USOO6514482B1 (12) United States Patent (10) Patent No.: US 6,514,482 B1 Bartus et al. (45) Date of Patent: Feb. 4, 2003 (54) PULMONARY DELIVERY IN TREATING 5,985,309 A 11/1999 Edwards et al. ............ 424/426 DSORDERS OF THE CENTRAL NERVOUS 6,019.968 A 2/2000 Platz et al. .............. 424/130.1 SYSTEM 6,048.857 A 4/2000 Ellinwood, Jr. et al. ... 514/221 6,103.270 A 8/2000 Johnson et al. ............. 424/489 (75) Inventors: Raymond T. Bartus, Sudbury, MA 6,136.295 A 10/2000 Edwards et al. .............. 424/45 (US); Dwaine F. Emerich, C t RI 6,165,463 A 12/2000 Platz et al. .............. 424/130.1 (US , UranSLOn, 6,193.954 B1 * 2/2001 Adjei et al. ................... 424/45 FOREIGN PATENT DOCUMENTS (73) Assignee: Advanced Inhalation Research, Inc., CA 2152684 6/1995 Cambridge, MA (US) EP O 496 307 A1 7/1992 (*) Notice: Subject to any disclaimer, the term of this wo WO E. E. patent is extended or adjusted under 35 WO WO 98/31346 7/1998 U.S.C. 154(b) by 0 days. WO WO 98/46245 10/1998 WO WO OO/72827 A2 12/2000 (21) Appl. No.: 09/665,252 WO WO 01/95874 A2 12/2001 (22) Filed: Sep. 19, 2000 OTHER PUBLICATIONS (51) Int. Cl. ............................ A61K 9/12, A61K 9/14, Journal of the Neurological Sciences, Vol. 150, Issue: 1001, s A61 K 9.75 supplement 1, p. S198, Sep. 1997.* (52) U.S. Cl. ........................... 424/45; 424/43; 424/789; * cited by examiner (8) Field of Styligi514/220; 128/203.15 C.E.O. M. Eitan s s s • -u- as (74) Attorney, Agent, or Firm-Hamilton, Brook, Smith & (56) References Cited Reynolds, P.C. U.S. PATENT DOCUMENTS (57) ABSTRACT 4.814.161 A 3/1989 Jinks et all 424/45 A method of pulmonary delivery of a medicament, for 4805710. A 1900 Radhakrishnana". 424/4s example a dopamine precursor or a dopamine agonist, which 5,118,494. A 6/1992 Schultz et al. ................ 424/45 includes administering to the respiratory tract of a patient in 5,166,202 A 11/1992 Schweizer .................. 514/220 need of rescue therapy particles comprising an effective 5,284,133 A 2/1994 Burns et al. ...... 128/200.23 amount of a medicament. The particles are delivered to the 5,354.885. A * 10/1994 Millman et al. .............. 560/43 pulmonary System and are released into the blood Stream 5,457,100 A : 10/1995 Daniel .............. ... 514/220 and delivered to the medicament's Site of action in a time 5. E. A . g s et l, - - - - - - - - - - - - - - 3.i. Sufficiently short to provide the rescue therapy. In addition to 5756,071 A E. MNN .. - - - - - - i.f45 the medicament, the particles can include other materials 5855,913 A 1/1999 Hanes et all - - - - - - - - - - - - - - - -424/489 Such as, for example, phospholipids, amino acids, combi 5.874.064 A 2/1999 Edwards et al... 424/46 nations thereof and others. Preferred particles have a tap 5,875,776 A 3/1999 Vaghefi ............ ... 128/203.15 density of less than about 0.4 g/cm. 5,922,354 A 7/1999 Johnson et al. ............. 424/489 5,981,474. A 11/1999 Manning et al. ............... 514/2 42 Claims, 9 Drawing Sheets O 10 20 30 40 SO 80 time (minutes) C) 0. 2O 30 40 .50 SC time minutes) U.S. Patent Feb. 4, 2003 Sheet 1 of 9 US 6,514,482 B1 3OOO 25OO 2OOO 5OO OOO time (minutes) FG. A 28OO > J 24OO -- lung St - -o- - Oro S 2OOO O 5 6.OO E i2OO o Cl O a 8OO - b C O time (minutes) FIG. B U.S. Patent Feb. 4, 2003 Sheet 2 of 9 US 6,514,482 B1 5OOO --O-- Lung Administration -- Oro Administration 4OOO 3OOO 2OOO 1 OOO BOSeine 2 min 15 m in 45 min FIG. 2A ---O--- Lung Administration 6- OO -- Oro AdministrOtion 5OO 4OO 3OO Bose line 2 min 15 min 45 min FIG. 2B U.S. Patent Feb. 4, 2003 Sheet 3 of 9 US 6,514,482 B1 -- blood-lung 25 -0- striatum lung --D-- blood-ord --O-- Striotum Oro 20 CfO N 3t E 5 N O t up O - i--------------- - - - - C d O st 5 O O min 2 min 5 min 5 min 4 2 -o- Oro n = 5 -O- Tracheotomy n = 9 E old -- Ventilator n = 9 N 2 8 2 9 6 GB 4 pre 2 m in 5 min 5 min Time Post-Administration (minutes) FIG. 4 U.S. Patent Feb. 4, 2003 Sheet 5 of 9 US 6,514,482 B1 Olfactory Occipital Strid to Fronto HPC Cerebellum F.G. 6A 2 ZZ 1 % O.5 % O-Fe- % Olfactory Occipitol Strid to FrontC HPC Cerebellum F.G. 6B U.S. Patent Feb. 4, 2003 Sheet 6 of 9 US 6,514,482 B1 6OOO O IV (n = 6) e 5OOO. Lung (n = 6) S s 4OOO s C 3OOO dis ce 20OO c V 1 OOO Kidney Spleen Heart Testes Muscle Blood FIG. 7A Kidney Spleen Heart Testes Muscle FG. 7B U.S. Patent Feb. 4, 2003 Sheet 7 of 9 US 6,514,482 B1 25OOO 2OOOO Pulmonary c)E 15OOO 9 N. S - to - a9 S.8 10OOO O ae (d CE 5OOO Oro O O 5 1O 15 2O 25 3O Time Post-Drug Administration (minutes) O - x * 8 Txx -e- Oro --e-- Pulmonary U.S. Patent Feb. 4, 2003 Sheet 8 of 9 US 6,514,482 B1 3. 