阅读说明：本技术 双磷脂素凝胶制剂及其用途 (Bispholipin gel formulations and uses thereof ) 是由 S·A·凯茨 K·A·约翰逊 于 2018-06-12 设计创作，主要内容包括：公开了具有抗微生物活性的凝胶制剂。进一步公开了使用凝胶制剂的方法。(Gel formulations having antimicrobial activity are disclosed. Further disclosed are methods of using the gel formulations.)

1. A gel formulation comprising:

a bisphosphinite selected from Nu-2, Nu-3, Nu-4, Nu-5 and Nu-8, or a pharmaceutically acceptable salt thereof, or any combination thereof;

a fatty alcohol thickener; and

a nonionic polymeric emulsifier.

2. The formulation of claim 1, wherein the bisphosphatilin is Nu-3 or a pharmaceutically acceptable salt thereof.

3. The formulation of claim 1, wherein the formulation has a pH of about pH 1 to about pH 5.

4. The formulation of claim 1, wherein the formulation has a pH of about pH 1.5 to about pH 4.

5. The formulation of claim 1, wherein the formulation has a pH of about pH 3 to about pH 4.

6. The formulation of claim 1, wherein the bisphosphatilin is present in the formulation in an amount of about 1% to about 20% (weight/weight).

7. The formulation of claim 6, wherein the bisphosphatilin is present in the formulation in an amount of about 5% to about 15% (weight/weight).

8. The formulation of claim 1, wherein the bisphosphipidin is present in the formulation in an amount from about 30% to about 50% (weight/weight).

9. The formulation of claim 1, wherein the fatty alcohol thickener is present in the formulation in an amount of about 1% to about 50% (weight/weight).

10. The formulation of claim 1, wherein the fatty alcohol thickener is present in the formulation in an amount of about 1% to about 20% (weight/weight).

11. The formulation of claim 1, wherein the fatty alcohol thickener is present in the formulation in an amount of about 1% to about 10% (weight/weight).

12. The formulation of claim 1, wherein the nonionic polymeric emulsifier is present in the formulation in an amount of from about 0.25% to about 15% (weight/weight).

13. The formulation of claim 1, wherein the nonionic polymeric emulsifier is present in the formulation in an amount of from about 0.5% to about 5% (weight/weight).

14. The formulation of claim 1, further comprising a diluent selected from the group consisting of water, glycerol, mannitol, saline, and phosphate buffered saline.

15. The formulation of claim 14, wherein the diluent is water.

16. The formulation of claim 15, wherein the water is present in the formulation in an amount of about 65% to about 97.5% (w/w).

17. The formulation of claim 1, wherein the fatty alcohol thickening agent is selected from the group consisting of cetyl alcohol, lauryl alcohol, stearyl alcohol, cetearyl alcohol, myristyl alcohol, behenyl alcohol, and oleyl alcohol.

18. The formulation of claim 17, wherein the fatty alcohol thickening agent is cetearyl alcohol.

19. The formulation of claim 18, wherein the cetearyl alcohol is present in the formulation in an amount from about 2% to about 10% (w/w).

20. The formulation of claim 1, wherein the non-ionic polymer is selected from the group consisting of ceteth-20, steareth-20, and ceteareth-20.

21. The formulation of claim 20 wherein the non-ionic polymeric emulsifier is ceteareth 20.

22. The formulation of claim 21, wherein ceteareth-20 is present in the formulation in an amount greater than about 0.5% (w/w).

23. The formulation of claim 21, wherein ceteareth-20 is present in the formulation in an amount from about 0.5% to about 5% (w/w).

24. The formulation of claim 1, wherein the formulation is suitable for topical administration.

25. A method of treating an infection in a patient in need thereof, comprising administering to the patient an effective amount of the formulation of claim 1.

26. The method of claim 25, wherein the infection is an infection of a diabetic foot ulcer.

27. The method of claim 25, wherein the infection is an infection of a burn wound.

28. The method of claim 25, wherein the infection is an infection of a complex venous leg ulcer.

29. The method of claim 25, wherein the infection is an otitis externa infection.

30. A method of treating acne vulgaris in a patient in need thereof comprising administering to the patient an effective amount of the formulation of claim 1.

31. A method of treating onychomycosis in a patient in need thereof, comprising administering to the patient an effective amount of the formulation of claim 1.

32. A method of treating conjunctivitis in a patient in need thereof, comprising administering to the patient an effective amount of the formulation of claim 1.

33. A method of treating oral mucositis in a patient in need thereof, comprising administering to the patient an effective amount of the formulation of claim 1.

34. The method of claim 25, wherein at least one additional active ingredient is administered to the patient.

35. The method of claim 25, wherein the patient is a human.

36. The formulation of claim 1 for use in therapy.

37. The formulation of claim 1 for use in treating an infection.

38. The formulation of claim 1 for use in treating an infection of a diabetic foot ulcer.

39. The formulation of claim 1 for use in treating infection of burn wounds.

40. The formulation of claim 1 for use in treating an infection of a complex venous leg ulcer.

41. The formulation of claim 1 for use in the treatment of acne vulgaris.

42. The formulation of claim 1 for use in treating otitis externa.

43. The formulation of claim 1 for use in the treatment of onychomycosis.

44. The formulation of claim 1 for use in treating conjunctivitis.

45. The formulation of claim 1 for use in treating oral mucositis.

46. The formulation of claim 1 for use in the preparation of a medicament.

47. The use according to claim 46, wherein the medicament is for the treatment of infections of burn wounds.

48. The use according to claim 46, wherein the medicament is for the treatment of an infection of a diabetic foot ulcer.

49. The use according to claim 46, wherein the medicament is for the treatment of an infection of a complex venous leg ulcer.

50. The use of claim 46, wherein the medicament is for the treatment of acne vulgaris.

51. The use according to claim 46, wherein the medicament is for the treatment of otitis externa.

52. The use according to claim 46, wherein the medicament is for the treatment of onychomycosis.

53. The use of claim 46, wherein the medicament is for the treatment of conjunctivitis.

54. The use according to claim 46, wherein the medicament is for the treatment of oral mucositis.

55. The use of claim 46, wherein the medicament is suitable for topical administration.

Technical Field

The present disclosure generally relates to gel formulations of deoxyribose-based therapeutic agents. The formulations of some embodiments of the present disclosure are particularly useful for the topical treatment of microbial infections.

Background

Pathogenic microbial infections of the skin and other soft tissues cause a variety of diseases. Epidermal bacterial infections are of particular concern and are responsible for a number of serious diseases. Antibiotic-resistant bacterial strains, such as methicillin-resistant Staphylococcus aureus (MRSA), are becoming increasingly prevalent and pose an increasing health threat to the united states and elsewhere in the world. Despite the enormous efforts in the last decades, the discovery of new antibiotics has proven extremely difficult, leading to a continuous decrease in the available treatment options as bacteria become more resistant to existing antibiotics.

The treatment of gram-negative bacterial infections is particularly challenging due to the lack of effective agents and the increasing incidence of drug-resistant strains. Gram-negative bacteria are known to cause serious, sometimes even life-threatening, Skin and Soft Tissue Infections (SSTIs), including trauma or surgical site infections. Gram-negative bacteria are generally resistant to most or all currently available drugs.

Biofilms also play a role in the most severe SSTIs. Currently, biofilms are estimated to be responsible for more than 65% of nosocomial infections and 80% of all microbial infections. It has proven very difficult to treat biofilm-mediated infections because the typical Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of biofilm bacterial cells are typically 10-1000 times higher than planktonic bacterial cells.

A new class of antibiotics, known as "biphospholipids" (bisphosphocins), has been discovered which can provide a means of treating a variety of clinically important bacterial infections, including infections caused by multidrug resistant bacteria. Members of the bisphosphatilin class are characterized by a core deoxyribose unit with two protected phosphate groups. These molecules are highly protonated/acidified and have excellent chemical stability, low pH tolerance, and resistance to degradation by nucleases. Bisphosphonates have been described as having antimicrobial activity. As an antibiotic, it is believed that bisphosphatives act by rapidly disrupting the bacterial cell membrane and/or cell wall in many different bacterial strains (including gram-positive, gram-negative, and certain antibiotic-resistant strains). Nu-3, the most advanced member of the bisphosphineoid family, is currently undergoing clinical trials for the treatment of infected diabetic foot ulcers.

The Nu-3 formulations currently used in clinical trials are aqueous solutions. The use of this formulation for the treatment of diabetic foot ulcers has proven to be challenging. For a variety of reasons, there is a need for more adherent topical formulations of Nu-3 and other bisphosphonates. More viscous formulations (such as gels in particular) are easier and easier to apply, are aesthetically pleasing, and allow longer topical exposure times. The preparation of gel formulations for bisphosphonates is particularly difficult for a number of reasons. Since the level of activity of bisphosphithins and their corresponding salts decreases when formulated at higher (more basic) pH levels, bisphosphithins and their corresponding salts are typically formulated at highly acidic pH, ranging from pH 1 to pH 5. For example, it is desirable to formulate a bisphosphidyline such as Nu-3 at a pH of 2 or less to maintain the most effective antimicrobial activity.

