Patent Grant
9724356
The present invention relates to pharmaceutical formulations of acid in water wherein the formulation is maintained at a pH such that precipitation of sodium deoxycholate is substantially inhibited.
Rapid removal of body fat is an age-old ideal, and many substances have been claimed to accomplish such results, although few have shown results. “Mesotherapy,” or the use of injectables for the removal of fat, is not widely accepted among medical practitioners due to safety and efficacy concerns, although homeopathic and cosmetic claims have been made since the 1950's. Mesotherapy was originally conceived in Europe as a method of utilizing cutaneous injections containing a mixture of compounds for the treatment of local medical and cosmetic conditions. Although mesotherapy was traditionally employed for pain relief, its cosmetic applications, particularly fat and cellulite removal, have recently received attention in the United States. One such reported treatment for localized fat reduction, which was popularized in Brazil and uses injections of phosphatidylcholine, has been erroneously considered synonymous with mesotherapy. Despite its attraction as a purported “fat-dissolving” injection, the safety and efficacy of these cosmetic treatments remain ambiguous to most patients and physicians (see, Rotunda, A. M. and M. Kolodney, Dermatologic Surgery “Mesotherapy and Phosphatidylcholine Injections: Historical Clarification and Review”, 2006, 32: 465-480).
Recently published literature reports that the bile acid deoxycholic acid has fat removing properties when injected into fatty deposits in vivo (See, WO 2005/117900 and WO 2005/112942, US2005/0261258; US2005/0267080; US2006/127468; and US2006/0154906). Deoxycholate injected into fat tissue has the effects of: 1) degrading fat cells via a cytolytic mechanism; and 2) causing skin tightening. Both of these effects are required to mediate the desired aesthetic corrections (i.e., body contouring). The effects of deoxycholate into fat are spatially contained because deoxycholate injected into fat is rapidly inactivated by exposure to protein, e.g. albumin, and then rapidly returns to the intestinal contents. As a result of this attenuation effect that confers clinical safety, fat removal therapies typically require 4-6 sessions. This localized fat removal without the need for surgery is beneficial not only for therapeutic treatment relating to pathological localized fat deposits (e.g., dyslipidemias incident to medical intervention in the treatment of HIV), but also for cosmetic fat removal without the attendant risk inherent in surgery (e.g., liposuction) (see, Rotunda et al., Dermatol. Surgery “Detergent effects of sodium deoxycholate are a major feature of an injectable phosphatidylcholine formulation used for localized fat dissolution”, 2004, 30: 1001-1008; and Rotunda et al., J. Am. Acad. Dermatol. “Lipomas treated with subcutaneous deoxycholate injections”, 2005: 973-978).
All publications and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.
It has been found that aqueous solutions of sodium deoxycholate at low (i.e., <5% w/v) concentrations of sodium deoxycholate can be stabilized by adjusting the pH of the solution. The present invention is directed to an aqueous pharmaceutical formulation comprising less than about 5% w/v sodium deoxycholate wherein the formulation is maintained at a pH sufficient to substantially inhibit precipitation of the sodium deoxycholate.
Also disclosed herein, are methods for inhibiting precipitation of sodium deoxycholate in an aqueous solution comprising less than about 5% w/v of sodium deoxycholate, said method comprising maintaining pH of the solution from about 8.0 to about 8.5.
As used herein, certain terms have the following defined meanings.
All numerical designations, e.g., pH, temperature, time, concentration, and molecular weight, including ranges, are approximations which are varied (+) or (−) by increments of 0.1. It is to be understood, although not always explicitly stated that all numerical designations are preceded by the term “about”. The term “about” also includes the exact value “X” in addition to minor increments of “X” such as “X+0.1” or “X−0.1.” It also is to be understood, although not always explicitly stated, that the reagents described herein are merely exemplary and that equivalents of such are known in the art.
As used herein, the term “comprising” is intended to mean that the compositions and methods include the recited elements, but do not exclude others. “Consisting essentially of” when used to define compositions and methods, shall mean excluding other elements of any essential significance to the combination when used for the intended purpose. Thus, a composition consisting essentially of the elements as defined herein would not exclude trace contaminants from the isolation and purification method and pharmaceutically acceptable carriers, such as phosphate buffered saline, preservatives, and the like. “Consisting of” shall mean excluding more than trace elements of other ingredients and substantial method steps for administering the compositions of this invention. Embodiments defined by each of these transition terms are within the scope of this invention.
As used herein, the term “sodium deoxycholate” refers to sodium (4R)-4-((3R,5R,10S,12S,13R,17R)-3,12-dihydroxy-10,13-dimethylhexadecahydro-1H-cyclopenta[a]phenanthren-17-yl)pentanoate as shown below. Other stereoisomers are within the scope of the invention.
Sodium deoxycholate or sodium (4R)-4-((3R,5R,10S,12S,13R,17R)-3,12-dihydroxy-10,13-dimethylhexadecahydro-1H-cyclopenta[a]phenanthren-17-yl)pentanoate can be prepared according to the methods disclosed in U.S. Patent Publication No. 2008/0318870A1 entitled “Synthetic Bile Acid Composition, Method And Preparation” filed on Feb. 21, 2008, which is hereby incorporated by reference in its entirety.
As used herein, the term “aqueous pharmaceutical formulation” refers to a formulation of sodium deoxycholate in water suitable for administration to a patient.
As used herein, the term “buffer” refers to an aqueous solution comprising a mixture of a weak acid and its conjugate base or a weak base and its conjugate acid. A buffer has the property that the pH of the solution changes very little when a small amount of acid or base is added to it. Buffer solutions are used as a means of keeping pH at a nearly constant value in a wide variety of chemical applications. Examples of suitable buffers include phosphate buffers and those known in the literature (see, for example, Troy, D. B., ed. (2005) Remington: The Science and Practice of Pharmacy, 21st ed., Lippincott Williams & Wilkins).
As used herein, the term “base” refers to various typically water-soluble compounds, molecules or ions that in solution have a pH greater than 7. Such compounds, molecules or ions are able to take up a proton from an acid or are able to give up an unshared pair of electrons to an acid. Examples of suitable bases include metal carbonates and bicarbonates, for example sodium carbonate, calcium carbonate, magnesium carbonate, zinc carbonate, sodium bicarbonate and the like; and metal hydroxides, for example sodium hydroxide, potassium hydroxide, and the like, such as those known in the literature (see, for example, Troy, D. B., ed. (2005) Remington: The Science and Practice of Pharmacy, 21st ed., Lippincott Williams & Wilkins).
As used herein, the term “metal carbonates” refers to the metal salt of CO32−. For example, sodium carbonate, calcium carbonate, magnesium carbonate, zinc carbonate, and the like.
As used herein, the term “metal bicarbonates” refers to the metal salt of HCO3−. For example, sodium bicarbonate, and the like.
As used herein, the term “metal hydroxides” refers to the metal salt of −OH. For example, sodium hydroxide, potassium hydroxide, and the like.
As used herein, the terms “sterile water” or “water for injection” refer to a sterile, nonpyrogenic preparation of water for injection which contains no bacteriostat, antimicrobial agent or added buffer. In general, the osmolar concentration of additives totals at least 112 mOsmol/liter (two-fifths of the normal osmolarity of the extracellular fluid −280 mOsmol/liter).
