US20120171298A1 - Use of pharmaceutical compositions in preparing pharmaceuticals for treating diabetic ulcer - Google Patents

Use of pharmaceutical compositions in preparing pharmaceuticals for treating diabetic ulcer Download PDF

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US20120171298A1
US20120171298A1 US13/132,066 US201013132066A US2012171298A1 US 20120171298 A1 US20120171298 A1 US 20120171298A1 US 201013132066 A US201013132066 A US 201013132066A US 2012171298 A1 US2012171298 A1 US 2012171298A1
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sesame oil
ulcer
earthworm
weight
huangqin
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Rongxiang Xu
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    • A61K36/48—Fabaceae or Leguminosae (Pea or Legume family); Caesalpiniaceae; Mimosaceae; Papilionaceae
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    • A61F13/00—Bandages or dressings; Absorbent pads
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    • A61F13/01008—Non-adhesive bandages or dressings characterised by the material
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    • A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
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Definitions

  • This invention relates to use of pharmaceutical compositions in preparing pharmaceuticals for treating diabetic ulcer in limb or on body surface, or in preparing medical dressing.
  • This invention also relates to a kind of medical dressing for treating diabetic ulcer in limb or on body surface, and the corresponding medicine box enclosing the said dressing.
  • Chinese Patent ZL931002761 has disclosed a pharmaceutical composition for treating thermal injuries; the said pharmaceutical composition consists of (A) 3 to 15% of edible beeswax and (B) 85 to 97% of sesame oil extract of Huangqin, Huanglian, Huangbai, earthworm and poppy capsule, based on the total weight of the pharmaceutical composition.
  • each of Huangqin, Huanglian, Huangbai, earthworm and poppy capsule is in an amount of 2 to 10% by weight of dry raw material based on the total weight of sesame oil.
  • the pharmaceutical composition for treating thermal injuries is mainly used in warm-blooded mammals or in human for treating thermal injuries, including burns, especially burns of large areas, scalds, chemical ambustion, etc. It can also be used to treat sore and ulcer of human, including wound surface ulcer, infected wound surface, vaginitis, cervical erosion, hemorrhoid, pressure ulcer, wound surface, congelation, and frostbite, etc.
  • the diabetic ulcer described in the present invention includes ulcers in limb and ulcers on body surface of diabetic patient.
  • the pathogenetic mechanism of diabetic ulcer is very complicated, and there is no unified and common clear understanding for the time being. In general, three interactive processes are involved: angiopathy, neuropathy, and immunopathy.
  • angiopathy There are two large types of angiopathy, wherein one is the pathological change in large blood vessels; the other is the pathological change in micro-vessels. These pathological changes result in ischemia of soft tissue in leg and on body surface, and finally evolve into ulcer.
  • Neuropathy participates in an early stage of pathogenesis of diabetic foot ulcer, and is also the most important detrimental factor in diabetic foot ulcer. During this pathogenesis, all the neural functions are damaged, but often, the longest and the thinnest nervous fiber, including the motor nerve that controls the foot muscles, is damaged first. Functional loss of lumbrical muscle leads to foot deformation, and this increases the pressure or friction in the sites of sub-metatarsophalangeal joint, toe dorsum or toe tips and the like. These factors easily induce ulcers. Damage to autonomic nerve function also emerges in the earlier stage of neuropathy, causing a series of pathological changes, including arteriovenous shunt, decreased tissue infusion, alopecia, functional loss of sebaceous glands and sweat glands. These elements work together and result in skin dryness, scale formation and liability to rhagades.