Furthermore, topical formulations containing relatively high concentrations of active bisphosphclaimed compounds are required, but are also difficult to prepare. In addition, since the bisphosphithins and salts thereof are strongly ionic, it is difficult to use an ionic polymer or emulsifier together with these compounds. Thus, the resulting formulation is unstable and exhibits poor cohesive properties.

Thus, there is a need for new antimicrobial bisphosphithin formulations that overcome the above-mentioned difficulties.

Disclosure of Invention

The present disclosure provides gel formulations and uses thereof that address the above challenges.

One aspect of the present disclosure provides a gel formulation. In some embodiments, the gel formulation comprises a bisphosphineol selected from Nu-2, Nu-3, Nu-4, Nu-5, and Nu-8, or a pharmaceutically acceptable salt thereof, or any combination thereof; a fatty alcohol thickener; and a nonionic polymeric emulsifier. In some embodiments, the bisphosphithin is Nu-3 or a pharmaceutically acceptable salt thereof.

In some embodiments, the formulation has a pH of about pH 1 to about pH 5. In some embodiments, the formulation has a pH of about pH 1.5 to about pH 4. In some embodiments, the formulation has a pH of about pH 3 to about pH 4.

In some embodiments, the bisphosphithins are present in the formulation in an amount from about 1% to about 20% (weight/weight). In some embodiments, the bisphosphithin is present in the formulation in an amount from about 5% to about 15% (weight/weight). In some embodiments, the bisphosphithin is present in the formulation in an amount from about 30% to about 50% (weight/weight).

In some embodiments, the fatty alcohol thickener is present in the formulation in an amount of about 1% to about 50% (weight/weight). In some embodiments, the fatty alcohol thickener is present in the formulation in an amount of about 1% to about 20% (weight/weight). In some embodiments, the fatty alcohol thickener is present in the formulation in an amount of about 1% to about 10% (weight/weight).

In some embodiments, the nonionic polymeric emulsifier is present in the formulation in an amount of from about 0.25% to about 15% (weight/weight). In some embodiments, the nonionic polymeric emulsifier is present in the formulation in an amount of from about 0.5% to about 5% (weight/weight).

In some embodiments, the formulation further comprises a diluent selected from the group consisting of water, glycerol, mannitol, saline, and phosphate buffered saline. In some embodiments, the diluent is water. In some embodiments, the water is present in the formulation in an amount of about 65% to about 97.5% (weight/weight).

In some embodiments, the fatty alcohol thickening agent is selected from the group consisting of cetyl alcohol, lauryl alcohol, stearyl alcohol, cetostearyl alcohol (cetostearyl alcohol), myristyl alcohol, behenyl alcohol, and oleyl alcohol. In some embodiments, the fatty alcohol thickening agent is cetearyl alcohol. In some embodiments, the cetearyl alcohol is present in the formulation in an amount from about 2% to about 10% (w/w).

In some embodiments, the nonionic polymer is selected from the group consisting of ceteth-20 (ceteth-20), steareth-20 (steareth-20), and ceteareth-20 (ceteareth-20). In some embodiments, the nonionic polymeric emulsifier is ceteareth 20. In some embodiments, the ceteareth-20 is present in the formulation in an amount greater than about 0.5% (w/w). In some embodiments, the ceteareth-20 is present in the formulation in an amount from about 0.5% to about 5% (w/w).

In some embodiments, the formulation is suitable for topical administration.

Another aspect of the disclosure provides a method of treating an infection in a patient in need thereof, the method comprising administering to the patient an effective amount of a formulation of the disclosure. In some embodiments, the infection is an infection of a diabetic foot ulcer. In some embodiments, the infection is an infection of a burn wound. In some embodiments, the infection is an infection of a complex venous leg ulcer. In some embodiments, the infection is an otitis externa infection.

Another aspect of the present disclosure provides a method of treating acne vulgaris in a patient in need thereof, the method comprising administering to the patient an effective amount of a formulation of the present disclosure.

Another aspect of the present disclosure provides a method of treating otitis externa in a patient in need thereof, the method comprising administering to the patient an effective amount of a formulation of the present disclosure.

Another aspect of the present disclosure provides a method of treating onychomycosis in a patient in need thereof, the method comprising administering to the patient an effective amount of a formulation of the present disclosure.

Another aspect of the disclosure provides a method of treating conjunctivitis in a patient in need thereof, the method comprising administering to the patient an effective amount of a formulation of the disclosure.

In some embodiments, at least one additional active ingredient is administered to the patient. In some embodiments, the patient is a human.

Another aspect of the disclosure provides a formulation of the disclosure for use in therapy.

Another aspect of the disclosure provides a formulation of the disclosure for use in treating an infection.

Another aspect of the disclosure provides a formulation of the disclosure for use in treating an infection of a diabetic foot ulcer.

Another aspect of the disclosure provides a formulation of the disclosure for use in treating infection of a burn wound.

Another aspect of the disclosure provides a formulation of the disclosure for use in treating an infection of a complex venous leg ulcer.

Another aspect of the disclosure provides a formulation of the disclosure for use in treating acne vulgaris.

Another aspect of the disclosure provides a formulation of the disclosure for use in treating otitis externa.

Another aspect of the disclosure provides a formulation of the disclosure for use in treating onychomycosis.

Another aspect of the disclosure provides a formulation of the disclosure for use in treating conjunctivitis.

Another aspect of the disclosure provides a formulation of the disclosure for use in the preparation of a medicament. In some embodiments, the medicament is for treating an infection of a burn wound. In some embodiments, the medicament is for treating an infection of a diabetic foot ulcer. In some embodiments, the medicament is for treating an infection of a complex venous leg ulcer. In some embodiments, the medicament is for treating acne vulgaris. In some embodiments, the medicament is for treating otitis externa. In some embodiments, the medicament is for treating onychomycosis. In some embodiments, the medicament is for treating conjunctivitis. In some embodiments, the medicament is suitable for topical administration.

One advantage of the formulation according to one embodiment of the present disclosure is that the mechanism of action of the activity of the bisphosphclaimed in is effective against a number of different clinically relevant pathogenic bacteria, including gram positive and gram negative bacteria. Another advantage of a formulation according to one embodiment of the present disclosure is that the formulation of this embodiment is non-toxic to patients treated with an effective amount of the formulation of the present disclosure.

Another advantage of a formulation according to one embodiment of the present disclosure is that such a formulation may be used to treat infections caused by biofilms. Another advantage of the formulation according to one embodiment of the present disclosure is that the formulation can be administered in an effective amount to treat a patient suffering from a skin disease, an ophthalmic condition, or a wound. Another advantage of formulations according to one embodiment of the present disclosure is that such formulations may be used during or after surgery (e.g., in conjunction with a surgical incision or implant).

Another advantage of formulations according to one embodiment of the present disclosure is that such formulations can be administered in effective amounts to treat patients suffering from skin diseases (such as, for example, complex skin and skin structure infections (cSSSI), acne vulgaris, otitis externa, or onychomycosis), ophthalmic conditions (such as, for example, conjunctivitis (pinkeye)), or wounds (such as, for example, burn wounds, complex diabetic foot ulcers (cDFCU), or complex venous leg ulcers (cVLU)).

These and other objects, advantages and features of the present disclosure will become apparent to those skilled in the art upon a reading of the details of the compounds and formulations and their use in accordance with the present disclosure as more fully described below.

Detailed Description

The embodiments described below are not intended to be exhaustive or to limit the invention to the precise forms disclosed in the following detailed description. Rather, the embodiments are chosen and described so that others skilled in the art may appreciate and understand the principles and practices of the present disclosure.

The present disclosure provides a gel formulation. In some embodiments, the gel formulation comprises a bisphosphineol selected from Nu-2, Nu-3, Nu-4, Nu-5 and Nu-8, or a pharmaceutically acceptable salt thereof, or any combination thereof. As used herein, the term "bisphosphinite" refers to a class of compounds having antimicrobial activity, including Nu-2, Nu-3, Nu-4, Nu-5, and Nu-8, or pharmaceutically acceptable salts thereof. U.S. patent nos. 6,627,215, 6,211,162, 7,868,162, 7,176,191, 8,435,960 and 6,211,349 (all of which are incorporated herein by reference in their entirety) disclose bisphosphithins and how to make and use bisphosphithins.