As used herein, the term “benzyl alcohol” refers to the compound
As used herein, the term “precipitation” refers to the formation of a solid in a solution. As used herein, the term “solution” refers to a substantially homogeneous mixture comprising two or more substances dissolved in a solvent.
As used herein, the term “substantially inhibit precipitation” means to inhibit most or all visible precipitation or maintain homogeneity. This may be done over a desired period of time.
As used herein, the term “relative standard deviation for homogeneity” or “HE” refers to the value obtained by dividing the standard deviation of the homogeneity by the absolute value of the mean. An HE less than 10 indicates very good homogeneity.
Knowledge about the chemical and physical stability of a drug formulation in the desired media for delivery is valuable. In the longer term, the stability of the formulation will dictate the shelf life of the marketed product. It is preferable that the active ingredient in a pharmaceutical formulation be at the required concentration when administered to a patient.
Current methods for the administration of sodium deoxycholate to a patient include the administration of a low concentration (i.e., <5% w/v) of an aqueous solution of sodium deoxycholate, as it has been shown that the low concentration is beneficial for the effective and safe removal of fat deposits in the body. However, it has been observed that a precipitate forms at both relatively low (i.e., <5% w/v) and high (i.e., >16% w/v) concentrations of sodium deoxycholate in aqueous media. This precipitation results in a limited shelf life of aqueous solutions of sodium deoxycholate, even at cold temperatures (3-5° C.). This instability of aqueous solutions of sodium deoxycholate can be circumvented by the preparation of an aqueous solution of sodium deoxycholate at a concentration of about 5% to about 16% w/v, and having the practitioner dilute the pharmaceutical composition of sodium deoxycholate just prior to use. Whereas this dilution method is effective to allow for both storage stability and effective patient dosing, it is not ideal as a method for routine use.
It has been found that aqueous solutions of sodium deoxycholate at low (i.e., <5% w/v) concentrations of sodium deoxycholate can be stabilized adjusting the pH of the solution. The present application is directed to an aqueous pharmaceutical formulation comprising less than about 5% w/v sodium deoxycholate wherein the formulation is maintained at a pH sufficient to substantially inhibit precipitation of the sodium deoxycholate. In some embodiments, the pharmaceutical formulation, comprising less than about 5% w/v sodium deoxycholate in water, or alternatively, less than about 4.5%, or alternatively, less than about 4%, or alternatively, less than about 3.5%, or alternatively, less than about 3%, or alternatively, less than about 2.5%, or alternatively, less than about 2%, or alternatively, less than about 1.5%, or alternatively, less than about 1%, or alternatively, less than about 0.75%, or alternatively, less than about 0.5%, or alternatively, less than about 0.1% w/v sodium deoxycholate in water.
Sodium deoxycholate or sodium (4R)-4-((3R,5R,10S,12S,13R,17R)-3,12-dihydroxy-10,13-dimethylhexadecahydro-1H-cyclopenta[a]phenanthren-17-yl)pentanoate can be prepared according to the methods disclosed in U.S. Patent Publication No. 2008/0318870A1 entitled “Synthetic Bile Acid Composition, Method And Preparation” filed on Feb. 21, 2008, which is hereby incorporated by reference in its entirety.
In one embodiment, the pharmaceutical formulations disclosed herein are suitable for injection into a human. The method of injection can be any type of injection, such as subcutaneous injection, as well as other forms of injection. Therefore, in some embodiments, the aqueous formulation is sterile. The aqueous formulation can be prepared using sterile water or water for injection (WFI).
In one aspect of the present invention, the precipitation of sodium deoxycholate is substantially inhibited for a period of at least about six months. In another aspect, the precipitation of sodium deoxycholate is substantially inhibited for a period of at least about one year. In yet another aspect, the precipitation of sodium deoxycholate is substantially inhibited for a period of at least about two years.
It is contemplated that when stored at various temperatures, for example at ambient or cold temperatures, the formulation can have an increased shelf life. In certain embodiments, the formulation is stored at a temperature of from about 17° C. to about 27° C. In some embodiments, the temperature of the formulation is increased to a temperature of about 25° C. to about 37° C. In other embodiments, the formulation is stored at a temperature of from about 2° C. to about 8° C.
In certain embodiments, the pH of the formulation ranges from about 8.0 to about 8.5. In one embodiment, the pH of the formulation is about 8.0, or alternatively, about 8.1, or alternatively, about 8.2, or alternatively, about 8.3, or alternatively, about 8.4, or alternatively, about 8.5.
In one embodiment, the pH is established by the use of a base. It is contemplated that any base can be used to increase the pH of the formulation provided that it does not react with the sodium deoxycholate and will not cause harm to the patient. In some embodiments, the base is selected from the group consisting of metal carbonates, metal bicarbonates, metal hydroxides, or a mixture thereof. Examples of bases include, but are not limited to, a base selected from the group consisting of sodium carbonate, calcium carbonate, magnesium carbonate, zinc carbonate, sodium bicarbonate, sodium hydroxide and potassium hydroxide or a mixture thereof. In one embodiment, the base is sodium hydroxide.
In certain cases, the pH of the formulation may be maintained with the use of a buffer. Various buffers are known in the art and it is contemplated that any buffer having buffering capacity at the desired pH can be used in the formulations disclosed herein. In one embodiment, the buffer is a phosphate buffer. The amount of phosphate in the formulation can be determined to provide a desired pH and salt concentration. In one embodiment, the formulation comprises about 10 mM phosphate.
In some embodiments, the formulation comprises at least one excipient to aid in achieving a formulation with desired properties, such as increased solubility, preservability or to provide an isotonic solution. Such excipients are known in the art. In one embodiment, the formulation comprises about 1% sodium chloride. In another embodiment, the formulation comprises about 1% benzyl alcohol. In some embodiments, the formulation comprises about 1% benzyl alcohol and about 1% sodium chloride. In some embodiments, the formulation comprises about 0.9% benzyl alcohol and about 0.9% sodium chloride.
The formulations disclosed herein comprise less than about 5% w/v sodium deoxycholate in water maintained at a pH sufficient to substantially inhibit precipitation of the sodium deoxycholate. The amount of precipitation or homogeneity of the formulation can be measured using various methods. For example, it can be measured quantitatively using light scattering by illuminating the formulation with a spectrophotometer. Or alternatively, the homogeneity can be measured qualitatively by observing the visual clarity of the solution with the eye. In some embodiments, the formulation has a relative standard deviation for homogeneity of less than about 5%. Alternatively, the formulation has a relative standard deviation for homogeneity of less than about 4%, or alternatively, about 3%, or alternatively, about 2%, or alternatively, about 1%.
The use of prodrugs of sodium deoxycholate in the formulations disclosed herein are also contemplated. A prodrug is an active or inactive compound that is modified chemically through in vivo physiological action, such as hydrolysis, metabolism and the like, into a compound of the embodiments following administration of the prodrug to a patient. For example, one may prepare an ester of the present deoxycholic acid at either or both of the hydroxyl groups thereon or of suitable derivatives thereof, so that the release of the deoxycholic acid or derivatives thereof is triggered by the disruption of the cell membrane, and release of esterase. With the release of esterase, the ester protecting group is cleaved so that the deoxycholic acid active form or derivatives thereof is present at the desired location in situ. For a general discussion of prodrugs involving esters see Svensson and Tunek Drug Metabolism Reviews 165 (1988) and Bundgaard Design of Prodrugs, Elsevier (1985).
