CN1110301C - 供吸入的治疗学制剂 - Google Patents
供吸入的治疗学制剂 Download PDFInfo
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- CN1110301C CN1110301C CN94193190A CN94193190A CN1110301C CN 1110301 C CN1110301 C CN 1110301C CN 94193190 A CN94193190 A CN 94193190A CN 94193190 A CN94193190 A CN 94193190A CN 1110301 C CN1110301 C CN 1110301C
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- insulin
- preparation
- respiratory tract
- lower respiratory
- therapeutics preparation
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- 230000001225 therapeutic effect Effects 0.000 title abstract 2
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Abstract
本发明提供了一种供吸入的治疗学制剂,它包含胰岛素和一种促进胰岛素在下呼吸道吸收的物质,以适合吸入的干粉制剂形式提供。
Description
本发明涉及一种胰岛素的治疗学制剂,该制剂适合吸入。
胰岛素在体内碳水化合物、脂肪、和蛋白质代谢的调节中起着重要作用。糖尿病(Diabetes mellitus)(通常简称为糖尿病(diabetes))是一种以代谢紊乱,特别是葡萄糖代谢紊乱为特征的疾病。在正常人中,血糖水平的上升(例如在紧随进食后所发生的那样)引起胰腺的胰岛beta细胞向血流中分泌一种肽类激素,胰岛素。胰岛素与很多类型的细胞最显著的是肌肉细胞上的胰岛素受体结合,从而用信号通知细胞增加将葡萄糖摄入细胞的速度。当血糖恢复至正常的餐前水平时,血液中的胰岛素量也下降。在缺乏胰岛素时,血糖水平可上升至危险的高度(一种称为高血糖症的病症),有可能导致死亡。过多的胰岛素引起不正常的低血糖水平(低血糖),这也是危险的并且可能致死。在正常人,内在的反馈环调节胰岛素的分泌和从系统循环中的清除,从而避免高血糖和低血糖症两者的发生。
糖尿病是一种影响瑞典约3%人口的疾病。在这3%中,近20%患I型糖尿病,其余的患II型糖尿病。
I型糖尿病,或胰岛素依赖型糖尿病(IDDM),通常在儿童期发病。其特点为胰腺的beta细胞萎缩,导致胰岛素产生的减少或停止,使病人依赖外源性胰岛素才能生存。
更常见的II型糖尿病,或非胰岛素依赖型糖尿病(NIDDM),一般发生于大于40岁的病人。尽管这些病人可能具有正常的或甚至是高的血中胰岛素水平,至少在疾病开始时是这样,但表现出胰岛素引起的细胞摄取葡萄糖的速度不正常的低下。虽然常可通过控制病人的饮食治疗II型糖尿病,但施用外源性胰岛素以补充病人beta细胞所分泌的胰岛素可能也是必要的。
有效剂量的胰岛素不能口服给药,因为在胰岛素到达血流中前已因胃肠道中的酶和胃中的低pH值被迅速降解。给药的标准方法是皮下注射胰岛素的等渗溶液,通常由病人自己注射。由于需要注射,给很多患者带来了很多的不便和不适,而且在注射部位还可发生局部反应。此外,注射胰岛素还有不正常的、非生理的血浆浓度分布。这种不正常的血浆浓度分布是不希望有的并且增加与糖尿病的长期治疗有关的副反应发生的危险。
由于这些不利之处,需要一种经非注射途径给药的形式的胰岛素。已提出多种设想,试图生产这样的各种形式的胰岛素。例如,已提出经鼻,经直肠和经颊给药的产品,较多的努力集中在经鼻给药的产品上。然而鼻腔给药仍存在问题而且只有很低的生物利用度。近些年来经肺部应用系统活性药物引起了越来越多的关注,一些研究中包括了经肺部应用胰岛素。其中绝大多数均涉及经肺应用的溶液或悬浮液,例如通过喷雾器或加压的用表测量的剂量吸入器应用,而所有这些都只取得了有限的成功。
本发明
我们现已发现胰岛素可被包括在一种供吸入的干粉制剂中并还包含一种促进胰岛素在肺内吸收的物质,从该制剂,胰岛素能以治疗学上可接受的速度和量被吸收。“促进吸收”一词的含义是指在有增强剂存在时吸收入系统循环的胰岛素的量较无增强剂存在时吸收的量高。
所以按照本发明,提供了一种治疗学制剂,它包含活性化合物(A)胰岛素,和(B)一种促进胰岛素在下呼吸道吸收的物质。该制剂制成适合吸入的干粉形式,其中活性化合物总质量的至少50%由(a)直径小于约10微米,比如在0.01和10微米之间,而优选1和6微米之间的初级颗粒,或(b)所述颗粒的附聚物组成。
