Abstract:
The effect of the action of collagenase in treating lesions containing collagen or mixed fibrin clots (e.g., burns or ulcers) is improved by applying collagenase to the wound in combination with an organogel and a phosphotidylcholine, of which lecithin is a readily available source, particularly when the collagenase is first mixed and stored with that choline and an organic solvent and is subsequently mixed with a second individually stored formulation comprising a gel-forming agent and water, the two formulations individually having satisfactory shelf lives and the resultant mixture being applied to the lesion promptly after being formed.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     Collagenase has been used for years in the debridement of burns, which involve collagen, and various ulcers, which comprise mixed fibrin clots. The collagenase acts to remove the undesired tissue and thus promote the healing of the lesion. The greater the speed at which the debridement takes place the sooner will the wound heal. Thus speed of debridement is a prime consideratum.  
         [0002]     We have discovered that if collagenase is applied to the wound in combination with a phosphotidylcholine (hereinafter termed “PC”) of which lecithin is a readily available source, and an organogel a surprising increase in the speed of debridement results. Lecithin organogels have been used in the past in combination with drugs, such as non-steroidal anti-inflammatories, anesthetics, hormones, steroids and anti-histamines, in order to enable the drugs to be applied topically and readily pass through normal skin and enter the bloodstream. Debridement, however, involves treatment of tissue other than skin, and the wound-debridement effect of collagenase is significantly different from the topical or transdermal delivery of drugs to the system because entry of the collagenase into the bloodstream, to the extent that it might occur, is not a factor.  
         [0003]     We have discovered that a combination of collagenase with an organogel including PC, such as a lecithin organogel, when applied to lesions of the type here discussed, gives rise to a surprisingly rapid debridement significantly superior to the debridement effect of other collagenase preparations. (Because of the ready availability of lecithin as a source of PC we will for the most part use the term “lecithin” to refer generically to any source of PC as well as specifically to those complex substances to which the term is normally applied.)  
         [0004]     Institutions where burns are treated, such as hospitals and in particular burn centers where burn treatment is the rule and not the exception, must maintain on the shelf adequate supplies of collagenase, so as to be ready to treat burn cases as soon as they are presented, in order both to speed healing and minimize pain. It therefore is essential that the collagenase standing on the shelf waiting to be used should have as long a shelf life as possible. However, it is well known that certain collagenase compositions which are quite satisfactory when first prepared find their potency waning significantly with time. In particular, combinations of collagenase with water or aqueous excipients, while therapeutically highly acceptable, nevertheless have a shelf life at room temperatures of two weeks or less, which makes them unsatisfactory.  
         [0005]     The PC (lecithin) organogels useful in the present invention may contain water. In patent application Ser. No. 10/094,226, filed Mar. 11, 2002, and titled “METHOD OF ENHANCING THE EFFECT OF COLLAGENASE ON WOUNDS” some of us have disclosed that the shelf life problem presented by aqueous collagenase mixtures, which are very effective in debridement, can be overcome by starting with a first substance comprising collagenase in a non-aqueous excipient and a separate second substance comprising an aqueous excipient, the two substances being combined at the time of application to produce an improved and surprisingly rapid treatment effect as compared with applying the collagenase to the wound in a non-aqueous excipient or in an aqueous excipient alone. The advantages of that approach to the use of collagenase are also obtainable in connection with the present invention when the collagenase is initially combined with lecithin and an organic solvent to produce a non-aqueous phase and when the gel-forming agent is initially combined with water to produce an aqueous phase, the two phases being separately stored and each having an effective shelf life, the two phases being mixed together shortly prior to application to the wound.  
         [0006]     It therefore is the prime object of the present invention to combine collagen with a substance which enhances the collagen&#39;s normal debridement effect, and to do so through the use of readily available ingredients and in a manner which enables the components when stored to have an adequate shelf life.  
     
    
     DETAILED DESCRIPTION  
       [0007]     The first, a non-aqueous phase, comprises, in addition to the collagenase, a PC, of which lecithin is a readily available source, and an organic solvent. The lecithin may be in the form of soya, but that is not essential. Other sources of lecithin are meringue tissue, hepatic tissue, cardiac tissue and egg yolks. The organic solvent is capable of dissolving lecithin and is preferably one of those solvents known to have the property of enhancing trans-dermal absorption of drugs. Preferred are ethanol, isopropyl palmitate, isopropyl myristate and ethoxy diglycol. While the relative proportions of PC and organic solvent are not critical, it has been found that approximately equal proportions by weight are quite satisfactory. A small amount of sorbic acid (0.12 g. per 6 g. of lecithin and solvent) may be added. A typical detailed composition comprises 1:1 to ‘0.5:5 (weight to volume) of Phosphlipon 90 (American Lecithin, Oxford, Conn.) and ethanol (1 g:1 ml). The amount of collagenase incorporated into this non-aqueous phase may vary widely, and in practice will vary depending upon the severity of the condition to be treated. 125-2500 units of collagenase per milliliter of the final combination are appropriate. 250 units per milliliter function very well. Amounts of collagenase in excess of 250 units per milliliter are not believed to be necessary when used in accordance with the present invention in view of the excellent debridement effect of 250 units, but may be called for in certain situations. If lower proportions of collagenase are employed the debridement results will be correspondingly lower but still clinically effective.  
