COMPOSITION COMPRISING PEPSTATIN AND ALGINIC ACID OR A SALT THEREOF, AND USE THEREOF

Abstract

The present invention relates to an aqueous composition for ophthalmic use comprising pepstatin and alginic acid or a salt thereof, and to the use of said composition in a method for the treatment of a disease or symptom of the eyeball and/or periocular region related with or deriving from the presence of pepsin in the lacrimal fluid.

Claims

1. An aqueous composition for ophthalmic use comprising (i) a mixture M comprising or, alternatively, consisting of: (a) a pepstatin or a pharmaceutically acceptable salt thereof, and (b) an alginic acid, or a pharmaceutically acceptable salt thereof; and (ii) at least one ophthalmological grade additive and/or excipient.

2. The composition according to claim 1, wherein said mixture M further comprises (c) hyaluronic acid or a pharmaceutically acceptable salt thereof.

3. The composition according to claim 2 wherein said (i) mixture (M) comprises or, alternatively, consists of: (a) a pepstatin; (b) an alginate of an alkaline or alkaline-earth metal, preferably a magnesium alginate; and, (c) a hyaluronate of an alkaline or alkaline-earth metal, preferably a sodium hyaluronate.

4. The composition according to claim 1, wherein the composition is formulated for ophthalmic use; preferably in liquid form for ophthalmic use, more preferably it is eye drops or aqueous-based eye drops; or, alternatively, in semi-solid form for ophthalmic use, preferably an ointment, a salve, a gel or a cream.

5. The composition according to claim 1 for use as medicament.

6. The composition according to claim 1 for use in a method for preventive and/or curative treatment of a disease or symptom of the eyeball and/or periocular region related with or deriving from the presence of pepsin in the lacrimal fluid in a subject in need.

7. The composition for use according to claim 6, wherein said disease or symptom of the eyeball and/or periocular region is selected from the group comprising or, alternatively, consisting of: lacrimal dysfunction syndrome (LDS) or dry eye syndrome, conjunctivitis of the conjunctiva, conjunctivitis of the cornea, ocular inflammation, periocular inflammation, blepharitis, keratitis, and uveitis; preferably selected from the group comprising or, alternatively, consisting of: lacrimal dysfunction syndrome (LDS) or dry eye syndrome, conjunctivitis of the conjunctiva, conjunctivitis of the cornea, ocular inflammation, and periocular inflammation.

8. The composition for use according to claim 6, wherein said composition is for use in a method for the preventive and/or curative treatment of a disease or symptom of the eyeball and/or periocular region in: (i) a subject with a gastric reflux, which manifests itself from the stomach to an oesophageal and/or extra-oesophageal region, (ii) a subject with a disease or symptom related with or deriving from said gastric reflux.

9. The composition for use according to claim 8, wherein said diseases or symptoms related with or deriving from, said gastric reflux, which manifests itself from the stomach to an oesophageal and/or extra-oesophageal region, are selected from the group comprising or, alternatively, consisting of: gastroesophageal reflux disease (GERD), erosive or non-erosive, laryngopharyngeal reflux (LPR) or extra-oesophageal reflux, oesophagitis, oesophageal ulcers, oesophageal mucosal de-epithelialisation, acid regurgitation, heartburn, feeling of gastric fullness, epigastric pain, dyspepsia, nausea, chronic cough, bronchospasm, sore throat, laryngitis, globus sensation or hypopharyngeal bolus, pyrosis, dysphonia, and rhinopharyngeal phlogosis.

10. A process for the preparation of the composition according to claim 1, wherein said process comprises: the step 1) for dissolving the pepstatin in a solvent, preferably an alcoholic solvent or ethanol, at neutral pH to obtain an alcoholic solution of pep statin, followed by the step 2) for diluting the alcoholic solution of pepstatin in an aqueous solution comprising an alginic acid salt, preferably an alginate of an alkaline or alkaline-earth metal, more preferably magnesium alginate.

11. A method for treating a disease or symptom of the eyeball and/or periocular region related with or deriving from the presence of pepsin in the lacrimal fluid, comprising: administering to the subject an aqueous composition comprising (i) a mixture M comprising: (a) a pepstatin or a pharmaceutically acceptable salt thereof, and (b) an alginic acid, or a pharmaceutically acceptable salt thereof; and (ii) at least one ophthalmological grade additive and/or excipient.

12. The method according to claim 11, wherein said mixture M further comprises (c) hyaluronic acid or a pharmaceutically acceptable salt thereof.

13. The method according to claim 12 wherein said (i) mixture (M) comprises: (a) a pepstatin; (b) magnesium alginate; and, (c) sodium hyaluronate.

14. The method according to claim 11, wherein the composition is formulated as eye drops, or as an ointment, a salve, a gel or a cream.

15. The method according to claim 11, wherein said disease or symptom of the eyeball and/or periocular region is selected from the group consisting of: lacrimal dysfunction syndrome (LDS) or dry eye syndrome, conjunctivitis of the conjunctiva, conjunctivitis of the cornea, ocular inflammation, periocular inflammation, blepharitis, keratitis, and uveitis; preferably selected from the group comprising or, alternatively, consisting of: lacrimal dysfunction syndrome (LDS) or dry eye syndrome, conjunctivitis of the conjunctiva, conjunctivitis of the cornea, ocular inflammation, and periocular inflammation.

