Patent Publication Number: US-2010112005-A1

Title: Compositions of activated botulinum toxin type B

Description:
STATEMENT OF RELATED APPLICATIONS 
     This application claims the benefit of U.S. Patent Application No. 61/198,107 filed on Nov. 3, 2008 which is incorporated herein by reference in its entirety. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to pharmaceutical compositions of activated botulinum toxin type B. In particular, the present invention relates to botulinum toxin type B pharmaceutical compositions wherein at least 90% of said botulinum toxin type B is activated—i.e., “nicked”. The invention also relates to a process of activating botulinum toxin type B wherein at least 90% of said botulinum toxin type B is nicked. The invention further relates to methods for the treatment of a variety of autonomic, neuromuscular diseases, pain, inflammatory, cosmetic and cutaneous disorders comprising administering a pharmaceutical composition of activated botulinum toxin type B wherein at least 90% of said botulinum toxin type B is nicked. 
     BACKGROUND OF THE INVENTION 
     The anaerobic, gram positive bacterium  Clostridium botulinum  produces a potent polypeptide neurotoxin, botulinum toxin, which causes a neuroparalytic illness in humans and animals by attacking peripheral cholinergic motor neurons. Botulinum toxin apparently binds with high affinity to these motor neurons, is translocated into the neuron and blocks the release of acetylcholine. 
     Seven immunologically distinct botulinum neurotoxins have been characterized—these being, respectively, botulinum neurotoxin serotypes A, B, C 1 , D, E, F and G—each of which is defined by neutralization with serotype-specific antibodies. Although all the botulinum toxin serotypes apparently inhibit release of the neurotransmitter acetylcholine at the neuromuscular and neuroglandular junction (parasympathetic autonomic nervous tissue interface with target organs), they do so by affecting different neurosecretory proteins and cleaving these proteins at different amino acid residue sites. Consequently, the different serotypes of botulinum toxin vary in their potency, duration of action, and species sensitivity and severity. 
     Botulinum toxins are the most lethal natural biological toxins known to man and the cause of toxicity in humans known as botulism. The recognition that these toxins could produce muscle paralysis at pharmacologically active doses has led to the development of these proteins as a treatment for many human disorders including: movement disorders, neuromuscular diseases (e.g., general dystonias, torticollis, hemifacial spasm, bruxism, strabismus, spasticity, cerebral palsy), as well as sensory disorders (e.g., myofascial pain, migraine, tension headaches, neuropathy), autonomic or cutaneous disorders (e.g., hyperhydrosis, drooling), and in the treatment of disorders involving inflammation. 
     Naturally occurring botulinum toxin serotype A is initially synthesized as an inactive single chain proteins which must be cleaved or “nicked” by proteases to become neuroactive, the bacterial strains that make type A possess endogenous proteases. Therefore, the serotype A toxin can be recovered from bacterial cultures in predominantly its active form: approximately 90-95 percent of type A toxin is nicked. In contrast, botulinum toxin serotypes C 1 , D and E are synthesized by non-proteolytic strains and are therefore typically unactivated when recovered from culture. Serotypes B and F are produced by both proteolytic and non-proteolytic strains and therefore can be recovered in either the active or inactive form. However, even the proteolytic strains that produce, for example, the botulinum toxin type B serotype only cleave a portion of the toxin produced. The exact proportion of nicked to unnicked molecules depends on the length of incubation and the temperature of the culture. Therefore, a certain percentage of any preparation of, for example, the botulinum toxin type B toxin is likely to be inactive, possibly accounting for the known significantly lower potency of botulinum toxin type B as compared to botulinum toxin type A. Furthermore, the presence of inactive botulinum toxin molecules in a clinical preparation will contribute to the overall protein load of the preparation, which has been linked to increased antigenicity, without contributing to its clinical efficacy. 
     The use of a pharmaceutical composition comprising a botulinum toxin type leads to a dose dependent action on nerve terminals that results in irreversible blockade of neurotransmitter release in affected terminal endings of the nerve. The effect is a so-called chemical denervation that results in muscle paralysis when injected into muscles. Recovery from this paralysis occurs by sprouting of immature multiple axon terminals that stabilize the nerve—target organ connection and reverses the denervating effects of the toxin within a period spanning two to six months. Consequently, repeated administration of the neurotoxin is required to maintain a therapeutic effect in a variety of conditions and disorders. However, immunity and resistance to the neurotoxin due to the production of neutralizing antibodies is an important clinical consequence and problem resulting from repeated administrations. The antigenicity of botulinum toxin type A stimulates antibody formation that reduces and most often completely obliterates the therapeutic effectiveness of botulinum toxin type-A-based pharmaceuticals. 
     SUMMARY OF THE INVENTION 
     In some embodiments, a pharmaceutical composition includes botulinum toxin type B and at least one excipient, wherein at least 90% of the botulinum toxin type B is nicked. 
