Patent Publication Number: US-2020289413-A1

Title: Compositions useful in the prevention  and/or treatment of disorders of the oral cavity, upper airways and esophagus

Description:
This Non-Provisional Application is a Divisional of U.S. Ser. No. 16/084,989 filed Sep. 14, 2018, which is a U.S. national stage of PCT/EP2017/056148 filed on 15 Mar. 2017, which claims priority to and the benefit of Italian Application No. 102016000028801 filed on 18 Mar. 2016, the contents of which are incorporated herein by reference in their entireties. 
    
    
     TECHNICAL FIELD OF THE INVENTION 
     The present invention relates to compositions comprising at least one film-forming agent able to adhere in a stable way to the mucosa of the mouth, esophagus and upper airways, and optionally at least one compound or extract obtained from a medicinal plant having antimicrobial or antiviral activity. 
     Said compositions are useful in the prevention and/or treatment of disorders of the oral cavity and upper airways caused by bacterial and/or viral agents, and of the esophagus. 
     BACKGROUND OF THE INVENTION 
     Reddening, inflammation and bacterial and/or fungal infections of the throat, with plaque formation, are symptoms that commonly accompany influenza, colds and similar disorders. 
     The common cold and influenza, which affect both children and adults up to three times a year on average, are mainly associated with viral infections, 40% of which are caused by rhinovirus, 10% by coronavirus and a smaller proportion by adenovirus and parainfluenza virus. Although there is no specific treatment for these disorders, antihistamines, decongestants and anti-inflammatories are considered useful, because reduction of oedema alleviates pain and shortens the length of the disorder underlying the inflammation. 
     These disorders sometimes involve complications due to the onset of secondary bacterial infections, because the outlets of the nasal sinuses are often obstructed due to congestion of the mucosa, where pathogenic germs can easily proliferate, causing fever and localized pain. In this case, antibiotic treatment is required in addition to symptomatic treatments. 
     One of the aspects to be considered during epidemics is the ease of transmission of the disease through involuntary contact with carriers. 
     There is still a need to identify alternative products which are useful in the prevention and/or treatment of disorders of the oral cavity, esophagus and upper airways caused by bacterial and/or viral agents and/or chemical agents. 
     SUMMARY OF THE INVENTION 
     The invention relates to compositions comprising at least one film-forming agent able to adhere in a stable way to the mucosa of the mouth, esophagus and upper airways. 
     The invention also relates to the use of said compositions in the prevention and/or treatment of disorders of the oral cavity, esophagus and upper airways caused by chemical agents and/or bacterial and/or viral agents. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The present invention relates to compositions comprising at least one film-forming agent able to adhere in a stable way to the mucosa of the mouth, esophagus and upper airways. 
     The composition can optionally contain at least one compound or extract obtained from a medicinal plant having antimicrobial or antiviral activity. 
     It has now surprisingly been found that compositions comprising at least one film-forming agent able to adhere in a stable way to the mucosa of the mouth, esophagus and upper airways protect against attack by a chemical agent and/or a bacterial and/or viral agent on the mucosa, thus allowing the prevention and/or treatment of disorders of the oral cavity, esophagus and upper airways caused by chemical agents and/or bacterial and/or viral agents. 
     The film-forming agent is selected from the group consisting of salts of hyaluronic acid, proteoglycans or alginic acid with anthocyanidins or proanthocyanidins, in free or glycosylated form; or tannins derived from procyanidins or ellagic acid incorporated in crosslinked hyaluronic or alginic acid, by the procedures reported in the examples. 
     The film-forming agent is made from known polymer molecules of natural or synthetic origin, by reacting them with compounds having a strong protein bond or with extracts obtained from medicinal plants containing said compounds, such as anthocyans, anthocyanidins or proanthocyanidins, in free or glycosylated form, tannins, alkaloids and flavonoids; in particular anthocyanidins, proanthocyanidin, in free or glycosylated form, and tannins. 
     Extracts suitable for said purpose are extracts of  Vaccinium myrtillus, Vaccinium uliginosum, Punica granatum, Vitis vinifera  and  Aesculus ippocastanum.  The extract is preferably  Vaccinium myrtillus  or  Vaccinium uliginosum  extract. More preferably it is  Vaccinium uliginosum  extract 
     According to a preferred aspect, an extract of  Vaccinium myrtillus, Vaccinium uliginosum, Punica granatum, Vitis vinifera  or  Aesculus ippocastanum  may be used in quantities ranging from 40 to 400 mg. 
     The polymer molecules may be hyaluronic acid and alginic acid, due to their property of generating salts with anthocyanosides and alkaloids or forming new polymers by cross-reactions able to incorporate tannic substances with a high affinity for proteins in the crosslinked structures. 
     With hyaluronic acid, chondroitin sulphate, keratan sulphate, sucralfate and alginates in salt form with sodium or potassium, anthocyanosides, by double exchange, give rise to new salts wherein the oxonium base bonds the carboxyls of the corresponding polymers, leaving the phenol part exposed; in vivo, the phenol part is anchored to the muciparous protein part of the mucosa of the mouth and adnexa, such as the palatine tonsils, Waldeyer&#39;s lymphatic ring, the proximal part of the esophagus and the upper airways, and partly to the phospholipid portion. 
     The barrier effect is so considerable due to the adhesion of the film-forming agent to the tissue, and is far greater than that obtainable by administering the compounds separately. 
     The film-forming agent reacts with the protein part of the secretion of the muciparous cells to form a protective and active barrier against the aggressive external pathogen. 