As used herein, the term "formulation" refers to a pharmaceutical formulation containing a bisphosphipidin or a pharmaceutically acceptable salt thereof and suitable for administration to a patient for therapeutic purposes. As used herein, the term "patient" refers to a living organism treated with a bisphosphinellin, including, but not limited to, any mammal such as, for example, a human, other primates (e.g., monkeys, chimpanzees, etc.), companion animals (e.g., dogs, cats, horses, etc.), farm animals (e.g., goats, sheep, pigs, cattle, etc.), laboratory animals (e.g., mice, rats, etc.), and wild and zoo animals (e.g., wolves, bears, deer, etc.). As used herein, the term "gel" refers to a semi-solid formulation comprising a polymer network capable of capturing and containing a fluid. As used herein, the term "semi-solid" refers to the rheological properties of a formulation such that the formulation can flow under applied force, but will remain in place after application to any accessible body surface of a patient.

Nu-2 has the chemical name ((2R,3R,4R,5R) -5- (2, 4-dioxo-3, 4-dihydropyrimidin-1 (2H) -yl) -3- ((hydroxy (4-hydroxybutoxy) phosphoryl) oxy) -4-methoxytetrahydrofuran-2-yl) methyl (4-hydroxybutyl) hydrogenphosphate. Nu-2 has a molecular formula of C₁₈H₃₂N₂O₁₄P₂. Nu-2 has the following formula:

nu-3 has the chemical name (2R,3S) -2- ((butoxy (hydroxy) phosphoryl) oxy) methyl) -5- (5-methyl-2, 4-dioxo-3, 4-dihydropyrimidin-1 (2H) -yl) tetrahydrofuran-2-yl) butylphosphonate. Nu-3 has a molecular formula of C₁₈H₃₂N₂O₁₁P₂. Nu-3 has the following formula:

nu-4 has the chemical name ((2R, 3S)) -3- ((butoxy (hydroxy) phosphoryl) oxy) tetrahydrofuran-2-yl) methylbutyl hydrogen phosphate. Nu-4 has a molecular formula of C₁₃H₂₈O₉P₂. Nu-4 has the following formula:

nu-5 has the chemical name dibutyl (oxybis (ethane-2, 1-diyl)) bis (hydrogen phosphate). Nu-5 has a molecular formula of C₁₂H₂₈O₉P₂. Nu-5 has the following formula:

nu-8 has the chemical name ((2R,3S,5R) -5- (4-amino-2-oxopyrimidin-1 (2H) -yl) -3- ((butoxyoxophosphoryl) oxy) tetrahydrofuran-2-yl) methylbutyl phosphate. Nu-8 has a molecular formula of C₁₇H₂₉N₃Na₂O₁₀P₂. Nu-8 has the following formula:

as used herein, the term "pharmaceutically acceptable" with respect to salts and formulation components such as carriers, excipients, and diluents, refers to those salts and components which are not harmful to the patient and are compatible with other ingredients, active ingredients, salts, or components. Pharmaceutically acceptable includes "veterinarily acceptable" and thus independently includes human and non-human mammalian applications.

As used herein, the term "pharmaceutically acceptable salt" refers to salts commonly used to form alkali metal salts and to form addition salts of a free acid or a free base. Such Salts include, for example, the physiologically acceptable Salts listed in the Handbook of Pharmaceutical Salts, Properties, Selection and Use, P.H.Stahl and C.G.Wermuth (Eds.), Wiley-VCH, New York,2002, which are known to those skilled in the art. Salt formation may occur at one or more sites having labile protons. Pharmaceutically acceptable salts of the bisphosphatidine include acid addition salts and base addition salts.

The bisphosphatidine can be used as an antimicrobial agent, which has activity against any microorganism. As used herein, the terms "microorganism", "microbial" and similar terms refer to bacteria, fungi, protozoa, viruses, yeasts and the like. As used herein, the term "antimicrobial agent" refers to a diphospholipid having the ability to kill or inhibit the growth of microorganisms, or to reduce the severity of a microbial infection.

A non-limiting list of bacteria against which the bisphosphinite is effective includes, but is not limited to, gram-positive bacteria, gram-negative bacteria, slow-growing bacteria, and acid-fast bacteria, as well as any species included in the following genera: aerococcus (Aerococcus), Listeria (Listeria), Streptomyces (Streptomyces), Chlamydia (Chlamydia), Lactobacillus (Lactobacillus), Eubacterium (Eubacterium), Burkholderia (Burkholderia), stenotrophomonas (Stentrophoromonas), Achromobacter (Achromobacter), Arachnibacter (Mycobacterium), Peptostreptococcus (Peptostreptococcus), Staphylococcus (Staphyloccocus), Corynebacterium (Corynebacterium), Erysipelothrix (Erysiothrix), Peptophilus (Dermatophilus), Rhodococcus (Rhodococcus), Pseudomonas (Pseudomonas), Streptococcus (Epicocculus), Bacillus (Bacillus), Peptococcus (Pneumococcus), Streptococcus (Streptococcus), Streptococcus (Streptococcus), Streptococcus (Streptococcus), Streptococcus (Streptococcus) and Streptococcus (Streptococcus) including Streptococcus (Streptococcus), Streptococcus (Streptococcus, Actinomycetes (Actinomyces), Helicobacter (Helicobacter), enterococci (Enterococcus), Shigella (Shigella), Vibrio (Vibrio), Clostridium (Clostridium), Salmonella (Salmonella), Yersinia (Yersinia) and Haemophilus (Haemophilus).

The diphospholipid can be used for treating nosocomial infections. A non-limiting list of specific bacteria causing nosocomial infections against which the bisphosphclaimed agents are effective includes, but is not limited to, Acinetobacter iwoffii (clinical isolate), Acinetobacter baumannii (clinical isolate), clostridium difficile (clostridium difficile) (multidrug resistant), Enterococcus faecalis (Enterococcus faecalis) (w.t. and vancomycin resistant), Enterococcus faecium (Enterococcus faecium) (vancomycin resistant), klebsiella pneumoniae (klebsiella pneumoniae) (clinical isolate and NDM-1), Pseudomonas aeruginosa (Pseudomonas aeruginosa) (W.T.), Pseudomonas aeruginosa (ciprofloxacin, MDR), Serratia serpentina (martensins) (penicillin resistant), Staphylococcus aureus (Staphylococcus aureus) and Staphylococcus epidermidis (resistant).

The bisphosphine may be used to treat community-acquired infections. A non-limiting list of specific bacteria causing community-acquired infections against which bisphosphonates are effective includes, but is not limited to, Aeromonas hydrophila (clinical isolates), Alcaligenes faecalis (clinical isolates), Borrelia burgdorferi (Boreliabuburgdorferi), Haemophilus influenzae (Haemophilus influenza), Mycobacterium tuberculosis (Mycobacterium tuberculosis) (WT, MDR), Moraxella catarrhalis (Moraxella catarrhalis), Neisseria meningitidis (rifampin resistance), Propionibacterium acnes (Propionibacterium acnes), Proteus mirabilis (Proteus mirabilis), and Streptococcus pneumoniae (Streptococcus pneumoniae) (penicillin resistance).

The bisphosphinites can be used to treat food-borne pathogens. A non-limiting list of specific food-borne pathogens against which the bisphosphclaimed compounds are effective include, but are not limited to, Escherichia coli (ampicillin resistant, NDM-1), Salmonella choleraesuis (Salmonella choleraesuis) (enteritis), and Salmonella typhimurium (streptomycin resistant).

A non-limiting list of fungi against which bisphosphinite is effective includes, but is not limited to, Trichophyton (Trichophyton), Epidermophyton (Epidermophyton), Microsporum (Microsporium), Candida albicans (Candida albicans) and other Candida species, Pityrosporum orbiculare (Pityrosporum orbiculare), Trichophyton mentagrophytes (Trichophyton aggregations), Trichophyton rubrum (Trichophyton rubrum), Epidermophyton (Epidermophyton flocouver) and Trichophyton trichotheca (Trichophyton solans). A non-limiting list of viruses against which the bisphosphineis effective includes, but is not limited to, Human Immunodeficiency Virus (HIV), Herpes Simplex Virus (HSV), Cytomegalovirus (CMV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and influenza viruses. Unless stated to the contrary, the description of the compounds of the present disclosure herein includes pharmaceutically acceptable salts of such compounds.

A non-limiting list of specific fungal pathogens against which bisphosphinite is effective includes, but is not limited to, Trichophyton rubrum (Trichophyton rubrum) and Trichophyton mentagrophytes (Trichophyton mentagrophytes), Microsporum gypseum (Microsporum) and Aspergillus fumigatus.

