阅读说明：本技术 叶酸类化合物制剂 (Folic acid compound preparation ) 是由 马丁·乌尔曼 格尔德·威斯勒 约瑟夫·弗拉默尔 于 2019-08-29 设计创作，主要内容包括：本发明涉及叶酸类化合物的制剂,其用于在存在眼压升高时的眼疾患的治疗。(The present invention relates to formulations of folic acid compounds for use in the treatment of ocular disorders in the presence of elevated intraocular pressure.)

1. A formulation for reducing intraocular pressure in a patient suffering from an ocular disease, the formulation comprising at least one folic acid compound in a reduced form.

2. The formulation for use according to claim 1, wherein the ocular disease is glaucoma, diabetic retinopathy and/or age-related macular degeneration.

3. Formulation according to claim 1 or 2, characterized in that it comprises at least one salt of folic acid and at least one sulphur compound or a salt thereof.

4. Formulation according to any one of claims 1 to 3, characterized in that it comprises at least one salt of a folic acid and at least one antioxidant or a salt thereof or at least one vitamin.

5. The formulation according to any one of the preceding claims, wherein the formulation is a liquid or semi-liquid formulation for topical application to the eye.

6. The formulation according to any of the preceding claims, characterized in that it is a liquid, semi-liquid or solid formulation for systemic application.

7. Formulation according to any one of the preceding claims, characterized in that it further comprises at least one compound selected from the group consisting of vitamin B12, B6, B5, B2, B1, vitamin C, D, E, carotenoids, natural orange oil and minerals.

8. The formulation of claim 7, further comprising at least one compound selected from the group consisting of: selenium (L-selenomethionine, sodium selenite, sodium hydrogen selenite, sodium selenate), cholecalciferol, pantothenic acid (dexpanthenol, D-calcium pantothenate, sodium D-pantothenate), vitamin B12 (methylcobalamin, cyanocobalamin, hydroxycobalamin, adenosylcobalamin), vitamin B6 (pyridoxine hydrochloride, pyridoxal 5 '-phosphate), vitamin B2 (riboflavin-5' -sodium phosphate, riboflavin), vitamin B1 (thiamine hydrochloride, thiamine mononitrate), zeaxanthin, lutein, vitamin E (D-alpha-tocopherol, DL-alpha-tocopherol, D-alpha-tocopherol), vitamin C (sodium ascorbate, potassium ascorbate, calcium ascorbate, L-ascorbic acid, L-ascorbyl-6-palmitate), Copper salts (copper gluconate, copper citrate, copper oxide, lysine copper complex), zinc salts (zinc oxide, zinc gluconate, zinc lactate, zinc citrate), natural orange oil (natural orange extract, limonene, myrcene), and sulfur compounds (N-acetyl-cysteine, N-acetyl cysteine amide, cysteine, lipoic acid, methionine).

9. Formulation according to any one of the preceding claims, characterized in that the folic acid is selected from the group consisting of 5-methyl- (6S) -tetrahydrofolic acid, 5-formyl- (6S) -tetrahydrofolic acid, 5, 10-methylene- (6R) -tetrahydrofolic acid, 5, 10-methenyl- (6R) -tetrahydrofolic acid, 5-methyl-10-formyl-tetrahydrofolic acid and 5-formyl-10-formyl-tetrahydrofolic acid, and the folic acid salt is selected from calcium, sodium, zinc, arginine, choline, acetylcholine, N-methylaminoethanol, 2-amino-2-methyl-propanol, 1-dimethylbiguanide, phenethylbiguanide, bisguanide, Diaminoguanidine, glucosamine and dimethylaminoethanol.

10. Formulation according to any of the preceding claims, characterized in that it comprises in the range of 0.15 to 1.8mg of at least one salt of a folic acid compound selected from the group consisting of 5-methyl- (6S) -tetrahydrofolic acid and 5-formyl- (6S) -tetrahydrofolic acid, in the range of 28 to 350mg of a sulfur compound or a salt thereof, in the range of 0.005 to 0.04mg of a selenium compound, in the range of 0.009 to 0.06mg of cholecalciferol, in the range of 0.45 to 8mg of D-pantothenic acid, in the range of 0.003 to 0.98mg of vitamin B12, in the range of 0.8 to 4mg of vitamin B6, in the range of 2 to 14mg of riboflavin, in the range of 0.2 to 2mg of vitamin B1, in the range of 1 to 3mg of zeaxanthin, in the range of 4 to 15mg of zeaxanthin, Vitamin E in the range of 1mg to 8mg, vitamin C in the range of 9mg to 100mg, natural orange oil in the range of 0.2mg to 5.5mg, copper in the range of 0.1 to 1mg and zinc in the range of 7mg to 33 mg.

11. Formulation according to any of the preceding claims, characterized in that it comprises in the range of 0.18 to 1.5mg of at least one folic acid compound salt selected from the group consisting of 5-methyl- (6S) -tetrahydrofolic acid, 5-formyl- (6S) -tetrahydrofolic acid, in the range of 29 to 316mg of a sulphur compound or a salt thereof, in the range of 0.01 to 0.03mg of selenium, in the range of 0.015 to 0.045mg of cholecalciferol, in the range of 2 to 6mg of D-pantothenic acid, in the range of 0.005 to 0.6mg of vitamin B12, in the range of 1.6 to 3.5mg of vitamin B6, in the range of 3.7 to 10.5mg of riboflavin, in the range of 0.45 to 1.6mg of vitamin B1, in the range of 1.9 to 2.1mg of zeaxanthin, in the range of 9 to 11mg of vitamin E, in the range of 2 to 11mg of vitamin E, Vitamin C in the range of 35mg to 50mg, natural orange oil in the range of 0.4mg to 3.9mg, copper in the range of 0.2 to 0.8mg and zinc in the range of 11mg to 26 mg.