     In some embodiments, a process of activating botulinum toxin type B includes the stages of: cell growth, activation, purification, and dilution; wherein at least one exogenous protease is administered to a volume of said botulinum toxin type B, and wherein the level of nicked botulinum toxin type B is increased to at least 90%. 
     In some embodiments, a method of treating a variety of disorders includes administering to a patient in need thereof, a pharmaceutical composition including activated botulinum toxin type B and at least one excipient, wherein at least 90% of said botulinum toxin type B is nicked. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are included to provide a further understanding of the invention and are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and together with the description serve to explain the principles of the invention. In the drawings: 
         FIG. 1  shows an overall manufacturing process flow chart for activated botulinum toxin type B; 
         FIG. 2  shows a detailed flow chart for the fermentation stage of the manufacturing process; 
         FIG. 3  shows a detailed flow chart for the recovery stage of the manufacturing process; 
         FIG. 4  shows a detailed flow chart for the purification stage of the manufacturing process; 
         FIG. 5  shows a detailed flow chart for the production and handling of a dilute bulk solution of activated botulinum toxin type B. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Toxins of the different  Clostridium botulinum  serotypes are produced in culture as aggregates of neurotoxin and non-toxic proteins non-covalently associated into polypeptide complexes of varying molecular weight. As used herein, “botulinum toxin type B” means an approximately 150 kD protein neurotoxin isolated from the Type B (i.e., Bean strain) of  Clostridium botulinum , including mixtures of its approximately 300-700 kD protein complexes, toxoid, and/or other clostridial proteins, and may refer to either its single-chain or di-chain (“nicked”) neurotoxin form. 
     As used herein, “activated botulinum toxin type B” means the single-chain 150 kD protein type B neurotoxin has undergone limited posttranslational proteolysis (“nicking”) typically between residues Lys 440 and Ala 441 to form a di-chain protein consisting of an approximately 50 kD light chain linked to an approximately 100 kD heavy chain by a di-sulfide bridge. This nicked form is essential for the neurotoxin&#39;s ability to enzymatically cleave proteins involved in neurotransmitter release at the neuromuscular junction and to produce acetylcholine blockage. 
     According to some embodiments, the present invention describes a pharmaceutical composition of activated botulinum toxin type B. In some embodiments, the present invention describes a process of activating botulinum toxin type B. And in some embodiments, the present invention describes a method of treating a variety of ophthalmologic disorders, neuromuscular diseases, otorhinolaryngological disorders, urogenital disorders, dermatological disorders, pain disorders, inflammatory disorders, secretory disorders, and cutaneous disorders or cosmetic treatment by administering an effective amount of a pharmaceutical composition of the present invention to a patient in need thereof. 
     I. Compositions of Activated Botulinum Toxin Type B 
     A. Activated Botulinum Toxin Type B 
     The proteolytic strains that produce the botulinum toxin type B serotype only cleave a portion of the toxin produced: approximately 60% to 70% of naturally produced botulinum toxin type B is activated. The present invention discloses a pharmaceutical composition wherein at least 90% of the botulinum toxin type B is activated—i.e., “nicked”. In some embodiments, the present invention is directed to pharmaceutical compositions of activated botulinum toxin type B. In some embodiments, at least 90 percent of the botulinum toxin type B in a pharmaceutical composition is nicked. In some embodiments, greater than 90 percent of the botulinum toxin type B in a pharmaceutical composition is nicked. In some embodiments, about 95 percent to about 100 percent of the botulinum toxin type B in a pharmaceutical composition is nicked. In some embodiments, greater than 95 percent of the botulinum toxin type B in a pharmaceutical composition is nicked. In some embodiments, greater than 99 percent of the botulinum toxin type B in a pharmaceutical composition is nicked. 
     The increased activation of botulinum toxin type B in the present invention results in pharmaceutical compositions with at least comparable efficacy, potency and specific activity to compositions of botulinum type A while limiting the adverse effects of inactive botulinum toxin molecules. In some embodiments, the increased activation of botulinum toxin type B in the present invention results in increased efficacy, potency and specific activity relative to compositions of botulinum type A while limiting the adverse effects of inactive botulinum toxin molecules. Relative to existing pharmaceutical compositions of botulinum toxin type B, the present invention has a decreased overall protein load which results in decreased antigenicity without diminishing clinical efficacy. 
