Abstract:
A composition for the treatment of Herpes Labialis which contains CTC-96 as the active ingredient is disclosed. Methods for using the composition are also disclosed. The composition may be used as a topical ointment.

Description:
RELATIONSHIP TO OTHER APPLICATIONS 
     This application is based on Provisional Application Ser. No. 60/805,921 filed Jun. 27, 2006, the priority of which is hereby claimed. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to the field of methods for the treatment of Herpes Facialis which is a recurrent disease characterized by episodic vesicular eruptions on the lips and peri-oral skin. 
     2. Description of Related Art 
     This disease is Oro-facial Herpes Labialis and is a Herpes Virus infection, also known in the vernacular as cold sores, sun sores, or fever blisters. Oro-facial Herpes Labialis is caused predominantly by Herpes Simplex Virus Type-1 (HSV-1), with a minor subset of patients infected with HSV-2. While oro-facial infection with HSV-2 is possible, recurrent HSV-2 eruptions are rare. Initial infection with Herpes Simplex Virus Type-1 (HSV-1) generally causes mild or negligible symptoms. Herpes Labialis (HSV-1) is characterized by a high rate of recurrences, most often at the site of initial infection (recurrent Herpes Labialis). In the United States 40-50% of the adolescent population and 80-90% of the adult population has been exposed to HSV-1 (1). Approximately 40% of the infected population has had a cold sore at one time or another (2) and most people who have had cold sores will have recurrent outbreaks. Over 50 million adults in the United States have 2 or more outbreaks per year. Episodes generally regress within 7-10 days with complete healing by 12-14 days although a flat scar or erythema may persist (3). While recurrent Herpes Labialis is a benign disease that regresses spontaneously, it is highly contagious with high viral titers in blisters and effluent. Herpes Labialis causes physical pain and can also be disfiguring especially in those patients with frequent recurrences (3). 
     Current treatments for Herpes Labialis can be divided into three major categories: 1) palliative treatment 2) topical antiviral medication 3) systemic antiviral medication. Palliative treatments with numbing agents (lidocaine, tetracaine, benzocaine, benzyl alcohol, camphor, and phenol) and emollients (petrolatum and allantoin) while alleviating some of the discomfort of a recurrence of Herpes Labialis have no effect on the time course or on the frequency of recurrences. There are several topical and systemic antiviral medications that purport to shorten the time course of Herpes Labialis eruptions. Abreva® (docosanol 10% Cream formula), a topical cream which has been approved by the FDA for over the counter (OTC) sale, interferes with the adsorption of virus to cell surface lipid membranes but not with the binding of virions to the cell surface (4). Abreva® (docosanol), which has not been shown to have any direct anti-viral activity (5), has been shown to shorten mean healing time from 7.3 to 5.7 days. For significant response, docosanol must be applied during the prodrome. The prescription antiviral drugs, Zovirax® (acyclovir), Valacyclovir®, penciclovir, and famciclovir used for HSV-1 infections are all analogs of acyclic guanosine. The FDA has not approved these drugs for OTC sale because of possible development of viral resistance (6). Due to low bioavailability, Zoviraxe has but marginal efficacy and application after the prodromal phase has little or no efficacy (7). Treatment with penciclovir in 1% concentration (Denavir® 1%) when started during the prodrome is more effective than Zovirax® in decreasing lesion healing time, alleviation of pain, and viral shedding (7;8). However, application after the prodromal phase has but marginal efficacy with 20-30% reduction in symptoms and time to healing (7). Famvir® (famciclovir) is converted to penciclovir in the body. Famciclovir is active against the same viruses as Acyclovir but has a longer duration of action. Valacyclovil, a valine ester of acyclovir, is another “prodrug,” which is converted to acyclovir in the body. Oral Valtrex® (Valacyclovir) is approved for use in immunocompetent adults as a one day treatment. Oral treatment with these acyclovir produgs shortens duration of Herpes Labialis episodes by approximately 1 day (9). 
     None of the current topical treatments for HSV-1 infection have proven to be completely effective and no cure is available. 
     SUMMARY OF THE INVENTION 
     I have discovered a method for the successful treatment of Herpes Labialis (cold sores). I have found that the application of a compound known as CTC-96 to the cold sore can substantially mediate both the severity and duration of the cold sore. CTC-96 is known to be a very efficient anti-HSV-1 drug as attested by ocular studies in animals (4) and is safe at efficacious doses in human eyes 
     
       
                 
         
             
             
         
      
     
     wherein R 1 , R 2 , R 3  and R 4  are methyl, R 5  are each hydrogen and L and L′ are each: 
     
       
                 