12. The formulation according to any one of the preceding claims, the preparation contains 0.9mg of at least one folic acid compound salt selected from the group consisting of 5-methyl- (6S) -tetrahydrofolic acid, 5-formyl- (6S) -tetrahydrofolic acid, 180mg of N-acetylcysteine or a salt thereof, 0.02mg of selenium as L-selenomethionine, 0.0375mg of cholecalciferol, 5mg of pantothenic acid as D-calcium pantothenate, 0.5mg of methylcobalamin, 3mg of pyridoxal 5' -phosphate, 10mg of riboflavin, 1.5mg of thiamine mononitrate, 2mg of zeaxanthin, 10mg of lutein, 5mg of D-alpha-tocopherol, 45mg of calcium ascorbate, natural orange oil, 0.667mg of copper as copper gluconate, and 25mg of zinc as zinc oxide.

13. The formulation according to any one of the preceding claims, the formulation comprises at least one folic acid compound salt selected from the group consisting of 5-methyl- (6S) -tetrahydrofolic acid, 5-formyl- (6S) -tetrahydrofolic acid in an amount of 0.6mg, N-acetylcysteine or a salt thereof in an amount of 100mg, selenium as L-selenomethionine in an amount of 0.02mg, cholecalciferol in an amount of 0.02mg, pantothenic acid in an amount of 3mg as D-calcium pantothenate, cyanocobalamin in an amount of 0.009mg, pyridoxal 5' -phosphate in an amount of 2.1mg, riboflavin in an amount of 4.2mg, thiamine mononitrate in an amount of 0.55mg, zeaxanthin in an amount of 2mg, lutein in an amount of 10mg, D-alpha-tocopherol in an amount of 3mg, calcium ascorbate in an amount of 40mg, natural orange oil, copper in an amount of 0.3mg as copper gluconate, and zinc in an amount of 12.5mg as zinc oxide.

14. The formulation of any one of claims 1 to 4 and 6 to 13, wherein the formulation is contained in a tablet, a hard gel capsule, or a soft gel capsule.

15. The formulation of any one of the preceding claims, wherein the formulation is contained in a solution, patch, ointment, cream, lotion, or for controlled or sustained release application.

16. A kit for reducing intraocular pressure in a patient suffering from an ocular disease, the kit comprising at least a 10 daily dose of a formulation comprising at least one folic acid compound in reduced form.

17. A method for reducing intraocular pressure in a patient suffering from an ocular disease, the method comprising administering to the patient a formulation comprising at least one folic acid compound in a reduced form.

Technical Field

The present invention relates to reduced folates and their use in the management of ocular diseases.

Background

Diseases and degenerative disorders of the optic nerve and retina are the leading causes of blindness in the world. Around the world, approximately 3 million people suffer from different forms of vision impairment caused by these diseases. The most common diseases are optic neuropathy, retinopathy, and glaucoma.

There are many forms of optic neuropathy. One form is toxic neuropathy, in which damage to the optic nerve is caused by toxic compounds such as methanol. Another form is vegetative neuropathy caused by a nutritional deficiency of one or more micronutrients such as folic acid (folates) and other B vitamins. Current methods of managing nutritional deficiencies are generally based on oral supplements. However, in the case of the eye, this approach may not always be effective because the Blood Retinal Barrier (BRB) in the retinal pigment epithelium may block the entry of nutrients to the deficient site. BRB regulates the movement of solutes and nutrients from the choroid to the subretinal space, similar to the Blood Brain Barrier (BBB), between retinal blood vessels and the retina and between the choroid and the retina.

Retinopathy is a disease that causes damage to the retina of the eye, often caused by abnormal blood flow. As in the case of optic nerve disorders, retinopathy has a variety of causes. Examples of retinopathies are Diabetic (DR), hypertensive and hereditary retinopathies. Age-related macular degeneration is technically a retinopathy, but is generally considered a separate disorder.

Glaucoma is a group of several different ocular diseases that result in vision loss by damaging the optic nerve. Risk factors for glaucoma include elevated intraocular pressure (IOP), genes, and hypertension. Glaucoma typically develops as the eye ages, or it may occur as a result of ocular trauma, inflammation, tumors, cataracts, or advanced cases of diabetes, or steroid treatment. Drug therapy for the treatment of glaucoma can lower IOP by reducing the production of vitreous humor or by promoting ocular drainage. However, patient compliance with these drugs is poor, mainly due to side effects. Thus, other treatments involving laser therapy and surgery have been developed, but these treatments are invasive and temporary solutions.

US 2004/087479 discloses a composition comprising folic acid (folic acid), vitamin B₆And vitamin B₁₂A composition in combination with a dextro-morphinan (dextromorphan). This composition appears to reduce homocysteine levels and inhibit the N-methyl-D-aspartate receptor, which is thought to reduce the risk of glaucoma. Folic acid (folic acid) contained in the composition is an oxidized and biologically inert form of folic acid. Reduced folic acid was not considered.

