to counteract
potential ototoxic effects that may arise from the use of specific
therapeutic agents or excipients, diluents or carriers.
Amifostine
[0256] Contemplated for use with the formulations disclosed herein
are agents that modulate the degeneration of neurons and/or hair
cells of the auris, and agents for treating or ameliorating hearing
loss or reduction resulting from destroyed, stunted,
malfunctioning, damaged, fragile or missing hairs in the inner ear.
Accordingly, some embodiments incorporate the use of agents which
rescue neurons and otic hair cells from cisplatin-induced
ototoxicity.
[0257] Amifostine (also known as WR-2721, or ETHYOL.RTM.) is an
otoprotective agent. In certain instances, it prevents or
ameliorates the damage to neuron and otic hair cells caused by
cisplatin. In certain instances, doses at or above 40 mg/kg are
needed to protect against or ameliorate the ototoxic effects of
cisplatin.
Salicylic Acid
[0258] Contemplated for use with the formulations disclosed herein
are agents that modulate the degeneration of neurons and/or hair
cells of the auris, and agents for treating or ameliorating hearing
loss or reduction resulting from destroyed, stunted,
malfunctioning, damaged, fragile or missing hairs in the inner ear.
Accordingly, some embodiments incorporate the use of salicylic
acid. In certain instances, salicyclic acid is an antioxidant and
when administered before treatment with an aminoglycoside, it
protects otic hair cells and spiral ganglion neurons from
aminoglycoside ototoxicity.
Modulation of Atoh/Math1
[0259] Contemplated for use with the formulations disclosed herein
are agents that promote the growth and/or regeneration of neurons
and/or otic hair cells. Atoh1 is a transcription factor which binds
to an E-box. In certain instances, it is expressed during the
development of the hair cells of the vestibular and auditory
systems. In certain instances, mice with Atoh1 knocked-out did not
develop otic hair cells. In certain instances, adenoviruses
expressing Atoh1 stimulate the growth and/or regeneration of otic
hair cells in guinea pigs treated with ototoxic antibiotics.
Accordingly, some embodiments incorporate modulation of the Atoh1
gene.
[0260] In some embodiments, a subject is administered a vector
engineered to carry the human Atoh1 gene (the "Atoh1 vector"). For
disclosures of techniques for creating the Atoh1 vector see U.S.
Pub. No. 2004/02475750, which is hereby incorporated by reference
for those disclosures. In some embodiments, the Atoh1 vector is a
retrovirus. In some embodiments, the Atoh1 vector is not a
retrovirus (e.g. it is an adenovirus; a lentivirus; or a polymeric
delivery system such as METAFECTENE, SUPERFECT.RTM.,
EFFECTENE.RTM., or MIRUS TRANSIT).
[0261] In some embodiments, the Atoh1 vector is incorporated into a
controlled-release auris-acceptable microsphere or microparticle,
hydrogel, liposome, or thermoreversible gel. In some embodiments,
the auris-acceptable microsphere, hydrogel, liposome, paint, foam,
in situ forming spongy material, nanocapsule or nanosphere or
thermoreversible gel is injected into the inner ear. In some
embodiments, the auris-acceptable microsphere or microparticle,
hydrogel, liposome, or thermoreversible gel. In some embodiments,
the auris-acceptable microsphere, hydrogel, liposome, paint, foam,
in situ forming spongy material, nanocapsule or nanosphere or
thermoreversible gel is injected into the cochlea, the organ of
Corti, the vestibular labyrinth, or a combination thereof.
[0262] In certain instances, after administration of the Atoh1
vector, the Atoh1 vector infects the cells at the site of
administration (e.g. the cells of cochlea, organ of Corti, and/or
the vestibular labyrinth). In certain instances the Atoh1 sequence
is incorporated into the subject's genome (e.g. when the Atoh1
vector is a retrovirus). In certain instances the therapy will need
to be periodically re-administered (e.g. when the Atoh1 vector is
not a retrovirus). In some embodiments, the therapy is
re-administered annually. In some embodiments, the therapy is
re-administered semi-annually. In some embodiments, the therapy is
re-administered when the subject's hearing loss is moderate (i.e.
the subject cannot consistently hear frequencies less than 41 db to
55 dB) to profound (i.e. the subject cannot consistently hear
frequencies less than 90 dB).
[0263] In some embodiments, a subject is administered the Atoh1
polypeptide. In some embodiments, the Atoh1 polypeptide is
incorporated into controlled-release auris-acceptable microsphere
or microparticle, hydrogel, liposome, or thermoreversible gel. In
some embodiments, the auris-acceptable microsphere, hydrogel,
liposome, paint, foam, in situ forming spongy material, nanocapsule
or nanosphere or thermoreversible gel. In some embodiments, the
auris-acceptable microsphere or microparticle, hydrogel, liposome,
or thermoreversible gel. In some embodiments, the auris-acceptable
microsphere, hydrogel, liposome, paint, foam, in situ forming
spongy material, nanocapsule or nanosphere or thermoreversible gel
is injected into the inner ear. In some embodiments, the
auris-acceptable microsphere or microparticle, hydrogel, liposome,
or thermoreversible gel. In some embodiments, the auris-acceptable
microsphere, hydrogel, liposome, paint, foam, in situ forming
spongy material, nanocapsule or nanosphere or thermoreversible gel
is injected into the cochlea, the organ of Corti, the vestibular
labyrinth, or a combination thereof. In some embodiments, the
auris-acceptable microsphere or microparticle, hydrogel, liposome,
or thermoreversible gel. In some embodiments, the auris-acceptable
microsphere, hydrogel, liposome, paint, foam, in situ forming
spongy material, nanocapsule or nanosphere or thermoreversible gel
is placed in contact with the round window membrane.
[0264] In some embodiments, a subject is administered a
pharmaceutically acceptable agent which modulates the expression of
the Atoh1 gene or activity of the Atoh1 polypeptide. In some
embodiments, the expression of the Atoh1 gene or activity of the
Atoh1 polypeptide is up-regulated. In some embodiments, the
expression of the Atoh1 gene or activity of the Atoh1 polypeptide
is down-regulated.
[0265] In certain instances, a compound which agonizes or
antagonizes Atoh1 is identified (e.g. by use of a high throughput
screen). In some embodiments, a construct is designed such that a
reporter gene is placed downstream of an E-box sequence. In some
embodiments, the reporter gene is luciferase, CAT, GFP,
.beta.-lactamase or .beta.-galactosidase. In certain instances, the
Atoh1 polypeptide binds to the E-box sequence and initiates
transcription and expression of the reporter gene. In certain
instances, an agonist of Atoh1 aids or facilitates the binding of
Atoh1 to the E-box sequence, thus increasing transcription and
expression of the reporter gene relative to a pre-determined
baseline expression level. In certain instances, an antagonist of
Atoh1 blocks the binding of Atoh1 to the E-box, thus decreasing
transcription and expression of the reporter gene relative to a
pre-determined baseline expression level.
BRN-3 Modulators
[0266] Contemplated for use with the formulations disclosed herein
are agents that promote the growth and/or regeneration of neurons
and/or otic hair cells. BRN-3 is a group of transcription factors
that include, but are not limited to, BRN-3a, BRN-3b, and BRN-3c.
In certain instances, they are expressed in postmitotic hair cells.
In certain instances, the hair cells of mice with BRN-3c
knocked-out did not develop stereocilia and/or underwent cell
death. In certain instances, BRN3 genes regulate the
differentiation of inner ear supporting cells into inner ear
sensory cells. Accordingly, some embodiments incorporate modulation
of the BRN3 genes, and/or polypeptides.
[0267] In some embodiments, a subject is administered a vector
engineered to carry a human BRN-3 gene (the "BRN3 vector"). In some
embodiments, the BRN3 vector is a retrovirus. In some embodiments,
the BRN3 vector is not a retrovirus (e.g. it is an adenovirus; a
lentivirus; or a polymeric delivery system such as METAFECTENE,
SUPERFECT.RTM., EFFECTENE.RTM., or MIRUS TRANSIT).
[0268] In some embodiments, the subject is administered the BRN3
vector before, during, or after exposure to an ototoxic agent (e.g
an aminoglycoside or cisplatin), or a sound of sufficient loudness
to induce acoustic trauma.
[0269] In some embodiments, the BRN3 vector is incorporated into a
controlled-release auris-acceptable microsphere or microparticle,
hydrogel, liposome, or thermoreversible gel. In some embodiments,
the auris-acceptable microsphere, hydrogel, liposome, paint, foam,
in situ forming spongy material, nanocapsule or nanosphere or
thermoreversible gel is injected into the inner ear. In some
embodiments, the auris-acceptable microsphere or microparticle,
hydrogel, liposome, or thermoreversible gel. In some embodiments,
the auris-acceptable microsphere, hydrogel, liposome, paint, foam,
in situ forming spongy material, nanocapsule or nanosphere or
thermoreversible gel is injected into the cochlea, the organ of
Corti, the vestibular labyrinth, or a combination thereof.
[0270] In certain instances, after administration of the BRN3
vector, the BRN3 vector infects the cells at the site of
administration (e.g. the cells of cochlea, organ of Corti, and/or
the vestibular labyrinth). In certain instances the BRN3 sequence
is incorporated into the subject's genome (e.g. when the BRN3
vector is a retrovirus). In certain instances the therapy will need
to be periodically re-administered (e.g. when the BRN3 vector is
not a retrovirus).
[0271] In some embodiments, a subject is administered a BRN3
polypeptide. In some embodiments, the BRN3 polypeptide is
incorporated into controlled-release auris-acceptable microsphere
or microparticle, hydrogel, liposome, or thermoreversible gel. In
some embodiments, the auris-acceptable microsphere, hydrogel,
liposome, paint, foam, in situ forming spongy material, nanocapsule
or nanosphere or thermoreversible gel. In some embodiments, the
auris-acceptable microsphere or microparticle, hydrogel, liposome,
or thermoreversible gel. In some embodiments, the auris-acceptable
microsphere, hydrogel, liposome, paint, foam, in situ forming
spongy material, nanocapsule or nanosphere or thermoreversible gel
is injected into the inner ear. In some embodiments, the
auris-acceptable microsphere or microparticle, hydrogel, liposome,
or thermoreversible gel. In some embodiments, the auris-acceptable
microsphere, hydrogel, liposome, paint, foam, in situ forming
spongy material, nanocapsule or nanosphere or thermoreversible gel
is injected into the cochlea, the organ of Corti, the vestibular
labyrinth, or a combination thereof. In some embodiments, the
auris-acceptable microsphere or microparticle, hydrogel, liposome,
or thermoreversible gel. In some embodiments, the auris-acceptable
microsphere, hydrogel, liposome, paint, foam, in situ forming
spongy material, nanocapsule or nanosphere or thermoreversible gel
is placed in contact with the round window membrane.
[0272] In some embodiments, a subject is administered a
pharmaceutically acceptable agent which modulates the expression of
the BRN3 gene or activity of the BRN3 polypeptide. In some
embodiments, the expression of the BRN3 gene or activity of the
BRN3 polypeptide is up-regulated. In some embodiments, the
expression of the BRN3 gene or activity of the BRN3 polypeptide is
down-regulated.
[0273] In some embodiments, a compound which agonizes or
antagonizes BRN3 is identified (e.g. by use of a high throughput
screen). In some embodiments, a construct is designed such that a
reporter gene is placed downstream of a BRN3 binding site. In some
embodiments, the BRN3 binding site has the sequence ATGAATTAAT
(SBNR3). In some embodiments, the reporter gene is luciferase, CAT,
GFP, .beta.-lactamase or .beta.-galactosidase. In certain
instances, the BRN3 polypeptide binds to the SBNR3 sequence and
initiates transcription and expression of the reporter gene. In
certain instances, an agonist of BRN3 aids or facilitates the
binding of BRN3 to the SBNR3 sequence, thus increasing
transcription and expression of the reporter gene relative to a
pre-determined baseline expression level. In certain instances, an
antagonist of BRN3 blocks the binding of BRN3 to the SBNR3, thus
decreasing transcription and expression of the reporter gene
relative to a pre-determined baseline expression level.
Carbamates
[0274] Contemplated for use with the formulations disclosed herein
are agents that modulate the degeneration of neurons and/or hair
cells of the auris, and agents for treating or ameliorating hearing
loss or reduction resulting from destroyed, stunted,
malfunctioning, damaged, fragile or missing hairs in the inner ear.
In certain instances, carbamate compounds protect neurons and otic
hair cells from glutamate-induced excitotoxicity. Accordingly, some
embodiments incorporate the use of carbamate compounds. In some
embodiments, the carbamate compounds are 2-phenyl-1,2-ethanediol
monocarbomates and dicarbamates, derivatives thereof, and/or
combinations thereof.
Gamma-Secretase Inhibitors
[0275] Contemplated for use with the formulations disclosed herein
are agents that modulate the degeneration of neurons and/or hair
cells of the auris, and agents for treating or ameliorating hearing
loss or reduction resulting from destroyed, stunted,
malfunctioning, damaged, fragile or missing hairs in the inner ear.
Accordingly, some embodiments incorporate the use of agents which
inhibit Notch1 signaling. Notch1 is a transmembrane polypeptide
which participates in cell development. In some embodiments, the
agents which inhibit Notch1 signaling are .gamma.-secretase
inhibitors. In certain instances, the inhibition of Notch1 by a
.gamma.-secretase inhibitor, following treatment with an ototoxic
agent, results in the production/growth of otic hair cells. In some
embodiments, the .gamma.-secretase inhibitor is LY450139
(hydroxylvaleryl monobenzocaprolactam), L685458
(1S-benzyl-4R[1-[1-S-carbamoyl-2-phenethylcarbamoyl)-1S-3-methylbutylcarb-
amoyl]-2R-hydroxy-5-phenylpentyl)carbamic acid tert-butyl ester);
LY411575
(N2-[(2S)-2-(3,5-difluorophenyl)-2-hydroxyethanoyl]-N1[(7S)-5-methyl-6-ox-
o-6,7-dihydro-5H-dibenzo[bid]azepin-7yl]-L-alaninamide), MK-0752
(Merck), tarenflurbil, and/or BMS-299897
(2-[(1R)-1-[[(4-chlorophenyl)
sulfony](2,5-difluorophenyl)amino]ethyl]-5-fluorobenzenepropanoic
acid).
Glutamate-Receptor Modulators
[0276] Provided herein are methods of treating an otic disorder
characterized by the dysregulation (e.g., over-activation or
over-stimulation) of a glutamate receptor. In some embodiments, a
method disclosed herein comprises administering to an individual in
need thereof a composition comprising a glutamate receptor
antagonist. Glutamate receptor antagonists which are not disclosed
herein but which are useful for the amelioration or eradication of
otic disorders are expressly included and intended within the scope
of the embodiments presented.
[0277] Contemplated for use with the formulations disclosed herein
are agents that modulate the degeneration of neurons and/or hair
cells of the auris, and agents for treating or ameliorating hearing
loss or reduction resulting from destroyed, stunted,
malfunctioning, damaged, fragile or missing hairs in the inner ear.
Accordingly, some embodiments incorporate the use of agents which
modulate glutamate receptors. In some embodiments, the glutamate
receptor is the AMPA receptor, and/or a group II or III mGlu
receptor. In some embodiments, the glutamate receptor is the NMDA
receptor. In some embodiments, the glutamate receptor modulator is
a glutamate receptor antagonist. In some embodiments, the glutamate
receptor antagonist is a non-competitive antagonist. In some
embodiments, the glutamate receptor antagonist is a small
molecule.
[0278] In some embodiments, the agent that modulates the AMPA
receptor is an AMPA receptor antagonist. In some embodiments, the
agent which antagonizes the AMPA receptors is CNQX
(6-cyano-7-nitroquinoxaline-2,3-dione); NBQX
(2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo[f]quinoxaline-2,3-dione);
DNQX (6,7-dinitroquinoxaline-2,3-dione); kynurenic acid;
2,3-dihydroxy-6-nitro-7-sulfamoylbenzo-[f]quinoxaline; or
combinations thereof.
[0279] In some embodiments, the glutamate receptor antagonist is an
NMDA receptor antagonist. In some embodiments, the agent that
modulates the NMDA receptor is an NMDA receptor antagonist. In some
embodiments, the glutamate receptor antagonist 1-aminoadamantane;
dextromethorphan; dextrorphan; ibogaine; ifenprodil; (S)-ketamine;
(R)-ketamine; memantine; dizocilpine (MK-801); gacyclidine; AM-101;
traxoprodil; D-2-amino-5-phosphonopentanoic acid (D-AP5);
3-((.+-.)2-carboxypiperazin-4-yl)-propyl-1-phosphonic acid (CPP);
conantokin; 7-chlorokynurenate (7-CK); licostinel; nitrous oxide;
phencyclidine; riluzole; tiletamine; aptiganel; remacimide; DCKA
(5;7-dichlorokynurenic acid); kynurenic acid;
1-aminocyclopropanecarboxylic acid (ACPC); AP7
(2-amino-7-phosphonoheptanoic acid); APV
(R-2-amino-5-phosphonopentanoate); CPPene
(3-[(R)-2-carboxypiperazin-4-yl]-prop-2-enyl-1-phosphonic acid);
(+)-(1S;
2S)-1-(4-hydroxy-phenyl)-2-(4-hydroxy-4-phenylpiperidino)-1-pro-panol;
(1S,2S)-1-(4-hydroxy-3-methoxyphenyl)-2-(4-hydroxy-4-phenylpiperi-dino)-1-
-propanol;
(3R,4S)-3-(4-(4-fluorophenyl)-4-hydroxypiperidin-1-yl-)-chroman-
-4,7-diol; (1R*;
2R*)-1-(4-hydroxy-3-methylphenyl)-2-(4-(4-fluoro-phenyl)-4-hydroxypiperid-
in-1-yl)-propan-1-ol-mesylate; or combinations thereof. In some
embodiments, the NMDA receptor antagonist is an
arylcycloalkylamine. In some embodiments, the NMDA receptor
antagonist is (S)-ketamine or a salt thereof. In some embodiments,
the NMDA receptor antagonist is a chinazoline. In some embodiments,
the NMDA receptor antagonist is 7-CK or a salt thereof. In some
embodiments, the NMDA receptor antagonist is AM-101 or a salt
thereof.
[0280] In some embodiments, the glutamate receptor antagonist is a
peptide. In some embodiments, the glutamate receptor antagonist is
a fusion peptide comprising (a) a transporter peptide, and (b) a
peptide inhibiting interaction of an NMDA receptor with NMDA
receptor interacting proteins. As used herein, a "transporter
peptide" means a peptide that promotes peptide penetration into
cells and tissues. In some embodiments, a transporter peptide is
TAT.
[0281] In some embodiments, the glutamate receptor antagonist is a
fusion peptide comprising (a) a TAT peptide, and (b) a peptide
inhibiting interaction of an NMDA receptor with NMDA receptor
interacting proteins. In some embodiments, the glutamate receptor
antagonist is a fusion peptide comprising (a) a (D)-TAT peptide,
and (b) a peptide inhibiting interaction of an NMDA receptor with
NMDA receptor interacting proteins. In some embodiments, the
glutamate receptor antagonist is a fusion peptide comprising (a) a
transporter peptide, and (b) an NR2B9c peptide. In some
embodiments, the glutamate receptor antagonist is a fusion peptide
comprising (a) a transporter peptide, and (b) a (D)-NR2B9c peptide.
In some embodiments, the glutamate receptor antagonist is a fusion
peptide comprising (a) a (D)-TAT peptide, and (b) a (D)-NR2B9c
peptide. In some embodiments, the glutamate receptor antagonist is
a fusion peptide comprising (a) a transporter peptide, and (b) a
(L)-NR2B9c peptide.
[0282] In certain instances, the over-activation of the AMPA and
NMDA glutamate receptors by the binding of excessive amounts of
glutamate, results in the excessive opening of the ion channels
under their control. In certain instances, this results in
abnormally high levels of Ca2+ and Na+ entering the neuron. In
certain instances, the influx of Ca2+ and Na+ into the neuron
activates multiple enzymes including, but not limited to,
phospholipases, endonucleases, and proteases. In certain instances,
the over-activation of these enzymes results in damage to the
cytoskeleton, plasma membrane, mitochondria, and DNA of the neuron.
Further, in certain instances, the transcription of multiple
pro-apoptotic genes and anti-apoptotic genes are controlled by Ca2+
levels.
[0283] The mGlu receptors, unlike the AMPA and NMDA receptors, do
not directly control an ion channel. However, in certain instances,
they indirectly control the opening of ion channels by the
activation of biochemical cascades. The mGlu receptors are divided
into three groups. In certain instances, the members of groups II
and III reduce or inhibit post-synaptic potentials by preventing or
decreasing the formation of cAMP. In certain instances, this causes
a reduction in the release of neurotransmitters, especially
glutamate. GRM7 is the gene which encodes the mGlu7 receptor, a
group III receptor. In certain instances, the agonism of mGlu7
results in a decrease in synaptic concentrations of glutamate. This
ameliorates glutamate excitotoxicity.
[0284] In some embodiments, the glutamate receptor is a group II
mGlu receptor. In some embodiments, the agent which modulates the
group II mGlu receptor is a group II mGlu receptor agonist. In some
embodiments, the group II mGlu receptor agonist is LY389795
((-)-2-thia-4-aminobicyclo-hexane-4,6-dicarboxylate); LY379268
((-)-2-oxa-4-aminobicyclo-hexane-4,6-dicarboxylate); LY354740
((+)-2-aminobicyclo-hexane-2,6dicarboxylate); DCG-IV
((2S,2'R,3'R)-2-(2',3'-dicarboxycyclopropyl)glycine); 2R,4R-APDC
(2R,4R-4-aminopyrrolidine-2,4-dicarboxylate), (S)-3C4HPG
((S)-3-carboxy-4-hydroxyphenylglycine); (S)-4C3HPG
((S)-4-carboxy-3-hydroxyphenylglycine); L-CCG-I
((2S,1'S,2'S)-2-(carboxycyclopropyl)glycine); and/or combinations
thereof
[0285] In some embodiments, the mGlu receptor is a group III mGlu
receptor. In some embodiments, the group III mGlu receptor is
mGlu7. In some embodiments, the agent which modulates the group III
mGlu receptor is a group III mGlu receptor agonist. In some
embodiments, the group III mGlu receptor agonist is ACPT-I
((1S,3R,4S)-1-aminocyclopentane-1,3,4-tricarboxylic acid); L-AP4
(L-(+)-2-Amino-4-phosphonobutyric acid); (S)-3,4-DCPG
((S)-3,4-dicarboxyphenylglycine); (RS)-3,4-DCPG
((RS)-3,4-dicarboxyphenylglycine); (RS)-4-phosphonophenylglycine
((RS)PPG); AMN082 (,N'-bis(diphenylmethyl)-1,2-ethanediamine
dihydrochloride); DCG-IV
((2S,2'R,3'R)-2-(2',3'-dicarboxycyclopropyl)glycine); and/or
combinations thereof. In some embodiments, the mGlu receptor is
mGlu7. In some embodiments, the agonist of mGlu7 is AMN082. In some
embodiments, the mGlu receptor modulator is 3,5-Dimethyl
pyrrole-2,4-dicarboxylic acid 2-propyl ester
4-(1,2,2-trimethyl-propyl) ester (3,5-dimethyl PPP);
3,3'-difluorobenzaldazine (DFB), 3,3'-dimlethoxybenzaldazine
(DMeOB), 3,3'-dichlorobenzaldazine (DCB) and other allosteric
modulators of mGluR5 disclosed in Mol. Pharmacol. 2003, 64,
731-740; (E)-6-methyl-2-(phenyldiazenyl)pyridin-3-ol (SIB 1757);
(E)-2-methyl-6-styrylpyridine (SIB 1893);
2-methyl-6-(phenylethynyl)pyridine (MPEP),
2-methyl-4-((6-methylpyridin-2-yl)ethynyl)thiazole (MTEP);
7-(Hydroxyimino)cyclopropa[b]chromen-1.alpha.-carboxylate ethyl
ester (CPCCOEt),
N-cyclohexyl-3-methylbenzo[d]thiazolo[3,2-a]imidazole-2-carboxamide
(YM-298198), tricyclo[3.3.3.1]nonanyl quinoxaline-2-carboxamide
(NPS 2390); 6-methoxy-N-(4-methoxyphenyl)quinazolin-4-amine (LY
456239); mGluR1 antagonists disclosed in WO2004/058754 and
WO2005/009987;
2-(4-(2,3-dihydro-1H-inden-2-ylamino)-5,6,7,8-tetrahydroquinazolin-2-ylth-
io)ethanol; 3-(5-(pyridin-2-yl)-2H-tetrazol-2-yl)benzonitrile,
2-(2-methoxy-4-(4-(pyridin-2-yl)oxazol-2-yl)phenyl)acetonitrile;
2-(4-(benzo[d]oxazol-2-yl)-2-methoxyphenyl)acetonitrile;
6-(3-methoxy-4-(pyridin-2-yl)phenyl)imidazo[2,1-b]thiazole;
(S)-(4-fluorophenyl)(3-(3-(4-fluorophenyl)-1,2,4-oxadiazol-5-yl)piperidin-
-1-yl)methanone (ADX47273) and/or combinations thereof.
[0286] In some embodiments, a glutamate receptor modulator is a
nootropic agent. Contemplated for use with the formulations
disclosed herein are nootropic agents that modulate neuronal
signalling by activating glutamate receptors. In some instances,
nootropic agents treat or ameliorate hearing loss (e.g, NIHL) or
tinnitus. Accordingly, some embodiments incorporate the use of
nootropic agents including, and not limited to, piracetam,
Oxiracetam, Aniracetam, Pramiracetam, Phenylpiracetam (Carphedon),
Etiracetam, Levetiracetam, Nefiracetam, Nicoracetam, Rolziracetam,
Nebracetam, Fasoracetam, Coluracetam, Dimiracetam, Brivaracetam,
Seletracetam, and/or Rolipram for the treatment of NIHL or
tinnitus.
Trophic Agents
[0287] Contemplated for use with the formulations disclosed herein
are agents that reduce or delay the degeneration of neurons and/or
hair cells of the auris. In some embodiments, contemplated for use
with the compositions described herein are agents that are trophic
agents, e.g., agents that promote the growth of tissue and/or
neurons and/or hair cells of the auris. Also contemplated for use
with the compositions described herein are agents for treating or
ameliorating hearing loss or reduction resulting from destroyed,
stunted, malfunctioning, damaged, fragile or missing hairs in the
inner ear. Accordingly, some embodiments incorporate the use of
trophic agents which promote the survival of neurons and otic hair
cells, and/or the growth of neurons and otic hair cells. In some
embodiments, the trophic agent which promotes the survival of otic
hair cells is a growth factor. In some embodiments, the growth
factor is a neurotroph. In certain instances, neurotrophs are
growth factors which prevent cell death, prevent cell damage,
repair damaged neurons and otic hair cells, and/or induce
differentiation in progenitor cells. In some embodiments, the
neurotroph is brain-derived neurotrophic factor (BDNF), ciliary
neurotrophic factor (CNTF), glial cell-line derived neurotrophic
factor (GDNF), neurotrophin-3, neurotrophin-4, and/or combinations
thereof. In some embodiments, the growth factor is a fibroblast
growth factor (FGF), an insulin-like growth factor (IGF), an
epidermal growth factor (EGF), a platlet-derived growth factor
(PGF) and/or agonists thereof. In some embodiments, the growth
factor is an agonist of the fibroblast growth factor (FGF)
receptor, the insulin-like growth factor (IGF) receptor, the
epidermal growth factor (EGF) receptor, and/or the platlet-derived
growth factor. In some embodiments, the growth factor is hepatocyte
growth factor.
[0288] In some embodiments, the trophic agent and/or neurotroph is
BDNF. In some embodiments, the trophic agent and/or neurotroph is
GDNF. In certain instances, BDNF and GDNF are neurotrophs that
promote the survival of existing neurons (e.g. spiral ganglion
neurons), and otic hair cells by repairing damaged cells,
inhibiting the production of ROS, and/or inhibiting cell death. In
certain instances, it also promotes the differentiation of neural
and otic hair cell progenitors. Further, in certain instances, it
protects the Cranial Nerve VII from degeneration. In some
embodiments, BDNF is administered in conjunction with fibroblast
growth factor.
[0289] In some embodiments, the neurotroph is neurotrophin-3. In
certain instances, neurotrophin-3 promotes the survival of existing
neurons and otic hair cells, and promotes the differentiation of
neural and otic hair cell progenitors. Further, In certain
instances, it protects the VII nerve from degeneration.
[0290] some embodiments, the neurotroph is CNTF. In certain
instances, CNTF promotes the synthesis of neurotransmitters and the
growth of neuritis. In some embodiments, CNTF is administered in
conjunction with BDNF.
[0291] In some embodiments, the trophic agent and/or neurotroph is
GDNF. In certain instances, GDNF expression is increased by
treatment with ototoxic agents. Further, in certain instances,
cells treated with exogenous GDNF have higher survival rates after
trauma than untreated cells.
[0292] In some embodiments, the trophic agent and/or growth factor
is an epidermal growth factor (EGF). In some embodiments, the EGF
is heregulin (HRG). In certain instances, HRG stimulates the
proliferation of utricular sensory epithelium. In certain
instances, HRG-binding receptors are found in the vestibular and
auditory sensory epithelium.
[0293] In some embodiments, the trophic agent and/or growth factor
is an insulin-like growth factor (IGF). In some embodiments, the
IGF is IGF-1. In some embodiments, the IGF-1 is mecasermin. In
certain instances, IGF-1 attenuates the damage induced by exposure
to an aminoglycoside. In certain instances, IGF-1 stimulates the
differentiation and/or maturation of cochlear ganglion cells.
[0294] In some embodiments, the FGF receptor agonist is FGF-2. In
some embodiments, the IGF receptor agonist is IGF-1. Both the FGF
and IGF receptors are found in the cells comprising the utricle
epithelium.
[0295] In some embodiments, the growth factor is hepatocyte growth
factor (HGF). In some instances, HGF protects cochlear hair cells
from noise-induced damage and reduces noise-exposure-caused ABR
threshold shifts.
[0296] Also contemplated for use in the otic formulations described
herein are growth factors including Erythropoietin (EPO),
Granulocyte-colony stimulating factor (G-CSF),
Granulocyte-macrophage colony stimulating factor (GM-CSF), Growth
differentiation factor-9 (GDF9), Insulin-like growth factor (IGF),
Myostatin (GDF-8), Platelet-derived growth factor (PDGF),
Thrombopoietin (TPO), Transforming growth factor alpha
(TGF-.alpha.), Transforming growth factor beta (TGF-.beta.),
Vascular endothelial growth factor (VEGF) or combinations thereof.
Also contemplated for use in the otic compositions described herein
are trophic factors including antioxidants and/or vitamins that are
described herein.
Anti-Intercellular Adhesion Molecule-1 Antibody
[0297] Contemplated for use with the formulations disclosed herein
are antibodies to anti-intercellular adhesion molecule (ICAM). In
some instances, ICAM blocks the cascade of reactive oxygen species
associated with exposure to noise. In some instances modulation of
the cascade of reactive oxygen species associated with exposure to
noise ameliorates or reduces the degeneration of neurons and/or
hair cells of the auris. Accordingly, some embodiments incorporate
the use of agents that are antibodies to ICAMs (e.g., anti-ICAM-1
Ab, anti-ICAM-2 Ab or the like).
Otoprotectants
[0298] Contemplated for use with the formulations disclosed herein
are agents that modulate the degeneration of neurons and/or hair
cells of the auris, and agents for treating or ameliorating hearing
loss or reduction resulting from destroyed, stunted,
malfunctioning, damaged, fragile or missing hairs in the inner ear.
Accordingly, some embodiments incorporate the use of
otoprotectants. In some embodiments, an otoprotectant is a
glutamate receptor antagonist as described herein. In some
embodiments, an otoprotectant is a corticosteroid as described
herein. In some embodiments, otoprotectants are agents that
modulate glutathione peroxidase (GPx). The enzyme GPx reduces
reactive oxygen species (ROS) in the cohclea and maintains the
health of neurons and/or hair cells in the inner ear. Modulators of
GPx include and are not limited to glutathione peroxidase mimics
such as 2-phenyl-1,2-benzoisoselenazol-3(2H)-one (ebselen,
SPI-1005), 6A,6B-diseleninic acid-6A',6B'-selenium bridged
.beta.-cyclodextrin (6-diSeCD), and
2,2'-diseleno-bis-.beta.-cyclodextrin (2-diSeCD).
[0299] In some embodiments, the use of otoprotectants reduces or
ameliorates hearing loss or reduction in hearing resulting from
destroyed, stunted, malfunctioning, damaged, fragile or missing
hairs in the inner ear. Otoprotectants include, but are not limited
to, D-methionine, L-methionine, ethionine, hydroxyl methionine,
methioninol, amifostine, mesna (sodium 2-sulfanylethanesulfonate),
a mixture of D and L methionine, N-acetyl methionine (NAM),
normethionine, homomethionine, S-adenosyl-L-methionine,
diethyldithiocarbamate, ebselen
(2-phenyl-1,2-benzisoselenazol-3(2H)-one), sodium thiosulfate,
AM-111 (a cell permeable JNK inhibitor, (Laboratoires Auris SAS)),
N-acetyl-DL-methionine, S-adenosylmethionine, cysteine,
homocysteine, cysteamine, N-acetylcysteine (NAC), glutathione,
glutathione ethylester, glutathione diethylester, glutathione
triethylester, cysteamine, cystathione, N,N'-diacetyl-L-cystine
(DiNAC),
2(R,S)-D-ribo-(1',2',3',4'-tetrahydroxybutyl)-thiazolidine-4(R)-carboxyli-
c acid (RibCys), 2-alkylthiazolidine
2(R,S)-D-ribo-(1',2',3',4'-tetrahydroxybutyl)thiazolidine
(RibCyst), and 2-oxo-L-thiazolidine-4-carboxylic acid (OTCA),
salicylic acid, leucovorin, leucovorin calcium, dexrazoxane,
piracetam, Oxiracetam, Aniracetam, Pramiracetam, Phenylpiracetam
(Carphedon), Etiracetam, Levetiracetam, Nefiracetam, Nicoracetam,
Rolziracetam, Nebracetam, Fasoracetam, Coluracetam, Dimiracetam,
Brivaracetam, Seletracetam, Rolipramand or combinations thereof
[0300] In some embodiments, otoprotectants include xanthine oxidase
inhibitors. Non-limiting examples of xanthine odixase inhibitors
include allopurinol; 1-methylallopurinol; 2-methylallopurinol;
5-methylallopurinol; 7-methylallopurinol; 1,5-dimethylallopurinol;
2,5-dimethylallopurinol; 1,7-dimethylallopurinol;
2,7-dimethylallopurinol; 5,7-dimethylallopurinol;
2,5,7-trimethylallopurinol; 1-ethoxycarbonylallopurinol; and
1-ethoxycarbonyl-5-methylallopurinol.
[0301] In some embodiments, otoprotectants are used in combination
with toxicants.
Modulators of Hair Cell Regeneration
[0302] Contemplated for use with the formulations disclosed herein
are agents that modulate the regeneration of neurons and/or hair
cells of the auris, and agents for treating or ameliorating hearing
loss or reduction resulting from destroyed, stunted,
malfunctioning, damaged, fragile or missing hairs in the inner ear.
In some embodiments, an auris sensory cell modulator allows for
proliferation and/or regeneration of auris hair cells and/or
supporing cells. Accordingly, some embodiments incorporate the use
of cyclin-dependent kinase (CDK) modulators. In some embodiments,
CDK modulators are p27Kip1 modulators. p27Kip1 mediates sensory
hair cell regeneration in the organ of Corti. In some instances,
sensory hair cells (e.g., short hair cells) of the inner ear are
regenerated by stimulation of proliferation of supporting cells
(e.g. Hansen's cells, Deiter's cells and/or Pillar's cells or the
like). In some instances modulators of the cyclin-dependent kinase
p27Kip1 are antisense molecules (e.g., siRNA molecules) or peptide
molecules (e.g., endogenous ligands for p27Kip1) that modulate the
activity of p27Kip1.
[0303] In some embodiments, a formulation described herein
comprises a nucleic acid and/or transcription factor (e.g., POU4F1,
POU4F2, POU4F3, Brn3a, Brn3b and/or Brn3c or the like) capable of
stimulating the formation of inner ear sensory hair cells or inner
ear support cells. Non-limiting examples of such nucleic acid
molecules and/or transcription factors include and are not limited
to molecules described in US Appl. Pub. Nos. 20070041957 and
20030203482, which disclosure described therein is incorporated
herein by reference.
Immune System Cells
[0304] Contemplated for use with the formulations disclosed herein
are agents that reduce, reverse or dealt' the degeneration of
neurons and/or hair cells of the auris, and agents for treating or
ameliorating hearing loss or reduction resulting from destroyed,
stunted, malfunctioning, damaged, fragile or missing hairs in the
inner ear. Accordingly, some embodiments incorporate the use of
cells which participate in the repair of otic hair cells and
neurons. In some embodiments, the cells which participate in the
repair of otic hair cells and neurons are macrophages, microglia,
and/or microglia-like cells. In certain instances, the
concentration of macrophages and microglia increase in ears damaged
by treatment with ototoxic agents. In certain instances,
microglia-like cells eliminate waste from ototoxic antibiotic
neomycin.
Ototoxic Agents and Toxicants
[0305] Contemplated for use with the formulations disclosed herein
are agents that destroy neurons and/or otic hair cells.
Accordingly, some embodiments incorporate the use of agents which
fatally damage and/or induce death in the neurons and/or otic hair
cells of the auris. In some embodiments, death of auris sensory
cells (e.g., hair cells) treats symptoms (e.g., vertigo) associated
with any otic disease or condition described herein. In some
embodiments, toxicants induce chemical lesions in the ear that
alleviate symptoms such as, by way of example, vertigo. In some
embodiments, the agents which fatally damage and/or induce death in
the neurons and/or otic hair cells of the auris are the
aminoglycoside antibiotics (e.g. gentamicin, and amikacin), the
macrolide antibiotics (e.g erythromycin), the glycopeptide
antibiotics (e.g. vancomycin), the loop diuretics (e.g.
furosemide), nicotine, 6-hydroxy dopamine (6-OH DPAT),
6,7-dinitroquinoxaline-2,3-dione (DNQX) or the like. In some
embodiments, a composition described herein comprises a toxicant
that is used to treat vertigo by selectively destroying hair cells
in the ear. In some of such embodiments, an otic composition
comprising a toxicant is advantageous; such a composition provides
therapeutic benefit for treatment of vertigo because it is
administered non-systemically to the ear and does not cause side
effects associated with systemic administration of a toxicant.