16. The method according to claim 15, wherein the subject has gastric reflux, which manifests itself from the stomach to an oesophageal and/or extra-oesophageal region.

17. The method according to claim 16, wherein said subject has gastroesophageal reflux disease (GERD), erosive or non-erosive, laryngopharyngeal reflux (LPR) or extra-oesophageal reflux, oesophagitis, oesophageal ulcers, oesophageal mucosal de-epithelialisation, acid regurgitation, heartburn, feeling of gastric fullness, epigastric pain, dyspepsia, nausea, chronic cough, bronchospasm, sore throat, laryngitis, globus sensation or hypopharyngeal bolus, pyrosis, dysphonia, or rhinopharyngeal phlogosis.

Description

FIGURES

[0034] FIG. 1: absorption spectra of the blank and of the sample (pepsin) without the presence of the inhibitory substance (pepstatin); conditions: pepsin 0.02%, haemoglobin 2%, pH 1.5, 37° C.

[0035] FIG. 2: absorption spectra of the blank and of the pepsin sample in the presence of pepstatin (pepstatin: suspension in H.sub.2O) and comparison with the spectra relating to free pepsin without the presence of pepstatin.

[0036] FIG. 3: absorption spectra of the blank (pepsin without pepstatin) and of the sample (pepsin+pepstatin) (pepstatin: dissolved in EtOH and diluted in water).

[0037] FIG. 4: pepsin activity spectra in the presence of an aqueous solution comprising magnesium alginate; conditions: pepsin 0.02%, haemoglobin 2%, 1% of aqueous solution comprising magnesium alginate; pH 1.5, 37° C.

[0038] FIG. 5: absorption spectra of the blank (pepsin in the absence of pepstatin but in the presence of an aqueous solution comprising magnesium alginate) and of the pepsin samples in the presence of an aqueous solution comprising magnesium alginate and pepstatin (pepstatin diluted in alginate aqueous solution after dissolution in EtOH).

DETAILED DESCRIPTION OF THE INVENTION

[0039] Forming an object of the present invention is a composition comprising (i) a mixture M of active components comprising or, alternatively, consisting of:

[0040] (a) pepstatin or a pharmaceutically acceptable salt thereof, preferably an alkali metal or alkaline earth metal salt (e.g. magnesium, sodium, potassium or calcium), and

[0041] (b) an alginic acid or a pharmaceutically acceptable salt thereof, preferably an alkali metal or alkaline-earth metal alginate (e.g. magnesium, sodium, potassium or calcium);

[0042] and, optionally, said composition comprises (ii) at least one pharmaceutical or ophthalmological grade additive and/or excipient.

[0043] Pepstatin (alternatively referred to as pepstatin A) is an aspartyl protease inhibitor. It is a hexapeptide containing the amino acid statin (Sta, (3S,4S)-4-amino-3-hydroxy-6-methylheptanoic) acid, with the sequence lsovaleryl-Val-Val-Sta-Ala-Sta (Iva-Val-Val-Sta-Ala-Sta) (example of CAS No.: 26305-03-3). Pepstatin is a molecule produced by actinomycete bacteria. At neutral pH (buffered) pepstatin is in acidic form and it can be dissolved in alcohol (for example ethanol) and then diluted in water. When in salt form instead, pepstatin can be dissolved in water at neutral pH. Preferably, for the preparation of the mixtures or compositions of the present invention, comprising (a), (b) and optionally (c) and/or other components described in the present invention, pepstatin is used as such, that is pepstatin not in the form of salt.

[0044] Together with (a) and, optionally, (c) and/or other components described in the present invention, the alginic acid comprised in the mixture or composition of the invention is preferably an alginic acid (for example CAS No. 9005-32-7) having an average molecular weight comprised in the range from about 50 kDalton (kDa) to about 800 kDa; preferably from about 100 kDa to about 600 kDa; more preferably from about 200 kDa to about 400 kDa, for example to about 240 kDa (atomic mass units). Advantageously, said (b) alginic acid or a salt thereof, is obtained from marine algae.

[0045] In a preferred embodiment, the mixture M of active components, comprised in the composition of the invention, comprises or, alternatively, consists of: (a) pepstatin or a salt thereof, (b) an alginic acid, or a salt thereof, preferably an alkali metal or alkaline earth metal salt (e.g. magnesium, sodium, potassium or calcium), more preferably magnesium alginate, and (c) a lubricating agent, preferably hyaluronic acid or a pharmaceutically acceptable salt thereof, more preferably an alkali metal or alkaline earth metal hyaluronate (e.g. magnesium, sodium, potassium or calcium),even more preferably sodium hyaluronate.

[0046] Together with (a) and (b) according to any one of the embodiments of the present invention, said lubricating agent (c), optionally comprised in the mixture M of the composition of the invention may be selected from: hyaluronic acid or a salt thereof, carboxymethyl cellulose, hypromellose, xanthan gum, polyvinylpyrrolidone (PVP), polyvinyl alcohol, and mixtures thereof; preferably hyaluronic acid or a salt thereof.