The publication "Folate prevention Glaucoma with a Folate Supplement" for previous Glaucoma, Bottom Line Health, 24 months 7 2014, describes Folate deficiency in humans with pseudoexfoliative Glaucoma (PEX) and elevated homocysteine levels. Ingestion of specific B vitamins is considered important to reduce PEX risk.

A prospective study of the uptake of folic acid, vitamin N6 and vitamin B12 in association with exfoliative glaucoma or suspected exfoliative glaucoma was described by Kang jang Jae et al (j am Ophthalmology, usa Ophthalmology, 4/3, 2014, volume 3, phase 5, page 549-559). Homocysteine levels are considered a parameter and are associated with the intake of folic acid, vitamin B6 and B12 mainly as folic acid (folic acid). Dietary intake data is obtained from the relevant database and the patient must complete a semi-quantitative food frequency questionnaire. The results indicate a tendency to reduce the risk of PEX and suspected PEX. The role of homocysteine in patients with exfoliative glaucoma was found to be inversely related to low folate uptake.

US 6103756 discloses a composition mainly comprising antioxidant compounds such as vitamin A, C, E and herbal extracts as supplements for patients suffering from different eye diseases. Prevention of oxidative damage is considered a primary goal. The composition contains a large amount of folic acid (folic acid), which produces unmetabolized folic acid (folic acid) in the body. Reduced folic acid was not considered.

Ramdas w.d. et al (effect of vitamins on glaucoma: systematic review), journal of nutrition (nutriments), 2018,10,359) published a meta analysis of The association of vitamins with glaucoma. The subject of the study was a glaucoma patient. Only for vitamins a and C, a beneficial correlation between intake and open angle glaucoma was found. Vitamin B9 (folic acid) was also considered in the study. However, synthetic and fully oxidized folic acid have different pharmacological properties and are not the active form in vivo.

Giaconi j.a. et al (The association of Consumption of Fruits/Vegetables with purified skin of glaucomatous flowers-American women in The Study of osteoporotic fractures), The association of Consumption of Fruits/Vegetables with a reduced Risk of Glaucoma in older African American women, Journal of American Journal of Ophthalmology, volume 154, stage 4, day 10/2012, pages 635 to 644) disclose a Study of The association of Consumption of Fruits/Vegetables with The occurrence of Glaucoma in older African American women. The authors suggested that higher vitamin a and C and carotenoid intake may be associated with a lower likelihood of developing glaucoma. Furthermore, it was found that the B vitamins (B1, B2, B3, B6), vitamins D and E, and lycopene are less likely to be associated with glaucoma when taken in higher amounts. Other B vitamins (folic acid and B12) were not considered in this study.

Ramdas W.D (relationship of dietary intake to glaucoma: systematic review: a systematic review, ophthalmic journal (Acta optocytology), 2018,96, 550-556) published reviews on meta analysis of 46 studies investigating The effect of nutrients with antioxidant properties such as nitric oxide, carotenoids, flavonoids, glutathione, omega-6 and omega-3 fatty acids. Of these, only glutathione, nitric oxide and flavonoids show protective effects on glaucoma. Selenium and iron appear to have adverse effects by even increasing the risk of glaucoma. Flavonoids are derivatives of the base compound chromen-4-one. In addition, prospective studies like the Rotterdam study did not reveal a significant association between flavonoid uptake and open angle glaucoma. Thus, evidence for the association of dietary intake of these compounds with glaucoma remains inadequate. The B vitamins were not studied in this meta assay.

WO 2014/177274 discloses a stable aqueous solution of reduced folic acid further comprising calcium. Such basic salts of reduced folic acid have very limited solubility and therefore there is a high risk of precipitate formation. No mention is made of the relationship to ocular diseases.

WO 2007/076416 discloses dietary supplements and methods for inhibiting the progression of macular degeneration and promoting healthy vision. The dietary supplement comprises vitamin E, carotenoids in the form of vitamin a, lutein and/or zeaxanthin. A number of additional ingredients are also contemplated, for example, vitamin C, copper, zinc, rosemary, DHA, and other vitamins and minerals. No information about glaucoma is provided.

Other treatment options include photodynamic therapy, alone or in combination with a photosensitive compound, and injection of Vascular Endothelial Growth Factor (VEGF) inhibitors, as VEGF can lead to the growth of abnormally weak vessels under the retina. VEGF secretion is the body's response to long-term hypoxia (hypoxia). Blocking of growth factors by compounds or monoclonal antibodies can block or reduce the formation of new blood vessels. VEGF is not only a cause of disruption of the blood-retinal barrier, but VEGF generally plays a key role in angiogenesis. Its role involves both physiological and pathological angiogenesis. VEGF synthesis is stimulated by ischemia through the stabilization of hypoxia inducible factor 1 (HIF). In addition, several cytokines associated with intraocular inflammation such as IL-1 α and IL-6 also promote VEGF synthesis. Some of the most common ocular diseases are age-related macular degeneration, diabetic retinopathy, retinal vein occlusion, and retinopathy of prematurity (ROP), among others, which lead to vision loss via VEGF-related neovascularization of macular edema.