本发明的治疗学制剂可只包含所述的活性化合物,或者它也可含有其它物质,如可药用载体。这种载体可主要由直径小于约10微米的颗粒组成,以使所产生的粉末的至少50%作为一个整体是由直径小于约10微米的初级颗粒任意地聚集而组成的;或者载体可主要由更大的颗粒(“粗颗粒”)组成,从而在活性化合物和所述载体间形成“有序的混合物”。在有序的混合物(也可称为相互作用的或粘着的混合物)中,细的药物颗粒(在本发明中为所述活性化合物)相当均匀地分布于粗的赋形剂颗粒(在本发明中为可药用载体)表面。优选在这些情况下活性化合物在形成有序的混合物之前不呈附聚物形式。粗颗粒的直径可大于20微米,例如大于60微米。在这些低限以上,粗颗粒的直径不是特别重要,因而根据需要,按照特定配方的实际要求,各种粗颗粒尺寸均可应用。不要求有序的混合物中的粗颗粒是同一尺寸的,但粗颗粒在有序的混合物中最好是相近尺寸的。优选地,粗颗粒具有60-800微米的直径。
因此在本发明的一项具体实施方案中提供了一种胰岛素和一种促进胰岛素在下呼吸道吸收的物质的治疗学制剂。该制剂制成适合吸入的干粉制剂形式,其中至少50%(质量)由(a)直径小于约10微米的颗粒或(b)所述颗粒的附聚物组成;在另一具体实施方案中,本发明提供了一种包含胰岛素、一种促进胰岛素在下呼吸道吸收的物质、和一种可药用载体的治疗学制剂,该制剂制成适合吸入的干粉形式,其中至少50%(质量)由(a)直径小于约10微米的颗粒,或(b)所述颗粒的附聚物组成;在还有另一具体实施方案中,本发明提供了一种包含活性化合物(A)胰岛素和(B)一种促进胰岛素在下呼吸道的吸收的物质,以及一种可药用载体的治疗学制剂,其中活性化合物(A)和(B)总质量的至少50%由直径小于约10微米的颗粒组成,该制剂制成适合吸入的干粉制剂形式,在该制剂中活性化合物与可药用载体之间可形成有序的混合物。
优选活性化合物(A)和(B)总质量的至少60%例如至少70%或至少80%而更优选至少90%由直径小于约10微米的颗粒组成,或由这种颗粒的附聚物组成。并且,当所需要的是包含载体的干粉制剂而不是有序的混合物时,优选全部干粉质量的至少60%例如至少70%或至少80%,并更优选至少90%由直径小于约10微米的颗粒或这种颗粒的附聚物组成。
不管有或无可药用载体,由于供吸入的干粉可含有上述颗粒的附聚物,所以在吸入时任何的附聚物都应基本上解聚,并产生一种其中至少50%由直径最高达10微米的颗粒组成的粉末。附聚物可以是经控制的聚集过程的结果,或也可简单地是粉末颗粒紧密接触的结果。不管是哪种情况,重要的是附聚物应可通过吸入器中的机械方法或其它方法被解聚为前面所述的颗粒。附聚物一般地优选不在有序的混合物中形成。在有序的混合物这种情况下,优选在吸入时,或者通过吸入器中的机械方式或简单地通过吸入动作,或通过其它途径,可从大颗粒中释放出活性化合物,然后使活性化合物沉积于下呼吸道而载体颗粒留在口中。
胰岛素的任何生物活性形式或衍生物均可用于本发明。例如牛的、猪的、或生物合成或半合成的人胰岛素、或人胰岛素的生物活性衍生物(“改型胰岛素”),例如Brange等人在“Diabetes Care”13:923,1990中所讲述的具有某些氨基酸取代者,均可应用。改型胰岛素被开发的目的是改进各种性能,例如改善稳定性或给予改良的药物动力学特性(profile)(即改良的经上皮细胞膜吸收的特性(profile))。该胰岛素应具低锌含量,因为锌降低胰岛素的溶解度,可能降低吸收速度,并且还因为锌可与用于本发明的某些增强剂物质形成不希望产生的不可溶沉淀。此外,该胰岛素应为可在水溶液中迅速溶解的干粉形式。
在下文中称为增强剂的促进胰岛素在肺中吸收的物质可为许多化合物中的任意一个,这些化合物的作用为促进通过下呼吸道中的上皮细胞层的吸收,并吸收入相邻的肺脉管系统。增强剂可通过任何下述几种可能机制实现这种作用:
(1)通过引起上皮细胞间紧密连接的结构改变增加胰岛素的细胞旁通透性。
(2)通过与膜的蛋白或脂质组分互相影响或提取膜的蛋白或脂质组分,从而使膜的完整性紊乱,而增加胰岛素的穿细胞通透性。
(3)增加胰岛素在水溶液中的溶解性的、增强剂与胰岛素间的相互作用。这可能通过防止胰岛素附聚物(二聚物、三聚物、六聚物)的形成,或通过在增强剂胶粒中增溶胰岛素分子而发生。
(4)使沿肺泡和肺气道分布的粘液障壁的粘性减小或使其溶解,从而暴露出上皮表面,以便直接吸收胰岛素。
增强剂可通过上述的单一一种,或两种或多种机制起作用。通过几种机制起作用的增强剂比只使用一或两种者更可能促进胰岛素的有效吸收。例如,表面活性剂是一族据信可通过上述所有四种机制起作用的增强剂。表面活性剂是具有亲脂和亲水两个部分的两亲分子,这两种特性之间具有各种平衡。如果该分子是非常亲脂的,则这种物质在水中的低溶解度可能限制其用途。然而,如果亲水部分绝对占优势,则该分子的表面活性特性可能最小。因而,表面活性剂只有在足够的溶解度和足够的表面活性之间达到合适的平衡时才有效。