[0306] In some embodiments, a composition described herein is
useful in pre-clinical animal studies (e.g., animal guinea pig
model studies). In some instances, a composition described herein
comprising a toxicant is used for induction of chemical lesions in
the ear of an animal. In some instances, such an animal is used for
testing therapeutic efficacy of compositions described herein in
animal models.
Retinoblastoma Protein Modulation
[0307] Contemplated for use with the formulations disclosed herein
are agents that modulate the degeneration of neurons and/or hair
cells of the auris, promote the growth of neurons and/or hair cells
of the auris, and agents for treating or ameliorating hearing loss
or reduction resulting from destroyed, stunted, malfunctioning,
damaged, fragile or missing hairs in the inner ear. Further
contemplated herein are agents that destroy neurons and/or otic
hair cells. Accordingly, some embodiments incorporate the use of
agents that modulate retinoblastoma protein (pRB). pRB is a member
of the pocket protein family. It is encoded by the RB1 gene. In
certain instances, it inhibits transition from G1 to S phase by
binding to and inactivating the E2f family of transcription
factors. In certain instances, it also regulates differentiation,
and survival of hair cells. In certain instances, pRB knock-out
mice demonstrate increased prioliferation of hair cells.
[0308] In some embodiments, the agent that modulates one or more of
the pRB is an agonist of pRB. In some embodiments, the agent that
modulates one or more of the pRB is an antagonist of pRB. In
certain instances, a compound which agonizes or antagonizes pRB is
identified (e.g. by use of a high throughput screen). In some
embodiments, a construct is designed such that a reporter gene is
placed downstream of an E2F binding sequence. In some embodiments,
the binding sequence is TTTCGCGC. In some embodiments, the reporter
gene is luciferase, CAT, GFP, .beta.-lactamase or
.beta.-galactosidase. In certain instances, E2f binds to the
binding sequence causing the transcription and expression of the
reporter gene. In certain instances, an agonist of pRB causes an
increase in the binding of pRB to E2f. In certain instances, the
increase in binding of pRB and E2f results in a decrease in the
transcription and expression of the reporter gene. In certain
instances, an antagonist of pRB causes a decrease in the binding of
pRB to E2f. In certain instances, the decrease in binding of pRB
and E2f results in a increase in the transcription and expression
of the reporter gene.
[0309] In some embodiments, the agent that modulates pRB is an
siRNA molecule. In certain instances, the siRNA molecule inhibits
the transcription of an RB1 gene by RNA interference (RNAi). In
some embodiments, a double stranded RNA (dsRNA) molecule with
sequences complementary to an RB1 mRNA sequence is generated (e.g
by PCR). In some embodiments, a 20-25 by siRNA molecule with
sequences complementary to an RB1 mRNA is generated. In some
embodiments, the 20-25 by siRNA molecule has 2-5 by overhangs on
the 3' end of each strand, and a 5' phosphate terminus and a 3'
hydroxyl terminus. In some embodiments, the 20-25 by siRNA molecule
has blunt ends. For techniques for generating RNA sequences see
Molecular Cloning: A Laboratory Manual, second edition (Sambrook et
al., 1989) and Molecular Cloning: A Laboratory Manual, third
edition (Sambrook and Russel, 2001), jointly referred to herein as
"Sambrook"); Current Protocols in Molecular Biology (F. M. Ausubel
et al., eds., 1987, including supplements through 2001); Current
Protocols in Nucleic Acid Chemistry John Wiley & Sons, Inc.,
New York, 2000) which are hereby incorporated by reference for such
disclosure.
[0310] In some embodiments, the dsRNA or siRNA molecule is
incorporated into a controlled-release auris-acceptable microsphere
or microparticle, hydrogel, liposome, or thermoreversible gel. In
some embodiments, the auris-acceptable microsphere, hydrogel,
liposome, paint, foam, in situ forming spongy material, nanocapsule
or nanosphere or thermoreversible gel is injected into the inner
ear. In some embodiments, the auris-acceptable microsphere or
microparticle, hydrogel, liposome, or thermoreversible gel. In some
embodiments, the auris-acceptable microsphere, hydrogel, liposome,
paint, foam, in situ forming spongy material, nanocapsule or
nanosphere or thermoreversible gel is injected into the cochlea,
the organ of Corti, the vestibular labyrinth, or a combination
thereof
[0311] In certain instances, after administration of the dsRNA or
siRNA molecule, cells at the site of administration (e.g. the cells
of cochlea, organ of Corti, and/or the vestibular labyrinth) are
transformed with the dsRNA or siRNA molecule. In certain instances
following transformation, the dsRNA molecule is cleaved into
multiple fragments of about 20-25 by to yield siRNA molecules. In
certain instances, the fragments have about 2 bp overhangs on the
3' end of each strand.
[0312] In certain instances, an siRNA molecule is divided into two
strands (the guide strand and the anti-guide strand) by an
RNA-induced Silencing Complex (RISC). In certain instances, the the
guide strand is incorporated into the catalytic component of the
RISC (i.e. argonaute). In certain instances, the guide strand binds
to a complementary RB1 mRNA sequence. In certain instances, the
RISC cleaves the RB1 mRNA. In certain instances, the expression of
the RB1 gene is down-regulated.
[0313] In some embodiments, a sequence complementary to RB1 mRNA is
incorporated into a vector. In some embodiments, the sequence is
placed between two promoters. In some embodiments, the promoters
are orientated in opposite directions. In some embodiments, the
vector is contacted with a cell. In certain instances, a cell is
transformed with the vector. In certain instances following
transformation, sense and anti-sense strands of the sequence are
generated. In certain instances, the sense and anti-sense strands
hybridize to form a dsRNA molecule which is cleaved into siRNA
molecules. In certain instances, the strands hybridize to form an
siRNA molecule. In some embodiments, the vector is a plasmid (e.g
pSUPER; pSUPER.neo; pSUPER.neo+gfp).
[0314] In some embodiments, the vector is incorporated into a
controlled-release auris-acceptable microsphere or microparticle,
hydrogel, liposome, or thermoreversible gel. In some embodiments,
the auris-acceptable microsphere, hydrogel, liposome, paint, foam,
in situ forming spongy material, nanocapsule or nanosphere or
thermoreversible gel is injected into the inner ear. In some
embodiments, the auris-acceptable microsphere or microparticle,
hydrogel, liposome, or thermoreversible gel. In some embodiments,
the auris-acceptable microsphere, hydrogel, liposome, paint, foam,
in situ forming spongy material, nanocapsule or nanosphere or
thermoreversible gel is injected into the cochlea, the organ of
Corti, the vestibular labyrinth, or a combination thereof.
Thyroid Hormone Receptor Modulation
[0315] Contemplated for use with the formulations disclosed herein
are agents that reduce or reverse the degeneration of neurons
and/or hair cells of the auris, and/or promote the growth of
neurons and/or hair cells of the auris, and agents for treating or
ameliorating hearing loss or reduction resulting from destroyed,
stunted, malfunctioning, damaged, fragile or missing hairs in the
inner ear. Accordingly, some embodiments incorporate the use of
agents that modulate Thyroid Hormone (TH) receptors. The TH
receptors are a family of nuclear hormone receptors. The family
includes, but is not limited to TR.alpha.1 and TR.beta.. In certain
instances, TR.beta. knock-out mice demonstrate a decreased
responsiveness to auditory stimuli, and a decrease in K+ current in
hair cells.
[0316] In some embodiments, the agent that modulates one or more of
the TH receptors is an agonist of the one or more TH receptors. In
some embodiments, the agonist of one or more of the TH receptors is
T3 (3,5,3'-triiodo-L-thyronine); KB-141
(3,5-dichloro-4-(4-hydroxy-3-isopropylphenoxy)phenylacetic acid);
GC-1 (3,5-dimethyl-4-(4'-hydroxy-3'-isopropylbenzyl)-phenoxy acetic
acid); GC-24
(3,5-dimethyl-4-(4'-hydroxy-3'-benzyl)benzylphenoxyacetic acid);
sobetirome (QRX-431); 4-OH-PCB106
(4-OH-2',3,3',4',5'-pentachlorobiphenyl); MB07811
((2R,4S)-4-(3-chlorophenyl)-2-[(3,5-dimethyl-4-(4-hydroxy-3-isopropylbenz-
yl)phenoxy)methyl]-2-oxido-[1,3,2]-dioxaphosphonane); MB07344
(3,5-dimethyl-4-(4-hydroxy-3-isopropylbenzyl)phenoxy)methylphosphonic
acid); and combinations thereof. In certain instances, KB-141;
GC-1; sobetirome; and GC-24 are selective for TR.beta..
TRPV Modulation
[0317] Contemplated for use with the formulations disclosed herein
are agents that modulate the degeneration of neurons and hair
cells, and agents for treating or ameliorating hearing loss or
reduction resulting from destroyed, stunted, malfunctioning,
damaged, fragile or missing hairs in the inner ear. Accordingly,
some embodiments incorporate the use of agents that modulate TRPV
receptors. The TRPV (Transient Receptor Potential Channel
Vanilloid) receptors are a family of non-selective ion channels
permeable to calcium, amongst other ions. There are six members of
the family: TRPV1-6. In certain instances, following treatment with
kanamycin, TRPV 1 is upregulated. Additionally, in certain
instances, antagonism of the TRPV 4 receptor makes mice vulnerable
to acoustic trauma. Further, in certain instances, capsaicin, an
agonist of TRPV 1, prevents hyperlocomotion following an ischemic
event.
[0318] In some embodiments, the agent that modulates one or more of
the TRPV receptors is an agonist of the one or more TRPV receptors.
In some embodiments, the agonist of one or more of the TRPV
receptors is capsaicin, resiniferatoxin, or combinations thereof.
In some embodiments, administration of an auris sensory cell
modulating composition comprising a TRPV agonist reduces or
reverses degeneration of neurons and hair cells.
Sodium Channel Blockers
[0319] Contemplated for use with the formulations disclosed herein
are agents that modulate the degeneration of neurons and hair
cells, and agents for treating or ameliorating hearing loss or
reduction resulting from destroyed, stunted, malfunctioning,
damaged, fragile or missing hairs in the inner ear. In certain
instances, excitotoxicity causes the excessive opening of Na+
channels. In certain instances, this results in excess Na+ ions
entering the neuron. In certain instances, the excess influx of Na+
ions into the neuron causes the neuron to fire more often. In
certain instances, this increased firing yields a rapid buildup of
free radicals and inflammatory compounds. In certain instances, the
free radicals damage the mitochondria, depleting the cell's energy
stores. Further, in certain instances, excess levels of Na+ ions
activate excess levels of enzymes including, but not limited to,
phospholipases, endonucleases, and proteases. In certain instances,
the over-activation of these enzymes results in damage to the
cytoskeleton, plasma membrane, mitochondria, and DNA of the neuron.
Accordingly, some embodiments incorporate the use of agents which
antagonize the opening of Na+ channels and reduce or reverse auris
hair cell death and/or auris hair cell damage.
[0320] In some embodiments, the Na+ channel blocker is vinpocetine
((3a,16a)-Eburnamenine-14-carboxylic acid ethyl ester); sipatrigine
(2-(4-Methylpiperazin-1-yl)-5-(2,3,5-trichlorophenyl)-pyrimidin-4-amine);
amiloride (3,5-diamino-N-(aminoiminomethyl)-6-chloropyrazinecarbox
amide hydrochloride); carbamazepine
(5H-dibenzo[b,f]azepine-5-carboxamide); TTX
(octahydro-12-(hydroxymethyl)-2-imino-5,9:7,10a-dimethano-10aH-[1,3]dioxo-
cino[6,5-d]pyrimidine-4,7,10,11,12-pen tol); RS100642
(1-(2,6-dimethyl-phenoxy)-2-ethylaminopropane hydrochloride);
mexiletine ((1-(2,6-dimethylphenoxy)-2-aminopropane
hydrochloride)); QX-314
(N-(2,6-Dimethylphenylcarbamoylmethyl)triethylammonium bromide);
phenytoin (5,5-diphenylimidazolidine-2,4-dione); lamotrigine
(6-(2,3-dichlorophenyl)-1,2,4-triazine-3,5-diamine); 4030W92
(2,4-diamino-5-(2,3-dichlorophenyl)-6-fluoromethylpyrimidine);
BW1003C87 (5-(2,3,5-trichlorophenyl) pyrimidine-2,4-1.1
ethanesulphonate); QX-222
(2-[(2,6-dimethylphenyl)amino]-N,N,N-trimethyl-2-oxoetha niminium
chloride); ambroxol
(trans-4-[[(2-Amino-3,5-dibromophenyl)methyl]amino]cyclo hexanol
hydrochloride); R56865
(N-[1-(4-(4-fluorophenoxyl)butyl]-4-piperidinyl-N-methyl-2-benzo-thiazola-
mine); lubeluzole; ajmaline ((17R,21alpha)-ajmalan-17,21-diol);
procainamide (4-amino-N-(2-diethylaminoethyl)benzamide
hydrochloride); flecainide; riluzoleor; or combinations
thereof.
Corticosteroids
[0321] Contemplated for use with the compositions and formulations
disclosed herein are agents that reduce, reverse or delay the
degeneration of neurons and/or hair cells of the auris, and agents
for treating or ameliorating hearing loss or reduction resulting
from destroyed, stunted, malfunctioning, damaged, fragile or
missing hairs in the inner ear. Accordingly, some embodiments
incorporate the use of agents which protect otic hair cells from
ototoxins. In some embodiments, the agent which protects otic hair
cells from ototoxins is a steroid. In some embodiments, the steroid
which protects otic hair cells from ototoxins is a corticosteroid.
In some embodiments, the corticosteroid is triamicinolone actenoide
and/or dexamethasone. In certain instances, triamicinolone
actenoide and dexamethasone protect otic hair cells from damage
caused by the naturally occurring toxin 4-hydroxy-2,3-nonenal
(HNE), which is produced in the inner ear in response to oxidative
stress. Other corticosteroids include, and are not limited to,
21-acetoxypregnenolone, alclometasone, algestone, amcinonide,
beclomethasone, betamethasone, budesonide, chloroprednisone,
clobetasol, clobetasone, clocortolone, cloprednol, corticosterone,
cortisone, cortivazol, deflazacort, desonide, desoximetasone,
dexamethasone, diflorasone, diflucortolone, difluprednate,
enoxolone, fluazacort, flucloronide, flumethasone, flunisolide,
fluocinolone acetonide, fluocinonide, fluocortin butyl,
fluocortolone, fluorometholone, fluperolone acetate, fluprednidene
acetate, fluprednisolone, flurandrenolide, fluticasone propionate,
formocortal, halcinonide, halobetasol propionate, halometasone,
halopredone acetate, hydrocortamate, hydrocortisone, loteprednol
etabonate, mazipredone, medrysone, meprednisone,
methylprednisolone, mometasone furoate, paramethasone,
prednicarbate, prednisolone, prednisolone 25-diethylamino-acetate,
prednisolone sodium phosphate, prednisone, prednival, prednylidene,
rimexolone, tixocortol, triamcinolone, triamcinolone acetonide,
triamcinolone benetonide, or triamcinolone hexacetonide, or
phosphate prodrug or ester prodrug thereof.
Stem Cells and Differentiated Auris Sensory Cells
[0322] Contemplated for use with the formulations disclosed herein
are transplants of cells that supplement and/or replace the
pre-existing neurons and/or hair cells of the auris. In some
embodiments, the agent is a stem cell. In some embodiments, the
agent is a partially or fully differentiated auris sensory cell. In
some embodiments, the differentiated auris sensory cell is derived
from a human donor. In some embodiments, the differentiated auris
sensory cell is derived from a stem cell, the differentiation of
which was induced under artificial (e.g. laboratory)
conditions.
[0323] Stem cells are cells that possess the capacity to
differentiate into multiple cell types. Totipotent stem cells can
differentiate into embryonic cells or extraembryonic cells.
Pluripotent cells can differentiate into cells of any of endoderm,
mesoderm, or ectoderm origin. Multipotent cells can differentiate
into closely related cells (e.g hematopoietic stem cells).
Unipotent cells can differentiate into only one type of cell, but
like other stem cells have the characteristic of self-renewal. In
some embodiments, the stem cell is totipotent, pluripotent,
multipotent, or unipotent. Further, stem cells can undergo mitotic
division without themselves differentiating (i.e.
self-renewal).
[0324] Embryonic stem (ES) cells are stem cells derived from the
epiblast tissue of the inner cell mass of a blastocyst or earlier
stage embryo. ES cells are pluripotent. In some embodiments, the
stem cell is an ES cell. Adult stem cells (also known as somatic
cells or germline cells) are cells isolated from a developed
organism wherein the cells possess the characteristic of
self-renewal, and the ability to differentiate into multiple cell
types. Adult stem cells are pluripotent (for example, stem cells
found in umbilical cord blood), multipotent or unipotent. In some
embodiments, the stem cell is an adult stem cell.
[0325] In some embodiments, a stem cell and/or a differentiated
auris sensory cell is administered in combination with a
differentiation stimulating agent. In some embodiments, the
differentiation stimulating agent is a growth factor. In some
embodiments, the growth factor is a neurotrophin (e.g. nerve growth
factor (NGF), brain-derived neurotrophic factor (BDNF),
neurotrophin-3 (NT-3), neurotrophin-4 (NT-4), or novel
neurotrophin-1 (NNT1). In some embodiments, the growth factor is
FGF, EGF, IGF, PGF, or combinations thereof.
[0326] In some embodiments, a stem cell and/or a differentiated
auris sensory cell is administered to a subject in need thereof as
a controlled release agent. In some embodiments, a stem cell and/or
a differentiated auris sensory cell is administered to a subject in
need thereof as an immediate release agent (e.g. in a cell
suspension) in combination with a controlled release auris sensory
cell modulating agent. In some embodiments, a controlled release
auris sensory cell modulating agent is a vector comprising an Atoh1
or BRN3 gene, an siRNA sequence targeting RB1, a growth factor, or
combinations thereof
[0327] In some embodiments, a stem cell and/or a differentiated
auris sensory cell is administered to the cochlea or vestibular
labyrinth. In some embodiments, a stem cell and/or a differentiated
auris sensory cell is administered by via intratympanic injection,
and/or a post-auricular incision. In some embodiments, a stem cell
and/or a differentiated auris sensory cell is contacted with the
organ of Corti, vestibulocochlear nerve, and/or crista
ampullaris.
Immediate Release Agents
[0328] In some embodiments, the composition further comprises a
modulator of neuron and/or hair cells of the auris as an immediate
release agent wherein the immediate release modulator of neuron
and/or hair cells of the auris is the same agent as the
controlled-release agent, a different modulator of neuron and/or
hair cells of the auris, an additional therapeutic agent, or a
combination thereof. In some embodiments, the immediate release
agent is a stem cell, a differentiated auris sensory cell, an
immune system cell, a vector carrying a copy of an Atoh1 gene, a
vector carrying a copy of a BRN3 gene, an siRNA sequence, an miRNA
sequence, or combinations thereof.
Direct Injection
[0329] In some embodiments, one of the agents is directly injected
into the auris interna, including through the round window
membrane, while a second agent is administered in the auris media,
on or in contact with the round window membrane such that the
second agent is in the form of a controlled release formulation. In
one embodiment, the directly-administered agent is a stem cell, a
differentiated auris sensory cell, an immune system cell, a vector
carrying a copy of an Atoh1 gene, a vector carrying a copy of a
BRN3 gene, an siRNA sequence, an miRNA sequence, or combinations
thereof.
Concentration of Active Agent
[0330] In some embodiments, the compositions described herein have
a concentration of active pharmaceutical ingredient between about
0.01% to about 90%, between about 0.01% to about 50%, between about
0.1% to about 70%, between about 0.1% to about 50%, between about
0.1% to about 40%, between about 0.1% to about 30%, between about
0.1% to about 20%, between about 0.1% to about 10%, or between
about 0.1% to about 5%, of the active ingredient, or
pharmaceutically acceptable prodrug or salt thereof, by weight of
the composition. In some embodiments, the compositions described
herein have a concentration of active pharmaceutical agent between
about 1% to about 50%, between about 5% to about 50%, between about
10% to about 40%, or between about 10% to about 30%, of the active
ingredient, or pharmaceutically acceptable prodrug or salt thereof,
by weight of the composition. In some embodiments, formulations
described herein comprise about 70% by weight of an auris sensory
cell modulating agent by weight of the formulation. In some
embodiments, formulations described herein comprise about 60% by
weight of an auris sensory cell modulating agent by weight of the
formulation. In some embodiments, formulations described herein
comprise about 50% by weight of an auris sensory cell modulating
agent by weight of the formulation. In some embodiments,
formulations described herein comprise about 40% by weight of an
auris sensory cell modulating agent by weight of the formulation.
In some embodiments, formulations described herein comprise about
30% by weight of an auris sensory cell modulating agent by weight
of the formulation. In some embodiments, formulations described
herein comprise about 20% by weight of an auris sensory cell
modulating agent by weight of the formulation. In some embodiments,
formulations described herein comprise about 15% by weight of an
auris sensory cell modulating agent, or pharmaceutically acceptable
prodrug or salt thereof, by weight of the formulation. In some
embodiments, formulations described herein comprise about 10% by
weight of an auris sensory cell modulating agent by weight of the
formulation. In some embodiments, formulations described herein
comprise about 5% by weight of an auris sensory cell modulating
agent, or pharmaceutically acceptable prodrug or salt thereof, by
weight of the formulation. In some embodiments, formulations
described herein comprise about 2.5% by weight of an auris sensory
cell modulating agent, or pharmaceutically acceptable prodrug or
salt thereof, by weight of the formulation. In some embodiments,
formulations described herein comprise about 1% by weight of an
auris sensory cell modulating agent, or pharmaceutically acceptable
prodrug or salt thereof, by weight of the formulation. In some
embodiments, formulations described herein comprise about 0.5% by
weight of an auris sensory cell modulating agent, or
pharmaceutically acceptable prodrug or salt thereof, by weight of
the formulation. In some embodiments, formulations described herein
comprise about 0.1% by weight of an auris sensory cell modulating
agent, or pharmaceutically acceptable prodrug or salt thereof, by
weight of the formulation. In some embodiments, formulations
described herein comprise about 0.01% by weight of an auris sensory
cell modulating agent, or pharmaceutically acceptable prodrug or
salt thereof, by weight of the formulation. In some embodiments,
the formulations described herein have a concentration of active
pharmaceutical ingredient, or pharmaceutically acceptable prodrug
or salt thereof, between about 0.1 to about 70 mg/mL, between about
0.5 mg/mL to about 70 mg/mL, between about 0.5 mg/mL to about 50
mg/mL, between about 0.5 mg/mL to about 20 mg/mL, between about 1
mg to about 70 mg/mL, between about 1 mg to about 50 mg/mL, between
about 1 mg/mL and about 20 mg/mL, between about 1 mg/mL to about 10
mg/mL, or between about 1 mg/mL to about 5 mg/mL, of the active
agent, or pharmaceutically acceptable prodrug or salt thereof, by
volume of the formulation.
Combination Therapy
[0331] In some embodiments, any composition or device described
herein comprises one or more active agents and/or a second
therapeutic agent including but not limited to anti-emetic agents,
antimicrobial agents, antioxidants, anti-septic agents or the
like.
Anti-Emetic Agents
[0332] Anti-Emetic agents are optionally used in combination with
the formulations disclosed herein. Anti-emetic agents include
promethazine, prochlorperazine, trimethobenzamide, and
triethylperazine. Other anti-emetic agents include 5HT3 antagonists
such as dolasetron, granisetron, ondansetron, tropisetron, and
palonosetron; and neuroleptics such as droperidol. Further
anti-emetic agents include antihistamines, such as meclizine;
phenothiazines such as perphenazine, and thiethyl perazine;
dopamine antagonists, including domperidone, properidol,
haloperidol, chlorpromazine, promethazine, prochlorperazine,
metoclopramide and combinations thereof; cannabinoids, including
dronabinol, nabilone, sativex, and combinations thereof;
anticholinergics, including scopolamine; and steroids, including
dexamethasone; trimethobenzamine, emetrol, propofol, muscimol, and
combinations thereof.
Antimicrobial Agents
[0333] Antimicrobial agents are also contemplated as useful with
the formulations disclosed herein. Antimicrobial agents include
agents that act to inhibit or eradicate microbes, including
bacteria, fungi or parasites. Specific antimicrobial agents may be
used to combat specific microbes. Accordingly, a skilled
practitioner would know which antimicrobial agent would be relevant
or useful depending on the microbe identified, or the symptoms
displayed. Antimicrobial agents include antibiotics, antiviral
agents, antifungal agents, and antiparasitic agents.
[0334] Antibiotics may include amikacin, gentamicin, kanamycin,
neomycin, netilmicin, streptomycin, tobramycin, paromomycin,
geldanmycin, herbimycin, loracarbef, ertapenem, doripenem,
imipenem, cilastatin, meropenem, cefadroxil, cefazolin, cefalotin,
cefalexin, cefaclor, cefamandole, cefoxitin, defprozil, cefuroxime,
cefixime, cefdinir, cefditoren, cefoperazone, cefotaxime,
cefpodoxime, ceftazidime, ceftibuten, ceftizoxime, ceftriaxone,
cefepime, ceftobiprole, teicoplanin, vancomycin, azithromycin,
clarithromycin, dirithromycin, erythromycin, roxithromycin,
troleandomycin, telithromycin, spectinomycin, aztreonam,
amoxicillin, ampicillin, azlocillin, carbenicillin, cloxacillin,
dicloxacillin, flucloxacillin, mezlocillin, meticillin, nafcillin,
oxacillin, penicillin, piperacillin, ticarcillan, bacitracin,
colistin, polymyxin B, ciprofloxacin, enoxacin, gatifloxacin,
levofloxacin, lomefloxacin, moxifloxacin, norfloxacin, ofloxacin,
trovfloxacin, mafenide, prontosil, sulfacetamide, sulfamethizole,
sulfanimilimde, sulfsalazine, sulfsioxazole, trimethoprim,
demeclocycline, doxycycline, minocycline, oxtetracycline,
tetracycline, arsphenamine, chloramphenicol, clindamycin,
lincomycin, ethambutol, fosfomycin, fusidic acid, furazolidone,
isoniazid, linezolid, metronidazole, mupirocin, nitrofurantoin,
platensimycin, pyrazinamide, quinuspristin/dalfopristin, rifampin,
tinidazole, and combinations thereof
[0335] Antiviral agents may include acyclovir, famciclovir and
valacyclovir. Other antiviral agents include abacavir, aciclovir,
adfovir, amantadine, amprenavir, arbidol., atazanavir, artipla,
brivudine, cidofovir, combivir, edoxudine, efavirenz,
emtricitabine, enfuvirtide, entecavir, fomvirsen, fosamprenavir,
foscarnet, fosfonet, ganciclovir, gardasil, ibacitabine, imunovir,
idoxuridine, imiquimod, indinavir, inosine, integrase inhibitors,
interferons, including interferon type III, interferon type II,
interferon type I, lamivudine, lopinavir, loviride, MK-0518,
maraviroc, moroxydine, nelfinavir, nevirapine, nexavir, nucleoside
analogues, oseltamivir, penciclovir, peramivir, pleconaril,
podophyllotoxin, protease inhibitors, reverse transcriptase
inhibitors, ribavirin, rimantadine, ritonavir, saquinavir,
stavudine, tenofovir, tenofovir disoproxil, tipranavir,
trifluridine, trizivir, tromantadine, truvada, valganciclovir,
vicriviroc, vidarabine, viramidine, zalcitabine, zanamivir,
zidovudine, and combinations thereof
[0336] Antifungal agents may include amrolfine, utenafine,
naftifine, terbinafine, flucytosine, fluconazole, itraconazole,
ketoconazole, posaconazole, ravuconazole, voriconazole,
clotrimazole, econazole, miconazole, oxiconazole, sulconazole,
terconazole, tioconazole, nikkomycin Z, caspofungin, micafungin,
anidulafungin, amphotericin B, liposomal nystastin, pimaricin,
griseofulvin, ciclopirox olamine, haloprogin, tolnaftate,
undecylenate, and combinations thereof. Antiparasitic agents may
include amitraz, amoscanate, avermectin, carbadox,
diethylcarbamizine, dimetridazole, diminazene, ivermectin,
macrofilaricide, malathion, mitaban, oxamniquine, permethrin,
praziquantel, prantel pamoate, selamectin, sodium stibogluconate,
thiabendazole, and combinations thereof.
Antioxidants
[0337] Antioxidants are optionally used in combination with the
compositions described herein. Antioxidants are also contemplated
as being useful with the formulations disclosed herein as agents
that modulate the degeneration of neurons and/or hair cells of the
auris. Accordingly, some embodiments incorporate the use of
antioxidants. In some embodiments, the antioxidant is vitamin C,
N-acetylcysteine, vitamin E, Ebselen
(2-phenyl-1,2-benzisoselenazol-3(2H)-one (also called PZ 51 or
DR3305), L-methionine, Idebenone
(2-(10-hydroxydecyl)-5,6-dimethoxy-3-methyl-cyclohexa-2,5-diene-1,4-dione-
). In some embodiments, antioxidants are trophic agents and promote
growth of healthy cells.
Anti-Septic Agents
[0338] Anti-septic agents are optionally used in combination with
the compositions described herein. Anti-septic agents are also
contemplated as useful with the formulations disclosed herein.
Anti-septic agents include, but are not limited to, acetic acid,
boric acid, gentian violet, hydrogen peroxide, carbamide peroxide,
chlorhexidine, saline, mercurochrome, povidone iodine, polyhyroxine
iodine, cresylate and aluminum acetate, and mixtures thereof
[0339] Other agents are optionally used in any composition or
device described herein. In some embodiments, a monoamine oxidase
inhibitor (e.g., Rasagiline, R(+)-N-propargyl-1-aminoindan) is used
in any composition or device described herein. In some embodiments,
an adenosine antagonist (e.g., R--N6-Phenylisopropyl adenosine,
1-2-oxothiazolidine-4-carboxylic acid (Procysteine)) is used in any
composition or device described herein. Any combination of active
agents and/or second therapeutic agent is compatible with the
compositions described herein.
Otic Surgery and Implants
[0340] In some embodiments, the pharmaceutical formulations,
compositions or devices described herein are used in combination
with (e.g., implantation, short-term use, long-term use, or removal
of) implants (e.g., cochlear implants). As used herein, implants
include auris-interna or auris-media medical devices, examples of
which include cochlear implants, hearing sparing devices,
hearing-improvement devices, short electrodes, micro-prostheses or
piston-like prostheses; needles; stem cell transplants; drug
delivery devices; any cell-based therapeutic; or the like. In some
instances, the implants are used in conjunction with a patient
experiencing hearing loss. In some instances, the hearing loss is
present at birth. In some instances, the hearing loss is associated
with conditions such as AIED, bacterial meningitis or the like that
lead to osteoneogenesis and/or nerve damage with rapid obliteration
of cochlear structures and profound hearing loss.
[0341] In some instances, an implant is an immune cell or a stem
cell transplant in the ear. In some instances, an implant is a
small electronic device that has an external portion placed behind
the ear, and a second portion that is surgically placed under the
skin that helps provide a sense of sound to a person who is
profoundly deaf or severely hard-of-hearing. By way of example,
such cochlear medical device implants bypass damaged portions of
the ear and directly stimulate the auditory nerve. In some
instances cochlear implants are used in single sided deafness. In
some instances cochlear implants are used for deafness in both
ears.
[0342] In some embodiments, administration of an auris sensory cell
modulator composition or device described herein in combination
with an otic intervention (e.g., an intratympanic injection, a
stapedectomy, a medical device implant or a cell-based transplant)
delays or prevents collateral damage to auris structures, e.g.,
irritation, cell damage, cell death, osteoneogeneis and/or further
neuronal degeneration, caused by the external otic intervention
(e.g., installation of an external device and/or cells in the ear).
In some embodiments, administration of an auris sensory cell
modulator composition or device described herein in combination
with an implant allows for a more effective restoration of hearing
loss compared to an implant alone.
[0343] In some embodiments, administration of an auris sensory cell
modulator composition or device described herein reduces damage to
cochlear structures caused by underlying conditions (e.g.,
bacterial meningitis, autoimmune ear disease (AIED)) allowing for
successful cochlear device implantation. In some embodiments,
administration of a composition or device described herein, in
conjunction with otic surgery, medical device implantation and/or
cell transplantation, reduces or prevents cell damage and/or death
(e.g., auris sensory hair cell death and/or damage) associated with
otic surgery, medical device implantation and/or cell
transplantation.
[0344] In some embodiments, administration of an auris sensory cell
modulator composition or device described herein (e.g., a
composition or device comprising a growth factor) in conjunction
with a cochlear implant or stem cell transplant has a trophic
effect (e.g., promotes healthy growth of cells and/or healing of
tissue in the area of an implant or transplant). In some
embodiments, a trophic effect is desirable during otic surgery or
during intratympanic injection procedures. In some embodiments, a
trophic effect is desirable after installation of a medical device
or after a cell transplant. In some of such embodiments, the auris
sensory cell modulator compositions or devices described herein are
administered via direct cochlear injection, through a chochleostomy
or via deposition on the round window.
[0345] In some embodiments, administration of an anti-inflammatory
or immunosuppressant composition (e.g., a composition comprising an
immunosuppresant such as a corticosteroid) reduces inflammation
and/or infections associated with otic surgery, implantation of a
medical device or a cell transplant. In some instances, perfusion
of a surgical area with an auris sensory cell modulator formulation
described herein reduces or eliminates post-surgical and/or
post-implantation complications (e.g., inflammation, hair cell
damage, neuronal degeneration, osteoneogenesis or the like). In
some instances, perfusion of a surgical area with a formulation
described herein reduces post-surgery or post-implantation
recuperation time. In some embodiments, a medical device is coated
with a composition described herein prior to implantation in the
ear.
[0346] In one aspect, the formulations described herein, and modes
of administration thereof, are applicable to methods of direct
perfusion of the inner ear compartments. Thus, the formulations
described herein are useful in combination with otic interventions.
In some embodiments, an otic intervention is an implantation
procedure (e.g., implantation of a hearing device in the cochlea).
In some embodiments, an otic intervention is a surgical procedure
including, by way of non-limiting examples, cochleostomy,
labyrinthotomy, mastoidectomy, stapedectomy, stapedotomy,
endolymphatic sacculotomy, tympanostomy or the like. In some
embodiments, the inner ear compartments are perfused with a
formulation described herein prior to otic intervention, during
otic intervention, or after otic intervention, or a combination
thereof
[0347] In some embodiments, when perfusion is carried out in
combination with otic intervention, the auris sensory cell
compositions are immediate release compositions. In some of such
embodiments, the immediate release formulations described herein
are non-thickened compositions and are substantially free of
extended release components (e.g., gelling components such as
polyoxyethylene-polyoxypropylene copolymers). In some of such
embodiments, the compositions contain less than 5% of the extended
release components (e.g., gelling components such as
polyoxyethylene-polyoxypropylene triblock copolymers) by weight of
the formulation. In some of such embodiments, the compositions
contain less than 2% of the extended release components (e.g.,
gelling components such as polyoxyethylene-polyoxypropylene
triblock copolymers) by weight of the formulation. In some of such
embodiments, the compositions contain less than 1% of the extended
release components (e.g., gelling components such as
polyoxyethylene-polyoxypropylene triblock copolymers) by weight of
the formulation. In some of such embodiments, a composition
described herein that is used for perfusion of a surgical area
contains substantially no gelling component and is an immediate
release composition.
[0348] In other embodiments, a composition described herein is
administered after an otic intervention (e.g., after implantation
of a medical device or a cell-based therapeutic). In some of such
embodiments, a composition described herein that is administered
after the otic intervention is an intermediate release or extended
release composition and contains gelling components as described
herein.
[0349] Presented below (Table 1) are examples of active agents
contemplated for use with the formulations and devices disclosed
herein. One or more active agents are used in any of the
formulations or devices described herein.
[0350] Active Agents (including pharmaceutically acceptable salts
of these active agents) for use with the Formulations Disclosed
Herein
TABLE-US-00001 TABLE 1 Auris Condition Therapeutic Agent Benign
Paroxysmal Diphenhydramine Positional Vertigo Benign Paroxysmal
Lorazepam Positional Vertigo Benign Paroxysmal Meclizine Positional
Vertigo Benign Paroxysmal Oldansetron Positional Vertigo Hearing
Loss Estrogen Vertigo DNQX Vertigo 6-OH Dopamine Tinnitus
(S)-Ketamine Hearing Loss Estrogen and progesterone (E + P) Hearing
Loss Folic acid Hearing Loss Lactated Ringer's with 0.03% Ofloxacin
Hearing Loss Methotrexate Hearing Loss N-acetyl cysteine Meniere's
Disease Betahistine Meniere's Disease Sildenafil Meniere's Disease
conivaptan Middle Ear Effusion Pneumonococcal vaccine Otitis
Externa Diclofenac sodium; dexotc Otitis Externa, Acute
AL-15469A/AL-38905 Otitis Media Amoxicillin/clavulanate Otitis
Media Dornase alfa Otitis Media Echinacea purpurea Otitis Media
Faropenem medoxomil Otitis Media Levofloxacin Otitis Media PNCRM9
Otitis Media Pneumococcal vaccine Otitis Media Telithromycin Otitis
Media Zmax Otitis Media with Lansoprazole Effusion Otitis Media,
Acute AL-15469A; AL-38905 Otitis Media, Acute Amoxicillin Otitis
Media, Acute Amoxicillin-clavulanate Otitis Media, Acute
Azithromycin Otitis Media, Acute Azithromycin SR Otitis Media,
Acute Cefdinir Otitis Media, Acute Hyland's earache drops Otitis
Media, Acute Montelukast Otitis Media, Acute Pneumonococcal vaccine
Otitis Media, Acute AL-15469A/AL38905 with Typanostomy Tubes Otitis
Media, Chronic Sulfamethoxazole- trimethoprim Otitis Media,
Azithromycin Suppurative Otitis Media, Telithromycin Suppurative
Otosclerosis Acetylcysteine Ototoxicity Aspirin Tinnitus
Acamprosate Tinnitus Gabapentin Tinnitus Modafinil Tinnitus
Neramexane Tinnitus Neramexane mesylate Tinnitus Piribedil Tinnitus
Vardenafil Tinnitus Vestipitant + Paroxetine Tinnitus Vestiplitant
Tinnitus Zinc sulfate
General Methods of Sterilization
[0351] Provided herein are otic compositions that ameliorate or
lessen otic disorders described herein. Further provided herein are
methods comprising the administration of said otic compositions. In
some embodiments, the compositions or devices are sterilized.
