METHODS FOR TREATING CELLULITE

Abstract

The invention relates to the discovery that collagenase injections are effective in dissolving and lysing the collagenase septa network in the skin that comprises cellulite. As such, the invention relates to methods of treating cellulite in a patient in need of such treatment comprising injecting or otherwise delivering the effective amount of purified collagenase to the collagenase septa network of cellulite in the skin. The invention also relates to the use of collagenase in the manufacture of a medicament to treat cellulite of the skin.

Claims

1. A method of treating cellulite in a subject in need of such treatment, the method comprising delivering an effective amount of purified collagenase to the collagenous septa network of cellulite.

2. The method according to claim 1, wherein the collagenase (Clostridiopeptidase A) is derived from the bacterium Clostridium histolyticum.

3. The method according to claim 1, wherein the purified collagenase is administered alone.

4. The method according to claim 1, wherein the purified collagenase is administered in an absence of traimcinolone or other corticosteroids.

5. The method according to claim 1, wherein the purified collagenase is injected in a dose comprising at least about 700 SRC units, applied in one or more injections.

6. The method according to claim 1, wherein the purified collagenase is injected in a dose comprising at least about 1000 SRC units, applied in one or more injections.

7. The method according to claim 1, wherein the purified collagenase is injected in a dose comprising at least about 1500 SRC units, applied in one or more injections.

8. The method according to claim 1, wherein the purified collagenase is injected in a dose comprising at least about 10000 ABC units, applied in one or more injections.

9. The method according to claim 1, wherein the purified collagenase is injected in a volume of about 1.0 ml.

10. The method according to claim 1, wherein the purified collagenase is injected at multiple sites.

11. The method according to claim 1, wherein the purified collagenase is comprised of collagenase I and collagenase II.

12. The method, according to claim 9, wherein the injection is delivered in the area of cellulite, characterized by skin dimpling.

13. The method according to claim 1, wherein the subject is a human patient.

14. The method according to claim 1, wherein the treatment is repeated after about four to six weeks.

15. The method according to claim 1, wherein after one month of receiving at least one administration of collagenase, the patient achieves a significant visual reduction in the appearance of cellulite.

16. The method according to claim 1, wherein the purified collagenase is injected in a dose comprising from about 500 SRC units/mg to about 15,000 SRC units/mg, applied in one or more injections.

Description

DETAILED DESCRIPTION OF SPECIFIC EMBODIMENTS

[0009] The invention related to the discovery that collagenase injections are effective in lysing the collagen septae network of cellulite in humans to treat cellulite and restore a smooth skin appearance. The invention relates to methods of treating cellulite in a subject in need of such treatment, which involves injecting an effective amount of collagenase to the thigh and/or buttocks. The invention also relates to the use of collagenase in the manufacture of a medicament to treat cellulite.

[0010] Collagenase injections have been proposed for the treatment of diseases such as Dupuytren's disease, adhesive capsulitis and Peyronie's disease. These diseases are all associated with collagen cords or plaques. (Wegman, Thomas L. U.S. Pat. No. 5,589,171 Dec. 31, 1996, U.S. Pat. No. 6,086,872 Jul. 11, 2000, U.S. Pat. No. 6,022,539, Feb. 8, 2000, Adhesive Capsulitis-patent Pending, all of which are incorporated herein by reference in their entirety).

[0011] Collagenase injections have also been proposed for the treatment of cellulite when combined with hyaluronidase, a soluble enzyme product prepared from mammalian testes (see Pinelle, Sheldon R. U.S. Pat. No. 4,645,668 Mar. 27, 1985). The patent disclosed one working example for cellulite with a low dose of collagenase (100 units) in combination with hyaluronidase (150 units) for only in female patient. No further details in the improvement of cellulite after the injections was presented.

[0012] The use of intralesional injection of purified Clostridial collagenase has been shown to be clinically safe and effective in clinical trials in Dupuytren's disease in correcting the flexion contracture deformity of the hand(s). Additionally, the use of extracapsular injection of purifies Clostridial collagenase has been shown to be clinically safe and effective in the treatment of adhesive capsulitis (frozen shoulder) in clinical trials in restoring injection has also been used by others in clinical trials in Peyronie's disease, a contracture deformity of the penis.

