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<p> Topical delivery of 1-Antichymotrypsin for wound healing Dissertation zur Erlangung des Doktorgrades der Fakultt fr Chemie und Pharmazie der Ludwig-Maximilians-Universitt Mnchen vorgelegt von Roland Schmidt aus Treuchtlingen Mnchen 2005 Erklrung Diese Dissertation wurde im Sinne von 13 Abs. 3 und 4 der Promotionsordnung vom 29. Januar 1998 von Herrn Prof. Dr. G. Winter betreut. Ehrenwrtliche Versicherung Diese Dissertation wurde selbstndig, ohne unerlaubte Hilfe erarbeitet. Mnchen, 01. Januar 2005 (Roland Schmidt) Dissertation eingereicht am: 10. Januar 2005 1. Berichterstatter: Prof. Dr. G. Winter 2. Berichterstatter: Prof. Dr. W. Frie Tag der mndlichen Prfung: 1. Februar 2005 ACKNOWLEDGMENTS Foremost, I wish to express my deepest appreciation to my supervisor, Prof. Dr. Gerhard Winter. I am much obliged to him for his professional guidance and his scientific support. On a personal note, I especially want to thank him for inspiring my interest in protein pharmaceuticals, for teaching me so much, and for creation of an outstanding working climate. I am also grateful to the Switch Biotech AG, Neuried, Germany for financial support. I would like to acknowledge Dr. Uwe Golar for rendering every assistance and the always professional and personally warm contact. Moreover, I would like to thank Annette, Bjrn, and especially Olivia for performing the Bioassays. Thanks are also extended to Prof. Dr. Bracher, Prof. Dr. Frie, PD Dr. Paintner, Prof. Dr. Schlitzer, and Prof. Dr. Wagner for serving as members of my thesis advisor committee. I very much enjoyed working at the Department for Pharmaceutical Technology and Biopharmaceutics of the Munich Ludwig-Maximilians-University, what was mainly due to the cooperative and most convenient atmosphere. Wolfgang, Silke, Sandra, Iris, Steffi, Fritz, Ingo and all the others, it was a pleasure to work with you. To my parents Table of contents 1 Introduction 1 1.1 Wound healing 3 1.1.1 Physiology of wound healing 3 Wound healing process 3 Growth factors in physiological wounds 8 Proteases in physiological wounds 12 Protease inhibitors in physiological wounds 15 1.1.2 Pathophysiology of chronic wounds 18 Cellular and biochemical imbalance in chronic wounds 19 Clinics of chronic wounds 20 Infection of wounds 21 1.1.3 Treatment of chronic wounds 21 Debridement 22 Moist wound treatment 23 History of moist wound treatment 23 Effects of moist wound treatment 23 Products for moist wound treatment 24 Infection control in wounds 25 Skin substitutes for wound healing 26 Growth factors control in chronic wounds 26 Protease control in chronic wounds 27 Active dressings for chronic wounds 28 Delivery of ACT in chronic wounds 28 1.2 Protein delivery from hydrogel formulations 30 1.2.1 Suitability of hydrogels for protein delivery 31 1.2.2 Protein delivery from hydrogels 32 Application in wounds 32 Transdermal delivery 33 Oral delivery 34 Ophthalmic delivery 35 Delivery by injection and general approaches 35 1.2.3 Summary 37 1.3 Aim of the thesis 39 2 Materials and Methods 41 2.1 Materials 41 2.1.1 1-Antichymotrypsin (ACT) 41 2.1.2 Excipients and chemicals 42 2.1.3 Polymers 43 Cellulose ethers 43 Gellan gum 43 Other polymers 44 2.2 Methods 45 2.2.1 Characterisation of ACT 45 ACT activity assay 45 ACT ELISA 45 Gel electrophoresis 46 2.2.2 Manufacture of matrices 46 Wet film manufacture with the scraper 46 Freeze-drying 46 Warm air drying 47 2.2.3 Characterisation of matrices 47 Viscometry 47 Mechanical tests 47 In vitro Release tests 48 Karl Fischer Titration 48 Differential scanning calorimetry (DSC) 48 X-ray diffraction 49 3 Results and Discussion 50 3.1 Analytical tools for the characterisation of ACT 51 3.2 Stabilisation of ACT in solution 52 3.2.1 Effects of pH, buffers, and electrolytes on ACT solution stability 52 Effect of pH on ACT solution stability 52 Effect of buffer species on ACT solution stability 56 Effect of salts on ACT solution stability 57 Effect of buffer content on ACT solution stability 58 Summary of the effects of electrolytes on ACT solution stability 60 3.2.2 Effects of stabilisers and excipients on ACT solution stability 61 Surfactants for the stabilisation of ACT in solution 61 Sugars and polyols for the stabilisation of ACT in solution 63 Cyclodextrins for the stabilisation of ACT in solution 65 Amino acids for the stabilisation of ACT in solution 68 Preservatives for ACT containing solutions 70 3.2.3 Summary of ACT solution stability studies 71 3.3 Hydrogels as delivery system for ACT into wounds 72 3.3.1 Development as delivery system for wound healing 72 Sterilisation of hydrogels 73 Viscosity of hydrogels 73 Viscosity of gellan gum/hydroxyethyl cellulose hydrogels 76 3.3.2 Stability of ACT in hydrogel formulations 80 Effects of polymers on ACT stability in hydrated formulations 80 Aseptic manufacture of ACT loaded hydrogels 83 Analysis of ACT loaded hydrogels 85 Mid term stability of ACT in hydrogel formulations 85 Principles of data interpretation 86 Experimental results and discussion 90 Summary 93 Freeze/thaw stability of ACT in hydrogel formulations 93 3.3.3 Summary of hydrogels as ACT delivery systems 94 3.4 Dry delivery systems 95 3.4.1 Xerogels as drug delivery systems for wound healing 96 Lyophilisation process 96 DSC studies 97 Lyophilisation program 97 Gel composition for xerogel formation 100 Hydroxyethyl cellulose qualities for xerogel formation 101 Excipients in hydroxyethyl cellulose xerogels 103 Hydroxyethyl cellulose/gellan gum mixtures for xerogels 108 Other polymers for xerogel formation 109 3.4.2 Stability of ACT in xerogel formulations 112 Stability of ACT during the lyophilisation process 112 Mid term stability of ACT in xerogel formulations 115 Principles of data interpretation 116 Experimental results and discussion 118 Summary 121 3.4.3 Polymer films as drug