Currently available treatments effectively slow the progression of eye disease. However, they do not cure ocular diseases. There is a continuing need for effective treatments for ophthalmic diseases such as Macular Degeneration (MD), age-related macular degeneration (AMD), Diabetic Retinopathy (DR), retinal and choroidal ischemia, glaucoma, cataracts, retinitis pigmentosa, choroidal neovascularization, retinal degeneration, ocular surface diseases, and oxygen-induced retinopathy, among others. Age-related vascular changes that occur systemically also affect the ocular vascular bed. Studies have shown that with age, ocular blood flow is often reduced, possibly due to the atherosclerotic process including glycocalyx structural changes and retinal vessel narrowing. Endothelial dysfunction leads to a decrease in Nitric Oxide (NO) production, thereby increasing vascular tone and vasoconstriction, restricting blood flow and increasing intraocular pressure.

Micronutrients are compounds or substances, commonly referred to as vitamins and minerals, which are vital to development, disease prevention and health, although the body needs only small amounts. Micronutrients are not produced in the body and must be obtained from the diet. For humans, they typically include dietary trace elements in amounts less than 100 mg/day-with a large demand for nutrients such as omega-3 fatty acidsAll are different. The microelements comprise at least iron, cobalt, chromium, copper, iodine, manganese, selenium, zinc and molybdenum. Micronutrients also include vitamins, which are organic compounds that are micronutrients required by the organism. Micronutrients such as iron, iodine, vitamin A, vitamin B₁₂Vitamin D, folic acid and zinc deficiency can have devastating consequences.

Folic acid (folic acid) is a widely occurring growth factor with vitamin properties. Reduced folate (folic acid) is essential for normal cell division, as it is essential for the production of genetic material DNA. Thus, rapidly dividing cells and tissues such as skin cells and intestinal cells are directly affected by the folate (folic acid) state.

In nature, folic acid exists in the form of reduced folic acid with mono-or polyglutamic acid groups. These folate compounds are not formed by the human metabolism. Therefore, folic acid has the properties of vitamins. De novo synthesis of folate compounds occurs only in microorganisms and plants. Folic acid (folic acid) is itself biologically inactive and must be enzymatically reduced to 7, 8-dihydrofolate and further to 5,6,7, 8-tetrahydrofolate via a dihydrofolate reductase. Tetrahydrofolic acid (THF) is the biologically active form of folic acid. THF as C₁A carrier for the unit, wherein the transfer is effected via 5-methyl-tetrahydrofolate, 5, 10-methylene-tetrahydrofolate, 5-formyl-tetrahydrofolate, 5-formimino-tetrahydrofolate, 10-formyl-tetrahydrofolate and 5, 10-methenyl-tetrahydrofolate, respectively. For example, C is required in the synthesis of purine nucleotides and deoxythymidine-5' -monophosphate₁And (4) units. Folic acid (folic acid) is the oxidized form of biological folic acid and the parent compound. Folic acid (folic acid) is used in supplements and dietary supplements due to its stability. However, folic acid (folic acid) is not metabolically active and requires reduction and one carbon substitution, which is then converted to 5-methyl- (6S) -tetrahydrofolic acid by several enzymatic steps. Although the enzymatic conversion of folate (folic acid) itself may be incomplete, disrupted or reduced at several points in its pathway, the effects of its deficiency may be multiplied as folate metabolism is linked to other metabolic cycles, which means thatDysfunction in one cycle may lead to dysfunction in other metabolic cycles. The Blood Retina (BRB) and the Blood Brain Barrier (BBB) are critical to meeting the nutritional needs of the eye and brain, as certain nutrients are concentrated several times across the BRB and BBB. BRB and BBB isolate the retina and brain from the blood/vasculature and selectively transport small molecules to the retina and brain.

Folate deficiency may be promoted or caused by a number of reasons. For example, as seen during pregnancy and aging, increased demand for folate may eventually lead to a folate deficient state. In addition, the ingestion of antimetabolites such as methotrexate, aminopterin, which are competitive inhibitors of dihydrofolate reductase, and alcoholism in the treatment of cancer may lead to folate deficiency due to malabsorption of folate in food caused by celiac disease. Furthermore, a dysfunction in the genetic establishment of one or more folate metabolising enzymes may result in folate levels that are below normal. In addition, inflammatory conditions may cause a reduction in folate levels, which may be due to depletion of existing folate and/or the malabsorption of folate required during repair of the tissue affected by inflammation. In the skin, a deficiency of folic acid may lead to a condition known as seborrheic dermatitis, and may be associated with vitiligo (loss of skin pigment). In diabetes, advanced glycosylation is one of the major pathways involved in the development and progression of different diabetic complications, including nephropathy, retinopathy and neuropathy.

The consequences of folate deficiency are numerous, as folic acid plays the same role in metabolism, for example, DNA methylation, disruption of amino acid and nucleic acid metabolism. The latter is directly related to the cell division process. In tissues exhibiting rapid cell division, such as bone marrow, this may lead to megaloblastic anemia or thrombocytopenia.

Thus, there is a continuing need for effective and safe formulations and methods to reduce intraocular blood pressure and improve retinal blood flow to better manage ocular diseases.