In some embodiments, the solutions herein do not include lipids, phospholipids, or phosphatidylcholine. In some embodiments, the solutions herein include up to 5% w/w, w/v, or v/v lipids, specifically phospholipids, or more specifically phosphatidylcholine.
In some embodiments, the aqueous pharmaceutical formulation of the invention can further comprise a second therapeutic agent selected from the group consisting of: anti-microbial agents, vasoconstrictors, anti-thrombotic agents, anti-coagulation agents, suds-depressants, anti-inflammatory agents, analgesics, dispersion agents, anti-dispersion agents, penetration enhancers, steroids, tranquilizers, muscle relaxants, and anti-diarrhea agents. In some embodiments, a solution is in a container that contains up to 500 mL of solution. Such container can be a syringe or syringe-loadable container.
In some embodiments, the formulations further comprise a molecule known to cause fat to die by an orthogonal mechanism. Such molecules include neuropeptide Y (NPY) antagonists including, but not limited to, NPY receptor antagonists, such as BIBP-3226 (Amgen), BIBO-3304 (Boehringer Ingleheim), BMS-192548 and AR-H040922 (Bristol-Myers Squibb), LY-357897 (Eli Lilly), 1229U91 and GW438014S (GlaxoSmithKline), JNJ-5207787 (Johnson & Johnson), Lu-AA-44608 (Lundbeck), MK-0557 (Merck NPY), NGD-95-1 (Neurgogen), NLX-E201 (Neurologix), CGP-71683 (Novartis), PD-160170 (Pfizer), SR-120819A, BIIE0246, and S.A.0204 (Sanofi Aventis), S-2367 (Shiongli), dihydropyridine and dihydropyridine derivatives that are NPY receptor antagonists, bicyclic compounds that are NPY receptor antagonists, carbazole NPY receptor antagonists, and tricyclic compounds that are NPY receptor antagonists (See, e.g., WO 2006/133160 and U.S. Pat. No. 6,313,128). Also contemplated are fat selective pro-apoptotic peptides such as the CKGGRAKDC peptide that homes to white fat vasculature (See, Kolonin M. G. et al., Nat. Med., 2004, 10(6): 625-32).
Another aspect of the invention relates to mixing adipo-ablative bile acids, such as, deoxycholic acid (DCA) with agents that kill fat cells. In one aspect, this invention contemplates a means to enhance the aesthetic effects of deoxycholate injections by mixing into the deoxycholate injectate a molecule that causes fat to die by an orthogonal mechanism. Examples of such candidate molecules include, but are not limited to, neuropeptide Y (NPY) antagonists and fat selective pro-apoptotic peptides. Since both fat cell killing and skin tightening may be required to mediate the desired effects, the effects of an agent with fat killing ability and potent skin tightening effects (such as deoxycholate) can be enhanced via the addition of a molecule with potent fat cell killing effects. Additionally, molecules that require access to the vasculature to kill (such as certain pro-apoptotic peptides that bind to proteins expressed on the luminal side of capillaries) can gain access to these proteins because deoxycholate may cause vascular leakage. Thus, such agents can be synergistic with deoxycholate potentially creating a more potent means to mediate body contouring in fewer therapeutic sessions.
Examples of NPY antagonists include, but are not limited to, NPY receptor antagonists, such as BIBP-3226 (Amgen), BIBO-3304 (Boehringer Ingleheim), BMS-192548 and AR-H040922 (Bristol-Myers Squibb), LY-357897 (Eli Lilly), 1229U91 and GW438014S (GlaxoSmithKline), JNJ-5207787 (Johnson & Johnson), Lu-AA-44608 (Lundbeck), MK-0557 (Merck NPY), NGD-95-1 (Neurgogen), NLX-E201 (Neurologix), CGP-71683 (Novartis), PD-160170 (Pfizer), SR-120819A, BIIE0246, and S.A.0204 (Sanofi Aventis), S-2367 (Shiongli), dihydropyridine and dihydropyridine derivatives that are NPY receptor antagonists, bicyclic compounds that are NPY receptor antagonists, carbazole NPY receptor antagonists, and tricyclic compounds that are NPY receptor antagonists. See, e.g., WO 2006/133160 and U.S. Pat. No. 6,313,128 (incorporated herein by reference in its entirety including figures).
Exemplary fat selective pro-apoptotic peptides includes, but is not limited to, CKGGRAKDC peptide that homes to white fat vasculature. See, Kolonin M. G. et al., Nat. Med. June 10(6):625-32 (2004).
Sodium deoxycholate or sodium (4R)-4-((3R,5R,10S,12S,13R,17R)-3,12-dihydroxy-10,13-dimethylhexadecahydro-1H-cyclopenta[a]phenanthren-17-yl)pentanoate can be prepared according to the methods disclosed in U.S. Patent Publication No. 2008/0318870A1 entitled “Synthetic Bile Acid Composition, Method And Preparation” filed on Feb. 21, 2008, which is hereby incorporated by reference in its entirety. It will be appreciated that where typical or preferred process conditions (i.e., reaction temperatures, times, mole ratios of reactants, solvents, pressures, etc.) are given, other process conditions can also be used unless otherwise stated. Optimum reaction conditions may vary with the particular reactants or solvent used, but such conditions can be determined by one skilled in the art by routine optimization procedures.
Disclosed herein is a method for inhibiting precipitation of sodium deoxycholate in an aqueous solution comprising less than about 5% w/v of sodium deoxycholate, said method comprising maintaining pH of the solution from at least about 8.0 to about 8.5.
In one aspect of the present invention, methods disclosed herein substantially inhibit the precipitation of sodium deoxycholate in solution over a period of at least about six months. In another aspect, the precipitation of sodium deoxycholate is substantially inhibited for a period of at least about one year. In yet another aspect, the precipitation of sodium deoxycholate is substantially inhibited for a period of at least about two years.
It has been found that the pH of the solution can inhibit the precipitation of sodium deoxycholate at concentrations of less than about 5% w/v in water allow the sodium deoxycholate to be maintained in solution. In one embodiment, the pH is established by the use of a base. It is contemplated that any base can be used to increase the pH of the formulation provided that it does not react with the sodium deoxycholate. In some embodiments, the base is selected from the group consisting of metal carbonates, metal bicarbonates, and metal hydroxides, or a mixture thereof. Examples of bases include, but are not limited to, a base selected from the group consisting of sodium carbonate, calcium carbonate, magnesium carbonate, zinc carbonate, sodium bicarbonate, sodium hydroxide and potassium hydroxide or a mixture thereof. In one embodiment, the base is sodium hydroxide.
In certain embodiments, the pH ranges from about 8.0 to about 8.5. In one embodiment, the pH of the formulation is about 8.0, or alternatively, about 8.1, or alternatively, about 8.2, or alternatively, about 8.3, or alternatively, about 8.4, or alternatively, about 8.5. In one embodiment, the pH of the aqueous solution is about 8.3.
In certain cases, the pH of the formulation may need to be maintained with the use of a buffer. Various buffers are know in the art and it is contemplated that any buffer having buffering capacity at the desired pH can be used in the formulations disclosed herein. In one embodiment, the buffer is a phosphate buffer. The amount of phosphate required to provide a desired pH and salt concentration can be calculated using methods well known in the art. In one embodiment, the formulation comprises about 10 mM phosphate.