Included within the embodiments disclosed herein are means and
processes for sterilization of a pharmaceutical composition or
device disclosed herein for use in humans. The goal is to provide a
safe pharmaceutical product, relatively free of infection causing
micro-organisms. The U. S. Food and Drug Administration has
provided regulatory guidance in the publication "Guidance for
Industry: Sterile Drug Products Produced by Aseptic Processing"
available at: http://www.fda.gov/cder/guidance/5882fn1.htm, which
is incorporated herein by reference in its entirety.
[0352] As used herein, sterilization means a process used to
destroy or remove microorganisms that are present in a product or
packaging. Any suitable method available for sterilization of
objects and compositions is used. Available methods for the
inactivation of microorganisms include, but are not limited to, the
application of extreme heat, lethal chemicals, or gamma radiation.
In some embodiments is a process for the preparation of an otic
therapeutic formulation comprising subjecting the formulation to a
sterilization method selected from heat sterilization, chemical
sterilization, radiation sterilization or filtration sterilization.
The method used depends largely upon the nature of the device or
composition to be sterilized. Detailed descriptions of many methods
of sterilization are given in Chapter 40 of Remington: The Science
and Practice of Pharmacy published by Lippincott, Williams &
Wilkins, and is incorporated by reference with respect to this
subject matter.
[0353] Sterilization by Heat
[0354] Many methods are available for sterilization by the
application of extreme heat. One method is through the use of a
saturated steam autoclave. In this method, saturated steam at a
temperature of at least 121.degree. C. is allowed to contact the
object to be sterilized. The transfer of heat is either directly to
the microorganism, in the case of an object to be sterilized, or
indirectly to the microorganism by heating the bulk of an aqueous
solution to be sterilized. This method is widely practiced as it
allows flexibility, safety and economy in the sterilization
process.
[0355] Dry heat sterilization is a method which is used to kill
microorganisms and perform depyrogenation at elevated temperatures.
This process takes place in an apparatus suitable for heating
HEPA-filtered microorganism-free air to temperatures of at least
130-180.degree. C. for the sterilization process and to
temperatures of at least 230-250.degree. C. for the depyrogenation
process. Water to reconstitute concentrated or powdered
formulations is also sterilized by autoclave. In some embodiments,
the formulations described herein comprise micoronized auris
sensory cell modulating agents (e.g., micro-ketamine powder) that
are sterilized by dry heating, e.g., heating for about 7-11 hours
at internal powder temperatures of 130-140.degree. C., or for 1-2
hours at internal temperatures of 150-180.degree. C.
[0356] Chemical Sterilization
[0357] Chemical sterilization methods are an alternative for
products that do not withstand the extremes of heat sterilization.
In this method, a variety of gases and vapors with germicidal
properties, such as ethylene oxide, chlorine dioxide, formaldehyde
or ozone are used as the anti-apoptotic agents. The germicidal
activity of ethylene oxide, for example, arises from its ability to
serve as a reactive alkylating agent. Thus, the sterilization
process requires the ethylene oxide vapors to make direct contact
with the product to be sterilized.
[0358] Radiation Sterilization
[0359] One advantage of radiation sterilization is the ability to
sterilize many types of products without heat degradation or other
damage. The radiation commonly employed is beta radiation or
alternatively, gamma radiation from a .sup.60Co source. The
penetrating ability of gamma radiation allows its use in the
sterilization of many product types, including solutions,
compositions and heterogeneous mixtures. The germicidal effects of
irradiation arise from the interaction of gamma radiation with
biological macromolecules. This interaction generates charged
species and free radicals. Subsequent chemical reactions, such as
rearrangements and cross-linking processes, result in the loss of
normal function for these biological macromolecules. The
formulations described herein are also optionally sterilized using
beta irradiation.
[0360] Filtration
[0361] Filtration sterilization is a method used to remove but not
destroy microorganisms from solutions. Membrane filters are used to
filter heat-sensitive solutions. Such filters are thin, strong,
homogenous polymers of mixed cellulosic esters (MCE),
polyvinylidene fluoride (PVF; also known as PVDF), or
polytetrafluoroethylene (PTFE) and have pore sizes ranging from 0.1
to 0.22 .mu.m. Solutions of various characteristics are optionally
filtered using different filter membranes. For example, PVF and
PTFE membranes are well suited to filtering organic solvents while
aqueous solutions are filtered through PVF or MCE membranes. Filter
apparatus are available for use on many scales ranging from the
single point-of-use disposable filter attached to a syringe up to
commercial scale filters for use in manufacturing plants. The
membrane filters are sterilized by autoclave or chemical
sterilization. Validation of membrane filtration systems is
performed following standardized protocols (Microbiological
Evaluation of Filters for Sterilizing Liquids, Vol 4, No. 3.
Washington, D.C: Health Industry Manufacturers Association, 1981)
and involve challenging the membrane filter with a known quantity
(ca. 10.sup.7/ cm.sup.2) of unusually small microorganisms, such as
Brevundimonas diminuta (ATCC 19146).
[0362] Pharmaceutical compositions are optionally sterilized by
passing through membrane filters. Formulations comprising
nanoparticles (U.S. Pat. No. 6,139,870) or multilamellar vesicles
(Richard et al., International Journal of Pharmaceutics (2006),
312(1-2):144-50) are amenable to sterilization by filtration
through 0.22 .mu.m filters without destroying their organized
structure.
[0363] In some embodiments, the methods disclosed herein comprise
sterilizing the formulation (or components thereof) by means of
filtration sterilization. In another embodiment the
auris-acceptable otic therapeutic agent formulation comprises a
particle wherein the particle formulation is suitable for
filtration sterilization. In a further embodiment said particle
formulation comprises particles of less than 300 nm in size, of
less than 200 nm in size, of less than 100 nm in size. In another
embodiment the auris-acceptable formulation comprises a particle
formulation wherein the sterility of the particle is ensured by
sterile filtration of the precursor component solutions. In another
embodiment the auris-acceptable formulation comprises a particle
formulation wherein the sterility of the particle formulation is
ensured by low temperature sterile filtration. In a further
embodiment, low temperature sterile filtration is carried out at a
temperature between 0 and 30.degree. C., between 0 and 20.degree.
C., between 0 and 10.degree. C., between 10 and 20.degree. C., or
between 20 and 30.degree. C.
[0364] In another embodiment is a process for the preparation of an
auris-acceptable particle formulation comprising: filtering the
aqueous solution containing the particle formulation at low
temperature through a sterilization filter; lyophilizing the
sterile solution; and reconstituting the particle formulation with
sterile water prior to administration. In some embodiments, a
formulation described herein is manufactured as a suspension in a
single vial formulation containing the micronized active
pharmaceutical ingredient. A single vial formulation is prepared by
aseptically mixing a sterile poloxamer solution with sterile
micronized active ingredient (e.g., ketamine) and transferring the
formulation to sterile pharmaceutical containers. In some
embodiments, a single vial containing a formulation described
herein as a suspension is resuspended before dispensing and/or
administration.
[0365] In specific embodiments, filtration and/or filling
procedures are carried out at about 5.degree. C. below the gel
temperature (Tgel) of a formulation described herein and with
viscosity below a theoretical value of 100 cP to allow for
filtration in a reasonable time using a peristaltic pump.
[0366] In another embodiment the auris-acceptable otic therapeutic
agent formulation comprises a nanoparticle formulation wherein the
nanoparticle formulation is suitable for filtration sterilization.
In a further embodiment the nanoparticle formulation comprises
nanoparticles of less than 300 nm in size, of less than 200 nm in
size, or of less than 100 nm in size. In another embodiment the
auris-acceptable formulation comprises a microsphere formulation
wherein the sterility of the microsphere is ensured by sterile
filtration of the precursor organic solution and aqueous solutions.
In another embodiment the auris-acceptable formulation comprises a
thermoreversible gel formulation wherein the sterility of the gel
formulation is ensured by low temperature sterile filtration. In a
further embodiment, the low temperature sterile filtration occurs
at a temperature between 0 and 30.degree. C., or between 0 and
20.degree. C., or between 0 and 10.degree. C., or between 10 and
20.degree. C., or between 20 and 30.degree. C. In another
embodiment is a process for the preparation of an auris-acceptable
thermoreversible gel formulation comprising: filtering the aqueous
solution containing the thermoreversible gel components at low
temperature through a sterilization filter; lyophilizing the
sterile solution; and reconstituting the thermoreversible gel
formulation with sterile water prior to administration.
[0367] In certain embodiments, the active ingredients are dissolved
in a suitable vehicle (e.g. a buffer) and sterilized separately
(e.g. by heat treatment, filtration, gamma radiation). In some
instances, the active ingredients are sterilized separately in a
dry state. In some instances, the active ingredients are sterilized
as a suspension or as a colloidal suspension. The remaining
excipients (e.g., fluid gel components present in auris
formulations) are sterilized in a separate step by a suitable
method (e.g. filtration and/or irradiation of a cooled mixture of
excipients); the two solutions that are separately sterilized are
then mixed aseptically to provide a final auris formulation. In
some instances, the final aseptic mixing is performed just prior to
administration of a formulation described herein.
[0368] In some instances, conventionally used methods of
sterilization (e.g., heat treatment (e.g., in an autoclave), gamma
irradiation, filtration) lead to irreversible degradation of
polymeric components (e.g., thermosetting, gelling or mucoadhesive
polymer components) and/or the active agent in the formulation. In
some instances, sterilization of an auris formulation by filtration
through membranes (e.g., 0.2 .mu.M membranes) is not possible if
the formulation comprises thixotropic polymers that gel during the
process of filtration.
[0369] Accordingly, provided herein are methods for sterilization
of auris formulations that prevent degradation of polymeric
components (e.g., thermosetting and/or gelling and/or mucoadhesive
polymer components) and/or the active agent during the process of
sterilization. In some embodiments, degradation of the active agent
(e.g., any therapeutic otic agent described herein) is reduced or
eliminated through the use of specific pH ranges for buffer
components and specific proportions of gelling agents in the
formulations. In some embodiments, the choice of an appropriate
gellling agent and/or thermosetting polymer allows for
sterilization of formulations described herein by filtration. In
some embodiments, the use of an appropriate thermosetting polymer
and an appropriate copolymer (e.g., a gellling agent) in
combination with a specific pH range for the formulation allows for
high temperature sterilization of formulations described with
substantially no degradation of the therapeutic agent or the
polymeric excipients. An advantage of the methods of sterilization
provided herein is that, in certain instances, the formulations are
subjected to terminal sterilization via autoclaving without any
loss of the active agent and/or excipients and/or polymeric
components during the sterilization step and are rendered
substantially free of microbes and/or pyrogens.
[0370] Microorganisms
[0371] Provided herein are auris-acceptable compositions or devices
that ameliorate or lessen otic disorders described herein. Further
provided herein are methods comprising the administration of said
otic compositions. In some embodiments, the compositions or devices
are substantially free of microorganisms. Acceptable bioburden or
sterility levels are based on applicable standards that define
therapeutically acceptable compositions, including but not limited
to U.S. Pharmacopeia Chapters <1111> et seq. For example,
acceptable sterility (e.g., bioburden) levels include about 10
colony forming units (cfu) per gram of formulation, about 50 cfu
per gram of formulation, about 100 cfu per gram of formulation,
about 500 cfu per gram of formulation or about 1000 cfu per gram of
formulation. In some embodiments, acceptable bioburden levels or
sterility for formulations include less than 10 cfu/mL, less that
50 cfu/mL, less than 500 cfu/mL or less than 1000 cfu/mL microbial
agents. In addition, acceptable bioburden levels or sterility
include the exclusion of specified objectionable microbiological
agents. By way of example, specified objectionable microbiological
agents include but are not limited to Escherichia coli (E. coli),
Salmonella sp., Pseudomonas aeruginosa (P. aeruginosa) and/or other
specific microbial agents.
[0372] Sterility of the auris-acceptable otic therapeutic agent
formulation is confirmed through a sterility assurance program in
accordance with United States Pharmacopeia Chapters <61>,
<62> and <71>. A key component of the sterility
assurance quality control, quality assurance and validation process
is the method of sterility testing. Sterility testing, by way of
example only, is performed by two methods. The first is direct
inoculation wherein a sample of the composition to be tested is
added to growth medium and incubated for a period of time up to 21
days. Turbidity of the growth medium indicates contamination.
Drawbacks to this method include the small sampling size of bulk
materials which reduces sensitivity, and detection of microorganism
growth based on a visual observation. An alternative method is
membrane filtration sterility testing. In this method, a volume of
product is passed through a small membrane filter paper. The filter
paper is then placed into media to promote the growth of
microorganisms. This method has the advantage of greater
sensitivity as the entire bulk product is sampled. The commercially
available Millipore Steritest sterility testing system is
optionally used for determinations by membrane filtration sterility
testing. For the filtration testing of creams or ointments
Steritest filter system No. TLHVSL210 are used. For the filtration
testing of emulsions or viscous products Steritest filter system
No. TLAREM210 or TDAREM210 are used. For the filtration testing of
pre-filled syringes Steritest filter system No. TTHASY210 are used.
For the filtration testing of material dispensed as an aerosol or
foam Steritest filter system No. TTHVA210 are used. For the
filtration testing of soluble powders in ampoules or vials
Steritest filter system No. TTHADA210 or TTHADV210 are used.
[0373] Testing for E. coli and Salmonella includes the use of
lactose broths incubated at 30-35.degree. C. for 24-72 hours,
incubation in MacConkey and/or EMB agars for 18-24 hours, and/or
the use of Rappaport medium. Testing for the detection of P.
aeruginosa includes the use of NAC agar. United States Pharmacopeia
Chapter <62> further enumerates testing procedures for
specified objectionable microorganisms.
[0374] In certain embodiments, any controlled release formulation
described herein has less than about 60 colony forming units (CFU),
less than about 50 colony forming units, less than about 40 colony
forming units, or less than about 30 colony forming units of
microbial agents per gram of formulation. In certain embodiments,
the otic formulations described herein are formulated to be
isotonic with the endolymph and/or the perilymph.
[0375] Endotoxins
[0376] Provided herein are otic compositions that ameliorate or
lessen otic disorders described herein. Further provided herein are
methods comprising the administration of said otic compositions. In
some embodiments, the compositions or devices are substantially
free of endotoxins. An additional aspect of the sterilization
process is the removal of by-products from the killing of
microorganisms (hereinafter, "Product"). The process of
depyrogenation removes pyrogens from the sample. Pyrogens are
endotoxins or exotoxins which induce an immune response. An example
of an endotoxin is the lipopolysaccharide (LPS) molecule found in
the cell wall of gram-negative bacteria. While sterilization
procedures such as autoclaving or treatment with ethylene oxide
kill the bacteria, the LPS residue induces a proinflammatory immune
response, such as septic shock. Because the molecular size of
endotoxins can vary widely, the presence of endotoxins is expressed
in "endotoxin units" (EU). One EU is equivalent to 100 picograms of
E. coli LPS. Humans can develop a response to as little as 5 EU/kg
of body weight. The bioburden (e.g., microbial limit) and/or
sterility (e.g., endotoxin level) is expressed in any units as
recognized in the art. In certain embodiments, otic compositions
described herein contain lower endotoxin levels (e.g. <4 EU/kg
of body weight of a subject) when compared to conventionally
acceptable endotoxin levels (e.g., 5 EU/kg of body weight of a
subject). In some embodiments, the auris-acceptable otic
therapeutic agent formulation has less than about 5 EU/kg of body
weight of a subject. In other embodiments, the auris-acceptable
otic therapeutic agent formulation has less than about 4 EU/kg of
body weight of a subject. In additional embodiments, the
auris-acceptable otic therapeutic agent formulation has less than
about 3 EU/kg of body weight of a subject. In additional
embodiments, the auris-acceptable otic therapeutic agent
formulation has less than about 2 EU/kg of body weight of a
subject.
[0377] In some embodiments, the auris-acceptable otic therapeutic
agent formulation or device has less than about 5 EU/kg of
formulation. In other embodiments, the auris-acceptable otic
therapeutic agent formulation has less than about 4 EU/kg of
formulation. In additional embodiments, the auris-acceptable otic
therapeutic agent formulation has less than about 3 EU/kg of
formulation. In some embodiments, the auris-acceptable otic
therapeutic agent formulation has less than about 5 EU/kg Product.
In other embodiments, the auris-acceptable otic therapeutic agent
formulation has less than about 1 EU/kg Product. In additional
embodiments, the auris-acceptable otic therapeutic agent
formulation has less than about 0.2 EU/kg Product. In some
embodiments, the auris-acceptable otic therapeutic agent
formulation has less than about 5 EU/g of unit or Product. In other
embodiments, the auris-acceptable otic therapeutic agent
formulation has less than about 4 EU/g of unit or Product. In
additional embodiments, the auris-acceptable otic therapeutic agent
formulation has less than about 3 EU/g of unit or Product. In some
embodiments, the auris-acceptable otic therapeutic agent
formulation has less than about 5 EU/mg of unit or Product. In
other embodiments, the auris-acceptable otic therapeutic agent
formulation has less than about 4 EU/mg of unit or Product. In
additional embodiments, the auris-acceptable otic therapeutic agent
formulation has less than about 3 EU/mg of unit or Product. In
certain embodiments, otic compositions described herein contain
from about 1 to about 5 EU/mL of formulation. In certain
embodiments, otic compositions described herein contain from about
2 to about 5 EU/mL of formulation, from about 3 to about 5 EU/mL of
formulation, or from about 4 to about 5 EU/mL of formulation.
[0378] In certain embodiments, otic compositions or devices
described herein contain lower endotoxin levels (e.g. <0.5 EU/mL
of formulation) when compared to conventionally acceptable
endotoxin levels (e.g., 0.5 EU/mL of formulation). In some
embodiments, the auris-acceptable otic therapeutic agent
formulation or device has less than about 0.5 EU/mL of formulation.
In other embodiments, the auris-acceptable otic therapeutic agent
formulation has less than about 0.4 EU/mL of formulation. In
additional embodiments, the auris-acceptable otic therapeutic agent
formulation has less than about 0.2 EU/mL of formulation.
[0379] Pyrogen detection, by way of example only, is performed by
several methods. Suitable tests for sterility include tests
described in United States Pharmacopoeia (USP)<71> Sterility
Tests (23rd edition, 1995). The rabbit pyrogen test and the Limulus
amebocyte lysate test are both specified in the United States
Pharmacopeia Chapters <85> and <151> (USP23/NF 18,
Biological Tests, The United States Pharmacopeial Convention,
Rockville, Md., 1995). Alternative pyrogen assays have been
developed based upon the monocyte activation-cytokine assay.
Uniform cell lines suitable for quality control applications have
been developed and have demonstrated the ability to detect
pyrogenicity in samples that have passed the rabbit pyrogen test
and the Limulus amebocyte lysate test (Taktak et al, J. Pharm.
Pharmacol. (1990), 43:578-82). In an additional embodiment, the
auris-acceptable otic therapeutic agent formulation is subject to
depyrogenation. In a further embodiment, the process for the
manufacture of the auris-acceptable otic therapeutic agent
formulation comprises testing the formulation for pyrogenicity. In
certain embodiments, the formulations described herein are
substantially free of pyrogens.
pH and Practical Osmolarity
[0380] As used herein, "practical osmolarity" means the osmolarity
of a formulation that is measured by including the active agent and
all excipients except the gelling and/or the thickening agent
(e.g., polyoxyethylene-polyooxypropylene copolymers,
carboxymethylcellulose or the like). The practical osmolarity of a
formulation described herein is measured by any suitable method,
e.g., a freezing point depression method as described in Viegas et.
al., Int. J. Pharm., 1998, 160, 157-162. In some instances, the
practical osmolarity of a composition described herein is measured
by vapor pressure osmometry (e.g., vapor pressure depresssion
method) that allows for determination of the osmolarity of a
composition at higher temperatures. In some instances, vapor
pressure depression method allows for determination of the
osmolarity of a formulation comprising a gelling agent (e.g., a
thermoreversible polymer) at a higher temperature wherein the
gelling agent is in the form of a gel. The practical osmolality of
an otic formulation described herein is from about 100 mOsm/kg to
about 1000 mOsm/kg, from about 200 mOsm/kg to about 800 mOsm/kg,
from about 250 mOsm/kg to about 500 mOsm/kg, or from about 250
mOsm/kg to about 320 mOsm/kg, or from about 250 mOsm/kg to about
350 mOsm/kg or from about 280 mOsm/kg to about 320 mOsm/kg. In some
embodiments, the formulations described herein have a practical
osmolarity of about 100 mOsm/L to about 1000 mOsm/L, about 200
mOsm/L to about 800 mOsm/L, about 250 mOsm/L to about 500 mOsm/L,
about 250 mOsm/L to about 350 mOsm/L, about 250 mOsm/L to about 320
mOsm/L, or about 280 mOsm/L to about 320 mOsm/L.
[0381] In some embodiments, the osmolarity at a target site of
action (e.g., the perilymph) is about the same as the delivered
osmolarity (i.e., osmolarity of materials that cross or penetrate
the round window membrane) of any formulation described herein. In
some embodiments, the formulations described herein have a
delieverable osmolarity of about 150 mOsm/L to about 500 mOsm/L,
about 250 mOsm/L to about 500 mOsm/L, about 250 mOsm/L to about 350
mOsm/L, about 280 mOsm/L to about 370 mOsm/L or about 250 mOsm/L to
about 320 mOsm/L.
[0382] The main cation present in the endolymph is potassium. In
addition the endolymph has a high concentration of positively
charged amino acids. The main cation present in the perilymph is
sodium. In certain instances, the ionic composition of the
endolymph and perilymph regulate the electrochemical impulses of
hair cells. In certain instances, any change in the ionic balance
of the endolymph or perilymph results in a loss of hearing due to
changes in the conduction of electrochemical impulses along otic
hair cells. In some embodiments, a composition disclosed herein
does not disrupt the ionic balance of the perilymph. In some
embodiments, a composition disclosed herein has an ionic balance
that is the same as or substantially the same as the perilymph. In
some embodiments, a composition disclosed herein does not disrupt
the ionic balance of the endolymph. In some embodiments, a
composition disclosed herein has an ionic balance that is the same
as or substantially the same as the endolymph. In some embodiments,
an otic formulation described herein is formulated to provide an
ionic balance that is compatible with inner ear fluids (e.g.,
endolymph and/or perilymph).
[0383] The endolymph and the perilymph have a pH that is close to
the physiological pH of blood. The endolymph has a pH range of
about 7.2-7.9; the perilymph has a pH range of about 7.2-7.4. The
in situ pH of the proximal endolymph is about 7.4 while the pH of
distal endolymph is about 7.9.
[0384] In some embodiments, the pH of a composition described
herein is adjusted (e.g., by use of a buffer) to an
endolymph-compatible pH range of about 5.5 to 9.0. In specific
embodiments, the pH of a composition described herein is adjusted
to a perilymph-suitable pH range of about 5.5 to about 9.0. In some
embodiments, the pH of a composition described herein is adjusted
to a perilymph-suitable range of about 5.5 to about 8.0, about 6 to
about 8.0 or about 6.6 to about 8.0. In some embodiments, the pH of
a composition described herein is adjusted to a perilymph-suitable
pH range of about 7.0-7.6.
[0385] In some embodiments, useful formulations also include one or
more pH adjusting agents or buffering agents. Suitable pH adjusting
agents or buffers include, but are not limited to acetate,
bicarbonate, ammonium chloride, citrate, phosphate,
pharmaceutically acceptable salts thereof and combinations or
mixtures thereof.
[0386] In one embodiment, when one or more buffers are utilized in
the formulations of the present disclosure, they are combined,
e.g., with a pharmaceutically acceptable vehicle and are present in
the final formulation, e.g., in an amount ranging from about 0.1%
to about 20%, from about 0.5% to about 10%. In certain embodiments
of the present disclosure, the amount of buffer included in the gel
formulations are an amount such that the pH of the gel formulation
does not interfere with the body's natural buffering system.
[0387] In one embodiment, diluents are also used to stabilize
compounds because they can provide a more stable environment. Salts
dissolved in buffered solutions (which also can provide pH control
or maintenance) are utilized as diluents in the art, including, but
not limited to a phosphate buffered saline solution.
[0388] In some embodiments, any gel formulation described herein
has a pH that allows for sterilization (e.g, by filtration or
aseptic mixing or heat treatment and/or autoclaving (e.g., terminal
sterilization) of a gel formulation without degradation of the
pharmaceutical agent (e.g., auris sensory cell modulating agent) or
the polymers comprising the gel. In order to reduce hydrolysis
and/or degradation of the otic agent and/or the gel polymer during
sterilization, the buffer pH is designed to maintain pH of the
formulation in the 7-8 range during the process of sterilization
(e.g., high temperature autoclaving).
[0389] In specific embodiments, any gel formulation described
herein has a pH that allows for terminal sterilization (e.g, by
heat treatment and/or autoclaving) of a gel formulation without
degradation of the pharmaceutical agent (e.g., auris sensory cell
modulating agent) or the polymers comprising the gel. For example,
in order to reduce hydrolysis and/or degradation of the otic agent
and/or the gel polymer during autoclaving, the buffer pH is
designed to maintain pH of the formulation in the 7-8 range at
elevated temperatures. Any appropriate buffer is used depending on
the otic agent used in the formulation. In some instances, since
pK.sub.a of TRIS decreases as temperature increases at
approximately -0.03/.degree. C. and pK.sub.a of PBS increases as
temperature increases at approximately 0.003/.degree. C.,
autoclaving at 250.degree. F. (121.degree. C.) results in a
significant downward pH shift (i.e. more acidic) in the TRIS buffer
whereas a relatively much less upward pH shift in the PBS buffer
and therefore much increased hydrolysis and/or degradation of an
otic agent in TRIS than in PBS. Degradation of an otic agent is
reduced by the use of an appropriate combination of a buffer and
polymeric additives (e.g. CMC) as described herein.
[0390] In some embodiments, a formulation pH of between about 5.0
and about 9.0, between about 5.5 and about 8.5, between about 6.0
and about 7.6, between about 7 and about 7.8, between about 7.0 and
about 7.6, between about 7.2 and 7.6, or between about 7.2 and
about 7.4 is suitable for sterilization (e.g, by filtration or
aseptic mixing or heat treatment and/or autoclaving (e.g., terminal
sterilization)) of auris formulations described herein. In specific
embodiments a formulation pH of about 6.0, about 6.5, about 7.0,
about 7.1, about 7.2, about 7.3, about 7.4, about 7.5, or about 7.6
is suitable for sterilization (e.g, by filtration or aseptic mixing
or heat treatment and/or autoclaving (e.g., terminal
sterilization)) of any composition descibed herein.
[0391] In some embodiments, the formulations have a pH as described
herein, and include a thickening agent (e.g, a vicosity enhancing
agent) such as, by way of non-limiting example, a cellulose based
thickening agent described herein. In some instances, the addition
of a secondary polymer (e.g., a thickening agent) and a pH of
formulation as described herein, allows for sterilization of a
formulation described herein without any substantial degradation of
the otic agent and/or the polymer components in the otic
formulation. In some embodiments, the ratio of a thermoreversible
poloxamer to a thickening agent in a formulation that has a pH as
described herein, is about 40:1, about 35:1, about 30:1, about
25:1, about 20:1, about 15:1 about 10:1, or about 5:1. For example,
in certain embodiments, a sustained and/or extended release
formulation described herein comprises a combination of poloxamer
407 (pluronic F127) and carboxymethylcellulose (CMC) in a ratio of
about 40:1, about 35:1, about 30:1, about 25:1, about 20:1, about
15:1, about 10:1 or about 5:1.
[0392] In some embodiments, the amount of thermoreversible polymer
in any formulation described herein is about 10%, about 15%, about
20%, about 25%, about 30%, about 35% or about 40% of the total
weight of the formulation. In some embodiments, the amount of
thermoreversible polymer in any formulation described herein is
about 10%, about 11%, about 12%, about 13%, about 14%, about 15%,
about 16%, about 17%, about 18%, about 19%, about 20%, about 21%,
about 22%, about 23%, about 24% or about 25% of the total weight of
the formulation. In some embodiments, the amount of
thermoreversible polymer (e.g., pluronic F127) in any formulation
described herein is about 7.5% of the total weight of the
formulation. In some embodiments, the amount of thermoreversible
polymer (e.g., pluronic F127) in any formulation described herein
is about 10% of the total weight of the formulation. In some
embodiments, the amount of thermoreversible polymer (e.g., pluronic
F127) in any formulation described herein is about 11% of the total
weight of the formulation. In some embodiments, the amount of
thermoreversible polymer (e.g., pluronic F127) in any formulation
described herein is about 12% of the total weight of the
formulation. In some embodiments, the amount of thermoreversible
polymer (e.g., pluronic F127) in any formulation described herein
is about 13% of the total weight of the formulation. In some
embodiments, the amount of thermoreversible polymer (e.g., pluronic
F127) in any formulation described herein is about 14% of the total
weight of the formulation. In some embodiments, the amount of
thermoreversible polymer (e.g., pluronic F127) in any formulation
described herein is about 15% of the total weight of the
formulation. In some embodiments, the amount of thermoreversible
polymer (e.g., pluronic F127) in any formulation described herein
is about 16% of the total weight of the formulation. In some
embodiments, the amount of thermoreversible polymer (e.g., pluronic
F127) in any formulation described herein is about 17% of the total
weight of the formulation. In some embodiments, the amount of
thermoreversible polymer (e.g., pluronic F127) in any formulation
described herein is about 18% of the total weight of the
formulation. In some embodiments, the amount of thermoreversible
polymer (e.g., pluronic F127) in any formulation described herein
is about 19% of the total weight of the formulation. In some
embodiments, the amount of thermoreversible polymer (e.g., pluronic
F127) in any formulation described herein is about 20% of the total
weight of the formulation. In some embodiments, the amount of
thermoreversible polymer (e.g., pluronic F127) in any formulation
described herein is about 21% of the total weight of the
formulation. In some embodiments, the amount of thermoreversible
polymer (e.g., pluronic F127) in any formulation described herein
is about 23% of the total weight of the formulation. In some
embodiments, the amount of thermoreversible polymer (e.g., pluronic
F127) in any formulation described herein is about 25% of the total
weight of the formulation.
[0393] In some embodiments, the amount of thickening agent (e.g., a
gelling agent) in any formulation described herein is about 1%,
about 5%, about 10%, or about 15% of the total weight of the
formulation. In some embodiments, the amount of thickening agent
(e.g., a gelling agent) in any formulation described herein is
about 0.5%, about 1%, about 1.5%, about 2%, about 2.5%, about 3%,
about 3.5%, about 4%, about 4.5%, or about 5% of the total weight
of the formulation.
[0394] In some embodiments, the pharmaceutical formulations
described herein are stable with respect to pH over a period of any
of at least about 1 day, at least about 2 days, at least about 3
days, at least about 4 days, at least about 5 days, at least about
6 days, at least about 1 week, at least about 2 weeks, at least
about 3 weeks, at least about 4 weeks, at least about 5 weeks, at
least about 6 weeks, at least about 7 weeks, at least about 8
weeks, at least about 1 month, at least about 2 months, at least
about 3 months, at least about 4 months, at least about 5 months,
or at least about 6 months. In other embodiments, the formulations
described herein are stable with respect to pH over a period of at
least about 1 week. Also described herein are formulations that are
stable with respect to pH over a period of at least about 1
month.
[0395] Tonicity Agents
[0396] In general, the endolymph has a higher osmolality than the
perilymph. For example, the endolymph has an osmolality of about
304 mOsm/kg H.sub.2O while the perilymph has an osmolality of about
294 mOsm/kg H.sub.2O. In certain embodiments, tonicity agents are
added to the formulations described herein in an amount as to
provide a practical osmolality of an otic formulation of about 100
mOsm/kg to about 1000 mOsm/kg, from about 200 mOsm/kg to about 800
mOsm/kg, from about 250 mOsm/kg to about 500 mOsm/kg, or from about
250 mOsm/kg to about 350 mOsm/kg or from about 280 mOsm/kg to about
320 mOsm/kg. In some embodiments, the formulations described herein
have a practical osmolarity of about 100 mOsm/L to about 1000
mOsm/L, about 200 mOsm/L to about 800 mOsm/L, about 250 mOsm/L to
about 500 mOsm/L, about 250 mOsm/L to about 350 mOsm/L, about 280
mOsm/L to about 320 mOsm/L or about 250 mOsm/L to about 320
mOsm/L.
[0397] In some embodiments, the deliverable osmolarity of any
formulation described herein is designed to be isotonic with the
targeted otic structure (e.g., endolymph, perilymph or the like).
In specific embodiments, auris compositions described herein are
formulated to provide a delivered perilymph-suitable osmolarity at
the target site of action of about 250 to about 320 mOsm/L; and
preferably about 270 to about 320 mOsm/L. In specific embodiments,
auris compositions described herein are formulated to provide a
delivered perilymph-suitable osmolality at the target site of
action of about about 250 to about 320 mOsm/kg H.sub.2O; or an
osmolality of about 270 to about 320 mOsm/kg H.sub.2O. In specific
embodiments, the deliverable osmolarity/osmolality of the
formulations (i.e., the osmolarity/osmolality of the formulation in
the absence of gelling or thickening agents (e.g., thermoreversible
gel polymers) is adjusted, for example, by the use of appropriate
salt concentrations (e.g., concentration of potassium or sodium
salts) or the use of tonicity agents which renders the formulations
endolymph-compatible and/or perilymph-compatible (i.e. isotonic
with the endolymph and/or perilymph) upon delivery at the target
site. The osmolarity of a formulation comprising a thermoreversible
gel polymer is an unreliable measure due to the association of
varying amounts of water with the monomeric units of the polymer.
The practical osmolarity of a formulation (i.e., osmolarity in the
absence of a gelling or thickening agent (e.g. a thermoreversible
gel polymer) is a reliable measure and is measured by any suitable
method (e.g., freezing point depression method, vapor depression
method). In some instances, the formulations described herein
provide a deliverable osmolarity (e.g., at a target site (e.g.,
perilymph) that causes minimal disturbance to the environment of
the inner ear and causes minimum discomfort (e.g., vertigo and/or
nausea) to a mammal upon administration.
[0398] In some embodiments, any formulation described herein is
isotonic with the perilymph and/or endolymph. Isotonic formulations
are provided by the addition of a tonicity agent. Suitable tonicity
agents include, but are not limited to any pharmaceutically
acceptable sugar, salt or any combinations or mixtures thereof,
such as, but not limited to dextrose, glycerin, mannitol, sorbitol,
sodium chloride, and other electrolytes.
[0399] Useful auris compositions include one or more salts in an
amount required to bring osmolality of the composition into an
acceptable range. Such salts include those having sodium, potassium
or ammonium cations and chloride, citrate, ascorbate, borate,
phosphate, bicarbonate, sulfate, thiosulfate or bisulfite anions;
suitable salts include sodium chloride, potassium chloride, sodium
thiosulfate, sodium bisulfite and ammonium sulfate.
[0400] In some embodiments, the formulations described herein have
a pH and/or practical osmolarity as described herein, and have a
concentration of active pharmaceutical ingredient between about 1
.mu.M and about 10 .mu.M, between about 1 mM and about 100 mM,
between about 0.1 mM and about 100 mM, between about 0.1 mM and
about 100 nM. In some embodiments, the formulations described
herein have a pH and/or practical osmolarity as described herein,
and have a concentration of active pharmaceutical ingredient
between about 0.01%-about 20%, between about 0.01%-about 10%.,
between about 0.01%-about 7.5%, between about 0.01%-6%, between
about 0.01-5%, between about 0.1-about 10%, or between about
0.1-about 6% of the active ingredient by weight of the formulation.
In some embodiments, the formulations described herein have a pH
and/or practical osmolarity as described herein, and have a
concentration of active pharmaceutical ingredient between about 0.1
and about 70 mg, between about 1 mg and about 70 mg/mL, between
about 1 mg and about 50 mg/mL, between about 1 mg/mL and about 20
mg/mL, between about 1 mg/mL to about 10 mg/mL, between about 1
mg/mL to about 5 mg/mL, or between about 0.5 mg/mL to about 5 mg/mL
of the active agent by volume of the formulation. In some
embodiments, the formulations described herein have a pH and/or
practical osmolarity as described herein, and have a concentration
of active pharmaceutical ingredient between about 1 .mu.g/mL and
about 500 .mu.g/mL, between about 1 .mu.g/mL and about 250
.mu.g/mL, between about 1 .mu.g and about 100 .mu.g/mL, between
about 1 .mu.g/mL and about 50 .mu.g/mL, or between about 1 .mu.g/mL
and about 20 .mu.g/mL of the active agent by volume of the
formulation.
Particle Size
[0401] Size reduction is used to increase surface area and/or
modulate formulation dissolution properties. It is also used to
maintain a consistent average particle size distribution (PSD)
(e.g., micrometer-sized particles, nanometer-sized particles or the
like) for any formulation described herein. In some embodiments,
any formulation described herein comprises multiparticulates, i.e.,
a plurality of particle sizes (e.g., micronized particles,
nano-sized particles, non-sized particles, colloidal particles);
i.e, the formulation is a multiparticulate formulation. In some
embodiments, any formulation described herein comprises one or more
multiparticulate (e.g., micronized) therapeutic agents.
Micronization is a process of reducing the average diameter of
particles of a solid material. Micronized particles are from about
micrometer-sized in diameter to about nanometer-sized in diameter.
In some embodiments, the average diameter of particles in a
micronized solid is from about 0.5 .mu.m to about 500 .mu.m. In
some embodiments, the average diameter of particles in a micronized
solid is from about 1 .mu.m to about 200 .mu.m. In some
embodiments, the average diameter of particles in a micronized
solid is from about 2 .mu.m to about 100 .mu.m. In some
embodiments, the average diameter of particles in a micronized
solid is from about 3 .mu.m to about 50 .mu.m. In some embodiments,
a particulate micronized solid comprises particle sizes of less
than about 5 microns, less than about 20 microns and/or less than
about 100 microns. In some embodiments, the use of particulates
(e.g., micronized particles) of auris sensory cell modulating agent
allows for extended and/or sustained release of the auris sensory
cell modulating agent from any formulation described herein
compared to a formulation comprising non-multiparticulate (e.g,
non-micronized) auris sensory cell modulating agent. In some
instances, formulations containing multiparticulate (e.g.
micronized) auris sensory cell modulating agent are ejected from a
lmL syringe adapted with a 27G needle without any plugging or
clogging.
[0402] In some instances, any particle in any formulation described
herein is a coated particle (e.g., a coated micronized particle,
nano-particle) and/or a microsphere and/or a liposomal particle.