表面活性剂另一个可能具有重要性的特性是在肺中pH值(近似7.4)时表面活性剂的净电荷。胰岛素的等电pH值为5.5。在pH7.4时,胰岛素带负的净电荷。这导致胰岛素分子间的静电排斥,从而防止聚集而增加溶解度。如果表面活性剂也带负电荷,然而可与胰岛素通过比如憎水相互反应而相互作用,则胰岛素分子间将产生附加的排斥。因此,阴离子表面活性剂通过帮助胰岛素稳定在单体状态而具有促进吸收的附加优越性(与在生理性pH值时带净正电荷或中性者相比)。
一些在本发明的方法中作为增强剂的潜在地有用的不同的化合物在大鼠中按下面实施例5中所述方法进行试验。具有已知吸收促进特性,或具有使其作为可能的候选物用于本发明的方法中的物理特性的其它物质,可很容易地由本领域技术人员用体内测定法或按照实施例6中所述的体外测定法进行测试。
有可能两种或多种增强剂物质的结合也给出满意的结果。在本发明的方法中使用这样的结合应认为是在本发明的范围中。
在本发明的方法中有用的增强剂同时具备对胰岛素吸收的有效促进作用和(1)在使用的浓度下没有毒性和(2)好的粉末性质,即在固体状态没有粘性或蜡样坚固性。可使用诸如MTT测定法,如在Int.J.Pharm.,65(1990),249-259中所述方法之类的标准方法测定给定物质的毒性。给定物质的粉末特性可从已发表的有关该物质的资料确定或经验地确定。
一非常有前途类型的增强剂是脂肪酸的盐。已发现碳链长度为10(即癸酸钠),12(月桂酸钠)和14(肉豆蔻酸钠)的饱和脂肪酸的钠盐在本发明的方法中表现良好。还发现癸酸的钾盐和赖氨酸盐在本发明的方法中也有效。如果碳链的长度短于约10,则该表面活性剂的表面活性可能过低,而如果链长度长于约14,则脂肪酸盐在水中溶解度的下降限制了其用途。
本发明中最优选的促进胰岛素在下呼吸道吸收的物质是癸酸钠。
因此在本发明的一项特别优选的实施方案中提供了一种治疗学制剂,它包含适合吸入的干粉形式的活性化合物(A)胰岛素和(B)癸酸钠,其中活性化合物(A)和(B)总质量的至少50%由(a)具有小于约10微米的直径,例如在0.01至10微米之间并优选在1至6微米之的初级颗粒,或(b)这种颗粒的附聚物组成;具体地,在这项特别优选的实施方案中本发明提供了:
一种胰岛素和癸酸钠的治疗学制剂,该制剂制成适合吸入的干粉形式,其中至少50%(质量)由(a)直径小于约10微米的颗粒或(b)所述颗粒的附聚物构成;
一种包含胰岛素、癸酸钠和一种可药用载体的治疗学制剂,该制剂制成适合吸入的干粉形式,其中至少50%(质量)由(a)直径小于约10微米的颗粒或(b)所述颗粒的附聚物构成;和
一种由活性化合物(A)胰岛素和(B)癸酸钠组成的治疗学制剂,其中活性化合物(A)和(B)的总质量的至少50%由直径小于约10微米的颗粒组成。该制剂还包含一种可药用载体。该制剂制成适合吸入的干粉制剂形式,其中活性化合物和可药用载体之间可形成有序的混合物。
不同的抗衡离子可改变饱和脂肪酸盐在水中的溶解度。这样,具有10至14以外的碳链长度的增强剂也可能被证实甚至比上述具体提及的增强剂更具优越性。在本发明中不饱和脂肪酸盐也可能有用,因为它们比饱和脂肪酸盐更易溶于水,因而可具有比后者更长的链长度而仍维持成功的胰岛素吸收增强剂所需的溶解性。
测定了胆汁盐和胆汁盐衍生物作为本发明的方法中的增强剂的可用性。所有那些被测试者(乌素脱氧胆酸盐(ursodeoxycholate),牛磺胆酸盐,甘氨胆酸盐,和牛磺二氢梭链孢酸盐(taurodihydrofusidate)的钠盐)均有效地促进肺中胰岛素的吸收。
对磷脂类也作为增强剂予以测试。发现一种单链磷脂(溶血磷脂酰胆碱)是一种有效的增强剂,而两种双链磷脂(二辛酰磷脂酰胆碱和二癸酰磷脂酰胆碱)则不是。这一点可用双链磷脂在水中的溶解度远小于它们的单链对应物这一事实来解释。然而,有理由期望链长度较短的双链磷脂由于比其较长链的对应物具有更大的水溶性,因而有可能在本发明中用作增强剂。这样,单链和双链磷脂两者都可能得到应用。
一种糖苷,即辛基吡喃葡糖苷,也作为本发明中的增强剂被测试并被发现具有一些促进吸收的性质。其他的烷基糖苷例如硫吡喃葡糖苷和吡喃麦芽糖苷也可望在本发明的方法中具有促进吸收的性质。
环糊精类及其衍生物有效地促进胰岛素的鼻吸收,并可在肺中起类似作用。二甲基-β-环糊精在本发明的方法中被测试并被发现具有促进吸收的效果。
其它可能有用的表面活性剂是水杨酸钠,5-甲氧基水杨酸钠,和天然存在的表面活性剂诸如甘草酸(glycyrrhizine acid)、皂草苷糖苷和酰基肉碱类的盐。
对于离子性的增强剂(如上文所述的阴离子表面活性剂),抗衡离子的性质可能是重要的。所选的具体抗衡离子可能影响增强剂或包含增强剂的任何制剂的粉末特性、溶解性,稳定性,收湿性,和局部/系统毒性。还可影响其与之结合的胰岛素的稳定性和/或溶解性。一般来说,可望单价金属阳离子如钠、钾、锂,铷,和铯能用作阴离子性增强剂的抗衡离子。氨和有机胺形成另一类阳离子,被期望适合用于具有羧酸部分的阴离子性增强剂。这种有机胺的实例包括乙醇胺,二乙醇胺,三乙醇胺,2-氨基-2-甲基乙基胺,甜菜碱类,乙二胺,N,N-二苄基(bensyl)亚乙基四胺,精氨酸,六亚甲基四胺,组氨酸,N-甲基哌啶,赖氨酸,哌嗪,亚精胺,精胺和三(羟甲基)氨基甲烷。