  • diabetic foot the main symptoms of diabetic foot are pain of leg, numbness, foot ulcer and acromelic gangrene resulted from angiopathy, neuropathy, and infection of leg. Clinically, it is often referred to as diabetic foot (commonly called rotten foot), with the major manifestations as follows:
  • diabetic ulcers should be treated with systematic medical therapy, including blood sugar control, anti-infection, improvement of microcirculation and topical management of wound areas, for example, using cephalosporins, lincomycin, penicillin, clarithromycin, aciclovir, amoxicillin and dicloxacillin sodium capsules, compound sulfamethoxazole and the like as measures for anti-infection; using mupirocin ointment externally, etc. But once that diabetic ulcer occur, there will be no ideal and effective therapy for curing this ulcerous wound surface, surgical amputation is still often adopted for the time being. So in clinical practice, a non-operative therapy for diabetic ulcer is badly needed, new medical techniques or pharmaceuticals are also in great demand.
  • the technical problem to be resolved in this present invention is to use the above-mentioned all known pharmaceutical composition for treating thermal injuries to treat diabetic ulcer in limb or on body surface (diabetic ulcer for short).
  • this present invention relates to use of pharmaceutical composition in preparing pharmaceuticals for treating diabetic ulcer in limb or on body surface, or in preparing medical dressing.
  • the said pharmaceutical composition consisting of (A) 3 to 15% of edible beeswax, and (B) 85 to 97% of sesame oil extract of Huangqin, Huanglian, Huangbai, earthworm and poppy capsule, based on the total weight of the pharmaceutical composition.
  • each of Huangqin, Huanglian, Huangbai, earthworm and poppy capsule is in an amount of 2 to 10% by weight of dry raw material based on the total weight of sesame oil.
  • compositions described in the present invention are for external use.
  • pharmaceuticals for external use may include many dosage forms, e.g., solution, tincture, powder, lotion, oil, emulsion, ointment, paste, emplastrum, and gel, etc. Oil, emulsion, ointment, paste, emplastrum or gel is the preferred form for the pharmaceutical compositions in the present invention.
  • compositions described in the present invention further comprise a carrier which is pharmaceutically acceptable.
  • the use of the present invention only relates to use of the pharmaceutical compositions described in the present invention in preparing pharmaceuticals for treating diabetic ulcer in limb or on body surface, in other words, pharmaceutical compositions described in the present invention shall be used externally to treat diabetic ulcer.
  • the present invention does not relate to use of the pharmaceutical compositions described in the present invention in preparing pharmaceuticals used internally for treating diabetes, in other words, the present invention does not relate to the pharmaceutical compositions described in the present invention as pharmaceuticals used internally for treating diabetes itself.
  • This present invention still relates to a kind of medical dressing for treating diabetic ulcer in limb or on body surface
  • the herein said dressing includes pharmaceutical compositions consisting of the following ingredients: (A) 3 to 15% of edible beeswax, and (B) 85 to 97% of sesame oil extract of Huangqin, Huanglian, Huangbai, earthworm and poppy capsule, based on the total weight of the pharmaceutical composition.
  • each of Huangqin, Huanglian, Huangbai, earthworm and poppy capsule is in an amount of 2 to 10% by weight of dry raw material based on the total weight of sesame oil.
  • Medical cotton gauze and medical bandage are the preferred forms for the herein said medical dressing.
  • This present invention also relates to a kind of medicine box, which includes the pharmaceutical compositions described in the present invention or the herein said medical dressing, and Directions for Use.
  • the medicine box integrates with the said pharmaceutical compositions or the said medical dressing containing this said pharmaceutical compositions, meanwhile, at least one copy of Directions for Use is enclosed along with, making it more convenient to use the medicine box of this present invention in clinical practice.
  • diabetic ulcers were treated with the pharmaceutical compositions described in the present invention and satisfactory therapeutic effectiveness was obtained.
  • the effectiveness was remarkable.
  • the clinical implementation methods are as follows:
  • the pharmaceutical compositions of this present invention were directly smeared 1 to 3 mm thick on the wound surface of diabetic ulcer.
  • the wound surface was covered and bound (not very thick) with cotton gauze (or other similar ventilative material) with the dressing change twice daily in morning and evening or once daily (if in a less favourable condition).