     This reduces bacterial and viral adhesion to the tissues, and the harm which can be caused to mucosa damaged and inflamed by pathogens, acidity or food. 
     The compositions according to the invention therefore prevent the formation of purulent plaques deriving from saprophytic infections of the oral cavity, thus avoiding the use of antibiotics, especially in infants and the elderly. 
     Moreover, the compositions according to the invention perform a favourable activity by cleaning the oral cavity reducing bacterial adhesion to the mucosa, with a consequent preventive effect. 
     The reaction between anthocyanosides and polymer can take place in water or ethanol/water mixtures; the resulting paste-like polymer is then freeze-dried. Natural acidic polymers reacted with binders that retain the polyphenols in the matrices can be advantageously used as an alternative to salts, which are not obtainable with non-cationic molecules. 
     As reported in the literature, hyaluronic acid and alginic acid, like some pectins, can react with crosslinkers such as divinyl sulfone (DVS), 1,4-butanediol diglycidyl ether, water-soluble carbodiimides (e.g. 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide), crosslinkers with amino groups or urea to give rise to crosslinked polymers which can incorporate other substances in the matrix, in this case polyphenols, which can increase adhesion to the mucosa or other tissues. 
     Many of said biopolymers are normally compatible with human tissues, but various problems arise. In fact, it has been found that not all these crosslinkers possess adequate biocompatibility with body tissues, especially the mucosa, giving rise to adverse reactions. Biopolymers were therefore selected which, when combined with polyphenols, possess high biocompatibility with the mucosa and skin tissues. 
     The biopolymer obtainable with urea is preferred. Said crosslinked biopolymer is a sufficiently fluid, physiologically acceptable macromolecular matrix. The end product is obtainable by reacting hyaluronic acid with urea by acid catalysis, or by other methods reported in the examples. 
     In some cases, hyaluronic acid salified with sodium or potassium is crosslinked by reacting it with urea, and a compound characterised by possessing two amino groups bonded to a carbonyl functional group is obtained. 
     The hyaluronic acid or alginic acid preferably has a molecular weight ranging between 100,000 and 10,000,000 daltons, more preferably 1,000,000 daltons. 
     Hyaluronic or alginic acid can normally dissolve in water in amounts ranging from 0.5 to 5% w/w, and urea in amounts ranging from 0.2 to 2% w/w, using dilute mineral acids such as sulphuric or hydrochloric acid, mainly dilute sulphuric acid, for the acid catalysis. 
     In the case of crosslinking, the polymers are characterised by analysis of viscosity η and shear stress τ as a function of shear rate γ by methods extensively reported in the literature, or by IR determination. The procedure anyhow establishes the consistency and applicability of the polymer to the tissues to be treated. 
     According to a preferred aspect, the compositions according to the present invention may further comprise at least one extract obtained from a medicinal plant having antimicrobial or antiviral activity, for example able to inhibit replication of the pathogens that usually cause colds and influenza, such as an essential oil. The extract obtained from a medicinal plant having antimicrobial or antiviral activity is preferably a lipophilic extract of  Zingiber officinale.    
     The lipophilic extract of  Zingiber officinale  is preferably obtained from the roots and rhizomes. 
     The compositions may comprise the lipophilic extract of  Zingiber officinale  in amounts ranging from 0.01% w/w to 1% w/w, preferably in amounts ranging from 0.1% w/w to 0.8% w/w, and even more preferably in amounts of 0.5% w/w. 
     The lipophilic extract of  Zingiber officinale  can be obtained by extraction from the roots or rhizomes with alcohols, ketones or aliphatic ethers or, preferably, with carbon dioxide under supercritical conditions as described in EP0464298 A1 (page 2 lines 1-52, and page 5 line 45 to page 6 line 7). 
     According to a further aspect, the compositions may comprise excipients designed to make their flavour, and consequently their administration, pleasant. 
     The compositions according to the invention can be prepared by well-known methods, such as those described in “Remington&#39;s Pharmaceutical Handbook”, Mack Publishing Co., N.Y., USA. 
     The compositions according to the invention may preferably be formulated in the form of tablets that dissolve slowly in the oral cavity, in suitable chewing gum forms, or in the form of gels to be held in the mouth, in such a way as to guarantee a reasonable time for adhesion to the mucosa so as to form a barrier against both pathogens and mechanical injuries. 
     A further object of the present invention is the use of compositions comprising at least one film-forming agent able to adhere in a stable way to the mucosa of the mouth, esophagus and upper airways, and optionally at least one compound or extract obtained from a medicinal plant having antimicrobial or antiviral activity, in the prevention and/or treatment of disorders of the oral cavity, esophagus and upper airways caused by chemical agents and/or bacterial and/or viral agents. 
     The disorders caused by chemical agents and/or bacterial and/or viral agents may be, for example, colds, influenza, oral and esophageal mucositis of various origins, damages to the esophageal mucosa induced by hyperacidity and esophageal reflux. 
     It has been found that by administering the compositions according to the invention, considerable, long-lasting adhesion thereof to the mucosa is obtained. A barrier effect is thus achieved that protects the oropharyngeal/esophageal tract against attack by acids and enzymes due to reflux, and reduces the extent of the above-mentioned damage. This result is very useful in view of the high percentage of individuals suffering from said disorder. 
     Moreover, the barrier effect keeps bacterial and viral proliferation under control, thus reducing the transmission of pathogens at oropharyngeal level. 
     The examples below further illustrate the invention. 
     EXAMPLE 1 
     Aqueous Gel Based on Salts of Alginic Acid with Anthocyanosides 
       