由于已观察到许多被测试的增强剂具有对肺中胰岛素吸收的有效促进作用,因此期望发现更多的可起这种作用的物质。淀粉微球体有效地促进经鼻粘膜施用的胰岛素的生物利用度,并在本发明的方法中被作为增强剂进行测试。虽然在本文使用的动物模型中证实它们在经肺施用的途径中仅有很小用途,但认为这主要是由于技术上的困难所致,如果克服了,即可导致成功的经肺途径的施用。螯合剂是一组被认为通过结合钙离子发生作用的增强剂。由于钙离子协助维持细胞之间空间的大小并额外地减小胰岛素的溶解性,所以结合掉这些离子从理论上说可既增加胰岛素的溶解性,又增加胰岛素的细胞旁通透性。虽然测试的一种整合剂,即乙二胺四乙酸(EDTA)的钠盐,在测试的大鼠模型中被发现在促进胰岛素吸收方面无效,但其它钙离子-结合螯合剂有可能被证实更有用途。
通常,在保证快速而有效的促进胰岛素吸收的范围内,保持胰岛素对增强剂的比率尽可能高是合乎需要的。为了最大限度地减小归因于增强剂的副反应的危险,包括局部的和系统的,这一点是重要的。通过在如本文所述的体内模型中测试各种比率可确定任何给定的增强剂的胰岛素对增强剂的最适宜比例。胰岛素对增强剂的比率可以在9∶1至1∶1范围内,适宜地为5∶1至2∶1范围内,优选4∶1至3∶1范围内。例如,胰岛素与癸酸钠按下述重量/重量比率结合:50/50,75/25,82.5/17.5,和90/10。在含50%和25%癸酸钠时胰岛素的吸收得到显著提高。10%只给予吸收方面极差的提高,而17.5%得到的结果居中。这表明在本发明的方法中使用的癸酸钠的最低有效浓度接近15-25%,并很可能为20-25%。其它的增强剂可具有更高的或更低的相对于胰岛素的浓度,因此每一个个别的增强剂必须分别予以测试。然而基于上述结果,期望表面活性剂型的增强剂的最理想的比率一般在胰岛素/增强剂混合物的10%和50%之间,例如在15%和50%之间比如在25%和50%之间。应当注意的是,上述比率代表增强剂仅仅相对于胰岛素的比率,而未考虑在内任何载体或其它可能添加的例如为提高配方的粉末特性而添加的添加剂。
按照本发明吸收的胰岛素量可显著高于无增强剂存在下的吸收量。在本文的实施例4中显示,一种按照本发明的治疗学制剂,当被吸入后,其生物利用度比单独胰岛素的吸入制剂高三倍以上。
优选地,按照本发明吸收的胰岛素量显著(p<0.05)高于缺乏增强剂时的吸收量。
如上文所述,通常包括在治疗学制剂中的添加物质,如可药用载体,可包括在本发明的治疗学制剂中。制剂中包括添加物质的目的是,例如:将粉末稀释至合适的量以适于经特殊打算使用的粉末吸入器给药;易化制剂的加工;提高制剂的粉末特性;提高制剂的稳定性(例如通过抗氧化剂或调节pH值的化合物);或给制剂增加口味。任何的添加剂不应不利地影响胰岛素或吸收增强剂的稳定性,或不利地妨碍胰岛素吸收。它也应是稳定的,不吸湿的,具有良好的粉末特性并没有气道副反应。作为潜在的添加剂的实例可以提及单糖、双糖、和多糖、糖醇类和其它多元醇,例如乳糖、葡萄糖、棉子糖、松三糖、乳糖醇(lactitol)、麦芽糖醇(maltitol)、海藻糖、蔗糖、甘露糖醇和淀粉。由于还原糖如乳糖和葡萄糖具有与蛋白质形成复合物的倾向,非还原糖如棉子糖、松三糖、乳糖醇、麦芽糖醇、海藻糖、蔗糖、甘露糖醇和淀粉可能是用于本发明的优选的添加剂。根据所要使用的吸入器,这种添加剂的总量可在非常宽的范围内改变。在一些情况下需要很少或不需要添加剂,而例如在吸入器运行需要大量粉末体积的情况下,治疗学制剂中很高百分比由添加剂组成。添加剂的需要量可由本领域技术人员根据具体情况很容易地确定。
一种将粉末送入患者肺中的有用的机制是通过一件适合干粉吸入的轻便吸入器装置。很多这种装置,典型的是被设计用于施用抗哮喘或抗炎症剂于呼吸系统者,可在市场上购买。优选该装置是干粉吸入器,其设计使粉末防止受潮从而没有偶然的大剂量的危险;此外还希望尽可能多的下述特点:使粉末避光;高的可呼吸部分和在主要流速间歇期的高的肺沉降率;低的剂量和可呼吸部分偏差;低的口罩内粉末存留;对吸收器表面的低吸附;剂量大小的灵活性;和低吸入阻力。该吸入器优选为单次剂量吸入器,虽然多次剂量吸入器也可使用。后者优选例如具有多种用途的多次剂量、呼吸启动的、干粉吸入器。优选所使用的吸入器为具有单一用途的单次剂量、呼吸启动的、干粉吸入器。
所述粉末制剂可用常规技术按几种方法制备。可能需要在加工过程的某一时刻在适用的碾机中,例如在喷射碾机(jet mill)中使活性化合物和如果必要时(即不想要有序的混合物的情况下)任何载体微粒化,以生产具有适合在下呼吸道最大沉积的大小范围(即小于10μm)的初级颗粒。例如,可将胰岛素和增强剂粉末干燥混合,如果必要的话也与载体一起干燥混合,然后使这些物质一起微粒化:或者,这些物质也可分别微粒化,然后再混合。当要混合的化合物具有不同的物理性质例如坚硬度和脆性时,对微粒化的抵抗力就不同,因而它们可能需要不同的压力才能破裂为合适的颗粒大小。因而,当它们在一起微粒化时,所得到的一种成分的颗粒大小可能是不令人满意的。在这种情况下使不同的成分分别微粒化然后再将它们混合是有利的。