[0047] Together with (a) and (b) and optionally other components described in the present invention, hyaluronic acid or a salt thereof (e.g. sodium hyaluronate) comprised in the mixture or composition of the invention preferably is or is derived from a linear or branched hyaluronic acid with an average molecular weight comprised in the range from about 200 kDa to about 5,000 kDa; preferably from about 1,000 kDa to about 3,000 kDa; more preferably from about 1,500 kDa to about 2.000 kDa.

[0048] According to a preferred example, the composition of the invention comprises or, alternatively, consists of: (a) pepstatin; (b) alkali metal or alkaline earth metal alginate, preferably magnesium alginate, (c) alkali metal or alkaline earth metal hyaluronate, preferably sodium hyaluronate and ophthalmological grade additives and/or excipients.

[0049] According to a more preferred example, the composition of the invention comprises or, alternatively, consists of: (a) pepstatin, (b) magnesium alginate, (c) sodium hyaluronate, and ophthalmological grade additives and/or excipients.

[0050] According to a further preferred example, the composition of the invention comprises or, alternatively, consists of: (a) pepstatin, (b) magnesium alginate from alginic acid obtained from marine algae having an average molecular weight from about 200 kDa to about 400 kDa, for example to about 240 kDa, (c) sodium hyaluronate with an average molecular weight from about 1,500 kDa to about 2,000 kDa, and ophthalmological grade additives and/or excipients.

[0051] Besides (a) pepstatin, (b) alginic acid or a salt thereof, and, optionally, (c) a lubricating agent, preferably hyaluronic acid or a salt thereof, the mixture M comprised together with the additives in the composition of the invention may additionally comprise at least one further active component (d) selected from the group consisting of: plant extracts (for example extracts of green tea (Camellia sinensis), amino acids, vitamins of group A, B, C, D and/or E, and mixtures thereof.

[0052] The compositions of the present invention, comprising said mixture M comprising (a), (b), and, optionally (c), may comprise at least one acceptable pharmaceutical or food grade additive and/or excipient, that is a substance devoid of therapeutic activity suitable for pharmaceutical or food use. In the context of the present invention, the acceptable additives and/or excipients for pharmaceutical or food use comprise all the ancillary substances known to the person skilled in the art for the preparation of compositions in semi-solid or liquid form, such as, for example, diluents, solvents (including water), solubilisers, acidifiers, thickeners, sweeteners, lubricants, surfactants, preservatives, stabilisers, pH stabilising buffers and mixtures thereof.

[0053] The composition and the mixture M of the present invention, comprises (a), (b), and optionally (c) according to any one of the described embodiments, preferably do not comprise a steroidal compound.

[0054] According to an aspect of the invention, the mixtures or compositions of the invention are not formulated for oral use.

[0055] The composition for ophthalmic use of the invention, comprising (a), (b) and, optionally, (c) (according to any one of the described embodiments) may be in liquid form, such as water-based eye drops, and it shows high stability (preferably≥(greater than or equal to) 24 months), homogeneity and no formation of precipitates in liquid form, preferably water or oil-based eye drops, or in semi-solid form, preferably an ointment, a salve, a gel or a cream.

[0056] The composition of the invention in liquid form, for example in the form of eye drops, may comprise pepstatin in a molar concentration (M) comprised in a range from 0.1 nM (0.0001 μM) to 50 μM; preferably from 0.01 μM to 5 μM; more preferably from 0.5 μM to 2 μM (for example about 1 μM).

[0057] According to an aspect of the invention, the composition of the invention may comprise, in percentage (%) by weight with respect to the total weight of the composition: (a) pepstatin as such from 0.0000001% (1×10.sup.−8%) a 0.001% (1×10.sup.−3%), preferably from 0.000001% (1×10.sup.−6%) to 0.0003% (3×10.sup.−4%), more preferably from 0.00003% (3×10.sup.−5%) to 0.0001% (1×10.sup.−4%), (b) alginic acid or a salt thereof, preferably magnesium alginate, from 0.01% to 10%, preferably from 0.05% to 2%, more preferably from 0.05% to 0,4%, for example 0,2%; and, optionally, (c) lubricating agent, preferably hyaluronic acid or a salt thereof, more preferably sodium hyaluronate, from 0.01% to 10%; preferably from 0.05% to 2%; more preferably from 0.05% to 0.30%, for example 0.15%.

[0058] In the context of the present invention, the expression “composition” is used to indicate a pharmaceutical composition or medical device composition according to the European regulation on medical devices [EU 2017/745 —(MDR), Directive 93/42/EEC—(MDD)].

[0059] Forming an object of the present invention are the compositions and the mixture M of the present invention, comprising (a), (b), and optionally (c) and/or additives/excipients according to any one of the described embodiments, for use as medicament.

[0060] Forming an object of the present invention are the compositions and the mixture M of the present invention, comprising (a), (b), and optionally (c) and/or additives/excipients according to any one of the described embodiments, for use in a method for preventive and/or curative treatment of a disorder or disease of the eyeball and/or periocular region, preferably of inflammatory nature, such as for example lacrimal dysfunction syndrome (LDS), conjunctivitis, ocular inflammation or periocular inflammation (for example blepharitis, keratitis, uveitis), primarily related with or deriving from the presence of pepsin in the lacrimal fluid, in subjects in need.