In one embodiment, the methods disclosed herein provide formulations which are suitable for injection into a human. The method of injection can be any type of injection, such as subcutaneous injection, as well as other forms of injection. Therefore, in some embodiments, the aqueous solution comprises sterile water or water for injection (WFI).
In one aspect, it may be that one or more excipients are used to maintain the solubility, or increase the preservability of sodium deoxycholate present in the formulation. In one embodiment, the method comprises adding about 1% benzyl alcohol. In some embodiments, the formulation also comprises at least one excipient to aid in achieving an isotonic solution. Such excipients are known in the art. In one embodiment, the method comprises adding about 1% sodium chloride. In some embodiments, the method comprises adding both 1% benzyl alcohol and 1% sodium chloride. In some embodiments, the method comprises adding both 0.9% benzyl alcohol and 0.9% sodium chloride. Using the methods disclosed herein, an aqueous solution comprising less than about 5% w/v sodium deoxycholate is maintained at a pH sufficient to substantially inhibit precipitation of the sodium deoxycholate. The amount of precipitation or homogeneity of the formulation can be measured using various methods. For example, it can be measured quantitatively by measuring the light scattering via illumination by a spectrophotometer. Or alternatively, the homogeneity can be measured qualitatively by simply observing the visual clarity of the solution with the eye. In some embodiments, the method provides a pharmaceutical formulation having a relative standard deviation for homogeneity of less than about 5%. Alternatively, the relative standard deviation for homogeneity of less than about 4%, or alternatively, about 3%, or alternatively, about 2%, or alternatively, about 1%.
The storage temperature can assist in maintaining the solubility of the sodium deoxycholate of the formulation. In certain embodiments, the storage temperature is from about 17° C. to about 27° C. In some embodiments, the storage temperature is about 25° C. to about 37° C. In other embodiments, the storage temperature is from about 2° C. to about 8° C.
It is contemplated that the sodium deoxycholate concentration can vary from about 0.05% w/v to about 5% w/v without effecting solubility in the formulation. In certain embodiments, the formulation comprises a sodium deoxycholate concentration of about 0.05% w/v. Alternatively, the formulation comprises a sodium deoxycholate concentration of about 0.07% w/v, or alternatively, about 0.1% w/v, or alternatively, about 0.3% w/v, or alternatively, about 0.5% w/v, or alternatively, about 0.7% w/v, or alternatively, about 1% w/v, or alternatively, about 2% w/v, or alternatively, about 3% w/v, or alternatively, about 4% w/v, or alternatively, about 5% w/v.
In the examples and elsewhere in the specification, abbreviations have the following meanings
The invention is further understood by reference to the following examples, which are intended to be purely exemplary of the invention. The present invention is not limited in scope by the exemplified embodiments, which are intended as illustrations of single aspects of the invention only. Any methods that are functionally equivalent are within the scope of the invention. Various modifications of the invention in addition to those described herein will become apparent to those skilled in the art from the foregoing description. Although several embodiments of the invention are described herein in detail, it will be understood by those skilled in the art that variations may be made thereto without departing from the spirit of the invention or the scope of the appended claims. Such modifications fall within the scope of the appended claims.
This example demonstrates that aqueous formulations containing less than 5% w/v sodium deoxycholate forms a precipitate at various temperatures which cannot be brought back into solution. Solubility was best in aqueous formulations containing 5% w/v.
The stability of three lots of sodium deoxycholate dissolved in 0.9% benzyl alcohol and water for injection (WFI) was examined for changes in pH and visual observations, such as the formation of precipitate. Each lot was formulated at four concentrations: 5, 50, 100 and 160 mg/mL (0.5, 5, 10 and 16% w/v, respectively) dissolved in 0.9% benzyl alcohol and WFI. Table 1 provides a summary of the variables that were tested in this example.
The solutions were prepared as follows. Two samples for each condition were filled at 2.0 mL into sterile 3 c.c. glass vials (West Pharma P/N 68000316), and stoppered with sterile 13 mm serum stoppers (West Pharma P/N 19560001). These samples were analyzed in duplicate at each time point in order to verify any changes in pH and visual observations, during storage at 2-8° C. and 25° C. for two weeks. Table 2 summarizes the conditions and time points at which samples were analyzed throughout the study.
As seen in Tables 3 and 4, at 5 mg/mL (0.5% w/v), fine particulates were seen generally across all lots and at both 4° C. and 25° C., though Sample 1 at 4° C. did not precipitate. At 50 mg/mL (5% w/v), all samples and conditions were clear. At 100 mg/mL (10% w/v), there was a temperature effect as all lots at 4° C. precipitated out while the 25° C. lots remained clear. At 160 mg/mL (16% w/v), there was a temperature effect as all lots at 4° C. precipitated out while the 25° C. lots remained clear. The precipitation observed at 160 mg/mL (16% w/v) was more severe and rapid than 100 mg/mL, however, the precipitated product at these two concentrations could be resolubilized after warming to room temperature and vortexing. The precipitated material at 5 mg/mL (0.5% w/v) could not be brought back into solution. This data is shown graphically in
The pH profiles for both 4° C. and 25° C. were overlapping, so it appears that temperature did not have an impact at concentrations less than 50 mg/mL (5% w/v). Instead, there appears to be a solubility pH for formulations less than 50 mg/mL (5% w/v). At 100 and 160 mg/mL, the 4° C. samples had a higher pH than the 25° C. samples. However, with increasing concentration, temperature appears to become more important than pH, and the formulation is increasingly sensitive to temperature.
Table 5 shows that the solubility of sodium deoxycholate is independent of the lot to lot variability in pH. In general, there was no difference in physical stability across lots under like conditions.
Three factors have been identified to contribute to solubility. In no particular order these are concentration, pH and temperature. It has been found that the lot to lot variability in pH does not account for better or poorer solubility. Overall, the 50 mg/mL seems to be the most robust condition, where all lots appear to be above the “solubility” pH, and where temperature has no impact within the two-week time frame of this study. The results suggest that concentration, pH, and storage temperature factor into the stability of sodium deoxycholate. The samples at 50 mg/mL showed the best stability at 4° C. and 25° C. for two weeks.
This example demonstrates that aqueous formulations of less than 5% w/v sodium deoxycholate at a pH of 8.0 to 8.5 exhibited very good solubility. This example also demonstrates that sodium deoxycholate shows no degradation in aqueous formulations having less than 5% w/v sodium deoxycholate during storage for eight weeks at 4° C., 25° C. and 37° C. A number of formulations were subjected to agitation, UV exposure, and freeze-thaw cycles and exhibited no degradation or precipitation when exposed to those stresses.
A two-month stability study of sodium deoxycholate in several different formulations was conducted. By reverse phase HPLC, sodium deoxycholate showed no degradation in all formulations at all temperatures. However, solubility was best in formulations containing 10 mM phosphate, 0.9% NaCl, 0.9% Benzyl Alcohol at a pH of 8.0 or 8.5. Storage temperatures of 25° C. and 37° C. also assisted solubility. All formulations that were chosen for agitation, UV exposure, and freeze-thaw exhibited no degradation or precipitation when exposed to those stresses.
Table 6 provides a list of chemicals used in the preparation of the formulations disclosed herein.
The stability of the sodium deoxycholate formulations was examined at the conditions summarized in Table 7. Reverse phase HPLC was used along with visual observations which were conducted at each time point to monitor any precipitation or cloudiness. The formulations tested for vortex, UV exposure, and freeze-thaw, were chosen from the formulations that performed the best in the temperature study. The major stability issues of sodium deoxycholate observed during this study were solubility and pH drift.
The formulations were incubated at 4° C., 25° C. and 37° C. and analyzed for a) degradation products, b) pH stability and c) formulation clarity.
Except for formulations only consisting of water, sodium deoxycholate was dissolved in buffer that had been titrated to a pH of 6. Each formulation, except for the two only consisting of water, was then titrated to its target pH with NaOH. All formulations were sterile filtered and filled to 1.5 mL in sterile 2 cc glass vials. The filled vials were then autoclaved. The formulations 3A and 3B were cloudy prior to filling.
a) Degradation Products
Reverse phase HPLC was used to visualize degradation products. A sample chromatogram of formulation 4A shows the main peak with respect to the degradation products (
b) pH Stability
Table 9 shows the pH of the formulations prior to filling and at t=0. In general, the pH drifted towards 8 and remained constant throughout the study. This suggests that sodium deoxycholate has some buffering capacity.
c) Formulation Clarity
The clarity of each formulation was determined by two methods. One method was by visual observation, where the vial was held up to an intense light and the presence of particles was determined by what the eye could see. A set of vials filled with the formulation buffers and incubated at the three temperatures where used as reference standards. The other method used light scattering by illuminating the samples across a 1 cm path length with 500 nm light in a spectrophotometer.
The presence of visible precipitates in some formulations increased over time, particularly at 4° C. The formulations containing sorbitol at the lowest pH produced the most precipitation. The formulations that performed the best contained 10 mM phosphate, 0.9% NaCl, 0.9% Benzyl Alcohol at pH 8.0 or 8.5.
Tables 10, 11, 12 and 13 show the clarity results. The “Visual Clarity” column has a ranking system as follows: 0=clear, no particles; 1=clear, few particles; 2=clear, several particles; 3=clear, many large particles, 4=slightly cloudy; 5=very cloudy.
Based on the results from the temperature study, the following formulations in Table 14 were chosen to test the effects of Agitation, UV Exposure, and Freeze-Thaw on stability.
a) Degradation Products
Reverse phase HPLC was used to visualize degradation products.
b) pH Stability
Table 15 shows the pH of the formulations prior to filling different than the pH's after opening the vials.
c) Formulation Clarity
The clarity of each formulation was determined by two methods. One method was by visual observation, where the vial was held up to an intense light and the presence of particles was determined by what the eye could see. A set of vials filled with the formulation buffers and incubated at the three temperatures where used as reference standards. The other method used light scattering by illuminating the samples across a 1 cm path length with 500 nm light in a spectrophotometer.
Agitation, UV exposure, and freeze-thaw cycles does not appear to induce precipitation.
Tables 16, 17 and 18 show the clarity results. The “Visual Clarity” column has a ranking system as follows: 0=clear, no particles; 1=clear, few particles; 2=clear, several particles; 3=clear, many large particles, 4=slightly cloudy; 5=very cloudy.
After screening the stability profile of sodium deoxycholate in seventeen unique formulations, it was determined that formulations containing 10 mM Phosphate, 0.9% NaCl and 0.9% Benzyl Alcohol at pH 8.0 or 8.5 best prevented visible precipitation in addition to maximizing solubility. By reverse phase HPLC, sodium deoxycholate shows no degradation in all formulations at all temperatures, during storage for eight weeks at 4° C., 25° C. and 37° C. As far as visual clarity of formulations, storage temperatures of 25° C. and 37° C. actually improved the solubility of sodium deoxycholate as compared to 4° C.
All formulations that were chosen for agitation, UV exposure, and freeze-thaw exhibited no degradation or precipitation when exposed to those stresses. Upon completion of the eight week storage stability study, selected formulations were subjected to these acute stress conditions. These experiments help determine the stability of sodium deoxycholate during the stress of common manufacturing and shipping procedures. The data obtained from these acute stress studies confirm the stability of sodium deoxycholate in formulations containing 10 mM Phosphate, 0.9% NaCl and 0.9% Benzyl Alcohol at pH 8.0 or 8.5, with sodium deoxycholate concentration of 5, 10 and 20 mg/mL.
This application is a continuation of U.S. Ser. No. 13/733,729, filed Jan. 3, 2013, which is a continuation of U.S. Ser. No. 13/323,605, filed Dec. 12, 2011, now U.S. Pat. No. 8,367,649; which is a continuation of U.S. Ser. No. 12/716,070, filed Mar. 2, 2010, now U.S. Pat. No. 8,101,593; which, in turn, claims the benefit under 35 U.S.C. §119(e) to U.S. provisional application Ser. No. 61/274,129 which was converted from U.S. nonprovisional application Ser. No. 12/397,229, filed Mar. 3, 2009; the contents of all of which is are incorporated hereby by reference in it their entirety.
| Number | Name | Date | Kind |
|---|---|---|---|
| 4113882 | Okazaki et al. | Sep 1978 | A |
| 4117121 | Gallo-Torres et al. | Sep 1978 | A |
| 4158707 | Steffen et al. | Jun 1979 | A |
| 4664910 | Caserio et al. | May 1987 | A |
| 4681876 | Marples et al. | Jul 1987 | A |
| 4722888 | Broder et al. | Feb 1988 | A |
| 4851435 | Sauer et al. | Jul 1989 | A |
| 4866044 | Sato et al. | Sep 1989 | A |
| 4994439 | Longenecker et al. | Feb 1991 | A |
| 5085864 | Cannon et al. | Feb 1992 | A |
| 5288498 | Stanley et al. | Feb 1994 | A |
| 5326562 | Scott | Jul 1994 | A |
| 5344822 | Levine et al. | Sep 1994 | A |
| 5371104 | Feigenbaum | Dec 1994 | A |
| 5376646 | Pittrof et al. | Dec 1994 | A |
| 5395545 | Fischer et al. | Mar 1995 | A |
| 5506218 | Parker et al. | Apr 1996 | A |
| 5603932 | Blaas et al. | Feb 1997 | A |
| 5616342 | Lyons | Apr 1997 | A |
| 5674855 | Levine et al. | Oct 1997 | A |
| 5747066 | Pittrof et al. | May 1998 | A |
| 5759445 | Yamamoto et al. | Jun 1998 | A |
| 5849883 | Boone et al. | Dec 1998 | A |
| 5863554 | Illum | Jan 1999 | A |
| 5876721 | Alexander et al. | Mar 1999 | A |
| 5891083 | Capella et al. | Apr 1999 | A |
| 5914390 | Nathan et al. | Jun 1999 | A |
| 5942248 | Barnwell | Aug 1999 | A |
| 5952313 | Carlson | Sep 1999 | A |
| 5952392 | Katz et al. | Sep 1999 | A |
| 6025396 | Kim et al. | Feb 2000 | A |
| 6120805 | Spenlehauer et al. | Sep 2000 | A |
| 6197327 | Harrison et al. | Mar 2001 | B1 |
| 6221378 | Modi | Apr 2001 | B1 |
| 6225343 | Behl et al. | May 2001 | B1 |
| 6251428 | Yoo | Jun 2001 | B1 |
| 6255502 | Penkler et al. | Jul 2001 | B1 |
| 6294192 | Patel et al. | Sep 2001 | B1 |
| 6313128 | Blanc-Ferras et al. | Nov 2001 | B1 |
| 6315984 | Modi | Nov 2001 | B1 |
| 6342489 | Palmieri et al. | Jan 2002 | B1 |
| 6350458 | Modi | Feb 2002 | B1 |
| 6375975 | Modi | Apr 2002 | B1 |
| 6383471 | Chen et al. | May 2002 | B1 |
| 6416779 | D'Augustine et al. | Jul 2002 | B1 |
| 6417179 | Burkhart et al. | Jul 2002 | B1 |
| 6451286 | Modi | Sep 2002 | B1 |
| 6489312 | Stogniew et al. | Dec 2002 | B1 |
| 6537561 | Fukui et al. | Mar 2003 | B1 |
| 6544972 | Steer et al. | Apr 2003 | B1 |
| 6663885 | Hager et al. | Dec 2003 | B1 |
| 6713470 | Jackson | Mar 2004 | B2 |
| 6849263 | Modi | Feb 2005 | B2 |
| 6884768 | Kimura et al. | Apr 2005 | B2 |
| 7226775 | Mapleson et al. | Jun 2007 | B2 |
| 7303768 | Yoo | Dec 2007 | B2 |
| 7538093 | Engler et al. | May 2009 | B2 |
| 7622130 | Kolodney et al. | Nov 2009 | B2 |
| 7754230 | Kolodney et al. | Jul 2010 | B2 |
| 8101593 | Hodge et al. | Jan 2012 | B2 |
| 8258146 | Morita et al. | Sep 2012 | B2 |
| 8298556 | Kolodney et al. | Oct 2012 | B2 |
| 8367649 | Hodge et al. | Feb 2013 | B2 |
| 8653058 | Hodge et al. | Feb 2014 | B2 |
| 20010051595 | Lyons et al. | Dec 2001 | A1 |
| 20020028766 | Papadimitriou | Mar 2002 | A1 |
| 20020031558 | Yoo | Mar 2002 | A1 |
| 20020032159 | Maruyama et al. | Mar 2002 | A1 |
| 20020058010 | Picard-Lesboueyries et al. | May 2002 | A1 |
| 20020107291 | De Tommaso | Aug 2002 | A1 |
| 20020168402 | Kipp et al. | Nov 2002 | A1 |
| 20030027833 | Cleary et al. | Feb 2003 | A1 |
| 20030035831 | Modi | Feb 2003 | A1 |
| 20030054981 | Milton et al. | Mar 2003 | A1 |
| 20030064097 | Patel et al. | Apr 2003 | A1 |
| 20030072807 | Wong et al. | Apr 2003 | A1 |
| 20030077329 | Kipp et al. | Apr 2003 | A1 |
| 20030161886 | Dickinson et al. | Aug 2003 | A1 |
| 20030186933 | Yoo | Oct 2003 | A1 |
| 20030219472 | Pauletti et al. | Nov 2003 | A1 |
| 20040022862 | Kipp et al. | Feb 2004 | A1 |
| 20040038952 | Feher | Feb 2004 | A1 |
| 20040067919 | Jee | Apr 2004 | A1 |
| 20040096494 | Siekmann et al. | May 2004 | A1 |
| 20040101569 | Rang | May 2004 | A1 |
| 20040115255 | Leigh et al. | Jun 2004 | A1 |
| 20040141949 | Rosenthal et al. | Jul 2004 | A1 |
| 20040161407 | Kimura et al. | Aug 2004 | A1 |
| 20040201117 | Anderson | Oct 2004 | A1 |
| 20040213855 | Pettersson et al. | Oct 2004 | A1 |
| 20040220283 | Zhang et al. | Nov 2004 | A1 |
| 20050019404 | Sung et al. | Jan 2005 | A1 |
| 20050048126 | Rabinow et al. | Mar 2005 | A1 |
| 20050079228 | Jaiswal et al. | Apr 2005 | A1 |
| 20050089555 | Boderke et al. | Apr 2005 | A1 |
| 20050123582 | Sung et al. | Jun 2005 | A1 |
| 20050143347 | Boderke et al. | Jun 2005 | A1 |
| 20050158408 | Yoo | Jul 2005 | A1 |
| 20050163821 | Sung et al. | Jul 2005 | A1 |
| 20050261258 | Kolodney et al. | Nov 2005 | A1 |
| 20050266065 | Perrier et al. | Dec 2005 | A1 |
| 20050287199 | Denney et al. | Dec 2005 | A1 |
| 20060074057 | Marchewitz | Apr 2006 | A1 |
| 20060127468 | Kolodney et al. | Jun 2006 | A1 |
| 20060154906 | Kolodney et al. | Jul 2006 | A1 |
| 20060222673 | Chern et al. | Oct 2006 | A1 |
| 20060222695 | Zadini et al. | Oct 2006 | A1 |
| 20080318870 | Moriarty et al. | Dec 2008 | A1 |
| 20090270642 | Prasad et al. | Oct 2009 | A1 |
| 20090275545 | Boderke et al. | Nov 2009 | A1 |
| 20100292650 | Kolodney et al. | Nov 2010 | A1 |
| 20110002896 | Kolodney et al. | Jan 2011 | A1 |
| 20120237492 | Walker | Sep 2012 | A1 |
| 20120258943 | Hodge et al. | Oct 2012 | A1 |
| 20130190282 | Hodge et al. | Jul 2013 | A1 |
| 20140004206 | Kolodney et al. | Jan 2014 | A1 |
| 20140148429 | Hodge et al. | May 2014 | A1 |
| 20150051182 | Kolodney et al. | Feb 2015 | A1 |
| Number | Date | Country |
|---|---|---|
| 2033725 | May 2001 | CA |
| 2551474 | Jul 2005 | CA |
| 1348360 | May 2002 | CN |
| 0 208 519 | Jan 1987 | EP |
| 0408174 | Jan 1991 | EP |
| 0 426 029 | May 1991 | EP |
| 0 439 042 | Jun 1995 | EP |
| 0 439 513 | Mar 1996 | EP |
| 1 111 390 | Jun 2001 | EP |
| 0 730 860 | Jan 2002 | EP |
| 0 806 940 | Apr 2003 | EP |
| 1 005 324 | Mar 2005 | EP |
| 61-158995 | Jul 1986 | JP |
| 03-048622 | Mar 1991 | JP |
| 04-235918 | Aug 1992 | JP |
| 11-240835 | Sep 1999 | JP |
| 2007-515439 | Jun 2007 | JP |
| 2007-515494 | Jun 2007 | JP |
| 2007-538104 | Dec 2007 | JP |
| WO-9012583 | Nov 1990 | WO |
| WO-9305811 | Apr 1993 | WO |
| WO-9404177 | Mar 1994 | WO |
| WO-9915152 | Apr 1999 | WO |
| WO-0013029 | Mar 2000 | WO |
| WO-02058610 | Aug 2002 | WO |
| WO-03018134 | Mar 2003 | WO |
| WO-03082340 | Oct 2003 | WO |
| WO-03094894 | Nov 2003 | WO |
| WO-2004010941 | Feb 2004 | WO |
| WO-2004039326 | May 2004 | WO |
| WO-2005020894 | Mar 2005 | WO |
| WO-2005061004 | Jul 2005 | WO |
| WO-2005063169 | Jul 2005 | WO |
| WO-2005063205 | Jul 2005 | WO |
| WO-2005112942 | Dec 2005 | WO |
| WO-2005117832 | Dec 2005 | WO |
| WO-2005117900 | Dec 2005 | WO |
| WO-2006007675 | Jan 2006 | WO |
| WO-2006133160 | Dec 2006 | WO |
| WO-2011075701 | Jun 2011 | WO |
| Entry |
|---|
| Sigma RIPA Buffer (available before Apr. 5, 2007). |
| Shimazawa et al (Mol Vis 13:578-587, 2007). |
| Duncan et al., “Fat Reduction Using Phosphatidylcholine/Sodium Deoxycholate Injections: Standard of Practice”, Aesthetic Plastic Surgery, 2008, 32(6):858-872. |
| Extended European Search Report for Appl. No. 12747416.1, dated Jun. 10, 2014. |
| Hutchinson, ABC News Medical Unit: “Docs Question Bayer's Injection for Dissolving Double Chin”, 2011, Retrieved from Internet: URL:http://abcnews.go.com/Health/WellnessNews/bayer-tests-fat-loss-injection-double-chin/story?id=12600333, [retrieved on May 22, 2014]. |
| Japanese Office Action for Appl. No. 2013-034203, mailed Apr. 17, 2014. |
| U.S. Appl. No. 11/710,601, filed Feb. 23, 2007, Burkhart et al. |
| U.S. Appl. No. 12/062,445, filed Apr. 3, 2008, Kolodney et al. |
| U.S. Appl. No. 12/397,229, filed Mar. 3, 2009, Hodge et al. |
| U.S. Appl. No. 13/753,366, filed Jan. 29, 2013, Hodge et al. |
| Author Unknown. Deoxycholic acid, Product Information, SIGMA, Nov. 2002. |
| Author Unknown. Health Alert: Lipostabil. http://kyw.com/health/local.sub.--story.sub.--336152706.html, Dec. 2, 2002. |
| Author Unknown. Learn about lecithins. Oxford, CT: American Lecithin Company (2003). |
| Author Unknown. Lipostabil. Rhone-Poulenc Rorer. Cologne, West Germany: Natterman International GMBH (1990). |
| Author Unknown. Lose those love handles, A CBS HealthWatch Special Report http://cbsnewyork.com/healthwatch/local.sub.--story.sub.--329141707.html, Nov. 25, 2002. |
| Author Unknown. Love handles can be shrunk without surgery http://www.macleans.ca/topstories/health/article.jsp?content=20040225.sub- .--090843.sub.--4800, Feb. 25, 2004. |
| Ablon et al. Treatment of Lower Eyelid Fat Pads Using Phosphatidylcholine: Clinical Trial and Review, Dermatol. Surg. (2004) 30(3):422-427. |
| Alkan-Onyuksel et al. A mixed micellar formulation suitable for the parenteral administration of taxol. Pharm Res (1994) 11(2):206-212. |
| Almgren M. Mixed micelles and other structures in the solubilization of bilayer lipid membranes by surfactants. Biochim Biophys Acta (2000)1508:146-163. |
| Asaadi et al. Mesoplasty: a new approach to non-surgical liposculpture. Plastic Surgery 2004, Oct. 10, 2004, Philadelphia, PA. |
| ASAPS. American Society for Aesthetic Plastic Surgery. Lipoplasty (liposuction) without surgery?, Oct. 2002. |
| Banerjee et al. Differential solubilization of lipids along with membrane proteins by different classes of detergents. Chem Phys Lipids (1995) 77:65-78. |
| Bates B. Fat dissolving substance injects CCs of controversy. Skin and Allergy News (2003) 34(2). |
| Bayer Press Release. First Patients enrolled in EU Phase III Clinical Development Program to evaluate ATX-101 for reduction of Submental Fat. (2008). |
| Bellman B. Phosphatidylcholine reaction. Skin and Allergy News (2003) 34(4). |
| Bryant R. Controversial mesotherapy: could it be the next botox. Dermatology Times (2004) 1-2. |
| Buko et al. Hepatic and pancreatic effects of polyenoylphosphatidylcholine in rats with alloxan-induced diabetes. Cell Biochem Function (1996)14:131-137. |
| Canty et al. Lecithin and choline: research update on health and nutrition. Fort Wayne, IN: Central Soya Company, Inc. (1998). |
| Chalmers K. Fat loss a needle away. http://surgerynews.neUnews/0204/meso020402.htm, Feb. 1, 2004. |
| Davidson et al. Limitations of phosphatidylcholine/deoxycholate mixtures for the analysis of phospholipase A2 inhibition and activation: illustration with annexins. Biochimica et Biophysica Acta, (1992) 1127(3):270-276. |
| Duncan et al. Injectable therapies for localized fat loss: state of the art., Clinics in Plastic Surgery, Lnkdpubmed:21824545, (2011) 38(3): 489-501. |
| Duncan et al. Lipodissolve for Subcutaneous Fat Reduction and Skin Retraction, Aesthetic Surgery Journal (2005) 25(5):530-543. |
| Durr et al. Investigation on mixed micelle and liposome preparations for parental use on soya phosphatidylcholine. Eur J Pharm Biopharm (1994) 40(3):147-156. |
| Ebihara et al. Effect of benzyl alcohol on lipid bilayers. A comparisons of bilayer systems. Biophys J (1979) 28:185-196. |
| Engelke et al. Effect of inhalation anaesthetics on the phase behaviour, permeability and order of phosphatidylcholine bilayers. Biophys Chem (1997)67:127-138. |
| FDA news release: FDA issues warning letters for drugs promoted in fat elimination procedure (2010) Retrieved from the Internet: URL:http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm207453.htm [retrieved on Oct. 18, 2011]. |
| Goldman et al. Cecil Textbook of Medicine. St. Louis, MO: W.B. Saunders Co. (2001)21(1):821-833. |
| Gordon et al. The increase in bilayer fluidity of rat liver plasma membranes achieved by the local anesthetic benzyl alcohol affects the activity of intrinsic membrane enzymes. J Biol Chem (1980) 255(10):4519-4527. |
| Gustafson et al. Influence of organic solvent mixtures on biological membranes. Br J Ind Med (1985) 42:591-595. |
| Hammad et al. Increasing drug solubility by means of bile salt-phosphatidylcholine-based mixed micelles. Eur J Pharm Biopharm (1998) 46:361-367. |
| Hasengschwandtner F. Phosphatidylcholine treatment to induce lipolysis. Journal of Cosmetic Dermatology (2005) 4:308-313. |
| Heerklotz et al. Correlation of membrane/water partition coefficients of detergents with the critical micelle concentration. Biophys J (2000) 78:2435-2440. |
| Hexsel et al. Phosphatidylcholine in the treatment of localized fat, J. Drugs Dermatol. (2003) 2(5):511-518. |
| Hofmann et al. Bile acid solubility and precipitation in vitro and in vivo: the role of conjugation, pH, and Ca2+ ions, Journal of Lipid Research (1992) 33:617-626. |
| Igimi et al. pH-Solubility relations of chenodeoxycholic and ursodeoxycholic acids: physical-chemical basis for dissimilar solution and membrane phenomena, Journal of Lipid Research (1980) 21:72-90. |
| Jones MN. Surfactants in membrane solubilisation. Int J Pharm (1999)177:137-59. |
| Kawanaka et al., Kan Tan Sui, (2002) 44(4): 521-526 with partial translation. |
| Kern et al. Regulation of Lipoprotein Lipase Immunoreactive Mass in Isolated Human Adipocytes. J. Clin. Invest. (1988) 81:398-406. |
| Klein et al. A New Method to Quantify the Effect After Subcutaneous Injection of Lipolytic Substances. Aesth Plast Surg. (2008) 32:667-672. |
| Kolonin et al. Reversal of obesity by targeted ablation of adipose tissue. Nature Medicine, Nature Publishing Group (2004) 10(6): 625-632. |
| Kythera Biopharmaceuticals: Evaluation of safety and efficacy of ATX-101 in the reduction of submental fat (2011) Retrieved from the Internet: URL:http://clinicaltrials.gov/ct2/show/NCT01305577, [retrieved on Oct. 18, 2011]. |
| Kythera Newsroom. Two Phase 2 studies with ATX-101—study results demonstrated statistically significant reduction in patients' unwanted submental fat. Kythera Biopharmaceuticals, Inc. (2009) 1-2. |
| Landman B. Beyond Botox. Cosmetic Surgery Guide 2003 http://newyorkmetro.com/nymetro/health/bestdoctors/cosmeticsurgery/2003/n- .sub.--9281/index.html. |
| Lester et al. Action of organic solvents on protein kinase C. Eur J Pharmacol (1991) 206:301-308. |
| Lichtenberg D. Characterization of the solubilization of lipid bilayers by surfactants. Biochim Biophys Acta (1985) 821:470-478. |
| Lichtenberg et al. Solubilization of phospholipids by detergents. Structural and kinetic aspects. Biochim Biophys Acta (1983) 737:285-304. |
| Lichtenberg et al. Structural and kinetic studies on the solubilization of lecithin by sodium deoxycholate. Biochemistry (1979) 18(16):3517-3525. |
| Lieber et al. Phosphatidylcholine protects against fibrosis and cirrhosis in the baboon. Gastroenterology (1994)106:152-159. |
| McCaslin. Detergent Properties, Encyclopedia of Biological Chemistry. (2004) 1:577-581. |
| Milovic et al. Effects of deoxycholate on human colon cancer cells: apoptosis or proliferation. European Journal of Clinical Investigation. (2002) 32(1):29-34. |
| Moy LS. Phosphatidylcholine injections: a study measuring decreased subcutaneous fat thickness. Combined Annual Meeting of the American Society for Dermatologic Surgery and the American Society of Mohs Micrographic Surgery and Cutaneous Oncology, San Diego, CA Sep. 30-Oct. 3, 2004. |
| Parnham et al. Phospholipids and liposomes—safety for cosmetical and pharmaceutical use. Nattermann Phospholipid GMBH Scientific Publication (1995)No. 2:1-56. |
| Powell et al. Bile acid hydrophobicity is correlated with induction of apoptosis and/or growth arrest in HCT116 cells. Biochem. J. (2001) 356:481-486. |
| Rittes PG. The use of phosphatidylcholine for correction of localized fat deposits, Aesthetic Plast. Surg. (2003) 27(4):315-318. |
| Rittes PG. The use of phosphatidylcholine for correction of lower lid bulging due to prominent fat pads. Dermatol Surg (2001) 27:391-392. |
| Rosenbaum M. An exploratory investigation of the morphology and biochemistry of cellulite, Annual Meeting of American Society for Aesthetic Surgery (1997)101(7):1934-1939. |
| Rossi et al. Cellulite: a review. JEADV (2000)14:251-262. |
| Rotunda et al. Lipomas treated with subcutaneous deoxycholate injections. J. Am. Acad. Dermatol., (2005)973-978. |
| Rotunda et al. Mesotherapy and Phosphatidylcholine Injections: Historical Clarification and Review Dermatologic Surgery (2006) 32: 465-480. |
| Rotunda et al. Detergent effects of sodium deoxycholate are a major feature of injectable phosphatidylcholine. American Society for Dermatologic Surgery, New Orleans, LA, Oct. 11, 2003. |
| Rotunda et al. Detergent Effects of Sodium Deoxycholate Are a Major Feature of an Injectable Phosphatidylcholine Formulation Used for Localized Fat Dissolution, Dermatol. Surg. (2004), 30(7):1001-1008. |
| Rotunda et al. Randomized Double-Blind Clinical Trial of Subcutaneously Injected Deoxycholate Versus a Phosphatidylcholine-Deoxycholate Combination for the Reduction of Submental Fat. Dermatol Surg. (2009) 35:792-803. |
| Sager S. New fat removal technique getting raves: Is it safe? Does it work? http://abclocal.go.com/wabc/news/wabc.sub.--020703.sub.--mesotherap- y.html, Feb. 7, 2003. |
| Salti et al. Phosphatidylcholine and Sodium Deoxycholate in the Treatment of Localized Fat: A Double-Blind, Randomized Study. Dermatol Surg. (2008)34:60-66. |
| Schuck et al. Resistance of cell membranes to different detergents. Proc Natl Acad Sci (2003) 100(10):5795-5800. |
| Serra M. Subcutaneous infiltration with phosphatidylcholine solution for treatment of buffalo hump and fatty pads. 3rd Int'l workshop on adverse drug reactions and lipodystrophy in HIV, Athens, Oct. 2001, 115. |
| Sigma: Rifa Buffer, 2003, retrieved from the internet: URL:http://www.sigmaaldrich.com/etc/medialib/docs/Sigma/Bulletin/r0278bul.Par.0001.File.tmp/r0278bul.pdf. |
| Singer et al. The fluid mosaic model of the structure of cell membranes. Science (1972) 175:720-731. |
| Small D.M. Size and structure of bile salt micelles. Molecular Association in Biological and Related Systems Chapter 4. (1968) 31-52. |
| Teelmann et al. Preclinical safety evaluation of intravenously administered mixed micelles. Arzneimittelforschung (1984)34:1517-1523. |
| Toyama M. Next-Gen Liposuction. http://www.time.com/time/europe/forecast2003/html/liposuction.html, Dec. 8, 2002. |
| Victor S. Phosphatidylcholine works. Skin and Allergy News (2003) 34. |
| Womack et al. Detergent effects on enzyme activity and solubilization of lipid bilayer membranes. Biochim Biophys Acta (1983)733:210-215. |
| Young, VL. Lipostabil: The effect of phosphatidylcholine on subcutaneous fat. Aesthetic Surg J (2003)23:413-417. |
| Zeghari et al., “Adipocyte and erythrocyte plasma membrane phospholipid composition and hyperinsulinemia: a study in nondiabetic and diabetic obese women”, International Journal of Obesity and Related Metabolic Disorders:Journal of the International Association for the Study of Obesity, 2000, 24(12):1600-1607. |
| Number | Date | Country | |
|---|---|---|---|
| 20140155364 A1 | Jun 2014 | US |
| Number | Date | Country | |
|---|---|---|---|
| 61274129 | Mar 2009 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 13733729 | Jan 2013 | US |
| Child | 14175086 | US | |
| Parent | 13323605 | Dec 2011 | US |
| Child | 13733729 | US | |
| Parent | 12716070 | Mar 2010 | US |
| Child | 13323605 | US |