也可能先将这些成分,如果不想要有序的混合物则还可将任何载体,溶于合适的溶剂例如水中,以在分子水平上取得混合。这一方法也使调节pH值至所希望的水平成为可能。已经知道胰岛素的经鼻吸收受制剂的pH值影响,当pH值从胰岛素的等电点,即5.5左右不论向上或向下移动时吸收均增加。但是,在pH值显著高于或低于5.5时胰岛素的稳定性可能减小,而且还应考虑到对于吸入产品pH3.0至8.5的可药用限度,因为pH值在此限度以外的产品可能引起气道激惹和收缩。为了得到粉末,必须将溶剂经过一种能保持胰岛素的生物活性的过程去除。适合的干燥方法包括真空浓缩、开放(open)干燥、喷雾干燥、和冷冻干燥。一般应避免温度在40℃以上超过几分钟,因为胰岛素可发生一些降解,在干燥步骤之后,如果需要,可将固体材料研磨成粗粉末,然后,如果需要的话,再微粒化。
如果需要,该微粒化的粉末可被进一步加工以提高流动性质,例如,通过干式造粒形成,形成具有优良的操纵(handling)特性的球形附聚物,然后再将其加入所想使用的吸入器装置。在这种情况下,该装置应制成一定形状以保证附聚物在离开该装置前基本解聚,以使进入患者呼吸道的颗粒大部分在所希望的大小范围之内。
当需要有序的混合物时,如果需要的话,可通过例如微粒化加工活性化合物,以得到在特定大小范围内的颗粒。也可对载体进行加工,比如为取得所希望的大小和所希望的表面特性,例如特定的表面与重量比值,或某种粗糙度,以保证有序的混合物中的最佳粘附力。这种有序的混合物的物理学要求是公知的,取得符合所述要求的有序的混合物的各种方法也是公知的,这可由技术人员根据具体情况很容易地确定。
现通过实施例描述本发明,这些实施例是用于说明的,而非限定本发明的范围。
实施例 比较实施例 胰岛素的治疗学制剂,不含增强剂
将半合成的人胰岛素(Diosynth,0.8g)和水(150ml)加入烧杯中,用1M HCl将pH值降至pH3.4然后用1M NaOH漂洗使之升至pH7.4,以溶解胰岛素。
将乳糖(可商业化地得到,9.2g)加入并再将pH值调至pH7.4。将溶液搅动直至澄清或稍星乳白色,并在37℃温度下蒸发浓缩约2天时间。
将得到的固体饼压碎,通过0.5mm的滤网筛分,所得到的粉末通过喷射碾机微粒化成具有约2微米直径的颗粒。实施例1 胰岛素和癸酸钠的治疗学制剂:比率75∶25
将半合成人胰岛素(9.75g)和水(250ml)加入烧杯中。用1MHCl将pH值降至pH3.4,然后用1M NaOH漂洗使之升至pH7.4,以溶解胰岛素。
将癸酸钠(Sigma,3.25g)加入并将pH再调至pH7.4。将溶液搅动直至澄清或稍呈乳白色,在37℃温度下蒸发浓缩约2天时间。
将得到的固体饼压碎,通过0.5mm的滤网筛分,并将得到的粉末通过喷射碾机微粒化成具有约2微米直径的颗粒。实施例2 胰岛素和癸酸钠的治疗学制剂,含有乳糖;比率50∶25∶25
将半合成人胰岛素(7.5g)按照实施例中所述方法溶于水(150ml)。将癸酸钠(3.75g)和乳糖(3.75g)加入并按照实施例1的方法产生主要由直径约2微米的颗粒组成的粉末。实施例3 胰岛素和癸酸钠的治疗学制剂,含乳糖;比率4∶4∶92
按照实施例2的方法,使用0.5g半合成人胰岛素,150ml水,0.5g癸酸钠和11.5g乳糖。吸入研究 研究1
实施例1中的制剂被用于在两条狗中的吸入研究。将该制剂装入Wright Dust Feed吸入装置并对狗施用。剂量水平为1U./kg(1U.=1单位人胰岛素=35μg人胰岛素,100%)在不同时间间隔测定血糖和血浆胰岛素水平并将结果归纳于下面的表1和表2。
表I
暴露(expo)终止后血样本时间(分钟) | 血糖(mmol/L) | 胰岛素浓度(μU/ml) |
之前 | 3.9 | 6.70 |
0.5 | 3.6 | 120.66 |
5 | 2.8 | 194.47 |
10 | 2.6 | 195.39 |
20 | n.d. | 139.74 |
22.5 | 1.6 | n.d. |
31 | 2.0 | 73.42 |
45 | 1.7 | 47.49 |
59.5 | 1.7 | 36.21 |
89.5 | 2.3 | 19.28 |
120 | 3.0 | 14.58 |
240 | 4.5 | 5.28 |
n.d.=未测定
表II
暴露(expo)终止后血样本时间(分钟) | 血糖(mmol/L) | 胰岛素浓度(μU/ml) |
之前 | 3.9 | 44.84 |
3 | 4.2 | 165.10 |
6 | 4.3 | 158.28 |
12 | 3.9 | n.d. |
14 | n.d. | 180.72 |
19 | 3.0 | 133.75 |
30 | 2.7 | 143.71 |
45 | 2.5 | 91.62 |
60 | 2.4 | 66.70 |
90 | 2.7 | 38.58 |
122 | 3.7 | 29.15 |
241 | 4.1 | n.d. |
242.5 | n.d. | 19.76 |