  • the dressing change herein said means to remove the metabolites in wound surface of diabetic ulcer and the residual pharmaceutical composition with cotton swabs very gently first, then cover the wound surface with new and the same pharmaceutical composition, finally bind with gauze dressing.
  • necrotic musculotendinous tissue appears on ulcerous wound surface, remove it with scissors.
  • disinfectants are forbidden to use for disinfecting the ulcerous wound surface.
  • the pharmaceutical composition of this present invention was directly smeared on wound surface of diabetic ulcer, normally thinner than 2 mm thick.
  • the ulcerous wound surface was exposed after covered with the pharmaceutical composition, then it appears that the pharmaceutical composition covered on the ulcerous wound surface begins to be warmed up and melted, some white metabolites in wound surface also begin to be discharged out of the drug layer, or mixed with the pharmaceutical composition.
  • all the pharmaceutical composition on wound surface will be turned into a white mixture of metabolites within 6 to 8 hours, at this moment, remove this white mixture with cotton swabs, and then cover the ulcerous wound surface again with new and the same pharmaceutical composition. Change new pharmaceutical composition whenever the applied pharmaceutical composition is completely turned into white mixture of metabolites. Repeat this process until healing of the ulcerous wound surface.
  • necrotic musculotendinous tissue appears on wound surface of the ulcer, remove it with scissors.
  • disinfectants are forbidden to use for disinfecting the ulcerous wound surface.
  • Gauze was immersed in the pharmaceutical composition of this present invention after the latter being warmed up and melted, just like the process of making vaseline gauze.
  • the ulcerous wound surface was covered with the pharmaceutical composition gauze, and then treated with bandaging method or semi-exposed method.
  • the gauze was changed once daily.
  • Diabetes is a disease that is characteristic of chronic hyperglycemia. Concomitant ulcers in the lower extremities, delayed healing of wound surface, and other complications are also often seen. In the present techniques, most of the diabetic ulcers can often result in amputation, which is one of the major causes of disablement and death for diabetic patients. There exists a direct or indirect relationship between the hyperglycemia, which is the most remarkable characteristic of diabetes, and difficult healing of ulcerous wound surface. Strict control of blood sugar can effectively prevent the emergence and development of difficult healing wound surfaces, but in many patients, even if the blood sugar level is controlled within the normal range, healing of diabetic ulcer is still very difficult.
  • This present invention reveals that, under effective control of blood sugar, the pharmaceutical compositions of this present invention can remarkably promote healing of the diabetic ulcers.
  • Linoleic acid as an active ingredient in the pharmaceutical composition of this present invention, is a kind of essential fatty acid and an indispensable component of the plasma membrane. It is also an essential substance for cellular repair after tissue injury, it can increase nutrition for local inflammatory wound surface and provide essential nutritional medium for cellular repair of wound surface. Diabetes is a kind of neurotrophic and metabolic disease. Diabetic ulcers always occur to toes, ankles and heels, indicating that the pathogenesis is closely related to peripheral angiopathy and peripheral neurotrophy.
  • necrotic tissue in time, because surface of chronic ulcer easily becomes dry and therefore is not easily to be cleared. Excision of necrotic tissue by operation shall be sure to injure part of the normal tissue, especially when the tissue is in serious ischemia due to the use of anesthetics containing epinephrine. Ointment form with frame configuration is preferred for pharmaceutical composition of this present invention. It is characteristic of oiliness and moisture, can remain in wound surface for longer time, keep wound surface moisturized, and make the necrotic tissue enzymolyzed and rancidified, and finally the secretion in wound surface is excreted by ‘self drainage’, which is very beneficial to the clearance of necrotic tissue.