     B. Excipients 
     In some embodiments, the pharmaceutical compositions include activated botulinum toxin type B, and at least one excipient. As used herein, the term “excipient” means a pharmaceutically acceptable chemical composition, compound, or solvent with which the activated botulinum toxin type B may be combined, may stabilize the botulinum toxin and does not alter its physical or therapeutic properties. Excipients suitable for use in the present invention may be selected from the group consisting of, but not limited to: carriers, sequestration agents, surfactants, crystalline agents, buffers, polyaccharides, metals, non-oxidizing amino acid derivatives, sodium chloride, surface active agents, dispersing agents, inert diluents, granulating and disintegrating agents, binding agents, lubricating agents, preservatives, physiologically degradable compositions such as gelatin, aqueous vehicles and solvents, oily vehicles and solvents, suspending agents, dispersing or wetting agents, emulsifying agents, demulcents, salts, thickening agents, fillers, antioxidants, stabilizing agents, and any pharmaceutically acceptable polymeric or hydrophobic materials and other ingredients as known to one of ordinary skill in the art. Examples of excipients that are potentially suitable are disclosed in U.S. Pat. No. 7,211,261 which is incorporated herein by reference in its entirety. 
     1. Sequestration Agents 
     In some embodiments, a pharmaceutical composition of the present invention includes activated botulinum toxin type B, and at least one excipient such as a sequestration agent. As used herein, “sequestration agent” means an agent that enhances localization, delivery and/or retention of the botulinum toxin to the site of administration. Examples of proteins, polysaccharides, lipids, polymers, gels and hydrogels that are potentially suitable as sequestration agents are disclosed in U.S. Pat. No. 4,861,627, which is incorporated herein by reference in its entirety. Methods of using and making protein microspheres as sequestration agents, including albumin microspheres, are disclosed in U.S. Pat. Nos. 6,620,617; 6,210,707; 6,100,306; and 5,069,936 which are each incorporated herein by reference in their entirety. 
     In some embodiments, the sequestration agent is albumin. Human serum albumin may bind with many pharmaceutical agents, including peptides and proteins such as botulinum toxin, which can influence potency, complication rate, clearance, and other pharmacodynamic properties of these agents. Albumin in botulinum toxin pharmaceutical compositions may maintain biologic activity by promoting nerve and other receptor contact and preventing wash out from free neurotoxin release at injection points. Additionally, albumin can non-covalently bind cations that serve as cofactors for enzymatic reactivity of portions of the botulinum toxin polypeptide complex. Specifically, zinc is a cofactor for the endopeptidase activity of the botulinum toxin light chain which enters the target cells after heavy chain binding to the cell surface protein receptors. Higher quantities of zinc bound to albumin enhance endopeptidase activity and thus enhances the denervating effect of botulinum toxin type B. Finally, although other proteins (e.g., gelatin, lactalbumin, lysozyme), lipids and carbohydrates may serve as effective sequestration agents, albumin, including encapsulated albumin and solid microspheres is the preferred protein sequestration agent, in part, because of its low immunogenicity. 
     2. Buffers 
     The pH of a pharmaceutical composition of botulinum toxin affects the toxin&#39;s efficacy, potency and specific activity. Thus, pH levels outside certain ranges lead to less active compounds and it may be desirable to stabilize the pH level via a buffer. In some embodiments of the present invention, the excipient is a buffer. In some embodiments, the buffer is succinate. The buffer may be any buffer able to maintain the adequate pH. In some embodiments, the excipient is a buffer to maintain pH from about 5.0 to about 6.0, more preferably from about 5.2 to about 5.8, and most preferably about 5.6. 
     II. Process of Activating Botulinum Toxin Type B 
     In some embodiments, the present invention describes a process of activating botulinum toxin type B. Referring to  FIG. 1 , which shows an overall manufacturing process flow chart for activated botulinum toxin type B, in some embodiments, a process of activating botulinum toxin type B according to the present invention may generally be divided into four stages: Fermentation ( FIG. 2 ), Recovery ( FIG. 3 ), Purification ( FIG. 4 ), and Dilute Bulk Solution Preparation ( FIG. 5 ). 
     A. Fermentation (Cell Growth) Stage 
       FIG. 2  shows a detailed flow chart for the fermentation or cell growth stage  100  of  FIG. 1  of the manufacturing process for activated botulinum toxin type B. In some embodiments, a process of activating botulinum toxin type B requires at least one fermentation or cell growth stage  100 . 
     In some embodiments, the fermentation stage  100  includes a media/buffer preparation step  110 . In some embodiments, the media buffer preparation step  110  includes autoclaving thioglycollate and Type B mediums for cell growth. 
     In some embodiments, the fermentation stage  100  includes a working cell bank (WCB) step  120 . In some embodiments, the WCB step  120  includes utilizing a frozen culture of  Clostridium botulinum , Type B and thawing the frozen culture in a biological safety cabinet (BSC). In some embodiments, the WCB step  120  includes taking a sample of the frozen culture for quality control. 
     In some embodiments, the fermentation stage  100  includes an S 1  fermentation step  130  wherein the autoclaved thioglycollate medium of step  110  is inoculated with the thawed frozen culture of the WCB step  120  and incubated. In some embodiments, the S 1  fermentation step  130  includes taking a sample of the resulting S 1  cell culture for quality control. 