Disclosure of Invention

In a first aspect, the present invention provides a formulation for reducing intraocular pressure in a patient suffering from an ocular disease, the formulation comprising at least one folic acid compound in a reduced form.

In a second aspect, the present invention provides a formulation for increasing total retinal blood flow in a patient suffering from an ocular disease, the formulation comprising at least one folate in reduced form.

These objects are achieved by the formulation according to claim 1, respectively the method of its use. Preferred embodiments of the invention are restricted by the dependent claims.

The formulation according to the invention comprises at least one salt of a folic acid. The formulation is useful for treating ocular diseases in the presence of elevated intraocular pressure.

Normal intraocular pressure is considered to be between 10mmHg and 20 mmHg. The mean intraocular pressure was 15.5mmHg with fluctuations of about 2.75 mmHg. Pressures above 20mmHg are considered elevated intraocular pressure. Lowering intraocular pressure to below 20mmHg may be beneficial and may delay progression of the disease.

In another aspect, the present invention provides a kit for reducing ocular pressure in a patient suffering from an ocular disease, said kit comprising at least a 10 daily dose of a formulation comprising at least one folic acid in reduced form. Preferably, the package comprises at least 60 daily doses of the formulation, for example about 90 daily doses.

In yet another aspect, the present invention provides a method for reducing ocular pressure in a patient having an ocular disorder, the method comprising administering to the patient a formulation comprising at least one folic acid in a reduced form. Preferably, the formulation is administered to the patient for at least 10 days, more preferably at least 60 days, and most preferably 90 days.

In yet another aspect, the present invention provides a method for reducing the risk of elevated ocular pressure in a patient at risk of developing an ocular disease, comprising administering to the patient a formulation comprising at least one folic acid compound in a reduced form. Preferably, the formulation is administered to the patient for at least 10 days, more preferably at least 60 days, and most preferably at least 90 days.

In another embodiment, the formulation is for the treatment of glaucoma. The disease condition is associated with the development of elevated intraocular pressure. An example of glaucoma is pseudoexfoliation glaucoma (PEX).

In another embodiment, the formulation further comprises one or more sulfur compounds in addition to the at least one salt of a folic acid compound. The sulfur compound is a compound containing a sulfur atom. It may be an organic compound or a salt thereof.

In a preferred embodiment, the formulation comprises one or more salts of folic acid compounds, one or more sulfur compounds and at least one vitamin.

Formulations for treating ocular conditions in the presence of elevated intraocular pressure may be liquid or semi-liquid formulations for systemic or topical application to the eye.

Topical administration of a drug is understood to be a drug that is applied to a body surface such as the skin or mucosa. Many topical drugs are epidermal, meaning that they are applied directly to the skin. Topical drugs may also be applied to the eye as a route of administration, in contrast to enteral (in the digestive tract) and intravascular/intravenous (injected into the circulatory system).

The formulation for systemic application may be a liquid, semi-liquid or solid formulation.

In a preferred embodiment, the formulation further comprises at least one compound selected from the group consisting of vitamin B12, B6, B5, B2, B1, vitamin C, D, E, carotenoids, natural orange oil and minerals. The mineral is, for example, copper or zinc.

Natural orange oil is used as a flavor compound to mask other compounds having unpleasant flavors, such as sulfur compounds. In addition, natural orange oil has antioxidant properties.

In another embodiment, the formulation comprises at least one folate salt and at least one additional compound selected from the group consisting of: selenium, cholecalciferol, pantothenic acid, vitamin B12, vitamin B6, vitamin B2, vitamin B1, zeaxanthin, lutein, vitamin E, vitamin C, copper salts, zinc salts, natural orange oil, and sulfur compounds.

Optionally, the formulation may also comprise meso-zeaxanthin, omega-3 fatty acids, or resveratrol. The latter are polyphenols and have antioxidant properties.

A suitable selenium compound is L-selenomethionine. The selenium compound may also be sodium selenite, sodium hydrogen selenite or sodium selenate, and the cholecalciferol is also known as vitamin D, in particular vitamin D3. Pantothenic acid can be present as dexpanthenol, calcium D-pantothenate or sodium D-pantothenate. Vitamin B12 is included in the formulation in one of its different forms, such as methylcobalamin, cyanocobalamin, hydroxycobalamin, adenosylcobalamin. Vitamin B6 may be included as pyridoxine hydrochloride or pyridoxal 5' -phosphate. Vitamin B2 is for example riboflavin 5' -sodium phosphate or riboflavin. Vitamin B1 can be thiamine hydrochloride or thiamine mononitrate. Vitamin E is included in one of its different forms, for example D-alpha-tocopherol, DL-alpha-tocopherol, D-alpha-tocopherol. In addition, vitamin C may be present as sodium ascorbate, potassium ascorbate, calcium ascorbate, L-ascorbic acid or L-ascorbyl-6-palmitate. The copper salt is copper gluconate, copper citrate, copper oxide or lysine copper complex. Suitable forms of zinc salts are zinc oxide, zinc gluconate, zinc lactate or zinc citrate. Natural orange oil is for example natural orange extract, limonene or myrcene. And the sulfur compound may be included as N-acetyl-cysteine, N-acetyl cysteine amide, cysteine, lipoic acid, or methionine.

