Abstract:
Disclosed are pharmaceutical compositions comprising mdivi-1 and nutlin-3, individually and in combination, for topical or intravitreal ophthalmic delivery and a method of treatment comprising administering said composition when indicated for glaucoma, optic neuropathies including Leber Hereditary Optic Neuropathy, arteritic or non-arteritic Ischemic Optic Neuropathy, and retinal artery and vein occlusions.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    This invention relates to the topical and/or intravitreal ophthalmic use of mdivi-1 and nutlin-3, individually or in combination, when indicated for treatment of glaucoma, ischemic optic neuropathies, hereditary optic neuropathies and retinal artery and vein occlusions. 
         [0002]    Nutlin-3 is disclosed in U.S. Pat. No. 6,617,346, 6,734,302, 6,916,833, 7,060,713, 7,425,638, 7,579,368, 7,625,895. The claims of the listed patents describe nutlin-3 inhibition of the interaction of MDM2 protein with a p53-like peptide and hence have anti proliferative activity. In this invention, nutlin-3 inhibit apoptosis by inhibiting Bax and Bak in the apoptosis pathway and produce neuroprotective effects rather than induce apoptosis as claimed in the previous patent disclosures. 
         [0003]    mdivi-1 is disclosed in U.S. Pat. Application No. 20050038051 and 20080287473. The claims of the listed patents describe mdivi-1 regulation of apoptosis via regulating mitochondrial fission or fusion. 
         [0004]    This patent claims nutlin-3 and mdivi-1 as an ophthalmic drug. In combination, these drugs block Bax/Bak and Drp1 interaction on the mitochondria surface as a key step in the apoptotic pathway of various ophthalmic diseases including glaucoma, ischemic optic neuropathy, hereditary optic neuropathy and retinal artery/vein occlusions. 
     
    
     DESCRIPTION OF THE INVENTION 
       [0005]    Nutlin-3 is represented by the chemical formula described in U.S. Pat. No. 6,617,346, 6,734,302, 6,916,833, 7,060,713, 7,425,638, 7,579,368, 7,625,895. 
         [0006]    Mdivi-1 is represented by the chemical formula described in U.S. Pat. Application No. 20050038051 and 20080287473 
         [0007]    Nutlin-3 and its active emantiomer nutlin-3a are available from Roche, Inc and Cayman Chemical, Inc. Mdivi-1 is available from various sources, including Enzo Life Science. 
         [0008]    The compositions of the present invention are administered either topically or intravitreally. The dosage is 0.001 to 1.0, e.g. mg/per eye BID to QID or as 1 time dose; wherein the cited mass figures represent the sum of the two components, mdivi-1 and nutlin-3. The compositions of the present invention can be administered as solutions in a suitable ophthalmic vehicle. 
         [0009]    The precise regimen is left to the discretion of the clinician, it is recommended that the solution be topically applied by placing one drop in each eye once to four times a day or as one time or weekly intravitreal injections. Other ingredients which may be desirable to use in the ophthalmic preparations of the present invention include preservatives, co-solvents and viscosity building agents. 
       Antimicrobial Preservative 
       [0010]    Ophthalmic products are typically packaged in multidose form. Preservatives are thus required to prevent microbial contamination during use. Suitable preservatives include: benzalkonium chloride, thimerosal, chlorobutanol, methyl paraben, propyl paraben, phenylethyl alcohol, edetate disodium, sorbic acid, Onamer M, or other agents known to those skilled in the art. In the prior art ophthalmic products, typically such preservatives are employed at a level of from 0.004% to 0.02%. In the compositions of the present application the preservative, preferably benzalkonium chloride, may be employed at a level of from 0.001% to less than 0.01%, e.g. from 0.001% to 0.008%, preferably about 0.005% by weight. It has been found that a concentration of benzalkonium chloride of 0.005% is sufficient to preserve the compositions of the present invention from microbial attack. This concentration may be advantageously compared to the requirement of 0.01% benzalkonium chloride to preserve mdivi-1 and nutlin-3 in the individual, commercially-available ophthalmic products. It is noted that it is known that benzalkonium chloride at high concentrations is cytotoxic. Therefore, minimizing the patient&#39;s exposure to benzalkonium chloride, while providing the preservative effects afforded by benzalkonium chloride, is clearly desirable. 
       Co-Solvents: 
       [0011]    The solubility of the components of the present compositions may be enhanced by a surfactant or other appropriate co-solvent in the composition. Such cosolvents include polysorbate 20, 60, and 80, Pluronic F68, F-84 and P-103, cyclodextrin, or other agents known to those skilled in the art. Typically such co-solvents are employed at a level of from 0.01% to 2% by weight. 
       Viscosity Agents: 
       [0012]    Viscosity increased above that of simple aqueous solutions may be desirable to increase ocular absorption of the active compound, to decrease variability in dispensing the formulation, to decrease physical separation of components of a suspension or emulsion of the formulation and/or to otherwise improve the ophthalmic formulation. Such viscosity building agents include as examples polyvinyl alcohol, polyvinyl pyrrolidone, methyl cellulose, hydroxy propyl methylcellulose, hydroxyethyl cellulose, carboxymethyl cellulose, hydroxy propyl cellulose or other agents known to those skilled in the art. Such agents are typically employed at a level of from 0.01% to 2% by weight. 
         [0013]    The present invention further comprises an article of manufacture comprising packaging material and a pharmaceutical agent contained within said packaging material, wherein the pharmaceutical agent is therapeutically effective for neuroprotection and wherein the packaging material comprises a label which indicates the pharmaceutical agent can be used for lowering intraocular pressure and wherein said pharmaceutical agent comprises an effective amount of mdivi-1 and an effective amount of nutlin-3. 
         [0014]    The following example is a representative pharmaceutical composition of the invention for topical use when indicated for treating glaucoma, ischemic optic neuropathy, hereditary optic neuropathy and retinal artery or vein occlusion. 
       EXAMPLE I 
       [0015]    The combination of active pharmaceutical ingredients is as follows: mdivi-1 0.10% (w/v) and nutlin-3 Maleate 0.25% (w/v) 
         [0016]    The formulation vehicle contains an isotonic phosphate buffer system at pH 6.9. The formulation preservative is benzalalkonium chloride (BAK) at a concentration of 0.005% (w/v) (50 ppm). 
         [0017]    The invention has been described herein by reference to certain preferred embodiments. However, as obvious variations thereon will become apparent to those skilled in the art, the invention is not to be considered as limited thereto.