     In some embodiments, the fermentation stage  100  includes an S 2  fermentation step  140 . In some embodiments, the S 2  fermentation step  140  includes a three sub-stage progression  141 ,  142 ,  143 . In some embodiments, the S 2  fermentation step  140  includes a first sub-stage  141  wherein the autoclaved Type B medium of step  110  is inoculated with the S 1  cell culture of step  130  and incubated. In some embodiments, the S 2  fermentation step  140  includes a second sub-stage  142  wherein the autoclaved Type B medium of step  110  is inoculated with the cell culture of the first sub-stage  141  and incubated. In some embodiments, the S 2  fermentation step  140  includes a third sub-stage  143  wherein the autoclaved Type B medium of step  110  is inoculated with the cell culture of the second sub-stage  143  and incubated. In some embodiments, the S 2  fermentation step  140  includes taking a sample of the resulting cell culture of the third sub-stage  143  for quality control. 
     In some embodiments, the fermentation stage  100  includes an S 3  fermentation step  150 . In some embodiments, the S 3  fermentation step  150  includes an integrity test and exhaust filters. In some embodiments, the S 3  fermentation step  150  includes sterilizing Type B medium in a fermenter. In some embodiments, the S 3  fermentation step  150  includes adding autoclaved glucose via a sterile addition port to the sterilized Type B medium. In some embodiments, the S 3  fermentation step  150  includes inoculating the sterilized fermentation media with the resulting step  143  cell culture via sterile transfer. In some embodiments, the S 3  fermentation step  150  includes incubating the fermentation medium with a nitrogen overlay, agitation, and pH control of less than pH 6.2. In some embodiments, the S 3  fermentation step  150  includes taking a sample of the resulting cell culture for quality control. 
     In some embodiments, the fermentation stage  100  includes an acid precipitation (AP) step  160 . In some embodiments, the AP step  160  includes chilling the S 3  cell culture of step  150  to less than 20° C. In some embodiment, the AP step  160  includes adjusting the pH of the step  150  fermentation medium with sulfuric acid. In some embodiments, the AP step  160  includes precipitating the cell culture out of the medium and transferring the cell culture to a 20 L carboy with sanitary connection and subsequent transfer to bottles within a BSC. In some embodiments, the AP step  160  includes centrifuging the precipitated cell culture and discarding the supernatant. 
     In some embodiments, the fermentation stage  100  includes an AP water wash step  170 . In some embodiments, the AP water wash step  170  includes re-suspending the centrifuged pellet of step  160  in sterile water for irrigation within a BSC. In some embodiments, the AP water wash step  170  includes centrifuging the re-suspended cell culture and discarding the supernatant. In some embodiments, the AP water wash step  170  includes storing the centrifuged pellet at about 2-8° C. 
     B. Recovery (Activation) Stage 
       FIG. 3  shows a detailed flow chart for the recovery or activation stage  200  of  FIG. 1  of the manufacturing process for activated botulinum toxin type B. In some embodiments, a process of activating botulinum toxin type B requires at least one recovery or activation stage  200 . As inactive toxin exhibits the same process chemistry as the activated toxin, an active toxin cannot be seperated from a mixture of active and inactive toxins in a purification process. Activation may be performed by the addition of controlled amounts of a proteolytic agent. Activation is controlled by the addition of pre-determined amounts of a proteolytic enzyme and incubating the mixture for a limited time under controlled temperature, pH and mixing. 
     In some embodiments, the recovery stage  200  includes a buffer preparation step  210 . In some embodiments, the buffer preparation step  210  includes preparing and adjusting the pH of phosphate buffers. In some embodiments, the buffer preparation step  210  includes filtering the buffers through a 0.2 μm filter, and storing the filtered buffer at room temperature. 
     In some embodiments, the recovery stage  200  includes an AP buffer wash step  220 . In some embodiments, the AP buffer wash step  220  includes transferring the centrifuged pellet of step  170  from the fermentation suite and re-suspension of the pellet in the phosphate buffer of step  210 . In some embodiments, the AP buffer wash step  220  includes centrifugation of the re-suspended pellet and saving the supernatant. 
     In some embodiments, the recovery stage  200  includes an ammonium chloride precipitation step  230 . In some embodiments, the precipitation step  230  includes adding an ammonium chloride solution to the suspension of step  210  to achieve target concentration. In some embodiments, the precipitation step  230  includes stirring the mixture while refrigerated to dissolve salts. In some embodiments, the precipitation step  230  includes centrifuging the mixture and saving the supernatant. 
     In some embodiments, the recovery stage  200  includes an ammonium sulfate precipitation step  240 . In some embodiments, the precipitation step  240  includes adding a solution of ammonium sulfate to the supernatant of step  230  to achieve target concentration. In some embodiments, the precipitation step  240  includes stirring the mixture while refrigerated. In some embodiments, the precipitation step  240  includes centrifuging the mixture and saving the supernatant. In some embodiments, the precipitation step  240  includes adding a second solution of ammonium sulfate to the precipitate to achieve target concentration. In some embodiments, the precipitation step  240  includes stirring the suspension while refrigerated. In some embodiments, the precipitation step  240  includes a second centrifugation and saving the pellet. 