[0013] The published work of the inventor, Dr. Badalamente, in Dupuytren's disease forms the rationale for the proposed invention (Starkweather, K., Lattuga, S., Hurst, L. C., Badalamente, M. A., Guilak, F., Sampson, S. P., Dowd, A., Wisch, D. Collagenase in the Treatment of Dupuytren's Disease: An in vitro Study, J. Hand Surg. 21A:490-95, 1996; Badalamente, M. A., Hurst, L. C., Enzyme Injection as a Non-operative Treatment for Dupuytren's Disease, J. Drug-Delivery 3(1):35-40, 1996; Hurst, L. C., Badalamente, M. A. (invited authorship) Non-operative Treatment of Dupuytren's Disease, Hand Clinics, G. M. Rayan (ed). W. B. Saunders 15(1), 97-107, 1999; Hurst, L. C., Badalamente, M. A. (invited editors & authorship), Dupuytren's Disease, R. Tubinana, R. Tubiana, C. Leclercq, L. C. Hurst, M. A. Badalamente (eds), Martin Dunitz Publisher, London (2000); Badalamente, M. A., Hurst, L. C. Enzyme Injection as a Non-operative Treatment of Dupuytren's Disease, J. Hands Surg. 25A(4); 629-36, 2000; Badalamente, M. A., Hurst, L. C., Hentz, V. R. Collagen as a Clinical Target: Non-operative Treatment of Dupuytren's Disease, J. Hand Surg. 27A(5):788-98, 2002) In Dupuytren's disease, the pathognomonic fibrous cord is often interspersed with a septa-like arrangement of adipose tissue. These present clinically as mattress-type “lumps” of varying sizes and in Dupuytren's disease, are termed nodules. It has been a consistent clinical finding in both Phase 2 and 3 trials for Dupuytren's disease that after purified Clostridial collagenase injection, not only does the collagenous cord dissolve and rupture when subjected to pressure in extension, but the fibro-fatty nodules, also resolve, and harmlessly resorb. Therefore, collagenase injected subcutaneously into an area of cellulite was postulated to be a safe and effective treatment for this condition in restoring a smooth appearance of the skin of the thighs and/or buttocks.

[0014] Collagenase is an enzyme that has specific ability to digest collagen. A preferred form of a collagenase is derived from fermentation by Clostridium histolyticum and is purified by a chromatographic technique, such as that disclosed in U.S. Application Ser. No. 60/763,470 filed on Jan. 20, 2006 (Attorney Docket Number 4024.3001 US), which is incorporated herein by reference. Collagenase naturally produced by Clostridium histolyticum once purified will exhibit two distinct peaks when run on an electrophoresis SDS gel. It is these two distinct peaks that are referred to as collagenase I and collagenase II.

[0015] Sterilized lyophilized collagenase powder is commercially available having a minimum assay of 50 units per mg. The assay may range considerably above that from batch to batch, but is taken into account in determining the weight of the powder to use with a pharmaceutically acceptable carrier, for example, normal saline, in preparing a desired concentration for treatment.

[0016] The collagenase is applied in a liquid carrier that is pharmaceutically acceptable, including inertness towards the collagenase. Examples are normal saline, aqueous, NaCl CaCl2 buffer, aqueous dextran solution, aqueous hetastarch solution.

[0017] One form of the Purified Collagenase used for Injection, is comprised of two microbial collagenases, referred to as “Collagenase ABC I” and “Collagenase ABC II”. Both collagenases are isolated and purified from the fermentation of the bacterium Clostidium histolyticum and belong to the same metalloprotease.

[0018] Collagenase ABC I is a single polypeptide chain consisting of approximately 1000 amino acids of known sequence. It has an observed molecular weight of 115 kiloDalton (kD), an isoelectric point (pi) between 5.63-5.68 and an extinction coefficient of 1.480. From its activity behavior toward synthetic substrate, it has been determined that Collagenase ABC

I is the class I Clostridium histolyticum collagenase in the literature.

[0019] Collagenase ABC II is also a single polypeptide chain consisting of about 1000 amino acids of deduced sequence. It has an observed molecular weight of 110 kD, an isoelectric point between 5.46-5.57 and an extinction coefficient of 1.576. Collagenase ABC functionally belongs to the class II Clostridium histolyticum collagenase in the literature.

[0020] The drug substance may have a 1 to 1 mass ratio for collagenase ABC-I and ABC-II with an extinction coefficient of 1.528. Both collagenases require tightly bound zinc and loosely bound calcium for their activity. Collagenase ABC I and Collagenase ABC II are not immunologically crossreactive and have a very broad hydrolyzing reactivity toward all types of collagen. Even though each collagenase shows different specificity, together they synergistic activity toward collagen.

[0021] Lyophilized Collagen for Injection is purified clostridial collagenase prepared as lyophilized formulation and may contain about 0.1 mg lactose monohydrate USP per 1,000 ABC units of collagenase activity.