In some embodiments, the bisphosphatidine may be used in therapeutic and non-therapeutic medical applications. In some embodiments, including non-therapeutic medical applications, the antimicrobial effect of the bisphosphatilin allows the use of bisphosphatilin for sterilization (e.g., sterilization of a patient's skin, or sterilization of a surface or object (e.g., surgical instruments)) or disinfection (e.g., cleaning of a surface, an instrument, such that there is no undesirable concentration of pathogenic microorganisms on the surface). In some embodiments, the compounds of the present disclosure are effective against microbial contamination of laboratory cultures, consumables (e.g., food or beverage preparations), medical devices, hospital equipment, or industrial processes. Therapeutic applications of bisphosphatidines are described herein.

In some embodiments of the present disclosure, the gel formulation comprises a fatty alcohol thickener. As used herein, the term "fatty alcohol thickener" refers to a fatty alcohol compound or composition that increases the viscosity of the formulations of the present disclosure without substantially altering other properties of the formulation. In some embodiments, the fatty alcohol thickening agent is selected from cetyl alcohol, lauryl alcohol, stearyl alcohol, cetearyl alcohol, myristyl alcohol, behenyl alcohol, and oleyl alcohol, or combinations thereof. In some embodiments, the fatty alcohol thickening agent is cetearyl alcohol. In some embodiments, cetearyl alcohol is present in the formulation in an amount from about 2% to about 10% (w/w). In some embodiments, cetearyl alcohol is used such that the final viscosity is from 10 to 50000 centipoise (cps). In some embodiments, the final viscosity is from 500 to 20000 cps.

A particular challenge to overcome by the formulations described herein is to identify emulsifiers that are suitable for low pH gel formulations containing charged molecules (such as diphospholin). Typical ionic polymers, such as polyethylene glycol (PEG) esters, cannot be used in the disclosed gel formulations because of their electrostatic interaction with the bisphosphclaimed phospholipids resulting in gel collapse. In contrast, anionic polymers that can withstand low pH are needed.

In some embodiments of the present disclosure, the gel formulation comprises a nonionic polymeric emulsifier. As used herein, the term "nonionic polymeric emulsifier" refers to a nonionic surfactant. In some embodiments, the nonionic polymer is selected from polysorbate 20, polysorbate 60, polysorbate 80, ceteareth-12, ceteareth-20 (or Cetomacrogol 1000), ceteareth 30, ceteth-10, ceteth-20, steareth-10, steareth-20, steareth-40, and steareth-100. In some embodiments, the nonionic polymeric emulsifier is selected from ester-based products such as PEG-100 stearate, PEG-40 stearate, PEG-120 glyceryl laurate, PEG-40 castor oil, PEG-60 hydrogenated castor oil, PEG-75 lanolin, PEG-120, and methyl glucose dioleate. As used herein, "Cetomacrogol 1000" also refers to polyethylene glycol hexadecyl ether (polyethylene glycol decacyl ether).

In some embodiments, the nonionic polymeric emulsifier is ceteareth 20. In some embodiments, ceteareth-20 is present in the formulation in an amount greater than about 0.5% (w/w). In some embodiments, ceteareth-20 is present in the formulation in an amount from about 0.5% to about 5% (w/w).

In some embodiments, the formulation may comprise other pharmaceutically acceptable components, including but not limited to other pharmaceutically acceptable carriers, excipients, or diluents, to provide an improved formulation of the bisphosphatilin. Other carriers, excipients or diluents may take a variety of forms depending on the form of preparation desired for administration.

In some embodiments, the formulation further comprises a diluent selected from the group consisting of water, glycerol, mannitol, saline, and phosphate buffered saline. In some embodiments, the diluent is water. In some embodiments, water is present in the formulation in an amount of about 65% to about 97.5% (weight/weight).

In some embodiments of the present disclosure, the amount of bisphosphithins present in the formulation is varied. In some embodiments, the bisphosphithins are present in the formulation in an amount from about 1% to about 20% (weight/weight). In some embodiments, the bisphosphithins are present in the formulation in an amount from about 5% to about 15% (weight/weight). In some embodiments, the bisphosphithins are present in the formulation in an amount from about 30% to about 50% (weight/weight).

In some embodiments of the present disclosure, the amount of fatty alcohol thickener present in the formulation is varied. In some embodiments, the fatty alcohol thickener is present in the formulation in an amount of about 1% to about 50% (weight/weight). In some embodiments, the fatty alcohol thickener is present in the formulation in an amount of about 1% to about 20% (weight/weight). In some embodiments, the fatty alcohol thickener is present in the formulation in an amount of about 1% to about 10% (weight/weight). In some embodiments, the fatty alcohol thickener is present in the formulation in an amount of about 2% to about 8% (weight/weight).

In some embodiments of the present disclosure, the amount of nonionic polymeric emulsifier present in the formulation is varied. In some embodiments, the nonionic polymeric emulsifier is present in the formulation in an amount of from about 0.25% to about 15% (weight/weight). In some embodiments, the nonionic polymeric emulsifier is present in the formulation in an amount of from about 0.5% to about 5% (weight/weight).

Since the bisphosphithins are more active at lower pH, it is necessary to create suitable gel formulations that retain the antimicrobial activity of the bisphosphithins while maintaining the physical integrity of the gel. It is not uncommon to formulate gels at a desired pH range of about pH 1 to about pH 5, even at pH levels of 3 or lower. The inventors of the present disclosure successfully formulated a unique combination of active ingredient, thickener and emulsifier to achieve this objective. To achieve the desired pH, in some embodiments, the formulation has a pH of about pH 1 to about pH 5. In some embodiments, the formulation has a pH of about pH 1.5 to about pH 4. In some embodiments, the formulation has a pH of about pH 3 to about pH 4.

The activity of the bisphosphclaimed is pH dependent. Thus, the formulations of some embodiments of the present disclosure further comprise a pH adjuster. In some embodiments, the pH adjusting agent may be an acid (e.g., 10% HCl), an acid salt, or a mixture thereof. The pH adjuster may be a buffer. Suitable buffers include citrate/citric acid buffers, acetate/acetic acid buffers, phosphate/phosphoric acid buffers, formate/formic acid buffers, propionate/propionic acid buffers, lactate/lactic acid buffers, carbonate/carbonic acid buffers, ammonium/ammonia buffers, and the like. In some embodiments, the pH adjusting agent is present in an amount sufficient to adjust the pH of the composition to about pH 1.0 to about pH 5.0. In some embodiments, the pH adjusting agent is present in an amount sufficient to adjust the pH of the composition to about pH 2 to about pH 4. In another aspect of the disclosure, the pH adjusting agent is present in an amount sufficient to adjust the pH of the composition to about pH 3 to about pH 4.

In some embodiments, the formulations of the present disclosure are suitable for topical administration. As used herein, the term "topical application" refers to the application of a bisphosphipin to the skin surface of a patient such that the bisphosphipin passes through the layers of the skin. The term topical administration also encompasses transdermal administration and transmucosal administration. As used herein, the term "transdermal" refers to the passage of a diphosporidin through at least one skin layer of a patient. As used herein, "transmucosal" refers to the passage of diphosporidin through the mucosa of a patient. Unless otherwise stated or implied, the terms "topical administration", "transdermal administration" and "transmucosal administration" are used interchangeably herein.

A variety of topical delivery systems for delivering biologically active compounds to microorganisms in a patient are well known in the art. By selecting a suitable carrier in the art, such systems include, but are not limited to, lotions, creams, gels, oils, ointments, solutions, suspensions, emulsions, and the like.

In some embodiments, other materials may also be added to the topical formulations of the present disclosure, which materials have additional moisturizing effects and improve the consistency of the formulation. Examples of such compounds include, but are not limited to, cetyl esters wax, stearyl alcohol, cetyl alcohol, glycerin, methyl paraben, propyl paraben, quaternary ammonium salt-15, humectants, volatile methyl silicone fluids, and polydiorganosiloxane-polyoxyalkylenes. If additional cleaning of the formulation is desired in certain embodiments, chemicals such as sodium lauryl sulfate or metal salts of carboxylic acids may be added.

The present disclosure also provides a method of treating an infection in a patient in need thereof. In some embodiments, the method comprises administering to the patient an effective amount of a formulation of the present disclosure. As used herein, the term "infection" refers to any microbial infection of a patient's body. Infections involve the invasion of microorganisms into the body of a patient and subsequent proliferation within the patient's body.

As used herein, the terms "treating", "treatment", "therapy" and similar terms refer to the administration of a bisphosphipin or a formulation of the present disclosure in an amount effective to prevent, alleviate or ameliorate one or more symptoms of a disease or disorder (i.e., indication) and/or prolong the survival of the patient being treated. In some embodiments, "treating", "therapy" and similar terms also include, but are not limited to, reducing or eliminating infection in a patient.