  • the characteristic of diabetic ulcer change during the treatment with moisturizing exposed method is that liquefaction and excretion of necrotic tissue is concomitant with the formation of transparent membrane of lipoprotein. Once that the transparent membrane forms, the ulcer repair is initiating. Special attention should be paid to protect the integrity of this transparent membrane of lipoprotein so as to assure that the whole process of repair for the ulcer is always carried on beneath the transparent membrane of lipoprotein. After the basal tissue of skin forms, transparent membrane of lipoprotein shall disappear by itself.
  • the surface active substance in the pharmaceutical composition of this present invention is composed of hydrophilic groups and lipophilic-non polar groups; the pharmaceutical composition of this present invention has a higher surface activity and has solubilizing effect [Rongxiang Xu. Regenerative medicine: research, creation and prospect. Chinese Journal of Burns, Wounds and Ulcers, 2002, 14(2):122-130].
  • the two-state conversion of the pharmaceutical composition of this present invention effectively segregates ulcerous wound surface, resulting in an effect of anti-infection, i.e., to decrease bacterial infection, make bacteria lose addiction to the live tissue, therefore, effectively decrease bacterial number and inhibit bacterial growth, with the final effect of blocking, inhibiting and discharging the bacteria.
  • Effective segregation of ulcer by the ointment also help maintain the enzymatic activity, diminish and block oxidation of unsaturated fatty acids and vitamin C, and effectively prevent formation of peroxides, protect cell membrane and fat from oxidation damage, and play a role in maintaining normal metabolism of the tissue.
  • the pharmaceutical composition of this present invention effectively segregate ulcerous wound surface, and avoid stimuli of external factors to exposed nerve endings, resulting in an analgesic effect.
  • the pharmaceutical layer blocks the stimuli of foreign objects to wound surface
  • other mechanisms that involve the said analgesic effect are: (1) beta-sitosterol and other ingredients in the pharmaceutical composition of this present invention can effectively reduce inflammatory reactions; (2) the pharmaceutical itself is non-irritative; (3) the pharmaceutical improves local microcirculation, enhances local blood flow, promotes local metabolism, attenuates stimulatory effect of tissue ischemia, anoxia, edema on nerve endings. (4) in the course, a physiological environment for in situ stem cell differentiation is also established, leading to the activation of the dormant stem cells and regeneration of the tissue, and these are all favorable to ulcer healing.
  • the present invention has filled in the gaps of curing diabetic ulcers with the pharmaceuticals in modern clinical medicine.
  • FIG. 2 Picture of pasting and smearing medical gauze on the ulcer of the diabetic patient described in Example 7.
  • FIG. 4 Picture of treatment progress of the ulcer in left external malleolus of the diabetic patient described in Example 7.
  • FIG. 6 Picture of the ulcer in left external malleolus of the diabetic patient described in Example 8.
  • FIG. 8 Picture of pasting and smearing on the ulcer for the diabetic patient described in Example 8.
  • FIG. 9 Picture of diabetic ulcer before treatment of the diabetic patient described in Example 9.
  • FIG. 12 Picture of diabetic ulcer before treatment of the diabetic patient described in Example 10.
  • FIG. 13 Picture of diabetic ulcer after treatment of the diabetic patient described in Example 10.
  • FIG. 14 Picture of diabetic ulcer after treatment of the diabetic patient described in Example 10.
  • FIG. 15 Picture of diabetic ulcer after treatment of the diabetic patient described in Example 10.
  • FIG. 16 Picture of treatment with emplastrum for the diabetic patient described in Example 11 of Implementation.
  • FIG. 18 Picture of day 60 post treatment for the diabetic patient described in Example 11.
  • FIG. 19 Picture of day 90 post treatment for the diabetic patient described in Example 11.
  • FIG. 20 Picture of day 110 post treatment for the diabetic patient described in Example 11.
  • sesame oil extract of Huangqin, Huanglian, Huangbai, earthworm and poppy capsule is obtained.
  • Pharmaceutical Composition 1 described in the present invention is obtained.