[0061] The presence of pepsin in the lacrimal fluid is plausibly due to a gastric reflux in the esophageal and/or extraesophageal region.

[0062] The presence of pepsin in the lacrimal fluid may be determined through conventional diagnostic methods and methods known to the person skilled in the art suitable to detect pepsin in a liquid.

[0063] The presence of pepsin in the lacrimal fluid manifests itself in subjects with a gastric reflux and/or a disease or symptom associated with said gastric reflux.

[0064] Said diseases or symptoms associated with gastric reflux are selected from the group comprising or, alternatively, consisting of: gastroesophageal reflux disease (GERD), laryngopharyngeal reflux disease (RFL) or extraoesophageal reflux, esophagitis (acute or chronic inflammation of the oesophagus mucosa), oesophageal ulcers, oesophageal mucosal de-epithelialisation, acid regurgitation, heartburn, feeling of gastric fullness, epigastric pain, dyspepsia, nausea, chronic cough, bronchospasm, sore throat, laryngitis, globus sensation or hypopharyngeal bolus, pyrosis, dysphonia, rhinopharyngeal phlogosis, and all disorders primarily caused or co-caused by gastric reflux.

[0065] Said diseases or symptoms associated with gastric reflux, including the disease or symptom of the eyeball and/or periocular region, preferably of inflammatory nature, such as for example lacrimal dysfunction syndrome (SDL), conjunctivitis, ocular inflammation or periocular inflammation (for example blepharitis, keratitis, uveitis), may be present even in the absence of a diagnosis of gastroesophageal reflux disease (GERD), that is in subjects not suffering from GERD.

[0066] Furthermore, the present invention further relates to a process for preparing the mixture or composition of the invention (in short, process of the invention), preferably for ophthalmic use, comprising a step 1) for dissolving pepstatin in a suitable solvent (for example alcoholic solvent, ethanol or ethyl alcohol, isopropyl alcohol, glycerine, propylene glycol, sorbitol 20 or Tween® 20 (mixture of partial tri-esters of sorbitol with the mono and di-anhydrides thereof with stearic acid), ethoxylated hydrogenated castor oil 40 moles (Peg-40 hydrogenated castor oil); preferably in an alcoholic solvent, more preferably ethanol) at neutral pH (obtained using a buffer solution; preferably a borate buffer solution) to obtain a pepstatin alcoholic solution, preferably a pepstatin alcoholic solution at a concentration comprised in the range from 0.01 mg/ml to 1 mg/ml, preferably comprised from 0.1 mg/ml to 1 mg/ml, for example 1 mg/ml. Said step 1) is followed by the step 2) for diluting the pepstatin alcoholic solution in an aqueous solution comprising an alginic acid salt, preferably an alkali metal or alkaline earth metal alginate, more preferably magnesium alginate.

[0067] Pepstatin at neutral pH is not soluble in water and—in the prior art—pepstatin is used in the form of aqueous suspension.

[0068] On the contrary, the process of the invention allows to dissolve pepstatin in aqueous phase and without using solvents that are potentially toxic or unsuitable for ophthalmic use.

[0069] For the sake of clarity, in order to achieve the object of the present invention, the components (or active components) (a), (b) and, optionally (c) of the mixture or composition of the invention can be administered simultaneously or separately, (preferably in a time interval from 5 minutes to 30 minutes) and in any order; preferably, the active components are administered to a subject simultaneously, even more preferably in a single composition to obtain a more rapid effect and for ease of administration. When the active components of the invention are administered in a single composition, said single composition corresponds to the composition of the present invention.

[0070] In the context of the present invention and the expression “subject/s” is used to indicate human or animal subjects, preferably mammals (e.g. pets such as dogs, cats, horses, sheep or bovines). Preferably, the compositions of the invention are for use in methods for the treatment of human subjects.

[0071] Unless specified otherwise, the expression composition or mixture or other comprising a component at an amount “comprised in a range from x to y” is used to indicate that said component may be present in the composition or mixture or other at all the amounts present in said range, even though not specified, extremes of the range included.

[0072] Unless specified otherwise, the content of a component in a composition or mixture refers to the percentage (%) by weight of that component with respect to of said total weight of said composition or mixture.

[0073] Unless specified otherwise, the indication that a composition or mixture or other “comprises” one or more components means that other components can be present besides that or those specifically indicated, and the indication that a composition or mixture or other “consists” of determined components means that the presence of other components not indicated is excluded.

[0074] In the context of the present invention, the expression “treatment method” is used to indicate an intervention on a subject in need, comprising the administration of a composition or mixture of the invention to the subject at a therapeutically effective amount, with the aim of eliminating, reducing/decreasing or preventing a disease or ailment and the symptoms or disorders thereof.

[0075] The expression “therapeutically effective amount” refers to the amount of active compound that elicits the biological or medicinal response in a tissue, system, mammal, or human being that is sought and defined by an individual, researcher, veterinarian, physician, or other clinician or health worker.

EXAMPLES

[0076] Examples of ophthalmic composition in liquid form according to the invention are reported in Table 1, 2, 3 and 4 (solutions buffered to about pH 7.6±0.1: 7.4-7.8±0.1).