In another embodiment of the formulation according to the invention, the folate compound is selected from the group consisting of 5-methyl- (6S) -tetrahydrofolic acid, 5-formyl- (6S) -tetrahydrofolic acid, 5, 10-methylene- (6R) -tetrahydrofolic acid, 5, 10-methenyl- (6R) -tetrahydrofolic acid, 5-methyl-10-formyl-tetrahydrofolic acid and 5-formyl-10-formyl-tetrahydrofolic acid, and the cation of the folate compound salt is selected from the group consisting of calcium, sodium, zinc, arginine, choline, acetylcholine, N-methylaminoethanol, 2-amino-2-methyl-propanol, 1-dimethylbiguanide, phenethylbiguanide, diaminoguanidine, dihydroguanidine, tetrahydrofolic acid, Glucosamine and dimethylaminoethanol.

In yet another embodiment, the formulation comprises in the range of 0.15mg to 1.8mg of at least one folate salt selected from the group consisting of 5-methyl- (6S) -tetrahydrofolic acid and 5-formyl- (6S) -tetrahydrofolic acid, in the range of 28mg to 350mg of a sulfur compound or a salt thereof, in the range of 0.005mg to 0.04mg of a selenium compound, in the range of 0.009mg to 0.06mg of cholecalciferol, in the range of 0.45mg to 4mg of D-pantothenic acid, in the range of 0.003mg to 0.98mg of vitamin B12, in the range of 0.8mg to 4mg of vitamin B6, in the range of 2mg to 14mg of riboflavin, in the range of 0.2mg to 2mg of vitamin B1, in the range of 1mg to 3mg of zeaxanthin, in the range of 4mg to 15mg of vitamin E, in the range of 1mg to 8mg of vitamin E, in the range of 9mg to 65mg of ascorbic acid, Natural orange oil in the range of 0.2mg to 5.5mg, copper in the range of 0.1 to 1mg and zinc in the range of 7mg to 33 mg.

In a preferred embodiment, the formulation comprises in the range of 0.18mg to 1.5mg of at least one folate salt selected from the group consisting of 5-methyl- (6S) -tetrahydrofolic acid and 5-formyl- (6S) -tetrahydrofolic acid, in the range of 29mg to 316mg of a sulphur compound or a salt thereof, in the range of 0.01mg to 0.03mg of selenium, in the range of 0.015mg to 0.045mg of cholecalciferol, in the range of 2mg to 6mg of D-pantothenate, in the range of 0.005mg to 0.6mg of vitamin B12, in the range of 1.6mg to 3.5mg of vitamin B6, in the range of 3.7mg to 10.5mg of riboflavin, in the range of 0.45mg to 1.6mg of vitamin B1, in the range of 1.9mg to 2.1mg of zeaxanthin, in the range of 9mg to 11mg of riboflavin, in the range of 2mg to 6mg of vitamin E, in the range of 35mg to 50mg of ascorbic acid, Natural orange oil in the range of 0.4 to 3.9mg, copper in the range of 0.2 to 0.8mg and zinc in the range of 11 to 26 mg.

In another preferred embodiment, the formulation comprises at least one folic acid compound salt selected from the group consisting of 5-methyl- (6S) -tetrahydrofolic acid and 5-formyl- (6S) -tetrahydrofolic acid in an amount of 0.9mg, N-acetylcysteine or a salt thereof in an amount of 180mg, selenium as L-selenomethionine in an amount of 0.02mg, cholecalciferol in an amount of 0.0375mg, pantothenic acid in an amount of 5mg as D-calcium pantothenate, methylcobalamin in an amount of 0.5mg, pyridoxal 5' -phosphate in an amount of 3mg, riboflavin in an amount of 10mg, thiamine mononitrate in an amount of 1.5mg, zeaxanthin in an amount of 2mg, lutein in an amount of 10mg, D-alpha-tocopherol in an amount of 5mg, calcium ascorbate in an amount of 45mg, natural orange oil, copper as copper gluconate in an amount of 0.667, and zinc in an amount of 25mg, the zinc is in the form of zinc oxide.

Yet another embodiment of the formulation comprises at least one folic acid compound salt selected from the group consisting of 5-methyl- (6S) -tetrahydrofolic acid and 5-formyl- (6S) -tetrahydrofolic acid in an amount of 0.6mg, N-acetylcysteine or a salt thereof in an amount of 100mg, selenium as L-selenomethionine in an amount of 0.02mg, cholecalciferol in an amount of 0.02mg, pantothenic acid in an amount of 3mg as D-calcium pantothenate, methylcobalamin in an amount of 0.009mg, pyridoxal 5' -phosphate in an amount of 2.1mg, riboflavin in an amount of 4.2mg, thiamine mononitrate in an amount of 0.55mg, zeaxanthin in an amount of 2mg, lutein in an amount of 10mg, D-alpha-tocopherol in an amount of 3mg, calcium ascorbate in an amount of 40mg, natural orange oil, copper as copper gluconate in an amount of 0.3mg and zinc as zinc oxide in an amount of 12.5 mg.