  • the pharmaceutical composition described in the present invention is manufactured, except that 10 Kg of each of Huanglian, Huangqin and Huangbai pieces, 2 kg of each of earthworm and poppy capsule, 100 Kg of sesame oiland 10 Kg of beeswax are used.
  • 10 Kg of each of Huanglian, Huangqin and Huangbai pieces, 2 kg of each of earthworm and poppy capsule, 100 Kg of sesame oiland 10 Kg of beeswax are used.
  • Pharmaceutical Composition 2 is obtained.
  • the pharmaceutical composition described in the present invention is manufactured, except that 8 Kg of each of Huanglian, Huangqin and Huangbai pieces, 3 kg of each of earthworm and poppy capsule, 100 Kg of sesame oiland 8 Kg of beeswax are used.
  • 8 Kg of each of Huanglian, Huangqin and Huangbai pieces, 3 kg of each of earthworm and poppy capsule, 100 Kg of sesame oiland 8 Kg of beeswax are used.
  • Pharmaceutical Composition 3 is obtained.
  • the pharmaceutical composition described in the present invention is manufactured, except that 3 Kg of each of Huanglian, Huangqin and Huangbai pieces (prepared pieces in the art,), 4 kg of each of earthworm and poppy capsule, 100 Kg of sesame oil and 15 Kg of beeswax are used.
  • 3 Kg of each of Huanglian, Huangqin and Huangbai pieces prepared pieces in the art,
  • 4 kg of each of earthworm and poppy capsule 100 Kg of sesame oil and 15 Kg of beeswax are used.
  • Pharmaceutical Composition 4 is obtained.
  • the pharmaceutical composition described in the present invention is manufactured, except that 10 Kg of each of Huanglian, Huangqin and Huangbai pieces, 10 kg of each of earthworm and poppy capsule, 100 Kg of sesame oil and 3 Kg of beeswax are used.
  • 10 Kg of each of Huanglian, Huangqin and Huangbai pieces, 10 kg of each of earthworm and poppy capsule, 100 Kg of sesame oil and 3 Kg of beeswax are used.
  • Pharmaceutical Composition 5 is obtained.
  • Example 1 to 5 of The pharmaceutical compositions in the present invention obtained in Example 1 to 5 of are warmed up and melted. According to the method known to the persons skilled in the art, the medical gauze is immersed directly into each of the five pharmaceutical compositions respectively until it is completely soaked, thus medical dressing containing the pharmaceutical compositions of this present invention is obtained. The dressing was packed into marketable medical products.
  • Diabetic patient male, 59 years old, left external malleolus ulcerated for 2 years, with an area of about 4 ⁇ 4 cm (see FIG. 1 ), diagnosed in confirmation as diabetic ulcer.
  • expectant treatment of lowering blood sugar was adopted, and the medical gauze described in Example 6 prepared from pharmaceutical composition manufactured according to method described in Example 1 was used.
  • the ulcerous wound surface was pasted and covered with the dressing (see FIG. 2 and FIG. 3 ), which was changed once daily.
  • the patient was healed and discharged after treatment for one month (see FIG. 4 and FIG. 5 ).
  • Diabetic patient male, 58 years old, left internal malleolus ulcerated for 2 years, with an area of about 3.5 ⁇ 4 cm (see FIG. 6 ), diagnosed in confirmation as diabetic ulcer.
  • expectant treatment of lowering blood sugar was adopted, and the medical gauze described in Example 6 made from pharmaceutical composition manufactured according to method described in Example 2 used.
  • the ulcerous wound surface was pasted and covered with the dressing (see FIG. 7 ), which was changed once daily.
  • the patient was healed and discharged after treatment for one month (see FIG. 8 ).