TABLE-US-00001 TABLE 1 Component % weight/total weight (w/w) Purified water from 90% to 99% Pepstatin or 1 × 10.sup.−8 to 1 × 10.sup.−3 (3 × 10.sup.−5%-1 × 10.sup.−4%) Pepstatin in EtOH 1 mg/ml from 0.01% to 1% (0.01%-0.1%) Magnesium alginate from 0.01% to 10% (0.05%-0.4%) Additives and/or excipients q.s at 100

TABLE-US-00002 TABLE 2 Component % weight/total weight (w/w) Purified water from 90% to 99% Pepstatin or 1 × 10.sup.−8 to 1 × 10.sup.−3 (3 × 10.sup.−5%-1 × 10.sup.−4%) Pepstatin in EtOH 1 mg/ml from 0.01% to 1% (0.01%-0.1%) Magnesium alginate from 0.01% to 10% (0.05%-0.4%) Di-sodium tetraborate from 0.01% to 5% (0.05%-0.50%) Boric acid from 0.01% to 5% (0.30%-1.50%) Sodium chloride from 0.01% to 5% (0.10%-1.00%) optional, other additives q.s at 100 and/or excipients

TABLE-US-00003 TABLE 3 Component % weight/total weight (w/w) Purified water from 95% to 99% Pepstatin or 1 × 10.sup.−8 to 1 × 10.sup.−3 (3 × 10.sup.−5%-1 × 10.sup.−4%) Pepstatin in EtOH 1 mg/ml from 0.01% to 1% (0.01%-0.1%) Magnesium alginate from 0.01% to 10% (0.05%-0.4%) Hyaluronic acid sodium salt from 0.01% to 10% (0.05%-0.30%) Additives and/or excipients q.s at 100

TABLE-US-00004 TABLE 4 Component % weight/total weight (w/w) Purified water from 95% to 99% Pepstatin or 1 × 10.sup.−8 to 1 × 10.sup.−3 (3 × 10.sup.−5%-1 × 10.sup.−4%) Pepstatin in EtOH 1 mg/ml from 0.01% to 1% (0.01%-0.1%) Magnesium alginate from 0.01% to 10% (0.05%-0.4%) Hyaluronic acid sodium salt from 0.01% to 10% (0.05%-0.30%) Di-sodium tetraborate from 0.01% to 5% (0.05%-0.50%) Boric acid from 0.01% to 5% (0.30%-1.50%) Sodium chloride from 0.01% to 5% (0.10%-1.00%) optional, other additives q.s at 100 and/or excipients

Experimental Part

I. Method

[0077] The method used to measure the enzymatic activity of pepsin alone or together with the inhibitory substance (pepstatin), consists of an adaptation of the Anson method [Anson et al, J. Gen. Physiol. 1931, 16, 59] which provides for the use of denatured haemoglobin as substrate. The enzymatic activity was determined after precipitation with trichloroacetic acid of the non-hydrolysed substrate. The activity of the enzyme was determined spectrophotometrically from the concentration of soluble peptides released by the proteolytic action.

[0078] Reaction studied:

[0079] (Haemoglobin+H.sub.2O)+pepsin.fwdarw.oligopeptides

II. Reagents:

[0080] Hydrochloric acid 12 M.

[0081] Humans haemoglobin (Sigma-Aldrich).

[0082] Pepsin (BDH; 1 Anson units per gram): enzyme.

[0083] Trichloroacetic acid solution 6.1 N (Sigma-Aldrich).

[0084] Pepstatin A: inhibitory substance (or inhibitor).

III. Conditions

[0085] T=37° C., pH=1,5, A.sub.nm, optical path 1 cm, reaction time 10 minutes. At pH=1.5, in which the experiments were conducted, there is a maximum activity of pepsin.

[0086] Haemoglobin 2%, pepsin 0,02%, inhibitor 0.01%.

IV. Preparation

[0087] Substrate: 250 mg of human haemoglobin are weighed in a 10 mL flask, it is brought up to volume with distilled water and left under stirring for 10 minutes in a water bath at 37° C. to obtain a solution 2.5%. The solution is passed through a filter paper to eliminate insoluble residues. 8 mL of the filtrate are taken and the volume is brought up to 10 mL with acidic water so as to have a final pH finale of 1.5 and a solution 2% (w/V).

[0088] Enzyme: 5 mg of pepsin are weighed in a 5 mL flask and it is brought up to volume with acidic water (pH=1.5).

[0089] Enzyme together with inhibitory substance: 5 mg of pepsin are weighed in a 5 mL flask. 0.5 mg/mL of a solution or suspension at pH=1.5 of the inhibitory substance are prepared separately (checking the pH with a pH meter and correcting it, if necessary, with hydrochloric acid 12 M in an amount such not to change the total volume). The flask containing pepsin is brought up to volume with the solution or suspension of the inhibitory substance 0.5 mg/mL and the entirety is kept under magnetic stirring for 10 minutes prima before prior to beginning the experiment.

[0090] Trichloroacetic acid: a trichloroacetic acid solution 6.1 N is diluted 20 folds in distilled water to obtain a solution 5% (wN).