Particle size reduction techniques include, by way of example,
grinding, milling (e.g., air-attrition milling (jet milling), ball
milling), coacervation, complex coacervation, high pressure
homogenization, spray drying and/or supercritical fluid
crystallization. In some instances, particles are sized by
mechanical impact (e.g., by hammer mills, ball mill and/or pin
mills). In some instances, particles are sized via fluid energy
(e.g., by spiral jet mills, loop jet mills, and/or fluidized bed
jet mills). In some embodiments formulations described herein
comprise crystalline particles and/or isotropic particles. In some
embodiments, formulations described herein comprise amorphous
particles and/or anisotropic particles. In some embodiments,
formulations described herein comprise therapeutic agent particles
wherein the therapeutic agent is a free base, or a salt, or a
prodrug of a therapeutic agent, or any combination thereof
[0403] In some embodiments, a formulation described herein
comprises one or more auris sensory cell modulating agents wherein
the auris sensory cell modulating agent comprises nanoparticulates.
In some embodiments, a formulation described herein comprises auris
sensory cell modulating agent beads (e.g., dextromethorphan beads)
that are optionally coated with controlled release excipients. In
some embodiments, a formulation described herein comprises an auris
sensory cell modulating agent that is granulated and/or reduced in
size and coated with controlled release excipients; the granulated
coated auris sensory cell modulating agent particulates are then
optionally micronized and/or formulated in any of the compositions
described herein.
[0404] In some instances, a combination of an auris sensory cell
modulating agent as a neutral molecule, free acid or free base and
a salt of the auris sensory cell modulating agent is used to
prepare pulsed release otic agent formulations using the procedures
described herein. In some formulations, a combination of a
micronized auris sensory cell modulating agent (and/or salt or
prodrug thereof) and coated particles (e.g., nanoparticles,
liposomes, microspheres) is used to prepare pulsed release otic
agent formulations using any procedure described herein.
Alternatively, a pulsed release profile is achieved by solubilizing
up to 20% of the delivered dose of the auris sensory cell
modulating agent (e.g., micronized auris sensory cell modulating
agent, free base, free acid or salt or prodrug thereof
multiparticulate auris sensory cell modulating agent, free base,
free acid or salt or prodrug thereof) with the aid of
cyclodextrins, surfactants (e.g., poloxamers (407, 338, 188), tween
(80, 60, 20,81), PEG-hydrogenated castor oil, cosolvents like
N-methyl-2-Pyrrolidone or the like and preparing pulsed release
formulations using any procedure described herein.
[0405] In specific embodiments, any auris-compatible formulation
described herein comprises one or more micronized pharmaceutical
agents (e.g., auris sensory cell modulating agents). In some of
such embodiments, a micronized pharmaceutical agent comprises
micronized particles, coated (e.g., with an extended release coat)
micronized particles, or a combination thereof. In some of such
embodiments, a micronized pharmaceutical agent comprising
micronized particles, coated micronized particles, or a combination
thereof, comprises an auris sensory cell modulating agent as a
neutral molecule, a free acid, a free base, a salt, a prodrug or
any combination thereof. In certain embodiments, a pharmaceutical
composition described herein comprises an auris sensory cell
modulating agent as a micronized powder. In certain embodiments, a
pharmaceutical composition described herein comprises an auris
sensory cell modulating agent in the form of a micro-auris sensory
cell modulating agent powder.
[0406] The multiparticulates and/or micronized auris sensory cell
modulating agents described herein are delivered to an auris
structure (e.g., inner ear) by means of any type of matrix
including solid, liquid or gel matrices. In some embodiments, the
multiparticulates and/or micronized auris sensory cell modulating
agents described herein are delivered to an auris structure (e.g.,
inner ear) by means of any type of matrix including solid, liquid
or gel matrices via intratympanic injection.
Tunable Release Characteristics
[0407] The release of active agent from any formulation,
composition or device described herein is optionally tunable to the
desired release characteristics. In some embodiments, a composition
described herein is a solution that is substantially free of
gelling components. In such instances, the composition provides
essentially immediate release of an active agent. In some of such
embodiments, the composition is useful in perfusion of otic
structures, e.g., during surgery.
[0408] In some embodiments, a composition described herein is a
solution that is substantially free of gelling components and
comprises micronized otic agent (e.g., a corticosteroid). In some
of such embodiments, the composition provides release of an active
agent from about 2 days to about 4 days. In some embodiments, a
composition described herein comprises a gelling agent (e.g.,
poloxamer 407) and provides release of an active agent over a
period of from about 1 day to about 3 days. In some embodiments, a
composition described herein comprises a gelling agent (e.g.,
poloxamer 407) and provides release of an active agent over a
period of from about 1 day to about 5 days. In some embodiments, a
composition described herein comprises a gelling agent (e.g.,
poloxamer 407) and provides release of an active agent over a
period of from about 2 days to about 7 days.
[0409] In some embodiments, a composition described herein
comprises a gelling agent (e.g., poloxamer 407) in combination with
micronized otic agent and provides extended sustained release over
a longer period of time. In some embodiments, a composition
described herein comprises about 14-17% of a gelling agent (e.g.,
poloxamer 407) and micronized otic agent, and provides extended
sustained release over a period of from about 1 week to about 3
weeks. In some embodiments, a composition described herein
comprises about 18-21% of a gelling agent (e.g., poloxamer 407) and
micronized otic agent, and provides extended sustained release over
a period of from about 3 weeks to about 6 weeks.
[0410] Accordingly, the amount of gelling agent in a composition,
and the particle size of an otic agent are tunable to the desired
release profile of an otic agent from the composition.
[0411] As described herein, compositions comprising micronized otic
agents provide extended release over a longer period of time
compared to compositions comprising non-micronized otic agents. In
some instances, the micronized otic agent provides a steady supply
(e.g., +/-20%) of active agent via slow degradation and serves as a
depot for the active agent; such a depot effect increases residence
time of the otic agent in the ear. In specific embodiments,
selection of an appropriate particle size of the active agent
(e.g., micronized active agent) in combination with the amount of
gelling agent in the composition provides tunable extended release
characteristics that allow for release of an active agent over a
period of hours, days, weeks or months.
[0412] In some embodiments, the viscosity of any formulation
described herein is designed to provide a suitable rate of release
from an auris compatible gel. In some embodiments, the
concentration of a thickening agent (e.g., gelling components such
as polyoxyethylene-polyoxypropylene copolymers) allows for a
tunable mean dissolution time (MDT). The MDT is inversely
proportional to the release rate of an active agent from a
composition or device described herein. Experimentally, the
released otic agent is optionally fitted to the Korsmeyer-Peppas
equation
Q Q .alpha. = k t n + b ##EQU00001##
where Q is the amount of otic agent released at time t,
Q.sub..alpha., is the overall released amount of otic agent, k is a
release constant of the nth order, n is a dimensionless number
related to the dissolution mechanism and b is the axis intercept,
characterizing the initial burst release mechanism wherein n=1
characterizes an erosion controlled mechanism. The mean dissolution
time (MDT) is the sum of different periods of time the drug
molecules stay in the matrix before release, divided by the total
number of molecules and is optionally calculated by:
M D T = n k - 1 / n n + 1 ##EQU00002##
[0413] For example, a linear relationship between the mean
dissolution time (MDT) of a composition or device and the
concentration of the gelling agent (e.g., poloxamer) indicates that
the otic agent is released due to the erosion of the polymer gel
(e.g., poloxamer) and not via diffusion. In another example, a
non-linear relationship indicates release of otic agent via a
combination of diffusion and/or polymer gel degradation. In another
example, a faster gel elimination time course of a composition or
device (a faster release of active agent) indicates lower mean
dissolution time (MDT). The concentration of gelling components
and/or active agent in a composition are tested to determine
suitable parameters for MDT. In some embodiments, injection volumes
are also tested to determine suitable parameters for preclinical
and clinical studies. The gel strength and concentration of the
active agent affects release kinetics of an otic agent from the
composition. At low poloxamer concentration, elimination rate is
accelerated (MDT is lower). An increase in otic agent concentration
in the composition or device prolongs residence time and/or MDT of
the otic agent in the ear.
[0414] In some embodiments, the MDT for poloxamer from a
composition or device described herein is at least 6 hours. In some
embodiments, the MDT for poloxamer from a composition or device
described herein is at least 10 hours.
[0415] In some embodiments, the MDT for an active agent from a
composition or device described herein is from about 30 hours to
about 48 hours. In some embodiments, the MDT for an active agent
from a composition or device described herein is from about 30
hours to about 96 hours. In some embodiments, the MDT for an active
agent from a composition or device described herein is from about
30 hours to about 1 week. In some embodiments, the MDT for an
active agent from a composition or device described herein is from
about 1 week to about 6 weeks.
[0416] In certain embodiments, any controlled release otic
formulation described herein increases the exposure of an otic
agent and increases the Area Under the Curve (AUC) in otic fluids
(e.g., endolymph and/or perilymph) by about 30%, about 40%, about
50%, about 60%, about 70%, about 80% or about 90% compared to a
formulation that is not a controlled release otic formulation. In
certain embodiments, any controlled release otic formulation
described herein increases the exposure time of an otic agent and
decreases the C.sub.max in otic fluids (e.g., endolymph and/or
perilymph) by about 40%, about 30%, about 20%, or about 10%,
compared to a formulation that is not a controlled release otic
formulation. In certain embodiments, any controlled release otic
formulation described herein alters (e.g. reduces) the ratio of
C.sub.max to C.sub.min compared to a formulation that is not a
controlled release otic formulation. In certain embodiments, any
controlled release otic formulation described herein increases the
exposure of an otic agent and increases the length of time that the
concentration of an otic agent is above C.sub.min by about 30%,
about 40%, about 50%, about 60%, about 70%, about 80% or about 90%
compared to a formulation that is not a controlled release otic
formulation. In certain instances, controlled release formulations
described herein delay the time to C.sub.max. In certain instances,
the controlled steady release of a drug prolongs the time the
concentration of the drug will stay above the C.sub.min. In some
embodiments, auris compositions described herein prolong the
residence time of a drug in the inner ear and provide a stable drug
exposure profile. In some instances, an increase in concentration
of an active agent in the composition saturates the clearance
process and allows for a more rapid and stable steady state to be
reached.
[0417] In certain instances, once drug exposure (e.g.,
concentration in the endolymph or perilymph) of a drug reaches
steady state, the concentration of the drug in the endolymph or
perilymph stays at or about the therapeutic dose for an extended
period of time (e.g., one day, 2 days, 3 days, 4 days, 5 days, 6
days, or 1 week, 3 weeks, 6 weeks, 2 months). In some embodiments,
the steady state concentration of active agent released from a
controlled release formulation described herein is about 20 to
about 50 times the steady state concentration of an active agent
released from a formulation that is not a controlled release
formulation. FIG. 5 shows predicted tunable release of an active
agent from four compositions
Pharmaceutical Formulations
[0418] Provided herein are pharmaceutical compositions or devices
that include at least one auris sensory cell modulating agent and a
pharmaceutically acceptable diluent(s), excipient(s), or
carrier(s). In some embodiments, the pharmaceutical compositions
include other medicinal or pharmaceutical agents, carriers,
adjuvants, such as preserving, stabilizing, wetting or emulsifying
agents, solution promoters, salts for regulating the osmotic
pressure, and/or buffers. In other embodiments, the pharmaceutical
compositions also contain other therapeutic substances.
[0419] In some embodiments, the compositions or devices described
herein include a dye to help enhance the visualization of the gel
when applied. In some embodiments, dyes that are compatible with
the auris-acceptable compositions or devices described herein
include Evans blue (e.g., 0.5% of the total weight of an otic
formulation), Methylene blue (e.g., 1% of the total weight of an
otic formulation), Isosulfan blue (e.g., 1% of the total weight of
an otic formulation), Trypan blue (e.g., 0.15% of the total weight
of an otic formulation), and/or indocyanine green (e.g., 25
mg/vial). Other common dyes, e.g, FD&C red 40, FD&C red 3,
FD&C yellow 5, FD&C yellow 6, FD&C blue 1, FD&C
blue2, FD&C green 3, fluorescence dyes (e.g., Fluorescein
isothiocyanate, rhodamine, Alexa Fluors, DyLight Fluors) and/or
dyes that are visualizable in conjunction with non-invasive imaging
techniques such as MRI, CAT scans, PET scans or the like.
Gadolinium-based MRI dyes, iodine-base dyes, barium-based dyes or
the like are also contemplated for use with any otic formulation
described herein. Other dyes that are compatible with any
formulation or composition described herein are listed in the
Sigma-Aldrich catalog under dyes (which is included herein by
reference for such disclosure).
[0420] In some embodiments, mechanical or imaging devices are used
to monitor or survey the hearing, balance or other auris disorder.
For example, magnetic resonance imaging (MRI) devices are
specifically contemplated within the scope of the embodiments,
wherein the MRI devices (for example, 3 Tesla MRI devices) are
capable of evaluating Meniere Disease progression, and subsequent
treatment with the pharmaceutical formulations disclosed herein.
Gadolinium-based dyes, iodine-base dyes, barium-based dyes or the
like are also contemplated for use with any auris-compatible
composition or device described herein and/or with any mechanical
or imaging devices described herein. In certain embodiments,
gadolinium hydrate is used in combination with MRI and/or any
pharmaceutical composition or device described herein to evaluate
disease severity (e.g., size of endolymphatic hydrops), formulation
penetration into the inner ear, and/or therapeutic effectiveness of
the pharmaceutical formulations/devices in the otic diseases
described herein (e.g., Meniere's disease).
[0421] Any pharmaceutical composition or device described herein is
administered by locating the composition or device in contact with
the crista fenestrae cochlea, the round window, the tympanic
cavity, the tympanic membrane, the auris media or the auris
externa.
[0422] In one specific embodiment of the auris-acceptable
controlled release auris sensory cell modulating agent
pharmaceutical formulations described herein, the auris sensory
cell modulating agent is provided in a gel matrix, also referred to
herein as "auris acceptable gel formulations," "auris
interna-acceptable gel formulations," "auris media-acceptable gel
formulations," "auris externa-acceptable gel formulations", "auris
gel formulations" or variations thereof. All of the components of
the gel formulation must be compatible with the targeted auris
structure. Further, the gel formulations provide controlled release
of the auris sensory cell modulating agent to the desired site
within the targeted auris structure; in some embodiments, the gel
formulation also has an immediate or rapid release component for
delivery of the auris sensory cell modulating agent to the desired
target site. In other embodiments, the gel formulation has a
sustained release component for delivery of the auris sensory cell
modulating agent. In some embodiments, the gel formulation
comprises a multiparticulate (e.g., micronized) auris sensory cell
modulating agent. In some embodiments, the auris gel formulations
are biodegradeable. In other embodiments, the auris gel
formulations include a mucoadhesive excipient to allow adhesion to
the external mucous layer of the round window membrane. In yet
other embodiments, the auris gel formulations include a penetration
enhancer excipient; in further embodiments, the auris gel
formulation contains a viscosity enhancing agent sufficient to
provide a viscosity of between about 500 and 1,000,000 centipoise,
between about 750 and 1,000,000 centipoise; between about 1000 and
1,000,000 centipoise; between about 1000 and 400,000 centipoise;
between about 2000 and 100,000 centipoise; between about 3000 and
50,000 centipoise; between about 4000 and 25,000 centipoise;
between about 5000 and 20,000 centipoise; or between about 6000 and
15,000 centipoise. In some embodiments, the auris gel formulation
contains a viscosity enhancing agent sufficient to provide a
viscosity of between about 50,0000 and 1,000,000 centipoise.
[0423] In some embodiments, the compositions or devices described
herein are low viscosity compositions or devices at body
temperature. In some embodiments, low viscosity compositions or
devices contain from about 1% to about 10% of a viscosity enhancing
agent (e.g., gelling components such as
polyoxyethylene-polyoxypropylene copolymers). In some embodiments,
low viscosity compositions or devices contain from about 2% to
about 10% of a viscosity enhancing agent (e.g., gelling components
such as polyoxyethylene-polyoxypropylene copolymers). In some
embodiments, low viscosity compositions or devices contain from
about 5% to about 10% of a viscosity enhancing agent (e.g., gelling
components such as polyoxyethylene-polyoxypropylene copolymers). In
some embodiments, low viscosity compositions or devices are
substantially free of a viscosity enhancing agent (e.g., gelling
components such as polyoxyethylene-polyoxypropylene copolymers). In
some embodiments, a low viscosity auris sensory cell modulator
composition or device described herein provides an apparent
viscosity of from about 100 cP to about 10,000 cP. In some
embodiments, a low viscosity auris sensory cell modulator
composition or device described herein provides an apparent
viscosity of from about 500 cP to about 10,000 cP. In some
embodiments, a low viscosity auris sensory cell modulator
composition or device described herein provides an apparent
viscosity of from about 1000 cP to about 10,000 cP. In some of such
embodiments, a low viscosity auris sensory cell modulator
composition or device is administered in combination with an
external otic intervention, e.g., a surgical procedure including
but not limited to middle ear surgery, inner ear surgery,
typanostomy, cochleostomy, labyrinthotomy, mastoidectomy,
stapedectomy, stapedotomy, endolymphatic sacculotomy or the like.
In some of such embodiments, a low viscosity auris sensory cell
modulator composition or device is administered during an otic
intervention. In other such embodiments, a low viscosity auris
sensory cell modulator composition or device is administered before
the otic intervention.
[0424] In some embodiments, the compositions or devices described
herein are high viscosity compositions or devices at body
temperature. In some embodiments, high viscosity compositions or
devices contain from about 10% to about 25% of a viscosity
enhancing agent (e.g., gelling components such as
polyoxyethylene-polyoxypropylene copolymers). In some embodiments,
high viscosity compositions or devices contain from about 14% to
about 22% of a viscosity enhancing agent (e.g., gelling components
such as polyoxyethylene-polyoxypropylene copolymers). In some
embodiments, high viscosity compositions or devices contain from
about 15% to about 21% of a viscosity enhancing agent (e.g.,
gelling components such as polyoxyethylene-polyoxypropylene
copolymers). In some embodiments, a high viscosity auris sensory
cell modulator composition or device described herein provides an
apparent viscosity of from about 100,000 cP to about 1,000,000 cP.
In some embodiments, a high viscosity auris sensory cell modulator
composition or device described herein provides an apparent
viscosity of from about 150,000 cP to about 500,000 cP. In some
embodiments, a high viscosity auris sensory cell modulator
composition or device described herein provides an apparent
viscosity of from about 250,000 cP to about 500,000 cP. In some of
such embodiments, a high viscosity composition or device is a
liquid at room temperature and gels at about between room
temperature and body temperature (including an individual with a
serious fever, e.g., up to about 42.degree. C.). In some
embodiments, an auris sensory cell modulator high viscosity
composition or device is administered as monotherapy for treatment
of an otic disease or condition described herein. In some
embodiments, an auris sensory cell modulator high viscosity
composition or device is administered in combination with an
external otic intervention, e.g., a surgical procedure including
but not limited to middle ear surgery, inner ear surgery,
typanostomy, cochleostomy, labyrinthotomy, mastoidectomy,
stapedectomy, stapedotomy, endolymphatic sacculotomy or the like.
In some of such embodiments, a high viscosity auris sensory cell
modulator composition or device is administered after the otic
intervention. In other such embodiments, a high viscosity auris
sensory cell modulator composition or device is administered before
the otic intervention.
[0425] In other embodiments, the auris interna pharmaceutical
formulations described herein further provide an auris-acceptable
hydrogel; in yet other embodiments, the auris pharmaceutical
formulations provide an auris-acceptable microsphere or
microparticle; in still other embodiments, the auris pharmaceutical
formulations provide an auris-acceptable liposome. In some
embodiments, the auris pharmaceutical formulations provide an
auris-acceptable foam; in yet other embodiments, the auris
pharmaceutical formulations provide an auris-acceptable paint; in
still further embodiments, the auris pharmaceutical formulations
provide an auris-acceptable in situ forming spongy material. In
some embodiments, the auris pharmaceutical formulations provide an
auris-acceptable solvent release gel. In some embodiments, the
auris pharmaceutical formulations provide an actinic radiation
curable gel. Further embodiments include a thermoreversible gel in
the auris pharmaceutical formulation, such that upon preparation of
the gel at room temperature or below, the formulation is a fluid,
but upon application of the gel into or near the auris interna
and/or auris media target site, including the tympanic cavity,
round window membrane or the crista fenestrae cochleae, the
auris-pharmaceutical formulation stiffens or hardens into a
gel-like substance.
[0426] In further or alternative embodiments, the auris gel
formulations are capable of being administered on or near the round
window membrane via intratympanic injection. In other embodiments,
the auris gel formulations are administered on or near the round
window or the crista fenestrae cochleae through entry via a
post-auricular incision and surgical manipulation into or near the
round window or the crista fenestrae cochleae area. Alternatively,
the auris gel formulation is applied via syringe and needle,
wherein the needle is inserted through the tympanic membrane and
guided to the area of the round window or crista fenestrae
cochleae. The auris gel formulations are then deposited on or near
the round window or crista fenestrae cochleae for localized
treatment of autoimmune otic disorders. In other embodiments, the
auris gel formulations are applied via microcathethers implanted
into the patient, and in yet further embodiments the formulations
are administered via a pump device onto or near the round window
membrane. In still further embodiments, the auris gel formulations
are applied at or near the round window membrane via a
microinjection device. In yet other embodiments, the auris gel
formulations are applied in the tympanic cavity. In some
embodiments, the auris gel formulations are applied on the tympanic
membrane. In still other embodiments, the auris gel formulations
are applied onto or in the auditory canal.
[0427] In further specific embodiments, any pharmaceutical
composition or device described herein comprises a multiparticulate
auris sensory cell modulating agent in a liquid matrix (e.g., a
liquid composition for intratympanic injection, or otic drops). In
certain embodiments, any pharmaceutical composition described
herein comprises a multiparticulate auris sensory cell modulating
agent in a solid matrix.
Controlled Release Formulations
[0428] In general, controlled release drug formulations impart
control over the release of drug with respect to site of release
and time of release within the body. As discussed herein,
controlled release refers to immediate release, delayed release,
sustained release, extended release, variable release, pulsatile
release and bi-modal release. Many advantages are offered by
controlled release. First, controlled release of a pharmaceutical
agent allows less frequent dosing and thus minimizes repeated
treatment. Second, controlled release treatment results in more
efficient drug utilization and less of the compound remains as a
residue. Third, controlled release offers the possibility of
localized drug delivery by placement of a delivery device or
formulation at the site of disease. Still further, controlled
release offers the opportunity to administer and release two or
more different drugs, each having a unique release profile, or to
release the same drug at different rates or for different
durations, by means of a single dosage unit.
[0429] Accordingly, one aspect of the embodiments disclosed herein
is to provide a controlled release auris sensory cell modulating
agent auris-acceptable composition or device for the treatment of
autoimmune disorders and/or inflammatory disorders. The controlled
release aspect of the compositions and/or formulations and/or
devices disclosed herein is imparted through a variety of agents,
including but not limited to excipients, agents or materials that
are acceptable for use in the auris interna or other otic
structure. By way of example only, such excipients, agents or
materials include an auris-acceptable polymer, an auris-acceptable
viscosity enhancing agent, an auris-acceptable gel, an
auris-acceptable paint, an auris-acceptable foam, an
auris-acceptable xerogel, an auris-acceptable microsphere or
microparticle, an auris-acceptable hydrogel, an auris-acceptable in
situ forming spongy material, an auris-acceptable actinic radiation
curable gel, an auris-acceptable solvent release gel, an
auris-acceptable liposome, an auris-acceptable nanocapsule or
nanosphere, an auris-acceptable thermoreversible gel, or
combinations thereof.
Auris-Acceptable Gels
[0430] Gels, sometimes referred to as jellies, have been defined in
various ways. For example, the United States Pharmacopoeia defines
gels as semisolid systems consisting of either suspensions made up
of small inorganic particles or large organic molecules
interpenetrated by a liquid. Gels include a single-phase or a
two-phase system. A single-phase gel consists of organic
macromolecules distributed uniformly throughout a liquid in such a
manner that no apparent boundaries exist between the dispersed
macromolecules and the liquid. Some single-phase gels are prepared
from synthetic macromolecules (e.g., carbomer) or from natural
gums, (e.g., tragacanth). In some embodiments, single-phase gels
are generally aqueous, but will also be made using alcohols and
oils. Two-phase gels consist of a network of small discrete
particles.
[0431] Gels can also be classified as being hydrophobic or
hydrophilic. In certain embodiments, the base of a hydrophobic gel
consists of a liquid paraffin with polyethylene or fatty oils
gelled with colloidal silica, or aluminum or zinc soaps. In
contrast, the base of hydrophobic gels usually consists of water,
glycerol, or propylene glycol gelled with a suitable gelling agent
(e.g., tragacanth, starch, cellulose derivatives,
carboxyvinylpolymers, and magnesium-aluminum silicates). In certain
embodiments, the rheology of the compositions or devices disclosed
herein is pseudo plastic, plastic, thixotropic, or dilatant.
[0432] In one embodiment the enhanced viscosity auris-acceptable
formulation described herein is not a liquid at room temperature.
In certain embodiments, the enhanced viscosity formulation is
characterized by a phase transition between room temperature and
body temperature (including an individual with a serious fever,
e.g., up to about 42.degree. C.). In some embodiments, the phase
transition occurs at 1.degree. C. below body temperature, at
2.degree. C. below body temperature, at 3.degree. C. below body
temperature, at 4.degree. C. below body temperature, at 6.degree.
C. below body temperature, at 8.degree. C. below body temperature,
or at 10.degree. C. below body temperature. In some embodiments,
the phase transition occurs at about 15.degree. C. below body
temperature, at about 20.degree. C. below body temperature or at
about 25.degree. C. below body temperature. In specific
embodiments, the gelation temperature (Tgel) of a formulation
described herein is about 20.degree. C., about 25.degree. C., or
about 30.degree. C. In certain embodiments, the gelation
temperature (Tgel) of a formulation described herein is about
35.degree. C., or about 40.degree. C. In one embodiment,
administration of any formulation described herein at about body
temperature reduces or inhibits vertigo associated with
intratympanic administration of otic formulations. Included within
the definition of body temperature is the body temperature of a
healthy individual, or an unhealthy individual, including an
individual with a fever (up to .about.42.degree. C.). In some
embodiments, the pharmaceutical compositions or devices described
herein are liquids at about room temperature and are administered
at or about room temperature, reducing or ameliorating side effects
such as, for example, vertigo.
[0433] Polymers composed of polyoxypropylene and polyoxyethylene
form thermoreversible gels when incorporated into aqueous
solutions. These polymers have the ability to change from the
liquid state to the gel state at temperatures close to body
temperature, therefore allowing useful formulations that are
applied to the targeted auris structure(s). The liquid state-to-gel
state phase transition is dependent on the polymer concentration
and the ingredients in the solution.
[0434] Poloxamer 407 (PF-127) is a nonionic surfactant composed of
polyoxyethylene-polyoxypropylene copolymers. Other poloxamers
include 188 (F-68 grade), 237 (F-87 grade), 338 (F-108 grade).
Aqueous solutions of poloxamers are stable in the presence of
acids, alkalis, and metal ions. PF-127 is a commercially available
polyoxyethylene-polyoxypropylene triblock copolymer of general
formula E106 P70 E106, with an average molar mass of 13,000. The
polymer can be further purified by suitable methods that will
enhance gelation properties of the polymer. It contains
approximately 70% ethylene oxide, which accounts for its
hydrophilicity. It is one of the series of poloxamer ABA block
copolymers, whose members share the chemical formula shown
below.
##STR00001##
[0435] PF-127 is of particular interest since concentrated
solutions (>20% w/w) of the copolymer are transformed from low
viscosity transparent solutions to solid gels on heating to body
temperature. This phenomenon, therefore, suggests that when placed
in contact with the body, the gel preparation will form a
semi-solid structure and a sustained release depot. Furthermore,
PF-127 has good solubilizing capacity, low toxicity and is,
therefore, considered a good medium for drug delivery systems.
[0436] In an alternative embodiment, the thermogel is a
PEG-PLGA-PEG triblock copolymer (Jeong et al, Nature (1997),
388:860-2; Jeong et al, J. Control. Release (2000), 63:155-63;
Jeong et al, Adv. Drug Delivery Rev. (2002), 54:37-51). The polymer
exhibits sol-gel behavior over a concentration of about 5% w/w to
about 40% w/w. Depending on the properties desired, the
lactide/glycolide molar ratio in the PLGA copolymer ranges from
about 1:1 to about 20:1. The resulting coploymers are soluble in
water and form a free-flowing liquid at room temperature, but form
a hydrogel at body temperature. A commercially available
PEG-PLGA-PEG triblock copolymer is RESOMER RGP t50106 manufactured
by Boehringer Ingelheim. This material is composed of a PGLA
copolymer of 50:50 poly(DL-lactide-co-glycolide) and is 10% w/w of
PEG and has a molecular weight of about 6000.
[0437] ReGel.RTM. is a tradename of MacroMed Incorporated for a
class of low molecular weight, biodegradable block copolymers
having reverse thermal gelation properties as described in U.S.
Pat. Nos. 6,004,573, 6,117,949, 6,201,072, and 6,287,588. It also
includes biodegradable polymeric drug carriers disclosed in pending
U.S. patent application Ser. Nos. 09/906,041, 09/559,799 and
10/919,603. The biodegradable drug carrier comprises ABA-type or
BAB-type triblock copolymers or mixtures thereof, wherein the
A-blocks are relatively hydrophobic and comprise biodegradable
polyesters or poly(orthoester)s, and the B-blocks are relatively
hydrophilic and comprise polyethylene glycol (PEG), said copolymers
having a hydrophobic content of between 50.1 to 83% by weight and a
hydrophilic content of between 17 to 49.9% by weight, and an
overall block copolymer molecular weight of between 2000 and 8000
Daltons. The drug carriers exhibit water solubility at temperatures
below normal mammalian body temperatures and undergo reversible
thermal gelation to then exist as a gel at temperatures equal to
physiological mammalian body temperatures. The biodegradable,
hydrophobic A polymer block comprises a polyester or poly(ortho
ester), in which the polyester is synthesized from monomers
selected from the group consisting of D,L-lactide, D-lactide,
L-lactide, D,L-lactic acid, D-lactic acid, L-lactic acid,
glycolide, glycolic acid, .epsilon.-caprolactone,
.epsilon.-hydroxyhexanoic acid, .gamma.-butyrolactone,
.gamma.-hydroxybutyric acid, .delta.-valerolactone,
.delta.-hydroxyvaleric acid, hydroxybutyric acids, malic acid, and
copolymers thereof and having an average molecular weight of
between about 600 and 3000 Daltons. The hydrophilic B-block segment
is preferably polyethylene glycol (PEG) having an average molecular
weight of between about 500 and 2200 Daltons.
[0438] Additional biodegradable thermoplastic polyesters include
AtriGel.RTM. (provided by Atrix Laboratories, Inc.) and/or those
disclosed, e.g., in U.S. Pat. Nos. 5,324,519; 4,938,763; 5,702,716;
5,744,153; and 5,990,194; wherein the suitable biodegradable
thermoplastic polyester is disclosed as a thermoplastic polymer.
Examples of suitable biodegradable thermoplastic polyesters include
polylactides, polyglycolides, polycaprolactones, copolymers
thereof, terpolymers thereof, and any combinations thereof. In some
such embodiments, the suitable biodegradable thermoplastic
polyester is a polylactide, a polyglycolide, a copolymer thereof, a
terpolymer thereof, or a combination thereof. In one embodiment,
the biodegradable thermoplastic polyester is 50/50
poly(DL-lactide-co-glycolide) having a carboxy terminal group; is
present in about 30 wt. % to about 40 wt. % of the composition; and
has an average molecular weight of about 23,000 to about 45,000.
Alternatively, in another embodiment, the biodegradable
thermoplastic polyester is 75/25 poly (DL-lactide-co-glycolide)
without a carboxy terminal group; is present in about 40 wt. % to
about 50 wt. % of the composition; and has an average molecular
weight of about 15,000 to about 24,000. In further or alternative
embodiments, the terminal groups of the
poly(DL-lactide-co-glycolide) are either hydroxyl, carboxyl, or
ester depending upon the method of polymerization. Polycondensation
of lactic or glycolic acid provides a polymer with terminal
hydroxyl and carboxyl groups. Ring-opening polymerization of the
cyclic lactide or glycolide monomers with water, lactic acid, or
glycolic acid provides polymers with the same terminal groups.
However, ring-opening of the cyclic monomers with a monofunctional
alcohol such as methanol, ethanol, or 1-dodecanol provides a
polymer with one hydroxyl group and one ester terminal groups.
Ring-opening polymerization of the cyclic monomers with a diol such
as 1,6-hexanediol or polyethylene glycol provides a polymer with
only hydroxyl terminal groups.
[0439] Since the polymer systems of thermoreversible gels dissolve
more completely at reduced temperatures, methods of solubilization
include adding the required amount of polymer to the amount of
water to be used at reduced temperatures. Generally after wetting
the polymer by shaking, the mixture is capped and placed in a cold
chamber or in a thermostatic container at about 0-10.degree. C. in
order to dissolve the polymer. The mixture is stirred or shaken to
bring about a more rapid dissolution of the thermoreversible gel
polymer. The auris sensory cell modulating agent and various
additives such as buffers, salts, and preservatives are
subsequently added and dissolved. In some instances the auris
sensory cell modulating agent and/or other pharmaceutically active
agent is suspended if it is insoluble in water. The pH is modulated
by the addition of appropriate buffering agents. round window
membrane mucoadhesive characteristics are optionally imparted to a
thermoreversible gel by incorporation of round window membrane
mucoadhesive carbomers, such as Carbopol.RTM. 934P, to the
composition (Majithiya et al, AAPS PharmSciTech (2006), 7(3), p.
E1; EP0551626, both of which is incorporated herein by reference
for such disclosure).
[0440] In one embodiment are auris-acceptable pharmaceutical gel
formulations which do not require the use of an added viscosity
enhancing agent. Such gel formulations incorporate at least one
pharmaceutically acceptable buffer. In one aspect is a gel
formulation comprising an auris sensory cell modulating agent and a
pharmaceutically acceptable buffer. In another embodiment, the
pharmaceutically acceptable excipient or carrier is a gelling
agent.
[0441] In other embodiments, useful auris sensory cell modulating
agent auris-acceptable pharmaceutical formulations also include one
or more pH adjusting agents or buffering agents to provide an
endolymph or perilymph suitable pH. Suitable pH adjusting agents or
buffers include, but are not limited to acetate, bicarbonate,
ammonium chloride, citrate, phosphate, pharmaceutically acceptable
salts thereof and combinations or mixtures thereof. Such pH
adjusting agents and buffers are included in an amount required to
maintain pH of the composition between a pH of about 5 and about 9,
in one embodiment a pH between about 6.5 to about 7.5, and in yet
another embodiment at a pH of about 6.5, 6.6, 6.7, 6.8, 6.9, 7.0,
7.1, 7.2, 7.3, 7.4, 7.5. In one embodiment, when one or more
buffers are utilized in the formulations of the present disclosure,
they are combined, e.g., with a pharmaceutically acceptable vehicle
and are present in the final formulation, e.g., in an amount
ranging from about 0.1% to about 20%, from about 0.5% to about 10%.
In certain embodiments of the present disclosure, the amount of
buffer included in the gel formulations are an amount such that the
pH of the gel formulation does not interfere with the auris media
or auris interna's natural buffering system, or does not interfere
with the natural pH of the endolymph or perilymph: depending on
where in the cochlea the auris sensory cell modulating agent
formulation is targeted. In some embodiments, from about 10 .mu.M
to about 200 mM concentration of a buffer is present in the gel
formulation. In certain embodiments, from about a 5 mM to about a
200 mM concentration of a buffer is present. In certain
embodiments, from about a 20 mM to about a 100 mM concentration of
a buffer is present. In one embodiment is a buffer such as acetate
or citrate at slightly acidic pH. In one embodiment the buffer is a
sodium acetate buffer having a pH of about 4.5 to about 6.5. In one
embodiment the buffer is a sodium citrate buffer having a pH of
about 5.0 to about 8.0, or about 5.5 to about 7.0.
[0442] In an alternative embodiment, the buffer used is
tris(hydroxymethyl)aminomethane, bicarbonate, carbonate or
phosphate at slightly basic pH. In one embodiment, the buffer is a
sodium bicarbonate buffer having a pH of about 6.5 to about 8.5, or
about 7.0 to about 8.0. In another embodiment the buffer is a
sodium phosphate dibasic buffer having a pH of about 6.0 to about
9.0.
[0443] Also described herein are controlled release formulations or
devices comprising an auris sensory cell modulating agent and a
viscosity enhancing agent. Suitable viscosity-enhancing agents
include by way of example only, gelling agents and suspending
agents. In one embodiment, the enhanced viscosity formulation does
not include a buffer. In other embodiments, the enhanced viscosity
formulation includes a pharmaceutically acceptable buffer. Sodium
chloride or other tonicity agents are optionally used to adjust
tonicity, if necessary.
[0444] By way of example only, the auris-acceptable viscosity agent
include hydroxypropyl methylcellulose, hydroxyethyl cellulose,
polyvinylpyrrolidone, carboxymethyl cellulose, polyvinyl alcohol,
sodium chondroitin sulfate, sodium hyaluronate. Other viscosity
enhancing agents compatible with the targeted auris structure
include, but are not limited to, acacia (gum arabic), agar,
aluminum magnesium silicate, sodium alginate, sodium stearate,
bladderwrack, bentonite, carbomer, carrageenan, Carbopol, xanthan,
cellulose, microcrystalline cellulose (MCC), ceratonia, chitin,
carboxymethylated chitosan, chondrus, dextrose, furcellaran,
gelatin, Ghatti gum, guar gum, hectorite, lactose, sucrose,
maltodextrin, mannitol, sorbitol, honey, maize starch, wheat
starch, rice starch, potato starch, gelatin, sterculia gum, xanthum
gum, gum tragacanth, ethyl cellulose, ethylhydroxyethyl cellulose,
ethylmethyl cellulose, methyl cellulose, hydroxyethyl cellulose,
hydroxyethylmethyl cellulose, hydroxypropyl cellulose,
poly(hydroxyethyl methacrylate), oxypolygelatin, pectin,
polygeline, povidone, propylene carbonate, methyl vinyl
ether/maleic anhydride copolymer (PVM/MA), poly(methoxyethyl
methacrylate), poly(methoxyethoxyethyl methacrylate), hydroxypropyl
cellulose, hydroxypropylmethyl-cellulose (HPMC), sodium
carboxymethyl-cellulose (CMC), silicon dioxide,
polyvinylpyrrolidone (PVP: povidone), Splenda.RTM. (dextrose,
maltodextrin and sucralose) or combinations thereof. In specific
embodiments, the viscosity-enhancing excipient is a combination of
MCC and CMC. In another embodiment, the viscosity-enhancing agent
is a combination of carboxymethylated chitosan, or chitin, and
alginate. The combination of chitin and alginate with the auris
sensory cell modulating agents disclosed herein acts as a
controlled release formulation, restricting the diffusion of the
auris sensory cell modulating agents from the formulation.