  • Diabetic patient female, 42 years old, came to see the doctor after left foot ulcerated for 22 days and began to exacerbate. Amputation had been advised by doctors but was rejected by her. On admission, fasting blood sugar in early morning was 22.67 mmol/L, and the patient was clinically diagnosed in confirmation as diabetes. Serious diabetic ulcer appeared in the internal and lower site of the left foot, with remarkable swelling of left foot, intensive ulceration from external portion of foot dorsum to middle and rear portion of planta, meanwhile fistulous tracts formed and linked up, phalanges of toes exposed, fasciae and muscles began to necrotize, ulcerate and was fetid(see FIG. 9 ).
  • the patient was smeared with the pharmaceutical composition described in Example 3 with a thickness of about 2 mm on the ulcer, subsequently the ulcerous wound surface which was covered with the pharmaceutical composition was completely exposed.
  • the pharmaceutical was changed once daily (see FIG. 10 ). After treatment for 45 days, the ulcer basically healed and the patient was discharged from the hospital (see FIG. 11 ).
  • foot ulcers were chronic and deep down to fatty layer and ulcerous wound surfaces lacked granulation tissue, dry and little exudative. The minimum area was 2.0 cm ⁇ 1.0 cm and the maximum area was 2.2 cm ⁇ 5.5 cm. Foot ulcers were surrounded by thick and hard callous tissue. 5 in 6 cases of pretibial ulcer were caused by external wounds, all with area less than 2.0 cm ⁇ 3.5 cm, obvious red, swelling, itching and pain of the surrounding skin. All the cases were divided into two groups by randomization: 30 cases for observation group and 30 cases for control group. There was no significant difference (P >0.05) in statistics between the two groups in age, sex, disease phase, and the ulcerous size.
  • observation group In observation group (test group), the ulcerous wound surface and the surrounding skin was disinfected with 1% povidone-iodine, cleaned with sterile normal salt solution, and the necrotic tissue was cleared with sterile forceps and scissors, then cleaned with sterile normal salt solution or 3% hydrogen peroxide solution. All the ulcers in observation group were externally and topically applied povidone-iodine evenly allowing the drug to infiltrate into the tissue for 1 to 2 minutes. Then the pharmaceutical composition of the present invention described in Example 1 was smeared on the ulcers with cotton swabs, wiped flat, maintained a thickness of 1.5 mm to 2.0 mm. Sterile gauze was placed on the ointment, bandaged.
  • the therapeutic strategy was changed to moisturizing exposed method when the necrotic tissue began to liquefy. With a thickness of 1.0 mm, the pharmaceutical was changed twice daily. The liquefied necrotic tissue was cleared in time when changing the pharmaceutical each time.
  • control group the sterile gauze was soaked in 160,000 U of Gentamycin, and then applied to the ulcers bandaged with dressing once daily.
  • liquefied mixture or the necrotic tissue in the ulcers in two groups should be cleared away, until the granulation tissue grew and epithelization completely realized.
  • Time span for liquefaction and excretion of necrotic tissue is related to the types of primary diseases and necrotic intensification of ulcerous wound surface, but all necrotic tissue can begin to liquefy after treatment for 3 to 4 days, and liquefaction and excretion will finish within 2 to 4 weeks.
  • the second and the first stages are linked up, i.e., transparent lipoprotein membrane develops step by step during the liquefaction and excretion of necrotic tissue, and liquefaction and excretion of necrotic tissue finishes when transparent lipoprotein membrane completely forms. Once that transparent lipoprotein membrane forms, regenerative repair will accelerate, macroscopically, patch-like skin nails or skin islands grows and expands.
  • callous tissue surrounding wound surface will gradually exfoliate, newly grown skin will emerge and grow concentrically, and finally ulcerous wound surfaces repair themselves.
  • a kind of medicine box was manufactured using pharmaceutical composition obtained from Example 1, or medical dressing obtained from Example 6 with a method known in the art. Finally, the printed Directions for Use were combined with the respectively packed pharmaceutical compositions (e.g., ointment) or the said medical dressing (e.g., emplastrum) and became marketable medicine box after packing.
  • pharmaceutical compositions e.g., ointment
  • medical dressing e.g., emplastrum

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