     In some embodiments, the recovery stage  200  includes a buffer re-suspension step  250 . In some embodiments, the re-suspension step  250  includes dissolving the pellet of step  240  in a succinate buffer of pH 5.5. In some embodiments, the re-suspension step  250  includes centrifuging the suspension and saving the supernatant. 
     In some embodiments, the recovery stage  200  includes an activation step  260 . In some embodiments, the activation step  260  includes addition of a protease to the supernatant of step  250 . In some embodiments, the protease administered is selected from the group consisting of: trypsin, immobilized TPCK-trypsin, metalloproteases, endogenous proteases, bacterial proteases, plant derived proteases, and gastric proteases. In some embodiments, the protease is an animal free trypsin. In some embodiments, the animal free trypsin used is TrypZean™ (distributed by Sigma-Aldrich®). In some embodiments, the toxin to TrypZean™ ratio is 1:20 to 1:50 (w/w). 
     In some embodiments, the pH range during the activation step  260  is about pH 5 to about pH 6. In some embodiments, the pH level is about 5.6. In some embodiments, the incubation time of the activation step  260  is about 15 minutes to about 24 hours. In some embodiments, the temperature condition of the activation step  260  is about room temperature to about 37° C. In some embodiments, the activation step  260  may be terminated by removing the added protease through diafiltration using suitable filters which can retain the toxin while removing the enzyme. In some embodiments, the activation step  260  may be terminated by adding protease inhibitors to the mixture. In some embodiments, termination of the activation step  260  and the nicking process at various time points yields toxin with varying levels of percentage nicking. 
     In some embodiments, the recovery stage  200  includes a concentration and filtration step  270 . In some embodiments, the concentration and filtration step  270  includes diafiltration of the solution of step  260  with a succinate buffer of pH 5.5 to a concentration of about 300 mL. In some embodiments, the concentration and filtration step  270  includes filtering the product containing solution through a 0.45 μm filter. In some embodiments, the concentration and filtration step  270  includes storing the filtered buffer at about 2-8° C. 
     C. Purification Stage 
       FIG. 4  shows a detailed flow chart for the purification stage  300  of  FIG. 1  of the manufacturing process for activated botulinum toxin type B. In some embodiments, a process of activating botulinum toxin type B includes a purification stage  300 . 
     In some embodiments, the purification stage  300  includes a buffer preparation step  310 . In some embodiments, the buffer preparation step  310  includes preparing a succinate buffer, sodium hydroxide, and ethanol. In some embodiments, the buffer preparation step  310  includes filtering the succinate buffer and reagents through a 0.2 μm filter. In some embodiments, the filtered buffer and reagents is stored at room temperature. 
     In some embodiments, the purification stage  300  includes an anion exchange chromatograph step  320 . In some embodiments, the chromatograph step  320  includes packing a chromatograph column with DEAE resin. In some embodiments, the chromatograph step  320  includes cleaning the column with 0.5 N NaOH and rinsing with filtered water. In some embodiments, the chromatograph step  320  includes sampling the column rinse for bioburden, total organic carbon (TOC) and limulus amebocyte lysate (LAL) for endotoxin testing. In some embodiments, the chromatograph step  320  includes equilibrating the chromatograph column with the succinate buffer of step  310 . In some embodiments, the chromatograph step  320  includes loading an ultra-filtration diafiltration (UFDF) pool on the column. In some embodiments, the chromatograph step  320  includes collecting and analyzing fractions via SDS-PAGE gels. In some embodiments, the chromatograph step  320  includes pooling acceptable fractions. In some embodiments, the chromatograph step  320  includes filtering the pooled fractions through a 0.2 μm filter and sampling the filtered pooled fractions. In some embodiments, the chromatograph step  320  includes storing the filtered pooled fractions at about 2-8° C. 
     In some embodiments, the purification stage  300  includes a size exclusion chromatography (SEC) step  330 . In some embodiments, the size exclusion chromatography step  330  includes a column packing sub-step  331 , a column use sub-step  332 , and a column cleaning and storage sub-step  333 . In some embodiments, the column packing sub-step  331  includes packing the column with SEC resin. In some embodiments, sub-step  331  includes testing the column for efficiency and peak asymmetry. In some embodiments, sub-step  331  includes cleaning the column with 0.5 NaOH and rinsing with filtered water. In some embodiments, sub-step  331  includes sampling the column rinse for bioburden, TOC, and LAL. In some embodiments, sub-step  331  includes storing the column in 20% ethanol. 