Moreover, the combination of carboxymethylated chitosan and
alginate is optionally used to assist in increasing the
permeability of the auris sensory cell modulating agents through
the round window membrane.
[0445] In some embodiments is an enhanced viscosity formulation,
comprising from about 0.1 mM and about 100 mM of an auris sensory
cell modulating agent, a pharmaceutically acceptable viscosity
agent, and water for injection, the concentration of the viscosity
agent in the water being sufficient to provide a enhanced viscosity
formulation with a final viscosity from about 100 to about 100,000
cP. In certain embodiments, the viscosity of the gel is in the
range from about 100 to about 50,000 cP, about 100 cP to about
1,000 cP, about 500 cP to about 1500 cP, about 1000 cP to about
3000 cP, about 2000 cP to about 8,000 cP, about 4,000 cP to about
50,000 cP, about 10,000 cP to about 500,000 cP, about 15,000 cP to
about 1,000,000 cP. In other embodiments, when an even more viscous
medium is desired, the biocompatible gel comprises at least about
35%, at least about 45%, at least about 55%, at least about 65%, at
least about 70%, at least about 75%, or even at least about 80% or
so by weight of the auris sensory cell modulating agent. In highly
concentrated samples, the biocompatible enhanced viscosity
formulation comprises at least about 25%, at least about 35%, at
least about 45%, at least about 55%, at least about 65%, at least
about 75%, at least about 85%, at least about 90% or at least about
95% or more by weight of the auris sensory cell modulating
agent.
[0446] In some embodiments, the viscosity of the gel formulations
presented herein are measured by any means described. For example,
in some embodiments, an LVDV-II+CP Cone Plate Viscometer and a Cone
Spindle CPE-40 is used to calculate the viscosity of the gel
formulation described herein. In other embodiments, a Brookfield
(spindle and cup) viscometer is used to calculate the viscosity of
the gel formulation described herein. In some embodiments, the
viscosity ranges referred to herein are measured at room
temperature. In other embodiments, the viscosity ranges referred to
herein are measured at body temperature (e.g., at the average body
temperature of a healthy human).
[0447] In one embodiment, the pharmaceutically acceptable enhanced
viscosity auris-acceptable formulation comprises at least one auris
sensory cell modulating agent and at least one gelling agent.
Suitable gelling agents for use in preparation of the gel
formulation include, but are not limited to, celluloses, cellulose
derivatives, cellulose ethers (e.g., carboxymethylcellulose,
ethylcellulose, hydroxyethylcellulose, hydroxymethylcellulose,
hydroxypropylmethylcellulose, hydroxypropylcellulose,
methylcellulose), guar gum, xanthan gum, locust bean gum, alginates
(e.g., alginic acid), silicates, starch, tragacanth, carboxyvinyl
polymers, carrageenan, paraffin, petrolatum and any combinations or
mixtures thereof. In some other embodiments,
hydroxypropylmethylcellulose (Methocel.RTM.) is utilized as the
gelling agent. In certain embodiments, the viscosity enhancing
agents described herein are also utilized as the gelling agent for
the gel formulations presented herein.
[0448] In some embodiments, the otic therapeutic agents disclosed
herein are dispensed as an auris-acceptable paint. As used herein,
paints (also known as film formers) are solutions comprised of a
solvent, a monomer or polymer, an active agent, and optionally one
or more pharmaceutically-acceptable excipients. After application
to a tissue, the solvent evaporates leaving behind a thin coating
comprised of the monomers or polymers, and the active agent. The
coating protects active agents and maintains them in an immobilized
state at the site of application. This decreases the amount of
active agent which may be lost and correspondingly increases the
amount delivered to the subject. By way of non-limiting example,
paints include collodions (e.g. Flexible Collodion, USP), and
solutions comprising saccharide siloxane copolymers and a
cross-linking agent. Collodions are ethyl ether/ethanol solutions
containing pyroxylin (a nitrocellulose). After application, the
ethyl ether/ethanol solution evaporates leaving behind a thin film
of pyroxylin. In solutions comprising saccharide siloxane
copolymers, the saccharide siloxane copolymers form the coating
after evaporation of the solvent initiates the cross-linking of the
saccharide siloxane copolymers. For additional disclosures
regarding paints, see Remington: The Science and Practice of
Pharmacy which is hereby incorporated with respect to this subject
matter. The paints contemplated for use herein, are flexible such
that they do not interfere with the propagation of pressure waves
through the ear. Further, the paints may be applied as a liquid
(i.e. solution, suspension, or emulsion), a semisolid (i.e. a gel,
foam, paste, or jelly) or an aerosol.
[0449] In some embodiments, the otic therapeutic agents disclosed
herein are dispensed as a controlled-release foam. Examples of
suitable foamable carriers for use in the compositions disclosed
herein include, but are not limited to, alginate and derivatives
thereof, carboxymethylcellulose and derivatives thereof, collagen,
polysaccharides, including, for example, dextran, dextran
derivatives, pectin, starch, modified starches such as starches
having additional carboxyl and/or carboxamide groups and/or having
hydrophilic side-chains, cellulose and derivatives thereof, agar
and derivatives thereof, such as agar stabilised with
polyacrylamide, polyethylene oxides, glycol methacrylates, gelatin,
gums such as xanthum, guar, karaya, gellan, arabic, tragacanth and
locust bean gum, or combinations thereof. Also suitable are the
salts of the aforementioned carriers, for example, sodium alginate.
The formulation optionally further comprises a foaming agent, which
promotes the formation of the foam, including a surfactant or
external propellant. Examples of suitable foaming agents include
cetrimide, lecithin, soaps, silicones and the like. Commercially
available surfactants such as Tween.RTM. are also suitable.
[0450] In some embodiments, other gel formulations are useful
depending upon the particular auris sensory cell modulating agent,
other pharmaceutical agent or excipients/additives used, and as
such are considered to fall within the scope of the present
disclosure. For example, other commercially-available
glycerin-based gels, glycerin-derived compounds, conjugated, or
crosslinked gels, matrices, hydrogels, and polymers, as well as
gelatins and their derivatives, alginates, and alginate-based gels,
and even various native and synthetic hydrogel and hydrogel-derived
compounds are all expected to be useful in the auris sensory cell
modulating agent formulations described herein. In some
embodiments, auris-acceptable gels include, but are not limited to,
alginate hydrogels SAF.RTM.-Gel (ConvaTec, Princeton, N.J.),
Duoderm.RTM. Hydroactive Gel (ConvaTec), Nu-gel.RTM.(Johnson &
Johnson Medical, Arlington, Tex.); Carrasyn.RTM.(V) Acemannan
Hydrogel (Carrington Laboratories, Inc., Irving, Tex.); glycerin
gels Elta.RTM. Hydrogel (Swiss-American Products, Inc., Dallas,
Tex.) and K-Y.RTM. Sterile (Johnson & Johnson). In further
embodiments, biodegradable biocompatible gels also represent
compounds present in auris-acceptable formulations disclosed and
described herein.
[0451] In some formulations developed for administration to a
mammal, and for compositions formulated for human administration,
the auris-acceptable gel comprises substantially all of the weight
of the composition. In other embodiments, the auris-acceptable gel
comprises as much as about 98% or about 99% of the composition by
weight. This is desirous when a substantially non-fluid, or
substantially viscous formulation is needed. In a further
embodiment, when slightly less viscous, or slightly more fluid
auris-acceptable pharmaceutical gel formulations are desired, the
biocompatible gel portion of the formulation comprises at least
about 50% by weight, at least about 60% by weight, at least about
70% by weight, or even at least about 80% or 90% by weight of the
compound. All intermediate integers within these ranges are
contemplated to fall within the scope of this disclosure, and in
some alternative embodiments, even more fluid (and consequently
less viscous) auris-acceptable gel compositions are formulated,
such as for example, those in which the gel or matrix component of
the mixture comprises not more than about 50% by weight, not more
than about 40% by weight, not more than about 30% by weight, or
even those than comprise not more than about 15% or about 20% by
weight of the composition.
[0452] Auris-Acceptable Suspending Agents
[0453] In one embodiment, at least one auris sensory cell
modulating agent is included in a pharmaceutically acceptable
enhanced viscosity formulation wherein the formulation further
comprises at least one suspending agent, wherein the suspending
agent assists in imparting controlled release characteristics to
the formulation. In some embodiments, suspending agents also serve
to increase the viscosity of the auris-acceptable auris sensory
cell modulating agent formulations and compositions.
[0454] Suspending agents include, by way of example only, compounds
such as polyvinylpyrrolidone, e.g., polyvinylpyrrolidone K12,
polyvinylpyrrolidone K17, polyvinylpyrrolidone K25, or
polyvinylpyrrolidone K30, vinyl pyrrolidone/vinyl acetate copolymer
(S630), sodium carboxymethylcellulose, methylcellulose,
hydroxypropylmethylcellulose (hypromellose), hydroxymethylcellulose
acetate stearate, polysorbate-80, hydroxyethylcellulose, sodium
alginate, gums, such as, e.g., gum tragacanth and gum acacia, guar
gum, xanthans, including xanthan gum, sugars, cellulosics, such as,
e.g., sodium carboxymethylcellulose, methylcellulose, sodium
carboxymethylcellulose, hydroxypropylmethylcellulose,
hydroxyethylcellulose, polysorbate-80, sodium alginate,
polyethoxylated sorbitan monolaurate, polyethoxylated sorbitan
monolaurate, povidone and the like. In some embodiments, useful
aqueous suspensions also contain one or more polymers as suspending
agents. Useful polymers include water-soluble polymers such as
cellulosic polymers, e.g., hydroxypropyl methylcellulose, and
water-insoluble polymers such as cross-linked carboxyl-containing
polymers.
[0455] In one embodiment, the present disclosure provides
auris-acceptable gel compositions comprising a therapeutically
effective amount of an auris sensory cell modulating agent in a
hydroxyethyl cellulose gel. Hydroxyethyl cellulose (HEC) is
obtained as a dry powder which is reconstituted in water or an
aqueous buffer solution to give the desired viscosity (generally
about 200 cps to about 30,000 cps, corresponding to about 0.2 to
about 10% HEC). In one embodiment the concentration of HEC is
between about 1% and about 15%, about 1% and about 2%, or about
1.5% to about 2%.
[0456] In other embodiments, the auris-acceptable formulations,
including gel formulations and viscosity-enhanced formulations,
further include excipients, other medicinal or pharmaceutical
agents, carriers, adjuvants, such as preserving, stabilizing,
wetting or emulsifying agents, solution promoters, salts,
solubilizers, an antifoaming agent, an antioxidant, a dispersing
agent, a wetting agent, a surfactant, and combinations thereof.
[0457] Auris-Acceptable Actinic Radiation Curable Gel
[0458] In other embodiments, the gel is an actinic radiation
curable gel, such that following administration to or near the
targeted auris structure, use of actinic radiation (or light,
including UV light, visible light, or infrared light) the desired
gel properties are formed. By way of example only, fiber optics are
used to provide the actinic radiation so as to form the desired gel
properties. In some embodiments, the fiber optics and the gel
administration device form a single unit. In other embodiments, the
fiber optics and the gel administration device are provided
separately.
[0459] Auris-Acceptable Solvent Release Gel
[0460] In some embodiments, the gel is a solvent release gel such
that the desired gel properties are formed after administration to
or near the targeted auris structure, that is, as the solvent in
the injected gel formulation diffuses out the gel, a gel having the
desired gel properties is formed. For example, a formulation that
comprises sucrose acetate isobutyrate, a pharmaceutically
acceptable solvent, one or more additives, and the auris sensory
cell modulating agent is administered at or near the round window
membrane: diffusion of the solvent out of the injected formulation
provides a depot having the desired gel properties. For example,
use of a water soluble solvent provides a high viscosity depot when
the solvent diffuses rapidly out of the injected formulation. On
the other hand, use of a hydrophobic solvent (e.g., benzyl
benzoate) provides a less viscous depot. One example of an
auris-acceptable solvent release gel formulation is the SABER.TM.
Delivery System marketed by DURECT Corporation.
[0461] Auris-Acceptable In Situ Forming Spongy Material
[0462] Also contemplated within the scope of the embodiments is the
use of a spongy material, formed in situ in the auris interna or
auris media. In some embodiments, the spongy material is formed
from hyaluronic acid or its derivatives. The spongy material is
impregnated with a desired auris sensory cell modulating agent and
placed within the auris media so as to provide controlled release
of the auris sensory cell modulating agent within the auris media,
or in contact with the round window membrane so as to provide
controlled release of the auris sensory cell modulating agent into
the auris interna. In some embodiments, the spongy material is
biodegradable.
[0463] Round Window Membrane Mucoadhesives
[0464] Also contemplated within the scope of the embodiments is the
addition of a round window membrane mucoadhesive with the auris
sensory cell modulating agent formulations and compositions and
devices disclosed herein. The term `mucoadhesion` is used for
materials that bind to the mucin layer of a biological membrane,
such as the external membrane of the 3-layered round window
membrane. To serve as round window membrane mucoadhesive polymers,
the polymers possess some general physiochemical features such as
predominantly anionic hydrophilicity with numerous hydrogen bond
forming groups, suitable surface property for wetting mucus/mucosal
tissue surfaces or sufficient flexibility to penetrate the mucus
network.
[0465] Round window membrane mucoadhesive agents that are used with
the auris-acceptable formulations include, but are not limited to,
at least one soluble polyvinylpyrrolidone polymer (PVP); a
water-swellable, but water-insoluble, fibrous, cross-linked
carboxy-functional polymer; a crosslinked poly(acrylic acid) (e.g.
Carbopol.RTM. 947P); a carbomer homopolymer; a carbomer copolymer;
a hydrophilic polysaccharide gum, maltodextrin, a cross-linked
alignate gum gel, a water-dispersible polycarboxylated vinyl
polymer, at least two particulate components selected from the
group consisting of titanium dioxide, silicon dioxide, and clay, or
a mixture thereof. The round window membrane mucoadhesive agent is
optionally used in combination with an auris-acceptable viscosity
increasing excipient, or used alone to increase the interaction of
the composition with the mucosal layer target otic component. In
one non-limiting example, the mucoadhesive agent is maltodextrin.
In some embodiments, the mucoadhesive agent is an alginate gum.
When used, the round window membrane mucoadhesive character
imparted to the composition is at a level that is sufficient to
deliver an effective amount of the auris sensory cell modulating
agent composition to, for example, the mucosal layer of round
window membrane or the crista fenestrae cochleae in an amount that
coats the mucosal membrane, and thereafter deliver the composition
to the affected areas, including by way of example only, the
vestibular and/or cochlear structures of the auris interna. When
used, the mucoadhesive characteristics of the compositions provided
herein are determined, and using this information (along with the
other teachings provided herein), the appropriate amounts are
determined. One method for determining sufficient mucoadhesiveness
includes monitoring changes in the interaction of the composition
with a mucosal layer, including but not limited to measuring
changes in residence or retention time of the composition in the
absence and presence of the mucoadhesive excipient.
[0466] Mucoadhesive agents have been described, for example, in
U.S. Pat. Nos. 6,638,521, 6,562,363, 6,509,028, 6,348,502,
6,319,513, 6,306,789, 5,814,330, and 4,900,552, each of which is
hereby incorporated by reference for such disclosure.
[0467] In another non-limiting example, a mucoadhesive agent is,
for example, at least two particulate components selected from
titanium dioxide, silicon dioxide, and clay, wherein the
composition is not further diluted with any liquid prior to
administration and the level of silicon dioxide, if present, is
from about 3% to about 15%, by weight of the composition. Silicon
dioxide, if present, includes fumed silicon dioxide, precipitated
silicon dioxide, coacervated silicon dioxide, gel silicon dioxide,
and mixtures thereof. Clay, if present, includes kaolin minerals,
serpentine minerals, smectites, illite or a mixture thereof. For
example, clay includes laponite, bentonite, hectorite, saponite,
montmorillonites or a mixture thereof.
[0468] In one non-limiting example, the round window membrane
mucoadhesive agent is maltodextrin. Maltodextrin is a carbohydrate
produced by the hydrolysis of starch that is optionally derived
from corn, potato, wheat or other plant products. Maltodextrin is
optionally used either alone or in combination with other round
window membrane mucoadhesive agents to impart mucoadhesive
characteristics on the compositions disclosed herein. In one
embodiment, a combination of maltodextrin and a carbopol polymer
are used to increase the round window membrane mucoadhesive
characteristics of the compositions or devices disclosed
herein.
[0469] In another embodiment, the round window membrane
mucoadhesive agent is an alkyl-glycoside and/or a saccharide alkyl
ester. As used herein, an "alkyl-glycoside" means a compound
comprising any hydrophilic saccharide (e.g. sucrose, maltose, or
glucose) linked to a hydrophobic alkyl. In some embodiments, the
round window membrane mucoadhesive agent is an alkyl-glycoside
wherein the alkyl-glycoside comprises a sugar linked to a
hydrophobic alkyl (e.g., an alkyl comprising about 6 to about 25
carbon atoms) by an amide linkage, an amine linkage, a carbamate
linkage, an ether linkage, a thioether linkage, an ester linkage, a
thioester linkage, a glycosidic linkage, a thioglycosidic linkage,
and/or a ureide linkage. In some embodiments, the round window
membrane mucoadhesive agent is a hexyl-, heptyl-, octyl-, nonyl-,
decyl-, undecyl-, dodecyl-, tridecyl-, tetradecyl, pentadecyl-,
hexadecyl-, heptadecyl-, and octadecyl .alpha.- or
.beta.-D-maltoside; hexyl-, heptyl-, octyl-, nonyl-, decyl-,
undecyl-, dodecyl-, tridecyl-, tetradecyl, pentadecyl-, hexadecyl-,
heptadecyl-, and octadecyl .alpha.- or .beta.-D-glucoside; hexyl-,
heptyl-, octyl-, nonyl-, decyl-, undecyl-, dodecyl-, tridecyl-,
tetradecyl, pentadecyl-, hexadecyl-, heptadecyl-, and octadecyl
.alpha.- or .beta.-D-sucroside; hexyl-, heptyl-, octyl-, dodecyl-,
tridecyl-, and tetradecyl-.beta.-D-thiomaltoside; dodecyl
maltoside; heptyl- or octyl-1-thio-.alpha.- or
.beta.-D-glucopyranoside; alkyl thiosucroses; alkyl maltotriosides;
long chain aliphatic carbonic acid amides of sucrose
.beta.-amino-alkyl ethers; derivatives of palatinose or
isomaltamine linked by an amide linkage to an alkyl chain and
derivatives of isomaltamine linked by urea to an alkyl chain; long
chain aliphatic carbonic acid ureides of sucrose .beta.-amino-alkyl
ethers and long chain aliphatic carbonic acid amides of sucrose
.beta.-amino-alkyl ethers. In some embodiments, the round window
membrane mucoadhesive agent is an alkyl-glycoside wherein the alkyl
glycoside is maltose, sucrose, glucose, or a combination thereof
linked by a glycosidic linkage to an alkyl chain of 9-16 carbon
atoms (e.g., nonyl-, decyl-, dodecyl- and tetradecyl sucroside;
nonyl-, decyl-, dodecyl- and tetradecyl glucoside; and nonyl-,
decyl-, dodecyl- and tetradecyl maltoside). In some embodiments,
the round window membrane mucoadhesive agent is an alkyl-glycoside
wherein the alkyl glycoside is dodecylmaltoside, tridecylmaltoside,
and tetradecylmaltoside.
[0470] In some embodiments, the round window membrane mucoadhesive
agent is an alkyl-glycoside wherein the alkyl-glycoside is a
disaccharide with at least one glucose. In some embodiments, the
auris acceptable penetration enhancer is a surfactant comprising
.alpha.-D-glucopyranosyl-.beta.-glycopyranoside,
n-Dodecyl-4-O-.alpha.-D-glucopyranosyl-.beta.-glycopyranoside,
and/or
n-tetradecyl-4-O-.alpha.-D-glucopyranosyl-.beta.-glycopyranoside.
In some embodiments, the round window membrane mucoadhesive agent
is an alkyl-glycoside wherein the alkyl-glycoside has a critical
miscelle concentration (CMC) of less than about 1 mM in pure water
or in aqueous solutions. In some embodiments, the round window
membrane mucoadhesive agent is an alkyl-glycoside wherein an oxygen
atom within the alkyl-glycoside is substituted with a sulfur atom.
In some embodiments, the round window membrane mucoadhesive agent
is an alkyl-glycoside wherein the alkylglycoside is the 0 anomer.
In some embodiments, the round window membrane mucoadhesive agent
is an alkyl-glycoside wherein the alkylglycoside comprises 90%,
91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 99.1%, 99.5%, or 99.9%
of the 0 anomer.
[0471] Auris-Acceptable Controlled Release Particles
[0472] Auris sensory cell modulating agents and/or other
pharmaceutical agents disclosed herein are optionally incorporated
within controlled release particles, lipid complexes, liposomes,
nanoparticles, microparticles, microspheres, coacervates,
nanocapsules or other agents which enhance or facilitate the
localized delivery of the auris sensory cell modulating agent. In
some embodiments, a single enhanced viscosity formulation is used,
in which at least one auris sensory cell modulating agent is
present, while in other embodiments, a pharmaceutical formulation
that comprises a mixture of two or more distinct enhanced viscosity
formulations is used, in which at least one auris sensory cell
modulating agent is present. In some embodiments, combinations of
sols, gels and/or biocompatible matrices is also employed to
provide desirable characteristics of the controlled release auris
sensory cell modulating agent compositions or formulations. In
certain embodiments, the controlled release auris sensory cell
modulating agent formulations or compositions are cross-linked by
one or more agents to alter or improve the properties of the
composition.
[0473] Examples of microspheres relevant to the pharmaceutical
formulations disclosed herein include: Luzzi, L. A., J. Pharm. Psy.
59:1367 (1970); U.S. Pat. No. 4,530,840; Lewis, D. H., "Controlled
Release of Bioactive Agents from Lactides/Glycolide Polymers" in
Biodegradable Polymers as Drug Delivery Systems, Chasin, M. and
Langer, R., eds., Marcel Decker (1990); U.S. Pat. No. 4,675,189;
Beck et al., "Poly(lactic acid) and Poly(lactic acid-co-glycolic
acid) Contraceptive Delivery Systems," in Long Acting Steroid
Contraception, Mishell, D. R., ed., Raven Press (1983); U.S. Pat.
No. 4,758,435; U.S. Pat. No. 3,773,919; U.S. Pat. No. 4,474,572.
Examples of protein therapeutics formulated as microspheres
include: U.S. Pat. No. 6,458,387; U.S. Pat. No. 6,268,053; U.S.
Pat. No. 6,090,925; U.S. Pat. No. 5,981,719; and U.S. Pat. No.
5,578,709, and are herein incorporated by reference for such
disclosure.
[0474] Microspheres usually have a spherical shape, although
irregularly-shaped microparticles are possible. Microspheres may
vary in size, ranging from submicron to 1000 micron diameters.
Microspheres suitable for use with the auris-acceptable
formulations disclosed herein are submicron to 250 micron diameter
microspheres, allowing administration by injection with a standard
gauge needle. The auris-acceptable microspheres are prepared by any
method which produces microspheres in a size range acceptable for
use in an injectable composition. Injection is optionally
accomplished with standard gauge needles used for administering
liquid compositions.
[0475] Suitable examples of polymeric matrix materials for use in
the auris-acceptable controlled release particles herein include
poly(glycolic acid), poly-d,l-lactic acid, poly-1-lactic acid,
copolymers of the foregoing, poly(aliphatic carboxylic acids),
copolyoxalates, polycaprolactone, polydioxonene,
poly(orthocarbonates), poly(acetals), poly(lactic
acid-caprolactone), polyorthoesters, poly(glycolic
acid-caprolactone), polydioxonene, polyanhydrides,
polyphosphazines, and natural polymers including albumin, casein,
and some waxes, such as, glycerol mono- and distearate, and the
like. Various commercially available poly (lactide-co-glycolide)
materials (PLGA) are optionally used in the method disclosed
herein. For example, poly (d,l-lactic-co-glycolic acid) is
commercially available from Boehringer-Ingelheim as RESOMER RG 503
H. This product has a mole percent composition of 50% lactide and
50% glycolide. These copolymers are available in a wide range of
molecular weights and ratios of lactic acid to glycolic acid. One
embodiment includes the use of the polymer
poly(d,l-lactide-co-glycolide). The molar ratio of lactide to
glycolide in such a copolymer includes the range of from about 95:5
to about 50:50.
[0476] The molecular weight of the polymeric matrix material is of
some importance. The molecular weight should be high enough so that
it forms satisfactory polymer coatings, i.e., the polymer should be
a good film former. Usually, a satisfactory molecular weight is in
the range of 5,000 to 500,000 daltons. The molecular weight of a
polymer is also important from the point of view that molecular
weight influences the biodegradation rate of the polymer. For a
diffusional mechanism of drug release, the polymer should remain
intact until all of the drug is released from the microparticles
and then degrade. The drug is also released from the microparticles
as the polymeric excipient bioerodes. By an appropriate selection
of polymeric materials a microsphere formulation is made such that
the resulting microspheres exhibit both diffusional release and
biodegradation release properties. This is useful in affording
multiphasic release patterns.
[0477] A variety of methods are known by which compounds are
encapsulated in microspheres. In these methods, the auris sensory
cell modulating agent is generally dispersed or emulsified, using
stirrers, agitators, or other dynamic mixing techniques, in a
solvent containing a wall-forming material. Solvent is then removed
from the microspheres, and thereafter the microsphere product is
obtained.
[0478] In one embodiment, controlled release auris sensory cell
modulating agent formulations are made through the incorporation of
the auris sensory cell modulating agents and/or other
pharmaceutical agents into ethylene-vinyl acetate copolymer
matrices. (See U.S. Pat. No. 6,083,534, incorporated herein for
such disclosure). In another embodiment, auris sensory cell
modulating agents are incorporated into poly (lactic-glycolic acid)
or poly-L-lactic acid microspheres. Id. In yet another embodiment,
the auris sensory cell modulating agents are encapsulated into
alginate microspheres. (See U.S. Pat. No. 6,036,978, incorporated
herein for such disclosure). Biocompatible methacrylate-based
polymers to encapsulate the auris sensory cell modulating agent
compounds or compositions are optionally used in the formulations
and methods disclosed herein. A wide range of methacrylate-based
polymer systems are commercially available, such as the EUDRAGIT
polymers marketed by Evonik. One useful aspect of methacrylate
polymers is that the properties of the formulation are varied by
incorporating various co-polymers. For example, poly(acrylic
acid-co-methylmethacrylate) microparticles exhibit enhanced
mucoadhesion properties as the carboxylic acid groups in the
poly(acrylic acid) form hydrogen bonds with mucin (Park et al,
Pharm. Res. (1987) 4(6):457-464). Variation of the ratio between
acrylic acid and methylmethacrylate monomers serves to modulate the
properties of the co-polymer. Methacrylate-based microparticles
have also been used in protein therapeutic formulations (Naha et
al, Journal of Microencapsulation 4 Feb., 2008 (online
publication)). In one embodiment, the enhanced viscosity
auris-acceptable formulations described herein comprises auris
sensory cell modulating agent microspheres wherein the microspheres
are formed from a methacrylate polymer or copolymer. In an
additional embodiment, the enhanced viscosity formulation described
herein comprises auris sensory cell modulating agent microspheres
wherein the microspheres are mucoadhesive. Other controlled release
systems, including incorporation or deposit of polymeric materials
or matrices onto solid or hollow spheres containing auris sensory
cell modulating agents, are also explicitly contemplated within the
embodiments disclosed herein. The types of controlled release
systems available without significantly losing activity of the
auris sensory cell modulating agent are determined using the
teachings, examples, and principles disclosed herein
[0479] An example of a conventional microencapsulation process for
pharmaceutical preparations is shown in U.S. Pat. No. 3,737,337,
incorporated herein by reference for such disclosure. The auris
sensory cell modulating agent substances to be encapsulated or
embedded are dissolved or dispersed in the organic solution of the
polymer (phase A), using conventional mixers, including (in the
preparation of dispersion) vibrators and high-speed stirrers, etc.
The dispersion of phase (A), containing the core material in
solution or in suspension, is carried out in the aqueous phase (B),
again using conventional mixers, such as high-speed mixers,
vibration mixers, or even spray nozzles, in which case the particle
size of the microspheres will be determined not only by the
concentration of phase (A), but also by the emulsate or microsphere
size. With conventional techniques for the microencapsulation of
auris sensory cell modulating agents, the microspheres form when
the solvent containing an active agent and a polymer is emulsified
or dispersed in an immiscible solution by stirring, agitating,
vibrating, or some other dynamic mixing technique, often for a
relatively long period of time.
[0480] Methods for the construction of microspheres are also
described in U.S. Pat. No. 4,389,330, and U.S. Pat. No. 4,530,840,
incorporated herein by reference for such disclosure. The desired
auris sensory cell modulating agent is dissolved or dispersed in an
appropriate solvent. To the agent-containing medium is added the
polymeric matrix material in an amount relative to the active
ingredient which gives a product of the desired loading of active
agent. Optionally, all of the ingredients of the auris sensory cell
modulating agent microsphere product can be blended in the solvent
medium together. Suitable solvents for the agent and the polymeric
matrix material include organic solvents such as acetone,
halogenated hydrocarbons such as chloroform, methylene chloride and
the like, aromatic hydrocarbon compounds, halogenated aromatic
hydrocarbon compounds, cyclic ethers, alcohols, ethyl acetate and
the like.
[0481] The mixture of ingredients in the solvent is emulsified in a
continuous-phase processing medium; the continuous-phase medium
being such that a dispersion of microdroplets containing the
indicated ingredients is formed in the continuous-phase medium.
Naturally, the continuous-phase processing medium and the organic
solvent must be immiscible, and includes water although nonaqueous
media such as xylene and toluene and synthetic oils and natural
oils are optionally used. Optionally, a surfactant is added to the
continuous-phase processing medium to prevent the microparticles
from agglomerating and to control the size of the solvent
microdroplets in the emulsion. A preferred surfactant-dispersing
medium combination is a 1 to 10 wt. % poly (vinyl alcohol) in water
mixture. The dispersion is formed by mechanical agitation of the
mixed materials. An emulsion is optionally formed by adding small
drops of the active agent-wall forming material solution to the
continuous phase processing medium. The temperature during the
formation of the emulsion is not especially critical but influences
the size and quality of the microspheres and the solubility of the
drug in the continuous phase. It is desirable to have as little of
the agent in the continuous phase as possible. Moreover, depending
on the solvent and continuous-phase processing medium employed, the
temperature must not be too low or the solvent and processing
medium will solidify or the processing medium will become too
viscous for practical purposes, or too high that the processing
medium will evaporate, or that the liquid processing medium will
not be maintained. Moreover, the temperature of the medium cannot
be so high that the stability of the particular agent being
incorporated in the microspheres is adversely affected.
Accordingly, the dispersion process is conducted at any temperature
which maintains stable operating conditions, which preferred
temperature being about 15.degree. C. to 60.degree. C., depending
upon the drug and excipient selected.
[0482] The dispersion which is formed is a stable emulsion and from
this dispersion the organic solvent immiscible fluid is optionally
partially removed in the first step of the solvent removal process.
The solvent is removed by techniques such as heating, the
application of a reduced pressure or a combination of both. The
temperature employed to evaporate solvent from the microdroplets is
not critical, but should not be that high that it degrades the
auris sensory cell modulating agent employed in the preparation of
a given microparticle, nor should it be so high as to evaporate
solvent at such a rapid rate to cause defects in the wall forming
material. Generally, from 5 to 75%, of the solvent is removed in
the first solvent removal step.
[0483] After the first stage, the dispersed microparticles in the
solvent immiscible fluid medium are isolated from the fluid medium
by any convenient means of separation. Thus, for example, the fluid
is decanted from the microsphere or the microsphere suspension is
filtered. Still other, various combinations of separation
techniques are used if desired.
[0484] Following the isolation of the microspheres from the
continuous-phase processing medium, the remainder of the solvent in
the microspheres is removed by extraction. In this step, the
microspheres are suspended in the same continuous-phase processing
medium used in step one, with or without surfactant, or in another
liquid. The extraction medium removes the solvent from the
microspheres and yet does not dissolve the microspheres. During the
extraction, the extraction medium with dissolved solvent is
optionally removed and replaced with fresh extraction medium. This
is best done on a continual basis. The rate of extraction medium
replenishment of a given process is a variable which is determined
at the time the process is performed and, therefore, no precise
limits for the rate must be predetermined. After the majority of
the solvent has been removed from the microspheres, the
microspheres are dried by exposure to air or by other conventional
drying techniques such as vacuum drying, drying over a desiccant,
or the like. This process is very efficient in encapsulating the
auris sensory cell modulating agent since core loadings of up to 80
wt. %, preferably up to 60 wt. % are obtained.
[0485] Alternatively, controlled release microspheres containing an
auris sensory cell modulating agent is prepared through the use of
static mixers. Static or motionless mixers consist of a conduit or
tube in which is received a number of static mixing agents. Static
mixers provide homogeneous mixing in a relatively short length of
conduit, and in a relatively short period of time. With static
mixers, the fluid moves through the mixer, rather than some part of
the mixer, such as a blade, moving through the fluid.
[0486] A static mixer is optionally used to create an emulsion.
When using a static mixer to form an emulsion, several factors
determine emulsion particle size, including the density and
viscosity of the various solutions or phases to be mixed, volume
ratio of the phases, interfacial tension between the phases, static
mixer parameters (conduit diameter; length of mixing element;
number of mixing elements), and linear velocity through the static
mixer. Temperature is a variable because it affects density,
viscosity, and interfacial tension. The controlling variables are
linear velocity, sheer rate, and pressure drop per unit length of
static mixer.
[0487] In order to create microspheres containing an auris sensory
cell modulating agent using a static mixer process, an organic
phase and an aqueous phase are combined. The organic and aqueous
phases are largely or substantially immiscible, with the aqueous
phase constituting the continuous phase of the emulsion. The
organic phase includes an auris sensory cell modulating agent as
well as a wall-forming polymer or polymeric matrix material. The
organic phase is prepared by dissolving an auris sensory cell
modulating agent in an organic or other suitable solvent, or by
forming a dispersion or an emulsion containing the auris sensory
cell modulating agent. The organic phase and the aqueous phase are
pumped so that the two phases flow simultaneously through a static
mixer, thereby forming an emulsion which comprises microspheres
containing the auris sensory cell modulating agent encapsulated in
the polymeric matrix material. The organic and aqueous phases are
pumped through the static mixer into a large volume of quench
liquid to extract or remove the organic solvent. Organic solvent is
optionally removed from the microspheres while they are washing or
being stirred in the quench liquid. After the microspheres are
washed in a quench liquid, they are isolated, as through a sieve,
and dried.
[0488] In one embodiment, microspheres are prepared using a static
mixer. The process is not limited to the solvent extraction
technique discussed above, but is used with other encapsulation
techniques. For example, the process is optionally used with a
phase separation encapsulation technique. To do so, an organic
phase is prepared that comprises an auris sensory cell modulating
agent suspended or dispersed in a polymer solution. The non-solvent
second phase is free from solvents for the polymer and active
agent. A preferred non-solvent second phase is silicone oil. The
organic phase and the non-solvent phase are pumped through a static
mixer into a non-solvent quench liquid, such as heptane. The
semi-solid particles are quenched for complete hardening and
washing. The process of microencapsulation includes spray drying,
solvent evaporation, a combination of evaporation and extraction,
and melt extrusion.
[0489] In another embodiment, the microencapsulation process
involves the use of a static mixer with a single solvent. This
process is described in detail in U.S. application Ser. No.
08/338,805, herein incorporated by reference for such disclosure.
An alternative process involves the use of a static mixer with
co-solvents. In this process, biodegradable microspheres comprising
a biodegradable polymeric binder and an auris sensory cell
modulating agent are prepared, which comprises a blend of at least
two substantially non-toxic solvents, free of halogenated
hydrocarbons to dissolve both the agent and the polymer. The
solvent blend containing the dissolved agent and polymer is
dispersed in an aqueous solution to form droplets. The resulting
emulsion is then added to an aqueous extraction medium preferably
containing at least one of the solvents of the blend, whereby the
rate of extraction of each solvent is controlled, whereupon the
biodegradable microspheres containing the pharmaceutically active
agent are formed. This process has the advantage that less
extraction medium is required because the solubility of one solvent
in water is substantially independent of the other and solvent
selection is increased, especially with solvents that are
particularly difficult to extract.
[0490] Nanoparticles are also contemplated for use with the auris
sensory cell modulating agents disclosed herein. Nanoparticles are
material structures of about 100 nm or less in size. One use of
nanoparticles in pharmaceutical formulations is the formation of
suspensions as the interaction of the particle surface with solvent
is strong enough to overcome differences in density. Nanoparticle
suspensions are sterilized as the nanoparticles are small enough to
be subjected to sterilizing filtration (see, e.g., U.S. Pat. No.
6,139,870, herein incorporated by reference for such disclosure).
Nanoparticles comprise at least one hydrophobic, water-insoluble
and water-indispersible polymer or copolymer emulsified in a
solution or aqueous dispersion of surfactants, phospholipids or
fatty acids. The auris sensory cell modulating agent is optionally
introduced with the polymer or the copolymer into the
nanoparticles.
[0491] Lipid nanocapsules as controlled release structures, as well
for penetrating the round window membrane and reaching auris
interna and/or auris media targets, is also contemplated herein.
Lipid nanocapsules are optionally formed by emulsifying capric and
caprylic acid triglycerides (Labrafac WL 1349; avg. mw 512),
soybean lecithin (LIPOID.RTM. S75-3; 69% phosphatidylcholine and
other phospholipids), surfactant (for example, Solutol HS15), a
mixture of polyethylene glycol 660 hydroxystearate and free
polyethylene glycol 660; NaCl and water. The mixture is stirred at
room temperature to obtain an oil emulsion in water. After
progressive heating at a rate of 4.degree. C./min under magnetic
stirring, a short interval of transparency should occur close to
70.degree. C., and the inverted phase (water droplets in oil)
obtained at 85.degree. C. Three cycles of cooling and heating is
then applied between 85.degree. C. and 60.degree. C. at the rate of
4.degree. C./min, and a fast dilution in cold water at a
temperature close to 0.degree. C. to produce a suspension of
nanocapsules. To encapsulate the auris sensory cell modulating
agents, the agent is optionally added just prior to the dilution
with cold water.