         
             
             
         
      
     
     and Q′ is Br − . 
     CTC-96 may be prepared by the method described in the U.S. Pat. No. 5,756,491, the contents of which are hereby incorporated by reference. 
     I have further discovered a dermal formulation containing CTC-96 wherein the active ingredient penetrates only into the epidermis with exceptionally low systemic penetration. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWING 
         FIG. 1  is a graphical representation showing the anti-viral activity of CTC-96 extracted from the dermal formulation. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Accordingly I have discovered that subjects infected with Herpes Simplex Virus Type-1 (HSV-1) and Herpes Simplex Virus Type-2 (HSV-2) may be therapeutically treated to decrease the severity and duration of the Herpes Labialis by administering an anti-HSV-1 and HSV-2 effective amount of the compound CTC-96 to a subject infected with the disease. The compound may be administered topically, intramuscularly or orally. The drug is very active against HSV-1 and HSV-2 in the micromolar range of concentrations, particularly for its dermal manifestations. It prevents HSV-1 and HSV-2 penetration into cells and also cell-cell transmission of the virus (14). It thus reduces viral yields and the severity of Oro-facial Herpes Labialis and considerably accelerates the cure of the disease. Moreover, since the drug has a unique mode of action in binding to imidazole groups of histidines in proteins and does not involve DNA synthesis, it will act against current and emerging strains of HSV-1 and HSV-2 which are drug resistant to the known anti-viral drugs, e.g., acyclovir, penciclovir, cidofovir, ganciclovir and idoxuridine. In addition, the drug reduces inflammatory reactions to the virus infection and thus lowers or eliminates the severity of the symptoms. 
     Because HSV-1 propagates in the epidermis of the skin, CTC-96 is a valuable and safe drug in a topical formulation for cutaneous viral infections. This compound was approved by FDA for phase 2 studies in human eyes. The drug has a unique mode of action in that it inactivates certain proteins by binding to the imidazole of specific histidines (10) and possesses activity due to the superoxide scavenging capacity of the compound (11) in addition to anti-viral efficacy. It has both an anti-microbial activity and a therapeutic effect on HSV-1. Because of its unique mode of action the drug is effective against drug-resistant strains of HSV-1 which have become a problem in the control of the virus. 
     The percutaneous absorption of Doxovir-L® (CTC-96) was evaluated by mixing CTC-96 at two concentrations (10 mg/g and 1 mg/g) to homogeneity with a Dermal ointment Formulation (petrolatum 10% by weight, camphor 0.92% by weight, menthol 0.5% by weight, methyl salicylate 0.26% by weight, eucalyptus oil 0.30% by weight) and was determined in vitro, using the human cadaver skin model using the finite dose technique and Franz Diffusion Cells (12;13). Placebo consisted of the drug formulation without drug. The amount of Dermal ointment that is applied at each treatment was determined is shown in the following table (TABLE 1): 
     
       
         
               
               
               
             
               
               
               
             
           
               
                 TABLE 1 
               
               
                   
               
               
                   
                   
                 Average Amount of Dermal 
               
               
                   
                 Amount of Dermal Ointment 
                 Ointment Applied/10 cm 2   
               
               
                 Subject 
                 Applied/10 cm 2  (mg) 
                 (mg) 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 V.S 
                 19.6 
                 18.0 
               
               
                   
                 16.6 
               
               
                 D.T. 
                 27.4 
                 27.4 
               
               
                   
                 27.4 
               
               
                 Average 
                   
                 22.7 
               
               
                   
               
             
          
         
       
     
     The percutaneous absorption of Doxovir-L® (CTC-96) was determined is shown in the following table (TABLE 2 &amp; TABLE 3): 
     
       
         
               
             
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 2 
               
             
             
               
                   
               
               
                 Percutaneous Absorption of CTC-96 through Human Cadaver Skin 
               
               
                 over 48 hours from a Single Application: Percent of Applied Dose* 
               
             
          
           
               
                   
                 Drug concentration 
                   
               
             
          
           
               
                 Sample Source 
                 10 mg/g 
                 1 mg/g 
                 Blank controls 
               
               
                   
               
               
                 Receptor Solution 
                 0 
                 0 
                 0 
               
               
                 Dermis 
                 0 
                 0 
                 0 
               
               
                 Epidermis 
                 3.63 ± 0.58 
                 2.20 ± 1.09 
                 0 
               
               
                 Stratum 
                 1.29 ± 0.67 
                 0.06 ± 0.06 
                 0 
               
               
                 Corneum** 
               
               
                 Surfacewash 
                 10.81 ± 3.79  
                 7.41 ± 0.30 
                 0 
               
               
                 Total Recovery 
                 15.72 ± 3.12  
                 9.67 ± 1.34 
                 0 
               
               
                   
               
               
                 *(Mean ± SE, n = 3 Donors, in triplicate). 
               