     In some embodiments, the size exclusion chromatography step  330  includes a column use sub-step  332 . In some embodiments, sub-step  332  includes cleaning the column with 0.5 NaOH and rinsing with Sterile Water for Irrigation. In some embodiments, sub-step  332  includes sampling the column rinse for bioburden, TOC, and LAL. In some embodiments, sub-step  332  includes equilibrating the column with the succinate buffer of step  310 . In some embodiments, sub-step  332  includes loading the filtered pooled fractions of step  320  on the column. In some embodiments, sub-step  332  includes collection and analyzing fractions via SDS-PAGE gels. In some embodiments, sub-step  332  includes pooling acceptable fractions. 
     In some embodiments, the size exclusion chromatography step  330  includes a column cleaning and storage sub-step  333 . In some embodiments, sub-step  333  includes cleaning the column with 0.5 NaOH and rinsing with Sterile Water for irrigation. In some embodiments, sub-step  333  includes sampling the column rinse for bioburden, TOC, and LAL. In some embodiments, sub-step  333  includes storing the column in 20% ethanol. 
     In some embodiments, the purification process  300  includes a filtration step  340 . In some embodiments, the filtration step  340  includes filtering the pooled fractions of step  332  through a 0.2 μm filter into a sterile bottle. 
     In some embodiments, the purification process  300  includes a concentrated product (CP) step  350 . In some embodiments, the filtered concentrated product of step  340  is stored at about 2-8° C. 
     D. Dilute Bulk Solution Preparation Stage 
       FIG. 5  shows a detailed flow chart for the production and handling of a dilute bulk solution of activated botulinum toxin type B. In some embodiments, a process for activating botulinum toxin type B includes a dilute bulk solution preparation stage  400 . 
     In some embodiments, the dilute bulk solution preparation stage  400  includes a component preparation step  410 . In some embodiments, the component step  410  includes washing and sterilizing the components at 123.5° C. for 30 minutes. 
     In some embodiments, the dilute bulk solution preparation stage  400  includes a succinate buffer preparation step  420 . In some embodiments, the buffer preparation step  420  includes weighing sodium succinate and sodium chloride and dissolving them in Water for Injection. In some embodiments, the sodium succinate weighed is 2.7 mg/mL. In some embodiments, the sodium chloride weighed is 5.8 mg/mL. In some embodiments, the buffer preparation step  420  includes adding human serum albumin (HSA). In some embodiments, the HSA is 0.5 mg/mL. In some embodiments, the buffer preparation step  420  includes addition of Sterile Water for Injection, stirring, and adjustment of the buffer to a pH of 5.6 using hydrogen chloride. 
     In some embodiments, the dilute bulk solution preparation stage  400  includes a dilution step  430  of the concentrated product with succinate buffer. In some embodiments, the dilution step  430  includes calculating the amount of the concentrated product (CP) of step  350  required and diluting the CP with the prepared succinate buffer of step  420 . In some embodiments, the CP is diluted with about 3 L of succinate buffer. In some embodiments, the dilution step  430  includes pumping about the succinate buffer of step  420  into a dilute bulk vessel through a 0.2 μm filter. In some embodiments, the dilution step  430  includes pumping the pre-diluted CP into a dilute bulk vessel through a 0.2 μm filter. In some embodiments, the dilution step  430  includes pumping additional succinate buffer through the 0.2 μm filter, stirring for 20-30 minutes, and storing the diluted bulk solution at about 2-8° C. 
     III. Method of Treatment Using Activated Botulinum Toxin Type B 
     The increased percentage of activated botulinum toxin type B molecules in a pharmaceutical composition of the present invention enhances the clinical effectiveness of the botulinum toxin, allows for the decreased protein load of a preparation, and results in decreased antigenicity. 
     The pharmaceutical compositions of the present invention may be administered by any means known in the art to deliver the activated botulinum holotoxin type B (150 kD) to the desired therapeutic target. In some embodiments, the pharmaceutical compositions are delivered by transmucosal administration. In some embodiments, the pharmaceutical compositions are delivered by transcutaneous administration. In some embodiments, the pharmaceutical compositions are delivered by intramuscular administrations. In some embodiments, the pharmaceutical compositions are delivered by transdermal administration. In some embodiments, the pharmaceutical compositions are injection. In some embodiments, the pharmaceutical compositions are delivered topically. 
     The pharmaceutical compositions of the present invention may be used in any of the methods of treatment disclosed herein. According to the methods disclosed herein, the pharmaceutical compositions of the present invention may be administered as a single treatment or repeated periodically to provide multiple treatments. 
     In some embodiments, the present invention describes a method of treating a variety of ophthalmologic disorders, neuromuscular diseases, otorhinolaryngological disorders, urogenital disorders, dermatological disorders, pain disorders, inflammatory disorders, secretory disorders, and cutaneous disorders or cosmetic treatment by administering an effective amount of a pharmaceutical composition of the present invention to a patient in need thereof. As used herein, an “effective amount” is an amount sufficient to produce a therapeutic response. An effective amount may be determined with dose escalation studies in open-labeled clinical trials or bin studies with blinded trials. 