[0492] Auris sensory cell modulating agents are also inserted into
the lipid nanocapsules by incubation for 90 minutes with an aqueous
micellar solution of the auris active agent. The suspension is then
vortexed every 15 minutes, and then quenched in an ice bath for 1
minute.
[0493] Suitable auris-acceptable surfactants are, by way of
example, cholic acid or taurocholic acid salts. Taurocholic acid,
the conjugate formed from cholic acid and taurine, is a fully
metabolizable sulfonic acid surfactant. An analog of taurocholic
acid, tauroursodeoxycholic acid (TUDCA), is a naturally occurring
bile acid and is a conjugate of taurine and ursodeoxycholic acid
(UDCA). Other naturally occurring anionic (e.g., galactocerebroside
sulfate), neutral (e.g., lactosylceramide) or zwitterionic
surfactants (e.g., sphingomyelin, phosphatidyl choline, palmitoyl
carnitine) are optionally used to prepare nanoparticles.
[0494] The auris-acceptable phospholipids are chosen, by way of
example, from natural, synthetic or semi-synthetic phospholipids;
lecithins (phosphatidylcholine) such as, for example, purified egg
or soya lecithins (lecithin E100, lecithin E80 and phospholipons,
for example phospholipon 90), phosphatidylethanolamine,
phosphatidylserine, phosphatidylinositol, phosphatidylglycerol,
dipalmitoylphosphatidylcholine,
dipalmitoylglycerophosphatidylcholine,
dimyristoylphosphatidylcholine, distearoylphosphatidylcholine and
phosphatidic acid or mixtures thereof are used more
particularly.
[0495] Fatty acids for use with the auris-acceptable formulations
are chosen from, by way of example, lauric acid, mysristic acid,
palmitic acid, stearic acid, isostearic acid, arachidic acid,
behenic acid, oleic acid, myristoleic acid, palmitoleic acid,
linoleic acid, alpha-linoleic acid, arachidonic acid,
eicosapentaenoic acid, erucic acid, docosahexaenoic acid, and the
like.
[0496] Suitable auris-acceptable surfactants are selected from
known organic and inorganic pharmaceutical excipients. Such
excipients include various polymers, low molecular weight
oligomers, natural products, and surfactants. Preferred surface
modifiers include nonionic and ionic surfactants. Two or more
surface modifiers are used in combination.
[0497] Representative examples of auris-acceptable surfactants
include cetyl pyridinium chloride, gelatin, casein, lecithin
(phosphatides), dextran, glycerol, gum acacia, cholesterol,
tragacanth, stearic acid, calcium stearate, glycerol monostearate,
cetostearyl alcohol, cetomacrogol emulsifying wax, sorbitan esters,
polyoxyethylene alkyl ethers, polyoxyethylene castor oil
derivatives, polyoxyethylene sorbitan fatty acid esters; dodecyl
trimethyl ammonium bromide, polyoxyethylenestearates, colloidal
silicon dioxide, phosphates, sodium dodecylsulfate,
carboxymethylcellulose calcium, hydroxypropyl cellulose (HPC,
HPC-SL, and HPC-L), hydroxypropyl methylcellulose (HPMC),
carboxymethylcellulose sodium, methylcellulose,
hydroxyethylcellulose, hydroxypropylcellulose,
hydroxypropylmethyl-cellulose phthalate, noncrystalline cellulose,
magnesium aluminum silicate, triethanolamine, polyvinyl alcohol
(PVA), polyvinylpyrrolidone (PVP),
4-(1,1,3,3-tetaamethylbutyl)-phenol polymer with ethylene oxide and
formaldehyde (also known as tyloxapol, superione, and triton),
poloxamers, poloxamnines, a charged phospholipid such as
dimyristoyl phophatidyl glycerol, dioctylsulfosuccinate (DOSS);
Tetronic.RTM. 1508, dialkylesters of sodium sulfosuccinic acid,
Duponol P, Tritons X-200, Crodestas F-110,
p-isononylphenoxypoly-(glycidol), Crodestas SL-40 (Croda, Inc.);
and SA9OHCO, which is C.sub.18 H.sub.37 CH.sub.2
(CON(CH.sub.3)--CH.sub.2 (CHOH).sub.4 (CH.sub.2 OH).sub.2 (Eastman
Kodak Co.); decanoyl-N-methylglucamide; n-decyl
.beta.-D-glucopyranoside; n-decyl .beta.-D-maltopyranoside;
n-dodecyl .beta.-D-glucopyranoside; n-dodecyl .beta.-D-maltoside;
heptanoyl-N-methylglucamide; n-heptyl-.beta.-D-glucopyranoside;
n-heptyl .beta.-D-thioglucoside; n-hexyl .beta.-D-glucopyranoside;
nonanoyl-N-methylglucamide; n-noyl .beta.-D-glucopyranoside;
octanoyl-N-methylglucarmide; n-octyl-.beta.-D-glucopyranoside;
octyl .beta.-D-thioglucopyranoside; and the like. Most of these
surfactants are known pharmaceutical excipients and are described
in detail in the Handbook of Pharmaceutical Excipients, published
jointly by the American Pharmaceutical Association and The
Pharmaceutical Society of Great Britain (The Pharmaceutical Press,
1986), specifically incorporated by reference for such
disclosure.
[0498] The hydrophobic, water-insoluble and water-indispersible
polymer or copolymer may be chosen from biocompatible and
biodegradable polymers, for example lactic or glycolic acid
polymers and copolymers thereof, or polylactic/polyethylene (or
polypropylene) oxide copolymers, preferably with molecular weights
of between 1000 and 200,000, polyhydroxybutyric acid polymers,
polylactones of fatty acids containing at least 12 carbon atoms, or
polyanhydrides.
[0499] The nanoparticles may be obtained by coacervation, or by the
technique of evaporation of solvent, from an aqueous dispersion or
solution of phospholipids and of an oleic acid salt into which is
added an immiscible organic phase comprising the active principle
and the hydrophobic, water-insoluble and water-indispersible
polymer or copolymer. The mixture is pre-emulsified and then
subjected to homogenization and evaporation of the organic solvent
to obtain an aqueous suspension of very small-sized
nanoparticles.
[0500] A variety of methods are optionally employed to fabricate
the auris sensory cell modulating agent nanoparticles that are
within the scope of the embodiments. These methods include
vaporization methods, such as free jet expansion, laser
vaporization, spark erosion, electro explosion and chemical vapor
deposition; physical methods involving mechanical attrition (e.g.,
"pearlmilling" technology, Elan Nanosystems), super critical CO2
and interfacial deposition following solvent displacement. In one
embodiment, the solvent displacement method is used. The size of
nanoparticles produced by this method is sensitive to the
concentration of polymer in the organic solvent; the rate of
mixing; and to the surfactant employed in the process. Continuous
flow mixers provide the necessary turbulence to ensure small
particle size. One type of continuous flow mixing device that is
optionally used to prepare nanoparticles has been described (Hansen
et al J Phys Chem 92, 2189-96, 1988). In other embodiments,
ultrasonic devices, flow through homogenizers or supercritical CO2
devices may be used to prepare nanoparticles.
[0501] If suitable nanoparticle homogeneity is not obtained on
direct synthesis, then size-exclusion chromatography is used to
produce highly uniform drug-containing particles that are freed of
other components involved in their fabrication. Size-exclusion
chromatography (SEC) techniques, such as gel-filtration
chromatography, is used to separate particle-bound auris sensory
cell modulating agent or other pharmaceutical compound from free
auris sensory cell modulating agent or other pharmaceutical
compound, or to select a suitable size range of auris sensory cell
modulating agent-containing nanoparticles. Various SEC media, such
as Superdex 200, Superose 6, Sephacryl 1000 are commercially
available and are employed for the size-based fractionation of such
mixtures. Additionally, nanoparticles are optionally purified by
centrifugation, membrane filtration and by use of other molecular
sieving devices, crosslinked gels/materials and membranes.
[0502] Auris-Acceptable Cyclodextrin and Other Stabilizing
Formulations
[0503] In a specific embodiment, the auris-acceptable formulations
alternatively comprises a cyclodextrin. Cyclodextrins are cyclic
oligosaccharides containing 6, 7, or 8 glucopyranose units,
referred to as .alpha.-cyclodextrin, .beta.-cyclodextrin, or
.gamma.-cyclodextrin respectively. Cyclodextrins have a hydrophilic
exterior, which enhances water-soluble, and a hydrophobic interior
which forms a cavity. In an aqueous environment, hydrophobic
portions of other molecules often enter the hydrophobic cavity of
cyclodextrin to form inclusion compounds. Additionally,
cyclodextrins are also capable of other types of nonbonding
interactions with molecules that are not inside the hydrophobic
cavity. Cyclodextrins have three free hydroxyl groups for each
glucopyranose unit, or 18 hydroxyl groups on .alpha.-cyclodextrin,
21 hydroxyl groups on .beta.-cyclodextrin, and 24 hydroxyl groups
on .gamma.-cyclodextrin. One or more of these hydroxyl groups can
be reacted with any of a number of reagents to form a large variety
of cyclodextrin derivatives, including hydroxypropyl ethers,
sulfonates, and sulfoalkylethers. Shown below is the structure of
.beta.-cyclodextrin and the hydroxypropyl-.beta.-cyclodextrin
(HP.beta.CD).
##STR00002##
[0504] In some embodiments, the use of cyclodextrins in the
pharmaceutical compositions described herein improves the
solubility of the drug. Inclusion compounds are involved in many
cases of enhanced solubility; however other interactions between
cyclodextrins and insoluble compounds also improves solubility.
Hydroxypropyl-.beta.-cyclodextrin (HP.beta.CD) is commercially
available as a pyrogen free product. It is a nonhygroscopic white
powder that readily dissolves in water. HP.beta.CD is thermally
stable and does not degrade at neutral pH. Thus, cyclodextrins
improve the solubility of a therapeutic agent in a composition or
formulation. Accordingly, in some embodiments, cyclodextrins are
included to increase the solubility of the auris-acceptable auris
sensory cell modulating agents within the formulations described
herein. In other embodiments, cyclodextrins in addition serve as
controlled release excipents within the formulations described
herein.
[0505] By way of example only, cyclodextrin derivatives for use
include .alpha.-cyclodextrin, .beta.-cyclodextrin,
.gamma.-cyclodextrin, hydroxyethyl .beta.-cyclodextrin,
hydroxypropyl .gamma.-cyclodextrin, sulfated .beta.-cyclodextrin,
sulfated .alpha.-cyclodextrin, sulfobutyl ether
.beta.-cyclodextrin.
[0506] The concentration of the cyclodextrin used in the
compositions and methods disclosed herein varies according to the
physiochemical properties, pharmacokinetic properties, side effect
or adverse events, formulation considerations, or other factors
associated with the therapeutically active agent, or a salt or
prodrug thereof, or with the properties of other excipients in the
composition. Thus, in certain circumstances, the concentration or
amount of cyclodextrin used in accordance with the compositions and
methods disclosed herein will vary, depending on the need. When
used, the amount of cyclodextrins needed to increase solubility of
the auris sensory cell modulating agent and/or function as a
controlled release excipient in any of the formulations described
herein is selected using the principles, examples, and teachings
described herein.
[0507] Other stabilizers that are useful in the auris-acceptable
formulations disclosed herein include, for example, fatty acids,
fatty alcohols, alcohols, long chain fatty acid esters, long chain
ethers, hydrophilic derivatives of fatty acids, polyvinyl
pyrrolidones, polyvinyl ethers, polyvinyl alcohols, hydrocarbons,
hydrophobic polymers, moisture-absorbing polymers, and combinations
thereof. In some embodiments, amide analogues of stabilizers are
also used. In further embodiments, the chosen stabilizer changes
the hydrophobicity of the formulation (e.g., oleic acid, waxes), or
improves the mixing of various components in the formulation (e.g.,
ethanol), controls the moisture level in the formula (e.g., PVP or
polyvinyl pyrrolidone), controls the mobility of the phase
(substances with melting points higher than room temperature such
as long chain fatty acids, alcohols, esters, ethers, amides etc. or
mixtures thereof; waxes), and/or improves the compatibility of the
formula with encapsulating materials (e.g., oleic acid or wax). In
another embodiment some of these stabilizers are used as
solvents/co-solvents (e.g., ethanol). In other embodiments,
stabilizers are present in sufficient amounts to inhibit the
degradation of the auris sensory cell modulating agent. Examples of
such stabilizing agents, include, but are not limited to: (a) about
0.5% to about 2% w/v glycerol, (b) about 0.1% to about 1% w/v
methionine, (c) about 0.1% to about 2% w/v monothioglycerol, (d)
about 1 mM to about 10 mM EDTA, (e) about 0.01% to about 2% w/v
ascorbic acid, (f) 0.003% to about 0.02% w/v polysorbate 80, (g)
0.001% to about 0.05% w/v. polysorbate 20, (h) arginine, (i)
heparin, (j) dextran sulfate, (k) cyclodextrins, (1) pentosan
polysulfate and other heparinoids, (m) divalent cations such as
magnesium and zinc; or (n) combinations thereof
[0508] Additional useful auris sensory cell modulating agent
auris-acceptable formulations include one or more anti-aggregation
additives to enhance stability of auris sensory cell modulating
agent formulations by reducing the rate of protein aggregation. The
anti-aggregation additive selected depends upon the nature of the
conditions to which the auris sensory cell modulating agents, for
example auris sensory cell modulating agent antibodies are exposed.
For example, certain formulations undergoing agitation and thermal
stress require a different anti-aggregation additive than a
formulation undergoing lyophilization and reconstitution. Useful
anti-aggregation additives include, by way of example only, urea,
guanidinium chloride, simple amino acids such as glycine or
arginine, sugars, polyalcohols, polysorbates, polymers such as
polyethylene glycol and dextrans, alkyl saccharides, such as alkyl
glycoside, and surfactants.
[0509] Other useful formulations optionally include one or more
auris-acceptable antioxidants to enhance chemical stability where
required. Suitable antioxidants include, by way of example only,
ascorbic acid, methionine, sodium thiosulfate and sodium
metabisulfite. In one embodiment, antioxidants are selected from
metal chelating agents, thiol containing compounds and other
general stabilizing agents.
[0510] Still other useful compositions include one or more
auris-acceptable surfactants to enhance physical stability or for
other purposes. Suitable nonionic surfactants include, but are not
limited to, polyoxyethylene fatty acid glycerides and vegetable
oils, e.g., polyoxyethylene (60) hydrogenated castor oil; and
polyoxyethylene alkylethers and alkylphenyl ethers, e.g., octoxynol
10, octoxynol 40.
[0511] In some embodiments, the auris-acceptable pharmaceutical
formulations described herein are stable with respect to compound
degradation over a period of any of at least about 1 day, at least
about 2 days, at least about 3 days, at least about 4 days, at
least about 5 days, at least about 6 days, at least about 1 week,
at least about 2 weeks, at least about 3 weeks, at least about 4
weeks, at least about 5 weeks, at least about 6 weeks, at least
about 7 weeks, at least about 8 weeks, at least about 3 months, at
least about 4 months, at least about 5 months, or at least about 6
months. In other embodiments, the formulations described herein are
stable with respect to compound degradation over a period of at
least about 1 week. Also described herein are formulations that are
stable with respect to compound degradation over a period of at
least about 1 month.
[0512] In other embodiments, an additional surfactant
(co-surfactant) and/or buffering agent is combined with one or more
of the pharmaceutically acceptable vehicles previously described
herein so that the surfactant and/or buffering agent maintains the
product at an optimal pH for stability. Suitable co-surfactants
include, but are not limited to: a) natural and synthetic
lipophilic agents, e.g., phospholipids, cholesterol, and
cholesterol fatty acid esters and derivatives thereof; b) nonionic
surfactants, which include for example, polyoxyethylene fatty
alcohol esters, sorbitan fatty acid esters (Spans), polyoxyethylene
sorbitan fatty acid esters (e.g., polyoxyethylene (20) sorbitan
monooleate (Tween 80), polyoxyethylene (20) sorbitan monostearate
(Tween 60), polyoxyethylene (20) sorbitan monolaurate (Tween 20)
and other Tweens, sorbitan esters, glycerol esters, e.g., Myrj and
glycerol triacetate (triacetin), polyethylene glycols, cetyl
alcohol, cetostearyl alcohol, stearyl alcohol, polysorbate 80,
poloxamers, poloxamines, polyoxyethylene castor oil derivatives
(e.g., Cremophor.RTM. RH40, Cremphor A25, Cremphor A20,
Cremophor.RTM. EL) and other Cremophors, sulfosuccinates, alkyl
sulphates (SLS); PEG glyceryl fatty acid esters such as PEG-8
glyceryl caprylate/caprate (Labrasol), PEG-4 glyceryl
caprylate/caprate (Labrafac Hydro WL 1219), PEG-32 glyceryl laurate
(Gelucire 444/14), PEG-6 glyceryl mono oleate (Labrafil M 1944 CS),
PEG-6 glyceryl linoleate (Labrafil M 2125 CS); propylene glycol
mono- and di-fatty acid esters, such as propylene glycol laurate,
propylene glycol caprylate/caprate; Brij.RTM. 700,
ascorbyl-6-palmitate, stearylamine, sodium lauryl sulfate,
polyoxethyleneglycerol triiricinoleate, and any combinations or
mixtures thereof; c) anionic surfactants include, but are not
limited to, calcium carboxymethylcellulose, sodium
carboxymethylcellulose, sodium sulfosuccinate, dioctyl, sodium
alginate, alkyl polyoxyethylene sulfates, sodium lauryl sulfate,
triethanolamine stearate, potassium laurate, bile salts, and any
combinations or mixtures thereof; and d) cationic surfactants such
as cetyltrimethylammonium bromide, and
lauryldimethylbenzyl-ammonium chloride.
[0513] In a further embodiment, when one or more co-surfactants are
utilized in the auris-acceptable formulations of the present
disclosure, they are combined, e.g., with a pharmaceutically
acceptable vehicle and is present in the final formulation, e.g.,
in an amount ranging from about 0.1% to about 20%, from about 0.5%
to about 10%.
[0514] In one embodiment, the surfactant has an HLB value of 0 to
20. In additional embodiments, the surfactant has an HLB value of 0
to 3, of 4 to 6, of 7 to 9, of 8 to 18, of 13 to 15, of 10 to
18.
[0515] In one embodiment, diluents are also used to stabilize the
auris sensory cell modulating agent or other pharmaceutical
compounds because they provide a more stable environment. Salts
dissolved in buffered solutions (which also can provide pH control
or maintenance) are utilized as diluents, including, but not
limited to a phosphate buffered saline solution. In other
embodiments, the gel formulation is isotonic with the endolymph or
the perilymph: depending on the portion of the cochlea that the
auris sensory cell modulating agent formulation is targeted.
Isotonic formulations are provided by the addition of a tonicity
agent. Suitable tonicity agents include, but are not limited to any
pharmaceutically acceptable sugar, salt or any combinations or
mixtures thereof, such as, but not limited to dextrose and sodium
chloride. In further embodiments, the tonicity agents are present
in an amount from about 100 mOsm/kg to about 500 mOsm/kg. In some
embodiments, the tonicity agent is present in an amount from about
200 mOsm/kg to about 400 mOsm/kg, from about 280 mOsm/kg to about
320 mOsm/kg. The amount of tonicity agents will depend on the
target structure of the pharmaceutical formulation, as described
herein.
[0516] Useful tonicity compositions also include one or more salts
in an amount required to bring osmolality of the composition into
an acceptable range for the perilymph or the endolymph. Such salts
include those having sodium, potassium or ammonium cations and
chloride, citrate, ascorbate, borate, phosphate, bicarbonate,
sulfate, thiosulfate or bisulfite anions; suitable salts include
sodium chloride, potassium chloride, sodium thiosulfate, sodium
bisulfite and ammonium sulfate.
[0517] In some embodiments, the auris-acceptable gel formulations
disclosed herein alternatively or additionally contains
preservatives to prevent microbial growth. Suitable
auris-acceptable preservatives for use in the enhanced viscosity
formulations described herein include, but are not limited to
benzoic acid, boric acid, p-hydroxybenzoates, alcohols, quarternary
compounds, stabilized chlorine dioxide, mercurials, such as merfen
and thiomersal, mixtures of the foregoing and the like.
[0518] In a further embodiment, the preservative is, by way of
example only, an antimicrobial agent, within the auris-acceptable
formulations presented herein. In one embodiment, the formulation
includes a preservative such as by way of example only, methyl
paraben, sodium bisulfite, sodium thiosulfate, ascorbate,
chorobutanol, thimerosal, parabens, benzyl alcohol, phenylethanol
and others. In another embodiment, the methyl paraben is at a
concentration of about 0.05% to about 1.0%, about 0.1% to about
0.2%. In a further embodiment, the gel is prepared by mixing water,
methylparaben, hydroxyethylcellulose and sodium citrate. In a
further embodiment, the gel is prepared by mixing water,
methylparaben, hydroxyethylcellulose and sodium acetate. In a
further embodiment, the mixture is sterilized by autoclaving at
120.degree. C. for about 20 minutes, and tested for pH,
methylparaben concentration and viscosity before mixing with the
appropriate amount of the auris sensory cell modulating agent
disclosed herein.
[0519] Suitable auris-acceptable water soluble preservatives which
are employed in the drug delivery vehicle include sodium bisulfite,
sodium thiosulfate, ascorbate, chorobutanol, thimerosal, parabens,
benzyl alcohol, Butylated hydroxytoluene (BHT), phenylethanol and
others. These agents are present, generally, in amounts of about
0.001% to about 5% by weight and, preferably, in the amount of
about 0.01 to about 2% by weight. In some embodiments,
auris-compatible formulations described herein are free of
preservatives.
[0520] Round Window Membrane Penetration Enhancers
[0521] In another embodiment, the formulation further comprises one
or more round window membrane penetration enhancers. Penetration
across the round window membrane is enhanced by the presence of
round window membrane penetration enhancers. Round window membrane
penetration enhancers are chemical entities that facilitate
transport of coadministered substances across the round window
membrane. Round window membrane penetration enhancers are grouped
according to chemical structure. Surfactants, both ionic and
non-ionic, such as sodium lauryl sulfate, sodium laurate,
polyoxyethylene-20-cetyl ether, laureth-9, sodium dodecylsulfate,
dioctyl sodium sulfosuccinate, polyoxyethylene-9-lauryl ether
(PLE), Tween.RTM. 80, nonylphenoxypolyethylene (NP-POE),
polysorbates and the like, function as round window membrane
penetration enhancers. Bile salts (such as sodium glycocholate,
sodium deoxycholate, sodium taurocholate, sodium
taurodihydrofusidate, sodium glycodihydrofusidate and the like),
fatty acids and derivatives (such as oleic acid, caprylic acid,
mono- and di-glycerides, lauric acids, acylcholines, caprylic
acids, acylcarnitines, sodium caprates and the like), chelating
agents (such as EDTA, citric acid, salicylates and the like),
sulfoxides (such as dimethyl sulfoxide (DMSO), decylmethyl
sulfoxide and the like), and alcohols (such as ethanol,
isopropanol, glycerol, propanediol and the like) also function as
round window membrane penetration enhancers.
[0522] In some embodiments, the auris acceptable penetration
enhancer is a surfactant comprising an alkyl-glycoside wherein the
alkyl glycoside is tetradecyl-.beta.-D-maltoside. In some
embodiments, the auris acceptable penetration enhancer is a
surfactant comprising an alkyl-glycoside wherein the alkyl
glycoside is dodecyl-maltoside. In certain instances, the
penetration enhancing agent is a hyaluronidase. In certain
instances, a hyaluronidase is a human or bovine hyaluronidase. In
some instances, a hyaluronidase is a human hyaluronidase (e.g.,
hyaluronidase found in human sperm, PH20 (Halozyme), Hyelenex.RTM.
(Baxter International, Inc.)). In some instances, a hyaluronidase
is a bovine hyaluronidase (e.g., bovine testicular hyaluronidase,
Amphadase.RTM. (Amphastar Pharmaceuticals), Hydase.RTM.
(PrimaPharm, Inc). In some instances, a hyluronidase is an ovine
hyaluronidase, Vitrase.RTM. (ISTA Pharmaceuticals). In certain
instances, a hyaluronidase described herein is a recombinant
hyaluronidase. In some instances, a hyaluronidase described herein
is a humanized recombinant hyaluronidase. In some instances, a
hyaluronidase described herein is a pegylated hyaluronidase (e.g.,
PEGPH20 (Halozyme)). In addition, the peptide-like penetration
enhancers described in U.S. Pat. Nos. 7,151,191, 6,221,367 and
5,714,167, herein incorporated by references for such disclosure,
are contemplated as an additional embodiment. These penetration
enhancers are amino-acid and peptide derviatives and enable drug
absorption by passive transcellular diffusion without affecting the
integrity of membranes or intercellular tight junctions.
[0523] Round Window Membrane Permeable Liposomes
[0524] Liposomes or lipid particles may also be employed to
encapsulate the auris sensory cell modulating agent formulations or
compositions. Phospholipids that are gently dispersed in an aqueous
medium form multilayer vesicles with areas of entrapped aqueous
media separating the lipid layers. Sonication, or turbulent
agitation, of these multilayer vesicles results in the formation of
single layer vesicles, commonly referred to as liposomes, with
sizes of about 10-1000 nm. These liposomes have many advantages as
auris sensory cell modulating agents or other pharmaceutical agent
carriers. They are biologically inert, biodegradable, non-toxic and
non-antigenic. Liposomes are formed in various sizes and with
varying compositions and surface properties. Additionally, they are
able to entrap a wide variety of agents and release the agent at
the site of liposome collapse.
[0525] Suitable phospholipids for use in auris-acceptable liposomes
here are, for example, phosphatidyl cholines, ethanolamines and
serines, sphingomyelins, cardiolipins, plasmalogens, phosphatidic
acids and cerebrosides, in particular those which are soluble
together with the auris sensory cell modulating agents herein in
non-toxic, pharmaceutically acceptable organic solvents. Preferred
phospholipids are, for example, phosphatidyl choline, phosphatidyl
ethanolmine, phosphatidyl serine, phosphatidyl inositol,
lysophosphatidyl choline, phosphatidyl glycerol and the like, and
mixtures thereof especially lecithin, e.g. soya lecithin. The
amount of phospholipid used in the present formulation range from
about 10 to about 30%, preferably from about 15 to about 25% and in
particular is about 20%.
[0526] Lipophilic additives may be employed advantageously to
modify selectively the characteristics of the liposomes. Examples
of such additives include by way of example only, stearylamine,
phosphatidic acid, tocopherol, cholesterol, cholesterol
hemisuccinate and lanolin extracts. The amount of lipophilic
additive used range from 0.5 to 8%, preferably from 1.5 to 4% and
in particular is about 2%. Generally, the ratio of the amount of
lipophilic additive to the amount of phospholipid ranges from about
1:8 to about 1:12 and in particular is about 1:10. Said
phospholipid, lipophilic additive and the auris sensory cell
modulating agent and other pharmaceutical compounds are employed in
conjunction with a non-toxic, pharmaceutically acceptable organic
solvent system which dissolve said ingredients. Said solvent system
not only must dissolve the auris sensory cell modulating agent
completely, but it also has to allow the formulation of stable
single bilayered liposomes. The solvent system comprises
dimethylisosorbide and tetraglycol (glycofurol, tetrahydrofurfuryl
alcohol polyethylene glycol ether) in an amount of about 8 to about
30%. In said solvent system, the ratio of the amount of
dimethylisosorbide to the amount of tetraglycol range from about
2:1 to about 1:3, in particular from about 1:1 to about 1:2.5 and
preferably is about 1:2. The amount of tetraglycol in the final
composition thus vary from 5 to 20%, in particular from 5 to 15%
and preferably is approximately 10%. The amount of
dimethylisosorbide in the final composition thus range from 3 to
10%, in particular from 3 to 7% and preferably is approximately
5%.
[0527] The term "organic component" as used hereinafter refers to
mixtures comprising said phospholipid, lipophilic additives and
organic solvents. The auris sensory cell modulating agent may be
dissolved in the organic component, or other means to maintain full
activity of the agent. The amount of auris sensory cell modulating
agent in the final formulation may range from 0.1 to 5.0%. In
addition, other ingredients such as anti-oxidants may be added to
the organic component. Examples include tocopherol, butylated
hydroxyanisole, butylated hydroxytoluene, ascorbyl palmitate,
ascorbyl oleate and the like.
[0528] Liposomal formulations are alternatively prepared, for auris
sensory cell modulating agents or other pharmaceutical agents that
are moderately heat-resistant, by (a) heating the phospholipid and
the organic solvent system to about 60-80.degree. C. in a vessel,
dissolving the active ingredient, then adding any additional
formulating agents, and stirring the mixture until complete
dissolution is obtained; (b) heating the aqueous solution to
90-95.degree. C. in a second vessel and dissolving the
preservatives therein, allowing the mixture to cool and then adding
the remainder of the auxiliary formulating agents and the remainder
of the water, and stirring the mixture until complete dissolution
is obtained; thus preparing the aqueous component; (c) transferring
the organic phase directly into the aqueous component, while
homogenizing the combination with a high performance mixing
apparatus, for example, a high-shear mixer; and (d) adding a
viscosity enhancing agent to the resulting mixture while further
homogenizing. The aqueous component is optionally placed in a
suitable vessel which is equipped with a homogenizer and
homogenization is effected by creating turbulence during the
injection of the organic component. Any mixing means or homogenizer
which exerts high shear forces on the mixture may be employed.
Generally, a mixer capable of speeds from about 1,500 to 20,000
rpm, in particular from about 3,000 to about 6,000 rpm may be
employed. Suitable viscosity enhancing agents for use in process
step (d) are for example, xanthan gum, hydroxypropyl cellulose,
hydroxypropyl methylcellulose or mixtures thereof. The amount of
viscosity enhancing agent depends on the nature and the
concentration of the other ingredients and in general ranges from
about 0.5 to 2.0%, or approximately 1.5%. In order to prevent
degradation of the materials used during the preparation of the
liposomal formulation, it is advantageous to purge all solutions
with an inert gas such as nitrogen or argon, and to conduct all
steps under an inert atmosphere. Liposomes prepared by the above
described method usually contain most of the active ingredient
bound in the lipid bilayer and separation of the liposomes from
unencapsulated material is not required.
[0529] In other embodiments, the auris-acceptable formulations,
including gel formulations and viscosity-enhanced formulations,
further include excipients, other medicinal or pharmaceutical
agents, carriers, adjuvants, such as preserving, stabilizing,
wetting or emulsifying agents, solution promoters, salts,
solubilizers, an antifoaming agent, an antioxidant, a dispersing
agent, a wetting agent, a surfactant, and combinations thereof.
[0530] Suitable carriers for use in an auris-acceptable formulation
described herein include, but are not limited to, any
pharmaceutically acceptable solvent compatible with the targeted
auris structure's physiological environment. In other embodiments,
the base is a combination of a pharmaceutically acceptable
surfactant and solvent.
[0531] In some embodiments, other excipients include, sodium
stearyl fumarate, diethanolamine cetyl sulfate, isostearate,
polyethoxylated castor oil, nonoxyl 10, octoxynol 9, sodium lauryl
sulfate, sorbitan esters (sorbitan monolaurate, sorbitan
monooleate, sorbitan monopalmitate, sorbitan monostearate, sorbitan
sesquioleate, sorbitan trioleate, sorbitan tristearate, sorbitan
laurate, sorbitan oleate, sorbitan palmitate, sorbitan stearate,
sorbitan dioleate, sorbitan sesqui-isostearate, sorbitan
sesquistearate, sorbitan tri-isostearate), lecithin pharmaceutical
acceptable salts thereof and combinations or mixtures thereof
[0532] In other embodiments, the carrier is a polysorbate.
Polysorbates are nonionic surfactants of sorbitan esters.
Polysorbates useful in the present disclosure include, but are not
limited to polysorbate 20, polysorbate 40, polysorbate 60,
polysorbate 80 (Tween 80) and any combinations or mixtures thereof.
In further embodiments, polysorbate 80 is utilized as the
pharmaceutically acceptable carrier.
[0533] In one embodiment, water-soluble glycerin-based
auris-acceptable enhanced viscosity formulations utilized in the
preparation of pharmaceutical delivery vehicles comprise at least
one auris sensory cell modulating agent containing at least about
0.1% of the water-soluble glycerin compound or more. In some
embodiments, the percentage of auris sensory cell modulating agent
is varied between about 1% and about 95%, between about 5% and
about 80%, between about 10% and about 60% or more of the weight or
volume of the total pharmaceutical formulation. In some
embodiments, the amount of the compound(s) in each therapeutically
useful auris sensory cell modulating agent formulation is prepared
in such a way that a suitable dosage will be obtained in any given
unit dose of the compound. Factors such as solubility,
bioavailability, biological half-life, route of administration,
product shelf life, as well as other pharmacological considerations
are contemplated herein.
[0534] If desired, the auris-acceptable pharmaceutical gels also
contain co-solvents, preservatives, cosolvents, ionic strength and
osmolality adjustors and other excipeints in addition to buffering
agents. Suitable auris-acceptable water soluble buffering agents
are alkali or alkaline earth metal carbonates, phosphates,
bicarbonates, citrates, borates, acetates, succinates and the like,
such as sodium phosphate, citrate, borate, acetate, bicarbonate,
carbonate and tromethamine (TRIS). These agents are present in
amounts sufficient to maintain the pH of the system at 7.4.+-.0.2
and preferably, 7.4. As such, the buffering agent is as much as 5%
on a weight basis of the total composition.
[0535] Cosolvents are used to enhance auris sensory cell modulating
agent solubility, however, some auris sensory cell modulating
agents or other pharmaceutical compounds are insoluble. These are
often suspended in the polymer vehicle with the aid of suitable
suspending or viscosity enhancing agents.
[0536] Moreover, some pharmaceutical excipients, diluents or
carriers are potentially ototoxic. For example, benzalkonium
chloride, a common preservative, is ototoxic and therefore
potentially harmful if introduced into the vestibular or cochlear
structures. In formulating a controlled release auris sensory cell
modulating agent formulation, it is advised to avoid or combine the
appropriate excipients, diluents or carriers to lessen or eliminate
potential ototoxic components from the formulation, or to decrease
the amount of such excipients, diluents or carriers. Optionally, a
controlled release auris sensory cell modulating agent formulation
includes otoprotective agents, such as antioxidants, alpha lipoic
acid, calicum, fosfomycin or iron chelators, to counteract
potential ototoxic effects that may arise from the use of specific
therapeutic agents or excipients, diluents or carriers.
[0537] Thof therapeutically acceptable otic formulations:
TABLE-US-00002 Example Formulation Example Characteristics Chitosan
tunable degradation of matrix in vitro glycerophosphate (CGP)
tunable TACE inhibitor release in vitro: e.g., ~50% of drug
released after 24 hrs biodegradable compatible with drug delivery
to the inner ear suitable for macromolecules and hydrophobic drugs
PEG-PLGA-PEG triblock tunable high stability: e.g., maintains
mechanical integrity polymers >1 month in vitro tunable fast
release of hydrophilic drugs: e.g., ~50% of drug released after 24
hrs, and remainder released over ~5 days tunable slow release of
hydrophobic drugs: e.g., ~80% released after 8 weeks biodegradable
subcutaneous injection of solution: e.g., gel forms within seconds
and is intact after 1 month PEO-PPO-PEO triblock Tunable sol-gel
transition temperature: e.g., decreases copolymers (e.g., with
increasing F127 concentration Pluronic or Poloxameres) (e.g., F127)
Chitosan CGP formulation tolerates liposomes: e.g., up to 15 uM/ml
glycerophosphate with liposomes. drug-loaded liposomes liposomes
tunably reduce drug release time (e.g., up to 2 weeks in vitro).
increase in liposome diameter optionally reduces drug release
kinetics (e.g., liposome size between 100 and 300 nm) release
parameters are controlled by changing composition of liposomes
[0538] The formulations disclosed herein alternatively encompass an
otoprotectant agent in addition to the at least one active agent
and/or excipients, including but not limited to such agents as
antioxidants, alpha lipoic acid, calcium, fosfomycin or iron
chelators, to counteract potential ototoxic effects that may arise
from the use of specific therapeutic agents or excipients, diluents
or carriers.
Modes of Treatment
[0539] Dosing Methods and Schedules
[0540] Drugs delivered to the inner ear have been administered
systemically via oral, intravenous or intramuscular routes.
However, systemic administration for pathologies local to the inner
ear increases the likelihood of systemic toxicities and adverse
side effects and creates a non-productive distribution of drug in
which high levels of drug are found in the serum and
correspondingly lower levels are found at the inner ear.
[0541] Intratympanic injection of therapeutic agents is the
technique of injecting a therapeutic agent behind the tympanic
membrane into the middle and/or inner ear. In one embodiment, the
formulations described herein are administered directly onto the
round window membrane via transtympanic injection. In another
embodiment, the auris sensory cell modulating agent
auris-acceptable formulations described herein are administered
onto the round window membrane via a non-transtympanic approach to
the inner ear. In additional embodiments, the formulation described
herein is administered onto the round window membrane via a
surgical approach to the round window membrane comprising
modification of the crista fenestrae cochleae.
[0542] In one embodiment the delivery system is a syringe and
needle apparatus that is capable of piercing the tympanic membrane
and directly accessing the round window membrane or crista
fenestrae cochleae of the auris interna. In some embodiments, the
needle on the syringe is wider than a 18 gauge needle. In another
embodiment, the needle gauge is from 18 gauge to 31 gauge. In a
further embodiment, the needle gauge is from 25 gauge to 30 gauge.
Depending upon the thickness or viscosity of the auris sensory cell
modulating agent compositions or formulations, the gauge level of
the syringe or hypodermic needle may be varied accordingly. In
another embodiment, the internal diameter of the needle can be
increased by reducing the wall thickness of the needle (commonly
referred as thin wall or extra thin wall needles) to reduce the
possibility of needle clogging while maintaining an adequate needle
gauge.