V. Experimental Procedure

[0091] 0.25 mL of substrate (haemoglobin) are pipetted in a suitable vial and almost entirely submerged in a water bath thermostated at 37° C. It is left under magnetic stirring for 10 minutes at 37° C. 50 microlitres of the enzyme solution (pepsin) or of the enzyme together with the inhibitory substance (pepsin+pepstatin A) are then added and the system is kept under incubation for exactly 10 minutes. 0.5 mL of the trichloroacetic acid solution 5% are added after this period of time and then left for another 5 minutes. Exactly 3 mL of distilled water at pH=1.5 are added into the vial using a graduated pipette; the solution is stirred and filtered using a 0.45 μm syringe filter. An absorption spectrum (with absorbance (A) always below 1) with wavelengths comprised between 300 nm and 250 nm is recorded using a spectrophotometer using the absorbance value at 280 nm as reference.

[0092] Blank: 0.25 mL of substrate (haemoglobin) are pipetted in a suitable vial and almost entirely submerged in a water bath thermostated at 37° C. It is left under magnetic stirring for 10 minutes. 50 microlitres 0.5 mg/mL of the inhibitory substance solution (without enzyme) are then added and the system is kept under incubation for exactly 10 minutes. 0.5 mL of the trichloroacetic acid solution 5% are added after this period of time and then left for another 5 minutes.

[0093] 50 microlitres of solution 1 mg/mL of enzyme without inhibitory substance are the introduced. Exactly 3 mL of distilled water at pH=1.5 are added into the vial using a graduated pipette, then the solution is stirred and filtered using a 0.45 μm syringe filter. An absorbance with wavelengths comprised between 300 nm and 250 nm is recorded using a spectrophotometer using the absorbance value at 280 nm as reference.

VI. Calculations

[0094] Each experiment was repeated at least twice. The final absorbance value (A) at 280 nm was the mean of the absorbance values obtained (with an uncertainty on the values always much lower than 10%). A ΔA, with ΔA.sub.x=A.sub.280sample substanceX−A.sub.280blank substance X and ΔA.sub.o=A.sub.280sample free pepsin−A.sub.280blank free pepsin in the event of absence of the inhibitory substance are associated with the pepsin-inhibiting substance. The ΔA found is proportional to the amount of soluble aromatic amino acid residues released in the solution due to the proteolytic action of pepsin alone or in the presence of the inhibitor (pepstatin A).

[0095] FIG. 1 reports the absorption spectra of the blank and of the sample (reaction time=10 minutes) without the presence of any inhibitor. ΔA.sub.o=0.40.

[0096] The maximum absorbance difference between the sample and the blank at 280 nm found is equal to 0.34 and it regards the proteolytic action of the pepsin enzyme against the substrate within a 10-minute period of time without the presence of any inhibitor under these experimental conditions.

[0097] The residual activity in the presence of substance X was calculated based on the equation below:

Residual activity=(ΔA.sub.x/66 A.sub.o)×100   Equation 1

VII. Results and Discussion

VII.A. Pepstatin

[0098]

TABLE-US-00005 TABLE 5 Values of ΔA.sub.X at 280 nm regarding the substance studied and of the residual activity with respect to the maximum activity measured. Substance ΔA.sub.X Residual activity None 0.340 100% PEPSTATIN 0  0%

[0099] The concentration of the substance (0.01%) was selected both so as to observe an inhibition against pepsin and so as to reduce the optical diffusion caused by the inhibitor to the maximum. The Anson method used allows to normalise the increase in absorbance regarding diffusion which has an equivalent effect both on the blank and on the sample for each substance. As a matter of fact, an absorbance difference at 280 nm was measured irrespective of the diffusion phenomena.

[0100] Pepstatin showed a total abatement in the residual activity (ΔA.sub.x=0).

[0101] Pepstatin is insoluble in H.sub.2O, but the suspension produced in laboratory was fully effective for the purposes sought (ΔA.sub.x=0).

[0102] FIG. 2 reports the absorption spectra of the blank and of the sample (reaction time=10 minutes) in the presence of pepstatin 0.01% (suspension in H.sub.2O; greater absorbance of the blank due to the pepstatin suspension), ΔA.sub.o=0.004, and comparison with the spectra regarding free pepsin without the presence of inhibitors ΔA.sub.x=0.340.

[0103] Pepstatin was perfectly soluble in ethanol (EtOH) at a concentration of 1 mg/mL. Such solution can be diluted in water. Pepstatin maintains the inhibitory activity thereof even after diluting in water from EtOH and it remains soluble; this is proven by the fact that it maintains the inhibitory ability thereof and by the fact that no scattering effect is observed with respect to the blank (aggregation index of the molecules not found in this case).

[0104] The activity of pepsin in the presence of pepstatin 1 μM was then measured under test conditions identical to the previous tests. Pepstatin was added to haemoglobin 2% before adding pepsin. In the light of the above, it was studied whether the binding of the enzyme with the inhibitor was immediate or slower in the time scale of the experiment (t=10 minutes) (kinetics study). Haemoglobin solutions 2%, 1 μM in pepstatin were prepared and the various activities were measured after adding the enzyme. The results the experiment are shown in FIG. 3. FIG. 3 reports the absorption spectra of the blank (pepsin without pepstatin) and of the sample (reaction time=10 min) at pH=1.5 in the presence of pepstatin (diluted in H.sub.2O after dissolution in EtOH 1 mg/mL) 1 μM.