In a preferred embodiment, the formulation comprises calcium salt of L-5-methyl-tetrahydrofolate in an amount of 0.9mg, N-acetylcysteine in an amount of 180mg, selenium as L-selenomethionine in an amount of 0.02mg, cholecalciferol in an amount of 0.0375mg, pantothenic acid in an amount of 5mg as D-calcium pantothenate, methylcobalamin in an amount of 0.5mg, pyridoxal 5' -phosphate in an amount of 3mg, riboflavin in an amount of 10mg, thiamine mononitrate in an amount of 1.5mg, zeaxanthin in an amount of 2mg, lutein in an amount of 10mg, D-alpha-tocopherol in an amount of 5mg, calcium ascorbate in an amount of 45mg, copper as copper gluconate in an amount of 0.667mg, and zinc as zinc acetate in an amount of 25 mg.

In a preferred embodiment, the formulation comprises calcium salt of L-5-methyl-tetrahydrofolate in an amount of 0.6mg, N-acetylcysteine in an amount of 100mg, selenium as L-selenomethionine in an amount of 0.02mg, cholecalciferol in an amount of 0.02mg, pantothenic acid in an amount of 3mg as D-calcium pantothenate, methylcobalamin in an amount of 0.009mg, pyridoxal 5' -phosphate in an amount of 2.1mg, riboflavin in an amount of 4.2mg, thiamine mononitrate in an amount of 0.55mg, zeaxanthin in an amount of 2mg, lutein in an amount of 10mg, D-alpha-tocopherol in an amount of 3mg, calcium ascorbate in an amount of 40mg, copper as copper gluconate in an amount of 0.3mg, and zinc as zinc acetate in an amount of 12.5 mg.

The formulation according to the present invention may be contained in a tablet, hard capsule or soft gel capsule. These forms are suitable for systemic application.

Other suitable formulations are solutions, patches, ointments, creams, lotions, nanoparticle formulations or devices for controlled and/or sustained release.

In addition to elevated intraocular pressure, there is increasing evidence that both vascular and immune factors are involved in the development of glaucoma lesions, where ischemia/reperfusion injury and inflammatory stress share common consequences. In addition, the association between glaucoma and various endocrine disorders has been described, and changes in the autonomic nervous system have been found. In addition, similarities to other neurodegenerative diseases such as alzheimer's disease and parkinson's disease have been observed.

Further evidence suggests that ocular hypotension does not prevent progression in all patients; therefore, the disease must involve other risk factors than those related to intraocular pressure. The need for alternative non-ocular hypotensive treatments intended to prevent progression, such as neuroprotective agents, is a concern for both patients and physicians.

In patients with glaucoma (e.g., pseudoexfoliative glaucoma), oral administration of antioxidants for three months results in an increase in biomarkers of ocular blood flow in the retina and retrobulbar vascular bed. Thus, the microcirculation of the blood appears to play an important role in glaucoma disease. The microvasculature or microvasculature refers to the smallest vascular system in the body (e.g., arterioles, capillaries, venules), including those responsible for microcirculation, the smaller vascular systems that distribute blood and nutrients within organs and tissues. It can be measured in μ l/min.

Microvascular processes may contribute to optic nerve head ischemia. Evidence in this regard includes changes in hemodynamics within the ocular and retinal arteries in glaucoma patients, a link between glaucoma and vascular disease, and acceleration of the glaucoma process in the presence of nocturnal hypotension. Factors that cause ophthalmic artery disease may indirectly contribute to the pathogenic process. Homocysteine is an independent risk factor for coronary artery disease, stroke, and venous thrombosis. Recently, elevated serum homocysteine has been shown to be strongly associated with vascular disorders that specifically affect the eye. These include retinal artery and vein occlusion, non-arterial anterior ischemic optic neuropathy, neovascular macular degeneration, and diabetic retinopathy. Homocysteine may also be involved in the development of open angle glaucoma if it is part of an ocular vascular disorder.

By "managing" is meant addressing a medical condition or disease with the goal of improving or stabilizing a person's outcome or addressing a potential nutritional need. Thus, "managing" includes treatment of a medical condition or disease, as well as dietary or nutritional management of a medical condition or disease by addressing the nutritional needs of a person. "management" and "management" have grammatically corresponding meanings.

In order to lower intraocular pressure in an eye disease patient, the amount of reduced folate in the formulation to be administered will vary depending on factors such as: the risk and severity of the disease, any potential medical condition or disease, age, form of formulation and other drugs being administered. Furthermore, the amount may vary depending on whether reduced folate is used to reduce/increase (when the dose may be higher) or whether reduced folate is used during maintenance (when the dose may be lower). However, the required amount can be readily set by the medical practitioner and is typically in the range of from about 0.2mg to about 50mg per day, in certain embodiments from about 0.5mg to about 15mg per day, for example from about 0.8mg to about 3mg per day. Appropriate dosages can be determined based on several factors, including, for example, body weight and/or condition, the severity of the disease being treated or prevented, other ailments and/or diseases, the incidence and/or severity of side effects, and the mode of administration. Suitable dosage ranges can be determined by methods known to those skilled in the art. In the initial phase, the dosage may be higher (e.g., 0.2mg to 100mg per day, preferably 0.2mg to 50mg per day). During the maintenance phase, the dose may be reduced (e.g. from 0.2mg to 50mg per day, preferably from 0.5mg to 15mg per day, more preferably from 0.6mg to 3 mg).