In practicing the methods of the present disclosure, an effective amount of a bisphosphatilin is administered to a patient in need thereof. As used herein, the term "effective amount," in the context of administration, refers to an amount of a bisphosphipin of the present disclosure that, when administered to a patient, is sufficient to prevent, alleviate or ameliorate one or more symptoms of a disease or disorder (i.e., indication) and/or prolong the survival of the patient being treated. Such an amount should cause no adverse events or only few adverse events in the treated patient. Similarly, such an amount should cause no or little toxic effects in the patient being treated. One skilled in the art will appreciate that the amount of bisphosphatidine will vary depending on a number of factors, including, but not limited to, the activity of bisphosphatidine (in vitro activity, e.g., bisphosphatidine versus target, or in vivo activity in animal models of efficacy), the pharmacokinetic results in animal models (e.g., biological half-life or bioavailability), the type of patient being treated, the age, size, weight, and general physical condition of the patient, the disease associated with the patient, and the dosage regimen employed in the treatment.

In some embodiments, the bisphosphatilin is suitable for administration at a dosage of about 1% to about 15%. In some embodiments, the bisphosphatilin is suitable for administration at a dosage of about 2% to about 10%. In some embodiments, the bisphosphatilin is suitable for administration at a dosage of about 3% to about 8%. In some embodiments, the bisphosphatilin is suitable for administration at a dosage of about 5%.

The present disclosure also provides a method of treating an infection of a lower limb (lower extremity) ulcer in a patient in need thereof. In some embodiments, the method comprises administering to the patient an effective amount of a bisphosphipidin or a pharmaceutically acceptable salt thereof. As used herein, the term "lower limb" refers to the lower limbs (lower limbs) of the patient's body, including but not limited to the buttocks, thighs (thigh), legs (leg), ankles, and feet. As used herein, the term "ulcer" refers to an open wound found anywhere in a patient's lower limb.

In some embodiments, the patient is a human. In some embodiments, the administration is topical administration. In some embodiments, the administration is performed using a bisphosphineol or a pharmaceutically acceptable salt thereof in a lotion, paste, cream, ointment, oil, or other viscous composition. In some embodiments, at least one additional active ingredient is administered to the patient. In some embodiments, the administration is performed as a multiple dose regimen. As used herein, the term "multiple dose regimen" refers to a treatment period of more than one day.

In some embodiments, the present disclosure provides a method of treating an infection of a diabetic foot ulcer in a patient in need thereof. In some embodiments, the method comprises administering to the patient an effective amount of a bisphosphipidin or a pharmaceutically acceptable salt thereof. In some embodiments, the patient has type I diabetes or type II diabetes. As used herein, the term "diabetic foot ulcer" refers to an open wound located anywhere on a patient's foot. In some embodiments, the wound is located on the heel, midfoot and/or forefoot of the patient's foot. As used herein, the term "treating" in the context of a diabetic foot ulcer also includes, but is not limited to, (a) limiting the progression of the foot ulcer in size, area, and/or depth; (b) reducing the size, area, and/or depth of foot ulcers; (c) improving the cure rate and/or reducing the time to cure; (d) healing of foot ulcers (100% epithelialization, no drainage); and (e) reducing the incidence of amputation or slowing the time to amputation.

In some embodiments, the foot ulcer can result from any underlying pathology, including but not limited to neuropathy, trauma, deformity, high plantar pressure, callus formation, edema, and peripheral arterial disease. In some embodiments, a human diabetic foot ulcer is an ulcer that is caused, at least in part, by neuropathy and the resulting pressure (bearing extreme weight due to lack of sensation in the foot). It is known to those skilled in the art that human diabetic foot ulcers tend to be due to neuropathy and stress, which is distinct from, for example, murine acute wounds. In some embodiments, the diabetic foot ulcer comprises one or more calluses.

In some embodiments, the diabetic foot ulcer is a chronic ulcer. As used herein, a "chronic" foot ulcer is an ulcer that has been present for at least 7 days without a reduction in size. In some embodiments, the chronic foot ulcer is an ulcer that has been present for at least 14 days. In some embodiments, a chronic foot ulcer is an ulcer that has been present for at least 21 or 28 days without a reduction in size. In some embodiments, the chronic foot ulcer is not responsive to any other treatment (i.e., the foot ulcer is not reduced in size, area, and/or depth; the foot ulcer is not healed).

The methods of the present disclosure may include administering the gel formulations described herein as appropriate, i.e., once daily, twice daily, etc. The methods according to the present disclosure may further comprise topically administering a formulation comprising a compound of the present disclosure, or a pharmaceutically acceptable salt thereof, for a time desired by the attending physician, e.g., until the ulcer heals. In some embodiments, the gel formulation forms a continuous film covering the entire area of the ulcer (including the margins). In some embodiments, the gel formulation is applied at a thickness of about 0.25 to 2 mm. In some embodiments, the gel formulation is applied at a thickness of about 0.5 to 1.5 mm. In some embodiments, the topical formulation is applied at a thickness of about 1 mm.

The gel formulations disclosed herein may be applied in any suitable manner, which may include any wound dressing to seal in a formulation deemed suitable by a human patient or caregiver. Examples of such dressings include, but are not limited to, semi-permeable membranes, foams, hydrocolloids, and calcium alginate swabs.

The methods of the present disclosure relating to diabetic foot ulcers may further include debridement within and around the wound surface in conjunction with administration of the compounds of the present disclosure and pharmaceutical compositions thereof. Debridement of total necrosis, callus and fibrous tissue is commonly performed for the treatment of diabetic foot ulcers. Unhealthy tissue is cleaned up to bleeding tissue to fully visualize the extent of the ulcer and detect potential abscesses or sinuses. Any suitable debridement procedure as determined by the attending physician may be used. After debridement, the wound surface may be thoroughly rinsed with sterile saline or a non-cytotoxic cleanser.

In some embodiments, the patient is a human. In some embodiments, the administration is topical administration. In some embodiments, the administration is performed using a bisphosphineol or a pharmaceutically acceptable salt thereof in a lotion, paste, cream, ointment, oil, or other viscous composition. In some embodiments, at least one additional active ingredient is administered to the patient. In some embodiments, the administration is performed as a multiple dose regimen.

The present disclosure also provides a method of treating infection of a burn wound in a patient in need thereof. In some embodiments, the method comprises administering to the patient an effective amount of a bisphosphipidin or a pharmaceutically acceptable salt thereof. As used herein, the term "burn wound" refers to a burn injury to a patient's body that involves damage to the patient's skin and possibly tissue underlying the patient's skin. Three major types of burn degrees are known to those skilled in the art, including but not limited to first, second and third degree burns. In some embodiments, the methods of treating infection of a burn wound contemplated by the present disclosure are for treating first, second and/or third degree burns.

In some embodiments, the patient is a human. In some embodiments, the administration is topical administration. In some embodiments, the administration is performed using a bisphosphineol or a pharmaceutically acceptable salt thereof in a lotion, paste, cream, ointment, oil, or other viscous composition. In some embodiments, at least one additional active ingredient is administered to the patient. In some embodiments, the administration is performed as a multiple dose regimen.

In some embodiments, the present disclosure provides a method of treating an infection of a complex venous leg ulcer in a patient in need thereof. In some embodiments, the method comprises administering to the patient an effective amount of a bisphosphipidin or a pharmaceutically acceptable salt thereof. As used herein, the term "complex venous leg ulcer" refers to an open wound located anywhere in the leg of a patient that is caused by an abnormality in venous function.

In some embodiments, the patient is a human. In some embodiments, the administration is topical administration. In some embodiments, the administration is performed using a bisphosphineol or a pharmaceutically acceptable salt thereof in a lotion, paste, cream, ointment, oil, or other viscous composition. In some embodiments, at least one additional active ingredient is administered to the patient. In some embodiments, the administration is performed as a multiple dose regimen.

The present disclosure also provides a method of treating otitis externa in a patient in need thereof. In some embodiments, the method comprises administering to the patient an effective amount of a bisphosphipidin or a pharmaceutically acceptable salt thereof. As used herein, the term "otitis externa" refers to infections of the external auditory canal of a patient.

In some embodiments, the patient is a human. In some embodiments, the administration is topical administration. In some embodiments, the administration is performed using a bisphosphineol or a pharmaceutically acceptable salt thereof in a lotion, paste, cream, ointment, oil, or other viscous composition. In some embodiments, at least one additional active ingredient is administered to the patient. In some embodiments, the administration is performed as a multiple dose regimen.

The present disclosure also provides a method of treating acne vulgaris in a patient in need thereof. In some embodiments, the method comprises administering to the patient an effective amount of a bisphosphipidin or a pharmaceutically acceptable salt thereof. As used herein, the term "acne vulgaris" refers to an inflammatory disease of the pilosebaceous glands characterized by eruption of the skin, usually pustular but not purulent.