     Pharmaceutical compositions according to the invention may be used for preparing medicaments intended to treat a disease, condition, or syndrome may be chosen from, but not limited to, the following: 
     A. Ophthalmologic Disorders 
     In some embodiments, a method of treating ophthalmologic disorders includes administering an effective amount of a pharmaceutical composition of the present invention to a patient in need thereof. In some embodiments, the ophthalmologic disorder is selected from the group consisting of, but not limited to: blepharospasm, strabismus (including restrictive or myogenic strabismus), amblyopia, oscillopsia, protective ptosis, theraputic ptosis for corneal protection, nystagmus, estropia, diplopia, entropion, eyelid retraction, orbital myopathy, heterophoria, concomitant misalignment, nonconcomitant misalignment, primary or secondary esotropia or exotropia, internuclear ophthalmophegia, skew deviation, Duane&#39;s syndrome and upper eyelid retraction. 
     B. Overactive Muscles or Neuromuscular Diseases 
     As used herein, “overactive muscles or neuromuscular diseases” refer to any disease adversely affecting both nervous elements (brain, spinal cord, peripheral nerve) or muscle (striated or smooth muscle), including but not limited to: involuntary movement disorders, dystonias, spinal cord injury or disease, multiple sclerosis, and spasticity from cerebral palsy, stroke, or other cause. 
     In some embodiments, a method of treating overactive or neuromuscular diseases includes administering an effective amount of a pharmaceutical composition of the present invention to a patient in need thereof. In some embodiments, the overactive or neuromuscular disease is an involuntary movement disorder selected from the group consisting of, but not limited to: hemifacial spasm, torticollis, spasticity of the child or of the adult (e.g., in cerebral palsy, post-stroke, multiple sclerosis, traumatic brain injury or spinal cord injury patients), idiopathic focal dystonias, muscle stiffness, writer&#39;s cramp, hand dystonia, CN VI nerve palsy, oromandibular dystonia, head tremor, tardive dyskinesia, occupational cramps (including musicians&#39; cramp), facial nerve palsy, jaw closing spasm, facial spasm, synkinesia, tremor, primary writing tremor, myoclonus, stiff-person-syndrome, foot dystonia, facial paralysis, painful-arm-and-moving-fingers-syndrome, tic disorders, dystonic tics, Tourette&#39;s syndrome, neuromyotonia, trembling chin, lateral rectus palsy, dystonic foot inversion, jaw dystonia, Rabbit syndrome, cerebellar tremor, III nerve palsy, palatal myoclonus, akasthesia, muscle cramps, IV nerve palsy, freezing-of-gait, extensor truncal dystonia, post-facial nerve palsy synkinesis, secondary dystonia, off period dystonia, cephalic tetanus, myokymia and benign cramp-fasciculation syndrome. 
     C. Otorhinolaryngological or gastrointestinal Disorders 
     In some embodiments, a method of treating otorhinolaryngological or gastrointestinal disorders includes administering an effective amount of a pharmaceutical composition of the present invention to a patient in need thereof. In some embodiments, the otorhinolaryngological disorder is selected from the group consisting of, but not limited to: spasmodic dysphonia, hypersalivation, sialorrhoea, ear click, tinnitus, vertigo, Meniere&#39;s disease, cochlear nerve dysfunction, stuttering, cricopharyngeal dysphagia, bruxism, closure of larynx in chronic aspiration, vocal fold granuloma, ventricular dystonia, ventricular dysphonia, mutational dysphonia, trismus, snoring, voice tremor, aspiration, tongue protrusion dystonia, palatal tremor and laryngeal dystonia; gastrointestinal disorders selected from the group consisting of achalasia, anal fissure, constipation, temperomandibular joint dysfunction, sphincter of Oddi dysfunction, sustained sphincter of Oddi hypertension, intestinal muscle disorders, puborectalis syndrome, anismus, pyloric spasm, gall bladder dysfunction, gastrointestinal or oesophageal motility dysfunction, diffuse oesophageal spasm, oesophageal diverticulosis and gastroparesis. 
     D. Urogenial Disorders 
     In some embodiments, a method of treating urogenital disorders includes administering an effective amount of a pharmaceutical composition of the present invention to a patient in need thereof. In some embodiments, the urogenital disorder is selected from the group consisting of, but not limited to: detrusor sphincter dyssynergia, detrusor hyperreflexia, neurogenic bladder dysfunction in Parkinson&#39;s disease, spinal cord injury, stroke or multiple sclerosis patients, bladder spasms, urinary incontinence, urinary retention, hypertrophied bladder neck, voiding dysfunction, interstitial cystitis, vaginismus, endometriosis, pelvic pain, prostate gland enlargement (benign prostatic hyperplasia), prostatodynia, prostate cancer and priapism. 