To increase total retinal blood flow in a patient with an ocular disease, the amount of reduced folate in the formulation to be administered will vary depending on factors such as: the risk and severity of the disease, any potential medical condition or disease, age, form of formulation and other drugs being administered. Furthermore, the amount may vary depending on whether reduced folate is used to reduce/increase (when the dose may be higher) or whether reduced folate is used during maintenance (when the dose may be lower). However, the required amount can be readily set by the medical practitioner and is typically in the range of from about 0.2mg to about 50mg per day, in certain embodiments from about 0.5mg to about 15mg per day, for example from about 0.8mg to about 3mg per day. Appropriate dosages can be determined based on several factors, including, for example, body weight and/or condition, the severity of the disease being treated or prevented, other ailments and/or diseases, the incidence and/or severity of side effects, and the mode of administration. Suitable dosage ranges can be determined by methods known to those skilled in the art. In the initial phase, the dosage may be higher (e.g., 0.2mg to 100mg per day, preferably 0.2mg to 50mg per day). During the maintenance phase, the dose may be reduced (e.g. from 0.2mg to 50mg per day, preferably from 0.5mg to 15mg per day, more preferably from 0.6mg to 3 mg).

The administration of the formulation comprising at least one folic acid in reduced form is preferably performed over a period of 2 to 12 months, more preferably over a period of 3 to 8 months.

A method for reducing intraocular pressure in a patient suffering from an ocular disease, the method comprising administering to the patient a formulation comprising at least one folic acid compound in a reduced form.

Use of at least one reduced form of a folate for managing intraocular pressure in a patient suffering from an eye disease, comprising administering said at least one reduced form of a folate to the patient.

A formulation comprising at least one reduced form of a folic acid for managing intraocular pressure in a patient having an eye disease, comprising administering to the patient a formulation comprising the at least one reduced form of the folic acid.

Use of a formulation comprising at least one reduced form of a folic acid for managing intraocular pressure in a patient suffering from an eye disease, comprising administering to the patient a formulation comprising the at least one reduced form of the folic acid.

Use of a formulation comprising at least one reduced form of a folic acid for treating ocular pressure in a patient suffering from an eye disease, comprising administering to the patient a formulation comprising the at least one reduced form of the folic acid.

Detailed Description

Example 1

One female patient with pseudoexfoliative glaucoma (PEX) examined intraocular pressure at the point of ophthalmologist at two examinations. The first examination was completed at 2019 on day 03 and 05, and found to have intraocular pressures of 15mm Hg (right eye) and 15mm Hg (left eye). The patient takes one tablet from 5/1/2019 to 08/21/2019forte capsule, the composition of which is shown below. At the second examination of intraocular pressure on day 13 of 08 months in 2019, the measurement of intraocular pressure gave the following results, 12mm Hg (right eye) and 12mm Hg (left eye).

Is taken every dayA reduction in intraocular pressure from 15mm Hg to 12mm Hg during about 3 months of forte is a significant reduction, even considering that intraocular pressure of 15mm Hg is in the range of 12mm Hg to 20mm Hg, which is considered normal.forte is a preparation comprising L-5-methyl-folic acid, respectively its calcium salt. The compositions and the amounts of the effective ingredients thereof are shown below, respectively.

The compound forming the capsules is not shown.

Example 2

The following table shows seven exemplary patients enrolled in the studyIn patients with diabetes, the study was aimed at assessing the effect of a formulation comprising L-methylfolate on intraocular pressure, total ocular blood flow and systemic homocysteine plasma concentration over a period of 3 months for 12 weeks (1 capsule per day). The preparation used in this study, which contained at least one folic acid compound in reduced form, wasforte. The composition is as shown in example 1. Except that 25mg of zinc was included in the form of zinc acetate.

Systolic, diastolic and mean blood pressures (SBP, DBP, MAP) of the upper arm were measured by an automatic oscillometric device. The pulse rate is automatically recorded by a finger pulse oximeter.

Intraocular pressure was measured with a Goldmann applanation tonometer equipped with a slit lamp. Prior to each measurement, a drop of oxybutynin hydrochloride (oxybuprocaine hydrochloride) was combined with sodium fluorescein for local anesthesia of the cornea.

Fourier Domain Optical Coherence Tomography (FDOCT) was used to determine total ocular blood flow. It is based on local phase analysis of the backscattered signal and allows two-way doppler flow imaging. It does not require a reference arm scan and records a full depth and doppler profile in parallel. The system operates at an equivalent a-scan rate of 25kHz and allows real-time imaging of color-coded doppler information and tissue morphology at a rate of 2-4 tomographic images (40x512 pixels) per second. Despite the high detection speed, a system sensitivity of 86dB can be achieved using a 500 μ W beam power at the cornea. The fundus camera allows simultaneous viewing of selected target areas. Bidirectional blood flow and blood flow velocity pulsations in retinal vessels were observed with a doppler detection bandwidth of 12.5kHz and a longitudinal velocity sensitivity in tissue of 200 μm/s. A 60 second diffuse brightness flash was applied during the measurement.

Plasma homocysteine levels were determined by the CMIA (chemiluminescent one-step particle immunoassay) method (ShipcHandler, M.T. and E.G.Moore, Rapid, full automatic measurement of plasma homology (e) with the Abbott IMx analyzer. Clin Chem,1995.41(7): p.991-4).

Day 1 represents the start of the study, while day 2 represents the time point in the study after 12 weeks of supplementation.

Only five of seven subjects were tested for total ocular blood flow.