n.d.=未测定
这些表说明胰岛素/癸酸钠制剂显著增加血浆胰岛素水平并降低血糖。血浆胰岛素峰值和血糖的最小值分别在约15和60分钟后达到。研究2
比较实施例和实施例1中的制剂通过一种Wright Dust Feed吸入装置,以恒定的1U./kg剂量水平分别各对4或5只狗施用。在不同的时间点测定每个制剂对血浆胰岛素水平和血糖水平的影响并将结果显示子图1和图2。发现不含增强剂的对照制剂基本不使血浆胰岛素水平产生变化,而包含胰岛素和增强剂两者的制剂使血浆胰岛素水平从零时间点的约20μU/ml上升至吸入粉末15分钟后的约80μU/ml。类似地,对照动物在吸入不伴增强剂的胰岛素后记录到最大的血糖下降约为0.5mmol/L,而吸入胰岛素加增强剂的动物记录到约1.7mmol/L的短暂下降,从约4.0mmol/L降至约2.3mmol/L。因此,胰岛素与增强剂、癸酸钠一起被快速地吸收入系统循环并被快速清除出去,引起对应的短暂的血糖水平下降。相反地,胰岛素加载体(乳糖)而非增强剂仅测定到很小程度的吸收(p=0.0002,胰岛素/癸酸盐VS胰岛素/乳糖。)研究3
实施例1-3的制剂各自在不同剂量水平在两条狗中测试。这些制剂通过Wright Dust Feed吸入装置施用。在吸入后在不同时间间隔测定血浆胰岛素和血糖水平。结果在图3-6中显示,表明按不同比例与癸酸钠结合使用的胰岛素很快被吸收并在20-30分钟后达到峰值,继以相应的血糖水平的下降。结果还显示通过胰岛素粉末的吸入可得到比胰岛素的皮下注射后得到的分布图更接近自然的生理分布图的血浆分布图。实施例4 胰岛素和癸酸钠,75∶25;微粒化的粉末的混合
将生物合成的人胰岛素(53g)在Airfilco Jet Mill(商标,Airfilco Process Plant Limited)中用加压氮气(进料压力7巴,室压力5巴)微粒化,至总平均直径(mass median diameter)为2.4微米。
将癸酸钠(170g)在Airfilco Jet Mill(TM)中用加压氮气(进料压力5巴,室压力3巴)微粒化,至总平均直径为1.6微米。
按照下述方法将微粒化的生物合成人胰岛素(45g)和癸酸钠(14.26g)干燥混合:将胰岛素的一半加入包括一个体积4.4升的混合量筒的混合装置中,该量筒被一个宽1mm的筛网分为两室,每室中有一个金属环帮助混合和搅拌。将癸酸钠并最终将剩下的胰岛素加入。将混合量筒密封,转180度,并安置在一个电动的震动装置中。将马达开动并持续震动约2分钟,直至所有的胰岛素和癸酸钠都已通过滤网。将马达关掉并将混合量筒转180度,再安置在震动装置上并再次进行震动,直至所有的粉末均已通过滤网。这一程序再重复8次,使总混合时间达到约20分钟。
将如此得到的制剂通过使用Wright Dust Feed吸入装置以剂量水平为1U./kg吸入施用于5只狗,并在施用后不同时间点测定血浆胰岛素水平。
取得的结果与上述微粒化为具有2.4微米的总平均直径的生物合成胰岛素以同样方式和同样剂量水平施用于5只狗所得到的血浆胰岛素水平比较,并与将胰岛素和癸酸钠按90∶10的比例组成的治疗学制剂按上述同样方式和同样剂量水平施用于5只狗所得到的血浆胰岛素水平相比较。在这种情况下该治疗学制剂按下述方法进行制备:人的半合成胰岛素用凝胶过滤以使锌含量从相当于胰岛素的含量的0.52%减少至0.01%。将胰岛素(4.5g)和癸酸钠(0.5g)溶于水(232ml)中。将溶液搅动直至澄清并调pH值至7.0。溶液在37℃经过约2天时间通过蒸发进行浓缩。将所得到的固体饼压碎,并用0.5mm滤网过筛,并将得到的粉末经喷射碾机微粒化为具有3.1微米的总平均直径的颗粒。
这些比较的结果显示于图9。结果表明与单用胰岛素相比,本发明的90∶10配方的胰岛素的生物利用度有一定的提高,而本发明的75∶25制剂的胰岛素的生物利用度显著提高。(75∶25与100∶0间的差异,p=0.0147)。实施例5 增强剂的选择
在大鼠模型中试验表III中所列的每种化合物促进胰岛素吸收的能力,从而影响血糖水平的能力。使用不同形式的胰岛素:重组的或半合成的人的或牛的胰岛素。每种配方按照上面实施例1-3中所述方法制备,干燥并加工胰岛素/增强剂溶液以生产一种可吸入的粉末。
将粉末通过吸入施用于大鼠,随后监测大鼠的血糖水平。将这些水平与从吸入无增强剂的胰岛素配方的大鼠得到的相对应值相比较。
表III
物质 | 增强剂∶胰岛素∶乳糖 | 效果 |
辛基吡喃葡糖苷 | 4∶4∶92 | (+) |
乌素脱氧胆酸钠 | 4∶4∶92 | + |
牛磺胆酸钠 | 4∶4∶92 | + |
甘氨胆酸钠 | 4∶4∶92 | + |
溶血磷脂酰胆碱 | 4∶4∶92 | + |
二辛酰磷脂酰胆碱 | 2∶4∶94 | (+) |
二癸酰磷脂酰胆碱 | 4∶4∶94 | - |
牛磺二氢棱链孢酸钠 | 2∶4∶94 | + |
辛酸钠 | 25∶75∶0 | - |
癸酸钠 | 10∶90∶0 | (+) |
癸酸钠 | 17.5∶82.5∶0 | (+) |
