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(12) United States Patent (10) Patent No.: US 6,190,315 B1 Kost Et Al

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(12) United States Patent (10) Patent No.: US 6,190,315 B1 Kost Et Al USOO6190315B1 (12) United States Patent (10) Patent No.: US 6,190,315 B1 KOst et al. (45) Date of Patent: Feb. 20, 2001 (54) SONOPHORETIC ENHANCED Grups & Frohmüller, “Cyclic Interferon Gamma Treatment TRANSIDERMAL TRANSPORT of Patients with Metastatic Renal Carcinoma, Br. J. Urol ogy 64(3):218–220 (1989). (75) Inventors: Joseph Kost, Omer (IL); Samir S. Junginger, et al., “Visualization of Drug Transport AcroSS Mitragotri, Cambridge; Robert S. Human Skin and the Influence of Penetration Enhancers,” in Langer, Newton, both of MA (US) Drug Permeation Enhancement (Hsieh, Ed.), pp. 59-89, Marcel Dekker, Inc.:New York, 1994. (73) Assignee: Sontra Medical, Inc., Cambridge, MA Kost & Langer, “Ultrasound-Mediated Transdermal Drug (US) Delivery” in Topical Drug Bioavailability Bioequivalence (*) Notice: Under 35 U.S.C. 154(b), the term of this and Penetration (Maibach & Shah, Eds.), pp. 91-104, patent shall be extended for 0 days. Plenum Press:New York, 1993. Krall, et al., World Book of Diabetes in Practice Elsevier: (21) Appl. No.: 09/227,623 Amsterdam, 1988. Levy, et al., “Effect of Ultrasound on Transdermal Drug (22) Filed: Jan. 8, 1999 Delivery to Rats and Guinea Pigs,” J. Clin. Invest. 83:2074–2078 (1989). Related U.S. Application Data Parkin, et al., “Atopic manifestations in the acquired (60) Provisional application No. 60/070,813, filed on Jan. 8, immune deficiency Syndrome: response to recombinant 1998. interferon gamma,” Br. Med. J. 294:1185-1186 (1987). (51) Int. Cl." - A61B 65/20 Prausnitz, et al., “Electroporation of mammalian Skin: A (52) U.S. Cl. ............................................... 600/309; 604/22 mechanism to enhance transdermal drug delivery,” Proc. (58) Field of Search .................................. 604/20, 22, 49; Natl. Acad. Sci. USA 90:10504–10508 (1993). 600/578,573, 309; 601/2 Tamada, et al., “Measurement of glucose in diabetic Subjects using noninvasive transdermal extraction,” Nature Med. (56) References Cited 1:1198–1201 (1995). U.S. PATENT DOCUMENTS Walters, “Penetration enhancers and their use in transdermal therapeutic systems' Transdermal Drug Delivery. Develop 3,551,554 12/1970 Herschler. ment Issues and Research Initiatives (Hadgraft and Guy, 3,711,602 1/1973 Herschler. 3,711,606 1/1973 Herschler. eds.) pp. 197-246, Marcel Dekker:New York, 1986. 4,557,943 12/1985 Rosler et al.. Waynforth, Experimental and Surgical technique in the rat 4,767,402 8/1988 Kost et al. (2" Ed.) pp. 215-222, Academic Press: London, (1992). 5,165,418 11/1992 Tankovich. 5,445,611 8/1995 Eppstein et al. Primary Examiner Eric F. Winakur 5,458,140 10/1995 Eppstein et al.. ASSistant Examiner Joseph Cadugan FOREIGN PATENT DOCUMENTS (74) Attorney, Agent, or Firm Arnall Golden & Gregory, LLP 9-202736 5/1997 (JP). WO 97/04832 (57) ABSTRACT A1 2/1997 (WO). WO 97/18851 Methods for enhanced transdermal transport wherein the A1 5/1997 (WO). application of ultrasound is required only once for repeated WO 98/OO.194 or Sustained transdermal extraction or delivery, over a period A2 1/1998 (WO). of time, rather than prior to each extraction or delivery. The method is applicable to analyte extraction, as well as for OTHER PUBLICATIONS drug delivery. The method involves the initial application of Bommer, et al., “Subcutaneous Erythropoietin,” Lancet an amount of low frequency ultrasound effective to perme 2:406 (1988). abilize the skin or membrane followed by analyte extraction Burnette, “Iontophoresis' Transdermal Drug Delivery or drug delivery over a period of time. The initial application Developmental Issues and Research Initiatives (Hadgraft & of ultrasound is effective to permeabilize the skin or mem Guy, Eds.), pp. 247–291.Marcel Kekker:New York, 1989. brane for at least about 30 minutes, preferably at least one Elias, “The Microscopic Structure of the Epidermis and Its to two hours, and more preferably up to four to ten hours. Derivatives” in Percutaneous Absorption. Mechanisms The ultrasound is preferably low frequency ultrasound, leSS Methodology-Drag Delivery (Bronaugh & Maibach, Eds.), than 2.5 MHz, more preferably less than 1 MHz. The pp. 1-12 Marcel Dekker, New York, 1989. transdermal transport can be enhanced by the application of Flynn, “Mechanism of Percutaneous Absorption from Physi a Secondary driving force Such as Suction, osmotic pressure cochemical Evidence” in Percutaneous Absorption. Mecha gradient, concentration gradient, iontophore Sis, nisms-Methodology-Drug Delivery (Bronaugh & Maibach electroporation, magnetic field, additional ultrasound, or Eds.), pp. 27-51 Marcel Dekker:New York, 1989. mechanical pressure. Friedman, Interferons. A Primer, Academic Press: New York, 1981. 