[0022] A preferred collagenase composition comprises a mixture of collagenase I and collagenase II in a mass ratio of about 1 to 1 and having specific activity from about 500 SRC units/mg to about 15,000 SRC units/mg, preferably of at least about 700 SRC units/mg, more preferably of at least about 1000 SRC units/mg, even more preferably at least about 1500 SRC units/mg. One SRC unit will solubilize rat tail collagen into ninhydrin reaction material equivalent to 1 nanomole of leucine per minute, at 25 degrees, C, pH 7.4. Collagenase has been described in ABC units as well. The potency assay of collagenase is based on the digestion of undenatured collagen (from bovine tendon) at pH 7.2 and 37 degrees C. for 20-24 hours. The number of peptide bonds cleaved are measured by reaction with ninhydrin. Amino groups released by a solubilize digestion control are subtracted. One net ABC unit of collagenase will solubilize ninhydrin reactive material equivalent to 1.09 nanomoles of leucine per minute. One SRC unit equals approximately 6.3 ABC units.

[0023] The collagenase is preferably administered via injection in a liquid carrier that is pharmaceutically acceptable. Preferably, the carrier does not interact or deactivate the collagenase. Examples are normal saline, aqueous NaCl/CaCl, buffer (containing 0.9% NaC 1 and 2 mM CaCl2). For example, the lyophilized formulation can contain 0.1 mg lactose monohydrate per 1,000 ABC units. Each glass vial used below contained 5,150 ABC units collagenase.

[0024] In accordance with the invention, collagenase in a liquid carrier is injected into an area of cellulite in the subject's posterolateral thigh. The amount and concentration of collagenase used is effective to lyse and dissolve the collagen septa network of the cellulite.

[0025] The injection is a sterile one and does not exceed 1.0 ml. The total dosage is injected at five different points into the posterolateral thigh where the cellulite dimples of the thigh are most apparent. The objective is to assure good distribution of the collagenase. Patients preferably rest on the contra lateral thigh, in bed, for about one, preferably two hours or more.

[0026] In other embodiments, the collagenase can be administrated locally or topically, such as, a transdermal patch or topical cream or topical ointment to the area of cellulite or can be administered via an implant, such as, microcapsules or michrospheres which release collagenase over time.

[0027] In one embodiment, the patient is characterized as having an area of at least 10×10 cm of cellulite on the posterolateral thigh. The invention can achieve improvement in restoring normal and smooth skin appearance in the 1 O×10 cm are of cellulite on the posterolateral though.

[0028] In another embodiment of the present invention, collagenase can be administrated locally or topically, such as, a transdermal patch or topical cream or topical ointment to the area of cellulite or can be administered via an implant, such as, microcapsules or michrospheres which release collagenase over time and is administered in the absence of traimcinolone or other corticosteroids.

[0029] In cases where results of a single treatment are considered inadequate, the same procedures, total amount of collagenase and concentration may be repeated at 4-6 weeks intervals. Areas of cellulite, other than the posterolateral thigh may also require treatment, or repeated treatment at 4-6 week intervals. For example, the front of the thigh and the buttocks may contain areas of cellulite.

EXPERIMENTAL

Methods

[0030] Ten patients entered the study protocol, all females, mean age 41=10 years. The mean body mass index (BMI) was 28.

[0031] The minimum are of cellulite of the posterolateral thigh needed for inclusion was 10×10 cm. All patients had areas of cellulite of the posterolateral thigh which exceeds the minimum 10×10 cm area. Baseline digital photographs were taken of the treatment area. In a sterile fashion, 10,000 ABC units (0.58 mg) were injected at five points in the 10×10 cm target cellulite area. The total fluid volume of the injection was 1.0 ml. The buffer used was sterile 0.9% NaCL and 2 mM CaCl2. All patients are flowed post injection, at one day, one week, one, three, and six months. Post treatment photographs are taken serially.

[0032] Patients had the option of choosing to have a similar collagenase injection on the opposite side, for cosmetic symmetry, when they reached the time interval of 4-6 weeks post the first collagenase injection. Qualification of the reduction/elimination of cellulite in the target area of the thigh was by visual inspection and photographic documentation.

[0033] The target area of the cellulite treated was divided into four equal quadrants in the 10×10 cm target treatment area. Reduction/elimination of cellulite in the target treatment area was quantified by visual inspection by quadrant, e.g., 4/4=no quadrants responded to treatment, 3/4=three quadrants responded to treatment, 2/4 two quadrants responded to treatment, 1/4=one quadrant responded to treatment, 0/4=all quadrants responded to treatment. The actual are in cm of any remaining cellulite of the posterolateral target area of cellulite was also measured. Photographs were also used for documentation.