In some embodiments, the patient is a human. In some embodiments, the administration is topical administration. In some embodiments, the administration is performed using a bisphosphineol or a pharmaceutically acceptable salt thereof in a lotion, paste, cream, ointment, oil, or other viscous composition. In some embodiments, at least one additional active ingredient is administered to the patient. In some embodiments, the administration is performed as a multiple dose regimen.

The present disclosure also provides a method of treating onychomycosis in a patient in need thereof. In some embodiments, the method comprises administering to the patient an effective amount of a bisphosphipidin or a pharmaceutically acceptable salt thereof. As used herein, the term "onychomycosis" refers to a fungal infection of the nail.

In some embodiments, the patient is a human. In some embodiments, the administration is topical administration. In some embodiments, the administration is performed using a bisphosphineol or a pharmaceutically acceptable salt thereof in a lotion, paste, cream, ointment, oil, or other viscous composition. In some embodiments, at least one additional active ingredient is administered to the patient. In some embodiments, the administration is performed as a multiple dose regimen.

The present disclosure also provides a method of treating conjunctivitis in a patient in need thereof. In some embodiments, the method comprises administering to the patient an effective amount of a bisphosphipidin or a pharmaceutically acceptable salt thereof. As used herein, the term "conjunctivitis" refers to inflammation or infection of the outer membrane of the eyeball and/or the inner eyelid.

In some embodiments, the patient is a human. In some embodiments, the administration is topical administration. In some embodiments, the administration is performed using a bisphosphineol or a pharmaceutically acceptable salt thereof in a lotion, paste, cream, ointment, oil, or other viscous composition. In some embodiments, at least one additional active ingredient is administered to the patient. In some embodiments, the administration is performed as a multiple dose regimen.

The present disclosure also provides a method of treating oral mucositis in a patient in need thereof. In some embodiments, the method comprises administering to the patient an effective amount of a bisphosphipidin or a pharmaceutically acceptable salt thereof. As used herein, the term "oral mucositis" refers to inflammation and ulceration of the oral mucosa.

In some embodiments, the patient is a human. In some embodiments, the administration is topical administration. In some embodiments, the administration is performed using a bisphosphineol or a pharmaceutically acceptable salt thereof in a lotion, paste, cream, ointment, oil, or other viscous composition. In some embodiments, at least one additional active ingredient is administered to the patient. In some embodiments, the administration is performed as a multiple dose regimen.

The present disclosure also provides the use of a bisphosphinite, or a pharmaceutically acceptable salt thereof, in the preparation of a medicament. As used herein, the term "drug" refers to a formulation according to the present disclosure. In some embodiments, the formulation is contained in any article of manufacture, such as a package, container, or the like.

In some embodiments, the bisphosphithins used in formulations according to the present disclosure have the structure of formula (I), (II), (III), (IV), (V), or (VI), or a pharmaceutically acceptable salt thereof:

wherein A is H, alkyl- (O-alkyl), aryl, alkenyl, alkanol, phenol, or enol;

wherein Q is O, S, P-H, P-OH, P-alkyl, P-aryl, P-acyl, N-H, N-OH, N-alkyl, N-aryl, N-acyl, -CH₂-CH (OH) or-CH (O-alkyl);

wherein X and Z are alkyl or O-alkyl terminal blocking groups; and

wherein W is H, purine, pyrimidine, or a modified analog of purine or pyrimidine.

In some embodiments, X and/or Z comprise an alkyl terminal blocking group, and wherein the alkyl moiety is linear, branched, or cyclic. In some embodiments, the alkyl moiety has 1 to 4 carbons and is straight chain. In some embodiments, X and Z have the same chemical moiety. In some embodiments, X and Z have different chemical moieties. In some embodiments, X and Z comprise butyl. In some embodiments, X is butyl and Z is butanol. In some embodiments, X is butanol and Z is butyl. In some embodiments, X and/or Z comprises a group selected from CH₃CH₂CH₂CH₂-、CH₃CH₂CH₂-、CH₃CH₂-and HOCH₂CH₂CH₂CH₂-in the structure of (a).

In another embodiment, the compound has formula (VII):

wherein ring A is a stable 5-to 7-membered monocyclic or 7-to 10-membered bicyclic carbocyclic or heterocyclic moiety which is saturated or partially unsaturated, one free amino group being attached to a ring carbon atomAnd R is₁And R₂Each independently selected from C₁-C₈An alkyl moiety, which may be branched or unbranched.

In some embodiments, R₁And R₂Are all butyl groups:

or a pharmaceutically acceptable salt thereof.

In some embodiments of the present disclosure, the bisphosphithins used in the formulations of the present disclosure include those having the structure of formula (IX) shown below:

or a pharmaceutically acceptable salt thereof.

All pharmaceutically acceptable salt forms of the compounds of formulae (I) - (IX) are contemplated herein.

Another aspect of the disclosure provides a method of treating a diabetic foot ulcer in a patient in need thereof using a formulation of the disclosure. In some embodiments, the method comprises administering to the patient an effective amount of a compound of the present disclosure by applying a formulation according to the present disclosure. In some embodiments, the patient is a human.

Another aspect of the disclosure provides a method of treating a burn wound in a patient in need thereof using a formulation of the disclosure. In some embodiments, the method comprises administering to the patient an effective amount of a compound of the present disclosure by applying a formulation according to the present disclosure. In some embodiments, the patient is a human.

Another advantage of an embodiment of the present disclosure is that the formulation according to some embodiments may be administered in an effective amount to treat a patient suffering from a skin disease (such as, for example, a complex skin and skin structure infection (cSSSI), acne vulgaris, otitis externa, or onychomycosis), an ophthalmic disorder (such as, for example, conjunctivitis (pinkeye)), or a wound (e.g., burn wound, complex diabetic foot ulcer (cDFCU), or complex venous leg ulcer (cVLU)). In another embodiment, the gel formulations of the present disclosure can be used during or after surgery (e.g., in conjunction with a surgical incision or implant).

The present disclosure also provides a method of treating venous leg ulcers in a patient in need thereof using the formulations of the present disclosure. In some embodiments, the method comprises administering to the patient an effective amount of a compound of the present disclosure by applying a formulation according to the present disclosure. In some embodiments, the patient is a human.

The present disclosure also provides a method of treating a skin disorder in a patient in need thereof using the formulations of the present disclosure. In some embodiments, the method comprises administering to the patient an effective amount of a compound of the present disclosure by applying a formulation according to the present disclosure. In some embodiments, the patient is a human.

The present disclosure also provides a method of treating infections of complex skin and skin structures in a patient in need thereof using the formulations of the present disclosure. In some embodiments, the method comprises administering to the patient an effective amount of a compound of the present disclosure by applying a formulation according to the present disclosure. In some embodiments, the patient is a human.

The present disclosure also provides a method of treating acne vulgaris using the formulations of the present disclosure. In some embodiments, the method comprises administering to the patient an effective amount of a compound of the present disclosure by applying a formulation according to the present disclosure. In some embodiments, the patient is a human.

The present disclosure also provides a method of treating otitis externa in a patient in need thereof using the formulations of the present disclosure. In some embodiments, the method comprises administering to the patient an effective amount of a compound of the present disclosure by applying a formulation according to the present disclosure. In some embodiments, the patient is a human.

The present disclosure also provides a method of treating onychomycosis in a patient in need thereof using the formulation of the present disclosure. In some embodiments, the method comprises administering to the patient an effective amount of a compound of the present disclosure by applying a formulation according to the present disclosure. In some embodiments, the patient is a human.

The present disclosure also provides a method of treating an ophthalmic disorder in a patient in need thereof using the formulation of the present disclosure. In some embodiments, the method comprises administering to the patient an effective amount of a compound of the present disclosure by applying a formulation according to the present disclosure. In some embodiments, the patient is a human.

The present disclosure also provides methods of inhibiting or preventing bacterial, fungal, or viral growth by contacting an infectious organism with the formulations disclosed herein. In some embodiments, the method is for treating a mammal. In certain embodiments, the method is for treating a human. In some embodiments, the disclosure provides methods of treating a mammal having a bacterial infection caused by staphylococcus aureus, streptococcus pyogenes (streptococcus pyogenes), streptococcus pneumoniae, mycobacterium, escherichia coli, aerococcus, listeria, streptomyces, chlamydia, lactobacillus, eubacterium, arahnid, mycobacterium, peptostreptococcus, corynebacterium, erysiphe, pheophytococcus, rhodococcus, Pseudomonas aeruginosa, streptococcus, bacillus, peptococcus, pneumococcus, neisseria, Klebsiella (Klebsiella pneumoniae)), kurthella, nocardia, serratia, rosa, escherichia, propionibacteria, actinomyces, streptococcus, peptococcus, streptococcus, Pseudomonas aeruginosa, streptococcus, neisseria, Klebsiella, streptococcus, actinomyces, streptococcus, helicobacter, enterococcus (enterococcus sp), shigella, vibrio, clostridium, salmonella, yersinia, haemophilus, morganella (morganella morganii), Proteus mirabilis (Proteus mirabilis), coagulase-negative staphylococcus (d-coagulative staphylococcus), coagulase-negative staphylococcus (cogongase negative staphylococcus), Enterobacteriaceae (Enterobacteriaceae), enterococcus faecalis (e.g. faecalis), and acinetobacter baumannii.