     
       
         
           
               
               
               
             
               
                   
               
             
            
               
                   Vaccinium myrtillus  extract (36% anthocyanosides) 
                 400 
                 mg 
               
               
                 Alginic acid potassium salt 
                 500 
                 mg 
               
               
                 Lipophilic extract of  Zingiber officinale   
                 15 
                 mg 
               
               
                 Potassium aspartame 
                 20 
                 mg 
               
               
                 Xylitol 
                 250 
                 mg 
               
            
           
           
               
               
            
               
                 Water 
                 q.s. to 100 ml 
               
               
                   
               
            
           
         
       
     
     EXAMPLE 2 
     Preparation of Orodispersible Tablets 
       
     
       
         
           
               
               
               
               
             
               
                   
                   
               
             
            
               
                   
                   Vaccinium myrtillus  extract (36% anthocyanosides) 
                 40 
                 mg 
               
               
                   
                 Alginic acid potassium salt 
                 250 
                 mg 
               
               
                   
                 Mannitol 
                 600 
                 mg 
               
               
                   
                 Ammonium glycyrrhizinate 
                 10 
                 mg 
               
               
                   
                 Sodium cyclamate 
                 40 
                 mg 
               
               
                   
                 Polysorbate 80 
                 5 
                 mg 
               
               
                   
                 Lipophilic extract of  Zingiber officinale   
                 8 
                 mg 
               
               
                   
                   
               
            
           
         
       
     
     EXAMPLE 3 
     Preparation of Orodispersible Tablets 
       
     
       
         
           
               
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Extract of  Vaccinium uliginosum   
                 40 
                 mg 
               
               
                   
                 (30% cyaniding glucoside Cl) 
               
               
                   
                 Alginic acid potassium salt 
                 200 
                 mg 
               
               
                   
                 Mannitol 
                 600 
                 mg 
               
               
                   
                 Ammonium glycyrrhizinate 
                 10 
                 mg 
               
               
                   
                 Sodium cyclamate 
                 40 
                 mg 
               
               
                   
                 Polysorbate 80 
                 5 
                 mg 
               
               
                   
                   Zingiber officinale  lipophilic extract 
                 10 
                 mg 
               
               
                   
                   
               
            
           
         
       