[0543] In another embodiment, the needle is a hypodermic needle
used for instant delivery of the gel formulation. The hypodermic
needle may be a single use needle or a disposable needle. In some
embodiments, a syringe may be used for delivery of the
pharmaceutically acceptable gel-based auris sensory cell modulating
agent-containing compositions as disclosed herein wherein the
syringe has a press-fit (Luer) or twist-on (Luer-lock) fitting. In
one embodiment, the syringe is a hypodermic syringe. In another
embodiment, the syringe is made of plastic or glass. In yet another
embodiment, the hypodermic syringe is a single use syringe. In a
further embodiment, the glass syringe is capable of being
sterilized. In yet a further embodiment, the sterilization occurs
through an autoclave. In another embodiment, the syringe comprises
a cylindrical syringe body wherein the gel formulation is stored
before use. In other embodiments, the syringe comprises a
cylindrical syringe body wherein the auris sensory cell modulating
agent pharmaceutically acceptable gel-based compositions as
disclosed herein is stored before use which conveniently allows for
mixing with a suitable pharmaceutically acceptable buffer. In other
embodiments, the syringe may contain other excipients, stabilizers,
suspending agents, diluents or a combination thereof to stabilize
or otherwise stably store the auris sensory cell modulating agent
or other pharmaceutical compounds contained therein.
[0544] In some embodiments, the syringe comprises a cylindrical
syringe body wherein the body is compartmentalized in that each
compartment is able to store at least one component of the
auris-acceptable auris sensory cell modulating agent gel
formulation. In a further embodiment, the syringe having a
compartmentalized body allows for mixing of the components prior to
injection into the auris media or auris interna. In other
embodiments, the delivery system comprises multiple syringes, each
syringe of the multiple syringes contains at least one component of
the gel formulation such that each component is pre-mixed prior to
injection or is mixed subsequent to injection. In a further
embodiment, the syringes disclosed herein comprise at least one
reservoir wherein the at least one reservoir comprises an auris
sensory cell modulating agent, or a pharmaceutically acceptable
buffer, or a viscosity enhancing agent, such as a gelling agent or
a combination thereof. Commercially available injection devices are
optionally employed in their simplest form as ready-to-use plastic
syringes with a syringe barrel, needle assembly with a needle,
plunger with a plunger rod, and holding flange, to perform an
intratympanic injection.
[0545] In some embodiments, the delivery device is an apparatus
designed for administration of therapeutic agents to the middle
and/or inner ear. By way of example only: GYRUS Medical Gmbh offers
micro-otoscopes for visualization of and drug delivery to the round
window niche; Arenberg has described a medical treatment device to
deliver fluids to inner ear structures in U.S. Pat. Nos. 5,421,818;
5,474,529; and 5,476,446, each of which is incorporated by
reference herein for such disclosure. U.S. patent application Ser.
No. 08/874,208, which is incorporated herein by reference for such
disclosure, describes a surgical method for implanting a fluid
transfer conduit to deliver therapeutic agents to the inner ear.
U.S. Patent Application Publication 2007/0167918, which is
incorporated herein by reference for such disclosure, further
describes a combined otic aspirator and medication dispenser for
intratympanic fluid sampling and medicament application.
[0546] The auris-acceptable compositions or formulations containing
the auris sensory cell modulating agent compound(s) described
herein are administered for prophylactic and/or therapeutic
treatments. In therapeutic applications, the auris sensory cell
modulating agent compositions are administered to a patient already
suffering from an autoimmune disease, condition or disorder, in an
amount sufficient to cure or at least partially arrest the symptoms
of the disease, disorder or condition. Amounts effective for this
use will depend on the severity and course of the disease, disorder
or condition, previous therapy, the patient's health status and
response to the drugs, and the judgment of the treating
physician.
Frequency of Administration
[0547] In some embodiments, a composition disclosed herein is
administered to an individual in need thereof once. In some
embodiments, a composition disclosed herein is administered to an
individual in need thereof more than once. In some embodiments, a
first administration of a composition disclosed herein is followed
by a second administration of a composition disclosed herein. In
some embodiments, a first administration of a composition disclosed
herein is followed by a second and third administration of a
composition disclosed herein. In some embodiments, a first
administration of a composition disclosed herein is followed by a
second, third, and fourth administration of a composition disclosed
herein. In some embodiments, a first administration of a
composition disclosed herein is followed by a second, third,
fourth, and fifth administration of a composition disclosed herein.
In some embodiments, a first administration of a composition
disclosed herein is followed by a drug holiday.
[0548] The number of times a composition is administered to an
individual in need thereof depends on the discretion of a medical
professional, the disorder, the severity of the disorder, and the
individuals's response to the formulation. In some embodiments, a
composition disclosed herein is administered once to an individual
in need thereof with a mild acute condition. In some embodiments, a
composition disclosed herein is administered more than once to an
individual in need thereof with a moderate or severe acute
condition. In the case wherein the patient's condition does not
improve, upon the doctor's discretion the administration of an
auris sensory cell modulator may be administered chronically, that
is, for an extended period of time, including throughout the
duration of the patient's life in order to ameliorate or otherwise
control or limit the symptoms of the patient's disease or
condition.
[0549] In the case wherein the patient's condition does not
improve, upon the doctor's discretion the administration of the
auris sensory cell modulating agent compounds may be administered
chronically, that is, for an extended period of time, including
throughout the duration of the patient's life in order to
ameliorate or otherwise control or limit the symptoms of the
patient's disease or condition.
[0550] In the case wherein the patient's status does improve, upon
the doctor's discretion the administration of the auris sensory
cell modulating agent compounds may be given continuously;
alternatively, the dose of drug being administered may be
temporarily reduced or temporarily suspended for a certain length
of time (i.e., a "drug holiday"). The length of the drug holiday
varies between 2 days and 1 year, including by way of example only,
2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 10 days, 12 days,
15 days, 20 days, 28 days, 35 days, 50 days, 70 days, 100 days, 120
days, 150 days, 180 days, 200 days, 250 days, 280 days, 300 days,
320 days, 350 days, and 365 days. The dose reduction during a drug
holiday may be from 10%-100%, including by way of example only 10%,
15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%,
80%, 85%, 90%, 95%, and 100%.
[0551] Once improvement of the patient's otic conditions has
occurred, a maintenance auris sensory cell modulating agent dose is
administered if necessary. Subsequently, the dosage or the
frequency of administration, or both, is optionally reduced, as a
function of the symptoms, to a level at which the improved disease,
disorder or condition is retained. In certain embodiments, patients
require intermittent treatment on a long-term basis upon any
recurrence of symptoms.
[0552] The amount of auris sensory cell modulating agent that will
correspond to such an amount will vary depending upon factors such
as the particular compound, disease condition and its severity,
according to the particular circumstances surrounding the case,
including, e.g., the specific auris sensory cell modulating agent
being administered, the route of administration, the autoimmune
condition being treated, the target area being treated, and the
subject or host being treated. In general, however, doses employed
for adult human treatment will typically be in the range of 0.02-50
mg per administration, preferably 1-15 mg per administration. The
desired dose is presented in a single dose or as divided doses
administered simultaneously (or over a short period of time) or at
appropriate intervals.
[0553] In some embodiments, the initial administration is a
particular auris sensory cell modulating agent and the subsequent
administration a different formulation or auris sensory cell
modulating agent.
Pharmacokinetics of Controlled Release Formulations
[0554] In one embodiment, the formulations disclosed herein
additionally provides an immediate release of an auris sensory cell
modulating agent from the composition, or within 1 minute, or
within 5 minutes, or within 10 minutes, or within 15 minutes, or
within 30 minutes, or within 60 minutes or within 90 minutes. In
other embodiments, a therapeutically effective amount of at least
one auris sensory cell modulating agent is released from the
composition immediately, or within 1 minute, or within 5 minutes,
or within 10 minutes, or within 15 minutes, or within 30 minutes,
or within 60 minutes or within 90 minutes. In certain embodiments
the composition comprises an auris-pharmaceutically acceptable gel
formulation providing immediate release of at least one auris
sensory cell modulating agent. Additional embodiments of the
formulation may also include an agent that enhances the viscosity
of the formulations included herein.
[0555] In other or further embodiments, the formulation provides an
extended release formulation of at least one auris sensory cell
modulating agent. In certain embodiments, diffusion of at least one
auris sensory cell modulating agent from the formulation occurs for
a time period exceeding 5 minutes, or 15 minutes, or 30 minutes, or
1 hour, or 4 hours, or 6 hours, or 12 hours, or 18 hours, or 1 day,
or 2 days, or 3 days, or 4 days, or 5 days, or 6 days, or 7 days,
or 10 days, or 12 days, or 14 days, or 18 days, or 21 days, or 25
days, or 30 days, or 45 days, or 2 months or 3 months or 4 months
or 5 months or 6 months or 9 months or 1 year. In other
embodiments, a therapeutically effective amount of at least one
auris sensory cell modulating agent is released from the
formulation for a time period exceeding 5 minutes, or 15 minutes,
or 30 minutes, or 1 hour, or 4 hours, or 6 hours, or 12 hours, or
18 hours, or 1 day, or 2 days, or 3 days, or 4 days, or 5 days, or
6 days, or 7 days, or 10 days, or 12 days, or 14 days, or 18 days,
or 21 days, or 25 days, or 30 days, or 45 days, or 2 months or 3
months or 4 months or 5 months or 6 months or 9 months or 1
year.
[0556] In other embodiments, the formulation provides both an
immediate release and an extended release formulation of an auris
sensory cell modulating agent. In yet other embodiments, the
formulation contains a 0.25:1 ratio, or a 0.5:1 ratio, or a 1:1
ratio, or a 1:2 ratio, or a 1:3, or a 1:4 ratio, or a 1:5 ratio, or
a 1:7 ratio, or a 1:10 ratio, or a 1:15 ratio, or a 1:20 ratio of
immediate release and extended release formulations. In a further
embodiment the formulation provides an immediate release of a first
auris sensory cell modulating agent and an extended release of a
second auris sensory cell modulating agent or other therapeutic
agent. In yet other embodiments, the formulation provides an
immediate release and extended release formulation of at least one
auris sensory cell modulating agent, and at least one therapeutic
agent. In some embodiments, the formulation provides a 0.25:1
ratio, or a 0.5:1 ratio, or a 1:1 ratio, or a 1:2 ratio, or a 1:3,
or a 1:4 ratio, or a 1:5 ratio, or a 1:7 ratio, or a 1:10 ratio, or
a 1:15 ratio, or a 1:20 ratio of immediate release and extended
release formulations of a first auris sensory cell modulating agent
and second therapeutic agent, respectively.
[0557] In a specific embodiment the formulation provides a
therapeutically effective amount of at least one auris sensory cell
modulating agent at the site of disease with essentially no
systemic exposure. In an additional embodiment the formulation
provides a therapeutically effective amount of at least one auris
sensory cell modulating agent at the site of disease with
essentially no detectable systemic exposure. In other embodiments,
the formulation provides a therapeutically effective amount of at
least one auris sensory cell modulating agent at the site of
disease with little or no detectable detectable systemic
exposure.
[0558] The combination of immediate release, delayed release and/or
extended release auris sensory cell modulating agent compositions
or formulations may be combined with other pharmaceutical agents,
as well as the excipients, diluents, stabilizers, tonicity agents
and other components disclosed herein. As such, depending upon the
auris sensory cell modulating agent used, the thickness or
viscosity desired, or the mode of delivery chosen, alternative
aspects of the embodiments disclosed herein are combined with the
immediate release, delayed release and/or extended release
embodiments accordingly.
[0559] In certain embodiments, the pharmacokinetics of the auris
sensory cell modulating agent formulations described herein are
determined by injecting the formulation on or near the round window
membrane of a test animal (including by way of example, a guinea
pig or a chinchilla). At a determined period of time (e.g., 6
hours, 12 hours, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, and
7 days for testing the pharmacokinetics of a formulation over a 1
week period), the test animal is euthanized and a 5 mL sample of
the perilymph fluid is tested. The inner ear removed and tested for
the presence of the auris sensory cell modulating agent. As needed,
the level of auris sensory cell modulating agent is measured in
other organs. In addition, the systemic level of the auris sensory
cell modulating agent is measured by withdrawing a blood sample
from the test animal. In order to determine whether the formulation
impedes hearing, the hearing of the test animal is optionally
tested.
[0560] Alternatively, an inner ear is provided (as removed from a
test animal) and the migration of the auris sensory cell modulating
agent is measured. As yet another alternative, an in vitro model of
a round window membrane is provided and the migration of the auris
sensory cell modulating agent is measured.
Kits/Articles of Manufacture
[0561] The disclosure also provides kits for preventing, treating
or ameliorating the symptoms of a disease or disorder in a mammal.
Such kits generally will comprise one or more of the auris sensory
cell modulating agent controlled-release compositions or devices
disclosed herein, and instructions for using the kit. The
disclosure also contemplates the use of one or more of the auris
sensory cell modulating agent controlled-release compositions, in
the manufacture of medicaments for treating, abating, reducing, or
ameliorating the symptoms of a disease, dysfunction, or disorder in
a mammal, such as a human that has, is suspected of having, or at
risk for developing an inner ear disorder.
[0562] In some embodiments, kits include a carrier, package, or
container that is compartmentalized to receive one or more
containers such as vials, tubes, and the like, each of the
container(s) including one of the separate elements to be used in a
method described herein. Suitable containers include, for example,
bottles, vials, syringes, and test tubes. In other embodiments, the
containers are formed from a variety of materials such as glass or
plastic.
[0563] The articles of manufacture provided herein contain
packaging materials. Packaging materials for use in packaging
pharmaceutical products are also presented herein. See, e.g., U.S.
Pat. Nos. 5,323,907, 5,052,558 and 5,033,252. Examples of
pharmaceutical packaging materials include, but are not limited to,
blister packs, bottles, tubes, inhalers, pumps, bags, vials,
containers, syringes, bottles, and any packaging material suitable
for a selected formulation and intended mode of administration and
treatment. A wide array of auris sensory cell modulating agent
formulations compositions provided herein are contemplated as are a
variety of treatments for any disease, disorder, or condition that
would benefit by controlled release administration of an auris
sensory cell modulating agent to the inner ear.
[0564] In some embodiments, a kit includes one or more additional
containers, each with one or more of various materials (such as
reagents, optionally in concentrated form, and/or devices)
desirable from a commercial and user standpoint for use of a
formulation described herein. Non-limiting examples of such
materials include, but not limited to, buffers, diluents, filters,
needles, syringes; carrier, package, container, vial and/or tube
labels listing contents and/or instructions for use and package
inserts with instructions for use. A set of instructions is
optionally included. In a further embodiment, a label is on or
associated with the container. In yet a further embodiment, a label
is on a container when letters, numbers or other characters forming
the label are attached, molded or etched into the container itself;
a label is associated with a container when it is present within a
receptacle or carrier that also holds the container, e.g., as a
package insert. In other embodiments a label is used to indicate
that the contents are to be used for a specific therapeutic
application. In yet another embodiment, a label also indicates
directions for use of the contents, such as in the methods
described herein.
[0565] In certain embodiments, the pharmaceutical compositions are
presented in a pack or dispenser device which contains one or more
unit dosage forms containing a compound provided herein. In another
embodiment, the pack for example contains metal or plastic foil,
such as a blister pack. In a further embodiment, the pack or
dispenser device is accompanied by instructions for administration.
In yet a further embodiment, the pack or dispenser is also
accompanied with a notice associated with the container in form
prescribed by a governmental agency regulating the manufacture,
use, or sale of pharmaceuticals, which notice is reflective of
approval by the agency of the form of the drug for human or
veterinary administration. In another embodiment, such notice, for
example, is the labeling approved by the U.S. Food and Drug
Administration for prescription drugs, or the approved product
insert. In yet another embodiment, compositions containing a
compound provided herein formulated in a compatible pharmaceutical
carrier are also prepared, placed in an appropriate container, and
labeled for treatment of an indicated condition.
EXAMPLES
Example 1
Preparation of a Thermoreversible Gel AMN082 Formulation
TABLE-US-00003 [0566] Quantity (mg/g of Ingredient formulation)
AMN082 3.0 Methylparaben 0.3 Hypromellose 3.0 Poloxamer 407 54 TRIS
HCl buffer (0.1M) 239.7
[0567] AMN082 is supplied as a solid. It is rehydrated in water to
a final molarity of 10 mM.
[0568] A 10-g batch of gel formulation containing 1.0% of AMN082 is
prepared by first suspending Poloxamer 407 (BASF Corp.) in TRIS HCl
buffer (0.1 M). The Poloxamer 407 and TRIS are mixed under
agitation overnight at 4.degree. C. to ensure complete dissolution
of the Poloxamer 407 in the TRIS. The hypromellose, methylparaben
and additional TRIS HCl buffer (0.1 M) is added. The composition is
stirred until dissolution is observed. A solution of AMN082 is
added and the composition is mixed until a homogenous gel is
produced. The mixture is maintained below room temperature until
use.
Example 2
Preparation of a Mucoadhesive, Thermoreversible Gel AMN082
Formulation
TABLE-US-00004 [0569] Quantity (mg/g of Ingredient formulation)
AMN082 3.0 methylparaben 0.3 Hypromellose 3.0 Carbopol 934P 0.6
Poloxamer 407 54 TRIS HCl buffer (0.1M) 239.1
[0570] AMN082 is supplied as a solid. It is rehydrated in water to
a final molarity of 10 mM.
[0571] A 10-g batch of mucoadhesive gel formulation containing 1.0%
of AMN082 is prepared by first suspending Poloxamer 407 (BASF
Corp.) and Carbopol 934P in TRIS HCl buffer (0.1 M). The Poloxamer
407, Carbopol 934P and TRIS are mixed under agitation overnight at
4.degree. C. to ensure complete dissolution of the Poloxamer 407
and Carbopol 934P in the TRIS. The hypromellose, methylparaben and
additional TRIS HCl buffer (0.1 M) is added. The composition is
stirred until dissolution is observed. The AMN082 solution is added
and the composition is mixed until a homogenous gel is produced.
The mixture is maintained below room temperature until use.
Example 3
Preparation of a Hydrogel-based CNQX Formulation
TABLE-US-00005 [0572] Quantity (mg/g of Ingredient formulation)
CNQX 15.0 paraffin oil 300.0 trihydroxystearate 15.0 cetyl
dimethicon copolyol 45.0 water qs ad 1000 phosphate buffer pH 7.4
qs pH 7.4
[0573] The cream-type formulation is first prepared by gently
mixing CNQX with water until the CNQX is dissolved. Then, the oil
base is prepared by mixing paraffin oil, trihydroxystearate and
cetyl dimethicon copolyol at temperatures up to 60.degree. C. The
oil base is cooled to room temperature and the CNQX solution is
added. The two phases are mixed until a homogenous, monophasic
hydrogel is formed.
Example 4
Preparation of a Gel Carbamazepine Formulation
TABLE-US-00006 [0574] Quantity (mg/g of Ingredient formulation)
Carbamazepine 6.4 chitosan 3.2 Glycerophosphate disodium 12.8 water
134.4
[0575] A 5 ml solution of acetic acid is titrated to a pH of about
4.0. The chitosan is added to achieve a pH of about 5.5. The
carbamazepine is then dissolved in the chitosan solution. This
solution is sterilized by filtration. A 5 ml aqueous solution of
glycerophosphate disodium is also prepared and sterilized. The two
solutions are mixed and within 2 h at 37.degree. C., the desired
gel is formed.
Example 5
Preparation of a Mucoadhesive, Thermoreversible Gel D-Methionine
Formulation
TABLE-US-00007 [0576] Quantity (mg/g of Ingredient formulation)
D-Methionine 3.0 Benzyl alcohol 0.3 Hypromellose 3.0 Carbopol 934P
0.6 Poloxamer 407 54 Phosphate buffer, pH 7.4 qs to grams
[0577] D-Methionine is dissolved in phosphate buffer. A 10-g batch
of mucoadhesive gel formulation containing D-methionine is prepared
by first suspending Poloxamer 407 (BASF Corp.) and Carbopol 934P in
phosphate buffer. The Poloxamer 407, Carbopol 934P and phosphate
buffer are mixed under agitation overnight at 4.degree. C. to
ensure complete dissolution of the Poloxamer 407 and Carbopol 934P
in the buffer. The hypromellose, benzyl alcohol and additional
phosphate buffer is added to the mixture. The composition is
stirred until dissolution is observed. The D-methionine solution is
added and the composition is mixed until a homogenous gel is
produced. The mixture is maintained below room temperature until
use.
Example 6
Preparation of a Liposomal AMN082 Formulation
TABLE-US-00008 [0578] Ingredient Quantity (mg/g) AMN082 3.0 soya
lecithin 200.0 cholesterol 20.0 tetraglycol 100.0
dimethylisosorbide 50.0 methylparaben 2.0 propylparaben 0.2 BHT 0.1
sodium chloride 1.0 HPMC 15.0 sodium hydroxide 0.6 citric acid 1.0
purified water, USP 603.6
[0579] AMN082 is supplied as a solid. It is rehydrated in water to
a final molarity of 10 mM.
[0580] Heat the soya lecithin, tetraglycol and dimethyl isosorbide
to about 70-75.degree. C. Dissolve the cholesterol and butylated
hydroxytoluene in the heated mixture. Stir until complete
dissolution is obtained. Heat about one third of the water to
80-95.degree. C. in a separate vessel and dissolve the
preservatives methylparaben and propylparaben in the heated water
while stirring. Allow the solution to cool to about 25.degree. C.
and then add the AMN082, disodium edetate, sodium chloride, sodium
hydroxide and citric acid. Add the remainder of the water and stir
to obtain a complete solution. Transfer the organic mixture into
the aqueous mixture by means of a vacuum, while homogenizing the
combination with a high-shear mixer until a homogeneous product is
obtained. Add the hydroxypropyl methylcellulose into the biphasic
mixture by means of a vacuum while homogenizing with a mixer.
Single bilayered liposomes are formed.
Example 7
Preparation of a Thermoreversible Gel Comprising (S)-Ketamine
TABLE-US-00009 [0581] Quantity (mg/g of Ingredient formulation)
(S)-ketamine 21.0 methylparaben 2.1 Hypromellose 21.0 Poloxamer 407
378 TRIS HCl buffer (0.1M) 1677.9
[0582] A 10-g batch of gel formulation containing 1.0% of
(S)-ketamine is prepared by first suspending Poloxamer 407 (BASF
Corp.) in TRIS HCl buffer (0.1 M). The Poloxamer 407 and TRIS are
mixed under agitation overnight at 4.degree. C. to ensure complete
dissolution of the Poloxamer 407 in the TRIS. The hypromellose,
methylparaben and additional TRIS HCl buffer (0.1 M) is added. The
composition is stirred until dissolution is observed. A solution of
(S)-ketamine is added and the composition is mixed until a
homogenous gel is produced. The mixture is maintained below room
temperature until use.
Example 8
Preparation of a Thermoreversible Gel (S)-Ketamine Composition
Comprising Micronized (S)-Ketamine Powder
TABLE-US-00010 [0583] Quantity (mg/g of Ingredient formulation)
(S)-Ketamine 20.0 BHT 0.002 Poloxamer 407 160.0 PBS buffer (0.1M)
9.0
[0584] A 10-g batch of gel formulation containing 2.0% of
micronized (S)-Ketamine, 13.8 mg of sodium phosphate dibasic
dihydrate USP (Fisher Scientific.) +3.1 mg of sodium phosphate
monobasic monohydrate USP (Fisher Scientific.) +74 mg of sodium
chloride USP (Fisher Scientific.) is dissolved with 8.2 g of
sterile filtered DI water and the pH is adjusted to 7.4 with 1 M
NaOH. The buffer solution is chilled down and 1.6 g of poloxamer
407 (BASF Corp., containing approximately 100 ppm of BHT) is
sprinkled into the chilled PBS solution while mixing, solution is
mixed until all the poloxamer is dissolved. The poloxamer is
sterile filtered using a 33 mm PVDF 0.22 .mu.m sterile syringe
filter (Millipore Corp.) and delivered to 2 mL sterile glass vials
(Wheaton) in an aseptic environment, the vials are closed with
sterile butyl rubber stoppers (Kimble) and crimped sealed with 13
mm A1 seals (Kimble). 20 mg of micronized (S)-ketamine is placed in
separate clean depyrogenated vials, the vials are closed with
sterile butyl rubber stoppers (Kimble) and crimped sealed with 13
mm A1 seals (Kimble), vials are dry heat sterilized (Fisher
Scientific Isotemp oven) for 7 hours at 140.degree. C. Before
administration for the experiments described herein, 1 mL of the
cold poloxamer solution is delivered to a vial containing 20 mg of
sterile micronized (S)-ketamine using a 21G needle (Becton
Dickinson) attached to a 1 mL sterile syringe (Becton Dickinson),
suspension mixed well by shaking to ensure homogeneity of the
suspension. The suspension is then withdrawn with the 21G syinge
and the needle is switched to a 27 G needle for administration.
Example 9
Preparation of a Thermoreversible Gel Micronized AM-101 Composition
Comprising a Penetration Enhancer
TABLE-US-00011 [0585] Quantity (mg/g of Ingredient formulation)
AM-101 20.0 methylparaben 1.0 Dodecyl maltoside (A3) 1.0 HPMC 10.0
Poloxamer 407 180.0 TRIS HCl buffer (0.1M) 789.0
[0586] A 10-g batch of gel formulation containing 2.0% of
micronized AM-101 is prepared by suspending 1.80 g of Poloxamer 407
(BASF Corp.) in 5.00 g of TRIS HCl buffer (0.1 M) and the
components are mixed under agitation overnight at 4.degree. C. to
ensure complete dissolution. (S)-Ketamine (200.0 mg),
hydroxypropylmethylcellulose (100.0 mg), methylparaben (10 mg) and
dodecyl maltoside (10 mg) and additional TRIS HCl buffer (0.1 M)
(2.89 g) is added and further stirring allowed until complete
dissolution is observed. The mixture is maintained below room
temperature until use.
Example 10
Effect of pH on Degradation Products for Autoclaved 17% Poloxamer
407NF/2% Otic Agent in PBS Buffer
[0587] A stock solution of a 17% poloxamer 407/2% otic agent is
prepared by dissolving 351.4 mg of sodium chloride (Fisher
Scientific), 302.1 mg of sodium phosphate dibasic anhydrous (Fisher
Scientific), 122.1 mg of sodium phosphate monobasic anhydrous
(Fisher Scientific) and an appropriate amount of an otic agent with
79.3 g of sterile filtered DI water. The solution is cooled down in
a ice chilled water bath and then 17.05 g of poloxamer 407NF
(SPECTRUM CHEMICALS) is sprinkled into the cold solution while
mixing. The mixture is further mixed until the poloxamer is
completely dissolved. The pH for this solution is measured.
[0588] 17% Poloxamer 407/2% Otic Agent in PBS pH of 5.3.
[0589] Take an aliquot (approximately 30 mL) of the above solution
and adjust the pH to 5.3 by the addition of 1 M HCl.
[0590] 17% Poloxamer 407/2% Otic Agent in PBS pH of 8.0.
[0591] Take an aliquot (approximately 30 mL) of the above stock
solution and adjust the pH to 8.0 by the addition of 1 M NaOH.
[0592] A PBS buffer (pH 7.3) is prepared by dissolving 805.5 mg of
sodium chloride (Fisher Scientific), 606 mg of sodium phosphate
dibasic anhydrous (Fisher Scientific), 247 mg of sodium phosphate
monobasic anhydrous (Fisher Scientific), then QS to 200 g with
sterile filtered DI water.
[0593] A 2% solution of an otic agent in PBS pH 7.3 is prepared by
dissolving an appropriate amount of the otic agent in the PBS
buffer and QS to 10 g with PBS buffer.
[0594] One mL samples are individually placed in 3 mL screw cap
glass vials (with rubber lining) and closed tightly. The vials are
placed in a Market Forge-sterilmatic autoclave (settings, slow
liquids) and sterilized at 250.degree. F. for 15 minutes. After the
autoclave the samples are left to cool down to room temperature and
then placed in refrigerator. The samples are homogenized by mixing
the vials while cold.
[0595] Appearance (e.g., discoloration and/or precipitation) is
observed and recorded. HPLC analysis is performed using an Agilent
1200 equipped with a Luna C18(2) 3 .mu.m, 1001, 250.times.4.6 mm
column) using a 30-80 acetonitrile gradient (1-10 min) of
(water-acetonitrile mixture containing 0.05% TFA), for a total run
of 15 minutes. Samples are diluted by taking 304 of sample and
dissolved with 1.5 mL of a 1:1 acetonitrile water mixture. Purity
of the otic agent in the autoclaved samples is recorded.
[0596] Formulations comprising DNQX, D-methionine, micronized
AM-101 or micronized (S)-ketamine, prepared according to the
procedure above, are tested using the above procedure to determine
the effect of pH on degradation during the autoclaving step.
Example 11
Effect of Autoclaving on the Release Profile and Viscosity of a 17%
Poloxamer 407NF/2% Otic Agent in PBS
[0597] An aliquot of a sample (autoclaved and not autoclaved) is
evaluated for release profile and viscosity measurement to evaluate
the impact of heat sterilization on the properties of the gel.
[0598] Dissolution is performed at 37.degree. C. in snapwells (6.5
mm diameter polycarbonate membrane with a pore size of 0.4 .mu.m).
0.2 mL of gel is placed into snapwell and left to harden, then 0.5
mL is placed into reservoir and shaken using a Labline orbit shaker
at 70 rpm. Samples are taken every hour (0.1 mL withdrawn and
replace with warm buffer). Samples are analyzed for poloxamer
concentration by UV at 624 nm using the cobalt thiocyanate method,
against an external calibration standard curve. In brief, 204 of
the sample is mixed with 19804 of a 15 mM cobalt thiocyanate
solution and absorbance measured at 625 nm, using a Evolution 160
UV/Vis spectrophotometer (Thermo Scientific).
[0599] The released otic agent is fitted to the Korsmeyer-Peppas
equation
Q Q .alpha. = k t n + b ##EQU00003##
where Q is the amount of otic agent released at time t,
Q.sub..alpha. is the overall released amount of otic agent, k is a
release constant of the nth order, n is a dimensionless number
related to the dissolution mechanism and b is the axis intercept,
characterizing the initial burst release mechanism wherein n=1
characterizes an erosion controlled mechanism. The mean dissolution
time (MDT) is the sum of different periods of time the drug
molecules stay in the matrix before release, divided by the total
number of molecules and is calculated by:
M D T = n k - 1 / n n + 1 ##EQU00004##
[0600] Viscosity measurements are performed using a Brookfield
viscometer RVDV-II+P with a CPE-51 spindle rotated at 0.08 rpm
(shear rate of 0.31 s.sup.-1), equipped with a water jacketed
temperature control unit (temperature ramped from 15-34.degree. C.
at 1.6.degree. C./min). Tgel is defined as the inflection point of
the curve where the increase in viscosity occurs due to the sol-gel
transition.
[0601] Formulations comprising DNQX, D-methionine, micronized
AM-101 or micronized (S)-ketamine, prepared according to the
procedures described above, are tested using the procedure
described above to determine Tgel.
Example 12
Effect of Addition of a Secondary Polymer on the Degradation
Products and Viscosity of a Formulation Containing 2% Otic Agent
and 17% Poloxamer 407NF after Heat Sterilization (Autoclaving)
[0602] Solution A.
[0603] A solution of pH 7.0 comprising sodium
carboxymethylcellulose (CMC) in PBS buffer is prepared by
dissolving 178.35 mg of sodium chloride (Fisher Scientific), 300.5
mg of sodium phosphate dibasic anhydrous (Fisher Scientific), 126.6
mg of sodium phosphate monobasic anhydrous (Fisher Scientific)
dissolved with 78.4 of sterile filtered DI water, then 1 g of
Blanose 7M65 CMC (Hercules, viscosity of 5450 cP @ 2%) is sprinkled
into the buffer solution and heated to aid dissolution, and the
solution is then cooled down.
[0604] A solution of pH 7.0 comprising 17% poloxamer 407NF/1%
CMC/2% otic agent in PBS buffer is made by cooling down 8.1 g of
solution A in a ice chilled water bath and then adding an
appropriate amount of an otic agent followed by mixing. 1.74 g of
poloxamer 407NF (Spectrum Chemicals) is sprinkled into the cold
solution while mixing. The mixture is further mixed until all the
poloxamer is completely dissolved.
[0605] Two mL of the above sample is placed in a 3 mL screw cap
glass vial (with rubber lining) and closed tightly. The vial is
placed in a Market Forge-sterilmatic autoclave (settings, slow
liquids) and sterilized at 250.degree. F. for 25 minutes. After
autoclaving the sample is left to cool down to room temperature and
then placed in refrigerator. The sample is homogenized by mixing
while the vials are cold.
[0606] Precipitation or discoloration are observed after
autoclaving. HPLC analysis is performed using an Agilent 1200
equipped with a Luna C18(2) 3 .mu.m, 100 .ANG., 250.times.4.6 mm
column) using a 30-80 acetonitrile gradient (1-10 min) of
(water-acetonitrile mixture containing 0.05% TFA), for a total run
of 15 minutes. Samples are diluted by taking 30 .mu.L of sample and
dissolving with 1.5 mL of a 1:1 acetonitrile water mixture. Purity
of the otic agent in the autoclaved samples is recorded.
[0607] Viscosity measurements are performed using a Brookfield
viscometer RVDV-II+P with a CPE-51 spindle rotated at 0.08 rpm
(shear rate of 0.31 s.sup.-1), equipped with a water jacketed
temperature control unit (temperature ramped from 15-34.degree. C.
at 1.6.degree. C./min). Tgel is defined as the inflection point of
the curve where the increase in viscosity occurs due to the sol-gel
transition.
[0608] Dissolution is performed at 37.degree. C. for the
non-autoclaved sample in snapwells (6.5 mm diameter polycarbonate
membrane with a pore size of 0.4 .mu.m), 0.2 mL of gel is placed
into snapwell and left to harden, then 0.5 mL is placed into
reservoir and shaken using a Labline orbit shaker at 70 rpm.
Samples are taken every hour (0.1 mL withdrawn and replaced with
warm buffer). Samples are analyzed for otic agent concentration by
UV at 245 nm, against an external calibration standard curve.
[0609] Formulations comprising DNQX, D-methionine, micronized
AM-101 or micronized (S)-ketamine, are tested using the above
procedure to determine the effect addition of a secondary polymer
on the degradation products and viscosity of a formulation
containing 2% otic agent and 17% poloxamer 407NF after heat
sterilization (autoclaving).
Example 13
Effect of Buffer Type on the Degradation Products for Formulations
Containing Poloxamer 407NF after Heat Sterilization
(Autoclaving)
[0610] A TRIS buffer is made by dissolving 377.8 mg of sodium
chloride (Fisher Scientific), and 602.9 mg of Tromethamine (Sigma
Chemical Co.) then QS to 100 g with sterile filtered DI water, pH
is adjusted to 7.4 with 1M HCl.
Stock Solution Containing 25% Poloxamer 407 Solution in TRIS
Buffer:
[0611] Weigh 45 g of TRIS buffer, chill in an ice chilled bath then
sprinkle into the buffer, while mixing, 15 g of poloxamer 407 NF
(Spectrum Chemicals). The mixture is further mixed until all the
poloxamer is completely dissolved.
[0612] A series of formulations is prepared with the above stock
solution. An appropriate amount of otic agent (or salt or prodrug
thereof) and/or otic agent as micronized/coated/liposomal particles
(or salt or prodrug thereof) is used for all experiments.
Stock Solution (pH 7.3) Containing 25% Poloxamer 407 Solution in
PBS Buffer:
[0613] PBS buffer described above is used. Dissolve 704 mg of
sodium chloride (Fisher Scientific), 601.2 mg of sodium phosphate
dibasic anhydrous (Fisher Scientific), 242.7 mg of sodium phosphate
monobasic anhydrous (Fisher Scientific) with 140.4 g of sterile
filtered DI water. The solution is cooled down in an ice chilled
water bath and then 50 g of poloxamer 407NF (SPECTRUM CHEMICALS) is
sprinkled into the cold solution while mixing. The mixture is
further mixed until the poloxamer is completely dissolved.
[0614] A series of formulations is prepared with the above stock
solution. An appropriate amount of otic agent (or salt or prodrug
thereof) and/or otic agent as micronized/coated/liposomal particles
(or salt or prodrug thereof) is used for all experiments.
[0615] Tables 2 and 3 list samples prepared using the procedures
described above. An appropriate amount of otic agent is added to
each sample to provide a final concentration of 2% otic agent in
the sample.
TABLE-US-00012 TABLE 2 Preparation of samples containing TRIS
buffer 25% Stock Solution TRIS Buffer Sample pH (g) (g) 20% P407/2%
otic agent/TRIS 7.45 8.01 1.82 18% P407/2% otic agent/TRIS 7.45
7.22 2.61 16% P407/2% otic agent/TRIS 7.45 6.47 3.42 18% P407/2%
otic agent/TRIS 7.4 7.18 2.64 4% otic agent/TRIS 7.5 -- 9.7 2% otic
agent/TRIS 7.43 -- 5 1% otic agent/TRIS 7.35 -- 5 2% otic
agent/TRIS 7.4 -- 4.9 (suspension)
TABLE-US-00013 TABLE 3 Preparation of samples containing PBS buffer
(pH of 7.3) 25% Stock Solution Sample in PBS (g) PBS Buffer (g) 20%
P407/2% otic agent/ 8.03 1.82 PBS 18% P407/2% otic agent/ 7.1 2.63
PBS 16% P407/2% otic agent/ 6.45 3.44 PBS 18% P407/2% otic agent/
-- 2.63 PBS 2% otic agent/PBS -- 4.9
[0616] One mL samples are individually placed in 3 mL screw cap
glass vials (with rubber lining) and closed tightly. The vials are
placed in a Market Forge-sterilmatic autoclave (setting, slow
liquids) and sterilized at 250.degree. F. for 25 minutes. After the
autoclaving the samples are left to cool down to room temperature.
The vials are placed in the refrigerator and mixed while cold to
homogenize the samples.
[0617] HPLC analysis is performed using an Agilent 1200 equipped
with a Luna C18(2) 3 .mu.m, 100 .ANG., 250.times.4.6 mm column)
using a 30-80 acetonitrile gradient (1-10 min) of
(water-acetonitrile mixture containing 0.05% TFA), for a total run
of 15 minutes. Samples are diluted by taking 304 of sample and
dissolving with 1.5 mL of a 1:1 acetonitrile water mixture. Purity
of the otic agent in the autoclaved samples is recorded. The
stability of formulations in TRIS and PBS buffers is compared.
[0618] Viscosity measurements are performed using a Brookfield
viscometer RVDV-II+P with a CPE-51 spindle rotated at 0.08 rpm
(shear rate of 0.31 s.sup.-1), equipped with a water jacketed
temperature control unit (temperature ramped from 15-34.degree. C.
at 1.6.degree. C./min). Tgel is defined as the inflection point of
the curve where the increase in viscosity occurs due to the sol-gel
transition. Only formulations that show no change after autoclaving
are analyzed.
[0619] Formulations comprising DNQX, D-methionine, micronized
AM-101 or micronized (S)-ketamine, are tested using the above
procedure to determine the effect addition of a secondary polymer
on the degradation products and viscosity of a formulation
containing 2% otic agent and 17% poloxamer 407NF after heat
sterilization (autoclaving). Stability of formulations containing
micronized otic agent is compared to non-micronized otic agent
formulation counterparts.