[0105] FIG. 3 immediately shows a total abatement in the activity at the concentration of 1 μM. From a kinetic point of view, given that the activity is basically null, it is clear that this is an immediate binding between the enzyme and the inhibitor given that the enzyme does not have the time to perform the proteolytic action thereof when the inhibitor is already present in the haemoglobin 2%.

VII.B. Magnesium Alginate

[0106] A sterile aqueous solution containing magnesium alginate 0.2% w/w (in short, alginate solution) was added to the haemoglobin solution as a subsequent step of the experiments.

[0107] The selected concentration of said alginate solution in haemoglobin was 1%. This concentration allows to avoid scattering and not have a total abatement of the activity. The alginate solution in haemoglobin showed to inhibit pepsin with a 60% decrease in activity with respect to free pepsin at pH=1.5 (FIG. 4). FIG. 4 reports the decrease in activity of pepsin in the presence of magnesium alginate aqueous solution 1% at pH=1.5.

VII.C. Pepetatin+Magnesium Alginate

[0108] In order to test a synergistic effect of pepstatin together with the magnesium alginate (compositions according to the invention) in totally inhibiting pepsin, solutions at pH=1.5 of haemoglobin in which there was present 1% of said aqueous solution containing magnesium alginate 0.2% w/w (see paragraph VII.B.) and 1 μM in pepstatin dissolved in such solution (in the amount of solution containing alginate added to haemoglobin there was an amount of pepstatin such to obtain the final concentration in pepstatin sought) were prepared and the various activities were measured after adding the enzyme (pepsin). The results the experiment are shown in FIG. 5.

[0109] The dilution of a ethanolic solution of pepstatin 1 mg/mL in the magnesium alginate aqueous solution does not jeopardise the dissolution and the inhibitory ability of pepstatin.

[0110] FIG. 5 reports the absorption spectra of the blank (pepsin without pepstatin but with 1% in haemoglobin of solution containing magnesium alginate) and of the samplesi (reaction time=10 min) at pH=1.5 in the presence of 1% of magnesium alginate solution and pepstatin 100 nM (pepstatin diluted in magnesium alginate aqueous solution after dissolution in EtOH 1mg/mL).

[0111] The synergistic effect of pepstatina together with magnesium alginate allowed to obtain a total abatement of the pepsin activity through a concentration in pepstatin equal to100 nM (an order of magnitude less with respect to pepstatin in water).

VIII. Conclusions

[0112] Pepsin may be present in the tears in patients with gastroesophageal reflux. Such enzyme causes damage to the eye due to the proteolytic action when it is still active. Alginates inhibit pepsin in a non-competitive and dose-dependent manner. Pepstatin A instead, inhibits pepsin in picomolar concentrations. The pepstatin-magnesium alginate binary system has a synergistic inhibitory effect which totally deactivates the pepsin enzyme right from the picomolar concentrations due to pepstatin, and it sequestrates such enzyme through a non-specific binding by the magnesium alginate which at the same time carries out a lubricating action. Such binary system therefore cures and prevents the ocular damage caused by pepsin.

[0113] Pepstatin is not soluble in water; as a matter of fact, it has always been used as a suspension capable of inhibiting pepsin in any case. The Applicant found a method through which such inhibitor could be dissolved in water without using toxic solvents. An ethanolic solution of pepstatin can be diluted in water. It still maintains its inhibitory activity and remains soluble after dilution. The pepstatin dissolved in water through this method is able to inhibit pepsin stoichiometrically. There was no presence of suspensions or precipitates in solution. Binding with pepsin in water is immediate in the human time scale to the extent that the pepsin added to haemoglobin during the experiments cannot carry out the proteolytic action thereof when the inhibitor is present.

IX. Preparation Method

[0114] Described hereinafter are the steps for the preparation of a composition in aqueous-based liquid form comprising pepstatin and magnesium alginate (composition according to the invention, Table 6).

[0115] Step 1: [0116] Measure the water and pour it into the beaker with magnetic stirring; [0117] Turn on the stirring and heat the water to 50° C.; [0118] Add Buffer salts.

[0119] Raw materials: Demineralised water, di-sodium tetraborate, Boric acid.

[0120] Step 2: [0121] Add the ingredients in the sequence reported (1. Sodium chloride, 2. Magnesium alginate) progressively waiting for complete dissolution; [0122] Leave the obtained solution under stirring for 30 minutes.

[0123] Filtration step 1 The resulting solution should be filtered with a 0.2 μm PES filter.

[0124] Step 3: [0125] After 1.sup.st filtration, measure the water and pour it into a beaker, turn on the stirring and heat the water to 50° C.; [0126] Add the ethanolic solution of pepstatin (for example, at a concentration of 1 mg/ml); [0127] Leave the obtained solution under stirring for 30 minutes.