Some fungi or molds (known as dermatophytes) cause dermatophyte infections. These fungi are parasitic organisms on the skin and cause different symptoms in different parts of the body. They are extremely contagious and spread from person to person. Although usually these infections are local, in certain patients (e.g. immunosuppressed patients) they may occur systemically or in vivo.

Fungal infections that may be treated with the gel compositions of the present disclosure include dermatophytosis (trichophyton, epidermophyton, and microsporum), candidiasis (candida albicans and other candida species), tinea versicolor (pityrosporum orbicularis), tinea pedis (trichophyton mentagrophytes, trichophyton rubrum, and epidermophyton floccosum), tinea capitis, and tinea circinata (trichophyton clinopodium polycephalum).

Vaginal yeast infections are usually caused by candida albicans, which, together with several bacteria, are usually present in relatively small numbers in the vaginal area. Sometimes, yeast rapidly multiply and become occupied, leading to candida infections (candidiasis) or candidiasis (monilia). This is usually due to changes in the vaginal environment, injury, sexual transmission, HIV infection, etc. Common environmental changes that favor yeast include increased pH, increased calories and moisture, allergic reactions, increased sugar levels, hormonal instability, and a reduction in the number of normal bacteria.

In some embodiments, one dosage unit may be topically administered once every 10, 9, 8, 7, 6, 5, 4,3, 2 days or 1, 2, 3,4, 5,6, 7,8, 9, 10 or more than 10 times per day until remission is achieved or until the symptoms are gone or satisfactorily reduced. In some embodiments, one dosage unit is topically administered from about once to about four times daily. In some embodiments, the patient is instructed to use two to three dosage units per day. Treatment regimens using the compositions of the present disclosure may be short-term (acute) or long-term (chronoic). In some embodiments, particular dosing regimens include 7, 14, 21, and 28 days of administration.

The disclosure also provides formulations and methods of treatment using the compounds of the disclosure as active ingredients in gel formulations containing another active ingredient (e.g., an antibiotic, antifungal, antiprotozoal, or antiviral agent). In some embodiments, the compounds of the present disclosure are the only active ingredients administered to a patient to treat a microbial infection (such as a bacterial, fungal, viral, or protozoal infection), i.e., the compounds of the present disclosure are administered as a monotherapy. Monotherapy may be administered with or without treatment that is not directed to an infection, such as an analgesic (e.g., acetaminophen or a non-steroidal anti-inflammatory drug such as aspirin, ibuprofen, or naproxen) or an anesthetic.

The present disclosure further provides disinfectant compositions comprising the formulations disclosed herein. The disinfectant composition may be suitable for use on the skin, or may be used for disinfecting a surface (such as a medical device, e.g. a surgical instrument). The disinfectant composition may also be used in bandages or other dressings to prevent or treat wound infections.

The compounds of the present disclosure used in the formulations described herein may be present in the form of pharmaceutically acceptable salts. Salt formation may occur at one or more sites having labile protons. Pharmaceutically acceptable salts of the compounds of the present disclosure include acid addition salts and base addition salts. The term "pharmaceutically acceptable salts" encompasses salts commonly used to form alkali metal salts and to form addition salts of a free acid or a free base. These SALTS include physiologically acceptable SALTS known to those skilled in the art AND are listed in HANDBOOK OF PHARMACEUTICAL SALTS, PROPERTIES, SELECTION AND USE, P.H.Stahl AND C.G.Wermuth (Eds.), Wiley-VCH, New York, 2002.

Suitable pharmaceutically acceptable acid addition salts of the compounds of the present disclosure may be prepared from inorganic or organic acids, such as hydrochloric, hydrobromic, hydroiodic, nitric, carbonic, sulfuric, and phosphoric acids suitable organic acids may be selected from aliphatic, alicyclic, aromatic, arylaliphatic, heterocyclic, carboxylic, and sulfonic organic acids, such as formic, acetic, propionic, succinic, glycolic, gluconic, maleic, pamoic, methanesulfonic (methanesulfonic), ethanesulfonic, 2-hydroxyethanesulfonic, pantothenic, benzenesulfonic, toluenesulfonic, sulfanilic, methanesulfonic (mesyl), cyclohexylsulfamic, stearic, alginic, β -hydroxybutyric, malonic, glacial acetic (galactaric) and galacturonic acids and the like pharmaceutically acceptable acid/anion salts also include acetate, benzenesulfonate, benzoate, bicarbonate, tartrate, bromide, calcium ethylenediaminetetraacetate, bromide, bicarbonate, mandelate, citrate, citrates, galacturonate, glycollate, maleate, glycolate, glycollate, glycolate, cinnamate, salicylate, cinnamate, salicylate, cinnamate, fumarate, salicylate, cinnamate, salicylate, fumarate, salicylate, cinnamate, fumarate, salicylate, fumarate, salicylate, fumarate, salicylate, fumarate, salicylate, fumarate, salicylate, fumarate, salicylate, fumarate, salicylate, and the like.

Suitable pharmaceutically acceptable base addition salts of the compounds of the present disclosure include, but are not limited to, metal salts formed from aluminum, calcium, lithium, magnesium, potassium, sodium, and zinc, or organic salts formed from N, N' -dibenzylethylenediamine, chloroprocaine, choline, diethanolamine, ethylenediamine, N-methylglucamine, lysine, arginine, and procaine. All of these salts can be prepared from the corresponding compounds represented by the compounds of the present disclosure by conventional means, for example, by treating the compounds of the present disclosure with a suitable acid or base. Pharmaceutically acceptable basic/cationic salts also include diethanolamine, ammonium, ethanolamine, piperazine, triethanolamine and the like.

In one embodiment, the pharmaceutically acceptable salt comprises a monovalent cation or a divalent cation. In another embodiment, the pharmaceutically acceptable salt is the bis-sodium bis-phosphate.

Depending on the condition being treated, the compounds of the present disclosure may be co-formulated with other active agents in the gel formulations described herein, or co-administered with other active agents. Co-administration may include administering both agents simultaneously in the same dosage form, administering both agents simultaneously in separate dosage forms, and administering both agents separately. In various embodiments, co-administration of a compound of the present disclosure as part of a single treatment plan refers to at the same time and frequency, or more typically at a different time and frequency, as the compound of the present disclosure. Aspects of the present disclosure include administering a compound of the present disclosure before, after, and/or during administration of another antimicrobial agent. Thus, antimicrobial agents other than the disclosed compounds (e.g., agents that generally or specifically target microorganisms) can be used in combination with the compounds of the present disclosure, but are administered at different times, in different doses, and at different frequencies with the compounds of the present disclosure.

Dosage and mode of administration

The presently described gel formulations comprising the presently disclosed compounds can be formulated with a variety of active ingredients and a variety of physiological carrier molecules. The compounds of the present disclosure may optionally be complexed with molecules that enhance their ability to enter target cells. Examples of such molecules include, but are not limited to, carbohydrates, polyamines, amino acids, peptides, lipids, and molecules critical to bacterial growth.

Administration of the gel formulations of the present disclosure may introduce the compounds of the present disclosure to a patient in diluted amounts. In some embodiments, a unit dose suitable for topical administration of the present disclosure may be greater than about 1, 5, 10, 50, 100, or 500 mg/kg.

In some embodiments of the present disclosure, the gel formulation contains from about 0.001% to about 40% by weight of a compound of the present disclosure. In some embodiments, the gel formulation contains from about 0.5% to about 30% by weight of a compound of the present disclosure. In other embodiments, the gel formulation contains from about 1% to about 20% by weight of a compound of the present disclosure. In other embodiments, the gel formulation contains from about 5% to about 20% by weight of a compound of the present disclosure.

In one embodiment, one dosage unit may be topically administered once every 10, 9, 8, 7, 6, 5, 4,3, 2, or 1 day, or 1, 2, 3,4, 5,6, 7,8, 9, 10, or more than 10 times per day, until remission is achieved or until the symptoms disappear or are satisfactorily reduced. In some embodiments, one dosage unit is topically administered from about once to about four times daily. In some embodiments, the dosing regimen for topical administration includes 1, 7, 14, 21, and 28 days of dosing.

Therapeutic uses of gel compositions comprising the disclosed compounds

It is also envisaged that the presently described formulations are effective against microbial (e.g. bacterial, fungal, protozoan or viral) contamination of laboratory cultures, consumables (food or beverage preparations), medical devices, hospital equipment or industrial processes.

The gel formulations disclosed herein are particularly useful for treating infections caused by biofilms. Biofilms are formed when individual microorganisms attach to hydrated surfaces and grow as adherent cellular matrices for other microorganisms. The biofilm forms a tightly packed microbial cell community surrounded by secreted polymers. Biofilms are notoriously difficult to treat and are associated with a number of distinct diseases, such as atherosclerosis, chronic sinusitis and chronic wound healing.

The bactericidal and/or bacteriostatic activity of a gel formulation comprising a compound of the present disclosure, or a pharmaceutically acceptable salt thereof, can be measured using a variety of methods available to those skilled in the art. One example of such a method is to measure antibacterial activity by using a MIC (minimum inhibitory concentration) test, which is believed to predict the in vivo efficacy of antibiotics for the topical treatment of bacterial infections. The gel formulations of the present disclosure showed antibacterial activity in this test, even without bacterial pretreatment to permeabilize the membrane.

The present disclosure provides methods of inhibiting the growth of a microorganism by contacting the microorganism with a gel formulation of the present disclosure in which the active agent is a compound of the present disclosure. These methods are effective for in vivo infections, particularly topical infections. This is demonstrated by test data showing the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of the formulations against various pathogenic organisms cultured in vitro under standard conditions. These in vitro tests are closely related to in vivo activity, as evidenced by the extensive use of MIC and MBC assays to predict the utility of antimicrobial agents in the treatment of infections in animals, including humans.

Of particular interest, gel formulations of the present disclosure comprising the compounds of the present disclosure are able to extend the range of antimicrobial efficacy against bacteria previously thought to be non-reactive to certain conventional antibiotics. For example, gel formulations comprising compounds of the present disclosure are particularly useful in formulations for treating acne, diabetic foot ulcers, otitis externa, or burn wounds.

In addition to having antibacterial activity, the compounds of the present disclosure may also have activity as antifungal agents. Thus, the compounds of the present disclosure may be used as active agents in gel formulations for the treatment of fungal infections (e.g., athlete's foot and candidiasis).

Gel formulations comprising the compounds of the present disclosure may also have activity as antiviral agents. Thus, such formulations are useful as topical treatments for viral infections (e.g., herpes simplex).

The gel formulations disclosed herein may also be used as topical disinfectants for disinfection of surfaces (such as, for example, countertops, surgical instruments, bandages, and skin); as pharmaceutical formulations for topical application to the skin (e.g. hand disinfectants) and mucosal surfaces (e.g. nasal disinfectants), including the cornea, skin incisions and abrasions, burns and sites of bacterial or fungal infection; as a pharmaceutical formulation for administration to an internal mucosal surface, such as the oral cavity or vagina, to inhibit the growth of bacteria, viruses or fungi (including yeast); and as pharmaceutical preparations for coating indwelling catheters and similar implants which are prone to harbor bacterial or fungal infections.

Antibiotic

The gel formulations of the present disclosure may be used as topical antibiotic formulations containing other antibiotic agents, both prescription agents (e.g., benzethycin) and over-the-counter agents (e.g., salicylic acid, benzoyl peroxide, etc.). When used in the treatment of disease, the appropriate dosage of a gel formulation containing a compound of the present disclosure and another active ingredient may be determined by any of a variety of well-known methodologies. For example, animal studies are commonly used to determine the Maximum Tolerated Dose (MTD) of a bioactive agent per kilogram of weight. Typically, at least one of the animal species tested is a mammal. One skilled in the art regularly extrapolates (extrapolate) doses to achieve efficacy and avoid toxicity to other species, including humans. In addition, the therapeutic dose may also vary depending on factors such as the severity of the infection and the size or type of host.

Antiviral agents

Because some of the compounds of the present disclosure are based on natural nucleoside structures, formulations containing the compounds of the present disclosure may have potent antiviral activity.

Viruses that may be treated with the formulations of the present disclosure include, but are not limited to, Human Immunodeficiency Virus (HIV), Herpes Simplex Virus (HSV), Cytomegalovirus (CMV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and influenza virus.

Combination therapy

Gel formulations comprising the compounds of the present disclosure may also be used in combination with conventional antimicrobial agents. The increased activity of the active ingredient may provide a more effective formulation and may provide a variety of mechanisms for targeting microorganisms. Pharmaceutical compositions containing a compound of the present disclosure in admixture with another active agent may be prepared according to conventional pharmaceutical compounding techniques.

For example, a composition for treating acne may comprise a compound of the present disclosure with salicylic acid, benzoyl peroxide, and/or sulfur. Such combination therapy using the compounds of the present disclosure with another active agent may increase the efficacy of the gel formulations of the present disclosure without increasing the amount of the agent currently used by the consumer, such as in over-the-counter products.

Over The Counter (OTC) antifungal agents that may be other active ingredients in the gel compositions of the present disclosure include, but are not limited to: miconazole, miconazole nitrate, synoxicoline (polynoxlin), clotrimazole, sulconazole nitrate, econazole nitrate, Tolnaftate (Tolnaftate), selenium sulfide, tioconazole. Prescribed antifungal agents include drugs such as allylamines, azoles, polyene macrolides, fluorocytosine, pseudomycin (pseudomycin) and griseofulvin. Exemplary antifungal agents include amphotericin B, fluconazole/Difluian, flucytosine, foscarnet, itraconazole/sertralino, ketoconazole/rillic and nystatin 1. See also Elewski, Cutanous Fungal Infections, 2 nd edition (1998) and Segal, pathogenic Yeast and Yeast Infections (1994), which are incorporated by reference.

Gel formulations of the present disclosure contain a compound of the present disclosure as an active ingredient, and may also contain any of a variety of additives that are themselves active ingredients, such as retinoic acid, glycolic acid, lactic acid, α -hydroxy acids, ketone hydroxy acids, citric acid, glucuronic acid, galacturonic acid, glucuronolactone, gluconolactone, α -hydroxybutyric acid, α -hydroxyisobutyric acid, malic acid, pyruvic acid, phenyllactic acid, phenylpyruvic acid, saccaronic acid, mandelic acid, tartaric acid, tartronic acid (tartronical), hydroxybutyric acid, vitamin a palmitate (retinyl palmitate), and/or vitamin E acetate (tocopheryl acetate).

Other active ingredients that may be used in the gel formulations of the present disclosure include those in U.S. patent No. 5,652,266, which relates to a combination of α -hydroxy acid, tretinoin, and salicylic acid, those in U.S. patent No. 5,843,998, which relates to a composition containing α -hydroxy acid and carbamide peroxide with or without salicylic acid, those in U.S. patent No. 5,153,230, which relates to a formulation whose primary active ingredient is glycolic acid, those in 4,464,392, which relates to an antimicrobial formulation containing glycolic acid derivatives, and those in U.S. patent No. 4,105,782, which describes many other similar active agents that may be used in the gel compositions of the present disclosure.

The gel formulations of the present disclosure may also be used as carrier materials for and/or in combination with other drugs, such as insecticides, antiviral agents, and antifungal agents, to further extend the medical efficacy of the compositions. The gel formulations of the present disclosure may also contain a local anesthetic (such as lidocaine hydrochloride) and a local steroid (such as a corticosteroid) to reduce pain or itching during treatment.

Use of gel formulations as disinfectants

Gel formulations containing the compounds of the present disclosure described herein may also be used as disinfectants, as well as formulations having biostatic or biocidal properties. The disinfectant gel formulations of the present disclosure may also contain other active ingredients having biostatic and/or biocidal properties. For example, a disinfectant gel may contain a compound of the present disclosure and a suitable concentration of a quaternary ammonium compound, such as: dimethyl benzyl dodecyl ammonium chloride, dimethyl benzyl decyl ammonium bromide and dimethyl benzyl octyl ammonium chloride.

In another example, suitable microbicidal biguanide compounds, such as oligohexamethylene biguanides (oligohexamethylene biguanidines salt) and bisbiguanides (bisbiguanidines), may be used. See, for example, U.S. Pat. No. 5,030,659. Other biocidal ingredients include aldehydes, phenol derivatives and halophenyl derivatives. See, for example, U.S. patent No. 5,767,054. Other compounds having such activity may also be used in the gel formulations described herein, along with the compounds of the present disclosure, as will be appreciated by those skilled in the art.

These formulations are particularly suitable for surface disinfection in medical-related environments, such as hospitals, veterinary clinics, dental clinics, and medical offices. In some embodiments, the formulations of the present disclosure are used for sterilization of surgical instruments. These formulations may also be used in public places such as schools, public transportation, restaurants, hotels and laundry. Disinfectants may also be used in the home as disinfectants for toilets, sinks and kitchen areas.