Results:

[0034] All patients experienced a reduction in cellulite of the target thigh after collagenase injection. Table 1 shows the results of the reduction in the cellulite in the quadrants of the thighs in the patients treated. There was significant reduction in cellulite appearance of the injected are. Cellulite was reduced by 77% by day 1 in comparison to baseline. This result was sustained in the longer term. In comparison to baseline, cellulite area was reduced by 74% at 1 week, by 89% at 1 month, by 86% at 3 months and by 76% at 6 months.

[0035] Adverse events included tenderness in the injection area, ecchymosis and mild edema which resolved well in the mean of 10, 18 and 6 days respectively.

[0036] Significant improvement in the reduction of cellulite of the posterolateral thigh was seen in the patients who received collagenase injection(s). This study has shown that collagenase injection of areas of cellulite is a safe and effective method.

[0037] While this invention has been particularly shown and described with reference to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims.

TABLE-US-00001 TABLE 1 1 day 1 week 1 month 3 month 6 month Patient Age Sex Thigh Parameters Baseline post 1st post 1st post 1st post 1st post 1st LY C-009 37 F Right BMI 33 33 34 34 34 36 circumference: 68 cm 68 cm 68 cm 68 cm 68 cm 69 cm Area (cm): 12 × 14 cm 12 × 14 cm 5 × 5 cm 5 × 5 cm 5 × 5 cm 8 × 9 cm Quadrants 4 4 2 2 2 3 1 day 1 week 1 month 3 month 6 month Patient Age Sex Thigh Parameters Baseline post 2nd post 1st post 1st post 1st post 1st NW C-001 52 F Right BMI (cm) 32 31 31 31 32 32 circumference: 68 cm 66 cm 64 cm 64 cm 64 cm 64 cm Area (cm): 16 × 12 cm 2 × 2 cm 5 × 5 cm 0 5 × 1 cm 5 × 1 cm Quadrants 4 1 2 0 1 1 1 day 1 week 1 month 3 month 6 month Patient Age Sex Thigh Parameters Baseline post 2nd post 2nd Post 2nd post 2nd post 2nd NW C-001 52 F Left BMI (cm) 32 32 32 32 31 30 circumference: 68 cm 68 cm 69 cm 66 cm 63 cm 63 cm Area (cm): 19 × 19 cm 19 × 19 cm 5 × 5 cm 0 4 × 0 cm 0 Quadrants 4 4 2 0 1 0 1 day 1 week 1 month 3 month 6 month Patient Age Sex Thigh Parameters Baseline post 1st post 1st post 1st post 1st post 1st PD C-004 44 F Left BMI (cm) 24 24 25 24 25 25 circumference: 57 65 66 63 56 56 Area (cm): 10 × 10 0 0 4 × 3 4 × 3 4 × 3 Quadrants 4 0 0 1 1 1 1 day 1 week 1 month 3 month 6 month Patient Age Sex Thigh Parameters Baseline post 2nd post 2nd Post 2nd post 2nd post 2nd PD-C-004 44 F Right BMI (cm) 25 25 25 25 25 circumference: 60 62 62 62 62 Area (cm): 10 × 10 0 1 × 4 0 0 Quadrants 4 0 1 0 0 1 day 1 week 1 month 3 month 6 month Patient Age Sex Thigh Parameters Baseline post 1st post 1st post 1st post 1st post 1st AP C-012 54 F Right BMI (cm) 23 23 23 23 Lost to circumference: 56 56 56 52 follow up Area (cm): 10 × 11 3 × 9 3 × 5 5 × 4 Quadrants 4 2 1 1 ER-C-015 44 F Left BMI (cm) 22 22 22 22 21 circumference: 51 54 52 53 53 Area (cm): 10 × 10 5 × 9 4 × 10 0 0 Quadrants 4 2 3 0 0 AE C-016 40 F Right BMI (cm) 31 31 31 31 31 30 circumference: 67 79 72 69 68 64 Area (cm): 12 × 12 0 9 × 5 2 × 3 2 × 7 2 × 7 Quadrants 4 0 3 1 2 2 1 day 1 week 1 month 3 month 6 month Patient Age Sex Thigh Parameters Baseline post 2nd post 2nd Post 2nd post 2nd post 2nd AE C-016 40 F Left BMI (cm) 31 31 31 31 31 circumference: 69 71 68 68 68 Area (cm): 12 × 14 0 2 × 4 1 × 2 0 Quadrants 4 0 1 1 0 1 day 1 week 1 month 3 month 6 month Patient Age Sex Thigh Parameters Baseline post 1st post 1st post 1st post 1st post 1st MM C-017 27 F Right BMI (cm) 37 37 37 37 Lost to circumference: 74 74 74 74 Follow up Area (cm): 14 × 14 0 1 × 10 6 × 3 Quadrants 4 0 2 1