               
                 **Stratum Corneum was measured from the Tape Strip samples 
               
             
          
         
       
     
     
       
         
               
             
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 3 
               
             
             
               
                   
               
               
                 Percutaneous Absorption of CTC-96 through Human Cadaver Skin 
               
               
                 over 48 hours from a Single Application: Mass (μg/cm2)* 
               
             
          
           
               
                   
                 Drug concentration 
                   
               
             
          
           
               
                 Sample Source 
                 10 mg/g 
                 1 mg/g 
                 Blank controls 
               
               
                   
               
               
                 Receptor Solution 
                 0 
                 0 
                 0 
               
               
                 Dermis 
                 0 
                 0 
                 0 
               
               
                 Epidermis 
                 1.81 ± 0.29 
                 0.11 ± 0.05 
                 0 
               
               
                 Stratum 
                 0.64 ± 0.33 
                 0.03 ± 0.00 
                 0 
               
               
                 Corneum** 
               
               
                 Surface wash 
                 5.41 ± 1.90 
                 3.17 ± 0.01 
                 0 
               
               
                 Total Recovery 
                 7.86 ± 1.56 
                 4.83 ± 0.07 
                 0 
               
               
                   
               
               
                 *(Mean ± SE, n = 3 Donors, in triplicate). 
               
               
                 **Stratum Corneum was measured from the Tape Strip samples 
               
             
          
         
       
     
     These studies indicate penetration of CTC-96 only into the epidermis with exceptionally low dermal and thus possible systemic penetration (based on the dermal and receptor solution data). Because HSV-1 propagates in the epidermis of the skin CTC-96 is a valuable and safe topical formulation for cutaneous viral infections. 
     The CTC-96 exhibits excellent in vitro stability and efficacy in dermal formulation as shown by the following (TABLE 4 &amp; TABLE 5): 
     CTC-96 was mixed to homogeneity with a Dermal Ointment Formulation (petrolatum 10% by weight, camphor 0.92% by weight, menthol 0.5% by weight, methyl salicylate 0.26% by weight, eucalyptus oil 0.30% by weight). 
     
       
         
               
             
               
               
             
               
               
               
               
               
             
           
               
                 TABLE 4 
               
             
             
               
                   
               
               
                 Stability CTC-96 In Dermal Ointment Formulation 
               
               
                 Recovery of CTC-96 from CTC-96 incubated in in Dermal ointment 
               
               
                 Formulation 
               
             
          
           
               
                   
                 Incubation for: 
               
             
          
           
               
                   
                   
                 0 
                 12 
                 6 
               
               
                   
                   
                 Time 
                 weeks 
                 months 
               
               
                   
                 Incubation 
                 % Recovery 
                 % Recovery 
                 % Recovery 
               
               
                 Drug 
                 Temperature 
                 Mean ± SD 
                 Mean ± SD 
                 Mean ± SD 
               
               
                   
               
               
                 Placebo 
                  4° C. 
                 0.0 
                 nd 
                 nd 
               
               
                 CTC-96 
                  4° C. 
                 103.5 ± 3.8 
                 92.3 ± 0.7 
                 110.2 ± 4.8 
               
               
                 10 mg/ml 
               
               
                 Placebo 
                 40° C. 
                 0.0 
                 nd 
                 nd 
               
               
                 CTC-96 
                 40° C. 
                 104.0 ± 0.9 
                 92.9 ± 4.2 
                 112.2 ± 4.1 
               
               
                 10 mg/ml 
               
               
                 CTC-96 Drug 
                   
                 100.0  
                 100.0 
                 100.0 
               
               
                 standard 
               
               
                   
               
             
          
         
       
     
                                                     TABLE 5                   Recovery of CTC-96 Anti-viral Activity from CTC-96       incubated in Dermal Ointment Formulation                % Inhibition*                    Incubation   4° C.   40° C.           Time   Mean ± SD   Mean ± SD                       0   91.8 ± 1.7   88.8 ± 2.7           3 mo   91.5 ± 0.5   90.1 ± 0.8           6 mo   91.5 ± 3.4   92.1 ± 1.0           Placebo    9.9 ± 11.0   −10.3 ± 3.4                        *CTC-96 extracted from Dermal Ointment Formulation was diluted to 2.5 μg/ml and assayed for antiviral activity. Results are presented as % inhibition ± standard deviation.            
Reference List
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