2.5 O P 2 -as 5 1.5 d Ol S S. d O Integrate: O5 Ared Under Curve = 11, 1423 O 2 4. 6 8 1O Time (hours) FIG. O U.S. Patent Feb. 4, 2003 Sheet 9 of 9 US 6,514,482 B1 1O 6 Integrate: Ared Under Curve = 19.9237 Time (hours) FIG. US 6,514,482 B1 1 2 PULMONARY DELIVERY IN TREATING epilepsy) is approximately 250,000. A significant number of DSORDERS OF THE CENTRAL NERVOUS patients also Suffer from So-called “cluster Seizures', SYSTEM wherein an initial Seizure forewarns that a Series of addi tional Seizures will occur within a relatively short time frame. By some reports, 75% of all patients continue to BACKGROUND OF THE INVENTION experience Seizures despite taking medication chronically. Poor compliance with the prescribed medications is believed Parkinson's disease is characterized neuropathologically to be a significant (albeit not Sole) contributing factor. The by degeneration of dopamine neurons in the basal ganglia importance of controlling or minimizing the frequency and and neurologically by debilitating tremors, SlowneSS of intensity of Seizures lies in the fact that incidence of Seizures movement and balance problems. It is estimated that over has been correlated with neuronal deficits and is believed to one million people suffer from Parkinson's disease. Nearly cause loSS of neurons in the brain. all patients receive the dopamine precursor levodopa or Despite chronic treatment, as many as 75% of all patients L-Dopa, often in conjunction with the dopa-decarboxylase continue to exhibit periodic Seizures. The uncontrolled Sei inhibitor, carbidopa. L-Dopa adequately controls Symptoms Zures occur in many forms. In the case of “cluster Seizures,” of Parkinson's disease in the early Stages of the disease. 15 one Seizure Serves notice that a cascade has begun which However, it tends to become less effective after a period will lead to a Series of Seizures before the total episode which can vary from Several months to Several years in the passes. In certain patients, prior to the onset of a Severe course of the disease. Seizure, Some Subjective feeling or Sign is detected by the It is believed that the varying effects of L-Dopa in patient (defined as an aura). In both instances, an opportu Parkinson's disease patients is related, at least in part, to the nity exists for these patients to Significantly reduce the plasma half life of L-Dopa which tends to be very short, in liability of the seizure through “self medication'. While the range of 1 to 3 hours, even when co-administered with many patients are instructed to do So, the drugs currently carbidopa. In the early Stages of the disease, this factor is available to permit effective self medication are limited. mitigated by the dopamine Storage capacity of the targeted 25 Panic attacks purportedly affect about 2.5 million people striatal neurons. L-Dopa is taken up and Stored by the in this country alone. The disorder is characterized by acute neurons and is released over time. However, as the disease episodes of anxiety, leading to difficult breathing, dizziness, progresses, dopaminergic neurons degenerate, resulting in heart palpitations and fear of losing control. The disorder is decreased dopamine Storage capacity. Accordingly, the posi believed to involve a problem with the sympathetic nervous tive effects of L-Dopa become increasingly related to fluc System (involving an exaggerated arousal response, leading tuations of plasma levels of L-Dopa. In addition, patients to overstimulation of adrenaline release and/or adrenergic tend to develop problems involving gastric emptying and neurons). Benzodiazepines are effective against these poor intestinal uptake of L-Dopa. Patients exhibit increas attackS. ingly marked Swings in Parkinson's disease Symptoms, A pure vasogenic etiology/pathogenesis for migraine was ranging from a return to classic Parkinson's disease 35 first proposed in the 1930s; by the 1980s, this was replaced Symptoms, when plasma levels fall, to the So-called by a neurogenic etiology/pathogenesis, which temporarily dyskinesis, when plasma levels temporarily rise too high won favor among migraine investigators.