         [0008]     The second formulation, an aqueous phase, comprises a gel-forming agent and water. Preferred gel-forming agents are poloxamer compounds such as those sold under the trade name PLURONIC or polymers of crosslinked acrylic acid such as those sold under the trade name CARBOPOL. We have found PLURONIC F-127, which corresponds to POLAXAMO 407, a polyoxypropylene-polyoxyethylene block propolymer, to be particularly useful as a gel-forming agent. Preferred CARBOPOL resins are those which are crosslinked with polyalykeny ethers or divinyl glycol. Relative proportions of gel-forming agents and water may vary, but the combination of 10 gms of PLURONIC F-172 and 50 mls of water is quite satisfactory.  
         [0009]     To prepare a mixture for application to the lesions, the two formulations are thoroughly mixed in relative proportions which may vary, but a combination of non-aqueous phase:aqueous phase volume relationship of 20%:80% has given excellent results. The selected volumes of the two phases are mixed by transferring appropriate amounts of each of them to individual syringes the sizes of which will depend upon the respective volumes. The two syringes are then connected to one another with a luer-to-luer lock connector and the phases are mixed by continuous transfer between the syringes, accomplished by pushing alternately on one syringe plunger and then the other. The mixture may be transferred from one syringe to the other perhaps twenty times and the shear caused by passing the mixture through the connector helps form the gel.  
         [0010]     To demonstrate the surprising debridement effect which this procedure has, we set forth the following experimental results. For these experiments we added into each well of a six well plate an 8 ml collagen gel prepared by mixing rat tail collagen type I with DMEM, 10% fetal bovine serum, adjusting the pH to netrality and adding human fibroblasts. Phenol red was used as a pH indicator and is not an active ingredient. To initiate the experiment, small amounts (−0.5 ml) of the mixed first and second phases of the present invention mixed as described above, with a final collagenase concentration of 250 units/ml of excipient was applied to a separate gel; additional gels (placebo) with nothing added were used as controls. All of the plates were incubated for 24 hours at 37° C. The collagen gels with the placebo and with Santyl remained almost entirely intact; Santyl digested only 5-6% of the collagen. In contrast, in all five of the tests we performed the new formulation digested 34% of the collagen when mixed immediately prior to testing, representing at least a 5-6 fold increase in the activity. Again, when stored at 4° C. for 11 weeks and then tested, the new formulation digested  30 % of the collagen, indicating reasonable stability.  
         [0011]     In a report on the impact of phosphotidylcholines (PC&#39;s) on collagenase activity (digestion of collagenase), it was shown that dilinoleoyl-PC itself increases collagenase enzymatic activity two-fold whereas 2-linoleoyl-1-palmitoyl-PC is without such effect (LiJ, Kim C-I, Leo M A, et al. Polyunsaturated Lecithin Prevents Acetaldehyde=mediated Hepatic Collagen Accumulation by Stimulating Collagenase Activity in Cultured Lipocytes. Hepatology 1992;15:373-381). A preferred organogel formulation uses soy lecithin whose major PC is dilinoleoyl-PC activation of collagenase or by the novel delivery system here disclosed. Therefore, we compared mixtures in which the non-aqueous phase comprised, in addition to collagenase and an organic solvent, either soy lecithin or 2-linoleoyl-1-palmitoyl-PC. If the dilinoleoyl-PC in the soy lecithin were responsible for the increased collagenase activity, we should have observed a lower collagenase activity using the mixture made with 2-linoleoyl-1-palmitoyl-PC. However, the formulation using 3-linoleoyl-1-palmitoyl-PC resulted in an increase in collagenase activity (70% as compared with 35%). It is therefore likely that the difference between Santyl and the new formulation is due to the collagenase-phosphotidylcholine organogel combination here disclosed.  
         [0012]     It should be noted that although collagenase is water soluble, in accordance with the present invention it is incorporated into the first formulation, the non-aqueous formulation, in association with an organic (non-aqueous) solvent. In this way the life of the first formulation in particular is lengthened. When the two formulations are mixed the known favorable effect of water on the debridement effect of collagenase takes place, and the additional favorable debridement effect produced by the use of lecithin organogel in accordance with the present invention further enhances the wound-treatment efficacy of the combination.  
         [0013]     While but a limited number of the embodiments of the present invention have been here specifically disclosed it will be apparent to those skilled in the art that variations may be made therein without departing from the spirit of the invention as defined in the following claims: