WO2000061177A9 - Composition based on oppositely-charged polypeptides - Google Patents
Composition based on oppositely-charged polypeptidesInfo
- Publication number
- WO2000061177A9 WO2000061177A9 PCT/US2000/008682 US0008682W WO0061177A9 WO 2000061177 A9 WO2000061177 A9 WO 2000061177A9 US 0008682 W US0008682 W US 0008682W WO 0061177 A9 WO0061177 A9 WO 0061177A9
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- igf
- insulin
- composition
- arginine
- polypeptides
- Prior art date
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/0012—Galenical forms characterised by the site of application
- A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
- A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
- A61K47/16—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing nitrogen, e.g. nitro-, nitroso-, azo-compounds, nitriles, cyanates
- A61K47/18—Amines; Amides; Ureas; Quaternary ammonium compounds; Amino acids; Oligopeptides having up to five amino acids
- A61K47/183—Amino acids, e.g. glycine, EDTA or aspartame
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
- A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
- A61K47/20—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing sulfur, e.g. dimethyl sulfoxide [DMSO], docusate, sodium lauryl sulfate or aminosulfonic acids
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
- A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
- A61K47/36—Polysaccharides; Derivatives thereof, e.g. gums, starch, alginate, dextrin, hyaluronic acid, chitosan, inulin, agar or pectin
- A61K47/40—Cyclodextrins; Derivatives thereof
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P3/00—Drugs for disorders of the metabolism
- A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
- A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P5/00—Drugs for disorders of the endocrine system
- A61P5/48—Drugs for disorders of the endocrine system of the pancreatic hormones
- A61P5/50—Drugs for disorders of the endocrine system of the pancreatic hormones for increasing or potentiating the activity of insulin
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S435/00—Chemistry: molecular biology and microbiology
- Y10S435/808—Optical sensing apparatus
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S530/00—Chemistry: natural resins or derivatives; peptides or proteins; lignins or reaction products thereof
- Y10S530/808—Materials and products related to genetic engineering or hybrid or fused cell technology, e.g. hybridoma, monoclonal products
Definitions
- This invention relates to formulations contaming mixtures of oppositely-charged polypeptides such as insulin-like growth factor (IGF-I) and msulm
- IGF-I insulin-like growth factor
- this mvention entails a formulation contammg selected excipients that enable the mixing of oppositely-charged proteins m the same formulation the excipients preventing the interaction of the proteins that normally would make them precipitate from the solution Description of Related Art
- Human IGF-I is a 7649-dalton polypeptide (Rinderknecht and Humbel, Proc Natl Acad Sci USA. 73 2365 (1976), Rinderknecht and Humbel, J Biol Chem . 253 2769 (1978) belongmg to a family of somatomedins with insulin-like and mitogenic biological activities that modulate the action of growth hormone (GH) Van Wyk p.tal .
- GH growth hormone
- IGF-I contains three disulfide bonds, and has a pi of 8 65 and molar absorptivity of 0 645 at 276 nm IGF-I naturally occurs in human body fluids, for example, blood and human cerebral spinal fluid
- IGF-I is a potent anabolic protein See Tanner et al , Acta Endocnnol . 84 681-696 ( 19771. Uthne e? al J dm Endocnnol Metab .39 548-554 (1974) See also Ross et al . Intensive Care Med . 19 Suppl 2 S54-57 (1993), which is a review of the role of insulin, growth hormone, and IGF-I as anabolic agents in the cntically ill IGF-I may be punfied from natural sources, e g , human serum (Rinderknecht and Humbel.
- IGF-I has hypoglycemic effects in humans similar to insulin when administered by intravenous bolus injection, but also promotes positive nitrogen balance Underwood et al . Hormone Research, 24 166 (1986)
- IGF-I is known to exert glucose-lowering effects in both normal (Guler et al , N Engl J Med , 317 137-140 (1987)) and diabetic individuals (Schoenle et al , Diabetologia. 34 675-679 (1991), Zenobi et al , J Clm Invest . 90 2234-2241 (1992)) (see also Sherwin et al , Hormone Research 4J. (Suppl 2) 97-101 (1994), Takano et al , Endocnnol Japan, 37 309-317 (1990).
- Recombinant human IGF-I has the ability to improve insulin sensitivity.
- rhIGF-I 70 ⁇ g kg bid
- Saad et al, Diabetologia. 37: Abstract 40 (1994) reported dose-dependent improvements in insulin sensitivity in adults with obesity and impaired glucose tolerance following 15 days of rhIGF-I treatment (25 ⁇ g and 100 ⁇ g/kg bid).
- RhIGF-I also improved insulin sensitivity and glycemic control in some patients with severe type A insulin resistance (Schoenle et al, Diabetologia. 34: 675-679 (1991); Morrow et al., Diabetes. 42 (Suppl.): 269 (1993) (abstract); Kuzuya et al., Diabetes.42: 696-705 (1993)) or others with non-insulin dependent diabetes mellitus.
- Schalch et al "Short-term metabolic effects of recombinant human insulin-like growth factor I (rhIGF-I) in type II diabetes mellitus", in: Spencer EM. ed.. Modern Concepts of Insulin-like Growth Factors (New York: Elsevier: 1991)pp.705-715; Zenobi et al, J. Clin. Invest.. 90: 2234-2241 (1993).
- insulin resistance has not been considered a prominent feature of type I diabetes, it is clearly present in some individuals and may be most clinically important during adolescence.
- GH has well known anti- insulin effects, the elevated GH levels during adolescence may mediate much of this insulin resistance. Press et al, supra; Defeo et al, supra; Campbell et a/.. N. Eng. J. Med.. supra, Campbell et al, Metabolism, supra; Arias et al, supra; Davidson et al, supra.
- WO 94/16722 discloses a method of chronic modification of cell barrier properties by exposmg a cell to a modification-effective amount of IGF-I for at least about seven days and a method of chronic amelioration or reversal of insulin resistance
- IGF-I was used to treat type II diabetes patients in the clinic at a dose of 120-160 ⁇ g/kg twice daily, the side effects outweighed the benefit of the treatment Jabn et al .
- US Pat 4,988,675 discloses a combination of IGF-I with a lower amount of insulin than normal to treat Type II diabetes
- WO 96/01125 published 18 January 1996 discloses the use of a combmation of insulin and an IGF-I m the manufacture of a medicament for counteracting a decrease m nitrogen balance and for counteracting a decrease in protein synthesis and which can be used for treatment of a protein catabo sm due to glucocorticoid excess
- U S Pat No 5,091,173 discloses a composition suitable for topical application to mammalian skin or hair comprising a cell-free supernatant from a culture of dermal papilla cells sufficient to increase hair growth comprising one or more members of the IGF family selected from IGF-I, IGF-II, and insulin
- NPH-insulin is an intermediate- acting insulin; its onset of action occurs in 1.5 hours and its duration of action is 18-26 hours. 70/30 insulin is composed of 70% NPH-insulin and 30% Regular insulin.
- Semilente insulin amorphous precipitate of zinc insulin complex
- UltraLente insulin zinc insulin crystal suspension
- Lente insulin a 3:7 mixture of amorphous and crystalline insulin particles
- Humalog insulin rapid- acting monomeric insulin solution, as a result of reversing the Lys (B28) and Pro(B29) amino acids on the insulin B-chain
- NPH-, 70/30, and Regular insulin are the most widely used insulins, accounting for 36%, 28%, and 15%, respectively, of the insulin prescriptions in 1996. These three forms of insulin add up to 79% of all insulin prescriptions. It was therefore determined that the IGF-I formulation needs to be mixable with Regular, NPH-, and 70/30 insulin.
- Type I or Type II diabetes typically take two to four subcutaneous injections of insulin daily to control their blood sugar.
- an injectable drug other than insulin to treat diabetes such as IGF-I
- IGF-I insulin to treat diabetes
- Adding two more subcutaneous injections daily, for IGF-I administration, to regimens that already require several injections per day of insulin is not practical.
- U.S. Pat. No. 5,788,959 discloses a drug delivery device comprising a single-phase matrix solution of oppositely-charged water-soluble polymers such as polypeptides wherein the matrix solution has dispersed therein a pharmaceutically-active ingredient different from the polymers. Further Burgess et al. , J. Pharm.
- EP 615,444 discloses a peroral administration form for peptidic medicaments containing the medicament, such as insulin, distributed in a gelatin or gelatin derivative matrix of opposite charge.
- EP 313,343 discloses a method of purifying a crude protein from its impurities by ion-exchange chromatography at a pH such that the protein and impurities have an opposite charge so that selective binding occurs.
- NPH-insulin intermediate-acting neutral protamine hagedorn insulin
- Regular insulin It would be desirable to mix oppositely-charged polypeptides such as insulin and IGF-I, each from separate vials in the same syringe or other delivery vessel, and to inject or otherwise deliver the mixture immediately.
- U.S. Patent No. 5,783,556 discloses a formulation of mixed NPH-insulin and IGF-I.
- U.S. Patent No. 4,608,364 discloses an active-compound combination of an insulin derivative and an unmodified insulin or a specific analog thereof for treating diabetes. It would be desirable to mix all types of insulin with IGF-I for this purpose, as well as to mix other polypeptides such as protamine and insulin, which are cunently sold as a precipitating complex.
- polypeptides that are oppositely charged tend to associate with each other and form an aggregate or precipitate out of solution.
- Use of certain formulation excipients can prevent aggregation and precipitation of such polypeptides when mixed, including IGF-I with insulin and protamine with insulin.
- Many excipients such as salts, buffers, neutral amino acids, polyols, sugars, and detergents were not effective in preventing precipitation.
- the present invention provides, in one embodiment, a composition
- a composition comprising a mixture of pharmaceutically-active polypeptides of opposite charge and an excipient selected from the group consisting of arginine, lysine, glutamate (glutamic acid), sodium dodecyl sulfate, and a combination of beta-hydroxy cyclodextrin and arginine, wherein the polypeptides are soluble in the composition.
- the composition may further comprise a buffer such as histidine, at a pH of about 7 to 7.5.
- a buffer such as histidine
- the invention provides a kit comprising:
- composition (b) instructions for using the above composition to treat a disorder against which the composition is effective.
- the polypeptides are IGF-I and an insulin
- the disorder is preferably a hyperglycemic disorder.
- the invention supplies a method for preparing the above composition comprising mixing together as component (a) a first polypeptide in an excipient selected from the group consisting of arginine, lysine, glutamic acid, sodium dodecyl sulfate, beta-hydroxy cyclodextrin, and beta-cyclodextrin sulfobutyl ether; and as component (b) a second polypeptide having an opposite charge from the first polypeptide.
- the method may further comprise the step of incubating the mixture for a period of time at about 30-40°C, preferably for about 15 minutes at 37°C, wherein the composition further comprises phosphate-buffered saline.
- the invention provides a kit for preparing the above composition comprising:
- a container comprising a first polypeptide in an excipient selected from the group consisting of arginine, lysine, glutamic acid, sodium dodecyl sulfate, and a combination of beta-hydroxy cyclodextrin and arginine, and;
- the invention provides a method for treating a hyperglycemic disorder such as diabetes in a mammal comprising administering to the mammal, preferably by either injection or infusion, an effective amount of the above composition.
- the formulation of the first polypeptide can be a clear liquid formulation, or a suspension formulation in which the polypeptide (such as IGF-I) is in the form of crystals, amorphous precipitate, or protein dry powder.
- the targeted IGF-I dose will be 10, 20 or 40 ⁇ g/kg/injection (or 1, 2 or 4 ⁇ l/kg/injection for a 10 mg/ml IGF-I formulation). From the insulin dosage used by Type I and Type II patients in phase II clinical trials, it can be calculated that maximum potential mixing ratio can reach 6: 1 (vokvol) for Regular insulin:IGF-I. The minimum potential mixing ratio can reach 1 : 15 (vol: vol) for NPH- insulin:IGF-I.
- mixing ratios ranging from 1 :6 to 6: 1 were studied for mixing Regular insulin with IGF-I; mixing ratios ranging from 1:15 to 15:1 (vol: vol) were smdied for mixing NPH-insulin with IGF-I; and mixing ratios ranging from 1:15 to 6:1 (vokvol) were studied for mixing 70/30 insulin with IGF-I.
- Figure 1 shows the acidic pH reversed-phase HPLC chromatogram of an IGF-I sample.
- Figure 2 shows the acidic pH reversed-phase HPLC chromatogram of Regular insulin.
- Figure 3 shows the acidic pH reversed-phase HPLC chromatogram for an IGF-I and insulin mixture.
- Figure 4 shows a graph of solution clarity of Regular insulin (triangles) or IGF-I in an acetate-buffered formulation used as a control herein (circles) as a function of solution pH, which was adjusted by adding 0. IN HCI or NaOH.
- polypeptide or “polypeptide of interest” refers generally to peptides and proteins having more than about ten amino acids.
- mammalian polypeptides include molecules such as, e.g., renin, a growth hormone, including human growth hormone; bovine growth hormone; growth hormone releasing factor; parathyroid hormone; thyroid stimulating hormone; lipoproteins; ⁇ l-antitrypsin; insulin A-chain; insulin B-chain; proinsulin; thrombopoietin; follicle stimulating hormone; calcitonin; luteinizing hormone; glucagon; clotting factors such as factor VIIIC, factor IX, tissue factor, and von Willebrands factor; anti-clotting factors such as Protein C; atrial naturietic factor; lung surfactant; a plasminogen activator, such as urokinase or human urine or tissue-type plasminogen activator (t-PA); bombesin; thrombin; hemopoi
- the prefened polypeptides of mterest are mammalian polypeptides, most preferably human polypeptides
- mammalian polypeptides include t-PA, VEGF, gpl20, ant ⁇ -HER-2, anti-CDl la, ant ⁇ -CD18, DNase, IGF-I, IGF-II, msulm, protamme, bram IGF-I, growth hormone, relaxin chains, LHRH analogues, cholecystok ⁇ n ⁇ n-8 analogues, growth hormone releasing factor, insulin chams or pro-msulm, urokinase, lmmunotoxins, neurotrophins, and antigens
- Especially preferred mammalian polypeptides are those combmations that are administered to mammals sufficiently frequently that it would be desirable to give one shot or dosage contammg both Particularly preferred such combinations include, e g , insulin and an IGF, most preferably IGF-I, or
- this native-sequence IGF-I is recombinantly produced and is available from Genentech, Inc , South San Francisco, CA for clinical investigations
- the preferred IGF-I vanants are those described in US Pat Nos 5,077,276, 5,164,370, or 5,470,828, or m WO 87/01038, t e , those wherein at least the glutamic acid residue is absent at position 3 from the N-terminus of the mature molecule or those having a deletion of up to five amino acids at the N- terminus
- the most preferred vanant has the first three ammo acids from the N-terminus deleted (variously designated as brain IGF, tIGF-I, des(l-3)-IGF-I, or des-IGF-I)
- msulm refers to any type of insulin from any species, including bovine, ovine, porcme, equine, and preferably human, and from any source, whether natural, synthetic, or recombmant All insulin drugs reported, for example, in Diabetes Mellitus - Theory and Practice, fourth edition, Harold Rifkin, MD, Ed (Elsevier, New York, 1990), Chapter 29, and U S
- Insulin The Physico-chemical and Pharmaceutical Aspects of Insulin and Insulin Preparations (Spnnger- Verlag, New York, 1987), page 17-40 These include Regular insulm, NPH (Neutral Protamine Hagedorn) insulin, also called Isophane Insulin, 70/30 msulm, composed of 70% NPH-insulm and 30% Regular msulm, Semilente insulin, UltraLente msulm, Lente insulin, and Humalog insulm Preferred herem for animal use is that form of msulm from the particular species being treated, such as human insulin to treat humans
- disorders in general refers to any condition that would benefit from treatment with the oppositely-charged polypeptides ingredients in the composition herein, including any disease or disorder that can be treated by effective amounts of these polypeptides
- This m cludes chronic and acute disorders, as well as those pathological conditions which predispose the mammal to the disorder in question
- disorders to be treated herem mclude benign and malignant tumors, leukemias and lymphoid malignancies, neuronal, g al, astrocytal, hypothalamic and other glandular, macrophagal, epithelial, stromal, and blastocoehc disorders, hematopoiesis-related disorders, tissue-growth disorders, skin disorders, desmoplasia, fibrotic lesions, hyperglycemic disorders, kidney disorders, bone-related disorders, trauma such as burns, incisions, and other wounds, catabohc states, testicular-related disorders, and inflammatory, an
- hyperglycemic disorders refers to all forms of diabetes, such as type I and type II diabetes, as well as hypennsulmemia and hyperlipidemia, e g , obese subjects, and insulin-resistant diabetes, such as Mendenhall's Syndrome, Werner Syndrome, leprechaunism, hpoatrophic diabetes, and other hpoatrophies
- diabetes especially type I and type II diabetes "Diabetes” itself refers to a progressive disease of carbohydrate metabolism involving inadequate production or utilization of msulm and is charactenzed by hyperglycemia and glycosuna
- the term “treating” refers to both therapeutic treatment and prophylactic or preventative measures Those in need of treatment mclude those already with the disorder as well as those prone to having the disorder or diagnosed with the disorder or those in which the disorder is to be prevented
- Consecutive treatment or administration refers to treatment on at least a daily basis without interruption in treatment by one or more days
- Intermittent treatment or administration, or treatment or administration in an intermittent fashion refers to treatment that is not consecutive, but rather cyclic in nature
- the treatment regime herein can be either consecutive or intermittent, but preferably is consecutive when both proteins are formulated and administered together
- “mammal” for purposes of treatment refers to any animal classified as a mammal, including humans, domestic, and farm animals, and zoo, sports, or pet animals, such as dogs, horses, cats, sheep, pigs, cows, etc
- the preferred mammal herein is a human
- non-adult refers to mammals that are from pennatal age (such as low-birth- weight infants)
- complexed in the context of polypeptides means that they are covalently bonded or otherwise have a b ding affinity that is greater than about 1 (m ⁇ ) Examples would include a complex of IGF-I and one or more of its binding protems, or of a ligand and its receptor, or of methemoglobin and the tryptic fragment of bovme liver cytochrome b, or complex coacervation, as with albumm and acacia
- soluble refers to polypeptides that, when in aqueous solutions, are completely dissolved, resulting in a clear to slightly opalescent solution with no visible particulates, as assessed by visual inspection
- a further assay of the turbidity of the solution may be made by measuring UV absorbances at 320 to 360 nm with a 1-cm pathlength cell (Eckhardt e/ ⁇ / J Pharmaceutical Science and Technology. 48 64-70 (1994))
- a “stabilizer” is any compound that functions to preserve the active polypeptides in the formulation, e g , msulm and IGF-I, so that they do not degrade or otherwise become inactive over a reasonable penod of tune or develop pathogens or toxins that prevent their use
- stabilizers mclude preservatives that prevent bacteria, viruses, and fungi from proliferating in the formulation, anti-oxidants, or other compounds that function m vanous ways to preserve the stability of the formulation
- a “buffer” as used herein is any suitable buffer that is GRAS and generally confers a pH from about 4 8 to 8, preferably from about 7 to 7 5, most preferably about 7 2, if the polypeptides are IGF-I and insulin
- acetic acid salt buffer which is any salt of acetic acid, including sodium acetate and potassium acetate, succmate buffer, phosphate buffer, citrate buffer, histidine buffer, or any others known to the art to have the desired effect
- the most prefened buffer is histidine for a pH of about 7 to 7 5
- the formulations are prepared by mixing the polypeptides of opposite charge, each at the desired degree of punty, uniformly and intimately with one another and with one or more of the following excipients arginine, lysme, glutamate, or sodium dodecyl sulfate, or with a combmation of the two excipients beta-hydroxy cyclodextrin and arginine
- the composition may also contain, for parenteral administration, a pharmaceutically or parenterally acceptable earner, I e , one that is non-toxic to recipients at the dosages and concentrations employed and is compatible with other mgredients of the formulation
- the formulation preferably does not include oxidizing agents and other compounds that are known to be deleterious to polypeptides
- the carrier is a parenteral earner, more preferably a solution that is lsotomc with the blood of the recipient Examples of such carrier vehicles include water, saline or a buffered solution such as phosphate
- the preferred excipients depend on the types of polypeptides bemg employed, the molar ratio of the two polypeptides m the composition, the presence, types, and amounts of other ingredients, etc
- the preferred excipient is arginine in a concentration of 100-200 mM, more preferably about 160 mM for a 1 1 vol/vol ratio of IGF-I and insulin
- the insulm is NPH-msulm, it cannot have the beta-cyclodextnn sulfobutyl ether as excipient, alone or in combination with arginine, because it causes re-solubi zation of insulin m the NPH portion, thereby dissociating NPH-msulm complex
- the composition preferably also contains a buffer that brings the pH to about 7-7 5, such as histidine, if the polypeptides are insulin and IGF-I
- concentration of excipient employed also depends on the type and the ratio of the polypeptides
- the maximum ratio of insulin to IGF-I is 0 85 1 if the concentration of argimne is 150 mM
- the ratio of Regular insulin to IGF-I is increased, such that at 230 mM argmme, the maximum ratio is 2 5 1
- the mixing ratio can be 1 1 to 6 1 when 0 5% SDS is employed Mixmg can be done at less than a 1 4 1 ratio
- the polypeptides are typically formulated m such vehicles at a pH of from about 4 5 to 8, dependmg mainly on the pi of the polypeptides, preferably m the presence of a buffer that mamtams the pH level If the polypeptides are IGF-I and insulin, preferably the IGF-I is formulated at about pH 7 to 7 5, more preferably about 7 2, usmg histidine as buffer, before mixmg with the msulm The final preparation is a stable liquid
- the composition comprises IGF-I and NPH-insulin in a volume ratio of insulin IGF-I of from about 15 1 to 1 15 (v/v)
- the more preferred amounts of IGF-I and insulm m this composition are from about 1 to 10 mg IGF-I and from about 0 2 to 2 mg insulin
- the composition of claim 7 wherem the volume volume ratio of msulm IGF-I is from about 0 2 1 to about 1 1
- composition herein also may contam a stabilizer
- quaternary ammonium salts are useful stabilizers in which the molecular structure includes a central nitrogen atom jomed to four organic (usually alkyl or aryl) groups and a negatively- charged acid radical
- These salts are useful as surface-active germicides for many pathogenic non-sporulating bactena and fungi and as stabilizers Examples include octadecyldimethylbenzyl ammonium chloride, hexamethonium chloride, benzalkonium chloride (a mixture of alkylbenzyldrmethylammonium chlondes m which the alkyl groups are long-cham compounds), and benzethomum chlonde
- Other types of stabilizers include aromatic alcohols such as phenol and benzyl alcohol, alkyl parabens such as methyl or propyl paraben, and m-cresol
- the preferred stabilizer herein is phenol or benzyl
- the stabilizer is included in a stable liquid form of the insulin and IGF-I formulation, but not in a lyophihzed form of the formulation In the latter case, the stabilizer is present m the bacteriostatic water for injection (BWFI) used for reconstitution
- the arginine is present m a concentration of about 100 to 300 mM and the ratio of insulin IGF-I is from about 0 1 1 to 10 1, more preferably about 0 2 1 to about 1 1
- this formulation with 100 to 300 mM argimne, as well as buffer such as histidine and a phenol also contains beta-cyclodextrm sulfobutyl ether as an excipient in a concentration of about 1 - 10%
- a more preferred composition of this type comprises about 5-20 mg/ml IGF-I, about 2-10 mg/ml insulin, about 100-200 mM arginine, about 5-20 mM histidine at pH about 7-7 5, and about 1-5 mg/ml phenol
- the final formulation if a liquid, is preferably stored at a temperature of from about 2 to 8 °C for a suitable time period.
- the formulation can be lyophilized and provided as a powder for reconstitution with water for injection that is stored as described for the liquid formulation.
- the polypeptides to be used for therapeutic administration must be sterile. Sterility is readily accomplished by filtration through sterile filtration membranes (e.g., 0.2 micron membranes).
- Therapeutic compositions generally are placed into a container having a sterile access port, for example, an intravenous solution bag or vial having a stopper pierceable by a hypodermic injection needle.
- the polypeptide composition ordinarily will be stored in unit or multi-dose containers, for example, sealed ampules or vials, as an aqueous solution or as a lyophilized formulation for reconstitution.
- a lyophilized formulation 10-mL vials are filled with 5 mL of sterile-filtered 1% (w/v) aqueous IGF-I solution, and the resulting mixture is lyophilized.
- the subcutaneous injection solution is prepared by reconstituting the lyophilized insulin using bacteriostatic Water-for-Injection. This solution is then mixed with a similarly reconstituted insulin solution or a liquid insulin solution.
- the formulation containing both the IGF-I and insulin can be made by many different methods.
- One method comprises mixing insulin with an IGF-I-containing composition (having the ingredients as described below).
- the IGF-I-containing solution useful for administering with the insulin solution as described above preferably contains arginine, more preferably contains arginine and a stabilizer, still more preferably contains arginine, a stabilizer, and a buffer, and more preferably is as follows: About 5-20 mg/ml IGF-I, about 100-200 mM arginine, about 5-20 mM buffer at about pH 7-7.5, and about 1 -5 mg/ml phenol.
- the most preferred composition for this purpose comprises about 10 mg/ml IGF-I, about 160 mM arginine, about 10 mM histidine at about pH 7.2, and about 3 mg/ml phenol. Kits are also contemplated for this invention.
- a typical kit would comprise a container, preferably a vial, for a first polypeptide such as IGF-I in an excipient as described above; a container, preferably a vial, comprising a second polypeptide of the opposite charge, and instructions, such as a product insert or label, directing the user to combine the contents of the two containers, i.e., the two formulations.
- This would preferably provide a pharmaceutical formulation.
- the polypeptides are IGF-I and insulin
- the pharmaceutical formulation is for treating diabetes.
- the container with IGF-I additionally comprises a stabilizer such as benzyl alcohol or phenol, or both, in the buffer at a pH of from about 7.0 to 1.5.
- the user will be instructed to combine the contents of the containers, i.e., the two formulations, in a syringe for immediate injection.
- kits are one where the composition is already prepared such that it is contained in one container and the kit also has instructions for using the composition to treat an appropriate disorder.
- the composition of polypeptides is directly administered to the mammal by any suitable technique, including infusion, injection, and pulmonary and transdermal administration.
- the specific route of administration will depend, e.g., on the medical history of the patient, including any perceived or anticipated side effects using either polypeptide alone, the types of polypeptides employed, and the particular disorder to be corrected.
- parenteral administration include subcutaneous, intramuscular, intravenous, intraarterial, and intraperitoneal administration of the composition.
- One preferred method of delivery for systemic-acting drugs involves administration by continuous infusion (using, e.g. , slow-release devices or minipumps such as osmotic pumps or skin patches), or by injection (using, e.g. , intravenous or subcutaneous means, including single-bolus administration)
- continuous infusion using, e.g. , slow-release devices or minipumps such as osmotic pumps or skin patches
- injection using, e.g. , intravenous or subcutaneous means, including single-bolus administration
- delivery of the composition by injection will be the prefened form of administration for treatmg diabetes
- Iontophoresis is a means of enhancing the flux of ionic drugs across skin by the applicatino of an electrochemical potential gradient
- Drugs suitable for this method of delivery include LHRH analogues, insulin, growth hormone, and cholecystok ⁇ n ⁇ n-8 analogues See, for example, Snmvasan et al , J Pharm Sci .79 588-591
- composition to be used in the therapy will be formulated and dosed in a fashion consistent with good medical practice, taking into account the clmical condition of the mdividual patient (especially the side effects of treatment with the polypeptides as smgle agents), the site of delivery of the composition, the types of polypeptides employed, the method of administration, the schedulmg of administration, and other factors known to practitioners
- the "effective amounts" of each component for purposes herein are thus determined by such considerations and must be amounts that result in bioavailabihty of the drugs to the mammal
- the total pharmaceutically effective amount of the polypeptides admmistered parenterally per dose will be m the range of from about 10 ⁇ g/kg/day to about 1 mg/kg/day based on kg of patient body weight
- the parenteral amount per dose ranges from about 10 to 200 ⁇ g/kg/day of IGF-I based on kg of patient body weight, and
- an infusion device may also be employed for continuous SC infusions
- An intravenous bag solution may also be employed
- the key factor m selecting an appropnate dose is the result obtained, for example, m the case of diabetes as measured by decreases m blood glucose so as to approximate the normal range, or by other cntena for measunng treatment of diabetes as defined herein as are deemed appropnate by the practitioner Further information on dosmg insulin can be found in Diabetes Mellitus - Theory and Practice.
- the formulation herein is suitably administered along with other agents that produce the desired pharmacological effect, for example, m the case of IGF-I and insulin, an IGF binding protem, for example, one of those currently known, t e , IGFBP-1, IGFBP-2, IGFBP-3, IGFBP-4, IGFBP-5, or IGFBP-6, or with the ALS of the IGF bmding complex
- IGFBP-3 which is described m U S Pat No 5J58J87 and by Martin and Baxter.
- This glycosylated IGFBP-3 protein is an acid-stable component of about 53 Kd on a non-reducing SDS-PAGE gel of a 125-150 Kd glycoprotein complex found in human plasma that carries most of the endogenous IGFs and is also regulated by GH
- the administration of the IGF binding protein with IGF-I and insulin may be accomplished by the method described in U S Pat No 5,187,151 Briefly, the IGF-I and IGFBP are administered in effective amounts by subcutaneous bolus injection m a molar ratio of from about 0 5 1 to 3 1 , preferably about 1 1 , the insulin is already present with the IGF-I Furthermore, the formulation is suitably administered along with an effective amount of a hypoglycemic agent such as a sulfonylurea.
- the hypoglycemic agent is administered to the mammal by any suitable technique including parenterally, intranasally, orally, or b any other effective route. Most preferably, the administration is by the oral route.
- MICRONASETM Tablets marketed by Upjohn in 1.25, 2.5, and 5 mg tablet concentrations are suitable for oral administration.
- the usual maintenance dose for Type II diabetics, placed on this therapy, is generally in the range of from about 1.25 to 20 mg per day, which may be given as a single dose or divided throughout the day as deemed appropriate (Physician's Desk Reference. 2563-2565 (1995)).
- Other examples of glyburide-based tablets available for prescription include GLYNASETM brand drug (Upjohn) and DIABETATM brand drug (Hoechst-Roussel).
- GLUCOTROLTM is the trademark for a glipizide (1- cyclohexyl-3-(p-(2-(5-methylpyrazine carboxamide)ethyl)phenyl)sulfonylurea) tablet available in both 5 and 10 mg strengths and is also prescribed to Type II diabetics who require hypoglycemic therapy following dietary control or in patients who have ceased to respond to other sulfonylureas (Physician's Desk Reference. 1902-1903 (1995)).
- hypoglycemic agents such as the biguanides (e.g., metformin and phenformin) or troglitozones, or other drugs affecting insulin action may also be employed.
- biguanides e.g., metformin and phenformin
- troglitozones or other drugs affecting insulin action may also be employed.
- the invention will be more fully understood by reference to the following examples. They should not, however, be construed as limiting the scope of the invention. All literature and patent citations mentioned herein are expressly incorporated by reference.
- HUMULINTM 70/30 insulin (HUMULINTM 70/30) were obtained from Eli Lilly and Company.
- the 0.5-cc and 1-cc insulin syringes were obtained from Becton Dickinson, and PD10 columns (SEPHADEXTM G25M) were obtained from Pharmacia (catalog #17-0851-01).
- Table 1 lists formulation dosage forms for Regular, NPH-, and 70/30 insulin.
- IGF-I concentration determined by UV absorbance at 276 nm using an absorptivity of 0 646 cm (mg/ml) ,
- Solvent B 0 1 % tnfluroacetic acid in acetonitrile
- FIG. 1 shows the acidic reversed-phase HPLC of an IGF-I sample
- Figure 2 shows the acidic reversed- phase HPLC of Regular insulm
- Figure 3 shows the acidic reversed-phase HPLC of a 1 1 (vol vol ) mixture of Regular insulin IGF-I
- Quantitation of both IGF-I and insulin can be achieved by utilizing the peak areas of IGF-I and msulin peaks For example, the percentage of IGF-I remaining m solution can be obtamed by comparing the IGF-I peak areas before and after IGF-I is mixed with msulm Procedure for mixing IGF-I and insulin
- the acetate-buffered IGF-I formulation used as a standard herem is a clear liquid and contains 10 mg/ml
- IGF-I 100 mM sodium chlonde, 2 mg/ml polysorbate 20, 9 mg/ml benzyl alcohol, 50 mM acetate, pH 5 4 This product is mtended for multi-use purposes for up to 28 days of use Shelf life was set at 60 months at 2-8°C storage
- Table 2 shows results of mixing the acetate-buffered IGF-I formulation with Regular insulm At 1 1 (vol vol) mixing ratio, the solution turned very cloudy upon mixing 43% of insulin and 14% of IGF-I precipitated out of solution
- the isoelectric points of IGF-I and insulin are 8.7 and 5.4, respectively.
- Data shown in Figure 4 suggest that no suitable pH range exists at which both IGF-I and Regular insulin can stay in solution. Therefore, it is not possible simply to adjust the pH of the acetate IGF-I formulation to produce a clear IGF-I/insulin mixture.
- Table 3 shows the result of mixing the acetate IGF-I formulation with NPH-insulin at various mixing ratios.
- NPH:IGF-I mixing ratios 1 : 1 and 14:1 (vokvol)
- both NPH-insulin and IGF-I were unchanged before and after mixing.
- All IGF-I remained in solution and all NPH remained as NPH crystals with no soluble insulin in solution.
- NPH and IGF-I were mixed at a 1:14 (vokvol) ratio, 100% of the insulin was released from the NPH crystals, although IGF-I remained unchanged.
- the control acetate-buffered IGF-I formulation turned cloudy when the pH was adjusted to above 6 4
- Many of the excipients listed in Table 4 enabled IGF-I to be a clear solution at pH 7 2
- These excipients included ammo acids (glycine, lysme, argmme, histidine, glutamate, aspartate), salts (sodium chloride, sulfate, phosphate, citrate, bicarbonate, ascorbate, succmate), cyclodextnn denvatives ( ⁇ -hydroxy cyclodextnn and ⁇ -cyclodextnn sulfobutyl ether), SDS, and glycerol
- ammo acids glycine, lysme, argmme, histidine, glutamate, aspartate
- salts sodium chloride, sulfate, phosphate, citrate, bicarbonate, ascorbate, succmate
- excipients that proved to be effective in preventmg precipitation of Regular insulm and IGF-I upon mixing were arginine, lysine, glutamate, SDS, ⁇ -hydroxy cyclodextnn and ⁇ -cyclodextnn sulfobutyl ether Mixmg results using these excipients are shown in Table 5 0 5% SDS was very effective in achieving a clear insulin and
- IGF-I formulations contain 10 mg/ml IGF-I and 10 mM histidine at pH 1.2.
- Arginine was more effective than lysine or glutamate in keeping both insulin and IGF-I in solution.
- Regular insulin and IGF-I could be mixed at mixing ratios up to 0.85:1 (vokvol). When mixing ratios exceeded 0.85: 1, precipitation of both IGF-I and insulin occurs.
- more Regular insulm could be mixed with IGF-I to form a clear mixture, up to a mixing ratio of 2 5 1 (vol vol)
- the protection against precipitation offered by arginine is believed to be due to the fact that at pH 7 2 msulin molecules are negatively charged, and the positively-charged argmme molecules interact with negatively-charged msulin, thereby shielding the mteraction and subsequent precipitation between positively-charged IGF-I and negatively-charged msulm High concentrations of arginine are required for mixing at a high insulm IGF-I ratio
- 1% ⁇ -cyclodext ⁇ n sulfobutyl ether allows mixmg of Regular insulin and IGF-I at a mixmg ratio below 0 25 1
- Use of 5% ⁇ -hydroxy cyclodextnn did not allow mixing at any ratio
- Use of both cyclodextnn and arginine is extremely effective m preventing insulin and IGF-I precipitation upon mixing ⁇ - cyclodextnn sulfobutyl ether used at a concentration of 2% to 5% together with argmme used at a concentration of 150 mM to 230 mM allowed Regular msulin and IGF-I to be mixed at a very wide range of mixing ratios, up to 10 1 (msulm vol IGF-I vol) Without being limited to any one theory, it is believed that this is due to the fact that at pH 7 2, positively-charged argimne interacts with negatively-charged insulin, and negatively-charged ⁇ - cyclodextn
- the above excipient screenmg study results identified arginine to be the preferred choice of excipient for an IGF-I formulation to be mixed with both Regular and NPH-msulm A study was then earned out to evaluate the effect of argmme concentration on the ability of IGF-I to mix with msulin
- the IGF-I formulation tested in this study contained 10 mg/ml IGF-I, 10 mM histidine, pH 7 2, 3 mg/ml phenol, and varying amounts of argmme
- the IGF-I formulation tested in this study contained 10 mg/ml IGF-I, 10 mM histidine, pH 7.2, 3 mg/ml phenol, and varying amounts of arginine.
- a preferred IGF-I formulation for mixing with insulin was therefore defined to be 10 mg/ml IGF-I, 160 mM arginine, 10 mM histidine at pH 7.2 and 3 mg/ml phenol.
- the mixability of this formulation with Regular, NPH-, and 70/30 insulin at various mixing ratios was assessed and results are tabulated in Tables 7, 8 and 9, respectively.
- the new IGF-I formulation contained 10 mg/ml IGF-I, 160 mM arginine, 10 mM histidine at pH 7.2 and 3 mg/ml phenol.
- the new IGF-I formulation contams 10 mg/ml IGF-I, 160 mM arginine, 10 mM histidine atpH 7 2 and 3 mg/ml phenol
- the new IGF-I formulation contained 10 mg/ml IGF-I, 160 mM argmme, 10 mM histidine at pH 7 2 and 3 mg/ml phenol
- IGF-I insulin-derived neurotrophic factor-I
- a preferred IGF-I formulation was developed for mixing with insulin. It contains 10 mg/ml IGF-I, 160 mM arginine, 10 mM histidine at pH7.2 and 3 mg/ml phenol. The ability of this arginine formulation to mix with Regular, NPH-, and 70/30 insulin at various mixing ratios was assessed. When this formulation was mixed with Regular insulin, percent soluble IGF-I and insulin were nearly 90% or above for all potential mixing ratios. Mixing of this IGF-I formulation and NPH-insulin at most of the mixing ratios resulted in no change in IGF-I and NPH before and after mixing. At very low NPH/IGF-I mixing ratios, portions of NPH-insulin-protamine complex dissociated.
- Excipients such as arginine, lysine, glutamate, SDS, and/or certain cyclodextrins were shown to be effective in preventing IGF-I and insulin electrostatic interaction and subsequent precipitation upon mixing.
- SDS and ⁇ -cyclodextrin sulfobutyl ether together with arginine in the IGF-I formulation proved to be extremely effective in allowing IGF-I and Regular insulin to be mixed at a very wide range of mixing ratios.
- they can not be used to mix with NPH-insulin due to the dissociation of NPH-insulin-protamine complexes in the presence of SDS and ⁇ -cyclodextrin sulfobutyl ether.
Abstract
Description
Claims
Priority Applications (9)
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CA002369451A CA2369451C (en) | 1999-04-08 | 2000-03-30 | Composition based on oppositely-charged polypeptides |
DE60005806T DE60005806T2 (en) | 1999-04-08 | 2000-03-30 | COMPOSITION BASED ON OPPOSITELY CHARGED POLYPEPTIDES |
IL14559700A IL145597A0 (en) | 1999-04-08 | 2000-03-30 | Composition based on oppositely-charged polypeptides |
EP00920012A EP1165119B1 (en) | 1999-04-08 | 2000-03-30 | Composition based on oppositely-charged polypeptides |
DK00920012T DK1165119T3 (en) | 1999-04-08 | 2000-03-30 | Composition based on oppositely charged polypeptides |
AT00920012T ATE251466T1 (en) | 1999-04-08 | 2000-03-30 | COMPOSITION BASED ON OPPOSITELY CHARGED POLYPEPTIDES |
AU40613/00A AU763039B2 (en) | 1999-04-08 | 2000-03-30 | Composition based on oppositely-charged polypeptides |
JP2000610509A JP4360758B2 (en) | 1999-04-08 | 2000-03-30 | Compositions based on oppositely charged polypeptides |
HK02100485.0A HK1039065B (en) | 1999-04-08 | 2002-01-22 | Composition based on oppositely-charged polypeptides |
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US12839299P | 1999-04-08 | 1999-04-08 | |
US60/128,392 | 1999-04-08 |
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US (2) | US6559122B1 (en) |
EP (1) | EP1165119B1 (en) |
JP (2) | JP4360758B2 (en) |
AT (1) | ATE251466T1 (en) |
AU (1) | AU763039B2 (en) |
CA (1) | CA2369451C (en) |
DE (1) | DE60005806T2 (en) |
DK (1) | DK1165119T3 (en) |
ES (1) | ES2208305T3 (en) |
HK (1) | HK1039065B (en) |
IL (1) | IL145597A0 (en) |
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WO (1) | WO2000061177A1 (en) |
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US5783556A (en) * | 1996-08-13 | 1998-07-21 | Genentech, Inc. | Formulated insulin-containing composition |
DE60005806T2 (en) * | 1999-04-08 | 2004-08-05 | Genentech, Inc., South San Francisco | COMPOSITION BASED ON OPPOSITELY CHARGED POLYPEPTIDES |
EP1265630B1 (en) * | 2000-03-24 | 2006-06-07 | Genentech, Inc. | Use of insulin for the treatment of cartilagenous disorders |
AU2003219958B2 (en) * | 2002-02-27 | 2006-01-05 | Immunex Corporation | Polypeptide formulation |
JP4602075B2 (en) * | 2002-05-06 | 2010-12-22 | トーマス・ジェファーソン・ユニバーシティ | Insulin-related peptide effective for brain health |
NZ541365A (en) * | 2002-12-27 | 2009-09-25 | Diobex Inc | Compositions and methods for the prevention and control of insulin-induced hypoglycemia |
US7655618B2 (en) | 2002-12-27 | 2010-02-02 | Diobex, Inc. | Compositions and methods for the prevention and control of insulin-induced hypoglycemia |
KR20070010115A (en) * | 2003-11-13 | 2007-01-22 | 알자 코포레이션 | Composition and apparatus for transdermal delivery |
SI1733037T1 (en) | 2004-03-11 | 2015-02-27 | Genentech, Inc. | Process for producing polypeptides |
DK3520779T3 (en) | 2004-04-23 | 2022-03-21 | Cydex Pharmaceuticals Inc | DPI formulation containing sulfoalkyl ether cyclodextrin |
EP1674113A1 (en) | 2004-12-22 | 2006-06-28 | F. Hoffmann-La Roche Ag | Conjugates of insulin-like growth factor-1 (IGF-1) and poly(ethylene glycol) |
KR20080031684A (en) | 2005-06-14 | 2008-04-10 | 암젠 인코포레이티드 | Self-buffering protein formulations |
KR101105871B1 (en) * | 2005-09-27 | 2012-01-16 | 주식회사 엘지생명과학 | hFSF Aqueous Formulation |
US7629331B2 (en) | 2005-10-26 | 2009-12-08 | Cydex Pharmaceuticals, Inc. | Sulfoalkyl ether cyclodextrin compositions and methods of preparation thereof |
CL2007002502A1 (en) | 2006-08-31 | 2008-05-30 | Hoffmann La Roche | VARIANTS OF THE SIMILAR GROWTH FACTOR TO HUMAN INSULIN-1 (IGF-1) PEGILATED IN LISIN; METHOD OF PRODUCTION; FUSION PROTEIN THAT UNDERSTANDS IT; AND ITS USE TO TREAT ALZHEIMER'S DISEASE. |
BRPI0715754A2 (en) * | 2006-08-31 | 2013-07-09 | Hoffmann La Roche | Method for the production of insulin-like growth factor |
ATE533060T1 (en) * | 2008-04-03 | 2011-11-15 | Hoffmann La Roche | ASSAY WITH PEGYLATED INSULIN-LIKE GROWTH FACTORS |
US20110152188A1 (en) * | 2009-12-23 | 2011-06-23 | Hanns-Christian Mahler | Pharmaceutical compositions of igf/i proteins |
US20110207764A1 (en) * | 2010-02-23 | 2011-08-25 | Valery Alakhov | Cyclopolysaccharide compositions |
US8383663B2 (en) | 2010-07-19 | 2013-02-26 | Supratek Pharma Inc. | Bendamustine anionic-catioinic cyclopolysaccharide compositions |
BR112015021000A2 (en) * | 2013-03-14 | 2017-07-18 | Allergan Inc | composition of a prolonged release distribution and method of stabilizing proteins during the manufacturing process |
BR112019007858A2 (en) | 2016-10-21 | 2019-07-02 | Amgen Inc | pharmaceutical formulations and methods for producing the same |
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US20030195142A1 (en) | 2003-10-16 |
US6559122B1 (en) | 2003-05-06 |
JP2009029803A (en) | 2009-02-12 |
HK1039065B (en) | 2004-04-16 |
JP2002541212A (en) | 2002-12-03 |
DK1165119T3 (en) | 2003-12-15 |
AU763039B2 (en) | 2003-07-10 |
DE60005806D1 (en) | 2003-11-13 |
IL145597A0 (en) | 2002-06-30 |
WO2000061177A1 (en) | 2000-10-19 |
JP4360758B2 (en) | 2009-11-11 |
AU4061300A (en) | 2000-11-14 |
ATE251466T1 (en) | 2003-10-15 |
ES2208305T3 (en) | 2004-06-16 |
CA2369451C (en) | 2009-09-22 |
US7186686B2 (en) | 2007-03-06 |
EP1165119A1 (en) | 2002-01-02 |
HK1039065A1 (en) | 2002-04-12 |
EP1165119B1 (en) | 2003-10-08 |
PT1165119E (en) | 2004-02-27 |
CA2369451A1 (en) | 2000-10-19 |
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