     E. Dermatological Disorders 
     In some embodiments, a method of treating dermatological disorders includes administering an effective amount of a pharmaceutical composition of the present invention to a patient in need thereof. In some embodiments, the dermatological disorder is selected from the group consisting of, but not limited to: axillary hyperhidrosis, palmar hyperhidrosis, Frey&#39;s syndrome, bromhidrosis, psoriasis, skin wounds and acne. 
     F. Pain Disorders 
     In some embodiments, a method of treating pain disorders includes administering an effective amount of a pharmaceutical composition of the present invention to a patient in need thereof. In some embodiments, the pain disorder is selected from the group consisting of, but not limited to: joint pain, upper back pain, lower back pain, myofascial pain, tension headache, fibromyalgia, myalgia, migraine, whiplash, joint pain, post-operative pain and pain associated with smooth muscle disorders. 
     G. Inflammatory Disorders 
     In some embodiments, a method of treating inflammatory disorders includes administering an effective amount of a pharmaceutical composition of the present invention to a patient in need thereof. In some embodiments, the inflammatory disorder is selected from the group consisting of, but not limited to: pancreatitis, gout, tendonitis, bursitis, dermatomyositis and ankylosing spondylitis. 
     H. Secretory Disorders 
     In some embodiments, a method of treating secretory disorders includes administering an effective amount of a pharmaceutical composition of the present invention to a patient in need thereof. In some embodiments, the secretory disorder is selected from the group consisting of, but not limited to: excessive gland secretions, mucus hypersecretion and hyperlacrimation and holocrine gland dysfunction. 
     I. Cutaneous Disorders or Cosmetic Treatment 
     In some embodiments, a method of treating cutaneous disorders or cosmetic treament includes administering an effective amount of a pharmaceutical composition of the present invention to a patient in need thereof. In some embodiments, the cutaneous disorder or cosmetic treatment is selected from the group consisting of, but not limited to: skin defects; facial asymmetry; wrinkles selected from glabellar frown lines and facial wrinkles; downturned mouth; and hair loss. 
     EXAMPLES 
     The following Examples serve to further illustrate the present invention and are not to be construed as limiting its scope in any way. 
     Example 1 
     Preparation of an Activated Botulinum Toxin Type B Composition: Fermentation (Cell Growth) Stage 
     The drug substance manufacturing process, which utilizes a frozen culture of  C. botulinum , Type B Bean strain (working cell bank), proceeds through two successive seed cultures (S 1  and S 2 ). The S 2  seed culture is used as the inoculum for the production culture (S 3 ). In S 3 , a fermentor containing liquid medium of casein hydrolysate (trypticase peptone), yeast extract, cysteine hydrochloride, and glucose is inoculated with an S 2  culture. After fermentation, the crude toxin complex is precipitated by acidifying the culture. 
     Example 2 
     Preparation of an Activated Botulinum Toxin Type B Composition: Recovery (Activation) Stage 
     The precipitated toxin is re-suspended in phosphate buffer and purified by a series of salt precipitations including 2 M ammonium chloride/0.7 mM magnesium chloride precipitation step, a 15% ammonium sulfate precipitation step and 30% ammonium sulfate precipitation step. The pellet is re-suspended in succinate buffer. The dissolved toxin is digested with TrypZean™ (animal free proteolytic enzyme) to nick and activate the toxin at temperature range of 20° C.-40° C. and pH of 5-6, for a period of 30 min to 120 minute. Upon completion of incubation, the toxin solution is diafiltered to remove solutes and the added proteolytic enzyme, and then filtered (0.45 μm). The activation yields toxin with percentage nicking of &gt;90%, and typically &gt;99%. 
     Example 3 
     Preparation of an Activated Botulinum Toxin Type B Composition: Purification Stage 
     Purification is accomplished using anion exchange and size exclusion column chromatography, each followed by 0.2 μm filtration. The concentrated product is produced at the completion of the filtering step from the SEC column. 
     Example 4 
     Preparation of an Activated Botulinum Toxin Type B Composition: Dilute Bulk Solution Stage 
     The concentrated product (CP) is diluted to 5000 U/mL with 10 mM succinate buffer (pH 5.6) containing 100 mM sodium chloride and 0.5 mg Human Serum Albumin (HSA) per mL to prepare the bulk drug product, also named dilute bulk solution. The dilute bulk is 0.2 μm filtered to reduce bioburden and prepared in a 45 L batch size. 
     Example 5 
     Preparation of an Activated Botulinum Toxin Type B Composition: Final Container Preparation 
     The dilute bulk solution is sterile filtered through two 0.22 um filters in series prior to filling. Three final product presentations 0.5 mL, 1.0 mL, and 2.0 mL are filled into USP Type I glass vials (3.5 mL). The vials are closed with siliconized butyl rubber stoppers and sealed with aluminum seals. The final product is stored refrigerated at 5±3° C. Alternatively, the final product may be stored at &lt;25° C. for a period of three months. 
     The present application incorporates U.S. patent application Ser. No. 12/462,559 herein by reference in its entirety.