     
     EXAMPLE 4 
     Preparation of Orodispersible Tablets 
       
     
       
         
           
               
               
               
             
               
                   
               
             
            
               
                 Extract of  Vaccinium uliginosum  (30% cyanidin glucoside Cl) 
                 40 
                 mg 
               
               
                 Hyaluronic acid potassium salt (1 million daltons) 
                 200 
                 mg 
               
               
                 Xylitol 
                 600 
                 mg 
               
               
                 Ammonium glycyrrhizinate 
                 10 
                 mg 
               
               
                 Sodium cyclamate 
                 40 
                 mg 
               
               
                 Polysorbate 80 
                 5 
                 mg 
               
               
                 Lipophilic extract of  Zingiber officinale   
                 10 
                 mg 
               
               
                   
               
            
           
         
       
     
     EXAMPLE 5 
     Preparation of Crosslinked Hyaluronic Acid in the Presence of  Vaccinium Uliginosum  Extract Containing 30% Cyanidin-3-O-glucoside Cl 
     16 g of hyaluronic acid potassium salt (1 million daltons) are dissolved in 200 ml of distilled water together with 5 g of  Vaccinium uliginosum  extract having a 30% cyanidin-3-glucoside content and a 35% procyanidin content. A solution of 20 g of urea in 100 ml of 1.4% hydrochloric acid is added slowly to said solution. The mixture is left under stirring for 12 h at 25° C. A bright red rubbery mass forms, which can be separated from the reaction medium by centrifugation to eliminate the excess urea and salts. The gelatinous residue is freeze-dried, and the resulting product in powder form can be used to prepare gels or orodispersible tablets. 
     EXAMPLE 6 
     Preparation of Crosslinked Alginic Acid in the Presence of Procyanidins Obtained from  Vitis Vinifera    
     12 g of sodium alginate (250,000 D) are dissolved in 250 ml of saline solution; 8 g of  Vitis vinifera  extract containing 90% procyanidins are added, and after homogenization, 20 g of urea dissolved in 200 ml of physiological saline solution are added under stirring. The mixture is treated with 20 ml of 0.5 N hydrochloric acid. The strongly gelled solution is left to stand for 12 hours. The gel is then buffered with NaOH and poured under stirring into 500 ml of ethanol. The solid is centrifuged, then collected and freeze-dried. This product can be used in solid formulations or suitably diluted to form gels. 
     EXAMPLE 7 
     Preparation of Crosslinked Alginic Acid in the Presence of  Vaccinium Myrtillus  Extract and  Punica Granatum  Extract 
     12 g of sodium alginate (250,000 D) are dissolved in 250 ml of physiological saline solution; 4 g of  Punica granatum  extract containing 45% punicalagin and 3 g of  Vaccinium myrtillus  extract containing 36% anthocyanosides are added, and after homogenisation, 20 g of urea dissolved in 200 ml of physiological saline solution are added under stirring. The mixture is treated with 20 ml of 0.5 N hydrochloric acid. The strongly gelled solution is left to stand for 12 hours. The gel is then buffered with NaOH and poured under stirring into 500 ml of ethanol. The solid is centrifuged, then collected and freeze-dried. This product can be used in solid formulations or suitably diluted to form gels. 
     EXAMPLE 8 
     Preparation of Orodispersible Tablets 
       
     
       
         
           
               
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Crosslinked compound obtained in example 5 
                 200 
                 mg 
               
               
                   
                 Lipophilic extract of  Zingiber officinale   
                 5 
                 mg 
               
               
                   
                 Xylitol 
                 400 
                 mg 
               
               
                   
                 Ammonium glycyrrhizinate 
                 10 
                 mg 
               
               
                   
                 Sodium cyclamate 
                 40 
                 mg 
               
               
                   
                 Polysorbate 80 
                 5 
                 mg 
               
               
                   
                   
               
            
           
         
       
     
     EXAMPLE 9 
     Preparation of Orodispersible Tablets 
       
     
       
         
           
               
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 Crosslinked compound obtained in example 6 
                 200 
                 mg 
               
               
                   
                 Lipophilic extract of  Zingiber officinale   
                 5 
                 mg 
               
               
                   
                 Xylitol 
                 400 
                 mg 
               
               
                   
                 Ammonium glycyrrhizinate 
                 10 
                 mg 
               
               
                   
                 Sodium cyclamate 
                 40 
                 mg 
               
               
                   
                 Polysorbate 80 
                 5 
                 mg