癸酸钠 | 25∶75∶0 | + |
癸酸钠 | 4∶4∶92 | + |
月桂酸钠 | 25∶75∶0 | (+) |
油酸钾 | 4∶4∶92 | + |
癸酸钾 | 27∶73∶0 | + |
赖氨酸癸酸盐 | 35∶65∶0 | + |
肉豆蔻酸钠 | 30∶70∶0 | + |
二甲基-β-环糊精 | 75∶25∶0 | + |
+ 有效,即增强剂使血糖水平显著下降
- 无或很小效果
(+)有效,不如“+”显著实施例6 增强剂的选择
使用上皮细胞系,CaCo-2(可从美国典型培养物保藏中心(ATCC),Rockville,MD,USA得到)建立了一种标准的体外测定法,用以评价各种增强剂化合物促进胰岛素和其它标记物穿过单层上皮细胞层转运的能力,该上皮细胞层是作为在肺中起到将肺泡与肺血供应分开的功能的上皮细胞层的一个模型。在该测定法中,将增强剂和胰岛素或其它标记物以不同的比例和/或浓度溶于水溶液,并应用于单层细胞层的顶侧。在37℃和95%RH(相对湿度)下温育60分钟后,测定细胞基底旁侧(basolateral side)的标记物总量:例如,通过使用放射性标记的标记物。对于图5和6中显示的实验中测定的特定增强剂(癸酸钠),在基底旁测出现的标记物(甘露糖醇,分子量360)的总量依赖于所用增强剂的浓度,至少达16mM癸酸钠(图7)。甚至于当胰岛素被加入增强剂/甘露糖醇混合物(癸酸钠∶胰岛素,重量比1∶3)中时更是如此(图8)。还发现癸酸钠的这一浓度(16mM)促进胰岛素穿过单层细胞层吸收。与没有任何增强剂情况下的总量相比,在有16mM癸酸钠存在下,穿过单层细胞层的胰岛素总量增加为2倍。预期在更高浓度的癸酸钠存在下,细胞的通透性将进一步增加;然而癸酸钠的潜在细胞毒性可能妨碍该特定增强剂的实际上更高浓度的使用。
这种上皮细胞通透性的体外模型可作为用于快速测定任何所需的增强剂在本发明的方法中的用途的筛选工具。
Claims (49)
1.一种治疗学制剂,它包含活性化合物(A)胰岛素和(B)一种促进胰岛素在下呼吸道吸收的物质,呈适合吸入下呼吸道的干粉形式,其中活性化合物的总质量的至少50%由(a)具有最高达10微米直径的颗粒或(b)该颗粒的附聚物组成,其中增强胰岛素在下呼吸道中吸收的物质是胆汁盐或胆汁盐衍生物,磷脂(条件是如果它是双链磷脂,则该磷脂的每个链在长度上为8个或更少个碳原子),烷基糖苷、环糊精或其衍生物或脂肪酸盐。
2.一种治疗学制剂,它包含活性化合物(A)胰岛素和(B)一种促进胰岛素在下呼吸道吸收的物质,呈适合吸入下呼吸道的干粉形式,其中活性化合物的总质量的至少50%由(a)具有最高达10微米直径的颗粒或(b)该颗粒的附聚物组成,其中该干粉除含有所述活性化合物外,还含有可药用载体。
3.按照权利要求1中所要求的治疗学制剂,其特征在于该干粉除含有所述活性化合物外,还含有可药用载体。
4.按照权利要求3中所要求的治疗学制剂,其特征在于所述载体由具有最高达10微米直径的颗粒组成,以使所述干粉的至少50%由(a)具有最高达10微米直径的颗粒或(b)该颗粒的附聚物组成。
5.按照权利要求3中所要求的治疗学制剂,其特征在于所述载体由粗颗粒组成,以使所述活性化合物和该载体之间能形成有序的混合物。
6.按照权利要求4中所要求的治疗学制剂,其中干粉的至少50%由(a)具有1至6微米之间直径的颗粒或(b)该颗粒的附聚物组成。
7.按照权利要求1或权利要求5中所要求的治疗学制剂,其中活性化合物(A)和(B)总质量的至少50%由具有1至6微米之间直径的颗粒组成。
8.按照任何在先的权利要求中所要求的治疗学制剂,其特征在于所述胰岛素是牛的、猪的、生物合成或半合成的人胰岛素,或人胰岛素的生物活性衍生物。
9.按照权利要求8中所要求的治疗学制剂,其特征在于所述胰岛素是半合成的人胰岛素。
10.按照权利要求8中所要求的治疗学制剂,其特征在于所述胰岛素是生物合成的人胰岛素。
11.一种如任何在先的权利要求中所要求的胰岛素的治疗学制剂,其特征在于所述促进胰岛素在下呼吸道吸收的物质是一种促进胰岛素经过下呼吸道的上皮细胞层并进入邻近肺脉管系统的吸收的物质。
12.一种如权利要求11中所要求的治疗学制剂,其特征在于所述促进胰岛素在下呼吸道吸收的物质是表面活性剂。
13.一种如权利要求11中所要求的治疗学制剂,其特征在于述促进胰岛素在下呼吸道吸收的物质是阴离子表面活性剂。
14.一种如权利要求11中所要求的治疗学制剂,其特征在于所述促进胰岛素在下呼吸道吸收的物质是胆汁盐或胆汁盐衍生物。
15.一种如权利要求11中所要求的治疗学制剂,其特征在于所述促进胰岛素在下呼吸道吸收的物质是乌索脱氧胆酸钠、牛磺胆酸钠、甘氨胆酸钠或牛磺二氢梭链孢酸钠。
16.一种如权利要求11中所要求的治疗学制剂,其特征在于所述促进胰岛素在下呼吸道吸收的物质是牛磺胆酸钠。
17.一种如权利要求11中所要求的治疗学制剂,其特征在于所述促进胰岛素在下呼吸道吸收的物质是磷脂。
18.一种如权利要求11中所要求的治疗学制剂,其特征在于所述促进胰岛素在下呼吸道吸收的物质是烷基糖苷。