Example 14
Pulsed Release Otic Formulations
[0620] A combination of D-methionine and D-methionine hydrochloride
(ratio of 1:1) is used to prepare a pulsed release otic agent
formulation using the procedures described herein. 20% of the
delivered dose of D-methione is solubilized in a 17% poloxamer
solution of example 10 with the aid of beta-cyclodextrins. The
remaining 80% of the otic agent is then added to the mixture and
the final formulation is prepared using any procedure described
herein.
[0621] Pulsed release formulations comprising DNQX, D-methionine,
micronized AM-101 or micronized (S)-ketamine, prepared according to
the procedures and examples described above, are tested using
procedures described herein to determine pulse release
profiles.
Example 15
Preparation of a 17% Poloxamer 407/2% Otic Agent/78 Ppm Evans Blue
in PBS
[0622] A Stock solution of Evans Blue (5.9 mg/mL) in PBS buffer is
prepared by dissolving 5.9 mg of Evans Blue (Sigma Chemical Co)
with 1 mL of PBS buffer (from example 10).
[0623] A Stock solution containing 25% Poloxamer 407 solution in
PBS buffer is used in this study. An appropriate amount of an otic
agent is added to the stock solution to prepare formulations
comprising 2% of an otic agent (Table 4).
TABLE-US-00014 TABLE 4 Preparation of poloxamer 407 samples
containing Evans Blue 25% P407 in Evans Blue Sample ID PBS (g) PBS
Buffer (g) Solution (.mu.L) 17% P407/2% otic agent/ 13.6 6 265 EB
20% P407/2% otic agent/ 16.019 3.62 265 EB 25% P407/2% otic agent/
19.63 -- 265 EB
[0624] Formulations comprising DNQX, D-methionine, micronized
AM-101 or micronized (S)-ketamine, are prepared according to the
procedures described above and are sterile filtered through 0.22
.mu.m PVDF syringe filters (Millipore corporation), and
autoclaved.
[0625] The above formulations are dosed to guinea pigs in the
middle ear by procedures described herein and the ability of
formulations to gel upon contact and the location of the gel is
identified after dosing and at 24 hours after dosing.
Example 16
Terminal Sterilization of Poloxamer 407 Formulations with and
without a Visualization Dye
[0626] 17% Poloxamer 407/2% Otic Aunt/in Phosphate Buffer, pH
7.3:
[0627] Dissolve 709 mg of sodium chloride (Fisher Scientific), 742
mg of sodium phosphate dibasic dehydrate USP (Fisher Scientific),
251.1 mg of sodium phosphate monobasic monohydrate USP (Fisher
Scientific) and an appropriate amount of an otic agent with 158.1 g
of sterile filtered DI water. The solution is cooled down in an ice
chilled water bath and then 34.13 g of poloxamer 407NF (Spectrum
chemicals) is sprinkled into the cold solution while mixing. The
mixture is further mixed until the poloxamer is completely
dissolved.
[0628] 17% Poloxamer 407/2% Otic Aunt/59 Ppm Evans Blue in
Phosphate Buffer:
[0629] Take two mL of the 17% poloxamer 407/2% otic agent/in
phosphate buffer solution and add 2 mL of a 5.9 mg/mL Evans blue
(Sigma-Aldrich chemical Co) solution in PBS buffer.
[0630] 25% Poloxamer 407/2% Otic Aunt/in Phosphate Buffer:
[0631] Dissolve 330.5 mg of sodium chloride (Fisher Scientific),
334.5 mg of sodium phosphate dibasic dehydrate USP (Fisher
Scientific), 125.9 mg of sodium phosphate monobasic monohydrate USP
(Fisher Scientific) and an appropriate amount of an otic agent with
70.5 g of sterile filtered DI water.
[0632] The solution is cooled down in an ice chilled water bath and
then 25.1 g of poloxamer 407NF (Spectrum chemicals) is sprinkled
into the cold solution while mixing. The mixture is further mixed
until the poloxamer is completely dissolved.
[0633] 25% Poloxamer 407/2% Otic Aunt/59 Ppm Evans Blue in
Phosphate Buffer:
[0634] Take two mL of the 25% poloxamer 407/2% otic agent/in
phosphate buffer solution and add 2 mL of a 5.9 mg/mL Evans blue
(Sigma-Aldrich chemical Co) solution in PBS buffer.
[0635] Place 2 mL of formulation into a 2 mL glass vial (Wheaton
serum glass vial) and seal with 13 mm butyl str (kimble stoppers)
and crimp with a 13 mm aluminum seal. The vials are placed in a
Market Forge-sterilmatic autoclave (settings, slow liquids) and
sterilized at 250.degree. F. for 25 minutes. After the autoclaving
the samples are left to cool down to room temperature and then
placed in refrigeration. The vials are placed in the refrigerator
and mixed while cold to homogenize the samples. Sample
discoloration or precipitation after autoclaving is recorded.
[0636] HPLC analysis is performed using an Agilent 1200 equipped
with a Luna C18(2) 3 .mu.m, 100 .ANG., 250.times.4.6 mm column)
using a 30-95 methanol:acetate buffer pH 4 gradient (1-6 min), then
isocratic for 11 minutes, for a total run of 22 minutes. Samples
are diluted by taking 304 of sample and dissolved with 0.97 mL of
water. The main peaks are recorded in the table below. Purity
before autoclaving is always greater than 99% using this
method.
[0637] Viscosity measurements are performed using a Brookfield
viscometer RVDV-II+P with a CPE-51 spindle rotated at 0.08 rpm
(shear rate of 0.31 s.sup.-1), equipped with a water jacketed
temperature control unit (temperature ramped from 15-34.degree. C.
at 1.6.degree. C./min). Tgel is defined as the inflection point of
the curve where the increase in viscosity occurs due to the sol-gel
transition.
[0638] Formulations comprising DNQX, D-methionine, micronized
AM-101 or micronized (S)-ketamine, prepared according to the
procedures described herein, are tested using the above procedures
to determine stability of the formulations.
Example 17
In Vitro Comparison of Release Profile
[0639] Dissolution is performed at 37.degree. C. in snapwells (6.5
mm diameter polycarbonate membrane with a pore size of 0.4 .mu.m),
0.2 mL of a gel formulation described herein is placed into
snapwell and left to harden, then 0.5 mL buffer is placed into
reservoir and shaken using a Labline orbit shaker at 70 rpm.
Samples are taken every hour (0.1 mL withdrawn and replace with
warm buffer). Samples are analyzed for otic agent concentration by
UV at 245 nm against an external calibration standard curve.
Pluronic concentration is analyzed at 624 nm using the cobalt
thiocyanate method. Relative rank-order of mean dissolution time
(MDT) as a function of % P407 is determined. A linear relationship
between the formulations mean dissolution time (MDT) and the P407
concentration indicates that the otic agent is released due to the
erosion of the polymer gel (poloxamer) and not via diffusion. A
non-linear relationship indicates release of otic agent via a
combination of diffusion and/or polymer gel degradation.
[0640] Alternatively, samples are analyzed using the method
described by Li Xin-Yu paper [Acta Pharmaceutica Sinica 2008,
43(2):208-203] and Rank-order of mean dissolution time (MDT) as a
function of % P407 is determined.
[0641] Formulations comprising DNQX, D-methionine, micronized
AM-101 or micronized (S)-ketamine, prepared according to the
procedures described herein, are tested using the above procedure
to determine the release profile of the otic agents.
Example 18
In Vitro Comparison of Gelation Temperature
[0642] The effect of Poloxamer 188 and an otic agent on the
gelation temperature and viscosity of Poloxamer 407 formulations is
evaluated with the purpose of manipulating the the gelation
temperature.
[0643] A 25% Poloxamer 407 stock solution in PBS buffer and the PBS
solution described above are used. Poloxamer 188NF from BASF is
used. An appropriate amount of otic agent is added to the solutions
described in Table 5 to provide a 2% formulation of the otic
agent.
TABLE-US-00015 TABLE 5 Preparation of samples containing poloxamer
407/poloxamer 188 25% P407 Stock Poloxamer PBS Buffer Sample
Solution (g) 188 (mg) (g) 16% P407/10% P188 3.207 501 1.3036 17%
P407/10% P188 3.4089 500 1.1056 18% P407/10% P188 3.6156 502 0.9072
19% P407/10% P188 3.8183 500 0.7050 20% P407/10% P188 4.008 501
0.5032 20% P407/5% P188 4.01 256 0.770
[0644] Mean dissolution time, viscosity and gel temperature of the
above formulations are measured using procedures described
herein.
[0645] An equation is fitted to the data obtained and can be
utilized to estimate the gelation temperature of F127/F68 mixtures
(for 17-20% F127 and 0-10% F68).
T.sub.gei=-1.8(% F127)+1.3(% F68)+53
[0646] An equation is fitted to the data obtained and can be
utilized to estimate the Mean Dissolution Time (hr) based on the
gelation temperature of F127/F68 mixtures (for 17-25% F127 and
0-10% F68), using results obtained in examples above.
MDT=-0.2(T.sub.gei)+8
[0647] Formulations comprising DNQX, D-methionine, micronized
AM-101 or micronized (S)-ketamine, are prepared by addition of an
appropriate amount of otic agents to the solutions described in
Table 5. The gel temeparature of the formulations is determined
using the procedure described above.
Example 19
Determination of Temperature Range for Sterile Filtration
[0648] The viscosity at low temperatures is measured to help guide
the temperature range at which the sterile filtration needs to
occur to reduce the possibility of clogging.
[0649] Viscosity measurements are performed using a Brookfield
viscometer RVDV-II+P with a CPE-40 spindle rotated at 1, 5 and 10
rpm (shear rate of 7.5, 37.5 and 75 s.sup.-1), equipped with a
water jacketed temperature control unit (temperature ramped from
10-25.degree. C. at 1.6.degree. C./min).
[0650] The Tgel of a 17% Pluronic P407 is determined as a function
of increasing concentration of otic agent. The increase in Tgel for
a 17% pluronic formulation is estimated by:
.DELTA.T.sub.gel=0.93[% otic agent]
[0651] Formulations comprising DNQX, D-methionine, micronized
AM-101 or micronized (S)-ketamine, prepared according to procedures
described herein, are tested using the above procedure to determine
the temperature range for sterile filtration. The effect of
addition of increased amounts of otic agent on the Tgel, and the
apparent viscosity of the formulations is recorded.
Example 20
Determination of Manufacturing Conditions
TABLE-US-00016 [0652] TABLE 6 Viscosity of potential formulations
at manufacturing/filtration conditions. Apparent Viscosity.sup.a
(cP) Sample 5.degree. C. below Tgel 20.degree. C. Temperature @ 100
cP Placebo 52 cP @ 17.degree. C. 120 cP 19.degree. C. 17% P407/2%
90 cP @ 18.degree. C. 147 cP 18.5.degree. C. otic agent 17% P407/6%
142 cP @ 22.degree. C. 105 cP 19.7.degree. C. otic agent
.sup.aViscosity measured at a shear rate of 37.5 s.sup.-1
[0653] An 8 liter batch of a 17% P407 placebo is manufactured to
evaluate the manufacturing/filtration conditions. The placebo is
manufactured by placing 6.4 liters of DI water in a 3 gallon SS
pressure vessel, and left to cool down in the refrigerator
overnight. The following morning the tank is taken out (water
temperature 5.degree. C., RT 18.degree. C.) and 48 g of sodium
chloride, 29.6 g of sodium phosphate dibasic dehydrate and 10 g of
sodium phosphate monobasic monohydrate is added and dissolved with
an overhead mixer (IKA RW20 @ 1720 rpm). Half hour later, once the
buffer is dissolved (solution temperature 8.degree. C., RT
18.degree. C.), 1.36 kg of poloxamer 407 NF (spectrum chemicals) is
slowly sprinkled into the buffer solution in a 15 minute interval
(solution temperature 12.degree. C., RT 18.degree. C.), then speed
is increased to 2430 rpm. After an additional one hour mixing,
mixing speed is reduced to 1062 rpm (complete dissolution).
[0654] The temperature of the room is maintained below 25.degree.
C. to retain the temperature of the solution at below 19.degree. C.
The temperature of the solution is maintained at below 19.degree.
C. up to 3 hours of the initiation of the manufacturing, without
the need to chill/cool the container.
[0655] Three different Sartoscale (Sartorius Stedim) filters with a
surface area of 17.3 cm.sup.2 are evaluated at 20 psi and
14.degree. C. of solution [0656] 1) Sartopore 2, 0.2 .mu.m
5445307HS-FF (PES), flow rate of 16 mL/min [0657] 2) Sartobran P,
0.2 .mu.m 5235307HS-FF (cellulose ester), flow rate of 12 mL/min
[0658] 3) Sartopore 2 XLI, 0.2 .mu.m 5445307IS-FF (PES), flow rate
of 15 mL/min
[0659] Sartopore 2 filter 5441307H4-SS is used, filtration is
carried out at the solution temperature using a 0.45, 0.2 .mu.m
Sartopore 2 150 sterile capsule (Sartorius Stedim) with a surface
area of 0.015 m.sup.2 at a pressure of 16 psi. Flow rate is
measured at approximately 100 mL/min at 16 psi, with no change in
flow rate while the temperature is maintained in the 6.5-14.degree.
C. range. Decreasing pressure and increasing temperature of the
solution causes a decrease in flow rate due to an increase in the
viscosity of the solution. Discoloration of the solution is
monitored during the process.
TABLE-US-00017 TABLE 7 Predicted filtration time for a 17%
poloxamer 407 placebo at a solution temperature range of
6.5-14.degree. C. using Sartopore 2, 0.2 .mu.m filters at a
pressure of 16 psi of pressure. Estimated flow rate Time to filter
8 L Filter Size (m.sup.2) (mL/min) (estimated) Sartopore 2, size 4
0.015 100 mL/min 80 min Sartopore 2, size 7 0.05 330 mL/min 24 min
Sartopore 2, size 8 0.1 670 mL/min 12 min
[0660] Viscosity, Tgel and UV/Vis absorption is check before
filtration evaluation. Pluronic UV/Vis spectra are obtained by a
Evolution 160 UV/Vis (Thermo Scientific). A peak in the range of
250-300 nm is attributed to BHT stabilizer present in the raw
material (poloxamer). Table 8 lists physicochemical properties of
the above solutions before and after filtration.
TABLE-US-00018 TABLE 8 Physicochemical properties of 17% poloxamer
407 placebo solution before and after filtration Viscosity.sup.a @
19.degree. C. Absorbance @ Sample Tgel (.degree. C.) (cP) 274 nm
Before filtration 22 100 0.3181 After filtration 22 100 0.3081
.sup.aViscosity measured at a shear rate of 37.5 s.sup.-1
[0661] The above process is applicable for manufacture of 17% P407
formulations, and includes temperature analysis of the room
conditions. Preferably, a maximum temperature of 19.degree. C.
reduces cost of cooling the container during manufacturing. In some
instances, a jacketed container is used to further control the
temperature of the solution to ease manufacturing concerns.
Example 21
In Vitro Release of Otic Agent from an Autoclaved Micronized
Sample
[0662] 17% poloxamer 407/1.5% otic agent in TRIS buffer: 250.8 mg
of sodium chloride (Fisher Scientific), and 302.4 mg of
Tromethamine (Sigma Chemical Co.) is dissolved in 39.3 g of sterile
filtered DI water, pH is adjusted to 7.4 with 1M HCl. 4.9 g of the
above solution is used and an appropriate amount of micronized otic
agent is suspended and dispersed well. 2 mL of the formulation is
transferred into a 2 mL glass vial (Wheaton serum glass vial) and
sealed with 13 mm butyl styrene (kimble stoppers) and crimped with
a 13 mm aluminum seal. The vial is placed in a Market
Forge-sterilmatic autoclave (settings, slow liquids) and sterilized
at 250.degree. F. for 25 minutes. After the autoclaving the sample
is left to cool down to room temperature. The vial is placed in the
refrigerator and mixed while cold to homogenize the sample. Sample
discoloration or precipitation after autoclaving is recorded.
[0663] Dissolution is performed at 37.degree. C. in snapwells (6.5
mm diameter polycarbonate membrane with a pore size of 0.4 .mu.m),
0.2 mL of gel is placed into snapwell and left to harden, then 0.5
mL PBS buffer is placed into reservoir and shaken using a Labline
orbit shaker at 70 rpm. Samples are taken every hour [0.1 mL
withdrawn and replaced with warm PBS buffer containing 2% PEG-40
hydrogenated castor oil (BASF) to enhance otic agent solubility].
Samples are analyzed for otic agent concentration by UV at 245 nm
against an external calibration standard curve. The release rate is
compared to other formulations disclosed herein. MDT time is
calculated for each sample.
[0664] Solubilization of otic agent in the 17% poloxamer system is
evaluated by measuring the concentration of the otic agent in the
supernatant after centrifuging samples at 15,000 rpm for 10 minutes
using an eppendorf centrifuge 5424. Otic agent concentration in the
supernatant is measured by UV at 245 nm against an external
calibration standard curve.
[0665] Formulations comprising DNQX, D-methionine, micronized
AM-101 or micronized (S)-ketamine, prepared according to the
procedures described herein, are tested using the above procedures
to determine release rate of the otic agent from each
formulation.
Example 22
Release Rate or MDT and Viscosity of Formulation Containing Sodium
Carboxymethyl cellulose
[0666] 17% poloxamer 407/2% otic agent/1% CMC (Hercules Blanose
7M): A sodium carboxymethylcellulose (CMC) solution (pH 7.0) in PBS
buffer is prepared by dissolving 205.6 mg of sodium chloride
(Fisher Scientific), 372.1 mg of sodium phosphate dibasic dihydrate
(Fisher Scientific), 106.2 mg of sodium phosphate monobasic
monohydrate (Fisher Scientific) in 78.1 g of sterile filtered DI
water. 1 g of Blanose 7M CMC (Hercules, viscosity of 533 cP @ 2%)
is sprinkled into the buffer solution and heated to ease solution,
solution is then cooled down and 17.08 g poloxamer 407NF (Spectrum
Chemicals) is sprinkled into the cold solution while mixing. A
formulation comprising 17% poloxamer 407NF/1% CMC/2% otic agent in
PBS buffer is made adding/dissolving an appropriate amount of otic
agent to 9.8 g of the above solution, and mixing until all the otic
agent is completely dissolved.
[0667] 17% poloxamer 407/2% otic agent/0.5% CMC (Blanose 7M65): A
sodium carboxymethylcellulose (CMC) solution (pH 7.2) in PBS buffer
is prepared by dissolving 257 mg of sodium chloride (Fisher
Scientific), 375 mg of sodium phosphate dibasic dihydrate (Fisher
Scientific), 108 mg of sodium phosphate monobasic monohydrate
(Fisher Scientific) in 78.7 g of sterile filtered DI water. 0.502 g
of Blanose 7M65 CMC (Hercules, viscosity of 5450 cP @ 2%) is
sprinkled into the buffer solution and heated to ease solution,
solution is then cooled down and 17.06 g poloxamer 407NF (Spectrum
Chemicals) is sprinkled into the cold solution while mixing. A 17%
poloxamer 407NF/1% CMC/2% otic agent solution in PBS buffer is made
adding/dissolving an appropriate amount of otic agent to 9.8 g of
the above solution, and mixing until the otic agent is completely
dissolved.
[0668] 17% poloxamer 407/2% otic agent/0.5% CMC (Blanose 7H9): A
sodium carboxymethylcellulose (CMC) solution (pH 7.3) in PBS buffer
is prepared by dissolving 256.5 mg of sodium chloride (Fisher
Scientific), 374 mg of sodium phosphate dibasic dihydrate (Fisher
Scientific), 107 mg of sodium phosphate monobasic
monohydrate(Fisher Scientific) in 78.6 g of sterile filtered DI
water, then 0.502 g of Blanose 7H9 CMC (Hercules, viscosity of 5600
cP @ 1%) is sprinkled to the buffer solution and heated to ease
solution, solution is then cooled down and 17.03 g poloxamer 407NF
(Spectrum Chemicals) is sprinkled into the cold solution while
mixing. A 17% poloxamer 407NF/1% CMC/2% otic agent solution in PBS
buffer is made adding/dissolving an appropriate amount of otic
agent to 9.8 of the above solution, and mixing until the otic agent
is completely dissolved.
[0669] Viscosity measurements are performed using a Brookfield
viscometer RVDV-II+P with a CPE-40 spindle rotated at 0.08 rpm
(shear rate of 0.6 s.sup.-1), equipped with a water jacketed
temperature control unit (temperature ramped from 10-34.degree. C.
at 1.6.degree. C./min). Tgel is defined as the inflection point of
the curve where the increase in viscosity occurs due to the sol-gel
transition.
[0670] Dissolution is performed at 37.degree. C. in snapwells (6.5
mm diameter polycarbonate membrane with a pore size of 0.4 .mu.m).
0.2 mL of gel is placed into snapwell and left to harden, then 0.5
mL PBS buffer is placed into reservoir and shaken using a Labline
orbit shaker at 70 rpm. Samples are taken every hour, 0.1 mL
withdrawn and replaced with warm PBS buffer. Samples are analyzed
for otic agent concentration by UV at 245 nm against an external
calibration standard curve. The release rate is compared to the
formulations disclosed in above examples, and MDT time is
calculated for each of the above formulations.
[0671] Formulations comprising DNQX, D-methionine, micronized
AM-101 or micronized (S)-ketamine, prepared according to procedures
described above, are tested using the above procedures to determine
relationship between release rate and/or mean dissolution time and
viscosity of formulation containing sodium carboxymethyl cellulose.
Any correlation between the mean dissolution time (MDT) and the
apparent viscosity (measured at 2.degree. C. below the gelation
temperature) is recorded.
Example 23
Effect of Poloxamer Concentration and Otic Agent Concentration on
Release Kinetics
[0672] A series of compositions comprising varying concentrations
of a gelling agent and micronized dexamethasone was prepared using
procedures described above. The mean dissolution time (MDT) for
each composition in Table 9 was determined using procedures
described above.
TABLE-US-00019 TABLE 9 Preparation of poloxamer/otic agent
compositions Sample pH MDT 15.5% P407/1.5% dexamethasone/PBS 7.4 46
h 16% P407/1.5% dexamethasone/PBS 7.4 40 h 17% P407/1.5%
dexamethasone/PBS 7.4 39 h 15.5% P407/4.5% dexamethasone/PBS 7.4
>7 days 16% P407/4.5% dexamethasone/PBS 7.4 >7 days 17%
P407/4.5% dexamethasone/PBS 7.4 >7 days
[0673] The effect of gel strength and otic agent concentration on
release kinetics of an otic agent from the composition or device
was determined by measurement of the MDT for poloxamer, and
measurement of MDT for otic agent. The half life of the otic agent
and mean residence time of the otic agent was also determined for
each formulation by measurement of concentration of the otic agent
in the perilymph.
[0674] The apparent viscosity of each composition was measured as
described above. A thermoreversible polymer gel concentration of
about 15.5% in a composition or device described above provided an
apparent viscosity of about 270,000 cP. A thermoreversible polymer
gel concentration of about 16% in a composition or device described
above provided an apparent viscosity of about 360,000 cP. A
thermoreversible polymer gel concentration of about 17% in a
composition or device described above provided an apparent
viscosity of about 480,000 cP.
[0675] Compositions comprising micronized DNQX, D-methionine,
micronized AM-101 or micronized (S)-ketamine, prepared according to
the procedures described above, are tested using the above
procedure to determine release rate of the otic agent from each
composition.
Example 24
Application of an Enhanced Viscosity Auris Sensory Cell Modulating
Agent Formulation onto the Round Window Membrane
[0676] A formulation comprising AM-101 prepared according to
Example 8 is prepared and loaded into 5 ml siliconized glass
syringes attached to a 15-gauge luer lock disposable needle.
Lidocaine is topically applied to the tympanic membrane, and a
small incision made to allow visualization into the middle ear
cavity. The needle tip is guided into place over the round window
membrane, and the auris sensory cell modulating agent formulation
applied directly onto the round-window membrane.
Example 25
In Vivo Testing of Intratympanic Injection of Auris Sensory Cell
Modulating Agent Formulation in a Guinea Pig
[0677] A cohort of 21 guinea pigs (Charles River, females weighing
200-300 g) is intratympanically injected with 50 .mu.L of different
P407-otic agent formulations described herein, containing 0 to 50%
otic agent. The gel elimination time course for each formulation is
determined. A faster gel elimination time course of a formulation
indicates lower mean dissolution time (MDT). Thus the injection
volume and the concentration of an auris sensory cell modulating
agent in a formulation are tested to determine optimal parameters
for preclinical and clinical studies.
Example 26
In Vivo Extended Release Kinetics
[0678] A cohort of 21 guinea pigs (Charles River, females weighing
200-300 g) is intratympanically injected with 50 .mu.L 17% Pluronic
F-127 formulation buffered at 280 mOsm/kg and containing 1.5% to
35% auris sensory cell modulating agent by weight of the
formulation. Animals are dosed on day 1. The release profile for
the formulations is determined based on analysis of the
perilymph.
Example 27
Evaluation of (S)-Ketamine in a Tinnitus Mouse Model
[0679] Twelve Harlan Sprague-Dawley mice weighing 20 to 24 g are
used. Each mouse is trained to drink from a water dispenser during
periods no sound, but to refrain from drinking in the presence of
sound. Each mouse is administered 350 mg of aspirin per kilogram of
body weight (mg/kg).
[0680] The control group (n=10) are administered saline following
administration of the aspirin. The experimental group (n=10) are
administered (S)-ketamine (400 mg/kg of body weight) following
administration of the aspirin. Administration occurs via an
intra-tympanic injection.
[0681] Following administration of (S)-ketaminewhether the mice
drink in the absence of external sound is monitored.
Example 28
Evaluation of N-Acetylcysteine (NAC) in a Cisplatin-Induced
Ototoxicity Mouse Model
[0682] Methods and Materials
[0683] Induction of Ototoxicity
[0684] Twelve Harlan Sprague-Dawley mice weighing 20 to 24 g are
used. Baseline auditory brainstem response (ABR) at 4-20 mHz is
measured. The mice are treated with cisplatin (6 mg/kg of body
weight). The cisplatin is delivered to the aorta by IV
infusion.
[0685] Treatment
[0686] The control group (n=10) are administered saline following
administration of the cisplatin. The experimental group (n=10) are
administered NAC (400 mg/kg of body weight) following
administration of the cisplatin.
[0687] Analysis of Results
[0688] Electrophysiologic Testing
[0689] The hearing threshold for the auditory brainstem response
threshold (ABR) to click stimuli for each ear of each animal is
initially measured and 1 week after the experimental procedure. The
animals are placed in a single-walled acoustic booth (Industrial
Acoustics Co, Bronx, N.Y., USA) on a heating pad. Subdermal
electrodes (Astro-Med, Inc. Grass Instrument Division, West
Warwick, R.I., USA) were inserted at the vertex (active electrode),
the mastoid (reference), and the hind leg (ground). Click stimuli
(0.1 millisecond) are computer generated and delivered to a Beyer
DT 48, 200 Ohm speaker fitted with an ear speculum for placement in
the external auditory meatus. The recorded ABR is amplified and
digitized by a battery-operated preamplifier and input to a
Tucker-Davis Technologies ABR recording system that provides
computer control of the stimulus, recording, and averaging
functions (Tucker Davis Technology, Gainesville, Fla., USA).
Successively decreasing amplitude stimuli are presented in 5-dB
steps to the animal, and the recorded stimulus-locked activity is
averaged (n=512) and displayed. Threshold is defined as the
stimulus level between the record with no visibly detectable
response and a clearly identifiable response.
Example 29
Clinical Trial of (S)-ketamine as a Treatment for Tinnitus
[0690] Active Ingredient: (S)-ketamine
[0691] Dosage: 10 ng delivered in 10 .mu.L of a thermoreversible
gel. Release of (S)-ketamine is controlled release and occurs over
thirty (30) days.
[0692] Route of Administration: Intratympanic injection
[0693] Treatment Duration: 12 weeks
Methodology
[0694] Monocentric [0695] Prosepective [0696] Randomized [0697]
Double-blind [0698] Placebo-controlled [0699] Parallel group [0700]
Adaptive
Inclusion Criteria
[0700] [0701] Male and female subjects between the 18 and 64 years
of age. [0702] Subjects experiencing subjective tinnitus. [0703]
Duration of tinnitus is greater than 3 months. [0704] No treatment
of tinnitus within 4 weeks.
Evaluation Criteria
[0704] [0705] Efficacy (Primary) [0706] 1. Total score of the
Tinnitus Questionnaire [0707] Efficacy (Secondary) [0708] 1.
Audiometric measurements (mode, frequency, loudness of the
tinnitus, pure tone audiogram, speech audiogram) [0709] 2. Quality
of Life questionnaire [0710] Safety [0711] 1. Treatment groups were
compared with respect to incidence rates of premature termination,
treatment-emergent adverse events, laboratory abnormalities, and
ECG abnormalities.
Study Design
[0712] Subjects are divided into three treatment groups. The first
group is the safety sample. The second group is the intent-to-treat
(ITT) sample. The third group is the valid for efficacy (VfE)
group.
[0713] For each group, one half of subjects to be given
(S)-ketamine and the remainder to be given placebo.
Statistical Methods
[0714] The primary efficacy analysis is based on the total score of
the Tinnitus Questionnaire in the ITT sample. The statistical
analysis is based on an analysis of covariance (ANCOVA) with
baseline as covariant and the last observation carried forward
value as dependent variable. Factor is "treatment." The homogeneity
of regression slopes is tested. The analysis is repeated for the
VfE sample.
[0715] Audiometric measurements (mode, frequency, loudness of the
tinnitus, pure tone audiogram, speech audiogram) as well as quality
of life are also analyzed via the aforementioned model. The
appropriateness of the model is not tested. P values are
exploratory and are not adjusted for multiplicity.
Example 30
Evaluation of AMN082 on Cisplatin-Induced Ototoxicity
[0716] Study Objective
[0717] The primary objective of this study will be to assess the
safety and efficacy of AMN082 (100 mg) compared with that of
placebo in preventing Cisplatin-induced ototoxicity.
[0718] Methods
[0719] Study Design
[0720] This will be a phase 3, multicentre, double-blind,
randomised, placebo-controlled, parallel group study comparing
AMN082 (100 mg) to placebo in the treatment of Cisplatin-induced
ototoxicity. Approximately 140 subjects will be enrolled in this
study, and randomised (1:1) to 1 of 2 treatment groups based on a
randomisation sequence prepared by sponsor. Each group will receive
either AMN082 100 mg or placebo.
[0721] Subjects who do not complete the study will not be replaced.
Patients will receive weekly chemotherapy (cisplatin at a dose of
70 mg/m.sup.2 for 7 weeks and daily radiation. Following
chemotherapy, patients will receive the study drug (AMN082 500 mg
or matching placebo) administered as a gel formulation directly
onto the subjects' round window membrane for 8 weeks.
[0722] Each patient will receive a hearing evaluation before each
treatment with Cisplatin. Two to four weeks after the final dose of
Cisplatin, each patient will receive a hearing evaluation.
Pre-treatment audiogram will be compared with the post treatment
audiogram to determine the degree of cisplatin-induced ototoxicity.
Patients will thereafter receive a hearing evaluation at 4-week
intervals concomitant with the AMN082 treatment.
[0723] Main Criteria for Inclusion
[0724] Male or female outpatients aged between 18 and 75 years
receiving chemotherapy with Cisplatin. Patients expected to receive
a minimum of 3 rounds of chemotherapy. If a subject becomes
pregnant during the study, she will be immediately withdrawn and no
study medication will be administered.
[0725] Exclusion Criteria
[0726] Patients who have had middle ear surgery. Patients who have
active external or middle ear disease. Patients who have preceding
pure tone average of >40 dB HL.
Example 31
Clinical Trial of AM-101 as a Treatment for Noise Induced Hearing
Loss
[0727] Active Ingredient: AM-101
[0728] Dosage: A composition comprising 4% by weight of micronized
AM-101 delivered in 10 .mu.L dose of a thermoreversible gel.
Release of AM-101 is controlled release and occurs over 3
weeks.
[0729] Route of Administration: Intratympanic injection
[0730] Treatment Duration: 12 weeks, one injection every 3
weeks
Methodology
[0731] Monocentric [0732] Prosepective [0733] Randomized [0734]
Double-blind [0735] Placebo-controlled [0736] Parallel group [0737]
Adaptive
Inclusion Criteria
[0737] [0738] Male and female subjects between the 18 and 64 years
of age. [0739] Acoustic trauma followed by hearing loss that is
documented by audiogram and medical report with an inner ear
hearing loss of at least 15 dB [0740] Acute tinnitus that has
persisted for at least 3 months. [0741] No prior treatment of
tinnitus within 4 weeks.
Evaluation Criteria
[0741] [0742] Efficacy (Primary) [0743] 1. Total score of the
Tinnitus Questionnaire [0744] Efficacy (Secondary) [0745] 1.
Audiometric measurements (mode, frequency, loudness of the
tinnitus, pure tone audiogram, speech audiogram) [0746] 2. Quality
of Life questionnaire [0747] Safety [0748] 1. Treatment groups were
compared with respect to incidence rates of premature termination,
treatment-emergent adverse events, laboratory abnormalities, and
ECG abnormalities.
Study Design
[0749] Subjects are divided into three treatment groups. The first
group is the safety sample. The second group is the intent-to-treat
(ITT) sample. The third group is the valid for efficacy (VfE)
group.
[0750] For each group, one half of subjects to be given AM-101 and
the remainder to be given placebo.
Statistical Methods
[0751] The primary efficacy analysis is based on the total score of
the Tinnitus Questionnaire in the ITT sample. The statistical
analysis is based on an analysis of covariance (ANCOVA) with
baseline as covariant and the last observation carried forward
value as dependent variable. Factor is "treatment." The homogeneity
of regression slopes is tested. The analysis is repeated for the
VfE sample.
[0752] Audiometric measurements (mode, frequency, loudness of the
tinnitus, pure tone audiogram, speech audiogram) as well as quality
of life are also analyzed via the aforementioned model. The
appropriateness of the model is not tested. P values are
exploratory and are not adjusted for multiplicity.
Example 32
Clinical Trial of (S)-Ketamine as a Treatment in Combination with
Implantation of a Cochlear Hearing Device
[0753] Active Ingredient: (S)-ketamine in combination with
dexamethasone
Dosage: A composition comprising micronized (S)-ketamine and
micronized dexamethasone, used as a pre-surgical irrigation
solution and a post-surgical irrigation solution. Release of
(S)-ketamine and dexamethasone is immediate release.
Study Design
[0754] Twenty patients will be enrolled in the study. Ten patients
will be in the control group and ten patients will be in the
treatment group.
Eligibility Criteria
[0755] having severe to profound sensorineural hearing impairment
in both ears [0756] having a functioning auditory nerve [0757]
having lived at least a short amount of time without hearing
(approximately 70+ decibel hearing loss, on average) [0758] having
good speech, language, and communication skills, or in the case of
infants and young children, having a family willing to work toward
speech and language skills with therapy [0759] not benefitting
enough from other kinds of hearing aids [0760] having no medical
reason to avoid surgery
[0761] Each patient will be subjected to chochloestomy and
insertion of electrodes. The treatment group will be subjected to
perfusion of the surgical area with the test composition prior to
surgery and after surgery. The patients will be monitored for 6
weeks. Intracochlear trauma will be evaluated based on audiometric
measurements, speech audiogram as well as quality of life.
Occurrence of secondary infections and/or inflammation will be
monitored.
Example 33
Clinical Trial of Auris Sensory Cell Modulator Formulations in
Combination with Surgery
[0762] The purpose of this study is to determine if a composition
comprising a combination of AM-101 and Dexamethasone administered
in combination with tympanostomy is safe and effective in
preventing and/or treating middle ear infections in patients with
ear tubes.
[0763] Study Type: Interventional
[0764] Study Design: This will be a non-inferiority open label
study to compare the current standard of care versus the use of
extended release intratympanic compositions in combination with
tympanostomy. The current standard of care requires the use of otic
drops for 5-7 days post-surgery. The study is designed to test
whether administration of a sustained release composition at the
time of surgery obviates the need for out-patient treatment. The
test hypothesis is that administration of a single injection of an
extended release composition at the time of surgery is not inferior
to administration of otic drops after surgery.
[0765] Inclusion Criteria: [0766] 6 months to 12 years old, hearing
loss in one or both ears [0767] Patient may not have had otic
surgery other than tube placement in the last year [0768] Patient
may not have any disease or condition that would negatively affect
the conduct of the study [0769] Patient may not require any other
systemic antimicrobial therapy during the study. [0770] Analgesic
use (other than acetaminophen) is not allowed
[0771] Exclusion Criteria: Age
[0772] Study Protocol: Twenty patients will be divided into two
groups. The first group of patients will receive an injection of an
extended release composition comprising micronized AM-101 and
micronized dexamethasone, prepared according to Example 22, during
the surgical procedure. Each patient will undergo a tympanostomy
for placement of a tube. During the surgical procedure, the surgeon
will clean the ear and while the myngotomoy incision is open, the
surgeon injects a test composition into the middle ear space. The
tube is inserted after injection of the extended release
composition into the middle ear space. The test composition is
either prepared in the operating room by suspending dry micronized
powder of AM-101 and dexamethasone with other excipients, or the
test composition is a prepared suspension ready for injection.
[0773] The second group of patients will be given ear drops
comprising non-micronized AM-101 and non-micronized dexamethasone
as immediate release components to be administered for 5-7 days
after the surgery.
[0774] Patients are monitored with weekly follow up visits for one
month. Any differences in treatment outcomes between the two groups
are recorded.
[0775] Primary Outcome Measures: Time to cessation of otorrhea as
recorded by the parent or guardian via a patient.
[0776] Secondary Outcome Measures: Clinical cure rate;
Microbiological outcome; Treatment failures; Recurrence of
disease.
[0777] The treatment outcome for each group of patients is compared
to determine whether administration of the extended release
composition comprising AM-101 and dexamethasone in combination with
tympanostomy is no worse than administration of ear drops
comprising AM-101 and dexamethasone after surgery for reduction of
otorrhea, infections, and/or inflammation associated with
tympanostomy.
[0778] While preferred embodiments of the present invention have
been shown and described herein, such embodiments are provided by
way of example only. Various alternatives to the embodiments
described herein are optionally employed in practicing the
inventions. It is intended that the following claims define the
scope of the invention and that methods and structures within the
scope of these claims and their equivalents be covered thereby.
* * * * *
References