13 Claims, 5 Drawing Sheets U.S. Patent Feb. 20, 2001 Sheet 1 of 5 US 6,190,315 B1 1.4 1.2 1. O h O. 8 O. 6 O. 4 O. 2 O.O O 5 O 5 2O 25 TIME AFTER ULTRASOUND APPLICATION (HOURS ) A/G 7 OO O. O 2 5 12 O O O1 5 9 O 6 O 3 O O O 5O 1OO 15O 2OO 25O TIME ( MINUTES) A/G 2 U.S. Patent US 6,190,315 B1 U.S. Patent Feb. 20, 2001 Sheet 3 of 5 US 6,190,315 B1 2.5 10 O C) 3 2 1o 2 PRETREATMENT + O ACTIVE (PROTOCOL 3) -F N. 1.5 lo E 5 O (f) N 2 EOl 1 to 59 ACTIVE ALONE E 5 o' (PROTOCOL 2) 3 E PRETREATMENT C ALONE (PROTOCOL. 1) O 2O 4O 6O 8O OO 12O 14O TME (MINUTES) A/G 5 U.S. Patent Feb. 20, 2001 Sheet 5 of 5 US 6,190,315 B1 5.5 lo U C N 5.o 1o 1 to5 N S E St 4.51o 4 S d 8 to a 4.o 1o Ol - 9 9 3.5 to 6 o' O an S 3.o 1o 4. L d 8 4 10" 9. 2.51O OC) O P i 2.o 1o 2 o' ct 2O 4O 6O 8O 1 OO 12O 140 16O 8O TME ( MINUTES) A/G 3 4. O O 3OO 2OO 1 OO O 1OO 20O 3OO 4OO 5OO Venous Glucose Levels (mg/dL) A/G 9 US 6,190,315 B1 1 2 SONOPHORETC ENHANCED than 500) across human skin, a phenomenon referred to as TRANSIDERMAL TRANSPORT sonophoresis (Levy, J. Clin. Invest. 1989, 83, 2974–2078; Kost and Langer in “Topical Drug Bioavailability, CROSS REFERENCE TO RELATED Bioequivalence, and Penetration'; pp. 91-103, Shah V. P., APPLICATION M. H. I., Eds. (Plenum: New York, 1993); Frideman, R. M., “Interferons: A Primer", Academic Press, New York, 1981). Priority is claimed to provisional application Serial No. Although a variety of ultrasound conditions have been used 60/070,813, filed on Jan. 8, 1998, entitled “Sonophoretic for Sonophoresis, the most commonly used conditions cor Transdermal Analyte Extraction” by Joseph Kost, Samir S. respond to therapeutic ultrasound (frequency in the range of Mitragotri, and Robert S. Langer. between one MHz and three MHz, and intensity in the range of between above zero and two W/cm) (U.S. Pat. No. FIELD OF THE INVENTION 4,767,402 to Kost, et al.). It is a common observation that the typical enhancement induced by therapeutic ultrasound is The present invention generally relates to improved meth less than ten-fold. In many cases, no enhancement of trans ods for transdermal transport using ultrasound. More dermal drug transport has been observed upon ultrasound Specifically, methods are provided enabling repeated analyte 15 application. U.S. Pat. Nos. 5,458,140 and 5,445,611 to extraction or dug delivery over a period of time following a Eppstein et al. disclose the use of ultrasound at a frequency Single application of low frequency ultrasound. range of between 0.1 and 100 MHz, preferably between 3 and 30 MHz, in combination with chemical enhancers, to BACKGROUND OF THE INVENTION enhance skin permeability. The ultrasound was frequency, intensity and/or phase modulated. An increase in permeabil Transdermal drug delivery (TDD) offers several advan ity was noted during application of the ultrasound but tages over traditional delivery methods including injections decreased to passive diffusion rates when ultrasound was and oral delivery. When compared to oral delivery, TDD discontinued (see Example 4 in both patents). avoids gastrointestinal drug metabolism, reduces first-pass U.S. Pat. No. 5,323,769 to Bommannan discloses ultra effects, and provides Sustained release of drugs for up to 25 Sound enhanced delivery of molecules into and through the Seven days, as reported by Elias, in Percutaneous AbSOrp skin, in combination with chemical permeation enhancers. tion. Mechanisms-Methodology-Drug Delivery, Bronaugh, The ultrasound is applied at frequencies above 10 MHz. The R. L. et al. (Eds), pages 1-12, Marcel Dekker, New York ultrasound must be applied “relatively simultaneously” with (1989). the molecules being delivered, within at least six minutes, The skin is a complex Structure. There are at least four preferably within two minutes. distinct layers of tissue: the nonviable epidermis (stratum Application of low frequency (between approximately 20 corneum, SC), the viable epidermis, the viable dennis, and and 200 kHz) ultrasound can dramatically enhance trans the Subcutaneous connective tissue. Located within these dermal transport of molecules when applied directly to the layers are the skin's circulatory System, the arterial plexus, drug or at the time of collection, as described in WO and appendages, including hair follicles, Sebaceous glands, 35 97/04832 by Massachusetts Institute of Technology. Trans and Sweat glands. The circulatory System lies in the dermis dermal transport enhancement induced by low-frequency and tissues below the dennis. The capillaries do not actually ultrasound was found to be as much as 1000-fold higher than enter the epidermal tissue but come within 150 to 200 that induced by therapeutic ultrasound. microns of the outer surface of the skin.
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