19.一种如权利要求11中所要求的治疗学制剂,其特征在于所述促进胰岛素在下呼吸道吸收的物质是环糊精或其衍生物。
20.一种如权利要求11中所要求的治疗学制剂,其特征在于所述促进胰岛素在下呼吸道吸收的物质是脂肪酸的盐。
21.一种如权利要求11中所要求的治疗学制剂,其特征在于所述促进胰岛素在下呼吸道吸收的物质是胆汁盐。
22.一种包含活性化合物(A)胰岛素和(B)牛磺胆酸钠的治疗学制剂,该制剂制成适合吸入的干粉形式,其中活性化合物(A)和(B)的总质量的至少50%由(a)具有小于10微米直径的初级颗粒,或(b)这种颗粒的附聚物组成。
23.一种如权利要求22中所要求的治疗学制剂,它仅含有所述活性化合物。
24.一种如权利要求22中所要求的治疗学制剂,其特征在于该干粉除含有所述活性化合物外还含有可药用载体。
25.一种包含胰岛素、牛磺胆酸钠和可药用载体的治疗学制剂,该制剂制成适合吸入的干粉形式,其中至少50%(质量)由(a)具有小于约10微米直径的颗粒,或(b)所述颗粒的附聚物组成。
26.一种治疗学制剂,它包含
活性化合物(A)胰岛素和(B)牛磺胆酸钠,其中的活性化合物(A)和(B)总质量的至少50%由具有小于约10微米直径的颗粒组成,和
可药用载体,
该制剂制成适合吸入的干粉制剂形式,其中在活性化合物和可药用载体间可形成一种有序的混合物。
27.一种如任何在先的权利要求中所要求的治疗学制剂,其特征在于所述制剂中胰岛素对增强剂的比率在9∶1至1∶1范围内。
28.一种如权利要求27中所要求的治疗学制剂,其特征在于所述比率在5∶1至2∶1范围内。
29.一种如权利要求27中所要求的治疗学制剂,其特征在于所述比率在4∶1至3∶1范围内。
30.一种如权利要求1或权利要求3-29中任意一项中所要求的治疗学制剂,其特征在于所述添加剂选自单糖、双糖和多糖、糖醇类和其它多元醇。
31.一种如权利要求30中所要求的治疗学制剂,其特征在于所述添加剂为非还原糖。
32.一种如权利要求31中所要求的治疗学制剂,其特征在于所述添加剂为棉子糖、松三糖、乳糖醇、麦芽糖醇、海藻糖、蔗糖、甘露糖醇或淀粉。
33.按照任何在先的权利要求中所要求的治疗学制剂在一种吸入装置中的用途。
34.如权利要求33中所要求的用途,其特征在于所述吸入装置可防止供吸入的粉末受潮,并且过量用药的危险最小。
35.按照权利要求33中所要求的用途,其特征在于所述吸入装置为供单一用途的单次剂量,呼吸启动的,干粉吸入器。
36.按照权利要求33中所要求的用途,其特征在于所述吸入装置是供多种用途的多次剂量,呼吸启动的、干粉吸入器。
37.一种含有任何在先的权利要求的治疗学制剂的干粉吸入器装置。
38.一种供单一用途的单次剂量、呼吸启动的、干粉吸入器,它含有一种供吸入的治疗学制剂,该制剂包含活性化合物(A)胰岛素和(B)牛磺胆酸钠并制成干粉形式,其中活性化合物(A)和(B)的总质量的至少50%由具有最高达10微米直径的颗粒组成。
39.一种胰岛素的治疗学制剂的制备方法,该方法包含形成一种由胰岛素和一种促进胰岛素在下呼吸道吸收的物质组成的溶液,通过蒸发或其它方法除去溶剂以得到固体,然后任选研磨和/或混合所述固体以得到一种其中至少50%由具有最高达10微米直径的颗粒组成的粉末。
40.一种如权利要求39中所要求的方法,该方法包含除加入所述促进在下呼吸道吸收的物质以外还添加一种可药用载体。
41.一种制备胰岛素的治疗学制剂的方法,该方法包含将胰岛素与一种促进胰岛素在下呼吸道吸收的物质干燥混合,然后任选研磨和/或混合所述固体以得到一种其中至少50%由具有最高达10微米直径的颗粒组成的粉末。
42.一种如权利要求41中所要求的方法,该方法包含将一种可药用载体与胰岛素和促进胰岛素在下呼吸道吸收的物质一起干燥混合。
43.一种如权利要求39或41中所要求的方法,该方法包含使制剂微粒化的附加步骤。
44.一种如权利要求40或42中所要求的方法,该方法包含将所述粉末与一种可药用载体一起制备一种有序的混合物的附加步骤。
45.增强剂在制备具有促进胰岛素在下呼吸道的系统吸收性质的胰岛素的可吸入的干粉制剂中的用途,其中胰岛素和增强剂总质量的至少50%由(1)具有10微米或更小直径的颗粒,或(2)所述颗粒的附聚物组成。
46.按照权利要求45的用途,其中所述增强剂是一种表面活性剂。
47.按照权利要求45的用途,其中所述增强剂是胆汁盐或胆汁盐衍生物。
48.按照权利要求47的用途,其中所述增强剂是牛磺胆酸钠。
49.按照权利要求1-32中的任何一项中所要求的治疗学制剂在制备用于治疗糖尿病的药物中的应用。
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SE9400370A SE9400370L (sv) | 1994-02-04 | 1994-02-04 | Terapeutisk komposition för inhalation |
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