delivery systems for wound healing 122 Production process 122 Gel composition for polymer film formation 124 Gelling agents for film formation 124 Polymers as additives to hydroxyethyl cellulose films 125 Hydroxyethyl cellulose / gellan gum mixtures for film formation 132 Protein stabilisers in polymer films 134 3.4.4 Stability of ACT in film formulations 135 Stability of ACT during the film manufacturing process 136 Mid term stability 138 Summary 141 3.4.5 Summary for dry matrices as ACT delivery systems 141 3.5 Release of ACT from dry delivery systems 143 3.5.3 Experimental setup 143 Membrane 143 Acceptor medium 144 Chamber model 145 3.5.4 Theoretical background and data interpretation 146 3.5.5 Release of model substances from gel based matrices 147 3.5.6 Release of ACT from formulations 151 Dynamic model 151 Static model 153 Evaluation of the model 153 Release of ACT from xerogel formulations 157 Release of ACT from film formulations 161 Summary 166 4 General summary 167 5 References 171 Curriculum vitae 183 Chapter 1 - Introduction - 1 - 1 Introduction The World Health Organisation of the United Nations prognoses the development of world-wide diabetes cases over the next decades in actual studies. Accordingly, the number of type II patients will more than double until 20301. Next to the disease itself, moreover, 25% of diabetes patients frequently develop chronic wounds with about half of them requiring elaborate inpatient treatment. Therefore, the diabetic foot causes more hospitalisation than does any other complication associated with diabetes and represents approximately 2.5% of all hospital admissions2. Not least driven by this need wound treatment has gone through great revolution during the last decades. The paradigm shift from dry dressings based on woven fabrics towards a moist environment caused whole lots of new developments in this field. Nevertheless, the pathological cases of chronic wounds are still difficult to handle. Even with the moist concept they require very patient and persistent treatment. Therefore, there still is strong desire for improved methods of therapy. And, due to the prognosed rise of the diabetes, this desire is likely to largely increase over the next decades. One resort out of this situation could be revealed by biotechnology. Especially in the year 2000, the even greater revolutions in this field mostly occurring in typical scientific laboratories but praised and supported by highest authorities raised great expectations for new drug candidates. Hence for example, on international level United States President Bill Clinton announced the completion of the first survey of the entire human genome and nationally the government of the free state of Bavaria launched its high-tech-offensive endowed with investments of 1.35 billion Euros in local life science research. In this environment several small new biotech companies were founded. A considerable number of those established in Martinsried near Munich and began their research work. One of those companies is the SWITCH BIOTECH AG focusing its research on wound treatment based on peptides. One outcome of this work was the identification of 1-antichymotrypsin (ACT) as potential therapeutic for chronic wounds. Hence, to take the next step in development of 1-antichymotrypsin (ACT) as drug candidate a collaboration between SWITCH BIOTECH AG and the Department Pharmaceutical Technology and Biopharmaceutics of the LMU Munich was Chapter 1 - Introduction - 2 - contracted in terms of a Ph. D. study at the Department under the supervision of Prof. Dr. Winter. The aim of this study is to create formulations and drug carriers that stabilise and deliver ACT in bioactive state into the wound site. This thesis addresses introductory remarks about wound healing and protein delivery from hydrogels followed by the results of the research on the ACT formulation and concomitant carrier development. Chapter 1 - Introduction - 3 - 1.1 Wound healing In this section an overview over the physiology and pathophysiology of wound healing is described. This represents the medicinal context of this work and highlights the scientific rational behind the delivery of ACT in chronic wounds. Moreover, the established methods for treatment of wounds including dressings and carriers are discussed. Hereby, the methodical context of a treatment with ACT as drug product with the indication wound treatment is given. 1.1.1 Physiology of wound healing The following paragraph describes the physiology of wound healing. It starts with the process of healing itself. Next, a selection of growth factors involved in the process is outlined in detail. The role of growth factors is essential for the present understanding of wound healing. Moreover, growth factors are important starting points for drug based wound treatment having led to approval of platelet-derived growth factor (PDGF), the main competitor of a maybe future product based on ACT. Consequently, proteases and their inhibitors relevant in wound healing are highlighted. As well as growth factors, proteases play important roles in wounds. And, together with their inhibitors proteases are also starting points for wound therapy. Thereby, the discussion focuses on the inhibitor ACT and its target cathepsin G because ACT and its delivery represents the main topic of this thesis. Wound healing process The physiological wound healing process in the present understanding is usually divided into four steps coagulation, inflammation, followed by migration and proliferation and finally the remodelling phase. These phases are not exactly distinguishable from each other, because occasionally they overlap or proceed concurrently. In the damaged vessel wall platelets - stimulated by mediators - immediately adhere to the exposed collagen of the vessel wall. The clustered platelets partially coalesce...</p>