[0128] Pepstatin: Isovaleryl-L-val-L-val-statyl-L-alanyl-statin or Isovaleryl-L-val-L-val-4-(S)-amino-3-(S)-Hydroxy-6-methyl-heptanoyl-2-ala-4-(S)-amino-3-(S)-hydroxy-6-methyl-heptanoic acid).

[0129] Filtration step 2: The resulting solution should be filtered with a 0.2 μm PES filter.

TABLE-US-00006 TABLE 6 (final concentration in pepstatin about 1 μM) Components amount U.M. PURIFIED WATER 95.00-99.00 g DI-SODIUM TETRABORATE 0.050-0.250 g BORIC ACID 0.250-1.250 g MAGNESIUM ALGINATE 0.050-0.350 g Na CHLORIDE ANHYDROUS 0.200-0.760 g PEPSTATIN in EtOH 1 mg/mL 0.005-0.100 g

[0130] Physical characteristics of the composition of Table 6:

TABLE-US-00007 pH about 7.53; Osmolality about 304 mOsm Kg.sup.−1; Viscosity about 1.309 cSt; Density about 1.003 g mL.sup.−1

[0131] Methods for measuring the reported physical quantities:

[0132] Osmolarity: osmometer

[0133] Viscosity: Ostwald viscometer (measured at room temperature)

[0134] pH: pH meter

[0135] Density: Pycnometer

[0136] Expected amount of pepstatin in the composition: less than or equal to 1μM.

[0137] Pepstatin soluble in ethanol up to 1 mg/mL.

[0138] Embodiments E(n) of the present invention are illustrated below:

[0139] E1. An aqueous composition for ophthalmic use comprising

[0140] (i) a mixture M comprising or, alternatively, consisting of: [0141] (a) a pepstatin or a pharmaceutically acceptable salt thereof, and [0142] (b) an alginic acid, or a pharmaceutically acceptable salt thereof; and

[0143] (ii) at least one ophthalmological grade additive and/or excipient.

[0144] E2. The composition according to E1, wherein said mixture M further comprises (c) hyaluronic acid or a pharmaceutically acceptable salt thereof.

[0145] E3. The composition according to E2, wherein said (i) mixture (M) comprises or, alternatively, consists of:

[0146] (a) a pepstatin;

[0147] (b) an alginate of an alkaline or alkaline-earth metal, preferably magnesium alginate; and,

[0148] (c) a hyaluronate of an alkaline or alkaline-earth metal, preferably a sodium hyaluronate.

[0149] E4. The composition according to any one of E1-E3, wherein the composition is formulated for ophthalmic use; preferably in liquid form for ophthalmic use, more preferably it is eye drops or aqueous-based eye drops; or, alternatively, in semi-solid form for ophthalmic use, preferably an ointment, a salve, a gel or a cream.

[0150] E5. The composition according to any one of E1-E4 for use as medicament.

[0151] E6. The composition according to any one of E1-E4 for use in a method for preventive and/or curative treatment of, a disease or symptom of the eyeball and/or periocular region related with or deriving from the presence of pepsin in the lacrimal fluid in a subject in need.

[0152] E7. The composition for use according to E6, wherein said disease or symptom of the eyeball and/or periocular region is selected from the group comprising or, alternatively, consisting of: lacrimal dysfunction syndrome (LDS) or dry eye syndrome, conjunctivitis of the conjunctiva, conjunctivitis of the cornea, ocular inflammation, periocular inflammation, blepharitis, keratitis, and uveitis; preferably selected from the group comprising or, alternatively, consisting of: lacrimal dysfunction syndrome (LDS) or dry eye syndrome, conjunctivitis of the conjunctiva, conjunctivitis of the cornea, ocular inflammation, and periocular inflammation.

[0153] E8. The composition for use according to E6 or E7, wherein said composition is for use in a method for the preventive and/or curative treatment of a disease or symptom of the eyeball and/or periocular region in: (i) a subject with a gastric reflux, which manifests itself from the stomach to an oesophageal and/or extra-oesophageal region, (ii) a subject with a disease or symptom related with or deriving from said gastric reflux.

[0154] E9. The composition for use according to E8, wherein said diseases or symptoms related with or deriving from, said gastric reflux, which manifests itself from the stomach to an oesophageal and/or extra-oesophageal region, are selected from the group comprising or, alternatively, consisting of: gastroesophageal reflux disease (GERD), erosive or non-erosive, laryngopharyngeal reflux (LPR) or extra-oesophageal reflux, oesophagitis, oesophageal ulcers, oesophageal mucosal de-epithelialisation, acid regurgitation, heartburn, feeling of gastric fullness, epigastric pain, dyspepsia, nausea, chronic cough, bronchospasm, sore throat, laryngitis, globus sensation or hypopharyngeal bolus, pyrosis, dysphonia, and rhinopharyngeal phlogosis.

[0155] E10. A process for the preparation of the composition according to any one of E1-E4, wherein said process comprises:

[0156] the step 1) for dissolving the pepstatin in a solvent, preferably an alcoholic solvent or ethanol, at neutral pH to obtain an alcoholic solution of pepstatin, followed by

[0157] the step 2) for diluting the alcoholic solution of pepstatin in an aqueous solution comprising an alginic acid salt, preferably an alginate of an alkaline or alkaline-earth metal, more preferably magnesium alginate.